Are some narratives better than others?: The impact of different narrative forms on adolescents' intentions to text and drive.

Psychological reactance theory posits individuals seek to restore freedom when threatened. Communication scholars have hypothesized persuasive messages can constitute threats to freedom. The current study engages questions about the potential for different forms of narratives in public service announcements (PSAs) to trigger freedom threats by examining responses to a PSA campaign that utilized three forms of narrative (celebrity testimonials, peer testimonials, and accident stories) to decrease adolescent texting and driving intentions. Participants (N = 214) watched anti-texting and driving narratives, and completed measures of threat to freedom, anger, negative cognition, and attitudes/intentions toward texting/driving. Compared to celebrity/peer testimonial PSAs, accident stories triggered increased anger and, indirectly, decreased intentions to drive safely. The results also suggest the need for continued examination of the best way to model psychological reactance theory, and the value of further research explicating anger as a mechanism of message effects.

Digital Health Engagement in the US Population: Insights From the 2018 Health Information National Trends Survey.

Objectives. To examine prevalence and predictors of digital health engagement among the US population. Methods. We analyzed nationally representative cross-sectional data on 7 digital health engagement behaviors, as well as demographic and socioeconomic predictors, from the Health Information National Trends Survey (HINTS 5, cycle 2, collected in 2018; n = 2698-3504). We fitted multivariable logistic regression models using weighted survey responses to generate population estimates. Results. Digitally seeking health information (70.14%) was relatively common, whereas using health apps (39.53%) and using a digital device to track health metrics (35.37%) or health goal progress (38.99%) were less common. Digitally communicating with one's health care providers (35.58%) was moderate, whereas sharing health data with providers (17.20%) and sharing health information on social media (14.02%) were uncommon. Being female, younger than 65 years, a college graduate, and a smart device owner positively predicted several digital health engagement behaviors (odds ratio range = 0.09-4.21; P value range < .001-.03). Conclusions. Many public health goals depend on a digitally engaged populace. These data highlight potential barriers to 7 key digital engagement behaviors that could be targeted for intervention.

Prevalence and Correlates of Family Cancer History Knowledge and Communication Among US Adults.

INTRODUCTION: Knowing one's family cancer history (FCH) plays an important role in cancer prevention. Communicating health histories with relatives can increase awareness about familial cancer risk and aid health care providers in personalizing cancer prevention recommendations. METHODS: This study used data from the National Cancer Institute's 2018 Health Information National Trends Survey. We calculated frequencies and weighted population estimates for key FCH communication variables. Multivariable logistic regression models estimated associations between sociodemographic characteristics and FCH communication. RESULTS: Findings provide the first nationally representative estimates of FCH communication. Less than one-third (31.1%) of the population reported knowing FCH very well, 70.0% had discussed FCH with at least 1 biological relative, 39.0% had discussed FCH with a health care provider, and 22.2% reported being completely confident in completing FCH on medical forms. Findings also identified key demographic factors, including sex, household income, education level, and race and ethnicity, associated with these FCH measures among the US adult population. CONCLUSION: Results can be used to target and tailor FCH communication interventions for patients, families, and providers.

Cancer communication research in the era of genomics and precision medicine: a scoping review.

Effective use of genetic and genomic data in cancer prevention and treatment depends on adequate communication with patients and the public. Although relevant empirical work has emerged, the scope and outcomes of this communication research have not been characterized. We conducted a comprehensive scoping review of recent published research (2010-2017) on communication of cancer-related genetic and genomic testing (CGT) information. Searches in six databases revealed 9243 unique records; 513 papers were included. Most papers utilized an observational quantitative design; fewer utilized an experimental design. More attention has been paid to outcomes of CGT results disclosure than to decision making regarding CGT uptake or the process of results disclosure. Psychosocial outcomes were most common across studies. This literature has a strong focus on BRCA1/2, with few papers focused on Lynch syndrome or next-generation technologies. Women, Caucasians, older adults, and those of higher socioeconomic status were overrepresented. Research gaps identified include the need for studies on the process of CGT communication; examining behavioral, decision making, and communication outcomes; and inclusion of diverse populations. Addressing these gaps can help improve the use of genomics in cancer control and reduce disparities in access to and use of CGT.

Addressing Rural Geographic Disparities Through Health IT: Initial Findings From the Health Information National Trends Survey.

BACKGROUND: Rural communities experience disparate rates of chronic diseases and face distinct challenges in gaining access to health care. Increasing the reach of the US health information and communication technology infrastructure can support rural health by overcoming geographic and temporal health care barriers. OBJECTIVES: The goal of the study is to establish statistically valid point estimates for the use of health information technology within rural versus urban populations, and to understand the degree to which structural factors may account for the overall variance in the use of these technologies. METHODS: Data from the National Cancer Institute's 2017 Health Information National Trends Survey were used to estimate prevalence of Health IT engagement across rural and urban populations and model factors influencing use of online medical records. RESULTS: Rural residents reported similar rates of providers maintaining electronic health records and offering access to online medical records. However, rural residents with provider-maintained records were less likely to receive a provider recommendation to use online medical records and were subsequently less likely to actually access records. Observed differences in online medical record use were accounted for by variance in Internet access, access to a regular health care provider, and whether providers encouraged patients to use online records. CONCLUSIONS: Findings shed light on structural opportunities for overcoming geographic and temporal barriers to Health IT and extending the benefits of digital health information technologies to underserved populations.

A Community-Based Qualitative Assessment of Knowledge, Barriers, and Promoters of Communicating about Family Cancer History among African-Americans.

Family cancer history (FCH) can shape prevention and early detection behaviors to decrease cancer risk. However, many individuals are unaware of increased risk for cancers based on family patterns. For some African-American communities, communication about FCH is rare and barriers have not been well studied. To optimize the use of FCH, it is crucial to understand how patients gather and share FCH with relatives and healthcare providers. We conducted four focus groups (n = 40) and seven key informant interviews (n = 9) to investigate knowledge, experiences, and barriers/promoters of FCH in the East Baltimore African-American community. Thematic analysis identified 14 distinct themes across six communication domains: participants' understanding of FCH, past FCH communication with family and providers, barriers to FCH communication, promoters of FCH communication, suggestions for future communication, and community health priorities. FCH was most often defined by narratives of family cancer experiences, and the majority of participants had shared little FCH with family members. Five psychosocial domains were commonly reported as barriers to sharing FCH: fear/denial, pride/dignity, selflessness/self-sacrifice, cancer fatalism, and distrust/skepticism of medical care. Diagnosis/death and caregiving/social support promoted FCH communication and encouraged cancer prevention behaviors such as screening. Although most participants had experienced cancer in their families, communication about FCH was low and psychosocial barriers were common. Understanding these communication domains in minority populations is crucial to developing interventions to address disparities in cancer prevention and control, particularly where effective screening and care recommendations exist for those with positive family histories.

Loss/Gain Framing, Dose, and Reactance: A Message Experiment.

Whether a loss or gain frame has a persuasive advantage in communicating health risks is a matter of ongoing debate. Findings reported in the literature are mixed, suggesting that framing effects are likely complex and may be influenced by a combination of factors. This study examined reactance as a mediator and dose as a moderator of loss/gain framing effects. Adults (N = 1,039) read framed messages about the health consequences of physical (in)activity in varying message doses (i.e., number of framed statements). Compared to loss frames, gain frames generated more threat to freedom and reactance. Dosage exerted significant influence at the extremes; the one-dose messages invoked less intentions to exercise compared to the four-dose messages. Planned contrasts revealed significant frame × dose interactions. Notably, the one-dose gain-framed messages triggered significantly more freedom threat and less intentions to engage in physical activity-a situation that changed when the information was loss-framed or when the dosage was increased.

Invited Commentary: Moving From Evidence to Impact for Human Papillomavirus Vaccination-The Critical Role of Translation and Communication in Epidemiology.

In response to the accompanying article by Yih et al. (Am J Epidemiol. 2018;187(6):1269-1276), we highlight the importance of moving beyond epidemiologic research on human papillomavirus (HPV) vaccine safety to focus on translation of this strong evidence base into successful vaccine safety communication strategies to bolster vaccine uptake. The potential of the HPV vaccine to reduce cancer incidence is substantial, yet actual HPV vaccination rates in the United States are disappointingly low in comparison with other routine childhood vaccines with similar safety profiles. This is no doubt due, in part, to persistent parental safety concerns. In 2016, safety remained the second most common reason for lack of vaccination intent by parents of unvaccinated adolescents. While the strong study by Yih et al. makes use of a novel statistical method and a large medical claims database to confirm the low occurrence of adverse events following HPV vaccination observed globally, their study also highlights a key challenge for epidemiologists: translating our research findings to other public health domains, so that evidence-informed communication strategies can be used to disseminate the information in a way that is understandable and useful to the public. Moving forward, multidisciplinary research teams will be essential to ensure that our epidemiologic findings have a broad public health impact.

Ethnic newspapers and low-income Spanish-speaking adults: influence of news consumption and health motivation on cancer prevention behaviors.

OBJECTIVE: Ethnic newspapers have the potential to reach and influence various cultural and ethnic subpopulations traditionally underserved in the United States. The current study sought to explore how ethnic news consumption interacts with health motivation to predict cancer prevention behaviors in a sample of Spanish-speaking adults. DESIGN: Participants (N = 100) completed a survey in Spanish, with items measuring demographics, acculturation, health literacy, health motivation, ethnic newspaper consumption (for two papers: La Viva and La Raza), and cancer prevention behaviors. RESULTS: Results indicated consumption of ethnic newspapers correlated positively to acculturation, and cancer screening utilization. In hierarchical regression analyses, the interaction of consumption of an ethnic newspaper (La Raza) and health motivation predicted two of the six prevention behaviors assessed: avoidance of fatty foods and screening behavior. CONCLUSION: The study provides evidence that consumption of Spanish-language newspapers enhances the likelihood that individuals with high levels of health motivation will engage in healthy behaviors. This finding highlights the utility of utilizing Spanish-language newspapers to reach underserved populations.

Theorizing Foreshadowed Death Narratives: Examining the Impact of Character Death on Narrative Processing and Skin Self-Exam Intentions.

Narratives are common in health campaigns and interventions, with many depicting individuals battling a particular illness or disease. Past research has focused primarily on the form and effects of survivor stories, but considerably less attention has been devoted to stories in which 1 or more of the central characters passes away. The goal of the current study was to compare the relative persuasive impact of survivor and death narratives in influencing skin prevention behaviors and to test narrative mediators that might explicate underlying mechanisms of effect. To that end, adults (N = 635, M age = 32.43 [SD = 11.23]) were randomly assigned to 1 of 6 narrative intervention conditions in an online message experiment. Participants read 1 of 2 stories about a person with melanoma (Rusty or Diane) that was manipulated as a narrative depicting the survival, death, or foreshadowed death of the main character. Foreshadowed death narratives increased intentions to perform a skin self-exam (SSE), a relationship that was mediated by narrative transportation and perceived SSE benefits. The results support the central postulate of narrative transportation theory and the utility of using foreshadowed death narratives in communication-based interventions designed to increase SSE frequency.

Graphic Narratives and Cancer Prevention: A Case Study of an American Cancer Society Comic Book.

As the interest in graphic medicine grows, health communicators have started engaging readers with compelling visual and textual accounts of health and illness, including via comic books. One context where comics have shown promise is cancer communication. This brief report presents an early example of graphic medicine developed by the American Cancer Society. "Ladies … Wouldn't It Be Better to Know?" is a comic book produced in the 1960s to provide the public with lay information about the Pap test for cervical cancer prevention and detection. An analysis of a key narrative attribute, plot development, illustrates the central role that perceived barriers played in this midcentury public health message, a component that remains a consideration of cancer communication design today. This case study of an early graphic narrative identifies promising cancer message features that can be used to address and refute barriers to cervical cancer screening and connects contemporary research with historical efforts in public health communication.

Health e-mavens: identifying active online health information users.

BACKGROUND: Given the rapid increase of Internet use for effective health communication, it is important for health practitioners to be able to identify and mobilize active users of online health information across various web-based health intervention programmes. We propose the concept 'health e-mavens' to characterize individuals actively engaged in online health information seeking and sharing activities. OBJECTIVES: This study aimed to address three goals: (i) to test the factor structure of health e-mavenism, (ii) to assess the reliability and validity of this construct and (iii) to determine what predictors are associated with health e-mavenism. METHODS: This study was a secondary analysis of nationally representative data from the 2010 Health Tracking Survey. We assessed the factor structure of health e-mavenism using confirmatory factor analysis and examined socio-demographic variables, health-related factors and use of technology as potential predictors of health e-mavenism through ordered regression analysis. RESULTS: Confirmatory factor analyses showed that a second-order two-factor structure best captured the health e-maven construct. Health e-mavenism comprised two second-order factors, each encompassing two first-order dimensions: information acquisition (consisting of information tracking and consulting) and information transmission (consisting of information posting and sharing). Both first-order and second-order factors exhibited good reliabilities. Several factors were found to be significant predictors of health e-mavenism. DISCUSSION AND CONCLUSION: This study offers a starting point for further inquiries about health e-mavens. It is a fruitful construct for health promotion research in the age of new media technologies. We conclude with specific recommendations to further develop the health e-maven concept through continued empirical research.

Framing Obesity: How News Frames Shape Attributions and Behavioral Responses.

Based on a public health model of obesity, this study set out to examine whether a news article reporting the obesity issue in a societal versus individual frame would increase perceptions of societal responsibilities for the obesity problem and motivate responsibility-taking behaviors. Responsibility-taking behaviors were examined at 3 levels: personal, interpersonal, and societal. Data from a Web-based experiment revealed significant framing effects on behaviors via causal and treatment responsibility attributions. The societal frame increased societal causal and treatment attribution, which led to greater likelihoods of interpersonal and social responsibility-taking behaviors as well as personal behaviors. Our findings suggest that news framing can be an effective venue for raising awareness of obesity as a societal issue and mobilizing collective efforts.

Collateral Damage and Critical Turning Points: Public Health Implications of HPV Vaccine News Coverage for Boys and Men in 2011.

In 2009, the Food and Drug Administration (FDA) officially expanded approval of the Gardasil vaccine to include human papillomavirus (HPV) vaccination for boys and men, and in 2011, the Centers for Disease Control and Prevention (CDC) issued a formal recommendation for routine vaccination for this population. Despite these efforts, HPV vaccination rates for boys and men continue to fall short of public health targets. While news was breaking about the benefits of the HPV vaccine for boys and men, public attention shifted as a result of political debates concerning the vaccine. This study examines a pivotal time period for public health in which the vaccine became officially recommended for boys and men and at the same time became the center of political controversies in the lead-up to the 2012 presidential campaign. The current study extends previous research and presents a content analysis of newspaper articles (N = 154) about the HPV vaccine for the year 2011. Results indicate that the lack of comprehensive coverage of HPV and the HPV vaccine found in previous studies continued in this year. Results shed light on key political events that may have functioned to overshadow the recommendation of the HPV vaccine for boys and men. The implications of this pattern of news coverage can inform public health efforts to address low rates of HPV vaccination uptake among boys and men in present day.

Explicating perceived barriers to mammography for the USCREEN project: concerns about breast implants, faith violations, and perceived recommendations.

In line with the health belief model, perceived barriers have proven to be a key determinant of intentions to screen for breast cancer. The standard measure of perceived barriers to breast cancer screening is an 11 item scale developed by Victoria Champion. However, perceived barriers emerge and change over time, and Champion's perceived barriers scale was last revised in 1999. Moreover, the original scale did not address barriers which may be more pronounced in particular populations, such as congruity of action with faith. As part of the Utah Screening Project, a sample of women 40-74 (N = 341, Mage = 51.19, SD = 8.11) were recruited from four Utah counties in 2014 to complete a survey. The results revealed that the four new perceived barrier items explained 6.4 % of intentions to screen, above and beyond other predictors. In addition to barriers identified in past research, the current study identified several novel barriers including (a) concerns about negative effects to breast implants, (b) perceived conflict with faith, and the (c) perception that mammography is no longer recommended. The new perceived barriers items are useful to researchers interested in exploring barriers not addressed by the original instrument. The barriers also suggest potential belief-based targets and channels (e.g., plastic surgery clinics, faith-based interventions) for delivering mammography interventions.

Against conventional wisdom: when the public, the media, and medical practice collide.

BACKGROUND: In 2009, the U.S. Preventive Services Task Force released new mammography screening guidelines that sparked a torrent of criticism. The subsequent conflict was significant and pitted the Task Force against other health organizations, advocacy groups, the media, and the public at large. We argue that this controversy was driven by the systematic removal of uncertainty from science communication. To increase comprehension and adherence, health information communicators remove caveats, limitations, and hedging so science appears simple and more certain. This streamlining process is, in many instances, initiated by researchers as they engage in dissemination of their findings, and it is facilitated by public relations professionals, journalists, public health practitioners, and others whose tasks involve using the results from research for specific purposes. ANALYSIS: Uncertainty is removed from public communication because many communicators believe that it is difficult for people to process and/or that it is something the audience wants to avoid. Uncertainty management theory posits that people can find meaning and value in uncertainty. We define key terms relevant to uncertainty management, describe research on the processing of uncertainty, identify directions for future research, and offer recommendations for scientists, practitioners, and media professionals confronted with uncertain findings. CONCLUSIONS: Science is routinely simplified as it is prepared for public consumption. In line with the model of information overload, this practice may increase short-term adherence to recommendations at the expense of long-term message consistency and trust in science.

Validating Cross-Modal Measures for Comparative Research: Message Veracity, Novelty, and Memorability.

Marketing researchers are interested in the relative persuasiveness of different message modes, such as narratives and arguments. A desire to explicate and compare underlying mechanisms is central to this research, yet progress is hindered by a dearth of measures that can be used meaningfully across modes. In the current project, we identify and validate three cross-modal message perceptions - veracity, novelty, and memorability - that can mediate the relationship between different modes and outcomes. Three studies (Study 1: N = 105; Study 2: N = 322; Study 3: N = 248) confirmed the factor structure, discriminant validity, and cross-modal (narrative vs. argument) value of all three message perceptions. The results of this study provide researchers with three cross-modal measures to support comparative message effects research.

What cancer research makes the news? A quantitative analysis of online news stories that mention cancer studies.

Journalists' health and science reporting aid the public's direct access to research through the inclusion of hyperlinks leading to original studies in peer-reviewed journals. While this effort supports the US-government mandate that research be made widely available, little is known about what research journalists share with the public. This cross-sectional exploratory study characterises US-government-funded research on cancer that appeared most frequently in news coverage and how that coverage varied by cancer type, disease incidence and mortality rates. The subject of analysis was 11436 research articles (published in 2016) on cancer funded by the US government and 642 news stories mentioning at least one of these articles. Based on Altmetric data, researchers identified articles via PubMed and characterised each based on the news media attention received online. Only 1.88% (n = 213) of research articles mentioning US government-funded cancer research included at least one mention in an online news publication. This is in contrast to previous research that found 16.8% (n = 1925) of articles received mention by online mass media publications. Of the 13 most common cancers in the US, 12 were the subject of at least one news mention; only urinary and bladder cancer received no mention. Traditional news sources included significantly more mentions of research on common cancers than digital native news sources. However, a general discrepancy exists between cancers prominent in news sources and those with the highest mortality rate. For instance, lung cancer accounted for the most deaths annually, while melanoma led to 56% less annual deaths; however, journalists cited research regarding these cancers nearly equally. Additionally, breast cancer received the greatest coverage per estimated annual death, while pancreatic cancer received the least coverage per death. Findings demonstrated a continued misalignment between prevalent cancers and cancers mentioned in online news media. Additionally, cancer control and prevention received less coverage from journalists than other cancer continuum stages, highlighting a continued underrepresentation of prevention-focused research. Results revealed a need for further scholarship regarding the role of journalists in research dissemination.

'There were some clues': a qualitative study of heuristics used by parents of adolescents to make credibility judgements of online health news articles citing research.

OBJECTIVE: To identify how parents judge the credibility of online health news stories with links to scientific research. DESIGN: This qualitative study interviewed parents who read online stories about e-cigarettes and human papillomavirus (HPV) vaccination published by top-tier US news organisations. Researchers asked participants to describe elements of a story that influenced their judgement about content credibility. Researchers analysed transcripts using inductive and deductive techniques. Deductive analysis drew on cognitive heuristics previously identified as being used by the public to judge online health information. Inductive analysis allowed the emergence of new heuristics, especially relating to health. SETTING: The US National Cancer Institute's Audience Research Lab in Maryland, in August-November 2018. PARTICIPANTS: Sixty-four parents with at least one child between the ages of 9 and 17 residing in Maryland, Virginia, or the District of Columbia participated. Researchers randomly assigned 31 parents to the HPV vaccination story and 33 to the e-cigarette story. RESULTS: Evidence of existing heuristics, including reputation, endorsement, consistency, self-confirmation, expectancy violation and persuasive intent emerged from the interviews, with participants deeming stories credible when mentioning physicians (reputation heuristic) and/or consistent with information provided by personal physicians (consistency heuristic). Participants also described making credibility judgements based on presence of statistics, links to scientific research and their general feelings about news media. In relation to presence of statistics and links, participants reported these elements increased the credibility of the news story, whereas their feelings about the news media decreased their credibility judgement. CONCLUSIONS: Parents used a constellation of heuristics to judge the credibility of online health news stories. Previously identified heuristics for online health information are also applicable in the context of health news stories. The findings have implications for initiatives in education, health communication and journalism directed towards increasing the public's engagement with health news and their credibility judgements.