Socioeconomic Status and Health Communication Inequalities in Japan: A Nationwide Cross-Sectional Survey

Background: Considerable evidence suggests that communication inequality is one potential mechanism linking social determinants, particularly socioeconomic status, and health inequalities. This study aimed to examine how dimensions of health communication outcomes (health information seeking, self-efficacy, exposure, and trust) are patterned by socioeconomic status in Japan. Methods: Data of a nationally representative cross-sectional survey of 2,455 people aged 15–75 years in Japan were used for secondary analysis. Measures included socio-demographic characteristics, subjective health, recent health information seeking, self-efficacy in seeking health information, and exposure to and trust in health information from different media. Results: A total of 1,311 participants completed the questionnaire, giving a response rate of 53.6%. Multivariate logistic regression revealed that education and household income, but not employment, were significantly associated with health information seeking and self-efficacy. Socioeconomic status was not associated with exposure to and trust in health information from mass media, but was significantly associated with health information from healthcare providers and the Internet. Conclusion: Health communication outcomes were patterned by socioeconomic status in Japan thus demonstrating the prevalence of health communication inequalities. Providing customized exposure to and enhancing the quality of health information by considering social determinants may contribute to addressing social disparities in health in Japan

Using a Marginal Structural Model to Design a Theory-Based Mass Media Campaign.

The essential first step in the development of mass media health campaigns is to identify specific beliefs of the target audience. The challenge is to prioritize suitable beliefs derived from behavioral theory. The purpose of this study was to identify suitable beliefs to target in a mass media campaign to change behavior using a new method to estimate the possible effect size of a small set of beliefs.Data were drawn from the 2010 Japanese Young Female Smoker Survey (n = 500), conducted by the Japanese Ministry of Health, Labor and Welfare. Survey measures included intention to quit smoking, psychological beliefs (attitude, norms, and perceived control) based on the theory of planned behavior and socioeconomic status (age, education, household income, and marital status). To identify suitable candidate beliefs for a mass media health campaign, we estimated the possible effect size required to change the intention to quit smoking among the population of young Japanese women using the population attributable fraction from a marginal structural model.Thirteen percent of study participants intended to quit smoking. The marginal structural model estimated a population attributable fraction of 47 psychological beliefs (21 attitudes, 6 norms, and 19 perceived controls) after controlling for socioeconomic status. The belief, "I could quit smoking if my husband or significant other recommended it" suggested a promising target for a mass media campaign (population attributable fraction = 0.12, 95% CI = 0.02-0.23). Messages targeting this belief could possibly improve intention rates by up to 12% among this population. The analysis also suggested the potential for regulatory action.This study proposed a method by which campaign planners can develop theory-based mass communication strategies to change health behaviors at the population level. This method might contribute to improving the quality of future mass health communication strategies and further research is needed

Does Computer-Aided Instruction Improve Children's Cognitive and Noncognitive Skills?

This paper examines the causal effects of computer-aided instruction (CAI) on children's cognitive and noncognitive skills. We ran a clustered randomized controlled trial at five elementary schools with more than 1,600 students near Phnom Penh, Cambodia. After 3 months of intervention, we find that the average treatment effects on cognitive skills are positive and statistically significant, while hours of study were unchanged both at home and in the classroom. This indicates that CAI is successful in improving students’ learning productivity per hour. Furthermore, we find that CAI raises students’ subjective expectation to attend college in the future

Population-Attributable Fraction Using the Marginal Structural Model.

<p>Population-Attributable Fraction Using the Marginal Structural Model.</p

Population-Attributability Using Hornik and Woolf’s Method.

<p>Population-Attributability Using Hornik and Woolf’s Method.</p

Basic Characteristics of Study Participants.

<p>Basic Characteristics of Study Participants.</p

Frequencies and percentages of demographic variables.

a<p>Population Census, 2010.</p>b<p>Comprehensive Survey of Living Conditions, 2010.</p

Logistic regression of trust in health information sources and socio-demographic status.

<p>Note: All models are additionally adjusted for gender, age, marital status, and subjective health status.</p

Frequencies and percentages of health communication outcomes.

<p>Frequencies and percentages of health communication outcomes.</p

Logistic regression of exposure to health information sources and socio-demographic status.

<p>Note: All models are additionally adjusted for gender, age, marital status, and subjective health status.</p