A study on the role of AIDS mass communication: How do the mass media affect HIV testing behavior? 1

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1 Japanese Psychological Research 1998, Volume 40, No. 4, Special Issue: Japanese social life in transition A study on the role of mass communication: How do the mass media affect HIV testing behavior? 1 HIROTADA HIROSE Department of Psychology, School of Arts and Science, Tokyo Woman s Christian University, Suginami-ku, Tokyo , Japan NAOKO NAKAUNE Graduate School of Decision Science and Technology, Tokyo Institute of Technology, Meguro-ku, Tokyo , Japan TOMOICHI ISHIZUKA National Center for Entrance Examinations, Meguro-ku, Tokyo , Japan SHOJI TSUCHIDA Faculty of Sociology, Kansai University, Suita, Osaka , Japan YASUE TAKANASHI Department of Psychology, School of Arts and Science, Tokyo Woman s Christian University, Suginami-ku, Tokyo , Japan Abstract: The present study shows how mass communication messages regarding HIV/ affect HIV antibody testing behavior. Two surveys were carried out in 1995 and 1996, using face-to-face interviews. The area surveyed covered towns and wards within 30 km of the center of Tokyo. Subjects were male and female individuals 18 to 65 years old in 1995 and 17 to 59 in Samples were extracted by means of a two-step stratified random sampling of the basic town register. Completion rates were 57.3% (N = 1099) in the 1995 survey and 52.2% (N = 630) in The variable Exposure to mass communication on together with the variable Interest in issues play vital roles in attitude formation toward HIV/ and in decision making over HIV antibody testing. The mass media s coverage promotes HIV/ prevention behavior by changing perceptions and attitudes. Key words: (acquired immunodeficiency syndrome), HIV (human immunodeficiency virus), mass communication, HIV antibody testing behavior, causal analysis. Nature of the problem in Japan Acquired immunodeficiency syndrome (), caused by the human immunodeficiency virus (HIV), was officially confirmed as an infectious disease in At present, the prevalence rate of HIV/ in Japan is lower than in many other countries, and the accumulated number of patients reported through to the end of 1 The data-set used derived from surveys which were carried out by the Study Group of and Society in Research Program on Epidemiology and Control of HIV, funded by the Ministry of Health and Welfare ( ) Japanese Psychological Association. Published by Blackwell Publishers Ltd, 108 Cowley Road, Oxford OX4 1JF, UK and 350 Main Street, Malden, MA 02148, USA.

2 A study on the role of mass communication 247 Table 1. cases by exposure category reported through to February 1998 Male Female Total Heterosexual contact Homo/bisexual male Injecting drug user (IDU) Mother-to-child infection Hemophilia/coagulation disorder Others Undetermined Total 1, ,720 Source: The Surveillance Committee of the Ministry of Health and Welfare, March February 1998 stood at 1,720. Percentages of the population in exposure categories like homosexual contacts and drug abuse in Japan are also low compared with Europe and the United States, but there are relatively high percentages of hemophiliac patients infected through HIV-contaminated blood products. Further, a characteristic of the epidemic in Japan is that infection through heterosexual contacts is the most common cause after infected blood products 473 compared with 628, respectively (see Table 1). in Japan has gradually entered the phase of sexual transmission. The number of recorded deaths claimed by HIV/ by February 1998 was 1,024. Dr. Yamasaki, chairman of the Surveillance Committee of the Ministry of Health and Welfare, expressed concern about spread of the infection, and mentioned that it was imperative that people undergo HIV antibody testing to confirm whether or not they are infected. The role of mass media reporting of The mass media have an important role in reporting on HIV/ to the general public, in educating them, and in maintaining and strengthening interest in the subject. Maeda, Inagaki, Ishii, Ashizawa, and Minamitani (1994), discussing the campaign against in the Tokyo metropolis in 1994, mentioned the mass media as a useful information source regarding HIV/ and its prevention. In Japan, where people with HIV/ are few, much can be expected of the mass media in terms of sustaining interest in, in the formation of positive attitudes toward people with HIV/, condom use, the promotion of HIV antibody testing, and so on. However, almost no systematic examination had ever been made in Japan of the effect of reports from the mass media (Hirose, 1989). Hirata, Watanabe, and Katsuno (1995) indicated that the number of articles in the press and the number of people undergoing HIV antibody testing were related. Jemmott, Jemmott, and Fong (1992) reported educational effects when they gave instructions on condom use and safer sex in a 5-hour educational intervention, including a video, given to 15-year-old youths in Philadelphia. In Britain, Bellingham and Gullies (1993) investigated the effect on truanting youths aged years of a street intervention using cartoons. It helped decrease the intention to have sexual intercourse and increased knowledge on HIV/. Objective The trump card in the battle against is said to be education and public relations (Hirose, 1991). High expectation is held of the mass media, in particular by the administration, in this regard because it enables the

3 248 H. Hirose, N. Nakaune, T. Ishizuka, S. Tsuchida, and Y. Takanashi supply of relevant information to many people at one time. As the mass media have their own functions, it is clearly a mistake if we seek only educational functions there (Netter, 1992). However, should information be found to have the desired effect, we can proceed to the next step, which is to explore how this can be communicated more effectively. This research examines how mass communication leads to a perception of the risk of and how it affects HIV antibody testing behavior. Method Subjects Two surveys were conducted, during July 20 31, 1995, and July 19 31, 1996, using faceto-face interviews. The area investigated covered towns and wards within 30 km of the center of Tokyo. Subjects were male and female individuals from 18 to 65 years old in 1995 and 17 to 59 years old in Samples were extracted by means of a two-step stratified random sampling of the basic town register; 1,952 people from 100 districts were chosen in 1995 and 1,208 people out of 60 districts in The completion rates were 57.3% (N = 1099) in 1995, and 52.2% (N = 630) in Relevant data do not show any significant differences with the census data in 1990 by age and sex groups. The variables used in the present study Free-association words on. The respondents were asked to supply as many freeassociation words as possible on in the survey of Interest in issues and interest in caused by the blood products tainted with HIV. Both attitudes were measured on a six-point scale from 1 (not interested at all) to 6 (very much interested). The variable Interest in caused by blood products tainted with HIV was added to the questionnaire battery in 1996 because an apology had been made by the government to people infected with HIV/ from such products. Information source concerning. Respondents selected from a list as to where knowledge about HIV/ had been obtained; there were 12 items, such as television, newspapers, and magazines. Exposure to mass communication on. Respondents again rated this on a six-point scale (for newspapers, 1, not read at all, to 6, read without fail; for television, 1, not watch at all, to 6, watch without fail). Talking about. Respondents were asked to rate on a four-point scale from 1 (not at all) to 4 (talking often) whether or not they talked about HIV/ with family members and friends. Risk perception of. We used the response to the question What is your opinion regarding the extent of risk of toward the whole of Japanese society? as the measure of social risk perception, and What is your opinion regarding the extent of risk of to you and your family? as the measure of private risk perception. Responses were on a four-point scale (1, not risky at all, to 4, very risky). Perception of seriousness of problems. Respondents rated the seriousness of three problems increasing spread of HIV/, slow action by the administration, and HIV infection of hemophiliacs in Japan on a fourpoint scale (1, not grave at all, to 4, very serious). The variable Perception of seriousness of problems was the sum of all three scores. HIV antibody testing intention. Respondents indicated whether they wanted to receive antibody testing or not (no was rated 1, yes, 2). HIV antibody testing behavior. We also asked whether or not respondents had undergone HIV antibody testing (again, no was rated 1, yes, 2). Results and discussion Tokyoites major sources of information regarding in both 1995 and 1996 surveys were television, newspapers and magazines, in that order (Figure 1). This corresponds to the

4 A study on the role of mass communication 249 TV Newspapers Magazines Municipal information brochures Conversation with friends Radio Conversation with family members Books in general Medical books Lectures Others None % Figure 1. Sources of information on HIV/. results of a survey conducted by Maeda et al. (1994). In the present study, television and newspapers were the two top sources of information on HIV/. Respondents reliance on these two media as sources of information had increased by the 1996 survey, compared with Thus the mass media, especially television and newspapers, play a vital role as a tool for obtaining information regarding by the public. Perceptions of the private and social risks The correlation between television watching and newspaper reading was high, and also similarities were seen in the content of reports between television and newspapers. We made a new variable, mass communication exposure, by summing these two variables. Respondents were then divided into the high mass communication exposure group (upper 25%) and the low

5 250 H. Hirose, N. Nakaune, T. Ishizuka, S. Tsuchida, and Y. Takanashi More risky Very much 4 Pretty much Safer Somewhat 2 Not at all 1 * p<.05 Low exposure to mass communication '96 social risk ** '95 social risk *** '96 private risk ns '95 private risk** High exposure to mass communication Figure 2. Social versus private risk perception of HIV/. group (lower 25%). As shown in Figure 2, the social risk perceptions of in 1995 and 1996 differed significantly between the high and the low groups (p.001 and p.01, respectively). The high-exposure group perceived as more risky to society than the low-exposure group. Regarding private risk (how risky might be for individuals and their families), the results show that the high-exposure group perceived that was more risky according to the data in 1995 (p.01), but no significant difference was observed in the data in Figure 2 shows that the level of social risk perception was higher than that of private risk perception in both surveys. In February 1996, an apology was expressed by the Minister of Health and Welfare for HIV contamination of blood products, and in March reconciliation was concluded with the pharmaceutical companies which sold unheated blood products. Thus it was the year when the mass media took up events related to hemophiliacs infected by blood products tainted with the virus in a big way. In this connection, a word association method was adopted to seek people s impression of in Figure 3 shows that 58.4% of the people questioned mentioned hemophilia and caused by blood products tainted with the virus. Grasping the causal structure The present study examines causal structure by means of covariance structure analysis. Causal models were used for this analysis because they can reveal the overall structure of causal

6 A study on the role of mass communication 251 caused by blood products Negative affection Illness 52.6 Infection routes 24.8 Prevention/control 16.1 Positive affection 7.8 No association 2.5 Others % Figure 3. Words associated with (1996 survey data). relations among mass communication exposure on, perceptions of, HIV testing behavior and so on. As a result of examining several models, those shown in Figure 4 and Figure 5 were obtained. Figure 4 shows a model depicting the data in 1995 and Figure 5 the data in The chi-squared values of both models are significant, which suggests that there are discrepancies between the models and the data but, generally speaking, if too many variables are included the chi-square value often becomes significant (Toyoda, 1992) even if application of the model is suitable. Other than chi-square, the goodness-of-fit index (GFI) was and the adjusted GFI (AGFI) was in the 1995 model, while GFI was and AGFI was in the 1996 model. The fit between the data and the models seems to be fairly good, because the values of GFI and AGFI from both models exceed 0.9. Since the model extracted from the 1995 data was almost identical to the model from the 1996 data (except for the issue of hemophilia), and each model s fit to each data-set is good, it appears that this model is stable chronologically and that it explains the data well. A positive path coefficient between two variables indicates that when one gets higher the other becomes higher, too. For example, a path from Interested in issues to Exposure to mass communication on with a positive coefficient indicates that the more one is interested in issues, the more one is exposed to reports. A negative path coefficient indicates that as one gets higher the other becomes lower. Variables working as the center in this model are Interested in issues and Exposure to mass communication on. Paths from many variables go through one or other of these, directly or indirectly. One of our goals was to find causal relations leading to HIV antibody testing behavior. HIV antibody

7 252 H. Hirose, N. Nakaune, T. Ishizuka, S. Tsuchida, and Y. Takanashi Social risk perception of *** Private risk perception of *** *** Increase of HIV infection in Japan is serious Exposure to mass communication on *** *** *** *** * * Talking about Age Min: 18 Max: 65 Sex * *** *** Interest in issues *** Perception of seriousness of problems Male: 1 Female: ** HIV antibody testing intention *** * ** *** p<.05 p<.01 p< *** HIV antibody testing behavior χ 2 = df = 68 p<.0001 GFI = AGFI = Figure 4. Causal models of mass communication exposure (1995 survey data). testing behavior is affected by HIV antibody testing intention. Four significant indirect paths (the path sequences in which all the paths are significant) in Figure 4 and five in Figure 5 to HIV antibody testing intention pass through Interested in issues. Exposure to mass communication on is also an important variable having an effect on HIV antibody testing intention. Though Exposure to mass communication on may be seen to have a somewhat weak influence compared with Interested in issues, of the five indirect paths to HIV antibody testing intention, four go through Exposure to mass communication on. Interest in issues and Exposure to mass communication on play vital roles in attitude formation toward HIV/ and in decision making over HIV antibody testing. The former has a stronger, more immediate influence on HIV antibody testing behavior, while the latter has a more indirect and modest influence on HIV testing behavior. Now we turn to consider the effect of demographic factors on the paths toward each variable. A path from Age to Exposure to mass communication on in Figure 4 and Figure 5 shows that the higher the age is, the higher is the tendency toward being exposed to reports (p.05 in Figure 4 and p.001 in Figure 5). A path from Age to Talking about in Figure 5 indicates that older respondents were more inclined to talk about (p.05). Two indirect paths

8 A study on the role of mass communication 253 Social risk perception of Private risk perception of Sex *** Male: 1 Female: *** *** *** *** ** Increase of HIV infection in Japan is serious *** Exposure to mass communication on *** *** Interest in issues *** HIV antibody testing intention *** Interest in caused by tainted blood products *** *** *** *** *** * Talking about More promotion of policies is necessary Age caused by blood products tainted with HIV is serious *** Min: 17 Max: *** * ** *** p<.05 p<.01 p< *** HIV antibody testing behavior χ 2 = df = 57 p<.0001 GFI = AGFI = Figure 5. Causal models of mass communication exposure (1996 survey data). from Age and then Exposure to mass communication on ( Age Exposure to mass communication on Talking about Interest in issues HIV antibody testing intention ; and Age Exposure to mass communication on Increase of HIV infection in Japan is serious Social risk perception on Interest in issues HIV antibody testing intention ) are positively linked to testing behavior in the long run, passing the variable Interest in issues. But a direct path from Age to HIV antibody testing intention shows a negative link (p.001 in both Figure 4 and Figure 5) the younger the respondents were, the more they indended to take testing. Thus the effects are reversed between direct and indirect paths. The path from Sex to Private risk perception on indicates statistical significance (p.05 in Figure 4 and p.001 in Figure 5). It shows that males have a higher private risk perception of than females. However, the path from Sex to Exposure to mass communication on shows that females have more exposure to reports (p.001 in both Figure 4 and Figure 5). The discrepancy between direct and indirect paths has arisen with sex in the same manner as with age. Females have more exposure to reports, and paths from here pass several variables to be positively linked to testing intention indirectly. The direct path from Sex

9 254 H. Hirose, N. Nakaune, T. Ishizuka, S. Tsuchida, and Y. Takanashi to HIV antibody testing intention shows males having a higher intention to receive testing (p.01 in Figure 4 and Figure 5) in contrast with the indirect paths ( Sex Exposure to mass communication on Talking about Interest in issues HIV antibody testing intention ; and Sex Exposure to mass communication on Increase of HIV infection in Japan is serious Social risk perception on Interest in issues HIV antibody testing intention ), which show females having more intention to take the test. From the viewpoint of the direct paths, the younger the person is the stronger is the HIV testing intention, and males have stronger HIV testing intentions than females. But there are also indirect ways to enhance HIV testing intention, through variables such as Exposure to mass communication on, Talking about, Increase of HIV infection in Japan is serious, Social risk perception on, and Interested in issues. Demographic variables are impossible to alter. Accordingly, this indirect way should be utilized. In other words, HIV testing intention can be generated through enhancing interest toward HIV/ and increasing exposure to through the mass media s reports. Private risk perception of is not linked to HIV antibody testing behavior in either of the almost identical causal models for 1995 and Tyler and Cook (1984) mention that mass media reports affecting only social risk perception are ineffective in reducing risky behavior. They assert that only private risk perception is linked to risk-reducing behavior. However, in the casual models of this study, the perception of the risk to society is linked to HIV antibody testing behavior, albeit indirectly. In short, this study shows that enhancing the sense of crisis in society through the mass media would lead to risk-reducing behavior among individuals. campaigns through the mass media will be indispensable for maintaining awareness and preparedness in society. Conclusion This study has examined the mass media s influences on perception, attitudes, and behavior among Tokyoites from teens to 60s (up to 50s for 1996). As a result of having examined the causal structure of perceptions, attitudes, and behavior toward HIV/, it is confirmed that two variables, Exposure to mass communication on, and Interest in issues, are acting as key variables. In view of the fact that social risk perception indirectly influences HIV antibody testing behavior, enhancing the sense of crisis on the social level would help reduce risky behavior (Hirose et al., 1996). As mentioned above, we cannot demand a purely educational role on the part of the mass media, but it is the fact that the effective use of the mass media is necessary to prevent further HIV infections. It would be necessary for us to pursue through a longitudinal study how the mass media influence perceptions and how this is related to prevention and risk-reducing behavior. Middlestadt et al. (1995) examined the effect of campaigns through the mass media in a comparison between a group exposed to the campaign and a group not exposed to it, and stated that well planned mass media campaigning based on corroborative evidence proved effective in containing the epidemic. The campaign through the mass media has to be continued in the future, as does basic research into the process of its influence on the public. References Bellingham, K., & Gullies, P. A. (1993). Evaluation of an education programme for young adults. Journal of Epidemiology and Community Health, 47, Hirata, S., Watanabe, M., & Katsuno, S. (1995). in the Japanese mass media: Content analysis of articles about from 1982 to 1992 in the Japanese newspapers. Japanese Journal of Health and Human Ecology, 61, (In Japanese.)

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