The Antecedents and Consequences of Interpersonal Communication during a School-based Health Intervention.

School-based health interventions often have limited and inconsistent effects. Although interpersonal communication likely is important, hardly any studies have investigated interpersonal communication of students with their friends, classmates, and parents about the health programs and health behaviors in school-based health interventions. In a two-wave prospective study of 389 adolescents focusing on three health behaviors (i.e., alcohol use, snack intake, and exercise), we addressed two aims. Our first aim was to investigate how student evaluations of a school-based health intervention influenced interpersonal communication about health behaviors (i.e., valence and frequency of conversations). Findings showed that positively evaluating a school-based health intervention increased how often students talked about the intervention with friends, classmates, and parents, as well as how they discussed the three health behaviors. Our second aim was to investigate the influence of interpersonal communication with friends, classmates, and parents on predictors of health behaviors. We found for conversational frequency that frequently discussing health behaviors resulted in healthier (more positive) predictors of exercise, but also in unhealthier (more positive) predictors of snacking and drinking. Furthermore, findings showed that positively discussing exercising, and negatively discussing snacking and drinking, resulted in healthier predictors of these behaviors. Our findings show that it is important to understand the impact of post-intervention communication and that post-intervention communication with peers and parents about health behaviors are predictors of health behavior.

The Intervening Role of Conversational Frequency and Valence in a School-Based Health Intervention.

School-based health interventions are potentially an effective method to communicate health messages to adolescents. Unfortunately, effectiveness of such interventions is limited. Research in other contexts has shown that interpersonal communication can influence the effectiveness of health programs, but this has not been thoroughly tested for school-based health interventions. Therefore, our study investigated interpersonal communication (i.e., conversational valence and frequency) in a school-based intervention context. We used a three-wave randomized-controlled trial with 1056 students to study three aims. The first aim was to investigate the influence of a health intervention on conversational frequency and valence about drinking, snacking, and exercising. Our second aim was to investigate the influence of conversational frequency and valence on (predictors of) drinking, snacking, and exercising. Our third aim was to investigate whether the health intervention indirectly influenced the program outcomes through conversational frequency and valence. Findings showed that conversational frequency and valence were related to (predictors of) the three behaviors. Additionally, findings showed that the intervention did not influence conversational frequency and valence. Accordingly, findings showed no indirect influence of the intervention on program outcomes through conversational frequency and valence. Our findings show the potential of interpersonal communication for health behaviors and predictors; however, they also stress the importance of a health intervention to properly influence interpersonal communication. If health interventions can successfully influence interpersonal communication, intervention effectiveness can be improved.

Intervening through Conversations: How Instructions Influence Conversational Valence and Binge Drinking Determinants.

A promising avenue for health behavior change is to influence conversational valence, that is, the extent to which people talk negatively or positively about health behaviors. However, no research to date has experimentally manipulated conversational valence, thereby inhibiting conclusions about causal inferences. This study aims to fill this gap by investigating the influence of conversational valence instructions on perceived conversational valence and subsequent binge drinking determinants. College students (N = 138) read either negative or positive conversational valence instructions. Subsequently, dyads engaged in a 5-min conversation about drinking, before self-reporting perceived conversational valence and binge drinking determinants (i.e., attitudes, norms, perceived behavioral control, and intentions). Results revealed that valence instructions influenced binge drinking determinants via perceived conversational valence. Those instructed to talk negatively about binge drinking reported healthier binge drinking determinants than those instructed to talk positively. Furthermore, this effect on binge drinking determinants was mediated by perceived conversational valence. These findings demonstrate that conversational valence about health can be manipulated through simple instructions and confirm the idea that conversational valence is causally linked to binge drinking determinants. Thereby, these findings show the potential that interpersonal communication in general, and conversational valence instructions, in particular, have when integrated in health interventions.

Causal Effects of Alcohol-Related Facebook Posts on Drinking Behavior: Longitudinal Experimental Study.

BACKGROUND: Adolescents and young adults frequently post alcohol-related content (ie, alcoholposts) on social media. This is problematic because both social norms theory and social learning theory suggest that viewing alcoholposts of peers could increase drinking behavior. It is therefore paramount to understand the effects of exposure to alcoholposts on viewers. OBJECTIVE: This study aimed to investigate the causal effects of exposure to alcoholposts on alcohol consumption by using a rigorous design. METHODS: We conducted a 6-week longitudinal study during which alcoholposts were measured by a newly developed app that copied Facebook posts shared by participants (n=281) to a new social media environment. In addition, daily questionnaires assessed alcohol use. Effects of natural alcoholposts (ie, posted by the participants) were assessed in phase 1, and effects of experimental posts (ie, posted by fake participants) were explored in phase 2. RESULTS: Results showed that natural alcoholposts increased the occurrence and quantity of drinking the following day. That is, exposure to a single additional alcoholpost increased the log odds of drinking the next day by 0.27 (b=.27, credible interval [CI] .18 to .35). Furthermore, the number of natural alcoholposts had a positive (predictive) effect on the number of glasses drunk the next day (b=.21, CI .14 to .29). In phase 2 when experimental posts were also present, these effects decreased. Experimental posts themselves had hardly any effects. CONCLUSIONS: This study illustrates clear and direct effects of exposure to alcoholposts on next-day alcohol consumption and suggests that alcoholposts represent an important societal problem that interventions need to address.

The interpersonal effects of distinct emotions in online reviews.

Emotional expressions in online reviews affect reviews' informative value. By comparing high and low arousal emotions with a negative and positive valence, the current research demonstrates that the effects of emotional expressions in online reviews are determined not by the level of arousal, but by the perceived rationality of the reviewer and the perceived appropriateness of the emotional expression. In a lab experiment (N = 242) among university students, and an online experiment (N = 252) on Prolific Academic involving native English speakers, participants read an online restaurant review with the negative emotions anger, disappointment, or disgust, or with the positive emotions happiness, excitement, or contentment. Results showed that readers of online reviews considered expressions of anger more inappropriate than expressions of disappointment or disgust; this led them to judge the reviewer as more irrational, which decreased the informative value of the review. As a consequence, angry reviews led to less negative restaurant evaluations and stronger intentions to visit the restaurant than reviews expressing disappointment or disgust. We found no differences between contentment and happiness (Study 1), or between contentment and excitement (Study 2). Our findings underscore the importance of studying the effects of discrete emotions in online reviews.

Is Involvement a Good Thing? The Undesirable Consequences of Topical and Conversational Involvement in the Context of Alcohol Consumption.

Whereas there is evidence that interpersonal communication, or conversation, influences predictors of alcohol consumption, the role of involvement in conversation effects remains unclear. This study explored how three aspects of involvement (topical relevance, or how relevant the topic of alcohol is; conversational relevance, or how relevant a conversation about alcohol is; and conversational effort, or how much effort people put into such a conversation), influence conversation effects. After assessing topical relevance, 46 same-sex dyads were requested to talk about the negative consequences of heavy drinking. Within each dyad, one participant was asked to take on an active talking role and the other participant a passive listening role. Next, conversational relevance, effort, and predictors of heavy drinking were measured. Results showed that participants who drank more alcohol found the topic of heavy drinking more relevant. This topical relevance increased conversational relevance and conversational effort. Conversational effort further increased when a talking role was assigned. Furthermore, participants who put more effort in the conversation and found it more relevant had more positive norms, identified more strongly with alcohol, and had higher intentions to drink. These findings suggest that more involvement in an alcohol-related conversation does not always lead to desirable outcomes.

How Viewing Alcohol Posts of Friends on Social Networking Sites Influences Predictors of Alcohol Use.

Young adults are frequently exposed to alcohol posts from their friends on social networking sites, and little research has investigated the influences of these posts on alcohol use. Therefore, this study investigated how exposure to alcohol posts influenced determinants of alcohol use, and whether alcohol posts of close friends influenced these determinants more strongly compared to alcohol posts of distant friends. Students from Dutch universities (N = 210) participated in an experiment with a 2 (post condition: alcohol or neutral) x 2 (friend condition: close or distant) between-subjects design. Participants that were exposed to alcohol posts reported higher intention to use alcohol, F(1, 204) = 4.32, p =.039, willingness to use alcohol, F(1, 204) = 8.15, p =.005, and more positive affective attitudes about alcohol, F(1, 204) = 5.84, p =.017, than participants that were exposed to neutral posts. Additionally, participants who viewed alcohol posts of close friends reported more positive affective attitudes about alcohol compared to participants who viewed alcohol posts of distant friends, F(1, 204) = 5.15, p =.024. Developers of health interventions could use these findings to raise awareness about the unhealthy influences of alcohol posts on determinants of young adults' alcohol use.

A Laughing Matter? How Humor in Alcohol Ads Influences Interpersonal Communication and Persuasion.

Exposure to alcohol ads increases alcohol consumption. A potential partial explanation is that certain (e.g., humorous) alcohol ads trigger conversations which can, in turn, increase drinking behaviors. Therefore, we investigated the influence of humor in alcohol ads on conversational occurrence, length, and valence about alcohol and alcohol ads. One hundred and fourteen participants were shown one of three beer ads (humor; positive; no ad), after which participants could voluntarily discuss the ad and alcohol. Next, all participants were requested to discuss the topic and answered a questionnaire assessing conversational valence and ad, brand, and alcohol evaluations. Results showed that humor leads to more conversations about the ad and alcohol, longer conversations about alcohol, and more positive conversations about the ad. This interpersonal communication, and especially conversational valence, was subsequently related to ad, brand, and alcohol evaluations. These findings may explain the effect of alcohol ads on alcohol consumption, and provide important starting points for using humor as a potentially effective behavior change tool.

Vocational Community College Students' Conversations about Binge Drinking.

The large amount of vocational community college students that continue showing binge-drinking behavior might be an indication that interventions targeting this behavior have not been hugely successful. It might be that these interventions targeted beliefs that are less or not related with vocational community college binge-drinking behavior. The aim of this study was to identify vocational community college students` salient beliefs about binge drinking. In the context of the integrative model of behavioral prediction, we applied deductive qualitative content analysis of conversations about binge drinking. The analysis of vocational community college students` conversations about binge drinking revealed a significant amount of salient beliefs, such as cognitive and affective outcome beliefs and efficacy beliefs. These beliefs may be important indicators of vocational community college students` binge drinking. Moreover, to our knowledge, this study was the first to reveal a new set of beliefs, namely social judgment beliefs (i.e., vocational community college students` judgments about their peers` binge-drinking behavior). We believe that our study yielded salient beliefs that may serve as input for future interventions targeting binge drinking among vocational community college students.

Is It More Feeling or Thinking? The Influence of Affective and Cognitive Attitude on Adolescents' Intention to Engage in Binge Drinking.

Previous work has revealed that interventions aiming to reduce adolescent binge drinking commonly focus on cognitive attitudes, but are insufficiently effective in changing binge-drinking intentions. The focus on these cognitive attitudes might be the reason for this insufficient success. That is, other work has revealed that affective attitudes have a stronger influence on binge-drinking intention than cognitive attitudes. However, this relation has so far only been found among traditional college students and pre-vocational school students, therewith neglecting another important population at risk, namely vocational community college students. This study examines whether affective attitudes are also significantly stronger influencers of binge-drinking intentions among vocational community college students. Using a sample of 298 vocational community college students (Mage = 17.63), the current study shows that affective attitudes were more strongly related to vocational community college students' intention to engage in binge drinking than cognitive attitudes. This finding indicates that the effectiveness of interventions targeting adolescent binge drinking can be improved by incorporating content elements concerning affective attitudes.

Social Drinking on Social Media: Content Analysis of the Social Aspects of Alcohol-Related Posts on Facebook and Instagram.

BACKGROUND: Alcohol is often consumed in social contexts. An emerging social context in which alcohol is becoming increasingly apparent is social media. More and more young people display alcohol-related posts on social networking sites such as Facebook and Instagram. OBJECTIVE: Considering the importance of the social aspects of alcohol consumption and social media use, this study investigated the social content of alcohol posts (ie, the evaluative social context and presence of people) and social processes (ie, the posting of and reactions to posts) involved with alcohol posts on social networking sites. METHODS: Participants (N=192; mean age 20.64, SD 4.68 years, 132 women and 54 men) gave researchers access to their Facebook and/or Instagram profiles, and an extensive content analysis of these profiles was conducted. Coders were trained and then coded all screenshotted timelines in terms of evaluative social context, presence of people, and reactions to post. RESULTS: Alcohol posts of youth frequently depict alcohol in a positive social context (425/438, 97.0%) and display people holding drinks (277/412, 67.2%). In addition, alcohol posts were more often placed on participants' timelines by others (tagging; 238/439, 54.2%) than posted by participants themselves (201/439, 45.8%). Furthermore, it was revealed that such social posts received more likes (mean 35.50, SD 26.39) and comments than nonsocial posts (no people visible; mean 10.34, SD 13.19, P<.001). CONCLUSIONS: In terms of content and processes, alcohol posts on social media are social in nature and a part of young people's everyday social lives. Interventions aiming to decrease alcohol posts should therefore focus on the broad social context of individuals in which posting about alcohol takes place. Potential intervention strategies could involve making young people aware that when they post about social gatherings in which alcohol is visible and tag others, it may have unintended negative consequences and should be avoided.

Online and Offline Conversations About Alcohol: Comparing the Effects of Familiar and Unfamiliar Discussion Partners.

Although research has demonstrated that interpersonal communication about alcohol influences drinking behaviors, this notion has mainly been examined in offline contexts with familiar conversation partners. The present study investigated how communication mode and familiarity influence conversational valence (i.e., how negatively or positively people talk) and binge drinking norms. During a 2 (offline vs. online communication) × 2 (unfamiliar vs. familiar conversation partner) lab experiment, participants (N = 76) were exposed to an anti-binge drinking campaign, after which they discussed binge drinking and the campaign. Binge drinking norms were measured 1 week before and directly after the discussion. Results revealed that conversations between unfamiliar conversation partners were positive about the campaign, especially in offline settings, subsequently leading to healthier binge drinking norms. We recommend that researchers further investigate the influence of communication mode and familiarity on discussion effects, and we suggest that health promotion attempts might benefit from eliciting conversations about anti-binge drinking campaigns between unfamiliar persons.

Subjective Reality: The Influence of Perceived and Objective Conversational Valence on Binge Drinking Determinants.

Previous studies have shown that interpersonal communication, and particularly perceived conversational valence (i.e., the perceived negativity or positivity of conversations) about health topics, influences health determinants. On the basis of 43 dyads (N = 86) discussing the topic of alcohol consumption, this study is the first to show that whereas perceived and objective conversational valence are positively related, only perceived conversational valence is a significant predictor of binge drinking attitudes and intentions. Thus, subjective reality matters more than objective reality. Furthermore, only the perceived valence of the participants' own contributions-and not of their conversation partners--influences binge drinking intentions, indicating that self-persuasion is more influential than persuasion by others. Thus, conversations in which discussants themselves express negative opinions about unhealthy behaviors can enhance public health.

Predicting health: the interplay between interpersonal communication and health campaigns.

The present study experimentally investigated the interplay between interpersonal communication and health message exposure in relation to alcohol consumption intentions. Participants were 174 students who took part in a study on the effects of an antialcohol message. At baseline, the authors assessed intention to refrain from binge drinking. At the second wave (2 weeks later), participants were assigned to the conditions of a 2 (antialcohol message or no-alcohol message) × 2 (alcohol conversation or control conversation) between-subjects design, after which intention was again assessed. Results showed that when participants talked about alcohol (instead of the control topic) and were not exposed to an antialcohol message, they were less inclined to refrain from binge drinking, an effect that was not visible when participants talked about alcohol after viewing an antialcohol message. These findings suggest that health campaign exposure moderates the influence of interpersonal communication on health variables.

Changing the conversation: the influence of emotions on conversational valence and alcohol consumption.

Health campaign effects may be improved by taking interpersonal communication processes into account. The current study, which employed an experimental, pretest-posttest, randomized exposure design (N = 208), investigated whether the emotions induced by anti-alcohol messages influence conversational valence about alcohol and subsequent persuasion outcomes. The study produced three main findings. First, an increase in the emotion fear induced a negative conversational valence about alcohol. Second, fear was most strongly induced by a disgusting message, whereas a humorous appeal induced the least fear. Third, a negative conversational valence elicited healthier binge drinking attitudes, subjective norms, perceived behavioral control, intentions, and behaviors. Thus, health campaign planners and health researchers should pay special attention to the emotional characteristics of health messages and should focus on inducing a healthy conversational valence.

Dealing with Alcohol-Related Posts on Social Media: Using a Mixed-Method Approach to Understand Young Peoples' Problem Awareness and Evaluations of Intervention Ideas.

Young individuals frequently share and encounter alcohol-related content (i.e., alcohol posts) on social networking sites. The prevalence of these posts is problematic because both the sharing of and exposure to these posts can increase young individuals' alcohol (mis)use. Consequently, it is essential to develop effective intervention strategies that hinder young individuals from sharing these posts. This study aimed to develop such intervention strategies by following four steps: (1) assessing young individuals' problem awareness of alcohol posts, (2) unraveling individuals' own intervention ideas to tackle the problem of alcohol posts, (3) examining their evaluations of theory/empirical-based intervention ideas, and (4) exploring individual differences in both problem awareness and intervention evaluations. To reach these aims, a mixed-method study (i.e., focus-group interviews and surveys) among Dutch high-school and college students (Ntotal = 292, Agerange = 16-28 years) was conducted. According to the results, most youth did not consider alcohol posts to be a problem and were, therefore, in favor of using automated warning messages to raise awareness. However, these messages might not work for every individual, as group differences in problem awareness and intervention evaluations exist. Overall, this study puts forward potential intervention ideas to reduce alcohol posts in digital spheres and can therefore serve as a steppingstone to test the actual effects of the ideas.

Social Media Use and Alcohol Consumption: A 10-Year Systematic Review.

Many studies have looked at the relationship between social media and alcohol consumption. There is a need for a comprehensive review that synthesizes the results of past research to systematically understand the relationship between social media use and alcohol consumption. The present systematic literature review synthesizes the findings from global social media and alcohol use studies (n = 206, 204 retained for analysis) between 2009 and 2019. Codes included type of study, methods, use of theory, and whether and how the relationship between social media and alcohol use was tested, among others. In addition to providing descriptive findings, the current study compared the findings across studies that primarily focused on advertising and marketing, self-generated user-generated content (UGC), other-generated UGC, social media uses and affordances, and a mixture of more than one type of content/focus. Most articles used quantitative methods (77.94%), which is followed by qualitative methods (15.20%), mixed methods (6.37%), and 0.49% that did not fit in any of the methods categories. Of the studies that tested the relationship between social media use and alcohol consumption, an overwhelming majority found that relationship to be positive (93.10%). The results of the present study provide a comprehensive understanding of past findings regarding social media and alcohol consumption and provide important future research suggestions.

A Prospective Longitudinal Cohort Study of College Students' Alcohol and Abstinence Displays on Social Media.

PURPOSE: The past decade has seen tremendous growth in research focused on understanding college students' alcohol-related social media displays. However, longitudinal studies remain rare. The purpose of this 5-year study was to describe alcohol and abstinence display patterns on Facebook. METHODS: This prospective longitudinal cohort study recruited incoming 17- to 19-year-old college students from two universities upon entering college. Trained coders evaluated Facebook profiles monthly over five years to identify alcohol and abstinence displays. Alcohol displays were further categorized as general alcohol use or intoxication/problem drinking references. Analyses included multivariate negative binomial regression. RESULTS: Among 338 participants recruited (mean age = 18.4, SD = .6), 56.1% were female, 74.8% were Caucasian, and 58.8% were from the Midwest college. General alcohol use references were most common in the spring semester of the third year (mean = 3.9 displays; 95% CI: 3.21-4.73), these often included references to a "21 run." Intoxication/problem drinking references were most common in spring semester of the first year (mean = .79 displays, 95% confidence interval: .56-1.10) and second year of college (mean = .77 displays, 95% confidence interval: .54-1.11). There were no gender differences associated with alcohol displays at any time point. Abstinence displays were rare and declined in frequency to a low of four total displays in year 5. CONCLUSIONS: This 5-year study is the first to document patterns of alcohol and abstinence displays throughout the undergraduate experience. Findings may inform planning targeted interventions by time point, or longitudinal studies of other substances or on different platforms.

Reliable or not? An automated classification of webpages about early childhood vaccination using supervised machine learning.

OBJECTIVE: To investigate the applicability of supervised machine learning (SML) to classify health-related webpages as 'reliable' or 'unreliable' in an automated way. METHODS: We collected the textual content of 468 different Dutch webpages about early childhood vaccination. Webpages were manually coded as 'reliable' or 'unreliable' based on their alignment with evidence-based vaccination guidelines. Four SML models were trained on part of the data, whereas the remaining data was used for model testing. RESULTS: All models appeared to be successful in the automated identification of unreliable (F1 scores: 0.54-0.86) and reliable information (F1 scores: 0.82-0.91). Typical words for unreliable information are 'dr', 'immune system', and 'vaccine damage', whereas 'measles', 'child', and 'immunization rate', were frequent in reliable information. Our best performing model was also successful in terms of out-of-sample prediction, tested on a dataset about HPV vaccination. CONCLUSION: Automated classification of online content in terms of reliability, using basic classifiers, performs well and is particularly useful to identify reliable information. PRACTICE IMPLICATIONS: The classifiers can be used as a starting point to develop more complex classifiers, but also warning tools which can help people evaluate the content they encounter online.

Conversations about binge drinking among vocational community college students: the relation with drinking attitudes and intentions and the moderating role of conversation partner popularity.

Objective: The association between conversational valence (i.e. how positive/negative people perceive their conversations to be) and binge-drinking attitudes and intentions has been well established. However, too few studies have recognised a potential reciprocal association as well as the potential role of the conversation partner. In order to address these gaps, this study explored whether conversational valence and binge-drinking attitudes and intentions were reciprocally associated and whether this association was moderated by conversation partner popularity. Design: Vocational community college students (N = 112, Mage = 18.09) participated in a two-wave study (one month between the waves). Methods. Binge-drinking attitudes and intentions, and popularity were measured at baseline. At the second wave, conversational valence, and binge-drinking attitudes and intentions were assessed. Results: In revealing that only conversational valence was indicative of binge-drinking attitudes and intentions, it was shown that conversational valence and binge-drinking attitudes and intentions were not reciprocally associated. Furthermore, it was shown that conversation-partner popularity moderated the association between conversational valence and binge-drinking attitudes. Conclusion: Conversational valence was shown to be indicative of binge-drinking attitudes and intentions, and not vice versa. Furthermore, after talking to a popular conversation partner, adolescents' attitudes towards binge drinking became more positive.