Native Americans' Responses to Obesity Attributions and Message Sources in an Obesity Prevention Campaign.

This study investigated the effectiveness of Native American (NA) targeted obesity prevention messages. The researchers manipulated obesity attributions (internal vs. external) and message sources (NAs vs. non-NAs) in a 2 × 2 mixed experimental design to examine the way these message attributes influence NAs' emotional, attitudinal, cognitive, and behavioral responses. One-hundred and eighteen Cheyenne and Arapaho (C&A) tribal citizens read two paper-based obesity prevention PSAs and then answered questions that assessed their message responses. The key findings demonstrated that the match between participants' ethnicity and the message source's ethnicity had a significant effect, as it reduced anger and promoted positive message attitudes and favorable source evaluations. Implications, limitations, and suggestions for future research and NA targeted health campaigns are discussed.

Smoking Status Matters: A Direct Comparison of Smokers' and Nonsmokers' Psychophysiological and Self-Report Responses to Secondhand Smoke Anti-Tobacco PSAs.

Extensive research demonstrates that exposure to threatening anti-tobacco messages can lead to defensive message processing which reduces message effectiveness. However, research investigating whether this effect is moderated by the smoking status of the message viewer is lacking. In this study, participants (N = 48 smokers and N = 51 non-smokers) viewed and rated secondhand smoke anti-tobacco messages depicting both smoking cues and threat content, or messages depicting neither while heart rate, skin conductance, and facial EMG were recorded. Post viewing, self-reported emotional experience, level of counterarguing, and recognition memory were measured. In support of the LC4MP, there were no differences between smokers and non-smokers' responses for non-threatening messages absent in smoking cues. However, messages that contained both smoking cues and threat content were defensively processed by smokers - but not non-smokers - as indicated by significantly faster heart rate, lower recognition memory and higher self-reported negativity, arousal, and counterarguments. The theoretical and practical implications are discussed.

Deceived, Disgusted, and Defensive: Motivated Processing of Anti-Tobacco Advertisements.

A 2 × 2 experiment was conducted, where participants watched anti-tobacco messages that varied in deception (content portraying tobacco companies as dishonest) and disgust (negative graphic images) content. Psychophysiological measures, self-report, and a recognition test were used to test hypotheses generated from the motivated cognition framework. The results of this study indicate that messages containing both deception and disgust push viewers into a cascade of defensive responses reflected by increased self-reported unpleasantness, reduced resources allocated to encoding, worsened recognition memory, and dampened emotional responses compared to messages depicting one attribute or neither. Findings from this study demonstrate the value of applying a motivated cognition theoretical framework in research on responses to emotional content in health messages and support previous research on defensive processing and message design of anti-tobacco messages.

Countering Craving with Disgust Images: Examining Nicotine Withdrawn Smokers' Motivated Message Processing of Anti-Tobacco Public Service Announcements.

There is a lack of research examining whether smoking cues in anti-tobacco advertisements elicit cravings, or whether this effect is moderated by countervailing message attributes, such as disgusting images. Furthermore, no research has examined how these types of messages influence nicotine withdrawn smokers' cognitive processing and associated behavioral intentions. At a laboratory session, participants (N = 50 nicotine-deprived adults) were tested for cognitive processing and recognition memory of 12 anti-tobacco advertisements varying in depictions of smoking cues and disgust content. Self-report smoking urges and intentions to quit smoking were measured after each message. The results from this experiment indicated that smoking cue messages activated appetitive/approach motivation resulting in enhanced attention and memory, but increased craving and reduced quit intentions. Disgust messages also enhanced attention and memory, but activated aversive/avoid motivation resulting in reduced craving and increased quit intentions. The combination of smoking cues and disgust content resulted in moderate amounts of craving and quit intentions, but also led to heart rate acceleration (indicating defensive processing) and poorer recognition of message content. These data suggest that in order to counter nicotine-deprived smokers' craving and prolong abstinence, anti-tobacco messages should omit smoking cues but include disgust. Theoretical implications are also discussed.

Discard the Smoking Cues-Keep the Disgust: An Investigation of Tobacco Smokers' Motivated Processing of Anti-tobacco Commercials.

This study experimentally examines the effect of smoking cues and disgust images commonly found in anti-tobacco advertisements on tobacco smokers' message processing. In a 2 (smoking cues) × 2 (disgust) within-subjects experiment, smokers watched anti-tobacco advertisements selected to vary in presence/absence of smoking cues and high/low ratings of disgust. The results of the experiment suggest that smoking cues and disgust images each have effects on resource allocation, recognition memory, emotional responses, smoking urges, and intentions to quit smoking. However, the most notable finding in this study was how the combination of smoking cues and disgust images in a single anti-tobacco message resulted in defensive message processing. Theoretical and applied implications of these findings are discussed along with future research directions.

The Role of Narrative and Other-Referencing in Attenuating Psychological Reactance to Diabetes Self-Care Messages.

This study charts pathways through message resistance to enhance the persuasiveness of diabetes self-care messages. A 2 (narrative) × 2 (other-referencing) × 2 (message) × 4 (order) experiment with adult diabetics (N = 58) tested whether packaging overt recommendations as a story rather than an informational argument (i.e., narrative structure) and highlighting the impact of health decisions on family and friends rather than the individual (i.e., other-referencing) can effectively attenuate psychological reactance to messages encouraging healthy diet and physical activity. Narrative and other-referencing each led to lower perceived threat to choice, less state anger and counterarguing, less negative cognitive responses, more positive attitudes toward the ad and the behaviors promoted, and greater intended compliance with message recommendations. Findings illustrate two strategies that communicators may employ in order to benefit from clear, direct health messages while avoiding the reactance they may provoke. Moreover, findings inform message design for diabetes self-care education.

Individual and social determinants of obesity in strategic health messages: Interaction with political ideology.

Antiobesity health communication campaigns often target individual behavior, but these ads might inflate the role of individual responsibility at the expense of other health determinants. In a 2 × 2 full-factorial, randomized, online experiment, 162 American adults viewed antiobesity advertisements that varied in emphasizing social or individual causation for obesity through text and images. Locus for attribution of responsibility for obesity causes and solutions was measured, as was how these responses were moderated by political ideology. Participants who viewed text emphasizing individual responsibility were less likely to agree that genetic factors caused obesity. Conservative participants who viewed images of overweight individuals were less likely than liberal participants to agree that social factors were responsible for causing obesity. In addition, among conservative participants who viewed images of fast food versus images of overweight individuals, agreement that the food industry bore some responsibility mediated support for policy solutions to obesity. These findings, among others, demonstrate that awareness of multilevel determinants of health outcomes can be a precursor of support for policy solutions to obesity among those not politically inclined to support antiobesity policy. In addition, stigmatizing images of overweight individuals in antiobesity campaigns might overemphasize the role of individual behavior in obesity at the expense of other factors.

COVID-19 vaccine messaging for young adults: Examining framing, other-referencing, and health beliefs.

OBJECTIVE: This study investigates the interaction between message framing and point-of-reference (self vs. others) for vaccine benefits on young adults' COVID-19 vaccine confidence and intentions. It also examines how COVID-19-related health beliefs-such as perceived severity of COVID-19 and perceived benefits of obtaining the vaccine to protect others-mediate these interactions. METHOD: In a 2 (framing: gain vs. loss) × 3 (reference point: self, others, university community) between-subjects experiment (Fall 2021), 202 participants ages 18-23 were shown animated messages with embedded manipulations to convey vaccine information. Moderated mediation models tested the conditional indirect effects of framing on vaccine confidence and intentions. RESULTS: Reference point significantly moderated the effect of framing on the perceived severity of COVID-19. More specifically, and somewhat contrary to previous literature, perceived severity was highest when messages emphasized gains for others. In turn, perceived severity correlated positively with vaccine confidence and intentions, resulting in a significant conditional indirect effect. Despite its positive relationship with COVID-19 vaccine confidence and intentions, perceived benefit to others was not a significant mediator. CONCLUSION: This study provides evidence for the role of reference point in moderating the effect of gain-loss message framing on COVID-19 vaccine attitudes and intentions. However, the findings differ from past research, suggesting other-gain messages may be an optimal strategy for promoting these vaccine outcomes for young adults. Overall, findings have implications for developing tailored messaging strategies that account for the nature of targeted populations and the evolving perceptions of the disease and its associated messaging campaigns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Messaging to prevent and reduce young adults' waterpipe tobacco smoking: A randomized trial.

INTRODUCTION: More than 10% of U.S. young adults have smoked waterpipe tobacco in the past month and >25% of those who have never smoked are susceptible. We tested messages designed to prevent and reduce waterpipe tobacco smoking (WTS). METHODS: In 2020, we recruited 830 U.S. young adults (18-30 years) who had never smoked waterpipe tobacco and were susceptible or currently smoked waterpipe tobacco for an online study. We randomized participants to intervention messages about the risks of WTS or control messages unrelated to tobacco. Participants had up to four message exposures over 12 weeks and completed two-, four-, and six-month follow-ups. Outcomes were WTS initiation and curiosity (susceptible never smokers), WTS frequency, cessation, motivation to quit (those who currently smoked), and WTS risk perceptions. RESULTS: Intervention messages increased perceived addictiveness of WTS at two months (ß = 0.27; 95% CI: 0.11, 0.43) in susceptible never smokers. There were no significant intervention effects in those who currently smoked. Exploratory analyses among intervention participants showed that higher dose of message exposure decreased WTS initiation at six months in susceptible never smokers (RR = 0.68; 95% CI: 0.48, 0.96) and decreased WTS frequency (IRR = 0.84; 95% CI: 0.73, 0.97) and increased cessation (RR = 1.31; 95% CI: 1.07, 1.59) at six months in those who smoked. CONCLUSIONS: Although the WTS intervention messages had few significant effects on outcomes overall, a higher dose of message exposure affected behavioral outcomes in the intervention arm. Findings highlight the need to identify effective message content and optimal message dose, especially for digital media campaigns.

An extension of the extended parallel process model to promote heart-healthy exercise behavior: An experimental study.

Background: The prevalence of heart disease has increased and is a leading cause of death in the U.S. Despite the importance of physical activity, only one-third of adults in the United States meet the amount of physical activity recommended by the Centers for Disease Control and Prevention (CDC). The purpose of this study was to extend the extended parallel process model (EPPM) by adding a 'barrier' (a construct from Health Belief Model) and exploring the roles of threat, efficacy, and barrier on participants' self-efficacy, attitudes, and intentions toward exercise. Methods: A between-subject experimental design was conducted online in 2018 in the U.S. A total of 446 participants were recruited from the Amazon Mechanical Turk age 18 or above. The participants were first provided with stimuli messages about physical activity behaviors. Then participants' responses to self-efficacy, intention, and attitudes toward exercise were assessed. Results: The results found an interaction between efficacy and barrier to participants' attitudes toward exercise [F(1,435)=4.35, P=0.038, η2 part=0.01]. The results also showed that there was a statistically significant effect of barriers on participants' self-efficacy regarding exercise behavior [F(1,442)=4.21, P=0.04, η2 part=0.009]. However, three-way interactions of threat, efficacy, and barrier were not found in attitudes or intentions to exercise. Conclusion: The findings suggested that addressing an individual's perceived barrier regarding a health behavior may lead to an increase in self-confidence ensuing in higher physical activity. Future studies should further explore how addressing barriers may influence other health behaviors to design unique and effective health messages.

How marijuana use status affects responses to anti-marijuana messages.

Background: The current study examined how cannabis use status impacts cognitive and emotional reactions to public health campaigns about cannabis, and the degree to which these reactions influence message likeability and attitudes about cannabis-related harms. Methods: In a between-subjects design, 252 subjects recruited via Amazon Mechanical Turk viewed six real-world cannabis education messages: three message themes (cognitive ability, driving, and health harms) from each of two real-world public campaigns. Subjects answered questions measuring their cognitive and emotional reactions to each message as well as message likeability and harm perceptions of cannabis. Analyses examined the mediating effects of message responsiveness on the association between baseline cannabis use (user vs non-user) with indices of liking and harm. Results: For all three message themes, informativeness ratings mediated the effect of cannabis user status on the outcomes of perceived harmfulness and message likeability. Specifically, cannabis users perceived cannabis as less harmful and reported all messages as less likeable compared to non-users, partly because they perceived the messages to be less informative than non-users. Surprisingly, users found some of the messages to be more pleasant, which was associated with increased perceptions of harm and message liking compared to non-users. Conclusions: Cannabis education campaigns that take into account differences in emotional and cognitive reactions by use experience, rather than use a "one size fits all" approach, could possibly maximally impact likeability and harm perceptions of these messages.

Cognitive and affective responses to marijuana prevention and educational messaging.

BACKGROUND: Perceptions of risk of using marijuana have decreased significantly in the US over the last decade, while marijuana use has increased. In order to educate people on the risks associated with marijuana use, large-scale health messaging campaigns have been deployed to educate the public about the risks associated with marijuana use, particularly in states where medical or recreational marijuana is legal. Few studies have examined how messages about marijuana affect the audiences' cognitive and emotional responsivity to these messages. METHODS: To address this knowledge gap, this study used psychophysiological assessment (heart rate, skin conductance, facial action coding) and self-report measures to explore the impact of different marijuana risk messages on real-time cognitive and affective responses and self-reported message receptivity, likeability, and intentions to use marijuana in a sample of 50 young adult marijuana users and non-users. Each participant saw six messages. Three messages were used from each of two campaigns, representing one of three risks (cognitive ability, driving, health harms). RESULTS: Psychophysiological responses showed that the driving-themed messages for both campaigns had the greatest cognitive resource allocation to encoding the message, the greatest arousal, and the most positive emotional response, regardless of user status. Self-reports showed a less consistent pattern. CONCLUSIONS: Overall, psychophysiological measures provided a more consistent picture of message processing and effects than self-report measures. Findings from this study provide immediately useful data for improving the development and effectiveness of marijuana health-risk prevention campaigns by elucidating cognitive and emotional processes that could be targeted in future programs.

Integrating Self-Report and Psychophysiological Measures in Waterpipe Tobacco Message Testing: A Novel Application of Multi-Attribute Decision Modeling.

BACKGROUND: Waterpipe (i.e., hookah) tobacco smoking (WTS) is one of the most prevalent types of smoking among young people, yet there is little public education communicating the risks of WTS to the population. Using self-report and psychophysiological measures, this study proposes an innovative message testing and data integration approach to choose optimal content for health communication messaging focusing on WTS. METHODS: In a two-part study, we tested 12 WTS risk messages. Using crowdsourcing, participants (N = 713) rated WTS messages based on self-reported receptivity, engagement, attitudes, and negative emotions. In an in-lab study, participants (N = 120) viewed the 12 WTS risk messages while being monitored for heart rate and eye-tracking, and then completed a recognition task. Using a multi-attribute decision-making (MADM) model, we integrated data from these two methods with scenarios assigning different weights to the self-report and laboratory data to identify optimal messages. RESULTS: We identified different optimal messages when differently weighting the importance of specific attributes or data collection method (self-report, laboratory). Across all scenarios, five messages consistently ranked in the top half: four addressed harms content, both alone and with themes regarding social use and flavors and one addiction alone message. DISCUSSION: Results showed that the self-report and psychophysiological data did not always have the same ranking and differed based on weighting of the two methods. These findings highlight the need to formatively test messages using multiple methods and use an integrated approach when selecting content.

Associations Between Exposure to The Real Cost Campaign, Pro-Tobacco Advertisements, and Tobacco Use Among Youth in the U.S.

INTRODUCTION: E-cigarette use is rising among youth. Advertising and anti-tobacco campaigns may be associated with the use of E-cigarettes and other tobacco products. This study examines the associations between tobacco use and exposure to The Real Cost's first campaign focusing on E-cigarettes. METHODS: Using the 2019 National Youth Tobacco Survey, a national survey of middle and high school students, the associations between exposure to The Real Cost anti-tobacco campaign, exposure to pro-tobacco advertising, and the use of tobacco products in the past 30 days (exclusive E-cigarettes, exclusive other tobacco use, and dual/poly use of E-cigarettes and other tobacco products) was examined. Other tobacco included anything but E-cigarettes. RESULTS: Participants (N=13,165) were aged 11-17 years. Exposure to The Real Cost campaign was associated with decreased odds of using other tobacco products (AOR=0.60, 95% CI=0.43, 0.84) and dual/poly use (AOR=0.77, 95% CI=0.63, 0.94) but not E-cigarette use. Greater E-cigarette advertising exposure was associated with increased odds of being an exclusive E-cigarette user (AOR=1.90, 95% CI=1.52, 2.30) or dual/poly user (AOR=1.69, 95% CI=1.31, 2.18). Greater exposure to other tobacco advertising was associated with increased odds of being a dual/poly user (AOR=1.32, 95% CI=1.01, 1.71) but lower odds of exclusive E-cigarette use (AOR=0.76, 95% CI=0.60, 0.97). CONCLUSIONS: Exposure to The Real Cost campaign was associated with decreased odds of using other tobacco products and dual/poly products. Exposure to pro-tobacco advertising was also associated with use. Future studies should assess the long-term effectiveness of anti-tobacco messaging.

Psychophysiological responses to hookah tobacco public education messages among young adults.

OBJECTIVE: Hookah tobacco use among young adults may be driven by misperceptions of health harms and addictiveness, appealing flavors, and social use. This study examined the effects of hookah prevention messages on participants' cognitive and emotional processing in a lab setting. METHOD: One hundred twenty participants (61 susceptible never-users, 59 current users) were exposed to messages representing six categories: health risks only, health risks of social use, health risks of flavors, addiction risks only, addiction risks of social use, and addiction risks of flavors. Guided by the Limited Capacity Model of Motivated Mediated Message Processing, participants' psychophysiological responses (heart rate, skin conductance, facial action coding) were recorded while participants viewed the messages. Recognition memory and counterarguing were measured postexposure. RESULTS: The combination of heart rate, skin conductance, both positive and negative facial action coding, and recognition memory indicated that social themed messages were more defensively processed than the other message types. Addiction-social messages, in particular, were least likely to be encoded. Further, defensive processing indicated by the psychophysiological and recognition data did not vary according to user status. Counterarguing was higher for users than for never-users across all message themes and risks. DISCUSSION: Messages about health risks and addiction, whether or not they included information on flavors, evoked relatively similar responses. But social themed messages stand out as potentially problematic, especially addiction-social messages. Using psychophysiological and self-report measures extend opportunities to identify optimal hookah tobacco public education message features. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Development and Pretesting of Hookah Tobacco Public Education Messages for Young Adults.

Young adults' hookah tobacco use is fueled by misperceptions about risks, appealing flavors, and social use. We developed and pretested public education messages to prevent and reduce hookah tobacco smoking among young adults. We used a two (user status: current hookah user, susceptible never user) by two (risk content: health harms or addiction) by three (message theme: harms/addiction risk alone, harms/addiction risk flavors, or harms/addiction risk social use) design with two messages/condition (n = 12 total messages). Young adults aged 18-30 (N = 713) were randomized to 1 of 12 messages and completed measures assessing message receptivity, attitudes, and negative emotional response. Harms messages were associated with greater receptivity (p < 0.001), positive attitudes (p < 0.001), and negative emotional response (p < 0.001) than addiction messages. Messages with harm or addiction content alone were associated with greater receptivity than social use-themed messages (p = 0.058). Flavor-themed messages did not differ in receptivity from harm or addiction content alone or social use-themed messages. Messages about the health harms of hookah tobacco use resonate more with young adults than addiction risk messages. Social use-themed messages produce the lowest receptivity. These findings can guide population-based approaches to communicate hookah tobacco risks to young adults.

People in E-Cigarette Ads Attract More Attention: An Eye-Tracking Study.

OBJECTIVES: Minimally regulated electronic cigarettes (e-cigarette) advertising may be one potential factor driving the increasing prevalence of young adult e-cigarette use. Using eye-tracking, the current study examined which e-cigarette advertising features were the most appealing to young adults as a first step to examine how e-cigarette advertising may be regulated. METHODS: Using a within-subjects design, 30 young adults (M age = 20.0 years) viewed e-cigarette ads in a laboratory. Ad features or areas of interest (AOIs) included: 1) brand logo, 2) product descriptor, and 3) people. During ad viewing, eye-tracking measured participants' dwell time and time to first fixation for each AOI as well as each ad brand. Harm perceptions pre- and post-viewing were measured. RESULTS: Participants spent the longest dwell time on people (M = 2701 ms), then product descriptors (M = 924 ms), then brand logos (M = 672 ms; ps < .001). They also fixated fastest on AOIs in that order. Participant sex significantly impacted dwell time of ad brand, and harm perceptions decreased after viewing the ads (ps < .05). CONCLUSIONS: This study provides initial evidence about which e-cigarette ad features may appeal most to young adults and may be useful when designing evidence-based policy.

The effects of frame, appeal, and outcome extremity of antismoking messages on cognitive processing.

Research on the impact of antismoking advertisements in countermarketing cigarette advertising is equivocal. Although many studies examined how different message appeal types influence people's attitudes and behavior, there have been few studies that have explored the mechanism of how individuals attend to and remember antismoking information. This study examined how message attributes of antismoking TV ads (frame, appeal type, and outcome extremity) interacted to influence people's attention (secondary task reaction time) and memory (recognition). Antismoking public service announcements were chosen that were either loss- or gain-framed, had either a health or social appeal, or had either a more or less extreme outcome described in the message. Among the key findings were that loss-framed messages with more extreme outcomes required the most processing resources (i.e., had the slowest secondary task reaction times) and were the best remembered (i.e., were best recognized). These findings indicate ways that different message attributes affect individuals' cognitive processing, and they are discussed in light of prior framing and persuasion research.

Scare' em or disgust 'em: the effects of graphic health promotion messages.

This study experimentally tested the effects of 2 types of content commonly found in anti-tobacco television messages-content focused on communicating a health threat about tobacco use (fear) and content containing disgust-related images-on how viewers processed these messages. In a 2 x 2 within-subjects experiment, participants watched anti-tobacco television ads that varied in the amount of fear and disgust content. The results of this study suggest that both fear and disgust content in anti-tobacco television ads have significant effects on resources allocated to encoding the messages and on recognition memory. Heart-rate data indicated that putting fear- or disgust-related content into anti-tobacco ads led to more resources allocated to encoding compared to messages without either feature. However, participants appeared to allocate fewer resources to encoding during exposure to messages featuring both fear and disgust content. Recognition was most accurate for messages that had either fear or disgust content but was significantly impaired when these 2 message attributes occurred together. The results are discussed in the context of motivated processing and recommendations about message construction are offered to campaign designers.

Perceived Effectiveness of Anti-Marijuana Messages in Adult Users and Nonusers: An Examination of Responses to Messages About Marijuana's Effects on Cognitive Performance, Driving, and Health.

OBJECTIVE: Marijuana use is associated with negative cognitive and health outcomes and risky driving. Given the rapidly changing policies regarding legal recreational and medicinal marijuana use, it is important to examine what types of marijuana prevention messages may be effective in minimizing such outcomes. This study examined cognitive and affective responses to anti-marijuana public health messages in a sample of adult marijuana users and nonusers to determine the correlates of perceived message effectiveness. METHOD: Participants (N = 203; mean age = 37.7 years) were adult marijuana users and nonusers recruited via Amazon Mechanical Turk (August 2017). After completing self-report measures of marijuana use, they viewed six anti-marijuana messages presented in a random order, addressing marijuana's effects in each of three topic areas: cognitive performance, driving, and adverse health outcomes (e.g., two messages per topic). Participants completed assessments of cognitive and affective perceptions after viewing each message. For each message topic, a linear regression model was used to determine which cognitive and affective perceptions were most predictive of perceived message effectiveness. RESULTS: For all message topics, nonusers perceived the messages as more effective than did users (p < .001). In the majority of analyses, greater message effectiveness was associated with increased perceived harm of marijuana and increased liking of the message. For driving and health messages, greater message effectiveness was also significantly correlated with lower pleasant affect. CONCLUSIONS: The findings suggest that audience perceptions may be uniquely predictive of message effectiveness, depending on the topic.