The Use of Mobile Assessments for Monitoring Mental Health in Youth: Umbrella Review.

BACKGROUND: Improving mental health in youth is a major concern. Future approaches to monitor and intervene in youth mental health problems should rely on mobile tools that allow for the daily monitoring of mental health both actively (eg, using ecological momentary assessments [EMAs]) and passively (eg, digital phenotyping) by capturing individuals' data. OBJECTIVE: This umbrella review aims to (1) report the main characteristics of existing reviews on mental health and young people, including mobile approaches to mental health; (2) describe EMAs and trace data and the mental health conditions investigated; (3) report the main results; and (4) outline promises, limitations, and directions for future research. METHODS: A systematic literature search was carried out in 9 scientific databases (Communication & Mass Media Complete, Psychology and Behavioral Sciences Collection, PsycINFO, CINAHL, ERIC, MEDLINE, the ProQuest Sociology Database, Web of Science, and PubMed) on January 30, 2022, coupled with a hand search and updated in July 2022. We included (systematic) reviews of EMAs and trace data in the context of mental health, with a specific focus on young populations, including children, adolescents, and young adults. The quality of the included reviews was evaluated using the AMSTAR (Assessment of Multiple Systematic Reviews) checklist. RESULTS: After the screening process, 30 reviews (published between 2016 and 2022) were included in this umbrella review, of which 21 (70%) were systematic reviews and 9 (30%) were narrative reviews. The included systematic reviews focused on symptoms of depression (5/21, 24%); bipolar disorders, schizophrenia, or psychosis (6/21, 29%); general ill-being (5/21, 24%); cognitive abilities (2/21, 9.5%); well-being (1/21, 5%); personality (1/21, 5%); and suicidal thoughts (1/21, 5%). Of the 21 systematic reviews, 15 (71%) summarized studies that used mobile apps for tracing, 2 (10%) summarized studies that used them for intervention, and 4 (19%) summarized studies that used them for both intervention and tracing. Mobile tools used in the systematic reviews were smartphones only (8/21, 38%), smartphones and wearable devices (6/21, 29%), and smartphones with other tools (7/21, 33%). In total, 29% (6/21) of the systematic reviews focused on EMAs, including ecological momentary interventions; 33% (7/21) focused on trace data; and 38% (8/21) focused on both. Narrative reviews mainly focused on the discussion of issues related to digital phenotyping, existing theoretical frameworks used, new opportunities, and practical examples. CONCLUSIONS: EMAs and trace data in the context of mental health assessments and interventions are promising tools. Opportunities (eg, using mobile approaches in low- and middle-income countries, integration of multimodal data, and improving self-efficacy and self-awareness on mental health) and limitations (eg, absence of theoretical frameworks, difficulty in assessing the reliability and effectiveness of such approaches, and need to appropriately assess the quality of the studies) were further discussed. TRIAL REGISTRATION: PROSPERO CRD42022347717; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=347717.

Tobacco-control policy support among people from low socioeconomic positions in Massachusetts.

People from low socioeconomic positions (SEP) are at a higher risk of smoking, face greater barriers to smoking cessation, and have lower access to health information. To improve tobacco-related health outcomes, policies requiring altering labeling on cigarette packs could be implemented. However, public support is needed to influence the policymaking process. We assessed factors associated with supporting tobacco-control communication policies. We analyzed data from Project CLEAR, a study conducted in Massachusetts. The analytic sample included participants who answered questions on their support for three policies: 1) graphic health warnings (GHWs), 2) Quitline number, and 3) smoking cessation information on cigarette packs (n = 357). Binomial logistic regression modeling was conducted by policy. Independent variables included demographic characteristics and smoking status. We found that younger vs. older individuals (aOR = 0.41, 95 %CI:0.23-0.72), males vs. females (aOR = 0.58, 95 %CI:0.35-0.96), and people who smoke vs. those who don't smoke (aOR = 0.41, 95 %CI:0.24-0.70) were less likely to support a law requiring GHWs. Participants with a low vs. higher level of education (aOR = 0.55, 95 %CI:0.32-0.95) were less likely to support a law requiring a Quitline number. Younger (18-39) vs. older individuals (aOR = 0.53, 95 %CI:0.29-0.94), males vs. females (aOR = 0.57, 95 %CI:0.34-0.96), and participants with a low vs. higher level of education (aOR = 0.56, 95 %CI:0.32-0.98) were less likely to support a law requiring cessation information on cigarette packs. Findings suggest that targeted theory-based public health and communication strategies should be developed to increase awareness and support towards policies that would help reduce cigarette smoking among people from low SEP to eliminate tobacco-related health inequities in the US.

Conceptualizing and Measuring Social Media Use in Health and Well-being Studies: Systematic Review.

BACKGROUND: Despite an increasing number of studies revealing both the benefits and harms of social media use on well-being, there is heterogeneity and a lack of consensus on how social media use is conceptualized, defined, and measured. Additionally, little is known whether existing literature focuses on ill-being or well-being outcomes and whether studies use theories. OBJECTIVE: The main objective of this review was to examine (1) how social media use has been conceptualized and measured, (2) what health and well-being outcomes have been focused on, and (3) whether studies used theories. METHODS: Studies were located through a comprehensive search strategy involving 4 steps. First, keyword searches were conducted on 6 major databases: PubMed, Web of Science, PsycINFO, Embase, ProQuest, and Annual Reviews. Second, a search was conducted on Google Scholar using the same sets of search terms, and the first 100 results were examined. Third, the reference sections of reviews identified in the first 2 rounds of searches were examined, and finally, the reference lists of the final set of papers included in the review were searched. Through a multistage screening, papers that met our inclusion criteria were analyzed. RESULTS: The review included a total of 233 papers published between 2007 and 2020 in 51 different countries. While 66 (28%) of the studies investigated the effects of the problematic use or addiction of social media on health and well-being, 167 (72%) studied the effects of social media use as a "normal" behavior. Most of the studies used measures assessing the time users spend using social media. Most of the studies that examined the effects of problematic social media use or addiction used addiction scales. Most studies examined the association of social media use with mental illnesses such as depression, anxiety, self-esteem, and loneliness. While there are a considerable number of studies investigating physical health outcomes such as self-rated health, sleep, and sitting time or lack of physical activity, relatively a small number of studies examined social, psychological, and emotional well-being. Most of the studies 183 (79%) did not use any theory. CONCLUSIONS: Most studies conceptualized social media use as a "normal" behavior and mostly used time-spent measures, whereas a considerable number of studies conceptualized social media use as an addiction and used various addiction measures. The studies disproportionately focused on investigating the associations of social media use with negative health and well-being outcomes. The findings suggest the need for going beyond time spent to more sophisticated measurement approaches that consider the multiplicity of activities that users perform on social media platforms and the need for more theory-based studies on the association of social media use with not only negative well-being or "ill-being" but also with positive health and well-being outcomes.

Toward an Extended Infodemiology Framework: Leveraging Social Media Data and Web Search Queries as Digital Pulse on Cancer Communication.

This study aims to extend the infodemiology framework by postulating that effective use of digital data sources for cancer communication should consider four components: (a) content: key topics that people are concerned with, (b) congruence: how interest in cancer topics differ between public posts (i.e., tweets) and private web searches, (c) context: the influence of the information environment, and (d) information conduits. We compared tweets (n = 36, 968) and Google web searches on breast, lung, and prostate cancer between the National Cancer Prevention Month and a non-cancer awareness month in 2018. There are three key findings. First, reliance on public tweets alone may result in lost opportunities to identify potential cancer misinformation detected from private web searches. Second, lung cancer tweets were most sensitive to external information environment - tweets became substantially pessimistic after the end of cancer awareness month. Finally, the cancer communication landscape was largely democratized, with no prominent conduits dominating conversations on Twitter.

Using Smart Speaker Technology for Health and Well-being in an Older Adult Population: Pre-Post Feasibility Study.

BACKGROUND: Although smart speaker technology is poised to help improve the health and well-being of older adults by offering services such as music, medication reminders, and connection to others, more research is needed to determine how older adults from lower socioeconomic position (SEP) accept and use this technology. OBJECTIVE: This study aimed to investigate the feasibility of using smart speakers to improve the health and well-being of low-SEP older adults. METHODS: A total of 39 adults aged between 65 and 85 years who lived in a subsidized housing community were recruited to participate in a 3-month study. The participants had a smart speaker at their home and were given a brief orientation on its use. Over the course of the study, participants were given weekly check-in calls to help assist with any problems and newsletters with tips on how to use the speaker. Participants received a pretest and posttest to gauge comfort with technology, well-being, and perceptions and use of the speaker. The study staff also maintained detailed process notes of interactions with the participants over the course of the study, including a log of all issues reported. RESULTS: At the end of the study period, 38% (15/39) of the participants indicated using the speaker daily, and 38% (15/39) of the participants reported using it several times per week. In addition, 72% (28/39) of the participants indicated that they wanted to continue using the speaker after the end of the study. Most participants (24/39, 62%) indicated that the speaker was useful, and approximately half of the participants felt that the speaker gave them another voice to talk to (19/39, 49%) and connected them with the outside world (18/39, 46%). Although common uses were using the speaker for weather, music, and news, fewer participants reported using it for health-related questions. Despite the initial challenges participants experienced with framing questions to the speaker, additional explanations by the study staff addressed these issues in the early weeks of the study. CONCLUSIONS: The results of this study indicate that there is promise for smart speaker technology for low-SEP older adults, particularly to connect them to music, news, and reminders. Future studies will need to provide more upfront training on query formation as well as develop and promote more specific options for older adults, particularly in the area of health and well-being.

Beyond Educating the Masses: The Role of Public Health Communication in Addressing Socioeconomic- and Residence-based Disparities in Tobacco Risk Perception.

Public health communication has long been a key component of tobacco control efforts. However, little is known whether and how such an effort could address disparities in tobacco risk perceptions among population subgroups. In this study, using data from the Global Adult Tobacco Survey of Ethiopia, we examined if tobacco risk perceptions varied across socioeconomic and urban vs. rural population subgroups, and whether and how exposure to anti-smoking message was associated with disparities in risk perceptions across socioeconomic and urban-rural subgroups. The results indicated that health risk perceptions of smoking and secondhand smoke exposure were significantly lower among rural, less educated and less affluent population subgroups. Controlling for age, gender, education, wealth, place of residence, and pro-smoking message exposure, anti-smoking message exposure was associated with greater risk perceptions of smoking. Moreover, anti-smoking message exposure moderated the associations of place of residence and education with risk perceptions of smoking and secondhand smoke exposure, respectively. The probability of risk perception of smoking associated with anti-smoking message exposure was higher among the rural populace compared to urbanites. Similarly, the probability of risk perception of secondhand smoke exposure associated with anti-smoking message exposure was the highest among individuals without formal education compared to those with primary, secondary, and college-level education. The findings suggest that efforts should be made to make sure adequate anti-smoking message exposure among less educated and rural audiences so as to reduce disparities in tobacco risk perceptions.

COVID-19 News and Misinformation: Do They Matter for Public Health Prevention?

An infodemic caused by a rampant spread of a mixture of correct and incorrect information in a connected world creates uncertainty about and dismissal of proven public health measures. Two key factors that can influence COVID-19 preventive behaviors are information and self-efficacy. Misinformation (inaccurate or misleading information) can modify people's attitudes and behaviors and deter them from following preventive behaviors. Self-efficacy, on the other hand, has been linked to the likelihood to engaging in preventive behaviors. This cross-sectional study used a nationally representative survey of Americans from 2020 to determine the associations between (1) COVID-19 news sources and COVID-19 misinformation and (2) COVID-19 misinformation and COVID-19 prevention self-efficacy, using multivariable logistic regression. Results indicate that reliance on conservative sources for COVID-19 news is significantly associated with endorsing COVID-19 misinformation. In contrast, reliance on liberal sources, mainstream print, or social media for COVID-19 news are significantly negatively associated with endorsing COVID-19 misinformation. Furthermore, endorsing COVID-19 misinformation is related to low COVID-19 prevention self-efficacy, which, in turn, can modify COVID-19 preventive behaviors. These findings suggest that customizing health messages to debunk misinformation and increase self-efficacy for preventive behaviors can motivate individuals to comply with preventive behaviors and protect themselves from COVID-19.

Individual and social determinants of COVID-19 vaccine uptake.

BACKGROUND: COVID-19 has had a devastating impact and efforts are being made to speed up vaccinations. The growing problem of vaccine hesitancy may affect the uptake of COVID-19 vaccine. We examined the individual, communication and social determinants associated with vaccines uptake. METHODS: Data come from a nationwide online probability-based panel of 1012 representative adults in the United States and the survey was conducted before the vaccines were available. People under the federal poverty level and racial and ethnic minorities were oversampled. Our outcome variables of interest were likelihood of vaccinating self and likelihood of vaccinating people under one's care (such as children) measuring behavioral intentions. Independent variables included perceptions of risk, exposure to different media for COVID-19 news, political party identification, confidence in scientists and social determinants of health. Logistic regression analysis was used to ascertain the effects of independent variables on the two outcome variables. RESULTS: The results indicated that 68 and 65% agreed to get the vaccine for themselves and people under their care, respectively. Risk perceptions (severity of and susceptibility to COVID-19) were significantly associated with vaccine uptake. People who relied on "conservative" news outlets, Republicans, and who had low confidence in scientists are least likely to vaccinate self or children. Non-Hispanic Blacks and those with least schooling were also less likely to receive vaccine for themselves or people in their care. CONCLUSIONS: Our study identified race/ethnicity, risk perceptions, exposure to different media for COVID-19 news, party identification and confidence in scientists as factors that would be affecting COVID-19 vaccine uptake. The good news is that these are addressable through strategic public health communications, but a lot of work remains to be done with some urgency.

Adherence to COVID-19 mitigation measures among American adults: the need for consistent and unified messaging.

In the United States, elite and media communications about the risks of, and mitigation strategies for, COVID-19 have been characterized by lack of consensus. In this study, we draw from a nationally representative sample of American adults to examine the associations between exposure to different media and platforms (mainstream, conservative, liberal or social media) and adherence to COVID-19 mitigation measures such as physical distancing and mask use. We also examine the individual and social factors associated with adherence to mitigation measures. We find that exposure to conservative outlets, being republican, having low confidence in scientists and high perception of information overload are associated with low adherence. In contrast, exposure to liberal and mainstream news outlets, being democrat, having high confidence in scientists, and low perception of information overload are associated with high adherence. The findings suggest the need for consistent and unified public health messaging that cuts across partisan splits and the growing skepticism in science.

Association of social participation, perception of neighborhood social cohesion, and social media use with happiness: Evidence of trade-off (JCOP-20-277).

Social participation and neighborhood social cohesion are positively associated with health and wellbeing. Given that in-person social interactions have generally dwindled over the past several decades at least in Western countries and social media use has become more common, in this study, we examined whether and how social media use interacts with social participation and neighborhood social cohesion in influencing happiness. Data were gathered from a representative sample of adults in Massachusetts, USA. General linear model was used to estimate the main and interaction effects of social participation, perception of neighborhood social cohesion and social media use on happiness, controlling for sociodemographics, marital status, employment, and self-rated health. Results indicated that both social participation and perception of neighborhood social cohesion were positively associated with happiness whereas social media use was not. However, there was a significant interaction effect of social media use and perception of neighborhood social cohesion on happiness. Compared with people with a high perception of neighborhood social cohesion, those with low perception were more likely to be happy as their social media use increased, suggesting that social media use may be helpful to promote happiness among people who perceive their neighborhoods as less supportive, trustworthy, and close-knit.

Association between different types of mass media and antenatal care visits in India: a cross-sectional study from the National Family Health Survey (2015-2016).

OBJECTIVE: To generate evidence for the association between different types of mass media and antenatal care (ANC) visits in India. DESIGN: A cross-sectional study design, analysing data from India's National Family Health Survey 4 (NFHS-4), 2015-2016. SETTING: Rural and urban India. PARTICIPANTS: From NFHS-4, women who had given birth in the last 5 years before survey administration were included in this study. Women with missing information about their number of ANC visits and their caste were excluded, leaving 187 894 women in the final analytical sample. PRIMARY OUTCOME MEASURES: Logistic regression analysis was conducted to determine the association of ANC utilisation with mass media exposure. RESULTS: Overall, our study showed that high exposure to all four types of mass media was positively associated with making at least eight ANC visits. In rural India, women who had high exposure to newspaper/magazine (adjusted OR (aOR), 1.43; 95% CI, 1.31 to 1.57), radio (aOR, 1.22; 95% CI, 1.09 to 1.37), television (aOR, 2.07; 95% CI, 1.94 to 2.2) and movies (aOR, 1.33; 95% CI, 1.2 to 1.47) were more likely to make at least eight ANC visits. In urban India, women who had high exposure to newspaper/magazine (aOR, 1.12; 95% CI, 1.02 to 1.24), radio (aOR, 1.37; 95% CI, 1.13 to 1.65), television (aOR, 1.39; 95% CI, 1.24 to 1.55) and movies (aOR, 1.23; 95% CI, 1.09 to 1.38) were more likely to make at least eight ANC visits. CONCLUSIONS: Our findings emphasise the need for increased awareness about adequate ANC visits in India, to improve maternal, neonatal and child health outcomes. Our study highlights that television penetration is broader than other forms of media and has the potential to create awareness about health in both urban and rural populations. These findings can inform ANC-related health awareness campaigns in the country to allocate resources to appropriate media sources to encourage healthy behaviours.

Comparing the knowledge gap hypothesis in the United States and Singapore: The case of nanotechnology.

This study examines the knowledge gap hypothesis in the United States and Singapore in the context of nanotechnology. This study proposes that academic discipline serves as a better indicator than education levels in predicting nanotechnology knowledge gaps. To reflect the contemporary media landscape, this study examines how attention to online media and documentaries alongside traditional news outlets affect individuals' nanotechnology knowledge. In both countries, online media and documentaries, as well as traditional news outlets, were related to nanotechnology knowledge to various extents. While the knowledge gap hypothesis was not observed in Singapore, results revealed that increased media attention and interpersonal discussion widened knowledge gaps between individuals from science and non-science disciplines in the United States. Education levels failed to reveal a consistent moderation effect. Taken together, the interaction analyses revealed that academic discipline predicted nanotechnology knowledge gaps more consistently than education levels in the United States. Theoretical and practical implications are discussed.

The Potential of Smartphone Apps in Informing Protobacco and Antitobacco Messaging Efforts Among Underserved Communities: Longitudinal Observational Study.

BACKGROUND: People from underserved communities such as those from lower socioeconomic positions or racial and ethnic minority groups are often disproportionately targeted by the tobacco industry, through the relatively high levels of tobacco retail outlets (TROs) located in their neighborhood or protobacco marketing and promotional strategies. It is difficult to capture the smoking behaviors of individuals in actual locations as well as the extent of exposure to tobacco promotional efforts. With the high ownership of smartphones in the United States-when used alongside data sources on TRO locations-apps could potentially improve tobacco control efforts. Health apps could be used to assess individual-level exposure to tobacco marketing, particularly in relation to the locations of TROs as well as locations where they were most likely to smoke. To date, it remains unclear how health apps could be used practically by health promotion organizations to better reach underserved communities in their tobacco control efforts. OBJECTIVE: This study aimed to demonstrate how smartphone apps could augment existing data on locations of TROs within underserved communities in Massachusetts and Texas to help inform tobacco control efforts. METHODS: Data for this study were collected from 2 sources: (1) geolocations of TROs from the North American Industry Classification System 2016 and (2) 95 participants (aged 18 to 34 years) from underserved communities who resided in Massachusetts and Texas and took part in an 8-week study using location tracking on their smartphones. We analyzed the data using spatial autocorrelation, optimized hot spot analysis, and fitted power-law distribution to identify the TROs that attracted the most human traffic using mobility data. RESULTS: Participants reported encountering protobacco messages mostly from store signs and displays and antitobacco messages predominantly through television. In Massachusetts, clusters of TROs (Dorchester Center and Jamaica Plain) and reported smoking behaviors (Dorchester Center, Roxbury Crossing, Lawrence) were found in economically disadvantaged neighborhoods. Despite the widespread distribution of TROs throughout the communities, participants overwhelmingly visited a relatively small number of TROs in Roxbury and Methuen. In Texas, clusters of TROs (Spring, Jersey Village, Bunker Hill Village, Sugar Land, and Missouri City) were found primarily in Houston, whereas clusters of reported smoking behaviors were concentrated in West University Place, Aldine, Jersey Village, Spring, and Baytown. CONCLUSIONS: Smartphone apps could be used to pair geolocation data with self-reported smoking behavior in order to gain a better understanding of how tobacco product marketing and promotion influence smoking behavior within vulnerable communities. Public health officials could take advantage of smartphone data collection capabilities to implement targeted tobacco control efforts in these strategic locations to reach underserved communities in their built environment.

Association of Social Media Use With Social Well-Being, Positive Mental Health, and Self-Rated Health: Disentangling Routine Use From Emotional Connection to Use.

Most studies addressing social media use as a normal social behavior with positive or negative effects on health-related outcomes have conceptualized and measured social media use and its effects in terms of dose-effect relations. These studies focus on measuring frequency and duration of use, and have seldom considered users' emotional connections to social media use and the effects associated with such connections. By using a scale with two dimensions capturing users' integration of social media use into their social routines and their emotional connection to the sites' use, the present study has brought preliminary evidence that may help map where social media use, as a normal social behavior, may be considered beneficial or harmful. Data from a nationally representative sample (n = 1,027) of American adults showed that while routine use is associated with positive health outcomes, emotional connection to social media use is associated with negative health outcomes. These associations have been consistent across three health-related outcomes: social well-being, positive mental health, and self-rated health. The data also showed that the strength of the positive and negative associations of routine use and emotional connection with the health outcomes varies across socioeconomic and racial/ethnic population subgroups. Our findings suggest that the link between social media use and health may not only be captured by and explained in terms of conventional dose-effect approaches but may also require a more sophisticated conceptualization and measurement of the social media use behavior.

Beliefs about smoking-related lung cancer risk among low socioeconomic individuals: the role of smoking experience and interpersonal communication.

INTRODUCTION: Previous research has documented that smoking prevalence is generally high among low socioeconomic groups and that tobacco industries continue to target these population groups. However, little research has investigated the beliefs of individuals with low socioeconomic position (SEP) about the association between smoking and cancer risks. In this study, we examined beliefs about smoking-related lung cancer risk and the role of smoking experience, mass media exposure and health-related interpersonal communication among a sample of low SEP population. METHODS: Data were gathered from 324 urban poor recruited from adult education centers in the greater Boston area, Massachusetts, USA as part of a larger project called Click to Connect. While we collected a variety of data at baseline and follow-up, the data for this study come from the baseline survey alone. RESULTS: We found that individuals with smoking experience tend to be better than those without in perceiving the lung cancer risks of smoking. Moreover, we found that health-related interpersonal communication with friends and family members is positively associated with beliefs about the link between smoking and lung cancer. CONCLUSION: Our findings suggest that low SEP individuals with smoking experience might be more exposed to anti-tobacco messages than are low SEP individuals without smoking experience. This could suggest that anti-tobacco interventions thus far may have done very little in raising the awareness of low SEP nonsmokers about the dangers of smoking and that they may have little potential to avert the initiation of smoking in this population.

Leveraging Breadth and Depth: Strategies to Characterize Population Diversity to Address Cancer Disparities in the DF/HCC Catchment Area.

BACKGROUND: NCI-Designated Cancer Centers provide key cancer research, prevention, and treatment services to members of their catchment area. Characterization of these areas may be complex given the diverse needs of the populations within, particularly those from low socioeconomic position (SEP). The purpose of this paper is to describe the characterization of the Dana-Farber/Harvard Cancer Center (DF/HCC) catchment area through using a two-pronged approach. METHODS: Participants (n = 1,511) were recruited through (i) an online, probability-based survey (n = 1,013) and (ii) a supplementary, in-person survey from priority groups (African Americans, Latinos, blue-collar workers, low SEP, homeless; n = 498) within Massachusetts. Study staff worked closely with community partners across the state to reach individuals who may not usually be included in online surveys. RESULTS: There were several differences across samples, with the community-based sample having a higher percentage of low SEP, low education, African Americans, and Latinos compared with the online sample. Differences were also noted in the cancer-related behaviors of the samples, with the community-based sample having higher rates of smoking, particularly within those who were homeless or make less than $20,000 per year. Fewer community-based subgroups were current with cancer screenings, and more showed more indication of potential communication inequalities compared with statewide estimates. CONCLUSIONS: The sampling strategy used to characterization of the DF/HCC catchment area provided broad, statewide estimates and additional focus on vulnerable populations, highlighting several potential areas for intervention. IMPACT: This study provides data to highlight the value of using multiple sampling strategies when characterizing cancer center catchment areas.

Smoking portrayal in Ethiopian movies: a theory-based content analysis.

Considerable research from high-income countries has characterized the amount, nature and effects of movie smoking depiction. However, in low- and middle-income countries (LMICs) where tobacco use and tobacco-related diseases are growing, little research has investigated smoking imagery in movies. This study examined the extent and nature of smoking portrayal in locally produced Ethiopian movies, and estimated the number of tobacco impressions movies delivered. Sample movies were taken from YouTube. Keyword searches were conducted using 'Ethiopian movies' and 'Ethiopian drama' on 18 September 2016. In each search, the first 100 most viewed movies were examined. Excluding repeated results, a total of 123 movies were selected for content analysis. Three coders participated. Results indicated that 86 (69.9%, 95% CI 63-78%) of the 123 most viewed movies contain at least one tobacco incident (TI). The movies depict a total of 403 TIs, with an average of 4.7 (95% CI 3.7-5.6) TIs in each movie. The average length of TIs is 1 min and 11 s. On average, the movies were viewed more than half a million times by September 2016, and received more 'likes' than 'dislikes', z = -8.05, p = 0.00. They delivered over 194 million tobacco impressions via YouTube alone from July 2012 through September 2016. Most TIs portray smoking as a socially acceptable behavior with no negative health consequences. The findings suggest that as with transnational Western movies, locally produced movies in LMICs should be scrutinized for compliance with national and international regulatory efforts.

Graphic and Arousing? Emotional and Cognitive Reactions to Tobacco Graphic Health Warnings and Associated Quit-Related Outcomes Among Low SEP Population Groups.

Research on graphic health warnings (GHWs) indicates that beyond changing cognitions about the health effects of smoking, GHWs evoke emotional reactions that can influence quit-related outcomes. Emotions can be classified based on valence (positive or negative) and arousal (calm or excited). However, although considerable research has examined the differential effectiveness of positive versus negative GHW-evoked emotions, research investigating the role of arousal activation in quit-related behaviors is scarce. This study examined associations between quit-related outcomes (intention and attempt to quit) and GHWs-evoked negative emotions classified as high and low in arousal activation as well as cognitive reactions among smokers of low socioeconomic position (SEP). It also examined whether perceived health risks of smoking moderate the relationship between emotional and cognitive reactions to GHWs and quit-related outcomes. Data were collected from low SEP smokers in three Massachusetts communities. Participants were screened and randomized to view one of the nine GHWs initially proposed for use by the U.S. Food and Drug Administration (FDA) and answered pre- and post-exposure questions. Results showed that GHW-evoked negative emotions high in arousal activation and cognitive reactions were both significantly associated with intention to quit during immediate post-test, controlling for age, warning label difference, and prior quit intention. However, these associations did not hold for quit attempts at follow-up. Perceived health risks of smoking moderated the association between cognitive reactions to GHWs and quit attempts at follow-up. The findings suggest that not all negative emotions evoked by GHWs are effective. Negative emotions high in arousal activation may be more effective in influencing quit-related behavioral intentions in low SEP groups. Additionally, unlike emotional reactions, cognitive reactions to GHWs may have effects that last relatively longer, but only among smokers who had low levels of perceived health risks of smoking at baseline.

The relative persuasiveness of narrative versus non-narrative health messages in public health emergency communication: Evidence from a field experiment.

Previous studies indicated that narrative health messages are more effective than non-narrative messages in influencing health outcomes. However, this body of evidence does not account for differences in health domain, and little is known about the effectiveness of this message execution strategy during public health emergencies. In this study, we examined the relative effectiveness of the two formats in influencing knowledge and perceived response efficacy related to prevention of pandemic influenza, and determined whether effects of message format vary across population sub-groups. Data for the study come from an experiment fielded in 2013 that involved a nationally representative sample of 627 American adults. Participants were randomly assigned to view either a narrative (n=322) or a non-narrative (n=305) video clip containing closely matched information about knowledge and preventive actions related to pandemic influenza, and completed pre- and post-viewing questions assessing knowledge and perceived response efficacy related to the prevention of pandemic influenza. Results indicated that participants in the non-narrative condition reported greater knowledge and rated pandemic influenza prevention measures as more effective compared with those in the narrative condition. Message format effects did not vary across population sub-groups; post-viewing scores of knowledge and perceptions related to pandemic influenza were consistently higher in the non-narrative condition compared with the narrative condition across five socio-demographic groups: age, gender, education, race/ethnicity and income. We concluded that didactic, non-narrative messages may be more effective than narrative messages to influence knowledge and perceptions during public health emergencies.