A Profile of Individuals with Anti-tobacco Message Fatigue

Identifying Population Segments by Differing Levels of COVID-19 Vaccine Confidence and Evaluating Subsequent Uptake of COVID-19 Prevention Behaviors: Web-Based, Longitudinal, Probability-Based Panel Survey

BACKGROUND

The COVID-19 pandemic prompted the launch of the US Department of Health and Human Services' COVID-19 Public Education Campaign to boost vaccine confidence and uptake among adults, as vaccines are key to preventing severe illness and death.

OBJECTIVE

Past segmentation research relevant to COVID-19 behavior has found important differences in attitudes, sociodemographics, and subsequent COVID-19 prevention behaviors across population segments. This study extends prior work by incorporating a more comprehensive set of attitudes, behaviors, and sociodemographic variables to identify population segments by differing levels of COVID-19 vaccine confidence and evaluate differences in their subsequent uptake of COVID-19 prevention behaviors.

METHODS

Data were obtained from 5 waves (January 2021 to June 2022) of a web-based longitudinal, probability-based panel survey of US adults (N=4398) administered in English and in Spanish. Participants were recruited from NORC at the University of Chicago's national AmeriSpeak panel and were invited to participate across multiple waves. Latent class cluster analysis estimated segments of respondents based on over 40 COVID-19 attitudes, beliefs, behaviors, and sociodemographics as reported in wave 1. Survey-weighted cross-tabulations and bivariate regression analyses assessed differences in COVID-19 vaccine uptake, booster uptake, mask use, and social distancing in all segments across all 5 survey waves.

RESULTS

A total of 6 segments (hardline nonintenders, prevention-compliant nonintenders, burned-out waiters, anxious waiters, skeptical confidents, and ready confidents) were identified, which differed by their COVID-19 vaccine confidence, prevention-related attitudes and behaviors, and sociodemographics. Cross-tabulations and regression results indicated significant segment membership differences in COVID-19 vaccine and booster timing, mask use, and social distancing. Results from survey-weighted cross-tabulations comparing COVID-19 vaccine and booster uptake across segments indicate statistically significant differences in these outcomes across the 6 segments (P<.001). Results were statistically significant for each segment (P<.01 for booster uptake among burned-out waiters; P<.001 for all other coefficients), indicating that, on average, respondents in segments with lower intentions to vaccinate reported later receipt of COVID-19 vaccines and boosters relative to the timing of vaccine and booster uptake among ready confidents.

CONCLUSIONS

Results extend previous research by showing that initial beliefs and behaviors relevant to COVID-19 vaccination, mask use, and social distancing are important for understanding differences in subsequent compliance with recommended COVID-19 prevention measures. Specifically, we found that across respondent segments, the probability of vaccine and booster uptake corresponded with both COVID-19 vaccine confidence and mask use and social distancing compliance; more compliant segments were more likely to get vaccinated or boosted than less compliant segments given similar levels of vaccine confidence. These findings help identify appropriate audiences for campaigns. Results highlight the use of a comprehensive list of attitudes, behaviors, and other individual-level characteristics that can serve as a basis for future segmentation efforts relevant to COVID-19 and other infectious diseases.

Network analysis of pandemic fatigue symptoms in samples from five South American countries

BACKGROUND

Pandemic fatigue generates low motivation or the ability to comply with protective behaviors to mitigate the spread of COVID-19.

AIMS

This study aimed to analyze the symptoms of pandemic fatigue through network analysis in individuals from five South American countries.

METHOD

A total of 1,444 individuals from Argentina, Bolivia, Paraguay, Peru, and Uruguay participated and were evaluated using the Pandemic Fatigue Scale. The networks were estimated using the ggmModSelect estimation method and a polychoric correlation matrix was used. Stability assessment of the five networks was performed using the nonparametric resampling method based on the case bootstrap type. For the estimation of network centrality, a metric based on node strength was used, whereas network comparison was performed using a permutation-based approach.

RESULTS

The results showed that the relationships between pandemic fatigue symptoms were strongest in the demotivation dimension. Variability in the centrality of pandemic fatigue symptoms was observed among participating countries. Finally, symptom networks were invariant and almost identical across participating countries.

CONCLUSIONS

This study is the first to provide information on how pandemic fatigue symptoms were related during the COVID-19 pandemic.

Message Fatigue and COVID-19 Vaccine Booster Uptake in the United States

Dissemination of public health information plays an essential role in communicable disease control and prevention. However, widespread and repeated messaging could become counterproductive if it leads to avoidance and disengagement due to message fatigue. Americans have been inundated with accurate and inaccurate COVID-19 information from myriad sources since the start of the pandemic. Using the health belief model (HBM) as a guiding framework, this study examines COVID-19-related message fatigue among adults in the United States who have gotten at least one dose of a COVID-19 vaccine and the association between message fatigue and COVID-19 booster uptake and intentions. A special survey module of The COVID States Project was fielded between August and September 2022 (n = 16,546). Results showed moderately high levels of message fatigue among vaccinated individuals. Message fatigue was negatively associated with the likelihood of having gotten a COVID-19 booster and intentions to do so among those who had not yet received a booster, above and beyond variance explained by the HBM constructs. These findings underscore the importance of monitoring and mitigating COVID-19-related message fatigue in encouraging the public to stay up to date with COVID-19 vaccination.

"No more COVID-19 messages via social media, please": the mediating role of COVID-19 message fatigue between information overload, message avoidance, and behavioral intention

Employing the stressor-strain-outcome framework, this study demonstrates that COVID-19 information overload on social media exerts a significant effect on the level of fatigue toward COVID-19-related messages. This feeling of message fatigue also makes people avoid another exposure to similar types of messages while diminishing their intentions to adopt protective behaviors in response to the pandemic. Information overload regarding COVID-19 on social media also has indirect effects on message avoidance and protective behavioral intention against COVID-19, respectively, through the feeling of fatigue toward COVID-19 messages on social media. This study emphasizes the need to consider message fatigue as a significant barrier in delivering effective risk communication.

Measuring information overload and message fatigue toward COVID-19 prevention messages in USA and China

COVID-19 prevention messages are a crucial component of disease mitigation strategies and the primary driver of health decision-making during the global pandemic. However, the constant and repetitive nature of COVID-19 messaging may cause unintended consequences. Among the commonly observed phenomena are information overload and message fatigue, which might be experienced differently depending on cultural background. Using measurement invariance testing, this study compared how individuals from two countries-USA (n = 493) and China (n = 571)-experienced information overload and message fatigue toward COVID-19 prevention messages. Findings revealed that people in China showed significantly lower level of information overload and message fatigue than those in the USA. This study explores the extent of the unintended persuasive effects that people have experienced during the COVID-19 pandemic in different societies, a comparison which has never been studied before, even outside of the context of COVID-19. The study also provides much-needed practical insights to develop public health initiatives that improve COVID-19 prevention communication, which can further reduce these unintended effects in both countries, and has implications for other countries as well.

Evaluating the Role of System-Generated Communications in Health Care Organizations

This Viewpoint discusses measures to improve the role of system-generated communications in health care organizations

How do information overload and message fatigue reduce information processing in the era of COVID-19? An ability–motivation approach

The global outbreak of COVID-19 in 2020 has led to the dominance of COVID-19 prevention information on all media channels. Drawing on the ability–motivation model of information processing, this study examined how such an information overabundance hampered individuals’ ability and motivation to process in the era of COVID-19. With a survey conducted from 493 participants, we found that less message elaboration of COVID-19 prevention information was predicted by greater message fatigue, a state of low motivation due to information overabundance. In addition, greater message fatigue was accompanied by greater information overload, a state of low ability due to information overabundance. Moreover, certain motivation-related (i.e. health status, trait reactance and frequency of information seeking) and ability–related factors (i.e. health literacy, health status, trait anxiety and information quality) were found to be associated with message fatigue and information overload, respectively. The theoretical and practical implications are discussed.

Why Don't You [Government] Help Us Make Healthier Foods More Affordable Instead of Bombarding Us with Labels? Maternal Knowledge, Perceptions, and Practices after Full Implementation of the Chilean Food Labelling Law

Experimental and real-life evaluations show that the use of front-of-package warning labels (FoP) in unhealthy foods is well understood and can modify people's behaviors. However, it is unclear whether these effects remain in the long term because of the risk of message fatigue. The purpose of this study is to explore after four years of implementation of the Chilean Food Labelling law people's dietary behavior and FoP labels attention. Nine focus groups of mothers (7-10 people each) of children (2-14 yo) were conducted in Santiago, Chile, and macrocodes were developed, combining an iterative process of deductive and inductive thematic analyses. We found that mothers experienced labels' fatigue but also had greater knowledge about nutrition and appreciation for more natural foods. This greater knowledge about better nutrition interferes with the perception that healthier and less processed foods are financial and physically inaccessible. The key role of schools as an environment for promoting healthier diets in children was strengthened by the mothers. These results suggest that policies based on providing consumer information need reinforcement campaigns to maintain their effectiveness and that we also need to advance policies to improve access and affordability of healthy foods to ensure better diets.

Awareness of heated tobacco products among US Adults - Health information national trends survey, 2020

Introduction: Heated Tobacco Products (HTP) have the potential to attain high uptake in the US. The current study estimated the prevalence of awareness, prevalence of use and the factors associated with awareness of HTP among US adults. Methods: This study included 3201 respondents from the Health Information National Trends Survey (HINTS) 5 Cycle 4 (2020). The prevalence of awareness of HTP and ever use of HTP among US adults were estimated. Multivariable logistic regression was conducted to identify the factors associated with awareness of HTP. Results: About 15% of the adult US population were aware of HTP, while 2.2% had ever used HTP. Age between 35 and 49 years (aOR, 1.9; 95% CI, 1.3-2.9; p-value = 0.003), male sex (aOR, 1.7; 95% CI, 1.0-2.7; p-value = 0.04), lower income ($0-$9,999) (aOR, 3.0; 95% CI, 1.3-6.9; p-value = 0.01), smoking on some days (aOR, 3.4; 95% CI, 1.2-9.4; p-value = 0.02) and moderately or extremely worrying about getting cancer (aOR, 1.7; 95% CI, 1.1-2.7; p-value = 0.03) were associated with higher odds of being aware of HTP; whereas, belief that there are so many cancer prevention recommendations, it's hard to know which ones to follow (aOR, 0.5; 95% CI, 0.3-0.8; p-value = 0.009) was associated with lower odds of being aware of HTP. Conclusions: A significant proportion of US adult population were aware of HTP in 2020. Given the recent high proliferation of e-cigarettes, potential health effects of the HTP products should be monitored by the regulators closely. Adequate surveillance and policy interventions are warranted in this regard.

Message Fatigue to Bystander Intervention Messages: Examining Pathways of Resistance among College Men

Bystander intervention programs are a feature on college campuses; however, the effectiveness of these programs among certain subsets of men has recently been questioned. The current study examines college men's resistance to bystander intervention efforts by investigating message fatigue as a theoretical explanation for how bystander intervention programs may fail among college men. Specifically, the current study examined both active (i.e., reactance) and passive (i.e., inattention) resistance to bystander intervention messages among a sample of college men (N = 518). Results were consistent with reactance as a mediating mechanism explaining message failure among fatigued audiences. The mediating role of inattention was not supported. Theoretical and practical implications of the current study are discussed.

New Zealand roll-your-own smokers' reaction to novel roll-your-own tobacco packaging warning labels

INTRODUCTION

Although roll-your-own (RYO) loose tobacco is increasingly popular among smokers, no jurisdictions have used RYO-specific pictorial warning labels (PWL) on tobacco packaging. We explored how New Zealand RYO smokers, a population with over 10 years of exposure to PWLs, reacted to RYO-specific warnings featuring novel themes.

METHODS

We conducted an online survey of 785 RYO smokers in March 2019. Eligible participants were smokers aged 18-70 years who smoked predominantly RYO cigarettes. Participants randomly viewed two of eight RYO-specific PWLs featuring themes of health information (mouth and throat cancer), suffering (male and female), toxins, material hardship, cost, family transmission of smoking and harm to pets and answered items assessing negative emotions and perceived effectiveness.

RESULTS

Compared to a reference health information PWL (most similar in content and tone to New Zealand's existing PWLs), only a male suffering PWL elicited both significantly stronger negative emotion and higher perceived effectiveness. No themes performed significantly worse than the health information PWL, suggesting any of the themes could be at least as effective as existing health warnings among New Zealand RYO smokers. The individual-level factors consistently associated with negative emotion and perceived effectiveness were age, desire to quit smoking, believing quitting could reduce risk of serious disease, a quit attempt within the previous 6 months and ever-planning to quit.

CONCLUSION

Our findings suggest that, in the New Zealand context, a PWL emphasising male suffering could be a useful starting point for assessing RYO-specific PWLs compared to general smoking warnings.

Factors Associated With Opting Out of Automated Text and Telephone Messages Among Adult Members of an Integrated Health Care System

IMPORTANCE

Health care systems deliver automated text or telephone messages to remind patients of appointments and to provide health information. Patients who receive multiple messages may demonstrate message fatigue by opting out of future messages.

OBJECTIVE

To assess whether the volume of automated text or interactive voice response (IVR) telephone messages is associated with the likelihood of patients requesting to opt out of future messages.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study was conducted at Kaiser Permanente Colorado (KPCO), an integrated health care system. All adult members who received 1 or more automated text or IVR message between October 1, 2018, and September 30, 2019, were included.

EXPOSURES

Receipt of automated text or IVR messages.

MAIN OUTCOMES AND MEASURES

Message volume and opt-out rates obtained from messaging systems over 1 year.

RESULTS

Of the 428 242 adults included in this study, 59.7% were women, and 66.5% were White; the mean (SD) age was 52.3 (17.7) years. During the study period, 84.1% received 1 or more text messages (median, 4 messages; interquartile range, 2-8 messages) and 67.8% received 1 or more IVR messages (median, 3 messages; interquartile range, 1-6 messages). A total of 8929 individuals (2.5%) opted out of text messages, and 4392 (1.5%) opted out of IVR messages. In multivariable analyses, individuals who received 10 to 19.9 or 20 or more text messages per year had higher opt-out rates for text messages compared with those who received fewer than 2 messages per year (adjusted odds ratio [aOR]: 10-19.9 vs <2 messages, 1.27 [95% CI, 1.17-1.38]; ≥20 vs <2 messages, 3.58 [95% CI, 3.28-3.91]), whereas opt-out rates increased progressively in association with IVR message volume, with the highest rates among individuals who received 10.0 to 19.9 messages (aOR, 11.11; 95% CI, 9.43-13.08) or 20.0 messages or more (aOR, 49.84; 95% CI, 42.33-58.70). Individuals opting out of text messages were more likely to opt out of IVR messages (aOR, 4.07; 95% CI, 3.65-4.55), and those opting out of IVR messages were more likely to opt out of text messages (aOR, 5.92; 95% CI, 5.29-6.61).

CONCLUSIONS AND RELEVANCE

In this cohort study among adult members of an integrated health care system, requests to discontinue messages were associated with greater message volume. These findings suggest that, to preserve the benefits of automated outreach, health care systems should use these messages judiciously to reduce message fatigue.

Predictors and Effects of Anti-Obesity Message Fatigue: A Thought-Listing Analysis

The prevalence of messages advocating weight management has likely resulted in considerable anti-obesity message fatigue but the phenomenon remains understudied. This study examined two aspects of antiobesity message fatigue: (1) effects of preexisting anti-obesity message fatigue on cognitive processing of an incoming anti-obesity message and (2) predictors and effects of message fatigue responses expressed after exposure to the message. Results from a two-wave online experiment involving overweight and obese adults in the U.S. (N = 251) showed that preexisting message fatigue (in wave 1) positively predicted counterarguments, while negatively predicting message-consistent and issue-relevant thoughts expressed after exposure to an anti-obesity message (in wave 2). Moreover, the experimental findings show that physical health frames generated greater message fatigue responses than mental health frames. Message fatigue responses, in turn, predicted more unfavorable attitude toward message recommendations, completely mediating the effects of physical health frames on attitude. Women and older participants were more likely to express anti-obesity message fatigue responses than their counterparts. These findings underscore the need to recognize message fatigue as a significant barrier to communicating health.

The Attitudinal and Motivational Effects of Anti-waterpipe Messages

Objectives: Waterpipe smoking can lead to negative health outcomes. In this study, we examined responses to anti-waterpipe smoking public service announcements (PSAs). Methods: In a pilot study, current waterpipe smokers (N = 20) and susceptible waterpipe never smokers (N = 25) were randomized to view either 3 anti-waterpipe PSAs, created by the Truth campaign, or 3 control videos. Participants answered questions pertaining to message acceptance at 3 time-points and perceived risk and motivation to quit or avoid waterpipe at 4 time-points. Results: Participants were recruited from the community (N = 45; Mage = 22.4 years). Whereas waterpipe smokers and never smokers who viewed the PSAs significantly increased in acceptance of (p < .05) and positive attitudes towards (p < .05) the messages with increased viewing of the mes- sages, waterpipe never smokers did so at a significantly higher rate (p < .05). Waterpipe never smokers who viewed the PSAs had increased perceived severity and susceptibility of health harms of waterpipe compared to the control (ps < .05). We also found gender differences. Conclusions: The 3 tested PSAs from the Truth campaign show evidence of effectiveness against waterpipe use.