Exposure to Pro and Anti-Cannabis Social Media Messages and Teens' and College Students' Intentions to Use Cannabis.

Content analyses have documented that posts about cannabis are increasingly common on social media. The relationship between the cannabis-related content to which teens and college students are exposed on social media and how such content may be associated with intentions to use and use of cannabis is less known, however. We conducted an online survey with teens (N = 350) who lived in Washington state using online survey panel participants in June 2018 and with college students (N = 966) in a Washington state-wide university system in February and March 2019. Participants in both samples reported seeing both pro-cannabis and anti-cannabis messages on social media platforms. Exposure to pro-cannabis messages on social media was associated with an increased intention to use cannabis. Exposure to anti-cannabis messages on social media was indirectly associated with decreased intentions to use cannabis through negative outcome beliefs of cannabis use and, among college students, through perceived norms. Among college students specifically, exposure to pro-cannabis messages on social media was also associated with more frequent cannabis use. Health communicators could focus anti-cannabis messaging on negative outcome beliefs among teens and college students as well as norms among college students to potentially influence constructs associated with intentions and use.

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.

An Exploratory Content Analysis of the Use of Health Communication Strategies and Presence of Objectification in Fitness Influencer Social Media Posts.

Health and fitness content intended to inspire people to live healthy lives (e.g. "fitspiration") has been linked to negative body image among girls and young women. Fitness influencers purport wanting to motivate healthy behaviors. This study seeks to examine the presence of strategies known to positively influence health behaviors (e.g. attitudes, self-efficacy) as well as of content known to have a negative influence (e.g. objectification) among fitness influencers. We conducted a content analysis (N = 441) of a random sample of one year of posts from four Instagram fitness influencers popular with girls and young women in the United States. The main analysis consisted of codes related to objectification, health promotion strategies, health-related content, and social engagement (i.e., likes). We found that fitness influencers included content that conveyed constructs previously found to positively influence health behaviors (e.g., attitudes and self-efficacy), but objectification was frequently present, in more than half of the posts. Additionally, we found that the presence of objectification in posts was negatively associated with likes, a form of social endorsement. We suggest health communicators aim to work in tandem with fitness influencers to include content that may motivate positive health behaviors and improve media literacy and that influencers aim to reduce the amount of objectifying content included in their posts. Our findings shed light on content being conveyed and possible insights into the negative effects associated with viewing such content.

#LoveYourBody: An Experimental Test of the Effects of Objectification and Body Appreciation Content on Instagram Fitness and Health Posts Among Young Women.

Fitspiration content on Instagram often includes images in which women are objectified but may also include captions that aim to positively motivate viewers, such as through messaging about body appreciation. Viewing objectifying content in fitspiration posts may be problematic for young women's mental health, but it's unclear if positive messaging may help to alleviate some of these effects. In this study, we conducted a 2 × 2 online experiment assessing the effects of body appreciation and objectification content present in Instagram fitness posts by influencers on young women (N = 200). The outcome variables were state body appreciation, trait body appreciation, self-esteem, and self-compassion. We found an interaction between the presence and absence of objectification and presence and absence of body appreciation that significantly influenced self-compassion and body appreciation. The interaction suggests that self-compassion and state body appreciation are higher in the presence of body appreciation messaging, although there were not main effects for just viewing objectifying images or body appreciation captions. This means that just body appreciation or just objectification may not affect state body appreciation and self-compassion, but the two together have an effect. Our findings suggest that body appreciation captions may serve as a protective factor for self-compassion and state body appreciation when young women view Instagram fitspiration posts that include sexual objectification. Health communicators could encourage influencers to include body appreciation content in their fitspiration posts to help improve self-compassion among viewers, and interventions could work to promote body appreciation among young women to encourage self-compassion.

Fifteen Years after a 10-year Retrospective: The State of Health Mass Mediated Campaigns.

In 2006, a 10-year retrospective of successful mass mediated health communication campaigns reviewed the field and highlighted strategies for successful campaigns. In the 15 years since the retrospective, there have been dramatic changes in the media environment and advances in health communication research. In this article, we describe changes in the health communication media landscape and in our understanding of mass mediated health communication campaigns in the 15 years since the retrospective. Although the media environment has shifted, we argue that effective principles of health communication have remained relatively constant. We note significant advances in technology since the previous retrospective that can further advance health communication campaigns, with new technologies offering promise as channels for health communication campaigns as well as for campaign planning. We also recommend that campaign researchers report in detail on their use of theory, audience segmentation, channel selection, and the role of formative research when describing campaign efforts; that communicators continue to develop frameworks that integrate principles of effective campaign design; and that additional research focus on understanding how technology can be effectively incorporated into campaign planning, distribution, and evaluation.

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.

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.

How Media Literacy and Science Media Literacy Predicted the Adoption of Protective Behaviors Amidst the COVID-19 Pandemic.

Individuals must navigate complex media environments filled with frequently changing and varyingly credible information to acquire and apply health information during times of uncertainty and danger. A process model tested in two U.S. national surveys in spring (N = 1220) and summer (N = 1264) of 2020 tested how three media literacy constructs (about sources, content, and science information) predicted the adoption of behaviors protective for COVID-19. Results showed that the three media literacy constructs were mediated by knowledge of COVID-19 (wave 1 TE = 0.190; wave 2 TE = 0.190) and expectancies (wave 1 TE = 0.496; wave 2 TE = 0.613). The model was confirmed as largely consistent across the two waves of data collection with independent samples. Results show the importance of expectancies for mediating the effects of media literacy, efficacy, and knowledge on behavior. The study suggests that media literacy and science media literacy skills aid health behavior adoption by contributing to knowledge gain and expectancies.

Adding to the Message Testing Tool Belt: Assessing the Feasibility and Acceptability of an EMA-Style, Mobile Approach to Pretesting mHealth Interventions.

Effective health message design requires strong pretesting to ensure that potential audiences see communication efforts as acceptable. Previous research has often used long-form surveys to test messaging, even when the potential communication efforts are going to take place in a non-traditional format, such as on a text message platform. This study asks whether real-time sampling on a mobile phone could serve as a message-testing alternative to traditional surveys. Participants evaluated health messages over a week using mobile phones in a style similar to ecological momentary assessment. More than 90 percent of messages were evaluated, and a majority of participants preferred this methodology to other pretesting methods. This approach, while not without limitations, is a viable tool for diversifying message testing efforts.

Friends over Doctors? The Influences of Source and Perceived Customization on College Drinking.

College drinking, often associated with college binge drinking, is a critical issue in the United States and may lead to harmful consequences such as academic failure, injury, sexual assault, and even death. Health interventions targeted at reducing problematic drinking are needed to help prevent these harmful behaviors among college students. The current work explores the intersection of different types of information sources (e.g., authority and peer) and perceived customization on various health-related outcomes related to college drinking (e.g., trust, attitudes, and behavioral intentions). Undergraduate students (N = 448) were presented with health information regarding college drinking in a 2 (perceived customization or non-customization) × 3 (authority, peer, or technology source) between-subjects experimental design. We found a strong effect of peer source of health information, somewhat surprisingly more effective than information from a professional source (i.e., a medical physician). Moreover, the results underscore the importance of not only promoting perceived customization but also fostering a sense of agency with such interface features. Theoretical and practical implications for health-related outcomes are discussed.

Effects of Website Interactivity on Skin Cancer-Related Intentions and User Experience: Factorial Randomized Experiment.

BACKGROUND: Digital media technologies provide users with the ability to interact with content and to receive information based on their preferences and engagement. OBJECTIVE: We used skin cancer and sun protection as a health topic to explore how modality interactivity, interface tools that afford users greater activity, resulting in greater depth and breadth of mentally representing and experiencing mediated content, and message interactivity, the extent to which the system allows users to exchange messages back and forth on health websites, influenced users' attitudes, knowledge, behavioral intentions, and experience. METHODS: We employed a 2×2 (modality interactivity: high vs low; message interactivity: high vs low) between-subject online experiment for which 4 websites were created. Participants (n=293) were recruited using Amazon Mechanical Turk and randomly assigned into to 1 of 4 conditions. After browsing the website, participants completed an online survey regarding their experience and cognitive perceptions. General linear models and path analysis were used to analyze the data. RESULTS: Both modality interactivity (P=.001) and message interactivity (P<.001) had an impact on intention to use sun protection. Attitudes toward health websites and perceived knowledge mediated the effects of modality interactivity and message interactivity on sun protection use intention, individually. Participants in the high modality interactivity and high message interactivity condition felt more satisfied (P=.02). Participants in the low message interactivity condition had more interest in the experience with health websites than participants in the high message interactivity condition (P=.044). CONCLUSIONS: Findings suggested that modality interactivity influenced intention to use sun protection directly as well as via attitudes toward the websites. Message interactivity impacted intention to use sunscreen directly and also through perceived knowledge. Implications for designing health websites and health intervention content are discussed.

Youth's Proximity to Marijuana Retailers and Advertisements: Factors Associated with Washington State Adolescents' Intentions to Use Marijuana.

The current study explored the influences of advertising exposure, numbers of marijuana retailers, distance to retailers, and constructs from the integrative model of behavioral prediction, including outcome beliefs, perceived norms, and efficacy, on youth's intentions to use marijuana in a state in which the use of recreational marijuana is legal. A state-wide online cross-sectional survey of 350 adolescents ages 13-17, residing in Washington state, was conducted in June 2018. The results of the regression analysis suggest that exposure to marijuana advertising, positive and negative outcome beliefs, and perceived peer norms were associated with intention to use marijuana. Distances to retailers moderated the relationships between exposure to advertising and intentions, as well as between positive outcome beliefs and intentions. States that have legalized recreational marijuana should continue considering the location of retailers in relation to neighborhoods and advertising regulations to reduce the appeal to youth. Additionally, prevention efforts could aim to influence outcome beliefs and norms in an attempt to reduce adolescents' intentions to use recreational marijuana.

A Cross-Cultural Comparison of an Extended Planned Risk Information Seeking Model on Mental Health Among College Students: Cross-Sectional Study.

BACKGROUND: Approximately 42.5 million adults have been affected by mental illness in the United States in 2013, and 173 million people have been affected by a diagnosable psychiatric disorder in China. An increasing number of people tend to seek health information on the Web, and it is important to understand the factors associated with individuals' mental health information seeking. Identifying factors associated with mental health information seeking may influence the disease progression of potential patients. The planned risk information seeking model (PRISM) was developed in 2010 by integrating multiple information seeking models including the theory of planned behavior. Few studies have replicated PRISM outside the United States and no previous study has examined mental health as a personal risk in different cultures. OBJECTIVE: This study aimed to test the planned risk information seeking model (PRISM) in China and the United States with a chronic disease, mental illness, and two additional factors, ie, media use and cultural identity, among college students. METHODS: Data were collected in both countries using the same online survey through a survey management program (Qualtrics). In China, college instructors distributed the survey link among university students, and it was also posted on a leading social media site called Sina Weibo. In the United States, the data were collected in a college-wide survey pool in a large Northwestern university. RESULTS: The final sample size was 235 for the Chinese sample and 241 for the US sample. Media use was significantly associated with mental health information-seeking intentions in the Chinese sample (P<.001), and cultural identity was significantly associated with intentions in both samples (China: P=.02; United States: P<.001). The extended PRISM had a better model fit than the original PRISM. CONCLUSIONS: Cultural identity and media use should be considered when evaluating the process of mental health information seeking or when designing interventions to address mental health information seeking.

Acceptability of a Computer-Tailored Safer Sex Intervention for Heterosexually Active African Americans Attending an STI Clinic.

Since African Americans are disproportionately affected by HIV/AIDS, interventions that increase correct and consistent condom use are urgently needed. We report baseline acceptability data from a randomized controlled trial (RCT) testing the Tailored Information Program for Safer Sex, a computer-tailored intervention designed to increase correct and consistent condom use among low income, heterosexually active African Americans attending an urban sexually transmitted infection (STI) clinic. We enrolled 274 participants at baseline in an RCT-147 in the intervention group. The intervention had high acceptability, with a mean acceptability of 4.35 on a 5-point scale. We conducted a multiple regression analysis examining demographic, structural, and sexual risk characteristics that revealed only sex to be significantly (p < .01) associated with intervention acceptability. While women were more likely than men to find the intervention acceptable, overall the results indicated broad acceptability of this intervention to the target audience. eHealth interventions are a viable option for HIV prevention among African Americans visiting a publicly-funded STI clinic. We discuss implications of these results for the future application of such programs.

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.

Adolescents' Sex-Related Alcohol Expectancies and Alcohol Advertisements in Magazines: The Role of Wishful Identification, Realism, and Beliefs about Women's Enjoyment of Sexualization.

In the United States, approximately one in five sexually active teens report alcohol or drug use before their last sexual encounter. The co-occurrence of alcohol with sex increases risky behaviors, such as having unprotected sex. Magazines that target adolescents often feature alcohol advertisements with sexual innuendo and female objectification. Such advertisements may inform adolescents' expectancies that alcohol can facilitate sex. With an experimental design and path analysis, we examined 874 adolescents' (ages 15-17, M = 16.05) exposure to objectifying alcohol ads, their perceptions of the ads, and their attitudes about women's sexualization in relation to sex-related alcohol expectancies. For female adolescents we assessed their enjoyment of sexualization, and for male adolescents, we assessed their perceived enjoyment of sexualization among women. Teens' perceptions that alcohol ads promote the co-occurrence of alcohol with sex mediated the effect of ad exposure and perceived realism of the ads on sex-related alcohol expectancies. The enjoyment of sexualization construct mediated the effect of wishful identification and perceived realism on sex-related alcohol expectancies. Wishful identification also directly related to sex-related alcohol expectancies. Results challenge the alcohol industry's compliance with advertisement regulations and suggest media literacy as a strategy to promote healthy sex-related alcohol expectancies among adolescents.

Assessing the Potential Use of Narrative and the Entertainment Education Strategy In an mHealth Text-Message Intervention.

As the use of mobile phones for health promotion continues to grow, more work needs to be done to determine which health communication strategies are influential on mobile devices. In two studies conducted with college women in the United States, we assessed the potential for the use of narratives, a strategy found successful in a number of communication channels, in a text-message intervention. The first study consisted of seven focus groups with young women (n = 31) about their perceptions of narrative storylines in a text-message intervention about alcohol and casual sexual encounters. In a second study, we then used an experiment (n = 137) to test the potential of narrative messages to influence transportation, counter-arguing, identification, attitudes toward the intervention type, and attitudes toward the messages. Results showed that women were interested in the possibility of receiving health messages, including narrative health messages, via text message. However, the experiment found limited differences between narrative, non-narrative, and control conditions. Transportation was greater in the narrative condition than in the control, but did not significantly differ from the non-narrative condition. Counter-arguing was also greater in the narrative condition than in the non-narrative condition. Participants who viewed the narrative messages had more positive attitudes toward the messages. Based on both studies, we found that the use of narratives in text messages may be a promising strategy, but it may be a challenge to craft effective content.

Using Text Message Surveys to Evaluate a Mobile Sexual Health Question-and-Answer Service.

Text message programs for sexual health are becoming increasingly popular as practitioners aim to meet youth on media they use frequently. Two-way mobile health (mHealth) interventions allow for feedback solicitation from participants. This study explores the use of a text message survey to assess demographics and program feedback from users of an adolescent sexual health text message question-and-answer service. Development and feasibility of the short-message service survey are discussed. The text message survey achieved a 43.9% response rate, which is comparable to response rates of surveys conducted via other methods. When compared to respondents who used the service and completed an online in-school questionnaire, text survey respondents were more likely to be female and older. They also reported higher service satisfaction. Results have implications for text message service providers and researchers. This article examines a community application of a new intervention strategy and research methodology.

The Entertainment-Education Strategy in Sexual Assault Prevention: A Comparison of Theoretical Foundations and a Test of Effectiveness in a College Campus Setting.

Among the existing sexual assault prevention efforts on college campuses, few use mass communication strategies designed to simultaneously entertain and educate. Although many entertainment-education efforts are guided by social cognitive theory, other theories may be useful in entertainment-education design. Previous research has found that social cognitive theory and social norms theory can successfully influence participants' perceived norms and efficacy related to sexual assault reduction; however, whether such results can be replicated in a naturalistic setting and the extent to which the guiding theoretical foundation may influence outcomes remain unknown. We used a pre- and posttest field experiment with college students in residence halls to assess how different theoretical foundations may influence effects. Over the course of a semester, the participants viewed eight mini-magazines developed using (1) social cognitive theory, (2) social norms theory, (3) a combination of both theoretical frameworks, or (4) a control condition with no sexual assault prevention messaging. Participants in the combined content condition had greater levels of self-efficacy related to sexual assault prevention and more accurate norm perceptions. There were also effects for the mini-magazines developed with only one theoretical framework. Overall, we found that multiple theories can effectively guide entertainment-education message development.

Placement and Format of Risk Information on Direct-to-Consumer Prescription Drug Websites.

We investigated whether the location and format of risk information on branded prescription drug websites influence consumers' knowledge and perceptions of the drug's risks. Participants (Internet panelists with high cholesterol [n = 2,609] or seasonal allergies [n = 2,637]) were randomly assigned to view a website promoting a fictitious prescription drug for their condition. The website presented risk information at the bottom of the homepage, or at the bottom of the homepage with a signal above indicating that the risk information was located below, or on a linked secondary page. We also varied the format of risk information (paragraph, checklist, bulleted list, highlighted box). Participants then answered questions on risk recall and perceptions. Participants recalled fewer drug risks when the risks were placed on a secondary page. The signal had little effect, and risk information format did not affect outcomes. The location of risk information on prescription drug websites can affect consumer knowledge of drug risks; however, signals and special formatting may not be necessary for websites to adequately inform consumers about drug risks. We recommend that prescription drug websites maintain risk information on their homepages to achieve "fair balance" as required by the U.S. Food and Drug Administration.