Laughing in the Face of Fear (of Disease Detection): Using Humor to Promote Cancer Self-Examination Behavior

Engaging Audience on Social Media: The Persuasive Impact of Fit Between Humor and Regulatory Focus in Health Messages

Drawing upon construal level theory and regulatory fit literature, this research examined the effect of fit between humor and regulatory focus on audience engagement with health information on social media. The results of two studies showed that incongruity humor (vs. aggressive humor) induced greater social proximity between the source and the viewer, and humor type interacted with regulatory focus of a message to impact audience engagement. Specifically, incongruity humor paired with a prevention-focused message (vs. a promotion-focused message) resulted in greater content endorsement and health information engagement, whereas aggressive humor combined with a promotion-focused message (vs. a prevention-focused message) led to greater content endorsement. Results further identified processing fluency as a mediator of the fit effect on audience engagement. This research offers important theoretical and practical implications for public health interventions on social media.

Engaging the dismissive: An assessment of humor-based strategies to support global warming action

This study aims to understand the influence of mirth, anger, and hope, as elicited by messages with different humor types, on support for global warming action, and the potential moderating role of individual climate concern. Although mirth did not significantly vary across the different stimuli, the analysis found that climate concern moderated the influence of hope on support for global warming actions. The implications of these findings, especially for respondents who were least supportive of actions to combat global warming, are discussed.

Patients and general practitioner knowledge and perception of testicular self-examination for cancer

PURPOSE

Testicular cancer (TC) predominantly affects young men and early detection enhances survival. However, uncertainty surrounds the impact of population-wide screening. Testicular self-examination (TSE) is a simple detection method but there is a gap in current practices that needs to be assessed. Our goal was to assess the perceptions and knowledge of male subjects in the general population (MP) and general practitioners (GPs) regarding TSE for TC.

METHODS

Two distinct surveys evaluating knowledge and perceptions of TSE for TC were administered to GPs and MP, aged 15‒45-years. Factors that could favour the realisation of TSE or improve the knowledge of TC were evaluated by multivariable logistic regression.

RESULTS

Overall, 1048 GPs (mean (SD) age: 35.1 ± 10.3 years) and 1032 MP (mean (SD) age: 27 ± 8.2 years) answered the survey. Among the GPs, only 93 (8.9%) performed scrotal examination for TC screening. Although the majority (n = 993, 94.8%) were aware of the age of onset of TC, most (n = 768, 73.3%) did not know the overall survival rate from TC. GPs familiar with the guidelines were more likely to explain TSE to their patients (OR = 2.5 [95% CI 1.5‒4.1]; p < 0.01). Among the MP, 800 (77.5%) admitted that they did not know how to perform TSE and 486 (47.1%) did not know the main symptoms associated with TC. MP who had already undergone TC screening were more likely to be familiar with the main symptoms (OR = 2.1 [95% CI 1.6‒2.7]; p < 0.001) and MP who knew someone with TC or who had already undergone TC screening were more likely to be aware of the correct prevalence of TC (OR = 1.9 [95% CI 1.3‒2.7], p < 0.01; and OR = 1.6 [95% CI 1.2‒2.1], p < 0.01; respectively).

CONCLUSION

The knowledge of both GPs and MP regarding TC could be improved. TSE screening and knowing someone close with TC improved the awareness of our subjects.

Boosts for walking: how humorous messages increase brisk walking among cognitively fatigued individuals

BACKGROUND

A well-studied internal barrier to regular physical activity, and more specifically brisk walking, is cognitive fatigue. However, thus far little research examined how cognitively fatigued individuals can be motivated to exercise, more specifically to engage in brisk walking. This study investigates whether humorous intervention messages might be an effective strategy to motivate cognitively fatigued individuals to brisk walk, and through which underlying processes.

METHODS

An online experiment was performed in which variation in cognitive fatigue was induced through mental arithmetic questions. Afterwards, participants (n = 250) recruited through Prolific, randomly received either humorous or non-humorous intervention messages related to brisk walking. Potential mediators of the relations between physical activity, humour and cognitive fatigue were measured, were self-efficacy, self-control, and motivation.

RESULTS

First, regression analyses confirmed that cognitive fatigue negatively influences brisk walking intentions and that the perceived humour of the intervention messages moderated this relationship. Second, results showed that self-control and self-efficacy are mediators explaining the relationship between cognitive fatigue and brisk walking intentions. Lastly, this study found that perceived humour of the intervention messages moderated the relationship between cognitive fatigue and self-control, indicating that perceptions of self-control were positively changed after receiving messages that were perceived as humorous compared to messages that were not perceived as humorous, subsequently increasing brisk walking intentions.

CONCLUSIONS

This study is the first to unravel the underlying relationship between humorous intervention messages and brisk walking intentions through positive changes in perceptions of self-control within a cognitively fatigued sample. Results of this study suggest that existing smartphone applications monitoring and promoting brisk walking should integrate tailored message strategies within their cues to brisk walk by implementing humour as a strategy to motivate users when they are cognitively fatigued.

An Experimental Test of the Effects of Public Mockery of a Social Media Health Campaign: Implications for Theory and Health Organizations' Social Media Strategies

This study explored how social media users' mocking of a public health campaign can affect other users' emotions, cognitions, and behavioral intentions. Inspired by public mocking of the CDC's "Say No to Raw Dough" campaign aiming to prevent food poisoning caused by eating raw flour-based products, this experiment (N = 681) employed a 2 (Public responses to a PSA: Mocking or serious) x 3 (Organizational response to public responses: Self-mocking, serious, or none) + 1 (control condition) design. Statistical tests revealed that user-generated mocking can lower intentions to avoid the health risk by decreasing perceptions of injunctive norms (that is, seeing others mock a public health campaign resulted in weaker perceptions that others think you should avoid the risky behavior). Mockery of a public health campaign also engender anger at the CDC and at other users, with the target of the anger having differential effects on intentions to avoid eating raw dough. Implications for theory and the practice of social media-based health promotion are discussed.

Humor-Based Messaging in Testicular Cancer Awareness Campaigns: A Comparative Critical Review

Extensive research showcases the extent and efficacy of humor-based messaging in general health promotion. However, the work describing humor's use within testicular cancer (TC) awareness is less developed. The aim of this comparative critical review was to determine the impact of using humor-based messaging in TC awareness campaigns to achieve a baseline assessment from which future research can be modeled. A literature search was conducted using seven databases to locate relevant literature. Three research questions guided this investigation: (1) To what extent has humor been used in TC awareness campaigns? (2) What does the literature reveal about the use of humor-based messaging on relevant health outcomes? (3) What are the limitations within current TC awareness strategies? Six studies were included in the review, of which three directly assessed the use of humor in TC awareness vis-à-vis intervention designs. Humor-based strategies were implemented to enhance knowledge of TC and testicular self-examination (TSE) procedures, reduce anxiety surrounding detection threat, and promote TSE. The rhetoric provided to men via various health interventions relied on humor and slang to promote TSE among males. Despite the small sample size of the included studies, this review determined that humor may be useful in reducing uncomfortable feelings surrounding TSE, increasing awareness of TC, and promoting TSE. When using humor-based messaging, however, the audience and type of humor implemented must be considered. Limited research exists assessing the long-term impact humor in TC promotion on health behavioral changes, easing anxieties related to detection, and increased self-efficacy surrounding TSE.

Seeing the funny side: Humor in pro-environmental communication

Our review, drawing from various fields such as communication, psychology, marketing, and environmental studies, delves into the potential for humor in pro-environmental messaging to mobilize social change. The review examines different forms of humor, including satire, stand-up comedy, and scripted entertainment programming, and their impact on audience responses. We also highlight the possible drawbacks of using humor and factors that moderate its effects. Overall, the evidence paints a mixed picture whereby pro-environmental humor is largely successful in influencing proximal cognitive outcomes (attention, perceptions) but has more limited influence on distal outcomes (behavior) with the greatest benefits seen among low-interest groups. The need for more diverse samples and robust experimental designs is emphasized to fully comprehend the efficacy of humor in effecting environmental change.

Fun with Frustration? TikTok Influencers' Emotional Expression Predicts User Engagement with COVID-19 Vaccination Messages

This study examined what kinds of TikTok video and message features are associated with user engagement in the context of COVID-19 vaccination. Content analysis was applied to study a sample of 223 COVID-19 vaccination-related videos from creators with at least 10,000 followers. The content analysis involved coding themes, video formats, the valence of attitude toward vaccination, and emotional expressions from the influencers. A majority of videos showcased personal vaccination experiences, followed by fictitious dramas and instructional information. More fictitious dramas expressed unclear attitudes, neither explicitly supporting nor opposing the COVID-19 vaccine, compared to personal vaccination stories and instructional videos. Some imaginative and dramatic scenes, such as zombie transformation or dramatic spasms after taking the vaccines, were widely imitated across influencers, perhaps humorously, and raised concerns about diminishing positive images of vaccine uptake. Videos with simultaneous expression of humor and frustration significantly predicted engagement when the video content opposed or was uncertain about taking the vaccine, implying the effectiveness of mixed emotional attributes within a message. This study provides insight into how social context and message choices by creators interact to influence audience engagement.

Creating persuasive health messages on social media: Effects of humor and perceived efficacy on health attitudes and intentions

This study examined how humor (incongruity humor vs. no humor) interacts with individual differences in perceived efficacy to influence health attitudes and behavioral intentions. Results of a controlled experiment (N = 294) revealed that among individuals with lower levels of perceived efficacy, incongruity humor, relative to no humor condition, resulted in greater source liking, which in turn, enhanced their attitudes and intentions to perform preventive health behaviors. However, for individuals higher in perceived efficacy, incongruity humor (vs. no humor) had an indirect negative effect on intentions via decreased attitudes. Theoretical and practical implications of these findings are discussed.

Death anxiety, death reflection and interpersonal communication as predictors of social distance towards people infected with COVID 19

Our study investigates several antecedents and consequences of negative emotional reactions to the COVID-19 pandemic in a cross-national sample of 737 participants. Our results show that COVID-19 anxiety and negative mood are positively predicted by death anxiety and the use in communication of general COVID-19 information. Death reflection reduces negative mood in relation to COVID-19 and attenuates the positive association between death anxiety on the one hand and the negative mood and anxiety in relation to COVID-19 on the other hand. The use of humoristic information about COVID-19 reduces anxiety and social distance towards people infected with COVID-19 and also attenuates the positive association between the use in communication of general COVID-19 information and negative mood in relation to COVID-19. Our results also show that the association between death anxiety and social distance towards those infected with COVID-19 is mediated by anxiety and negative mood in relation to COVID-19. Finally, the association between the use of COVID-19 information in interpersonal communication and social distance is mediated by anxiety and negative mood in relation to COVID-19. The study thus reveals specific insights for tailored interventions to reduce negativity towards people infected with COVID-19.

The effects of humor in health promotional messages on a college campus

This study examined how perceived threat moderates the effects of message type (humor vs. non-humor) on attitude and behavior intentions toward a mental health public service announcement (PSA) on a college campus. To investigate the relationships, a between-subject experimental survey was employed for 209 undergraduate students. Findings revealed a significant interaction effect between message type and perceived threat on attitude toward the PSA, visiting intention to a health center, and eWOM intention. Moreover, the moderated mediating role of attitude toward the PSA on visiting intention to a health center and eWOM intention was observed.

How Emotional Shifts Effect Youth Perceptions of Opioid Risk and Efficacy: Testing a Know the Truth Campaign Narrative

Integrating the extended parallel process model (EPPM) and the emotional flow hypothesis, we tested the persuasive effect of emotional shifts during exposure to a Know the Truth anti-opioid campaign narrative in a sample of middle-school students (n = 480). Testing two emotional flow sequences (threat to efficacy and efficacy to threat) of the Know the Truth narrative against a static (threat-only) emotional condition, we found that youth exposed to any emotional flow narrative reported higher levels of hope and lower levels of fear than those exposed to a threat-only narrative. We also found that a threat to efficacy narrative elicited higher levels of self-efficacy than an efficacy to threat emotional flow condition, suggesting that the emotional sequence influences self-efficacy, a well-established predictor of health behavior change. We conclude that the traditional threat to efficacy emotional flow may be superior to its inverse (efficacy to threat) when communicating with young people about opioid addiction. Implications for message design are discussed.

Framing Effects on US Adults’ Reactions to COVID-19 Public Health Messages: Moderating Role of Source Trust

Increasing politicization of health guidance and fluctuating trust in public health institutions have challenged effective coronavirus disease 2019 (COVID-19) public health communication in the United States. Applying the extended parallel process model, this research reports findings from two online survey experiments conducted at different points in the pandemic regarding two advocated risk reduction behaviors. Analyses test US adults’ emotional and argument strength reactions to experimental tweets attributed to the Centers for Disease Control (CDC) and Prevention which vary with regards to advocated behavior (social distancing; vaccination), emotional appeal, wellbeing orientation (individual vs. collective), and content frame (health vs. economic outcomes). Trust in the CDC is treated as a potential moderator. Results of path analyses indicated that emotional appeal and content frame had little impact on emotional or cognitive responses to the social distancing tweets, though unvaccinated adults with low trust in the CDC experienced greater hope and fear responses to tweets emphasizing collective benefits of vaccination. Hope reactions in both studies predicted greater perceived response efficacy for the advocated behavior, particularly among those with low CDC trust, while message annoyance undermined efficacy among low trust participants. Particularly among adults with low trust in the CDC, fear reactions led to reduced efficacy. Perceived efficacy of vaccination predicted greater intention to receive a COVID-19 vaccine, controlling for prior intention. Messages which inspire hope with regards to risk reduction behaviors and include sound arguments may be more motivating than fear-appeal messages, particularly among individuals with low levels of trust in public health institutions.

Using Humor to Promote Social Distancing on Tiktok During the COVID-19 Pandemic

Background

During the COVID-19 pandemic, many humorous videos on how to practice social distancing appeared on social media. However, the effect of using humor as a crisis communication strategy to persuade people to conform to social distancing rules is not known.

Objective

Drawing on the literature on humorous message framing and crisis communication, this research explores the effectiveness of a humorous message in communicating social distancing rules in two crisis severity phases (low vs. high severity) and also evaluates how humor affects individuals’ online and offline engagement intentions during the COVID-19 pandemic.

Methods

A 2 (message framing: humorous vs. non-humorous) x 2 (crisis severity phase: low vs. high) between-subjects design experiment was conducted to test the research questions during the first weeks of the COVID-19 pandemic in China from January 30 to February 2, 2020.

Results

The results showed that the severity of the phase of a health crisis can significantly affect stakeholders’ online and offline responses toward the disease. More specifically, in a low severity phase, humor led to increased source likability for the message, and more online and offline engagement intentions. However, no differences between a humorous and non-humorous message in perceived risk were observed. Whereas, in a high severity crisis phase, humor reduced individuals’ offline engagement intentions and a decrease in perceived risk, no significant difference was found between a humorous and non-humorous message on source likeability.

Conclusion

Humor can motivate both more online engagement and offline protective action intention when the crisis severity phase is low, while when crisis severity soars, a non-humorous message should be more desirable. More specifically, using humor in communicating information about an infectious disease can enhance the spokesperson’s likeability in a low severity phase, and also helps to spread health information to a larger audience. While, the negative side of using humor in communicating an infectious disease appears in severe crisis phases, as it then decreased the public’s perception of risk, and triggers less protective actions. Going beyond previous research, this study recognized that crisis severity changes in different phases of the spread of infectious disease, thereby providing actionable strategy selections for crisis practitioners in a dynamic communication environment.

Can A Funny Story about Tooth Brushing Decrease Plaque Scores in Children? A Longitudinal Field Experiment

Dental caries is the most common chronic condition among children, it is thus a necessity to develop health communication tools to increase children's dental hygiene. Prior research among adults indicates that entertaining narrative communication can promote health behaviors, but knowledge on narrative effects on children's health outcomes is limited. In a repeated measures field experiment (N = 94, 4-10 years) we examined the long-term effects of repeated exposure to a humorous tooth brushing narrative about an orange monkey, versus an expository text on dental care, on children's self-reported and biomedical dental hygiene (plaque scores). We also explored narrative, affective and cognitive processes. Findings showed that the humorous narrative increased character engagement, enjoyment, and moral judgment compared with the expository condition. Enjoyment and moral judgment, in turn, predicted increases and decreases in plaque scores, respectively. We conclude that effectiveness of humorous narrative approach crucially depends on whether the child understands it when a story character is violating the rule.

Exploring the Sequencing Effects of Fear-Hope Appeals on Promoting MMR Vaccination

Building upon recent theoretical perspectives on emotional flow and the dynamic nature of fear appeals specifically, this study examined the sequencing effects of the emotions (i.e., fear and hope) induced from a fear appeal on persuasion in the context of MMR vaccination. Specifically, an experiment (N = 386) with 2 video messages was conducted that manipulated the sequence in which participants experienced fear and hope, resulting in a fear → hope appeal and a hope → fear appeal. The findings show that the fear → hope appeal was more effective in increasing activism intentions than the hope → fear appeal. Fear and hope at different time points served as mediators for this effect. In addition, issue relevance was a moderator for this effect such that the fear → hope appeal was more effective only among those perceiving the issue as highly relevant. Discussions and implications are provided.

Experimental Effects of Tweets Encouraging Social Distancing: Effects of Source, Emotional Appeal, and Political Ideology on Emotion, Threat, and Efficacy

CONTEXT

Public health officials and celebrities use social media to provide guidance to reduce the spread of COVID-19. Messages apply different promotional strategies to motivate behavior change, likely yielding divergent reactions from partisan audiences. The Extended Parallel Process Model (EPPM) suggests that perceived threat for a negative outcome should impact perceived need for the advocated health behavior, which should be more appealing to an audience if perceived it to be efficacious and feasible.

OBJECTIVE

This study examines the interactive effects of Tweet source, message emotional appeal, and audience political affiliation on US adults' perceptions of COVID-19 threat and social distancing efficacy during early months of the pandemic.

DESIGN AND SETTING

This online survey experiment applies the EPPM to assess US adults' reactions to tweets encouraging social distancing. The experiment tests 3 emotional appeals (fear, humor, and neutral) and 2 sources (Centers for Disease Control and Prevention [CDC] and celebrity) on adults' emotional reactions and perceptions of COVID-19 threat and social distancing efficacy.

PARTICIPANTS

The final sample included 415 US adults (242 Democrat and 173 Republican) recruited through Amazon's Mechanical Turk.

MAIN OUTCOME MEASURES

Outcome measures were adapted from the EPPM and include perceived susceptibility to and severity of COVID-19, and response efficacy and self-efficacy regarding social distancing. Each was measured through the survey on a 7-point response scale.

RESULTS

Humor and fear appeal messages evoked less fear and guilt responses than a neutral tweet from the CDC. Fear and guilt emotions predicted greater perceived threat, while hope and pride predicted efficacy constructs in relationships moderated by political ideology.

CONCLUSIONS

Public health messages targeting a bipartisan audience through social media may increase perceived threat by inducing fear of COVID-19 infection. EPPM theory suggests boosting efficacy is also critical to message acceptance and behavior change; thus, inducing feelings of hope and pride in addition to fear may be particularly effective.

Why We Are Not Acting to Save Ourselves: ACT, Health, and Culture

Chronic health conditions are increasing at an alarming rate worldwide, and many could be prevented if people were to engage in specific lifestyle behaviors. Intervening on lifestyle behaviors is challenging due to the fact that the consequences associated with unhealthy behaviors are temporally distant and probabilistic, and the aversive functions of covert stimuli may interfere with people's engagement in healthy, preventative behaviors. This article explores the role of relational framing in the promotion of healthy lifestyle behaviors and summarizes research supporting the use of acceptance and commitment training (ACT) as a framework for prevention and intervention. We explore how ACT alters the context in which rigid patterns of rule following occur. ACT loosens the literal functions of stimuli so that experiential-avoidance behaviors are weakened, and healthy, values-consistent behaviors are strengthened. We propose culture-wide interventions inspired by contextual behavior science so that healthier societies can be cultivated.

A systematic review of humour-based strategies for addressing public health priorities

OBJECTIVE

To systematically review research into the use of humour-based health promotion strategies for addressing public health issues during the past 10 years.

METHOD

The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Thirteen studies were included in the review. Mental health, breast and testicular cancer self-examination, safe sex, skin cancer and binge drinking public health issues were targeted. Humour-based strategies were used to influence health attitudes and behaviours, encourage interpersonal sharing to indirectly affect health behaviour, and investigate the level of threat and humour associated with positive outcomes. Findings provided some evidence to support the use of humour-based strategies as determined by the right combination of audience characteristics, level of humour and amusement evoked, and message persuasion and behaviour change methods underpinning strategies.

CONCLUSION

Methodologies varied limiting comparability, although overall results indicate that humour-based health promotion strategies may be a useful tool for increasing awareness and help-seeking behaviour for public health priorities, particularly those associated with stigma. Implications for public health: Humour interventions vary widely because there can never be a standardised approach to evoking humour. Further research examining humour and public health promotion is needed.

Following science on social media: The effects of humor and source likability

Science communicators have been encouraged to use humor in their online engagement efforts. Yet, humor's effectiveness for engaging people with science remains an open question. We report the results of an experiment designed to elicit varied levels of mirth in respondents, which was positively associated with perceived likability of the communicator and motivation to follow more science on social media. Furthermore, mirth and perceived likability serially mediated the effect of the experimental manipulation on motivation and factual science knowledge served as a moderator. This indicates that, while humor might be an effective means of reaching audiences, downstream effects are likely to vary depending on individuals' knowledge.

Effects of Humor in Health Communication: Experimental Evidence for Video Sequences Aiming to Increase the Willingness to Donate Organs

Humor has been proven to provide support when dealing with fear-related aspects of life. Therefore, it might be a useful communication strategy for addressing the need for donated organs. We conducted an experimental study among University students in Germany (n = 236) aged about 25 years (M = 24.60, SD = 5.86) investigating the effects of four video sequences related to organ donation on the willingness to donate organs. Based on random allocation, each study participant received one video sequence. The video sequences were presented by either a prominent or non-prominent speaker and included either humorous or neutrally framed information related to organ donation. An online survey was conducted before and after the intervention. A follow-up to investigate long-term effects was conducted 4–6 weeks later. Overall, the four interventions led to high proportions of self-reported willingness to think about organ donation and talk about it with relatives and friends subsequent to the respective intervention. Appraisals beneficial to organ donation improved significantly only in the non-humorous interventions. It seems to be of little relevance whether the humorous message was communicated by a prominent or non-prominent person. However, future investigations should focus on sample populations with lower education, because they are less likely to possess an organ donor card and more likely to have lower levels of positive attitudes toward organ donation and may, therefore, show different results regarding the effectiveness of humorous interventions.

Your Eyes Do Not Lie! Dissecting Humor Effects in Health Messages Using Eye Tracker Technology

In the past decade, humor in scientific research has become more and more popular providing an increase of data identifying the context in which humor is a promising communication strategy in preventive health messages. To avoid the limits of declarative responses usually recorded in past studies, eye tracker technology offers the possibility to assess and dissect the effects of humor on visual attention. In this brief report, we first attempt to extend the results of previous studies by recording eye movements while participants were exposed to humorous and nonhumorous print health ads dealing with tobacco and alcohol consumption. A secondary purpose is specifically to test the visual attention French women devoted to humorous tobacco preventive ads, the worrying results of recent studies urging to find a way to improve tobacco preventive campaigns. Based on three complementary eye-tracking measures (i.e., total dwell time, fixation count, and revisits), the results showed that humorous health messages were scanned longer and more frequently and revisited more often compared to nonhumorous ones. In addition, humor appeared to reduce smokers' avoidance of preventive tobacco messages. The different pattern of visual exploration confirms that humor is a good strategy to grab attention even of individuals who are involved in the health topic addressed. In short, this paper argues for introducing lightness into a very serious subject, health communication, based on the analysis of eye movement evidence.

Let's Not Joke about It Too Much! Exposure to COVID-19 Messaging, Attitudes and Protective Behavioral Intentions

Our study evaluates the role of exposure to COVID-19 messaging in negativity towards COVID-19 and the intentions to engage in protective behaviors. Building on the theory of planned behavior (TPB), we derive a mediation model and test it in a sample of 737 participants (556 Romanians and 181 Kazakhs). The exposure to general information concerning COVID-19 positively predicts negative attitudes, negative emotions and the emergence of subjective norms in relation to COVID-19, as well as the likelihood of engaging in protective behavioral intentions. The exposure to humoristic communication, however, diluted the positive association between exposure to general information and negative attitudes, as well as negative emotions. The results support the overall predictions of the TPB and report positive associations between negative attitudes towards COVID-19, subjective norms and behavioral control on the one hand, and protective behavioral intentions on the other. Negative emotions significantly predict the likelihood of engaging in protective behaviors. Our results also show that older respondents tend to develop more negative attitudes towards COVID-19, yet they do not report stronger intentions to engage in protective behaviors than younger respondents. An important emergent result shows that time lapse seems to increase negativity towards COVID-19, yet it does not directly increase the likelihood of engaging in protective behaviors. Implications for public health communication related to COVID-19 are discussed.

A Laughing Matter? How Humor in Alcohol Ads Influences Interpersonal Communication and Persuasion

Exposure to alcohol ads increases alcohol consumption. A potential partial explanation is that certain (e.g., humorous) alcohol ads trigger conversations which can, in turn, increase drinking behaviors. Therefore, we investigated the influence of humor in alcohol ads on conversational occurrence, length, and valence about alcohol and alcohol ads. One hundred and fourteen participants were shown one of three beer ads (humor; positive; no ad), after which participants could voluntarily discuss the ad and alcohol. Next, all participants were requested to discuss the topic and answered a questionnaire assessing conversational valence and ad, brand, and alcohol evaluations. Results showed that humor leads to more conversations about the ad and alcohol, longer conversations about alcohol, and more positive conversations about the ad. This interpersonal communication, and especially conversational valence, was subsequently related to ad, brand, and alcohol evaluations. These findings may explain the effect of alcohol ads on alcohol consumption, and provide important starting points for using humor as a potentially effective behavior change tool.

Increasing the willingness to participate in organ donation through humorous health communication: (Quasi-) experimental evidence

Increasing people's willingness to donate organs after their death requires effective communication strategies. In two preregistered studies, we assessed whether humorous entertainment education formats on organ donation elicit positive effects on knowledge, fears, attitudes, and behavioral intentions-both immediately after the treatment and four weeks later. We test whether perceived funniness mediates expected effects on attitudes and intentions. Study 1 is a quasi-experiment which uses a live medical comedy show (N = 3,964) as an entertainment education format, which either contained or did not contain information about organ donation. Study 2, a lab experiment, tests humor's causal effect in a pre-post design with a control group (N = 144) in which the same content was provided in either a humorous or non-humorous way in an audio podcast. Results showed that humorous interventions per se were not more effective than neutral information, but that informing people about organ donation in general increased donation intentions, attitudes, and knowledge. However, humorous interventions were especially effective in reducing fears related to organ donation. The findings are discussed regarding the opportunities for sensitive health communication through entertainment education formats, psychological processes that humor triggers, and humor's role in health communication formats.

Application of the theory of regulatory fit to promote adherence to evidence-based breast cancer screening recommendations: experimental versus longitudinal evidence

OBJECTIVES

To reduce overtreatment caused by overuse of screening, it is advisable to reduce the demand for mammography screening outside the recommended guidelines among women who are not yet eligible for inclusion in systematic screening programmes. According to principles of regulatory fit theory, people make decisions motivated by either orientation to achieving and maximising gains or avoiding losses. A study developed in two phases investigated whether video messages, explaining the risks and benefits of mammography screening for those not yet eligible, are perceived as persuasive DESIGN: Phase 1 was an experimental study in which women's motivation orientation was experimentally induced and then they were exposed to a matching video message about mammography screening. A control group received a neutral stimulus. Phase 2 introduced a longitudinal component to study 1, adding a condition in which the messages did not match with the group's motivation orientation. Participants' natural motivation orientation was measured through a validated questionnaire PARTICIPANTS: 360 women participated in phase 1 and another 292 in phase 2. Participants' age ranged from 30 to 45 years, and had no history of breast cancer or known BReast CAncer gene (BRCA) 1/2 mutation.

RESULTS

In phase 1, a match between participants' motivation orientation and message content decreased the intention to seek mammography screening outside the recommended guidelines. Phase 2, however, did not show such an effect. Fear of breast cancer and risk perception were significantly related to intention to seek mammography screening CONCLUSIONS: Public health researchers should consider reducing the impact of negative emotions (ie, fear of breast cancer) and risk perception when promoting adherence to evidence-based breast cancer screening recommendations.

Perceived changes in psychological and physical symptoms after hospital clown performances in a cancer setting

Background: The therapeutic role of humor and hospital clowns has become a focus of interest in recent decades. Most of the research in the area has focused on children; here, we explore the influence of clown performances on adult cancer patients, their companions, and health-care staff.Methods: Ninety-nine cancer patients and 113 companions were assessed pre- and post-interventions performed by professional clowns; 31 health professionals were asked about the possible influence of the presence of clowns in hospital on their work.Results: Patients felt that clowning performances helped to reduce their level of psychological symptoms, but not their physical symptoms. Companions reported improvements in all the psychological symptoms explored. Health professionals reported that the presence of clowns in the workplace improved their well-being.Conclusions: Clowning performances helped to improve psychological functioning in all the populations studied, especially in companions. Adult hospitals should consider promoting clowning interventions to improve general well-being.

Effects of humorous interventions on the willingness to donate organs: a quasi-experimental study in the context of medical cabaret

Background

It has been shown that fears and misconceptions negatively affect the willingness to donate organs. Empirical studies have examined health communication strategies that serve to debunk these fears. There are promising indications that humor has the potential to influence health-related attitudes and behaviors. This study examines empirically whether medical cabaret, as a specific format for delivering health-related information in a humorous way, affects the willingness to donate organs.

Methods

A quasi-experimental study was conducted among the audience of a medical cabaret live show. Participants in two intervention groups and one control group were interviewed just before the start of the live show (t₀) and about 6 weeks later (t₁). Intervention group 1 (I₁) witnessed a ten-minute sequence by the cabaret artist about organ donation. Participants in I₂ witnessed the sequence and, in addition, received an organ donor card. Descriptive statistics and t-tests were used to investigate changes in attitudes and the willingness to donate organs from t₀ to t₁.

Results

A significant increase in the willingness to donate organs and an improvement in general attitude was observed in the intervention groups. Moreover, significantly more participants in I₂ carried an organ donor card after the intervention. Some fears could be reduced, while understanding of the reasons for organ donation could be increased via the intervention.

Conclusions

The study confirms that medical cabaret is able to affect respondents’ attitudes and behaviors even in the context of organ donation. Medical cabaret can enhance the willingness to donate organs and dispel negative concerns.

Joking about cancer as an avoidance strategy among US adults

Findings from years of research on fear appeals suggest that individuals with low efficacy utilize avoidance strategies when they perceive a significant threat-a process called fear control. Some research suggests that joking could be an avoidance strategy. The current study identifies conditions in which people are more likely to joke about colorectal cancer and explores how this behavior may be associated with screening avoidance. Older adults (N = 209) recruited from eight different worksites completed a survey measuring fear appeal constructs and enactment of colorectal cancer-related joking. Results of a moderated mediation analysis suggest that men were more likely to joke about colorectal cancer than women, particularly if they perceived significant threat but had limited self-efficacy, signifying fear control. Results support prior fear appeal research, suggesting that an increase in joking behavior concerning colorectal cancer may be indicative of screening avoidance, and describe belief-based mechanisms that explain differences between biological sex and joking.

The use of advertising appeals in breast cancer detection messages: a web content analysis

We explored the use of different advertising appeals in breast cancer detection messages. We analyzed the extent to which emotional appeals were applied in advertisements that promoted two forms of breast cancer detection behaviors: breast self-examination (BSE) and mammographic screening. Findings of a content analysis of 456 breast cancer-related advertisements gathered in February 2016 indicated that textual fear appeals, humor appeals and erotic appeals were more likely to be featured in BSE-promoting advertisements than in breast cancer-related advertisements with other message purposes. While shame-guilt appeals were more likely to be used in mammography-promoting messages, humor and erotic appeals were less likely to be applied. Regarding hybrid message appeals, combinations of humor appeals with erotic, fear and shame-guilt appeals, as well as combined erotic-fear appeals were found more in BSE-promotion messages. Mammography-promoting messages made less use of hybrid messages with a humorous touch as compared to breast cancer advertisements with other message purposes. The results are in contrast to research findings on the effectiveness of message appeals and thus allow to some extent the evaluation of whether scientific findings on the effectiveness of message appeals are reflected in the current advertising practice.

Fear and Humor Appeals in "The Real Cost" Campaign: Evidence of Potential Effectiveness in Message Pretesting

INTRODUCTION

In tobacco prevention campaigns, fear-appeal messages are widely used and generally shown to be effective, whereas the utility of humor appeals is less clear. This study compares the potential effectiveness of fear and humor ads developed for "The Real Cost" campaign.

METHODS

Adolescents (N=1,315) aged 13-17 years who were either experimenting with smoking or susceptible to smoking initiation were randomized to view either a single ad (of three fear and two humor ads in total) or nothing (control condition). Those in the ad viewing condition completed measures on fear, amusement, and perceived ad effectiveness. All participants completed measures on smoking attitudes and risk perceptions. Data were collected in 2014 and 2015. Analysis was performed in 2016.

RESULTS

Compared with control, both fear and humor ads produced greater risk perceptions (p<0.001). Fear ads also produced more negative smoking attitudes (p=0.001); humor ads had a similar effect on attitudes that approached significance (p=0.07). Fear ads scored higher on perceived ad effectiveness and fear, and lower on amusement than humor ads (p<0.001). In regression models, fear was a stronger predictor of perceived ad effectiveness, smoking attitudes, and risk perceptions than amusement for fear ads, whereas amusement was a stronger predictor of these outcomes than fear for humor ads.

CONCLUSIONS

Both fear and humor appeals have potential to be effective in "The Real Cost" campaign. Concurrent employment of these message strategies should help to diversify messaging and consistently recapture the target audience's attention.

SUPPLEMENT INFORMATION

This article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.

A visual affective analysis of mass media interventions to increase antimicrobial stewardship amongst the public

Objectives

In an innovative approach to improve the contribution of health psychology to public health we have analysed the presence and nature of affect within the visual materials deployed in antimicrobial stewardship interventions targeting the public identified through systematic review.

Design

A qualitative analysis focused on the affective content of visual materials garnered from a systematic review of antibiotic stewardship (k = 20).

Methods

A novel method was devised drawing on concepts from semiotics to analyse the affective elements within intervention materials.

Results

Whilst all studies examined tacitly rely on affect, only one sought to explicitly deploy affect. Three thematic categories of affect are identified within the materials in which specific ideological machinery is deployed: (1) monsters, bugs, and superheroes; (2) responsibility, threat, and the misuse/abuse of antibiotics; (3) the figure of the child.

Conclusions

The study demonstrates how affect is a present but tacit communication strategy of antimicrobial stewardship interventions but has not – to date – been adequately theorized or explicitly considered in the intervention design process. Certain affective features were explored in relation to the effectiveness of antimicrobial resistance interventions and warrant further investigation. We argue that further research is needed to systematically illuminate and capitalize upon the use of affect to effect behaviour change concerning antimicrobial stewardship.

Using efficacy cues in persuasive health communication is more effective than employing threats - An experimental study of a vaccination intervention against Ebola

OBJECTIVES

Although much effort has been made to study fear appeals in persuasive health communication, there is still mixed support for the effectiveness of this approach. Therefore, this research investigated the effect of invoked fear via health communication messages on crucial components of the Extended Parallel Process Model (EPPM) by focusing on the rarely examined interaction between perceptions of threat and efficacy and their effects on fear control and danger control processes as well as health-relevant outcomes.

DESIGN

We recruited 447 participants (M_age  = 32.00 years; 64% female) for a 2 × 2 between-subjects experimental study via quota sampling. While completing an online questionnaire, subjects were randomly assigned to view one of four versions of a mock website containing information about vaccinations against Ebola virus disease (EVD), which varied in threat and efficacy.

METHODS

After seeing the stimulus, participants completed assessments of their perceptions of threat and efficacy, evoked fear, adaptive and defensive responses to the presented message, attitudes, and intentions. Structure equation modelling (SEM) was used to analyse the relationships within the model (EPPM).

RESULTS

Promoting efficacy with respect to EVD was more effective than emphasizing threat, resulting in danger control rather than fear control processes. Although threat may be effective in attracting peoples' attention, there is a comparatively small effect of evoked fear on attitudes and intentions.

CONCLUSIONS

The data support the assumption that there is an important association between threat and coping appraisals facilitating behaviour change. Moreover, the widely held notion that people have to be scared or threatened to encourage attitude and behaviour changes should be treated with caution. Communication should instead focus on efficacy to foster adaptive responses. Statement of contribution What is already known on this subject? There is mixed support for the effectiveness of fear appeals in persuasive health communication, especially regarding the interaction of threat perceptions and coping appraisals for fear and danger control processes. The Extended Parallel Process Model - being a current and often applied model to investigate the effects of fear appeals - suggests a multiplicative relationship between threat perceptions and coping perceptions Most studies applying conventional analysis strategies (e.g., [M] ANOVAs) indicate that perceptions and appraisals of threat and efficacy are not directly related to each other. What does this study add? It demonstrates the parallelism and interaction between threat appraisal and coping appraisal processes and demonstrates the usefulness of SEM in testing associations within the EPPM. It confirms the assumption of an important multiplicative association between threat and coping appraisals within the EPPM, while related cognitive processes still seem to operate independently. Adaptive responses to persuasive messages are mainly triggered using efficacy cues, not threat, which could also be triggered by promoting positive emotional experiences (e.g., gain-framing or entertainment education).