Communicating COVID-19 Risk on Instagram: A Content Analysis of Official Public Health Messaging During the First Year of the Pandemic.

Early in the COVID-19 pandemic, social media platform Instagram surged in popularity as a source of health information. Both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) leveraged Instagram accounts to publicly distribute COVID-related information. The current study investigated whether WHO and CDC messaging strategies on Instagram adhered to best practices defined by two theoretical frameworks: the extended parallel process model and crisis and emergency risk communication. We conducted a quantitative content analysis of COVID-related posts (n = 726) published between January-December 2020 to determine how both agencies (1) communicated the threat of the pandemic (e.g. susceptibility and severity of negative COVID-19 consequences); (2) appealed to self-, response, and collective efficacy; (3) incorporated cues to action (e.g. preventive behaviors, information seeking); and (4) leveraged credibility cues (e.g. scientific evidence, experts). Results showed threat information was limited, whereas efficacy appeals and cues to action were abundant. The CDC relied more heavily on depictions of self- and response efficacy, whereas the WHO appealed more frequently than the CDC to collective efficacy. Neither visually modeled behaviors nor leveraged scientific evidence or experts with great frequency. Implications for future research and official communication efforts via social media are discussed.

Pediatric Media Guidance for Parents of Children on the Autism Spectrum: A Thematic Analysis.

Very little is known about pediatric media guidance, or the one-on-onse advice that medical and clinical professionals (MCPs) communicate to parents about their children's recreational media and technology (RMT) use. One population that stands to benefit from a closer examination is children on the autism spectrum due to their behavior and communication challenges. We surveyed one group of pediatric autism MCPs, applied behavioral analysis (ABA) providers (N = 234), due to their proximity to families and conducted an applied thematic analysis of RMT advice they deliver. Providers reported primarily suggesting that caregivers employ restrictive parental mediation with their autistic child, that RMT should primarily be limited to use as a reward or reinforcement, and that parents should set time limits. Our findings offer new insights into the intersections of health communication theory and practice, while highlighting the need for greater research into RMT guidance for children with and without disabilities.

Worry About the Future Health Issues of Smoking and Intention to Screen for Lung Cancer With Low-Dose Computed Tomography.

BACKGROUND: Early diagnosis of lung cancer is key to improving the long-term prognosis for many individuals. Still, utilization rates of lung cancer screening (LCS) remain low. OBJECTIVE: To investigate the association between worry about future health issues of smoking and intention to undergo recommended LCS with low-dose computed tomography (LDCT) within the next 3 months. METHODS: A cross-sectional online survey was conducted using the Qualtrics Panel to recruit adult smokers between ages 54 and 75 years, with no history of lung cancer, and at least 30-pack-year smoking history (n = 152). The survey gathered demographic, socioeconomic, and psychographic information, including intention to screen for lung cancer with LDCT and worry about the future health issues of smoking. Data were analyzed using multivariable logistic regression. RESULTS: Approximately 43.0% were White, 21.7% were Black, and 60.0% were female. Most (86.0%) reported intentions to undergo recommended LCS with LDCT in the next 3 months. More than one-third (32.0%) reported moderately/very worried about the future health issues of smoking. Smokers who were moderately/very worried had 20% (P = .022) higher odds of reporting an intention to undergo LCS with LDCT than those who were not at all or a little worried. CONCLUSIONS: Most eligible adults reported intentions to undergo LCS with LDCT. Our study also highlights sex, racial, and socioeconomic differences in LCS behavior. IMPLICATIONS FOR PRACTICE: The study findings provide an opportunity for healthcare providers to have in-depth discussions about the benefits of LCS with those who express worry about future health issues of smoking.

"Being a Person of Color in This Institution Is Exhausting": Defining and Optimizing the Learning Climate to Support Diversity, Equity, and Inclusion at the University of Washington School of Public Health.

Learning climate greatly affects student achievement. This qualitative study aimed to understand community definitions of climate; share lived experiences of students, faculty, and staff; and define priority areas of improvement in the University of Washington School of Public Health (UWSPH). Between March-May 2019, 17 focus group discussions were conducted-stratified by role and self-identified race/ethnicity, gender and sexual orientation-among 28 faculty/staff and 36 students. Topics included: assessing the current climate, recounting experiences related to roles and identities, and recommending improvements. Transcripts were coded using deductive and inductive approaches. Race/ethnicity, gender, and sexual orientation appeared to affect perceptions of the climate, with nearly all respondents from underrepresented or minoritized groups recounting negative experiences related to their identity. Persons of color, women, and other respondents who identified as lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual (LGBTQIA) frequently perceived the climate as "uncomfortable." Most felt that UWSPH operates within a structural hierarchy that perpetuates white, male, and/or class privilege and "protects those in power" while leaving underrepresented or minoritized groups feeling like "the way to move up… is to conform" in order to not be seen as "someone pushing against the system." Improvement priorities included: increasing community responsiveness to diversity, equity, and inclusion; intentionally diversifying faculty/staff and student populations; designing inclusive curricula; and supporting underrepresented or minoritized groups academically, professionally, and psychologically.

Gendered Conceptions of Preconception Health: A Thematic Analysis of Men's and Women's Beliefs about Responsibility for Preconception Health Behavior.

Preconception health (PCH) focuses on taking steps before a pregnancy to safeguard the health of the woman and future baby. Although recommendations to improve PCH target all people of reproductive age, research shows most interventions and messages focus primarily on women, which may contribute to existing normative beliefs that women are more responsible for protecting children's health. In this study, we explore society's gendered expectations of responsibility for engaging in recommended PCH behaviors (i.e., avoiding smoking, drinking, and environmental toxins). An applied thematic analysis of online survey responses from U.S. men and women (N = 573) identified five main themes and related subthemes: body and health, shared responsibility, choice and moral obligation, gender stereotypes, and doubt and uncertainty. Both men and women frequently referenced biological connections between prospective parents and offspring as justification for PCH behaviors. When challenging PCH recommendations, respondents mentioned excessive control of women and men's secondary role in reproduction. Overall, gender stereotypes were more commonly expressed in relation to men yet reflected both traditional and contemporary male roles (i.e., as supporters, co-parents). When judging personal responsibility, women commonly viewed PCH behaviors as the 'duty of a good mother'. Implications for PCH communication research and practice are discussed.

Physician Mediation Theory and Pediatric Media Guidance in the Digital Age: A Survey of Autism Medical and Clinical Professionals.

Research on physician mediation suggests that physicians actively discuss media use (e.g., seeking online health information) with their patients. This theory has been limited though with respect to incorporating key behavioral determinants, varied forms of mediation, and samples beyond primary care physicians (MDs). A survey of 335 U.S.-based medical and clinical professionals (MCPs) treating pediatric clients on the autism spectrum (e.g., pediatricians, speech-language pathologists) examined how they advise caregivers about managing their child's recreational media and technology use, also known as media guidance. Results indicate the frequency of these discussions varies by MCP type. Hierarchical regression analyses show, as hypothesized, that additional behavioral and contextual determinants not previously considered (i.e., perceived norms, self-efficacy, information sources and child factors) are significantly associated with positive, negative and redirective mediation practices. Results expand existing theory and justify extending physician mediation research beyond MDs. Implications for clinical practice and health communication research are discussed.

Gender Stereotypes and Preconception Health: Men's and Women's Expectations of Responsibility and Intentions to Engage in Preventive Behaviors.

Introduction As mounting evidence underscores the importance of both men and women taking steps before pregnancy to improve reproductive outcomes, public health priorities are shifting toward a more gender-inclusive program of promoting preconception health (PCH). This study examined whether prescriptive gender stereotypes, defined as men's and women's beliefs about PCH behavioral norms each gender should uphold, were positively associated with intentions to engage in behaviors to protect a future child's health. Methods Data came from a June 2017 online survey of 609 U.S. men and women ages 18-44. Two six-item scales of prescriptive same- and opposite-gender stereotypes were used to predict a six-item scale of intentions to engage in six recommended PCH behaviors (i.e., avoiding smoking, secondhand smoke, drinking, exposure to bisphenol A and pesticides, and preventing Zika infection). Multiple linear regression models also adjusted for demographic, socioeconomic, and health characteristics. Results Among both male and female respondents, PCH prescriptive gender stereotypes for men were rated significantly lower than those for women. Adjusting for covariates, stronger prescriptive same-gender stereotypes were associated with increased PCH intentions (men: B = 0.496, p < 0.001; women: B = 0.486, p < 0.001). Opposite-gender stereotypes were also positively associated with PCH intentions (men: B = 0.205, p < 0.001; women: B = 0.235, p < 0.001). Current every day smoking status (men and women), being uninsured (women only), and having children (women only) were also associated with lower PCH intentions. Conclusion Prescriptive gender stereotypes may play an important, yet slightly different, role in promoting PCH behavior among men and women.

Speaking up about Lighting up in Public: Examining Psychosocial Correlates of Smoking and Vaping Assertive Communication Intentions among U.S. Adults.

Against a backdrop of increasing smoke-free policies, electronic cigarette use, and discussion about public health risks posed by smoking and vaping, this study examines psychosocial predictors of intentions to ask others not to use e-cigarettes (vape) and smoke - i.e., assertive communication intentions. A national sample of U.S. adults (n = 474) reported assertive communication intentions for public venues. Psychosocial correlates included perceived risks of exposure to secondhand smoke (SHSe) and secondhand vapor (SHVe), SHSe and SHVe attitudes, subjective norms, and perceived self-efficacy. Separate linear regression models were conducted for smoking and vaping assertive communication intention outcomes. Perceived risks and self-efficacy were associated with greater vaping and smoking assertive communication intentions; subjective norms were only significant for vaping assertive communication intentions. Although a majority of respondents indicated they were unlikely to intervene to voice objections about SHSe and SHVe in public venues, this study suggests that incidental or intentional messages and policies that influence perceptions of risk, norms, and efficacy could affect willingness to voice objections about others' vaping and smoking in public.

Assertive communication about others' smoking and vaping in public venues: Results from a National Survey of US adults.

INTRODUCTION: This study describes prevalence and correlates of US adults' intentions to engage in assertive communication (i.e., speak up) about others' smoking and vaping in public venues. METHODS: Participants from a nationally representative online survey of 1551 US adults conducted October-December 2013 reported intentions to ask others not to smoke/vape in three types of public venues (restaurants, bars/casinos/nightclubs, and parks). We examined weighted prevalence of intentions and conducted weighted logistic regression. RESULTS: Fifty-two percent of participants reported being likely to ask someone not to smoke in at least one venue compared with 19% for vaping. Assertive communication intentions for smoking in restaurants (48%), bars/casinos/nightclubs (35%), and parks (32%) were higher than for vaping (16%, 14%, and 12%, respectively). Significant correlates of assertive communication intentions in one or more venues were current smoking status, ever trying e-cigarettes, gender, age, health status, political ideology, and party identification. CONCLUSIONS: US adults were more willing to ask others not to smoke than vape. Intentions to speak up about smoking and vaping differed by venue, demographics, and cigarette/e-cigarette use. These findings help establish an evidence base to inform policymakers in developing strategies to promote compliance with smoke-free and vape-free laws.

Explaining the effects of a decision intervention on mammography intentions: The roles of worry, fear and perceived susceptibility to breast cancer.

OBJECTIVE: This study examines the effects of a mammography decision intervention on perceived susceptibility to breast cancer (PSBC) and emotion and investigates how these outcomes predict mammography intentions. DESIGN: Randomised between-subjects online experiment. Participants were stratified into two levels of risk. Within each stratum, conditions included a basic information condition and six decision intervention conditions that included personalised risk estimates and varied according to a 2 (amount of information: brief vs. extended) × 3 (format: expository vs. untailored exemplar vs. tailored exemplar) design. Participants included 2465 US women ages 35-49. MAIN OUTCOME MEASURES: PSBC as a percentage, PSBC as a frequency, worry, fear and mammography intentions. RESULTS: The intervention resulted in significant reductions in PSBC as a percentage for women in both strata and significant increases in worry and fear for women in the upper risk stratum. Of the possible mediators examined, only PSBC as a percentage was a consistent mediator of the effect of the intervention on mammography intentions. CONCLUSION: The results provide insight into the mechanism of action of the intervention by showing that PSBC mediated the effects of the intervention on mammography intentions.

Knowledge about Chemicals in e-Cigarette Secondhand Vapor and Perceived Harms of Exposure among a National Sample of U.S. Adults.

Potentially harmful chemicals are detectable in e-cigarette secondhand vapor (hereafter SHV), contrary to advertising and marketing claims that it contains "only water vapor." We assessed public knowledge about the presence of chemicals in SHV and associations between knowledge and perceived harms of exposure to SHV. We conducted an online survey of a nationally representative sample of 1,449 U.S. adults (GfK's KnowledgePanel) from October to December 2013. Respondents were asked whether e-cigarette vapor contains only water vapor, contains tar, or contains formaldehyde (true/ false/ do not know). Responses to these three items were recoded (1 = incorrect, 2 = do not know, and 3 = correct) and averaged into a knowledge scale. They were also asked if they perceived breathing SHV to be harmful to one's health (two-item scale) and comparative harm of breathing SHV versus breathing secondhand smoke (SHS). Multiple regression analyses were weighted to the U.S. adult population and adjusted for potential confounders. Most respondents (58-75%) reported not knowing whether SHV contained only water vapor, if SHV contained tar, and if it contained formaldehyde. African-American respondents (vs. white) and current smokers (vs. nonsmokers) had lower levels of knowledge about chemicals in SHV. Adjusting for covariates, correct knowledge about chemicals in SHV was associated with higher perceived harms about SHV for one's health and perceived comparative harm of SHV versus SHS. These findings suggest a need to provide accurate information about the presence of chemicals in SHV (e.g., using product ingredient labels or public education).

Who's Responsible? Media Framing of Pediatric Environmental Health and Mothers' Perceptions of Accountability.

How the media frames issues of environmental health may affect mothers' views of who is responsible for addressing environmental risks to pediatric health and, ultimately, their protective behaviors. This article describes how information-oriented media sources attribute responsibility for such risks and examines associations between mothers' routine media exposure, or scanning, and perceptions of responsibility. First, a content analysis was conducted on a sample of 474 media stories (i.e., Associated Press, parenting magazines, and websites) about childhood exposure to environmental chemicals over a 6-month period (September 2012-February 2013). We found that media stories attributed responsibility most frequently to parents, though significant differences were observed across media sources, such that websites focused more on parents and general news more on government agencies and manufacturers. Next, we conducted an online survey of mothers (N = 819) and revealed that website scanning during the prior 6 months was significantly associated with perceived personal responsibility, even after we adjusted for potential confounders. Scanning general news was also significantly associated with perceived government and manufacturer responsibility. Understanding media framing of these issues highlights opportunities for health communicators to offset pressure placed on mothers by encouraging greater social and policy support in and exposure to certain media.

To Regulate or Not to Regulate? Views on Electronic Cigarette Regulations and Beliefs about the Reasons for and against Regulation.

BACKGROUND: Policies designed to restrict marketing, access to, and public use of electronic cigarettes (e-cigarettes) are increasingly under debate in various jurisdictions in the US. Little is known about public perceptions of these policies and factors that predict their support or opposition. METHODS: Using a sample of US adults from Amazon Mechanical Turk in May 2015, this paper identifies beliefs about the benefits and costs of regulating e-cigarettes and identifies which of these beliefs predict support for e-cigarette restricting policies. RESULTS: A higher proportion of respondents agreed with 8 different reasons to regulate e-cigarettes (48.5% to 83.3% agreement) versus 7 reasons not to regulate e-cigarettes (11.5% to 18.9%). The majority of participants agreed with 7 out of 8 reasons for regulation. When all reasons to regulate or not were included in a final multivariable model, beliefs about protecting people from secondhand vapor and protecting youth from trying e-cigarettes significantly predicted stronger support for e-cigarette restricting policies, whereas concern about government intrusion into individual choices was associated with reduced support. DISCUSSION: This research identifies key beliefs that may underlie public support or opposition to policies designed to regulate the marketing and use of e-cigarettes. Advocates on both sides of the issue may find this research valuable in developing strategic campaigns related to the issue. IMPLICATIONS: Specific beliefs of potential benefits and costs of e-cigarette regulation (protecting youth, preventing exposure to secondhand vapor, and government intrusion into individual choices) may be effectively deployed by policy makers or health advocates in communicating with the public.

Effects of a risk-based online mammography intervention on accuracy of perceived risk and mammography intentions.

OBJECTIVE: This experiment tested the effects of an individualized risk-based online mammography decision intervention. The intervention employs exemplification theory and the Elaboration Likelihood Model of persuasion to improve the match between breast cancer risk and mammography intentions. METHODS: 2918 women ages 35-49 were stratified into two levels of 10-year breast cancer risk (<1.5%; ≥1.5%) then randomly assigned to one of eight conditions: two comparison conditions and six risk-based intervention conditions that varied according to a 2 (amount of content: brief vs. extended) x 3 (format: expository vs. untailored exemplar [example case] vs. tailored exemplar) design. Outcomes included mammography intentions and accuracy of perceived breast cancer risk. RESULTS: Risk-based intervention conditions improved the match between objective risk estimates and perceived risk, especially for high-numeracy women with a 10-year breast cancer risk ≤1.5%. For women with a risk≤1.5%, exemplars improved accuracy of perceived risk and all risk-based interventions increased intentions to wait until age 50 to screen. CONCLUSION: A risk-based mammography intervention improved accuracy of perceived risk and the match between objective risk estimates and mammography intentions. PRACTICE IMPLICATIONS: Interventions could be applied in online or clinical settings to help women understand risk and make mammography decisions.

Predicting Behaviors to Reduce Toxic Chemical Exposures Among New and Expectant Mothers: The Role of Distal Variables Within the Integrative Model of Behavioral Prediction.

There is a growing body of evidence linking childhood exposure to environmental toxins and a range of adverse health outcomes, including preterm birth, cognitive deficits, and cancer. Little is known, however, about what drives mothers to engage in health behaviors to reduce such risks. Guided by the integrative model of behavioral prediction, this study surveyed women who were pregnant and/or had children younger than 7 years (N = 819) to identify the factors that determine engagement in behaviors to reduce childhood exposure to toxic chemicals in the environment. Structural equation modeling pertaining to three different environmental toxins-bisphenol A, arsenic, and pesticides-demonstrated that perceived normative pressure was the primary determinant of behavior across all three models. Additionally, we identified two key distal variables-perceived risk and information seeking-that not only increased the model's predictive power but also consistently and positively predicted perceived social norms regarding exposure reduction behaviors. Findings also suggest important differences across these behaviors. Implications for health communication researchers and practitioners developing interventions, communication campaigns, and persuasive messages to promote prenatal and pediatric environmental health are discussed.

Media Coverage of Pediatric Environmental Health Risks and its Effects on Mothers' Protective Behaviors.

This study explores the relationship between exposure to U.S. media coverage of chemical threats to pediatric environmental health and mothers' behaviors to protect their children. Prior content analytic work revealed that media coverage volume from September 2012 to February 2013 differed significantly by type of chemical (i.e., pesticides = high coverage volume; bisphenol A [BPA] = moderate; and arsenic = low). Survey data collected from new and expecting mothers in March 2013 (n = 822) revealed mothers incidentally encountered-or scanned-this information in the media in the prior six months, and after adjusting for a series of potential confounders, such scanning was positively associated with mothers' self-reported behaviors to reduce chemical exposures. To test the hypothesis that coverage volume moderates the relationship between scanning and behavior, content analysis and survey data were combined in mixed effects regression analyses. Results showed significant differences between the effects of media scanning at different levels of coverage volume, but in a direction not entirely consistent with the study's hypothesis. The relationship between scanning and behavior was strongest for BPA, suggesting that a characteristic of media coverage other than volume may drive maternal responses to environmental health threats. Implications of these findings for risk communication research and practice are discussed.

Perceived Harm of Secondhand Electronic Cigarette Vapors and Policy Support to Restrict Public Vaping: Results From a National Survey of US Adults.

INTRODUCTION: There is ongoing debate over banning electronic cigarette (e-cigarette) use (vaping) in public places. Many people perceive secondhand e-cigarette vapors (SHV) to be relatively harmless, which may affect their support for policies to restrict vaping in public places. Given that awareness of secondhand cigarette smoke risks predicts public support for clean air policies, we hypothesized that greater perceived harm of SHV to personal health would be associated with stronger support for vaping restrictions. METHODS: Data from 1449 US adults in a national online panel was collected from October to December 2013. Using multiple regressions, we predict a three-item scale of support for e-cigarette restricting policies in restaurants, bars/casinos/clubs, and parks using a two-item scale measuring concern and perceptions of harm to personal health from breathing SHV. Analyses adjusted for demographic covariates, smoking status and e-cigarette use, and were weighted to represent the US adult population. RESULTS: Overall, respondents considered SHV exposure to be moderately harmful to their health and tended to favor restricting vaping in public places. Perceived harm of SHV to personal health was associated with support for vaping restrictions in public spaces (unstandardized regression coefficient, B = 0.18, 95% CI = 0.16, 0.20). Current smokers (vs. nonsmokers), those who ever tried e-cigarettes (vs. never), those who directly observed others vaping, and those with some college education (vs. high school or less) demonstrated less support for such policies. IMPLICATIONS: This study shows that support for banning vaping in public spaces in the United States is positively associated with perceived health harms of SHV exposure. The findings suggest that continued monitoring of public perception of SHV harm and the accuracy of e-cigarette marketing claims about reduced harm would be needed to guide clean air policy decisions. With the emergence of new scientific evidence of the potential effects of SHV exposure, these results will serve as an important baseline of public perceptions and opinion during a time when such evidence was particularly limited.

Is exposure to e-cigarette communication associated with perceived harms of e-cigarette secondhand vapour? Results from a national survey of US adults.

OBJECTIVES: E-cigarettes are frequently advertised and portrayed in the media as less harmful compared with regular cigarettes. Earlier surveys reported public perceptions of harms to people using e-cigarettes; however, public perceptions of harms from exposure to secondhand vapour (SHV) have not been studied. We examined associations between self-reported exposure to e-cigarette advertising, media coverage, and interpersonal discussion and perceived harms of SHV. DESIGN: Observational study. SETTING: National online sample of US adults aged ≥18 years. PARTICIPANTS: 1449 US adults (mean age 49.5 years), 51.3% female, 76.6% non-Hispanic Caucasian, 7.5% African-American, 10.0% Hispanic and 5.9% other races. OUTCOMES: Perceived harm measures included (1) harmfulness of SHV to one's health, (2) concern about health impact of breathing SHV and (3) comparative harm of SHV versus secondhand smoke (SHS). Predictors were (1) self-reported frequency of exposure to e-cigarette advertising, media coverage and interpersonal discussion (close friends or family) and (2) perceived valence of exposure from each source. Covariates were demographic characteristics, cigarette smoking status and e-cigarette use, and were weighted to the general US adult population. RESULTS: More frequent interpersonal discussion was associated with lower perceived harmfulness of SHV to one's health and lower perceived comparative harm of SHV versus SHS. Frequency of e-cigarette ad and other media exposure were not significant predictors. Perceived negative valence of ad exposure and interpersonal discussion (vs no exposure) was associated with higher perceived harm across all three outcomes, while negative valence of media coverage was associated with higher concern about health impact of breathing SHV. Perceived positive valence (vs no exposure) of interpersonal discussion was associated with lower perceived harm across all three outcomes about health impact of breathing SHV. CONCLUSIONS: Exposure to information about e-cigarettes through advertising, media coverage and interpersonal discussion could play a role in shaping public perceptions of the harmfulness of SHV.

Media Coverage of Toxic Risks: A Content Analysis of Pediatric Environmental Health Information Available to New and Expecting Mothers.

Mass media play a central role in providing environmental health information to the public. Despite several decades of environmental and health communication research, the nature of environmental health information available to one of the most vulnerable populations--new and expecting mothers--has received limited attention. To address this gap, this study poses two questions: (1) How prevalent is information related to prenatal and pediatric environmental health (PPEH) in the media, and (2) how much coverage do the most concerning chemical threats to PPEH receive? A content analysis of 2,543 texts in popular media sources (i.e., the Associated Press [AP], parenting magazines, and parenting websites) from September 2012 to February 2013 revealed that roughly three pieces of PPEH information were made available to mothers daily. Prior research has shown that media coverage of environmental health issues has decreased over the years; however, these results suggest that at-risk populations are likely to encounter this type of information in the media. Also, while certain chemicals received ample coverage (i.e., pesticides, cigarette smoke, mercury), other issues deemed concerning by federal agencies did not (i.e., lead, phthalates). This study also introduces a novel method for harvesting online content encountered incidentally. Implications of these findings for communication research and practice are discussed.