An extended communication inequalities approach to disparities in obesity preventive behaviors

This dissertation integrates the theory of planned behavior (TPB) with information exposure and concepts from the communication inequality perspective with the purpose of identifying disparities between the more and less advantaged segments of society throughout the communication for behavioral change process. It was expected to find differences in exposure to health information, as well as differences in the degree to which attitudes, norms, and perceived behavioral control (PBC) influence intentions, and the degree to which intentions lead to behavior. To test the hypotheses and research questions, structural equation modelling and multigroup analysis using MPlus 7.2 were conducted. Two datasets were analyzed, the first one from the Youth Media Campaign Longitudinal Survey (YMCLS), which was conducted with the purpose of assessing the effect of the VERB media campaign in a nationally representative sample of children aged 9 to 13 years and their parents between 2004 and 2006 (N = 2,773). The second study corresponds to a two-Wave survey among female adolescents conducted in schools in Santiago, Chile (N = 751). In the first study, the effect of exposure to the VERB campaign on the practice of physical activity two years later was examined through a mediation model. In the second study, the effect of seeking and scanning information about physical activity and fruit and vegetable consumption in the practice of the respective behaviors was examined, also with a mediation model. In the context of physical activity, across the two studies the main tenets of the TPB held, as norms and PBC were positive and significantly associated with intentions, which in turn led to the practice of the behavior. Furthermore, mediated effects of norms and PBC via intentions were supported in the two studies. The integration of the TPB with information exposure also received support in the two studies, with exposure to the VERB campaign being a significant predictor of attitudes and PBC, and indirectly influencing physical activity via PBC and intentions. In the Chile study, information scanning led to positive attitudes, norms, and PBC, and indirectly affected behavior though attitudes, PBC, and intentions. Information seeking, however, was negatively associated with behavior, both directly and mediated by other variables in the model. With respect to the disparities in the communication for behavioral change process it was found that children and adolescents from more disadvantaged backgrounds reported lower levels of exposure to the campaign and to health information. Moreover, subjects from more advantaged backgrounds were able to turn their intentions into behavioral change, whereas subjects from less advantaged backgrounds were not. Some results regarding the moderating role of social position indicators were unexpected for example, the positive association between exposure to the VERB campaign and attitudes only among children from less advantaged backgrounds. Taken together, the results of the two studies presented in this dissertation support an integration of the TPB with the concepts of information exposure and the moderation of social position indicators, as suggested by the communication inequality approach to better understand disparities in the communication for behavioral change process