Messages influencing college women's tanning bed use: statistical versus narrative evidence format and a self-assessment to increase perceived susceptibility

Update on "Cell Therapy" Clinics Offering Treatments of Ocular Conditions Using Direct-To-Consumer Marketing Websites in the U.S

PURPOSE

To assess the scope of U.S.-based companies advertising and administering non-Federal Drug Administration (FDA) approved cell-based therapy (herein called NFACT) for ocular conditions based on information from companies' public websites after the FDA's legal actions against specific NFACT clinics in 2018 and 2019. Current findings are compared to previously published data from 2017.

DESIGN

Trend study looking at U.S.-based companies that use direct-to-consumer marketing and have websites advertising therapy for ocular conditions.

METHODS

A systematic and extensive keyword-based Internet search was utilized to identify, document, and analyze U.S. business websites offering NFACT for ocular conditions as of August 2022. Main outcomes measured include, clinic locations, marketed ocular conditions, types of NFACT offered, source of stem cells used, routes of administration, and treatment costs.

RESULTS

From the prior analysis in 2017 to the 2019 analysis, there was a decrease in the number of NFACT clinics from 76 to 62 and companies from 40 to 39. Given the concerning persistence of NFACTs in August 2019 an additional analysis was performed in 2022 which showed a drastic decrease in NFACT clinics from 62 in 2019 to 18 in 2023 and from 39 companies to 13 in 2023. In both 2019 and 2022, the most commonly referenced ocular condition was age-related macular degeneration (2019 - 72%, 2022 - 92%). The state with the most clinics was in Texas (2019 - 12; 2022 - 5). Autologous adipose-derived stem cells were the most common cell type used in both analyses.

CONCLUSIONS

In 2019 U.S.-based direct-to-consumer companies marketing NFACT persisted despite (1) a lack of high-quality clinical evidence supporting the efficacy of these procedures, (2) the association of some of these treatments with severe vision loss, and (3) increasing FDA oversight and recent legal action. In 2022 the number of clinics and companies decreased, but their persistence is a reminder that continued concern is necessary and ophthalmic associations need to continue advocacy efforts to protect patients from these potentially predatory organizations.

Communication Strategies to Promote COVID-19 Vaccination Intention: How Effective are Source, Appeal, Framing, and Evidence Type Approaches?

This systematic review analyzed the effectiveness of key persuasive strategies - source, appeal, framing, and evidence (SAFE) - on COVID-19 vaccination intention. Quantitative studies were searched in Web of Science, Scopus, and PubMed following the PRISMA guidelines. From the 61 studies that met inclusion criteria, source and framing are the most commonly applied SAFE strategies. However, source characteristics are a more consistent influence on vaccine intentions than message framing strategies, with expert sources and general practitioners emerging as the key sources contributing to greater vaccine intentions. In addition, a range of mediators and moderators influence the process through which SAFE message strategies impact vaccine intentions. Framing effects, in particular, are moderated by political identity, source characteristics, and vaccine perceptions. Tests of mediating processes highlight how health behavior judgments (e.g. perceived vaccine benefits, risks, trust in vaccination, perceived severity) and message response/perceptions (e.g. counterarguing, perceived similarity/empathy) operate as key intervening factors between SAFE message strategies and vaccine intentions. Overall, when practitioners apply various structural approaches (narrative elements, fear appeals, framing cues) to vaccine promotion campaigns, they should be cognizant of who is providing that appeal. Targeted populations may benefit most from different structural elements if they are integrated with sources that resonate with the audience.

How People Process Different Types of Health Misinformation: Roles of Content Falsity and Evidence Type

Emerging communication technologies have seen the proliferation of misleading claims, untruthful narratives, and conspiracies. To understand how people perceive and act on different types of misinformation, this study examines how health misinformation varying in falsity (fabrication versus misuse) and evidence type (statistical versus narrative) affects sharing and verification intentions. Using COVID-19 vaccines as cases, the results from an online experiment showed that misused misinformation was perceived as less false than fabricated misinformation and resulted in higher sharing intentions for the issue of vaccine efficacy. Misinformation with narrative evidence, as compared to that with statistical evidence, was perceived as less false and led to lower verification intentions. These findings can be explained by psychological processes such as counterarguing and narrative engagement. Our results can help practitioners develop dedicated misinformation literacy programs.

Developing messages to encourage healthy, sustainable dietary substitutions: A qualitative study with US emerging adults

Prior research shows that adopting simple dietary substitutions (e.g., replacing beef with poultry or plant-based entrees) can improve dietary quality and reduce the negative environmental consequences of food production, but little is known about how to encourage people to adopt these substitutions. This study aimed to examine reactions to messages encouraging healthy, sustainable dietary substitutions among emerging adults ages 18-25. We conducted four online focus groups with a diverse sample of US emerging adults (n = 28; 61% female). Focus groups explored emerging adults' reactions to messages encouraging them to adopt three target dietary substitutions: replacing beef and pork with poultry and plant-based entrees; replacing juice with whole fruit; and replacing dairy milk with non-dairy milk. We transcribed discussions verbatim and adopted a thematic approach to analyzing the transcripts. Results showed that participants perceived messages to be most effective at encouraging the target dietary substitutions when the messages: encouraged specific, achievable dietary changes; linked these dietary changes to clear consequences; included personally relevant content; included statistics; were succinct; and used a positive tone. Across the target dietary substitutions, two message topics (small changes, big benefits, which emphasized how small dietary changes can have large positive health and environmental impacts, and warning, which discussed the negative health and environmental impacts of dietary choices) were generally perceived to be most effective. A few participants expressed doubt that the target dietary substitutions would have meaningful environmental impacts. Results suggest that campaign messages to encourage healthy, sustainable dietary substitutions may be more effective if the messages make the target dietary substitutions seem achievable and use statistics to clearly describe the positive impacts of making these changes.

Why Do People Believe in Vaccine Misinformation? The Roles of Perceived Familiarity and Evidence Type

The proliferation of health misinformation poses a significant threat to public health, making it increasingly important to understand why misinformation is accepted. The illusory truth effect, which refers to the increased believability of a message due to repeated exposure, has been widely studied. However, there is limited research on this effect in the context of COVID-19 vaccine misinformation. This paper aims to examine the role of perceived familiarity with COVID-19 vaccine misinformation on various message perceptions, including perceived accuracy, agreement, perceived message effectiveness, and determinants of vaccination, including vaccine attitude and vaccination intention. Furthermore, it explores the impact of misinformation evidence (statistical vs. narrative) on the magnitude of the effects of perceived familiarity. To investigate these factors, a between-subjects experimental study was conducted, employing a 2 (Familiarity: strong vs. weak) × 3 (Evidence type: statistical, narrative, and both evidence) + 1 (Control: a message about drinking water) design. The results revealed that perceived familiarity with COVID-19 vaccine misinformation significantly predicted perceived accuracy, which was found to be negatively correlated with vaccine attitudes and vaccination intentions. Moreover, statistical evidence presented in misinformation was perceived as more persuasive in perceived message effectiveness, compared to narrative and mixed evidence. Interestingly, the effects of perceived familiarity were not contingent on the type of evidence used in COVID-19 vaccine misinformation. These findings emphasize the importance of avoiding the repetition of misinformation, reducing the processing fluency associated with misinformation correction, and educating individuals on how to critically evaluate statistical evidence when encountering (mis)information.

A Social Media-Delivered Melanoma Prevention Program for Young Women Engaged in Frequent UV Tanning: Protocol for a Randomized Controlled Trial

BACKGROUND

Rates of melanoma have increased dramatically in the United States over the past 25 years, and it has become among the most prevalent cancers for young adult women. Intentional skin tanning leads to a pattern of intense and intermittent UV radiation exposure that is associated with increased risk of melanoma. Frequent tanning is most common among young women and is linked to a variety of sociocultural pressures that negatively impact body image and drive appearance control behaviors. Unfortunately, there are no established interventions designed for frequent tanners. This intervention addresses this gap with unique content informed by body image and acceptance-based interventions. The intervention is delivered using Facebook secret groups, an approach designed to support behavior change and ensure scalability.

OBJECTIVE

This study aims to describe the rationale and methodology of a randomized controlled trial of a melanoma prevention program targeting young women engaged in frequent indoor or outdoor UV tanning.

METHODS

Participants are women aged 18-25 years who report high-risk tanning (ie, at least 10 indoor tanning sessions in the past 12 months or 10 outdoor sessions in the previous summer). After recruitment and screening, participants completed a baseline survey and were randomly assigned to receive the intervention or an attention-matched control condition. Both conditions were 8-week-long Facebook groups (approximately 25 members each) with daily posting of content. Follow-up surveys are administered at 3, 8, and 18 months after baseline. The primary trial outcome is the combined number of indoor and outdoor tanning sessions reported at the 8-month follow-up. Hypothesized intervention mediators are assessed at the 3-month follow-up.

RESULTS

This project was funded by a National Cancer Institute award (R01 CA218068), and the trial procedures were approved by the University of Kentucky Institutional Review Board in February 2020. Trial recruitment and enrollment occurred in 6 waves of data collection, which started in February 2022 and closed in May 2023. The study is closed to enrollment but remains open for follow-ups, and this protocol report was prepared before data analyses. As of February 2024, all participants have completed the 8-month follow-up assessment, and data collection is scheduled to close by the end of 2024 after the collection of the 18-month follow-up.

CONCLUSIONS

This trial will contribute unique knowledge to the field of skin cancer prevention, as no fully powered trials have examined the efficacy of an intervention designed for frequent indoor or outdoor tanning. The trial may also contribute evidence of the value in translating principles of body image and acceptance-based interventions into the field of skin cancer prevention and beyond. If successful, the use of the Facebook platform is intended to aid in dissemination as it provides a way to embed the intervention into individuals' everyday routines.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03441321; https://clinicaltrials.gov/study/NCT03441321.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56562.

A Content Analysis of Problematic Gambling Prevention Interventions in the United States

Gambling revenue in the United States is at all-time highs while recent and forthcoming legislation relaxes constraints on casino gaming, sports betting, and fantasy sports betting. Increased gambling will result in increased problematic gambling, highlighting the need to study the impact of our problematic gambling prevention interventions. To address this, we conducted a content analysis of problematic gambling prevention messages in the U.S. Results reveal that although there is overlap between theoretically-based messaging appeals recommended by research and those used in actual prevention interventions, health behavior theory is inconsistently applied and there are numerous examples of potential backfire effects. Results are discussed in terms of their impact on theory development and their noteworthy practical application.

The Facts or the Story? It Takes Both to Sensitize People About Unknown Health Hazards

Communicating about new or unknown health risks is challenging because it requires audiences to engage with and process novel and often complex health information. This study examines how texts can convey awareness and increase knowledge about health risks people are unaware of. The focus is on how text genre (narrative, expository, and mixed-genre) affects relevant emotional (arousal, transportation) and cognitive outcomes (knowledge and risk severity), measured using both online (electrodermal activity) and offline self-report measures. Mixed-effects model analyses revealed that narrative texts exhibit the highest self-reported arousal, transportation, and risk severity. Additionally, transportation mediates the relationship between text genre and risk severity. Ultimately, mixed-genre texts produced significantly higher arousal peaks and confidence ratings on knowledge posttests compared to expository texts. Taken together, the findings suggest that narrative texts perform better at raising awareness, whereas mixed-genre texts seem more effective in learning. The implications for health risk communication are discussed.

A Meta-Analysis Comparing the Effectiveness of Narrative vs. Statistical Evidence: Health vs. Non-Health Contexts

This study is a meta-analysis of primary studies that make a direct comparison between narrative and statistical evidence in both health- and non-health-related communication contexts. The meta-analysis included 50 studies with 65 experimental pairs (k = 65) based on 13,113 (20-1270) participants. We examined the overall persuasiveness of evidence type by computing the correlations (r's) for all pairs, based on the random-effects model, which revealed an effect size of 0.016 (95% CI, -0.014 to 0.045, p = 0.296). Two types of evidence did not significantly differ in effectiveness under either communicative context. The moderation analysis indicated that narrative evidence had a significant advantage over statistical evidence for health messages advocating for prevention behaviors. Compared to non-student samples, the narrative evidence trumped statistical evidence for health-related issues. As communication research continues to investigate the implications for message persuasiveness derived by narrative and statistical appeals, our study suggests that the relative effectiveness is likely a complicated and nuanced matter. Practical implications and limitations have also been outlined.

Exploring the Association Between Suicide Prevention Public Service Announcements and User Comments on YouTube: A Computational Text Analysis Approach

In the United States, suicide rates have increased by 30% over the past few decades. Public service announcements (PSAs) are effective health promotion vehicles and social media can help spread PSAs to hard-to-engage individuals who may benefit from intervention efforts, yet the most meaningful characteristics of PSAs for influencing health promotion attitudes and behaviors are inconclusive. This study applied content and quantitative text analyses to suicide prevention PSAs and comments on YouTube to assess the relationships between message frame, message format, and the level of sentiment and help-seeking language within them. Seventy-two PSAs were analyzed for gain/loss-framing and narrative/argument-format, and 4,335 related comments were analyzed for positive/negative sentiment and frequency of help-seeking language use. Results indicate that a higher ratio of positive comments was more likely to be found on gain-framed and narrative-formatted PSAs, and a higher ratio of comments with help-seeking language was more likely to be found on narrative-formatted PSAs. Implications and future research are discussed.

Interactive Health Messages Work Better for Those Who Feel Less in Control: The Role of External Health Locus of Control and Risk Perception

Interactive websites, which provide greater user control over a site's interface, are commonly employed in health communication campaigns to deliver risk information in more vivid and engaging ways. The present study explored whether interactive health websites could increase risk perception and encourage systematic processing (i.e. analytical review of persuasive arguments based on prior knowledge and experience) and information seeking and sharing intentions of anti-sugar consumption content. We further investigated whether the effect of interactivity could be moderated by individuals' beliefs in the role of external factors such as sheer luck in determining their health outcomes. A between-subjects design experiment compared a high interactive website (n = 94) to a low interactive website (n = 73). Results showed that interactivity increased risk perception regarding sugar consumption, especially for the individuals who reported a higher level of external health locus of control. Risk perception was a positive predictor of systematic processing, as well as information seeking and sharing intentions. Theoretical and practical implications of this study are discussed.

Predicting College Students’ Preventative Behavior During a Pandemic: The Role of the Health Belief Model, Source Credibility, and Health Literacy

In this study, we examined the effects of perceived source credibility of the Centers for Disease Control (CDC) and college student health literacy in predicting the likelihood of enacting preventative behaviors related to mitigating COVID-19. Using the Health Belief Model (HBM) as an explanatory tool, we analyzed how perceived source credibility and health literacy levels predict college students’ likelihood to enact preventative behaviors during a public health crisis. Sample population entirely consisted of undergraduate students enrolled in a basic communication course at a large, southern university. The participants completed survey questionnaires about their perceived health literacy, health beliefs, trust in the CDC, perceptions of COVID-19, and demographic measures during the fall 2020 semester. A multiple regression analysis revealed that (a) HBM predictors, health literacy and CDC source credibility accounted for 44% of the variance in likelihood of enacting preventative health behaviors, and (b) health literacy, CDC source credibility, and perceived severity were all positive predictors of enacting preventative health behaviors, while (c) perceived barriers negatively predicted enactment of preventative health behaviors. Perceived susceptibility and perceived benefits were not significant predictors of college student risk mitigation. Our data suggests the importance of health literacy and source credibility in predicting college students’ likelihood to enact preventative behaviors during public health crises.

Public Health Messaging to Address Indoor Tanning: A Scoping Review

Indoor tanning (IT) is an avoidable skin cancer risk. Although numerous communication interventions have been assessed for IT deterrence, less attention has been paid to the persuasive messages within these interventions. This scoping review summarizes the current peer-reviewed literature on persuasive messages for IT. Overall, 20 articles (21 studies) were included. Most were experimental or quasi-experimental and conducted in the US. Participants were mostly young women who had tanned indoors before. Few studies evaluated persuasive theme; in those that did, health and appearance themes were effective. Narrative and statistical evidence formats were also effective. The included studies also supported normative messages, loss-framed messages, and images. Improved reporting on message design and evaluation would be beneficial for future evidence synthesis. Our understanding of persuasive messages for IT has expanded in recent years, but more research is needed to optimize them.

Effects of rhetorical devices on audience responses with online videos: An augmented elaboration likelihood model

The way in which information is linguistically presented can impact audience attention, emotion, and cognitive responses, even if the content remains unchanged. The present study aims to examine the effects of rhetorical devices on audience responses by introducing a new theoretical framework, the augmented elaboration likelihood model (A-ELM), which integrates elements of the Elaboration Likelihood Model and narrative theory. The results show that the mediation effects of attention on the relationships between rhetorical devices and affective and cognitive elaborations are moderated by involvement. Nonnarrative evidence, combined narrative and numerical evidence, source credibility, and tropes versus the lack of figures of speech, elicit better audience responses in low-involvement situations, whereas numerical evidence outperforms narratives in high-involvement situations. This study not only offers a novel theoretical framework in the form of A-ELM, but also has important implications for advancing methodologies and practical applications.

Global COVID-19 Advertisements: Use of Informational, Transformational and Narrative Advertising Strategies

This study employs the informational and transformational approaches from Taylor's Six-Segment Message Strategy Wheel and narrative transportation theory to understand the use of different advertising message strategies in COVID-19 advertisements on a global scale. Understanding how advertisers constructed their public messages during a global pandemic is a necessary first step before follow-up research can be done to assess which message strategies were most effective. Content analysis was performed on the entire COVID-19 video ad library (N = 354) from Ads of the World website that were published from March to September 2020 from 49 countries. Results suggested that most of the ads used a transformational strategy with a focus on the social aspect of limiting community spread instead of an informational approach. Many of the ads also employed a narrative message strategy that used storytelling to transport and persuade viewers. Perhaps the most interesting finding is that the use of narrative message strategy was related to storytelling, ad length, music, and humor, but independent from the use of informational strategies.

Reducing COVID-19 vaccine hesitancy among African Americans: the effects of narratives, character's self-persuasion, and trust in science

This research examines the efficacy of self-persuasion narratives (i.e., narratives that describe how a character has changed their mind about the COVID-19 vaccines) in encouraging vaccine uptake among unvaccinated African Americans. A five-condition experiment (N = 394) was conducted in June 2021. Participants viewed one of the three pro-vaccine messages (a self-persuasion narrative, a narrative without self-persuasion, or a non-narrative message) or an irrelevant message or completed a self-persuasion task. Findings supported the persuasive benefits of the self-persuasion narrative compared to the narrative without self-persuasion, actual self-persuasion, and the irrelevant message. Its advantage over the narrative without self-persuasion was mediated by increased self-referencing, affective empathy, and perceived similarity with the character. Moreover, its psychological effects were moderated by participants’ trust in science. Unexpectedly, the non-narrative showed persuasive benefits compared to other intervention strategies. The theoretical implications for narrative persuasion and practical implications for vaccine promotion were discussed.

Maintaining a Fair Balance? Narrative and Non-Narrative Strategies in Televised Direct-to-Consumer Advertisements for Prescription Drugs Aired in the United States, 2003-2016

Televised direct-to-consumer advertising for prescription drugs (hereafter DTCA) are among the most widespread forms of health communication encountered by American adults. DTCA shape public understanding of health problems and support the commercial interests of pharmaceutical companies by offering prescription drugs as a treatment option. The U.S. Food and Drug Administration (FDA) requires DTCA to present fair and balanced information regarding drug benefits versus risks. While narrative persuasion theory suggests that narratives can enhance persuasion by facilitating message processing and reducing counter-arguing, prior assessments of the balance between drug benefits versus risk information in DTCA have largely overlooked whether the ads employ narratives and/or other evidentiary strategies that may confer a persuasive advantage. This study content analyzed narrativity in DTCA aired on television between 2003 and 2016 for four different health conditions (heart disease, diabetes, depression, and osteoarthritis). Results showed that while televised DTCA spent more time discussing drug risks than drug benefits, both narratives and factual evidence were more frequently used to communicate drug benefits than drug risks. These findings raise concerns that narratives are strategically used by DTCA to highlight drug benefits rather than drug risks, which could lead to inaccurate perceptions of drug risks among viewers.

COVID-19 health misinformation: using design-based research to develop a theoretical framework for intervention

Purpose

Because health misinformation pertaining to COVID-19 is a serious threat to public health, the purpose of this study is to develop a framework to guide an online intervention into some of the drivers of health misinformation online. This framework can be iterated upon through the use of design-based research to continue to develop further interventions as needed.

Design/methodology/approach

Using design-based research methods, in this paper, the authors develop a theoretical framework for addressing COVID-19 misinformation. Using a heuristic analysis of research on vaccine misinformation and hesitancy, the authors propose a framework for education interventions that use the narrative effect of transportation as a means to increase knowledge of the drivers of misinformation online.

Findings

This heuristic analysis determined that a key element of narrative transportation includes orientation towards particular audiences. Research indicates that mothers are the most significant household decision-makers with respect to vaccines and family health in general; the authors suggest narrative interventions should be tailored specifically to meet their interests and tastes, and that this may be different for mothers of different backgrounds and cultural communities.

Originality/value

While there is a significant body of literature on vaccine hesitancy and vaccine misinformation, more research is needed that helps people understand the ways in which misinformation works upon social media users. The framework developed in this research guided the development of an education intervention meant to facilitate this understanding.

Message Strategies and Viewer Responses: Content Analysis of HPV Vaccination Videos on YouTube

Using content analysis, this study examined the effects of several messaging strategies in YouTube videos promoting human papillomavirus vaccines in Korea. It analyzed a total of 201 videos, focusing on five message strategies-temporal framing, narrative format, gain-loss framing, emotional appeals, and message sensation value. The analysis revealed that the creators of these YouTube videos frequently utilized all of these strategies, except for emotional appeals. It also showed that present-focused framing was effective in eliciting positive responses from viewers, and not including gain-loss framing was more effective in provoking responses. Meanwhile, message sensation values were found to increase both positive and negative viewer responses.

"It's a war! It's a battle! It's a fight!": Do militaristic metaphors increase people's threat perceptions and support for COVID-19 policies?

At the beginning of the COVID‐19 pandemic, governments around the world employed militaristic metaphors to draw attention to the dangers of the virus. But, do militaristic metaphors truly affect individuals' perceived threat of the COVID‐19 virus and increase their support for corresponding restrictive policies? This study assessed the effects of fictitious newspaper articles that described COVID‐19 policies using similarly negatively valenced metaphors but with differing militaristic connotations (e.g., “war” vs. “struggle”). Overall, data from three framing experiments (N = 1114) in Germany and the United States indicate limited evidence on the effectiveness of the tested militaristic metaphors. In the U.S. context, the non‐militaristic concept of struggle was consistently more strongly associated with the desired outcomes than militaristic metaphors were. In Studies 2 and 3, we also tested whether reporting using a narrative or straightforward facts had additional influence on the framing effect. A congruency effect of the use of a narrative and of warfare metaphors was found in the German sample, but not in that of the United States. Results of post‐experimental norming studies (N = 437) in both countries revealed that the metaphor of war is associated with people ascribing greater responsibility to their governments, whereas the concept of struggle triggers a sense of individual responsibility. These results are discussed in terms of the usefulness and appropriateness of militaristic metaphors in the context of a pandemic.

Five Steps Towards Avoiding Narrative Traps in Decision-Making

Narratives provide simple rules about how we ought to live and what our priorities ought to be. They are especially appealing in times of high uncertainty. Using the uncertainty surrounding Covid-19 as an illustration, we show how a narrative to preserve life has become dominant, and we illustrate how it has been reinforced by several behavioural biases. We argue that being able to identify and critically evaluate the impact of dominant narratives is vital to ensuring optimal decision-making. To facilitate this, we offer five recommendations-the ABCDE of decision-making-that can help to reduce the "narrative trap" in decision-making in any uncertain environment.

Exploring the Role of Regulatory Focus and Processing Fluency in the Effectiveness of Narrative versus Non-narrative Advertising: A Study about Sugar Intake in the USA

Given that many health problems in the United States are closely related to high sugar consumption, this research examined the effectiveness of ad forms (narrative vs. non-narrative) on persuading people to limit sugar intake through an online experiment completed by 1,104 participants. It was found that individual difference of regulatory focus moderated the effect of narrative vs. non-narrative advertising. Moreover, this study revealed an underlying mechanism of how audiences processed narrative vs. non-narrative advertising differently via the mediator of processing fluency, and further resulted in different advertising effectiveness. The findings contributed in providing implications for policy makers and ad professionals to help them with the improvement of public's health in the USA.

Improving Health Literacy Responsiveness: A Randomized Study on the Uptake of Brochures on Doctor-Patient Communication in Primary Health Care Waiting Rooms

Presenting attractive and useful health education materials in waiting rooms can help improve an organization’s health literacy responsiveness. However, it is unclear to what extent patients may be interested in health education materials, such as brochures. We conducted a three-week field study in waiting rooms of three primary care centers in Groningen. Three versions of a brochure on doctor-patient communication were randomly distributed, 2250 in total. One version contained six short photo stories, another version was non-narrative but contained comparable photos, and the third version was a traditional brochure. Each day we counted how many brochures were taken. We also asked patients (N = 471) to participate in a brief interview. Patients who consented (N = 390) were asked if they had noticed the brochure. If yes (N = 135), they were asked why they had or had not browsed the brochure, and why they had or had not taken it. Interview responses were categorized by two authors. Only 2.9% of the brochures were taken; no significant association with brochure version was found. Analysis of the interview data showed that the version with the photo narrative was noticed significantly more often than the non-narrative version or the traditional version. These results suggest that designing attractive and comprehensible health materials is not enough. Healthcare organizations should also create effective strategies to reach their target population.

Association between perceived risk of harm and self-reported binge drinking, cigarette smoking, and marijuana smoking in young adults

OBJECTIVES

Evaluate the association between perceived risk of harm and self-reported binge drinking, cigarette smoking, and marijuana smoking among college students.

PARTICIPANTS

Participants were 599 students (ages 19-28) at a large Midwestern university recruited from October 2015 to December 2017.

METHODS

Hurdle regression was used to test the relationship between perceived risk of harm from substance use (i.e., binge drinking, cigarette smoking, and marijuana smoking), and self-reported use. Demographic characteristics were tested as moderators of this relationship.

RESULTS

Engagement in all three substance use behaviors was less likely when perceived risk was high. Age moderated the association between perceived risk and self-reported marijuana smoking with younger participants demonstrating a stronger relationship between perceived risk of smoking marijuana and self-reported marijuana smoking.

CONCLUSION

Intervention programs will be most effective when perceived risk of substance use is high. Therefore, intervention programs should aim to increase college students' perceived risk of substance use.

Systematic Review of Interventions to Increase Awareness of Ultraviolet Radiation-Induced Harm and Protective Behaviors in Post-Secondary School Adults

College and university students are a group known for excessive sun exposure and indoor tanning. Health education campaigns for avoidance of ultraviolet (UV) radiation have been relatively unsuccessful in this population. This systematic review examines interventions aimed at post-secondary school young adults on college and university campuses for skin cancer awareness, photoprotection, and change in UV-exposure-related behavior. Fifty-nine studies were identified for inclusion according to predetermined criteria. Study heterogeneity was high; methods of intervention were individual or group-based, and were mostly visually delivered and/or passive learning. Most interventions occurred at a single time point. Intervention success was assessed by evaluating subject behavior, intention, attitudes, knowledge, and emotion. Multicomponent interventions, generally consisting of UV photography and a passively delivered educational component, may be more effective than a single component alone. Overall, study quality was poor. Sample size of the majority of studies was <150 subjects. Most studies used self-report of behavior and had a short follow-up time. Generalizability of findings may be impacted as women, particularly white/Caucasian women, were overrepresented in the studies identified by this systematic review. For this specific target population, themes arising from the review include the importance of self-relevance and message framing. Self-affirmation was identified as a potential challenge in designing interventions for this target group, which can lead to defensiveness and a negative reaction to the health message. The findings of this systematic review may inform future research in this field, as well as guide planning of effective interventions in this target population.

You don't have to tell a story! A registered report testing the effectiveness of narrative versus non-narrative misinformation corrections

Misinformation often has an ongoing effect on people's memory and inferential reasoning even after clear corrections are provided; this is known as the continued influence effect. In pursuit of more effective corrections, one factor that has not yet been investigated systematically is the narrative versus non-narrative format of the correction. Some scholars have suggested that a narrative format facilitates comprehension and retention of complex information and may serve to overcome resistance to worldview-dissonant corrections. It is, therefore, a possibility that misinformation corrections are more effective if they are presented in a narrative format versus a non-narrative format. The present study tests this possibility. We designed corrections that are either narrative or non-narrative, while minimizing differences in informativeness. We compared narrative and non-narrative corrections in three preregistered experiments (total N = 2279). Experiment 1 targeted misinformation contained in fictional event reports; Experiment 2 used false claims commonly encountered in the real world; Experiment 3 used real-world false claims that are controversial, in order to test the notion that a narrative format may facilitate corrective updating primarily when it serves to reduce resistance to correction. In all experiments, we also manipulated test delay (immediate vs. 2 days), as any potential benefit of the narrative format may only arise in the short term (if the story format aids primarily with initial comprehension and updating of the relevant mental model) or after a delay (if the story format aids primarily with later correction retrieval). In all three experiments, it was found that narrative corrections are no more effective than non-narrative corrections. Therefore, while stories and anecdotes can be powerful, there is no fundamental benefit of using a narrative format when debunking misinformation.

Effects of message framing and evidence type on health information behavior: the case of promoting HPV vaccination

Purpose

Based on the examination of the roles of message framing and evidence type, this study made an analysis of the promotion methods of intention and information need towards HPV vaccination.

Design/methodology/approach

The study conducted a 2 (gain-framed messages vs loss-framed messages) × 2 (statistical evidence vs narrative evidence) quasi-experimental design built upon theories of message framing and evidence type. This experiment recruited college students who were not vaccinated against HPV as participants. The analysis of variance (ANOVA), the analysis of covariance (ANCOVA), and the independent sample T-test were used to test the hypotheses.

Findings

The results (N = 300) indicate that (1) Loss-framed messages will lead to a more favorable intention towards HPV vaccination than gain-framed messages. (2) Statistical evidence will lead to a more explicit information need than narrative evidence. (3) Message framing and evidence type will interact and (a) for statistical evidence, loss-framed messages will lead to a more favorable intention towards HPV vaccination than gain-framed messages and (b) for narrative evidence, gain-framed messages will lead to a more favorable intention towards HPV vaccination than loss-framed messages. (4) Message framing and evidence type will interact and (a) for loss-framed messages, statistical evidence will stimulate more explicit information need of HPV vaccination than narrative evidence and (b) for gain-framed messages, narrative evidence will stimulate more explicit information need of HPV vaccination than statistical evidence.

Originality/value

This paper can help to further understand the important roles of message framing and evidence type in health behavior promotion. The study contributes to the literature on how health information can be well organized to serve the public health communication and further enhance the health information service.

Testing threat-to-efficacy ratios in health communications about cardiovascular disease among an older population

To test threat-to-efficacy ratios within health communications about cardiovascular disease (CVD) for older individuals. Participants were randomly assigned to one of six messages: (i) 'standard' message with 1/1 threat-to-efficacy ratio, (ii) 'low efficacy' message with 1/0 threat-to-efficacy ratio, (iii) 'low threat' message with 0/1 threat-to-efficacy ratio, (iv) 'high efficacy' message with 1/2 threat-to-efficacy ratio; (v) 'high threat' message with 2/1 threat-to-efficacy ratio and (vi) 'overload' message with 2/2 threat-to-efficacy ratio. Participants had to be of 60 years of age or older (N = 242, Male = 92, Age: M = 68.29, SD = 6.71). Advanced univariate analyses and multiple regression modelling were conducted to examine associations between the message groups, and danger- and fear-control processes, as well as the impact of threat and efficacy appraisals on the relationship between the message groups and behavioural intentions. No differences were found between the message groups for danger-control processes. Those who received the 'overload' message did report higher levels of fear, nervousness and anxiety in comparison to the 'standard' message group. For physical activity, it was found that efficacy impacted the relationship between the message groups and behavioural intentions, as participants' levels of efficacy increased and if these individuals received high levels of efficacy information, their behavioural intentions for physical activity increased. Results from this study were dissimilar to those of previous research. However, they highlighted the impact of efficacy and negative emotional reactions when communicating to older individuals about CVD and the associated health behaviours.

Discussing non-invasive prenatal testing on Reddit: The benefits, the concerns, and the comradery

OBJECTIVE

As the use of non-invasive prenatal testing (NIPT) increases, its benefits and concerns are being examined through surveys, qualitative studies, and bioethical analysis. However, only scant research has examined public discourse on the topic. This research examined NIPT discussions on the social media platform Reddit.

METHOD

Content and qualitative description analysis was performed on 98 NIPT discussions (2682 comments), obtained by inputting "NIPT" into Reddit's search engine.

RESULTS

Detailing of benefits and concerns was found in collaborative and supportive discussions. Overall, NIPT is seen as valuable and desirable. Some concerns focused on cost-related barriers to access, anxiety related to testing, and interpretation of results. NIPT is often portrayed as offering peace of mind and is sometimes described as a means of preparing for possible outcomes.

CONCLUSION

In the discussions analyzed, NIPT is seen, overall, as valuable and greater access to it is desired. Some questions and concerns about NIPT were evident. Reddit stands as a valuable and appreciated tool for individuals wishing to discuss NIPT and to solicit and share information, opinions, and experiences. Health care providers should consider the ways social platforms such as Reddit can be engaged to better inform and educate the public.

Consumer-Guided Development of an Engagement-Facilitation Intervention for Increasing Uptake and Adherence for Self-Guided Web-Based Mental Health Programs: Focus Groups and Online Evaluation Survey

Background

Self-guided web-based mental health programs are effective in treating and preventing mental health problems. However, current engagement with these programs in the community is suboptimal, and there is limited evidence indicating how to increase the use of existing evidence-based programs.

Objective

This study aims to investigate the views of people with lived experience of depression and anxiety on factors influencing their engagement with self-guided web-based mental health (e–mental health) programs and to use these perspectives to develop an engagement-facilitation intervention (EFI) to increase engagement (defined as both uptake and adherence) with these programs.

Methods

A total of 24 community members (female=21; male=3) with lived experience of depression and anxiety or depression or anxiety alone participated in 1 of 4 focus groups discussing the factors influencing their engagement with self-guided e–mental health programs and the appearance, delivery mode, and functionality of content for the proposed EFI. A subsequent evaluation survey of the focus group participants (n=14) was conducted to evaluate the resultant draft EFI. Data were thematically analyzed using both inductive and deductive qualitative methods.

Results

Participants suggested that the critical component of an EFI was information that would challenge personal barriers to engagement, including receiving personalized symptom feedback, information regarding the program’s content or effectiveness and data security, and normalization of using e–mental health programs (eg, testimonials). Reminders, rewards, feedback about progress, and coaching were all mentioned as facilitating adherence.

Conclusions

EFIs have the potential to improve community uptake of e–mental health programs. They should focus on providing information on the content and effectiveness of e–mental health programs and normalizing their use. Given that the sample comprised predominantly young females, this study may not be generalizable to other population groups. There is a strong value in involving people with a lived experience in the design and development of EFIs to maximize their effectiveness.

How to Communicate Food Safety after Radiological Contamination: The Effectiveness of Numerical and Narrative News Messages

Food risk and the safety of foodstuffs in the aftermath of contamination are highly sensitive issues to communicate. Food risks receive extensive attention from the news media, which requires messages to be carefully drafted to minimize harm and avoid unnecessary boycotts. Once a food risk is deemed eliminated, communication efforts must rebuild trust among consumers. The latter is a particularly difficult task after radiological contamination. This study tests whether numerical messages, narrative messages, or messages combining both elements are more effective in persuading the public to consume foodstuffs from Fukushima, a region that continues to battle stigma since the nuclear accident in 2011. We employ a survey-embedded experiment on a sample of the general Belgian population (N = 1085), during which respondents are presented with a mock news article presenting either a (1) numerical, (2) narrative, or (3) a combined message and test their subsequent evaluation of the article. We find that the numerical message leads to significantly higher perceived credibility and message acceptance than both the combined and the narrative message. Furthermore, we find that attitudes towards nuclear energy have a strong independent effect on message acceptance and evaluation, with those respondents who report a more positive stance towards nuclear energy more readily accepting the message. Food risk and safety communication may thus benefit from adopting a more detached, numerical approach for sensitive issues.

How to Peddle Hope: An Analysis of YouTube Patient Testimonials of Unproven Stem Cell Treatments

Providers capitalize on patient testimonials to market unproven stem cell treatments (SCTs). We evaluated 159 YouTube videos and found patients discussed health improvements (91.2%), praised providers (53.5%), and recommended SCTs (28.9%). In over a third of the videos, providers posed questions to patients, thereby directing narratives and making them a powerful marketing tool.

Persuasive Effects of Linguistic Agency Assignment and Linguistic Markers of Argumentation in Health Messages about an Emerging Sexually Transmitted Disease

Answering the call by some health communication researchers to give greater attention to message strategies at the level of word choices and sentence structures, this study examined how the linguistic marking of argumentative orientation and linguistic agency assignment affects young adults' reactions to an informational message about a sexually transmitted infection presented as a new emerging health threat. Participants were randomly assigned to read one of the four versions of a fact sheet defined by a 2 × 2 (agency assignment x marking of argumentation orientation) factorial design and thereafter completed a questionnaire. Results indicated that the assignment of agency to the virus (vs. human) increased the perceived severity of the health threat, perceived susceptibility to it, persuasiveness of the message, and safer sex intentions. The same outcomes occurred when the message was phrased with a high marking of the argumentative orientation rather than a low marking. These findings suggest that a better understanding of language variable effects can boost the efficacy of promotional health messages.

Improving Adherence to Colorectal Cancer Screening: A Randomized Intervention to Compare Screener vs. Survivor Narratives

Interventions are needed to increase colorectal cancer screening (CRCS) uptake. Narratives may have advantages over didactic information. We tested different narratives for increasing CRCS intentions and behaviors, and examined their mechanisms of influence. We randomized 477 unscreened adults 50-75 years old to one of three groups: CRCS information only (1) or CRCS information plus a photo and text narrative of a CRC survivor (2) or CRC screener who did not have cancer (3). Photos were tailored on participants' sex, age group, and race/ethnicity. Participants completed online surveys before and after intervention exposure, and 1-, 6-, and 12-months follow-up. Thirty percent of participants completed CRCS. Narrative conditions (vs. information only) were negatively associated with intention, but also positively influenced intentions through greater emotional engagement. Survivor (vs. screener) narratives were positively associated with CRCS, and had mixed effects on intention - positively through emotional engagement and negatively through self-referencing engagement to self-efficacy. Survivor narratives elicited more negative affect, which had positive and negative influences on intention. Continued research using path models to understand the mechanisms of narrative effects will inform theory development and message design. Additional measurement evaluation is needed to adequately capture and then compare the effects of different components of narrative engagement.

"It Changed Our Outlook on How We Want to Live": Cancer as a Transformative Health Experience for Young Adult Survivors and Their Family Members

Although young adult cancer survivors (YACSs) and their families face unique psychosocial and health-related challenges related to cancer, little is known about how the illness experience of cancer may positively transform their mental, physical, and social well-being following primary treatment. We conducted individual qualitative interviews with 30 YACSs and 21 of their family members. Participants described positive transformations as (a) perspective shifts on health and risk, (b) behavior changes toward more proactive healthy living, and (c) opportunities for more open communication about wellness. Few participants reported little to no transformation based on a fatalistic view of their diagnosis. Our findings illuminate important implications for health promotion and support in this population, including the role health care providers can play following primary treatment. We also discuss how YACSs can serve as important advocates for others and the need for more work exploring how and why positive illness transformations take place.

Designing Anti-Binge Drinking Prevention Messages: Message Framing vs. Evidence Type

We investigated whether presenting anti-binge drinking health campaign messages in different message framing and evidence types influences college students' intention to avoid binge drinking, based on prospect theory (PT) and exemplification theory. A 2 (message framing: loss-framed message/gain-framed message) X 2 (evidence type: statistical/narrative) between-subjects factorial design with a control group was conducted with 156 college students. College students who were exposed to the loss-framed message condition exhibited a higher level of intention to avoid binge drinking in the near future than those who did not see any messages (the control group). This finding was mainly among non-binge drinkers. Regardless of evidence type, those who were exposed to the messages exhibited a higher level of intention to avoid binge drinking than those in the control group. This is also mainly among non-binge drinkers. We also found the main effects of message framing and evidence type on attitude toward the message and the main effect of message framing on attitude toward drinking.

Effects of an entertaining, culturally targeted narrative and an appealing expert interview on the colorectal screening intentions of African American women

Universal screening for colorectal cancer (CRC) is recommended for individuals 50-75 years of age, but screening uptake is suboptimal and African Americans have suffered persistent racial disparities in CRC incidence and deaths. We compared a culturally tailored fictional narrative and an engaging expert interview on the ability to increase intentions to be screened for CRC among African American women. In a post-only experiment, women (N = 442) in face-to-face listening groups in African American churches heard audio recordings of either a narrative or an expert interview. Questionnaires were completed immediately afterward and 30 days later. Women who heard narratives reported stronger intentions to be screened with a home stool blood test than women who heard the interview; the effect lasted at least 30 days. Culturally tailored, fictional narratives appear to be an effective persuasive strategy for reducing racial disparities in CRC outcomes.

Lifestyle Factors Associated With Sunscreen Use Among Young Adults

Background. Skin cancer is the most common cancer in the United States with melanoma rates increasing. Sunscreen use is an effective way to protect the skin and reduce skin cancer risk. Limited research has been conducted examining the relationship between sunscreen use and other lifestyle factors. Interventions aimed at multiple lifestyle factors have shown promise for prevention and reduced health care costs. Objective. This study explores the relationship between sunscreen use and lifestyle factors associated with mortality and morbidity among young adults. Lifestyle factors examined included physical activity, substance abuse, smoking, sexual behavior, unintentional injury, and mental well-being. Methods. A convenience sample of 747 college students was surveyed about sunscreen use and other health risks. Data were analyzed using SPSS 19. Results. White, female students older than 21 years were more likely to use sunscreen. Texting while driving, low life satisfaction, and binge drinking were associated with inadequate sunscreen use. Limitations. Convenience sampling limits generalizability and surveys are subject to recall, self-report, and self-selection bias. Conclusions. The findings provide the framework to develop multiple risk factor interventions.

Perceived Risk of Emerging Recreational Drugs: Impact of Anecdotal and Statistical Evidence

This study investigated the relative impact of personal stories and base rate evidence on the perceived risk of using two emerging recreational drugs: kratom and Spice. A 3 × 2 × 2 mixed-methods design was employed. Four hundred fifty-three young adults were randomly assigned to read internet postings that presented either 1) base rate information depicting the frequency of adverse reactions to Spice and kratom; 2) base rate information plus four personal web-postings describing beneficial reactions to Spice and kratom; or 3) base rate information plus four personal web-postings describing adverse reactions to Spice and kratom. Respondents subsequently evaluated the risk of using both drugs. Anecdotal evidence (personal stories) outweighed the impact of base rate evidence only when the personal stories described adverse drug reactions. Effective risk communication will benefit from differential use of both base rate evidence and personal stories.

Effect of interventions incorporating personalised cancer risk information on intentions and behaviour: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

To provide a comprehensive review of the impact on intention to change health-related behaviours and health-related behaviours themselves, including screening uptake, of interventions incorporating information about cancer risk targeted at the general adult population.

DESIGN

A systematic review and random-effects meta-analysis.

DATA SOURCES

An electronic search of MEDLINE, EMBASE, CINAHL and PsycINFO from 1 January 2000 to 1 July 2017.

INCLUSION CRITERIA

Randomised controlled trials of interventions including provision of a personal estimate of future cancer risk based on two or more non-genetic variables to adults recruited from the general population that include at least one behavioural outcome.

RESULTS

We included 19 studies reporting 12 outcomes. There was significant heterogeneity in interventions and outcomes between studies. There is evidence that interventions incorporating personalised cancer risk information do not affect intention to attend or attendance at screening (relative risk 1.00 (0.97-1.03)). There is limited evidence that they increase smoking abstinence, sun protection, adult skin self-examination and breast examination, and decrease intention to tan. However, they do not increase smoking cessation, parental child skin examination or intention to protect skin. No studies assessed changes in diet, alcohol consumption or physical activity.

CONCLUSIONS

Interventions incorporating personalised cancer risk information do not affect uptake of screening, but there is limited evidence of effect on some health-related behaviours. Further research, ideally including objective measures of behaviour, is needed before cancer risk information is incorporated into routine practice for health promotion in the general population.

Understanding Knowledge, Attitudes, and Behaviors Toward West Nile Virus Prevention: A Survey of High-Risk Adults in Maryland

OBJECTIVE

To assess knowledge, attitudes, and behaviors toward West Nile virus (WNV) prevention among Maryland adults ≥60 years old who are at increased risk of severe WNV disease utilizing the health belief model.

METHODS

Using a stratified random sample of households from zip codes with ≥2 human WNV cases, we conducted a telephone survey of 211 Maryland adults ≥60 years old between October and December 2012.

RESULTS

Participants expressing worry about WNV were over thrice more likely to use insect repellent in the prior 90 days (adjusted odds ratio [aOR] = 3.46, 95% confidence interval [CI] = 1.33-8.95) and nearly thrice more likely to drain standing water around their homes than those not worried (aOR = 2.86, 95% CI = 1.25-6.52). Respondents perceiving a benefit in paying less for WNV vaccine were more likely to support mosquito control programs (aOR = 16.00, 95% CI = 1.50-170.68).

CONCLUSIONS

Future interventions to promote WNV prevention among older adults should seek to enhance perceptions of vulnerability to WNV through risk communication, including media outreach and written messaging, emphasizing the benefits of personal protective behaviors. Community partnerships may aid in outreach to this population.

Effect of Message Format and Content on Attitude Accessibility Regarding Sexually Transmitted Infections

Sexually transmitted infections (STIs) are widespread in the United States among people ages 15-24 years and cost almost $16 billion yearly. It is therefore important to understand message design strategies that could help reduce these numbers. Guided by exemplification theory and the extended parallel process model (EPPM), this study examines the influence of message format and the presence versus absence of a graphic image on recipients' accessibility of STI attitudes regarding safe sex. Results of the experiment indicate a significant effect from testimonial messages on increased attitude accessibility regarding STIs compared to statistical messages. Results also indicate a conditional indirect effect of testimonial messages on STI attitude accessibility, though threat is greater when a graphic image is included. Implications and directions for future research are discussed.

Indoor Tanning Dependence in Young Adult Women

Background: There is mounting evidence that young people can develop a dependence on indoor tanning, but research on factors associated with indoor tanning dependence remains limited.Methods: This cross-sectional study investigated factors associated with indoor tanning dependence in a community sample of 389 non-Hispanic white young adult women ages 18 to 30 who had indoor tanned ≥1 time in the past year. Participants completed measures of indoor tanning dependence, including the modified CAGE and modified Diagnostic and Statistical Manual for Mental Disorders-IV psychiatric screening assessments, indoor tanning behavior and beliefs, and behavioral and psychiatric comorbidity.Results: Overall, 22.6% of the sample screened positive for indoor tanning dependence. In multivariable analyses, indoor tanning dependence was associated with younger age of indoor tanning initiation [adjusted odds ratio (aOR) = 0.79; P = 0.017], indoor tanning ≥20 times in the past year (aOR = 3.03; P = 0.015), stronger beliefs about the benefits of tanning (aOR = 2.15; P = 0.004), greater perceived susceptibility to indoor tanning risks (aOR = 2.72; P < 0.001), stronger beliefs about physical appearance (aOR = 1.73; P = 0.037), and depressive symptoms (aOR = 3.79; P < 0.001).Conclusions: Indoor tanning dependence among young, non-Hispanic white women is associated with behaviors that increase the risk of skin cancer, beliefs favoring the perceived benefits of tanning, and comorbid risks such as stronger beliefs about physical appearance and depressed mood.Impact: Comprehensive skin cancer prevention efforts should address indoor tanning dependence among young women and its leading risk factors. Cancer Epidemiol Biomarkers Prev; 26(11); 1636-43. ©2017 AACR.

Support for indoor tanning policies among young adult women who indoor tan

The purpose of this study to examine support for indoor tanning policies and correlates of policy support among young adult women who indoor tan. Non-Hispanic white women ages 18-30 who indoor tanned in the past year (n = 356, M 23.3 age, SD 3.1) recruited in the Washington, DC area from 2013 to 2016 completed measures of indoor tanning behaviors, attitudes, perceptions, beliefs, and policy support. Most women in the sample supported policies to prevent children under the age of 18 from indoor tanning (74.0 %) and stronger warnings about the risks of indoor tanning on tanning devices (77.6 %); only 10.1 % supported a total ban. In multivariable analyses, support for individual indoor tanning policies varied by demographics (e.g., age), frequent indoor tanning behavior, indoor tanning beliefs, and risk perceptions. Non-Hispanic white young adult women who indoor tan, the primary consumers of indoor tanning, and a high-risk population, largely support indoor tanning prevention policies implemented by many state governments and those currently under review for national enactment. Given low levels of support for a total indoor tanning ban, support for other potential policies (e.g., increasing the minimum age to 21) should be investigated to inform future steps to reduce indoor tanning and the associated health risks.

When Health Information Meets Social Media: Exploring Virality on Sina Weibo

This study explored the impacts social media bring about on health communication. The impacts involved four factors: authority, privacy, evidence, and incentive appeals. They were adopted to predict virality of health messages on Sina Weibo in terms of retweeting, endorsing, and replying. A quantitative content analysis was conducted with a two-stage probability sample of 1,261 messages from 34 accounts. The results illustrated two modes Weibo users employed to process health information. The heuristic mode was used for retweeting that was sensitive to public messages, negative appeals, and nonprofessional authority. The systematic mode was used for endorsing and replying that were sensitive to private messages, positive appeals, and both professional and nonprofessional authorities.

Designing Skin Cancer Prevention Messages: Should We Emphasize Gains or Losses? Message Framing, Risk Type, and Prior Experience

PURPOSE

To test whether message framing (ie, gain vs. loss) and risk type (ie, health vs appearance risk) in skin cancer prevention messages interact with one's prior experience.

DESIGN

Two experiments with a 2 (message framing: gain vs loss) × 2 (risk type: health vs appearance risk) factorial design were conducted.

SETTING

The participants were given a URL to the experiment website via e-mail. On the first page of the website, the participants were told that they would be asked to evaluate a skin cancer print public service announcement (PSA): Online experiments.

PARTICIPANTS

A total of 397 individuals participated (236 for experiment 1 and 161 for experiment 2). Apparatus: Four versions of the skin cancer print PSAs were developed. Four PSAs were identical except for the 2 manipulated components: message framing and risk type.

MEASURES

Measures were adopted from Cho and Boster (message framing), Jones and Leary and Kiene et al. (risk type), De Vries, Mesters, van't Riet, Willems, and Reubsaet and Knight, Kirincich, Farmer, and Hood (prior experience), and Hammond, Fong, Zanna, Thrasher, and Borland and Hoffner and Ye (behavioral intent).

ANALYSIS

General linear models were used to test hypotheses.

RESULTS

Three-way interactions among message framing, risk type, and prior experience were found: When the intent of the message was to encourage sunscreen use, the effects of message framing and risk type were shown to be the exact opposite directions from when the intent was to discourage indoor/outdoor tanning.

CONCLUSION

To discourage tanning among those with prior experience, messages emphasizing losses in terms of one's health will work better. For those with no prior experience, messages emphasizing potential appearance losses will work better for discouraging tanning while messages emphasizing gains like improving appearance will do a better job in encouraging sunscreen use.