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.

Extending the Theory of Normative Social Behavior: Collective Norms, Opinion Leadership, and Masking During the COVID-19 Pandemic

Novel, public behaviors, such as masking, should be susceptible to normative influence. This paper advances the theory of normative social behavior by considering a new set of moderators of normative influence - superdiffuser traits - and by clarifying the antecedents and consequences of exposure to collective norms. We use data from a two-wave survey of a cohort living in one U.S. county during the pandemic (N = 913) to assess normative effects on masking. We also used a bipartite network (based on people shopping for food in the same stores) to examine exposure to collective norms. The results show different superdiffuser traits have distinct effects on the relationship between perceived injunctive norms and masking intentions. Exposure to collective norms influences masking, but this influence depends on how people interact with their social environments. Network analysis shows that behavioral homophily is a significant predictor of selective exposure to collective norms earlier (but not later) in the pandemic. Implications for understanding normative influence in a context where opinion leadership matters are discussed.

Stories to Prevent Cancer: A Pilot Study Using Cancer Survivor Narratives to Increase Human Papillomavirus Vaccine Intentions

INTRODUCTION

Human papillomavirus (HPV) vaccination rates are lower than other recommended adolescent vaccines. Cancer survivor narratives are used to promote cancer prevention and control, but little is known about their impact on adolescent HPV vaccination.

OBJECTIVE

This pilot study explored the feasibility and effects of a video education intervention using a cancer survivor narrative to improve parents' attitudes toward and intentions to get the HPV vaccine.

METHODS

This study utilized a one-group design; participants completed a pre-intervention survey, watched the video before attending their sons' wellness visits, and completed a post-intervention survey within one week of their appointment. Using the narrative persuasion framework, we developed a 4-minute video of a local HPV-related cancer survivor to promote the HPV vaccine as cancer prevention. We recruited 37 participants between June and October 2020. Participants were parents of males ages 9-17 who had not yet initiated HPV vaccination.

RESULTS

After the video, more parents agreed that HPV vaccination is safe (pre: 66% vs. post: 82%; P = .045) and that their child's chances of getting HPV-related cancer in the future are high (pre: 24% vs. post: 46%; P = .014). Overall, 91% of parents felt the cancer survivor story helped them understand the risks of HPV cancers, and 52% said the story influenced their decision to start HPV vaccination for their child.

CONCLUSIONS

Our findings suggest that cancer survivor narratives influence parents' vaccine opinions and understanding of their child's risk of HPV infection, leading to increased parental intent to get the HPV vaccine for their adolescent males.

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

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

Adoption and Discontinuance of Innovation Packages: A Longitudinal Study of Transitions in COVID-19 Mitigation

The past decades have seen growing interest and application of interventions targeting the change of multiple behaviors at once. We advance this work by using the diffusion of innovations theory (DOI) to consider constellations of behaviors as innovation packages: multiple innovations that are logically related, interdependent in their use or effects, and often promoted as a set (Rogers, 2003). In addition, we embraced DOI's focus on behavioral decisions as a continual process that can include adoption and discontinuance over time, especially as new innovations (e.g., COVID-19 vaccine) appear. To that end, we conducted a latent transition analysis of COVID-19 mitigation behaviors (N = 697; 97% received a COVID-19 vaccine) across three time points in the pandemic: initial outbreak; a secondary, record-breaking rise in cases; and after the CDC recommended that fully vaccinated adults could discontinue wearing masks. This analysis allowed us to identify latent classes based on shared behavioral patterns and transitions between classes over time. The results showed evidence of three possible packages: (a) a package of traditional, symptom-management behaviors (covering coughs and sneezes, staying home if ill, and seeking medical care), (b) a package of just-novel COVID-19 behaviors (wearing masks, keeping six feet apart, and avoiding mass gatherings), and (c) a package of all COVID-19 mitigation behaviors. Movement between classes exemplified adoption and discontinuance of different packages, as well as widespread discontinuance with the replacement innovation: COVID-19 vaccines. Additional analyses showed that increases in hope were associated with sustained and delayed adoption; decreases in social approval were associated with discontinuance. Future directions in theorizing around innovation packages are discussed.

Information Seeking and Avoidance in the COVID-19 Pandemic as a Function of Political Ideology and National Context: A Survey Comparing the US and Germany

The COVID-19 pandemic sparked a globally heightened need for scientific information. At the same time, the abundance of information led to tendencies of media fatigue and information avoidance. Both information seeking and avoidance are embedded in a specific national context, in which conditions of and measures against the pandemic may differ dramatically. In addition, the pandemic quickly became entangled with political ideology. Using the Risk Information Seeking and Processing Model (RISP) as a theoretical background, we investigate the role of national context and political ideology for information seeking and avoidance in a comparative survey in the U.S. and Germany during the early phase of the pandemic. Results show that the factors predicting information behavior are effective in both countries with only few differences: In both countries, perceived hazard characteristics, information norms and perceived information gathering capacity were related to higher information seeking and lower information avoidance. Ideology too is an important influence: Right-leaning ideology was associated with lower levels of information norms in both countries; but only in the US was right-leaning ideology connected to less perceived hazard characteristics and less negative affective responses. Results are discussed regarding their implications for the RISP model.

Perceived risk, emotions, and stress in response to COVID-19: The interplay of media use and partisanship

Relationships between risk perceptions, emotions, and stress are well-documented, as are interconnections between stress, emotion, and media use. During the early COVID-19 pandemic, the public responded psychologically to the threat posed by the pandemic, and frequently utilized media for information and entertainment. However, we lack a comprehensive picture of how perceived risk, emotion, stress, and media affected each other longitudinally during this time. Further, although response to the pandemic was highly politicized, research has yet to address how partisan affiliation moderated relationships between risk, emotion, stress, and media use over time. This three-wave (N = 1021) panel study assessed the interplay of risk, emotion, stress, and media use for Americans with different political affiliations between March and May of 2020. Findings indicate that perceived risk, emotion, and stress at Time 1 predicted media use at Time 2, with predictors varying by type of media. Use of entertainment media and social/mobile media predicted later stress (Time 3), but news consumption did not. Later risk perceptions (Time 3) were not influenced by media use at Time 2. The predictors and consequences of different types of media use were notably different for Republicans and Democrats. In particular, risk perceptions predicted greater news use among Democrats but greater entertainment media use among Republicans. Moreover, social/mobile media use resulted in perceiving the risks of COVID-19 as less serious for Republicans while increasing stress over time for Democrats.

Who is your Fitspiration? An Exploration of Strong and Weak Ties with Emotions, Body Satisfaction, and the Theory of Planned Behavior

Physical inactivity has become an increasingly important concern for public health. "Fitspiration" social media posts may influence attitudes and intentions toward exercising. An online survey (N = 485) was conducted to examine the potential for fitspiration content from weak and strong ties to shape user emotions, attitudes, norms and behaviors related to exercising. Guided by the theory of planned behavior (TPB) and social cognitive theory (SCT), the results show that exposure to fitspiration content from both strong ties and weak ties were significant predictors of particular attitudes, norms, intentions, actual exercise frequency. However, our path analyses reveal significant indirect paths between exposure to fitspiration content and outcomes for weak ties through negative emotions (guilt), but only through positive emotions (hope and curiosity) for strong ties. Additionally, we found evidence that body satisfaction levels do matter in shaping the interrelationships between exposure to fitspiration content, emotions, and our outcome variables. In light of our results, we encourage researchers to consider the inclusion of emotional responses as antecedents to TPB outcomes and for practitioners to consider the role of source in campaign design.

Social media exposure, interpersonal network, and tampon use intention: A multigroup comparison based on network structure

The scarcity of tampons in China has attracted scholarly attention. Extending the theory of planned behavior with social network structure, this cross-sectional online survey (N = 763) found that exposure to tampon-related information on social media was positively related to Chinese women's tampon use intentions. This association was mediated through attitudes, descriptive norms, and self-efficacy toward using tampons. Furthermore, the effects of social media exposure differed among people with different network structures. Our findings shed light on the promotion of nonconventional feminine hygiene products, which, in turn, may enhance Chinese women's well-being and gender equity across the globe.

A Mixed Methods Inquiry into the Role of Tom Hanks' COVID-19 Social Media Disclosure in Shaping Willingness to Engage in Prevention Behaviors

Given the vast amounts of COVID-19-related messages flooding mediated and interpersonal communication channels during the global pandemic, celebrity COVID-19 disclosures offer rare opportunities to cut through message fatigue and apathy and garner the attention of wide swaths of the public. We conducted a convergent mixed method analysis of audience responses to actor Tom Hanks' March 11, 2020 disclosure of his COVID-19 diagnosis via social media. We collected our data within 24 hours of his announcement, allowing us to quickly capture emotional and cognitive responses to the announcement and to assess both demographic and psychosocial differences in types of people who heard the news in this time frame and those who had not. In our study, 587 participants had heard the news of Hanks' disclosure while 95 had not. Participants who had heard responded to an open-ended prompt asking if the disclosure affected them at all. Those who had not heard were funneled into a field intervention to test how random assignment to seeing Hanks' disclosure post or not would affect audiences' COVID-19-related emotions, cognitions, and willingness to enact prevention behaviors. The results of this mixed methods study revealed differences in responses to Hanks' disclosure based on health information source trust and involvement with Hanks as well as effects of the intervention on efficacy for dealing with COVID-19. We discuss implications for health communication theory and crafting messages that can effectively build off the attentional inertia generated by celebrity illness disclosures to encourage prevention efforts.

The Effects of Embedded Skin Cancer Interventions on Sun-Safety Attitudes and Attention Paid to Tan Women on Instagram

Background and Objectives

Because of high skin cancer risks for young women, it is vital that effective interventions reach and influence this demographic. Visual social media platforms, like Instagram, are popular with young women and are an appropriate intervention site; yet, they also host competing images idealizing tan skin. The present study tested the ability of digital sun-safety interventions to affect self-control-related emotions and visual attention to subsequent tan-ideal images as well as sun-safety attitudes.

Methods

Women were recruited from a large public Mid-Atlantic university in the United States. Participants (N = 120) were randomly assigned to view an appearance benefits intervention, a self-control emotions intervention, or a control message, each designed to look like an Instagram sponsored story. After self-reporting self-compassion and anticipated pride, participants then viewed seven pairs of Instagram posts featuring either tan or pale women while an eye tracker assessed visual attention. Finally, participants self-reported their responses to questions assessing sun-safety-related norms, efficacy, and attitudes.

Results

A mixed design analysis of covariance revealed that women who first viewed the appearance benefits intervention story spent less time visually fixated on Instagram images of tan women than did those who viewed the self-control emotions intervention or control message (p = 0.005, ηp2 = 0.087). Regressions also revealed interactions between the intervention conditions and feelings of anticipated pride on both visual attention and sun-safety attitudes.

Conclusion

Sponsored stories on Instagram can promote sun-safety attitudes, depending on the emotional responses they generate. Additionally, sponsored interventions can affect subsequent visual attention.

Associations Between Human Papillomavirus Vaccine Decisions and Exposure to Vaccine Information in Social Media

PURPOSE

Exposure to different types of vaccine information in social media can result in parents making disparate vaccine decisions, including not following national guidelines for human papillomavirus (HPV) vaccination. We sought to characterize parents' exposure to and engagement with information about HPV vaccination in social media, and the associations between exposure to such information and vaccine decisions for their adolescent children.

METHODS

In 2019, we conducted a web-based survey with a national sample of 1073 parents of adolescents who use social media. The survey assessed whether parents have seen information in favor, against, or mixed about HPV vaccination. Multivariable logistic regressions assessed correlates of vaccine decisions, including HPV vaccine initiation, delay, and refusal.

RESULTS

Sixty-one percent of parents reported that their children have initiated HPV vaccination. Over one-third of parents (37%) reported seeing HPV vaccine information on social media, which was either in favor (20%), against (5%), or a mix (12%). Parents exposed to information in favor were more likely than those who saw no information to have initiated HPV vaccination (OR = 1.74, 95% CI:1.24, 2.44). Parents exposed to information against vaccination were more likely to have delayed (OR = 3.29, 95% CI:1.66, 6.51) or refused (OR = 4.72, 95% CI:2.35, 9.50) HPV vaccination. Exposure to mixed information was also significantly associated with vaccine delay and refusal.

DISCUSSION

Our findings suggest that the type of information seen on social media regarding HPV vaccination may influence the decisions parents make about vaccinating their children. Efforts should be sought to increase online information in favor of HPV vaccination and combat vaccine misinformation in social media.

The "celebrity canary in the coal mine for the coronavirus": An examination of a theoretical model of celebrity illness disclosure effects

RATIONALE

On March 11, 2020, actor Tom Hanks announced via social media that he had been diagnosed with COVID-19. Previous research has found celebrity illness disclosures to influence behavior, but during the uncertainty of a pandemic, the effects of such a disclosure were unclear.

OBJECTIVE

To test the proposed Celebrity Illness Disclosure Effects (CIDE) model, demonstrating how an illness disclosure, communicated through mediated and interpersonal channels, may shape willingness to engage in prevention behaviors.

METHODS

We conducted an online survey (N = 587) 24 hours after Hanks' COVID-19 disclosure.

RESULTS

Findings revealed that celebrity-related perception variables predicted illness-related cognitions and emotions\, which were associated with willingness to enact prevention behaviors. Greater willingness to seek information, stronger perceptions of COVID as a threat, and stronger perceptions of efficacy for dealing with COVID after learning of Hanks' diagnosis predicted stronger willingness to enact prevention behaviors. However, anxiety about COVID predicted lower willingness to enact prevention behaviors.

CONCLUSIONS

The CIDE model can serve as a guide for future research in this area. The results can help scholars who aim to better understand the phenomena around celebrities and health communication as well as policymakers who hope to ride the wave of star power to improved public health outcomes.

Appearance, Friends, and Feelings: A Two-Study Exploration of Young Women's Emotional Associations and Indoor Tanning Frequency

BACKGROUND

Knowledge of its potential cancer risk is often not enough to motivate individuals to avoid indoor tanning. Previous research has found that emotions toward indoor tanning and appearance motivations may prompt people to continue despite the risks.

METHODS

We conducted two online surveys of US young adult women. Study one included a convenience sample of female undergraduates (N = 502) at a university in the northwestern USA. Study two included young women from a nationwide US online panel (N = 270).

RESULTS

Results suggest that emotional associations, both positive and negative, with indoor tanning explain greater variances in indoor tanning behavior than demographics and previously established psychosocial predictors of tanning alone. Appearance motivations were also positively associated with indoor tanning in both samples.

CONCLUSIONS

This research has implications for health care providers and health communicators, as indoor tanning prevention messages and campaigns should consider the association between both positive and negative emotions on tanning behaviors as well as appearance motivations.

Health information source use and trust among a vulnerable rural disparities population

PURPOSE

Because rural residents, particularly those near mining sites, are susceptible to numerous environmental health hazards, it is important to gain deeper insights into their use and trust of health information, which they may employ to help recognize symptoms, learn ways to reduce exposure, or find health care.

METHODS

We surveyed residents (N = 101) of rural Kentucky, Virginia, and West Virginia to assess predictors of health information source use and trust. A project manager administered face-to-face paper and pencil questionnaires assessing demographics, health status, smoking behavior, and health information use and source trust. Bivariate correlations and ordinary least squares regressions were used to analyze the data.

FINDINGS

The data suggest that rural individuals frequently use nurses, doctors, and websites to seek health information, whereas traditional media are often not their preferred channel for health information. Media sources were not found as trustworthy as interpersonal and medical health information sources. While only 13.0% of individuals in the sample said they ever turned to county or state health departments for health information, these sources were trusted more than any media source and more than friends. Moreover, living closer to active mining sites-meaning these individuals are at a higher risk of environmental health hazards-predicted even less use of traditional media and greater trust in peer sources.

CONCLUSIONS

Not all sources of health information are equally used or trusted by individuals from a rural disparities population. The findings have implications for health campaign message dissemination and intervention designs targeting individuals in rural Appalachia.

Associations Between Emotions, Social Media Use, and Sun Exposure Among Young Women: Ecological Momentary Assessment Study

Background

Research has pointed to a connection between social media use, emotions, and tanning behaviors. However, less is known about the role specific emotions may play in influencing social media use and how emotions and social media use may each be associated with outdoor tanning.

Objective

This paper aims to examine the connection between emotions, social media use, and outdoor tanning behaviors among young women, a group particularly important for skin cancer prevention efforts.

Methods

We used ecological momentary assessment to collect data from 197 women aged 18 to 25 years 3 times a day for 7 days in July 2018. We collected data from women in 2 states.

Results

We found that boredom was associated with increased time spent on social media and that increased time spent on social media was associated with increased time spent outdoors without sun protection.

Conclusions

Our results highlight that social media may be a particularly important channel for skin cancer prevention efforts targeting young women, as more social media use was associated with increased time spent outdoors with skin exposed. Researchers should consider the role of emotions in motivating social media use and subsequent tanning behaviors. Additionally, as boredom was associated with social media use, intervention developers would benefit from developing digital and social media interventions that entertain as well as educate.

Mental Health and Its Predictors during the Early Months of the COVID-19 Pandemic Experience in the United States

To date, there has been relatively little published research on the mental health impacts of COVID-19 for the general public at the beginning of the U.S.' experience of the pandemic, or the factors associated with stress, anxiety, depression, and post-traumatic growth during this time. The current study provides a longitudinal examination of the predictors of self-reported stress, anxiety, depression, and post-traumatic growth for U.S. residents between April and May, 2020, including the influence of demographic, psychosocial, and behavioral factors on these outcomes. The findings indicate that, generally, the early months of the U.S. COVID-19 experience were characterized by a modest negative impact on mental health. Younger adults, people with pre-existing health conditions, and those experiencing greater perceived risk, higher levels of rumination, higher levels of co-rumination, greater social strain, or less social support reported worse mental health. Positive mental health was associated with the adoption of coping strategies, especially those that were forward-looking, and with greater adherence to national health-protection guidelines. The findings are discussed with regard to the current status of health-protective measures and mental health in the U.S., especially as these impact future management of the on-going pandemic.

Measuring Trivialization of Mental Illness: Developing a Scale of Perceptions that Mental Illness Symptoms are Beneficial

Much of the extant research on representations of mental illness in the media have focused on stigmatization. The negative effects of these stigmatizing portrayals on individuals with mental illness are serious. However, recent scholarship has identified another phenomenon in the mediated portrayal of mental illness whereby these conditions are trivialized. As opposed to stigmatizing portrayals that make people with mental illness seem violent and incompetent, media portrayals that trivialize mental illnesses often treat the symptoms of these conditions (e.g., organizational ability for people with obsessive compulsive disorder or high energy levels for people with attention-deficit/hyperactivity disorder) as benefits, thereby diminishing the seriousness of these conditions. The aim of the present study was to develop a reliable and valid scale for assessing how individuals perceive symptoms of mental illnesses as benefits (and, thereby, trivialize these illnesses). Results across three studies support the existence of a reliable and valid measure whereby symptoms demark individuals with a mental illness as receiving a benefit. By establishing this scale, researchers will be better suited to assess the potential intersections and interaction of processes related to mental illness trivialization and stigmatization, both through media portrayals and through everyday interactions.

Online media use and HPV vaccination intentions in mainland China: integrating marketing and communication perspectives to improve public health

This study investigates the role of media in shaping human papilloma virus vaccination intentions in mainland China by applying both communication and marketing-focused theoretical frameworks in order to better understand ways to increase vaccine uptake across young men and women in China. An online survey (N = 359) revealed direct effects of online information consumption on perceived scarcity of the vaccine, as well as an indirect effect via perceived influence of media on others. Scarcity perceptions, in turn, predicted vaccine attitudes and behavioral intentions. Additionally, gender differences emerged in the data. Compared with women, men's intent to be vaccinated were not high, even if they realized the vaccine shortage. Implications for theory and practice are discussed.

Connections between sources of health and beauty information and indoor tanning behavior among college women

Objective: This study tested how media, family, and peer sources of health and beauty information predict indoor tanning (IT) beliefs and behavior. Participants: 210 undergraduate women at a state university in the southeastern United States. Methods: Respondents completed a survey about sources of health and beauty information, IT beliefs, and IT behavior. Correlations and a path model were used to test associations between variables. Results: Friends were positively and family were negatively associated with positive outcome expectations, with mood enhancement beliefs positively predicting behavior. Reliance on news positively predicted appearance damage and immediate risk, which both predicted behavior. Reliance on social media was negatively associated with beliefs about immediate risks. Conclusion: Health and beauty information from social media and from friends may promote beliefs about tanning, while information from news or one's family may reduce risky beliefs. Prevention efforts could leverage information sources to shift tanning beliefs and behavior.

A Closer Look at Descriptive Norms and Indoor Tanning: Investigating the Intermediary Role of Positive and Negative Outcome Expectations

Indoor tanning is a risky behavior that dramatically increases skin cancer risk. Researchers from multiple disciplines aim to better understand this behavior to develop interventions and messages to curtail it. As such, we investigated the role of social norms and outcome expectations as predictors of tanning behavior as part of a larger test of constructs included in the Theory of Normative Social Behavior. In addition to offering additional empirical results to support theoretical claims for the importance of social norms and outcome expectations in predicting health behaviors, we offer indoor tanning-specific operationalizations in a conditional process model with the aim of assessing how content-specific measurements predict indoor tanning intentions. Results of a survey of adult indoor tanners from across the U.S. (N = 262) highlight when and how descriptive norms influence tanning intentions through the mediating roles of anticipatory socialization, injunctive norms, and health threat, and through the moderating role of mood-based tanning motivations. Implications for theory building as well as for intervention and message design are discussed.

An Experimental Test of the Roles of Audience Involvement and Message Frame in Shaping Public Reactions to Celebrity Illness Disclosures

Much research has investigated what happens when celebrities disclose an illness (via media) to the public. While audience involvement (i.e., identification and parasocial relationships) is often the proposed mechanism linking illness disclosures with audience behavior change, survey designs have prevented researchers from understanding if audience involvement prior to the illness disclosure actually predicts post-disclosure emotions, cognitions, and behaviors. Rooted in previous work on audience involvement as well as the Extended Parallel Process Model, the present study uses a national online experiment (N = 1,068) to test how pre-disclosure audience involvement may initiate post-disclosure effects for the message context of skin cancer. The data demonstrate that pre-disclosure audience involvement as well as the celebrity's framing of the disclosure can shape emotional responses (i.e., fear and hope), and that cognitive perceptions of the illness itself also influence behavioral intentions.

The Role of Media-Induced Nostalgia after a Celebrity Death in Shaping Audiences' Social Sharing and Prosocial Behavior

When a celebrity dies and news coverage repeatedly pays homages to the celebrity's life, it is possible that audiences experience nostalgia as they fondly recall past memories of that celebrity. Nostalgia has yet to be examined as a mechanism of audience behavior related to the health condition associated with that celebrity. As such, we proposed a conceptual model of the interplay of predictors of feeling nostalgic after a celebrity death (i.e., identification, audience age, audience gender, consumption of media about the celebrity death, and previous viewing of celebrity-related media) and two outcomes: prosocial behaviors (e.g., donating to or volunteering for a health-related organization associated with the celebrity) and social sharing of information with others. We conducted a nationwide survey (N = 466) within weeks following the death of television star Mary Tyler Moore to test our model. The results demonstrate that nostalgia is evoked by a number of factors after a celebrity death, and that together with these previously studied predictors it can influence outcomes of interest.

Uplifting Fear Appeals: Considering the Role of Hope in Fear-Based Persuasive Messages

Fear appeal research has focused, understandably, on fear as the primary emotion motivating attitude and behavior change. However, while the threat component of fear appeals associates with fear responses, a fear appeals' efficacy component likely associates with a different emotional experience: hope. Drawing from appraisal theories of emotion in particular, this article theorizes about the role of hope in fear appeals, testing hypotheses with two existing data sets collected within the context of sun safety messages. In both studies, significant interactions between hope and self-efficacy emerged to predict behavioral intentions. Notable main effects for hope also emerged, though with less consistency. Further, these effects persisted despite controlling for the four cognitions typically considered central to fear appeal effectiveness. These results, consistent across two samples, support the claim that feelings of hope in response to fear appeals contribute to their persuasive success. Implications for developing a recursive model of fear appeal processing are discussed.

Examining Differences in Audience Recall and Reaction Between Mediated Portrayals of Mental Illness as Trivializing Versus Stigmatizing

Researchers have documented the ways in which media stigmatize mental illness. However, media also portray mental illness trivially when diseases are mocked, oversimplified, shown to be less severe than in actuality, or represented as beneficial to an individual. Trivialization of mental illnesses could potentially lead audiences to be less likely to seek help or less likely to support related policy efforts. Therefore, it is important to understand how audiences recall and react to stigmatizing and trivializing mental illness portrayals. An experiment (N = 175) asked participants to recall either a media portrayal where mental illness was stigmatized or a portrayal where it was trivialized. Results suggest that audiences recall certain components of stigmatization and trivialization better than others. And, recollections of trivialization were associated with different patterns of word use than stigmatization. A second experiment (N = 141) found similar patterns when showing participants specific examples of different mental illness portrayals and asking them to immediately recall the content. Overall, these results suggest that theory and conceptual models about the nature and effects of mental illness portrayals could be updated to include both stigmatization and trivialization.

Public Perceptions of Celebrity Cancer Deaths: How Identification and Emotions Shape Cancer Stigma and Behavioral Intentions

Celebrity cancer deaths can focus public attention on the disease like few events can. However, not all celebrities or their families are open about the exact cause of death. Anecdotal reports suggest that some do not reveal the exact cause of death due to fears of stigma associated with the specific type of cancer. However, empirical evidence regarding whether or how the cause of death actually impacts public perceptions and behaviors is lacking. A three (cause of death: nonspecified cancer, liver cancer, or lung cancer) by two (celebrity obituary: David Bowie or Alan Rickman) fully factorial between-subjects online experiment (N = 390) tested a proposed model of effects on identification, discrete emotional reactions, stigma-related perceptions, and behavioral intentions. Results suggest that specific causes of death do not have a direct impact on stigma but they can alter identification and emotional reactions, such as compassion and anxiety, which subsequently shape stigma-related perceptions and behavioral intentions.

Educated but anxious: How emotional states and education levels combine to influence online health information seeking

This study combined conceptual frameworks from health information seeking, appraisal theory of emotions, and social determinants of health literatures to examine how emotional states and education predict online health information seeking. Nationally representative data from the Health Information National Trends Survey (HINTS 4, Cycle 3) were used to test the roles of education, anxiety, anger, sadness, hope, happiness, and an education by anxiety interaction in predicting online health information seeking. Results suggest that women, tablet owners, smartphone owners, the college educated, those who are sad some or all of the time, and those who are anxious most of the time were significantly more likely to seek online health information. Conversely, being angry all of the time decreased the likelihood of seeking. Furthermore, two significant interactions emerged between anxiety and education levels. Discrete psychological states and demographic factors (gender and education) individually and jointly impact information seeking tendencies.

Identification and Emotions Experienced after a Celebrity Cancer Death Shape Information Sharing and Prosocial Behavior

Based on the previous work investigating public reactions to celebrity cancer deaths as well as on the appraisal theory of emotions, an online survey (N = 641) was conducted after the cancer death of popular sportscaster Stuart Scott. The aim was to better understand how the public shared news and reactions with others and if this social sharing impacted prosocial cancer-related behaviors (e.g., donating, volunteering, talking to others about cancer research). Two hierarchical logistic regression models were run. In the first, identification with Scott and emotional reactions to hearing about his death were significant predictors of sharing, even after controlling for demographics. In the second, feeling hopeful and having shared information with others predicted prosocial cancer-related behaviors. These results suggest promising strategies for designing more effective cancer awareness messages and fundraising campaigns after celebrity cancer announcements.

The Relationships Between Female Adolescents’ Media Use, Indoor Tanning Outcome Expectations, and Behavioral Intentions

Background. Unlike other types of cancer, skin cancer incidence rates are on the rise and adolescent females are particularly likely to tan indoors, a major risk factor. However, little research has examined the role of media use in encouraging or discouraging this dangerous behavior in this population. Aims. To empirically assess the links between media use, indoor tanning-related outcome expectations, and behavioral intentions. Method. A survey of adolescent females ( N = 510) ages 15 to 18 in the Southeastern United States assessed demographics, types of media use, and indoor tanning intentions. Results. Significant correlations between media use and indoor tanning outcome expectations were found. Use of interpersonal and social media (i.e., talking on the phone, texting, and online social media) were positively associated with positive outcome expectations about indoor tanning and negatively associated with negative outcome expectations. A path analysis revealed that interpersonal/social media use had indirect associations with indoor tanning intentions via tanning outcome expectations. Mass media use (e.g., news media, entertainment media, and magazines) was not significantly associated with most indoor tanning outcome expectations but did have a direct negative association with behavioral intentions. Discussion. There are important relationships between media use, indoor tanning outcome expectations, and behavioral intentions. Interpersonal and social media use may help cultivate outcome expectations that encourage indoor tanning, which in turn may increase intentions to tan, while news media consumption in particular may reduce intentions to tan. Conclusion. These findings highlight the social nature of adolescent females and point to specific intervention channels for reducing indoor tanning among this population.

A health fundraising experiment using the "foot-in-the-door" technique

Foot-in-the-door (FITD) involves obtaining compliance with a small request to boost compliance with a larger request. Only a few studies to date have tested the technique in health and fundraising contexts, and even fewer have examined the psychological processes involved. To address these gaps, we conducted an experiment as an actual fundraiser for a cancer-awareness organization. The technique activated a self-concept as a supporter of cancer awareness among those in the FITD condition. Donation amount was also higher among those in FITD, but only among those with higher levels of worry and low to moderate levels of preference for consistency.

Tweeting and Trivializing

A quick search of social media websites demonstrates that users often describe their benign behaviors (e.g., organizing drawers or color-coding) as related to obsessive–compulsive disorder (OCD). Yet, the actual disease is complex and often much more severe than suggested by Twitter users who employ the term #OCD. The present experiment examines the effects of such disease trivialization on social media users’ perceptions of the disease, emotional reactions, and intentions to take action related to the disease. To do so, it first explicates the concept of disease trivialization as a three-part phenomenon involving oversimplification, decreased severity, and mockery. Findings from an experiment ( N = 574) indicate that different patterns of emotional reactions can be found in response to framing of OCD as either trivial, clinical, or both trivial and clinical. Moreover, significant interactions between independent variables were found. Participant gender and preexisting familiarity with OCD also shaped participant perceptions and behavioral intentions. Directions for future work are discussed.

A longitudinal test of the Comprehensive Indoor Tanning Expectations Scale: The importance of affective beliefs in predicting indoor tanning behavior

In order to better understand drivers of dangerous indoor tanning behaviors, researchers developed the Comprehensive Indoor Tanning Expectations scale. To examine the longitudinal effectiveness of Comprehensive Indoor Tanning Expectations, we surveyed young women in the Southeastern United States at two time points ( N = 553). The scale demonstrated strong test–retest reliability. Participants who believed indoor tanning would improve their mood and afford social approval were significantly more likely to tan 6 months later, while participants who believed indoor tanning leads to psychological/physical discomfort were significantly less likely to tan 6 months later. Knowing the psychological bases for indoor tanning can inform intervention and message design.

Does Context Matter? Examining PRISM as a Guiding Framework for Context-Specific Health Risk Information Seeking Among Young Adults

Research indicates that when people seek health information, they typically look for information about a specific symptom, preventive measure, disease, or treatment. It is unclear, however, whether general or disease-specific theoretical models best predict how people search for health information. We surveyed undergraduates (N = 963) at a large public southeastern university to examine health information seeking in two incongruent health contexts (sexual health and cancer) to test whether a general model would hold for specific topics that differed in their immediate personal relevance for the target population. We found that the planned risk information seeking model was statistically a good fit for the data. Yet multiple predicted paths were not supported in either data set. Certain variables, such as attitudes, norms, and affect, appear to be strong predictors of intentions to seek information across health contexts. Implications for theory building, research methodology, and applied work in health-related risk information seeking are discussed.

An Empirical Analysis of Indoor Tanners: Implications for Audience Segmentation in Campaigns

Tanning bed use before age 35 has been strongly associated with several types of skin cancer. The current study sought to advance an understanding of audience segmentation for indoor tanning among young women. Panhellenic sorority systems at two universities in the Southeastern United States participated in this study. A total of 1,481 young women took the survey; 421 (28%) had tanned indoors in the previous 12 months and were the focus of the analyses reported in this article. Results suggested two distinct tanner types: regular (n = 60) and irregular (n = 353) tanners. Regular tanners tanned more frequently (M = 36.2 vs. 8.6 times per year) and reported significantly higher positive outcome expectations (p < .001) and lower negative outcome expectations (p < .01) than irregular tanners, among other significant differences. Hierarchical logistic regression analysis revealed several significant (p < .001) predictors of regular tanning type, with tanning dependence emerging as the strongest predictor of this classification (OR = 2.25). Implications for developing anti-tanning messages directed at regular and irregular tanners are discussed.

#Stupidcancer: Exploring a Typology of Social Support and the Role of Emotional Expression in a Social Media Community

Social network sites (SNSs) like Twitter continue to attract users, many of whom turn to these spaces for social support for serious illnesses like cancer. Building on literature that explored the functionality of online spaces for health-related social support, we propose a typology that situates this type of support in an SNS-based open cancer community based on the type (informational or emotional) and the direction (expression or reception) of support. A content analysis applied the typology to a 2-year span of Twitter messages using the popular hashtag "#stupidcancer." Given that emotions form the basis for much of human communication and behavior, including aspects of social support, this content analysis also examined the relationship between emotional expression and online social support in tweets about cancer. Furthermore, this study looked at the various ways in which Twitter allows for message sharing across a user's entire network (not just among the cancer community). This work thus begins to lay the conceptual and empirical groundwork for future research testing the effects of various types of social support in open, interactive online cancer communities.

Testing a social cognitive theory-based model of indoor tanning: implications for skin cancer prevention messages

The lack of a theory-based understanding of indoor tanning is a major impediment to the development of effective messages to prevent or reduce this behavior. This study applied the Comprehensive Indoor Tanning Expectations (CITE) scale in an analysis of indoor tanning behavior among sorority women (total N = 775). Confirmatory factor analyses indicated that CITE positive and negative expectations were robust, multidimensional factors and that a hierarchical structure fit the data well. Social cognitive theory-based structural equation models demonstrated that appearance-oriented variables were significantly associated with outcome expectations. Outcome expectations were, in turn, significantly associated with temptations to tan, intention to tan indoors, and indoor tanning behavior. The implications of these findings for the development of messages to prevent and reduce indoor tanning behavior are discussed in two domains: (a) messages that attempt to change broader societal perceptions about tan skin, and (b) messages that focus more narrowly on indoor tanning-challenging positive expectations, enhancing negative expectations, and encouraging substitution of sunless tanning products.

Development and validation of the Comprehensive Indoor Tanning Expectations Scale

IMPORTANCE

Strong links between indoor tanning behavior and skin cancer have been demonstrated across several studies. Understanding the complex belief systems that underlie indoor tanning in young women is a crucial first step in developing interventions to deter this behavior.

OBJECTIVES

To develop and validate a comprehensive, multidimensional, theory-based outcome expectations measure to advance an understanding of the sets of beliefs that underlie indoor tanning behavior among young women.

DESIGN, SETTING, AND PARTICIPANTS

Cross-sectional study comprising a web-based survey of 11 sororities at a large university in the southeastern United States. Study participants (n = 706) were aged 18 to 25 years; 45.3% had tanned indoors in their lifetime and 30.3% in the past year.

MAIN OUTCOMES AND MEASURES

Intention to tan indoors, frequency of indoor tanning behavior in the past year, and indoor tanner type (nontanner, former tanner, or current tanner).

RESULTS

A comprehensive scale assessing indoor tanning outcome expectations was developed. In total, 6 positive outcome expectations factors and 5 negative outcome expectations factors were identified. These subscales were reliable (coefficient α range, 0.86-0.95) and were significantly (mostly at P < .001) correlated with a set of established measures, including appearance motivation, indoor tanning attitudes and norms, and intention to tan indoors. Examination of subscales across the 3 indoor tanning groups also revealed significant (P < .001) differences on all 11 subscales. Current tanners had the most positive and least negative perceptions about indoor tanning, while nontanners had the most negative and least positive perceptions. Former tanners tended to fall in between these 2 groups. The 2 subscales with the largest differences across the groups were mood enhancement (positive outcome expectation) and psychological/physical discomfort (negative outcome expectation). Multiple linear regression analyses demonstrated several outcome expectations subscales to be significantly associated with intention to tan indoors and frequency of indoor tanning behavior.

CONCLUSIONS AND RELEVANCE

Results suggest that the Comprehensive Indoor Tanning Expectations (CITE) Scale provides a reliable and valid assessment of the complex sets of beliefs that underlie indoor tanning, including positive (motivational) and negative (deterrent) beliefs. This new scale may further advance research on indoor tanning beliefs and can guide health communications to prevent and deter indoor tanning behavior.

Laughing and crying: mixed emotions, compassion, and the effectiveness of a YouTube PSA about skin cancer

Emotionally evocative public service announcements are one way that public health advocates hope to persuade people to take action against skin cancer, the most common type of cancer in the United States. This article describes an experiment (N = 193) to test the ways mixed emotional appeals influence communication and health outcomes. The data indicate that mixed emotional appeals foster feelings of compassion, which in turn motivate individual and social behaviors. The findings also provide insight into how audience reactions of fear impact postmessage behaviors. Implications for future research and health message design are discussed.

Public reaction to the death of Steve Jobs: implications for cancer communication

The present study aimed to examine the public reaction to the death of Steve Jobs, focusing on general and cancer-specific information seeking and interpersonal communication. Shortly after Jobs's death, employees from a large university in the Southeastern United States (N = 1,398) completed a web-based survey. Every employee had heard about Steve Jobs's death, and 97% correctly identified pancreatic cancer as the cause of his death. General (50%) and pancreatic cancer-specific (7%) information seeking, as well as general (74%) and pancreatic cancer-specific (17%) interpersonal communication, took place in response to Steve Jobs's death. In multivariate logistic regression analyses controlling for demographics and several cancer-oriented variables, both identification with Steve Jobs and cancer worry in response to Steve Jobs's death significantly (p < .05) predicted pancreatic cancer information seeking as well as interpersonal communication about pancreatic cancer. Additional analyses revealed that cancer worry partially mediated the effects of identification on these outcome variables. Implications of these results for future research as well as cancer prevention and communication efforts are discussed.

Public figure announcements about cancer and opportunities for cancer communication: a review and research agenda

Announcements by public figures and celebrities about cancer diagnosis or death represent significant events in public life. But what are the substantive effects of such events, if any? The purpose of this article is to systematically review studies that examined the impact of public figure cancer announcements on cancer-oriented outcomes. Using comprehensive search procedures, we identified k = 19 studies that examined 11 distinct public figures. The most commonly studied public figures were Jade Goody, Kylie Minogue, Nancy Reagan, and Steve Jobs, with the most common cancers studied being breast (53%), cervical (21%), and pancreatic (21%) cancer. Most studies assessed multiple outcome variables, including behavioral outcomes (k = 15), media coverage (k = 10), information seeking (k = 8), cancer incidence (k = 3), and interpersonal communication (k = 2). Results fairly consistently indicated that cancer announcements from public figures had meaningful effects on many, if not most, of these outcome variables. While such events essentially act as naturally occurring interventions, the effects tend to be relatively short term. Gaps in this literature include few contemporary studies of high-profile public figures in the United States and a general lack of theory-based research. Directions for future research as well as implications for cancer communication and prevention are discussed.