K Viswanath

Dana-Farber Cancer Institute, Boston, Massachusetts, United States

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Publications (90)196.71 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Studies have shown communication inequalities - differences among individuals and social groups in accessing and using information on health and specific threats - have consequential impacts on people’s knowledge, emotions and behavior responses, and ultimately health outcomes. Without being properly addressed, these inequalities could result in leaks in the surveillance net and compromise public health systems’ efforts to prevent and respond to pandemic influenza outbreaks or other types of emergencies. Here we have investigated the role communication inequalities play during the 2009/2010 A(H1N1) pandemics focusing on the associations among people’s concerns about being infected by the A(H1N1) virus, levels of A(H1N1)-related knowledge, and the subsequent health behavioral responses. Using nationally-representative cross-sectional survey data collected during the 2009/2010 A(H1N1) pandemic among American adults, we conducted hierarchical ordered or general logistic regression analyses, whenever appropriate. We found a strong association persists between health behavioral and levels of concerns about the possibility of self or family members being infected by the A(H1N1) virus, even after adjustment for socioeconomic position. Specifically, concerns, general media exposure, and being Hispanic were positively associated with the uptake of hygienic practices, employment of social distancing, and seeking of medical consultation. Knowing the modes of transmission of A(H1N1) virus was also positively related to the use of non-pharmaceutical interventions. Therefore, carefully crafted health communication campaigns that raise the public sense of urgency to a proper level could help cue people to take actions to protect themselves and loved ones.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Reducing fear of cancer is significant in developing cancer screening interventions, but the levels of fear may vary depending on the degrees of media exposure as well as individuals' socioeconomic positions (SEP). However, few studies have examined how the SEP influences the fear of cancer under the moderating process of general and specific forms of media exposure. We investigated the moderating effect of media exposure on the relationship between SEP and the level of fear of cancer by assuming that cancer knowledge is a covariate between those two. In particular, this study examined how exposure to both general and specific media changes the series of processes from SEP to fear of cancer. We conducted path analyses with three types of media - television, radio and the Internet- using data from a health communication survey of 613 adults in Massachusetts in the United States. We found that SEP influences cancer knowledge directly and fear of cancer indirectly, as moderated by the level of media exposure. Health-specific exposure, however, had a more consistent effect than general media exposure in lowering the fear of cancer by increasing knowledge about cancer. A higher level of health-specific exposure and greater amount of cancer knowledge lessened the fear of cancer. In addition, the more people were exposed to health information on television and the Internet, the lower the level of fear of cancer as a result. These findings indicate a relationship between SEP and fear of cancer, as moderated by the level and type of media exposure. Furthermore, the findings suggest that for early detection or cancer prevention strategies, health communication approaches through mass media need to be considered.
    Asian Pacific journal of cancer prevention: APJCP 07/2014; 15. · 1.50 Impact Factor
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    ABSTRACT: It is known that HIV-related stigma hinders prevention efforts. Previous studies have documented that HIV-related stigma may be associated with socioeconomic and socioecological factors. Mass media use may moderate this association, but there is limited research addressing that possibility. In this study, based on cross-sectional data pooled from the 2006-2011 Demographic and Health Surveys of 11 sub-Saharan African countries (N = 204,343), we investigated the moderating effects of exposure to mass media on HIV-related stigma. Hierarchical regression analysis indicated that HIV-related stigma tends to be higher among rural residents and individuals with low levels of education and HIV knowledge, as well as those who do not know people living with HIV. Media use was generally associated with low levels of HIV-related stigma, and attenuated the gap between individuals with high and low educational levels. However, the effect of mass media was found to be stronger among urbanites rather than among rural residents, which could lead to a widening gap between the two groups in endorsement of HIV-related stigma. The implication of this study regarding the effect of media use on HIV-related stigma in sub-Saharan Africa is twofold: 1) mass media may have the potential to minimize the gap in HIV-related stigma between individuals with high and low educational levels, and hence future efforts of reducing HIV-related stigma in the region may benefit from utilizing media; 2) due perhaps to low media penetration to rural sub-Saharan Africa, mass media could have the unintended effect of widening the urban-rural gap further unless other more customized and rural-focused communication interventions are put in place.
    PLoS ONE 06/2014; · 3.53 Impact Factor
  • 10th Annual Harvard University Junior Investigators’ Health Disparities Research Poster Session. Boston, MA, USA, 8 May 2014.; 05/2014
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    ABSTRACT: Promoting healthy behaviors may reduce the risk of co-morbidities among childhood and young adult (CYA) cancer survivors. Although behavioral interventions are one way to encourage such activities, there is increasing evidence that health media use-particularly health information seeking-also may influence health knowledge, beliefs, and behaviors. The current study explores patterns of health media use among survivors of CYA cancer. Our focus is on survivors who smoke and thus are at even greater risk of co-morbidities. We analyzed data from the Partnership for Health-2 study, a web-based smoking cessation intervention, to examine the prevalence of and factors associated with health media use (N = 329). Nearly two thirds (65.3 %) of CYA survivors who smoke reported infrequent or no online health information seeking. Many reported never reading health sections of newspapers or general magazines (46.2 %) or watching health segments on local television news (32.3 %). Factors associated with health media use include education and employment, cancer-related distress, and smoking quit attempts. Health information engagement is low among CYA survivors who smoke, particularly active seeking of health information online. Population subgroups differ in their media use patterns; some of these differences reflect communication inequalities, which have the potential to exacerbate health disparities. Clinicians have an opportunity to guide CYA survivors towards useful and reliable information sources. This guidance could help survivors fulfill their unmet information and support needs and may be particularly important for less educated survivors and other underserved populations.
    Supportive Care in Cancer 04/2014; · 2.09 Impact Factor
  • Progress in community health partnerships : research, education, and action. 01/2014; 8(2):143.
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    ABSTRACT: Human papilloma virus (HPV) infection is highest among Black women and women of low socio economic position (SEP). These groups face inequities in access to health information on HPV.
    Progress in community health partnerships : research, education, and action. 01/2014; 8(2):169-79.
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    ABSTRACT: We examined relationships between individual-level community participation, two types of contextual effects-community capacity for mobilization and capacity for health communication-and residents' self-reported health status in order to explore the role health communication may play in community building for health. To estimate multi-level effects of the community participation and the two contextual indicators with self-rated health status, we applied hierarchical generalized linear regression to crosssectional data from the Korean National Health and Nutrition Examination Survey. After adjusting for individual- and community-level confounders, the likelihood of having high self-rated health status is significantly higher among those who live in a region with higher community capacity for mobilization, higher health communication capacity at the community level, and higher participation in community groups at the individual-level. Our findings suggest that living in a community characterized by higher levels of communication and mobilization capacity is beneficial to residents' self-rated health status-increasing the odds of high health status by up to 9 %. Thus, building community capacity in mobilization and health communication may help develop better health promotion campaigns.
    International Journal of Public Health 12/2013; · 1.99 Impact Factor
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    Mike Mccauley, Sara Minsky, K. Viswanath
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    Mike Mccauley, Sara Minsky, K. Viswanath
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    ABSTRACT: Background: Throughout history, people have soothed their fear of disease outbreaks by searching for someone to blame. Such was the case with the April 2009 H1N1 flu outbreak. Mexicans and other Latinos living in the US were quickly stigmatized by non-Latinos as carriers of the virus, partly because of news reports on the outbreak’s alleged origin in Mexican pig farms. Methods: In this exploratory study we examined the psychological processes of cue convergence and associative priming, through which many people likely conflated news of the H1N1 outbreak with pre-existing cognitive scripts that blamed Latino immigrants for a variety of social problems. We also used a transactional model of stress and coping to analyze the transcripts from five focus groups, in order to examine the ways in which a diverse collection of New England residents appraised the threat of H1N1, processed information about stereotypes and stigmas, and devised personal strategies to cope with these stressors. Results: Twelve themes emerged in the final wave of coding, with most of them appearing at distinctive points in the stress and coping trajectories of focus group participants. Primary and secondary appraisals were mostly stressful or negative, with participants born in the USA reporting more stressful responses than those who were not. Latino participants reported no stressful primary appraisals, but spoke much more often than Whites or Non-Hispanic Blacks about negative secondary appraisals. When interactions between participants dealt with stigmas regarding Latinos and H1N1, Latinos in our focus groups reported using far more negative coping strategies than Whites or Non-Hispanic Blacks. When discussions did not focus on stereotypes or stigmas, Latino participants spoke much more often about positive coping strategies compared to members of these same groups. Conclusions: Participants in all five focus groups went through a similar process of stress and coping in response to the threat of H1N1, though individual responses varied by race and ethnicity. Stigmatization has often been common during pandemics, and public health and emergency preparedness practitioners can help to mitigate its impacts by developing interventions to address the social stressors that occur during outbreaks in highly-localized geographic regions.
    BMC Public Health 12/2013; 13:1116. · 2.08 Impact Factor
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    ABSTRACT: Background: There is limited research examining the coping strategies of youth and their associations with discrimination and bullying. We used a latent class analysis (LCA) to characterize coping styles of ethnically diverse urban youth and examined if coping styles moderated the association between experiencing discrimination and bullying and depressive symptoms. Methods: The data come from the 2006 Boston Youth Survey (BYS), where students were asked to select two behaviors they do most often when they are upset, from a list of 14 options. A total of 927 (75%) students contributed to the LCA analytic sample (45% Non-Hispanic Black, 29% Hispanic and 58% female). Relative and absolute fit indices determined the number of classes. An interaction term between types of discrimination/bullying experienced and coping style tested for moderation. Results: The LCA revealed that 3-class solution had the best fit (LMR-LRT, 4-class vs. 3-class, p-value 0.12). The largest coping style class was characterized by high endorsement of distractive coping strategies (59%), the second class by using supportive coping strategies (27%), and the third class by using avoidant coping strategies (12%). We found a significant interaction between discrimination and coping style for depressive symptoms, indicating avoidant coping style exacerbated the risk of depressive symptoms associated with experiencing discrimination/bullying. Conclusion: Further research is needed to understand the coping strategies that youth use to buffer the effects of bullying and discrimination and which may have the most protective effects.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Despite efforts to raise public awareness of health disparities to gain public support for structural solutions, surveys have shown that Americans remain largely unaware of disparities and social determinants of health. Local news media may contribute to this knowledge deficit. While media content analyses have found some evidence of national disparities coverage, it is equally important to consider local print news. Local news may play a critical role in shaping public opinion and the local policy agenda. Research has shown that people rely on local print sources for news about their communities, and local media use is associated with greater community involvement and engagement. In this study, we present results of a content analysis of local print news in two lower-income cities with substantial racial/ethnic minority populations. These data were collected as part of Project IMPACT, a federally-funded study designed to influence media coverage and public opinion about health disparities. After establishing inter-coder reliability (Krippendorff's alpha=0.601.00), coders reviewed the primary English- and Spanish-language newspaper in each city, identifying health disparities stories published in 2010. We found that disparities coverage was rare in both mainstream and ethnic print media: only one disparities story was identified in the Lawrence Eagle-Tribune, while the greatest number (n=10) was identified in Providence En Espaol. Although some stories identified causes of disparities, these were often framed in individual (e.g., poor dietary habits) rather than social contextual terms (e.g., lack of food availability/affordability). Implications for health journalism and campaigns to raise disparities awareness will be discussed.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
  • Minsoo Jung, Leesa Lin, K Viswanath
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    ABSTRACT: During the H1N1 pandemic in 2009-10, the vaccination behavior of parents played a critical role in preventing and containing the spread of the disease and the subsequent health outcomes among children. Several studies have examined the relationship between parents' health communication behaviors and vaccinations for children in general. Little is known, however, about the link between parents' health communication behaviors and the vaccination of their children against the H1N1 virus, and their level of vaccine-related knowledge. We drew on a national survey among parents with at least one child less than 18 years of age (n=639) to investigate Parents' H1N1-related health communication behaviors including sources of information, media exposure, information-seeking behaviors, H1N1-related knowledge, and neighborhood social capital, as well as the H1N1 vaccination rates of their children. Findings showed that there is a significant association between the degree at which parents obtained H1N1 vaccination for their children and health communication variables: watching the national television news and actively seeking H1N1 information. And this association was moderated by the extent of the parents' H1N1-related knowledge. In addition, the parents' degree of neighborhood social capital mediated the association between H1N1 knowledge of the parents and H1N1 vaccination acceptance for their children. We found, compared to those with a low-level of neighborhood social capital, parents who have a high-level of neighborhood social capital are more likely to vaccinate their children. These findings suggest that it is necessary to design a strategic health communication campaign segmented by parent health communication behaviors.
    Vaccine 08/2013; · 3.77 Impact Factor
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    ABSTRACT: Background. Many U.S. adults have multiple behavioral risk factors, and effective, scalable interventions are needed to promote population-level health. In the health care setting, interventions are often provided in print, although accessible to nearly everyone, are brief (e.g., pamphlets), are not interactive, and can require some logistics around distribution. Web-based interventions offer more interactivity but may not be accessible to all. Healthy Directions 2 was a primary care-based cluster randomized controlled trial designed to improve five behavioral cancer risk factors among a diverse sample of adults (n = 2,440) in metropolitan Boston. Intervention materials were available via print or the web. Purpose. To (a) describe the Healthy Directions 2 study design and (b) identify baseline factors associated with whether participants opted for print or web-based materials. Methods. Hierarchical regression models corrected for clustering by physician were built to examine factors associated with choice of intervention modality. Results. At baseline, just 4.0% of participants met all behavioral recommendations. Nearly equivalent numbers of intervention participants opted for print and web-based materials (44.6% vs. 55.4%). Participants choosing web-based materials were younger, and reported having a better financial status, better perceived health, greater computer comfort, and more frequent Internet use (p < .05) than those opting for print. In addition, Whites were more likely to pick web-based material than Black participants. Conclusions. Interventions addressing multiple behaviors are needed in the primary care setting, but they should be available in web and print formats as nearly equal number of participants chose each option, and there are significant differences in the population groups using each modality.
    Health Education &amp Behavior 05/2013; · 1.54 Impact Factor
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    R F McCloud, M Jung, S W Gray, K Viswanath
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    ABSTRACT: Background:Information seeking may increase cancer survivors' ability to make decisions and cope with the disease, but many also avoid cancer information after diagnosis. The social determinants and subsequent communication barriers that lead to avoidance have not been explored. The purpose of this study is to examine the influence of social determinants on information avoidance among cancer survivors.Methods:We examined how health information avoidance is associated with structural and individual factors in a mail-based survey of 519 cancer survivors. Factor analysis was conducted to determine barriers to obtaining cancer information, and multivariable logistic regression models by gender were run to analyze social determinants of avoidance from an intersectional approach.Results:Participants who were younger, female, had greater debt and lower income, and had difficulty finding suitable information were more likely to avoid information. The probability of information avoidance increased when survivors reported barriers to information use or comprehension.Conclusion:These results indicate that survivors' information avoidance may be driven, in part, by social determinants, particularly among those at the intersection of multiple social status categories. Customized strategies are needed that maximize the likelihood that information will be used by vulnerable groups such as those from a lower socioeconomic position.British Journal of Cancer advance online publication, 16 May 2013; doi:10.1038/bjc.2013.182 www.bjcancer.com.
    British Journal of Cancer 05/2013; 108(10):1949-1956. · 5.08 Impact Factor
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    ABSTRACT: The aim of this study was to examine the relationship between time availability and preference for computer-based (e-health) communication channels when receiving nutrition and physical activity information, two key behaviors related to cancer prevention. Students from a large, diverse, urban university (n = 397) completed a web-based survey indicating their usage patterns and preferences for multiple eHealth channels. Bivariate analyses were performed based on a measure of time availability, comprised of working status (25 h/week or more, 1-24 h/week, or not working) and enrollment status (full-time or part-time). Most e-health channels were broadly used by students and did not differ according to time availability. Those with the most amount of time available preferred receiving nutrition and physical activity information via social networking more frequently compared to those with the least amount of time available (60 versus 43 %, P ≤ 0.05). Our study suggests that time availability may be another important factor to consider when planning cancer prevention programs.
    Journal of Cancer Education 05/2013; · 0.88 Impact Factor
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    ABSTRACT: Given persistent communication inequalities, it is important to develop interventions to improve Internet and health literacy among underserved populations. These goals drove the Click to Connect (C2C) project, a community-based eHealth intervention that provided novice computer users of low socioeconomic position (SEP) with broadband Internet access, training classes, a Web portal, and technical support. In this paper, we describe the strategies used to recruit and retain this population, the budgetary implications of such strategies, and the challenges and successes we encountered. Results suggest that personal contact between study staff and participants and provision of in-depth technical support were central to successful recruitment and retention. Such investments are essential to realize the promise of eHealth with underserved populations.
    Journal of Communication 02/2013; 63(1):201-220. · 2.45 Impact Factor
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    ABSTRACT: Background Despite the growing penetration of the Internet, little is known about the usage and browsing patterns of those in poverty. We report on a randomized controlled trial that sheds light on the Internet use and browsing patterns among the urban poor. Methods The data come from 312 participants in Boston, Massachusetts, from Click to Connect, a study that examined the impact of an intervention that provided computers, Internet, and training to people from lower socioeconomic position (SEP). Data were gathered through pre- and posttest surveys and Internet use tracking software that generated approximately 13 million network activity files and more than 5.5 million records. Results Internet use increased among Intervention participants, with most of their time spent on social and participatory media sites or Internet portals. Differential patterns of use by gender and race/ethnicity were observed. Purposive searching for health information was low among all participants. Most of the visits to health-related sites were to local hospitals' sites suggesting the influence of possible preexisting relationships and trust. Social networking sites were frequently visited, with three sites enjoying similar popularity among all groups. Conclusions Our data show that the availability of Internet can lead to significant increase in its use among low SEP groups. Low SEP members used the Internet for participation and engagement, but the sites visited differed by group. Harnessing the power of social networking sites and shareware sites may be a way to increase access to health information.
    JNCI Monographs 01/2013; 2013(47):199-205.
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    ABSTRACT: In India, tobacco kills 900 000 people every year though the burden of tobacco is faced disproportionately in poorer states such as Bihar. Teachers may be a particularly influential group in setting norms around tobacco use in the Indian context. However, tobacco use among teachers remains high and perceptions of tobacco-related health risks are unexplored. To qualitatively explore perceptions about tobacco use among teachers in Bihar and to examine how risk information may be communicated through a variety of message formats, 12 messages on tobacco health risks varying in formats were tested in focus groups with teachers from Bihar. Participants stated that teachers were already aware of tobacco-related health risks. To further increase awareness of these risks, the inclusion of evidence-based facts in messages was recommended. Communicating risk information using negative emotions had a great appeal to teachers and was deemed most effective for increasing risk perception. Messages using narratives of teachers' personal accounts of quitting tobacco were deemed effective for increasing knowledge about the benefits of quitting. To conclude, messages using evidence-based information, possibly with negative emotions, testimonials with role models and those messages emphasizing self-efficacy in the format of narratives appear to appeal to teachers in Bihar.
    Health Education Research 12/2012; · 1.66 Impact Factor
  • Ezequiel M Galarce, K Viswanath
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    ABSTRACT: Objective: Although the field of crisis risk communication has generated substantial research, the interaction between social determinants, communication processes, and behavioral compliance has been less well studied. With the goal of better understanding these interactions, this report examines how social determinants influenced communications and behavioral compliance during the 2010 Boston, Massachusetts, water crisis. Methods: An online survey was conducted to assess Boston residents' knowledge, beliefs, attitudes, mass and interpersonal communication, and preventive behaviors on emergency preparedness topics dealing with the water crisis. Of a total sample of 726 respondents, approximately one-third (n = 267) reported having been affected by the water crisis. Only data from affected participants were analyzed. Results: Following an order to boil water, 87.5% of respondents refrained from drinking unboiled tap water. These behaviors and other cognitive and attitudinal factors, however, were not uniform across population subgroups. All communication and behavioral compliance variables varied across sociodemographic factors. Conclusions: Crisis communication, in conjunction with other public health preparedness fields, is central to reducing the negative impact of sudden hazards. Emergency scenarios such as the Boston water crisis serve as unique opportunities to understand how effectively crisis messages are conveyed to and received by different segments of the population.
    Disaster Medicine and Public Health Preparedness 12/2012; 6(4):349-56. · 1.14 Impact Factor

Publication Stats

1k Citations
196.71 Total Impact Points


  • 2005–2014
    • Dana-Farber Cancer Institute
      • • Center for Community-Based Research
      • • Department of Medical Oncology
      Boston, Massachusetts, United States
  • 2013
    • Boston University
      Boston, Massachusetts, United States
  • 2006–2013
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2005–2011
    • Harvard University
      • Department of Society, Human Development, and Health
      Cambridge, MA, United States
  • 2009
    • University of Massachusetts Lowell
      • Department of Community Health and Sustainability
      Lowell, MA, United States
  • 2007
    • Massachusetts Department of Public Health
      Boston, Massachusetts, United States
    • University of Texas MD Anderson Cancer Center
      • Health Disparities Research
      Houston, TX, United States
  • 2004
    • National Institutes of Health
      • Division of Cancer Prevention
      Bethesda, MD, United States
  • 1990
    • The Ohio State University
      Columbus, Ohio, United States