Concerns for others increases the likelihood of vaccination against influenza and COVID-19 more in sparsely rather than densely populated areas.

Vaccination yields the direct individual benefit of protecting recipients from infectious diseases and also the indirect social benefit of reducing the transmission of infections to others, often referred to as herd immunity This research examines how prosocial concern for vaccination, defined as people's preoccupation with infecting others if they do not vaccinate themselves, motivates vaccination in more and less populated regions of the United States. A nationally representative, longitudinal survey of 2,490 Americans showed that prosocial concern had a larger positive influence on vaccination against influenza in sparser regions, as judged by a region's nonmetropolitan status, lesser population density, and lower proportion of urban land area. Two experiments (total n = 800), one preregistered, provide causal evidence that drawing attention to prosocial (vs. individual) concerns interacted with social density to affect vaccination intentions. Specifically, prosocial concern led to stronger intentions to vaccinate against influenza and COVID-19 but only when social density was low (vs. high). Moderated mediation analyses show that, in low-density conditions, the benefits of inducing prosocial concern were due to greater perceived impact of one's vaccination on others. In this light, public health communications may reap more benefits from emphasizing the prosocial aspects of vaccination in sparser environments.

Longitudinal Pathways to Influenza Vaccination Vary With Socio-Structural Disadvantages.

BACKGROUND: Although influenza vaccination can prevent influenza-related deaths, uptake remains low, particularly in disadvantaged populations. PURPOSE: A theoretical model of psychological pathways to vaccination accounting for the direct and moderating role of socio-structural factors was tested. The study sought to understand the joint contributions of psychological (i.e., knowledge, attitudes, and intention) and socio-structural factors (i.e., income, education, and insurance) to influenza vaccination, prospectively. METHODS: A nationally representative empaneled sample of over 3,000 U.S. adults answered questions about vaccination knowledge, attitudes, and intentions, as well as actual vaccination across five timepoints from September 2018 to May 2019. Socio-structural factors were examined as moderators. RESULTS: Findings revealed strong positive associations between knowledge and attitudes, attitudes and intentions, as well as intentions and subsequent vaccination. Importantly, health insurance moderated the associations between attitudes and intentions and between intentions and vaccination, such that those without insurance had weaker associations between attitudes and intentions and between intentions and vaccination. In addition, education moderated the path from knowledge to attitude and from intentions to vaccination, such that people with lower educational attainment had weaker associations between knowledge and attitudes and between intentions and vaccination. CONCLUSIONS: Socio-structural factors act as barriers to the influence of knowledge on attitudes, attitudes on intentions, and intentions on behavior. Future research needs to be mindful of the specific paths disrupted by social disadvantages and examine ways to intervene to decrease those effects.

State health policies and interest in PrEP: evidence from Google Trends.

This study investigated the association between interest in Pre-exposure Prophylaxis (PrEP) in the US using Google Health Trends as a source of big data and state policy variables of Medicaid expansions under the Affordable Care Act (ACA) and initiation of PrEP Assistance Programs (PrEP-AP). As of December 2019, thirty-three states and the District of Columbia have accepted federal Medicaid funding provided through the ACA to expand eligibility to low-income adults. Among these expansion states, eight states also implemented PrEP-AP, a program that finances PrEP. A difference-in-differences approach estimated how changes in Google search for PrEP before and after the expansion differed across expansion and non-expansion states. Analyses also gauged whether the magnitude of the correlation between Medicaid expansions and Google searches was higher in states that also initiated PrEP-AP. Findings indicated that the Medicaid expansions were associated with a higher share of Google searches for PrEP keywords (ß=1.536, S.E. =.36, p<.001). Moreover, the magnitude of correlation for some keywords was higher in states that also implemented PrEP-APs.

Testing a digitally distributed method to recruit a network of community organizations to fight the consequences of the drug epidemic: A study in 13 American states.

To mitigate the opioid epidemic, a concerted effort to educate, prevent, diagnose, treat, and engage residents is required. In this study, a digitally distributed method to form a large network of organizations was tested with 99 counties in regions with high vulnerability to hepatitis C virus (HCV). The method involved a cascade of contacts going from email to phone calls, to videoconferencing and measuring the number of contacts required, amount of time taken, and the proportion of success at recruiting at least one community organization per county. A recruitment period of 5 months and 2118 contact attempts led to the recruitment of organizations from 73 out of our 99 target counties. Organizations belonging to health departments required more attempts and time to recruit but ultimately enrolled at higher rates than did other organizations such as coalitions and agencies. Organizations from counties more (vs. less) vulnerable to HCV outbreaks required more attempts to recruit and, using multiple recruitment methods (e.g., emails, phone calls, and Zoom meetings), improved enrollment success. Overall, this method proved to be successful at remotely engaging a large-scale network of communities with different levels of risk within a large geographic region.

Policy Views and Negative Beliefs About Vaccines in the United States, 2019.

Objectives. To determine whether holding vaccine misconceptions, in the form of negative beliefs about vaccines, correlates with opposing governmental action at all levels designed to increase vaccination (e.g., removing personal belief and religious vaccine exemptions).Methods. Drawing on data from a nationally representative survey of 1938 US adults, we assessed the relation between negative beliefs about vaccines and provaccination policies.Results. Beyond sociodemographic and policy-relevant variables, such as gender and partisan affiliation, questionable negative beliefs about vaccines are the strongest predictor of opposition to policies designed to increase vaccination.Conclusions. Negative beliefs about vaccines in the general population may thwart the passage or implementation of policies designed to increase vaccination. Implementing strategies that reduce these negative beliefs should be a priority of educators and public health officials.

Intentions to Seek Information About the Influenza Vaccine: The Role of Informational Subjective Norms, Anticipated and Experienced Affect, and Information Insufficiency Among Vaccinated and Unvaccinated People.

When deciding whether to vaccinate, people often seek information through consequential processes that are not currently well understood. A survey of a nationally representative sample of U.S. adults (N = 2,091) explored the factors associated with intentions to seek influenza vaccine information in the 2018-2019 influenza season. This survey shed light on what motivates intentions to seek information about the influenza vaccine through the lens of the risk information seeking and processing (RISP) model. The model explained information-seeking intentions well among both unvaccinated and vaccinated respondents. Key findings show that informational subjective norms, information insufficiency, and different types of affect are strong predictors of information-seeking intentions. Theoretical insights on extending the RISP model and practical guidance on designing interventions are provided.

Does Interest in Smoking Affect Youth Selection of Pro-smoking Videos? A Selective Exposure Experiment.

BACKGROUND: Many pro-smoking videos on YouTube reach view counts in the hundreds of thousands and more. Yet, there is limited information on who is viewing these potentially misleading videos. This study attempts to understand the viewership of online pro-smoking videos to examine if youth at high risk for smoking are more likely to watch these videos. METHODS: We conducted a selective exposure experiment with a national sample of youths (ages 15-21 years; n = 614) to identify characteristics that make individuals more likely to select pro-smoking videos. During a 10-min browsing session, participants were given a set of 16 videos (eight smoking and eight nonsmoking) and were asked to view video(s) of their choice. Exposure to videos was unobtrusively logged. View count was manipulated such that smoking videos had either high or low views. RESULTS: Behavioral data revealed that youth with higher interest in smoking were more likely to select and spend more time watching pro-smoking videos than youth with lower interest in smoking. The view count manipulation did not affect selection patterns. However, exposure to high view count smoking videos was associated with more positive attitudes toward smoking. CONCLUSIONS: The findings of this study call into question the existence and prominence of pro-smoking videos on YouTube and bring to attention the need for regulatory or monitoring efforts of such content. IMPLICATIONS: Given the presence and prevalence of misleading pro-smoking videos online, this is the first study to ask the practical and important question of who is viewing these videos. Using behavioral data, we are able to demonstrate that youth who are high at risk for smoking are more susceptible to select and spend more time viewing pro-smoking videos than youth who are low at risk for smoking. Findings also show that when pro-smoking videos appear to be "popular," they affect attitudes toward smoking. Our findings provide policy implications regarding regulation of smoking promotion videos online.

Attitudes and Attitude Change.

This review covers research on attitudes and attitude change published between 2010 and 2017. We characterize this period as one of significant progress toward an understanding of how attitudes form and change in three critical contexts. The first context is the person, as attitudes change in connection to values, general goals, language, emotions, and human development. The second context is social relationships, which link attitude change to the communicator of persuasive messages, social media, and culture. The third context is sociohistorical and highlights the influence of unique events, including sociopolitical, economic, and climatic occurrences. In conclusion, many important recent findings reflect the fact that holism, with a focus on situating attitudes within their personal, social, and historical contexts, has become the zeitgeist of attitude research during this period.

An Online Risk Index for the Cross-Sectional Prediction of New HIV Chlamydia, and Gonorrhea Diagnoses Across U.S. Counties and Across Years.

The present study evaluated the potential use of Twitter data for providing risk indices of STIs. We developed online risk indices (ORIs) based on tweets to predict new HIV, gonorrhea, and chlamydia diagnoses, across U.S. counties and across 5 years. We analyzed over one hundred million tweets from 2009 to 2013 using open-vocabulary techniques and estimated the ORIs for a particular year by entering tweets from the same year into multiple semantic models (one for each year). The ORIs were moderately to strongly associated with the actual rates (.35 < rs < .68 for 93% of models), both nationwide and when applied to single states (California, Florida, and New York). Later models were slightly better than older ones at predicting gonorrhea and chlamydia, but not at predicting HIV. The proposed technique using free social media data provides signals of community health at a high temporal and spatial resolution.

Sources affecting knowledge and behavior responses to the Zika virus in US households with current pregnancy, intended pregnancy and a high probability of unintended pregnancy.

Background: This study examined the influences of information sources on Zika-relevant knowledge and behaviors in US households containing members who are pregnant, intend to become pregnant, or have a higher probability of unintended pregnancy in Zika-affected regions (i.e. respondents who are younger, are black, have less education, are unmarried, and reside in the southern USA). Methods: Over 32 000 US adults completed a survey measuring Zika-relevant knowledge and behaviors along with information sources (e.g. discussing Zika with practitioners), general media usage (e.g. TV) and demographic information over 30 weeks. Results: Respondents in the group with (versus without) either pregnancy or intended pregnancy were more likely to use all information sources, which in turn created differences in knowledge and behavior responses. To gauge information sources in US-South respondents with a high probability of having a household member with unintended pregnancy based on demographics, younger, less-educated, unmarried, black respondents had fewer Zika discussion with practitioners than another group. Conclusions: Efforts to increase Zika-related knowledge and protective behaviors should target households with members who are pregnant or intending to become pregnant via practitioners, family and friends. Additional efforts should target information channels to reach younger, less educated, unmarried, black respondents, which are at risk for unintended pregnancy.

Misleading Claims About Tobacco Products in YouTube Videos: Experimental Effects of Misinformation on Unhealthy Attitudes.

BACKGROUND: Recent content analyses of YouTube postings reveal a proliferation of user generated videos with misleading statements about the health consequences of various types of nontraditional tobacco use (eg, electronic cigarettes; e-cigarettes). OBJECTIVE: This research was aimed at obtaining evidence about the potential effects of YouTube postings about tobacco products on viewers' attitudes toward these products. METHODS: A sample of young adults recruited online (N=350) viewed one of four highly viewed YouTube videos containing misleading health statements about chewing tobacco, e-cigarettes, hookahs, and pipe smoking, as well as a control YouTube video unrelated to tobacco products. RESULTS: The videos about e-cigarettes and hookahs led to more positive attitudes toward the featured products than did control videos. However, these effects did not fully translate into attitudes toward combustive cigarette smoking, although the pipe video led to more positive attitudes toward combustive smoking than did the chewing and the hookah videos, and the e-cigarette video led to more positive attitudes toward combustive cigarette smoking than did the chewing video. CONCLUSIONS: This research revealed young people's reactions to misleading claims about tobacco products featured in popular YouTube videos. Policy implications are discussed.

Debunking: A Meta-Analysis of the Psychological Efficacy of Messages Countering Misinformation.

This meta-analysis investigated the factors underlying effective messages to counter attitudes and beliefs based on misinformation. Because misinformation can lead to poor decisions about consequential matters and is persistent and difficult to correct, debunking it is an important scientific and public-policy goal. This meta-analysis ( k = 52, N = 6,878) revealed large effects for presenting misinformation ( ds = 2.41-3.08), debunking ( ds = 1.14-1.33), and the persistence of misinformation in the face of debunking ( ds = 0.75-1.06). Persistence was stronger and the debunking effect was weaker when audiences generated reasons in support of the initial misinformation. A detailed debunking message correlated positively with the debunking effect. Surprisingly, however, a detailed debunking message also correlated positively with the misinformation-persistence effect.

Action Tweets Linked to Reduced County-Level HIV Prevalence in the United States: Online Messages and Structural Determinants.

HIV is uncommon in most US counties but travels quickly through vulnerable communities when it strikes. Tracking behavior through social media may provide an unobtrusive, naturalistic means of predicting HIV outbreaks and understanding the behavioral and psychological factors that increase communities' risk. General action goals, or the motivation to engage in cognitive and motor activity, may support protective health behavior (e.g., using condoms) or encourage activity indiscriminately (e.g., risky sex), resulting in mixed health effects. We explored these opposing hypotheses by regressing county-level HIV prevalence on action language (e.g., work, plan) in over 150 million tweets mapped to US counties. Controlling for demographic and structural predictors of HIV, more active language was associated with lower HIV rates. By leveraging language used on social media to improve existing predictive models of geographic variation in HIV, future targeted HIV-prevention interventions may have a better chance of reaching high-risk communities before outbreaks occur.

Disparities in attention to HIV-prevention information.

Compared to European-Americans, African-Americans have greater probability of becoming infected with HIV, as well as worse outcomes when they become infected. Therefore, adequate health communications should ensure that they capture the attention of African-Americans and do not perpetuate disadvantages relative to European-Americans. The objective of this report was to examine if racial disparities in attention to health information parallel racial disparities in health outcomes. Participants were clients of a public health clinic (Study 1 n = 64; Study 2 n = 55). Unobtrusive observation in a public health waiting room, message reading times, and response-time on a modified flanker task were used to examine attention to HIV- and flu-information across racial groups. In Study 1, participants were observed for the duration of their time in a public health clinic waiting room (average duration: 31 min). In Study 2, participants completed tasks in a private room at the public health clinic (average duration: 21 min). Across all attention measures, results suggest an interaction between race and information type on attention to health information. In particular, African-Americans differentially attended to information as a function of information type, with decreased attention to HIV- versus flu-information. In contrast, European-Americans attended equally to both HIV- and flu-information. As such, disparities in attention yielded less access to certain health information for African- than European-Americans in a health setting. The identified disparities in attention are particularly problematic because they disadvantage African-Americans at a time of great effort to correct racial disparities. Modifying the framing of health information in ways that ensure attention by all racial groups may be a strategy to increase attention, and thereby reduce disparities in health outcomes. Future research should find solutions that increase attentional access to health communications for all groups.

Neuroticism and attitudes toward action in 19 countries.

Although individuals scoring high on Neuroticism tend to avoid taking action when faced with challenges, Neuroticism is also characterized by impulsivity. To explore cognitive biases related to this costly behavior pattern, we tested whether individuals who rated themselves as higher in Neuroticism would evaluate the general concepts of action and inaction as, respectively, more negative and positive. We further investigated whether anxiety and depression would mediate and individualism-collectivism would moderate these relations in a large international sample. Participants (N = 3,827 college students; 69% female) from 19 countries completed surveys measuring Neuroticism, attitudes toward action and inaction, depression, anxiety, and individualism-collectivism. Hierarchical linear models tested the above predictions. Neuroticism negatively correlated with attitudes toward action and positively correlated with attitudes toward inaction. Furthermore, anxiety was primarily responsible for emotionally unstable individuals' less positive attitudes toward action, and individuals who endorsed more collectivistic than individualistic beliefs showed a stronger negative association between Neuroticism and attitudes toward action. Researchers and practitioners interested in understanding and remediating the negative consequences of Neuroticism should pay greater attention to attitudes toward action and inaction, particularly focusing on their links with anxiety and individualism-collectivism.

Barriers to accessing HIV-prevention in clinic settings: Higher alcohol use and more sex partners predict decreased exposure to HIV-prevention counseling.

Understanding barriers to accepting HIV-prevention counseling among vulnerable populations is of critical importance, as prevention efforts can only have a public health impact if high-risk populations are willing to enroll. A correlational field study was conducted in a health care setting with a high-risk community sample (N = 350) to determine if number of sex partners and alcohol consumption predict acceptance of an invitation to take part in HIV-prevention counseling. Findings indicated that participants engaging in the least risky behavior (i.e. individuals reporting no alcohol consumption and few sex partners) were more likely to accept an offer to receive HIV-prevention counseling. Moreover, heavy drinking was associated with decreased exposure to HIV-prevention counseling, regardless of the number of sex partners reported (b = .12, p > .05). Given associations between heavy drinking and sexual risk taking, finding ways to increase exposure to HIV-prevention counseling programs among heavy drinkers could serve a vital public health function.

Motivational barriers to retention of at-risk young adults in HIV-prevention interventions: perceived pressure and efficacy.

Multi-session HIV-prevention interventions are efficacious but depend on the retention of clients over time. In a sample of at-risk young adults (N = 386), we investigated three potential motivational barriers that might affect the likelihood of retention. Perceived pressure, perceived efficacy and fear and anxiety during the initial session were measured, along with demographic characteristics, partner characteristics, and HIV-related health knowledge. Logistic regressions demonstrated that (1) in general, perceived ineffectiveness was negatively associated with retention; (2) perceived pressure or coercion was negatively associated with retention but only for younger clients; (3) experienced fear and anxiety had no significant association with retention. Implications for theory and counseling practices to reduce motivational barriers and effectively tailor interventions are discussed.

Bypassing as a non-confrontational influence strategy.

Psychological interventions tend to be confrontational in nature. That is, when psychologists seek to bring about change in beliefs, attitudes, or behaviors, they often do so by directly confronting the presumed barrier to change. Confrontational approaches can be effective, but suffer from limitations to their efficacy, such as the possibility of arousing discomfort or defensiveness from the recipient. The current piece seeks to highlight an alternative strategy that we refer to as bypassing, which refers to a general approach for bringing about behavior change without confrontation. Leveraging insights from research on misinformation, stereotypes, and persuasion, we present evidence that non-confrontational approaches can be as effective, if not more so, than the traditional confrontational paradigm.

Health Communication and Behavioral Change During the COVID-19 Pandemic.

The COVID-19 pandemic challenged the public health system to respond to an emerging, difficult-to-understand pathogen through demanding behaviors, including staying at home, masking for long periods, and vaccinating multiple times. We discuss key challenges of the pandemic health communication efforts deployed in the United States from 2020 to 2022 and identify research priorities. One priority is communicating about uncertainty in ways that prepare the public for disagreement and likely changes in recommendations as scientific understanding advances: How can changes in understanding and recommendations foster a sense that "science works as intended" rather than "the experts are clueless" and prevent creating a void to be filled by misinformation? A second priority concerns creating a culturally fluent framework for asking people to engage in difficult and novel actions: How can health messages foster the perception that difficulties of behavior change signal that the change is important rather than that the change "is not for people like me?" A third priority entails a shift from communication strategies that focus on knowledge and attitudes to interventions that focus on norms, policy, communication about policy, and channel factors that impair behavior change: How can we move beyond educating and correcting misinformation to achieving desired actions?