Do Young Adults Attend to Health Warnings in the First IQOS Advertisement in the U.S.? An Eye-Tracking Approach

INTRODUCTION

In October 2019, a heated tobacco product (HTP) IQOS debuted in the United States. This study examined young adults' attention and cognitions in response to an IQOS ad that carried two mandated textual health warnings (Surgeon General's warning and nicotine warning), and how their vaping and smoking status may interact with attention patterns to affect attitude and intention to use IQOS.

METHODS

In November 2019, college students (N = 164) viewed IQOS' first U.S. magazine ad and two distractor ads. Viewing patterns were recorded with eye-tracking. Masked recall and aided recognition, attitude and intention towards IQOS use were later assessed with self-report. Ordinary Least Squares (OLS) regressions and moderated mediation analyses examined the associations between visual attention and viewers' cognitions about IQOS use.

RESULTS

Promotional content attracted significantly more attention compared to the warnings. Attention to the Surgeon General's warning but not to the nicotine warning was associated with recall and recognition of the warning's content. For ever-vapers, greater attention allocation to the promotional content in the IQOS ad was associated with more favorable attitude toward IQOS use, which was in turn positively associated with intention to use IQOS. Attention allocation to the warnings did not affect attitude or intentions, regardless of tobacco use status.

CONCLUSIONS

The results revealed the effects of IQOS promotional content overshadowed the two health warnings in influencing young people's attitude and intention to use IQOS. Young adults who vaped were more vulnerable to HTP advertising with respect to future use and vaping may be a gateway to HTP use.

IMPLICATIONS

This is the first eye-tracking study examining attention and cognitions associated with the new IQOS ad exposure among young adults. Promotional content in the ad attracted significantly more attention than the two warnings combined. Attention to the Surgeon General's warning but not to the nicotine warning was associated with recall and recognition of the warning's content. Greater attention allocation to the promotional content led to a more favorable attitude toward IQOS use which was associated with increased intention to use IQOS for ever-vapers. However, greater attention allocation to the warnings did not affect attitude or intentions to use IQOS.

Intergroup Contact, COVID-19 News Consumption, and the Moderating Role of Digital Media Trust on Prejudice Toward Asians in the United States: Cross-Sectional Study

Background

The perceived threat of a contagious virus may lead people to be distrustful of immigrants and out-groups. Since the COVID-19 outbreak, the salient politicized discourses of blaming Chinese people for spreading the virus have fueled over 2000 reports of anti-Asian racial incidents and hate crimes in the United States.

Objective

The study aims to investigate the relationships between news consumption, trust, intergroup contact, and prejudicial attitudes toward Asians and Asian Americans residing in the United States during the COVID-19 pandemic. We compare how traditional news, social media use, and biased news exposure cultivate racial attitudes, and the moderating role of media use and trust on prejudice against Asians is examined.

Methods

A cross-sectional study was completed in May 2020. A total of 430 US adults (mean age 36.75, SD 11.49 years; n=258, 60% male) participated in an online survey through Amazon’s Mechanical Turk platform. Respondents answered questions related to traditional news exposure, social media use, perceived trust, and their top three news channels for staying informed about the novel coronavirus. In addition, intergroup contact and racial attitudes toward Asians were assessed. We performed hierarchical regression analyses to test the associations. Moderation effects were estimated using simple slopes testing with a 95% bootstrap confidence interval approach.

Results

Participants who identified as conservatives (β=.08, P=.02), had a personal infection history (β=.10, P=.004), and interacted with Asian people frequently in their daily lives (β=.46, P<.001) reported more negative attitudes toward Asians after controlling for sociodemographic variables. Relying more on traditional news media (β=.08, P=.04) and higher levels of trust in social media (β=.13, P=.007) were positively associated with prejudice against Asians. In contrast, consuming news from left-leaning outlets (β=–.15, P=.001) and neutral outlets (β=–.13, P=.003) was linked to less prejudicial attitudes toward Asians. Among those who had high trust in social media, exposure had a negative relationship with prejudice. At high levels of trust in digital websites and apps, frequent use was related to less unfavorable attitudes toward Asians.

Conclusions

Experiencing racial prejudice among the Asian population during a challenging pandemic can cause poor psychological outcomes and exacerbate health disparities. The results suggest that conservative ideology, personal infection history, frequency of intergroup contact, traditional news exposure, and trust in social media emerge as positive predictors of prejudice against Asians and Asian Americans, whereas people who get COVID-19 news from left-leaning and balanced outlets show less prejudice. For those who have more trust in social media and digital news, frequent use of these two sources is associated with lower levels of prejudice. Our findings highlight the need to reshape traditional news discourses and use social media and mobile news apps to develop credible messages for combating racial prejudice against Asians.

Marketing a health Brand on Facebook: Effects of reaction icons and user comments on brand attitude, trust, purchase intention, and eWOM intention

This study examined effects of Facebook reaction icons and user comments on brand attitude, trust, information seeking, purchase intention, and eWOM intention towards a health brand, as well as potential moderating effects of SNS use. Results of a 3 (reaction icons: positive/neutral/negative) × 3 (valence of comments: positive/neutral/negative) between-subjects experiment (N = 306) indicated that positive Facebook reaction icons significantly influenced brand attitude, trust, purchase intention, and eWOM intention, while neutral comments significantly impacted brand attitude and trust. The degree of SNS use also negatively moderated between reaction icon valence and eWOM intention. Implications for health marketing communication are discussed.

Pro-veganism on Instagram

Purpose

Through two experiments, this study assessed source and message effects of Instagram-based pro-veganism messages.

Design/methodology/approach

Experiment 1 (N = 294) examined effects of organization (brand vs nonprofit) and message types (egoistic vs altruistic) on consumer responses to Instagram-based pro-veganism content. Experiment 2 (N = 288) examined effects of source type (celebrity vs noncelebrity) and message valence (positive vs negative) on consumer responses to Instagram-based pro-veganism content.

Findings

Results demonstrated significant main effects of organization type, with consumers indicating more positive attitudes and higher credibility toward the brand. Significant main effects of message type were also found, with altruistic messages eliciting higher perceived information value than egoistic messages. Subjective norms had moderating effects on attitude toward the organization, while attitude toward veganism had moderating effects on perceived information value. Results also indicated significant main effects of message valence on perceived information value of pro-veganism Instagram posts and significant interaction effects of the two manipulated factors on intention to spread electronic word-of-mouth (eWOM) about pro-veganism.

Originality/value

Implications for use of Instagram-based health marketing communication about veganism were discussed. Specifically, organizations looking to use social media to influence attitudes and behavioral intentions toward health issues should seek to reach their target audiences through selecting endorsers and messages that will optimally present the health issue in a relatable and engaging way.

Participation in electronic cigarette-related social media communities: Effects on attitudes toward quitting, self-efficacy, and intention to quit

This study examined the effects of joining and actively participating in electronic-cigarette-related social media communities (SMCs), along with e-cigarette-related subjective norms, and social identification with other electronic-cigarette (e-cigarette) users, on current e-cigarette users' attitudes toward quitting, self-efficacy, and intention to quit. Results (n = 1016) indicated that greater e-cigarette-related social media use, more positive e-cigarette-related subjective norms and greater identification with other e-cigarette users, resulted in significantly more negative attitudes toward quitting, lower self-efficacy and lower intention to quit. E-cigarette-related social media use also interacted with subjective norms to influence intention to quit, and with identification with other e-cigarette users to influence self-efficacy.

Sport team-endorsed brands on Facebook

Purpose

Applying social identity theory, the social identity-brand equity model and excitation-transfer theory, the purpose of this paper is to examine effects of game outcome (win/loss) and location (home/away) on sport fans’ brand attitude and purchase intention toward a brand endorsed by their favorite sport team on Facebook, as well as the mediating role of team identification.

Design/methodology/approach

A two (win/loss) by two (home/away) full-factorial between-subjects experiment was conducted during the US National Collegiate Athletic Association (NCAA) football season over a four-month period. Participants (n=338), who were Facebook users and fans of a NCAA division I football team, completed an online questionnaire assessing brand attitude and purchase intention toward a team-endorsed brand on Facebook, during weeks after the team: won a home game, lost a home game, won an away game, or lost an away game. Results were analyzed using analysis of variance and bootstrapping mediation methods.

Findings

Results revealed a significant main effect for game outcome (win/loss), and a significant interaction effect between game outcome (win/loss) and game location (home/away). Team identification also mediated between game outcome (win/loss) and game location (home/away) to influence brand attitude, but not purchase intention.

Originality/value

Implications for use of social networking site (SNS)-based brand endorsements as an integral part of brands’ advertising strategies were discussed. Specifically, brands utilizing SNSs to advertise to sport fans should highlight team endorsements, particularly after home game wins, and also target highly identified fans, to maximize positive SNS-based brand evaluations.

Social marketing nutrition education for low-income population

As access to healthy food (or lack thereof) could be considered a social justice issue, social workers should be concerned about this issue and willing to collaborate with colleagues of various disciplines to address it. This study was a formative evaluation conducted to understand best practices, recommendations, and feasibility of a social-marketing-based nutrition education program tailored to the needs of adults with limited income. The authors report findings from focus groups conducted with Cooperative Extension Agents (CEAs) and region coordinators (n = 45) and Supplemental Nutrition Assistance Program Education (SNAP-Ed) (n = 69) eligible participants to inform the development of a social marketing nutrition intervention for SNAP-Ed in Georgia. Barriers to healthy eating included cultural preferences, costs of healthy food, lack of time, and lack of availability. Social marketing has a potential to deliver effective and efficient SNAP-Ed targeted to large, limited-resource Georgians. Segmenting the low-income population based on geographical location as well as best methods for outreach can allow tailored messages to meet identified needs, lifestyles, and other variables that make these individuals most likely to respond to the program. Food security and nutrition education are topics of concern for all health care professionals interested in addressing complex health issues of many low-income adults.

From ICU to Emergency Department: 9-Year Experience with Non-Invasive Ventilation for COPD

Introduction

Non-invasive ventilation (NIV) has been shown to be beneficial for chronic obstructive pulmonary disease (COPD) patients with persistent respiratory acidosis during acute exacerbations. This clinical study described the experience of implementing an NIV program in the emergency department for COPD patients.

Methods

In the pre-implementation phase, patients who presented to the emergency department were transferred to the intensive care unit for NIV. Following the NIV program, patients had NIV commenced in the emergency department. We reported the change in hospital outcomes pre and post-implementation.

Results

A total of 153 patients received NIV, 34 in the pre-implementation phase and 119 patients in the post-implementation phase. The mean pH was 7.22±0.07 and the Acute Physiology and Chronic Health Evaluation (APACHE) II score was 18.9±4. Hospital mortality was lower in the post-implementation phase (1.7% versus 11.8%; p=0.008). The median door-to-NIV time was shorter in the post-implementation phase (64 minutes; interquartile range [IQR] 35-113) versus (457 minutes; IQR 143-1320).

Conclusions

NIV program in the emergency department is feasible and is associated with better hospital outcomes in patients with COPD. (Hong Kong j.emerg.med. 2014;21:140-147)

Celebrity-endorsed e-cigarette brand Instagram advertisements: Effects on young adults’ attitudes towards e-cigarettes and smoking intentions

Celebrities endorsing e-cigarette brands on social media may exert a strong influence on e-cigarette uptake. Using a between-subject experiment, this study examines the effects of endorser type (celebrities, non-celebrities and products only) in e-cigarette brand Instagram advertisements on e-cigarette attitudes and smoking intentions. Results showed that celebrity endorsers significantly increased positive attitudes towards e-cigarettes and smoking intentions, compared to non-celebrities or products only. Celebrity endorsers also rated significantly higher on trustworthiness, expertise, goodwill and attractiveness, compared to non-celebrities. Additionally, identification, social comparison, health consciousness and social networking site use moderated between endorser type and key dependent measures. Implications for e-cigarette marketing regulation are discussed.

Authenticity in Obesity Public Service Announcements: Influence of Spokesperson Type, Viewer Weight, and Source Credibility on Diet, Exercise, Information Seeking, and Electronic Word-of-Mouth Intentions

This study examined the joint influence of spokesperson type in obesity public service announcements (PSAs) and viewer weight on diet intention, exercise intention, information seeking, and electronic word-of-mouth (eWoM) intention. Results of a 2 (spokesperson type: real person vs. actor) × 2 (viewer weight: overweight vs. non-overweight) between-subjects experiment indicated that overweight viewers who saw the PSA featuring the real person had the highest diet intention, exercise intention, information seeking, and eWoM intention. Parasocial interaction was also found to mediate the relationships between spokesperson type/viewer weight and two of the dependent variables: diet intention and exercise intention. In addition, viewers who saw the PSA featuring the real person rated the spokesperson as significantly higher on source credibility (trustworthiness, competence, and goodwill) than those who saw the PSA featuring the actor.

The effects of similarity, parasocial identification, and source credibility in obesity public service announcements on diet and exercise self-efficacy

This study examined the effect of the audience’s similarity to, and parasocial identification with, spokespersons in obesity public service announcements, on perceived source credibility, and diet and exercise self-efficacy. The results ( N = 200) indicated that perceived similarity to the spokesperson was significantly associated with three dimensions of source credibility (competence, trustworthiness, and goodwill), each of which in turn influenced parasocial identification with the spokesperson. Parasocial identification also exerted a positive impact on the audiences’ diet and exercise self-efficacy. Additionally, significant differences were found between overweight viewers and non-overweight viewers on perceived similarity, parasocial identification with the spokesperson, and source credibility.

The impact of clinical protocols in the management of severe sepsis: a prospective cohort study

This study aimed to assess the availability of clinical protocols and their effect on compliance to the Surviving Sepsis Campaign bundles and on mortality in severe sepsis in ten Singaporean adult teaching intensive care units (ICU). The presence of 11 protocols in the ICUs, steps taken based on the Johns Hopkins University Quality and Safety Research Group's model to translate protocols into practice, and organisational characteristics were assessed. Clinical and research personnel recorded characteristics of patients with severe sepsis who were admitted in July 2009, the achievement of sepsis bundle targets and outcomes. Hospital mortality was 39% for 128 patients. Fewer than half of the ICUs had protocols for early goal-directed therapy, blood cultures, antibiotics, steroids, lung-protective ventilation and weaning. Compliance rates with the resuscitation and management bundles were 18 and 3% respectively. Units with protocols were generally not more likely to achieve associated bundle targets. Steps from the Johns Hopkins model to measure performance, engage teams and sustain and extend interventions were taken in fewer than half of the available protocols. However, on logistic regression analysis, the number of protocols available per ICU was independently and inversely associated with mortality. In conclusion, clinical protocols are infrequently available in Singapore's ICUs and when present do not generally improve compliance to the sepsis bundles. These protocols may, however, be a surrogate marker of the quality of care as they are independently associated with decreased mortality. The use of an integrated and multifaceted approach to translate protocols into practice should be considered.

Utility of the electronic information resource UpToDate for clinical decision-making at bedside rounds

INTRODUCTION

Clinical questions often arise at daily hospital bedside rounds. Yet, little information exists on how the search for answers may be facilitated. The aim of this prospective study was, therefore, to evaluate the overall utility, including the feasibility and usefulness of incorporating searches of UpToDate, a popular online information resource, into rounds.

METHODS

Doctors searched UpToDate for any unresolved clinical questions during rounds for patients in general medicine and respiratory wards, and in the medical intensive care unit of a tertiary teaching hospital. The nature of the questions and the results of the searches were recorded. Searches were deemed feasible if they were completed during the rounds and useful if they provided a satisfactory answer.

RESULTS

A total of 157 UpToDate searches were performed during the study period. Questions were raised by all ranks of clinicians from junior doctors to consultants. The searches were feasible and performed immediately during rounds 44% of the time. Each search took a median of three minutes (first quartile: two minutes, third quartile: five minutes). UpToDate provided a useful and satisfactory answer 75% of the time, a partial answer 17% of the time and no answer 9% of the time. It led to a change in investigations, diagnosis or management 37% of the time, confirmed what was originally known or planned 38% of the time and had no effect 25% of the time.

CONCLUSION

Incorporating UpToDate searches into daily bedside rounds was feasible and useful in clinical decision-making.

Effect of a blood conservation device in patients with preserved admission haemoglobin in the intensive care unit

An important iatrogenic cause of anaemia in the intensive care unit is loss of the discarded blood during phlebotomy via indwelling vascular catheters. A closed system blood conservation device has previously been shown to reduce the need for blood transfusion and to blunt the decrease of haemoglobin in intensive care unit patients. However such a device may not benefit patients who are admitted with a relatively preserved haemoglobin. In this sub-group analysis of a before-and-after study, 128 patients had admission haemoglobin > or =115 g/l and did not receive any blood transfusions while in the intensive care unit. In the control group of 50 patients a blood conservation device was not used, while in the active group of 78 patients the device was used. Use of the blood conservation device did not affect the haemoglobin trends when both groups were compared using the general linear model. For patients with admission haemoglobin > or = 115 g/l, use of a blood conservation device does not affect the subsequent rate of haemoglobin decline in the intensive care unit. These patients are unlikely to benefit from the use of such devices.

Monitoring of extubated patients: are routine arterial blood gas measurements useful and how long should patients be monitored in the intensive care unit?

Restitution of respiratory support, which may include continuous positive airway pressure, non-invasive ventilation or reintubation, is needed in some patients post-extubation. We aimed to investigate whether serial arterial blood gas measurements done in the post-extubation period would help to identify such patients and to delineate the optimal post-extubation duration for close monitoring. We retrospectively analysed 115 consecutive adult patients who were extubated following successful spontaneous breathing trials in the medical intensive care unit, excluding patients who were extubated to immediate non-invasive ventilation. Arterial blood gases were measured at one and three hours post-extubation and patients were followed for any restitution of respiratory support for the remainder of their hospital stay. Restitution of respiratory support was required for 22 of 115 (19.1%) patients, of whom 20 were originally intubated for pneumonia. These patients could all be detected clinically from deteriorating pulse oximetry or increasing drowsiness. Performing serial arterial blood gas measurements following extubation did not improve the detection rate or allow earlier detection of patient deterioration. Among the patients with pneumonia, restitution of respiratory support was required within 24 hours of extubation for 16 patients (80%) and after more than 49 hours for four patients. Serial arterial blood gas measurements at one and three hours after a planned extubation are not useful and patients originally intubated for pneumonia should be monitored post-extubation for at least 24 hours in the intensive care unit.

How well do serum sTREM-1 measurements prognosticate in septic shock?

The soluble triggering receptor expressed on myeloid cells (sTREM)-1 has emerged as a potentially useful biomarker for the diagnosis of sepsis. This study aimed to evaluate the prognostic utility of serum sTREM-1 in septic shock, in comparison with that of procalcitonin measurements. Thirty-one consecutive patients in a tertiary medical intensive care unit with septic shock were studied. sTREM-1 levels in blood were measured using a modified immunoblot array technique on days one to three of intensive care unit admission. Serum procalcitonin and interleukin (IL)-1beta, IL-6, IL-IO and tumour necrosis factor-alpha levels were also measured. No significant difference was observed in the sTREM-1 levels on the first three days between survivors and nonsurvivors. sTREM-1 levels moderately correlated with the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores on day three, but did not correlate with vasopressor requirements, cytokine levels and the presence of bacteraemia. In contrast, procalcitonin levels were significantly higher in nonsurvivors than in survivors on days two and three. A significant relationship also existed between procalcitonin levels and the other variables. In conclusion, this study found that the prognostic utility of serum sTREM-1 in septic shock is poor and that procalcitonin measurements perform better in this regard.

Soluble triggering receptor expressed on myeloid cells-1 in acute respiratory infections

Levels of the soluble form of the triggering receptor expressed on myeloid cells (sTREM)-1 are elevated in severe sepsis. However, it is not known whether sTREM-1 measurements can distinguish milder bacterial infections from noninfectious inflammation. The present authors studied whether serum sTREM-1 levels differ in community-acquired pneumonia, exacerbations of chronic obstructive pulmonary disease (COPD), asthma and controls, and whether sTREM-1 may be used as a surrogate marker for the need for antibiotics. Serum sTREM-1 levels in 150 patients with pneumonia, COPD and asthma exacerbations and 62 healthy controls were measured. Serum sTREM-1 levels were significantly elevated in pneumonia (median 295.2 ng x mL(-1)), COPD (280.3 ng x mL(-1)) and asthma exacerbations (184.0 ng x mL(-1)) compared with controls (83.1 ng x mL(-1)). Levels were higher in pneumonia and Anthonisen type 1 COPD exacerbations than in type 2 and 3 COPD and asthma exacerbations. The area under the receiver operating characteristics curve for sTREM-1 as a surrogate marker for the need for antibiotics was 0.77. Serum levels of the soluble form of the triggering receptor expressed on myeloid cells-1 were elevated predominantly in pneumonia and Anthonisen type 1 COPD exacerbations versus type 2 and 3 chronic obstructive pulmonary disease exacerbations, asthma and controls. Serum levels of the soluble form of the triggering receptor expressed on myeloid cells-1 has moderate but insufficient accuracy as a surrogate marker for the need for antibiotics in lower respiratory tract infections.

Severe Sepsis and Septic Shock in Adult Patients: An Approach to Management and Future Trends

Severe sepsis is sepsis associated with acute organ dysfunction. Septic shock in turn, implies severe sepsis that has led to circulatory shock refractory to fluid resuscitation alone. The immediate approach to severe sepsis follows the ABCs of resuscitation: Airway, Breathing, and Circulation. Special emphasis on the circulation involves early goal-directed therapy, adequate fluid resuscitation, and vasopressor/inotropic support. Once the patient's cardiorespiratory status is stabilized, efforts must be directed at uncovering the source and empirically yet accurately treating the infective underpinnings of severe sepsis. Following that, each of the patient's other organ systems at risk needs to be addressed: Renal/metabolic, gastrointestinal, hematological, and endocrine. Novel treatments will target both the proinflammatory and procoagulation cascades of sepsis.