Trust and Coping Beliefs Contribute to Racial Disparities in COVID-19 Vaccination Intention.

Racial disparities in intention to obtain the COVID-19 vaccination have been noted in academic and popular press reports. The present study sought to identify cognitive and affective factors that contribute to the observed lack of acceptance of COVID-19 vaccination, even before a vaccine was made publicly available, among Black and White Americans through a national survey (N = 487; 50.6% female, 24.8% Black). Our findings are consistent with previous studies that Black respondents had lower intention to obtain the eventual COVID-19 vaccine than White respondents. Protection motivation theory's construct of coping efficacy and an additional COVID-19-relevant variable, trust in vaccination, mediated the effect of race on behavioral intention. Lastly, beliefs were elicited from Black and White Americans to identify communication strategies regarding the issue.

Portrayals of Vaccination in Entertainment Television: A Content Analysis.

Entertainment media have been found to influence viewers' health perceptions and behaviors, yet little is currently known about how vaccination, an issue that has become controversial, is being portrayed in fictional television. The present study combined constructs from the health belief model and entertainment theory to conduct a quantitative content analysis of 51 television episodes released in 2000 or after. Results indicate that vaccination is portrayed in a variety of different program types including, but not limited to, medical dramas. The tone of vaccination portrayals was mostly positive across the episodes examined. Episodes with a positive vaccination tone tended to have more information than those presenting vaccination negatively, but overall there was little information provided. Pro-vaccination characters tended to be cast as the protagonists in a main starring role, whereas anti-vaccination characters played supporting characters, typically as parents making vaccination decisions for their children. The majority of episodes featured anti-vaccination arguments, such as those perpetuating the link between vaccines and autism.

Patient Perceptions of Illness Identity in Cancer Clinical Trial Decision-Making.

When patients are diagnosed with cancer, they begin to negotiate their illness identity in relation to their past and future selves, their relationships, and their group memberships. Thus, how patients view their cancer in relation to their other identities may affect how and why they make particular decisions about treatment options. Using the Communication Theory of Identity (CTI), the current study explores: (1) how and why illness identity is framed across identity layers in relation to one particular cancer treatment: participation in a cancer clinical trial (CT); and (2) how and why patients experience identity conflicts while making their treatment decisions. Semi-structured, in-depth interviews were analyzed for 46 cancer patients who were offered a CT. Results of a grounded theory analysis indicated that patients expressed separate identity frames (e.g., personal, relational, and communal), aligned identity frames (e.g., personal and communal), and identity conflicts (e.g., personal-personal). This study theoretically shows how and why patient illness identity relates to cancer treatment decision-making as well as how and why patients relate (and conflict) with the cancer communal identity frame. Practical implications include how healthcare providers and family members can support patient decision-making through awareness of and accommodating to identity shifts.

The Role of Health Care Provider and Partner Decisional Support in Patients' Cancer Treatment Decision-Making Satisfaction.

Cancer patients rely on multiple sources of support when making treatment decisions; however, most research studies examine the influence of health care provider support while the influence of family member support is understudied. The current study fills this gap by examining the influence of health care providers and partners on decision-making satisfaction. In a cross-sectional study via an online Qualtrics panel, we surveyed cancer patients who reported that they had a spouse or romantic partner when making cancer treatment decisions (n = 479). Decisional support was measured using 5-point, single-item scales for emotional support, informational support, informational-advice support, and appraisal support. Decision-making satisfaction was measured using Holmes-Rovner and colleagues' (1996) Satisfaction With Decision Scale. We conducted a mediated regression analysis to examine treatment decision-making satisfaction for all participants and a moderated mediation analysis to examine treatment satisfaction among those patients offered a clinical trial. Results indicated that partner support significantly and partially mediated the relationship between health care provider support and patients' decision-making satisfaction but that results did not vary by enrollment in a clinical trial. This study shows how and why decisional support from partners affects communication between health care providers and cancer patients.

Teens' Reactance to Anti-Smoking Public Service Announcements: How Norms Set the Stage.

Data from a study of the effects of anti-smoking ads were analyzed. This study measured the accessibility of peer and parent norms for smoking, exposed teens to three anti-smoking ads that either emphasized personal narratives of the dangers of smoking or had a surprise ending, and measured reactance to the messages. Readiness to smoke was assessed via a phone survey 3 months later. The accessibility of pro-smoking peer norms increased readiness to engage in smoking behavior through reactance toward anti-smoking messages. The accessibility of parent norms was unrelated to reactance. Reactance was particularly strong when the ads included a surprise ending. Peer norms that oppose smoking, particularly if they can be brought to mind quickly, are an important protective factor in that they may reduce reactance to anti-smoking messages.

How neuroticism affects responses to anti-smoking messages.

The effect of trait neuroticism on college students' (n=200) responses to anti-smoking public service announcements (PSAs) was examined using a 2 (neuroticism: high vs. low) × 3 (message type: personal testimony, secondhand smoke, and informative) × 3 (message: nested within message type) design. We hypothesized that those high in neuroticism would be avoidant toward anti-smoking messages, have quicker and stronger negative reactions and perceive the messages as more biased and less involving. As hypothesized, those high in neuroticism were more likely to want to avoid thinking about smoking as a function of viewing the messages and more likely to see messages as biased; however, neuroticism did not affect judgments of message involvement. Tobacco use and gender also affected message bias and avoidance. Those scoring high in neuroticism also responded quicker to negative emotion assessments to messages. Implications for the importance of neuroticism in message design and message processing research are discussed.

Racism and Professional Competence: Nursing Students in Interracial Evaluations.

BACKGROUND: This pilot study examined the association of internal and external motivation of White nursing students to avoid appearing racist while interacting with standardized patients in a simulation-based learning experience (SP-SBLE). The influence of nursing students' preexisting motivations to avoid racism were examined for their effect on clinical performance in their SP-SBLE. METHOD: White nursing students (N = 50) completed measures of motivations to avoid racism prior to their end of semester practical examination. Students were then randomly assigned to an SBLE with a SP portraying chest pain. RESULTS: White students interacting with White SPs performed better than White students interacting with Black SPs. CONCLUSION: Concern about appearing racist may interfere with White students' ability to perform well in a clinical setting because it may draw cognitive resources away from the clinical task. This is a first step in understanding how nursing students' perceptions may contribute to racial inequities in health. [J Nurs Educ. 2022;61(1):41-45.].

Social determinants of flu vaccine uptake among racial/ethnic minorities in the United States.

Research on the social determinants of vaccine uptake often occur between racial/ethnic groups and not within groups. Though minoritized individuals face inequalities across the board, these are also not evenly distributed amongst minoritized individuals within groups. Using the National Health Interview Survey data, we examined disparities in flu vaccine uptake across racial/ethnic groups in the United States (US). We examined (a) NH (non-Hispanic) White (n = 32,655), (b) NH Asian (n = 2335), (c) NH African American (n = 5137), and (d) Hispanic (n = 5718) respondents who lived in the United States using the combined 2017 and 2018. We used multivariable logistic regression to predict flu vaccination (yes/no) both in models comparing racial/ethnic groups and within groups. Less than 50% of any of the four major racial/ethnic groups in the US received a flu vaccination in 2017-18. Flu vaccine uptake varied within racial and ethnic groups. These results suggest that increasing vaccination may require a complex, multi-faceted perspective that considers subgroups more directly.

Predicting College Student Drinking and Smoking Intentions With Cognitively Accessible Attitudes and Norms.

Understanding the factors that make college students more likely to drink alcohol and smoke cigarettes is key to developing effective interventions in order to reduce these behaviors. This study sought to understand entering college students' intentions to engage in smoking and drinking behavior by examining the cognitive accessibility (ease of retrieval from memory) of attitudes and norms for drinking. A sample of 413 first-year college students living in on-campus residence halls participated in the study in the first 2 weeks of their first semester of college. Reaction time measures of attitudes and norms assessed the cognitive accessibility of these constructs. Hierarchical linear regression analysis was conducted. Results indicated that the cognitive accessibility of both attitudes and peer injunctive norms predicted behavioral intentions to drink and smoke. Our findings indicate that when injunctive peer norms are accessible from memory, they are better predictors of drinking and smoking intentions than descriptive norms or injunctive family norms. Our work provides important guidance for interventions to reduce risky behavior in college students and suggests that emphasizing social costs of these behaviors may be a promising strategy.

Prototypes of drinkers and accessibility of injunctive norms predict college drinking.

A self-report survey of first-year college students ( n = 421; 46% female) included measures of perceived prototype, attitude and injunctive norm accessibility, past drinking behavior, and future drinking intention. Both norm accessibility and prototype perception were significant predictors of intention to drink in the future among first-year college students. The effect of prototypes on drinking diminished as pro-drinking norms became more accessible, indicating greater automaticity of drinking decision-making. Theoretical models of drinking intention should include both normative constructs and prototypes. Implications for interventions to reduce college student drinking are discussed.

Age and gender differences in risky driving: the roles of positive affect and risk perception.

A phone survey of 504 teen (age 16-20) and 409 adult (age 25-45) drivers in the US state of Alabama was conducted to examine the relationships among risk perception, positive affect and risky driving. Male drivers reported engaging in risky driving behaviors more frequently than female drivers and teen drivers reported engaging in risky driving behaviors more frequently than adult drivers. Positive affect (liking for risky driving behaviors) and perceived risk mediated the relationships of age and gender with risky driving. Affect and risk perception were independent predictors of risky driving behavior. Interactions of positive affect and perceived risk with gender and age showed that positive affect more strongly predicted risky driving for teen and male drivers than for adult and female drivers. These findings are interpreted in the context of dual process models of behavioral decision making. Future research into interventions designed to moderate the positive affect surrounding driving may have promise for reducing risky driving behavior.

Eliminating catheter-associated urinary tract infections: part II. Limit duration of catheter use.

This article is the second in a two-part series focusing on catheter-associated urinary tract infections. Part I of the series focused on the most significant modifiable risk factor, avoiding use of urethral catheters. Part II focuses on the second major modifiable risk factor, reducing catheter-days. A quality improvement case is provided to illustrate the strategies for limiting the duration of catheter use. Together, these two articles provide important information on the two most significant risk facts for eliminating the incidence of catheter-associated urinary tract infections.

Eliminating catheter-associated urinary tract infections: part I. Avoid catheter use.

This article is the first in a two-part series focusing on catheter-associated urinary tract infections. There is a convergence of factors necessitating zero tolerance toward catheter-associated urinary tract infections, including the risks associated with patient safety and to a lesser extent the changes in reimbursement. Part I of this series focuses on the most significant modifiable risk factor, avoiding use of urethral catheters. A quality improvement case study is highlighted along with a practice bundle for evidence-based practice. Part II focuses on the second most significant risk factor, reducing urethral catheter-days.

The content of cigarette counter-advertising: are perceived functions of smoking addressed?

Media campaigns can be an effective tool in reducing adolescent smoking. To better understand the types of ads that have been used in campaigns in the United States, a content analysis was conducted of ads available at the U.S. Centers for Disease Control and Prevention (CDC) Media Campaign Resource Center (MCRC; Waves 1 through 7). A total of 487 ads were coded. Ads were coded for target audience, primary theme present in the ad, and sensation value-production techniques that have been demonstrated to attract attention and increase arousal. Primary themes extended earlier studies by focusing on the perceived functions of smoking (weight lose, stress management, controlling negative affect) as well as the traditional themes of industry attack, the health consequences of smoking, secondhand smoke, quitting, and the social image of smokers. A majority of ads were rated as having moderate sensation value, and ads targeted at teens and children were, on the average, higher in sensation value than those targeting general audiences. Changes across time suggest that campaigns are focusing more on adolescent smoking and relying more on attacking the tobacco industry. Research indicates that the functions of stress relief, mood regulation, and weight loss are strong reasons for initiating and continuing to smoke cigarettes; however, none of the 487 ads addressed these functional themes. Implications for developing campaigns that more closely relate to the functions of smoking are discussed.

Adolescents' perceptions of smoking and stress reduction.

The present study examined how adolescents perceive the relationship between smoking and stress and where they learn that smoking cigarettes may be an effective stress-reduction mechanism. Eight focus groups were conducted with low-income African American and European American 14- to 16-year-olds in urban and rural locations, in which they suggested that the primary reasons why they smoked-namely, as a coping mechanism (to calm nerves), for social acceptance, and because of environmental influences. Family issues, boyfriend/girlfriend problems, and school were common stressors. Although participants overwhelmingly believed that people smoke to reduce their stress, a few believed that cigarettes do not actually reduce stress. When asked for examples of smoking in popular media, teens predominantly generated examples of individuals smoking to reduce stress. Ethnic and gender differences were found among the types of media in which they had seen smoking, their opinions of anti-smoking messages, and the media's perceived influence.

Perspective: Autonomic care systems for hospitalized patients.

With advancements of medical technology and improved diagnostic and treatment options, children with severe birth defects who would otherwise have no chance of surviving post birth survive to go home every day. The average lifespan in the United States has increased substantially over the last century. These successes and many other medical breakthroughs in managing complex illnesses, particularly in frail, elderly patients, have resulted in an increasing percentage of patients with comorbidities. This, coupled with a policy change by Medicare (i.e., Medicare will no longer reimburse hospitals for costs associated with treating preventable errors and injuries that a patient acquires while in the hospital), creates an enormous challenge to health care providers. To meet the challenge, the authors propose a new model of health care--the autonomic care system (ACS)--a concept derived from the intensive care unit and the autonomic computing initiative in the computer industry. Using wound care as an example, the authors examine the necessity, feasibility, design, and challenges related to ACS. Specifically, they discuss the role of the human operator, the potential combination of ACS and existing hospital information technology (e.g., electronic medical records and computerized provider order entry), and the costs associated with ACS. ACS may serve as a roadmap to revamp the health care system, bringing down the barriers among different specialties and improving the quality of care for each problem for all hospitalized patients.

Attitude and norm accessibility affect processing of anti-smoking messages.

OBJECTIVE: Anti-smoking PSAs are not always effective in reducing cigarette smoking, and there is a lack of research into mechanisms through which PSAs affect the attitudes and behaviors of viewers. The present research was designed to better understand how smokers and non-smokers process anti-smoking ads. DESIGN: In a repeated measures design, the accessibility of smokers' (N = 70) and non-smokers' (N = 96) attitudes toward and norms concerning smoking were assessed and then their reactions to four anti-smoking PSAs were measured. RESULTS: The accessibility of smokers' attitudes toward smoking-how quickly they bring their attitudes to mind-predicted their central processing of ad content, and smokers who counterargued in response to the ads were not persuaded by them. The accessibility of smokers' norms for smoking-how quickly they bring to mind social support for smoking-predicted their peripheral processing of the ads, and imbued resistance to persuasion. In contrast, non-smokers' attitude and norm accessibility were unrelated to ad processing. CONCLUSION: These results suggest that anti-smoking ads may have paradoxical effects on smokers and may actually undermine anti-smoking efforts. Furthermore, smokers who can readily access a pro-smoking norm are unlikely to process anti-smoking messages, which may further hinder anti-smoking efforts.