Narrative Health Communication and Behavior Change: The Influence of Exemplars in the News on Intention to Quit Smoking

Development and Evaluation of Messages for Reducing Overscreening of Breast Cancer in Older Women

BACKGROUND

Many older women are screened for breast cancer beyond guideline-recommended thresholds. One contributor is pro-screening messaging from health care professionals, media, and family/friends. In this project, we developed and evaluated messages for reducing overscreening in older women.

METHODS

We surveyed women ages 65+ who were members of a nationally representative online panel. We constructed 8 messages describing reasons to consider stopping mammograms, including guideline recommendations, false positives, overdiagnosis, and diminishing benefits from screening due to competing risks. Messages varied in their format; some presented statistical evidence, and some described short anecdotes. Each participant was randomized to read 4 of 8 messages. We also randomized participants to one of 3 message sources (clinician, family member, and news story). We assessed whether the message would make participants "want to find out more information" and "think carefully" about mammograms.

RESULTS

Participants (N=790) had a mean age of 73.5 years; 25.8% were non-White. Across all messages, 73.0% of the time, participants agreed that the messages would make them seek more information (range among different messages=64.2%-78.2%); 46.5% of the time participants agreed that the messages would make them think carefully about getting mammograms (range =36.7%-50.7%). Top-rated messages mentioned false-positive anecdotes and overdiagnosis evidence. Ratings were similar for messages from clinicians and news sources, but lower from the family member source.

CONCLUSIONS

Overall, participants positively evaluated messages designed to reduce breast cancer overscreening regarding perceived effects on information seeking and deliberation. Combining the top-rated messages into messaging interventions may be a novel approach to reduce overscreening.

Designing and testing social media campaign messages to promote COVID-19 vaccine confidence among rural adults: A community-engaged approach featuring rural community leader and clinician testimonials

Despite the growing availability of effective COVID-19 vaccines in rural communities in the United States, widespread vaccine hesitancy delays COVID-19 vaccine coverage in rural communities and threatens to worsen pre-pandemic rural-urban disparities in other vaccination rates, including influenza and routine pediatric immunizations. Therefore, there is an urgent need to develop communication-based interventions to improve vaccine confidence in rural America. This study demonstrates the efficacy of a community-engaged approach to developing social media campaign messages in promoting COVID-19 vaccine uptake and pro-vaccine social diffusion among rural adults. Using a community-engaged approach, we developed social media campaign videos varying in (a) featured messengers (clinicians versus community leaders) and (b) the presence of personal testimonials. We conducted a national online experiment (N = 1,364 rural adults) in spring 2022. We found that videos featuring clinicians serving rural communities and their testimonials increased (a) vaccination intentions in the unvaccinated group (4-point scale, b = 0.23, p =.015) and (b) intention to discuss the messages with others (4-point scale, b = 0.14, p =.037), share the message (4-point scale, b = 0.15, p =.026), and promote the vaccines to others (9-point scale, b = 0.48, p =.013). Results suggest that vaccine promotional social media campaigns targeting rural populations can benefit from including clinician testimonials.

A Meta-Analysis Comparing the Effectiveness of Narrative vs. Statistical Evidence: Health vs. Non-Health Contexts

This study is a meta-analysis of primary studies that make a direct comparison between narrative and statistical evidence in both health- and non-health-related communication contexts. The meta-analysis included 50 studies with 65 experimental pairs (k = 65) based on 13,113 (20-1270) participants. We examined the overall persuasiveness of evidence type by computing the correlations (r's) for all pairs, based on the random-effects model, which revealed an effect size of 0.016 (95% CI, -0.014 to 0.045, p = 0.296). Two types of evidence did not significantly differ in effectiveness under either communicative context. The moderation analysis indicated that narrative evidence had a significant advantage over statistical evidence for health messages advocating for prevention behaviors. Compared to non-student samples, the narrative evidence trumped statistical evidence for health-related issues. As communication research continues to investigate the implications for message persuasiveness derived by narrative and statistical appeals, our study suggests that the relative effectiveness is likely a complicated and nuanced matter. Practical implications and limitations have also been outlined.

Overcoming Black Americans' Psychological and Cognitive Barriers to Clinical Trial Participation: Effects of News Framing and Exemplars

This study examines how news features (framing and the use of exemplars) can help overcome two common barriers (psychological and cognitive) impeding Black American participation in clinical trials. In an online experiment, Black participants (N = 390) viewed social media news posts varying in framing (focus on psychological vs. cognitive barriers) and use of an exemplar (present vs. absent and White vs. Black) and then responded to outcome measures including perceived message effectiveness, message attitudes, and intention to participate in clinical trials. The findings illustrate that including a racially matched (i.e. Black) exemplar improves attitudes toward clinical trial messages. Most notably, featuring a race-matched exemplar increases intention to participate in a trial when the messages discuss psychological barriers. These findings enhance our understanding of how messages can be better designed to increase Black American participation in clinical trials, thereby contributing to reducing health inequities and improving health outcomes.

Nudging policymakers on gendered impacts of policy

Despite the proliferation of nudge research in the last few decades, very little published work aims to nudge the behavior of policymakers. Here we explore the impact of a well-established nudge on policymakers in the Northwest Territories of Canada. In a pre-registered randomized controlled trial, we emailed an invitation to policymakers (N = 263) to attend an online briefing on gendered impacts of policy. In the treatment condition (N = 133), the invitation contained personal stories of two women whose lives were disproportionally impacted by public policies more than men. In the control condition (N = 130), the invitation did not contain such stories. After the briefing, we sent all participants in both conditions a link to a public pledge that they could sign. The pledge was to lead and advocate for equity-oriented policymaking. Contrary to our prediction, there was a small backfiring effect where policymakers in the treatment condition (3.0%) were less likely to attend the briefing than the control condition (7.7%). However, two policymakers (1.5%) in the treatment condition signed the public pledge compared to one (0.8%) in the control condition. The current findings reveal the limits of using personal stories as a nudge to influence policymakers. We discuss insights gained from this experiment and follow-up debriefings with policymakers on how to improve future behavioral interventions designed to nudge policymakers.

Optimization of an Information Leaflet to Influence Medication Beliefs in Women With Breast Cancer: A Randomized Factorial Experiment

BACKGROUND

Adherence to adjuvant endocrine therapy (AET) is low in women with breast cancer. Negative beliefs about the necessity of AET and high concerns are barriers to adherence.

PURPOSE

To use the multiphase optimization strategy to optimize the content of an information leaflet intervention, to change AET beliefs.

METHODS

We conducted an online screening experiment using a 25 factorial design to optimize the leaflet. The leaflet had five components, each with two levels: (i) diagrams about AET mechanisms (on/off); (ii) infographics displaying AET benefits (enhanced/basic); (iii) AET side effects (enhanced/basic); (iv) answers to AET concerns (on/off); (v) breast cancer survivor (patient) input: quotes and photographs (on/off). Healthy adult women (n = 1,604), recruited via a market research company, were randomized to 1 of 32 experimental conditions, which determined the levels of components received. Participants completed the Beliefs about Medicines Questionnaire before and after viewing the leaflet.

RESULTS

There was a significant main effect of patient input on beliefs about medication (β = 0.063, p < .001). There was one significant synergistic two-way interaction between diagrams and benefits (β = 0.047, p = .006), and one antagonistic two-way interaction between diagrams and side effects (β = -0.029, p = .093). There was a synergistic three-way interaction between diagrams, concerns, and patient input (β = 0.029, p = .085), and an antagonistic four-way interaction between diagrams, benefits, side effects, and concerns (β = -0.038, p = .024). In a stepped approach, we screened in four components and screened out the side effects component.

CONCLUSIONS

The optimized leaflet did not contain enhanced AET side effect information. Factorial experiments are efficient and effective for refining the content of information leaflet interventions.

The Use of Narrative in Science and Health Communication: A Scoping Review

BACKGROUND

Many people deny science and reject health recommendations despite widely distributed facts and statistics. Didactic science and health communication is often dry, and relies on the false assumption that people make purely evidence-based decisions. Stories can be a powerful teaching tool by capturing attention and evoking emotion.

OBJECTIVE

We explore the impact and appeal of, and describe best practices for, using narrative (storytelling) versus didactic methods in science and health communication.

PATIENT INVOLVEMENT

No patients were involved in the review process.

METHODS

We searched PubMed and Web of Science for articles either: assessing effectiveness of narrative science/health communication; assessing acceptability of (or preference for) narrative science/health communication; giving advice on how best to use narrative; and/or providing science-based explanations for how/why narrative succeeds.

RESULTS

Narrative science/health communication is effective and appealing for audiences across a variety of topics and mediums, with supporting evidence across fields such as epidemiology, neuroscience, and psychology. Whether narrative or didactic messaging is most effective depends on the topic, audience, and objective, as well as message quality. However, combining narrative with didactic methods is likely to be more effective than using either strategy alone.

DISCUSSION

Narrative science/health communication merits wider implementation and further research. Narrative communication creates openness to information by delaying the formulation of counterarguments.

PRACTICAL VALUE

Science and health communicators should collaborate with cultural and storytelling experts, work directly with their target audiences throughout the message development and testing processes, and rely on popular story elements (e.g., first-person point of view, relatable protagonists) to improve the comprehension, engagement, and thoughtful consideration of their intended audience.

FUNDING

This work was funded by Thirty Meter Telescope, with which two authors (GKS and SD) were affiliated. Otherwise, the funding organization had no role in the study and/or submission.

Narrative Messages and the Use of Emotional Appeals on Endometriosis Screening Intention: The Mediating Role of Positive Affect

Endometriosis affects around 10% of women globally, yet the awareness and screening rates for this condition are relatively low. Utilizing an online survey-based experiment with a sample of 18-30-year-old young women (N = 326), this study aimed to investigate the efficacy of narrative messages vs. non-narrative messages for promoting endometriosis screening intention, as well as to evaluate the effectiveness of hope appeal vs. fear appeal in narrative messages. The study also examined the potential mediating mechanisms through self-efficacy and positive affect responses that may help elucidate the effect of emotional appeals on behavioral intentions, while taking into account an individual's readiness to change. Findings indicated that narrative and non-narrative messages did not produce significantly different screening intentions. Compared to the use of fear appeal, the hope appeal in narrative messages predicted a higher level of positive affect responses, which was associated with increased endometriosis screening intentions. Individual difference in readiness to engage in endometriosis screening was not found to be a significant moderator. These results have implications for future research utilizing hope appeals in narrative health messaging. The observed significant mediational pathway through positive affect advances understanding of positive discrete emotions as facilitators to health-related cognition and behavior changes.

A Randomized Controlled Trial of A Theory-Based Concussion Education Video for NCAA Division I Athletes

A large body of research demonstrates that concussions are exceedingly common and extremely difficult to detect. Despite medical efforts to develop sophisticated tools to detect concussions, research continues to demonstrate that proper detection relies on prompt and thorough symptom reporting from the injured athlete. In the context of sports, such reporting requirements are complicated by systems that reward athletic performance. This study seeks to provide student athletes who play NCAA Division I high-contact sports with a theoretically driven intervention to improve their attitudes and behavior toward concussion reporting. Division I student athletes (N = 345) viewed one of three conditions: an NCAA handout consistent with current practices, the experimental video, or a non-treatment control video, then responded to questions regarding attitudes and behaviors toward concussion reporting. Overall, results support the video's effectiveness in changing perceptions of concussion injuries. Nuances of the findings lead to a discussion for practical implications to transform concussion-reporting attitudes and behaviors among athletes.

The Effectiveness of CDC's Rx Awareness Campaigns on Reducing Opioid Stigma: Implications for Health Communication

Often health communication campaigns addressing misusing prescription opioids and opioid use disorder (OUD) do not pay enough attention to the associated stigma. This study investigated the effectiveness of a well-designed opioid awareness campaign on reducing stigma and provided evidence for future health communication design. CDC's Rx Awareness videos were used as the experiment material. 137 college students participated in this online experiment, and audience characteristics and video features were considered and tested. The results showed that Rx Awareness videos significantly reduced participants' stigmatizing attitudes and perceived public stigma and increased their empathy toward people with OUD. Empathy is a promising strategy to reduce opioid stigma. People with an opioid prescription history expressed more empathy. Recovery information, prescription history, and narrators' race influenced the audience's perceived public stigma. Implications for health communications and limitations of the study are discussed.

Effects of Communication Source and Racial Representation in Clinical Trial Recruitment Flyers

The current study was designed to examine effective message strategies that can be employed in designing mediated communication messages to improve clinical trial research participation. In the study, a total of 300 participants completed an online experiment in which they responded to five different clinical trial recruitment advertisements whose information sources varied in their credentials and race. Overall, peer-featured ads in which previous clinical trial participants communicated their prior experience in clinical trial participation, compared to expert-featured ads in which medical doctors communicated information about clinical trials, led to higher message and topic relevance, higher message credibility, more favorable attitudes toward clinical trials, and higher intentions to participate in future clinical trials. Further, there was a statistically significant interaction among source credentials, racial match (between source and participant), and participant's race on message and topic relevance such that both White and Black participants rated ads from racially mismatched peers highly effective (greater message and topic relevance); however, for doctor featured ads, White participants reported higher message and topic relevance for racially matched (White doctor) ads, and Black participants reported higher message and topic relevance for racially mismatched (White doctor) ads. We discuss theoretical and practical implications.

"You're more engaged when you're listening to somebody tell their story": A qualitative exploration into the mechanisms of the podcast 'menopause: unmuted' for communicating health information

OBJECTIVE

While health podcasts can be effective in reducing stigma and increasing knowledge, we know little about their mechanisms of action. This qualitative study explored the mechanisms of how women connected with the podcast 'menopause: unmuted', which presented menopause information in a storytelling format.

METHODS

A diverse sample of 30 women aged 40-60 years were interviewed after listening to the podcast. Interviews covered participant's views and perceptions of the stories presented. Transcripts were analyzed thematically.

FINDINGS

Two overarching themes were identified. 'Openness and authenticity' describes the value of personal stories told in an authentic way by real experts-by-experience. 'Relatability and representation' explores participants' emotional reaction to the podcast, influenced by the extent to which they identified with the stories and storytellers on the podcast.

CONCLUSIONS

Authenticity and relatability were identified as key mechanisms through which participants connected with audio stories, consistent with Fisher's narrative theory. These findings have important implications for the application of storytelling in podcasts designed to influence health behaviors.

PRACTICE IMPLICATIONS

Diverse stories representing a range of demographic characteristics and experiences are needed when creating podcasts about health information to increase listener's relatability and connection.

Formative Research for the Development of the CHoBI7 Cholera Rapid Response Program for Cholera Hotspots in Bangladesh

Cholera is a severe form of acute watery diarrhea that if left untreated can result in death. Globally, there are 2.9 million cholera cases annually. Individuals living in close proximity to cholera cases are at a higher risk for developing cholera compared to the general population. Targeted water, sanitation, and hygiene (WASH) interventions have the potential to reduce cholera transmission in cholera hotspots around cholera cases. The objective of this study was to expand the scope of the Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) program, focused on cholera patient households, for delivery in cholera hotspots in urban slums in Dhaka, Bangladesh. Thirty-one semi-structured interviews were conducted in cholera hotspots around cholera patients, and three intervention planning workshops were conducted to inform modifications needed to the CHoBI7 program. After exploratory interviews, a two-phase, iterative pilot study was conducted for 9 months to test the developed CHoBI7 Cholera Rapid Response program among 180 participants to further inform modifications to intervention content and delivery. Findings from pilot participant interviews highlighted the need to adapt intervention content for delivery at the compound-rather than household-level, given an environment with multiple households sharing a water source, toilets, and kitchen facilities. This was addressed by conducting a "ring session" for intervention delivery in cholera hotspots for households to discuss how to improve their shared facilities together and encourage a compound-level commitment to promoted WASH behaviors and placement of soapy water bottles in shared spaces. Based on the low number of soapy water bottles observed in communal spaces during the first iteration of the pilot, we also added context-specific examples using the narratives of families in mobile messages to encourage WASH behavioral recommendations. Formative research identified important considerations for the modifications needed to tailor the CHoBI7 program for delivery in cholera hotspots in urban Bangladesh.

Are some narratives better than others?: The impact of different narrative forms on adolescents' intentions to text and drive

Psychological reactance theory posits individuals seek to restore freedom when threatened. Communication scholars have hypothesized persuasive messages can constitute threats to freedom. The current study engages questions about the potential for different forms of narratives in public service announcements (PSAs) to trigger freedom threats by examining responses to a PSA campaign that utilized three forms of narrative (celebrity testimonials, peer testimonials, and accident stories) to decrease adolescent texting and driving intentions. Participants (N = 214) watched anti-texting and driving narratives, and completed measures of threat to freedom, anger, negative cognition, and attitudes/intentions toward texting/driving. Compared to celebrity/peer testimonial PSAs, accident stories triggered increased anger and, indirectly, decreased intentions to drive safely. The results also suggest the need for continued examination of the best way to model psychological reactance theory, and the value of further research explicating anger as a mechanism of message effects.

Formative Research for the Development of Evidence-Based Targeted Water, Sanitation, and Hygiene Interventions to Reduce Cholera in Hotspots in the Democratic Republic of the Congo: Preventative Intervention for Cholera for 7 Days (PICHA7) Program

Compared to the general public, household members of cholera patients are at a 100 times higher risk of contracting cholera during the 7-day high-risk period after a cholera patient has been admitted to a health facility for treatment. The Preventative-Intervention-for-Cholera-for-7-days (PICHA7) program aims to reduce household transmission of cholera during this 7-day high-risk period through a health facility-initiated water, sanitation, and hygiene (WASH) program promoting handwashing with soap, water treatment, and safe water storage. The PICHA7 program is delivered to cholera patient households through: (1) a pictorial flipbook delivered by a health promoter; (2) a cholera prevention package (handwashing station, drinking water vessel with lid and tap, and chlorine tablets); and (3) weekly WASH mobile messages sent to patient households in the Democratic Republic of the Congo (DRC). The objectives of this study were to conduct formative research to identify facilitators and barriers of the promoted WASH behaviors for cholera patient households and to tailor the PICHA7 program to target these facilitators and barriers. Formative research included 93 semi-structured interviews with diarrhea patient households and healthcare workers during exploratory research and a pilot study of 518 participants. Barriers to the promoted WASH behaviors identified during exploratory and pilot study interviews included: (1) low awareness of cholera transmission and prevention; (2) unaffordability of soap for handwashing; and (3) intermittent access to water limiting water for handwashing. For intervention development, narratives of the lived experiences of patient households in our study were presented by health promoters to describe cholera transmission and prevention, and soapy water and ash were promoted in the program flipbook and mobile messages to address the affordability of soap for handwashing. A jerry can was provided to allow for additional water storage, and a tap with a slower flow rate was attached to the handwashing station to reduce the amount of water required for handwashing. The pilot findings indicate that the PICHA7 program has high user acceptability and is feasible to deliver to cholera patients that present at health facilities for treatment in our study setting. Formative research allowed for tailoring this targeted WASH program for cholera patient households in the DRC.

Do Storytelling and Processing Motivation Matter? Comparing Narratives and Exemplars in Promoting Hepatitis C Screening among College Students

Encouraging hepatitis C screening, particularly among young adults who are at increased risk of infection, is essential for eliminating viral hepatitis. A 3 (narrative vs. exemplar vs. informational message) × 2 (processing motivation: low vs. high) between-subjects experiment was conducted among college students to compare the effectiveness of different message strategies and examine the moderating role of processing motivation. Findings revealed that the narrative was perceived more favorably than the exemplar message, and both messages led to a greater screen intention than the informational message. The narrative persuaded by increasing transportation and identification and, then, enhancing message perceptions. However, these mediation paths did not explain the effects of the simple exemplar. Moreover, the effects of the narrative and the exemplar did not differ significantly depending on levels of processing motivation. The study advances a theoretical understanding of the differences between narratives and exemplars. It also offers practical suggestions for campaign message design.

Incorporating fantasy into gamification promotes student learning and quality of online interaction

We used the design-based research approach to test and refine a theoretically grounded goal-access-feedback-challenge-collaboration gamification model. The testbed was a 10-week, university-level e-learning design course offered in two consecutive semesters. In Study 1, we implemented the initial goal-access-feedback-challenge-collaboration model in semester one of the 2020-2021 academic year (N = 26). The aim was to enhance student behavioral engagement in online discussion forums, affective engagement in the class, and learning performance. The results of Study 1 showed that although most participants were engaged in this gamified learning experience during the first two sessions, they gradually lost interest and their participation in online discussions dropped over the next eight weeks. Thus, we introduced a new element, fantasy, into the original model. In Study 2, we tested the effectiveness of the goal-access-feedback-challenge-collaboration-fantasy model on students' learning outcomes in semester two of 2020-2021 (N = 23). The results of Study 2 suggested that, compared to the original model, the goal-access-feedback-challenge-collaboration-fantasy model can better promote students' engagement in online discussion, as measured by increased interaction with peers, learning experience, and learning performance.

Examining the Effects of Celebrity (Vs. Noncelebrity) Narratives on Opioid Addiction Prevention: Identification, Transportation, and the Moderating Role of Personal Relevance

Celebrity disclosures and narratives are popular strategies in health promotion. However, less is known about their joint effects and the mechanisms through which they function. A 2 (narrative type: celebrity vs. layperson) x 2 (personal relevance: low vs. high) online experiment (N = 248) tested the impact of different narrative types in increasing awareness about prescription opioid abuse. Results indicated that a celebrity narrative is more persuasive than its layperson counterpart. Also, personal relevance toward opioid addiction moderated the influence of narrative type. Celebrity narratives evoked more positive attitudes toward opioid prevention and greater behavioral compliance intentions with the recommended action for low-relevance individuals. Transportation and identification mediated the effects of celebrity narratives on participants' issue attitudes and behavioral intentions, but only for low-relevance individuals. Practically, the data suggest that incorporating celebrities in health narratives about opioid addiction prevention facilitates behavioral compliance, especially for individuals to whom a pressing health issue like opioid misuse is currently of low relevance.

Global COVID-19 Advertisements: Use of Informational, Transformational and Narrative Advertising Strategies

This study employs the informational and transformational approaches from Taylor's Six-Segment Message Strategy Wheel and narrative transportation theory to understand the use of different advertising message strategies in COVID-19 advertisements on a global scale. Understanding how advertisers constructed their public messages during a global pandemic is a necessary first step before follow-up research can be done to assess which message strategies were most effective. Content analysis was performed on the entire COVID-19 video ad library (N = 354) from Ads of the World website that were published from March to September 2020 from 49 countries. Results suggested that most of the ads used a transformational strategy with a focus on the social aspect of limiting community spread instead of an informational approach. Many of the ads also employed a narrative message strategy that used storytelling to transport and persuade viewers. Perhaps the most interesting finding is that the use of narrative message strategy was related to storytelling, ad length, music, and humor, but independent from the use of informational strategies.

Increasing Perceived Risk of Opioid Misuse: The Effects of Concrete Language and Image

Risk perception is a critical determinant for individuals' health behavior change, especially for behaviors with distal future consequences. Building on construal-level theory, this study investigates if and how thinking concretely about the negative consequences of opioid misuse influences people's risk perception toward opioid misuse. Two message cues - images and concrete (vs. abstract) language - are proposed to influence concrete thinking and perceived temporal distance, which in turn influence risk perception directly and through negative affect. Using a factorial online experiment with Amazon Mechanical Turk workers (N = 220), this study found that messages using concrete language made people think more concretely about the negative consequences of opioid misuse. Perceived concreteness, in turn, increased risk perception and negative affect. Negative affect also increased risk perception. The use of images decreased perceived temporal distance, which in turn, changed risk perception through its influence on negative affect. Theoretical and practical implications are discussed.

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.

How marijuana use status affects responses to anti-marijuana messages

Background

The current study examined how cannabis use status impacts cognitive and emotional reactions to public health campaigns about cannabis, and the degree to which these reactions influence message likeability and attitudes about cannabis-related harms.

Methods

In a between-subjects design, 252 subjects recruited via Amazon Mechanical Turk viewed six real-world cannabis education messages: three message themes (cognitive ability, driving, and health harms) from each of two real-world public campaigns. Subjects answered questions measuring their cognitive and emotional reactions to each message as well as message likeability and harm perceptions of cannabis. Analyses examined the mediating effects of message responsiveness on the association between baseline cannabis use (user vs non-user) with indices of liking and harm.

Results

For all three message themes, informativeness ratings mediated the effect of cannabis user status on the outcomes of perceived harmfulness and message likeability. Specifically, cannabis users perceived cannabis as less harmful and reported all messages as less likeable compared to non-users, partly because they perceived the messages to be less informative than non-users. Surprisingly, users found some of the messages to be more pleasant, which was associated with increased perceptions of harm and message liking compared to non-users.

Conclusions

Cannabis education campaigns that take into account differences in emotional and cognitive reactions by use experience, rather than use a "one size fits all" approach, could possibly maximally impact likeability and harm perceptions of these messages.

The Exploration of How Social Media Cultivate College Student Smokers: Theorizing Valence of Communication, Impression Management, and Perceived Risks and Benefits of Smoking in the O1-S-R1-O2-R2 Model

The purpose of this study is to build a theoretical framework to account for how social media lead college students to smoke. Arguing critical concepts, such as valence of communication, impression management, perceived risks and benefits, this study develops the O 1 -S-R 1 -O 2 -R 2 model. For this, we test a separated model for smokers and nonsmokers. For smokers, the effect of exposure to pro-smoking content on smoking behavior is mediated by an impression of smokers, a favorable expression about smoking, and perceived benefits. And, the effect of exposure to anti-smoking content on smoking behavior is mediated by an unfavorable expression about smoking and perceived risks. However, such mediation processes cannot be observed for nonsmokers; namely, the effect of exposure to pro-smoking content on smoking intention is only mediated by a favorable expression about smoking. Considering the separated path models for smokers and nonsmokers, theoretical and practical implications are suggested for future study. Methodological limitations are discussed as well.

Antecedents and Consequences of Smoking Cessation Intention in the Context of the Global COVID-19 Infodemic

A growing body of scientific studies has been published to inform responses to the ongoing coronavirus pandemic, and some have claimed that cigarette smoking has a beneficial or mixed effect on the prevention and treatment of COVID-19. The presentation of such findings, unfortunately, has created an infodemic. This study integrated the theory of planned behavior and the health belief model and incorporated findings on addiction from the medical literature to predict cessation intention and support for tobacco control measures in the context of the COVID-19 infodemic. The study found that cessation intention partially mediated the effect of perceived severity and fully mediated the effects of perceived benefits, self-efficacy, and addiction on support for control measures. In addition, a positively-valenced message of the effect of smoking on the prevention and treatment of COVID-19 vs. a mixedly-valenced message was significant in predicting cessation intention, and the positively-valenced message of smoking indirectly predicted support for tobacco control measures. Perceived susceptibility, barriers, and subjective norms, however, exerted neither direct nor indirect effects on the two outcome variables.

Exploring the Role of Regulatory Focus and Processing Fluency in the Effectiveness of Narrative versus Non-narrative Advertising: A Study about Sugar Intake in the USA

Given that many health problems in the United States are closely related to high sugar consumption, this research examined the effectiveness of ad forms (narrative vs. non-narrative) on persuading people to limit sugar intake through an online experiment completed by 1,104 participants. It was found that individual difference of regulatory focus moderated the effect of narrative vs. non-narrative advertising. Moreover, this study revealed an underlying mechanism of how audiences processed narrative vs. non-narrative advertising differently via the mediator of processing fluency, and further resulted in different advertising effectiveness. The findings contributed in providing implications for policy makers and ad professionals to help them with the improvement of public's health in the USA.

Effect of a storytelling intervention on the retention of serodiscordant couples in ART/PrEP services at antenatal clinic in Namacurra province in Zambézia, Mozambique

Background

Sub-Saharan Africa reported 550,000 new HIV infections among women in 2018. Pregnancy and the postpartum period are associated with an increased risk of HIV acquisition (adjusted risk ratio [RR]: 2.8 during pregnancy and 4.0 in postpartum period vs. non-pregnant or postpartum women, respectively). Acquisition of HIV during pregnancy and breastfeeding increases risk of mother to child transmission. We propose to test the impact of a peer-delivered oral storytelling intervention to increase retention in, and adherence to, pre-exposure prophylaxis (PrEP)/combination antiretroviral treatment (ART) among expectant couples.

Design

We propose a randomized controlled trial (RCT) (35 intervention and 35 control couples) at a health facility where 11% of expectant couples were in serodiscordant relationships in 2018. Couples randomized to the storytelling arm will be visited by a two community volunteers and who successfully adhered to PrEP/ART during a recent pregnancy. This expert couple will orate to participating couples three stories (at 1, 3 and 5 weeks after study enrollment) designed to empower, educate, and establish “ideal” interpersonal communication strategies within couples/families, and support adherence practices among participants. The primary outcome among HIV-uninfected women will be adherence to PrEP at 3 months.

Conclusions

PrEP among at-risk pregnant women must be implemented so that high levels of adherence and retention are achievable for them and their partners. We will test our storytelling intervention to identify an optimal strategy for PrEP education and family engagement in a region with high HIV prevalence. Our results will have an impact by effectively engaging serodiscordant couples in prevention/treatment during pregnancy and beyond.

Narrative persuasion and stigma: Using news accounts to denormalize texting while driving

Despite nearly universal texting while driving bans in U.S. states, distracted driving still poses a major risk for American motorists and pedestrians on a daily basis. We argue texting while driving behavior, due to its cultural, social, and psychological motivations, may be addressed by cultivating a stigma to denormalize TWD much in the same way public health campaigns and bans did with tobacco use. While extant strategies may similarly stigmatize this risky behavior, we contend the stigmatizing effect of news narratives offers an untapped and unexamined resource. In this paper we draw on emergent findings in narrative persuasion work to present an exploratory analysis and evidence indicates news narratives, through narrative engagement, can both stigmatize TWD behavior and diminish attitudes toward distracted driving. These initial findings are then validated against an independent sample. If applied widely, this method may be applied to increase social pressure against distracted driving, leading to fewer people engaging in TWD behavior, and making roads safer.

Benefit-Seeking or Risk-Taking? Examining the Portrayal of Cosmetic Surgery in Chinese News, 2000-2019

Analyzing 311 news articles published in representative Chinese newspapers, this study investigated how cosmetic surgery (CS) was represented in Chinese media from 2000 to 2019. Employing a coding scheme based on prior literature and sampled data, the study analyzed both features of the articles and profiles of the patients in the media. Results showed significant differences in media reporting across issue categories, reporting frames (benefit-focused, risk-focused, neutral), sources of information, drivers for and impacts of having surgeries. Among all the reasons for obtaining CS, boosting career confidence was ranked at the top. Additionally, significant differences in reporting were observed across types of the newspapers, gender of the patients, and time periods of the coverage. Implications of the findings for health promotion and regulation were discussed in reference to the social, cultural, and media context in China.

Narrative Voice Matters! Improving Smoking Prevention with Testimonial Messages through Identification and Cognitive Processes

Narrative messages are increasingly being used in the field of tobacco prevention. Our study is based on narrative persuasion and aims to analyze the psychological mechanisms that explain why the narrative voice is relevant to promote persuasive impact. An online experiment with a 2 (narrative voice) × 2 (message) factorial design was carried out. Participants (525 adult smokers) were randomly assigned to two experimental conditions (first-person versus third-person narrative message). To increase the external validity of the study, two different messages were used within each condition. After reading the narrative message the mediating and dependent variables were evaluated. Participants who read the narrative in the first person experienced greater identification. Moreover, mediational analysis showed that both counterarguing and cognitive elaboration played a significant role in the relationship between narrative voice, identification, and persuasive impact. This study confirm that narrative voice is not only an anecdotal formal choice but that it indirectly affects variables related to tobacco prevention, due to the fact that first-person messages activate a mechanism of affective connection with the message (increasing the identification with the protagonist) that decreases resistance to prevention (the counterarguing process) while simultaneously stimulating reflection or cognitive elaboration.

Grappling With the COVID-19 Health Crisis: Content Analysis of Communication Strategies and Their Effects on Public Engagement on Social Media

Background

The coronavirus disease (COVID-19) has posed an unprecedented challenge to governments worldwide. Effective government communication of COVID-19 information with the public is of crucial importance.

Objective

We investigate how the most-read state-owned newspaper in China, People’s Daily, used an online social networking site, Sina Weibo, to communicate about COVID-19 and whether this could engage the public. The objective of this study is to develop an integrated framework to examine the content, message style, and interactive features of COVID-19–related posts and determine their effects on public engagement in the largest social media network in China.

Methods

Content analysis was employed to scrutinize 608 COVID-19 posts, and coding was performed on three main dimensions: content, message style, and interactive features. The content dimension was coded into six subdimensions: action, new evidence, reassurance, disease prevention, health care services, and uncertainty, and the style dimension was coded into the subdimensions of narrative and nonnarrative. As for interactive features, they were coded into links to external sources, use of hashtags, use of questions to solicit feedback, and use of multimedia. Public engagement was measured in the form of the number of shares, comments, and likes on the People’s Daily’s Sina Weibo account from January 20, 2020, to March 11, 2020, to reveal the association between different levels of public engagement and communication strategies. A one-way analysis of variance followed by a post-hoc Tukey test and negative binomial regression analysis were employed to generate the results.

Results

We found that although the content frames of action, new evidence, and reassurance delivered in a nonnarrative style were predominant in COVID-19 communication by the government, posts related to new evidence and a nonnarrative style were strong negative predictors of the number of shares. In terms of generating a high number of shares, it was found that disease prevention posts delivered in a narrative style were able to achieve this purpose. Additionally, an interaction effect was found between content and style. The use of a narrative style in disease prevention posts had a significant positive effect on generating comments and likes by the Chinese public, while links to external sources fostered sharing.

Conclusions

These results have implications for governments, health organizations, medical professionals, the media, and researchers on their epidemic communication to engage the public. Selecting suitable communication strategies may foster active liking and sharing of posts on social media, which in turn, might raise the public’s awareness of COVID-19 and motivate them to take preventive measures. The sharing of COVID-19 posts is particularly important because this action can reach out to a large audience, potentially helping to contain the spread of the virus.

Success Expectancy: A Mediator of the Effects of Source Similarity and Self-Efficacy on Health Behavior Intention

Although many health communication studies have substantiated the role of self-efficacy as one of the most proximal determinants of behavioral intention, a recent body of research has also shown that high self-efficacy does not always translate into intention to perform a recommended health behavior. Recognizing the common ground among three independent lines of research on outcome expectancy, goal attainability, and expectation of success, the present study proposed success expectancy, or perceived likelihood of goal achievement, as a mediator between self-efficacy and health behavior intention, which may explain the inconsistent findings on self-efficacy. An online experiment (N = 336), in which similarity of the source in health messages was manipulated, demonstrated that success expectancy indeed mediated the relationship between self-efficacy and behavioral intention. Success expectancy also mediated the effects of source similarity on behavioral intention, while neither task nor coping self-efficacy showed such effects. These results suggest that health promotion messages focusing specifically on increasing perceptions of success expectancy may be more effective in inducing health behaviors than messages that promote self-efficacy, particularly in health contexts, in which people with high self-efficacy do not tend to successfully enact recommended health behaviors.

Exemplification and Stigmatization of the Depressed: Depression as the Main Topic versus an Incidental Topic in National US News Coverage

To understand the associations between the use of exemplars and other communication themes known to contribute to the stigmatization of the depressed, we conducted a content analysis of news stories about depression in three national media outlets - CNN.com, The New York Times, and The Washington Post (N = 986). The study found exemplars were often used in the coverage of depression by national news outlets. Such use was associated with an increased presence of common stereotypes about the depressed as violent and suicidal regardless of whether depression was the main topic of the news stories. Exemplars appeared more often in stories providing biomedical and environmental explanations for the mental illness when depression was mentioned incidentally rather than as the main topic of the news coverage. As for the context, stories with exemplars appeared most often in the healthcare, and culture and celebrity contexts when depression was the main topic. When depression was mentioned incidentally rather than as the main topic, news stories with exemplars appeared most often in the culture and celebrity context. These combinations of context and exemplar use were all associated with less frequent presentations of violent stereotypes and a more frequent use of biomedical attributions, which seem to challenge the stigma associated with the mental illness depression.

Automated Tool for Health Utility Assessments: The Gambler II

Background. The Gambler II is a web-based utility assessment tool supporting visual analogue scale (VAS), standard gamble (SG), and time trade-off (TTO) utility assessments. It contains novel features, including an easy to use project development authoring tool and use of multimedia clips for health state descriptions. Objectives. Evaluate the usability and understandability of the patient-facing side of The Gambler. Investigate the feasibility of using The Gambler and evaluate its impact on patient knowledge regarding the relevant health states. Materials and Methods. We used The Gambler to assess utilities on a convenience sample of 55 users for common long-term complications of type 2 diabetes mellitus: diabetic neuropathy, diabetic retinopathy, and diabetic foot infection requiring transmetatarsal amputation. Using VAS, SG, and TTO, we collected metadata, such as time spent on each assessment and the entire assessment process. We evaluated usability with an adaptation of the System Usability Scale survey and understandability. We evaluated impact on knowledge gained through knowledge assessments about these complications before and after use of The Gambler. Results. Overall satisfaction with The Gambler was high, 4.02 on a 5-point scale. Usability rated highly at 84.93 on a normalized scale between 0 and 100. Knowledge scores increased significantly following use of The Gambler from pretest mean of 68% to posttest mean of 76% (P < 0.01). Average time using the software: ∼7½ minutes. Conclusions. The Gambler is an easy to use and understand computer-based tool for utility assessment. It is feasible to use within clinical encounters to support shared decision making, and it has unique features that make it a powerful tool for investigators interested in research on health utilities.

Designing Effective Testimonial Pictorial Warning Labels for Tobacco Products

Warning labels on tobacco products sometimes feature images and stories of real people whose health has been affected by smoking. We examined effects of some of the design elements that may contribute to the effectiveness of these testimonial pictorial warning labels (PWLs). Beginning with a testimonial PWL that contained an image of a person and a basic warning statement (e.g., "Smoking can kill you"), we examined the impact of adding: (a) text detailing the person's name, age and health status (identifiers); and (b) explanatory statements that elaborated on the basic warning using a testimonial or non-testimonial message. In an online experiment, 1255 adult smokers in the United States were randomly assigned to one of six experimental conditions (2 [identifier: none/identifier] × 3 [explanatory statement: none/non-testimonial/testimonial]), or a control condition (text only warning labels that currently appear on packs in the United States). In each condition, participants were exposed to multiple labels each focused on a different health effect. Effectiveness was assessed using emotional responses, engagement and behavioral intentions measured immediately post-exposure, and quit attempts measured at five-week follow up. Testimonial PWLs were more effective than the text only labels. However, there was little evidence that adding identifiers or the explanatory statements enhanced effectiveness; rather, there was some evidence that testimonial explanatory statements reduced effectiveness. These findings suggest that the most effective design for testimonial PWLs may be to combine a basic warning statement with an image of a real person, without any additional textual components.

Positive Facts, Negative Stories: Message Framing as a Moderator of Narrative Persuasion in Antismoking Communication

This study examines the moderating role of message framing in narrative persuasion in the context of promoting smoking cessation. A controlled experiment involving 101 college smokers revealed a significant interaction effect between message framing (gain-framing vs. loss-framing) and evidence type (narrative vs. nonnarrative) on smoking-related risk perceptions. For the gain-framed message, the nonnarrative version produced significantly greater perceived susceptibility to smoking-related diseases than did the narrative version. For the loss-framed message, evidence type did not make a difference in perceived susceptibility. On perceived severity of smoking-related diseases, the interaction was such that for the loss-framed message, the narrative version resulted in significantly greater perceived severity than did the nonnarrative version. In contrast, for the gain-framed message, evidence type did not make a difference in perceived severity. In addition, our results revealed that the interaction between message framing and evidence type had an indirect effect on attitudes toward quitting smoking through perceived severity of smoking-related diseases. Theoretical and practical implications are discussed.

The Effects of Graphic Warning Labels' Vividness on Message Engagement and Intentions to Quit Smoking

The current study examined the effects of manipulating the level of vividness through the presence of various textual and visual components in the context of tobacco warning labels. An online experiment was conducted (N=2165) to examine whether increasing the vividness of warning labels, using narrative and non-narrative components, increased engagement with the messages, and the subsequent effects of vividness and engagement on intentions to quit smoking. Results showed that more vivid warning labels led to increased engagement, which in turn was linked to increased intentions to quit smoking. Specifically, the indirect effect of vividness on intentions to quit smoking was largely driven by the emotional component of engagement. Indirect effects of cognitive engagement were only apparent at higher levels of vividness.

Insuring Good Health: Outcomes and Acceptability of a Participatory Health Insurance Literacy Intervention in Diverse Urban Communities

BACKGROUND

The U.S. uninsured rate has dropped significantly since the passage of the Affordable Care Act (ACA), yet insurance coverage remains lower in historically marginalized communities than in the overall population. New consumer engagement approaches that involve these populations are needed. The purpose of this study was to evaluate the effectiveness of the Insuring Good Health Intervention, a website and video series designed to improve engagement with health insurance and ACA reforms. The study was designed and implemented using a community-based participatory research approach.

METHOD

We conducted a lagged-control cluster randomized controlled trial to evaluate Insuring Good Health with racially and ethnically diverse adults seeking services in medically underserved areas within the Detroit, Michigan metropolitan area. Outcomes were assessed at baseline and at 6 and 9 months postintervention, and including self-efficacy, knowledge, beliefs, and intention to seek help with insurance navigation and care.

RESULTS

Among 243 participants, mean age was 43.4 ( SD = 13) years, and all participants met federal guidelines for poverty. The study had an 86% response rate at 9-month follow-up ( n = 209). Compared with the lagged-control group, intervention participants had more positive beliefs concerning preventive care (estimate 0.51, standard error 0.16; p < .01), and intention to seek help with insurance navigation and care (estimate 0.43, standard error 0.17; p < .001) at 9-month follow-up. Hispanic participants benefitted the most from the intervention, including improved knowledge of health insurance eligibility over 9 months compared with other racial/ethnic groups (estimate -0.97, standard error 0.40, p < .01).

DISCUSSION

Insuring Good Health was associated with increased intention to seek help with insurance navigation and care, and improved beliefs around preventive care.

CONCLUSIONS

Insuring Good Health has the potential to be an important consumer engagement tool to reduce disparities in health insurance coverage and care seeking.

Stigma and Counter-Stigma Frames, Cues, and Exemplification: Comparing News Coverage of Depression in the English- and Spanish-Language Media in the U.S

A content analysis was conducted to compare news coverage of depression in the English- and Spanish-language media in the United States (N = 355). The study revealed that the English-language media reported stereotypes more frequently than the Spanish-language news media. The presence of all four types of stereotypes (i.e., the mentally ill as violent, suicidal, incompetent, and weak) was associated with the increased use of the stigma frame in the English-language news media, while only the violence stereotype was associated with the increased use of the stigma frame in the Spanish-language news media. The presence of recovery information and positive emotions was associated with the increased use of the counter-stigma frame in both English- and Spanish-language news media. Furthermore, the study found that the use of exemplars was generally correlated with an increase in stereotypical coverage, particularly in English-language news media, but a decrease in educational information in both news media.

Electronic cigarette substitution in the experimental tobacco marketplace: A review

The evolution of science derives, in part, from the development and use of new methods and techniques. Here, we discuss one development that may have impact on the understanding of tobacco regulatory science: namely, the application of behavioral economics to the complex tobacco marketplace. The purpose of this paper is to review studies that examine conditions impacting the degree to which electronic nicotine delivery system (ENDS) products substitute for conventional cigarettes in the Experimental Tobacco Marketplace (ETM). Collectively, the following factors constitute the current experimental understanding of conditions that will affect ENDS use and substitution for conventional cigarettes: increasing the base price of conventional cigarettes, increasing taxation of conventional cigarettes, subsidizing the price of ENDS products, increasing ENDS nicotine strength, and providing narratives that illustrate the potential health benefits of ENDS consumption in lieu of conventional cigarettes. Each of these factors are likely moderated by consumer characteristics, which include prior ENDS use, ENDS use risk perception, and gender. Overall, the ETM provides a unique method to explore and identify the conditions by which various nicotine products may interact with one another that mimics the real world. In addition, the ETM permits the efficacy of a broad range of potential nicotine policies and regulations to be measured prior to governmental implementation.

Friends Don't Let Friends Smoke: How Storytelling and Social Distance Influence Nonsmokers' Responses to Antismoking Messages

This study examines nonsmokers' responses to antismoking messages. Informed by construal-level theory (CLT), it investigates whether and how evidence type (narrative vs. non-narrative) and social distance might interact to influence nonsmokers' attitudes toward others' quitting smoking and intentions to persuade others to quit smoking. Results of a controlled experiment (N = 281) revealed an approximately significant two-way interaction pertaining to attitudes. Simple effects analyses revealed that narratives produced less-favorable attitudes toward others' quitting smoking than nonnarratives when participants thought about their best friend. Yet, there was no difference in attitudes between narratives and nonnarratives when participants thought about socially distant others. The results also indicated that nonnarratives overpowered narratives to influence participants' attitudes toward others' quitting smoking. Moreover, social distance had a consistent impact on their risk beliefs, such that they perceive fewer health risks of their close friends than an average college student. Theoretical and practical implications of the results are discussed.

Assessing Smoking Cessation Messages with a Discrete Choice Experiment

Objectives

Our aim was to identify message characteristics for cigarette pack inserts that aim to help smokers quit.

Methods

US adult smokers from an online consumer panel (N = 665) participated in a discrete choice experiment with a 2x2x2x2x4 within-subjects balanced incomplete block design, manipulating: image (vs no image), text type (testimonial vs informational), cessation resource information (vs none), call to action (vs none), and message topic (well-being, financial benefit, cravings, social support). Participants evaluated 9 choice sets, each with 4 inserts, selecting: (1) the most and least helpful for quitting; and (2) the most and least motivating to quit. Linear models regressed choices on insert characteristics, controlling for sociodemographics and smoking-related variables. We assessed interactions between insert characteristics and smoker attributes (ie, education, quit intention, self-efficacy).

Results

Inserts were most helpful and motivating when they included an image, provided cessation resource information, or referenced well-being and financial benefits. Significant interactions indicated that inserts with cessation resource information were relatively more helpful and motivating among smokers with low self-efficacy, an intention to quit, or lower education.

Conclusion

Cigarette pack inserts with imagery and cessation resource information may be particularly effective in promoting smoking cessation.

Analysis of Media Coverage on Breastfeeding Policy in Washington State

BACKGROUND

Media coverage and message framing about breastfeeding polices can influence important policy decisions in institutional and governmental settings. Research aim: This study aimed to describe the media coverage of breastfeeding policies and the message frames that are found in print newspapers and web-only news publications in Washington State between 2000 and 2014.

METHODS

For this retrospective media analysis study, 131 news articles published from January 2000 through June 2014 in Washington State that specifically discussed breastfeeding policy were identified, coded, and analyzed to explore the content of the sample and examine how arguments supporting or opposing breastfeeding policy were framed. The coding scheme was developed cooperatively and found to be reliable across coders.

RESULTS

The number of articles published each year about breastfeeding policy grew overall between 2000 and 2014 and peaked during periods of specific policy development. Seventy-four articles had a neutral tone, 49 supported breastfeeding policy, and 4 were in opposition. Nine distinct supporting frames and six distinct opposing frames were identified. Common supporting frames were health benefits of breastfeeding and the need for policies because of challenges of breastfeeding in public. The most common opposing frame was indecency of breastfeeding in public.

CONCLUSION

There is limited but growing media coverage of breastfeeding policies. For the most part, coverage is supportive of the need for policies. Breastfeeding advocates can apply information about media message frames to craft effective policy development strategies that counteract negative perceptions and promote the benefits of breastfeeding policies.

Social Media Propagation of Content Promoting Risky Health Behavior

While social media have been found useful in providing social support and health information, they have also been home to content advocating risky health behavior. This study focused on how content defending and even celebrating anorexia as a lifestyle are circulated among social media users, and investigates the characteristics that promote wide propagation of such messages. We captured anorexia-related content on Tumblr, a popular blog for talking about eating disorders, during a one-month period. Among the 35,432 posts collected, we examined the most highly propagated posts and coded them for message characteristics. Our findings revealed that posts in which the source of a narrative ("testimony") was identified (was either from an anorexic poster or about another's anorexia) and which were positive toward the pro-anorexia perspective were more likely to be propagated on Tumblr. In addition, posts containing content that references an anorexic person and contains an affective tone were more likely to be propagated. We also found that underweight bodies and bodies with a high degree of exposure were associated with propagation of posts. The present study suggested practical implications by focusing on the characteristics of highly propagated but potentially harmful content in social media.

Potential Effectiveness of Pictorial Warning Labels That Feature the Images and Personal Details of Real People

Introduction

Pictorial warning labels (PWL) that use photographs and the personal details of real people whose health has been affected by smoking (testimonial PWL) provide factual information about the consequences of tobacco use.

Methods

Nine hundred and twenty-four adult current smokers participated in an online experiment that tested responses to four types of warning labels: (1) non-testimonial text warning labels (currently on packs in the United States); (2) non-testimonial PWL (previously proposed by the United States Food and Drug Administration); (3) image only testimonial PWL (created for study); (4) image + personal details testimonial PWL (created for study). Participants were randomly assigned to condition and then exposed to up to five warning labels addressing different health effects. Differences between conditions were assessed using emotional responses and a set of intention measures immediately following exposure, and self-reported behavior change at 5-week follow-up.

Results

Compared to the non-testimonial text warning labels, all PWL elicited stronger emotional responses and intentions to forgo cigarettes and avoid the warning labels. Non-testimonial PWL and image + personal details testimonial PWL elicited stronger intentions to quit, whereas image only testimonial PWL generated a greater amount of quitting activity in the weeks following exposure. There were no significant differences in responses when comparing the non-testimonial PWL with both types of testimonial PWL.

Conclusions

PWL that use images of real people convey factual information about the health effects of tobacco use. These testimonial PWL may be a promising alternative to the images previously proposed for use on PWL in the United States.

Implications

In the United States, the PWL developed by the Food and Drug Administration (FDA) in 2011 were found by the courts to be unconstitutional, in part because they were deemed to present an opinion rather than fact. Findings from this experimental study indicate that PWL that use the images and personal details of real people to convey factual information about the health effects of tobacco use may satisfy the FDA's requirement for a set of PWL that (1) have the potential to positively impact the determinants of smoking cessation behavior, (2) meet legislative requirements under the Family Smoking Prevention and Tobacco Control Act and (3) may be more acceptable to the courts than the previously proposed and now dismissed PWL that carried non-factual images.

Effect of Message Format and Content on Attitude Accessibility Regarding Sexually Transmitted Infections

Sexually transmitted infections (STIs) are widespread in the United States among people ages 15-24 years and cost almost $16 billion yearly. It is therefore important to understand message design strategies that could help reduce these numbers. Guided by exemplification theory and the extended parallel process model (EPPM), this study examines the influence of message format and the presence versus absence of a graphic image on recipients' accessibility of STI attitudes regarding safe sex. Results of the experiment indicate a significant effect from testimonial messages on increased attitude accessibility regarding STIs compared to statistical messages. Results also indicate a conditional indirect effect of testimonial messages on STI attitude accessibility, though threat is greater when a graphic image is included. Implications and directions for future research are discussed.

Health Risk Perception and Risk Communication

Risk perceptions are a prerequisite for protective action. Both scientists and practitioners need to understand the multifaceted nature of health risk perception and risk communication. This article reviews insights from psychophysiological research, with a focus on neuroscientific approaches that examine the biological basis of risk perception in the brain and capture the brain response to health and risk messages. Specifically, we discuss the key role of intuitive processes for personal risk perception and the difference between absolute and comparative risk. We then describe the relationship between risk perception and health behavior change and present recent work that measures responses to health prevention messages. Finally, we discuss implications for translation to public health policy and point to needs for future research. A better understanding of the biological roots of personal risk perception and how these can be addressed via risk communication informs policymakers in designing effective public health interventions.

Role of Narrative Perspective and Modality in the Persuasiveness of Public Service Advertisements Promoting HPV Vaccination

In the context of public service advertisements promoting human papillomavirus (HPV) vaccination, the current research examines 1) the relative persuasiveness of narrative vs. non-narrative messages and 2) the influence of narrative perspective (first- vs. third-person) and modality (text-based vs. audio-based) on message effectiveness. Results of a controlled experiment (N = 121) suggested that both a non-narrative message and a first-person narrative message led to greater perceived risk of getting HPV than a third-person narrative message. There was no difference in risk perception between the non-narrative and first-person narrative conditions. These findings were confined to the text-based condition, however. When the messages were audio-based, no differential message effects were detected. The analysis also provided partial evidence for an indirect effect of narrative perspective on intentions to vaccinate against HPV through HPV risk perception. Theoretical and practical implications of the findings are discussed.