The Impact of Celebrity and Influencer Illness Disclosures.

When celebrities, political figures, influencers, or anyone with a large following publicly disclose an illness or die, the news becomes a de facto public health campaign. Until health communicators began studying such disclosures and the effects of the following waves of media coverage, however, it was not known to what extent these events impacted the public. A growing body of research has empirically documented these events and examined the factors that predict which types of audiences are most affected and why. Beyond motivating research opportunities, celebrity and influencer health disclosures or deaths can impact calls to hotlines, views on health-related websites, discussions of related topics on social media, behavioral changes relevant to the disclosure, increased news coverage of celebrity health research, integration of celebrity health narratives into strategic health campaigns, and even policy changes. We provide an overview of research conducted in this area and detail examples of the impact that celebrity health disclosures and studies about those disclosures have had on public discourse and public health.

Stories to Prevent Cancer: A Pilot Study Using Cancer Survivor Narratives to Increase Human Papillomavirus Vaccine Intentions.

INTRODUCTION: Human papillomavirus (HPV) vaccination rates are lower than other recommended adolescent vaccines. Cancer survivor narratives are used to promote cancer prevention and control, but little is known about their impact on adolescent HPV vaccination. OBJECTIVE: This pilot study explored the feasibility and effects of a video education intervention using a cancer survivor narrative to improve parents' attitudes toward and intentions to get the HPV vaccine. METHODS: This study utilized a one-group design; participants completed a pre-intervention survey, watched the video before attending their sons' wellness visits, and completed a post-intervention survey within one week of their appointment. Using the narrative persuasion framework, we developed a 4-minute video of a local HPV-related cancer survivor to promote the HPV vaccine as cancer prevention. We recruited 37 participants between June and October 2020. Participants were parents of males ages 9-17 who had not yet initiated HPV vaccination. RESULTS: After the video, more parents agreed that HPV vaccination is safe (pre: 66% vs. post: 82%; P = .045) and that their child's chances of getting HPV-related cancer in the future are high (pre: 24% vs. post: 46%; P = .014). Overall, 91% of parents felt the cancer survivor story helped them understand the risks of HPV cancers, and 52% said the story influenced their decision to start HPV vaccination for their child. CONCLUSIONS: Our findings suggest that cancer survivor narratives influence parents' vaccine opinions and understanding of their child's risk of HPV infection, leading to increased parental intent to get the HPV vaccine for their adolescent males.

An Experimental Test of the Effects of Public Mockery of a Social Media Health Campaign: Implications for Theory and Health Organizations' Social Media Strategies.

This study explored how social media users' mocking of a public health campaign can affect other users' emotions, cognitions, and behavioral intentions. Inspired by public mocking of the CDC's "Say No to Raw Dough" campaign aiming to prevent food poisoning caused by eating raw flour-based products, this experiment (N = 681) employed a 2 (Public responses to a PSA: Mocking or serious) x 3 (Organizational response to public responses: Self-mocking, serious, or none) + 1 (control condition) design. Statistical tests revealed that user-generated mocking can lower intentions to avoid the health risk by decreasing perceptions of injunctive norms (that is, seeing others mock a public health campaign resulted in weaker perceptions that others think you should avoid the risky behavior). Mockery of a public health campaign also engender anger at the CDC and at other users, with the target of the anger having differential effects on intentions to avoid eating raw dough. Implications for theory and the practice of social media-based health promotion are discussed.

Perceived risk, emotions, and stress in response to COVID-19: The interplay of media use and partisanship.

Relationships between risk perceptions, emotions, and stress are well-documented, as are interconnections between stress, emotion, and media use. During the early COVID-19 pandemic, the public responded psychologically to the threat posed by the pandemic, and frequently utilized media for information and entertainment. However, we lack a comprehensive picture of how perceived risk, emotion, stress, and media affected each other longitudinally during this time. Further, although response to the pandemic was highly politicized, research has yet to address how partisan affiliation moderated relationships between risk, emotion, stress, and media use over time. This three-wave (N = 1021) panel study assessed the interplay of risk, emotion, stress, and media use for Americans with different political affiliations between March and May of 2020. Findings indicate that perceived risk, emotion, and stress at Time 1 predicted media use at Time 2, with predictors varying by type of media. Use of entertainment media and social/mobile media predicted later stress (Time 3), but news consumption did not. Later risk perceptions (Time 3) were not influenced by media use at Time 2. The predictors and consequences of different types of media use were notably different for Republicans and Democrats. In particular, risk perceptions predicted greater news use among Democrats but greater entertainment media use among Republicans. Moreover, social/mobile media use resulted in perceiving the risks of COVID-19 as less serious for Republicans while increasing stress over time for Democrats.

Who is your Fitspiration? An Exploration of Strong and Weak Ties with Emotions, Body Satisfaction, and the Theory of Planned Behavior.

Physical inactivity has become an increasingly important concern for public health. "Fitspiration" social media posts may influence attitudes and intentions toward exercising. An online survey (N = 485) was conducted to examine the potential for fitspiration content from weak and strong ties to shape user emotions, attitudes, norms and behaviors related to exercising. Guided by the theory of planned behavior (TPB) and social cognitive theory (SCT), the results show that exposure to fitspiration content from both strong ties and weak ties were significant predictors of particular attitudes, norms, intentions, actual exercise frequency. However, our path analyses reveal significant indirect paths between exposure to fitspiration content and outcomes for weak ties through negative emotions (guilt), but only through positive emotions (hope and curiosity) for strong ties. Additionally, we found evidence that body satisfaction levels do matter in shaping the interrelationships between exposure to fitspiration content, emotions, and our outcome variables. In light of our results, we encourage researchers to consider the inclusion of emotional responses as antecedents to TPB outcomes and for practitioners to consider the role of source in campaign design.

Social media exposure, interpersonal network, and tampon use intention: A multigroup comparison based on network structure.

The scarcity of tampons in China has attracted scholarly attention. Extending the theory of planned behavior with social network structure, this cross-sectional online survey (N = 763) found that exposure to tampon-related information on social media was positively related to Chinese women's tampon use intentions. This association was mediated through attitudes, descriptive norms, and self-efficacy toward using tampons. Furthermore, the effects of social media exposure differed among people with different network structures. Our findings shed light on the promotion of nonconventional feminine hygiene products, which, in turn, may enhance Chinese women's well-being and gender equity across the globe.

Extending the Theory of Normative Social Behavior: Collective Norms, Opinion Leadership, and Masking During the COVID-19 Pandemic.

Novel, public behaviors, such as masking, should be susceptible to normative influence. This paper advances the theory of normative social behavior by considering a new set of moderators of normative influence - superdiffuser traits - and by clarifying the antecedents and consequences of exposure to collective norms. We use data from a two-wave survey of a cohort living in one U.S. county during the pandemic (N = 913) to assess normative effects on masking. We also used a bipartite network (based on people shopping for food in the same stores) to examine exposure to collective norms. The results show different superdiffuser traits have distinct effects on the relationship between perceived injunctive norms and masking intentions. Exposure to collective norms influences masking, but this influence depends on how people interact with their social environments. Network analysis shows that behavioral homophily is a significant predictor of selective exposure to collective norms earlier (but not later) in the pandemic. Implications for understanding normative influence in a context where opinion leadership matters are discussed.

Associations Between Human Papillomavirus Vaccine Decisions and Exposure to Vaccine Information in Social Media.

PURPOSE: Exposure to different types of vaccine information in social media can result in parents making disparate vaccine decisions, including not following national guidelines for human papillomavirus (HPV) vaccination. We sought to characterize parents' exposure to and engagement with information about HPV vaccination in social media, and the associations between exposure to such information and vaccine decisions for their adolescent children. METHODS: In 2019, we conducted a web-based survey with a national sample of 1073 parents of adolescents who use social media. The survey assessed whether parents have seen information in favor, against, or mixed about HPV vaccination. Multivariable logistic regressions assessed correlates of vaccine decisions, including HPV vaccine initiation, delay, and refusal. RESULTS: Sixty-one percent of parents reported that their children have initiated HPV vaccination. Over one-third of parents (37%) reported seeing HPV vaccine information on social media, which was either in favor (20%), against (5%), or a mix (12%). Parents exposed to information in favor were more likely than those who saw no information to have initiated HPV vaccination (OR = 1.74, 95% CI:1.24, 2.44). Parents exposed to information against vaccination were more likely to have delayed (OR = 3.29, 95% CI:1.66, 6.51) or refused (OR = 4.72, 95% CI:2.35, 9.50) HPV vaccination. Exposure to mixed information was also significantly associated with vaccine delay and refusal. DISCUSSION: Our findings suggest that the type of information seen on social media regarding HPV vaccination may influence the decisions parents make about vaccinating their children. Efforts should be sought to increase online information in favor of HPV vaccination and combat vaccine misinformation in social media.

The Effects of Embedded Skin Cancer Interventions on Sun-Safety Attitudes and Attention Paid to Tan Women on Instagram.

Background and Objectives: Because of high skin cancer risks for young women, it is vital that effective interventions reach and influence this demographic. Visual social media platforms, like Instagram, are popular with young women and are an appropriate intervention site; yet, they also host competing images idealizing tan skin. The present study tested the ability of digital sun-safety interventions to affect self-control-related emotions and visual attention to subsequent tan-ideal images as well as sun-safety attitudes. Methods: Women were recruited from a large public Mid-Atlantic university in the United States. Participants (N = 120) were randomly assigned to view an appearance benefits intervention, a self-control emotions intervention, or a control message, each designed to look like an Instagram sponsored story. After self-reporting self-compassion and anticipated pride, participants then viewed seven pairs of Instagram posts featuring either tan or pale women while an eye tracker assessed visual attention. Finally, participants self-reported their responses to questions assessing sun-safety-related norms, efficacy, and attitudes. Results: A mixed design analysis of covariance revealed that women who first viewed the appearance benefits intervention story spent less time visually fixated on Instagram images of tan women than did those who viewed the self-control emotions intervention or control message (p = 0.005, η p 2 = 0.087). Regressions also revealed interactions between the intervention conditions and feelings of anticipated pride on both visual attention and sun-safety attitudes. Conclusion: Sponsored stories on Instagram can promote sun-safety attitudes, depending on the emotional responses they generate. Additionally, sponsored interventions can affect subsequent visual attention.

A Mixed Methods Inquiry into the Role of Tom Hanks' COVID-19 Social Media Disclosure in Shaping Willingness to Engage in Prevention Behaviors.

Given the vast amounts of COVID-19-related messages flooding mediated and interpersonal communication channels during the global pandemic, celebrity COVID-19 disclosures offer rare opportunities to cut through message fatigue and apathy and garner the attention of wide swaths of the public. We conducted a convergent mixed method analysis of audience responses to actor Tom Hanks' March 11, 2020 disclosure of his COVID-19 diagnosis via social media. We collected our data within 24 hours of his announcement, allowing us to quickly capture emotional and cognitive responses to the announcement and to assess both demographic and psychosocial differences in types of people who heard the news in this time frame and those who had not. In our study, 587 participants had heard the news of Hanks' disclosure while 95 had not. Participants who had heard responded to an open-ended prompt asking if the disclosure affected them at all. Those who had not heard were funneled into a field intervention to test how random assignment to seeing Hanks' disclosure post or not would affect audiences' COVID-19-related emotions, cognitions, and willingness to enact prevention behaviors. The results of this mixed methods study revealed differences in responses to Hanks' disclosure based on health information source trust and involvement with Hanks as well as effects of the intervention on efficacy for dealing with COVID-19. We discuss implications for health communication theory and crafting messages that can effectively build off the attentional inertia generated by celebrity illness disclosures to encourage prevention efforts.

The "celebrity canary in the coal mine for the coronavirus": An examination of a theoretical model of celebrity illness disclosure effects.

RATIONALE: On March 11, 2020, actor Tom Hanks announced via social media that he had been diagnosed with COVID-19. Previous research has found celebrity illness disclosures to influence behavior, but during the uncertainty of a pandemic, the effects of such a disclosure were unclear. OBJECTIVE: To test the proposed Celebrity Illness Disclosure Effects (CIDE) model, demonstrating how an illness disclosure, communicated through mediated and interpersonal channels, may shape willingness to engage in prevention behaviors. METHODS: We conducted an online survey (N = 587) 24 hours after Hanks' COVID-19 disclosure. RESULTS: Findings revealed that celebrity-related perception variables predicted illness-related cognitions and emotions\, which were associated with willingness to enact prevention behaviors. Greater willingness to seek information, stronger perceptions of COVID as a threat, and stronger perceptions of efficacy for dealing with COVID after learning of Hanks' diagnosis predicted stronger willingness to enact prevention behaviors. However, anxiety about COVID predicted lower willingness to enact prevention behaviors. CONCLUSIONS: The CIDE model can serve as a guide for future research in this area. The results can help scholars who aim to better understand the phenomena around celebrities and health communication as well as policymakers who hope to ride the wave of star power to improved public health outcomes.

Appearance, Friends, and Feelings: A Two-Study Exploration of Young Women's Emotional Associations and Indoor Tanning Frequency.

BACKGROUND: Knowledge of its potential cancer risk is often not enough to motivate individuals to avoid indoor tanning. Previous research has found that emotions toward indoor tanning and appearance motivations may prompt people to continue despite the risks. METHODS: We conducted two online surveys of US young adult women. Study one included a convenience sample of female undergraduates (N = 502) at a university in the northwestern USA. Study two included young women from a nationwide US online panel (N = 270). RESULTS: Results suggest that emotional associations, both positive and negative, with indoor tanning explain greater variances in indoor tanning behavior than demographics and previously established psychosocial predictors of tanning alone. Appearance motivations were also positively associated with indoor tanning in both samples. CONCLUSIONS: This research has implications for health care providers and health communicators, as indoor tanning prevention messages and campaigns should consider the association between both positive and negative emotions on tanning behaviors as well as appearance motivations.

Health information source use and trust among a vulnerable rural disparities population.

PURPOSE: Because rural residents, particularly those near mining sites, are susceptible to numerous environmental health hazards, it is important to gain deeper insights into their use and trust of health information, which they may employ to help recognize symptoms, learn ways to reduce exposure, or find health care. METHODS: We surveyed residents (N = 101) of rural Kentucky, Virginia, and West Virginia to assess predictors of health information source use and trust. A project manager administered face-to-face paper and pencil questionnaires assessing demographics, health status, smoking behavior, and health information use and source trust. Bivariate correlations and ordinary least squares regressions were used to analyze the data. FINDINGS: The data suggest that rural individuals frequently use nurses, doctors, and websites to seek health information, whereas traditional media are often not their preferred channel for health information. Media sources were not found as trustworthy as interpersonal and medical health information sources. While only 13.0% of individuals in the sample said they ever turned to county or state health departments for health information, these sources were trusted more than any media source and more than friends. Moreover, living closer to active mining sites-meaning these individuals are at a higher risk of environmental health hazards-predicted even less use of traditional media and greater trust in peer sources. CONCLUSIONS: Not all sources of health information are equally used or trusted by individuals from a rural disparities population. The findings have implications for health campaign message dissemination and intervention designs targeting individuals in rural Appalachia.

Mental Health and Its Predictors during the Early Months of the COVID-19 Pandemic Experience in the United States.

To date, there has been relatively little published research on the mental health impacts of COVID-19 for the general public at the beginning of the U.S.' experience of the pandemic, or the factors associated with stress, anxiety, depression, and post-traumatic growth during this time. The current study provides a longitudinal examination of the predictors of self-reported stress, anxiety, depression, and post-traumatic growth for U.S. residents between April and May, 2020, including the influence of demographic, psychosocial, and behavioral factors on these outcomes. The findings indicate that, generally, the early months of the U.S. COVID-19 experience were characterized by a modest negative impact on mental health. Younger adults, people with pre-existing health conditions, and those experiencing greater perceived risk, higher levels of rumination, higher levels of co-rumination, greater social strain, or less social support reported worse mental health. Positive mental health was associated with the adoption of coping strategies, especially those that were forward-looking, and with greater adherence to national health-protection guidelines. The findings are discussed with regard to the current status of health-protective measures and mental health in the U.S., especially as these impact future management of the on-going pandemic.

Online media use and HPV vaccination intentions in mainland China: integrating marketing and communication perspectives to improve public health.

This study investigates the role of media in shaping human papilloma virus vaccination intentions in mainland China by applying both communication and marketing-focused theoretical frameworks in order to better understand ways to increase vaccine uptake across young men and women in China. An online survey (N = 359) revealed direct effects of online information consumption on perceived scarcity of the vaccine, as well as an indirect effect via perceived influence of media on others. Scarcity perceptions, in turn, predicted vaccine attitudes and behavioral intentions. Additionally, gender differences emerged in the data. Compared with women, men's intent to be vaccinated were not high, even if they realized the vaccine shortage. Implications for theory and practice are discussed.

Measuring Trivialization of Mental Illness: Developing a Scale of Perceptions that Mental Illness Symptoms are Beneficial.

Much of the extant research on representations of mental illness in the media have focused on stigmatization. The negative effects of these stigmatizing portrayals on individuals with mental illness are serious. However, recent scholarship has identified another phenomenon in the mediated portrayal of mental illness whereby these conditions are trivialized. As opposed to stigmatizing portrayals that make people with mental illness seem violent and incompetent, media portrayals that trivialize mental illnesses often treat the symptoms of these conditions (e.g., organizational ability for people with obsessive compulsive disorder or high energy levels for people with attention-deficit/hyperactivity disorder) as benefits, thereby diminishing the seriousness of these conditions. The aim of the present study was to develop a reliable and valid scale for assessing how individuals perceive symptoms of mental illnesses as benefits (and, thereby, trivialize these illnesses). Results across three studies support the existence of a reliable and valid measure whereby symptoms demark individuals with a mental illness as receiving a benefit. By establishing this scale, researchers will be better suited to assess the potential intersections and interaction of processes related to mental illness trivialization and stigmatization, both through media portrayals and through everyday interactions.

Connections between viewing media about President Trump's dietary habits and fast food consumption intentions: Political differences and implications for public health.

A nationally representative sample (N = 1050) responded to a survey testing possible connections between Americans' attention to media about President Donald J. Trump's preference for fast food, their perceptions of Trump, and public perceptions and behavioral intentions regarding fast food consumption. This survey utilized measures aimed at integrating theory about audience responses to celebrity health issues with the Theory of Planned Behavior and found a significant positive relationship between attention to media about Trump's diet and perceptions that fast food is socially acceptable, as well as intentions to consume it. Some, but not all, media-related variables in the analyses were positively associated with fast food perceptions and intentions, even after controlling for demographic and psychosocial factors. Attention to media specifically about Trump's dietary habits was more often associated with fast food-related perceptions and outcomes than were other types of media attention. Additionally, having a positive parasocial relationship with Trump was positively associated with increased perceived acceptability of fast food. There were also differences in the connections between attention to media about Trump's diet, parasocial relationships with Trump, and fast food perceptions and consumption intentions for audiences with different political affiliations. For instance, attention to media about Trump in general was positively associated with more positive attitudes toward fast food for Republicans, but not for Democrats are those unaffiliated with either political party. Attention to media specifically about Trump's diet was positively related to fast food attitudes for both Republicans and Democrats but not unaffiliated individuals. This study demonstrates the important role of social, political, and media influences in shaping fast food related perceptions and preferences and offers many potential avenues for future research in this area.

The Role of Media-Induced Nostalgia after a Celebrity Death in Shaping Audiences' Social Sharing and Prosocial Behavior.

When a celebrity dies and news coverage repeatedly pays homages to the celebrity's life, it is possible that audiences experience nostalgia as they fondly recall past memories of that celebrity. Nostalgia has yet to be examined as a mechanism of audience behavior related to the health condition associated with that celebrity. As such, we proposed a conceptual model of the interplay of predictors of feeling nostalgic after a celebrity death (i.e., identification, audience age, audience gender, consumption of media about the celebrity death, and previous viewing of celebrity-related media) and two outcomes: prosocial behaviors (e.g., donating to or volunteering for a health-related organization associated with the celebrity) and social sharing of information with others. We conducted a nationwide survey (N = 466) within weeks following the death of television star Mary Tyler Moore to test our model. The results demonstrate that nostalgia is evoked by a number of factors after a celebrity death, and that together with these previously studied predictors it can influence outcomes of interest.

Uplifting Fear Appeals: Considering the Role of Hope in Fear-Based Persuasive Messages.

Fear appeal research has focused, understandably, on fear as the primary emotion motivating attitude and behavior change. However, while the threat component of fear appeals associates with fear responses, a fear appeals' efficacy component likely associates with a different emotional experience: hope. Drawing from appraisal theories of emotion in particular, this article theorizes about the role of hope in fear appeals, testing hypotheses with two existing data sets collected within the context of sun safety messages. In both studies, significant interactions between hope and self-efficacy emerged to predict behavioral intentions. Notable main effects for hope also emerged, though with less consistency. Further, these effects persisted despite controlling for the four cognitions typically considered central to fear appeal effectiveness. These results, consistent across two samples, support the claim that feelings of hope in response to fear appeals contribute to their persuasive success. Implications for developing a recursive model of fear appeal processing are discussed.

An Experimental Test of the Roles of Audience Involvement and Message Frame in Shaping Public Reactions to Celebrity Illness Disclosures.

Much research has investigated what happens when celebrities disclose an illness (via media) to the public. While audience involvement (i.e., identification and parasocial relationships) is often the proposed mechanism linking illness disclosures with audience behavior change, survey designs have prevented researchers from understanding if audience involvement prior to the illness disclosure actually predicts post-disclosure emotions, cognitions, and behaviors. Rooted in previous work on audience involvement as well as the Extended Parallel Process Model, the present study uses a national online experiment (N = 1,068) to test how pre-disclosure audience involvement may initiate post-disclosure effects for the message context of skin cancer. The data demonstrate that pre-disclosure audience involvement as well as the celebrity's framing of the disclosure can shape emotional responses (i.e., fear and hope), and that cognitive perceptions of the illness itself also influence behavioral intentions.