Valence of YouTube Comments and College Student Reactions Towards Electronic Nicotine Product Counter-Marketing Messages.

Advertisements promoting and discouraging electronic nicotine products (ENPs) are widespread on social media. User interaction is a hallmark feature of social media sites. This study examined how user-comment valence (i.e. positive versus negative comments) influences attitudes toward counter-marketing ads, and determinants of ENP abstinence according to the theory of planned behavior (TPB). College students were randomly assigned to one of three conditions, a positive comment condition (n = 121), in which they were shown a YouTube comment section with eight positive comments and two negative comments; a negative comment condition (n = 126), in which they were shown a YouTube comment section with eight negative and two positive comments; and a control condition (n = 128). Then, all groups were shown a YouTube video advocating for ENP abstinence and completed measures about their attitudes toward the ad (Aad), attitudes toward ENP abstinence, injunctive and descriptive norms about ENP abstinence, perceived behavioral control (PBC) toward ENP abstinence, and intention to abstain from ENPs. Results indicated that exposure to negative comments yielded significantly less favorable Aad when compared to the positive condition, but no difference in Aad was observed between the negative and control conditions, or between the positive and control conditions. Further, there were no differences for any determinants of ENP abstinence. Additionally, Aad mediated the effects of negative comments on attitudes toward ENP abstinence, injunctive norms and descriptive norms about ENP abstinence, and behavioral intention. Findings indicate that negative user comments depress attitudes toward counter-persuasion ads targeting ENP use.

Death walks into a bar: Humor and profanity in advance care planning messages.

Although scholars note advantages and disadvantages to using humor and profanity, influential leaders in the Death Positive Movement (DPM) use both message features to motivate end-of-life (EOL) advance care planning (ACP). Through the lens of expectancy violations theory (EVT), this study examined relationships between perceived humor, profanity in messages, trait profanity use in receivers, perceived offensiveness, perceived speaker effectiveness, and perceived message effectiveness. Participants (N = 604) were randomly exposed to a podcast about ACP containing clean humor, profane humor, or no humor. Results indicated that profanity and perceived humor were positively related to offensiveness, and offensiveness was negatively related to perceived speaker and message effectiveness. When perceived as non-offensive, perceived humor was positively related to perceived speaker and message effectiveness. Surprisingly, profane messages offended profane receivers more than they offended less-profane receivers. These results suggest that to be maximally effective, ACP motivators should use humor cautiously and avoid profanity.

Social Support and Aggressive Communication on Social Network Sites during the COVID-19 Pandemic.

During the COVID-19 pandemic, use of social networking sites (SNSs) surged in many countries, including the United States. This content analysis of a convenience sample of English language conversations examined how users sought and provided social support on three Western-dominated SNSs, Reddit (N = 100), YouTube (N = 100), and Facebook (N = 100), during the week following the declaration of COVID-19 as a pandemic. In addition to analyzing social support, this study examined aggressive communication, which often leads to undesirable mental health outcomes, on Reddit, YouTube, and Facebook during this period. According to the Social Identity Model of Individuation Effects (SIDE), anonymous environments which codify civil communication norms are more likely to yield prosocial behavior. Results indicate that Reddit, YouTube, and Facebook varied significantly in supportive and aggressive communication prevalence. Reddit users more frequently provided social support than did YouTube and Facebook users. Additionally, Reddit users engaged in aggressive communication significantly less than both YouTube and Facebook users. These findings support predictions from the SIDE model, as Reddit both offers users greater anonymity than YouTube and Facebook and codifies supportive, civil communication norms in a rules system called, "Reddiquette."

COVID-19 Risk Perceptions and Intentions to Engage in Familial Advance Care Planning: The Mediating Role of Death Anxiety.

Advance care planning (ACP) is the process of communicating about end-of-life (EOL) care with loved ones. Due to the deadly nature of COVID-19, ACP is vital. Unfortunately, fewer than 30% of American patients engage in ACP. In addition to low motivation, people experiencing death anxiety (DA) similarly avoid ACP.  This finding coincides with predictions from terror management theory (TMT) that people avoid DA-arousing behaviors. Guided by the theory of planned behavior (TPB) and the health belief model (HBM), we posited COVID-19 risk perceptions would be positively associated with determinants of health behavior, including intention to share and ask loved ones about EOL wishes, as well as the associated attitudes, norms, and level of perceived behavioral control regarding ACP. Guided by TMT, we posited that DA negatively mediated relationships between COVID-19 risk perceptions and these behavioral determinants. An MTurk participant sample (N = 522) completed a survey about COVID-19 risk perceptions, DA, and health behavior determinants in the context of ACP. Results indicate COVID-19 risk perceptions were rarely directly related to these determinants. However, results of PROCESS mediation models examining the role of DA in these relationships reveal a different picture. While direct relationships were rarely significant, DA negatively mediated most relationships between COVID-19 risk perceptions and behavioral determinants. Our results indicate DA demotivates EOL communication during the COVID-19 pandemic; a concerning yet important finding due to the increased importance of ACP in the context of a deadly disease like COVID-19.

Benefit, Barrier, and Self-Efficacy Messages in Advance Care Planning Education Materials.

Advance care planning patient education materials are informational tools intended to empower patients to engage in preventative behaviors relevant to end-of-life decision-making. Fewer than 30% of patients engage in advance care planning (ACP) and little is known about specific messages relevant to health behavior change in ACP education materials. Using the Health Belief Model as a framework, this study used content analysis to examine both manifest and latent message content in ACP education materials (N = 58), focusing specifically on benefit, barrier, and self-efficacy messages. Results indicated that education materials lack unique, specific benefit, barrier, and self-efficacy messages, which may lower patients' motivation and self-efficacy with regard to ACP. Based on these findings, recommendations for designing ACP education materials in medical organizations are made.

Worry as a Mechanism to Motivate Information Seeking about Protective End-of-Life Communication Behaviors.

Making known one's end-of-life (EOL) care wishes via the processes of advance care planning (ACP) and advance directive (AD) completion is associated with many positive outcomes for patients including lower healthcare costs, greater patient-provider relationship satisfaction, increased quality of life, and more. Despite these benefits, fewer than 30% of patients in the United States engage in ACP or complete ADs. These low numbers are most likely due to several causes, including low self-efficacy and low motivation to engage in the process. Several researchers have examined the persuasive power of using worry to motivate patients to engage in preventive health behaviors. The present study expands upon this body of literature by examining patient intentions to seek information related to ACP and AD after being exposed to stimuli intended to arouse differing levels of worry regarding bad EOL outcomes. Participants (N = 804) were randomly assigned to either the high worry, low worry, or control group and asked to complete a questionnaire examining beliefs and information seeking intentions regarding ACP and AD completion. Additionally, to control for participants' level of trait worry, each participant completed the Penn State Worry Questionnaire, which was treated as a covariate in the final analysis. A repeated measures MANCOVA found a statistically significant increase for the worrying conditions on the participants' intention to seek information about ACP and ADs from time 1 to time 2 for those in the worry experimental conditions. However, those in the control group did not show a statistically significant increase. Additionally, exposure to the high worry condition was predictive of engaging in actual information seeking behavior about EOL care. Results of the experiment indicate worry is associated with greater motivation to engage in information seeking about ACP and AD. This study contributes to the literature on worry as a persuasive mechanism to motivate patients to engage in important preventative health behaviors.