Defensive reactions to health-promoting information: an overview and implications for future research

Savouring Moderates Affect Reactivity to Daily Events in Old Age

OBJECTIVE

This study investigated savouring as a moderator of affect reactivity to daily events among older adults.

METHOD

A sample of 108 individuals aged 65-92 years (M = 73.11, SD = 5.92; 58% women) completed daily diary questionnaires over 14 days, reporting on daily stressors, positive events, savouring, and positive and negative affect.

RESULTS

Multilevel models showed that on days when a stressor was experienced, negative affect was higher when daily savouring (within-person) was low, but this association was not observed when daily savouring was high. Additionally, on days with positive events, negative affect was lower when trait savouring (between-person) was high, but this effect was not found when trait savouring was low.

DISCUSSION

The findings highlight the importance of savouring as a key factor in managing emotional responses to daily experiences among older adults. Specifically, deliberately engaging with positive experiences might buffer daily negative emotional responses.

Defensive Responses to Masculinity Threat: The Role of Precarious Manhood in Reactions to the Male Contraceptive Pill

This study examines how men evaluate a potentially masculinity-threatening message about the availability of a male birth control pill, framed as being released in the near versus distant future. Drawing on research on health-related defense mechanisms and precarious manhood, we hypothesized that men with higher levels of precarious manhood beliefs would react more defensively to the message - exhibiting greater message derogation, avoidance, lower perceived efficacy, and heightened concerns about side effects - especially when the pill was framed as being released soon. We further explored whether these defensive evaluations mediated the relationship between precarious manhood and intentions, moderated by temporal framing. To test these hypotheses, a sample of 398 men (M = 42.90, SD = 12.38) read an article describing a male birth control pill framed as either being released in the near or distant future. Participants then reported their perceptions of the article and the pill, their behavioral intentions, and their precarious manhood beliefs. Regression analyses showed that precarious manhood significantly predicted greater avoidance and higher perceptions of side effects. Moreover, higher perceived side effects mediated the association between precarious manhood and intentions to purchase the pill when it was framed as being released in the near future, but not when framed as being released in the distant future. These findings highlight the role of defensiveness in shaping how men with strong precarious manhood beliefs respond to masculinity-threatening health messages. Careful consideration of message framing, particularly in media presentations of male contraceptives, is crucial to mitigate defensive reactions that could hinder desired behavioral outcomes.

The differential effects of parent-targeted alcohol harm-reduction campaigns with varying executional styles

INTRODUCTION

Parental provision of alcohol to children is associated with a range of negative outcomes. Public health campaigns discouraging this practice are required as part of a comprehensive approach to reduce alcohol-related harm among minors, however, limited research has examined the relative effectiveness of different messaging approaches. This study compared the effects of two campaigns with different executional styles on parents' intentions to provide alcohol to minors-one campaign used a fear-based approach and the other adopted a first-person narrative approach.

METHODS

The study used a repeated cross-sectional design. An independent samples t-test was used to compare the effects of two campaigns with alternative executional styles on parents' alcohol provision intentions. Two ordinal logistic generalised linear models were used to assess whether intentions effects differed according to parents' demographic and behavioural characteristics.

RESULTS

Both campaigns were effective at motivating parents to abstain from providing alcohol to minors. This outcome was particularly notable among female respondents and those who had never provided alcohol to their children. Older respondents and those who used less alcohol were more likely to intend to change their behaviours as a result of exposure to the fear-based campaign, while the campaign using a narrative approach was more effective with heavier drinkers.

DISCUSSION AND CONCLUSIONS

Overall strong performance of both campaigns combined with varying effectiveness by parent attributes highlights the utility of parent-focused campaigns targeting alcohol provision to minors. To best protect minors, continued investments are needed to develop suites of evidence-based campaigns that resonate with different parent subgroups.

Health Information as "Fodder for Fears": A Qualitative Analysis of Types and Determinants of the Nonuse of Health Information

As not all individuals are willing to pay attention to health information it is crucial to understand and distinguish the underlying motives and the scope of various nonuse behaviors. To increase conceptual clarity and specify theoretical assumptions about the types of nonuse of health information and their determinants, we used a qualitative research approach. Semi-structured interviews with 11 female, 10 male, and 10 non-binary participants aged between 18 and 67 (M = 39.7) showed that information ignoring and avoidance are two distinct behaviors characterized by their motivational patterns. Information ignoring is a preference for other content, serving as a strategy to manage limited time resources and receptivity. Information avoidance is understood as a decision to avoid threatening health information serving emotion regulation. Our data further indicate that information ignoring and avoidance are not unidimensional constructs. Instead, the selectivity and consistency of both behaviors build various types of information ignoring and avoidance, which need to be explained differently considering individual differences, cognitive, affective, socio-normative, and structural factors. Further, theory specification should build on the revealed findings and test which factors relate to which kind of nonuse behaviors.

The role of emotion in urban development decision-making: A qualitative exploration of the perspectives of decision-makers

People's feelings about their neighbourhoods are important for health, but they may be undervalued in urban development decision-making. This study explores how decision-makers understand and respond to residents' emotions. Reflexive thematic analysis was conducted on a secondary dataset consisting of 123 interviews with influential professionals in urban development decision-making. We developed three themes and one subtheme: '(mis)understanding residents' emotions', 'neglecting the health impact of positive emotions', 'avoidance of emotion in community engagement' and 'sanitized emotions'. We recommend decision-makers engage directly with residents' emotions during urban development processes to ensure healthier place-making.

Managing Fear Responses: A Qualitative Analysis of Pictorial Warning Labels Five Years Post-Plain Packaging

INTRODUCTION

Although pictorial warning labels (PWLs) now dominate tobacco packages sold in many countries, few studies have probed how people who smoke respond to the threats presented several years post-plain packaging and larger PWLs. Understanding how people manage the fear and dissonance PWLs arouse, and the strategies they use to rationalize, diminish, and reject risk messages, could inform future PWL design.

AIMS AND METHODS

We undertook 27 in-depth interviews with people aged 18 and over (16 female, 8 Māori, and 13 aged ≤35) who smoked roll-your-own tobacco and lived in Aotearoa New Zealand. We probed participants' views on current PWLs and how they responded to these, then asked them to use alternative images and headlines to create new PWLs. We drew on the extended parallel processing model to interpret the data, which we analyzed using a reflexive thematic analysis approach.

RESULTS

People who smoke dislike PWLs, which they think reduce them to diseased body parts. While a minority thought existing PWLs were believable and effective, most reported avoiding PWLs by hiding or cognitively blocking them. Participants used diverse counterarguments to diminish PWLs' relevance and impact, and a minority displayed strong reactance. Several suggested developing PWLs that recognized them as whole people rather than patients in waiting, and recommended greater use of testimonials, particularly from people who had successfully become smoke free.

CONCLUSIONS

PWLs using more holistic and diverse messages could elicit greater engagement and responsiveness, and motivate cessation more effectively than existing health-oriented warnings.

IMPLICATIONS

Our findings suggest existing PWLs, which aim to arouse fear of ill health, could be complemented by warnings that emphasize the benefits of quitting. Continuing to use threat-based PWLs could stimulate greater rationalization and reactance. By contrast, PWLs that aim to illustrate how cessation could benefit people who smoke and their families, rather than instill a fear of disease, could avoid message rejection and counter-argument, and may prove a more powerful way of motivating cessation.

Individual characteristics associated with perceptions of control over mortality risk and determinants of health effort

People who believe they have greater control over health and longevity are typically more likely to invest in their long-term health. Investigating individual differences in perceived control over risk and exploring different determinants of health effort may help to tailor health promotion programs to more effectively encourage healthy behaviors. From a sample of 1500 adults, we measured perceived control over 20 causes of death, overall perceived uncontrollable mortality risk (PUMR), state-level optimism, self-reported health effort, and the accuracy of estimations of avoidable deaths. We found individual differences in perceptions of control over specific causes of death based on age, gender, and income. PUMR was predicted by socioeconomic variables expected to influence exposure to risk and resource availability. Higher levels of PUMR, not perceptions of control over specific causes of death, predicted self-reported health effort. The strength of relationship between PUMR and lower health effort was not moderated by state-level optimism. Age and education both positively predicted greater accuracy in assessing the prevalence of avoidable deaths. We suggest that PUMR may capture people's "general sense" of mortality risk, influenced by both exposure to hazards and the availability of resources to avoid threats. Conversely, perceived control over specific risks may involve more deliberate, considered appraisals of risk. This general sense of risk is thought to play a more notable role in determining health behaviors than specific assessments of control over risk. Further study is needed to investigate the degree to which PUMR accurately reflects objective measures of individual risk.

How do young women approaching screening age interpret the NHS cervical screening leaflet? A mixed methods study of identifying interpretation difficulties, barriers, facilitators, and leaflet interpretation, engagement and future screening behaviour

BACKGROUND

Cervical cancer is a common cancer among young women aged 25-29 in England, and the NHS cervical screening leaflet is the first point of contact for those being invited for their first screening. This study aimed to explore how young women (18-24) understand and engage with the leaflet, as well as the barriers and facilitators associated with its interpretation, engagement, and screening intentions.

METHODS

The study used a mixed-methods approach, including a survey (n = 120) to identify interpretation difficulties and how they were affected by different characteristics, and a follow-up interview (n = 10) to assess the utility of the leaflet, identify issues with its practicality, and determine the factors that influence screening intentions.

RESULTS

The survey results showed that interpretation difficulties were common, particularly regarding HPV assessment, screening results, additional tests/treatment, and screening risks. Lower interpretation accuracy was associated with lower numeracy scores and non-white ethnicity. Despite these difficulties, participants had high confidence and motivation to engage with the leaflet. The interviews revealed knowledge gaps, issues with the leaflet's practicality, and a preference for digital information. Factors that were identified as barriers and facilitators of leaflet interpretation, engagement, and screening intentions included knowledge, social influence, beliefs about consequences, environmental context and resources, social role and identity, emotions and intentions.

CONCLUSION

The current leaflet does not provide enough information for young women to make an informed decision about screening attendance. Implementing a digital invitation featuring simplified gist representation, targeted behaviour change techniques (BCTs), videos, and interactive tools can enhance education and promote screening behaviour. Future research should consider using digital tools and strategies to address existing barriers related to interpretation and engagement.

Persuasion Through Focus Groups: Helping Teachers Maintain Healthy Voices

This study was designed to determine whether participation in a single, 1-hour focus group would spur a change in health-related behavior. All the respondents were teachers who had participated in a focus group designed to learn about teachers' understanding that voice is a working tool. In the discussions, health-related behaviors were discussed as ways to deal with possible vocal strain or injury. Two months later, a follow-up survey was distributed to these participants asking them if they recalled the discussion and if they had sought out more information and/or had changed their vocal behavior due to their participation in the focus group. The qualitative data shows that the majority of these respondents both recalled the messages and had engaged in some type of health-related behavior change due to their participation in the focus group. Behavior change included such modifications as drinking more water and use of voice-amplification equipment in the classroom. Implications of this finding are discussed.

Relevance of Emotion of Anxiety and Fear of Dentistry as Motivational Conflict in Oral Health Behaviors

AIM

This study was undertaken with an aim to explore the influence of factors associated with anxiety and fear of dentistry on oral health behavior.

MATERIALS AND METHODS

A total of 84 patients aged 20-40 years visiting the dental institute for the management of gum diseases (gingivitis and periodontitis) and tooth decay (dental caries) were enrolled. Fear of dentistry and oral health behaviors were recorded employing a dental fear survey (DFS) and oral health behaviors checklist. Each of the 20-item scale of DFS was rated on a 5-point Likert scale. The oral health behavior checklist was based on oral hygiene habits, patterns of utilization of dental services, food habits, and use of tobacco products. Each of the 13-item checklist comprised a closed-ended statement with a high score corresponding to more positive oral health behavior.

RESULTS

Domains of dental fear (avoidance of dentistry, physiological arousal, and fear of specific stimuli) and total dental fear did not predict oral hygiene habits and nutritional preferences (p > 0.05). Physiological arousal was a positive predictor of utilization of dental services (p = 0.009) and oral health behavior (p = 0.042). Oral health behaviors were found to be positively correlated with three factors of DFS.

CONCLUSION

Anxiety and fear of dentistry are not found to influence personal preventive oral care with reference to oral hygiene habits. Avoidance of dentistry factor of DFS is positively correlated with oral health behavior. Dental fear and anxiety do not impact oral health behaviors adversely.

CLINICAL SIGNIFICANCE

In this era of youth and beauty, the utilization of professional dental care services is not affected by fear of invasive nature of dental procedures. Establishing the groundwork for knowledge regarding the scope of fear appeals in anxiety for dentistry may help to augment positive oral health behaviors for effective primary prevention of oral diseases. Interactions among personality characteristics, attitudes, emotions, and health behavior need further exploration. How to cite this article: Supriya, Singh R, Ahsan A. Relevance of Emotion of Anxiety and Fear of Dentistry as Motivational Conflict in Oral Health Behaviors. J Contemp Dent Pract 2024;25(3):280-288.

The working memory approach of persuasion: Induced eye movements lead to more social media self-control behaviours

In the framework of prevention of social media addiction, persuasive messages can be used to stimulate people to engage in social media self-control behaviours. However, the effects of these messages may be weakened by defensive reactions. In the Working Memory account of Persuasion, these defensive self-regulatory actions in the Working Memory (WM) are activated to lower a given threat. Because the WM has limited capacity, and these defensive processes take WM capacity, they can be inhibited by inducing eye movements (EMi). Adults (N = 117) from the general population listened in an online experiment to an auditory message on the negative consequences of social media use (SMU). Half of the participants were randomly assigned to the EMi condition; they were asked to keep watching a moving red square on their screen during the exposure to the auditory message. SMU self-control behaviour was the outcome measure, assessed by self-report 2 weeks later. The effects of EMi on SMU self-control behaviour were moderated by individual differences, indicating defensive self-regulatory actions: EMi significantly increased behaviour in participants who scored low on Cognitive Self-affirmation Inclination, high on SMU-control-failure, and, unexpectedly, low in SMU. This study detected defensive reactions towards persuasive information concerning SMU, using the EMi research paradigm.

Predictors of correct recall of genetic risk information among Hispanic individuals in Florida and Puerto Rico

OBJECTIVE

To identify predictors of genetic risk recall and examine whether recall influences adoption of skin cancer preventive behaviors among Hispanic individuals.

METHODS

Hispanic participants randomized to intervention arms (n = 463) of a precision prevention trial were provided MC1R risk information (average, higher) and asked to recall their risk after 3 and 9 months. Predictors of recall (correct versus did not recall/misremembered) were determined by backwards stepwise logistic regression. Intervention effects on preventive behaviors were estimated within strata of 3-month recall.

RESULTS

Age inversely predicted correct recall in both risk groups (average: OR3-months(3)= 0.97, 95%CI:0.94-1.01, OR9-months(9)= 0.96, 95%CI:0.93-0.99; higher: OR3 = 0.98, 95%CI:0.95-1.01, OR9 = 0.98, 95%CI:0.95-1.00). Education positively predicted recall among participants at average risk (OR3 =1.64, 95%CI:1.06-2.63, OR9 =1.73, 95%CI:1.12-2.81). Darker untanned skin color inversely predicted recall among participants at higher risk (OR3 =0.68, 95%CI:0.45-0.99, OR9 =0.74, 95%CI:0.50-1.09). Intervention effects for routine sunscreen use and undergoing a clinical skin exam were stronger among participants at higher risk who correctly recalled at 3 months than those who did not recall/misremembered.

CONCLUSIONS

Younger age, higher education, and lighter untanned skin color predicted correct recall. Better recall may improve skin cancer prevention outcomes.

PRACTICE IMPLICATIONS

Additional strategies are needed to boost recall among Hispanic individuals who are older, less educated, and darker-skinned.

Too close for comfort: leveraging identity-based relevance through targeted health information backfires for Black Americans

Communicators frequently make adjustments to accommodate receivers' characteristics. One strategy for accommodation is to enhance the relevance of communication for receivers. The current work uses information targeting-a communication strategy where information is disseminated to audiences believed to experience heightened risk for a health condition-to test whether and why targeting health information based on marginalized racial identities backfires. Online experimental findings from Black and White adults recruited via MTurk (Study 1) and Prolific Academic (Study 2) showed that Black Americans who received targeted (vs. nontargeted) health messages about HIV or flu reported decreased attention to the message and reduced trust in the message provider. White Americans did not differentially respond to targeting. Findings also demonstrated that (a) these negative consequences emerged for Black Americans due to social identity threat, and (b) these consequences predicted downstream cognitive and behavioral responses. Study 2 showed that these consequences replicated when the targeting manipulation signaled relevance directly via marginalized racial identities. Collectively, findings demonstrate that race-based targeting may lead to overaccommodation, thus precluding the expected benefits of relevance.

Are Fear Campaigns Effective for Increasing Adherence to COVID-Related Mitigation Measures?

BACKGROUND

Using fear to increase the uptake of preventative health behaviours is a longstanding practice, which could be useful in mitigating the spread of COVID-19. However, the impact of fear campaigns beyond behavioural outcomes has rarely been considered. It is possible that these threatening health messages could heighten health-related anxiety by inducing a tendency to interpret ambiguous stimuli in a threatening manner. This research aimed to evaluate the effects of fear-based articles about COVID-19, on intentions to adhere to mitigation measures and interpretation bias-a core maintenance factor in health anxiety.

METHOD

Two pilot studies were conducted with the aim of validating our novel COVID-related measures and assessing engagement with the threat manipulation. Following this, 375 community members were recruited through social media for the main study. Participants were then randomly allocated to read an article about COVID which was manipulated on both threat and efficacy. After reading the article, participants then completed measures of interpretation bias and intentions to engage in COVID-19 mitigation measures.

RESULTS

Although the threatening articles consistently produced greater COVID-related threat, they only generated a stronger interpretation bias in the first pilot study. Importantly, threat-based communications failed to enhance intentions to perform mitigation measures in any of the studies. Likewise, reading an article which bolstered self-efficacy did not increase intentions, compared to reading a low efficacy article.

CONCLUSION

This research suggests that fear appeals are unlikely to increase intentions to perform COVID-related mitigation measures.

And they slept happily ever after: Online interpretive repertoires on the use of benzodiazepines and z-drugs

Drawing on a critical social-psychological framework for discourse analysis, data from a popular forum for people over 50 were analysed to study how the habitual use of benzodiazepines and Z-drugs (BZD/Z) is discursively negotiated by Flemish older adults. We present five different repertoires (risk and addiction; alternative pathways; suffering; rationalisation; cessation) that illustrate how a pharmaceutical imaginary of these medications is constructed online and how posters act as reflexive users taking on a health role. Most repertoires emerge from a tacit norm on the undesirability of medication use for sleeping problems. In the alternative pathways and cessation repertoires this norm is implicitly accepted by focussing on how to either prevent or overcome chronic use with various alternative solutions or through tapering off, while the risk and addiction repertoire is used to more openly defend and discursively magnify the idea that medication has to be avoided at all cost. We discuss how this reflects a prevailing imperative of health and ethos of healthicisation of sleep. The rationalisation and suffering repertoires on the other hand challenge this norm by defending medication use. We further explore how these repertoires are used to self-position as either 'noble non-user', 'deserving and/or compliant patient' or 'rational user', reflecting previously found moral positions in offline settings. Our data add another position that has thus far not been discussed extensively with regard to prescription medication use, namely that of a 'recovered user'. As such, this study shows how this particular online community is a site for contestation of health promotion and medical/pharmaceuticalised discourses on sleep by users and non-users alike and offers a unique insight into how people in the age group that is known to use most BZD/Z discursively negotiate the use of these medications in pseudonymised online interactions.

Spit, Disgust, and Parasite Stress Theory: A Message Experiment

Public health interventions targeting coughing and spitting during the Tuberculosis and 1918 flu epidemics were largely successful. Specifically, public health officials' messaging framed the behavior of spitting as repulsive and endangering to others, prompting an elicitation of disgust. Anti-spitting campaigns - messaging that focuses on the threat of spit or sputum - have long been common during pandemics and manifested once again to combat the spread of COVID-19. Yet, few scholars have theorized if and how anti-spitting campaigns function to change behavior. One possibility is parasite stress theory, which posits that human behavior is driven by a desire to avoid pathogenic threats like spit. The application of these types of disgust appeals in public health messaging remains understudied and warrants exploration. To test the applicability of the parasite stress theory, our message experiment with US adults (N = 488) examined reactions to anti-spit messages that varied in visual disgust (low and high). For more highly educated respondents, the high disgust appeal directly decreased spitting intentions, and this relationship was stronger for individuals with higher levels of pathogen and moral disgust. Given the importance of public messaging during pandemics, future research should continue to examine the efficacy and theoretical underpinnings of specific disgust appeals.

Perceived threat and fear responses to e-cigarette warning label messages: Results from 16 focus groups with U.S. youth and adults

AIMS

A warning on e-cigarette packaging is one way the U.S. government can inform the public of known harms of e-cigarette use. Currently, the only required warning on these products is: "WARNING: This product contains nicotine. Nicotine is an addictive chemical." This exploratory study aims to inform potential future investigations and FDA decisions regarding alternative warnings that may generate fear in addition to being intentionally informational.

METHOD

Data were obtained from responses by 16 online focus groups with adult (N = 47, age range = 18-64) and youth (N = 32, age range 14-16) participants with various smoking and vaping experiences. We showed each focus group a set of hypothetical e-cigarette warning labels to determine how they respond to currently existing public statements that communicate information on the toxicity of ingredients in e-cigarettes, potential health risks, addiction to nicotine, and the uncertainty of the science regarding health effects of using these products. The focus group interviews were audio recorded and transcribed. Transcripts were subjected to a multiphase coding process to identify common response themes. Codes derived from the Extended Parallel Processing Model were then applied to understand impact of potentially fear-inducing language by warning category and age group.

RESULTS

For adults, all warnings-except those about addiction-gave rise to spontaneous danger control (intended) responses, such as quit intentions. Warnings highlighting cognitive and uncertain effects may be particularly promising for adult consumers of tobacco products because both gengerated danger control and response efficacy without evidence of fear control. However, responses also suggest that warnings risk discouraging some adults who use combustible cigarettes from transitioning to e-cigarettes for harm reduction. For youth, while evidence of response efficacy and danger control emerged among youth exposed to messages in all warning categories but one-addiction-unproductive reactions indicative of fear control were also prevalent among youth respondent across most warning types. On average, youth were more skeptical than adults about the harms of using e-cigarettes.

POLICY IMPLICATIONS

Implications of study findings for the development of future effective e-cigarette warning messages are explored.

Evaluating an alcohol harm-reduction campaign advising drinkers of the alcohol-cancer link

INTRODUCTION

Public awareness of the alcohol-cancer link is low. Provision of this information could reduce alcohol consumption and related harms. The Spread campaign is a multi-media education campaign implemented in Western Australia to inform people about the carcinogenic properties of alcohol and associated harms. The aims of the present study were to (i) examine attitudinal and behavioural outcomes of the Spread campaign and (ii) identify demographic and drinking status factors associated with enactment of harm-reduction behaviours resulting from exposure.

METHOD

A cross sectional survey of Western Australian drinkers (consumed alcohol at least a few times in the previous 12 months, n = 760) examined campaign recognition, campaign perceptions, and behaviours resulting from campaign exposure. Chi-square analyses and a generalised linear model were used to identify demographic and alcohol-related factors associated with behavioural outcomes.

RESULTS

Around two-thirds of respondents recognised the campaign (65%), and of these, 22% reported successfully reducing how often or how much they drank due to seeing the campaign. Three quarters (73%) of all respondents considered the campaign message about the alcohol-cancer link to be believable. Respondents drinking at levels above the Australian guideline were less likely to have positive perceptions of the campaign than those complying with the guideline, but were more likely to report enacting the assessed harm-reduction behaviours as a result of campaign exposure.

DISCUSSION AND CONCLUSION

The results suggest that provision of information about the alcohol-cancer link has the potential to motivate reduced alcohol consumption. Implementing such campaigns could constitute an effective alcohol harm-reduction strategy.

Danger control and fear control during public health emergencies: Considering the roles of fear and hope in the EPPM across different levels of trust

Public health emergencies pose considerable threats to global health and safety. The control of these emergencies requires the efforts of healthcare professionals and calls for the public to take protective actions. The present study not only puts fear back in the extended parallel process model (EPPM) but also considers another similarly productive emotion: hope. We examined the mechanisms behind the effects of four cognitive perceptions on protective actions (i.e., danger control) and information avoidance (i.e., fear control). A national online survey was conducted with 1676 participants during the outbreak of COVID-19 in China from February 1 to 29, 2020. The results revealed that perceived severity and susceptibility could lead to fear, positively affecting protective actions. On the other hand, perceived response efficacy and self-efficacy induced hope, which was positively associated with protective actions but negatively associated with information avoidance. Furthermore, the mechanisms behind the relationships among cognitions, emotions, and behaviors varied across levels of trust in healthcare systems.

The role of defensive information processing in population-based colorectal cancer screening uptake

BACKGROUND

Internationally, colorectal cancer screening participation remains low despite the availability of home-based testing and numerous interventions to increase uptake. To be effective, interventions should be based on an understanding of what influences individuals' decisions about screening participation. This study investigates the association of defensive information processing (DIP) with fecal immunochemical test (FIT)-based colorectal cancer screening uptake.

METHODS

Regression modeling of data from a cross-sectional survey within a population-based FIT screening program was conducted. The survey included the seven subdomains of the McQueen DIP measure. The primary outcome variable was the uptake status (screening user or nonuser). Multivariable logistic regression was used to estimate the odds ratio (OR) for screening nonuse by DIP (sub)domain score, with adjustments made for sociodemographic and behavioral factors associated with uptake.

RESULTS

Higher scores (equating to greater defensiveness) on all DIP domains were significantly associated with lower uptake in the model adjusted for sociodemographic factors. In the model with additional adjustments for behavioral factors, the suppression subdomains of "deny immediacy to be tested" (OR, 0.53; 95% confidence interval [CI], 0.43-0.65; p < .001) and "self-exemption" (OR, 0.80; 95% CI, 0.68-0.96; p < .001) independently predicted nonuse of FIT-based screening.

CONCLUSIONS

This is the first study outside the United States that has identified DIP as a barrier to colorectal cancer screening uptake, and it is the first focused specifically on FIT-based screening. The findings suggest that two suppression barriers, namely denying the immediacy to be tested and self-exempting oneself from screening, may be promising targets for future interventions to improve uptake.

Predictors of genetic risk recall among the participants of a randomized controlled precision prevention trial against melanoma

PURPOSE

Inherited variation in MC1R imparts low to moderate risk of melanoma. Research on genetic risk recall, factors predicting recall, and whether recall influences adoption of preventive behaviors is limited.

METHODS

Participants (n = 447) enrolled in a melanoma precision prevention trial were provided with MC1R risk information (average or higher) and after 6 and 12 months, were asked to recall their genetic risk. Predictors of recall were identified using backward stepwise selection. Intervention effects were reassessed after stratifying by recall.

RESULTS

Participants at higher risk were 2 to 3 times more likely to misremember or not recall than participants with average risk. Misremembering was almost exclusively observed among participants at higher risk. Among the participants with average risk, lower health numeracy and not completing the telephone follow-up were associated with not recalling or misremembering. Among the participants at higher risk, lower education was associated with not recalling and lower perceived comparative chance of developing melanoma was associated with misremembering. In general, participants at higher risk who correctly recalled had modestly stronger intervention effects on sun protection behaviors than those who misremembered or did not recall.

CONCLUSION

Future studies should examine different strategies to increase genetic risk recall, which may result in improved behavioral outcomes, especially among participants with lower education and health numeracy.

A Pilot Randomised Trial Investigating the Effects of Including Efficacy Messaging on Tobacco Warning Labels

INTRODUCTION

Smokers can respond defensively to health risk communication such as on-pack warning labels, potentially reducing their effectiveness. Theory suggests that risk perception together with self-efficacy reduces defensive responses and predicts target behaviors. Currently, tobacco warning labels globally predominantly target risk and do not explicitly consider efficacy.

AIMS

This study explores the effectiveness of combining Australian tobacco warning labels with efficacy content to increase quitting intentions.

METHODS

RCT in 83 smokers over 3 weeks. After a seven-day baseline phase (smoking from usual tobacco packaging), participants were randomized to one of two adhesive labels groups for the remaining 14 days: Standard health warning labels (HWLs) featuring enhanced efficacy messages (experimental group) or unmodified standard HWLs (control group). Participants attached these labels to their tobacco packaging and recorded their cognitions and smoking behavior once daily using Smartphones. Multilevel structural equation modeling was used to test theorized effects of the labels on self-efficacy, risk perception, and intentions to quit.

RESULTS

There was no effect of exposure to efficacy messages on either self-efficacy, risk perceptions, or intentions to quit. However, self-efficacy and risk perceptions were positively associated with quitting intentions at the within-person level.

CONCLUSIONS

The predictive relationships between self-efficacy, risk perception, and intention to quit were supported, however, supplementing standard warning labels with efficacy messages had no effect on these cognitions. Whether this is due to conditioned avoidance of HWLS, characteristics of the messages, or limitations imposed by format are unclear.

IMPLICATIONS

Self-efficacy and risk perception predict intentions to quit smoking. Adding efficacy content to tobacco health warnings may have the potential to bolster these cognitions but more research is required to determine the contexts in which this would be effective and who would be likely to benefit. The time course by which exposure to efficacy content might influence cessation self-efficacy and downstream quitting intentions also needs to be investigated.

Exploring the roles of fear and powerlessness in the relationship between perceived risk of the COVID-19 pandemic and information-avoidance behavior

The COVID-19 has seriously impacted various aspects of the society on a global scale. However, it is still unclear how perceived risk influences epidemic information-avoidance behavior which generally helps us understand public information avoidance. This study aimed to assess the relationship between the perceived epidemic risk and information-avoidance behavior and the mediating role of fear and powerlessness during the COVID-19 pandemic in China. A total of 557 Chinese respondents with COVID-19 treated in modular hospitals ranging from 16 to 72 years old were recruited and completed questionnaires in the face-to-face manner containing scales of the perceived epidemic risk of COVID-19, fear, powerlessness, and information-avoidance behavior. To test the conceptual model, we adopted structural equation modeling (SEM) with the perceived risk of the COVID-19 pandemic as a predictor, fear and powerlessness as mediating variables, and information-avoidance behavior as the outcome. The results indicated a significant and positive association between the perceived epidemic risk of COVID-19 and information-avoidance behavior. Powerlessness acted as the mediator between the perceived epidemic risk of COVID-19 and information-avoidance behavior. The perceived epidemic risk of COVID-19 influenced information-avoidance behavior through fear and powerlessness in turn. Findings from this study implied that public health managers should consider the mediating roles of negative emotions such as fear and powerlessness for coping with behaviors in public health emergencies, especially the information avoidance behaviors related to risk perception.

Explicitness, disgust, and safe sex behavior: A message experiment with U.S. adults

Sexual health risks are challenging to communicate given the potential negative reactions of target audiences to explicit language. Grounded in research on pathogen avoidance, the current study examined the impact of varying levels of explicit language on message perceptions and safe sex behavioral intentions. U.S. adults (N = 498) were randomly assigned to view messages detailing pandemic safe sexual behavior that contained either low or high levels of explicit language. High explicit language significantly increased perceived disgust which also indirectly linked high explicit language with increased intentions to engage in safe sex behavior. Individual difference variables moderated the impact of message explicitness; dispositional hygiene disgust moderated the impact of high explicit, hygiene-focused messages on safe sex intentions. Those with relatively low levels of dispositional disgust were more positively impacted by explicit language. The results suggest the value of increased message explicitness for sexual health communication and have implications for pathogen avoidance behaviors, the behavioral immune system, and dispositional and affective forms of disgust.

When freedom of choice leads to bias: How threat fosters selective exposure to health information

Selective exposure to online health information can be ascribed to two related defense motives: the motivation to confirm one's subjective perceptions and the motivation to protect relevant parts of the self-image, such as physical integrity. Our aim was to identify how these motives come into effect in the context of a health threat (fictitious feedback on an alleged heart disease risk). In a preregistered online study with N = 763 participants, we analyzed the impact of perceived and suggested risk on the degree of bias in selecting risk-related information on a fictitious Google search results page. Applying a 2 × 2 design with the experimental factor "risk feedback" and the quasi-experimental factor "perceived risk," we formulated six hypotheses. First, we expected a main effect of perceived risk on selective exposure to information suggesting no risk, and second, we hypothesized a main effect of perceived risk on mean quality rating of information suggesting a risk. Third, we proposed a main effect of risk feedback on selective exposure to information which suggests no risk, and fourth, we proposed a main effect of risk feedback on mean quality rating of information suggesting a risk. Fifth, we expected an interaction effect between perceived and suggested risk, and sixth, we proposed an interaction effect between perceived and suggested risk in different forms for each of the four conditions on quality ratings. Only the third hypothesis was confirmed: Receiving information which suggested a health risk increased the tendency to select information denying the risk. Additional exploratory analyses revealed moderator effects of health information literacy and participant age on the aforementioned relationships. In sum, our results underline the crucial role of defense motives in the context of a suggested health threat.

Assessment of skin cancer precision prevention materials among Hispanics in Florida and Puerto Rico

OBJECTIVE

To assess Hispanic participants' ratings of intervention materials and examine differences by language preference.

METHODS

Participants on a skin cancer prevention trial were randomized to receive generic (n = 457) or precision prevention materials conveying average (n = 195) or higher genetic risk (n = 268) based on MC1R genotype. Three months after receiving either English or Spanish language prevention materials, participants reported amount read, believability and clarity of materials, and intention to change preventive behavior.

RESULTS

Participants reported high levels on all four outcomes, but the precision prevention groups noted lower clarity than the generic group (p = 3.2 ×10-6). Participants preferring Spanish provided consistently higher scores than those preferring English. Among English-preferring participants, those in the precision prevention groups scored lower on all measures than those in the generic group.

CONCLUSIONS

Skin cancer prevention materials were well-received by Hispanic participants. Higher scores among participants preferring Spanish may indicate acquiescence bias, or that translated prevention materials met their linguistic needs. Participants in the precision prevention groups with English language preference may have challenges in the uptake of genetic risk results.

PRACTICE IMPLICATIONS

Availability of Spanish materials may have facilitated higher scores. Additional strategies should be explored to optimize participants' believability and clarity of precision prevention materials.

Ex-ante reminders: The effect of messaging strategies on reducing non-sustainable consumption behaviors in access-based services

Users’ non-sustainable consumption behaviors are affecting the sustainability of access-based services (ABSs), but ABS firms can utilize messaging strategies (ex-ante reminders) to persuade users to curtail their non-sustainable consumption behaviors. Through two online scenario-based experiments in China, this study determined that: (1) Compared with rational appeal messaging, emotional appeal messaging is better able to persuade consumers to curtail non-sustainable consumption behaviors. Furthermore, loss-framed messages are more effective than gain-framed ones. (2) Message appeal and message framing have an interactive persuasive effect on reducing such consumer behaviors. Loss-framed rational appeal messages are more persuasive at reducing non-sustainable consumption behaviors than gain-framed rational appeal messages, and gain-framed emotional appeal messages persuade consumers to reduce non-sustainable consumption behaviors more than loss-framed ones. (3) Consumers’ psychological ownership moderates the persuasive effect of messaging. Among consumers with a high level of psychological ownership of shared goods, only gain-framed emotional appeal messaging is effective at reducing non-sustainable consumption behaviors, whereas among consumers with low psychological ownership, the persuasive effect of loss-framed rational appeal messaging is more effective than gain-framed emotional appeal messaging. This study extends the research on non-sustainable consumption behavior management in ABSs and provides important inspiration for the management of ABSs consumer behavior.

Taking advantage of multiple identities to reduce defensiveness to personally threatening health messages

A host of studies have shown that self-relevant health messages may result in increased defensiveness and rejection of protective recommendations. Drawing on research showing that multiple identities offer psychological resources to deal with identity threats, we sought to examine whether the salience of an alternative identity before people are exposed to a personally relevant health message may buffer the threat and reduce defensive responses. Two studies were conducted on samples of daily smokers asked to read an antismoking message before completing a range of measures of defensiveness. Half of the participants had an alternative identity made salient beforehand (vs. no salience condition). Consistent with our hypotheses, Study 1 (N = 90) showed that this manipulation significantly reduced defensiveness to the message. Study 2 (N = 95) additionally showed that such effects only occurred when the alternative identity overlapped highly with the threatened identity. The theoretical implications of these findings are discussed.

Humour Against Binge Drinking During the COVID-19 Pandemic: A Cartoon-Based Anti-Alcohol Health Campaign Targeting Women-Who-Have-Sex-With-Women

This study focuses on the role of humour in health and well-being of women-who-have-sex-with-women (WSW) during COVID-19. This group has been shown to be vulnerable to alcohol abuse, especially as self-medication coping with social consequences of the COVID-19 pandemic. We investigated the potential usefulness of WSW-inclusive (i.e., depicting a female-female romantic couple) versus hetero-normative (i.e., depicting a male-female romantic couple) humorous cartoons in an anti-alcohol health campaign against excessive drinking among WSW. One-hundred-and-twenty-seven self-categorized WSW of diverse genders (woman, non-binary) and sexual orientations (e.g., lesbian, bisexual, pansexual, queer, heterosexual) participated in a 2 × 2 factorial between-participants design. Data were collected during the first months of the COVID-19 pandemic in The Netherlands. Humorous cartoons explicitly referring to lockdown measures systematically varied the humour subject (punchline about excessive drinking versus staying sober) and the couple (male-female, female-female) that were depicted. Although the (very brief) health message did not influence binge drinking determinants, the humorous health campaign depicting a female-female couple was perceived as more inclusive and evoked more amusement and less anger than when the cartoons depicted a male-female couple. High WSW identifiers were less amused about the health campaign text (but not the cartoons), less likely to share campaign materials offline (but not online), and had more positive binge drinking attitudes but lower binge drinking intentions than low identifiers. Implications are discussed.

Enhancing Adherence and Management in Patients with Hypertension: Impact of Form and Frequency of Knowledge Intervention

BACKGROUND

The alarming rise in prevalence of hypertension warrants psychosocial methods supplementing pharmacotherapy for better management and prevention of cardiac emergencies. The objective of the study was to assess the differential impact of the form and frequency of knowledge intervention on management of primary hypertension.

MATERIALS AND METHOD

The study was conducted on 256 hypertensive patients recruited through purposive sampling at health centers in Hyderabad, India. Pretest post-test control group quasi-experimental design was adopted for the study. There were two forms of the knowledge intervention, namely 'Direct Interaction' and 'Audio-Visual'. Each form was presented in two frequencies namely 'single exposure' and 'double exposure'. The four groups were labelled as Direct Intervention Single (DIS), Direct Intervention Double (DID), Audio-Visual Single (AVS) and Audio-Visual Double (AVD). Adherence and management of hypertension were assessed at baseline and six weeks post experiment. Analysis of Covariance (ANCOVA) was applied using IBM SPSS Statistics version 20.

RESULTS

ANCOVA followed by Bonferroni Multiple Group Comparison Test revealed significant differences between the four intervention groups and control group on adherence (p<.001). In case of hypertension management significant differences were observed between Control group and DIS, DID (P<.001), Control and AVS (P<.01). Control group did not differ from AVD.

CONCLUSION

There was a positive impact of Knowledge Intervention on adherence and management of hypertension. Double exposure in audio visual form was counterproductive in hypertension management.

Uptake of guideline-recommended postpartum diabetes screening among diverse women with gestational diabetes: associations with patient factors in an integrated health system in USA

INTRODUCTION

Clinical guidelines urge timely postpartum screening for diabetes among women with gestational diabetes mellitus (GDM), yet patient factors associated with screening uptake remain unclear. We aimed to identify patient factors associated with completed postpartum diabetes screening (2-hour oral glucose tolerance test within 4-12 weeks postpartum), as recommended by the American Diabetes Association (ADA).

RESEARCH DESIGN AND METHODS

Within the context of Gestational Diabetes' Effects on Moms (GEM), a pragmatic cluster randomized trial (2011-2012), we examined survey and electronic health record data to assess clinical and sociodemographic factors associated with uptake of ADA-recommended postpartum screening. Participants included 1642 women (76% racial/ethnic minorities) identified with GDM according to the Carpenter and Coustan criteria in a health system that deploys population-level strategies to promote screening. To contextualize these analyses, screening rates derived from the GEM trial were compared with those in the health system overall using registry data from a concurrent 10-year period (2007-2016, n=21 974).

RESULTS

Overall 52% (n=857) completed recommended postpartum screening in the analytic sample, comparable to 45.7% (n=10 040) in the registry. Screening in the analytic sample was less likely among women at elevated risk for type 2 diabetes, assessed using items from an ADA risk test (vs non-elevated; adjusted rate ratio (aRR)=0.86 (95% CI 0.75 to 0.98)); perinatal depression (0.88 (0.79 to 0.98)); preterm delivery (0.84 (0.72 to 0.98)); parity ≥2 children (vs 0; 0.80 (0.69 to 0.93)); or less than college education (0.79 (0.72 to 0.86)). Screening was more likely among Chinese Americans (vs White; 1.31 (1.15 to 1.49)); women who attended a routine postpartum visit (5.28 (2.99 to 9.32)); or women who recalled receiving healthcare provider advice about screening (1.31 (1.03 to 1.67)).

CONCLUSIONS

Guideline-recommended postpartum diabetes screening varied by patient clinical and sociodemographic factors. Findings have implications for developing future strategies to improve postpartum care.

Assessment of melanoma precision prevention materials incorporating MC1R genetic risk information

Few studies have examined cognitive responses to mailed precision prevention materials. MC1R is a robust, well-described melanoma susceptibility marker. The purpose was to assess cognitive responses to generic or precision prevention materials incorporating MC1R genetic risk. Non-Hispanic White participants (n = 1134) enrolled in a randomized controlled trial received either precision prevention materials incorporating MC1R genetic risk (higher/average) or generic prevention (standard) materials. Six months after baseline, 808 (71.3%) participants reported on the amount of prevention materials read (5-point scale); believability and clarity of materials; intention to change preventive behaviors (7-point Likert scale); and recall of their MC1R genetic risk. Comparisons were conducted using Kruskal-Wallis and chi-squared tests. Overall, participants read most to all (Mdn = 4, IQR = 2) of the prevention materials, reported high believability (Mdn = 7, IQR = 1) and clarity (Mdn = 7, IQR = 1), and moderate intention to change preventive behaviors (Mdn = 5, IQR = 2). Higher-risk participants reported slightly less clarity (Mdn = 6, IQR = 2) than either average-risk (Mdn = 6, IQR = 1, p = 2.50 × 10-3) or standard participants (Mdn = 7, IQR = 1, p = 2.30 × 10-5); and slightly less believability (Mdn = 6, IQR = 1) than standard participants (Mdn = 7, IQR = 1, p = .005). Higher-risk participants were 2.21 times as likely (95% CI = 1.43-3.43) to misremember or forget their risk compared to average-risk participants; misremembering was observed only among higher-risk participants (14%). Mailed precision prevention information were mostly read, highly believable and clear, and resulted in moderate levels of intention to change sun protection behaviors, bolstering the feasibility of population-level precision prevention. Defensive reactions may explain lower clarity, believability, and higher incorrect risk recall among higher-risk participants.

Dismissing "Don't Know" Responses to Perceived Risk Survey Items Threatens the Validity of Theoretical and Empirical Behavior-Change Research

Since the middle of the 20th century, perceptions of risk have been critical to understanding engagement in volitional behavior change. However, theoretical and empirical risk perception research seldom considers the possibility that risk perceptions do not simply exist: They must be formed. Thus, some people may not have formulated a perception of risk for a hazard at the time a researcher asks them, or they may not be confident in the extent to which their perception matches reality. We describe a decade-long research program that investigates the possibility that some people may genuinely not know their risk of even well-publicized hazards. We demonstrate that indications of not knowing (i.e., "don't know" responses) are prevalent in the U.S. population, are systematically more likely to occur among marginalized sociodemographic groups, and are associated with less engagement in protective health behaviors. "Don't know" responses are likely indications of genuinely limited knowledge and therefore may indicate populations in need of targeted intervention. This body of research suggests that not allowing participants to indicate their uncertainty may threaten the validity and generalizability of behavior-change research. We provide concrete recommendations for scientists to allow participants to express uncertainty and to analyze the resulting data.

Two experimental studies on the differential effects of low and high treatability information on the inclination to engage in cancer prevention

Two 3(control versus LTI versus HTI) × 2(self-affirmation versus no self-affirmation)-experiments were conducted. The first study presented a news message on the treatability of bowel cancer (N = 717); the second study was about skin cancer (N = 342). The dependent variables were the intention to engage in preventive behaviors and message acceptance. The results showed that when participants were exposed to LTI, only when response efficacy was low, a self-affirmation procedure increased their intention to prevent cancer (experiment 1), and increased message acceptance (experiment 2). When participants were exposed to HTI, the self-affirmation procedure did not increase the intention, and even reduced message acceptance. The findings suggest that defensive processes were active in reaction to LTI, but not in reaction to HTI. Although publishing LTI and HTI information in the media serves legitimate goals, it may have positive but also negative unintended effects on preventive behaviors in the population.

Talking about Sugar-Sweetened Beverages: Causes, Processes, and Consequences of Campaign-Induced Interpersonal Communication

Media campaigns may influence audience members directly, via message exposure, or indirectly, via conversations about the campaign. Either process has the potential to produce persuasion or counter-persuasion (i.e., boomerang). A laboratory experiment (N = 297) was conducted in which individuals viewed three anti-sugar-sweetened beverage PSAs under three conditions: Prompt (discussion allowed with instructions to evaluate the effectiveness of the PSAs), no prompt (discussion allowed, but not guided), and discussion not allowed. Conversations between dyad members were coded for quantity of on-topic talk and frequency of cognitive process words (e.g., because, therefore). Results showed persuasion and counter-persuasion via direct and indirect processes. On-topic talk and cognitive process words predicted intentions to reduce beverage consumption among heavy drinkers. The study is among the few to examine conversations provoked by media messages and to demonstrate how an experimental manipulation can guide the quantity and quality of those interactions.

Fear, Efficacy, and Environmental Health Risk Reporting: Complex Responses to Water Quality Test Results in Low-Income Communities

Reducing disease from unsafe drinking-water is a key environmental health objective in rural Sub-Saharan Africa, where water management is largely community-based. The effectiveness of environmental health risk reporting to motivate sustained behaviour change is contested but as efforts to increase rural drinking-water monitoring proceed, it is timely to ask how water quality information feedback can improve water safety management. Using cross-sectional (1457 households) and longitudinal (167 participants) surveys, semi-structured interviews (73 participants), and water quality monitoring (79 sites), we assess water safety perceptions and evaluate an information intervention through which Escherichia coli monitoring results were shared with water managers over a 1.5-year period in rural Kitui County, Kenya. We integrate the extended parallel process model and the precaution adoption process model to frame risk information processing and stages of behaviour change. We highlight that responses to risk communications are determined by the specificity, framing, and repetition of messaging and the self-efficacy of information recipients. Poverty threatscapes and gender norms hinder behaviour change, particularly at the household-level; however, test results can motivate supply-level managers to implement hazard control measures—with effectiveness and sustainability dependent on infrastructure, training, and ongoing resourcing. Our results have implications for rural development efforts and environmental risk reporting in low-income settings.

The structural model of cyberchondria based on personality traits, health-related metacognition, cognitive bias, and emotion dysregulation

INTRODUCTION

Cyberchondria is excessive seeking for online health-related information related to increasing health anxiety and distress levels. The current study investigated the mediating role of health-related metacognition, cognitive bias, and emotion dysregulation in the relationship between personality traits and cyberchondria.

METHODS

Participants were 703 individuals 18+ years old who had access to the internet (males = 43.8%, mean age = 33.82 ± 10.09 years and females = 56.2%, mean age = 34.37 ± 11.16 years). They voluntarily completed a questionnaire package that included the Cyberchondria Severity Scale (CSS), the revised NEO Personality Inventory (NEO-PI-R), the Difficulties in Emotion Regulation Scale (DERS), the Meta-Cognitions about Health Questionnaire (MCQ-HA), and the Health Cognitions Questionnaire (HCQ).

RESULTS

The initial evaluation of the model demonstrated that the personality traits of openness to experience, agreeableness, and conscientiousness had no significant relationship with other variables in the structural model, and the effects of neuroticism and extroversion were the only significant results. Rerunning the model with the removal of non-significant variables revealed a full mediation of health-related metacognition, cognitive bias, and emotion dysregulation in the relation between personality traits (neuroticism and extraversion) and cyberchondria. Fit indices demonstrated the acceptable fit of the model with the collected data (χ² = 979.24, p <.001; NFI = 0.92, CFI = 0.93, GFI = 0.90, IFI = 0.93, RMSEA = 0.071, and SRMR = 0.063). The results indicated that the present model could explain R ² = 54% of cyberchondria variance.

DISCUSSION

These findings suggest that health-related metacognition, cognitive bias, and emotion dysregulation could demonstrate a full mediating role in the correlation between personality traits and cyberchondria.

Are smokers scared by COVID-19 risk? How fear and comparative optimism influence smokers' intentions to take measures to quit smoking

Research suggests that smoking may compound the risk of serious health problems to smokers who contract COVID-19. This study examines whether and how exposure to news stories reporting the severe COVID-19 risk to smokers may influence smokers’ emotional responses (fear, anxiety, and sadness) and intentions to take measures to quit smoking. Current smokers in the US participated in an online experiment (N = 495) and were randomized to read smoking risk news stories or news stories reporting the combined risk of smoking and COVID-19. We found that combined risk news stories lead to participants feeling more fearful and sadder than when they viewed smoking risk news stories (M = 5.74; SD = 2.57 vs. M = 5.20; SD = 2.74; p < .05). Fear fully mediated the effect of news exposure on intentions to take measures to quit smoking (ß = .09; SE = 05; 95% CI [.010, .200]). Moreover, moderated-mediation analyses revealed that the mediating effect of fear was conditioned on the levels of comparative optimism, such that the association between fear and intentions to take measures to quit smoking was only significant among smokers whose comparative optimism was at the mean score (ß = .16; SE = 05; 95% CI [.071, .250]), and for those whose comparative optimism was high (ß = .27; SE = .06; 95% CI [.146, .395]). These results suggest that fear of the pandemic and optimism might play important roles in predicting and explaining the association between exposure to news stories and intentions to take measures to quit smoking. Messages about heightened risk of COVID-19 complications for smokers that increase fear might be an effective strategy to motivate smokers to quit. Such messages should be used to turn the adversity of COVID-19 pandemic into an intervention opportunity to reduce tobacco-related disease.

Intentions to reduce sugar-sweetened beverage consumption: the importance of perceived susceptibility to health risks

OBJECTIVE

There are numerous health effects associated with excess sugar-sweetened beverage (SSB) consumption. Interventions aimed at reducing population-level consumption require understanding of the relevant barriers and facilitators. This study aimed to identify the variables with the strongest relationship with intentions to reduce SSB consumption from a suite of variables derived from the literature.

DESIGN

Random-digit dialling of landline and mobile phones was used to survey adults using computer-assisted telephone interviews. The outcome variable was 'likelihood of reducing SSB consumption in next 6 months', and the predictor variables were demographics, SSB attitudes and behaviour, health risk perceptions and social/environmental exposure.

SETTING

Australia.

PARTICIPANTS

A subsample of 1630 regular SSB consumers from a nationally representative sample of 3430 Australian adults (38 % female, 51 % aged 18-45 years, 56 % overweight or obese).

RESULTS

Respondents indicated that they were 'not at all' (30·1 %), 'somewhat' (43·9 %) and 'very likely' (25·3 %) to reduce SSB consumption. Multivariate nominal logistic regressions showed that perceiving future health to be 'very much' at risk was the strongest predictor of intention to reduce SSB consumption (OR = 8·1, 95 % CI 1·8, 37·0, P < 0·01). Other significant predictors (P < 0·01) included self-perceptions about too much consumption, habitual consumption, difficulty reducing consumption and likelihood of benefitting from reduced consumption.

CONCLUSIONS

Health risk perceptions had the strongest relationship with intentions to reduce consumption. Age and consumption perceptions were also predictors in the multivariate models, whereas social/environmental exposure variables were not. Interventions may seek to incorporate strategies to denormalise consumption practices and increase knowledge about perceived susceptibility to health risks.

Information avoidance during health crises: Predictors of avoiding information about the COVID-19 pandemic among german news consumers

This study investigates the prevalence of source-specific information avoidance among German consumers and predictors of information-avoidance behavior in the context of the COVID-19 pandemic. Guided by the Risk Information Seeking and Processing Model (RISP), we propose that the perceived social norms, information insufficiency, risk perception, affective risk response, and attitudes toward seeking predict information avoidance. We supplement the RISP model by considering information overload as the vast volume and the incredulous quality of information in the COVID-19 pandemic challenge individuals' information acquisition and processing. Using a stratified demographic sample of news consumers of a federal German state (N = 1,000), we empirically examined the proposed model, answered the research question, and tested our hypotheses using structural equation modeling. The results reveal information avoidance among one-third of the respondents. They avoided online sources, including online-mediated interpersonal sources, more often than interpersonal sources and traditional mass media. Information avoidance was linked to more negative attitudes toward seeking and negative affective risk responses, more pronounced descriptive and injunctive avoidance norms, and perceived information overload. Attitudes and information overload were the most influential predictors of avoidance. In contrast, risk perception and information insufficiency were not associated with information avoidance. This study provides insights into theory development, contributes to the information behavior literature, and identifies barriers to communication during health crises.

The Role of Approach and Avoidance Motivation and Emotion Regulation in Coping Via Health Information Seeking

When dealing with a health threat, health information seeking (HIS) is a prominent way of engagement coping. Yet, there is only limited research as to its motivational and emotion regulatory antecedents. We present a theoretical model integrating approach and avoidance motivation, emotion regulation, HIS self-efficacy, and problem and emotion coping focus as predictors of HIS. We propose that, in the context of HIS, (1) approach and avoidance motivation have a direct effect on emotion regulation ability (positive and negative, respectively), (2) approach and avoidance motivation have indirect effects on intended comprehensiveness of search via emotion regulation, HIS self-efficacy and problem coping focus, (3) avoidance motivation has a direct effect on emotion coping focus. Our model was tested by means of structural equation modeling in a sample of university students (N = 283). Model fit was good, and all three hypotheses were supported. We show that emotion regulation ability is essential to explain the effects of approach and avoidance motivation on HIS as it fosters self-efficacy and a problem coping focus. The direct effect of avoidance motivation on emotion focus may represent an alternative way of coping with a health threat for those individuals who are highly sensitive to threat-related emotions.

Efficacy Assessments as Predictors of Uncertainty Preferences

Abstract. Background: Health challenges can cause feelings of uncertainty that individuals intend to reduce, increase, or maintain. Those goals are connected to different information seeking and avoidance behaviors, building four uncertainty preferences. Aims: We aim to understand what drives people to seek or avoid information through a more differentiated look at the underlying uncertainty preferences and their determinants. Our starting point to explain different uncertainty preferences are stable, individual traits determining individuals’ efficacy assessments. Method: We conducted a secondary analysis of an online survey among the German public in a sample with stratified demographic characteristics ( N = 3,000). The questionnaire measured different uncertainty preferences as well as coping efficacies and communication efficacy. Regression analyses determined the relevance of these predictors for the four uncertainty preferences. Results: The considered efficacy assessments explained a greater amount of variance in uncertainty preferences applying information seeking than information avoidance, but the influencing patterns are similar. Only health literacy as a communication efficacy was positively associated with both preferences applying information seeking and negatively associated with both preferences applying information avoidance. Limitations: The concept of uncertainty preferences should be critically assessed concerning its completeness. The low explanatory power of efficacy assessments for preferences underlying information avoidance strategies shows that further research is needed to identify relevant predictors. Conclusion: The findings suggest that efficacy assessments provide cognitive resources for goal-oriented uncertainty management, but a deeper understanding of specific underlying mechanisms of the different preferences requires further examination.

Explaining cancer information avoidance comparing people with and without cancer experience in the family

OBJECTIVES

Cancer information avoidance (CIA) serves as a barrier to preventive efforts. To learn how to combat this barrier, we aim to examine predictors of CIA in populations with and without cancer experience in the family, which are addressed differently in cancer prevention, according to specific informational barriers.

METHODS

A subsample of people with and without cancer in the family (n = 2,757) of an online survey with a sample stratified for the German population by age, gender, education, and region was conducted via an online access panel. The survey instrument was adapted from the Health Information National Trends Survey. Separate stepwise regression analyses were conducted.

RESULTS

Only a comparatively small proportion of the variance in CIA was explained by the predictors, ranging from R²  = .148 for people without cancer experience to R²  = .180 for participants with cancer experience in their family. Across the groups, the findings showed that people who were fatalistic about the risk of cancer, less health literate, who perceived less social pressure to be informed, and were less trusting in information sources more often avoided cancer information.

CONCLUSIONS

Our findings identify relevant target groups to be addressed and barriers to be removed for cancer communication efforts. Adequate information provision can be supported by programs for fostering health literacy and social network diffusion strategies.

How do people with knee pain from osteoarthritis respond to a brief video delivering empowering education about the condition and its management?

OBJECTIVE

To evaluate responses by people with knee osteoarthritis to a brief educational video about their condition that aimed to empower and motivate effective self-management. The video content addressed psychosocial contributors to pain and barriers to behaviour change.

METHODS

A mixed methods design, including a survey and semi-structured interviews, was used to collect data from 118 people (46-83 years, 78% female) with knee osteoarthritis.

RESULTS

Quantitative data analysis showed the video was rated positively on 0-6 scales for enjoyability (mean 5.0), helpfulness (4.9), relevance (5.0) and believability (5.4). The majority would recommend the video (89%), learned new information (78%) and/or reported intentions to change behaviour (78%). A minority disliked aspects of the video (23%). The thematic analyses identified three main themes: Reactions to the video, including emotions; Learning from the video, including new knowledge and empowerment, but also unmet information needs or disagreement; and Intentions, including behaviour changes, cognitive changes and help seeking.

CONCLUSION

Education about knee osteoarthritis with a focus on empowerment is well received by people with the condition, although some discordant views emerged.

PRACTICE IMPLICATIONS

The educational video about knee osteoarthritis can be recommended to promote effective self-management and counteract potential drawbacks associated with biomedical-based education.

Fear appeals to promote better health behaviors: an investigation of potential mediators

Background: Fear appeals are widely used in health communication, despite conflicting views on their effectiveness. Unresolved issues include possible mediation mechanisms and the effect of defensive reactions aimed at controlling a perceived danger. Methods: The present study compared the impact of three versions of an existing online course on how to prevent noncommunicable diseases. Participants, recruited in South America via a crowdsourcing platform, were divided randomly between three versions of the course - 'threat only'/'threat plus coping information'/'coping information plus threat' (reverse order). We then asked them to complete a questionnaire measuring perceived efficacy, perceived threat, defensive reactions, and intention to change unhealthy behaviors. Results: Using a serial parallel mediation model to test the course's impact on our dependent variables did not reveal any significant differences between the three versions. Perceived efficacy was positively associated with intention to change behavior, as well as with lower suppression, lower reappraisal, and greater denial. Suppression was the only defensive reaction to be associated with intention to change behavior: greater suppression was linked to less intention to change. Conclusions: Our results open interesting perspectives for research into defensive reactions.

The Impact of Stalking-Related Fear and Gender on Personal Safety Outcomes

Research has consistently found that more women worry about their personal safety and feel vulnerable to most every crime compared with men suggesting there is a gender fear gap. Environmental risk and prior victimization history impact concerns about personal safety. However, few studies include stalking as part of the victimization history. Two reasons studies may not include stalking are that adding more questions to a research assessment increases participant burden and measurement of stalking has not always been clear. The current study used a community sample of 2,719 men and women and a five-item stalking assessment to examine the prevalence and impact of stalking and stalking-related fear on concern about personal safety, perceived vulnerability to an attack, perceptions that risk of victimization is higher due to personal characteristics, discomfort when thinking about safety, and posttraumatic stress symptoms controlling for victimization history, age, and environment risk by gender. Overall, 30% of women and 12% of men experienced stalking using the extreme fear standard which is double the national rates. Stalking-related fear, for both women and men, was associated with all of the outcome measures. Furthermore, there were significant main effects of gender after controlling for stalking-related fear on three of the outcomes consistent with the gender fear gap. Based on these results, research studies should consider including stalking as part of the victimization history as it is likely to impact health and mental health outcomes as well as personal safety concerns and responses for both men and women.

Backfire effect of salient information on vaccine take-up experimental evidence from scared-straight intervention in rural northern Nigeria

Vaccination is the most cost-effective way to prevent mothers and infants from contracting tetanus. However, developing countries struggle with the persistent low take-up of vaccination. The low risk perceptions of disease can be one of the barriers to vaccination. One way to increase the risk perceptions of disease is to use salient loss-framed messages to highlight negative consequences of not getting vaccinated. We conducted a randomized controlled trial among 1,660 women in 80 villages in northeastern Nigeria. Respondents were randomly assigned to view one of two flipcharts: (1) control flipcharts, which contained written explanation about the severity of the disease, or (2) `scared-straight' flipcharts that contain the salient information about the disease severity in addition to the written explanation about the severity of the disease. Additionally, respondents were provided randomly assigned amounts of cash incentives. The scared-straight intervention backfired among women with no previous experience of tetanus vaccination: it decreased their vaccine take-up by 3.7-6.1 percentage points, even though it increased their perceived risk of disease and their fear level. The negative effect of the scared-straight intervention is the most prevalent among women who received the lowest amount of cash incentive. Women without experience of tetanus vaccination might have responded to the scared-straight flipcharts by denying the information provided because the flipcharts were too frightening. The use of the scared-straight tactic is not recommended to aim for the improved take-up of vaccination in developing countries where people might face budget constraints for achieving desirable behaviors.Trial Registration: The trial was registered at ISRCTN registry (ID: ISRCTN95083356).