A meta-analysis of 166 HIV-prevention interventions tested theoretical predictions about the effects of experts, lay community members, and similar and dissimilar others, as agents of change. In general, expert interventionists produced greater behavior change than lay community members, and the demographic and behavioral similarity between the interventionist and the recipients facilitated behavioral change. Equally importantly, there were differences across groups in the efficacy of various sources, especially among populations of low status and/or power. These findings support the hypothesis that unempowered populations are more sensitive to characteristics of the interventionists who can facilitate access to various resources. In addition, they suggest the need to ensure the availability of health professionals from diverse demographic and behavioral backgrounds.

This meta-analysis examined the validity of various theoretical assumptions about cognitive and behavioral change following a communication recommending condom use. The synthesis comprised 82 treatment and 29 control groups included in 46 longitudinal reports with measures of perceived severity and susceptibility, attitudes and expectancies, norms, perceptions of control, intentions, knowledge, behavioral skills, or condom use. Results indicated that across the sample of studies, communications taught recipients about facts related to HIV and also induced favorable attitudes and expectancies, greater control perceptions, and stronger intentions to use condoms in the future. Moreover, messages that presented attitudinal information and modeled behavioral skills led to increased condom use. Results are discussed in the context of theories of human behavior and change and in reference to HIV-prevention interventions. KeywordsHIV and condom use; behavior; attitude; persuasion; intervention; meta-analysis Client-centered approaches and pragmatic skill-building interventions to reduce infection with HIV appear to be indispensable tools in reducing the epidemic of this disease (Kelly, 1982; Kelly & St. Lawrence, 1988, 1990. However, interventions to prevent HIV infection must also use less effortful yet persuasive approaches to reach large audiences at different Correspondence concerning this article should be addressed to Dolores Albarracín, Department of Psychology, University of Florida, Gainesville, Florida 32611. dalbarra@ufl.edu. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript levels of risk for HIV. In persuasive communications, a standard recommendation is presented, accompanied by material designed to increase the chance that message recipients will comply with the recommendation. Given the number of communications to prevent HIV that have been delivered over the years, there should be considerable knowledge about the impact of these communications on condom use. To date, however, there has been no precise estimation of the impact of persuasive messages that recommend condom use, nor is there knowledge of the general impact of different types of persuasive arguments designed to increase condom use. For example, the health belief model (Janz & Becker, 1984;Rosenstock, 1974;Rosenstock, Strecher, & Becker, 1994) and the protection-motivation theory (Floyd, Prentice-Dunn, & Rogers, 2000;Rogers, 1975) imply that communications will increase condom use when they induce recipients' (a) fear of the severity of the disease and (b) beliefs that they are personally susceptible to it (but see the null meta-analytic findings of Gerrard, Gibbons, & Bushman, 1996). However, other conceptualizations identify different factors that are relevant to behavioral change. The theory of reasoned action (Fishbein & Ajzen, 1975) and the theory of planned behavior (Ajzen & Madden, 1986; for a meta-analysis, see Albarracín, Johnson, Fishbein, & Muellerleile, 2001) suggest that communicati...

This series of studies identified individuals who chronically believe that they can successfully defend their attitudes from external attack and investigated the consequences of this individual difference for selective exposure to attitude-incongruent information and, ultimately, attitude change. Studies 1 and 2 validated a measure of defensive confidence as an individual difference that is unidimensional, distinct from other personality measures, reliable over a 2-week interval, and organized as a trait that generalizes across various personal and social issues. Studies 3 and 4 provided evidence that defensive confidence decreases preference for proattitudinal information, therefore inducing greater reception of counterattitudinal materials. Study 5 demonstrated that people who are high in defensive confidence are more likely to change their attitudes as a result of exposure to counterattitudinal information and examined the perceptions that mediate this important phenomenon.Keywords attitude strength; resistance; personality; persuasion; selective exposure; confidence Historical examples abound of people who strongly advocate and defend a given attitudinal position and then change this position, becoming "converted" to points of view that oppose the ones they initially held. We argue that one reason for such changes is the degree to which individuals perceive that they can defend their attitudes from attack and that, ironically, the very strength of this trait can make them vulnerable to attitude change (Albarracín, 2002). Presumably, people who are confident that their attitudes will survive future challenges are more willing to examine evidence that both supports and contradicts their attitudes. In contrast, people who doubt their defensive ability may prefer proattitudinal information over materials that challenge their perspectives (see also Byrne, 1961;Olson & Zanna, 1982b; for related views in other domains, see Tesser, 2001). Although, in many ways, denial may be a relatively primitive defense mechanism, avoiding counterattitudinal information may preserve the attitudes of people who doubt their defensive abilities. InCorrespondence concerning this article should be addressed to Dolores Albarracín, Department of Psychology, University of Florida, Gainesville, FL 32611; dalbarra@ufl.edu. The scale validation data reported in this article were first presented at the 2001 meeting of the Society for Personality and Social Psychology (February, San Antonio, TX). HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript contrast, individuals who believe that they will effectively defend themselves may willingly receive counterattitudinal information that succeeds in changing their attitudes. Obviously, once exposed to counterattitudinal information, these same individuals may actually counterargue the information more effectively than people who doubt their ability to defend their positions. Yet, even when perceived defensive ability may accurately reflect actual ability...

Purpose: To evaluate carcinogenic human papillomavirus (HPV) mRNA for E6 and E7 mRNA detection on clinical specimens to identify women with cervical precancer and cancer. Experimental Design: We evaluated a prototype assay that collectively detects oncogenes E6/ E7 mRNA for 14 carcinogenic HPV genotypes on a sample of liquid cytology specimens (n = 531), masked to clinical data and to the presence of HPV genotypes detected by PGMY09/ 11L1consensus primer PCR assay. Results: We found an increasing likelihood of testing positive for carcinogenic HPV E6/E7 mRNA with increasing severity of cytology (P Trend < 0.0001) and histology (P Trend < 0.0001), with 94% of cervical intraepithelial neoplasia grade 3 (CIN3) histology cases (46 of 49) and all five cancer cases testing positive for carcinogenic HPV E6/E7 mRNA. Overall, fewer specimens tested positive for carcinogenic HPV E6/E7 mRNA than for carcinogenic HPV DNA (P < 0.0001, McNemar's m 2 test), especially in women with

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Background “Financial toxicity” is a concern for patients, but little is known about how patients consider out‐of‐pocket cost in decisions. Sacubitril‐valsartan provides a contemporary scenario to understand financial toxicity. It is guideline recommended for heart failure with reduced ejection fraction, yet out‐of‐pocket costs can be considerable. Methods and Results Structured interviews were conducted with 49 patients with heart failure with reduced ejection fraction at heart failure clinics and inpatient services. Patient opinions of the drug and its value were solicited after description of benefits using graphical displays. Descriptive quantitative analysis of closed‐ended responses was conducted, and qualitative descriptive analysis of text data was performed. Of participants, 92% (45/49) said that they would definitely or probably switch to sacubitril‐valsartan if their physician recommended it and out‐of‐pocket cost was $5 more per month than their current medication. Only 43% (21/49) would do so if out‐of‐pocket cost was $100 more per month ( P <0.001). At least 40% across all income categories would be unlikely to take sacubitril‐valsartan at $100 more per month. Participants exhibited heterogeneous approaches to cost in decision making and varied on their use and interpretation of probabilistic information. Few (20%) participants stated physicians had initiated a conversation about cost in the past year. Conclusions Out‐of‐pocket cost variation reflective of contemporary cost sharing substantially influenced stated willingness to take sacubitril‐valsartan, a guideline‐recommended therapy with mortality benefit. These findings suggest a need for cost transparency to promote shared decision making. They also demonstrate the complexity of cost discussion and need to study how to incorporate out‐of‐pocket cost into clinical decisions.

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SUMMARY Understanding how drugs work in vivo is critical for drug design and for maximizing the potential of currently available drugs. 5-nitrofurans are a class of prodrugs widely used to treat bacterial and trypanosome infections, but despite relative specificity, 5-nitrofurans often cause serious toxic side effects in people. Here, we use yeast and zebrafish, as well as human in vitro systems, to assess the biological activity of 5-nitrofurans, and we identify a conserved interaction between aldehyde dehydrogenase (ALDH) 2 and 5-nitrofurans across these species. In addition, we show that the activity of nifurtimox, a 5-nitrofuran anti-trypanosome prodrug, is dependent on zebrafish Aldh2 and is a substrate for human ALDH2. This study reveals a conserved and biologically relevant ALDH2-5-nitrofuran interaction that may have important implications for managing the toxicity of 5-nitrofuran treatment.