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Ranker LR, Wu J, Hong T, Wijaya D, Benjamin EJ, Bhatnagar A, Robertson RM, Fetterman JL, Xuan Z. Social media use, brand engagement, and tobacco product initiation among youth: Evidence from a prospective cohort study. Addict Behav 2024; 154:108000. [PMID: 38461745 PMCID: PMC11135121 DOI: 10.1016/j.addbeh.2024.108000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/19/2024] [Accepted: 02/24/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To evaluate whether frequent social media use and liking/following tobacco brand accounts was associated with increased risk of tobacco and polytobacco initiation over approximately 1-year follow-up among youth with no prior tobacco use. METHODS Associations between measures of social media engagement (daily social media use and liking/following tobacco brands) and tobacco initiation risk were examined using data from Waves 2 and 3 (2014-2015) of the US Population Assessment for Tobacco and Health study. Separate log-binomial models, accounting for missing data via multiple imputation and using propensity score adjustment to address confounding, estimated the adjusted relative risk (aRR) of any tobacco initiation and poly-use (2 + products) initiation at 1-year follow-up. RESULTS Among the 8,672 youth with no prior tobacco use (49.3% female, mean [SD] age 14.1 [1.7]), 63.5% used social media at least daily, and 3.3% reported liking/following ≥ 1 tobacco brands on social media. Those reporting daily or more frequent social media use (compared to less) were at increased risk for tobacco (aRR 1.67; 95% CI 1.38-2.02) and polytobacco initiation (aRR 1.32; 95% CI 0.98-1.78). Although results were imprecise, liking/following ≥ 1 tobacco brands on social media (versus none) was associated with tobacco (aRR 1.34; 95% CI 0.95-1.89) or polytobacco initiation (aRR 1.60; 95% CI 0.99-2.60). In sensitivity analyses, liking/following cigarette or cigarillo brands was associated with polytobacco initiation. CONCLUSIONS This study adds to a growing evidence-base describing the exposure of youth to tobacco-related social media content. Such content-often generated by tobacco companies-may contribute to youth tobacco initiation.
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Affiliation(s)
- Lynsie R Ranker
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 4th floor, Boston, MA 02118, USA.
| | - Jiaxi Wu
- College of Communication, Boston University, 640 Commonwealth Avenue, Boston, MA 02215, USA; Annenberg School for Communication, University of Pennsylvania, 3620 Walnut St, PA 19104, Philadelphia
| | - Traci Hong
- College of Communication, Boston University, 640 Commonwealth Avenue, Boston, MA 02215, USA
| | - Derry Wijaya
- Department of Computer Science, Boston University, 111 Cummington Mall, Boston, MA 02215, USA
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 725 Albany Street, Boston, MA 02118, USA; Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, 4th floor, Boston, MA 02118, USA
| | - Aruni Bhatnagar
- Department of Medicine, University of Louisville, 302 E Muhammad Ali Boulevard, KY 40202, Louisville; American Heart Association Tobacco Regulation and Addiction Center, 7272 Greenville Ave., Dallas, TX 75231, USA
| | - Rose M Robertson
- American Heart Association Tobacco Regulation and Addiction Center, 7272 Greenville Ave., Dallas, TX 75231, USA; Department of Medicine, School of Medicine, Vanderbilt University, 1161 21st Ave. S., Nashville 37232, TN, USA
| | - Jessica L Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, 700 Albany Street, Boston, MA 02118, USA
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 4th floor, Boston, MA 02118, USA
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Hopkinson NS, Vrinten C, Parnham JC, Radó MK, Filippidis F, Vamos EP, Laverty AA. Association of time spent on social media with youth cigarette smoking and e-cigarette use in the UK: a national longitudinal study. Thorax 2024; 79:662-669. [PMID: 38755014 PMCID: PMC11187353 DOI: 10.1136/thorax-2023-220569] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/24/2023] [Indexed: 05/18/2024]
Abstract
BACKGROUND Social media may influence children and young people's health behaviour, including cigarette and e-cigarette use. METHODS We analysed data from participants aged 10-25 years in the UK Household Longitudinal Study 2015-2021. The amount of social media use reported on a normal weekday was related to current cigarette smoking and e-cigarette use. Generalised estimating equation (GEE) logistic regression models investigated associations of social media use with cigarette smoking and e-cigarette use. Models controlled for possible confounders including age, sex, country of UK, ethnicity, household income and use of cigarette/e-cigarettes by others within the home. RESULTS Among 10 808 participants with 27 962 observations, current cigarette smoking was reported by 8.6% of participants for at least one time point, and current e-cigarette use by 2.5% of participants. In adjusted GEE models, more frequent use of social media was associated with greater odds of current cigarette smoking. This was particularly apparent at higher levels of use (eg, adjusted odds ratio (AOR) 3.60, 95% CI 2.61 to 4.96 for ≥7 hours/day vs none). Associations were similar for e-cigarettes (AOR 2.73, 95% CI 1.40 to 5.29 for ≥7 hours/day social media use vs none). There was evidence of dose-response in associations between time spent on social media and both cigarette and e-cigarette use (both p<0.001). Analyses stratified by sex and household income found similar associations for cigarettes; however, for e-cigarettes associations were concentrated among males and those from higher household income groups. CONCLUSIONS Social media use is associated with increased risk of cigarette smoking and e-cigarette use. There is a need for greater research on this issue as well as potential policy responses.
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Affiliation(s)
| | - Charlotte Vrinten
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Jennie C Parnham
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Márta K Radó
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Filippos Filippidis
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Eszter P Vamos
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Anthony A Laverty
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
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Chaffee BW, Couch ET, Donaldson CD, Farooq O, Cheng NF, Ameli N, Zhang X, Gansky SA. Patterns in Tobacco, E-Cigarette, and Cannabis Advertising Exposure Among California Adolescents and Associations With Future Use Expectations. Subst Use Misuse 2024; 59:1240-1248. [PMID: 38509707 PMCID: PMC11045304 DOI: 10.1080/10826084.2024.2330912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Exposure to tobacco, e-cigarette, or cannabis marketing is associated with adolescent use. Few studies have examined advertising exposure prevalence and patterns across these products concurrently. METHODS This study assessed past 30-day recalled exposure to promotional messages about tobacco, e-cigarettes ("vapes" on the survey), and cannabis ("marijuana") from various sources among California adolescents (ages 12-17) in the 2022 Teens, Nicotine, and Tobacco Online Survey (N = 2530). Principal components analysis (PCA) was conducted to examine the underlying structure and patterns in advertising exposure sources. Multivariable logistic regression was used to evaluate associations between any advertising exposure and future use expectations (a susceptibility measure) in one year and at age 25 among current never-users. RESULTS Overall, 65.9% of participants recently noticed at least one tobacco (52.5%), vape (51.5%), or marijuana (45.6%) advertisement. Gas stations or convenience stores were the most common source for tobacco or vape ads; billboards were for marijuana ads. In PCA, advertising exposure patterns correlated with advertising source, not the type of product. Exposures from tobacco-specific sources and nearer point of sale were associated with current use, older age, LGBTQ + identity, and sensation seeking. Among never-users, advertising exposure was associated with one-year and age-25 use expectations for cigarettes (one-year expectations adjusted odds ratio: 1.7; 95% CI: 1.1, 2.5), vapes (2.3; 1.5, 3.5), and marijuana (2.1; 1.5, 3.0). CONCLUSION California adolescents' exposure to tobacco, e-cigarette, and cannabis marketing is common, follows similar patterns, and is associated with use susceptibility. Comprehensive restrictions on marketing accessible to adolescents could help prevent youth use.
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Affiliation(s)
- Benjamin W. Chaffee
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, USA 94143
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
| | - Elizabeth T. Couch
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, USA 94143
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
| | - Candice D. Donaldson
- California Tobacco Prevention Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA, USA 95899
| | - Omara Farooq
- California Tobacco Prevention Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA, USA 95899
| | - Nancy F. Cheng
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
| | - Niloufar Ameli
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
| | - Xueying Zhang
- California Tobacco Prevention Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA, USA 95899
| | - Stuart A. Gansky
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, USA 94143
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
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Sreeramareddy CT, Acharya K, Manoharan A, Oo PS. Changes in E-cigarette Use, Cigarette Smoking, and Dual-Use Among the Youth (13-15 Years) in 10 Countries (2013-2019)-Analyses of Global Youth Tobacco Surveys. Nicotine Tob Res 2024; 26:142-150. [PMID: 37466212 DOI: 10.1093/ntr/ntad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/05/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION The increasing use of e-cigarettes among the youth is a public health problem that needs surveillance. We report changes in e-cigarette use, cigarette smoking, and "dual use" among youth in 10 countries. AIMS AND METHODS Global Youth Tobacco Survey (GYTS)s from Georgia, Iraq, Italy, Latvia, Montenegro, Paraguay, Peru, Qatar, Romania, and San Marino were analyzed. Changes in prevalence of "awareness of e-cigarettes," "ever use" (even tried a few puffs) and "current use" (during last 30 days) of e-cigarettes and cigarette smoking, and "dual use" (both e-cigarette and cigarette smoking) between baseline (2013 and 2014) and most recent (2017-2019) surveys were estimated. RESULTS "Awareness of e-cigarettes" and "ever e-cigarette use" significantly increased (p < .001). "Ever e-cigarette use" was highest in Italy, 93% (95% CI 90.9, 94.4). "Current e-cigarette use" significantly (p < .05) increased by > 50% in most countries. During the most recent surveys, "current e-cigarette" use was > 10% in five countries Italy (18.3%) and Latvia (18.5%) being the highest. Cigarette smoking significantly declined in Italy, Latvia, Peru, and San Marino (p < .05) but remains unchanged in other countries. "Dual use" (both electronic and conventional cigarettes) significantly increased in all countries (p < .001). During the most recent surveys "dual use" was highest in Italy (10%, 95% CI 8.1, 12.2) and Latvia (8.6%, 95% CI 7.2, 10.2). Youth aged 14 and ≥15 years the smokers, were more likely to be e-cigarette users. CONCLUSIONS Awareness and use of e-cigarettes and "dual use" among youth have increased. Closer monitoring of tobacco use among youths and comprehensive tobacco control policies inclusive of e-cigarettes are needed. IMPLICATIONS Secondary data analyses of serial GYTSs in 10 countries showed that both awareness of e-cigarette and e-cigarette use has increased among school-going youth aged 13-15 years. A concurrent increase in "dual use" of e-cigarettes and cigarette smoking during the last 30 days in all 10 countries indicates continued cigarette smoking in the absence of e-cigarettes because of the common risk construct of tobacco product use. Results call for continued surveillance of both e-cigarettes and cigarette smoking among school-going youth. Comprehensive tobacco control measures inclusive of e-cigarettes should be implemented to reduce tobacco use among the youth.
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Affiliation(s)
| | | | | | - Phyu Synn Oo
- Department of Pathology, International Medical University, Kuala Lumpur, Malaysia
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Rutherford BN, Lim CCW, Cheng B, Sun T, Vu GT, Johnson B, Daniel Paul Ashley, Chung J, Huang S, Leung J, Stjepanović D, Connor JP, Chan GCK. Viral Vaping: A systematic review and meta analysis of e-cigarette and Tobacco-Related social media content and its influence on youth behaviours and attitudes. Addict Behav 2023; 147:107828. [PMID: 37591107 DOI: 10.1016/j.addbeh.2023.107828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
AIMS E-cigarette and tobacco-related content on social media continues to rise from lax restrictions on both personal and promotional posts. This content has been linked to various mechanisms of increased e-cigarette and tobacco use (i.e., lower risk perceptions and increased susceptibility). This study aimed to synthesis the association between exposure to e-cigarette and tobacco-related content and youth behaviours and attitudes. METHODS A comprehensive search was conducted on PubMed, Scopus, PsycINFO and Web of Science. Studies published post-2004 reporting effect estimates for exposure or engagement with e-cigarette or tobacco content on social media and behaviour or attitude outcomes were included. RESULTS Thirty-two studies (N = 274,283, aged 9 to 25 years) were included for synthesis. Meta-analyses revealed significant associations between engagement with tobacco content and use (OR 2.21; 95% CI = 1.27-3.82, p =.005; I2 = 96.4%), exposure to tobacco content and never users' lower risk perceptions (OR 0.68; 95% CI = 0.49-0.91; p =.011; I2 = 78.2%), and exposure to e-cigarette content and use (OR 1.37; 95% CI = 0.99-1.88; p = 0.058; I2 = 64.4%). There was no observed relationship between exposure to tobacco content and ever users' risk perceptions (OR 0.83; 95% CI = 0.61-1.13; p =.231; I2 = 83.5%). Qualitative synthesis found significant associations between tobacco exposure and increased current use and pro-tobacco attitudes; e-cigarette exposure and increased susceptibility and lower risk perceptions; tobacco engagement and increased susceptibility; e-cigarette engagement and increased use; dual exposure and increased susceptibility; and dual engagement and increased dual use. Mixed findings were identified for the influence of e-cigarette exposure on attitudes, tobacco exposure on susceptibility, dual exposure on dual use behaviours, and dual engagement on dual susceptibility. CONCLUSIONS Findings suggest an association between exposure and engagement to e-cigarette or tobacco products on social media and use or pro-use attitudes among youth. Further substantive research in the area of youth-specific use and attitudes following exposure and engagement with e-cigarette and tobacco content is needed to quantify this association.
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Affiliation(s)
- Brienna N Rutherford
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia; School of Psychology, The University of Queensland, St Lucia, Australia.
| | - Carmen C W Lim
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia; School of Psychology, The University of Queensland, St Lucia, Australia
| | - Brandon Cheng
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia; School of Psychology, The University of Queensland, St Lucia, Australia
| | - Tianze Sun
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia; School of Psychology, The University of Queensland, St Lucia, Australia
| | - Giang T Vu
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia; School of Psychology, The University of Queensland, St Lucia, Australia
| | - Benjamin Johnson
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia; School of Psychology, The University of Queensland, St Lucia, Australia
| | | | - Jack Chung
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia; School of Psychology, The University of Queensland, St Lucia, Australia
| | - Sandy Huang
- School of Medicine, The University of Queensland, Herston, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
| | - Jason P Connor
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia; School of Psychology, The University of Queensland, St Lucia, Australia; School of Medicine, The University of Queensland, Herston, Australia
| | - Gary C K Chan
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
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Stanton CA, Pasch KE, Pericot-Valverde I, Cruz-Cano R, Moran MB, Abadi MH, Mays D, Mercincavage M, Tang Z, Chen-Sankey J. Longitudinal associations between U.S. youth exposure to E-cigarette marketing and E-cigarette use harm perception and behavior change. Prev Med 2022; 164:107266. [PMID: 36152822 PMCID: PMC9691545 DOI: 10.1016/j.ypmed.2022.107266] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/28/2022] [Accepted: 09/17/2022] [Indexed: 10/31/2022]
Abstract
E-cigarette marketing tactics to reach and appeal to youth are rapidly changing. This study examined to what extent youth e-cigarette marketing exposure was associated with e-cigarette use behavior change one year later, during a time when youth e-cigarette use was starting to surge in the U.S. Using nationally representative longitudinal public-use data from the Population Assessment of Tobacco and Health (PATH) Study, we examined associations between recalled e-cigarette marketing exposure (2016-2018) at Wave (W) 4 and e-cigarette use harm perception and behavior change (ever, current, and regular use) one year later (W4.5; 2017-2018) among W4 never tobacco users (n = 9405). Recall of exposure to e-cigarette marketing through different channels was also examined in multivariable models controlling for socio-demographic factors and established e-cigarette use risk factors. Results show that the most frequently recalled channels of e-cigarette marketing exposure were retail stores (50.3%), television (22.2%), and websites/social media (20.2%). Over one year, 21.2%, 7.8%, 3.4%, and 1.2% of respondents reported reduced harm perceptions, and ever, current, and regular use of e-cigarettes, respectively, at follow-up. Recalled exposure to e-cigarette marketing was associated with reduced e-cigarette harm perception (AOR = 1.20; 95% CI = 1.05-1.37) and ever (AOR = 1.26; 95% CI = 1.01-1.56) and current use (AOR = 1.40; 95% CI = 1.02-1.92) at follow-up. E-cigarette marketing exposure through websites/social media was associated with reduced harm perceptions and all stages of e-cigarette use change, including regular use. Identifying marketing techniques and channels that change youth e-cigarette harm perceptions and influence e-cigarette use progression is essential to inform e-cigarette regulatory policies and prevention campaigns.
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Affiliation(s)
- Cassandra A Stanton
- Behavioral Health and Health Policy, Westat, Rockville, MD, United States of America
| | - Keryn E Pasch
- Department of Kinesiology and Health Education at the University of Texas, Austin, TX, United States of America
| | - Irene Pericot-Valverde
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States of America
| | - Raul Cruz-Cano
- Department of Epidemiology and Biostatistics Indiana University School of Public Health-Bloomington, University of Maryland, College Park, MD, United States of America
| | - Meghan B Moran
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Melissa H Abadi
- Pacific Institute for Research & Evaluation, Louisville, KY, United States of America
| | - Darren Mays
- Department of Internal Medicine, College of Medicine, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Zhiqun Tang
- Behavioral Health and Health Policy, Westat, Rockville, MD, United States of America
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States of America; School of Public Health, Rutgers University, Piscataway, NJ, United States of America.
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Loan CM, Khurana A, Wright J, Romer D. Selection versus socialization effects of peer norms on adolescent cigarette use. Tob Use Insights 2021; 14:1179173X211066005. [PMID: 34924778 PMCID: PMC8679053 DOI: 10.1177/1179173x211066005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022] Open
Abstract
Adolescent smokers tend to have friends who also smoke. This association has been attributed to peer socialization and peer selection effects. However, evidence regarding timing and relative magnitude of these effects is mixed. Using a random-intercept cross-lagged panel model, we examined the reciprocal relations between adolescent cigarette use and perceptions of friends' cigarette use in a sample of 387 adolescents, assessed annually for 4 years. Adolescent cigarette use predicted increases in perceived friend use before the reverse effect emerged. Further, some of the effect of early adolescent cigarette use on subsequent use was mediated by changes in perceived friend use. The results support a greater role for friend selection than socialization in predicting early adolescent cigarette use.
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Affiliation(s)
- Christopher M Loan
- Department of Educational
Methodology, Policy, and Leadership, University of Oregon, Eugene, OR, USA
| | - Atika Khurana
- Department of Counseling Psychology
and Human Services, University of Oregon, Eugene, OR, USA
| | - Joanna Wright
- Department of Counseling Psychology
and Human Services, University of Oregon, Eugene, OR, USA
| | - Daniel Romer
- Annenberg Public Policy Center, The University of
Pennsylvania, Philadelphia, PA, USA
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