Cancer Risk-Promoting Information: The Communication Environment of Young Adults

#4Corners4Health Social Media Cancer Prevention Campaign for Emerging Adults: Protocol for a Randomized Stepped-Wedge Trial

BACKGROUND

Many emerging adults (EAs) are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among EAs delivered over social media is limited. Cancer prevention information and recommendations may reach EAs more effectively over social media than in settings such as health care, schools, and workplaces, particularly for EAs residing in rural areas.

OBJECTIVE

This pragmatic randomized trial aims to evaluate a multirisk factor intervention using a social media campaign designed with community advisers aimed at decreasing cancer risk factors among EAs. The trial will target EAs from diverse backgrounds living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah.

METHODS

We will recruit a sample of EAs (n=1000) aged 18 to 26 years residing in rural counties (Rural-Urban Continuum Codes 4 to 9) in the Four Corners states from the Qualtrics' research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and human papillomavirus vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Campaign posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and EAs and focus groups with EAs. The EAs will complete assessments at baseline and at 12, 26, 39, 52, and 104 weeks after randomization. Assessments will measure 6 cancer risk behaviors, theoretical mediators, and participants' engagement with the social media campaign.

RESULTS

The trial is in its start-up phase. It is being led by a steering committee. Team members are working in 3 subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by EAs, and community resources available. A framework for the social media campaign with topics, format, and theoretical mediators has been created, along with protocols for campaign management.

CONCLUSIONS

Social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among EAs. Because of the popularity of web-based information sources among EAs, an innovative, multirisk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50392.

Communication and Social Determinants of Cancer Preventive Behaviors in Adolescents From Low Socio-Economic Backgrounds in India: A Cross-Sectional Study

PURPOSE

Promoting cancer preventive behaviors among adolescents, especially those from lower socioeconomic backgrounds, is crucial due to the significant impact of health behaviors in adolescence on disease risk in adulthood. With India witnessing a rise in cancer incidence and mortality, adolescence becomes a pivotal stage for establishing healthy habits, emphasizing the need for early cancer prevention efforts.

METHODS

This cross-sectional study used survey data from 2242 adolescents attending public schools of Mumbai, India. Multiple logistic regression was conducted to determine the associations between cancer preventive behaviors and: (1) the individual and social determinants of health, and (2) media exposure.

FINDINGS

Merely 21.5% of the adolescents ate fruits and vegetables daily, 50% of the adolescents exercised 3 or more times a week, and 20% of the adolescents admitted having used tobacco and/or supari. Girls were found to have lower odds of exercising, as well as using tobacco and/or supari. Wealth and father's education were positively associated with all 3 cancer preventive behaviors. Media exposure was negatively associated, with television exposure linked to reduced fruits and vegetables consumption, while movies and social media exposure were associated with increased tobacco and/or supari use.

INTERPRETATION

Our findings suggest that individual and social determinants of health and media exposure can influence cancer preventive health behaviors in low socio-economic status (SES) adolescents. Efforts to increase awareness to promote cancer preventive behaviors among the adolescents, particularly low SES adolescents, a population more vulnerable to poor health outcomes, is critical.

Exposure to tobacco retail outlet tobacco marketing and initiation of cigarette and e-cigarette use: Depressive symptoms as a moderator

INTRODUCTION

While tobacco retail outlet (TRO) marketing exposure has been associated with tobacco use, little research has explored how this relationship may vary by the experience of depressive symptoms. The purpose of this study was to examine if the relationship between TRO tobacco marketing exposure and tobacco use initiation is moderated by depressive symptoms among young adults.

METHODS

Participants were drawn from 24 colleges in Texas who were participating in a multi-wave cohort study (2014-2019). The present study included 2020 cigarette or ENDS naïve participants at wave 2 (69.2% female; 32.1% white; m age=20.6 [SD=2.0] at wave 1). Generalized mixed-effects logistic regression analyses were used to examine the association between cigarette and ENDS TRO marketing exposure and subsequent initiation for both products with depressive symptoms as a moderator.

RESULTS

The interaction between cigarette marketing and depressive symptoms was significant (OR=1.38 95% CI=[1.04,1.83]). Cigarette marketing did not impact cigarette initiation among participants with low depressive symptoms (OR=0.96 95% CI= [0.64,1.45]), but did impact cigarette initiation among participants with high depressive symptoms (OR=1.83 95% CI=[1.23,2.74]). There was no interaction effect for ENDS initiation. Main effects showed that ENDS marketing exposure predicted ENDS initiation (OR=1.43 95% CI=[1.10,1.87]).

CONCLUSIONS

Exposure to tobacco marketing at TROs is an important risk factor for initiation of cigarette and ENDS use, particularly for cigarette initiation among those who experience greater levels of depressive symptoms. Future work is needed to better understand why this type of marketing is influential for this group.

Examining beliefs and information-seeking behaviors of young adults aged 20-39 to help inform cancer prevention communication

Successfully reaching young adults with cancer early detection information is urgently important given the rising rates of cancer in this age group. We sought to describe to describe the 'when, who, where, what and how' of young adult cancer information seeking and how it differs from that of older participants. We analyzed information seeking and beliefs among young adult (aged 20-39 years) and middle aged and older (aged 40-75 years) respondents to the Health Information National Trends Survey (HINTS) 5, cycle 4 (N = 2784). A little less than half of young adults had searched for cancer information (44%), which was just as often as middle aged and older adults. Seeking cancer information was greater among young adults more worried about the disease (aOR = 1.39, 95% CI = 1.04, 1.86, p = .026). Like middle aged and older adults, young adults most often chose a doctor as their first choice for cancer information; however, they were more likely than their older counterparts to make the internet their first choice (38.9% vs. 28.5%, p = .013) and more frequently sought health information from YouTube (p = .010). They were more trusting of cancer information from government organizations than older adults (p = .019). Communicators may be able to better persuade young adults with early detection information framed around cherished values. Though respondents of all ages were most likely to choose protecting family as their top value, young adults valued happiness over safeguarding their health more than middle aged and older adults.

The Landscape of Cigar Marketing in Print Magazines from 2018-2021: Content, Expenditures, Volume, Placement and Reach

Cigar consumption has increased in the U.S. over the past decade, yet gaps remain in research on cigar promotion in print magazines. This study examines ad placement, volume, ad characteristics, and associated expenditures for cigars from 2018-2021, and readership data for magazines containing cigar ads. We merged content analysis data with Kantar Media data on magazine placement and expenditures and used magazine readership data from MRI-Simmons. The only brand in print magazines was Black & Mild (B & M), a top cigar brand in the U.S. There were 30 unique B & M magazine ads and 284 occurrences (i.e., appearances in magazines), translating to $46,504,578 in expenditures. All ads featured the word "enjoy/enjoyment" and a warning label. Filtered cigars were the most featured cigar type (75%) and sweets was the most featured flavor (78%). Nearly half of the publications in which B & M were advertised in have substantial Black/African American readership and were featured in publications with disproportionate young adult and Hispanic/Latino readership. This study identified tactics used in print advertising for a top cigar brand. Future research should examine how these tactics impact consumer perceptions. Findings of cigar ads reaching vulnerable populations may inform the FDA's efforts to reduce health disparities through regulations and public education.

Assessing the Role of Social Bots During the COVID-19 Pandemic: Infodemic, Disagreement, and Criticism

BACKGROUND

Social media has changed the way we live and communicate, as well as offering unprecedented opportunities to improve many aspects of our lives, including health promotion and disease prevention. However, there is also a darker side to social media that is not always as evident as its possible benefits. In fact, social media has also opened the door to new social and health risks that are linked to health misinformation.

OBJECTIVE

This study aimed to study the role of social media bots during the COVID-19 outbreak.

METHODS

The Twitter streaming API was used to collect tweets regarding COVID-19 during the early stages of the outbreak. The Botometer tool was then used to obtain the likelihood of whether each account is a bot or not. Bot classification and topic-modeling techniques were used to interpret the Twitter conversation. Finally, the sentiment associated with the tweets was compared depending on the source of the tweet.

RESULTS

Regarding the conversation topics, there were notable differences between the different accounts. The content of nonbot accounts was associated with the evolution of the pandemic, support, and advice. On the other hand, in the case of self-declared bots, the content consisted mainly of news, such as the existence of diagnostic tests, the evolution of the pandemic, and scientific findings. Finally, in the case of bots, the content was mostly political. Above all, there was a general overriding tone of criticism and disagreement. In relation to the sentiment analysis, the main differences were associated with the tone of the conversation. In the case of self-declared bots, this tended to be neutral, whereas the conversation of normal users scored positively. In contrast, bots tended to score negatively.

CONCLUSIONS

By classifying the accounts according to their likelihood of being bots and performing topic modeling, we were able to segment the Twitter conversation regarding COVID-19. Bot accounts tended to criticize the measures imposed to curb the pandemic, express disagreement with politicians, or question the veracity of the information shared on social media.

Young Adults' Use of Different Social Media Platforms for Health Information: Insights From Web-Based Conversations

Background

Social media–delivered health promotion has demonstrated limited uptake and effectiveness among young adults. Understanding how young adults interact with existing social media platforms for health might provide insight for future health promotion interventions.

Objective

The aim of this study is to describe how young adults interact with different social media platforms for health and health information.

Methods

We used a web-based conversation methodology to collect data from 165 young adults aged 18 to 24 years. Participants participated in an extended conversation with moderators and other participants about health and social media. They were prompted to discuss how they find health information, how they use different social media platforms, and how they evaluate the trustworthiness of information. A thematic qualitative analysis was applied to the data.

Results

Young adults spent a lot of time scrolling through Facebook newsfeeds, which often resulted in seeing health-related content either from their friends, news sources, or advertisements. Some actively sought out information about specific health areas by joining groups or following relevant pages. YouTube was considered a useful source for learning about everything and was often the go-to when searching for information or advice (after Google). Young adults found the video format easy to learn from. They stated that they could identify accurate YouTube health content by cross-checking multiple videos, by feeling that the presenter was real and relatable, or just through instinctively judging a video’s credibility. Instagram was a source of inspiration for health and wellness from those whose lives were dedicated to healthy lifestyles and fitness. Twitter, Tumblr, and Snapchat were rarely used for health information.

Conclusions

Most young adults obtain health information from social media, both actively and through passive exposure. Participants indicated looking to social media influencers for health and lifestyle inspiration and judged the credibility of sources by appearance and instinct. Health experts should try to use the channels in the way that young adults already use them; use relatable role models on Instagram and YouTube, eye-catching headlines and support groups on Facebook, and easy to follow instruction videos via YouTube.

International Registered Report Identifier (IRRID)

RR2-10.1111/1747-0080.12448

Distilling the curriculum: An analysis of alcohol industry-funded school-based youth education programmes

BACKGROUND AND AIM

For decades, corporations such as the tobacco and fossil fuel industries have used youth education programmes and schools to disseminate discourses, ideas and values favourable to their positions, and to pre-empt regulation that threatens profits. However, there is no systematic research into alcohol industry-funded youth education programmes. This article serves to address this important gap in the literature.

METHODS

Using a discourse theoretical approach informed by poststructural discourse theory and critical discourse analysis, we analysed teaching materials from three school-based youth education initiatives which focus on alcohol consumption and health harms: Drinkaware for Education, The Smashed Project (funded by Diageo), and Talk About Alcohol (Alcohol Education Trust). These materials, some of which are disseminated internationally, are provided to schools through intermediary bodies in receipt of alcohol industry funding.

FINDINGS

The analysis found that these materials drew from and presented discourses of personal responsibility, moderate alcohol consumption, and involved a narrowing of the problem definition and causes. The locus of the problem is located by the discourses within individuals including youth, with causes of youth alcohol consumption repeatedly presented as peer pressure and 'poor choices', with little or no mention of alcohol industry marketing or other practices. All programmes promoted familiarisation and normalisation of alcohol as a 'normal' adult consumer product which children must learn about and master how to use responsibly when older. The discourses constructed in these materials closely align with those of other alcohol industry corporate social responsibility discourses which employ selective presentation of harms, including misinformation about cancer, and ambiguous terms such as "responsible drinking". Furthermore, the role of alcohol price, availability and access, and the impacts of alcohol and the industry on inequities were not articulated within the discourses. The research was limited to an analysis of teaching materials and further research is needed to explore their impact on youth, teachers and wider discourses and social norms.

CONCLUSION

Alcohol industry-sponsored youth education programmes serve industry interests and promote moderate consumption while purportedly educating children about harms and influences of alcohol use. There are considerable conflicts of interest in the delivery of alcohol education programmes funded by the alcohol industry and intermediary bodies in receipt of such funding. Alcohol education materials should be developed independent from industry, including funding, and should empower children and young people to understand and think critically about alcohol, including harms and drivers of consumption, and effective interventions needed to protect them and others from alcohol-related harms. Independent organisations can use this analysis to critique their materials to strengthen alignment with meeting student and public health interests. The ongoing exposure of children and young people to such conflicted and misleading materials needs urgent attention from policymakers, practitioners, teachers and parents, and resources dependent on industry support should cease being used in schools.

Communication research at the National Cancer Institute, 2013-2019: a grant portfolio analysis

PURPOSE

To analyze communication-focused grants funded by the National Cancer Institute (NCI) between fiscal years 2013 and 2019 to provide insight into the characteristics of funded projects and identify promising areas for future research.

METHODS

iSearch, a portfolio analysis tool, was queried to identify communication-related grants funded by NCI. Abstracts and specific aims were coded for key study characteristics. 344 unique competing grants with a substantial communication component were included in the final analysis. SAS version 9.4 was used to calculate code frequencies.

RESULTS

Most communication grants focused on cancer prevention (n = 197), with fewer targeting diagnosis, treatment, survivorship, or end-of-life. Tobacco product use was the most frequently addressed topic (n = 128). Most grants targeted or measured outcomes at the individual (n = 332) or interpersonal level (n = 127). Cancer patients/survivors (n = 101) and healthcare providers (n = 63) were often the population of focus, while caregivers or those at increased risk for cancer received less attention. Studies were often based in healthcare settings (n = 125); few studies were based in schools or worksites. Many grants employed randomized controlled trials (n = 168), but more novel methods, like optimization trials, were uncommon.

CONCLUSION

NCI's support of health communication research covers a diverse array of topics, populations, and methods. However, the current analysis also points to several promising opportunities for future research, including efforts focused on communication at later stages of the cancer control continuum and at multiple levels of influence, as well as studies that take advantage of a greater diversity of settings and leverage novel methodological approaches.

How Are the Links between Alcohol Consumption and Breast Cancer Portrayed in Australian Newspapers?: A Paired Thematic and Framing Media Analysis

A dose-dependent relationship between alcohol consumption and increased breast cancer risk is well established, even at low levels of consumption. Australian women in midlife (45–64 years) are at highest lifetime risk for developing breast cancer but demonstrate low awareness of this link. We explore women’s exposure to messages about alcohol and breast cancer in Australian print media in the period 2002–2018. Methods: Paired thematic and framing analyses were undertaken of Australian print media from three time-defined subsamples: 2002–2004, 2009–2011, and 2016–2018. Results: Five key themes arose from the thematic framing analysis: Ascribing Blame, Individual Responsibility, Cultural Entrenchment, False Equilibrium, and Recognition of Population Impact. The framing analysis showed that the alcohol–breast cancer link was predominantly framed as a behavioural concern, neglecting medical and societal frames. Discussion: We explore the representations of the alcohol and breast cancer risk relationship. We found their portrayal to be conflicting and unbalanced at times and tended to emphasise individual choice and responsibility in modifying health behaviours. We argue that key stakeholders including government, public health, and media should accept shared responsibility for increasing awareness of the alcohol–breast cancer link and invite media advocates to assist with brokering correct public health information.

Testing the Effects of Hookah Tobacco Social Media Risk Communication Messages Among Young Adults

BACKGROUND

Hookah tobacco is commonly used among young adults, and use is driven in part by widespread misperceptions about risks. Social media use, particularly Instagram, is prominent in this population and exposure to commercial and user-generated content promoting hookah commonly occurs.

AIMS

This study tested the effects of hookah tobacco risk messaging for delivery via Instagram as a strategy to offset exposure to content promoting hookah use among young adults.

METHOD

Young adult hookah smokers were recruited online for a 2 × 3 between-subjects experiment (n = 601). Participants completed preexposure measures and were randomized to view hookah tobacco Instagram ads (commercial or user generated) with risk messages (none, risk education, or graphic risk). Stimuli were presented as a simulated Instagram feed. After viewing the stimuli, participants completed postexposure outcome measures.

RESULTS

There was a statistically significant main effect of risk message type but no significant main effect of Instagram ad type or risk message type by ad type interactions. Exposure to the graphic risk and risk education messages were associated with lower intentions to engage with hookah tobacco ads on Instagram. Graphic risk and risk education messages produced greater negative emotional response and the graphic messages increased motivation to quit compared with Instagram ads alone.

DISCUSSION

Findings provide preliminary evidence that hookah tobacco risk messages delivered via Instagram can offset the influence of content promoting the use of hookah tobacco.

CONCLUSION

This study represents an example of risk message testing and the results suggest the messages warrant further testing via social media delivery.

Receptivity to Tobacco Advertising among Young Adults with Internalizing Problems: Findings from the Population Assessment of Tobacco and Health Study

Background: Many risk factors for tobacco use among the general young adult population, such as tobacco advertising receptivity, have gone unexamined among those with internalizing problems, despite disproportionately high rates of tobacco use. Objective: The objective of this study was to examine the interrelationship of internalizing problems, tobacco advertising receptivity, and tobacco use among young adults using data from Wave 1 of the Population Assessment for Tobacco and Health Study. Methods: The sample included 9,110 young adults (ages 18-24). Multivariable logistic regression models examined the association between internalizing problems and advertising receptivity and tobacco use. Separate models were run for cigarettes, cigars, e-cigarettes, smokeless tobacco and any tobacco use. An interaction term (receptivity × internalizing problems) was added to each model. Results: Except for smokeless tobacco, individuals with high internalizing problems reported greater odds of product use compared to those with low internalizing problems. There was no association between internalizing problems and use of smokeless tobacco. For all products, receptivity was positively associated with tobacco use. A borderline significant interaction was detected between cigarette advertising receptivity and internalizing problems, such that the magnitude of the relationship between receptivity to cigarette advertising and cigarette use was stronger for those with high internalizing problems compared those with low internalizing problems. Conclusions/Importance: The relationship between cigarette advertising receptivity and cigarette use may differ for those with and without internalizing problems. Disproportionate receptivity to risk-promoting messages among young adults with internalizing problems could exacerbate disparities in cigarette use.

Patterns of Social Media Use and Their Relationship to Health Risks Among Young Adults

PURPOSE

Social media use is pervasive among young adults, and different sites have different purposes, features, and audiences. This study identified classes of young adults based on what combination of sites they use and how frequently, and compared their health risk factors and behaviors.

METHODS

Latent profile models were developed based on frequency of using 10 sites from a national sample of young adults aged 18-24 years (n = 1,062). Bivariate analyses and multivariable regressions examined the relationship between class membership and alcohol, tobacco, and other drug (ATOD) use, and symptoms of depression and anxiety.

RESULTS

The optimal model identified five classes: Low Users (7.9%), High Users (63.1%), Professional Users - high use of LinkedIn (10.1%), Creative Users - high use of Vine and Tumblr (11.5%), and Mainstream Users - high use of Facebook and YouTube (7.4%). Classes differed significantly on ATOD use and depressive symptoms. Compared to High Users, Creative Users had higher odds of using most substances and lower odds of depressive symptoms, Mainstream Users had higher odds of substances used socially (alcohol and hookah), Professional Users had higher odds of using alcohol, cigarettes, and cigars, and Low Users had higher odds of using other drugs (e.g., cocaine and heroin).

CONCLUSIONS

A young adult's social media site use profile is associated with ATOD use and depressive symptoms. Use and co-use of certain sites may influence the volume and nature of ATOD-related content and norms young adults experience in social media. Targeting interventions to sites selected based on use patterns associated with each health risk may be effective.

Cancer Prevention During Early Adulthood: Highlights From a Meeting of Experts

Using a life course approach, the Centers for Disease Control and Prevention's Division of Cancer Prevention and Control and the National Association of Chronic Disease Directors co-hosted a 2-day meeting with 15 multidisciplinary experts to consider evidence linking factors in early adulthood to subsequent cancer risk and strategies for putting that evidence into practice to reduce cancer incidence. This paper provides an overview of key themes from those meeting discussions, drawing attention to the influence that early adulthood can have on lifetime cancer risk and potential strategies for intervention during this phase of life. A number of social, behavioral, and environmental factors during early adulthood influence cancer risk, including dietary patterns, physical inactivity, medical conditions (e.g., obesity, diabetes, viral infections), circadian rhythm disruption, chronic stress, and targeted marketing of cancer-causing products (e.g., tobacco, alcohol). Suggestions for translating research into practice are framed in the context of the four strategic directions of the National Prevention Strategy: building healthy and safe community environments; expanding quality preventive services in clinical and community settings; empowering people to make healthy choices; and eliminating health disparities. Promising strategies for prevention among young adults include collaborating with a variety of community sectors as well as mobilizing young adults to serve as advocates for change. Young adults are a heterogeneous demographic group, and targeted efforts are needed to address the unique needs of population subgroups that are often underserved and under-represented in research studies.