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thesis entitled

THE MASS MEDIA, INTERPERSONAL CHANNELS, AND SELECTED GROUPS
AS SOURCES OF INFORMATION ABOUT THE CANCER INFORMATION
SERVICE'S TELEPHONE SYSTEM IN WASHINGTON, D.C., AND

UTILIZATION OF THE SERVICE BY BLACKS AND WHITES:
A COMPARATIVE COMMUNICATION STUDY

presented by

Paul Gregory Dykewicz

has been accepted towards fUlfillment
of the requirements for

M.A. Journalism

 

 

degree in

V-M. Mtg/Am

Major professor

Date May 5, I986

 

0-7 639 MS U is an Affirmative Action/Equal Opportunity Institution

 

 

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THE MASS MEDIAq INTERPERSONAL CHANNELS, AND SELECTED GROUPS
AS SOURCES OF INFORMATION ABOUT THE CANCER INFORMATION
SERVICE'S TELEPHONE SYSTEM.IN'WASHINGTON, D.C., AND
UTILIZATION OF THE SERVICE BY BLACKS AND WHITES:

A COMPARATIVE COMMUNICATION STUDY

BY

Paul Gregory Dykewicz

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF ARTS

School of Journalism

1986

‘Uv'o 7/5

Accepted by the faculty of the School of Journalism,

College of Communication Arts and Sciences, Michigan

State University, in partial fulfillment of the require-

ments for the Master of Arts Degree.

v. M- MAYA/K

Director of Thesis

ABSTRACT

THE MASS MEDIA, INTERPERSONAL CHANNELS, AND SELECTED GROUPS
AS SOURCES OF INFORMATION ABOUT THE CANCER INFORMATION
SERVICE'S TELEPHONE SYSTEM IN WASHINGTON, D.C., AND
UTILIZATION OF THE SERVICE BY BLACKS AND WHITES:

A COMPARATIVE COMMUNICATION STUDY

BY
Paul Gregory Dykewicz

This thesis describes an investigation of the utiliza-
tion patterns of various demographic groups that first heard
about the Cancer Information Service (CIS) through the mass
media, interpersonal channels, and selected groups. More
than one—third of the callers indicated they first heard
about the CIS through television. Radio ranked second,
attracting nearly 20 percent of the CIS callers. Blacks
exhibited a greater tendency to first learn about the CIS
through television than whites.

In addition, findings reveal the C18 in Washington,
ILC. more than doubled the national average of all CIS
offices in the percentage of calls received from blacks,
which the National Cancer Institute (NCI) identified as a
group at high risk to develop cancer. Without the availa-

bility of this analysis in 1985 to document the unparalleled

Paul Gregory Dykewicz

accomplishment of the C15 in Washington, BA: to attract a

high percentage of black callers, the NCI eliminated funding.

ACKNOWLEDGMENTS

The credit begins with my parents, Richard Dykewicz,
M.D., and Evelyn Dykewicz, R.N., who nurtured my interest in
health care and taught me to find happiness from helping
others. My brother Mark Dykewicz, MAL, provided me with a
physician's perspective for this thesis and served as a role
model in research studies, personifying excellence and
leading through example. I need to recognize the
contributions of my sister, Clare Dykewicz, MJL, for her
patience, reassuring words of encouragement, suggestions, and
other assistance, especially during the pressure-packed days
of meeting thesis deadlines. In addition, my brother Philip
Dykewicz, with degrees from one of the top business schools
in the country, downplays his own impressive accomplishments,
choosing instead to lead the cheers for me.

Medical faculty and other personnel associated with
the Howard University Cancer Center and the Vincent T.
Lombardi Cancer Center at Georgetown University deserve
acknowledgment for their assistance with this project. The
support of the communities at each university helped me feel

I had been adopted as one of their own students.

ii

At Michigan State University, I appreciated the
willingness of Dean Erwin Bettinghaus, PhJL, College of
Communication Arts and Sciences, to share his time for
discussions and to provide direction as I pursued my interest
in health communications. I also extend thanks to the
readers of my thesis committee, Robert Hudson, PhJL, and
Jerry Morton, for quality instruction worthy of Ivy League
tuition fees. I wish to emphasize the important
contributions of my thesis director, V. M. Mishra, PhJL,
for expert guidance in the preparation of my thesis. He
succeeded in a demanding role, including one meeting of
nearly 12 hours to review the thesis with me from cover to

cover during the 1985 Christmas holidays.

iii

Chapter

II.

III.

IV.

V.

TABLE OF CONTENTS

INTRODUCTION, REVIEW OF LITERATURE, AND
RATIONALE FOR STUDY . . . . . . . . . .

Introduction . . . . . . . . . . . . .

Review of Literature on Causes and
Effects of Cancer and Need of Cancer
Information . . . . . . . . . . .

Rationale for the Study . . . . . . .

STATEMENT OF THE PROBLEM, PURPOSE OF THE
STUDY, AND DEFINITION OF TERMS . . . . .

Statement of the Problem . . . . . . .
Purpose of the Study . . . . . . . . .
Definition of Terms . . . . . . . .
Organization of the Remainder of the
Thesis . . . . . . . . . . . . . . .

THE THEORETICAL AND METHODOLOGICAL
CONSIDERATIONS FOR THE STUDY . . . . . .

Theoretical Considerations . . . . . .
Background Assumptions . . . . . . .
Methodological Considerations . . . .

FINDINGS OF THE STUDY . . . . . . . . .

The Most Common Information Sources .
The Demographic Characteristics of
the Respondents . . . . . . . .

The Delineation of Specific Differences
in the Utilization of the CIS Between

Blacks and Whites . . . . . . . . .
The Indicators of Utilization of CIS .

SOME CONCLUSIONS AND GENERALIZATIONS . .

BIBLIOGRAPHY O O O O O O C O O O I O O O O O O 0

iv

Page

55
55
55
56

57

SB
58
73
74
83
83
85
91
93
116

120

CHAPTER I

INTRODUCTION, REVIEW OF LITERATURE, AND

RATIONALE FOR STUDY

Introduction

Life-saving potential exists when the mass media
disseminate health care information to the public. But dif-
ferences have emerged between various demographic groups in
the amount of benefit the groups gain from health care mes-
sages. As an example, individuals who typically learn about
health information from the print media, such as newspapers,
magazines, and books, tend to be well—informed in general.1

Not only does exposure to health care messages vary
widely between demographic groups, but so does access to
medical care. Income, age, and educational level of the
consumer influence the utilization of health care.32 Before

information, knowledge, and recommendations can effectively

 

1Les Butler, Gary King, and Jack E. White, M.D.,
”Communications Strategies, Cancer Information and Black
Populations: An Analysis of Longitudinal Data" (Washington,
D.C.: n.p., [1983]), p. 3.

2Robert A. Diseker, Robert Michielutte, and Virginia
Morrison, "Use and Reported Effectiveness of Tel- Med: A
Telephone Information System,“ ,Amgrigan_lgnrnal_gf_£nblig
.flgalth 70 (March 1980): 229.

reduce cancer morbidity and mortality, a health care delivery
system must offer accessibility and responsiveness to all.:3
It is assumed that a telephone service could help to bridge
the gap, encouraging consumers to enter the health care
delivery system.

In the United States at the end of 1985, 117,051,000
telephone access lines stretched across the country. reaching
more than 92 percent of all households. The total increased
beyond the 114,349,000 access lines in place at the end of
1984, and the number of access lines could reach 121,383,000
at the end of 1986. according to projections from the United
States Telephone Association.‘4 Telephone access lines
represent telephone service to an individual home or other
location without counting each telephone extension
separately.

With the wide accessibility and continued growth of
the telephone service, the concept of supplying health
information through Alexander Graham Bell's 1876 invention
captured the interest of the federal government. The seed of
the idea flourished into a national telephone service to
spread the latest information about cancer to the public.

Until 1985 when budget constraints led to the cutoff of

 

BButler, King, and White, p. 9.

4Interview with Courtney Snyder, United States Tele-
phone Association, Washington, DJL, 24 February 1986.

National Cancer Institute (NCI) funds for three offices, the
NCI sponsored 21 local centers throughout the United States
and an additional two sites in Bethesda, Maryland. The
centers'pmrsonnel would answer cancer-related questions from
callers. This group of centers composed the Cancer Informa-
tion Service (CIS).

One of the local offices, based in Washington, DAL,
answered calls beginning in 1976 until funding expired on
June 15, 1985. The vast majority of telephone calls received
at the CIS office in Washington, ILC. originated from the
District of Columbia and the suburbs of Virginia and Maryland
as expected. Two studies conducted during the past decade
indicated that black males and females in the District
exhibit extremely high rates of cancer. As a result,
District of Columbia leaders developed the Metropolitan
Washington Regional Cancer Registry (MWRCR) to compile data
on the matter. The CIS established a mechanism to allay
unwarranted fears of people in the metropolitan Washington,
ILC. area and encouraged residents to enter the health care
system for precautionary screening procedures.

While any definitive solutions for the high rate of
cancer incidence among minorities remain years away, the CIS
in Washington, ILC. provided individuals with counseling
about cancer-related concerns. The CIS staff supplied the

most recent information from the NCI on all types of cancer.

The service offered confidential answers to callers'
questions, besides distributing free publications on assorted
cancer topics.

The drive to reach the public with cancer information
involves promotional campaigns, referrals from friends, and
other forms of communication. To better determine the
demographic composition of callers, the counselors who
responded to the telephone calls queried people about their
race, age, residence, and educational background. The coun-
selors also determined the sex of the caller from a predeter-
mined procedure. The key to reach certain demographic groups
could involve selecting the ideal communication channels for
each. This study will examine the results of data collected
from callers of the CIS by counselors who answered their
questions. The analysis should reveal tendencies of how
various demographic groups in the metropolitan Washington,
D.C. area first heard about the CIS.

A preliminary observation of the telephone
information service gave impetus to conceptualize the thesis.

E' EI'I I C Staff I
Warm

A review of literature in the field further
concretized this thesis, The literature review was conducted
under the following rubrics: (l) the condition of health

care utilization, (2) literature on the causes of cancer,

(3) literature about the relationship between blacks and
cancer, (4) literature about the Cancer Information Service,
and (5) other cancer and health care information services.

TI C i'l' E H 1!]
C fll'J' I' S! i'

There is a paucity of systematic research findings
about health care utilization. Some findings in regard to
the use of health and social welfare services appear to have
been minimally useful. For example, when findings appear
inconsistent with results from other studies, attempts are
often never made to correlate results or to account for
apparent disparities.5

In many cases, the data collected to determine health
care utilization patterns contain significant limitations.
Most utilization data originate from the records of
physicians, hospitals, clinics, insurance companies, and
direct personal interviews or questionnaires in social
surveys.6 The value of data collected from hospitals,
clinics, and insurance companies is generally limited to the
planning and administration of health care agencies. As a
result, direct personal interviews or questionnaires in

surveys could elicit insightful feedback from health care

 

5John McKinlay, "Some Approaches and Problems in the
Study of the Use of Services--An Overview," .lgurnal_gf_flea11h
§_£ggia1_flgha1191 13 (June 1972): 115.

61bid., p. 116.

consumers that administrators and physicians may not consider
relevant in the delivery of medical services.

Unfortunately, physicians and administrators probably
have little opportunity to query persons other than those who
seek treatment from them. Individuals who remain outside the
health care delivery system might not be reached unless a
survey extends beyond a medical office. Even among
physicians who have an interest in surveying their patients,
the many years of a doctor's academic preparation may not
have included training in proper survey research methods.
Diligently kept physicians' records may provide a
chronological account of patients"visits, their purposes,
diagnoses, therapies, and treatment recommendations, but
difficulties exist in gaining access to the records.7

The lack of many scientific studies of health care
utilization leaves antiquated findings to serve as the sphere
of knowledge for a great number of physicians. «Many
mainstream practitioners rely on health studies of blacks
published more than a decade ago and assume that findings
from years past remain applicable today.8 Since the earliest
times in America, diseases and health care patterns among

blacks varied, depending on economic conditions and the

 

7Ibid.

8Jacqueline Johnson Jackson, "Urban Black Americans,"

in Ethn1g1ty_and_Mefi1c1ng, ed. Alan Harwood (Cambridge,

Mass.: Harvard University Press, 1981), p. 49.

skills of medical practitioners.9 Also, a danger exists with

self-reported health information. The information frequently
leads to the conclusion that blacks suffer more health
problems than whites.10

Also, a scarcity of information leads laymen to
become overconfident about their understanding of cancer
symptoms. In 1972, the Blue Cross/Blue Shield Association
commissioned a poll and discovered that many persons are
overconfident about their knowledge of health facts. .Among
respondents who participated in the Blue Cross/Blue Shield
poll and indicated that they knew the warning signs of

cancer, one-third of them could not name even one.11

W
W

Poor nutrition exerts a strong correlation with the
development of cancer. For instance, an elevated risk of
cancer occurs among individuals with a low intake of vitamin

Aulz Deficient amounts of either vitamin C or carotene will

 

91bid., p. 37. 1°Ibid., p. 49.

11Matilda Butler and‘William Paisley, ICommunicating

Cancer Control to the Public,“ HealtLEdncationJonographs 5
(Spring 1977): 8.

12Regina G. Ziegler et al., "Esophageal Cancer Among
Black Men in Washington, DJ; 1. Role of Nutrition,'119n1na1
911W 67 (December 1981) ° 1201.

also increase the risk of developing cancer.13 In addition,
experiments with animals revealed that very large doses of
vitamin A protect against cancer while a vitamin A deficiency
often increases the risk. Vitamin C inhibits cancer
development, too, blocking the formation of carcinogens that
sometimes form in food or the digestive tract once nitrate is
present.14

An experiment took place in Washington, ILC. to
determine the effect of nutrition on susceptibility to
cancer. Researchers categorized food to determine if a link
exists between the consumption of certain groups of food and
the risk of developing cancer.15 Foods were classified into
two categories. One group contained affluent foods, and a
second category consisted of cheaper foods to determine if
dietary patterns affected cancer rates."6 Affluent foods
were classified as beef, chicken, lamb, fresh or frozen fish,
and shellfish. The cheaper foods category included precooked
or processed meat and fish, frankfurters, lunch meat, canned
meat, canned fish, bacon, and sausage}.7 The study concluded
that a diet of affluent foods diminished cancer risk,
suggesting that social class may predict susceptibility to

cancer.

 

131bia. 14Ibia., p. 1204.
151bid., p. 1199. 15Ibid.
17Ibid.

Dietary patterns could hold responsibility for nearly
all major causes of death. For example, a case-control study
in Washington, ILC. found a strikingly high mortality rate
caused by esophageal cancer and revealed poor nutrition as a
primary factor. The least-nourished third of the entire
population suffered twice the cancer risk of the most-
nourished third.18

The study in Washington, ILC. suggested that general
malnutrition, probably a mild form, increased the
susceptibility of urban black men to esophageal cancer.19
Even among younger age groups, the black population exhibited
a greater percentage of esophageal cancer cases than the
'white populationfi20 Despite clinical research findings that
associate nitrite consumption with cancer, esophageal cancer
seemed more closely associated with precooked or processed
meat and fish consumption than with nitrite intake:21 The
rate of cancer risk declined when persons chose to bake
rather than fry meat and dropped further for those who

broiled meat.22

 

13Ibid., p. 1204. 191bid., p. 1205.
20” I III N I. I E . J C E . I
‘ ' , with a

foreword by Jack E. White (Washington, DAL: Howard Univer-
sity Cancer Center, the District of Columbiafs Department of
Human Services, and the Howard-Georgetown Comprehensive Can-
cer Center, May 1982),fh 20.

leiegler et al., p. 1205. 221bid., p. 1203.

10

The high rates of esophageal cancer among blacks in
Washington, ILC. contrasted with lower rates in other
geographic areas. Throughout most of the United States and
the Western World, cancer of the esophagus was relatively
uncommon. However, data from a study in South Carolina
suggested a prevalence of esophageal cancer among blacks.23

Diet seemed responsible for high rates of esophageal
cancer in spot locations throughout the world. Two separate
studies, 30 years apart in Sweden, found a correlation
between a person who smokes tobacco and his susceptibility to
cancer of the pharynx, larynx, and esophagus.24 Until
recently, iron and other micronutrient deficiencies existed
in northern areas of Sweden, where esophageal cancer appeared
unusually comnunnzs Poor nutrition is suspected of causing
esophageal cancer in Iran, the Soviet Union, and China.
Cancer appears endemic in regions with limited diets and
impoverished agriculture. Case-control studies in the United
States and Japan have demonstrated an association between
reduced consumption of certain basic food groups, notably

vegetables and fruits, and esophageal cancer.26

 

23Ernest L. Wynder and Irwin J. Bross, "A Study of
Etiological Factors in Cancer of the Esophagus,'.9an£££ l4
(March-April 1961): 389.

24Ibid., p. 390. 25Ziegler et al., p. 1204.
251bid., p. 1203.

11

In addition to poor nutrition corresponding to
development of cancer, several studies have established a
high correlation between consumption of alcoholic beverages
and esophageal cancer. Practically no daily requirements for
micronutrients and protein result from the intake of beer,
wine, and hard liquor, representing empty caloriesrz'7
Ziegler et al.'s Washington, D.C. study indicated a sharply
increased risk of cancer among individuals who heavily
consumed alcoholic beverages. A Chinese study revealed that
50 percent of esophageal cancer patients consumed Rai_kfln, a
strong vodka-like drink that contains between 65 percent and
85 percent alcohol, in comparison to 12 percent of the
control group. In Japan, 51 percent of male esophageal
cancer patients considered themselves heavy drinkers, while
23.2 percent of the control group put themselves in the
heavy-drinker category.28

In the early 19805, studies conducted by the NCI and
Howard University found that alcohol consumption was a major
risk factor leading to the occurrence of esophageal cancer.
Studies conducted by the Howard University Cancer Center
about the Washington, ILC. area indicated that two health

problems associated with alcohol, esophageal cancer and

cirrhosis of the liver, cause unusually high mortality rates

 

27Ibid. 28Wynder and Bross, p. 391.

12

in comparison with national average rates. The Howard
University findings determined that the mortality rates
for esophageal cancer and cirrhosis of the liver in the
Washington, DAL area ranged between two and three times the
national average.29
Findings from other studies have indicated socioeco-
nomic status exerts a major role in the development of
esophageal cancer. White residents in the District are
generally of higher socioeconomic status than blacks. While
esophageal cancer occurs much more frequently among blacks
than whites, the underlying causes of the disease are
probably related more closely with socioeconomic variables
rather than race, drug abuse, sexual habits, smoking, or
carcinogenic exposures.30 However, Ziegler et a1. disagreed.
The association of esophageal cancer with poor nutrition,
independent of socioeconomic status, suggested that
unidentified aspects of life style are not primarily
responsible for high cancer rates:31 Ziegler et al.
acknowledged the influence of socioeconomic status when they
cited studies in Puerto Rico and Singapore that demonstrated

a relationship between low socioeconomic status and

esophageal cancer.

 

29Metropolitan Washington Regional Cancer Registry
Report Series, p. 19.

30Ibid., p. 24. 31Ziegler et al., p. 1204.

13

A study of cancer rates among the inhabitants of the
District of Columbia and the surrounding suburbs indicated
similarities as well as stark contrasts between the various
demographic groups. .An estimated 80 percent of all adult
cancer incidences resulted from environmental factors.
Exposure to carcinogenic agents during a lengthy period of
time, such as between 10 and 40 years, often leads to cancer.
The long latency period of cancer causes difficulty in the
identification and control of specific causal agents.32

A study published in 1980 addressed cancer mortality
rates in 10 major U.S. Standard Metropolitan Statistical
Areas (SMSAs), identifying Washington, ILC. as an area with
unusually high cancer rates among its black (nonwhite)
population. An analysis of the data revealed that whites in
the Washington, ILC. area exhibited the lowest cancer rates
in a comparison with whites from other urban centers included
in the study. Black males and black females in the
Washington, ILC. area were found to have the highest and
second highest cancer rates, respectively, relative to other
areas. .A follow-up study involved 15 major SMSAs, indicating
once again that Washington, ILC. area blacks had the highest

cancer mortality rates and white residents among the lowest

 

32Metropolitan Washington Regional Cancer Registry
Report Series, p. l.

l4

rates. .A serious cancer mortality problem appears to exist
in the Washington, D.C. area.

The magnitude of cancer mortality rates in a
population resulted as a function of three elements.33 They
are: the high incidence of cancer in a population, the stage
of the disease at diagnosis, and the survival experience of
patients. An optimal effect results when the relationships
among these three elements are clearly understood on a
cancer-site-specific basis and integrated into a cancer-
control progrann The MWRCR indicated a positive community
effort to record cancer cases, and the dissemination of
cancer information to residents seems to represent the
logical next step.34

Incidence rates for esophageal cancer in Washington,
ILC. among black males are between 40 percent and 280 percent
higher than among black males in other metropolitan areasfi35
In addition, white males in the District have the greatest
incidence rate among other white male populations. Females,
regardless of race, exhibit higher than average incidence
rates of esophageal cancer than women from other urban
areas.36 An immediate need to diminish the devastating rates

of esophageal cancer seems to mandate intensive promotion of

 

33Ibid. 34Ibid. 35Ibid., p. 17.
35Ibid., p. 18.

15

cancer information through the most effective mechanisms
available.

Cultural and socioeconomic differences might explain
part of the problem with esophageal cancer. The sections of
the District that are most centrally located contained the
highest esophageal cancer rates in the entire metropolitan
area.3'7 The areas of highest risk also demonstrated the
lowest median family incomes, the highest percentage of
families below the poverty level, and the lowest median
educational level in the city. The esophageal cancer rate at
the bottom of the scale of risk occurred in the section of
Washington, DAL with the highest median family income, the
fewest families below the poverty level, the highest
educational level, and the fewest number of persons per
household:38 The data suggest a correlation between
esophageal cancer and people who live in the most centrally

located, poorest, and least educated subpopulations.

I'I I El Ill EJI' l'
W

A limited number of studies about the health care
needs of blacks have suggested a good deal remains unknown

about their health behavior.39 The relationship between

 

37Ibid. 38Ibid.

3gButler, King, and White, p. 9.

16

health institutions and subsequent health patterns among
members in a given community needs exploration. Blacks
infrequently receive attention in follow-up, longitudinal, or
explanatory studies. Also, studies about urban black
subjects seem prone to contain generalizations from
nonrepresentative and usually extremely small sample sizes,
among other shortcomings.40
In 1978, the U.S. Department of Health, Education,
and Welfare released data that showed racial variations in
mortality rates for malignant neoplasms. Except for females
under the age of 25 or beyond the age of 65, female mortality
rates consistently indicated higher incidence rates among
blacks than whites between 1950 and 1976. Black males
encountered higher rates than white males in 1960 for
malignant neoplasms among the 30-64 age bracket and in 1976
among those past the age of 30. An increase took place
between 1950 and 1975 among black males above the age of 35
for the same malignancy, but it decreased among black females
below the age of 65 during the same time span.41
Reasons for higher rates of cancer among blacks than
whites may involve different patterns of drug abuse, smoking,

or sexual intercourse, besides nutrition, socioeconomic, and

alcohol-consumption variations."2 The rising cancer

 

“Johnson, p. 48. 411b1d., p. 57.
42Ibid., p. 59.

17

mortality rates among blacks may also stem from environmental
causes, increased longevity, and better reporting of cases}:3
Some researchers propose that environmental factors could
explain a significant escalation in cancer mortality rates
between 1950 and 1967.44

Black females seem more prone than white females to
cancer of the esophagus, colon-rectum, pancreas, lung,
breast, and kidney. Incidence rates for various sites of
cancer among blacks and whites led Siedman, Silverberg, and
Holleb to find a 36 percent rise in cancer rates among black
males between 1947 and 1969. Cancer sites that demonstrated
increased incidence among blacks included the esophagus,
colon-rectum, pancreas, lung, prostate, kidney, and
bladder.45

A higher percentage of females than males in the UAL
poses indirect implications for health care. The scarcity of
males, especially in the black community, may exacerbate
poverty and health problems, such as alcoholism and cancer of
the cervix among female household heads. The inequity in the

numbers of females and males may increase the probability of

a greater number of partners for sexually active women. A

 

43Ibid., p. 57. 44Ibid., p. 59.
45Ibid.

18

link may exist between multiple sex partners and increased
prevalence of cancer of the cervix.46

Part of the health problems among blacks may stem
from a lack of information. The scarcity of black physicians
in the past retarded the dispersion of biomedical knowledge
among blacks, although the legal extinction of racial
segregation undoubtedly improved the accessibility of urban
blacks to mainstream medical care in recent years. Largely
as a result of racism and poverty, mainstream medical care
often proved inaccessible to urban blacks for many years
following the cessation of slavery. In the early 19708,
Bartley declared that "the black population must look to the
Negro physician for health care.'47

The rising levels of education among blacks
necessitate continuing modification in the way physicians
communicate to black patients. Nearly half of all blacks
beyond the age of 25 possess high school diplomas.
Physicians should consider the comprehension level of each
patient when the time arises to explain a specific medical
problem.48

One researcher linked a reluctance of certain blacks

to seek medical attention to lingering behavior patterns from

the days of slavery. After the abolition of slavery, blacks

 

461bid., p. 43. 47Ibid., p. 38.
431b1d., p. 44.

19

generally became responsible for their own health care. At
the time, the tradition of European and African beliefs
became part of a folk medical system that influenced both
blacks and poor whites in the South. After the Civil War,
the treatment of disease became the responsibility of the
blacks themselves. The need to avoid expensive medical
treatment focused attention on the 'root doctor“ or ”hoodo-
man” as the healer of diseases.49

A modern view of black medical care gives a different
perspective. The Howard University Medical Center in
Washington, ILC. practically never turns down anybody because
of an inability to pay, said Jack White, MAL, director,
Howard University Cancer Center. Options exist for those
who lack funds to receive medical care, he said. One, the
hospital staff can turn the case over to a social worker.
In most instances, the individual will receive medical
treatment. Only a small group of persons will not be
accommodated, White said. Two, patients without any money
can often gain admission to the hospital as an educational
case for training medical students, he said.50

A very small percentage of the indigent receive no

help. Some of them are foreign. White recalled the case of

 

491bid., p. 37.

50Interview with Jack White, MAL, Howard University
Cancer Center, Washington, D.C., 18 September 1984.

20

a Guyanan boy who desperately needed medical attention for a
malignancy. ”I couldnft admit hinu' White said. The boy may
have been admitted if his case was an emergency. A legal
requirement forces all hospitals to treat patients in an
emergency. Consequently, sometimes cases that could be
regarded as nonemergency situations are identified as actual
emergencies to insure that an individual receives care.51

Reimbursement from insurance carriers often creates
troublesome situations that discourage medical screening,
even though the practice may save lives. "Most third-party
carriers don‘t pay for screening,” White said. ”They pay for
care, not preventionfl' Until recently, no emphasis was
placed on preventive care, White said. Screening offers a
chance to reach target groups, such as those who may have
been exposed to carcinogenic substances.52 White identified
cancer of the following sites as common among blacks:
breast, cervix, rectal, colon, thyroid, mouth, lung, and
prostate.

The phenomenon of patients seeking medical care from
physicians with similar backgrounds needs to be recognized.
"Most black doctors take care of mostly black patients,” said
White. "Most patients I got when I began to practice

medicine were referred mostly from black doctors.” The same

 

51Ibid. 52Ibid.

21

situation exists with other groups who share an identity.
For example, Jewish physicians probably refer patients to
other Jewish physicians when a patient needs to see someone
from a specific specialty.53 ”There is no inherent bias,“
White said.

The reluctance of medical schools to admit more than
a handful of black students during the days of segregation
”certainly affects whatls happening now,“ said White. The
lack of health professionals within minority groups robbed
those communities from acquiring maternal, fetal, and infant
health care advice from neighbors who work in the health
professions. Besides a deficiency of health care
information, inadequate medical care, low socioeconomic
status, and poor nutrition also lead to poor health among
minorities. Socioeconomic status ranks as a major factor for
poor health, White said. The poor have more immediate
priorities than health care, such as providing food for the
kids, housing, and clothes 'to keep from freezing to death,“
White explained. "Poor males put health care way down the
list,“ he added. 'They tend to ignore minor aches and pains
and other symptoms, and develop more virulent types of

cancer," he said.

 

53Ibid.

22

A likely byproduct of low income is poor nutrition,
which adversely affects toleration of radiation therapy and
chemotherapy, White said. Nutrition exerts a bearing on
survival, he said. Other factors that cause cancer include
"stresses, strain, and anxiety" that develops undesirable
life cycles, White said.

Differences between blacks and whites must be couched
carefully, explained Bill Palm, former CIS health educator,
Washington, ILC. Comparisons “can sound racist," especially
when health problems are linked to sexual patterns and the
number of sex partners. The ratio of gonorrhea cases between
blacks and whites reaches 20:1, Palm said. Part of the
difference involves reporting, he said. The disease also
correlates closely with inner-city, low-income neighbor-
hoods.54 The situation signals a problem with the health
status of low-income people, Palm said. ZDifferences in
knowledge, diagnostic services, and adherence to proper
medical care all play a role in the quality of health care
among low-income groups, he said. Infant mortality affects
blacks more than whites in the U.S., said Palm. A lack of
prenatal care may hold responsibility for the difference, he

said.

 

54Interview with Bill Palm, Howard University Cancer
Center, Washington, D.C., 18 September 1984.

23

Low income and minimal education definitely seem
associated with infant mortality.55 One of the poorest
regions, South Carolina, still possesses the belief that
eating clay will help produce a healthy baby, said James
Pence, director of health planning, Pee Dee Regional Health
Systems Agency, Inc., Florence. South Carolina. Generations
of pregnant females, especially blacks, have dipped into the
deposits of clay mixed with dirt and eaten the substance.

The consumption of clay actually inhibits retention of iron
in the women, hindering the effort to give birth to a healthy
baby, Pence said. Despite attempts to educate them, many
families perpetuate the clay-eating ritual, said Pence.

Virtually no progress in the fight to reduce infant
mortality rates among blacks in the U.S. during the past few
years forced the Department of Health and Human Services
Secretary Margaret Heckler on the hot seat during a Senate
hearing.56 She called the problem a ”priority," but when
queried about why the budget appropriation for preventive
care was slated for cuts, Heckler responded that the record
national budget deficit forced reductions. Later in the same

week, Heckler told the Budget Committee in the House of

 

55Interview with James Pence, Pee Dee Regional Health
Systems Agency, Inc., Washington, D.C., 11 March 1985.

56Testimony of Margaret Heckler before the UAL
Senate Appropriations Subcommittee on Labor. Health and Human
Services, and Education, CLS. Department of Health and Human
Services, 5 March 1985.

24

Representatives that the HHS share of cuts would force a 2.2
percent cut in current services.

One pediatrician has said even school-age children
can understand health problems, including cancer. "You can
get across simple concepts," said Clare Dykewicz, M.D. She
added that inadequate nutrition undermines the health of
children and leads to inhibited growth and slow learning. At
the University of Chicago, where she served as a medical
resident and supervised the medical care of inner-city
children, Dykewicz noticed an "iron deficiency" among her
young patients. Dykewicz said she suspected children were
not fed nutritionally balanced meals, even in households with
adequate income. "Families may spend their money on Twinkies
and pop," Dykewicz said.57

"Dramatic deficiencies“ exist in the diets of
youngsters in Bangladesh, where Dykewicz worked for several
months in 1984 to provide medical care for malnourished
children. “In Bangladesh, the first priority for food is the
father/husband, and sick children get whatever is left over,“
Dykewicz said. "Families will criticize women who take a
child to the hospital, even if not seeking medical attention
means the death of a child. The child-mortality rate is

correlated with literacy in both Bangladesh and Chicago.”

 

57Interview with Clare Dykewicz, MAL, University of
Chicago Medical School, Flint, Michigan, 25 December 1984.

25

A faculty member at Northwestern University Medical
School, Mark Dykewicz, MAL, treats cancer patients at
several different hospitals, where he has detected "distinct
clinical populationsJ' For example, cancer rates at the
Veterans Administration (VA) hospital where he supervises the
medical care of patients are ”far higher" than at the other
university-affiliated hospitals. Dykewicz characterized VA
patients as typically poor and black. adding that many of
them have histories of heavy smoking and drinking, which lead
to high rates of lung cancer, pharaxyl cancer, esophageal
cancer, and laryngeal cancer.58
W
E I E l' S .

One mechanism to promote positive information about
survival rates and new forms of treatment is the Cancer
Information Service. Before the loss of funding for the CIS
in Washington, ILC. during June 1985, the cancer telephone
service provided area residents with an opportunity to
receive answers to their cancer-related questions. Since
1976, when former Massachusetts Senator Edward Brooks placed
the first call to the C18 in Washington, DAL. the telephone

service in the District had responded to more than 15,000

 

58Interview with Mark Dykewicz, MAL, Northwestern
University Medical School, Flint, Michigan, 25 December 1984.

26

telephone inquiries from the metropolitan Washington, ILC.
area.59 After the creation of the National Cancer Act in
1971, the National Cancer Institute funded the CIS to reduce
the widespread fear of cancer through the availability of
information to help the public understand and cope with the
disease.

Howard University, where the clientele are almost
universally black, and Georgetown University, which serves a
large number of white patients, combined forces to combat the
health risks associated with cancer. The National Institutes
of Health issued a CIS contract jointly to both cancer
centers to coordinate service to all area residents. White
and John Potter, M.D., who directs the Georgetown Cancer
Center, each contributed 5 percent of their full-time hours
to the CIS in the battle to wipe out cancer, until funding
expired and the CIS closed in 1985.

The CIS in Washington, D.C. not only answered queries
from people who sought information about cancer, but also
conducted numerous special projects, according to a Howard
University Cancer Center pamphlet. The special projects
include a program in cancer prevention geared toward students
in grades K through 12; instruction to Washington, D.C. area

clergy about how they can assist members of their

 

59Howard University Cancer Center, pamphlet (n.d.).

27

congregations to better cope with cancer; a speakers bureau
designed for the lay public and health professionals; a
project intended to contribute to the early detection and
treatment of breast, colon-rectum, and prostate cancer among
senior citizens; and the development of educational materials
for target groups.60

Regional CIS offices collectively form the Comprehen-
sive Cancer Center Communications Network (CCN) under the
direction of the NCI. The network is intended to deliver
accurate and up-to-date information on cancer causes, preven-
tion, early detection, diagnosis, treatment, rehabilitation,
and continuing care. Each CIS office in the network submits
a semi-annual report to explain in detail how the activities
of the past six months helped meet the cancer-information
needs of the community.61

In 1979, a National Publicity and Promotion Task
Force was established to link members from both the CCN and
NCI to develop short- and long-range promotional plans. The
group identifies target audiences and develops strategies to

publicize the CIS on a national level. The task force also

 

60Ibid.

61National Cancer Institute, “National Plan for
Publicity and Promotion of the Cancer Information Service"
(Bethesda, Md.: NCI, February 1982). (Mimeographed.)

28

reviews existing communication campaigns and recommends
modifications.62

An important objective of the CIS is to reduce the
widespread fear of cancer and to heighten public understand-
ing of the disease. The NCI, ACS, and scientists from member
institutions of the National Cancer Program provide CIS
offices with extensive summaries of basic cancer information
and frequent updates with new advances in the treatment of
cancer. Every CIS office also maintains a directory of local
cancer-related resources, including physicians from local and
state medical societies and medical specialists from regional
career centers.63

Nearly half of all calls to the CIS originate from
cancer patients and their relatives. The first CIS became
operational in February 1976 and handled 300 calls in the
inaugural month. Since then, the CIS has expanded throughout
the ELS., answering more than one million calls. The average
call volume for all CIS offices combined tops 21,000 per
month, rising every year until the loss of funding for three

offices: the Howard/Georgetown CIS, the Duke University CIS,

and the Mayo Clinic CIS.64

 

621bid.

63National Cancer Institute, ”Questions and Answers:
Cancer Information Service” (Bethesda, Md.: NCI, rndA.
(Mimeographed.)

64Ibid.

29

Both health professionals and specially trained
volunteers answer questions from callers. Representatives of
local medical organizations and staff of regional cancer
centers offer professional review of CIS operations on a
regular basis. A system of test calls serves as a further
means of quality control. Interestingly, the Washington,

ILC. CIS earned a near-perfect score, leading all other CIS
offices before eliminating funding to the Howard/Georgetown
€15.55

National_§IS_media_publicit¥_nlan. The NCI launched
a national promotional campaign in January 1983 to publicize
the CIS. The objectives of the effort included increasing
the total call volume and public awareness of the CIS,
especially among health professionals and selected high-risk
target groups. ‘Between September and November 1983, a series
of promotional activities were conducted to capture national
media attention for the CIS program. The campaign focused on
the CIS as an established service with access to the latest
information about cancer treatment breakthroughs via computer

data bases.56

 

65Ibid.

65National Cancer Institute, “Cancer Information
Service National Media Publicity Plan l-800-4-CANCER'
(Bethesda, Md.: NCI, 6 September 1983), p. l. (Mimeo-
graphed.)

30

The publicity blitz consisted of mailing promotional
materials in three waves to members of the media. Organizers
categorized the media into distinct groups, aiming messages
at the general news media, science writers, syndicated
columnists, and medical/health publications. The first wave
of materials mailed to each group communicated the creation
of a new toll-free telephone number, l-800-4-CANCER, which
covered all parts of the United States except Hawaii, Alaska,
and the District of Columbia. The second wave of promotional
mail contained broader information sent to selected members
of the media to generate feature coverage. The third wave of
the campaign encompassed the response from the CIS to queries
for additional information from both the media and public
that were sparked during the first two waves.67

A media kit developed at the NCI bluntly informs CIS
offices about “tactics" that may lead to positive news
coverage about the CIS. The kit identifies seven examples of
story angles that may attract news coverage. One story idea
advises local CIS officials to release data from research
findings on the demographic characteristics of CIS callers,
highlighting low utilization among certain populations.68

In recognition of the high rates of cancer and low

utilization of the CIS among blacks, the Office of Cancer

Communications (OCC).at the NCI formed the Black Audiences

 

67Ibid., p. 2. 68Ibid., p. 3.

31

Outreach Task Force. The task force consists of representa-
tives of numerous CIS offices throughout the nation who
participate in black outreach activities. The objective of
the outreach program is to develop a high-visibility
promotion that will focus attention on blacks and cancer and
generate specific recommendations for future campaigns to
reach b1acks.69
A preliminary report to improve awareness of cancer
among blacks was released in December 1983. The report
recommended more promotional efforts, intensified communica-
tion of ways to reduce the risk of developing cancer, and
warned of the need to boost call volume to the CIS by blacks.
The task force also presented a paper at the National Black
Congress on Health Law and Economics (BCHLE) convention
during July 1984, gaining the attention of more than 7,000
delegates. Member organizations of the BCHLE include the
National Bar Association, National Black Nurses' Association,
National Optometric Association, National Pharmaceutical
Association, National Podiatry Association, and the Black
Caucus of Health Workers of the American Public Health

Association. As a result, the task force reached opinion

 

69National Cancer Institute, “Update on Activities of
the Black Audiences Outreach Task Force" (Bethesda, Md.:
NCI, June 1984), p. l.

32

leaders in black communities across the country who could
become influential promoters of the €15.70

The National Cancer Act of 1971 authorized the
development of comprehensive cancer centers and specialized
cancer centers to transfer and expedite cancer research
results into effective clinical practice. The 21 comprehen—
sive cancer centers also hold responsibility for providing
coordination and leadership within their respective geo-
graphic regions. In communication. education, and outreach,
the NCI, ACS, and comprehensive cancer centers are the most
visible participants in the National Cancer Program. .The
primary role of the network of comprehensive cancer centers
is to disseminate and interpret new and existing knowledge
produced through the National Cancer Program to concerned
communities.71

At the Memorial Sloan-Kettering Cancer Center in New
York, a communications office opened in 1975 under the
auspices of the Cancer Center's control program. The
communications office launched numerous Cancer Center and
citywide programs in the fields of health communications,
school health, health education, public information, and

nursing education. Through television, radio, the press, and

 

7°Ibia.

71Memorial Sloan-Kettering Cancer Center, Proceed1ngs

W (New York: Grune
& Stratton, 1980), p. 762.

33

other media channels, the residents of New York City became
aware of the Cancer Center's communications office and its
programs, including the New York City €18.72

Confusion about cancer and fear about the disease led
to the formation of the CIS. A Gallup Poll conducted for the
ACS found that cancer ranked as the number one disease
concern of the public. Nearly 60 percent of American
respondents named cancer as the chief health concern, in
comparison to 32 percent for heart disease. As a result, an
important objective of the CIS became the reduction of the
public's fear of cancer with the latest information about
cancer-treatment developments.73

A 1979 evaluation of CIS callers in New York City
indicated that blacks accounted for 8.7 percent of the calls,
and Hispanics generated 3.5 percent of the telephone
contacts. Special promotional programs to reach both black
and Spanish-speaking New Yorkers included subway—car-card
campaigns and public-service announcements. Nearly 5,000
colorful cards were distributed along all lines of the New
York City subway station to promote the CIS. Surveys
indicated that the awareness level of the CIS more than
doubled in the two months following the posting of the cards.

Statistics compiled by the New York City Subway Advertising

 

721bid., p. 763. 731b1d., p. 764.

34

Company revealed subway advertising as an effective way to
reach large proportions of blacks, Hispanics, senior
citizens, and lower-income groups that underutilize the
crs.74

Overall, black Americans have poorer health than the
general population. As a way to combat the problem, many
health care professionals are applying social marketing
techniques to target messages to blacks. Efforts to
communicate health information to blacks require recognition
of sociological parameters. including institutional racism,
inequities of the health care delivery system, socioeconomic
status, health belief systems, and health-care—seeking
behavioral patterns.75

One of the National Institutes of Health, the
National Heart, Lung, Blood Institute (NHLBI), studied the
link between communications strategies and minority
audiences. The NHLBI Task Force on Diffusion Strategies in
Minority Populations identified that diffusion of health
information among culturally diverse populations depends on
individual characteristics, demographic characteristics,

communication channels, and community attributes. These

 

74Ibid., p. 766.

75Les Butler, "Communicating Health Information
to Black Audiences" (paper presented at the Congressional
Black Caucus Health Braintrust Workshop, Washington, DAL,
28 September 1984).

35

factors are believed to affect health status, how well groups
accept health information, and access to health care.76
A traditional vehicle to reach black audiences has
been public service announcements (PSAfls) on television and
radio. Until recently, commercial broadcasters provided
these 10-, 30-, and 60—second messages as a service to the
local community. Now, Federal Communication Commission (FCC)
regulations limit the number of PSA's commercial television
and radio stations need to offer a community; Regardless of
the new regulations, television and radio PSAfs involve
significant challenges that include an inability to control
the placement of messages where viewer/listenership is
highest for the targeted audience, the cost of production,
competition for PSA time, and development of creative
strategies that will command viewer/listener attention.77
As an additional complication, sensitive economic and
political difficulties exist in launching an anti-smoking
campaign that requires the use of local and national minority
publications. A sizable number of these publications, if not
the vast majority of them, rely on advertising dollars spent
by tobacco companies. In 1983, two of the top 25 magazine
advertisers were tobacco companies with combined ad

expenditures that totaled nearly $300 million.78

 

761bid. 77Ibid. 78Ibid.

36

The CIS developed a Black Task Force to boost the
current underutilization by black Americans. Further work
remains ahead to reach blacks with health information, and
Butler recommended:

. Heightened use of teachers, clergy, and community
leaders as intermediaries in the dissemination of health
information to blacks;

. Creative strategies that focus on specific socio-
economic and geographical factors;

. Increased use of pre- and post-testing methods;

. Training of minority health care providers in the
effective use of communication strategies;

. Exploration of new communications technologies in
disseminating health information;

. Increased involvement of black sociologists,
epidemiologists, and communications specialists in the
planning stages of health-information campaigns.79

But overall quality control of all CIS offices
requires two stages. The first stage consists of training
and certifying personnel at the CIS offices. The second
stage involves test calls to assess the performance of
telephone counselors. A test call measures four dimensions

of quality: accuracy (correct, timely, complete, precise),

 

791bid.

37

convenience (accessible, prompt), appropriateness (respon-
sive, referrals, language), and staff sensitivity (empa-
thetic, friendly, credible).8°

A more comprehensive evaluation occurred in 1984 with
a national survey of CIS users. The survey was designed to
record the perceptions and behavioral actions of CIS callers
after they used the service. Preliminary results of the NCI
survey, based on 1,745 respondents, revealed that 93.8
percent of the callers stated the service was useful and 95.6
percent described the CIS counselor as clear and easy to
understand. The glowing results continued as 93.8 percent of
respondents rated the CIS telephone counselors as knowledge-
able, while more than 95 percent indicated the staffers were
courteous, friendly, and sympathetic.81

The ultimate test may arise when callers regard the
service as helpful enough to use again or recommend to
someone else. More than 96 percent of the callers throughout
the country answered that they would call the CIS again if
they had other questions, and nearly 55 percent had already
recommended the CIS to others. Additionally, those who
expressed satisfaction with the CIS totaled more than 91
percent. .A similar number of respondents also took action

following their contact with the CIS. Among those who took

 

301616. Bllbid.

38

action, more than 81 percent of the respondents read
materials that they received from the CIS through the mail.
Nearly 91 percent of the respondents identified the CIS as
important in leading them to take action.82

The national demographic characteristics of respond-
ents in 1983 revealed that females composed 71.8 percent of
CIS callers. Also in 1983, the age group most likely to call
the CIS included those between 30 and 39, generating 2556
percent of the calls. The 20—29 age group initiated 21.9
percent of the calls, and those age 40-49 added 16.3 percent
of the telephone contacts. Those between age 50 and 59
contributed 14.3 percent of the calls, and others age 60 or
older combined to make 13.9 percent of the CIS calls. The
age category of 19 and younger totaled only 7.9 percent of
the CIS telephone calls.83

Nationally, better-educated Americans seemed more
likely to contact the CIS than their less-educated counter-
parts. Callers with at least a high school education combined
for more than 85 percent of the CIS contacts. Those with no
more than a grade school education accounted for barely 4.0
percent of the calls. Others with more than a grade school
education, but who never earned a high school diploma,

delivered less than 10 percent of the calls.84

 

821bid. 83Ibid. 84Ibid.

39

The racial composition of CIS callers in 1983
revealed that 87.3 percent of the respondents were white and
only 7.4 percent were black. Hispanics accounted for 3
percent of the total, and American Indians, Asians, and other
categories combined to place less than 2 percent of CIS
calls.85

The NCI formed an Evaluation Task Force, consisting
of CIS personnel, evaluation specialists, cancer-control
specialists, and NCI staff, to address CIS quality control as
one aspect of an overall evaluation program. A list of
"Dimensions of Quality" took shape, with the "test call'
approach selected as an appropriate methodology to evaluate
five of the six dimensions of quality for the CIS telephone
service. The six dimensions included accuracy, convenience,
appropriateness, staff sensitivity, effectiveness, and
standardization.86 Objectives of the test call are to assess
the quality of responses, to identify areas of deficiency

within individual offices, and to provide feedback and

corrective action to network offices.87

 

85Ibid.

86Judith Stein and Thomas Kean, "Quality Assessment
of the Cancer Information Service: Evolution of a Test Call
System." WW5 (New
York: Alan R. Liss, Inc., 1982), pp. 471-72.

87Ibid. , p. 474.

4O

cher.§hncer_and_flealth
g I E I' s .

A further review of literature under this rubric
generated some relevant findings. For example, some callers
who used the Can-Dial system reported no reaction or change
in behavior, while more than 60 percent attributed a bene-
ficial result with the service. Among the 60 percent who
received help, two-thirds reported a health-related change in
behavior, while the remaining one-third split their responses
between either a positive action unrelated to health or an
indirect behavior change, such as anxiety relief.88

The total number of calls increased substantially
immediately following television announcements about the Can-
Dial service, but subsided quickly with the disappearance of
the telephone number from the screen and the eyes of
viewers.89 Television ranked fourth as the source of
information that callers reported influenced them to call
Can-Dial. The response fell far short of brochures, the top
source of attracting calls. Brochures accounted for more
than 60 percent of the calls at a Can-Dial system telephone

line. Of course, brochures require printing and distribution

 

88Gregg S. Wilkinson, Edwin A. Mirand, and Saxon
Graham, "Cancer Information by Telephone: A Two-Year Evalua-

tion.“.Health.£ducation_flonogra2hs 5 (Fall 1977): 260.
891bid., p. 255.

41

costs, while public advertising exists with other sources
available to disseminate the information.90

Researchers found that the likelihood of persuading
an individual to call Can-Dial can be predicted, based on a
personls job. An examination of occupations relative to the
number of telephone calls that reached Can-Dial revealed that
students ranked as the most frequent users. The next most
probable callers were housewives, clerical workers, profes-
sionals, and the unemployed. Interestingly, three of these
occupational categories are likely to have free time and easy
access to telephones during a large portion of the day.91

The ultimate test for any telephone health service
might be to influence callers through the diffusion of
information.to reduce cancer risklamong community members.
Callers of Can-Dial were asked whether they discussed the
service with others, and 61 percent responded affirma-
tively.92 Discussions with friends and acquaintances of
physicians with cancer-stricken individuals and the
availability of a cancer telephone service, when taken
together, all probably played a part in any behavior change
93

undertaken.

An experiment in the Can-Dial system discovered that

utilization in two low-responding communities rose through

 

9°Ibid. 911bid., p. 256.
921bid., p. 260. 93Ibid., pp. 262-63.

42

intensive promotional activities. In addition, a much larger
series of experiments measured the effect of brochures in
well-defined areas. The researchers found that the rate of
response soared during the period when the brochures were
mailed, before falling back to the previous level of total
inquiries when the mailing stopped.94 Findings from a two-
year evaluation of the Can-Dial cancer public information
program at Roswell Park Memorial Institute revealed that
brochures stimulated more than half of the responses, while
public service announcements through the local media
accounted for close to 30 percent.95

Stepped-up promotional activity in seven specific
experimental communities usually resulted in heightened
response from the public for a short period of time.
Experiments in various communities throughout Erie County
suggested that utilization can be increased substantially
through direct mailing of a brochure, describing the program
and listing a telephone number.96 An important aspect of the
activity of a cancer telephone information program is to
improve public awareness about the service.97

Health-related telephone education services can serve

to answer many of the user's pressing questions in privacy,

 

941516., p. 256. 951bid., p. 261.
95Ibid. 97Ibid., p. 255.

43

free of charge, at a time convenient for the caller.98 From
an educational aspect, unlike many audiences. the caller's
decision to use the service suggests demonstrated interest in
the topic and a good probability to pay special attention to
the information. Evidence from the Can—Dial service seems to
indicate that the caller may take desired action partly as a
result of the call.99

Since 1973, Tel-Med, a nationally franchised health-
information system, has provided medically certified
information on a broad range of topics to telephone users.100
Information is provided free to callers who request specific
tapes from a tape library. Call volume varies in different
systems, depending on community size and hours of operation.
Effectiveness is difficult to determine because most
telephone information systems have been subject to only
limited evaluation. Among the evaluations, they generally
consisted of an analysis of call volume and topic popularity.
As the number of telephone services rises, this method of
disseminating health information for a medical-news-hungry
public becomes a considerable force.

Several evaluations of the Tel-Med system have
revealed notable findings. In a Winston-Salem study,

respondents were asked where they first heard about the

 

981bid., pp. 262-63. 991bid., p. 263.

100Diseker, Michielutte, and Morrison, Po 229-

44

Tel-Med Service. Respondents age 21 or older most often
cited the newspaper as their source of information. This
group of respondents identified the category of 'friend/
relative“ as the source of their initial awareness of Tel-Med
next most frequently. In addition, those age 21 or older
also ranked the categories of "television/radio" and “bro-
chures' as important information sources. The Tel-Med list-
ing in the "telephone book” also exerted some influence. The
Diseker et al. study further found that among respondents in
the entire sample, education and income levels positively
correlated with the use of Tel-Med. Interestingly, once
individuals at different levels of education and income
became informed of the service. they displayed a pattern of
use similar to other groups. As a result, the researchers
concluded that motivation for using Tel-Med failed to demon-
strate a correlation between utilization and either income or
educational attainment.

A limitation of the Winston-Salem study needs to be
recognized. The sample in the survey differed slightly from
the population of the telephone area. An overrepresentation
of adults with a high school education or better occurred
along with a minute underrepresentation of males. The over-
representation of better-educated adults might have biased
the results because highly educated respondents are less

likely to report that they received useful information. A

45

proven trend for females to use Tel-Med more than males might
have caused the underrepresentation of males to bias data.101
More females than males expressed an awareness of
Tel-Med before the interview. The survey also established a
relationship between socioeconomic status (defined as
education and income) and knowledge of Tel-Med for adults age
21 or older. A higher percentage of middle-aged adults had
prior knowledge of Tel-Med than either respondents under age
21 or those older than age 59. Sixteen percent of the sample
population in the Winston-Salem community used Tel-Med, and
approximately 37 percent of respondents with prior knowledge
of the service actually placed a call. While a smaller
proportion of younger respondents in the Diseker et a1.
studies had prior knowledge of Tel-Med, the young people who
heard of the service were more likely to have used it than
older people.102
Respondents age 50 or older indicated a greater
likelihood to call the Tel-Med about personal health problems
than adults between the ages of 21 and 49.103 Women
expressed more of a tendency than men to contact Tel-Med
because someone they knew had a health problem. More than 80

percent of the Tel-Med callers in Winston-Salem mentioned

 

1°11bid., p. 233. 102Ibid., p. 231.
1°3Ibid., p. 232.

46

that they contacted the service more than once. In compari-
son, a survey of 522 Pittsburgh households in March 1978
revealed that 72 percent of the respondents had called the
service more than once. The Winston-Salem respondents who
reported repeated use of Tel-Med were more likely than others
to seek medical care.104

The overall validity of the Winston-Salem survey
results draws considerable support from the independent study
of Tel-Med conducted in Pittsburgh during 1978. The Tel-Med
library contained information on topics of interest to 87
percent of the Winston-Salem respondents. .At least 40
percent said they received a "great deal“ of information. An
inverse relationship was found to exist between educational
level and the degree of information received.105

A closer analysis of responses from adults revealed a
pronounced tendency to report the newspaper as the first
source of information about Tel-Med. More than 25 percent of
adults between the ages of 21 and 29 identified the newspaper
as the first source of information, compared to slightly more
than 47 percent of adults age 60 or older who responded
similarly. Brochures also exerted considerable influence on

young adults.106

 

1041616., p. 233. 1°51bid.
105Ibid., p. 232.

47

The findings of Tel-Med studies further established
variations between males and females in regard to the time of
day when they called. During the pretest, female respondents
contacted the service more than males in the morning and
afternoon. In contrast, the largest percentage of males
reached Tel-Med later in the afternoon and during the
evening.107

Research questions for the Winston-Salem Tel-Med
system were devised to determine user characteristics, user
motivation, action taken, possible benefits, and needed
improvements. Nearly one-fourth of the survey respondents
indicated that Tel—Med encouraged them to seek medical or
dental care when they would have delayed it. After several
tests for possible biases, the researchers concluded that
interviewers were able to obtain reliable, unbiased data.

The test for biases involved an alteration of the order in
which the responses to three questions were presented. For
example, the responses to a question concerning the overall
evaluation of Tel—Med were: "very useful,” "fairly useful,"
and "not useful at all." The most positive response was read
first for one-half of the respondents and the most negative
response read first for the other one-half. An examination
of the three questions treated this way revealed no signifi-

cant differences in the percentage of positive responses.

 

1°7Ibid., p. 230.

48

Further tests were designed to detect differences between
interviewers with respect to the awareness, use, impact, and
evaluation of Tel-Med. Little difference emerged.108
Results from a Singapore study offer cross-cultural
validation of findings from the Tel-Med studies. A Family
Planning Telephone Information Service was instituted in
March 1974 to provide an extensive on-going education and
information service for the entire adult population of
Singapore.109 The service is intended especially to serve
young, working people who might not have the time or the
inclination to visit family planning clinics. Similar to the
cancer telephone services in the UAL, the Singapore service
permitted a convenient means of obtaining immediate and
reliable information on contraception, sterilization, and
abortion.110
Publicity of the Singapore service accelerated in
1975. During the first two months of the service, news
releases were published in Chinese, Malay, and English

press;111 The source where callers first heard about the

service varied significantly from comparable studies with

 

1091616.

109Wan Fook Kee, Margaret Loh, and Chen Ai Ju,
"Singapore Family Planning and Population Board Family

Planning Telephone Information Service," .The_Nurs1ng_Journa1
W16(n..:d) 88.

1101616. 1111bid., p. 89.

49

cancer services in the CLS. Newspapers caused 47.4 percent
to call the service, television led to 18.6 percent of the
calls, friends and spouses accounted for 10.3 percent, and
radio gained credit for 8.3 percent.112 Television dominated
other sources as the leading cause of CIS queries in the
District.

Two methods of publicizing the service were given
greater emphasis in 1975. First, efforts to publicize the
Singapore telephone service through newspapers, television,
radio, and rediffusion were intensified. The campaign
involved more frequent publicity for longer periods of time.
Second, the telephone number was printed in all pamphlets,
posters, and other publicity items such as calendars and
sewing kits. In 1974, most of the calls were received in
months when the Singapore service gained substantial
publicity through television, radio, newspapers, and cinema.
The correlation indicates an unquestionable relationship
between publicity and utilization of the service.113

The telephone number was printed in the 1974 issue of
the Singapore Telephone Directory. Newspapers exhibited

great success in generating calls, probably because the lit-

erate population in Singapore tops 76 percent.114 More than

 

1121616., p. 91. 113Ibid., p. 89.
1141616., p. 91.

50

50 percent of the male callers read about the service in the
newspapers, ranking it as unquestionably the most important

medium of information.

Marxian

A lack of studies exists that have examined health
care utilization patterns, especially among blacks. Conse-
quently, many health care professionals rely on findings from
more than a decade ago to determine health care utilization
tendencies. Thus, insufficient current information about
utilization patterns prevents health care professionals from
knowing which demographic groups largely remain outside the
health care system.

Another problem involves the need to reduce cancer
risk. Studies of populations throughout the world estab—
lished a link between poor nutrition and the development of
cancer. Findings from other studies suggested low socioeco-
nomic status is highly correlated with certain types of
cancer. Exposure to carcinogenic agents in the environment
was also found to heighten cancer risk. In addition, alcohol
consumption, and in some instances drug abuse and sexual
habits, have been identified as activities that increase
susceptibility to cancer.

Numerous factors could explain why blacks in the
Washington, ILC. area exhibit a higher incidence of cancer.

For example, poor nutrition and lower socioeconomic status

51

seem to more closely identify the status of blacks than
represent whites. Among other potential cancer causes,
smoking, alcohol consumption, drug abuse, and multiple sex
partners could account for greater cancer risk among blacks.

Knowledge, availability of diagnostic services, and
adherence to proper medical care all play a role in the
quality of health care for minorities. Poor black males put
health care way down the list of priorities, leading to the
development of more virulent types of cancer. Also, factors
such as poor nutrition adversely affect toleration of
radiation therapy and chemotherapy, reducing the chances of
survival.

Despite a near-perfect score on the test call and a
share of black callers that doubled the national average, the
NCI eliminated funding for the CIS in Washington, ILC. A
disappointed Dr. White said the Howard/Georgetown CIS
emphasized direct contact within the black community to
solicit support from ministers and other neighborhood
leaders, but when the time came to renew funding, the NCI was
"interested in call volume.“ The requests from community
organizations for cancer-information presentations still
occur, he said, but all CIS staffers lost their jobs. The
local CIS cost $300,000 per year, and the NCI called it 'too
expensive," said White. ”They didn“t offer any negotiations.

It was quite a blow, I'll tell you.”

52

Two objective observers expressed sympathy for the
loss of the CIS in Washington, ILC. In July 1984, the local
chapter of the American Cancer Society (ACS) began to field
telephone calls, offer information, and occasionally conduct
community outreach programs. A public information specialist
with the ACS, Elena Fletcher, described the relationship with
the CIS before the closure as cooperative. I'We were sorry
that it closed,” Fletcher said. ”We haven‘t done anything
differently than before it closed."l15 Joe Bangiolo, chief,
NCI Information Resources Branch, which is not involved with
the CIS, expressed disappointment with the shutdown of the
local CIS but said unfortunately "the number of telephone
calls is usually the determining factor."116

Numerous health-information services exist throughout
the United States and the world. The Can-Dial cancer
service, based at Roswell Park Memorial Institute in Buffalo,
New York, found utilization can escalate with direct mailing
campaigns of a service brochure. The nationally franchised
health-information Tel-Med system provides taped messages
that provide medically certified information on a broad range
of topics, extending beyond cancer. More Tel-Med callers

identified the newspaper as the source where they first

 

115Interview with Elena Fletcher, American Cancer
Society, Washington, D.C., 24 February 1986.

116Interview with Joe Bangiolo, National Cancer
Institute, Washington, D.C., 18 February 1986.

53

heard about the service. A Family Planning Telephone
Information Service begun in 1974 offered an extensive
on-going education and information service for the entire
adult population of Singapore. Newspapers unquestionably
finished as the best forum to publicize the service,
especially among men, as more than 50 percent of the male
callers indicated learning about the service this way. Of
course the results should not seem surprising as the literate
population in Singapore tops 76 percent.

In summary, cancer appears to be prevalent among
blacks and whites, but a paucity of information about cancer
thwarts efforts to curb cancer risk. The emergence of
health-information services offers hope that current
deficiencies in the assessment of utilization patterns will
be eliminated. In the meantime, physicians continue to
discover new cases of cancer every day that may have been

preventable.

W
The intent of the study about the Washington, ILC.
CIS is to determine the current utilization patterns among
the general population and specific demographic groups.
The results may give health professionals at Howard and

Georgetown Universities in Washington, ILC. an indication of

54

where strengths and weaknesses rest in regard to meeting the
cancer-information needs of the most vulnerable groups.

Findings of the study could help the fields of
journalism and mass communication examine their potential to
disseminate health care information to the public. The high
rates of cancer among minorities in the Washington, DAL area
indicate one of the greatest needs for an assessment of
possible health-improving benefits of the media efforts in
the nation's capital.

Community leaders in government and health care
already have recognized the high cancer rates in the District
as a serious problem, and results from the study may gain the
attention of high-level decision makers. Attentive listeners
with open minds may take discoveries from the study and
develop health policy based on the findings.

The disclosure of the mass media's significant
influence to reach the public with health care advice may
encourage other researchers to conduct similar investigations
and eventually create a topic for academic journals that is

as popular as political research.

CHAPTER II

STATEMENT OF THE PROBLEM, PURPOSE OF THE STUDY,

AND DEFINITION OF TERMS

W

What sources of communication lead the public to

telephone the Cancer Information Service (CIS) in Washington,

DAL, and how do blacks differ from whites in the utilization

of the service?

WW

Specifically, the study was conducted to

1.
relative to
Washington,

2.
callers;

3.
tion of the

4.
tion by the

5.

Determine the most common information sources
the number of telephone calls received by the
D.C. CIS;

Distinguish the demographic characteristics of the

Delineate specific differences in the utiliza-
service between blacks and whites;

Identify the various indicators of CIS utiliza-
diverse elements of the population; and

Formulate generalizations, draw conclusions,

and offer recommendations to former officials of the

55

56

Washington, ILC. CIS that might improve the service if they

regain funding.

D E' 'l' E T
Cancer--A group of diseases that affect different

parts of the body through the uncontrolled growth and spread
of abnormal cells.

Carg1nggen—-Any substance that causes cancer either
in animals or humans.

£13d1h1111y--The believability members of an
audience hold toward a source of information.

Hga1;h_pxgm911gn--A deliberate effort to improve the
quality of health among members of a society.

,Negplasms--Abnormal cells that grow into tumors.

Sgc1al_fla1ke11ng--The application of advertising
techniques to promote social service programs rather than
commodities.

Ta;get_grgup--The intended audience of a specific
health care screening or information campaign.

Hashim-~The metropolitan area includes the
Maryland suburbs of Prince Georges, Charles, and Montgomery
Counties, and the Virginia suburbs of Arlington, Fairfax,
Loudoun, Prince William Counties, and the cities of
Alexandria, Fairfax City, Falls Church, Manassas, and

Manassas Park.

57

: . l' E II E . i E II II .

The remainder of the thesis has been organized as
follows:

Chapter III will provide the theoretical as well as
methodological considerations involved in the execution of
the study.

Chapter IV will report the findings of the study,
while Chapter V will offer a set of generalizations and
recommendations.

In addition, the thesis will have a comprehensive

bibliography and appendices.

CHAPTER III

THE THEORETICAL AND METHODOLOGICAL CONSIDERATIONS

FOR THE STUDY

T] I' J C .3 I'

Research findings have indicated that the most
effective way to reach people with new ideas and persuade
them to utilize innovations results from a combination of
mass media and interpersonal communication channels.117
During the past 40 years, findings from communication
research disclosed that events and an audience‘s characteris—
tics interact to either strengthen or diminish effects on
knowledge, attitudes, and behavior.118 Another group of
researchers concluded that impact from promotional campaigns
only lasts for short periods of time, regardless of the mode
of promotion.119 An evaluation of various communication

sources in the analysis of this project should reveal how

well communication theory applies to health care.

 

117Everett M. Rogers and F. Floyd Shoemaker, Communi:
' ' ° - , 26 ed. (New
York: The Free Press, 1971), p. 260.

118Butler and Paisley, "Communicating Cancer Control
to the Public," pp. 8-9.

119Wilkinson, Mirand, and Graham, Po 255-

58

59

Communication research and basic psychological
research suggest interpersonal factors predict the effective-
ness of conveying information.120 Studies have shown that
the social and economic background of the audience will
significantly influence the responses of an audience to a
speaker and his or her message.121 Generally, studies
discovered that respondents tend to avoid responses that
might offend the interviewer of a different race.122 The
effect holds for both white and black respondents.

School, church, family, work, peers, and other forms
of socialization form an individual's first and continuing
social connection. Logic dictates that communication between
those of the same race or ethnic group would be more
effective than communication between people of different
races or ethnic groups. Sources regarded as credible for new
knowledge may not be persuasive in attempts to change
attitudes or behaviors.123 Also, one audience may consider a
source to lack credibility, while a different audience might

identify the same source as highly credible.124

 

120Butler and Paisley, p. 9.

121Michael Burgoon and Michael Ruffner, Human
.Commun1cat1gn (New York: Holt, Rinehart, and Winston, 1978),
p. 70.

122Carl W. Downs, G. Paul Smey, and Ernest Martin,
W (New York: Harper 8 ROW
Publishers, 1980), p. 362.

123Butler and Paisley, p. 9. 124Ibid.

60

The media exert a lifelong socialization influence,
especially the audiovisual media, demonstrating how members
of an audience should react to an enormous variety of
situations, including suspected illness and diagnosed
illness.125 One instance of the relationship between
socialization and health care occurs in India. Small,
organized groups of individuals meet regularly for a mass
media program and discuss the program's contents.126 The
sessions, known as media forums, help a quarter million
Indian peasants become aware of agricultural and health
innovations through twice-weekly radio forums that involve
group discussion after the broadcast.

Diffusion of new ideas involves communication through
certain channels during a given time period, among members of
a social system. Four essential elements in any analysis of
the diffusion process of an idea involve innovation, communi-
cation between individuals, presence of a social system, and
passage of time to permit change.12‘7 The social system is a
population of individuals who engage in collective problem-

solving behavior.128 Innovativeness is the extent to which

 

125Ibid. 126Rogers and Shoemaker. p. 261.

12731mm“: M. Rogers. Diffusion of W (New
York: The Free Press, 1969), p. 19.

1231bid., p. 20.

61

someone adopts an idea in comparison to other members of the
same social system.

Adoption represents a highly advanced stage of
communication that exists when a person decides to continue
full use of an innovation.129 The process of adoption
involves first hearing about an innovation and proceeds until
complete implementation. The adoption process consists of
five stages: awareness, interest, evaluation, trial, and
adoption itself.

The adoption process differs markedly from the
diffusion process. Full implementation of a new idea by an
individual would present an example of the adoption process,
while the spread of new ideas in a social system represents
the diffusion process.130 Once an individual decides to
continue an innovation, the adoption stage is reached.131

Before adoption takes place, the awareness stage
occurs first, identifying an individual's exposure to an
innovation. At this point, an individual lacks complete
information about the innovation}:32 The interest stage
arrives next as a person becomes curious about a new idea and
seeks out additional information.133 The evaluation stage

follows at the point when a person mentally applies an

 

129Ibid., p. 17. 13oibid., p. 18.
13libid., p. 81. 132Ibid., p. 82.
133Ibid., p. 83.

62

innovation to himself and then decides whether or not to try
it. At the trial stage, an individual begins to practice the
innovation on a small scale. Total implementation of the
innovation signifies the adoption stage.

In research studies, respondents who met the
researchers' description of maximum knowledge suggested
unusual patterns of media utilization between various
demographic groups.l34 Schramm and Wade controlled for the
effects of age, education, and sex, finding that persons with
minimal knowledge of cancer and polio exhibited little
difference, regardless of demographic group. The information
those with little knowledge did acquire probably represented
penetration from the mass media}:35 In the 1960s, Klapper
argued that the mass media reinforced socially prevalent
attitudes and behaviors initially created through the social
network.136

In the early 1970s, researchers showed configurations
of interacting factors from which different attitude and
behavior effects might be predicted}:37 Although several
studies addressed the relationship between knowledge and

attitudes, Philip J. Tichenor and his colleagues conducted

 

134Butler and Paisley, p. 8. 135Ibid.

1“Joseph T. Klapper. WWW
t1gn (Glencoe, Ill.: The Free Press, 1960), p. 42.

137Butler and Paisley, p. 8.

63

research that determined the existence of ways to bridge the
gulf;138 The group of researchers posited that information
or education programs usually stop at the point of first
impact, often only reaching the better educated.139 Tichenor
discovered that a better chance exists to bring attitudes
into line with knowledge when a program is extended over a
longer period of time.

Interest in a topic among the audience also plays a
role in communication of a message. One study found that
poorly informed individuals with interest in a subject paid
attention to media messages.140 The same project revealed
that those who were well informed, but not interested, paid
little attention. Zimmerman and Bauer concluded that
audiences remember message elements selectively, depending
on an individual's interpretation of the interest and
acceptability of information.

The findings from research studies may depend on
whether the data were collected from a laboratory environment
or out in the field. Hovland and his colleagues at Yale
studied communicator, message, context, and audience

variables under controlled conditions. Hovland uncovered

 

138Philip J. Tichenor, George A. Donahue, and Clarice

N. Olien. MW (Beverly
Hills, Calif.: Sage Publications, 1980), p. 229.

13911316., p. 230. 140Butler and Paisley, p. 7.

64

personal and social factors, which greatly influence field
studies but seem suppressed in the laboratory. Thus,
comparisons between laboratory studies and field studies
may offer limited value.

Human relationships may affect communication, too.
Barnlund stated the study of interpersonal communication is
concerned with the investigation of informal social
situations, in which people sustain interaction through the
reciprocal exchange of verbal and nonverbal cues in a face-
to-face setting.141 The importance of interpersonal
communication was epitomized when word of mouth carried news
of Ghandi's death to most of the Indian people.”2 When
President John F. Kennedy was assassinated, nearly half the
people heard the news first by word of mouth.143 Among other
examples, the rock festival at Woodstock, New Jersey, and the
political demonstrations of the 19605 that drew a hundred
thousand young people or more indicate the influence of word-

of-mouth communication.144

 

141Reed H. Blake and Irwin O. Haroldsen, A_Iaxgngmy
gf_§gnggpts_1n_ggm ' (New York: Hastings House
Publishers, Inc., 1975), p. 27.

“2Wilbur Schramm. WW
mun1cat1gn (New York: Harper & Row, Publishers,

aLHumanJom
Inc., 1973), p. 133.
143Ibid.. pp. 133-34. 144Ibid., p. 134.

65

The two-step flow hypothesis of communication
originated from Paul Lazerfeld and some of his colleagues
from Columbia University. The researchers defined two-step
communication as the flow from the mass media to opinion
leaders and from these to the less-active sections of the
population. The two-step flow theory set in motion a number
of studies of audience behavior, especially in relation to
campaigns and to the media.145

Despite the value of the two-step theory, it failed
to fully explain the communication process. Menzel and Katz
studied diffusion of a new drug among physicians in four
cities, expanding the two-step theory to a more sophisticated
multi-step communication process that involves a social
network.146 In some cases, only one step may exist. For
example, a great amount of information flows directly from
the media to a receptive person without the presence of a

midd1eman.147

In addition, the concept of a society divided
into opinion leaders and followers never held up.“8 No
convincing evidence emerged to prove that opinion leaders are
typically active forces in social persuasion. Rogers
identified opinion leadership as a continuous variable. A

two-step flow, beginning with media, moving to leader, and

stopping with the follower, fails to recognize that

 

145Ibid., p. 121. 146Butler and Paisley. p. 7.
147sdhramm, p. 122. 1431818.. p. 123-

66

information moves continuously through a social system and
follows the constraints and needs within the system.149 Thus
there is a multi-step flow of information in a social milieu.
The bullet theory joined the two-step flow theory as
a communication term with its best days buried in the past.
Harold Lasswell analyzed the effect of propaganda, suggesting
messages from the media would prove “irresistible” to the
public.150 The bullet theory of communication became
associated with the potential for widespread behavior
modification many linked with propaganda. The transference
of ideas was seen as caused by a magic bullet. After review,
scholars found that the audience, when hit by the bullet,
refused to fall over. In one experiment, prejudiced people
were fed anti-prejudice propaganda, and they actually used it
to reinforce their existing prejudices. Festinger's theory
of cognitive dissonance describes a different situation that
results when an individual finds difficulty in dismissing a
different point of view that is an attractive alternative but
contrary to his own previous belief.151 The viewpoint that

the mass media could dominate the public eroded in the 19405

 

149Ibid.. pp. 124-25.

150Wilbur Schramm and Donald Roberts,.Th£_ELQ££fi§—find

WW (Urbana. 111.: University of
Illinois Press, 1971), p. 8.

1“Leon Festinger. WW
(Stanford, Calif.: Stanford University Press, 1964), p. 99.

67

and 19505 when severe limitations were found with the
influence wielded by the mass media]-52

Besides the message itself, a number of factors can
affect the quality of communication. The credibility of a
communicator, appeal of a message, audience readiness to
respond, or ease of response all need evaluation.153 For
example, the Kate Smith war bond marathon elicited patriotic
sentiments and $39 million in pledges during World War 1.154
Merton first analyzed data from the bond drive and regarded
the campaign as a rousing success. Raymond Bauer later
conducted his own investigation and concluded that Kate Smith
at most persuaded 4 percent of her audience to buy bonds and
more likely convinced only 2 percent to invest.155

Another study indicated that physicians tend to seek
advice from professionals rather than commercial sources,
such as drug-company salesmen. When the seriousness of a
disease increases, physicians rely on the recommendations of
other professionals more than ever.156 A study about the

adoption of specific drugs to treat certain diseases was

 

152Daniel Lerner and Lyle M. Nelson, Communication
WWW (Honolulu: East-West
Center Publishers, University Press of Hawaii, 1977), p. 223.

153Butler and Paisley, p. 6.

15“Schramm and Roberts, p. 334. 155Ibid., p. 334.

155ibid., p. 340.

68

conducted by Coleman, Menzel, and Katz. The three
researchers found physicians exhibit great caution in the
information sources they trust to assess the efficacy of new
drugs.15l7

An additional determinant of an individual's reaction
to a given situation involves his or her mental set. Murray
defined mental set as the emotions, moods, personalities, and
temperaments of people that determine the perception of
external stimuli.158 A person who seeks constant reassurance
may view events differently than someone else who possesses
less need for security. For instance, Wever and Zener showed
that when people are required to judge the weight of objects
as light or heavy, the other objects in the same series will
affect the person's judgment.159 Sears and Freedman
conducted studies that suggested when a person received
exposure to biased or one-sided information, the same
individual later preferred information that favored the
opposite position.160

Theories even stretch to cover how science writers
should be trained. The question of how to train science
writers moved to the forefront in 1964 when James Stokley,
chairman of the professional training committee of the

National Association of Science Writers (NASW), proposed

 

157Ibid. 1581bid., p. 248.
159Ibid., p. 256. 15°ibid., p. 231.

69

an education program heavily oriented toward science
courses.161 A forceful objection from a former NASW
president criticized Stokley and claimed the training
committee lacked scientific data to back its conclusions.162
The critic apparently overlooked a statistical survey of 72
science writers conducted by William E. Small, with the
results published in the NASW Newsletter of December 1963.
Small, studying for a M.A. under Stokley at the Michigan
State University School of Journalism, discovered that the
average science writer was a 24-year veteran in journalism
with 14 years in science writing.163
Respondents to Smallis survey recommended several
areas of competence, with medicine topping all other
subjects. Next in importance: biology, psychology,
chemistry, astronomy, physics, and space technology.164
Writers indicated they most frequently covered medicine. The
next most common story topics, in order of frequency:
biology, chemistry, physics, psychology, astronomy, space

technologyr and chemistry. The science writer must know the

characteristics of his audience, how much the public

 

161DavidWarrenBurkett, '
.Mass_ned1a (Houston: Gulf Publishing Co., 1973), pp. 59-60.

1621bid., p. 60. 153ibid.. pp. 60-61.
164Ibid., p. 61.

7O

understands and wants to know about science, and how he can
transmit his information most effectively.165

A Nobel Prize winner claimed nearly 50 years ago that
science writers "live on the crumbs“ of researchers. In
response, than New_Yg1k_T1mes science editor William L.
Laurence replied, “Unfortunately it is a hard life because
the crumbs are so often staleJdfiG All except a few
scientists--largely in the autocratic domains of the medical
schools--now realize more than ever how the progress of
science depends on an understanding public.157 In an attempt
to bridge the void between scientists and science writers and
their respective levels of knowledge, greater educational
training about science for the journalists may help them earn
extra respect from the scientific community.

A further attempt to determine how best to prepare
science writers to meet the information needs of the public
occurred in the 19705. Michael Ryan and Sharon Dunwoody
surveyed science writers and discovered that English and
journalism represented the most popular undergraduate

majors.168 Ryan and Dunwoody agreed with Small's conclusion

 

16SEarl Ubell, "Science in the Press: Newspapers vs.

Magazines,“ Journal1sm_Qn311311y 40 (Summer 1963): 293.
155Ibid. 157Ibid.

168Michael Ryan and Sharon L. Dunwoody, "Academic and
Professional Training Patterns of Science Writers," Journal:
1§m_QnaL;ggly 52 (Summer 1975): 246.

71

that biology, physics, chemistry, and psychology were studied
by large percentages of science writers.169 Another
researcher, Lee Johnson, found that science writers take
courses in the physical and social sciences (pre-medical and
public health courses were most frequently recommended). In
addition, Johnson, Small, and Ryan and Dunwoody learned that
mathematics was recommended for potential science writers.”o
Small and Ryan and Dunwoody also discovered that astronomy,
biology, chemistry, and physics were highly recommended by
science writers.

More recent studies have discovered that disagreement
persists among science journalists themselves about whether
generalists with strong basic writing techniques or highly
trained specialists should handle science coverage, according
to a 1983 study conducted by Conrad Storad as a follow-up to
similar conclusions of Everette E. Dennis and James McCartney
in a 1978 study. Despite the absence of a consensus,
respondents to the Storad study revealed science reporting is
'entrusted to experienced, well-educated reporters, many with
special credentials and strong backgrounds in science.“ The
Storad study also found that science writers seemed somewhat

critical of editors and newspaper management, pleading for

 

159Ibid., p. 240. 170Ibid., p. 246.

72

more time, more space, more resources, and a greater
understanding and appreciation of the material.”1

The weight of theoretical evidence indicated that a
combination of mass media.and interpersonal communication
channels tailored to attract specific demographic groups
represents the best approach to reach those who could gain
the most from the Cancer Information Service. Diffusion of
new ideas requires communication during an extended period
among members of a social system. Four essential elements to
spread ideas through the diffusion process are innovation,
communication between individuals, presence of a social
system, and the passage of time. The adoption process, which
consists of complete implementation of an idea, begins with
awareness and includes interest, evaluation, trial, and
finally adoption.

The communication process occurs as information flows
through steps. The number of steps in the process has
sparked considerable debate throughout the years, with the
multi-step theory developed by Menzel gaining current
acceptance. He determined that information moves
continuously within a social system, poking holes in the

previously popular but overly simple two-step theory of Paul

 

171Conrad J. Storad, 'A Survey of Science Journalists
Working for Major American Metropolitan Daily Newspapers: Who
They Are, How They Work, and Their Perceptions of Science
Journalism in 1983' (applied project for a master's degree,
Arizona State University, December 1983), pp. 43-44.

73

Lazerfeld and the bullet theory of Harold Lasswell. Other
factors that affect the quality of communication include the
credibility of the communicator, appeal of the message, and

audience receptiveness.

Backgrounusaumptions

The foregoing theoretical discussion led to the
formulation of the following five basic assumptions for the
study:

First, it was assumed that selected groups, interper-
sonal communications, and the mass media may influence people
to use the Cancer Information Service in Washington, DAL

Second, it was further assumed that blacks rely more
heavily on television about the Cancer Information Service in
Washington, D.C. than any other source.

Third, the first source to communicate the existence
of the CIS in Washington, ILC. was assumed to exert the
influence needed to produce a telephone call to the CIS from
an individual.

Fourth, it was assumed that the most significant
communication of cancer information in the Washington, DAL
area occurred through the public-information activities of

the Washington, D.C. CIS office.

74

Fifth, the messages people received about the CIS in
Washington, ILC. were assumed to be essentially positive,

encouraging them to eventually contact the service.

M I] i J . J C .3 I'

The study utilized the techniques of survey research.
The justification for utilization of the survey research
technique is based on the experiences of several noted
researchers in the health care field. The greatest number,
and possibly the poorest, of health survey projects has
occurred in connection with the measurement of public
knowledge and information in the health care field.-1‘72 An
analysis of health education research that appeared in
Research_QuaLLexly between 1951 and 1960 revealed that three
out of four health care studies involved survey research
projects with either flawed designs or improper execution.”3
In general, public health education research failed to
implement current concepts and methods in public opinion and
communications research. .Mmong the shortcomings: unrepre-
sentative samples, poorly constructed questionnaires,
unskilled interviewing, and inadequate analysis. Bungled
public health studies represent the rule rather than the

exception.

 

172Charles Glock. MW
Sg1enges (New York: Russell Sage Foundation, 1967), p. 469.

173Ibid., p. 470.

75

Despite the drawbacks from the past, survey research
has achieved an established place in nearly all aspects of
health and medical research.”4 Numerous ways exist to
apply survey research techniques adeptly and to promote
public health education.175 Examples include:

1. planning, conducting, and evaluating health
education programs;

2. gathering information for volunteer health groups
in educational campaigns;

3. determining the usefulness of materials published
by health agencies;

4. obtaining public support for health programs;

5. collecting information essential to the
understanding of the health needs of a community; and

6. ascertaining knowledge of available health
facilities.176

Survey research offers great social, scientific, and
educational potentia1.I77 George Gallup and Elmo Roper
popularized surveys. The two public opinion kingpins

collected data from national samples for studies,'which were

 

174Ibid., p. 434. 1751bid., p. 470.
1751b1d., p. 470.

177Earl Babbie. W (Belmont.
Calif.: Wadsworth Publishing Co., 1973), p. 372.

76

essentially descriptive research}!78 The techniques of
surveying progressed during the past few decades, affirming
the value of survey research. Notable contributions in the
field of survey research include a study conducted by the
Edinburgh Public Health Department to analyze the effective-
ness of a large-scale health education campaign}!79 The
Edinburgh project was intended to inform the public of risks
of lung cancer associated with cigarette smoking but failed
to produce positive results. Another survey research
endeavor examined a Canadian community that attempted to
communicate mental health information and measure attitudes.
The campaign not only was devoid of success, it increased
anxiety among community members. These represent only two
examples of the relevance survey research exerts in the
health care field.

Survey research has probably attracted more interest
in the health area than any other field.180 While some
organizations employ well-trained staffs, many projects are
conducted by comparative amateurs. There is little
communication across disciplines, and creative innovations
from one field tend not to be known in another.181 As a

result, questionnaire construction may lack good structure.

 

178Glock, p. xv. 179Ibid., p. 470.
13°Ibid., p. 501. 13lroid., p. xi.

77

A model questionnaire consists of four parts: the
introduction, warm-up questions, the body of the study, and
demographic questions.182

The wording of questionnaires must be concise, to the
point, and easy to grasp.183 Lengthy questions create
difficulties for the respondent because he must listen to a
discourse that may overburden his level of comprehension and
drain his patience. Embarrassing questions, such as an
inquiry about someone's income, could cause a respondent to
squirm and pressure him to give an untruthful answer.184
For example, the introduction of a questionnaire should be
nonthreatening, brief, and realistically worded. Warm-up
questions prepare a respondent for the probing ”heart of the
study" queries.185 Questions about a respondent's residence
could serve as a useful device to launch an interview because
they are specific, nonthreatening, and relevant to the
information needed for an analysis. Questions within the
h'heart of the survey” section tackle serious topics of
importance to the study. Demographic information remains

fair game for researchers to seek during surveys. Questions

 

182Backstrom, p. 92. 183Ibid., p. 91.
134roid., p. 90. 135Ibid., p. 92.

78

about a personls age, income, religion, and political
affiliation are not taboo.186

This study adopted the recommendations, saving the
sensitive demographic questions for the end of the interview.
The brevity of CIS-related questions followed the suggestion
not to overburden respondents and drain their patience. The
dichotomous and multiple-choice questions also allowed data
processers at the NIH to code the information more easily.
The analysis of survey results necessitated electronic data-
processing equipment for rapid cumulation and association of
the data.187 Machine tabulations generated exact rapid
counts on responses, which the NIH facilitated. Key-punched
data cards, which have become a universal shorthand for
communicating volumes of data, were produced by a profes-
sional firm that handles other NIH survey research projects.

Numerous survey research techniques implemented in
this study protected the quality of the data. The abundance
of respondents who contacted the CIS in Washington, DAL
actually helped to ensure a sufficient number of callers to
permit an analysis of specific demographic groups.188 The
availability of respondents also diminished the possibility
of “armchair interviewing” that may lure a professional

interviewer to fill out the surveys himself, biasing data.

 

186Ibid., p. 97. 137Ibid., p. 16.
1881bid., p. 12.

79

The decision of this researcher to gain access to data from a
survey project that possessed federal funding helped yield
multiple advantages.

Expenditures in a field survey include supervision
of the project director, training of the interviewers,
verification and coding of questionnaires, mechanical and
electronic data processing, and secretarial and clerical
services.189 The NCI sponsorship of the CIS in Washington,
ILC. provided money to staff the Howard University site, pay
for qualified survey supervisors, train interviewers, gain
the services of professional questionnaire coders at the
National Institutes of Health, and benefit from the
availability of mechanical and electronic data processing.
In addition, Shirley Charles, who holds the greatest
responsibility for conducting the interviews for the survey
at the CIS in Washington, DAL, ranked at the top in
comparison to nearly two dozen other interviewers at CIS
offices around the country as she earned close to a perfect
score in a test call designed to evaluate telephone
personnel. Women, especially mature women, present little
threat to respondents and stimulate an almost automatic

interest from men.190

 

139Ibid., p. 14. 1901616., p. 12.

80

The omission of a demographic question about income
may have protected this survey from a possible flaw. If some
respondents object to the question and refuse to answer,
incomplete responses from individuals who represent a
population could introduce a strong possibility of biased
results.191 Pre-testing a survey on a small group of people
helps determine whether questions contain proper wording and
promote clarity.192 Accordingly, this study included a
pre—test at the NIH that involved the Washington, DAL
office.

Questions with an exact meaning are easier for
respondents to grasp and answer correctly than incomplete,
imprecise, or indefinite questions.”3 Structural questions
present the respondent with fixed response choices that allow
pre-coding.194 Two types of structured questions exist.
Dichotomous questions elicit either one response or one
other, such as a yes or no answer. Multiple-choice questions
involve more than two fixed alternatives. The drawback with
both dichotomous and multiple-choice questions rests with an
inability to determine a respondent's intensity with either
type of question. One solution is to use scaled responses

with different psychological weights (iAL. very agreeable,

 

191G1ock, p. 460. 1ngackstrom, p. 15.
1931bido I P. 84 o 194Ibid' I P. 76 °

81

agreeable, neutral, disagreeable, very disagreeable) to help
alleviate the problem.”5

This research project steered clear of open-ended
questions to avoid numerous drawbacks. Despite the advantage
of discovering elements of a respondent's opinion that a
researcher may not think to test when he develops a
questionnaire, open—ended questions tax both a respondent and
an interviewer with unwieldy and time-consuming queries.196
The analysis of open-ended questions can cause agonizing
problems with coding the free-form answers. In addition, a
researcher may classify the data from open-ended questions
differently than the respondents, if they were given the
coding task. Also, reliance on responses to an open-ended
question of a general nature may not elicit specific data
necessary for the analysis.197

The true value of a survey research endeavor surfaces
when the research design meets the objectives of the project.
In this survey, the population under examination consisted of
all individuals who called the CIS for cancer-related
information. The uniqueness of the CIS, which involves

contact that respondents initiate, permitted telephone

counselors to ask callers about demographic information

 

1951bid., p. 75. 196Ibid., p. 73.
197lbid., p. 75.

82

and the source that first led to the call without sparking
alienation and refusal of the respondents to participate.
As a result, this project queried 4,736 callers, nearly
every member of the population that contacted the CIS in
Washington, DAL for information about cancer. The mechanics
of drawing a sample of the population would have required
calculation of tolerable error, sample size, and confidence
levels before implementing data-collection procedures.198

The processing and compilation of data were conducted
at the NIH computing center. The participation of highly
skilled NIH data processers should minimize any mechanical
errors or clerical errors that may crop up. Mechanical and
clerical errors affect surveys that select a sample of

respondents and surveys that reach an entire population.199

 

1981bid.. p. 63. 1991bid., p. 28.

CHAPTER IV

FINDINGS OF THE STUDY

Findings of the study have been reported here under
the following sections or rubrics: (l) the most common
information sources relative to the number of telephone calls
received by the Washington, ILC. Cancer Information Service
(CIS); (2) the demographic characteristics of the callers;

(3) delineation of specific differences in the utilization of
the CIS between blacks and whites; and (4) the identification
of the various indicators of utilization of CIS by the
diverse elements of the population in the Washington, DAL
area.

The formulation of certain generalizations and

conclusions from the study will be offered in Chapter V.

W

The findings of the study indicate that television is
by far the single most common first source of information
about the CIS in Washington, ILC. among the 4,736 callers,
analyzing utilization between January 1983 and August 1984.
The findings reveal that 37 percent (N = 1,752) of the

respondents ranked television as the medium where they first

83

84

heard about the CIS. Radio finished second, attracting l9u6
percent (N = 926) of the respondents. The telephone book was
used by 13.3 percent (N = 628) of the respondents to call the
CIS. In fourth position, pamphlets provided 8.4 percent (N =
397) of the callers with their first knowledge of the
service. Friends informed 4.0 percent (N = 188) of the
callers about the CIS. The rankings of other sources of
information fell below 4 percent.

One reason for the phenomenal success of television
to spark calls to the CIS stems from the intensive efforts of
Les Butler, then CIS communications director, to gain air
time for public service announcements (PSAs) on Washington,
ILC. television stations. When contacted to explain the
dramatic number of calls the PSAs produced, Butler revealed
that he received requests from the local network affiliates
in Washington, ILC. to smooth over sensitive situations
between the stations and the black community. As a reward
for his efforts at mediating and resolving conflicts, Butler
gained enviable access to station executives.

When one D.C. station aired a PSA for the CIS, Butler
said rival stations balked at giving up their own PSA time
for a CIS announcement, arguing that CIS promotional needs
had been served. But the situation was nothing Butler could
not overcome. ‘Butler, who formerly served in a public

affairs capacity at WJLA-TV, the Washington, DAL affiliate

85

for the American Broadcasting Company (ABC), understood the
needs of the stations and offered to produce a new PSA and
give exclusive broadcast rights to one of the recalcitrant
stations. Thus, CIS announcements flashed across
metropolitan Washington, DAL television sets from several
channels, communicating the existence of the CIS to a great
number of viewers.

Many of the same techniques that Butler exercised
with television executives were applied to radio station
public service directors with almost as much success. For
example, Butler targeted one CIS campaign to reach the 50 and
older age group at stations that catered to these listeners,
offering a PSA that specifically addressed the health
concerns of the stations' listeners. The appeal of radio
stations to certain segments of the pOpulation provides an
opportunity to appeal directly to a demographic group that

underutilizes the CIS.

TIE 1'01 |.|. E
Went-E

Residence

The geographic location of CIS callers included the
District of Columbia and two bordering states, Maryland and
Virginia. A total of 4,736 respondents called the CIS, and
32.9 percent of them indicated Maryland as home. Nearly as

many, 32.1 percent, identified the District of Columbia as

86

their place of residence. Virginia was mentioned as home for
27.4 percent of the callers. A sizable number of callers,

360 out of 4,736, failed to reveal their place of residence.

Sex

Consistent with national findings of CIS utilization,
more women than men called the Washington, D.C. CIS. Out of
4,736 callers, 2f799 of them identified themselves as women,
accounting for 59.1 percent of the calls. In comparison,
1,926 men called the CIS, totaling 40.7 percent of the calls.

The first reaction about the findings is that
Washington, DAL black men exhibit the highest rate of many
kinds of cancer in comparison to other major U.S. cities, but
male residents of the District still called the service less
than women. .A closer analysis of the utilization revealed a
ratio of three calls from women for every two calls from men.
The 3:2 ratio indicated a disproportionately low rate of
utilization among men, but interestingly the ratio was less
extreme than on the national level. The findings suggest
that the CIS in Washington, ILC. experienced difficulty in
attracting male callers, but the local CIS generated a higher
percentage of calls from men than the national average that

combines all CIS offices.

87

.593

The highest percentage of callers described their age
as 50 or older. The age group that contained respondents
between ages 50 and 59 totaled 17:7 percent, representing 839
out of 4,936 calls. The oldest group, age 60 and beyond,
collected 764 out of 4,736 calls, registering 16.1 percent.
The group to produce the third highest call volume consisted
of respondents between the ages of 30 and 39, generating 570
out of 4,736 calls for 12.0 percent of the total. The
fourth-ranking age group contained callers between ages 40
and 49, leading to 537 out of 4,736 calls or 11.3 percent.
The respondents between ages 20 and 29 generated 304 out of
4,736 calls, accumulating 6.4 percent of the total. The
youngest age group, 19 and under, accounted for 74 out of
4,736 calls, barely reaching 1.6 percent.

Almost one—third of the respondents, 1,566 out of
4,736 callers. were not asked about their age. Another 51
callers or 1.1 percent of the total would not give their age.
Less than 1.0 percent of the respondents either had called
the CIS before, 27 callers, and thus were excluded from the
study, or the education category was blank when the
questionnaires were coded.

In some instances, compassion took priority over
completion of the questionnaires. Despite the large number

of callers who were not asked about their age, a telephone

88

counselor needed to weigh the costs and benefits of querying
a distressed caller to elicit demographic information. This
survey relied on the judgment of the counselors to recognize
when to press forward with demographic questions and the
times when a counselor should simply reassure a caller and
say good-bye. If a researcher has faith in the training and
discretion of the counselors to respond appropriately, no
need exists to find fault with their decisions.

Among callers who answered the demographic questions,
the finding that respondents age 50 and beyond generated more
calls than any other group could have been predicted. The
NCI devised a promotional campaign to inundate those age
50 and older, a high-risk group to develop cancer, with
announcements about the availability of the CIS. The success
of Les Butler in gaining PSA air time at television and radio
stations for the "50 plus” messages should explain the
popularity of the CIS among older callers. The findings
prove the "50 plus" campaign in Washington, D.C. was a

resounding success.

Education

In an analysis of responses from callers who
identified their level of education, college graduates placed
the largest number of calls. Those with a college degree,
but no postgraduate training, accounted for 994 out of 4,736

calls or 21 percent of the total. The next highest number of

89

calls, 676 out of 4,736 or 14.3 percent, was registered among
callers who had attended college without earning a degree.
High school graduates who never attended college generated
620 calls or 13.1 percent, ranking third. Callers with
postgraduate training initiated 489 calls or 10.3 percent,
finishing fourth. Just under 3 percent of the callers
possessed less education than a high school degree. Those
with some high school, but more than a grade school
education, totaled 93 callers or 2.0 percent of the
respondents. Only 31 respondents or 0.7 percent had no
more than a grade school education.

Out of 4,736 callers, 2,938 of them or 62.0 percent
indicated an educational level. Among the remaining callers,
1,687 of them or 35.6 percent were not asked about their
level of education, and 107 others or 2.3 percent gave no
information. The questionnaires of 35 callers or 0.7 percent
were found with the education category left blank, and four
callers had previously used the CIS.

The findings revealed a deficiency in the communica-
tion of cancer information to the least-educated residents of
metropolitan Washington, ILC. The results suggest a need for
new programs to bridge the gap that keeps individuals with
little education away from the mainstream of cancer informa-
tion. Another concern is that those with the least education

may already possess a lower level of knowledge about good

 

90

health care habits than their better-educated counterparts,
creating even more of an urgency to communicate information

about cancer symptoms to them.

.Reee

Whites dominated the CIS utilization, generating
2,149 out of 4,736 calls or 45.4 percent. Blacks accounted
for 849 out of 4,736 calls or 17.9 percent of the total.
Additionally, 1,573 out of 4,736 callers or 33 percent of
them were not asked to disclose their race. Another 57
callers or 1.2 percent failed to release information about
their race. No other ethnic group or alternative response to
the question registered more than a fraction of 1 percent of
the calls.

The high utilization of the CIS among whites sug-
gested a successful promotional campaign to reach this group
with cancer information, but the discovery that fewer than 28
percent of the CIS callers were black exposed a possible
weakness in the promotional system. The high cancer risk
among blacks demonstrated a significant challenge to reach
these individuals with cancer information, which could bring
blacks into the health care delivery system earlier and help
save lives. The absence of even 1 percent of the calls to
come from either Hispanics (N = 32) or Asians (N = 44)

revealed an additional area where improvement seems

91

warranted. The lack of a high-powered promotional campaign
to attract Hispanics or Asians to call the CIS may explain

part of the underutilization.

. . . . .
Ihe_Del1nfatifnTg£_fpe£l£%£T?I£€§§en£eS
BetueenJlackLandthifes

An evaluation of utilization differences between
blacks and whites revealed that blacks are responsible for
television leading all other sources as the first way that
callers learned about the CIS. Television ranked first among
blacks but took the runner-up position with whites as radio
finished at the top. Radio barely led television as the
number-one source of learning about the CIS among white
callers. Less than one percentage point separated the two
sources as radio sparked 30.1 percent of the calls and
television led to 29.3 percent. The telephone book and
pamphlets each assisted 10.0 percent of the callers with
information about the service. More than five percentage
points below, magazines accounted for 4.8 percent. Other
researchers have found whites watch less television and
read more than blacks. The dominance of television as the
first source about the CIS among blacks supports the results
from previous research projects.

Slightly under half the black respondents revealed
television led them to call the CIS. Out of 847 black

respondents, 421 of them or 49:7jpercent identified

92

television as their first source of learning about the CIS.
Radio encouraged 17.2 percent (N = 146) to call the service.
The telephone book ranked third among blacks, as well as
among whites, generating 7.9 percent (N = 67) of the calls.
Friends leaped into the top five among blacks with 5.1
percent (N = 43), finishing fourth. In comparison, the same
source ranked sixth among whites. In fifth position,
pamphlets accounted for 4.1 percent (N = 35) of the calls,
falling short of the 10.0 percent and fourth position among
white callers. The other sources of information drew less
than 4.0 percent of the callers. Significantly, the fifth
most frequently mentioned source among whites, magazines,
ranked eighth among blacks and only managed to attract 1:7
percent of the callers. The finding correlates with the
conclusions of other researchers that whites read more than
blacks.

Only 44 Asian respondents among 4,736 callers
prevented a statistically significant total for any racial
categories except whites and blacks. Even so, 16 out of 44
Asian callers or 36.4 percent indicated television provided
the first source of learning about the CIS. As further proof
of the great influence of television, 15 out of 32 or 46.9
percent of Hispanic callers identified television as the

first source of information about the service.

 

93

Several factors could explain the high rate of
success for CIS promotional campaigns on television to reach
blacks. One, former CIS official Les Butler, as described
earlier, enjoyed great success in gaining air time for PSAs.
Two, among the celebrities who appeared in CIS announcements
was Carl Rowan, a black syndicated columnist for The
Hash1ngtgn_£gst who likely encouraged a considerable number
of blacks to call the service. Three, blacks, in general,

probably watched more television than whites.

II I 3' l E HI']' I' E CIS

Sex of the respondents appeared to be a reliable
indicator of specific sources of information about the CIS in
Washington, ILC. The analysis of data on how male (N =
1,926) and female (N = 2,799) callers first heard about the
CIS indicated that television exerted the chief influence
among both groups. Television informed males about the CIS
before any other source in 40.1 percent of the cases. It
ranked well above radio, which 26.6 percent of the men men-
tioned as the first source. The telephone book finished as
the third most frequent source among men, totaling 9.2
percent. The survey revealed that.5.6 percent of men named
pamphlets as the first source of learning about the CIS.
Recommendations from friends led to CIS calls from 3H4

percent, taking the fifth spot.

94

Among women, 34.6 percent identified television as
the first source to communicate the existence of the CIS.
The telephone book served as the second most often mentioned
source, compiling 16.1 percent. Radio held third position,
attracting'l4.6 percent of the women to the CIS. Pamphlets
ranked as the fourth most popular source, accumulating 10.3
percent of the sample. Health professionals other than
physicians were identified as the first source to communicate
the existence of the CIS for 4.5 percent of the women. It
finished fifth, just ahead of the 4.4 percent who first heard

about the CIS through a friend.

Residence

The geographic location of CIS callers included the
District of Columbia and two bordering states, Maryland and
Virginia. A total of 4,736 respondents called the CIS, and
32.9 percent of them (N = 1,559) indicated Maryland as home.
Nearly as many, 32.1 percent (N = 1,521), identified the
District of Cdlumbia as their place of residence. Virginia
was mentioned as home for 27.4 percent of the callers (N =
1,296). A sizable number of callers, 360 out of 4,736,
failed to reveal their place of residence.

Television ranked as the top source to communicate
the CIS in Maryland, the District of Columbia, and Virginia.

In fact, the top five sources of learning about the CIS in

95

all three areas matched up exactly. Radio ranked second.

The telephone book and pamphlets finished third and fourth,
respectively. Friends took fifth position in each geographic
area.

Maryland residents who reached the CIS first learned
about the service through television in 36.8 percent of the
cases. More than 15 percentage points below television,
radio led to»21.0 percent of the calls from Maryland. The
telephone book provided the first source of learning about
the CIS for 11.9 percent of the callers. Pamphlets generated
8.9 percent and friends contributed 3.8 percent.

The District of Columbia seemed dependent on
television to communicate the existence of the CIS, topping
40 percent. Neither Maryland nor Virginia finished within
5 percent of the District, which reached 41.9 percent. Radio
led to 18.9 percent, and the telephone book ranked third with
11.2 percent. Pamphlets and friends accounted for 6.0
percent and 4.7 percent of the calls, respectively.

In Virginia, television provided the first source of
learning about the CIS for 36.6 percent of the callers.

Radio led to 23.1 percent of the calls, reaching a higher
percentage than in either Maryland or the District of
Columbia. The telephone book facilitated 13.3 percent of the
CIS calls. Pamphlets hit 9.0 percent and friends trailed

with 3.4 percent.

96

A92

An analysis of respondents who answered questions
about how they first heard about the CIS indicated that
television ranked as the number-one source for all age
groups, except the 60 and over category. Radio usually
ranked as the second most often identified source for
attracting callers to the CIS, but it tied for fifth position
among the 19 and under age group (N = 74). Any expectations
that radio might exert considerable influence among young
people because of their tendency to listen to rock music
stations proved unfounded in regard to the CIS. Television
closely matched its usual appeal with the youngest group,
reaching 37.8 percent. The telephone book turned 18.9
percent of callers aged 19 and under to the CIS, ranking
second. Just under 10 percent of the youths indicated that
pamphlets served as their first source of learning about the
CIS. Out of 74 respondents, 9.5 percent or 7 of them
described pamphlets as their first link with the service.
That result matched the 7 out of 74 respondents, 9.5 percent,
who identified friends as their first source of learning
about the CIS. .After the tie between pamphlets and friends
for third position followed another tie. Radio and health
professionals other than physicians each reached 5.4 percent

of the youths.

97

The next category included individuals between the
ages of 20 and 29 (N = 304). Television achieved its largest
share of the callers for any age group, topping 40 percent.
In this category, 41.4 percent of CIS callers mentioned
television as the number-one source. Friends took the second
position, generating 10.9 percent of the calls. The tele-
phone book attracted just under 10 percent of the calls,
finishing third with 9.9 percent. Radio and pamphlets each
recorded 8.9 percent, tying in fourth position. The fifth-
place finish for radio among the 19 and under category and
the fourth-place tie in the age group between 20 and 29
seemed contrary to expectations, based on the relatively
large number of young persons who probably listen to the
radio. It suggested that PSAs about the CIS may not receive
much air time on radio stations that attract a youthful
audience.

Among the respondents between ages 30 and 39 (N =
570), radio gained one position, ranking third with 13.9
percent of the callers. Television once again led the way,
gathering 30.0 percent of users in this category. It marks
more than an 11 percent drop from the callers between the
ages of 20 and 29 who cited television as the first source of
learning about the CIS. Sandwiched inside television and
radio, the telephone book assisted 14.6 percent of persons in

this category and finished in second position. Pamphlets

98

repeated the fourth-place finish among the category for those
between the ages of 20 and 29. Among persons between ages 30
and 39, 11.4 percent identified pamphlets as the first source
of learning about the CIS. In fifth spot, friends inspired
543 percent to try the service.

Radio continued an upward trend when it generated
16.9 percent of the callers between ages 40 and 49 (N = 537),
ranking second. Once again, television dominated as the
first source of learning for CIS callers, collecting 32.0
percent. Pamphlets moved up one place from the previous
category, finishing third with 13.0 percent. In fourth posi-
tion, the telephone book generated 12.7 percent of the
callers. Magazines jumped into the list of top sources that
led to CIS calls, encouraging 5.8 percent of the respondents
to try the service.

Radio doubled the number of callers it attracted
among the category for those between ages 50 and 59 (N =
839), based on a comparison of callers from the age group 40-
49. Television ranked as the first source of learning about
the CIS in 39.1 percent of the cases. Nearly as many
respondents, 36.8 percent, indicated that they first heard
about the CIS through radio--a substantial jump relative to
younger age categories. The third most frequently cited
first source involved a tie between pamphlets and the tele-

phone book, each gathering 5.6 percent. Magazines provided

99

the first source of learning about the service tc>2.6 percent
of the callers.

The category for callers who reached age 60 or older
(N = 764) revealed that radio topped television as the first
source to communicate the CIS to the callers. .An average of
slightly more than 4 out of every 10 respondents in this age
group identified radio as the first source of learning about
the CIS. Radio accumulated 40.1 percent and television col-
lected 35.1 percent. A drastic drop occurred before pamph-
lets finished third, collecting 6.4 percent. The telephone
book led 5.0 percent of the respondents to call the CIS,
ranking fourth. Magazines captured the attention of 4.5

percent of the callers.

Education

Television generated the highest percentage of CIS
calls among persons who either never reached college or never
finished it. In contrast, radio ranked as the source with
the highest percentage of callers among college graduates and
those with postgraduate training. Only 31 out of 2,938
callers who indicated how they first learned about the CIS
attained no higher than a grade school education. The low
number of CIS callers with that amount of education prevented
attaining statistical significance among this group. As
expected, television took the lionis share of the total,

attracting 3857 percent to call the CIS, collecting 12 out

100

of the 31 respondents. The telephone book trailed, with 25.8
percent or 8 out of 31. No other medium led to more than
three calls among persons with no more than a grade school
education.

The next highest rung on the educational ladder
included individuals with more than a grade school education,
who never graduated from high school (N = 93). Television
topped every other medium with 47.3 percent of calls among
this educational group, collecting 44 out of a possible 93
respondents. Less than half that number, 19.4 percent, iden-
tified the telephone book as the first source to communicate
the existence of the CIS. Radio ranked third, leading 14.0
percent of the respondents to call the CIS.

High school graduates (N = 620) who never attended
college composed the next educational level. Once again,
television headed the list, gathering a whopping 46.9
percent. Radio followed with 21.3 percent, falling short of
collecting half the response of television. More than 10
percentage points below radio, the telephone book ranked
third with 8.9 percent. Pamphlets and magazines completed
the top five sources of the CIS, collecting 6&6 percent and
4.8 percent, respectively.

Respondents with high school degrees and some college
background (N = 676), without becoming college graduates,

filled the next educational level. Television dominated

101

other sources with 36.5 percent. Nearly two-thirds as many
respondents, 24.4 percent, identified radio as the first
source of learning about the CIS. More than 10 percentage
points beneath radio, the telephone book collected 12.3
percent. Pamphlets ranked fourth with 7.2 percent. Friends
helped 5u0 percent first learn about the CIS.

College graduates who stopped short of obtaining
postgraduate education totaled 994 persons in the survey.
Radio edged television as the most frequently identified
first source of learning about the CIS, compiling 2957
percent among these respondents. Four fewer respondents,
2943 percent of all callers in this category of education,
indicated television provided them with their first dose of
information about the CIS. Pamphlets moved up one notch from
fourth position in the previous educational category to
capture 10.5 percent and rank third. The telephone book was
the fourth most popular source to publicize the service with
6.9 percent. Magazines led 5.1 percent to call the CIS.

Close to 500 callers indicated they earned a college
degree and advanced to postgraduate training. Out of 489
respondents in the highest educational level, 178 of them,
36.4 percent, said radio first communicated the existence of
the CIS. More than a 10 percent drop took place before
television accumulated 22:7 percent. Another decline of more

than 10 percent found pamphlets in third place, collecting

102

11.0 percent. The telephone book once again ranked fourth,
reaching 7.0 percent. Health professionals other than
physicians gave 3.7 percent of the respondents their first
information about the service, entering the group of the top
five sources for the only time in the entire educational

analysis.

Race
W131 An analysis of

variations in how respondents first heard about the CIS
revealed noteworthy results when a control of age was exerted
on white respondents. The control permitted more evidence

of specific tendencies in regard to utilization of the CIS
among certain demographic groups. The findings disclosed
television as the dominant source to communicate the CIS to
the callers.

Among white callers, television exerted a sizable
impact on the respondents across all age categories. Radio
gobbled up the greatest share of callers among older whites,
surpassing television as the number-one influence. Out of 13
whites who failed to identify their age, 11 of them said
television led to the CIS call. Only 35 white respondents
under the age of 20 called the CIS. Television and the
telephone book caused 12 calls each, equaling 34.3 percent

for each source. The next most frequently mentioned source

103

for the youngest callers, pamphlets, gained recognition as
the cause of a call from four respondents or 11.4 percent.

White respondents between the ages of 20 and 29
numbered 153 in total, and 47 of them or 30:7 percent named
television as the first source where they learned about the
CIS. The telephone book lost ground from the youngest
category as only 13.7 percent of white respondents identified
it as the influence that led to a call. In third position,
pamphlets generated 12.4 percent of the calls. Radio led to
11.8 percent of the calls, and friends persuaded 9.2 percent
of the white respondents to contact the service.

The category for ages 30 through 39 caused a six
percentage point drop in the influence of television relative
to the preceding age group. Only 24:7 percent of the 365
respondents in this category identified television as the
first source where they learned about the CIS. The telephone
book ranked second again, totaling 16.4 percent. Radio
jumped into third place with 15.3 percent of the white
callers. Pamphlets fell one position to fourth, causing 11.5
percent of the calls. Magazines and health professionals
other than physicians tied for fifth spot with 5.2 percent of
the respondents each. Close behind in seventh place, friends
convinced 4.9 percent of the callers to contact the CIS.

Television maintained the number-one position among

respondents between ages 40 and 49, but once again fell short

104

of reaching 25 percent. Only 24.9 percent of the 333
respondents indicated that television led them to call the
CIS. Pamphlets leaped into second place with 18.3 percent,
improving from the fourth-place finish in the previous age
group and increasing its share of callers nearly seven
percentage points. Radio held onto third position, reaching
17.1 percent of the callers. The telephone book dropped two
notches and nearly three percentage points, ranking fourth
with 13.5 percent. Magazines retained fifth place, collect-
ing 7.5 percent.

Radio improved more than 25 percentage points from
the previous category and ranked as the clear leader in the
age category, 50-59 whites. Out of 604 respondents, 259 of
them, or 42.9 percent, described radio as the source where
they first learned about the CIS. Television gained more
than five percentage points from its first-place finish in
the preceding category but still fell into second position
with.3l.0 percent of the respondents. Pamphlets lost more
than 11 percentage points from the previous age group and
fell from second place to third place as 7.0 percent of the
respondents indicated that it led them to contact the CIS.
The telephone book led to 5.6 percent of the calls and
maintained fourth position, but fell nearly nine percentage

points from the previous age group. Magazines clung

105

tenuously to fifth spot, compiling 2.8 percent of the
respondents.

Whites at least 60 years old and beyond (N = 571)
indicated that radio caused them to contact the CIS in 42.9
percent of the cases. Respondents in the previous age group
also identified radio as the cause of 42.9 percent of the
calls. Television ranked second once again, totaling 30.1
percent. Pamphlets repeated the third-place performance from
the age 50—59 category, gathering 6.7 percent of the respond-
ents. Magazines and the telephone book reversed positions.

A three percentage point increase ranked magazines as the
fourth leading source, totaling 5.8 percent. It nipped the
telephone book, which landed in fifth position with 5.3
percent of the callers.

Out of 23 white respondents who gave no information
about age, 15 of them or 65.2 percent named television as the
first source where they heard about the CIS. Television also
ranked first among the 52 white respondents who were not
asked about their age.

Blagk_rage_with_age_ggntrglled. Television ranked
first as the source where black respondents of all ages
initially learned about the existence of the CIS. The visual
medium never failed to collect at least 40 percent of the
black respondents in any group. Radiofls share of the black

respondents grew steadily as the age of the caller increased.

106

Blacks age 19 and under totaled only 33 callers, but
15 of them cited television as the source where they first
learned about the CIS. The total equaled 45.5 percent,
falling short of the 51.5 percent that television gathered
among black respondents between the ages of 20 and 29.
Friends recommended the CIS to'l3.6 percent of the black
respondents between ages 20 and 29 (N = 132). Health profes-
sionals other than physicians suggested the CIS to 7.6 per-
cent of the black callers in their twenties. Radio captured
6.8 percent, finishing fourth. Pamphlets and the telephone
book tied for fifth position with 6.1 percent each.

Among blacks between the ages of 30 and 39 (N = 166),
41.6 percent identified television as the first source where
they learned about the CIS. Radio jumped to second place,
collecting 12.0 percent. The telephone book improved from
its fifth-place tie among the previous age category to a
third-place finish, totaling 11.4 percent. Pamphlets took
fourth with 7.8 percent and friends dropped three places,
finishing fifth with 6.0 percent.

Between the ages of 40 and 49, blacks first learned
about the CIS from television in 44.9 percent of the 156
cases. Radio ranked second, compiling 18a6 percent. The
telephone book maintained third position with 11.5 percent.
Friends gained one place but lost 1.5 percentage points,

finishing fourth with 4.5 percent.

107

The majority of blacks between 50 and 59 (N = 187)
indicated that television first led them to call the CIS.

The total reached 58.8 percent. Radio trailed with 19.3
percent of the callers. The telephone book retained third
spot with 6.4 percent. Fourth position belonged to pamphlets
with a meager 2.7 percent.

Blacks age 60 and older first learned about the
Washington, ILC. area CIS from television in 51.3 percent of
the cases. “Radio once again ranked second, but significantly
increased its share of the callers with 32.9 percent. The
telephone book reached third place with only 3.9 percent of
the respondents.

WW White males
(N = 938) learned about the CIS for the first time from radio
in 40.1 percent of the cases. Television ranked second with
32.4 percent. Pamphlets finished third, leading 6.3 percent
of the white males to contact the C18. The telephone book
took fourth position with 5.3 percent. Magazines trailed and
finished fifth with 3.6 percent.

Television ranked first among white females (N =
1,205) with 26.9 percent. Radio followed behind closely,
attracting 22.1 percent of white females. The telephone book
advanced one slot, moving up to third position with 1357

percent. Pamphlets fell one position, finishing fourth with

108

12.9 percent. Magazines matched the fifth-place finish among
men, gathering 557 percent.

BMW The
majority of black males first learned about the CIS through
television. Out of 371, 196 of them or 52.8 percent
indicated television led to their attempts to contact the
CIS. Radio failed to exert the same degree of influence
among black males as it did among their white counterparts.
Among black males, 19.4 percent identified radio as the
source, while 40.1 percent of white males gave it credit.
Friends and the telephone book tied in third position, each
acquiring 642 percent. Another tie locked together pamphlets
and telephone directory assistance in fifth place with 257
percent apiece.

Less than half the black women who called the CIS
mentioned television as the source where they first heard
about the service. A total of 475 black females responded to
the question, and 47.4 percent said television led to their
call. Radio followed in second position, attracting 15.8
percent of the black females. The telephone book appealed to
9.3 percent, while pamphlets caused a response from 5.3
percent. Health professionals other than physicians led to
calls from 5.1 percent of the black females. In sixth

position, friends convinced 4.2 percent to contact the CIS.

109

W. Out of 4,736
callers who reached the CIS, 2,149 of them identified

themselves as white. Only 15 of the 2,149 white respondents
indicated that they possessed no more than a grade school
education. Among these callers, 33.3 percent said that they
learned about the CIS from the telephone book, and 2657
percent attributed their call to television.

White respondents who attended high school but never
graduated totaled 45 callers. Nearly one half, 22 out of 45
or 48.9 percent, mentioned television as the first source
where they learned about the CIS. The telephone book ranked
second with 22.2 percent.

High school graduates who never attended college
(N = 329) indicated that television led to 32.2 percent of
the CIS calls. Radio collected 27.4 percent, taking second
place. The telephone book ended up third with 12.5 percent.
Pamphlets finished in fourth spot, attracting 8.8 percent.
Magazines trailed in fifth place, generating 8.2 percent of
the CIS calls.

High school graduates who continued their education
but never completed the requirements for a college degree
(N = 434) represented the next category. The results in
regard to both television and radio almost duplicated the
findings from the previous group. Television led to 324)

percent of the calls. Radio matched the 27.4 percent share

110

of respondents whom it reached in the previous category. The
telephone book, pamphlets, and magazines ranked third,
fourth, and fifth once again. The telephone book led to 13.8
percent of the CIS calls. Pamphlets caused.8.5 percent of
the calls, and magazines led to 4.1 percent of the queries.

College graduates (N = 771) named radio as the first
source that led to a CIS call. Nearly a five percentage
point jump occurred from the previous educational group as
32.0 percent said radio caused them to contact the service.
Television fell to second place with 26.7 percent. Pamphlets
leaped into third spot, collecting 11.3 percent. The tele-
phone book dropped back to fourth with 6.7 percent. Maga-
zines maintained fifth place, grabbing 5.7 percent.

Radio soared further ahead with 40.5 percent among
respondents with postgraduate training (N = 393). Television
slipped, but still clung to second place with 21.4 percent.
Pamphlets held third position, accumulating 12.2 percent.

The telephone book retained fourth place with 6.4 percent.
Health professionals other than physicians collected 3.3
percent of the callers.

The telephone interviewers never asked 101 of the
white callers about their educational background. More than
one—third, 35.6 percent, mentioned that television caused
them to call the CIS. The telephone book ranked second with

18.8 percent. Radio followed closely with 17.8 percent of

111

the calls. Out of 46 white respondents who declined to
mention the extent of their education, 22 of them or 47.8
percent named television as their first source about the CIS.

WW Only 10 black
callers with no more than a grade school education contacted
the CIS. Six of them cited television as the source that led
them to contact the CIS. The literature review suggested
that television exerts a significant influence on those who
do not possess a great deal of education. The findings among
6 of the 10 respondents in this category backed it up.

Half the respondents with some high school education
indicated that they first learned about the CIS from
television. Out of 44 callers in this category, 22 of them
named television as the source that led to the CIS call. The
telephone book and radio tied for second with 18.2 percent of
the callers each.

High school graduates relied on television even more
than their less educated counterparts. A total of 270
respondents in this category answered the question, and 169
of the callers identified television as the source that
motivated them to contact the service. While 62.6 percent
cited television, 14.8 percent named radio. The telephone
book collected 542 percent, finishing third. Pamphlets

logged 4.1 percent of the respondents.

 

112

Blacks with some college, but no college diploma,
totaled 224 callers. Television took a share of 44.6
percent, while radio ranked second with 20.1 percent. In
comparison to the previous category, television lost more
than 15 percentage points and radio gained more than five.
Friends snatched 10.3 percent of the respondents and the
telephone book gathered 8.9 percent. Health professionals
other than physicians, and pamphlets tied in fifth place,
each collecting 4.5 perrcent.

Black college graduates (N = 181) failed to utilize
the CIS as much as the two previous groups. Televisionls
dominance slipped slightly as 40.3 percent of the callers
attributed their call to the visual medium. Radio moved up
to 21.5 percent of the callers relative to the previous
group. The telephone book accounted for 7.2 percent of the
respondents. Friends persuaded 5.5 percent of the callers to
contact the CIS, ranking fourth. Health professionals other
than physicians finished fifth with 5.0 percent.

Blacks with postgraduate training exhibited less
reliance on television for information about the CIS than
blacks with less education. Out of 68 respondents, 20 of
them named television as the source that first provided
information about the service. Radio earned an audience of
16.2 percent, finishing second. The telephone book stayed in

third position, helping 7.2 percent contact the CIS. Health

113

professionals other than physicians took fourth place with
7¢4 percent of the respondents. Newspapers emerged as the
fifth leading source about the CIS, reaching 5u9 percent.

A three-way tie resulted among magazines, pamphlets, and
physicians as they each earned 4.4 percent. The significant
influence of newspapers, magazines, and pamphlets matched the
expectation from the literature review that sources of print
journalism would influence scholarly respondents more than
callers with less education.

Out of 14 respondents who gave no information about
their education, eight of them named television as the
chief source where they learned about the CIS. Interviewers
never asked 31 black respondents about their educational
background, but 18 of them said television led them to
contact the service.

WWW Whites in the
suburbs of Maryland and Virginia represented 80 percent of
all whites who contacted the CIS. The District's
predominantly black population probably accounted for the
comparatively low number of calls from whites within the
capital city. Radio surpassed television as the source that
first led to CIS calls for whites who resided in the
District. Out of 403 callers from the District, 140 of them
or 3457 percent indicated that radio convinced them to

contact the service. Television trailed with 31.0 percent.

114

The telephone book collected 8.4 percent, finishing third.
Pamphlets ranked fourth among residents of the District with
7.4 percent, and friends ended up fifth, persuading 3.5
percent. Magazines took hold of sixth spot with 3.2 percent.
Maryland residents who identified themselves as
whites totaled 828. Television captured a share of 30.8 E
percent, nipping radio, which gathered 28.3 percent.
Pamphlets moved up one position to third with 10.5 percent.

The telephone book slipped a notch from the analysis of

 

whites in the District, gaining fourth place and 8.5 percent.
Magazines advanced to fifth spot with 5.4 percent.

Virginia totaled 822 callers who identified
themselves as white. Radio reached nearly one-third of them
with information about the C18. The airwaves led 3257
percent of the respondents to call the CIS, while television
caused 28.6 percent to contact the service. In third spot,
the telephone book generated 11.1 percent of the calls. Two
sources of print journalism finished fourth and fifth.
Pamphlets earned a share of 9.9 percent of the callers, and
magazines followed with 3.6 percent.

Only 96 white respondents did not indicate a place of
residence. The telephone book surprisingly finished first
with 20.8 percent. Pamphlets recorded 16.7 percent and took
second position. Magazines tied with television for third

place as each earned 15.6 percent.

115

WWW. More than two-
thirds of the 847 black respondents lived in the District

(N = 578), with nearly another 30 percent of them or 202
based in Maryland and less than 10 percent or 49 located in
Virginia. Television ranked as the top source to first
communicate the CIS to blacks in either Maryland, Virginia,
or the District of Columbia. Radio finished second in each
location. The telephone book took third position in the
District and Maryland. In the District, television recorded
51.9 percent; radio registered 15.9 percent; and the tele-
phone book gathered 8.1 percent. Among black respondents in
Maryland, television reached 46.0 percent; radio accumulated
20.3 percent; and the telephone book collected 8.9 percent.
Only 49 black respondents identified Virginia as their place
of residence. Television took a share of 42.9 percent, and
radio picked up 26.5 percent. No other source led to calls

from more than four black respondents in Virginia.

 

 

CHAPTER V

SOME CONCLUSIONS AND GENERALIZATIONS

The mass media, especially television and radio,
effectively communicated the existence of the Washington,
ILC. CIS, but interpersonal channels of communication and
selected groups barely exerted an influence in the amount of
CIS utilization. The phenomenal results of television and
radio promotional campaigns may never be equaled because of
recent changes in FCC laws that diminished the need for
stations to provide public service information to gain
relicensure. That leaves interpersonal channels of
communication and selected groups as alternatives that
must spread the word to supplement television and radio.

One major advantage with television and radio PSAs is
the tendency for stations to broadcast them repeatedly over a
period of time, fulfilling one of the ingredients to achieve
diffusion. Practically every other source of communication
failed to continue a promotional campaign for a significant
length of time. For example, the project officer of all the
CIS offices solicited free advertisements or news articles

about the service from some national publications, but many

116

 

117

of the magazines or newspapers only ran either one ad or news
story during a six-month period that was studied, beginning
in October 1983 and concluding in February 1984. DSA_IQday
published an article about the CIS on 10/28/83, but nothing
during the next four months. Eighteen other publications
gave attention to the CIS during the same six-month period,
and none of them except the Natignal_£ngnirer mentioned the
service in a follow-up ad or article, minimizing the
potential benefits of the promotions. This may partially
explain the disappointing results exhibited in an analysis of
magazines and newspapers as promotional vehicles.

Instead of directing promotional efforts at men, who
underutilize the CIS in comparison to women, practically all
the national magazines that wrote about the CIS appealed to a
female readership. filamouLMagazine, W,
EumuflflB_Da¥1.EamilX—Qixslfir.Lad¥_99mr,ankin9_flnmmuh and
Bedbggk may help draw more female callers, which is good,
but the absence of even one male-oriented publication during
the six-month promotional snapshot indicates a neglect of the
underutilization problem among men. The project officer at
the NCI, Judith Stein, may wish to actively seek advertising
space or news coverage of the CIS from publications geared
toward men. Magazines that appeal primarily to upscale,
white females will miss most of the demographic groups at

greatest risk to develop cancer.

 

118

The NCI emphasis on call volume to determine the
success or failure of a particular CIS office seems
misplaced. Rather than base the decision to renew the
contract of a local CIS on the number of calls, strong
consideration should be given to the demographic
characteristics of the callers. If calls to the CIS come .
from members of high—risk groups, such as blacks and
individuals age 50 or older, the CIS may actually bring

individuals into the health care delivery system who might

 

l‘llfivr‘ _

not normally seek medical attention until reaching an
advanced stage of cancer. The CIS in Washington, DJ;
received a large percentage of calls from blacks, exceeding
the national average, despite national promotions in print
media that possessed a readership of upscale, white females.
Evidently, officials at the CIS in Washington, D.C. must have
overcome the lack of support from national campaigns through
their own promotional endeavors, but the contract with the
NCI that provided funding to operate the local CIS office was
allowed to expire anyway.

The cancellation of the contract to conduct the CIS
in Washington, ILC. leaves a void in the dissemination of
cancer information in a metropolitan area that numerous
medical studies have established as an area with high cancer
rates, especially among blacks. Now, when a resident of the

Washington, DJ; area calls the CIS number, an operator at a

119

firm that responds to questions from callers throughout the
[LS. will not be able to offer referrals to specific physi—
cians, medical centers, and social service agencies within
the caller‘s own community along with appropriate telephone
numbers. The decision to eliminate the CIS in Washington,
ILC. cuts off a link between physicians, medical centers, and
social agencies of Washington, DJ; and the individuals who

need their help.

 

BIBLIOGRAPHY

120

.mM, '."

 

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Interrieus

Bangiolo, Joseph. National Cancer Institute, Bethesda, Md.,
18 February 1986.

Dykewicz, Clare. University of Chicago Medical School,
Flint, Michigan, 25 December 1984.

Dykewicz, Mark. Northwestern University Medical School,
Flint, Michigan, 25 December 1984.

 

Fletcher, Elena. American Cancer Society, Washington, D.C.,
24 February 1986.

Palm, Bill. Howard University Cancer Center, Washington,

Pence, James. Pee Dee Regional Health Systems Agency, Inc.,
Washington, D.C., 11 March 1985.

Snyder, Courtney. United States Telephone Association,
Washington, D.C., 24 February 1986.

White, Jack. Howard University Cancer Center, Washington,
D.C., 18 September 1984.

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