Emotional expressions in antismoking television advertisements: consequences of anger and sadness framing on pathways to persuasion

The role of mental well-being in the effects of persuasive health messages: A scoping review

Emerging evidence in health communication and psychology suggests that a) exposure to specific persuasive health messages can have unintended effects on the mental well-being of recipients and b) recipients' mental well-being before exposure can influence message processing. Available evidence regarding the relationship between mental well-being and exposure to specific health messages lacks consistency and is scattered across different fields. This scoping review of 24 publications summarizes what is known about mental health effects in health communication and provides a research agenda for future work. Among others, key findings suggest that particularly negative emotional appeals may have broad, negative effects on indicators of hedonic well-being. Further, humor and gain appeals may positively impact mental well-being, although positive message features are strongly understudied in this space. Lower mental well-being prior to message exposure may impact message processing, but not necessarily message effectiveness. We find that potential well-being effects of health communication have been largely ignored, especially outside the realm of mental health research. Yet, initial evidence does underline the importance of such inquiry. This review summarizes initial evidence of systematic, unintended effects of health messaging on mental well-being and highlights fruitful avenues for future work in this space.

Development of the Rural Perception Scale (RPS-18)

BACKGROUND

People living in rural areas often experience limited access to health resources, slow knowledge diffusion, and geographical isolation, and tend to be at higher risk for poor physical and mental health outcomes compared with nonrural populations. It is unclear, yet, how the concept of "rural" shapes observed differences from nonrural populations. We aim to develop a psychometrically sound scale to assess key dimensions that constitute individual-level perceived rurality.

METHODS

We first conducted a broad literature review to identify a priori concepts related to rurality and adapted survey items measuring relevant constructs, such as loneliness, attitudes toward people living in rural areas, and perceived social membership. We used these conceptual constructs and measures to develop a survey questionnaire focused on rural perceptions. We recruit residents in 3 rural states: Kentucky, New Hampshire, and Vermont. Using the explorative factor analysis and second-order measurement model in the structural equation model framework, we developed a rural perception scale consisting of 18 items.

RESULTS

We recruited 1,384 participants (n = 686 from KY; n = 698 from NH/VT) using Amazon Mechanical Turk (n = 897, 64.8%) and social media paid ads (n = 487, 35.2%). The average age of participants was 41 years old (SD = 15); 54.7% of respondents had less than college graduate education, and 94.2% reported their race as non-Hispanic White. Majority of the participants were from Rural Urban Commuting Area (RUCA)-designated urban areas (n = 798, 57.7%), followed by RUCA-designated large rural areas (257, 18.6%), RUCA-designated rural areas (n = 174, 12.6%) and RUCA-designated isolated areas (n = 133, 9.6%). Our final model revealed 4 latent constructs: "belonging" (Cronbach's α = 0.896), "attitudes toward rural life" (Cronbach's α = 0.807), "loneliness" (Cronbach's α = 0.898), and "community social ties to people in their community" (Cronbach's α = 0.846).

CONCLUSIONS

We identified 4 subfactors of the umbrella concept of rurality that explain how people in rural regions may perceive being in rural environments and having rural lifestyles.

Countering Antivax Misinformation via Social Media: Message-Testing Randomized Experiment for Human Papillomavirus Vaccination Uptake

BACKGROUND

Suboptimal adolescent human papillomavirus (HPV) vaccination rates have been attributed to parental perceptions of the HPV vaccine. The internet has been cited as a setting where misinformation and controversy about HPV vaccination have been amplified.

OBJECTIVE

We aimed to test message effectiveness in changing parents' attitudes and behavioral intentions toward HPV vaccination.

METHODS

We conducted a web-based message-testing experiment with 6 control messages and 25 experimental messages and 5 from each of the 5 salient themes about HPV vaccination (theme 1: safety, side effects, risk, and ingredient concerns and long-term or major adverse events; theme 2: distrust of the health care system; theme 3: HPV vaccine effectiveness concerns; theme 4: connection to sexual activity; and theme 5: misinformation about HPV or HPV vaccine). Themes were identified from previous web-based focus group research with parents, and specific messages were developed by the study team using content from credible scientific sources. Through an iterative process of message development, the messages were crafted to be appropriate for presentation on a social media platform. Among the 1713 participants recruited via social media and crowdsourcing sites, 1043 eligible parents completed a pretest survey questionnaire. Participants were then randomly assigned to 1 of the 31 messages and asked to complete a posttest survey questionnaire that assessed attitudes toward the vaccine and perceived effectiveness of the viewed message. A subgroup of participants (189/995, 19%) with unvaccinated children aged 9 to 14 years was also assessed for their behavioral intention to vaccinate their children against HPV.

RESULTS

Parents in the experimental group had increased positive attitudes toward HPV vaccination compared with those in the control group (t969=3.03, P=.003), which was associated with increased intention to vaccinate among parents of unvaccinated children aged 9 to 14 years (r=1.14, P=.05). At the thematic level, we identified 4 themes (themes 2-5) that were relatively effective in increasing behavioral intentions by positively influencing attitudes toward the HPV vaccine (χ25=5.97, P=.31, root mean square error of approximation [RMSEA]=0.014, comparative fit index [CFI]=0.91, standardized root mean square residual [SRMR]=0.031). On the message level, messages that provided scientific evidence from government-related sources (eg, the Centers for Disease Control and Prevention) and corrected misinformation (eg, "vaccines like the HPV vaccine are simply a way for pharmaceutical companies to make money. That isn't true") were effective in forming positive perceptions toward the HPV vaccination messages.

CONCLUSIONS

Evidence-based messages directly countering misinformation and promoting HPV vaccination in social media environments can positively influence parents' attitudes and behavioral intentions to vaccinate their children against HPV.

Informing women about the risks of exposing babies to tobacco smoke: outreach and education efforts using Facebook "boost posts"

Maternal smoking is associated with a host of negative health outcomes, including an increased risk of children developing attention-deficit/hyperactivity disorder (ADHD). This study evaluated the efficacy of health messages disseminated through Facebook Ads focused on reducing tobacco smoke exposure during pregnancy. Two message versions were promoted via post advertisements on Facebook-a static infographic and a video containing an animated version of the infographic. The reach of and engagement with each message version was evaluated. Comments made to the posts were assessed using content analysis. The infographic reached approximately 60,000 people and the video reached about 16,000 people. The average costs were $10.00 and $40.00 per 1,000 people reached for the infographic- and video-based posts, respectively. While there was no engagement with the video, the infographic was liked (n = 157), given alternative likes (n = 59), shared (n = 171 to 341), and commented on (n = 221). About one-quarter of comments contained a personal narrative and mentions of health history related to ADHD and/or smoking. Comments were more often negative (than positive) (16.6% vs 3.9%) and expressed skepticism more often than message acceptance (21.5% vs 12.2%). Facebook users were more responsive to the infographic (compared to the video) and static posts were a preferred channel (i.e., higher engagement at a lower cost) to disseminate messages when using the boost post feature on Facebook for health education. Our review of the comments provided insights into message acceptance and guidance for future social media-based health message campaigns. However, it is not known whether and if so, how, these findings on message exposure would correlate with behavioral intentions or changes in behavior, such as intentions to quit smoking or smoking cessation.

Death Narratives, Negative Emotion, and Counterarguing: Testing Fear, Anger, and Sadness as Mechanisms of Effect

Narrative messaging research has demonstrated that story outcome (e.g., whether the main character lives or dies) can impact audience behavior, but more research explicating and testing mechanistic pathways is needed. The current study tests fear, anger, and sadness as mechanisms of persuasion, assessing effects on counterarguing, reading flow, and behavioral intention. The current study utilized a 2 (story outcome: death vs. survivor) × 4 (story character: Marla, Erin, Don, and Ray) between-participants experiment (N = 735) to test the effect of story outcome on behavioral intentions via discrete emotion. Death narratives generated greater fear, anger, and sadness. Fear was related to greater behavioral intention and reading flow and diminished counterarguing. Sadness had the opposite effect. Anger produced a mixed persuasive effect, increasing both counterarguing and reading flow. Results have implications for discrete emotions theorizing and underscore the importance of conceptualizing narrative stimuli along multiple affective dimensions rather than single dimensions.

Impact of Abstract Versus Concrete Conceptualization of Genetic Modification (GM) Technology on Public Perceptions

Based on the scholarship of abstract/concrete cognition, mental schema, and the integrated model of behavior change, this study found that using concrete over abstract language increased support for specific genetically modified (GM) applications and GM in general, and improved intentions to purchase products containing genetically modified organisms (GMOs). An online survey with an embedded 3 × 2 experiment was conducted using a national sample of U.S. adults (N = 1,470). Participants were randomly assigned to conditions that varied in abstract/concrete conceptualization of GMOs and were prompted to assess GM risk and benefit perceptions with respect to human health and the environment. Regardless of whether they assessed risks or benefits, participants who assessed GMOs through concrete terms compared to abstract terms showed an increase in positive emotions, which in turn increased their support for specific GM applications and GM in general, and their intentions to buy products with GMOs.

The Role of Emotions and Perceived Ad Effectiveness: Evidence From the Truth FinishIt Campaign

PURPOSE

Examine association between emotional valence and intensity prompted by anti-tobacco advertising messages and perceived ad effectiveness among youth/young adults.

DESIGN

Online forced-exposure survey data from a nationally weighted, cross-sectional sample of youth/young adults, collected periodically over a 4-year period.

SETTING

National.

PARTICIPANTS

Thirty-seven cross-sectional surveys conducted online from June 2015 to January 2018; total N = 9534. All participants, aged 15 to 21, were in the intervention; no control group.

INTERVENTION

Individuals participating in premarket testing of truth ads were forced exposed to one of 37 anti-tobacco ads.

MEASURES

Emotional response, emotional intensity, and perceived ad effectiveness. Emotional response has been previously studied and measured. Including the discrete measure of "concerned" in positive emotions is unique to our study. It patterned with the other positive emotions when each ad was examined by each emotion. Intensity as measured in this study through the 5-point scale ("how much does this ad make you feel") is unique in the anti-tobacco ad literature. Although several past studies ranked the degree of emotion elicited by ads, they have not incorporated the intensity of emotion as reported by the participant themselves. The scale was used to determine whether perceived ad effectiveness is similar to those used in previous studies.

ANALYSIS

Linear regressions were estimated to assess type of emotional sentiment and level of intensity in relation to perceived effectiveness of the message.

RESULTS

All 9534 participants were exposed; no control group. The βs indicate how strongly the emotion variable influences the study outcome of perceived ad effectiveness. Positive emotions (β = .76) were more highly associated with perceived ad effectiveness (β = .06). Higher intensity with positive emotional sentiment and high-intensity negative produced the highest scores for perceived ad effectiveness (β = .30).

CONCLUSION

Eliciting a positive, high-impact emotional response from viewers can help improve perceived effectiveness, and in turn, overall ad effectiveness.

Fear, Sadness and Hope: Which Emotions Maximize Impact of Anti-Tobacco Mass Media Advertisements among Lower and Higher SES Groups?

Emotive anti-tobacco advertisements can increase quitting. Discrete emotion theories suggest evoking fear may be more effective than sadness; less research has focused on hope. A weekly cross-sectional survey of smokers and recent quitters (N = 7683) measured past-month quit attempts. The main predictor was level of exposure to four different types of anti-tobacco advertisements broadcast in the two months prior to quit attempts: advertisements predominantly evoking fear, sadness, hope, or evoking multiple negative emotions (i.e., fear, guilt, and/or sadness). Greater exposure to fear-evoking advertisements (OR = 2.16, p < .01) increased odds of making a quit attempt and showed similar effectiveness among those in lower and higher SES areas. Greater exposure to advertisements evoking multiple negative emotions increased quit attempts (OR = 1.70, p < .01), but interactions indicated this was driven by those in lower SES, but not higher SES areas. Greater exposure to hope-evoking advertisements enhanced effects of fear-evoking advertisements among those in higher SES, but not lower SES areas. Findings suggest to be maximally effective across the whole population avoid messages evoking sadness and use messages eliciting fear. If the aim is to specifically motivate those living in lower SES areas where smoking rates are higher, multiple negative emotion messages, but not hope-evoking messages, may also be effective.

Evaluating the Emotional Impact of Warning Images on Young Adult Smokers and Susceptible Non-Smokers

On-pack tobacco warnings typically feature long-term health risks, which many young adults rationalize or reject. We examined the emotions generated by more proximal warnings to see if we could identify common features among the most effective warnings. Respondents in a sample of 474 smokers and 476 susceptible non-smokers used a modified Geneva Emotion Wheel (GEW) to assess cigarette packs displaying 12 test warnings and one current warning. The strongest emotions aroused in smokers were disgust, disappointment, and regret. Three warnings showing the effect of smoking on babies and animals had significantly higher emotional potency scores than a current health warning. Among susceptible non-smokers, warnings showing harm to animals, child labor, and a dying smoker had the highest emotional potency. Stronger negative emotions were elicited from both smokers and susceptible non-smokers by warnings that featured more proximal outcomes than are typically shown in on-pack tobacco warnings. On-pack warnings that resonate with young people, the group most at risk of smoking and most likely to benefit from quitting, could promote cessation and deter initiation more effectively than warnings depicting long-term health outcomes. The GEW could be used to screen potential warning images to identify those most likely to be worth evaluating.

Fret not thyself: The persuasive effect of anger expression and the role of perceived appropriateness

Anger expression is increasingly prevalent in Western mass media, particularly in messages that aim to persuade the audience of a certain point of view. There is a dearth of research, however, investigating whether expressing anger in mediated messages is indeed effective as a persuasive strategy. In the present research, the results of four experiments showed that expressing anger in a persuasive message was perceived as less socially appropriate than expressing non-emotional disagreement. There was also evidence that perceived appropriateness mediated a negative persuasive effect of anger expression (Study 2–4) and that anger expression resulted in perceptions of the persuasive source as unfriendly and incompetent (Studies 1 and 2). In all, the findings suggest that politicians and other public figures should be cautious in using anger as a persuasive instrument.

Harnessing Facebook for Smoking Reduction and Cessation Interventions: Facebook User Engagement and Social Support Predict Smoking Reduction

Background

Social media technologies offer a novel opportunity for scalable health interventions that can facilitate user engagement and social support, which in turn may reinforce positive processes for behavior change.

Objective

By using principles from health communication and social support literature, we implemented a Facebook group–based intervention that targeted smoking reduction and cessation. This study hypothesized that participants’ engagement with and perceived social support from our Facebook group intervention would predict smoking reduction.

Methods

We recruited 16 regular smokers who live in the United States and who were motivated in quitting smoking at screening. We promoted message exposure as well as engagement and social support systems throughout the intervention. For message exposure, we posted prevalidated, antismoking messages (such as national antismoking campaigns) on our smoking reduction and cessation Facebook group. For engagement and social support systems, we delivered a high degree of engagement and social support systems during the second and third week of the intervention and a low degree of engagement and social support systems during the first and fourth week. A total of six surveys were conducted via Amazon Mechanical Turk (MTurk) at baseline on a weekly basis and at a 2-week follow-up.

Results

Of the total 16 participants, most were female (n=13, 81%), white (n=15, 94%), and between 25 and 50 years of age (mean 34.75, SD 8.15). There was no study attrition throughout the 6-time-point baseline, weekly, and follow-up surveys. We generated Facebook engagement and social support composite scores (mean 19.19, SD 24.35) by combining the number of likes each participant received and the number of comments or wall posts each participant posted on our smoking reduction and cessation Facebook group during the intervention period. The primary outcome was smoking reduction in the past 7 days measured at baseline and at the two-week follow-up. Compared with the baseline, participants reported smoking an average of 60.56 fewer cigarettes per week (SD 38.83) at the follow-up, and 4 participants out of 16 (25%) reported 7-day point prevalence smoking abstinence at the follow-up. Adjusted linear regression models revealed that a one-unit increase in the Facebook engagement and social support composite scores predicted a 0.56-unit decrease in cigarettes smoked per week (standard error =.24, P=.04, 95% CI 0.024-1.09) when baseline readiness to quit, gender, and baseline smoking status were controlled (F_{4, 11}=8.85, P=.002).

Conclusions

This study is the first Facebook group–based intervention that systemically implemented health communication strategies and engagement and social support systems to promote smoking reduction and cessation. Our findings imply that receiving one like or posting on the Facebook-based intervention platform predicted smoking approximately one less cigarette in the past 7 days, and that interventions should facilitate user interactions to foster user engagement and social support.

Threat appeals in health communication: messages that elicit fear and enhance perceived efficacy positively impact on young male drivers

Background

Health communications often present graphic, threat-based representations of the potential consequences of health-risk behaviours. These ‘threat appeals’ feature prominently in public health campaigns, but their use is controversial, with studies investigating their efficacy reporting inconsistent, and often negative, findings. This research examined the impact of a threat-based road safety advertisement on the driving behaviour of young male drivers.

Methods

To address limitations of previous research, we first identified a road safety advertisement that objectively and subjectively elicited fear using physiological and subjective measures. Study 1 (n = 62) examined the effect of this advertisement, combined with a manipulation designed to increase perceived efficacy, on speed choice. Study 2 (n = 81) investigated whether a state emotion, anger, impacts on the effectiveness of the advertisement in changing four distinct driving behaviours. Both studies examined short-term effects only.

Results

Study 1 findings indicated that a high threat message, when combined with high perceived efficacy, can lead to a decrease in speed choice. Study 2 results suggested that increased levels of state anger may counteract the potential value of combining fear-arousing threats and efficacy-building messages.

Conclusions

Findings suggest that threat-based road safety communications that target affective (fear) and cognitive (perceived efficacy) mechanisms can positively affect driving behaviours. State emotions, such as anger, may negatively impact on the effectiveness of the message. Taken together, these findings provide additional support for the use of efficacy-building messages in threat-based communications, but highlight the need for further research into the complex array of affective influences on driving.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3227-2) contains supplementary material, which is available to authorized users.