Toward Multidimensional Message Tailoring to Address COVID-19 and Influenza Vaccine-Hesitancy: A Latent Profile Analysis Approach.

Vaccines remain the best strategy as the COVID-19 pandemic enters into later stages and governments begin to shed pandemic-control measures. Vaccine hesitancy continues to be a major obstacle in efforts to end the pandemic. This study reports formative evaluation research that adopted a multidimensional approach using latent profile analysis to audience segmentation and message targeting. Within the framework of the integrated behavioral model, data were collected from a US national survey to explore the dimensions in which vaccine-confident vs. -hesitant individuals differed significantly across the topics of COVID-19 and influenza. Latent profile analyses were performed to identify subgroups and establish measurement invariance between COVID-19 and influenza vaccines. Matching message strategies were proposed for the distinctive characteristics of the subgroups for both topics and to be tested in future research.

The Role of Subjective Norm in Persuasion Through the Restoration of Personal Freedom.

Human behavior is largely influenced by social norms. While the social norm approach is frequently used in public health campaigns, their effectiveness is inconsistent. This study investigated the role of normative reactance - the amplification of subjective norms as a means of restoring threatened freedom - across two health behaviors: college drinking and STD testing. A 2 (message threat: low vs. high) × 2 (health topic: college drinking vs. STD testing) between-subjects experiment was conducted with 765 participants. The results indicated that, similar to attitudes, subjective norms could also be amplified as a self-justification strategy to restore threatened freedom, which led to reduced intention to follow a message recommendation. In addition, results showed that the role of subjective norms and attitudes can vary across health behaviors and individual differences, particularly concerning an individual's degree of self-monitoring. Theoretical implications, limitations, and future directions are discussed.

Persuasive Messages, Social Norms, and Reactance: A Study of Masking Behavior during a COVID-19 Campus Health Campaign.

Efforts by universities to reduce the spread of COVID-19 include health campaigns intended to encourage students to wear masks. While well-intended, these efforts may produce counter-persuasion (e.g., decrease masking) if they are seen as threatening individuals' freedom to choose. In a rolling cross-sectional study of one university campaign (n = 681), we found that the presence of the campaign did instigate a form of resistance known as reactance and that reactance was negatively associated with masking behavior. Masking was also diminished by the frequency with which respondents observed others not wearing a mask (anti-masking descriptive norm) and the frequency with which respondents observed others expressing disdain for masking (anti-masking injunctive norm). Most of these findings were magnified among students who identified as politically conservative. There was no evidence that the frequency of seeing others speak in favor of masks (pro-masking injunctive norm) produced an increase in masking. The results provide valuable theoretical insights into the causes of reactance and empirical evidence of the risks associated with student-oriented COVID safety campaigns.

Epistemic Egocentrism and Processing of Vaccine Misinformation (Vis-à-vis Scientific Evidence): The Case of Vaccine-Autism Link.

A web-based 2 (preexisting position: vaccine-inclined vs. -hesitant) by 2 (message type: scientific evidence vs. misinformation) experimental study was conducted to investigate individuals' processing of misinformation (vis-à-vis scientific evidence) on the vaccine-autism link within the framework of epistemic egocentrism. Data (N = 996) collected with Qualtrics panel demonstrated that preexisting position shaped individuals' responses to vaccine-related messages differently such that vaccine-hesitant individuals processed the message more superficially while vaccine-inclined individuals more systematically. There was evidence that involvement moderated information processing. Vaccine-hesitant and -inclined individuals' intentions to seek further information and to engage others with opposite views in public deliberation were shaped by message perception and source perceptions (trustworthiness and expertise), but in different patterns. Implications of the findings for vaccine-related health communication are discussed.

Features of Empathy-Arousing Strategic Messages.

There has been evidence that empathy-arousing messages might be an effective and ethical approach to persuasion in health communication. Knowledge of intrinsic message features is needed to better design and craft such messages. The goals of this research were (a) to identify message features with the potential to arouse state empathy, (b) to verify the association between the identified message features and state empathy, and (c) to determine if state empathy mediates the impact of the message features on persuasion and social stigma. In the present study, a coding scheme was developed for empathy-arousing message features; 532 individuals recruited from Qualtrics Panel each viewed five messages randomly selected from a total of 20 stimuli messages that varied in empathy message features. Multilevel modeling analyses confirmed the association between the identified message features and state empathy; and state empathy's mediating role of message feature effects on persuasion and social stigma.

Mechanisms of Social Media Effects on Attitudes Toward E-Cigarette Use: Motivations, Mediators, and Moderators in a National Survey of Adolescents.

BACKGROUND: Exposure to risk behavior on social media is associated with risk behavior tendencies among adolescents, but research on the mechanisms underlying the effects of social media exposure is sparse. OBJECTIVE: This study aimed to investigate the motivations of social media use and the mediating and moderating mechanisms of their effects on attitude toward electronic cigarette (e-cigarette) use among adolescents. METHODS: Using data from a national sample survey of adolescents (age=14-17 years, N=594), we developed and validated a social media use motivation scale. We examined the roles of motivations in the effect of social media use on risk exposure and risk attitude. RESULTS: Motivations for social media use included agency, self-expression, realism, social learning, social comparison, and filter. These motivations were associated differentially with the frequency of use of Facebook, Instagram, Snapchat, and YouTube. Frequency of social media use was positively associated with exposure to e-cigarette messages across the four platforms (Ps<.001). Exposure to e-cigarette messages on Instagram (P=.005) and Snapchat (P=.03) was positively associated with attitude toward e-cigarette use. Perceived social media realism moderated the effects of e-cigarette message exposure such that when realism was high, the exposure effect was amplified, but when realism was low, the effect was mitigated (P<.001). A three-way interaction effect (P=.02) among exposure, social learning motivation, and social norm on attitude toward e-cigarette use was found. When perceived social norm was high, the moderating effect of social learning motivation on e-cigarette use attitude was amplified, but when social norm was low, the social learning motivation effect was attenuated. CONCLUSIONS: Because perceived social media realism moderates the effect of exposure to e-cigarette messages on attitude toward e-cigarette use, future intervention efforts should address the realism perceptions. The three-way interaction among exposure, social learning motivation, and social norm indicates the importance of addressing both the online and offline social environments of adolescents. The social media use motivation scale, reflecting perceived affordances, is broadly applicable. Understanding social media use motivations is important, as they indirectly influence attitude toward e-cigarette use via frequency of social media use and/or frequency of exposure to e-cigarette messages on social media.

Reduction in ocular complement factor B protein in mice and monkeys by systemic administration of factor B antisense oligonucleotide.

PURPOSE: Age-related macular degeneration (AMD) is the leading cause of permanent vision loss among the elderly in many industrialized countries, and the complement system plays an important role in the pathogenesis of AMD. Inhibition of complement factor B, a key regulator of the alternative pathway, is implicated as a potential therapeutic intervention for AMD. Here we investigated the effect of liver factor B reduction on systemic and ocular factor B levels. METHODS: Second-generation antisense oligonucleotides (ASOs) targeting mouse and monkey factor B mRNA were administered by subcutaneous injection to healthy mice or monkeys, and the level of factor B mRNA was assessed in the liver and the eye. In addition, the factor B protein level was determined in plasma and whole eyes from the treated animals. RESULTS: Mice and monkeys treated with factor B ASOs demonstrated a robust reduction in liver factor B mRNA levels with no change in ocular factor B mRNA levels. Plasma factor B protein levels were significantly reduced in mice and monkeys treated with factor B ASOs, leading to a dramatic reduction in ocular factor B protein, below the assay detection levels. CONCLUSIONS: The results add to the increasing evidence that the liver is the main source of plasma and ocular factor B protein, and demonstrate that reduction of liver factor B mRNA by an ASO results in a significant reduction in plasma and ocular factor B protein levels. The results suggest that inhibition of liver factor B mRNA by factor B ASOs would reduce systemic alternative complement pathway activation and has potential to be used as a novel therapy for AMD.

Putting the Fear Back Again (and Within Individuals): Revisiting the Role of Fear in Persuasion.

The overwhelming majority of fear appeal research came from the between-individuals approach and yielded consistent evidence for a linear fear-persuasion relationship. A recent review suggested that the within-individuals approach might be more appropriate. Studies that measured fear at multiple time points have consistently revealed a curvilinear association between fear and persuasion predicted by the drive model. A Web-based experiment (N = 454) using tobacco warning labels was conducted to replicate the inverted-U shape curvilinear relationship between fear and persuasion, and to revisit the role of fear in fear appeal theories. Results showed that the inverted-U fear curve positively predicted persuasion and reduced maladaptive responses, and that the linear trajectory of fear positively predicted maladaptive responses and failure of persuasion.

Participants' Role Expectations in Genetics Research and Re-consent: Revising the Theory and Methods of Mental Models Research Relating to Roles.

The rise of large cohort-based health research that includes genetic components has increased the communication challenges for researchers. Controversies have been amplified over requirements for re-consent, return of results, and privacy protections, among other issues. This study extended research on the impact that the perceived role of "research participant" might have on communication expectations to illuminate research participants' preferences for re-consent. The study employed an online survey of participants in a long-standing cancer genetics registry. Results confirmed previous exploratory findings that research participants endorse multiple mental models of participant roles in research (doctor-patient, collaborator, donor, legal contract, etc.). Regression analyses indicated that high and low salience of different models of the role of research participant are related to different communication expectations. However, the pattern of relationships among roles is relevant. The results of the regression analysis also indicated that preference for mandatory re-consent and its relationship to mental models of roles are related to attitudes of trust, benefits, and informational risks. The discussion identifies implications as including the use of explicit approaches to address role relationships in communication with research participants. It also points to implications for methodological approaches in mental model research.

Targeting smokers with empathy appeal antismoking public service announcements: a field experiment.

A field experiment study (N = 189) was conducted to investigate the effectiveness of empathy appeal antismoking messages and their potential advantage over fear appeal messages. Data from 12 antismoking public service announcements showed that (a) smokers resist antismoking messages and (b) overall empathy appeal was equally effective as fear appeal messages. There was also evidence for moderators. First, empathy messages were more effective to women than to men. Second, fear appeal messages were more effective to occasional smokers than were empathy messages. Third, empathy messages were more effective to regular smokers than were fear appeal messages. Implications for audience segmentation and message targeting in public health antismoking efforts are discussed.

Antecedents to Psychological Reactance: The Impact of Threat, Message Frame, and Choice.

A 2 (Threat: high vs. low) × 2 (Frame: gain vs. loss) × 2 (Choice: yes vs. no) × 2 (Behavior: prevention vs. detection) factorial design Web-based experiment (N = 814) was conducted to investigate the impact of threat to freedom, message frame, and behavioral choice as antecedents to psychological reactance. The intertwined model for reactance measure was replicated. Results showed that threat to freedom and the loss frame increased, and the gain frame and choice mitigated psychological reactance. The advantages of choice and the gain frame were most salient when threat was high.

Mechanistic understanding for the greater sensitivity of monkeys to antisense oligonucleotide-mediated complement activation compared with humans.

Differences in sensitivity of monkeys and humans to antisense oligonucleotide (ASO)-induced complement alternative pathway (AP) activation were evaluated in monkeys, humans, and in serum using biochemical assays. Transient AP activation was evident in monkeys at higher doses of two 2'-O-methoxyethyl (2'-MOE) ASOs (ISIS 426115 and ISIS 183750). No evidence of AP activation was observed in humans for either ASO, even with plasma ASO concentrations that reached the threshold for activation in monkeys. The absence of complement activation in humans is consistent with a query of the Isis Clinical Safety Database containing 767 subjects. The in vivo difference in sensitivity was confirmed in vitro, as monkey and human serum exposed to increasing concentrations of ASO indicated that monkeys were more sensitive to AP activation with this class of compounds. The mechanistic basis for the greater sensitivity of monkeys to AP activation by 2'-MOE ASO was evaluated using purified human or monkey factor H protein. The binding affinities between a representative 2'-MOE ASO and either purified protein are similar. However, the IC50 of fluid-phase complement inhibition for monkey factor H is about 3-fold greater than that for human protein using either monkey serum or factor H-depleted human serum. Interestingly, there is a sequence variant in the monkey complement factor H gene similar to a single nucleotide polymorphism in humans that is correlated with decreased factor H protein function. These findings show that monkeys are more sensitive to 2'-MOE ASO-mediated complement activation than humans likely because of differences in factor H inhibitory capacity.

A Content Analysis of Online Messages about Sugar-Sweetened Beverages.

Media campaigns can reduce or promote the consumption of sugar-sweetened beverages (SSBs). Brief, US-based English-language online messages were gathered from searchable media platforms, a process that yielded 112 anti-SSB videos and 29 pro-SSB commercials. Using a combination of inductive and deductive methods, a content analysis of those messages was conducted to identify their properties. They were coded for the direction (pro vs. anti), target of the advocacy (e.g., consumption vs. policy), actor demographics (gender, age, and ethnicity), persuasive theme (e.g., excessive sugar, nurturing), and message sensation value. Anti-SSB appeals primarily targeted individual-level consumption behavior. They utilized six persuasive themes and often included more than one theme in a single message. Pro-SSB messages used feel-good themes and utilized only one theme per message. The proportions of adults, adolescents, and children differed by the direction of the advocacy. Black, Hispanic, and Asian actors were under-represented in the anti-SSB sample relative to Whites. Pro-SSB appeals were slightly higher than anti-SSB appeals in message sensation value (p = 0.09). The findings illuminate the message features that characterize the universe of brief anti-SSB appeals available online, highlight messaging disparities, and reveal the absence of certain common, effective persuasive themes.

Effects of message framing in anti-binge drinking PSAs: the moderating role of counterfactual thinking.

This experiment examined the interaction effects of message framing and counterfactual thinking on attitudes toward binge drinking and behavioral intentions. Data from a 2 (message framing: gain vs. loss) × 2 (counterfactual thinking priming: additive vs. subtractive) between-subjects factorial design showed that a gain-framed message resulted in lower binge drinking intentions than did a loss-framed message after subjects engaged in additive counterfactual thinking. The effects of a loss-framed message on binge drinking intentions occurred when subtractive counterfactual thinking was induced. Theoretical and practical implications for anti-binge drinking public service announcements are discussed.

What makes a message real? The effects of perceived realism of alcohol- and drug-related messages on personal probability estimation.

Perceived lack of realism in alcohol advertising messages promising positive outcomes and antialcohol and antidrug messages portraying negative outcomes of alcohol consumption has been a cause for public health concern. This study examined the effects of perceived realism dimensions on personal probability estimation through identification and message minimization. Data collected from college students in U.S. Midwest in 2010 (N = 315) were analyzed with multilevel structural equation modeling. Plausibility and narrative consistency mitigated message minimization, but they did not influence identification. Factuality and perceptual quality influenced both message minimization and identification, but their effects were smaller than those of typicality. Typicality was the strongest predictor of probability estimation. Implications of the results and suggestions for future research are provided.

Predicting COVID-19 and Influenza Vaccination Confidence and Uptake in the United States.

This study investigates and compares the predictors of COVID-19 and influenza vaccination confidence and uptake in the U.S. Vaccine hesitancy is defined as the reluctance or refusal (i.e., less than 100% behavioral intention) to vaccinate despite the availability of effective and safe vaccines. Vaccine hesitancy is a major obstacle in the fight against infectious diseases such as COVID-19 and influenza. Predictors of vaccination intention are identified using the reasoned action approach and the integrated behavioral model. Data from two national samples (N = 1131 for COVID-19 and N = 1126 for influenza) were collected from U.S. Qualtrics panels. Tobit regression models were estimated to predict percentage increases in vaccination intention (i.e., confidence) and the probability of vaccination uptake (i.e., intention reaching 100%). The results provided evidence for the reasoned approach and the IBM model and showed that the predictors followed different patterns for COVID-19 and influenza. The implications for intervention strategies and message designs were discussed.

Targeting COVID-19 vaccine-hesitancy in college students: An audience-centered approach.

Objective: The study tested potential factors that differentiated the COVID-19 vaccine-hesitant and -inclined college students and, based on these factors, identified subgroups of the vaccine-hesitant students. Participants: Participants were 1,183 U.S. college students attending four-year universities or community colleges recruited through Qualtrics between January 25 and March 3, 2021. Methods: Participants completed an online survey assessing their COVID-19 vaccination intention, perceived risks of COVID-19 and the COVID-19 vaccines, efficacy beliefs regarding COVID-19 and the COVID-19 vaccines, and emotions toward taking the COVID-19 vaccines. Results: Vaccine-hesitant and -inclined college students varied in their emotions, risk perceptions, and efficacy beliefs regarding the virus and the vaccines. Using these factors as indicators, vaccine-hesitant college students were classified into five latent subgroups with distinct characteristics. Conclusions: In identifying subgroups of the vaccine-hesitant college students, the study has important insights to offer regarding the design of vaccine-promotion messaging strategies targeting the college student population.

Psychological profiles of COVID vaccine-hesitant individuals and implications for vaccine message design strategies.

COVID-19 has caused tremendous consequences in the U.S., and combating the pandemic requires a significant number of Americans to receive COVID-19 vaccines. Guided by prominent health communication theories, this project took a formative evaluation approach and employed a national sample (N = 1041) in the U.S. to explore the potential differences between vaccine-inclined vs. -hesitant individuals and to generate profiles of hesitant individuals as the foundation for audience segmentation and message targeting. Five distinct profiles emerged in the sample. Characteristics of each profile were described, and appropriate messaging strategies were identified to target each group. Theoretical and practical implications were discussed.

Spillover effects of anti-sugar-sweetened beverage messages: From consumption decisions to policy preferences.

BACKGROUND: Intake of sugar-sweetened beverages (SSBs) is associated with many negative health outcomes. Efforts to curb consumption generally take one of two approaches: (a) Individual change based on the communication of personal risk information or (b) policies that limit or disincentivize the behavior, such as restricting access or implementing taxes. METHODS AND RESULTS: Using samples of 2347 persons and 139 pro- and anti-SSB messages, this study tested whether individual-level persuasion attempts would spill over to voting intentions and whether that spillover would amplify or attenuate policy preferences. The influence of anti-SSB messages was seen in (a) direct, positive effects on intention to vote for restrictive policies and in (b) indirect, positive effects where change in intended consumption mediated message impact on change in voting intentions. Anti-SSB messages were generally more powerful than pro-SSB advertising at producing direct and indirect change. Yet, there was evidence of boomerang effects among small numbers of both SSB drinkers and nondrinkers. CONCLUSIONS: Anti-SSB messages that target individual consumption bring about intentions to reduce consumption and increased receptivity to restrictive SSB policies.

Complement C3d/C4d Deposition on Platelets Correlates with 2'-O-Methoxyethyl Antisense Oligonucleotide-Induced Thrombocytopenia in Monkeys.

2'-O-Methoxyethyl antisense oligonucleotide (2'-MOE ASO)-induced severe thrombocytopenia (TCP) [platelet (PLT) count <50 K/µL] was observed in the Asian-sourced cynomolgus monkeys with low incidence (2%-4% at doses >5 mg/kg/week). The potential mechanisms for TCP were studied using the Mauritian-sourced cynomolgus monkeys, which were shown to be more susceptible to ASO-induced TCP, along with the Asian-sourced animals. ISIS 405879, a 2'-MOE ASO, induced severe TCP (PLT <50 K/µL) in seven of nine Mauritian-sourced monkeys but not in the Asian-sourced monkeys after 16 weeks of treatment at 40 mg/kg/week. Marked increases in PLT-bound C3d/C4d were detected in all thrombocytopenic Mauritian-sourced monkeys but not in the unaffected Mauritian- or Asian-sourced monkeys, suggesting increased PLT clearance due to complement deposition on the PLTs. However, this effect was independent of the ASO-mediated fluid-phase alternative complement activation. A correlation was also observed between serum antiglycoprotein (GP) IIb/IIIa immunoglobulin G (IgG) and PLT reduction. In addition, increases in total serum IgM, anti-PLT IgM, and anti-PLT factor 4 IgM levels were observed in monkeys from both sources but were more evident in the Mauritian-sourced monkeys. These data suggest an enhanced innate immune cell activation to ISIS 405879, leading to increased PLT destruction through complement fixation on the PLTs or PLT crossreacting polyclonal antibody production.