Avoiding the boomerang: testing the relative effectiveness of antidrug public service announcements before a national campaign

High vs. Low Intensity Behavior Therapy Delivered to Adolescents with ADHD: Potential Adverse Long-Term Effects on Substance Use Outcomes

Individuals with ADHD are at risk for substance use initiation in adolescence and escalation to problematic use in adulthood. Little is known about the impact of psychosocial ADHD treatment on substance use. Based on existing theory, both therapeutic (i.e., through reducing symptoms and impairments) and iatrogenic effects (i.e., through improved social functioning) of psychosocial treatment for ADHD on adolescent substance use initiation are plausible. A primarily ethnic/racial minority sample (~ 95% Latinx or Black) of rising ninth grade students with ADHD (n = 106) were randomly assigned to receive high intensity (i.e., Summer Treatment Program-Adolescent, parent training, and school consultation) or lower intensity (parent training, organization skills training, and school consultation) intervention the summer before entering high school. Participants were followed four-years post-baseline and substance use was documented. Analyses tested treatment effects on substance use initiation (alcohol and/or marijuana) and mediators of main effects. After controlling for covariates, participants assigned to HI (37.5%) were significantly more likely than LI (18.6%) to initiate substance use by end of high school, indicating an iatrogenic effect of HI treatment. No significant mediators were detected. Post-hoc exploration of moderators suggested that youth with elevated Posttraumatic Stress Disorder (PTSD) symptoms may have experienced a benefit of HI treatment on substance use whereas youth without elevated PTSD symptoms experienced iatrogenic effects. Large, well-powered, samples should examine moderated mediational models to better understand who is most risk for iatrogenic effects of ADHD psychosocial treatment and why. Clinicians delivering psychosocial treatment to adolescents with ADHD should monitor for potential iatrogenic effects.

The Relationship Between Receptivity, Targeted Beliefs, and Tobacco Use

Population-level tobacco prevention education campaigns influence a range of public health behaviors. Campaign receptivity is a precursor to shifts in campaign-targeted beliefs. This study examined the bi-directional nature of campaign receptivity and campaign-targeted beliefs (i.e. anti-industry, social movement, independence). Further, this study explored the relationship between campaign-targeted beliefs and campaign-targeted outcomes (i.e. tobacco behavior and intentions not to use). Data were drawn from the Truth Longitudinal Cohort, a nationally representative, probability-based cohort which includes youth and young adults (N = 3,771; 15-24 years). Campaign receptivity and campaign-targeted beliefs were measured at Times 1-4, while campaign-targeted outcomes were measured at Time 5. Findings indicate that a one unit increase in campaign receptivity is associated with an average increase of .94, .82, and .61 points in social movement, independence, and anti-industry beliefs, respectively. Analyses also revealed that for each unit increase in social movement and anti-industry beliefs, respondents' any current tobacco use declined by 0.06 and 0.08 points. Moreover, for each unit increase in social movement and independence beliefs, respondents' intentions not to use cigarettes/e-cigarettes increased by .12 and .10 points, respectively. This study reveals the pathway by which campaign receptivity translates to campaign-targeted beliefs and how this impacts campaign-targeted outcomes.

"The more I think about it, the less I like it": Effects of elaboration, narrative transportation, and freedom threat on the effectiveness of HPV vaccination advocacy messages

Approximately 80 million US adults-one in four-are infected with the human papillomavirus (HPV), which causes cancers of the cervix in women, cancers of the anus, penis, and throat in men, and genital warts in both sexes. Although HPV vaccinations are safe, effective, easily affordable, and readily available, a substantial percentage of parents resist recommendations to vaccinate their children against HPV. The current study tests the effects of different vaccination advocacy message strategies on attitudes toward HPV vaccination. Study participants (N = 963) were randomly assigned to one of four message conditions (a narrative story, an informational fact sheet, an appeal from an expert spokesperson, or an identical appeal from a nonexpert spokesperson) and assessed for change in attitude toward HPV vaccination along with levels of elaboration, narrative transportation, and freedom threat caused by the messages. Analyses showed that the messages' effects on attitude change were mediated by transportation and moderated by freedom threat. With the informative, expert, and nonexpert messages, increased message engagement produced increased freedom threat. With the narrative message, increased message engagement produced reduced levels of freedom threat. For risk communicators and planners of health interventions, the results suggest benefits for using a nonexpert advocacy message when levels of message engagement are expected to be low and using a story-based narrative advocacy message when levels of message engagement are expected to be high.

Examining the Longitudinal Relationship Between Perceived and Actual Message Effectiveness: A Randomized Trial

We sought to examine the relationship between perceived message effectiveness (PME) and actual message effectiveness (AME) in a 3-week randomized trial of vaping prevention advertisements. Participants were US adolescents (n = 1,514) recruited in 2021. We randomly assigned them to view The Real Cost vaping prevention ads or control videos online. Participants viewed three videos at Visit 1, again at Visits 2 and 3, and completed a survey at each visit that assessed AME (susceptibility to vaping) and two types of PME - effects perceptions (potential for behavioral impact) and message perceptions (potential for message processing). At Visit 4, AME was measured. Compared to control, The Real Cost ads led to improved AME (lower susceptibility to vaping at Visit 4, p < .001). This was anticipated by The Real Cost ads eliciting higher PME ratings (higher effects and message perceptions at Visit 1, both p < .001). Furthermore, PME (both effects and message perceptions) at Visit 1 predicted susceptibility to vaping at Visits 1, 2, 3, and 4 (all p < .001). Finally, effects perceptions fully mediated the impact of The Real Cost ads on susceptibility to vaping (β = -.30; p < .001), while message perceptions only partially mediated the effect (β = -.04; p = .001). Our findings indicate a relationship between PME and AME, especially effects perceptions, and suggest that PME may be useful in message pre-testing to select messages with greater behavior change potential.

Hotels re-explored: Experience and influence of reciprocity and social normative appeals

In this paper we report two high-powered and pre-registered experiments, testing the robustness and conceptual development of reciprocity and social norm appeals. Both experiments assessed both psychological processes for complying with these appeals and pro-environmental behavioral intention in tourism settings. In Experiment 1 (N = 2004), participants reported lower psychological reactance levels after learning that the hotel engaged in resource conservation (i.e., indirect homeomorphic reciprocity). No statistically significant effect was obtained for either obligatory motivation, prosocial motivation, skepticism, or behavioral intentions to reuse hotel towels. Importantly, high baseline intention of reusing hotel towels might have limited the effect of appeals. Therefore, we targeted meat consumption in Experiment 2 (n = 2540). Results first showed stronger obligatory and prosocial motivation for all three reciprocity appeals, compared to the standard appeal. No statistically significant results were found for either reactance or skepticism. Finally, after learning that the hotel had made a financial contribution to an environmental organization (i.e., indirect heteromorphic reciprocity) participants showed reduced meat consumption intentions compared to the standard appeal. Overall, the results provide initial evidence for conceptually refining the norm of reciprocity to encourage pro-environmental behaviors and for understanding the underlying psychological processes.

Scaling up the discovery of hesitancy profiles by identifying the framing of beliefs towards vaccine confidence in Twitter discourse

Our study focused on the discovery of how vaccine hesitancy is framed in Twitter discourse, allowing us to recognize at-scale all tweets that evoke any of the hesitancy framings as well as the stance of the tweet authors towards the frame. By categorizing the hesitancy framings that propagate misinformation, address issues of trust in vaccines, or highlight moral issues or civil rights, we were able to empirically recognize their ontological commitments. Ontological commitments of vaccine hesitancy framings couples with the stance of tweet authors allowed us to identify hesitancy profiles for two most controversial yet effective and underutilized vaccines for which there remains substantial reluctance among the public: the Human Papillomavirus and the COVID-19 vaccines. The discovered hesitancy profiles inform public health messaging approaches to effectively reach Twitter users with promise to shift or bolster vaccine attitudes.

An extension of the extended parallel process model to promote heart-healthy exercise behavior: An experimental study

Background: The prevalence of heart disease has increased and is a leading cause of death in the U.S. Despite the importance of physical activity, only one-third of adults in the United States meet the amount of physical activity recommended by the Centers for Disease Control and Prevention (CDC). The purpose of this study was to extend the extended parallel process model (EPPM) by adding a 'barrier' (a construct from Health Belief Model) and exploring the roles of threat, efficacy, and barrier on participants' self-efficacy, attitudes, and intentions toward exercise. Methods: A between-subject experimental design was conducted online in 2018 in the U.S. A total of 446 participants were recruited from the Amazon Mechanical Turk age 18 or above. The participants were first provided with stimuli messages about physical activity behaviors. Then participants' responses to self-efficacy, intention, and attitudes toward exercise were assessed. Results: The results found an interaction between efficacy and barrier to participants' attitudes toward exercise [F(1,435)=4.35, P=0.038, η² _part=0.01]. The results also showed that there was a statistically significant effect of barriers on participants' self-efficacy regarding exercise behavior [F(1,442)=4.21, P=0.04, η² _part=0.009]. However, three-way interactions of threat, efficacy, and barrier were not found in attitudes or intentions to exercise. Conclusion: The findings suggested that addressing an individual's perceived barrier regarding a health behavior may lead to an increase in self-confidence ensuing in higher physical activity. Future studies should further explore how addressing barriers may influence other health behaviors to design unique and effective health messages.

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

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

Effect of combining fear and anger in anti-smoking messages to discourage young smokers

OBJECTIVES

Previous studies have reported mixed results in reducing the prevalence of tobacco use among young people. The present study investigates the influence of a combined emotions (fear and anger) approach to strengthen the persuasive impact of anti-smoking messages aimed at young smokers.

STUDY DESIGN

The study adopts a between-subject design experiment.

METHODS

Participants were exposed to either a fear appeal or a fear and anger appeal message, after which they answered questions about their emotions, perceived message effectiveness, and intention to reduce cigarette consumption and to quit smoking. An original measure of the co-occurrence of emotions felt by the participants (minimum [MIN] score) was used and mediation analyses were conducted to test the relationship between the emotional content of the message and behavioral intentions through the co-occurrence of fear and anger and perceived message effectiveness.

RESULTS

The findings show that the co-occurrence of fear and anger felt by individuals and perceived message effectiveness serially mediate the positive influence of a fear and anger appeal message compared to a fear alone appeal on changes in intention behavior (intention to reduce cigarette consumption, indirect effect = 0.152, 95% confidence interval (CI) [0.014, 0.340], and intention to quit smoking, indirect effect = 0.236, 95% CI [0.096, 0.413]).

CONCLUSIONS

The study shows the interest of combining negative emotions in prevention messages and offers guidance for government agencies responsible for tobacco control policies to help them improve the effectiveness of anti-smoking messages.

How Anti-Substance Abuse Campaigns Influence Substance Abusers' Psychological Health in Chinese Communities: The Mediating Role of Perceived Stigma

The current study explored how anti-substance abuse campaigns influence substance abusers' psychological health through the perception of stigma. The study is based on a sample of substance abusers who received community-based treatments (n = 3457) and used structural equation modeling to estimate the role of perceived stigma in mediating between perceptions of overstatement of harm conveyed in anti-substance abuse campaigns and psychological outcomes. The results revealed that substance abusers' perception of overstatement of the harm caused by the substances and substance abusers enhanced their perceived stigma and impaired their psychological health in terms of anxiety, depression, and somatization, through both direct and indirect pathways. The results advocate for proper strategies in the design of anti-substance abuse campaigns. Possible initiatives to reduce substance abusers' perceived stigma are recommended.

Perceived communication effectiveness in implementation strategies: a measurement scale

BACKGROUND

Communication-based activities and products (i.e., training programs, webinars) are a critical component of implementation strategies that relay information to various audiences. Audience perceptions of communication effectiveness contribute important insight into the processes and mechanisms through which an implementation effort may succeed or fail. To advance research on this front, a psychometrically sound instrument for measuring perceived communication effectiveness (PCE) is needed.

METHODS

An expert panel identified the theoretical foundations and conceptual domains of PCE and drafted preliminary items. Five focus groups of correctional professionals who had recently completed an implementation leadership training reviewed the items and provided feedback for refinement. Revised items were then included in a survey-based evaluation of an ongoing eLearning curriculum designed to improve the practices used by front-line probation officers in supervising individuals in the field. The factorial structure of a final 6-item scale as well as its convergent, divergent, and predictive validity was evaluated using data from the evaluation surveys (Nfollow-up = 358, Nbaseline+follow-up = 159).

RESULTS

Confirmatory factor analysis of the final scale of PCE demonstrated adequate fit. PCE was strongly correlated with measures of implementation outcomes (acceptability, r = .819, p < .001; appropriateness, r = .809, p < .001; and feasibility, r = .754, p < .001), yet uncorrelated with a scale of need to evaluate (r = - .051, p = .422), demonstrating both convergent and divergent validities. The predictive validity of PCE was evidenced by significant associations between PCE and key training outcomes, including perceived staff use of evidence-based practices (β = .230, p < .05), agency climate (β = .261, p < .05), and value concordance (β = .209, p < .05), after controlling for baseline values and other confounders.

CONCLUSIONS

The PCE scale is psychometrically sound and can be a useful tool for gauging audience receptivity to and the potential impact of communication-based implementation activities and products.

How Does the Implicit Awareness of Consumers Influence the Effectiveness of Public Service Announcements? A Functional Near-Infrared Spectroscopy Study

A large number of scholars have conducted detailed studies on the effectiveness of commercial advertising by using neuroimaging methods, but only a few scholars have used this method to study the effectiveness of public service announcements (PSAs). To research the relationship between the effectiveness of PSAs and the audience’s implicit awareness, functional near-infrared spectroscopy (fNIRS) was employed to record the neural activity data of participants in this study. The results showed that there was a correlation between activation of dorsolateral prefrontal cortex (dlPFC) and the effectiveness of PSAs; The activation of the dlPFC could also be used as an indicator to represent the appeal of advertising content. The results means that neuroimaging tool can also be used to investigate the effectiveness of PSAs, not just commercial advertisements and a few PSAs study, and that neural activity can predict and improve the effectiveness of PSAs before they are released.

Perceived Message Effectiveness and Campaign-Targeted Beliefs: Evidence of Reciprocal Effects in Youth Tobacco Prevention

Perceived message effectiveness (PE) has been widely used in campaign formative research and evaluation. The relationship between PE and actual message effectiveness (AE) is often assumed to be causal and unidirectional, but careful conceptualization and empirical testing of this and other causal possibilities are generally lacking. In this study, we investigated the potential reciprocity in the relationship between PE and AE in the context of a national youth tobacco education campaign. In so doing, we also sought to generate much needed evidence on PE's utility to predict campaign-targeted outcomes in youth tobacco prevention. Using five waves of campaign evaluation data (N = 1,128), we found significant lagged associations between PE and campaign-targeted beliefs, and vice versa. These results suggest a dynamic, mutually influencing relationship between PE and AE and call for greater attention to such dynamics in campaign research.

Post-Legalization Drug Communication: Examining a Colorado Cannabis Campaign

Colorado legalized marijuana use for recreational purposes by adults over 21 in 2012. Our goal is to examine the first major communication campaign (called Good-To-Know) mounted by the state government with the objective of informing the public regarding regulatory and safety precautions surrounding newly legal use. Methods: We assess the content of campaign's central messaging qualitatively by comparing its major themes in terms of criteria developed from the literature and the campaign's own goals. Results: With minor exceptions (lack of audience segmentation; limiting the focus to generating knowledge) Colorado's Good-To-Know campaign rates well when assessed against specific criteria for effective drug communication campaigns as well as its own goals. Conclusions: We conclude that although there were minor limitations to this campaign, policy makers and activists should think proactively about messaging content in states where legalization is imminent. And that more research on legal drug use messaging needs to occur.

Hypocrisy Induction: Using Chatbots to Promote COVID-19 Social Distancing

Considering widespread resistance to COVID-19 preventive measures, the authors draw on hypocrisy induction theory to examine whether online chatbots can be used to induce hypocrisy and increase compliance with social distancing guidelines. The experiment demonstrates that when a chatbot induces hypocrisy by reminding participants that they have failed to comply with social distancing recommendations, they feel guilty about violating social norms. To reinstate confidence in their personal standards, they form favorable attitudes toward the chatbot ad and establish intentions to comply with recommendations. Interestingly, the persuasive power of hypocrisy induction differs depending on the level of anthropomorphism of the chatbot. When a humanlike chatbot reminds them of their hypocritical behavior, participants feel higher levels of guilt and act more desirably, but a machinelike chatbot is not effective for creating guilt or generating compliance.

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.

Recommendations for improving adolescent addiction recovery support in six northwest tribal communities

American Indian and Alaska Native (AI/AN) communities offer tangible and intangible resources, including centuries of indigenous wisdom and resiliency, to support their young people in recovery from substance use disorders. At the same time, tribal youth returning home from residential or inpatient treatment are vulnerable to relapse, especially if they encounter the same environmental triggers in which their substance misuse developed. This study endeavored to learn about community stakeholder perceptions of existing strengths and needs for supporting recovering adolescents among six tribal communities of the Inland Northwest. Using a Tribal Participatory Research approach, we conducted Group Level Assessments with key stakeholders representing educators/coaches, medical and behavioral health providers, social service providers, cultural leaders/elders, and legal professionals among each participating tribe (N = 166). We used content analysis to identify emergent themes among participants' recommendations for improving recovery support. The five emergent themes were (1) Communication, Collaboration, and Accountability among Tribal Departments and Agencies; (2) Community-wide Education; (3) The Importance of Providing Wraparound/Supportive Services; (4) Youth-focused Education, Services, and Events; and (5) Recovery Coaching Model. AI/AN culture was infused within nearly all recommendations for improving recovery support that composed these themes. We discuss specific ways to implement these recommendations, including the forthcoming development of a culturally-grounded community-wide mental health training program developed specifically for, and with, these tribes.

Comparison of Message and Effects Perceptions for The Real Cost E-Cigarette Prevention Ads

Perceived message effectiveness (PME) is commonly used in health communication research and practice, yet there has been a dearth of studies comparing different operationalizations of the PME construct. In the present study, we compared the two major types of PME - message perceptions and effects perceptions - among N = 557 young adults. Participants were randomized to one of two conditions: 1) The Real Cost e-cigarette prevention ads developed by the Food and Drug Administration (FDA condition) or 2) information-only e-cigarette control ads developed by the Mayo Clinic (control ad condition). Study predictors were message and effects perceptions measures and actual message effectiveness (AME) outcomes were risk beliefs about vaping and intentions to vape. Results showed that both message perceptions (M = 3.82 vs M = 3.29; p < .001) and effects perceptions (M = 4.13 vs M = 3.82; p < .001) were higher in the FDA ad condition compared to control. Risk beliefs about vaping were also higher in the FDA ad condition than control (M = 3.95 vs M = 3.79; p =.022), but we found no differences in participants' intentions to vape, which were low overall (M = 1.59 in FDA vs M = 1.58 in control). In multivariate analyses adjusting for covariates and including both types of PME, only effects perceptions (not message perceptions) were associated with risk beliefs about vaping (b =.37, p < .001) and intentions to vape (b = -.26, p < .001). Our findings advance PME research by demonstrating the differing nature of message and effects perceptions, and suggest that effects perceptions should be utilized during message pretesting.

Actions Speak Louder than Words: How Characters' Effectiveness as Message Sources Depend on Their Story Experiences

A television (TV) character's actions and the consequences of these actions in TV storylines can shape the audience's own behavioral intentions, especially if the audience identifies with that character. The current research examines how storylines depicting positive versus negative consequences of drinking affect youths' drinking intentions, and whether post-narrative intervention messages delivered by story characters alter these influences. Results indicate that a post-narrative intervention can correct drinking intentions shaped by a pro-alcohol storyline, but the effectiveness depends on the source: a peripheral character is more effective than the main character at delivering a corrective message. This research pinpoints the role of identification with the main character as a key driver of stories' influence and a key focus of health intervention efforts to correct these stories' potentially undesirable impact on vulnerable audiences.

"Study Natural" without Drugs: An Exploratory Study of Theory-Guided and Tailored Health Campaign Interventions to Prevent Nonmedical Use of Prescription Stimulants in College Students

Nonmedical use of prescription stimulants (NMUPS) among college students continues to rise. While some anti-NMUPS campaigns are available, little is known about the campaign development process and how well college students evaluate these messages. To bridge this gap, we developed theory-guided anti-NMUPS campaign interventions that are tailored to college students’ characteristics and evaluated students’ response towards them. A total of 445 college students (74.4% female; Mean_age of 20; 18 to 35 years old) reviewed the campaign interventions and offered their evaluation via an online survey. Findings indicate that students responded to the campaigns positively. Results also indicate that female students are more likely to perceive the campaigns as effective than their male counterparts. Overall, the findings of this study suggest that theory-guided and tailored anti-NMUPS campaigns have great potential in changing students’ attitudes and behavior towards NMUPS. While this study fills critical gaps in the literature, considering the progress needed to strengthen the research field, more research is needed to further identify effective strategies that could prevent college students’ participation in NMUPS activities.

A Pilot Study Determining Comprehension and the Acceptability of a Cancer Research Study Website for Cancer Patients and Caregivers

The purpose of this pilot study was to determine if a cancer research study website increased comprehension among patients and caregivers and if website evaluations differed across patient and caregiver groups. Participants (N = 200) were cancer patients and caregivers living in the USA. Comprehension was determined by the number of correct responses to a series of questions about key characteristics of cancer research studies that are frequently unknown or misinterpreted by patients and/or caregivers. Quantitative and qualitative analyses were conducted to determine participant evaluations across four domains: perceived website credibility, perceived website attractiveness, perceived information effectiveness, and perceived information clarity. Patients and caregivers perceived the website as highly credible and attractive and the information as both easy to understand and moderately effective in helping them make decisions about CCTs. Qualitative feedback underscores the importance of testimonials to website credibility. However, the range in the number of correct responses of certain items across participants coupled with discrepancies in comprehension between patients and caregivers suggests the need for stronger mechanisms evaluating knowledge outcomes.

Beyond Healthiness: The Impact of Traffic Light Labels on Taste Expectations and Purchase Intentions

The aim of traffic light labels on food products is to help consumers assess their healthiness. However, it is not clear whether traffic light labels do not have undesired side effects by signaling lower tastiness of healthy product alternatives and reducing purchase intentions. We therefore conducted a study with consumers from Austria (N = 173) in which we presented the amount of sugar contained in products on labels with or without traffic light colors based on the coding criteria of the UK Food Standards Agency. Expectations of products’ healthiness and tastiness, as well as purchase intentions were assessed. The products were randomly sampled from the category of desserts from a supermarket. The declared amount of sugar was experimentally varied. The traffic light labels helped participants differentiate between the healthiness of products with different sugar levels. They did not affect the expected tastiness of the healthier alternatives. Moreover, participants did not report lower purchase intentions for products high in sugar, but a higher purchase intention for products low in sugar when traffic light colors were used compared to when they were not used.

A Comparison of Metaphor Modality and Appeals in the Context of Skin Cancer Prevention

Health communication experts continually seek out effective strategies to strengthen persuasive campaigns. While there is evidence that verbal metaphors can improve persuasion, little attention has been given to the potential of visual metaphors to enhance health communication effects. To fill this gap, an experiment was conducted to test the effects of metaphor modality (visual vs. verbal) and type of fear appeal used (death-based or appearance-based) on skin protection intentions. Additionally, the moderating role of an individual characteristic (need for cognition), and the mediating role of two processing outcomes (message elaboration and perceived message effectiveness) were examined. Results indicated that there was no significant difference between the main effects of metaphor modality and type of fear appeal, but these message features interacted making the death-based fear appeal the most effective strategy. Need for cognition directly affected perceptions of effectiveness but did not affect skin protection intentions nor message elaboration. Of the two message processing outcomes examined, only perceived message effectiveness mediated the relationship between metaphor modality and skin protection intentions. Theoretical explanations and practical implications are discussed.

Perceived Effectiveness of Anti-Marijuana Messages in Adult Users and Nonusers: An Examination of Responses to Messages About Marijuana's Effects on Cognitive Performance, Driving, and Health

OBJECTIVE

Marijuana use is associated with negative cognitive and health outcomes and risky driving. Given the rapidly changing policies regarding legal recreational and medicinal marijuana use, it is important to examine what types of marijuana prevention messages may be effective in minimizing such outcomes. This study examined cognitive and affective responses to anti-marijuana public health messages in a sample of adult marijuana users and nonusers to determine the correlates of perceived message effectiveness.

METHOD

Participants (N = 203; mean age = 37.7 years) were adult marijuana users and nonusers recruited via Amazon Mechanical Turk (August 2017). After completing self-report measures of marijuana use, they viewed six anti-marijuana messages presented in a random order, addressing marijuana's effects in each of three topic areas: cognitive performance, driving, and adverse health outcomes (e.g., two messages per topic). Participants completed assessments of cognitive and affective perceptions after viewing each message. For each message topic, a linear regression model was used to determine which cognitive and affective perceptions were most predictive of perceived message effectiveness.

RESULTS

For all message topics, nonusers perceived the messages as more effective than did users (p < .001). In the majority of analyses, greater message effectiveness was associated with increased perceived harm of marijuana and increased liking of the message. For driving and health messages, greater message effectiveness was also significantly correlated with lower pleasant affect.

CONCLUSIONS

The findings suggest that audience perceptions may be uniquely predictive of message effectiveness, depending on the topic.

Mechanisms of Social Media Effects on Attitudes Toward E-Cigarette Use: Motivations, Mediators, and Moderators in a National Survey of Adolescents

BACKGROUND

Exposure to risk behavior on social media is associated with risk behavior tendencies among adolescents, but research on the mechanisms underlying the effects of social media exposure is sparse.

OBJECTIVE

This study aimed to investigate the motivations of social media use and the mediating and moderating mechanisms of their effects on attitude toward electronic cigarette (e-cigarette) use among adolescents.

METHODS

Using data from a national sample survey of adolescents (age=14-17 years, N=594), we developed and validated a social media use motivation scale. We examined the roles of motivations in the effect of social media use on risk exposure and risk attitude.

RESULTS

Motivations for social media use included agency, self-expression, realism, social learning, social comparison, and filter. These motivations were associated differentially with the frequency of use of Facebook, Instagram, Snapchat, and YouTube. Frequency of social media use was positively associated with exposure to e-cigarette messages across the four platforms (Ps<.001). Exposure to e-cigarette messages on Instagram (P=.005) and Snapchat (P=.03) was positively associated with attitude toward e-cigarette use. Perceived social media realism moderated the effects of e-cigarette message exposure such that when realism was high, the exposure effect was amplified, but when realism was low, the effect was mitigated (P<.001). A three-way interaction effect (P=.02) among exposure, social learning motivation, and social norm on attitude toward e-cigarette use was found. When perceived social norm was high, the moderating effect of social learning motivation on e-cigarette use attitude was amplified, but when social norm was low, the social learning motivation effect was attenuated.

CONCLUSIONS

Because perceived social media realism moderates the effect of exposure to e-cigarette messages on attitude toward e-cigarette use, future intervention efforts should address the realism perceptions. The three-way interaction among exposure, social learning motivation, and social norm indicates the importance of addressing both the online and offline social environments of adolescents. The social media use motivation scale, reflecting perceived affordances, is broadly applicable. Understanding social media use motivations is important, as they indirectly influence attitude toward e-cigarette use via frequency of social media use and/or frequency of exposure to e-cigarette messages on social media.

When Similarity Strikes Back: Conditional Persuasive Effects of Character-Audience Similarity in Anti-Smoking Campaign

Featuring an exemplar character similar to the target audience is one of the most widely used tactics of tailored and targeted communication. Having a similar character may increase the perceived relevance of the message and facilitate persuasion. However, the way the similar character is depicted may threaten the audience's social identity and cause a boomerang effect. In an experiment where daily smokers saw and evaluated anti-smoking messages, a significant interaction between character-audience similarity and message theme emerged, mediated by message engagement and character identification. Seeing a similar (vs. dissimilar) smoker character whose health was at risk increased the audience's identification with the character, which in turn was associated with greater perceived effectiveness. However, seeing a similar smoker character endangering innocent others via secondhand smoke undermined perceived effectiveness. The simple main effects of character-audience similarity on message engagement were not significant, although the overall pattern was consistent.

Mandatory minimum sentencing policies and cocaine use in the U.S., 1985-2013

BACKGROUND

As of May 2017, the United States federal government renewed its prioritization for the enforcement of mandatory minimum sentences for illicit drug offenses. While the effect of such policies on racial disparities in incarceration is well-documented, less is known about the extent to which these laws are associated with decreased drug use. This study aims to identify changes in cocaine use associated with mandatory minimum sentencing policies by examining differential sentences for powder and crack cocaine set by the Anti-Drug Abuse Act (ADAA) (100:1) and the Fair Sentencing Act (FSA), which reduced the disparate sentencing to 18:1.

METHODS

Using data from National Survey on Drug Use and Health, we examined past-year cocaine use before and after implementation of the ADAA (1985-1990, N = 21,296) and FSA (2009-2013, N = 130,574). We used weighted logistic regressions and Z-tests across models to identify differential change in use between crack and powder cocaine. Prescription drug misuse, or use outside prescribed indication or dose, was modeled as a negative control to identify underlying drug trends not related to sentencing policies.

RESULTS

Despite harsher ADAA penalties for crack compared to powder cocaine, there was no decrease in crack use following implementation of sentencing policies (odds ratio (OR): 0.72, p = 0.13), although both powder cocaine use and misuse of prescription drugs (the negative control) decreased (OR: 0.59, p < 0.01; OR: 0.42, p < 0.01 respectively). Furthermore, there was no change in crack use following the FSA, but powder cocaine use decreased, despite no changes to powder cocaine sentences (OR: 0.81, p = 0.02), suggesting that drug use is driven by factors not associated with sentencing policy.

CONCLUSIONS

Despite harsher penalties for crack versus powder cocaine, crack use declined less than powder cocaine and even less than drugs not included in sentencing policies. These findings suggest that mandatory minimum sentencing may not be an effective method of deterring cocaine use.

Definition and Multidimensionality of Security Awareness

This study proposes and examines a multidimensional definition of information security awareness. We also investigate its antecedents and analyze its effects on compliance with organizational information security policies. The above research goals are tested through the theoretical lens of technology threat avoidance theory and protection motivation theory. Information security awareness is defined as a second-order construct composed of the elements of threat and coping appraisals supplemented by the responsibilities construct to account for organizational environment. The study was executed in two stages. First, the participants (employees of a municipality) were exposed to a series of phishing messages. Second, the same individuals were asked to participate in a survey designed to examine their security awareness. The research model was tested using PLS-SEM approach. The results indicate that security awareness is in fact a second-order formative construct composed of six components. There are significant differences in security awareness levels between the victims of the phishing experiment and the employees who maintain compliance with security policies. Our study extends the theory by proposing and validating a general, yet practical definition of security awareness. It also bridges the gap between theory and practice - our contextualization of security awareness draws heavily on both fields.

Alcohol Storylines in Television Episodes: The Preventive Effect of Countering Epilogues

This experimental study assessed whether alcohol television storylines impact youth drinking attitudes and intentions and whether corrective epilogues can potentially moderate this impact. Television episodes were professionally produced to depict heavy drinking leading to either positive or negative consequences. The pro- and anti-alcohol episodes were shown alone or with an epilogue where a main character discussed the deleterious effects of excessive drinking. Attitudes toward drinkers and drinking intentions were measured subsequently, along with reactions to the episode and demographic data, among participants aged 14-17 using an online study. Exposure to the pro-alcohol episode was related to more positive attitudes toward drinkers. Including an epilogue after a pro-alcohol episode was related to more negative viewers' attitudes toward drinkers and lower drinking intentions compared to a pro-alcohol episode with no epilogue. By contrast, including an epilogue after an anti-alcohol episode was unrelated to attitudes toward drinkers or drinking intentions. Viewing a single television episode with a pro-alcohol message may lead to more positive attitudes toward drinkers. The finding that a brief epilogue may reduce the impact of the pro-alcohol storyline suggests easily implemented preventive strategies to counter the adverse impact of substance use portrayals in entertainment programming.

Alcohol harm reduction advertisements: a content analysis of topic, objective, emotional tone, execution and target audience

BACKGROUND

Public health mass media campaigns may contribute to reducing the health and social burden attributed to alcohol consumption, but little is known about which advertising characteristics have been used, or have been effective, in alcohol harm reduction campaigns to date. As a first step towards encouraging further research to identify the impact of various advertising characteristics, this study aimed to systematically identify and examine the content of alcohol harm reduction advertisements (ads).

METHOD

Ads were identified through an exhaustive internet search of Google, YouTube, Vimeo, and relevant government and health agency websites. Eligible ads were: English language, produced between 2006 and 2014, not primarily focused on drink-driving or alcohol in pregnancy, and not alcohol industry funded. Systematic content analysis of all ads was performed; each ad was double-coded.

RESULTS

In total, 110 individual ads from 72 different alcohol harm reduction campaigns were identified, with the main source countries being Australia (40%) and the United Kingdom (26%). The dominant topic for 52% of ads was short-term harms, while 10% addressed long-term harms, 18% addressed underage drinking, 17% communicated a how-to-change message, and 3% advocated for policy change. The behavioural objective of most ads was to motivate audiences to reduce their alcohol consumption (38%) or to behave responsibly and/or not get drunk when drinking (33%). Only 10% of all ads mentioned low-risk drinking guidelines. Eighty-seven percent of ads used a dramatisation execution style and 74% had a negative emotional tone. Ninety percent of ads contained messages or content that appeared to target adults, and 36% specifically targeted young adults.

CONCLUSIONS

Some message attributes have been employed more frequently than others, suggesting several promising avenues for future audience or population-based research to compare the relative effectiveness of different characteristics of alcohol harm reduction ads. Given most alcohol-attributable harm is due to long-term disease, these findings suggest future campaigns may fill a potentially important gap if they were to focus on long-term harms. There is scope for such long-term harm campaigns to place greater emphasis on encouraging reduced personal consumption of alcohol, potentially through more frequent communication of low-risk drinking guidelines.

Counteracting the Influence of Peer Smoking on YouTube

YouTube, a popular online site for user-generated content, is emerging as a powerful source of peer modeling of smoking. Previous research suggests that in counteracting such influence, health messages may inadvertently increase the perceived prevalence of drug use (a descriptive norm) without reducing its acceptability (injunctive norm). This research tested the ability of health messages to reduce the social acceptability of peer smoking on YouTube despite enhancing its perceived prevalence. In an online experiment with 999 adolescents, participants were randomly assigned to view one of two videos: (a) a mosaic displaying a variety of YouTube videos of adolescents smoking followed by a message about the mortality risk to those smokers, or (b) a control video on a health topic unrelated to smoking. Although exposure to the adolescent YouTube smokers increased perceived prevalence among some participants, it simultaneously increased beliefs about smoking's adverse health outcomes and negative attitudes toward smoking, effects that were associated with reductions in injunctive norms of social acceptability. Interventions that communicate the severity and scope of health risks associated with smoking may undercut the descriptive normative effects of peer modeling of smoking on social media sites such as YouTube.

The Influence of Statistical versus Exemplar Appeals on Indian Adults' Health Intentions: An Investigation of Direct Effects and Intervening Persuasion Processes

In two separate investigations, we examined the persuasive effectiveness of statistical versus exemplar appeals on Indian adults' smoking cessation and mammography screening intentions. To more comprehensively address persuasion processes, we explored whether message response and perceived message effectiveness functioned as antecedents to persuasive effects. Results showed that statistical appeals led to higher levels of health intentions than exemplar appeals. In addition, findings from both studies indicated that statistical appeals stimulated more attention and were perceived as more effective than anecdotal accounts. Among male smokers, statistical appeals also generated greater cognitive processing than exemplar appeals. Subsequent mediation analyses revealed that message response and perceived message effectiveness fully carried the influence of appeal format on health intentions. Given these findings, future public health initiatives conducted among similar populations should design messages that include substantive factual information while ensuring that this content is perceived as credible and valuable.

Perceptions of a drug prevention public service announcement campaign among street-involved youth in Vancouver, Canada: a qualitative study

Background

Due to the popularity of public service announcements (PSAs), as well as the broader health and social harms associated with illicit drug use, this study sought to investigate how drug prevention messages found in the Government of Canada’s DrugsNot4Me campaign were understood, experienced, and engaged with among a group of street-involved young people in Vancouver, Canada.

Methods

Qualitative interviews were conducted with 25 individuals enrolled in the At-Risk Youth Study, and a thematic analysis was conducted.

Results

Findings indicate that the campaign’s messages neither resonated with “at-risk youth”, nor provided information or resources for support. In some cases, the messaging exacerbated the social suffering experienced by these individuals.

Conclusions

This study underscores the importance of rigorous evaluation of PSAs and the need to consider diverting funds allocated to drug prevention campaigns to social services that can meaningfully address the structural drivers of drug-related harms among vulnerable youth populations.

The social image of drinking - mass media campaigns may inadvertently increase binge drinking

Mass media campaigns that promote responsible drinking are rarely tested for their usefulness in reducing heavy alcohol consumption. Existing campaigns that appeal to responsible drinking while simultaneously displaying young people in social drinking situations may even have paradoxical effects. To examine such possible effects, we drew on a real-world media campaign, which we systematically modified on the basis of recent prototype research. We pilot tested questionnaires (using n = 41 participants), developed two different sets of posters in the style of an existing campaign (n = 39) and investigated their effectiveness (n = 102). In the main study, young men were randomly assigned to one of three conditions: sociable or unsociable binge drinker prototype condition or a control group. Outcome variables were intention, behavioural willingness, attitude, subjective norm, self-efficacy, prototype evaluation and prototype similarity with respect to binge drinking. Binge drinking as a habit was included to control for the fact that habitual drinking in social situations is hard to overcome and poses a particular challenge to interventions. The manipulation check showed that the experimental variation (sociable vs. unsociable drinker prototype condition) was successful. Results of the main study showed that the sociable drinker prototype condition resulted in a higher willingness and - for those with less of a habit - a higher intention to binge drink the next weekend. The unsociable drinker prototype condition had no effects. The results imply that the social components of mass media campaigns might inadvertently exacerbate binge drinking in young men. We therefore advocate against campaigns including aspects of alcohol consumption that might be positively associated with drinker prototype perception. Finally, we provide suggestions for future research.

Interpreting Perceived Effectiveness: Understanding and Addressing the Problem of Mean Validity

Research has shown that perceived message effectiveness (PE) correlates reasonably well with indices of actual effectiveness, but little attention has been given to how to interpret mean PE. This article describes the problem of mean validity and presents a research design that can be used to address it. Participants (N = 195) viewed messages that advocated being screened for colorectal cancer. The results showed downward bias in PE among members of the non-target audience (persons younger than 50) and upward bias as the referent for the judgment became more abstract/distant (self vs. persons older than 50 vs. general). The need for more research on mean validity is discussed. For applied researchers, recommendations for preferred indices of PE are offered.

The moderating role of aggressiveness in response to campaigns and interventions promoting anti-violence attitudes

This research indicates that a critical factor for understanding the success or failure of anti-violence campaigns is the aggressiveness of the target audience. We propose that person and situation interact in predicting post-intervention attitudes toward violence, fighting expectations, and intentions to learn how to use real guns. Across two studies conducted in different countries and with different age populations, we found that anti-violence campaigns were effective, only for those for whom the message was already pro-attitudinal (low trait aggressiveness). In contrast, for individuals with relatively higher scores in trait aggressiveness, there was no difference in attitudes toward violence between those who received the anti-violence intervention and those assigned to the control group. In fact, the anti-violence messages resulted in a boomerang effect, increasing the favorability of attitudes toward violence in one of the studies. Aggr. Behav. 42:471-482, 2016. © 2016 Wiley Periodicals, Inc.

Female Ex-Offender Perspectives on Drug Initiation, Relapse, and Desire to Remain Drug Free

Recently released homeless women residing in temporary residential drug treatment (RDT) programs are at a critical juncture in the process of recovery, transition, and reentry. The purpose of this study was to explore factors influencing initial use of drugs and relapse triggers among a sample of incarcerated women exiting jails and prisons, residing in an RDT program, and preparing for reentry into their communities. Among this population, relapse to drug use and recidivism are common. A qualitative study was conducted utilizing focus groups to understand the perspectives of formerly incarcerated, currently homeless women residing in an RDT program. Content analysis generated the development of three broad categories: (a) factors associated with first drug use, (b) factors involved in relapse, and (c) factors influencing desire to remain drug free. A discussion follows highlighting the importance of targeted interventions at RDT sites that integrate physical, psychological, and social needs to optimize reentry into communities. This includes a focus on building self-esteem and life skills and providing access to resources such as housing, employment, and healthcare.

Developing an SMS Intervention for the Prevention of Underage Drinking: Results From Focus Groups

BACKGROUND

There is growing evidence that text messaging-"short message service" (SMS)-is useful for health promotion and behavior change. SMS has become a preferred channel of communication among adolescents. Despite burgeoning interest, there remains a critical need for formative research regarding developmentally and culturally appropriate SMS-based health promotion with teenagers.

OBJECTIVES

The primary objective was to develop SMS message protocols and procedures effective for reducing underage drinking among Hispanic teens. Using focus groups, we sought our target population's perspectives on SMS parameters including scheduling, frequency, content, themes, and confirmation-of-receipt.

METHOD

We conducted, recorded, and transcribed six mixed-gender focus groups (20 adolescents, 4-5 per group) recruited from the Division of Adolescent Medicine at Miami Children's Hospital. Alcohol-related and "attention control" text messages were assembled from two sources (http://www.mobilehealth4youth.org and the existing literature); these SMSs, along with SMS procedures, were the focus of discussion. The recordings and transcription were reviewed by two researchers who employed a qualitative iterative process analytical approach.

RESULTS

Findings revealed distinct preferences among teenagers about the scheduling, frequency, content, themes, and confirmation-of-receipt of SMSs. Moreover, teens were most enthusiastic about SMSs that addressed alcohol-related knowledge, self-efficacy, social support, or future orientation. Conclusion/Importance: Seeking our target population's perspectives on SMS parameters was essential for developing SMS message protocols and procedures with potential effectiveness for reducing underage drinking among Hispanic teens. It is strongly recommended that researchers or clinicians considering SMS-based interventions conduct a similar formative process prior to implementation.

What Do People Like to "Share" About Obesity? A Content Analysis of Frequent Retweets About Obesity on Twitter

Twitter has been recognized as a useful channel for the sharing and dissemination of health information, owing in part to its "retweet" function. This study reports findings from a content analysis of frequently retweeted obesity-related tweets to identify the prevalent beliefs and attitudes about obesity on Twitter, as well as key message features that prompt retweeting behavior conducive to maximizing the reach of health messages on Twitter. The findings show that tweets that are emotionally evocative, humorous, and concern individual-level causes for obesity were more frequently retweeted than their counterparts. Specifically, tweets that evoke amusement were retweeted most frequently, followed by tweets evoking contentment, surprise, and anger. In regard to humor, derogatory jokes were more frequently retweeted than nonderogatory ones, and in terms of specific types of humor, weight-related puns, repartee, and parody were shared frequently. Consistent with extant literature about obesity, the findings demonstrated the predominance of the individual-level (e.g., problematic diet, lack of exercise) over social-level causes for obesity (e.g., availability of cheap and unhealthy food). Implications for designing social-media-based health campaign messages are discussed.

Social Marketing in Malaysia: Cognitive, Affective, and Normative Mediators of the TAK NAK Antismoking Advertising Campaign

Antismoking mass media campaigns are known to be effective as part of comprehensive tobacco control programs in high-income countries, but such campaigns are relatively new in low- and middle-income countries and there is a need for strong evaluation studies from these regions. This study examines Malaysia's first national antismoking campaign, TAK NAK. The data are from the International Tobacco Control Malaysia Survey, which is an ongoing cohort survey of a nationally representative sample of adult smokers (18 years and older; N = 2,006). The outcome variable was quit intentions of adult smokers, and the authors assessed the extent to which quit intentions may have been strengthened by exposure to the antismoking campaign. The authors also tested whether the impact of the campaign on quit intentions was related to cognitive mechanisms (increasing thoughts about the harm of smoking), affective mechanisms (increasing fear from the campaign), and perceived social norms (increasing perceived social disapproval about smoking). Mediational regression analyses revealed that thoughts about the harm of smoking, fear arousal, and social norms against smoking mediated the relation between TAK NAK impact and quit intentions. Effective campaigns should prompt smokers to engage in both cognitive and affective processes and encourage consideration of social norms about smoking in their society.

Inoculating against reactance to persuasive health messages

This investigation examined the possibility of decreasing psychological reactance to health campaigns through the use of inoculation messages. It was hypothesized that an inoculation message, which forewarned of the potential of subsequent reactance, would decrease participants' likelihood of reacting negatively to a freedom-threatening message aimed to reduce excessive alcohol consumption. Participants (N = 275) who were inoculated against potential reactance felt less threatened and experienced less reactance compared to those who did not read an inoculation message. Structural equation modeling showed that inoculation indirectly predicted lower intention to drink alcohol via the theorized mediated reactance process. This research suggests that it is possible to inoculate against self-generated cognitions that might otherwise lead toward negative health behaviors.

On the conceptual ambiguity surrounding perceived message effectiveness

Health message quality is best understood in terms of a message's ability to effectively produce change in the variables that it was designed to change. The importance of determining a message's effectiveness in producing change prior to implementation is clear: The better a message's potential effectiveness is understood, the better able interventionists are to distinguish effective from ineffective messages before allocating scarce resources to message implementation. For this purpose, research has relied on perceived message effectiveness measures as a proxy of a message's potential effectiveness. Remarkably, however, very little conceptual work has been done on perceived message effectiveness, which renders its measures underinformed and inconsistent across studies. To encourage greater conceptual work on this important construct, we review several threats to the validity of existing measures and consider strategies for improving our understanding of perceived message effectiveness.

Low message sensation health promotion videos are better remembered and activate areas of the brain associated with memory encoding

Greater sensory stimulation in advertising has been postulated to facilitate attention and persuasion. For this reason, video ads promoting health behaviors are often designed to be high in “message sensation value” (MSV), a standardized measure of sensory intensity of the audiovisual and content features of an ad. However, our previous functional Magnetic Resonance Imaging (fMRI) study showed that low MSV ads were better remembered and produced more prefrontal and temporal and less occipital cortex activation, suggesting that high MSV may divert cognitive resources from processing ad content. The present study aimed to determine whether these findings from anti-smoking ads generalize to other public health topics, such as safe sex. Thirty-nine healthy adults viewed high- and low MSV ads promoting safer sex through condom use, during an fMRI session. Recognition memory of the ads was tested immediately and 3 weeks after the session. We found that low MSV condom ads were better remembered than the high MSV ads at both time points and replicated the fMRI patterns previously reported for the anti-smoking ads. Occipital and superior temporal activation was negatively related to the attitudes favoring condom use (see Condom Attitudes Scale, Methods and Materials section). Psychophysiological interaction (PPI) analysis of the relation between occipital and fronto-temporal (middle temporal and inferior frontal gyri) cortices revealed weaker negative interactions between occipital and fronto-temporal cortices during viewing of the low MSV that high MSV ads. These findings confirm that the low MSV video health messages are better remembered than the high MSV messages and that this effect generalizes across public health domains. The greater engagement of the prefrontal and fronto-temporal cortices by low MSV ads and the greater occipital activation by high MSV ads suggest that that the “attention-grabbing” high MSV format could impede the learning and retention of public health messages.