Research-based guidelines for warning design and evaluation

Protection motivation when using biocidal products - A survey study in Germany

Due to their inherent properties, biocidal products might pose a risk to human and animal health and the environment. In risk management, there exists uncertainty about private users' comprehension of and willingness-to-adhere to use instructions that mitigate these risks (e.g., limit frequency of use or application area). This study aimed at providing insights into the users' perspective by focusing on their attention, comprehension, and the attitudinal predictors of protection motivation. In the online study (N = 957 participants from Germany) were introduced to a hypothetical purchase scenario featuring an insect spray and a realistic set of use instructions. Next, the participants' attention for the use instruction was measured in self-report and by tracking the time spent on the page with the use instruction, while Likert scale-type questions measured the comprehensibility, protection motivation, and predictors. Participants reported higher protection motivation if they spent more time with the use instruction, perceived it as comprehensible, rated the threat to humans, animals, and the environment as more severe, perceived themselves as responsible (i.e., internal locus of control) and capable (i.e., self-efficacy) of adhering to the use instructions, perceived adherence to the use instructions as effective (i.e., response efficacy) and did not perceive biocidal products as inherently safe (i.e., neutral locus of control). These results offer valuable information for an improved regulation of biocidal products and better management of potential risks associated with their use. They also provide concepts for interventions to ensure users of biocidal products follow the instructions for a safe use and better protection of the environment.

Exploring the effects of cannabis health warnings on protective health intentions among US adults in legal recreational states

BACKGROUND

As cannabis policy trends toward liberalization, assessing cannabis health warning effects becomes increasingly important. This study investigated underlying mechanisms accounting for the effectiveness of cannabis health warnings on protective health intentions.

METHOD

A sample of 1,095 adults (21+) living in legal recreational US states who reported using cannabis in the past 12 months participated in an online experiment. Participants were randomly assigned to view cannabis health warnings that described risks of impaired driving, mental health, and smoke exposure and varied pictures and text (vs. text-only) attributes in warnings. Outcomes were message reactions (cognitive elaboration, fear, and hope), attitudes and beliefs (perceived severity of cannabis harms and perceived susceptibility to cannabis harms, and perceived response and self-efficacy to prevent cannabis harms), and protective health intentions (information-seeking about cannabis health effects and having interpersonal discussions about cannabis harms with family, friends, and medical professionals).

RESULTS

MANCOVA results showed no significant differences between text-only vs. pictorial attributes on protective health intentions; thus, warning conditions were controlled and analyzed using structural equation modeling (SEM). SEM results showed that attention to cannabis health warnings (text-only or pictorial) elicited higher cognitive elaboration, fear, and hope-an emotion associated with coping actions that motivate positive expectations of future events. These outcomes, in turn, were associated with greater perceived severity and susceptibility and greater perceived response efficacy, respectively. Hope, perceived severity, and perceived response and self-efficacy were independently associated with greater intentions to seek information about cannabis health effects and to discuss cannabis health harms.

CONCLUSION

Attention to warnings impacted emotions, attitudes, and protective health intentions. Fear is commonly associated with health warning effects, and our results suggest that hope is also an important factor. This research contributes to understanding the effects of cannabis health warnings and can inform regulatory agencies that mandate warnings on cannabis products.

High visual salience of alert signals can lead to a counterintuitive increase of reaction times

It is often assumed that rendering an alert signal more salient yields faster responses to this alert. Yet, there might be a trade-off between attracting attention and distracting from task execution. Here we tested this in four behavioral experiments with eye-tracking using an abstract alert-signal paradigm. Participants performed a visual discrimination task (primary task) while occasional alert signals occurred in the visual periphery accompanied by a congruently lateralized tone. Participants had to respond to the alert before proceeding with the primary task. When visual salience (contrast) or auditory salience (tone intensity) of the alert were increased, participants directed their gaze to the alert more quickly. This confirms that more salient alerts attract attention more efficiently. Increasing auditory salience yielded quicker responses for the alert and primary tasks, apparently confirming faster responses altogether. However, increasing visual salience did not yield similar benefits: instead, it increased the time between fixating the alert and responding, as high-salience alerts interfered with alert-task execution. Such task interference by high-salience alert-signals counteracts their more efficient attentional guidance. The design of alert signals must be adapted to a "sweet spot" that optimizes this stimulus-dependent trade-off between maximally rapid attentional orienting and minimal task interference.

A systematic review of cannabis health warning research

Background

Cannabis legalization provides an opportunity to communicate with consumers through mandated health warnings on cannabis packaging. However, research on cannabis health warnings is a nascent field. Therefore, a review is needed to synthesize cannabis health warning research and inform ongoing policy discussions.

Methods

This paper used systematic review guidelines to search online databases, including PubMed Central, Scopus, Web of Science, Jstor, Communication and Mass Media Complete, Medline, PsycINFO, and Google Scholar. Search strings combined the terms "cannabis" or "marijuana" with "health warning" or "health warning message" or "warning label" or "health warning label" or "health information label." Results were synthesized narratively.

Results

The search identified 90 research articles. After screening, 17 studies on the impact of cannabis health warnings were retained. Retained studies focused on the hypothetical effects of cannabis health warnings (n = 11; 64.7 %) and "real world" effects of implementing warnings post-legalization (n = 6; 35.3 %). Evidence indicated mandated cannabis health warnings improved noticing and recall of health warning content. Cannabis health warnings describing risks of addiction were consistently rated the least effective. Pictorial cannabis health warnings generally outperformed text-only warnings when displayed on their own, while experiments with warnings on products had mixed results. Cannabis health warnings decreased product appeal, mainly when package branding was minimized.

Conclusions

Health warnings on cannabis packaging are an important strategy to communicate risk to consumers. Mandating warnings increased notice, recall, and health knowledge. Warnings with pictures and describing specific risks were most effective, as was showing warnings without product branding.

Protecting the children -a virtual reality experiment on consumers' risk perceptions of household chemicals

Warnings on the labels of hazardous household chemicals (e.g. warning pictograms and use instructions) should create risk awareness and thus encourage safe storage, handling and disposal. However, scientific findings have called into question the effectiveness of warnings to prevent accidents, albeit mostly based on consumers' self-reports. This study aimed to contribute to existing data on household chemicals and consumer safety by applying a novel observational method using virtual reality (VR). The study participants (N = 119) were observed after receiving a task to childproof a virtual apartment from various interactable neutral and hazardous objects (i.e. knives, lighters and household chemicals with and without warnings) that were placed in the virtual apartment. For the analysis, the object placement (i.e. accessible or inaccessible to the children) and the level of interaction with the objects were coded, and the observational data were supplemented with data gathered through a questionnaire. The results showed that most hazardous household chemicals were moved to spots that were inaccessible to the children without any interactions of the participants with the warnings. Instead, they used their pre-existing knowledge and intuitive strategies to judge the objects' risks. These potentially misleading intuitive strategies should be increasingly considered in the regulation of hazardous household chemicals. This study also discussed the use and limitations of VR for the observation of human behaviour and decision making under uncertainty.

The Impact of Hazard Statement Design Elements in Procedures: Counterintuitive Findings and Implications for Standards

OBJECTIVE

The objective of these studies was to identify hazard statement (HS) design elements in procedures that affected whether both workers and lab participants performed the associated hazard mitigation.

BACKGROUND

Many of the incidents in high-risk industries are the result of issues with procedures (e.g., standard operating procedures; SOPs) workers use to support their performance. HSs in these procedures are meant to communicate potential work hazards and methods of mitigating those hazards. However, there is little empirical research regarding whether current hazard design guidelines for consumer products translate to procedures.

METHOD

Two experimental studies-(1) a laboratory study and (2) a high-fidelity simulation-manipulated the HS design elements present in procedures participants used while performing tasks. Participants' adherence to the mitigation of the hazard was compared for the HS designs.

RESULTS

The guidelines for HSs from consumer products did not translate to procedures. Specifically, the presence of an alert icon, a box around the statement, and highlighting the statement did not improve adherence to HSs. Indeed, the only consistent finding was for the Icon, with its presence reliably predicting nonadherence in both studies. Additionally, the total number of design elements did not have a positive effect on adherence.

CONCLUSION

These findings indicate that more fundamental procedure HSs research is needed to identify effective designs as well as to understand the potential attentional mechanisms associated with these findings.

APPLICATION

The findings from these studies indicate that current regulations and guidelines should be revisited regarding hazard presentation in procedures.

Farmers Interpretation of Pesticides Pictograms and Their Adherence to Different Ergonomic Principles for Different Sizes

OBJECTIVE

The objective of this study was to investigate the effect of the size of pesticide pictograms on comprehensibility and their adherence to principles of familiarity, compatibility, and standardization. Pictograms usually involve complex details, and space limitation demands size reductions, which reduces overall comprehensibility, especially in agriculture and healthcare.

METHODS

Two experiments were conducted. In experiment 1, the effect of different sizes of pictograms on comprehension was tested. In experiment 2, the level of compliance for different ergonomic principles on different sizes of pictograms was investigated.

RESULTS

Results of experiment 1 indicated significant variation in comprehension level (p < .05), with maximum comprehension for the size 15 mm × 15 mm (87.6%) and minimum comprehension for the size 7 mm × 7 mm (69.4%). Results of experiment 2 indicated significant variation in compliance of ergonomic principles with different pictogram sizes (p < .05), with maximum compliance for the size 15 mm × 15 mm (7.7, 7.7, 7.6) and minimum compliance for the size 7 mm × 7 mm (6.3, 6.3, 6.3). A significant increase in the comprehensibility of pictograms and their adherence to familiarity, compatibility, and standardization was observed with the increase in the sizes of pictograms.

CONCLUSION

The smallest size of pictograms with a mean comprehension level ≥ 65% and scores for familiarity, compatibility, and standardization ≥ 7 (on a scale of 1 to 10) was 10 mm × 10 mm. The potential application of this research is to identify the most comprehensible size of pictograms that adhere to the principles of familiarity, compatibility, and standardization.

Awareness, use and understanding of nutrition labels among children and youth from six countries: findings from the 2019 - 2020 International Food Policy Study

BACKGROUND

Nutrition facts tables (NFTs) on pre-packaged foods are widely used but poorly understood by consumers. Several countries have implemented front-of-package labels (FOPLs) that provide simpler, easier to use nutrition information. In October 2020, Mexico revised its FOPL regulations to replace industry-based Guideline Daily Amount (GDA) FOPLs with 'Warning' FOPLs, which display stop signs on foods high in nutrients of concern, such as sugar and sodium. This study examined self-reported awareness, use, and understanding of NFTs and FOPLs among young people in six countries with different FOPLs, with an additional focus on changes before and after implementation of Mexico's FOPL warning policy.

METHODS

A 'natural experiment' was conducted using 'pre-post' national surveys in Mexico and five separate comparison countries: countries with no FOPL policy (Canada and the US), countries with voluntary FOPL policies (Traffic Lights in the UK and Health Star Ratings in Australia), and one country (Chile) with mandatory FOPL 'warnings' (like Mexico). Population-based surveys were conducted with 10 to 17-year-olds in 2019 (n = 10,823) and in 2020 (n = 11,713). Logistic regressions examined within- and between-countries changes in self-reported awareness, use, and understanding of NFTs and FOPLs.

RESULTS

Across countries, half to three quarters of respondents reported seeing NFTs 'often' or 'all the time', approximately one quarter reported using NFTs when deciding what to eat or buy, and one third reported NFTs were 'easy to understand', with few changes between 2019 and 2020. In 2020, awareness, use and self-reported understanding of the Warning FOPLs in Mexico were higher than for NFTs in all countries, and compared with GDA FOPLs in Mexico (p < .001). Mandated Warning FOPLs in Mexico and Chile had substantially higher levels of awareness, use, and understanding than the voluntary Traffic Lights in the UK and Health Star Ratings in Australia (p < .001 for all).

CONCLUSIONS

Mandated easy-to-understand FOPLs are associated with substantially greater levels of self-reported awareness, use and understanding at the population-level compared to NFT and GDA-based labeling systems.

Human Factors Investigation of Ejection from a Roller Coaster

The Human Factors Analysis and Classification System (HFACS) was used to evaluate a complex forensic case. The use of HFACS in forensic human factors is demonstrated via a case study of the death of a roller coaster rider ejected from his seat. The analysis revealed systemic factors for the fatality throughout the amusement park and ride manufacturer organizations. Such system analyses are needed to move park management and state investigators away from their narrow focus on rider behavior as causes of injury incidents, and address systemic factors to make amusement parks safer for guests.

Consumers' Perceptions of the Design of Front-of-Package Warning Labels-A Qualitative Study in China

The warning label is identified as a simple front-of-package labeling format that assists consumers in making healthier food choices at the point of purchase. The color and/or shape of the design elements of the packaging labels can influence the understanding and purchase intention outcomes. This study aimed to explore the perceptions of consumers regarding differently designed warning labels (WLs) to identify a possibly suitable warning label design in the Chinese context. Using a qualitative approach, we collected data through 12 focus group discussions consisting of 116 participants residing in 6 provinces. Participants were selected by purposive sampling. Data were coded following inductive thematic analysis and summarized into three themes: (1) perceived preference for the appearance of the WLs, (2) perceived benefits of the WLs, and (3) suggestions for promoting the WLs. Participants preferred the black shield label showing a high content of the nutrients of concern (e.g., sodium, added sugar, and saturated fat) in both Chinese and English. Consumers generally agreed that the WLs were easy to understand and offered a simple method for choosing healthier foods. They anticipated that WLs could encourage the food industry to reformulate their products. Our study results will support the design and facilitate the use of WLs in China.

Awareness, use and understanding of nutrition labels among adults from five countries: Findings from the 2018-2020 International Food Policy Study

Few studies have compared the effects of different front-of-package label (FOPL) systems in the 'real world'. This study assessed adults' awareness, use and understanding of nutrition facts labels (NFLs) and nationally implemented FOPLs such as Health Star Ratings (HSR), Traffic lights, and Guideline Daily Amounts (GDAs) in five countries, including before and after implementation of Mexico's warning FOPLs in 2020. Data were from the International Food Policy Study, an annual repeat cross-sectional study conducted in 2018-2020 among adults (N=64,032) in Australia, Canada, Mexico, the UK and the US. Self-reported awareness, use, and understanding of NFLs (in all five countries) and FOPLs (in Australia, Mexico, and UK) were assessed over time, between countries, and between NFLs and FOPLs. Most respondents in all countries reported seeing their country's NFLs (awareness) 'often' or 'all the time' across all three years, with one third to half of respondents using NFLs 'often' or 'all the time' (Australia: 43-45%; Canada: 47-50%; Mexico: 36-39%; UK: 32-34%; US: 47-49%), and approximately one half to two thirds finding NFLs 'easy' or 'very easy to understand' (56-57%; 67-69%; 51-54%; 48-51%; 70-71%). In 2020, awareness, use and self-reported understanding of the Warning FOPLs in Mexico were highest among all countries with a FOPL (p<0.001), whereas awareness and use were lowest for Australia's HSR (p<0.001). In countries with FOPLs, self-reported understanding was higher for FOPLs than NFLs, except for the GDA FOPL in Mexico. Only modest changes were observed over time. Warning FOPLs were associated with greater levels of self-reported awareness, use and understanding among adults compared to NFLs and GDA-based FOPLs. FOPLs implemented on a voluntary basis, such as Australia's HSR, may be less likely to be seen and used.

When information security depends on font size: how the saliency of warnings affects protection behavior

Prior research on how to improve the effectiveness of information security warnings has predominantly focused on either the informational content of warnings or their visual saliency. In an online experiment (N = 1'486), we disentangle the effect of both manipulations and demonstrate that both factors simultaneously influence decision making. Our data indicate that the proportion of people who engage in protection behavior can be increased by roughly 65% by making a particular warning message more visually salient (i.e. a more conspicuous visual design is used). We also show that varying the message's saliency can make people behave very differently when confronted with the same threat or behave very similarly when confronted with threats that differ widely in terms of severity of outcomes. Our results suggest that the visual design of a warning may warrant at least as much attention as the informational content that the warning message conveys.

Are emojis ready to promote the WHO 5 moments for hand hygiene in healthcare?

Background

Hand hygiene is universally recognized as a cornerstone measure for the prevention of healthcare-associated infections. Although the WHO “My five Moments for hand hygiene” poster has been used for more than a decade to delineate hand hygiene indications and promote action, adherence levels among healthcare workers are still notoriously low and disquieting. To compensate for the lack of effective hand hygiene communication, we aimed to evaluate emojis as possible surrogates for the non-verbal aspects of hand hygiene behaviour.

Methods

Following a thorough review of the Unicode version 12.0, the most applicable emojis to the terms used in the WHO 5 Moments poster were extracted. We developed a self-administered questionnaire to assess the view of infection prevention and control (IPC) practitioners regarding the use of emojis to show the WHO 5 Moments. Completed questionnaires were collected and analysed to determine the suitability of the existing emojis to illustrate a unified emoji poster. Data were analysed using R (version 3.6.3).

Results

A total of 95 IPC practitioners completed the questionnaire from May to October 2019 from different countries. Of these, 69 (74%) were female, and the mean age of the participants was 44.6 ± 10.87 years. We found appropriate emojis for six of the words used in the poster, including for touching (72%), for patient (63%), for clean (53%), for procedure (56%), for body fluid (58%), and for exposure risk (71%). The existing emojis proposed for the words “hygiene”, “aseptic”, and “surrounding” seemed to be less satisfactory.

Conclusions

In summary, the findings of this study indicate that the existing emojis may not be able to substitute the words used in the WHO 5 Moments poster. Emojis might be helpful to address hand hygiene indications in healthcare that may eventually play a role in promoting this measure. However, emojis should be further studied to choose the most appropriate ones and avoid ambiguity and misinterpretation. More emojis to convey health related messages are needed. We recommend further research in this area to evaluate the effect of using emojis in healthcare-related behaviours.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13756-022-01164-1.

"I Think There Should Be Photos": Female Indoor Tanners' Perceptions of Health Warning Labels for Tanning Beds

This study explores female indoor tanners' perceptions of the current, text-only Canadian health warning label (HWL) for tanning equipment, as well as pictorial, evidence-based alternative HWLs. We created 10 test HWLs that depicted skin health effects, eye damage, premature aging, and death. Young women who had tanned indoors in the past year discussed these and the current federal HWL in focus groups. Although the current Canadian HWL was seen as informative, several participants did not recognize it, and many said that they would not read it due to the small text, wordiness, and lack of an image. Graphic images, particularly those depicting permanent conditions affecting the face, eyes, or appearance, were seen as effective. Common criticisms of the images were lack of believability, relatability, and comprehensibility. Although concise text was important for encouraging reading, many participants expressed a desire for more information in the test HWLs. Premature aging was of great concern to many participants, but the images selected for these HWLs were not perceived as effective. Although the text was seen as effective in the death HWLs, most participants dismissed the images. This research has implications for IT HWLs in Canada and globally. These results suggest that graphic images may be impactful in IT HWLs. Images must be supplemented with informative text that increases believability, relatability, and comprehensibility. These modifications would create HWLs that are engaging, informative, and that form part of a wider effort to spread awareness about the harmful effects of IT.

Novel sonification designs: Compressed, iconic, and pitch-dynamic auditory icons boost driving behavior

With the development of connected vehicles, in-vehicle auditory alerts enable drivers to effectively avoid hazards by quickly presenting critical information in advance. Auditory icons can be understood quickly, evoking a better user experience. However, as collision warnings, the design and application of auditory icons still need further exploration. Thus, this study aims to investigate the effects of internal semantic mapping and external acoustic characteristics (compression and dynamics design) on driver performance and subjective experience. Thirty-two participants (17 females) experienced 15 types of warnings - (3 dynamics: mapping 0 vs. 1 vs. 2) × (5 warning types: original iconic vs. original metaphorical vs. compressed iconic vs. compressed metaphorical auditory icon vs. earcon) - in a simulator. We found that compression design was effective for rapid risk avoidance, which was more effective in iconic and highly pitch-dynamic sounds. This study provides additional ideas and principles for the design of auditory icon warnings.

Effect of different front-of-package food labels on healthfulness perception of ultraprocessed food and intention to purchase the products- A randomised controlled trial

This study aimed to evaluate the effect of different labels on participants: identifying products high in nutrients of concern; identifying unhealthy products, and intention to purchase unhealthy products. This blinded randomised controlled trial included a representative sample of South African households (n = 1951). Per household we selected a member primarily responsible for food purchases. Participants were randomised into the Warning Label (WL), Guideline Dietary Amounts (GDA) or Multiple Traffic Light (MTL) arms. Each participant answered questions in a no label condition (control) followed by same questions in the label condition (experiment). Complete data were collected and analysed for 1948 participants (WL = 33.7%, GDA = 32.1% and MTL = 34.2%). The probability of correctly identifying products high in nutrients of concern and identifying products as being unhealthy was higher with the WL compared to the GDA or MTL for most items. There was no difference in performance between the GDA and the MTL when considering all items together. A higher percentage of participants reported a lower intention to purchase an unhealthy product after exposure to the WL compared to MTL for 5 out of 6 products; 2 out of 6 products for the WL compared to GDA and 2 out of 6 products for GDA compared to MTL. Compared to the control condition, exposure to each of the labels resulted in better identification of nutrients of concerns, unhealthy products and a lower intention to purchase when considering all specific outcome items together. The WL showed a higher potential to enable South African consumers to identify products high in nutrients of concern, identify unhealthy products and discourage purchasing of unhealthy products.

Perceived effect of warning label on parental food purchasing and drivers of food selection among South African parents–An exploratory study

Household food purchasing decision is a complex process influenced by factors such as marketing, cost, children food preference and parental choices. Most food products targeted toward children are unhealthy and are aggressively marketed to increase desirability among parents and children making healthier food selection even harder. The warning label (WL) is identified as a simple front-of-package labeling format that assist consumers to easily identify unhealthy foods and reduce their purchasing. This was a qualitative study that aimed to investigate the perceived effect of the warning label (WL) on parental food purchasing and drivers of food selection among parents. The study was conducted in a mainly rural part of South Africa, in Limpopo Province. Data were collected from 44 adult participants, all parents with children aged below 16 years selected using the snowball sampling method. Seven focus groups diversified according to age, literacy, income and urbanicity were utilized for data collection. Using a focus group discussion guide, parents were shown images of six products (crisps, soda, juice, biscuits, cereals, and yogurt) superimposed with the WL and questions asked were based on those images. Thematic analysis revealed that although some parents felt undeterred by the WL, some felt they would alter their food purchasing in the presence of the WL. Other parents felt they would reduce the frequency or the amount purchased or completely stop purchasing labeled products for their children. Motives behind perceived behavior modification included children's health being perceived as a priority and labeled products being viewed as unhealthy. Factors such as pressure from children, taste, poor nutrition knowledge and affordability seemed to influence parental food selection. These findings have important policy implications by providing evidence to policymakers that the WL may alter parental food purchasing and also provide insight into drivers of food selection among South African parents.

Communicating COVID-19 risk changes: Signalling with words, phrases, and messages

During COVID-19, governments issued messages to trigger action, encourage sustained behaviours (e.g., social distancing, hand hygiene), and manage system wide risk. This study examines messages issued across two stages established by the World Health Organization (WHO): (a) pre-pandemic early intervention stage and (b) within-pandemic escalation stage. In April 2020, approximately one month after COVID-19 was declared a pandemic, an experiment using a sample of 769 Australian participants was conducted. Using a between-subject design, participants assessed the way messages (curated and then expertly attributed to the two stages) were perceived and influenced behaviours. Next, it examined the power of words and phrases, selected from the same messages, for (a) their potential to signal risk, warning, and behavioural response and (b) the extent to which they reflected pandemic stages. Results showed that between the two stages, messages were differentiated by negative affect, assertiveness, and risk. Subsequently, increased negative affect, assertiveness, and risk indication increased adaptive behavioural intentions. However, increased assertiveness also increased non-adaptive behavioural intentions, though increased risk indication reduced non-adaptive behavioural intentions. Signal words and phrases, which hold potential as iconic features for biological hazard messages, showed varying performance across message stages, indicating an opportunity to improve them. Taken together, the findings contribute to academic and policy approaches for adapting communication to changing risk.

Typology of content warnings and trigger warnings: Systematic review

Content and trigger warnings give information about the content of material prior to receiving it. Different typologies of content warnings have emerged across multiple sectors, including health, social media, education and entertainment. Benefits arising from their use are contested, with recent empirical evidence from educational sectors suggesting they may raise anxiety and reinforce the centrality of trauma experience to identity, whilst benefits relate to increased individual agency in making informed decisions about engaging with content. Research is hampered by the absence of a shared inter-sectoral typology of warnings. The aims of this systematic review are to develop a typology of content warnings and to identify the contexts in which content warnings are used. The review was pre-registered (ID: CRD42020197687, URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020197687) and used five sources: electronic databases covering multiple sectors (n = 19); table of contents from multi-sectoral journals (n = 5), traditional and social media websites (n = 53 spanning 36 countries); forward and backward citation tracking; and expert consultation (n = 15). In total, 6,254 documents were reviewed for eligibility and 136 documents from 32 countries were included. These were synthesised to develop the Narrative Experiences Online (NEON) content warning typology, which comprises 14 domains: Violence, Sex, Stigma, Disturbing content, Language, Risky behaviours, Mental health, Death, Parental guidance, Crime, Abuse, Socio-political, Flashing lights and Objects. Ten sectors were identified: Education, Audio-visual industries, Games and Apps, Media studies, Social sciences, Comic books, Social media, Music, Mental health, and Science and Technology. Presentation formats (n = 15) comprised: education materials, film, games, websites, television, books, social media, verbally, print media, apps, radio, music, research, DVD/video and policy document. The NEON content warning typology provides a framework for consistent warning use and specification of key contextual information (sector, presentation format, target audience) in future content warning research, allowing personalisation of content warnings and investigation of global sociopolitical trends over time.

Speech-based takeover requests in conditionally automated driving: Effects of different voices on the driver takeover performance

This study explored the possibility of applying personalized takeover requests (TORs) in an automated driving system (ADS), which required drivers to regain control when the system reached its limits. A driving simulator experiment was conducted to investigate how speech-based TOR voices impacted driver performance in takeover scenarios with two lead time conditions in conditionally automated driving (level 3). Eighteen participants drove in three sessions, with each session having a different TOR voice (a synthesized male voice, a synthesized female voice, and a significant other voice). Two scenarios with a lead time of 5 s and two scenarios with a lead time of 12 s were provided per session. The driver takeover time and quality data were collected. A follow-up interview was conducted to gain a clearer understanding of the drivers' psychological feelings about each TOR voice during takeovers. Changes in takeover time and takeover quality caused by TOR voices were similar in both lead time conditions, except for the lateral acceleration. The synthesized male voice led to a larger maximum lateral acceleration than the other two voices in the 5 s condition. Interestingly, most drivers preferred choosing the synthesized female voice for future takeovers and showed negative attitudes toward the significant other voice. Our results implied that choosing TOR voices should consider the drivers' daily voice-usage habits as well as specific context of use, and personalized TOR voices should be incorporated into the ADS prudently.

The influence of packaging on consumers' risk perception of chemical household products

Chemical household products are found in most households. If consumers are to safely handle such products, they need to be aware of the risks posed by the particular product they are using. Although most countries require that chemical household products feature warning labels (e.g. the Globally Harmonized System of Classification and Labelling of Chemicals), consumers appear to also use other cues to determine the risks associated with a specific product. Thus, we studied the influence of packaging on consumers' risk perception of chemical household products. More specifically, we examined the effect of the colour of the packaging (black or pink packaging versus the original packaging) as well as the presence of images of flowers or food-imitating elements on the packaging. Significant differences with regard to consumer's risk perception were found in terms of all four studied manipulations. Therefore, we conclude that consumers' risk perception can be influenced by the packaging design. In particular, if elements that lower consumer's risk perception (e.g. featuring flowers on the label and food-imitating elements on the packaging) are omitted from the packaging, consumers might be able to more accurately judge the risks associated with a product and so take appropriate safety precautions.

Applying Insights on Categorisation, Communication, and Dynamic Decision-Making: A Case Study of a ‘Simple’ Maritime Military Decision

A complete understanding of decision-making in military domains requires gathering insights from several fields of study. To make the task tractable, here we consider a specific example of short-term tactical decisions under uncertainty made by the military at sea. Through this lens, we sketch out relevant literature from three psychological tasks each underpinned by decision-making processes: categorisation, communication and choice. From the literature, we note two general cognitive tendencies that emerge across all three stages: the effect of cognitive load and individual differences. Drawing on these tendencies, we recommend strategies, tools and future research that could improve performance in military domains – but, by extension, would also generalise to other high-stakes contexts. In so doing, we show the extent to which domain general properties of high order cognition are sufficient in explaining behaviours in domain specific contexts.

Effects of Automated Messages on Internet Users Attempting to Access "Barely Legal" Pornography

With the increasing number of individuals accessing online child sexual exploitation material (CSEM), there is an urgent need for primary prevention strategies to supplement the traditional focus on arrest and prosecution. We examined whether online warning messages would dissuade individuals from visiting a honeypot website purporting to contain barely legal pornography. Participants (n = 419) seeking the site were randomly assigned to one of five conditions; they went straight to the landing page (control; n = 100) or encountered a warning message advising of the potential harm to viewers (n = 74), potential harm to victims (n = 65), ability of police to track IP addresses (n = 81), or possible illegality of such pornography (n = 99). We measured the attempted click-through to the site. Attrition rates for the warning message conditions were 38% to 52%, compared with 27% for the control group. The most effective messages were those that warned that IP addresses can be traced (odds ratio [OR] = 2.64) and that the pornography may be illegal (OR = 2.99). We argue that warning messages offer a valuable and cost-effective strategy that can be scaled up to help reduce the accessing of CSEM online.

Influence of package colour, branding and health warnings on appeal and perceived harm of cannabis products among respondents in Canada and the US

'Plain packaging' and health warnings can reduce appeal and increase risk perceptions of tobacco products. This study tested the effect of health warnings and restricted brand imagery on perceptions of cannabis products. Participants in Canada and the US (n = 45,378) were randomized to view packages of three cannabis brands in 2019. A 3 (health warning) x 4 (brand imagery) between-group factorial experimental design was used. Health warning conditions were: none, Canadian or US warning. The Canadian warning conditions had three messages counterbalanced across brands: pregnancy, adolescent risk, and impaired driving. The US warning mentioned the same broad risk categories. The four branding conditions ranged from packages displaying no brand imagery and uniform colours-'plain packaging'-to full brand imagery. Regression tested differences between conditions on product appeal, perceived harm, and free recall of warning messages. Overall, full branding and plain packaging were rated the most and least appealing, respectively (p < 0.001). Products were rated as significantly less harmful when they had a white background with no or limited branding versus a coloured background (p ≤ 0.01). Products with health warnings were rated significantly less appealing and more harmful than those with no warning (p < 0.001). Message recall was significantly higher for Canadian versus US health warnings, and for the US warning versus no warning (p < 0.001). Message recall was greater among those who saw plain versus fully branded packages for two of the three warning messages (p < 0.01). Prominent health warnings and restrictions on brand imagery may be warranted in jurisdictions considering non-medical cannabis legalization.

Transfer of chemicals to a secondary container, from the introduction of new labelling regulation to COVID-19 lockdown: A retrospective analysis of exposure calls to the Poison Control Centre of Rome, Italy, 2017-2020

The transfer of a chemical product from its original container to an unlabelled secondary container by consumers is a potential health hazard that may result in unintentional exposures and intoxications. The aim of this study was to describe the pattern of prevalence of exposures to transferred products in Italy from year 2017, when the new European labelling regulation for chemicals became fully operative, to 2020, year of the coronavirus 19 disease first outbreak. Calls to the Poison Control Centre (PCC) of Policlinico Umberto I Hospital ‐ Sapienza University of Rome were analysed retrospectively for characteristics, clinical presentation and circumstances related to the event. We registered 198 cases of interest. There was a reduction in cases from 2017 (4.9%) to 2019 (2.2%), followed by an increased prevalence in 2020 (4.2%) mainly due to the months “post‐lockdown.” The transferred product was very frequently diluted, and an empty drinking bottle was usually used as secondary container. Exposures were mostly of minor severity, and no deaths occurred. The study highlights the importance of PCCs data in the evaluation of the hazard communication to users through labels and advises for public campaigns to promote safe behaviours during future lockdowns to prevent exposures at a later period.

South African consumers' perceptions of front-of-package warning labels on unhealthy foods and drinks

Front-of-package labeling (FOPL) is a policy tool that helps consumers to make informed food choices. South Africa has not yet implemented this labeling system. The aim of this study was therefore to explore adult South African consumers’ perceptions of front-of-package warning labels on foods and non-alcoholic beverages (referred to as drinks in this paper) and their insights into features that could influence the effectiveness of the warning label. Using a qualitative approach, the study purposively selected consumers diversified by urbanization, gender, socioeconomic status, and literacy. We collected data from a total of 113 participants through 12 focus group discussions. Data were systematically coded and divided into five themes namely, positive attitudes toward warning labels, perceived benefits of warning labels, perceived behavior modification, perceived beneficiaries of warning labels, and effective attributes of warning labels. Almost all participants from all socio-economic backgrounds were positive about warning labels, reporting that warning labels concisely and understandably educated them about the nutritional composition of foods. Other perceived advantages were that warning labels warn of health implications, are easily understandable and could benefit child health. Some participants anticipated that warning labels would reduce their purchases of unhealthy foods, while others thought the labels would have no effect on their purchasing habits. Participants found the warning labels attention grabbing and stated that they preferred a black triangle placed on a white background (referred to as a holding strap henceforth), the words “high in” and “warning” in bold and uppercase text, an exclamation mark, and an icon depicting the excessive nutrient. In South Africa warning labels may improve consumer understanding of nutrition information and assist consumers in determining the nutritional quality of packaged foods and drinks.

Noticing of cannabis health warning labels in Canada and the US

INTRODUCTION

Product labelling and health warnings are important components of regulatory frameworks for consumer products such as tobacco, alcohol and food. However, evidence in the cannabis domain is limited. This study aimed to examine the reach of mandated health warnings on cannabis products using a natural experimental design.

METHODS

Data are from the online International Cannabis Policy Study 2018 and 2019 surveys. Respondents were men and women aged 16 to 65 years in Canada and US states with illegal and legal nonmedical cannabis ("illegal" and "legal" states, respectively) (n = 72 549). Regression models tested differences in noticing health warnings on cannabis packages pre- and post-legalization in Canada, with comparisons to US states, adjusting for cannabis use, cannabis source and sociodemographics.

RESULTS

Respondents in Canada showed a greater increase in noticing warnings (+8.9%) in 2019 (14.7%) versus 2018 (5.8%) than respondents in US "illegal" states (+2.8%) and "legal" states (+3.2%). In 2019, consumers residing in jurisdictions with legal recreational cannabis who purchased from legal retail sources were more likely to report noticing warnings than consumers who obtained cannabis from illegal/unstated sources (Canada: 40.4% vs. 15.3%; US "legal" states: 35.3% vs. 17.0%). Regular cannabis consumers were more likely to notice warnings than less frequent consumers.

CONCLUSION

Mandating warning labels on cannabis products may increase exposure to messages communicating the health risks of cannabis, especially among frequent consumers and those who access the legal market.

Hand hygiene in health care: 20 years of ongoing advances and perspectives

Health-care-associated infections are the most prevalent adverse events of hospital care, posing a substantial threat to patient safety and burden on society. Hand hygiene with alcohol-based hand rub is the most effective preventive strategy to reduce health-care-associated infections. Over the past two decades, various interventions have been introduced and studied to improve hand hygiene compliance among health-care workers. The global implementation of the WHO multimodal hand hygiene improvement strategy and constant efforts to replace the use of soap and water with alcohol-based hand rub have led to a faster and more efficient hand cleaning method. These strategies have strongly contributed to the success of behaviour change and a subsequent decrease in health-care-associated infections and cross-transmission of multidrug-resistant organisms worldwide. The WHO multimodal behaviour change strategy requires a series of elements including system change as a prerequisite for behaviour, change, education, monitoring and performance feedback, reminders in the workplace, and an institutional safety climate. Successful adoption of the promotion strategy requires adaptation to available resources and sociocultural contexts. This Review focuses on the major advances and challenges in hand hygiene research and practices in the past 20 years and sets out various ways forward for improving this lifesaving action.

The Response of Smokers to Health Warnings on Packs in the United Kingdom and Norway Following the Introduction of Standardized Packaging

INTRODUCTION

Standardized packaging was phased in between May 2016 and May 2017 in the United Kingdom and July 2017 and July 2018 in Norway. In both countries, the health warnings on packs prior to standardized packaging being implemented were from the former Tobacco Products Directive library of warnings (text warnings covering 43% of the pack front and pictorial warnings covering 53% of the pack reverse). The warnings on packs, postimplementation, were from the current Tobacco Products Directive library of warnings (novel pictorial warnings covering 65% of the pack front and reverse) for the United Kingdom but unchanged in Norway.

AIMS AND METHODS

Longitudinal online surveys were conducted prior to standardized packaging (United Kingdom: April-May 2016; Norway: May-June 2017) and postimplementation (United Kingdom: September-November 2017 and May-July 2019; Norway: August-September 2018). We explored smokers' response to the on-pack warnings (salience, cognitive reactions, and behavioral reactions).

RESULTS

In the United Kingdom, noticing warnings on packs, reading or looking closely at them, thinking about them, thinking about the health risks, avoidant behaviors, forgoing cigarettes, and being more likely to quit due to the warnings significantly increased from waves 1 to 2, and then decreased from waves 2 to 3, but remained higher than at wave 1. In Norway, noticing warnings, reading or looking closely at them, thinking about them, thinking about the health risks, and being more likely to quit due to the warnings significantly decreased from waves 1 to 2; avoidant behaviors and forgoing cigarettes remained unchanged.

CONCLUSIONS

The inclusion of large novel pictorial warnings on standardized packs increases warning salience and effectiveness.

IMPLICATIONS

Two longitudinal online surveys in the United Kingdom and Norway explored the impact of standardized packaging on warning salience and effectiveness. That warning salience and effectiveness only increased in the UK postimplementation, where standardized packaging was implemented alongside new larger pictorial warnings on the pack front and reverse, and not in Norway, where standardized packaging was introduced but older smaller text warnings (pack front) and pictorial warnings (pack reverse) were retained, highlights the importance of removing full branding and introducing stronger warnings simultaneously.

An Augmented Warning System for Pedestrians: User Interface Design and Algorithm Development

Warning pedestrians of oncoming vehicles is critical to improving pedestrian safety. Due to the limitations of a pedestrian’s carrying capacity, it is crucial to find an effective solution to provide warnings to pedestrians in real-time. Limited numbers of studies focused on warning pedestrians of oncoming vehicles. Few studies focused on developing visual warning systems for pedestrians through wearable devices. In this study, various real-time projection algorithms were developed to provide accurate warning information in a timely way. A pilot study was completed to test the algorithm and the user interface design. The projection algorithms can update the warning information and correctly fit it into an easy-to-understand interface. By using this system, timely warning information can be sent to those pedestrians who have lower situational awareness or obstructed view to protect them from potential collisions. It can work well when the sightline is blocked by obstructions.

The Influence of Front-of-Package Nutrition Labeling on Consumer Behavior and Product Reformulation

Countries worldwide have implemented mandatory or voluntary front-of-package nutrition labeling systems. We provide a narrative review of (a) real-world evaluations of front-of-package nutrition labels that analyze objective sales data and (b) studies that objectively assess product reformulation in response to a front-of-package nutrition label implementation. We argue that there is sufficient scientific evidence to recommend that governments implement mandatory front-of-package nutrition labeling systems to improve population health. We also present a conceptual framework to describe front-of-package label influence and provide recommendations for the optimal label design, emphasizing that labeling systems should be highly visible and salient, be simple and easy to understand, leverage automatic associations, and integrate informational and emotional messaging. The existing research suggests that Guideline Daily Amount labels should be avoided and that the Health Star Rating and Nutri-Score systems are promising but that systems with warning labels like the one in Chile are likely to produce the largest public health benefits. Expected final online publication date for the Annual Review of Nutrition, Volume 41 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Developing sugar-sweetened beverage warning labels for young adults

OBJECTIVE

There is a lack of qualitative research developing sugar-sweetened beverage (SSB) warning labels with their intended end users. We sought to identify promising SSB warning elements for improving label effectiveness and for future testing in policy and institutional settings.

DESIGN

Mixed methods design using ten focus groups, a design task and a survey. The design task was used to generate ideas for an icon that would dissuade SSB consumption. The survey and focus group guide assessed participant perceptions of SSB warning label mock-ups of text (loss frame, gain frame and loss frame with attribution), colour and icon options.

SETTING

Three large public universities in California from February to March 2018.

PARTICIPANTS

Young adult SSB consumers (n 86) enrolled in one of three diverse California public universities.

RESULTS

Participants perceived the following elements as most effective for reducing SSB consumption: loss-frame text with attribution to a credible source, yellow and red colour for label background and an image or icon to accompany the text. Preferred images included sugar near or inside of an SSB, intuitive shapes like a triangle with exclamation mark or octagon and a visual indicator of SSB sugar content compared with recommended limits. Support was high for using SSB warning labels in university cafeterias and on bottles/cans.

CONCLUSIONS

Loss-frame text with a credible source, yellow or red label colour and icons could potentially enhance effectiveness of SSB warning labels and warrant further testing.

The impact of health warnings for sugar-sweetened beverages on consumer perceptions of advertising

OBJECTIVE

In February 2020, San Francisco proposed mandatory health warnings for sugar-sweetened beverage (SSB) advertisements. Industry legal challenges stated that the warning would detract from advertisers' ability to convey their intended message and mislead consumers into believing that SSB cause weight gain regardless of consumption amount, lifestyle or intake of other energy-dense foods.

DESIGN

Online between-group experiments tested the impact of SSB warnings on advertising outcomes and consumer perceptions. Respondents were randomised to view six SSB print advertisements with or without a health warning ('Warning' and 'No Warning' condition, respectively). Linear and binary logistic regression models tested differences between groups, including ad recall, brand perceptions and beliefs about SSB health effects.

SETTING

Panelists from the US Nielsen Global Panel.

PARTICIPANTS

Sixteen to 65-year-old respondents (n 1064).

RESULTS

Overall, 69·2 % of participants in the 'Warning' condition recalled seeing warnings on SSB ads. Compared with the 'No Warning' condition, participants in the 'Warning' condition who reported noticing the warnings were equally likely to recall the brands featured in the SSB ads and to recall specific attributes of the final ad they viewed. Similarly, no differences were observed between groups in perceptions of SSB, such as perceived taste, or in the prevalence of false beliefs regarding the health effects of SSB and intake of other sugary foods on weight gain.

CONCLUSIONS

Overall, there was no evidence that SSB health warnings detracted from attention to promotional elements in advertisements or that the warnings misled consumers into false beliefs about SSB as the exclusive cause of weight gain.

Designed to Be Noticed: A Reconceptualization of Carbon Food Labels as Warning Labels

Carbon labels are considered a fundamental tool for reducing emissions associated with grocery products. Although the prior literature has shown that both limited motivation and understanding of carbon labels explain the effectiveness of carbon labels, knowledge regarding how to improve the label design to increase noticeability is limited. Given the limited motivation of mainstream consumers to use carbon labels, this exploratory paper proposes that the label design should trigger bottom-up (or sensory-driven) attention mechanisms. Using grounded theory for the data collection and analysis of six focus groups, this study tests six features (i.e., location, size, color, icons, a colored background or border, and textual anchors) and identifies four design criteria (i.e., vividness, incongruity, simplicity, and clarity) that may increase label noticeability. The main conclusion of this qualitative study is that carbon labels are noticed when they are perceived as a cue of hazard. Based on this finding, we propose that carbon labels could be designed as warning labels; therefore, the insights already proven in the warning label literature should be applied to carbon label design to increase its noticeability and use.

Exploring the Implicit Link Between Red and Aggressiveness as Well as Blue and Agreeableness

Previous studies have found a link between red and aggressive behavior. For example, athletes who wear red uniforms in sports are considered to have a competitive advantage. So far, most previous studies have adopted self-report methods, which have low face validity and were easily influenced by the social expectations. Therefore, the study used two implicit methods to further explore the association between red and aggressiveness. A modified Stroop task was used in Experiment 1 to probe college students' differences between "congruent" tasks (i.e., red-aggressiveness and blue-agreeableness) and "incongruent" tasks (i.e., red-agreeableness and blue-aggressiveness). Result showed that participants responded more quickly to the congruent tasks than the incongruent tasks. Then, in order to adapt to the competitive context, Experiment 2 used an implicit association test with photos of athletes as the stimulus to college students and athletes to evaluate "congruent" tasks (i.e., red uniform photo-aggressiveness and blue uniform photo-agreeableness) as well as "incongruent" tasks (i.e., red uniform photo-agreeableness and blue uniform photo-aggressiveness), respectively. According to the results, both college students and athletes respond faster to congruent tasks than to incongruent tasks. Besides, athletes' reactions to the red-aggressiveness association are faster than college students, which may relate to the athletes' professional experience. The athletes may be more aggressive and impulsive. Overall, the study has attempted to examine the association between red and aggressiveness through implicit methods, but in the future, researches are need to find a deep association from brain mechanism aspect.

The new normal of web camera theft on campus during COVID-19 and the impact of anti-theft signage

OBJECTIVE

The opportunity for web camera theft increased globally as institutions of higher education transitioned to remote learning during COVID-19. Given the thousands of cameras currently installed in classrooms, many with little protection, the present study tests the effectiveness of anti-theft signage for preventing camera theft.

METHODS

Examined web camera theft at a southern, public university located in the United States of America by randomly assigning N = 104 classrooms to receive either anti-theft signage or no signage. Camera theft was analyzed using Blaker's exact test.

RESULTS

Classrooms not receiving anti-theft signage (control) were 3.42 times more likely to exhibit web camera theft than classrooms receiving anti-theft signage (medium effect size).

CONCLUSIONS

Using classrooms as the unit of analysis presents new opportunities for not only future crime prevention experiments, but also improving campus safety and security. Also, preventing web camera theft on campus is both fiscally and socially responsible, saving money and ensuring inclusivity for remote learners.

Impact of Sugar-Sweetened Beverage Warning Labels on Consumer Behaviors: A Systematic Review and Meta-Analysis

CONTEXT

As a primary source of added sugars, sugar-sweetened beverage consumption contributes to obesity. This study systematically synthesizes the scientific evidence regarding the impact of sugar-sweetened beverage warning labels on consumer behaviors and intentions.

EVIDENCE ACQUISITION

A keyword/reference search was performed in 2019 in Cochrane Library, PubMed, Web of Science, CINAHL, Scopus, and Google Scholar. Meta-analysis was conducted in 2020 to estimate the effect of sugar-sweetened beverage warning labels on consumers' purchase decisions.

EVIDENCE SYNTHESIS

A total of 23 studies (13 RCTs, 9 nonrandomized experiments, and 1 computer simulation study) met the eligibility criteria and were included. Labels were classified into 6 categories: (1) symbol with nutrient profile, (2) symbol with health effect, (3) text of nutrient profile, (4) text of health effect, (5) graphic with health effect, and (6) graphic with nutrient profile. Compared with the no-label control group, sugar-sweetened beverage warning label use was associated with reduced odds of choosing sugar-sweetened beverages (OR=0.49, 95% CI=0.41, 0.56) and a reduced sugar-sweetened beverage purchase intention (Cohen's d= -0.18, 95% CI= -0.31, -0.06). Across alternative label categories, the graphic with health effect (OR=0.34, 95% CI=0.08, 0.61), text of health effect (OR=0.47, 95% CI=0.39, 0.55), graphic with nutrient profile (OR=0.58, 95% CI=0.36, 0.81), and symbol with health effect (OR=0.67, 95% CI=0.39, 0.95) were associated with reduced odds of choosing sugar-sweetened beverages.

CONCLUSIONS

Sugar-sweetened beverage warning labels were effective in dissuading consumers from choosing them. Graphic with health effect labels showed the largest impact. Future studies should delineate the psychosocial pathways linking sugar-sweetened beverage warning labels to purchase decisions, recruit socioeconomically diverse participants, and design experiments in naturalistic settings.

Efficacy of Canadian health warning statements on caffeinated energy drinks: an experimental study among young Canadians

The current study examined the efficacy of health warnings on caffeinated energy drinks (CEDs). Participants aged 12-24 years (n = 2040) completed an online survey where they were asked to recall any existing warning statements on CED products and were randomized to one of 29 experimental warning conditions. Regression models were fitted to examine differences between conditions in product appeal, perceived safety and message recall. Overall, fewer than 30% of participants were able to accurately describe an existing CED product warning. Experimental findings indicated that exposure to CEDs with warning labels resulted in greater recall. Warnings on the back of CED cans featuring large font, a border, and a 'caution' heading resulted in significantly greater recall (P < 0.05 for all). Front-of-package 'High source of caffeine' labels resulted in greater recall than a quantitative description (P < 0.001); caffeine labels generally elicited lower product appeal (P < 0.001) and perceived safety (P = 0.002) ratings vs. no caffeine labels, and the qualitative caffeine statement elicited lower perceived safety ratings than the quantitative statement (P = 0.02). Existing warning statements in Canada have low levels of awareness. Warnings on CEDs could be enhanced to increase the salience of messages, with greater impact from clear, descriptive, front-of-package 'High source of caffeine' labels.

Can emojis mean "Earthquake"?

With the increase in digital communications systems and social media, there is a need for simple graphics-based ways to signal the occurrence of major disasters. We describe the development and initial usability testing of a sign to indicate that an earthquake has occurred. We involved 264 Italian adults, who completed an online survey to evaluate the evocativeness, simplicity, and universality of 16 emojis depicting earthquakes. Through a Self-Organising Map analysis we identified four similar response profiles to the evocativeness scale, differing in their mean strength. A non-metric Multidimensional Scaling suggested that evocativeness was higher for the emojis featuring a damaged building. Linear Mixed Models indicated that emojis with fabricated vs. natural structures were judged as more evocative, simpler, and more universal when characterized by danger from falling objects. In some cases, adding behavioral elements increased evocativeness. Practical implications for informing the development of a new emoji for earthquakes are discussed.

Appealing to Sense and Sensibility: System 1 and System 2 Interventions for Fake News on Social Media

Disinformation on social media—commonly called “fake news”—has become a major concern around the world, and many fact-checking initiatives have been launched in response. However, if the presentation format of fact-checked results is not persuasive, fact-checking may not be effective. For instance, Facebook tested the idea of flagging dubious articles in 2017 but concluded that it was ineffective and removed the feature. We conducted three experiments with social media users to investigate two different approaches to implementing a fake news flag—one designed to be most effective when processed by automatic cognition (System 1) and the other designed to be most effective when processed by deliberate cognition (System 2). Both interventions were effective, and an intervention that combined both approaches was about twice as effective. The awareness training on the meaning of the flags increased the effectiveness of the System 2 intervention but not the System 1 intervention. Believability influenced the extent to which users would engage with the article (e.g., read, like, comment, and share). Our results suggest that both theoretical routes can be used—separately or together—in the presentation of fact-checking results in order to reduce the influence of fake news on social media users.

Risk awareness, medication adherence, and driving behavior as determined by the provision of drug information to patients

OBJECTIVE

The study identifies appropriate risk expressions by healthcare professionals in communicating the risks of driving-impairing medicine to patients, gauging changed patient behavior, preventing traffic accidents due to drugs, and improving drug adherence.

METHODS

An online questionnaire survey was conducted on participants' perception of driving-related risks, and risk awareness, as well as reports of healthcare professionals' expressions and warning messages regarding driving-impairing drugs.

RESULTS

Approximately 80 % of participants were aware of the effects of pharmaceutical drugs on driving ability, and 50 % responded that they had received an explanation from their respective health professionals. As reported by participants, although healthcare professionals typically used more indirect expressions, direct warning messages were associated with high-risk awareness.

CONCLUSION

The content of the explanatory sentences and debriefing influenced risk perception among participants. Direct expressions were more desirable for appropriate risk perception by participants. Providing information from healthcare professional about the degree of risks and patients' determining their influence on driving behavior based on risk perception was necessary to clarify the predictors of driving behavior.

PRACTICE IMPLICATIONS

Health professionals should be aware that their warning messages could have a significant impact on patients' risk perception and driving behavior.

The Dilemma of User Engagement in Privacy Notices

Privacy notices and consent forms are the means of conveying privacy policy information to users. In Europe, a valid consent needs to be confirmed by a clear affirmative action. Despite previous research, it is not yet clear whether user engagement with consent forms via different types of interactions for confirming consent may play a significant role in effectively drawing user attention to the content, even after repeated exposure. We investigate, in a laboratory study, how different types of interactions that engage users with consent forms differ in terms of their effectiveness, efficiency, and user satisfaction. In addition, we examine if and how habituation affects user attention and satisfaction, and the time they spend on giving their consent. We conducted a controlled experiment with 80 participants in four different groups where people either were engaged actively with the policy content via Drag and Drop (DAD), Swipe, or Checkboxes, or were not actively engaged with the content (as the control condition) in a first-exposure phase and in a habituation phase. We measured user attention to consent forms along multiple dimensions, including direct, objective measurements and indirect, self-reported measures. Our results show that the different types of interactions may affect user attention to certain parts of policy information. In particular, the DAD action results in significantly more user attention to the data items compared to other groups. However, with repeated exposure to consent forms, the difference disappears. We conclude that user engagement with policy content needs to be designed with care, so that attention to substantial policy information is increased and not negatively affected.

The AngelMed Guardian® System in the Detection of Coronary Artery Occlusion: Current Perspectives

Total ischemic time, which specifies the time from the onset of chest pain to initiation of reperfusion during percutaneous coronary intervention, consists of two intervals: symptom to door time and door to balloon time. A door to balloon time of 90 mins or less has become a quality-of-care metric in the management of ST elevation myocardial infarction (STEMI). While national efforts made by the American College of Cardiology (ACC) and American Heart Association (AHA) have curtailed in-hospital door to balloon time over the years, a reduction in pre-hospital symptoms to door time presents a challenge in modern interventional Cardiology. Early and complete revascularization has been associated with improved clinical outcomes in MI and strategies that may help reduce symptom to door time, and thus the total ischemic time, are crucial. Rapidly evolving ST-segment changes commonly develop prior to ischemia-related symptom onset, and are detectable even in patients with clinically unrecognized silent MIs. Therefore, a highly intelligent ischemia detection system that alerts patients of ST segment deviation may allow for rapid identification of acute coronary occlusion. The AngelMed Guardian^® System is a cardiac activity monitoring and alerting system designed for rapid identification of intracardiac ST-segment changes among patients at a high risk for recurrent ACS events. This article reviews the clinical studies evaluating the design, safety and efficacy of the AngelMed Guardian System and discusses the clinical implications of the device.