Does COVID-19 Message Fatigue Lead to Misinformation Acceptance? An Extension of the Risk Information Seeking and Processing Model.

Based on the Risk Information Seeking and Processing Model, the present study examines whether COVID-19 message fatigue leads to greater information avoidance and heuristic processing, and consequently greater acceptance of misinformation. We conducted a survey of 821 Korean adults regarding their information seeking and processing regarding COVID-19 vaccination. Results of SEM analyses showed that COVID-19 message fatigue was (a) negatively related to information insufficiency and (b) positively related to information avoidance and heuristic processing. Information avoidance and heuristic processing were subsequently related to greater levels of misinformation acceptance. Theoretical and practical implications are discussed.

Beyond Depth and Breadth: Taking "Types" of Health Information Sought into Consideration with Cluster Analysis.

Online health information-seeking behavior (OHIS) has been typically operationalized in an aggregate form representing either depth (e.g., how long) or breadth (e.g., how much) of seeking, which is irrespective of what types of information are sought. Recognizing limitations of such practice, this research employs cluster analysis to reflect the content and types of health information sought in studying OHIS. Three online studies providing participants with opportunities to actually seek information about meningitis (Study 1; N = 408), Alzheimer's disease (Study 2; N = 190), and cancer (Study 3; N = 208) recorded the participants' information-seeking activities unobtrusively. Across the three studies, cluster analysis identified three common clusters representing distinctive information-seeking patterns (i.e., combinations of different types of information sought): One cluster sought information on "overview," the second one focused on "protection" information, and the third cluster sought "all" types of information provided. The relative preference for these types of information was predicted by several antecedents of information-seeking behavior proposed in Comprehensive Model of Information Seeking (CMIS) including age, fear, self- and response-efficacy. The findings demonstrate the utility of taking the actual content or types of health information sought into consideration and suggest several fruitful avenues it paves for future research on OHIS.

Tailoring Temporal Message Frames to Individuals' Time Orientation Strengthens the Relationship between Risk Perception and Behavioral Intention.

While health behavior theories conceptualize risk perception as a major factor motivating protective action against risk, empirical support for this widely-assumed proposition has been inconclusive. Given the inherent issue concerning the delay of desired outcomes in most health behaviors, this research proposes the congruence between temporal frame and individuals' trait time orientation (i.e., consideration of future consequences; CFC) as an important moderator in the risk perception-behavioral intention relationship. Findings from two experiments concerning messages promoting adequate sleep (N = 227; Study 1) and plastic bottle recycling (N = 223; Study 2) showed that the relationship between risk perception and behavioral intention was significantly stronger when temporal frames and CFC were more congruent (i.e., tailored). Nuanced differences in the moderating effects of frame-CFC congruence were observed depending on how risk perception was operationalized (i.e., susceptibility only, severity only, or combination of the two). Implications for health communication message design are discussed.

An Investigation of Cognitive Processing of Fear Appeal Messages Promoting HPV Vaccination: Predictors and Outcomes of Magnitude and Valence of Cognitive Responses.

An improvement in HPV vaccination rates is one of the primary goals of public health organizations. Toward this end, fear appeal communication is commonly used in health interventions, warning individuals of threats of HPV infection and promoting vaccination. However, little is known about how threat-related emotions, such as fear and anxiety, influence the cognitive processing of vaccination information and how this processing is associated with vaccination intention. To address this void, this study tests a model drawing upon functional emotion theories and dual-process models of persuasion. Results from an experimental study showed that fear and anxiety, which arose from exposure to threat information, triggered motivation to process HPV protection-related information, which in turn, was positively associated with depth of HPV vaccination information processing. Subsequently, greater depth of processing led to a greater number of positive cognitive responses when participants were presented with information with a high (vs. low), level of response efficacy. Finally, greater positivity of cognitive responses predicted greater intention to obtain HPV vaccination. Collectively, our findings provide a theory-based explanation about how the sequential provision and processing of threat and efficacy information in fear appeals contribute to the promotion of HPV vaccination. Implications for designing fear appeal messages are discussed.

Success Expectancy: A Mediator of the Effects of Source Similarity and Self-Efficacy on Health Behavior Intention.

Although many health communication studies have substantiated the role of self-efficacy as one of the most proximal determinants of behavioral intention, a recent body of research has also shown that high self-efficacy does not always translate into intention to perform a recommended health behavior. Recognizing the common ground among three independent lines of research on outcome expectancy, goal attainability, and expectation of success, the present study proposed success expectancy, or perceived likelihood of goal achievement, as a mediator between self-efficacy and health behavior intention, which may explain the inconsistent findings on self-efficacy. An online experiment (N = 336), in which similarity of the source in health messages was manipulated, demonstrated that success expectancy indeed mediated the relationship between self-efficacy and behavioral intention. Success expectancy also mediated the effects of source similarity on behavioral intention, while neither task nor coping self-efficacy showed such effects. These results suggest that health promotion messages focusing specifically on increasing perceptions of success expectancy may be more effective in inducing health behaviors than messages that promote self-efficacy, particularly in health contexts, in which people with high self-efficacy do not tend to successfully enact recommended health behaviors.

Predictors and Effects of Anti-Obesity Message Fatigue: A Thought-Listing Analysis.

The prevalence of messages advocating weight management has likely resulted in considerable anti-obesity message fatigue but the phenomenon remains understudied. This study examined two aspects of antiobesity message fatigue: (1) effects of preexisting anti-obesity message fatigue on cognitive processing of an incoming anti-obesity message and (2) predictors and effects of message fatigue responses expressed after exposure to the message. Results from a two-wave online experiment involving overweight and obese adults in the U.S. (N = 251) showed that preexisting message fatigue (in wave 1) positively predicted counterarguments, while negatively predicting message-consistent and issue-relevant thoughts expressed after exposure to an anti-obesity message (in wave 2). Moreover, the experimental findings show that physical health frames generated greater message fatigue responses than mental health frames. Message fatigue responses, in turn, predicted more unfavorable attitude toward message recommendations, completely mediating the effects of physical health frames on attitude. Women and older participants were more likely to express anti-obesity message fatigue responses than their counterparts. These findings underscore the need to recognize message fatigue as a significant barrier to communicating health.

Reactions to tobacco warning labels: predictors and outcomes of adaptive and maladaptive responses.

BACKGROUND: The Extended Parallel Process Model (EPPM) responses have not been evaluated from verbal reactions to cigarette warning labels. We identified the EPPM responses in reactions to cigarette warning labels and evaluated their predictors and relationship with warning perceptions. METHODS: U.S. adult current smokers, transitioning smokers (quit in the past two years or currently quitting) and never smokers (n=1,838) saw nine of 81 cigarette warning labels. Participants freely wrote their thoughts after viewing the first label and reported perceived informativeness, negative emotions, and denial for this label. Responses were coded for the presence of the EPPM response categories. Multivariable logistic regression models described adaptive and maladaptive respondent characteristics, and linear regression models assessed the relationship between the response categories and label perceptions. RESULTS: Participants' responses contained adaptive (65.4%), maladaptive (16.5%), no response (14.7%), and mixed responses (both adaptive and maladaptive; 3.4%). Current smokers had decreased odds of adaptive response compared to never and transitioning smokers. Compared to text warnings, pictorial warnings were associated with increased odds of adaptive and decreased odds of maladaptive responses. Adaptive response was associated with increased odds of intentions to quit smoking. Adaptive respondents reported the highest levels of informativeness and negative emotions among the four response categories. CONCLUSIONS: The finding demonstrating predominantly adaptive (and few maladaptive) responses to warning labels supports the continued use of fear appeals in warning label design. The greater adaptive and lower maladaptive responses to pictorial warnings could serve as additional evidence for FDA to implement pictorial warning labels.

How Message Fatigue toward Health Messages Leads to Ineffective Persuasive Outcomes: Examining the Mediating Roles of Reactance and Inattention.

Message fatigue refers to a state of being exhausted and tired of prolonged exposure to similarly-themed messages (e.g., anti-obesity messages; So, Kim, & Cohen, 2017). This study tests a mediational model that accounts for how one's preexisting fatigue toward anti-obesity messages may contribute to two different types of resistance-reactance and disengagement-toward an incoming anti-obesity message, which, in turn, reduce intention to adopt weight-management behaviors advocated in the message. The proposed model was tested in an experimental study (N = 312) involving a sample of overweight or obese adults in the United States. In the meditational model, reactance significantly mediated the negative effects of message fatigue on intention to adopt only one of four weight-management behaviors promoted in the message. However, inattention, which was an operationalization of disengagement, significantly mediated the negative effects of message fatigue on behavioral intention to adopt all four weight-management behaviors. This study urges future research on message fatigue and resistance to persuasion to consider disengagement with a message as a significant barrier to effective health communication and to devise ways to increase engagement with messages communicating "overtaught" health issues.

Which Type of Risk Information to Use for Whom? Moderating Role of Outcome-Relevant Involvement in the Effects of Statistical and Exemplified Risk Information on Risk Perceptions.

The extant empirical research examining the effectiveness of statistical and exemplar-based health information is largely inconsistent. Under the premise that the inconsistency may be due to an unacknowledged moderator (O'Keefe, 2002), this study examined a moderating role of outcome-relevant involvement (Johnson & Eagly, 1989) in the effects of statistical and exemplified risk information on risk perception. Consistent with predictions based on elaboration likelihood model (Petty & Cacioppo, 1984), findings from an experiment (N = 237) concerning alcohol consumption risks showed that statistical risk information predicted risk perceptions of individuals with high, rather than low, involvement, while exemplified risk information predicted risk perceptions of those with low, rather than high, involvement. Moreover, statistical risk information contributed to negative attitude toward drinking via increased risk perception only for highly involved individuals, while exemplified risk information influenced the attitude through the same mechanism only for individuals with low involvement. Theoretical and practical implications for health risk communication are discussed.

Could Watching TV Be Good for You? Examining How Media Consumption Patterns Relate to Salivary Cortisol.

This research explores whether media diet influences health, not through its effects on cognition and behavior but rather through its effects on biomarkers of stress, which are implicated in a host of acute and chronic illnesses. Two hundred and forty young adults completed assessments of their media consumption habits followed at least 2 days later by measures of the stress-related hormone cortisol. Results suggest that frequency of consuming different media and genres may decrease cortisol under certain conditions and increase them under others. Further, the patterns of results were wholly different from those found for perceived stress. The implications of these findings for health-related media effects and theoretical development are discussed.

What Do People Like to "Share" About Obesity? A Content Analysis of Frequent Retweets About Obesity on Twitter.

Twitter has been recognized as a useful channel for the sharing and dissemination of health information, owing in part to its "retweet" function. This study reports findings from a content analysis of frequently retweeted obesity-related tweets to identify the prevalent beliefs and attitudes about obesity on Twitter, as well as key message features that prompt retweeting behavior conducive to maximizing the reach of health messages on Twitter. The findings show that tweets that are emotionally evocative, humorous, and concern individual-level causes for obesity were more frequently retweeted than their counterparts. Specifically, tweets that evoke amusement were retweeted most frequently, followed by tweets evoking contentment, surprise, and anger. In regard to humor, derogatory jokes were more frequently retweeted than nonderogatory ones, and in terms of specific types of humor, weight-related puns, repartee, and parody were shared frequently. Consistent with extant literature about obesity, the findings demonstrated the predominance of the individual-level (e.g., problematic diet, lack of exercise) over social-level causes for obesity (e.g., availability of cheap and unhealthy food). Implications for designing social-media-based health campaign messages are discussed.

A further extension of the Extended Parallel Process Model (E-EPPM): implications of cognitive appraisal theory of emotion and dispositional coping style.

For two decades, the extended parallel process model (EPPM; Witte, 1992 ) has been one of the most widely used theoretical frameworks in health risk communication. The model has gained much popularity because it recognizes that, ironically, preceding fear appeal models do not incorporate the concept of fear as a legitimate and central part of them. As a remedy to this situation, the EPPM aims at "putting the fear back into fear appeals" ( Witte, 1992 , p. 330). Despite this attempt, however, this article argues that the EPPM still does not fully capture the essence of fear as an emotion. Specifically, drawing upon Lazarus's (1991 ) cognitive appraisal theory of emotion and the concept of dispositional coping style ( Miller, 1995 ), this article seeks to further extend the EPPM. The revised EPPM incorporates a more comprehensive perspective on risk perceptions as a construct involving both cognitive and affective aspects (i.e., fear and anxiety) and integrates the concept of monitoring and blunting coping style as a moderator of further information seeking regarding a given risk topic.

The role of audience favorability in processing (un)familiar messages: a heuristic-systematic model perspective.

Several mechanisms of processing (un)familiar messages-processing fluency, message fatigue, interest, and counterarguing-are documented but studied independently, preventing a holistic understanding of how we process (un)familiar messages. This research integrates these mechanisms under a coherent theoretical framework based on heuristic-systematic model and identifies which one becomes dominant as a joint function of message familiarity and audience favorability. Across two studies concerning social distancing (Study 1; N = 412) and smoking (Study 2; N = 300), message fatigue and counterarguing were heightened in unfavorable audiences processing familiar and unfamiliar messages, respectively. Interest was dominant among favorable audiences processing unfamiliar messages in Study 2. Processing fluency was not heightened under any conditions. In models testing mediational capacities of the four mechanisms simultaneously, message fatigue and interest were significant mediators of the effects of audience favorability and message familiarity on persuasion, respectively. This research underscores the importance of considering audience favorability when studying the effects of message familiarity.

What message features influence the intention to share misinformation about COVID-19 on social media? The role of efficacy and novelty.

Given the amount of misinformation being circulated on social media during the COVID-19 pandemic and its potential threat to public health, it is imperative to investigate ways to hinder its transmission. To this end, this study aimed to identify message features that may contribute to misinformation sharing on social media. Based on the theory of social sharing of emotion and the extant research on message credibility, this study examined if emotions and message credibility serve as mechanisms through which novelty and efficacy of misinformation influence sharing intention. An online experiment concerning COVID-19 misinformation was conducted by employing a 2 (novelty conditions: high vs. low) × 2 (efficacy conditions: high vs. low) between-subjects design using a national quota sample in South Korea (N = 1,012). The findings suggested that, contrary to the expectation, the overall effects of novelty on sharing intention were negative. The specific mechanisms played significant and unique roles in different directions: novelty increased sharing intention by evoking surprise, while also exerting a negative influence on sharing intention through an increase in negative emotions and a decrease in positive emotions and message credibility. Consistent with the expectation, efficacy exhibited positive total effects on sharing intention, which was explained by higher levels of (self- and response-) efficacy of protective action increasing positive emotions and message credibility but decreasing negative emotions. The implications and limitations of the study are discussed.

Counterproductive effects of overfamiliar antitobacco messages on smoking cessation intentions via message fatigue and resistance to persuasion.

OBJECTIVE: While smoking may result in various harmful effects, such as mental health issues caused by addiction, antitobacco messages have typically focused on the physical health consequences of smoking for decades. Prolonged exposures to these conventional messages may have not only increased awareness about the harmful health effects of smoking but may have also caused message fatigue and resultant resistance to persuasion. The latter effects, however, remain largely unexamined. Addressing this gap, this study examined the effects of overfamiliar antitobacco messages focusing on the health consequences of smoking on message fatigue and resistance to persuasion. METHOD: In an online experiment, current smokers (N = 296) in the U.S. were randomly assigned to one of the four message conditions that manipulated a degree of familiarity in a 2 (thematic frame: physical vs. mental health) × 2 (valence frame: loss vs. gain) factorial design. RESULTS: The results show that a message portraying physical health consequences of smoking in a loss frame (i.e., overfamiliar frame) induced greater message fatigue than that in a gain frame. Message fatigue, in turn, was associated with higher levels of active (i.e., reactance) and passive resistance (i.e., disengagement) toward antitobacco messages. Reactance induced by message fatigue predicted less favorable attitude and lower intentions to quit smoking. Overall, message fatigue showed both direct and indirect effects on intentions, with the latter being mediated by reactance. CONCLUSIONS: Overfamiliar antitobacco message frames may activate greater message fatigue and resistance to persuasion, which may dampen campaign effects. The findings caution against the habitual use of conventional antitobacco messages. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Genre-specific media and perceptions of personal and social risk of smoking among South Korean college students.

The smoking rate among adult men in South Korea is one of the highest in the world, standing at about 53%. Although various mass media-based educational initiatives have been taken to reduce this rate, their contribution toward the smoking risk perceptions of South Koreans has not been investigated. This study examined the association between genre-specific media exposure and personal and social risk perceptions of smokers and nonsmokers. Data from a survey of 558 South Korean college students (39% smokers) show that genre-specific media exposure differentially predicts personal and social risk perceptions of smokers and nonsmokers. News media exposure predicted smokers' personal risk perceptions, whereas entertainment media exposure predicted nonsmokers' personal risk perceptions. Exposure to a hybrid genre, health infotainment, predicted social risk perceptions, but not personal risk perceptions, of both smokers and nonsmokers. High rates of exposure to medical documentary were associated with low personal risk perceptions of nonsmokers, but not smokers. These results collectively suggest that mixed-media strategies may effectively address perceptions of personal and social risk of smoking. Suggestions for future research, and theoretical and practical implications, are offered.

Personal, social, and cultural correlates of self-efficacy beliefs among South Korean college smokers.

Much research has documented the significant influence of self-efficacy on smoking cessation, but considerably less is known as to what health communicators can do to promote or address barriers to self-efficacy. This study investigated personal, social, and cultural correlates of smoking self-efficacy. A survey of college smokers was done in South Korea, where the current smoking rate among males is over 56%. At the personal level, the perceived success-fullness of the last quit trial positively predicted self-efficacy. At the social level, interpersonal communication with friends was positively associated with self-efficacy. The cultural orientation of independent self-construal was positively associated with self-efficacy. These results indicate that factors affecting smokers' self-efficacy are operative in multiple domains and levels. Future communication programs should promote positive perceptions about prior quit trials, and segment the audience in terms of their self-construal to effectively enhance self-efficacy.

A Profile of Individuals with Anti-tobacco Message Fatigue.

OBJECTIVES: Message fatigue, a phenomenon of being tired of repeated exposure to messages promoting the same health behavior, may reduce the effectiveness of anti-tobacco messages, such as warning labels. As an initial step towards understanding the phenomenon, we examined predictors of anti-tobacco message fatigue. METHODS: An online study (N = 1838) involving a non-probability sample of nonsmokers and smokers in the United States assessed anti-tobacco message fatigue and individual-level factors including demographic variables and smoking status. General linear models were used to analyze the data. RESULTS: The multivariable results show that individuals who were younger, male, and had higher income and education reported higher levels of anti-tobacco message fatigue. African Americans reported significantly lower levels of message fatigue than other racial groups. Current smokers reported greater message fatigue than transitioning smokers and nonsmokers. Among current smokers, those with greater nicotine dependence reported higher levels of anti-tobacco message fatigue. CONCLUSIONS: These findings underscore the importance of segmenting the audience based on their levels of message fatigue and using more novel message strategies and delivery methods to influence populations with relatively higher levels of anti-tobacco message fatigue.

Do Emotions Spark Interest in Alternative Tobacco Products?

BACKGROUND: Exposure to advertisements for tobacco products and tobacco warning labels evokes emotions. This study evaluated the association of discrete positive and negative emotions with interest in alternative tobacco products. METHOD: In 2013, 1,226 U.S. adult nonsmokers and current smokers viewed advertisements for moist snuff, snus, and electronic cigarettes (e-cigarettes) with various warning labels and then indicated their emotional responses in terms of anger, anxiety, sadness, guilt, disgust, discouragement, hope, and contentment. Outcomes were openness to using moist snuff, snus, and e-cigarettes in the future and interest in a free sample of each product. Data were analyzed in 2016. RESULTS: Hope was positively associated with openness and interest across all alternative tobacco products as was contentment for moist snuff and snus. Anger was negatively associated with openness to moist snuff and e-cigarettes, disgust negatively to moist snuff and snus, and anxiety negatively to e-cigarettes. Being a current smoker, ever trying a corresponding product, being male, and younger age were associated with greater openness to and interest in moist snuff and snus. For e-cigarettes, being a current smoker, ever trying e-cigarettes, and being female were associated with greater openness, and being a current smoker was associated with greater odds of selecting a free sample. CONCLUSIONS: Positive emotions, particularly hope, were consistently positively associated with interest in alternative tobacco products. Hope is widely used by tobacco and e-cigarette companies to advertise their products. Antitobacco messages should aim to lower hope associated with tobacco products but increase hope for cessation or life without tobacco.

Facebook friends with (health) benefits? Exploring social network site use and perceptions of social support, stress, and well-being.

There is clear evidence that interpersonal social support impacts stress levels and, in turn, degree of physical illness and psychological well-being. This study examines whether mediated social networks serve the same palliative function. A survey of 401 undergraduate Facebook users revealed that, as predicted, number of Facebook friends associated with stronger perceptions of social support, which in turn associated with reduced stress, and in turn less physical illness and greater well-being. This effect was minimized when interpersonal network size was taken into consideration. However, for those who have experienced many objective life stressors, the number of Facebook friends emerged as the stronger predictor of perceived social support. The "more-friends-the-better" heuristic is proposed as the most likely explanation for these findings.