title: The role of health consciousness in predicting attention to health warning messages.
abstract: OBJECTIVE
  Guided by information processing theory and the health belief model, this paper considers the relationship between health consciousness among the general population and attention to environmental health warnings about alcohol consumption. Mechanisms of exposure to three dominant types of impersonal alcohol-related health messages in the environment are explored.
  
  
  METHODS
  Cross-sectional survey using telephone interview data.
  
  
  METHODS
  A representative nationwide sample of adults was interviewed in 1993 (n = 1026), with a response rate of 63%.
  
  
  METHODS
  Key variables include exposure to warning labels on alcoholic beverages, to point-of-sale posters, and to advertisements in the media, as well as respondents' alcohol consumption, health problems (indicative of salience of health warnings), and level of health consciousness assessed by items tapping concern with nutrition and seeking information on health topics.
  
  
  RESULTS
  In the total sample, over a third had seen a warning label or poster and almost all had seen an advertisement about the risks associated with alcohol consumption in 1993. Survey respondents scored very high on five individual items that make up the health consciousness scale introduced here, with 69% endorsing all items. The scale demonstrated good internal reliability (alpha = .70) and was significantly correlated (p < .01) with not enjoying getting drunk and with usually reading product warning labels, suggesting construct validity. Yet the hypothesized strong relationships between health consciousness and attention to health warnings about drinking were not observed; nor was salience of messages a predictor of recall. Importantly, high proportions of underage drinkers and young adults at elevated risk for drinking problems are reached by container warning label messages. Mechanisms of exposure recall vary based on message source, with "container label recall" associated with heavier drinking, younger age, and purchasing patterns; "poster recall" associated with purchasing and health consciousness; and "advertisement recall" associated with heavy consumption and younger age.
  
  
  CONCLUSIONS
  These results are contrary to predictions from skeptics of broad-based informational interventions, who argue that only the already-health conscious are attentive to health warnings about the risks of alcohol consumption. These data suggest that the label is reaching intended target audiences, especially younger people, males, and heavier alcohol consumers. Future research in predicting attention to impersonal health warnings in the environment should continue to improve the assessment of constructs such as salience and health consciousness, and should further test the applicability of available theoretical models. Subsequent research should also consider additional measures to tap mechanisms of exposure to impersonal health messages to enable a better understanding of the population that is not being reached by such public health interventions.
authors.affiliation: Alcohol Research Group, Western Consortium for Public Health, Berkeley, CA 94705-2176, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Kaskutas
authors.forename: T K
authors.initials: TK
authors.lastname: Greenfield
mesh_terms: D000293:Adolescent; D000328:Adult; D000329:Advertising; D000428:Alcohol Drinking / Q000517:prevention & control; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D008297:Male; D012494:Sampling Studies