Collective Identity: Making the Case for a Stage Model Approach to Addressing Water Quality in the Chesapeake Bay Watershed.

The Chesapeake Bay watershed encompasses six states and the District of Columbia. Consequently, the people within it display great diversity in terms of values, allegiances, and experiences. That diversity may help to explain an apparent inability to coordinate actions aimed at redressing the dismal water quality throughout the watershed. In this paper, we bridge theory to an applied scenario to examine the importance of developing a collective identity within the watershed to bring about changes in individual behavior and policies. We present the current conditions of the Chesapeake Bay watershed, propose a stage model for the development of a collective watershed identity, outline theoretically grounded determinants of each stage, and discuss the challenges in developing a collective identity. We further suggest several guiding questions for future research.

Persuasive Messages, Social Norms, and Reactance: A Study of Masking Behavior during a COVID-19 Campus Health Campaign.

Efforts by universities to reduce the spread of COVID-19 include health campaigns intended to encourage students to wear masks. While well-intended, these efforts may produce counter-persuasion (e.g., decrease masking) if they are seen as threatening individuals' freedom to choose. In a rolling cross-sectional study of one university campaign (n = 681), we found that the presence of the campaign did instigate a form of resistance known as reactance and that reactance was negatively associated with masking behavior. Masking was also diminished by the frequency with which respondents observed others not wearing a mask (anti-masking descriptive norm) and the frequency with which respondents observed others expressing disdain for masking (anti-masking injunctive norm). Most of these findings were magnified among students who identified as politically conservative. There was no evidence that the frequency of seeing others speak in favor of masks (pro-masking injunctive norm) produced an increase in masking. The results provide valuable theoretical insights into the causes of reactance and empirical evidence of the risks associated with student-oriented COVID safety campaigns.

Talking about Sugar-Sweetened Beverages: Causes, Processes, and Consequences of Campaign-Induced Interpersonal Communication.

Media campaigns may influence audience members directly, via message exposure, or indirectly, via conversations about the campaign. Either process has the potential to produce persuasion or counter-persuasion (i.e., boomerang). A laboratory experiment (N = 297) was conducted in which individuals viewed three anti-sugar-sweetened beverage PSAs under three conditions: Prompt (discussion allowed with instructions to evaluate the effectiveness of the PSAs), no prompt (discussion allowed, but not guided), and discussion not allowed. Conversations between dyad members were coded for quantity of on-topic talk and frequency of cognitive process words (e.g., because, therefore). Results showed persuasion and counter-persuasion via direct and indirect processes. On-topic talk and cognitive process words predicted intentions to reduce beverage consumption among heavy drinkers. The study is among the few to examine conversations provoked by media messages and to demonstrate how an experimental manipulation can guide the quantity and quality of those interactions.

Media Contributions to a Chesapeake Bay Watershed Collective Identity? A Tale of Three Cities.

Although collective action is needed to address many environmental challenges, it cannot proceed in the absence of collective identity, that is, evidence of group belongingness expressed in or via communicative behavior. This study looked for evidence of a collective identity in newspaper articles that referenced the Chesapeake Bay Watershed. The data were drawn from local papers published in municipalities located at the headwaters of the Susquehanna River, midway down the Susquehanna, and where the river meets the Bay. Computerized content analysis assessed the frequency with which the Chesapeake Bay and watershed were mentioned alongside a set of keywords thought to represent different facets of identity (e.g., agriculture, fishing, swimming). The results showed substantial variation in frequency across time and place but low absolute levels of coverage of the Bay and the watershed. Multidimensional scaling revealed different structures to collective identity as a function of place. These differences in content may be attributable to varying demographic and environmental characteristics along with proximity to the Bay. But, to the extent that media contribute to collective identity among residents of the watershed at all, they do so in a complex and heterogeneous manner.

Fear of Zika: Information Seeking as Cause and Consequence.

This study examined the relationship between information seeking and fear during the Zika-induced global health crisis. A longitudinal survey of women in the Southern U.S. (N = 306) was conducted in 2016, beginning just days after the World Health Organization declared Zika a global crisis. The data showed that time 1 fear stimulated information seeking at time 2 and that time 2 information seeking caused fear at time 3. This pattern held regardless of whether participants were pregnant or planning to become pregnant (high personal relevance) versus neither (low personal relevance). The findings are at odds with most theories of fear appeals and only partially supportive of contemporary models of information seeking. From an applied standpoint, the results suggest (a) that information seeking should not be assumed to produce uniformly attractive outcomes and (b) that, during a disease crisis, health agencies should anticipate proactive behaviors by members of the public and plan accordingly.

Communicating Antibiotic Stewardship: Emotional Responses and Their Impact on Adherence.

Although watchful watching has been recommended as a means of reducing unnecessary use of antibiotics, nonadherence has frequently been observed. Drawing from appraisal theories of emotion, this study (n = 579) examined (a) the factors that shape pediatric caregivers' emotional experiences in the medical contexts and (b) the influence of emotions on (non)adherence behavioral intentions. Caregivers reported more intense negative emotions and less intense positive emotions following watchful waiting advice versus receiving an antibiotic prescription. The differences were mostly driven by false beliefs about antibiotics' effectiveness. Emotional responses predicted intentions to adhere to watchful waiting advice (e.g., counterargue and seek another healthcare provider), with anger being the most consistent determinant of these outcomes. Improving antibiotic stewardship can be achieved by educational efforts to correct false beliefs and by training healthcare providers to manage caregiver emotions.

Anti-Sugar-Sweetened Beverage Messages Elicit Reactance: Effects on Attitudes and Policy Preferences.

Messages that convey the dangers associated with consumption of sugar-sweetened beverages (SSBs) may be the most effective means of changing attitudes toward consumption and policy preferences. However, there is a risk that this message type also stimulates reactance, a form of resistance to persuasion. A study (N = 618) using messages from the 2012 New York City anti-SSB campaign and a sample of New York City residents showed just such effects. Reactance was heightened by prior message exposure, conservative political orientation and prior consumption of SSBs. The net message effect was still persuasive overall for attitudes, but could be improved by 17% if reactance were eliminated. In contrast, the net message effect on policy preferences was counterpersuasive, due to processes other than reactance. Anti-SSB threat appeals can change attitudes toward one's own behavior in a more healthful direction, while simultaneously eroding support for more restrictive SSB policies.

Understanding Fear of Zika: Personal, Interpersonal, and Media Influences.

Fear of infectious disease often motivates people to protect themselves. But, it can also produce negative bio-social-psychological effects whose severity is on par with those of the disease. The WHO declaration of Zika as a world health crisis presented an opportunity to study factors that bring about fear. Beginning nine days after the WHO announcement, data were gathered from women aged 18-35 living in the southern United States (N = 719). Respondents reported experiencing fear of Zika at levels akin to those reported following other significant crises/disasters (e.g., the terrorist attacks of 9/11). Fear increased as a function of (1) personal, but not other-relevance, (2) frequency of media exposure, but not media content, and (3) frequency of interpersonal exposure and interpersonal content. It is argued that media and interpersonal message sources may be innately predisposed to amplify, rather than attenuate, risk.

Threat Appeals: The Fear-Persuasion Relationship is Linear and Curvilinear.

Drive theory may be seen as the first scientific theory of health and risk communication. However, its prediction of a curvilinear association between fear and persuasion is generally held to be incorrect. A close rereading of Hovland et al. reveals that within- and between-persons processes were conflated. Using a message that advocated obtaining a screening for colonoscopy, this study (N = 259) tested both forms of the inverted-U hypothesis. In the between-persons data, analyses revealed a linear effect that was consistent with earlier investigations. However, the data showed an inverted-U relationship in within-persons data. Hence, the relationship between fear and persuasion is linear or curvilinear depending on the level of analysis.

Interpreting Perceived Effectiveness: Understanding and Addressing the Problem of Mean Validity.

Research has shown that perceived message effectiveness (PE) correlates reasonably well with indices of actual effectiveness, but little attention has been given to how to interpret mean PE. This article describes the problem of mean validity and presents a research design that can be used to address it. Participants (N = 195) viewed messages that advocated being screened for colorectal cancer. The results showed downward bias in PE among members of the non-target audience (persons younger than 50) and upward bias as the referent for the judgment became more abstract/distant (self vs. persons older than 50 vs. general). The need for more research on mean validity is discussed. For applied researchers, recommendations for preferred indices of PE are offered.

A Content Analysis of Online Messages about Sugar-Sweetened Beverages.

Media campaigns can reduce or promote the consumption of sugar-sweetened beverages (SSBs). Brief, US-based English-language online messages were gathered from searchable media platforms, a process that yielded 112 anti-SSB videos and 29 pro-SSB commercials. Using a combination of inductive and deductive methods, a content analysis of those messages was conducted to identify their properties. They were coded for the direction (pro vs. anti), target of the advocacy (e.g., consumption vs. policy), actor demographics (gender, age, and ethnicity), persuasive theme (e.g., excessive sugar, nurturing), and message sensation value. Anti-SSB appeals primarily targeted individual-level consumption behavior. They utilized six persuasive themes and often included more than one theme in a single message. Pro-SSB messages used feel-good themes and utilized only one theme per message. The proportions of adults, adolescents, and children differed by the direction of the advocacy. Black, Hispanic, and Asian actors were under-represented in the anti-SSB sample relative to Whites. Pro-SSB appeals were slightly higher than anti-SSB appeals in message sensation value (p = 0.09). The findings illuminate the message features that characterize the universe of brief anti-SSB appeals available online, highlight messaging disparities, and reveal the absence of certain common, effective persuasive themes.

Spillover effects of anti-sugar-sweetened beverage messages: From consumption decisions to policy preferences.

BACKGROUND: Intake of sugar-sweetened beverages (SSBs) is associated with many negative health outcomes. Efforts to curb consumption generally take one of two approaches: (a) Individual change based on the communication of personal risk information or (b) policies that limit or disincentivize the behavior, such as restricting access or implementing taxes. METHODS AND RESULTS: Using samples of 2347 persons and 139 pro- and anti-SSB messages, this study tested whether individual-level persuasion attempts would spill over to voting intentions and whether that spillover would amplify or attenuate policy preferences. The influence of anti-SSB messages was seen in (a) direct, positive effects on intention to vote for restrictive policies and in (b) indirect, positive effects where change in intended consumption mediated message impact on change in voting intentions. Anti-SSB messages were generally more powerful than pro-SSB advertising at producing direct and indirect change. Yet, there was evidence of boomerang effects among small numbers of both SSB drinkers and nondrinkers. CONCLUSIONS: Anti-SSB messages that target individual consumption bring about intentions to reduce consumption and increased receptivity to restrictive SSB policies.

Impulsivity partially mediates the relationship between BIS/BAS and risky health behaviors.

Several theorists have suggested that impulsivity can be understood as a joint function of the behavioral approach (BAS) and behavioral inhibition systems (BIS). After resolving questions concerning the measurement of impulsivity and BAS, this study examined the relationships among risky health behaviors, impulsivity, BIS, and BAS. Utilizing a sample of undergraduates (N = 904), a structural model was tested in which BAS and BIS predicted impulsivity, which, in turn, predicted risky behavior. Fit indices were acceptable, but not good. A modified version of the model showed a statistically significant negative relationship between BAS and risky behaviors. However, the fit indices were not unequivocally supportive of the need to include that path. Overall, the data suggest that impulsivity is the joint result of countervailing motivational forces and that it partially or fully mediates the influence of BIS and BAS on risky health behavior.

An application of the integrative model to women's intention to be vaccinated against HPV: implications for message design.

Human papillomavirus (HPV) is the only definitively identified causal agent of cervical cancer. Given the availability of a vaccine that is effective against the two strains of HPV most commonly associated with cervical cancer, understanding the factors that influence women's decision to be vaccinated is crucial to uptake. Fishbein's (2000 ) integrative model of behavior provided theoretical guidance for a Web-based survey of college women (n=174). Taken together, attitude, subjective norm, and perceived control predicted intention to vaccinate at R=.83, with attitude being the strongest single predictor by a factor of 2. However, attitude and subjective norm interacted with perceived control such that both were more potent predictors of intention at higher levels of control. These results suggest modification of the integrative model. Attention to the beliefs that underlie attitude revealed that the best candidates for change were feelings of security regarding future health and certainty that the vaccine will provide protection. The findings are discussed in terms of their implications for health education.

Parental information seeking following a positive newborn screening for cystic fibrosis.

This investigation focused on the information-seeking behaviors of parents (N = 38) whose newborn had received a positive screening result for cystic fibrosis. Roughly half of the participants actively sought information about their child's potential disease prior to the clinic visit. The most common sources of information were the Internet, pediatricians, and family physicians. Analysis of behavior during the clinic visit showed rates of question asking that were judged as low, but they were comparable to the results of other studies. It was observed that parents occasionally would collaborate in the production of a single question. More educated parents tended to produce such questions more frequently. Importantly, frequency of collaborative questions was positively correlated with enhanced knowledge of cystic fibrosis six weeks after the clinic visit and with apparent dissatisfaction with the counseling interaction.

Message frames interact with motivational systems to determine depth of message processing.

Although several theoretical perspectives predict that negatively framed messages will be processed more deeply than positively framed messages, a recent meta-analysis found no such difference. In this article, the authors explore 2 explanations for this inconsistency. One possibility is methodological: the statistics used in the primary studies underestimated framing effects on depth of message processing because the data were maldistributed. The other is theoretical: the absence of a main effect is veridical, but framing interacts with individual differences that predispose individuals to greater or lesser depth of processing. Data from 2 experiments (Ns = 286 and 252) were analyzed via tobit regression, a technique designed to overcome the limitations of maldistributed data. One study showed the predicted main effect for framing, but the other did not. Both studies showed the anticipated interaction: Depth of processing correlated positively with a measure of the behavioral activation system in the advantage framing condition, whereas depth of processing correlated positively with the behavioral inhibition system in the disadvantage framing condition.

Potential threats to the effective communication of genetic risk information: the case of cystic fibrosis.

The dramatic increase in genetic knowledge engendered by the mapping of the human genome brings with it a need for greater understanding of how to effectively communicate genetic risk information. Using a combination of observational and self-report data, this study examined potential threats to effective risk communication in 17 families whose infant received a positive newborn screening test for cystic fibrosis. Five specific problems are identified: (a) copresence of interactants (or the lack thereof), (b) disruptions in the communication environment, (c) variations in parents' initial knowledge, (d) rigidity in counselors' behavioral scripts, and (e) emotional interference with information acquisition. We advance 3 proposals for research aimed at improving our understanding of these potential threats.

Self-regulation of emotional responses to Zika: Spiral of fear.

Fear of infectious disease can create a variety of problems not the least of which is fear itself. An important question is how individuals attempt to manage their fear. The appearance of Zika in the U.S. presented an opportunity to examine this issue in a consequential natural context. Beginning nine days after the W.H.O. declared Zika a world health crisis, two-waves of survey data were collected from women ages 18-35 who were living in the Southern U.S. (N = 561). Most respondents (71%) used one or more emotion regulation strategies and a plurality (41%) utilized multiple strategies. Fear of Zika showed no demonstrable effect on avoidance, reappraisal, or contesting and none of these three strategies were effective at down-regulating fear. Fear and suppression, however, showed a self-reinforcing cycle in which fear increased use of suppression and suppression increased intensity of the fear response. Although the observed associations were small, even modest effects can be consequential when cumulated over time or across large numbers of individuals.

Factors associated with participation in a prevention trial aimed at reducing biomarkers of breast cancer risk.

OBJECTIVES: Poor enrollment into prevention trials is a major obstacle to the conduct of clinical investigations. This study focuses on cognitive and affective influences on the decision to participate in a clinical trial aimed at reducing biomarkers of breast cancer risk. METHODS: Following a decision to participate or not in a clinical trial focused on reduction of breast cancer risk, women were recruited into the present study. Data were gathered via telephone survey. RESULTS: One hundred healthy women took part in the current study, 72 of whom had participated in the clinical trial, and 28 of whom had declined participation. Women who decided to enroll perceived more benefits and fewer costs, and they experienced more positive emotions and fewer negative emotions. They also made the decision more quickly, more easily, were more satisfied with it, and had fewer regrets than women who declined participation in the clinical trial. CONCLUSIONS: Participants to this clinical trial differed from nonparticipants in terms of antecedents, process, and outcomes of the decision to enroll. PRACTICE IMPLICATIONS: Although obstacles exist, accrual might be improved by greater emphasis on the practical and psychosocial benefits to participants.

ICU family communication and health care professionals: A qualitative analysis of perspectives.

OBJECTIVES: Although ineffective communication is known to influence patient and family satisfaction with care in intensive care unit [ICU] settings, there has been little systematic analysis of the features of the perceived problem from a communication theory perspective. This study was undertaken to understand perceptions of miscommunication and the circumstances in which they present. RESEARCH METHODOLOGY AND DESIGN: Semi-structured interviews were conducted with 22 health care professionals [HCPs] in five adult ICUs at an academic medical centre in the United States. FINDINGS: From qualitative analysis of the transcribed interviews, four themes emerged, each containing multiple subthemes. Person factors are problems that originate within individuals, related to education, cultural background and emotion. Structural factors are associated with boundaries and coordination of institutional roles. Information management problems result from social and psychological processes by which HCPs and family members seek, distribute and understand information. Relationship management problems arise from difficulties in interpersonal interactions. CONCLUSIONS: Ineffective communication is not a single problem, but rather several distinct problems that exist at different levels of abstraction and vary in over-time stability. These findings provide a framework for designing interventions to improve the well-being of patients and family members.