Pictorial Warning Labels and Memory for Cigarette Health-risk Information Over Time.

Background: Pictorial cigarette warning labels are thought to increase risk knowledge, but experimental research has not examined longer-term effects on memory for health risks named in text.

Purpose: To investigate memory-consolidation predictions that high- versus low-emotion warnings would support better long-term memory for named cigarette health risks and to test a mediational model of warning-label effects through memory on risk perceptions and quit intentions.

Methods: A combined sample of U.

Improving numeracy through values affirmation enhances decision and STEM outcomes.

Greater numeracy has been correlated with better health and financial outcomes in past studies, but causal effects in adults are unknown. In a 9-week longitudinal study, undergraduate students, all taking a psychology statistics course, were randomly assigned to a control condition or a values-affirmation manipulation intended to improve numeracy. By the final week in the course, the numeracy intervention (statistics-course enrollment combined with values affirmation) enhanced objective numeracy, subjective numeracy, and two decision-related outcomes (financial literacy and health-related behaviors).

Effects of Pictorial Warning Labels for Cigarettes and Quit-Efficacy on Emotional Responses, Smoking Satisfaction, and Cigarette Consumption.

Background: Experimental research on pictorial warning labels for cigarettes has primarily examined immediate intentions to quit.

Purpose: Here, we present the results of a clinical trial testing the impact on smoking during and after a 28-day period of naturalistic exposure to pictorial versus text-only warnings.

Methods: Daily cigarette smokers (N = 244) at two sites in the USA were randomly assigned to receive their regular brand of cigarettes for 4 weeks with one of three warnings: (a) text-only, (b) pictures and text as proposed by FDA, or (c) the warnings proposed by FDA with additional text that elaborated on the risks of smoking.

Cigarette graphic warning labels increase both risk perceptions and smoking myth endorsement.

Objective: Cigarette graphic warning labels elicit negative emotion, which increases risk perceptions through multiple processes. We examined whether this emotion simultaneously affects motivated cognitions like smoking myth endorsement (e.g.

Cigarette Graphic Warning Labels Are Not Created Equal: They Can Increase or Decrease Smokers' Quit Intentions Relative to Text-Only Warnings.

Introduction: Cigarette graphic-warning labels elicit negative emotion. Research suggests negative emotion drives greater risk perceptions and quit intentions through multiple processes. The present research compares text-only warning effectiveness to that of graphic warnings eliciting more or less negative emotion.

Presenting Numeric Information with Percentages and Descriptive Risk Labels: A Randomized Trial.

Background: Previous research demonstrated that providing (v. not providing) numeric information about the adverse effects (AEs) of medications increased comprehension and willingness to use medication but left open the question about which numeric format is best. The objective was to determine which of 4 tested formats (percentage, frequency, percentage + risk label, frequency + risk label) maximizes comprehension and willingness to use medication across age and numeracy levels.

Numbers matter to informed patient choices: a randomized design across age and numeracy levels.

Background: How drug adverse events (AEs) are communicated in the United States may mislead consumers and result in low adherence. Requiring written information to include numeric AE-likelihood information might lessen these effects, but providing numbers may disadvantage less skilled populations. The objective was to determine risk comprehension and willingness to use a medication when presented with numeric or nonnumeric AE-likelihood information across age, numeracy, and cholesterol-lowering drug-use groups.

Development and Testing of an Abbreviated Numeracy Scale: A Rasch Analysis Approach.

Research has demonstrated that individual differences in numeracy may have important consequences for decision making. In the present paper, we develop a shorter, psychometrically improved measure of numeracy-the ability to understand, manipulate, and use numerical information, including probabilities. Across two large independent samples that varied widely in age and educational level, participants completed 18 items from existing numeracy measures.

Deliberative disjunction: expert and public understanding of outcome uncertainty.

Many environmental and risk management decisions are made jointly by technical experts and members of the public. Frequently, their task is to select from among management alternatives whose outcomes are subject to varying degrees of uncertainty. Although it is recognized that how this uncertainty is interpreted can significantly affect decision-making processes and choices, little research has examined similarities and differences between expert and public understandings of uncertainty.

How do People with Different Levels of Activation Self-Manage their Chronic Conditions?

Background: : People with chronic conditions are better able to self-manage if they are more engaged, informed, and confident. Healthcare providers are increasingly offering support for self-management, and there is interest in improving the efficacy of these efforts by tailoring them to a person's knowledge, skill, and confidence to self-manage - so-called 'activation'.

Objective: : To explore how people with chronic conditions at different levels of 'activation' (as measured by the Patient Activation Measure) understand successful self-management, what barriers to self-management they face, and what strategies they employ to manage their condition and to cope with stress.

Development of the Patient Activation Measure for mental health.

Our objective was to adapt the physical health Patient Activation Measure (PAM) for use among people with mental health conditions (PAM-MH). Data came from three studies among people with chronic mental health conditions and were combined in Rasch analyses. The PAM-MH's psychometric properties equal those of the original 13-item PAM.

Improving the outcomes of disease management by tailoring care to the patient's level of activation.

Objective: To determine whether an approach that assesses patient capabilities for self-management and then tailors coaching support based on this assessment would be more effective in improving outcomes than the usual disease management approach.

Study Design: A quasi-experimental pre-post design was used, with an intervention group coached with a tailored approach and a control group coached in the usual way.

Methods: Data derived from telephonic coaching and from archival utilization data were used in the analysis.

Plan design and active involvement of consumers in their own health and healthcare.

Objective: Underlying consumer-driven health plans (CDHPs) is the belief that the financial incentives, enhanced choices, and increased information will stimulate consumers to become active, informed managers of their own health and healthcare (ie, activated consumers). To examine this assumption, we assessed whether enrollees became more activated after enrolling in a CDHP and the degree to which those who were more activated adopted productive health behaviors.

Methods: This was a longitudinal study of employees of a large manufacturing company where a CDHP was offered along with a preferred provider organization in 2004.

Racial/ethnic disparities and consumer activation in health.

In this paper we explore whether increasing individuals' activation (self-management) levels could hold potential for reducing racial and ethnic disparities in health. A causal model is posited that assumes that social-environmental factors influence activation levels, which in turn influence health outcomes. Relationships are examined separately for whites and African Americans, and findings are supportive of the model for both groups.

Does enrollment in a CDHP stimulate cost-effective utilization?

Consumer-driven health plans (CDHPs) are built on the assumption that with increased cost sharing consumers will select cost-effective evidence-based care. In this study, the authors explore whether patterns of utilization change after enrollment in a CDHP and whether the pattern reflects a shift toward evidence-based care. The study population is comprised of 18,025 employees and their adult dependents.

Consumer competencies and the use of comparative quality information: it isn't just about literacy.

While consumers are increasingly expected to use complex health care information to make informed decisions, it is unclear how many have the skills to do so. In this investigation we examine health literacy, numeracy, and patient activation, assessing the contribution of each to the comprehension of comparative health care performance reports and their use in making an informed choice. A convenience sample of 303 employed-age adults participated in the study.

Do increases in patient activation result in improved self-management behaviors?

Objective: The purpose of this study is to determine whether patient activation is a changing or changeable characteristic and to assess whether changes in activation also are accompanied by changes in health behavior.

Study Methods: To obtain variability in activation and self-management behavior, a controlled trial with chronic disease patients randomized into either intervention or control conditions was employed. In addition, changes in activation that occurred in the total sample were also examined for the study period.

Assessing activation stage and employing a "next steps" approach to supporting patient self-management.

Current approaches to chronic illness care seek to engage the patient as part of the care team. Yet, finding effective ways to engage patients in their own care and support patient self-management has been challenging. Instead of pushing patients to immediately adopt all recommended behavioral changes, many programs encourage small steps while working toward a larger goal.

Why worry? Worry, risk perceptions, and willingness to act to reduce medical errors.

Through the domain of medical errors, the role of worry and perceived risk in precautionary behaviors was examined in a convenience sample (N = 195, mean age = 42 years, 71% female). Worry was linked to fatality estimates. A model of the antecedents and consequences of worry also was tested.

Development and testing of a short form of the patient activation measure.

Objective: The Patient Activation Measure (PAM) is a 22-item measure that assesses patient knowledge, skill, and confidence for self-management. The measure was developed using Rasch analyses and is an interval level, unidimensional, Guttman-like measure. The current analysis is aimed at reducing the number of items in the measure while maintaining adequate precision.

Can patients be part of the solution? Views on their role in preventing medical errors.

Patients have the potential to play an important role in preventing medical errors. Yet little is known about how to effectively engage patients in this role as a "vigilant partner" in care. Respondents were asked to assess the perceived effectiveness of fourteen recommended actions for preventing medical errors.

Hospital performance reports: impact on quality, market share, and reputation.

This study builds on earlier work by assessing the long-term impact of a public hospital performance report on both consumers and hospitals. In doing so, we shed light on the relative importance of alternative assumptions about what stimulates quality improvements. The findings indicate that making performance data public results in improvements in the clinical area reported upon.

It isn't just about choice: the potential of a public performance report to affect the public image of hospitals.

Can a well-designed public performance report affect the public image of hospitals? Using a pre/postdesign and telephone interviews, consumer views and reports of their use of public hospital report are examined. The findings show that the report did influence consumer views about the quality of individual hospitals in the community 2 to 4 months after the release of the report.

Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers.

Background: Controlling costs and achieving health care quality improvements require the participation of activated and informed consumers and patients.

Objectives: We describe a process for conceptualizing and operationalizing what it means to be "activated" and delineate the process we used to develop a measure for assessing "activation," and the psychometric properties of that measure.

Methods: We used the convergence of the findings from a national expert consensus panel and patient focus groups to define the concept and identify the domains of activation.

Does publicizing hospital performance stimulate quality improvement efforts?

This study evaluates the impact on quality improvement of reporting hospital performance publicly versus privately back to the hospital. Making performance information public appears to stimulate quality improvement activities in areas where performance is reported to be low. The findings from this Wisconsin-based study indicate that there is added value to making this information public.