Thomas C. Lehman

Frequent intake of sugar-sweetened beverages (SSBs) is associated with adverse health outcomes such as obesity, type 2 diabetes, and cardiovascular disease. Little is known about when, where, and why U.S. adults consume SSBs. This study, using data from an online survey distributed in 2021, examined the occasions, locations, and reasons for consuming SSBs and the characteristics of the adults who consume them. Nearly 7 of 10 adults reported consuming a SSB (1–6 times) in the past 7 days, and more than a third (38%) reported doing so once or more per day (on average). For comparative purposes, the sample was limited to adults who reported consuming SSBs within the last 7 days. Mealtimes were reported as the most frequent occasion for the intake of SSBs (43%) and SSBs were most often consumed at home (70%). Over half of respondents (56%) reported they consume SSBs because they enjoy the taste. Younger adults (18–34 years old) were more likely to consume SSBs in social settings than older adults (≥50 years old). Hispanic adults were less likely to consume SSBs at the beginning of the day compared to non-Hispanic White adults. Younger (18–34 years old) and middle-aged (35–49 years old) adults were more likely to consume SSBs in restaurants, at work, and in cars than older adults (≥50 years old). Women were less likely to consume SSBs at work than men. Hispanic adults were less likely to consume SSBs in cars than non-Hispanic White adults, while those earning USD 50,000–<USD 100,000 were more likely to consume SSBs in cars than those earning ≥USD 100,000. Younger and middle-aged adults were more likely to consume SSBs due to cravings and enjoyment of the carbonation compared to older adults. These findings provide insights on specific populations for whom to tailor messaging and adapt interventions to help reduce SSB intake.

We conducted a content analysis of newspaper and television news coverage in Centers for Disease Control and Prevention (CDC) grantee locations from June 2011 through May 2013. After searching 2 databases for news stories related to overweight or obesity, we coded and analyzed stories for valence (how the author/reporter framed overweight and obesity control strategies), descriptors, causes and solutions, and populations mentioned. Of almost 3,000 stories analyzed, most had a neutral or positive valence, depicted overweight and obesity as epidemic, discussed individual causes and environmental solutions most frequently, and mentioned children most often. Earned media can be part of addressing overweight and obesity by emphasizing prevention and by emphasizing both environmental and individual causes and solutions.

From 2004 to 2008, in four U.S. test markets, Planned Parenthood Federation of America implemented Real Life. Real Talk.®, an initiative designed to foster open, honest, and balanced communication about sex and health among parents/caregivers, their children, and the general public. Funded by private donors and foundations, including the Ford Foundation, Real Life. Real Talk, combined community organizing and collaboration, education, community events, and promotion in an intervention that addressed the entire marketing mix. Through building local grassroots partnerships and providing a host of coordinated local educational events, including repeated offerings of Sex Ed for Parents™, Real Life. Real Talk. sought to reduce the public's level of shame, intolerance, and avoidance and, subsequently, to increase openness, acceptance, and engagement about issues of sexual health. Parents who participated in Sex Ed for Parents reported that these events were useful, and nearly all participating parents said they would recommend Sex Ed for Parents to a friend. Results from community-wide surveys show modest program awareness and several promising trends that correspond with the goals of the initiative. Real Life. Real Talk. is an example of community-level social marketing that evolved for continual improvement. Real Life. Real Talk. maintained an iterative design and implementation process. It allowed each community to embrace engagement on its own terms, and, as a result, each community contributed unique cultural elements.

Objective . To explore laypersons' responses to the communication of uncertainty associated with individualized cancer risk estimates and to identify reasons for individual differences in these responses.Design. A qualitative study was conducted using focus groups. Participants were informed about a new colorectal cancer risk prediction model, and presented with hypothetical individualized risk estimates using presentation formats varying in expressed uncertainty (range v. point estimate). Semistructured interviews explored participants' responses to this information.Participants and Setting. Eight focus groups were conducted with 48 adults aged 50 to 74 residing in 2 major US metropolitan areas, Chicago, IL and Washington, DC. Purposive sampling was used to recruit participants with a high school or greater education, some familiarity with information technology, and no personal or immediate family history of cancer.Results . Participants identified several sources of uncertainty regarding cancer risk estimates, including missing data, limitations in accuracy and source credibility, and conflicting information. In comparing presentation formats, most participants reported greater worry and perceived risk with the range than with the point estimate, consistent with the phenomenon of ``ambiguity aversion.'' However, others reported the opposite effect or else indifference between formats. Reasons suggested by participants' responses included individual differences in optimism and motivations to reduce feelings of vulnerability and personal lack of control. Perceptions of source credibility and risk mutability emerged as potential mediating factors.Conclusions. Laypersons' responses to the communication of uncertainty regarding cancer risk estimates differ, and include both heightened and diminished risk perceptions. These differences may be attributable to personality, cognitive, and motivational factors.

Objective  To explore laypersons’ understanding of individualized cancer risk estimates, and to identify conceptual problems that may limit this understanding.Background  Risk prediction models are increasingly used to provide people with information about their individual risk of cancer and other diseases. However, laypersons may have difficulty understanding individualized risk information, because of conceptual as well as computational problems.Design  A qualitative study was conducted using focus groups. Semi‐structured interviews explored participants’ understandings of the concept of risk, and their interpretations of a hypothetical individualized colorectal cancer risk estimate.Setting and participants  Eight focus groups were conducted with 48 adults aged 50–74 years residing in two major US metropolitan areas. Participants had high school or greater education, some familiarity with information technology, and no personal or family history of cancer.Results  Several important conceptual problems were identified. Most participants thought of risk not as a neutral statistical concept, but as signifying danger and emotional threat, and viewed cancer risk in terms of concrete risk factors rather than mathematical probabilities. Participants had difficulty acknowledging uncertainty implicit to the concept of risk, and judging the numerical significance of individualized risk estimates. The most challenging conceptual problems related to conflict between subjective and objective understandings of risk, and difficulties translating aggregate‐level objective risk estimates to the individual level.Conclusions  Several conceptual problems limit laypersons’ understanding of individualized cancer risk information. These problems have implications for future research on health numeracy, and for the application of risk prediction models in clinical and public health settings.

This article describes a formative strategy for developing effective tractor safety messages aimed at small crop and livestock farmers in New York. This population accounts for the highest proportion of tractors lacking rollover protective structures (ROPS), which reduce the risk of overturn injury or death. To encourage ROPS installation on unprotected tractors, persuasive messages were developed to be used as part of a social marketing intervention. The message development process involved evaluating concepts in small group discussions (triads) with the target audience. Participants were asked to review and provide feedback on 15 concepts, select two favorites, and discuss influential message channels. Results indicate that messages should address existing concerns for family safety or a permanently disabling injury and should realistically depict the lives of participants. Messages featuring financial incentives must clearly state the cost to the farmer. Although the data from the pilot test of intervention components has not yet been analyzed, data from the program hotline indicates concept development messages and rebates generated a greater demand for ROPS than generic messages and rebates. In conclusion, by employing the target population in the message development process it was possible to increase the efficacy of ROPS social marketing messages.

A national-level needs assessment of high school psychologists, social workers, counselors, and nurses was conducted to identify training and educational resource material needs of these staff relevant to providing health and mental health services to gay, lesbian, bisexual, and questioning (GLBQ) youth. Systematic sampling procedures were employed with professional membership lists of five national organizations. A self-administered survey, extensively pilot tested, was completed by 941 school staff. Results revealed that most staff acknowledged the presence of GLBQ youth in their schools; reported “accepting” attitudes toward these students; perceived GLBQ students to be at much higher risk, than their heterosexual counterparts, for several health and mental health problems; indicated that they should be providing more services to these students; and identified a number of barriers related to school climate, lack of staff training, and community/parental opposition that hamper service provision...

The Academy for Educational Development, a nonprofit organization specializing in social change communications, implemented a campaign to reduce nutrient pollution flowing into the Chesapeake Bay from the greater Washington D.C. area. Funded by the Chesapeake Bay Program, the primary campaign goal was to convince area residents not to fertilize their lawns in the spring, when fertilizer runoff is most damaging to the Bay, but to do so in the fall, if at all. For the 16% of residents who hire a lawn service, the goal was to convince them to hire a Bay-friendly partner lawn service. To overcome message fatigue from previous Bay-oriented campaigns and motivate this urban audience with a meaningful connection to the Bay, the campaign message was framed not as an environmental appeal, but as a way to ensure the continued availability of Chesapeake Bay seafood. Television, newspaper, and out-of home ads ran for a seven-week period during March and April 2005. In spite of a small budget, a post-intervention survey showed increased awareness of lawn care behaviors that contribute to Bay pollution, and decreased intent to fertilize in the spring.