The Impact of Celebrity and Influencer Illness Disclosures

When celebrities, political figures, influencers, or anyone with a large following publicly disclose an illness or die, the news becomes a de facto public health campaign. Until health communicators began studying such disclosures and the effects of the following waves of media coverage, however, it was not known to what extent these events impacted the public. A growing body of research has empirically documented these events and examined the factors that predict which types of audiences are most affected and why. Beyond motivating research opportunities, celebrity and influencer health disclosures or deaths can impact calls to hotlines, views on health-related websites, discussions of related topics on social media, behavioral changes relevant to the disclosure, increased news coverage of celebrity health research, integration of celebrity health narratives into strategic health campaigns, and even policy changes. We provide an overview of research conducted in this area and detail examples of the impact that celebrity health disclosures and studies about those disclosures have had on public discourse and public health.

Engagement With a Youth Community Advisory Board to Develop and Refine a Facebook HPV Vaccination Promotion Intervention (#HPVvaxtalks) for Young Black Adults (18-26 years old)

Human papillomavirus (HPV) vaccination rates remain suboptimal among young Black adults (18-26 years). Research focused on HPV vaccination among young Black adults is limited. Guided by the Theory of Planned Behavior, we developed #HPVvaxtalks, a theoretically grounded and culturally appropriate Facebook intervention in collaboration with a youth community advisory board (YCAB) to increase awareness of HPV risk factors, risk perception, HPV vaccine-related knowledge, vaccination intention, and uptake for Black individuals. Engagement with YCAB members fostered opportunity to discuss priorities reflecting the community's interest and make #HPVvaxtalks more relevant. This article describes the YCAB engagement and collaborative process in the development and refinement of posts/messages for #HPVvaxtalks. Five young Black adults (18-26 years of age) were invited to become members of a YCAB. YCAB reviewed the preliminary version of #HPVvaxtalks intervention materials and provided critiques and suggestions for refinement. Following the completion of the collaborative process, YCAB members completed individual interviews to reflect on the process. Feedback from YCAB participants focused on the relevance, engagement, clarity, and organization of the content and the media utilized. Participants suggested using "memes" to improve cultural relevance and engagement for young Black individuals. All YCAB members expressed satisfaction with the development process. Collaboration with a YCAB was crucial in developing a culturally relevant and acceptable #HPVvaxtalks intervention, which includes 40 messages/posts for young Black adults. Undergoing the iterative process of intervention development and refinement with the priority population can be an essential component in the design and implementation of health promotion activities.

Improving African Americans' Intentions to Enroll in a Health Registry: Message Development and Evaluation

African Americans' enrollment in health registries is low, negatively affecting their representation in clinical research. Young African Americans are particularly underrepresented. Because medical discoveries are typically based on findings from research that lacks minority representation, new treatments may not be equally effective with members of the African American community. This may further exacerbate health disparities. In this two-phase study, we first collected data from five focus groups to (a) investigate young African Americans' knowledge about and attitudes toward health registries and (b) explore their perceptions about current messages used to recruit participants into health registries. The findings from the first phase of our research showed that participants had limited awareness and understanding of health registries' functions and held negative attitudes toward research participation. In Phase 2, we conducted an experiment to compare the effects of a current message, a new message designed based on the findings from our Phase 1 study, and a control. Results showed mixed findings on the impact of the new targeted message. Based on the findings from both phases of this study, we present and discuss future strategies.

Understanding COVID-19 Vaccine Knowledge, Beliefs, and Trusted Information Sources Among Black Women in Kentucky: Implications for Vaccine Uptake

To optimize COVID-19 vaccination rates among Black women in the United States, it is crucial to understand their vaccine beliefs and determine the most effective communication sources and messages to encourage vaccination. Consequently, we conducted seven focus groups with 20 Black women from Kentucky (aged 18-37 years) between October and November 2020. We identified five themes reflecting the participants' level of awareness, knowledge of the vaccine and vaccine development process; their uncertainty about vaccine safety and clinical trials; their willingness to get vaccinated, and their preferences for trusted sources and persuasive messages to motivate vaccine uptake. Despite the participants' high level of awareness about the vaccine's development, significant concerns were identified regarding the speed of the vaccine's development and clinical trials, known medical injustices against Black people, political influence, vaccine efficacy, and potential side effects that fed their unwillingness to vaccinate. Based on our findings, we recommend vaccination campaigns targeting Black women should prioritize messaging highlighting the benefits and limitations of the vaccine while emphasizing its protective benefits for self, family, and community. Campaigns should also include Black healthcare providers as sources of messages. The findings have additional implications for encouraging continued confidence in the vaccine and improving uptake.

Beliefs Underlying Colorectal Cancer Information Seeking Among Young Black Adults: a Reasoned Action Approach Elicitation Study

Colorectal cancer in younger adults is more likely to be diagnosed at an advanced stage. Furthermore, younger Black adults are more likely to be diagnosed with and die from colorectal cancer than younger White adults. Given these persistent racial disparities, urgent attention is needed to increase colorectal cancer awareness and information seeking among young Black adults. Guided by the reasoned action approach, the purpose of this study was to identify behavioral, normative, and control beliefs that influence general colorectal cancer information seeking, talking to a healthcare provider about colorectal cancer, and talking to family about cancer history. The sample included N = 194 participants; Mage = 28.00 (SD = 5.48). Thirty-one percent had ever searched for colorectal cancer information. We identified salient educational advantages to seeking information about colorectal cancer and talking to healthcare providers and family members about cancer history. Barriers included fear, misinformation, low priority, inaccessibility of information, and lack of interest or willingness. This is one of the few studies to investigate cancer communication behaviors among young Black adults. The findings can inform interventions to motivate engagement in cancer communication behaviors.

A Theoretically Based Analysis of Twitter Conversations about Trauma and Mental Health: Examining Responses to Storylines on the Television Show Queen Sugar

Entertainment programming in the United States has long addressed major public health issues. In the present study, we used a culture-centric approach to systematically investigate the role of television storylines in facilitating health-related conversations on social media. In particular, we examined Twitter conversations about sexual and police-involved trauma prompted by portrayals on the fictional television drama Queen Sugar. Guided by the culture-centric model of narratives in health promotion, we classified the tweets (N = 1,671) into four main thematic categories: identification, social proliferation, emotions, and intentions. The analysis also revealed several subthemes, including identification with characters and cultural elements, expressions of pain and joy, information seeking and sharing, and the need to address intergenerational trauma and promote intergenerational conversations. The data suggests that Twitter may provide a vehicle for engaging in difficult conversations. We discuss the theoretical and practical implications of the study for mental health communication with Black Americans.

SARS-CoV-2 (COVID-19) Vaccine Intentions in Kentucky

Background

At the time of our writing, the COVID-19 pandemic continues to cause significant disruption to daily lives. In Kentucky, the burdens from this disease are higher, and vaccination rates for COVID-19 are lower, in comparison to the U.S. as a whole. Understanding vaccine intentions across key subpopulations is critical to increasing vaccination rates.

Purpose

This study explores COVID-19 vaccine intentions in Kentucky across demographic subpopulations and also investigates the influences on vaccine intention of attitudes and beliefs about COVID-19.

Methods

A population-based survey of 1,459 Kentucky adults was conducted between January 26 and March 20, 2021, with over-sampling of black/African American and Latino/a residents, using online and telephonic modalities. Descriptive statistics characterize the sample and overall vaccine intentions and beliefs. Multivariable linear regression models probed relationships between demographics and vaccination intentions, as well as relationships between vaccination beliefs and vaccination intention.

Results

Of the 1,299 unvaccinated respondents, 53% reported intent to get vaccinated, 16% had not decided, and 31% felt they would not get vaccinated. Lower vaccination intention was independently associated with age, lower educational attainment, black/African American race, lower income, Republican political affiliation, rural residence, and several beliefs: low vaccine safety, low vaccine efficacy, the rapidity of vaccine development, and mistrust of vaccine producers.

Implications

Increasing COVID-19 vaccination rates will help end this pandemic. Findings from this study can be used to tailor information campaigns aimed at helping individuals make informed decisions about COVID-19 vaccination.

Health Information Seeking as a Coping Strategy to Reduce Alzheimer's Caregivers' Stress

Individuals with Alzheimer's disease and other forms of dementia (referred to as AD) deteriorate over time, and there will likely be a corresponding increase in levels of burden and stress for caregivers. Despite the significant contributions made by informal caregivers, there are no widely available mechanisms that meet the information needs of informal caregivers. Using a qualitative approach, the current study focuses on AD caregiver information seeking. The study involved conducting interviews to answer the following research questions: (1) What motivating factors lead informal caregivers of people with AD to seek out information?; (2) Is there a relationship between information seeking and resulting perceived stress levels?; and (3) Why do informal caregivers choose to utilize certain resources more than others during their information seeking process? Findings revealed that caregivers' largest motivation for seeking information is to learn how to better care for their loved one. Caregivers tend to rely on mediated resources that they find credible, and interpersonal resources such as people with similar experiences to their own. Many participants were satisfied with information available, but others felt that their interactions with healthcare professionals created more stress and emotional anguish than anticipated. This study offers an initial step in finding ways to meet the needs of those who seek to mitigate their stress through information seeking. By studying the information needs of the caregiving population, healthcare workers and communicators will be more knowledgeable about the relationship between information seeking and stress and coping.

Cancer Fatalism and Cancer Information Seeking Among Black Women: Examining the Impact of Aretha Franklin's Death on Cancer Communication Outcomes

Information seeking is often heightened following news coverage of cancer announcements from prominent celebrities or public figures. While scholars have sought to explicate the mechanisms influencing cancer information seeking following celebrity health announcements, the focus has primarily been on cognitive and emotional factors. Other influences such as sociocultural constructs have largely been ignored in this domain. Additionally, few studies have examined the health communication behaviors of minority individuals. The purpose of this study was to examine Black women's information seeking behaviors as a response to the death of the singer Aretha Franklin from pancreatic cancer and the role of fatalistic beliefs about cancer in the information seeking process. Using a survey conducted a few weeks after Franklin's death (N = 164), we found moderate amounts of pancreatic cancer information seeking, with almost 30% of women looking for information. Younger Black women were much more likely to search for information after Franklin's death than older women. Moreover, while we found fatalistic beliefs to be associated with pancreatic cancer information seeking, the findings were driven by younger women. In particular, younger women were more likely to seek pancreatic cancer information regardless of their beliefs about cancer. This study advances the understanding of cancer information seeking among Black women. Implications for cancer communication with Black women are discussed.

Young African Americans' Communication with Family Members About COVID-19: Impact on Vaccination Intention and Implications for Health Communication Interventions

Communication with family members about the COVID-19 vaccine may play an important role in vaccination decisions, especially among young people. This study examined the association between family communication about the COVID-19 vaccine and vaccination intention. Participants were Black/African Americans aged 18-30 years (N = 312) recruited through an online survey in June 2020. We assessed family communication, vaccine attitudes, perceived norms, outcome expectancies, and vaccination intention. More than half (62%) of the participants had talked to family members about the vaccine. Females were more likely than males to have engaged in family communication (63% vs. 59%) (p. > .05). Family communication, injunctive norms, and descriptive norms were significantly (p. < .01) associated with vaccination intention. Family communication was the strongest predictor of intention.Promoting discussions about vaccinations between young Black adults and their families may increase the likelihood of adopting positive vaccination beliefs and influencing vaccine decision-making.

"Twitter is Really Therapeutic at Times": Examination of Black Men's Twitter Conversations Following Hip-Hop Artist Kid Cudi's Depression Disclosure

Mental illness affects a considerable number of African Americans, and Black men bare a heavy burden. Over the past few years, more and more Black male celebrities have publicly discussed their struggles with mental illness, aiming to raise awareness, educate the public, and reduce stigma around mental health in the Black community. In this exploratory study, I investigated Twitter conversations following hip-hop artist Scott "Kid Cudi" Mescudi's October 2016 depression disclosure. Following the disclosure, the hashtag #YouGoodMan was created to engage Black men on Twitter in conversations about mental health. I used thematic analysis to analyze a sample of 1,482 tweets from the hashtag. Three distinct themes emerged from this study, with implications for mental health communication. The three themes are (a) advocating for mental health disclosure, (b) providing online and offline support, and (c) acknowledging the role and impact of culture and society. The findings are discussed relevant to social representations theory, celebrity influence, and health campaigns.

Black College Women's Interpersonal Communication in Response to a Sexual Health Intervention: A Mixed Methods Study

We investigated interpersonal communication generated from a successful sexual health intervention for Black college women attending a Historically Black College/University (HBCU). Guided by the integrative model of behavioral prediction and the theory of gender and power, the intervention combined point-of-access health messages with condom distribution via condom dispensers. Using a mixed-methods approach, we examined communication partners, content, mode, valence, and perceived impact. Data were gathered from surveys (N = 105) and interviews (n = 10) with young adult women at an HBCU campus, conducted three months after the intervention. The findings revealed that 43% of women engaged in interpersonal communication and 21% engaged in online interactions about the dispensers. Friends were the most common conversation partners, and the conversations were mainly about condoms and the dispensers themselves. In general, the discussions were positive, showing support for the dispensers. Regression analyses revealed positive, significant associations between interpersonal communication and two key outcomes: condom acceptability and condom intentions. Overall, this study adds to research linking health communication interventions to interpersonal communication and subsequent attitudes and beliefs. Health communication interventions should actively encourage young Black women to share health-promoting information within their social networks to extend both the reach and impact of those interventions.

Values of cancer survivors and the supportive role of recreational video games

Value-affirming activities have been linked to positive health outcomes and improved ability to cope. For cancer survivors who regularly play video games, might the games have potential to affirm values? We surveyed gameplaying survivors and included an open-ended question asking about values and the extent to which they perceived gameplaying as supporting values. A content analysis of responses (N = 533) using Schwartz's value typology revealed that a majority perceived gameplaying as supporting values or offering other benefits. Self-transcendence followed by openness to change were the most frequently coded higher-order categories. The results contribute to a richer understanding of survivors who gameplay.

Impact of tobacco-pack pictorial warnings on youth and young adults: A systematic review of experimental studies

INTRODUCTION

We conducted a systematic review of the experimental literature on the impact of tobacco-pack pictorial warning labels (PWLs) on youth and young adults.

METHODS

We systematically searched computerized databases and the reference lists of relevant articles. We included studies that used an experimental protocol to assess PWLs. Studies had to report findings for youth or young adult samples (aged <30 years). Thirty-one studies met the inclusion criteria, with a total sample size of 27506. Two coders independently coded all study characteristics and outcomes.

RESULTS

Twenty-eight studies experimentally evaluated PWLs for cigarette packs while three studies evaluated PWLs for smokeless tobacco packs. Generally, PWLs led to higher attention, stronger cognitive and affective reactions, more negative pack attitudes and smoking attitudes, and increased intentions not to use tobacco products compared to text warnings. PWLs were perceived to be more effective than text warnings for both cigarette packs and smokeless tobacco packs.

CONCLUSIONS

The systematic review showed that PWLs on tobacco products are effective across a wide range of tobacco-related outcomes among young people. Gaps in the literature include a lack of research on tobacco initiation and cessation and a dearth of literature on non-cigarette tobacco products.

Young Black Men's Information Seeking following Celebrity Depression Disclosure: Implications for Mental Health Communication

Celebrity health disclosures motivate people to seek information about various health topics. However, limited systematic evaluations exist on effects of celebrity disclosures of mental illness, despite observations that this is a growing phenomenon and have important implications for public health education. Further, research has rarely examined the impact of such disclosures on minority populations. This study sought to understand factors associated with young Black men's information seeking following exposure to a depression disclosure by Scott Mescudi. Mescudi is a well-known Black male hip-hop artist who shared his depression diagnosis and subsequent treatment plans with his fans in October 2016. For this study, I surveyed 182 Black males aged 18-34, 1 month after the disclosure. Fifty percent sought general information about depression, and 16% sought information to ascertain whether they themselves were at risk for depression. Feeling emotional distress following the disclosure and having current depression symptoms were significantly associated with information seeking behaviors. Identification was indirectly related to information seeking through emotional distress. Thus, emotional distress appears to play an important role in information seeking behaviors following celebrity health disclosures. The findings suggest celebrity health disclosures are associated with proactive health behaviors among this sample. Implications of the results for theorization of celebrity health effects and research on mental health communication with young Black men are discussed.

"Be Straight Up and So Will He": Evaluation of a Novel HIV Prevention Condom Distribution and Health Communication Intervention Targeting Young African American Females

This study evaluated a novel 3-month campus-based HIV prevention condom distribution and health communication intervention for African American females attending a historically Black college in North Carolina. The theoretical framework for study incorporated the integrative model of behavioral prediction and the theory of gender and power. The intervention provided free condoms via condom dispensers with point-of-access messaging on the dispensers. We assessed 195 individuals before and 118 three months after the intervention. Almost 90% of participants were exposed to the intervention. Forty-four percent used the dispensers, 70% of whom reported using the condoms for sexual intercourse. Perceptions of condom availability and accessibility increased significantly after the intervention. In a multiple regression analysis controlling for covariates, dispenser use was significantly associated with greater condom use. These findings show the promise of a low-cost, broad-reach HIV/STI prevention intervention for young African American women.

Systematic Review of Measures Used in Pictorial Cigarette Pack Warning Experiments

BACKGROUND

We sought to describe characteristics and psychometric properties of measures used in pictorial cigarette pack warning experiments and provide recommendations for future studies.

METHODS

Our systematic review identified 68 pictorial cigarette pack warning experiments conducted between 2000 and 2016 in 22 countries. Two independent coders coded all studies on study features, including sample characteristics, theoretical framework, and constructs assessed. We also coded measurement characteristics, including construct, number of items, source, reliability, and validity.

RESULTS

We identified 278 measures representing 61 constructs. The most commonly assessed construct categories were warning reactions (62% of studies) and perceived effectiveness (60%). The most commonly used outcomes were affective reactions (35%), perceived likelihood of harm (22%), intention to quit smoking (22%), perceptions that warnings motivate people to quit smoking (18%), and credibility (16%). Only 4 studies assessed smoking behavior. More than half (54%) of all measures were single items. For multi-item measures, studies reported reliability data 68% of the time (mean α = 0.88, range α = 0.68-0.98). Studies reported sources of measures only 33% of the time and rarely reported validity data. Of 68 studies, 37 (54%) mentioned a theory as informing the study.

CONCLUSIONS

Our review found great variability in constructs and measures used to evaluate the impact of cigarette pack pictorial warnings. Many measures were single items with unknown psychometric properties. Recommendations for future studies include a greater emphasis on theoretical models that inform measurement, use of reliable and validated (preferably multi-item) measures, and better reporting of measure sources.

IMPLICATIONS

Robust and consistent measurement is important for building a strong, cumulative evidence base to support pictorial cigarette pack warning policies. This systematic review of experimental studies of pictorial cigarette warnings demonstrates the need for standardized, theory-based measures.

Communication technologies to improve HPV vaccination initiation and completion: A systematic review

OBJECTIVES

This systematic review examines the effectiveness of communication technology interventions on HPV vaccination initiation and completion.

METHODS

A comprehensive search strategy was used to identify existing randomized controlled trials testing the impact of computer-, mobile- or internet-based interventions on receipt of any dose of the HPV vaccine. Twelve relevant studies were identified with a total of 38,945 participants.

RESULTS

The interventions were delivered using several different methods, including electronic health record (i.e. recall/reminder) prompts, text messaging, automated phone calls, interactive computer videos, and email. Vaccine initiation and completion was greater for technology-based studies relative to their control conditions.

CONCLUSION

There is evidence that interventions utilizing communication technologies as their sole or primary mode for HPV vaccination intervention delivery may increase vaccination coverage.

PRACTICE IMPLICATIONS

Communication technologies hold much promise for the future of HPV vaccination efforts, especially initiatives in practice-based settings.

Believability of new diseases reported in the 2014 Surgeon General's Report on smoking: Experimental results from a national survey of US adults

BACKGROUND

Tobacco use is the leading cause of preventable disease and death globally. The 2014 Surgeon General's Report included new diseases linked to smoking, including liver and colon cancer, diabetes and tuberculosis. As more diseases are linked to smoking, which diseases should we communicate to the public and what message source has the most impact?

METHODS

Data were collected through a nationally representative phone survey of US adults (N=5014), conducted from September 2014 through May 2015. We experimentally randomized participants to a 2 (new smoking disease messages - liver and colon cancers compared to diabetes and tuberculosis) by 4 (message sources - CDC, FDA, Surgeon General, and none) experiment. The outcome was message believability.

RESULTS

About half the sample was female (51.5%) and 17.8% were a current smoker. Overall, 56% of participants said the messages were very believable. Cancer messages (liver and colon cancer) were significantly more believable than messages about chronic disease (tuberculosis and diabetes), 61% vs. 52%. Smokers were less likely to report both sets of new disease messages as very believable compared to non-smokers. Significantly more smokers intending to quit (44.5%) found the messages to be very believable compared to smokers not intending to quit (22.6%). Believability did not differ by message source.

CONCLUSION

Important differences exist in believability of disease messages about new tobacco-related information. Messages emphasizing the causal link between smoking and new diseases should be considered for use in mass media campaigns.

Effects of Strengthening Cigarette Pack Warnings on Attention and Message Processing: A Systematic Review

The current study sought to examine the impact of strengthening cigarette pack warnings on attention, message processing, and perceived effectiveness, through a systematic review of longitudinal observational studies. The review included 22 studies (N = 81,824 participants). Strengthened warnings increased attention to warnings, recall of warnings, and thinking about the health risks of smoking. Strengthened warnings also increased several perceived effectiveness outcomes, including perceptions that warnings reduce smoking and motivate quitting. Strengthened cigarette pack warnings achieve their goal of attracting attention and enhancing motivation to act. Strengthening warning policies should be a priority for tobacco control globally.

Perceptions of a campus-wide condom distribution programme: An exploratory study

OBJECTIVE

Condom distribution programmes are an important means of preventing sexually transmitted infections (STIs); yet little research has examined their perceived and actual impact on college campuses.

DESIGN

Quantitative, cross-sectional study.

SETTING

Large public university in the Southeastern USA.

METHOD

Approximately 2 months after a campus-wide condom distribution programme began, we utilised intercept surveys with 355 students (68% women; 43% racial/ethnic minorities) to examine their perceptions of the availability, accessibility and acceptability of condoms, and their perceptions and use of the newly installed condom dispensers.

RESULTS

Students perceived condoms to be available and accessible on campus after implementation of the condom dispensers. Students had heard about the dispensers from other people (36%), through social media (18%) and the campus newspaper (15%). Most students (71%) had seen the dispensers. Almost one in four students (23%) had taken a condom from the dispensers; among those who were sexually active during the 2months that the dispensers were available, 33% had used them. More than one-third of students (37%) - and 53% of sexually active students - indicated intentions to use the dispensers in the next 6months. Multiple regression analysis controlling for age, gender and race revealed that prior condom use, attitudes about the dispensers and comfort with the dispensers were significant predictors of sexually active students' intentions to use the dispensers (p<.001).

CONCLUSION

Overall, results indicate that over a short time period, this condom distribution programme was successful in reaching students and providing free condoms. Implications for implementing condom distribution programmes on college campuses as well as future directions for research are discussed.

The impact of strengthening cigarette pack warnings: Systematic review of longitudinal observational studies

OBJECTIVES

Cigarette pack warnings are a tobacco control strategy used globally. To understand their impact, we systematically reviewed longitudinal observational studies examining national implementation of strengthened warnings.

METHODS

We used comprehensive search procedures to identify observational studies examining the impact of strengthening cigarette pack warnings. We report longitudinal changes in knowledge, beliefs, attitudes, intentions, and behavior.

RESULTS

We identified 32 studies conducted in 20 countries with 812,363 participants. Studies commonly examined changes from text to pictorial warnings (64%); the remainder examined strengthened text or strengthened pictorial warnings. Knowledge increased in all 12 studies that assessed it. Studies of beliefs/attitudes and intentions showed mixed results. Quitline calls increased in four of six studies, while foregoing of cigarettes did not increase. Cigarette consumption decreased in three of eight studies; quit attempts increased in four of seven studies; and short-term cessation increased in two of three studies. Smoking prevalence decreased in six of nine studies.

CONCLUSIONS

Strengthening warnings was associated with longitudinal increases in knowledge, quitline calls and reductions in smoking behavior. Strengthening warning policies should be a priority for tobacco control globally.

Cancer Survivors Who Play Recreational Computer Games: Motivations for Playing and Associations with Beneficial Psychological Outcomes

OBJECTIVE

Playing recreational videogames is a common activity, yet little is known about its role in the lives of people who are coping with serious illness. These individuals may experience depression and isolation and may turn to games to help alleviate negative experiences and support well-being. We explored these possibilities in the context of cancer survivors. The study aimed to discover motivations underlying game play and the extent to which motivations are associated with psychological health and well-being.

METHODS

We conducted a cross-sectional online survey of survivors who play recreational games (N = 794). Key variables were motivations and indicators of psychological health, including self-efficacy in cancer communications, resilient coping, and beliefs that one is living a fulfilling and meaningful life (flourishing).

RESULTS

Participants were most likely to be motivated to play for stimulation and a sense of accomplishment (intrinsic rewards), followed by development of self, sense of community, and personal affirmation. Multiple regression analyses revealed positive associations between playing for intrinsic rewards and all three psychological health outcomes. Playing for a sense of community was also positively associated with coping and flourishing.

CONCLUSION

Playing recreational videogames, particularly to receive intrinsic rewards and to connect with others, may play a supportive role in the psychological health of survivors. Findings suggest future areas for research and implications for development of serious games.

Pictorial cigarette pack warnings: a meta-analysis of experimental studies

OBJECTIVE

To inform international research and policy, we conducted a meta-analysis of the experimental literature on pictorial cigarette pack warnings.

DATA SOURCES

We systematically searched 7 computerised databases in April 2013 using several search terms. We also searched reference lists of relevant articles.

STUDY SELECTION

We included studies that used an experimental protocol to test cigarette pack warnings and reported data on both pictorial and text-only conditions. 37 studies with data on 48 independent samples (N=33,613) met criteria.

DATA EXTRACTION AND SYNTHESIS

Two independent coders coded all study characteristics. Effect sizes were computed from data extracted from study reports and were combined using random effects meta-analytic procedures.

RESULTS

Pictorial warnings were more effective than text-only warnings for 12 of 17 effectiveness outcomes (all p<0.05). Relative to text-only warnings, pictorial warnings (1) attracted and held attention better; (2) garnered stronger cognitive and emotional reactions; (3) elicited more negative pack attitudes and negative smoking attitudes and (4) more effectively increased intentions to not start smoking and to quit smoking. Participants also perceived pictorial warnings as being more effective than text-only warnings across all 8 perceived effectiveness outcomes.

CONCLUSIONS

The evidence from this international body of literature supports pictorial cigarette pack warnings as more effective than text-only warnings. Gaps in the literature include a lack of assessment of smoking behaviour and a dearth of theory-based research on how warnings exert their effects.

How Does Gameplaying Support Values and Psychological Well-Being Among Cancer Survivors?

OBJECTIVE

This qualitative study examined the extent to which playing recreational computer games and videogames is perceived by cancer survivors as supporting personal values. Values serve as behavioral guides and may thus impact health outcomes; therefore activities that have the potential to support values deserve further attention so their role in promoting health may be better understood.

MATERIALS AND METHODS

We asked a sample of survivors who play recreational games (n = 73) open-ended questions about the types of recreational games they play, about something they really value in life, and the extent to which playing games supports the value. Data analysis used a grounded theory approach, supported by computer-assisted qualitative analysis software.

RESULTS

Three major themes emerged linking gameplaying to survivors' values: the need to create and maintain social connections, the desire to help others, and the need to experience alternate realities (including escape and exploration).

CONCLUSIONS

The present study offers a unique perspective by focusing on the intersection of values and gameplay among survivors. The findings suggest that playing recreational computer games and videogames may be congruent with survivors' personal values and may have potential to influence positive health outcomes among survivors. The findings have implications for developing effective values-based interventions for cancer survivors.

Emergency contraception: Sources of information and perceptions of access among young adults

Emergency contraception (EC) can prevent pregnancy for up to 5 days after unprotected sex. Although EC has become increasingly available, little is known about perceptions of young adults regarding access to EC or whether information sources about EC relate to perceived access among young adults. Over a 1-week period in November 2013, a self-report survey was administered to 352 college students (67% women) at the student union of a large, public university in the southeastern United States. The survey assessed three aspects of EC: perceived access, information sources, and prior use. Twenty-one percent of participants had used EC. Participants reported relatively high perceptions of access to EC, with females reporting higher perceptions of access than males. Prior to the study, 7.4% of students had never heard of EC; the remaining students had heard of EC from an average of four sources. Among women, hearing of EC from media, interpersonal, or health education sources was significantly associated with greater perceived access (ps < .05). Among men, no specific information sources were associated with perceived access (ps > .10). Future EC awareness efforts for women should leverage all three of these sources, while future research should examine specific sources to focus on the content, quality, and frequency of messages.

Pictorial cigarette pack warnings: a meta-analysis of experimental studies

Objective

To inform international research and policy, we conducted a meta-analysis of the experimental literature on pictorial cigarette pack warnings.

Data sources

We systematically searched 7 computerised databases in April 2013 using several search terms. We also searched reference lists of relevant articles.

Study selection

We included studies that used an experimental protocol to test cigarette pack warnings and reported data on both pictorial and text-only conditions. 37 studies with data on 48 independent samples (N=33 613) met criteria.

Data extraction and synthesis

Two independent coders coded all study characteristics. Effect sizes were computed from data extracted from study reports and were combined using random effects meta-analytic procedures.

Results

Pictorial warnings were more effective than text-only warnings for 12 of 17 effectiveness outcomes (all p<0.05). Relative to text-only warnings, pictorial warnings (1) attracted and held attention better; (2) garnered stronger cognitive and emotional reactions; (3) elicited more negative pack attitudes and negative smoking attitudes and (4) more effectively increased intentions to not start smoking and to quit smoking. Participants also perceived pictorial warnings as being more effective than text-only warnings across all 8 perceived effectiveness outcomes.

Conclusions

The evidence from this international body of literature supports pictorial cigarette pack warnings as more effective than text-only warnings. Gaps in the literature include a lack of assessment of smoking behaviour and a dearth of theory-based research on how warnings exert their effects.

Reducing Concurrent Sexual Partnerships Among Blacks in the Rural Southeastern United States: Development of Narrative Messages for a Radio Campaign

In the United States, heterosexual transmission of HIV infection is dramatically higher among Blacks than among Whites. Overlapping (concurrent) sexual partnerships promote HIV transmission. The authors describe their process for developing a radio campaign (Escape the Web) to raise awareness among 18-34-year-old Black adults of the effect of concurrency on HIV transmission in the rural South. Radio is a powerful channel for the delivery of narrative-style health messages. Through six focus groups (n = 51) and 42 intercept interviews, the authors explored attitudes toward concurrency and solicited feedback on sample messages. Men were advised to (a) end concurrent partnerships and not to begin new ones; (b) use condoms consistently with all partners; and (c) tell others about the risks of concurrency and benefits of ending concurrent partnerships. The narrative portrayed risky behaviors that trigger initiation of casual partnerships. Women were advised to (a) end partnerships in which they are not their partner's only partner; (b) use condoms consistently with all partners; and (c) tell others about the risks of concurrency and benefits of ending concurrent partnerships. Messages for all advised better modeling for children.

Cancer information seeking in the digital age: effects of Angelina Jolie's prophylactic mastectomy announcement

OBJECTIVE

. This study used digital surveillance to examine the impact of Angelina Jolie's prophylactic mastectomy announcement on cancer information seeking.

METHODS

. We analyzed 4 categories of breast cancer-related Internet search queries from 2010 to 2013 in the United States.

RESULTS

. Compared with the preceding 6 weeks, general information queries were 112% (95% confidence interval [CI], 79-146) higher the day of the announcement and remained 35% (95% CI, 22-49) higher over the week after the editorial. Risk assessment queries were 165% (95% CI, 110-222) higher the day of the announcement and 52% (95% CI, 31-75) higher across the week. Genetics and treatment queries showed little volume before the announcement but increased 2154% (95% CI, 1550-7076) and 9900% (95% CI, 3196-1,064,000) the day of, respectively, and remained higher across the week (812% [95% CI, 402-3913] and 2625% [95% CI, 551-317,000]). All query categories returned to normal volumes by the beginning of the second week.

CONCLUSION

. Jolie's unique announcement spurred significant information seeking about breast cancer genetic testing and treatment procedures, although the surge in queries returned to preannouncement levels after 1 week. Future research should apply digital methods to advance our understanding of cancer information seeking in the digital age.

Adolescent sexual health communication and condom use: a meta-analysis

OBJECTIVE

Condom use is critical for the health of sexually active adolescents, and yet many adolescents fail to use condoms consistently. One interpersonal factor that may be key to condom use is sexual communication between sexual partners; however, the association between communication and condom use has varied considerably in prior studies of youth. The purpose of this meta-analysis was to synthesize the growing body of research linking adolescents' sexual communication to condom use, and to examine several moderators of this association.

METHOD

A total of 41 independent effect sizes from 34 studies with 15,046 adolescent participants (M(age) = 16.8, age range = 12-23) were meta-analyzed.

RESULTS

Results revealed a weighted mean effect size of the sexual communication-condom use relationship of r = .24, which was statistically heterogeneous (Q = 618.86, p < .001, I² = 93.54). Effect sizes did not differ significantly by gender, age, recruitment setting, country of study, or condom measurement timeframe; however, communication topic and communication format were statistically significant moderators (p < .001). Larger effect sizes were found for communication about condom use (r = .34) than communication about sexual history (r = .15) or general safer sex topics (r = .14). Effect sizes were also larger for communication behavior formats (r = .27) and self-efficacy formats (r = .28), than for fear/concern (r = .18), future intention (r = .15), or communication comfort (r = -.15) formats.

CONCLUSIONS

Results highlight the urgency of emphasizing communication skills, particularly about condom use, in HIV/STI prevention work for youth. Implications for the future study of sexual communication are discussed.

Intrapulmonary coin lesions: the changing patterns

Of 71 intrapulmonary coin lesions seen at The Prince Charles Hospital during 1982-1984, 48 were primary pulmonary malignancies and six were metastases. There were two cases each of tuberculosis, cryptococcosis, hamartoma and granuloma. Overall, 76% of the lesions were malignant and only 3% were tuberculous. These findings contrast with those from the same institution published 20 years ago, when malignancy comprised only 38% and tuberculosis 27% of lesions. Malignancy now seems to be the major cause of coin lesions in Australia. In this survey, 82% of solitary pulmonary nodules that occurred in patients of over 50 years of age were malignant.