Leveraging Dynamic Norm Messages to Promote Counter-Normative Health Behaviors: The Moderating Role of Current and Future Injunctive Norms, Attitude and Self-Efficacy.

Describing that many people perform a certain behavior has been known to increase people's behavioral intentions. However, the underlying premise is that the behavior must be high in prevalence. The present study examined whether describing low-prevalence behaviors (static norm) and framing low-prevalence behaviors as increasing in popularity across time (dynamic norm) may increase behavioral intentions in the context of getting the flu shot and eating less red meat. In addition, the study aimed to examine whether other behavioral antecedents could moderate the effect of viewing these normative messages. An experiment that randomly assigned participants to view either dynamic norm messages, static norm messages, and no messages (control) was conducted. Results indicated that for the behavior of eating less red meat, viewing a static norm message backfired while viewing a dynamic norm message did not. Moreover, the effect of viewing low-prevalence norm messages was moderated by other behavioral antecedents such as, current and future injunctive norm perceptions and attitude. These findings contribute to the theoretical and practical understanding of utilizing low-prevalence norms for persuasion.

The impact of COVID-19 misinformation and trust in institutions on preventive behaviors.

Misinformation related to coronavirus disease 2019 (COVID-19) has the potential to suppress preventive behaviors that mitigate the spread of COVID-19. Early research on the behavioral consequences of COVID-19 misinformation is mixed, and most rely on cross-sectional data. We examined whether believing in COVID-19 misinformation at one time point influences engaging in preventive behaviors later. In addition, we investigated the role of trust in institutions. We conducted a two-wave survey in South Korea and examined the association between belief in COVID-19 misinformation at Wave 1 and preventive behaviors at Wave 2 controlling for preventive behaviors at Wave 1. We also analyzed whether there is an interaction between belief in COVID-19 misinformation and trust in institutions. Belief in COVID-19 misinformation at Wave 1 significantly increased avoidance of preventive behaviors at Wave 2, but after accounting for trust in institutions, this effect disappeared. Rather, trust in institutions significantly decreased avoidance of preventive behaviors. In addition, misinformation increased avoidance of preventive behaviors among those who trusted institutions the most. Results suggest that building trust in institutions is essential in promoting COVID-19 preventive behaviors. Belief in COVID-19 misinformation may have harmful effects, but these effects were pronounced for those who highly trust institutions.

The Role of Deliberative Cognitive Styles in Preventing Belief in Politicized COVID-19 Misinformation.

Misinformation related to COVID-19 is a threat to public health. The present study examined the potential for deliberative cognitive styles such as actively open-minded thinking and need for evidence in deterring belief in misinformation and promoting belief in true information related to COVID-19. In addition, regarding how responses to the pandemic have been politicized, the role of political orientation and motivated reasoning were also examined. We conducted a survey in South Korea (N = 1466) during May 2020. Participants answered measures related to demographics, open-minded thinking, need for evidence, and accuracy perceptions of COVID-19 misinformation and true information items. Multi-level analyses of the survey data found that while motivated reasoning was present, deliberative cognitive styles (actively open-minded thinking and need for evidence) decreased belief in misinformation without intensifying motivated reasoning tendencies. Findings also showed a political asymmetry where conservatives detected COVID-19 misinformation at a lesser rate. Overall, results suggest that health communication related to COVID-19 misinformation should pay attention to conservative populations. Results also imply that interventions that activate deliberative cognitive styles hold promise in reducing belief in COVID-19 misinformation.

The effect of vaping cues in e-cigarette advertisements on normative perceptions about cigarettes among young adults who use cigarettes and e-cigarettes in Boston.

INTRODUCTION: E-cigarette advertising frequently involves vaping cues-hand to mouth motions and vapor-that physically resemble traditional cigarette smoking cues. There has been concern that these vaping cues could make cigarettes seem more frequently used and acceptable by society. This analysis examined whether exposure to vaping cues in e-cigarette ads influence descriptive and injunctive normative perceptions about cigarettes among young adults who use cigarettes and e-cigarettes (dual use). METHOD: Secondary analysis was conducted on an experiment that randomly exposed young adults living in Boston who dual used in the past-week to either 1) E-cigarette ads with vaping cues; 2) E-cigarette ads that edited out vaping cues; or 3) Beverage ads. Descriptive and injunctive normative perceptions about cigarettes were compared across participants who viewed e-cigarette ads with vaping cues versus those who viewed ads without vaping cues. RESULTS: Those who viewed e-cigarette ads with vaping cues had decreased perceptions that cigarette smoking was common compared to those who viewed e-cigarette ads without vaping cues. Exposure to e-cigarette ads with vaping cues also led to increased perceptions of other peoples' unfavorable views toward cigarette smoking in general and their own cigarette smoking. CONCLUSION: Contrary to renormalization concerns, vaping cues in e-cigarette ads increased anti-smoking normative perceptions among people who dual used in the past week. Further research is needed to examine the impact of vaping cues in e-cigarette ads on normative perceptions among those who don't smoke or quit smoking cigarettes.

The Effects of Tobacco Coverage in the Public Communication Environment on Young People's Decisions to Smoke Combustible Cigarettes.

In today's complex media environment, does media coverage influence youth and young adults' (YYA) tobacco use and intentions? We conceptualize the "public communication environment" and effect mediators, then ask whether over time variation in exogenously measured tobacco media coverage from mass and social media sources predicts daily YYA cigarette smoking intentions measured in a rolling nationally representative phone survey (N = 11,847 on 1,147 days between May 2014 and June 2017). Past week anti-tobacco and pro-tobacco content from Twitter, newspapers, broadcast news, Associated Press, and web blogs made coherent scales (thetas = 0.77 and 0.79). Opportunities for exposure to anti-tobacco content in the past week predicted lower intentions to smoke (Odds ratio [OR] = 0.95, p < .05, 95% confidence interval [CI] = 0.91-1.00). The effect was stronger among current smokers than among nonsmokers (interaction OR = 0.88, p < .05, 95% CI = 0.77-1.00). These findings support specific effects of anti-tobacco media coverage and illustrate a productive general approach to conceptualizing and assessing effects in the complex media environment.

Disparities in HPV knowledge by race/ethnicity and socioeconomic position: Trusted sources for the dissemination of HPV information.

PURPOSE: To examine the differences in HPV and HPV vaccine awareness, knowledge, and beliefs by race/ethnicity and socioeconomic position (SEP) among a national sample of non-Hispanic whites (NH-Whites), non-Hispanic Blacks (NH-Blacks), and Hispanics in the United States. We also examine differences in trusted health information sources by race/ethnicity and SEP. METHODS: Data were obtained from the Health Information National Trends Survey, Cycle 1, conducted from January to April 2017. Descriptive statistics, bivariate analyses, multivariate logistic regression, and listwise deletion were used to examine HPV and HPV vaccine awareness and knowledge-related items, and trust in health information sources among NH-Whites, NH-Blacks, and Hispanics 18-49 years old. RESULTS: HPV vaccine awareness was moderate with no significant differences across racial/ethnic groups. NH-Whites had significantly higher knowledge that HPV causes cervical cancer than NH-Blacks and Hispanics (p < 0.001). High SEP NH-Blacks (OR = 0.42, 95% CI = [0.24-0.73], p = 0.002]) and Hispanics (OR = 0.49, 95% CI = [0.31-0.79, p = 0.003]) had lower odds of knowing HPV causes a sexually transmitted disease than their white counterparts. Low SEP NH-Blacks (OR = 11.03, 95% CI = [3.05-39.86, p < 0.001]) had 11 times the odds of ever hearing about the HPV vaccine than low SEP NH-Whites. NH-Blacks had twice the odds of trusting health information from television (OR = 2.39, 95% CI = [1.52-3.78]. p < 0.001), and almost six times the odds of trusting health information from religious organizations than low SEP NH-Whites (OR = 5.76, 95% CI = [2.02-16.44, p < 0.001]). CONCLUSION: Tailored communication strategies may address the low HPV knowledge among NH-Blacks and Hispanics from high and low SEP.

Rating the Valence of Media Content about Electronic Cigarettes Using Crowdsourcing: Testing Rater Instructions and Estimating the Optimal Number of Raters.

Electronic cigarettes (e-cigarettes) are a controversial public health topic due to their increasing popularity among youth and the uncertainty about their risks and benefits. Researchers have started to assess the valence of media content about e-cigarette use, mostly using expert coding. The current study aims to offer a methodological framework and guideline when using crowdsourcing to rate the valence of e-cigarette media content. Specifically, we present (1) an experiment to determine rating instructions that would result in reliable valence ratings and (2) an analysis to identify the optimal number of raters needed to replicate these ratings. Specifically, we compared ratings produced by crowdsourced raters instructed to rate from several different perspectives (e.g., objective vs. subjective) and determined the instructions that led to reliable ratings. We then used bootstrapping methods and a set of criteria to identify the minimum number of raters needed to replicate these ratings. Results suggested that when rating e-cigarette valence, instructing raters to rate from their own subjective perspective produced reliable results, and nine raters were deemed the optimal number of raters. We expect these findings to inform future content analyses of e-cigarette valence. The study procedures can be applied to crowdsourced content analyses of other health-related media content to determine appropriate rating instructions and the number of raters.

Youth and Young Adult Use of Pod-Based Electronic Cigarettes From 2015 to 2019: A Systematic Review.

Importance: The use of electronic cigarettes (e-cigarettes) has rapidly increased among youth and young adults, but knowledge gaps exist on the potential health effects of using recently introduced pod-based e-cigarettes. Objective: To conduct a systematic review of recent peer-reviewed scientific literature on pod-based e-cigarettes. Evidence Review: A search of online databases, including PubMed, Web of Science, Embase, and EBSCO HOST, was conducted to identify pod-based e-cigarette-associated articles from June 2015 (the time when JUUL [JUUL Labs] was introduced) to June 2019. We included English-language articles that presented primary data on pod-based e-cigarettes. Findings: Pod-based e-cigarettes represent a substantial evolution in design by increasing the efficient delivery of nicotine. While these products may contain less harmful constituents than other types of e-cigarettes and cigarettes, there is no evidence that the levels found are safe among youth. There is evidence for higher nicotine dependence associated with their use. Pod-based e-cigarette brands, compared with other e-cigarette brands, have targeted youth and young adults with social media marketing. There was less discussion about the use of these products as smoking cessation devices or their health risks on social media. The social acceptability and favorable perceptions of pod-based e-cigarettes may underlie the use of these products. Conclusions and Relevance: The appeal and dependence potential of pod-based e-cigarettes for youth emphasize the need for stronger regulations on product design, social media, marketing channels, and youth access together with health communications that emphasize the risks of nicotine dependence.

The Effect of Temporal Frames in Anti-Smoking Messages on the Extension of Anti-Smoking Arguments to Smokers.

The present study focused on how exposure to different health message characteristics can affect extension-i.e., the sharing of arguments that were not targeted by the messages but are consistent with the message theme. In the context of anti-smoking campaigns, many messages have either emphasized reasons to quit smoking (why-quit) or ways to quit smoking (how-to-quit). Therefore, guided by construal level theory, the study aimed to examine whether the message characteristic of temporal frames can increase or decrease extension when incorporated into why-quit and how-to-quit anti-smoking messages. Results from a randomized experiment showed that exposure to why-quit messages with distant temporal frames increased extension (vs. no-message control) while why-quit messages with proximal temporal frames did not. Findings further illustrated a potential mechanism, where why-quit messages with proximal frames significantly reduced extension compared to why-quit messages with no temporal frames. Temporal frames did not have a significant effect on extension for how-to-quit messages. Results indicate that emphasizing the present in anti-smoking messages could be detrimental for the extension of why-quit arguments. Implications for applying construal level theory to health message effects research are also discussed.

Identifying Potential Campaign Themes to Prevent Youth Initiation of E-Cigarettes.

Once a target audience and a health behavior of interest are selected for a potential mass media campaign, the next task is selecting beliefs about the health behavior to serve as the basis for campaign message content. For novel health behaviors, such as the use of emerging tobacco products, limited empirical research on beliefs about these behaviors exists. A multimethod approach was applied to generate potential campaign beliefs for emerging behaviors. Three methods were conducted in this investigation in order to generate a list of potential testable campaign beliefs, using youth e-cigarette use as a case study: (1) a search of published and unpublished literature including gathering measures from several national surveys (through 2016), (2) an online elicitation survey (conducted in 2016), and (3) unsupervised topic modeling of media texts (from 2014 to 2015, analyzed in 2016). Details are provided on how each method was employed to both generate and prioritize beliefs related to youth e-cigarette use into a final set of 115 beliefs across 23 belief themes. This multimethod approach can provide four utilities when thinking through a health campaign for novel health behaviors: (1) developing an exhaustive and complementary list of beliefs, (2) generating overarching themes and distilling larger themes into more nuanced beliefs, (3) identifying language most relevant to the target population, and (4) prioritizing beliefs for message pilot testing with members of the target audience. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.

Comparing the effects of organic, natural, and no additives labels on tobacco packaging between Lesbian, Gay, Bisexual (LGB) and heterosexual smokers.

INTRODUCTION: Previous research found that exposure to health-oriented language (e.g., natural, organic) on tobacco product packages is associated with reduced perceptions of harm and intention to purchase the product. However, how lesbian, gay, bisexual (LGB) individuals, who use tobacco products at a higher rate than heterosexual peers, respond to health-oriented labels has not yet been examined. This analysis examines whether responses to health-oriented labels differ between LGB persons and heterosexual individuals. METHODS: Secondary analysis was completed from an experimental study that exposed US adult smokers to a non-US cigarette (Study 1) or e-cigarette (Study 2) package that displayed either health-oriented language ('100% organic,' 'all natural' or 'no additives'), traditional marketing language ('fine quality,' 'premium blend' or '100% original') or no language. RESULTS: No significant differences were found between LGB smokers and heterosexual smokers in responses to cigarette packages with health-oriented labels (Study 1). However, LGB smokers had less favorable attitudes toward the e-cigarette product after viewing health-oriented labels (versus no language control label) while heterosexual smokers' attitudes did not differ across health-oriented and control labels (Study 2). In addition, LGB smokers had lower intention to purchase and vape e-cigarettes, and less favorable attitudes in response to health-oriented labels than heterosexual smokers. CONCLUSIONS: Findings suggest that LGB smokers process pro-tobacco messages differently than heterosexual smokers, and that product type (i.e., cigarette vs. e-cigarette) may be a factor to consider. Further research is needed to uncover underlying mechanisms.

Testing the Replication and Extension of Why-Quit and How-To-Quit Antismoking Health Messages.

Research on health campaigns and interpersonal communication has seldom examined how campaign message exposure can influence the transmission of campaign-relevant information into interpersonal communication. Specifically, an individual exposed to a campaign message may send the message's core argument (replication) or other campaign-consistent information (extension) to additional campaign targets. Replication and extension may enhance campaign effects because they are expected to extend a campaign's reach and produce more campaign-consistent communication. Using a randomized controlled experiment, this study examined how exposure to why-quit and how-to-quit themed antismoking messages influences replication and extension. Study results showed that while both why-quit and how-to-quit messages were successful in increasing replication, only why-quit messages were successful in influencing extension. The study results demonstrate that there is variation in the degree of how messages can successfully be replicated or extended in interpersonal contexts, which can inform campaign development.

Predictive Validity of an Empirical Approach for Selecting Promising Message Topics: A Randomized-Controlled Study.

Several message topic selection approaches propose that messages based on beliefs pretested and found to be more strongly associated with intentions will be more effective in changing population intentions and behaviors when used in a campaign. This study aimed to validate the underlying causal assumption of these approaches which rely on cross-sectional belief-intention associations. We experimentally tested whether messages addressing promising themes as identified by the above criterion were more persuasive than messages addressing less promising themes. Contrary to expectations, all messages increased intentions. Interestingly, mediation analyses showed that while messages deemed promising affected intentions through changes in targeted promising beliefs, messages deemed less promising also achieved persuasion by influencing nontargeted promising beliefs. Implications for message topic selection are discussed.