Christina L. Nelson

Bio: Christina L. Nelson is an academic researcher from University of North Carolina at Chapel Hill. The author has contributed to research in topics: Population & Randomized controlled trial. The author has an hindex of 6, co-authored 9 publications receiving 103 citations.

The Efficacy of Direct Mail, Patient Navigation, and Incentives for Increasing Mammography and Colonoscopy in the Medicaid Population: A Randomized Controlled Trial

Abstract: Background: Despite lower cancer screening rates and survival rates in the Medicaid population compared with those with private insurance, there is a dearth of population-based, evidence-based interventions targeting Medicaid clients to address this problem.Methods: This study reports results of a population-based randomized controlled trial (RCT) among all individuals enrolled in Minnesota's Medicaid program who were overdue for breast cancer (n = 22,113) and/or colorectal cancer (n = 94,294) screening. Individuals were randomized to intervention or control groups. The intervention group received persuasive and innovative direct mail materials coupled with a $20 incentive for using their Medicaid benefit to get screened. Direct mail materials provided a phone number to a call center staffed by patient navigators who addressed barriers and scheduled appointments via three-way calls. The control group received the intervention 15 months later. Primary outcomes were completion of mammography or colonoscopy within 12 weeks of the intervention. Billing claims served as evidence of screening.Results: Multivariate logistic regression showed significant differences for both breast cancer (P < 0.001) and colorectal cancer (P < 0.01). The odds of receiving a mammogram for the treatment group were significantly higher than the control group [OR = 1.30; 95% confidence interval (95% CI) = 1.16-1.46], and the treatment group was more likely to receive a colonoscopy than the control group (OR = 1.12; 95% CI = 1.04-1.21).Conclusions: This population-based intervention increased breast cancer and colorectal cancer screening in a Medicaid population overdue for screening.Impact: These findings may have broad application for reaching individuals who generally remain outside the health care system despite having public health insurance. Cancer Epidemiol Biomarkers Prev; 27(9); 1047-56. ©2018 AACR.

Interpersonal Communication and Smoking Cessation in the Context of an Incentive-Based Program: Survey Evidence From a Telehealth Intervention in a Low-Income Population.

Abstract: The tobacco epidemic disproportionately affects low-income populations, and telehealth is an evidence-based strategy for extending tobacco cessation services to underserved populations. A public health priority is to establish incentive-based interventions at the population level in order to promote long-term smoking cessation in low-income populations. Yet randomized clinical trials show that financial incentives tend to encourage only short-term steps of cessation, not continuous smoking abstinence. One potential mechanism for increasing long-term cessation is interpersonal communication (IPC) in response to population-level interventions. However, more research is needed on IPC and its influence on health behavior change, particularly in the context of incentive-based, population-level programs. This study used survey data gathered after a population-level telehealth intervention that offered $20 incentives to low-income smokers for being connected to Minnesota's free quitline in order to examine how p...

Coupling Financial Incentives with Direct Mail in Population-Based Practice: A Randomized Trial of Mammography Promotion.

Abstract: Financial incentives are being used increasingly to encourage a wide array of health behaviors because of their well-established efficacy. However, little is known about how to translate incentive-based strategies to public health practice geared toward improving population-level health, and a dearth of research exists on how individuals respond to incentives through public health communication strategies such as direct mail. This study reports results of a population-based randomized controlled trial testing a direct mail, incentive-based intervention for promoting mammography uptake. The study population was composed of a random sample of Minnesota women enrolled in Medicare fee-for-service and overdue for breast cancer screening. Participants ( N = 18,939) were randomized into three groups: (1) Direct Mail only, (2) Direct Mail plus Incentive, and (3) Control. Both direct mail groups received two mailers with a message about the importance of mammography; however, Mail plus Incentive mailers also offered a $25 incentive for getting a mammogram. Logistic regression analyses measured intervention effects. Results showed the odds for receiving mammography were significantly higher for the Direct Mail plus Incentive group compared with both Direct Mail only and Control groups. The use of incentives also proved to be cost-effective. Additionally, the Direct Mail only group was more likely to receive mammography than the Control group. Findings offer experimental evidence on how the population-based strategy of direct mail coupled with a financial incentive can encourage healthy behavior, as well as how incentive-based programs can be translated into health promotion practice aimed at achieving population-level impact.

Health Behavior And Health Education Theory Research And Practice

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Public Health Communication: Evidence for Behavior Change

Abstract: * Public Health Communication: Evidence for Behavior Change. Robert Hornik, ed. Mahwah, NJ: Lawrence Erlbaum Associates, Publishers, 2002. 405 pp. $99.95 hbk. $45 pbk. Public Health Communication: Evidence for Behavior Change is dedicated to answering a question that frustrates both health communication researchers and public health program planners worldwide: Do public health communication campaigns work? The book's answer to that question is a firm "yes," but the greatest value of the book is that it not only provides evidence supporting that conclusion but also helps us understand the circumstances under which campaigns successfully influence behavior. Perhaps even more importantly, it provides substantial explanation of the sorts of problems that may interfere with health communication campaign success. As Hornik's introduction notes, in recent years, several large-scale public health campaigns designed specifically to enable researchers to evaluate their effectiveness have produced discouraging results, suggesting that health communication campaigns have limited, if any, effects on behavior. In contrast, however, numerous other studies, along with the reality of increasing public adoption of many healthier behaviors, provide significant evidence that health communication campaigns can, indeed, produce positive behavior change. The book brings together a collection of sixteen case studies selected because, collectively, they support that conclusion. As the book notes, the cases selected are not meant to be representative of public health communication campaigns in general. Nonetheless, one of the strengths of the book is that Hornik has brought together a varied set of scholars writing on a wide variety of types of campaigns, conducted in numerous locations worldwide and focused on a broad range of health issues, including use of tobacco and marijuana among adults and adolescents, AIDS prevention behaviors, seat belt use, vaccination and other child health promotion behaviors, skin cancer prevention behaviors, and vasectomy adoption. In addition to the chapters examining intentional health campaigns, three chapters discuss how news coverage of health risks can influence behavior, often multiplying-but potentially also obscuring-the effects of intentional campaigns. Fan argues in the first of these three chapters that "the possibility should at least be contemplated that a major effect of an intervention effort is not the intervention itself but news about that intervention." Although this may be good news for the health promotion goals, it significantly complicates teasing out the effects of the intervention itself. As Viswanath and Finnegan note in the next chapter, the major community trials campaigns-those using intervention and control communities to enable evaluation of the campaign effects-largely have been underpowered to detect small differences between the intervention and reference communities. …

Predicting Dissemination of News Content in Social Media: A Focus on Reception, Friending, and Partisanship

Abstract: Social media are an emerging news source, but questions remain regarding how citizens engage news content in this environment. This study focuses on social media news reception and friending a journalist/news organization as predictors of social media news dissemination. Secondary analysis of 2010 Pew data (N = 1,264) reveals reception and friending to be positive predictors of dissemination, and a reception-by-friending interaction is also evident. Partisanship moderates these relationships such that reception is a stronger predictor of dissemination among partisans, while the friending-dissemination link is evident for nonpartisans only. These results provide novel insights into citizens’ social media news experiences.

Internet use, social networks, loneliness, and quality of life among adults aged 50 and older: mediating and moderating effects.

Abstract: The increase in longevity of people on one hand, and on the other hand the fact that the social networks in later life become increasingly narrower, highlights the importance of Internet use to enhance quality of life (QoL). However, whether Internet use increases or decreases social networks, loneliness, and quality of life is not clear-cut. To explore the direct and/or indirect effects of Internet use on QoL, and to examine whether ethnicity and time the elderly spent with family moderate the mediation effect of Internet use on quality of life throughout loneliness. This descriptive-correlational study was carried out in 2016 by structured interviews with a convenience sample of 502 respondents aged 50 and older, living in northern Israel. Bootstrapping with resampling strategies was used for testing mediation a model. Use of the Internet was found to be positively associated with QoL. However, this relationship was mediated by loneliness, and moderated by the time the elderly spent with family members. In addition, respondents’ ethnicity significantly moderated the mediation effect between Internet use and loneliness. Internet use can enhance QoL of older adults directly or indirectly by reducing loneliness. However, these effects are conditional on other variables. The indirect effect moderated by ethnicity, and the direct effect moderated by the time the elderly spend with their families. Researchers and practitioners should be aware of these interactions which can impact loneliness and quality of life of older persons differently.