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1.
Health Commun ; : 1-16, 2024 Feb 01.
Article in English | MEDLINE | ID: mdl-38299636

ABSTRACT

The current study has three main purposes: to examine 1) the impact of theory-driven corrective messages using individual vs. collective frames on information-seeking intention 2) the mediating role of risk perceptions and 3) the moderating role of reflection and gender. Our findings from a randomized experimental study and Hayes' moderated, moderated mediation model show collective frames were associated with high-risk perceptions among women, which in turn led to higher information seeking intention. The second moderator reveals that people who scored higher on reflection were more willing to seek information. Our findings have critical implications for misinformation research by demonstrating the importance of theoretically driven messages in understanding misperceptions as well as people's information seeking behavior.

2.
Health Commun ; 39(2): 417-427, 2024 Apr.
Article in English | MEDLINE | ID: mdl-36691229

ABSTRACT

Political polarization surrounding the COVID-19 health crisis has been on the rise since the beginning of the pandemic. We combine prior research on motivated reasoning, selective exposure, and news framing to understand the association between partisan media use and social distancing behavior related to COVID-19. To do so, we collected media content data and national survey data during the onset of the pandemic. We employed structural topic modeling (STM), dependency parsing, word co-occurrence, and manual coding to examine the media coverage. Next, we analyzed survey data collected with a Qualtrics panel from a sample of U.S. residents for factors explaining social distancing behaviors. Results reveal coverage from the right leaning outlets downplayed the virus and highlighted the consequences of lockdowns on the economy. Our survey findings show that even after accounting for a range of demographic, political orientation, and COVID-19 awareness variables, conservative media use was linked, although modestly, with a lower likelihood of social distancing behavior. Our findings echo past research on media framing of pandemics and their association with public attitudes and behavior.


Subject(s)
COVID-19 , Social Media , Humans , COVID-19/epidemiology , Pandemics , Physical Distancing , SARS-CoV-2 , Communicable Disease Control
3.
J Health Commun ; 29(1): 49-60, 2024 Jan 02.
Article in English | MEDLINE | ID: mdl-37970863

ABSTRACT

More than 6 million people have died due to the COVID-19 pandemic. In order to slow down the spread of COVID-19, health authorities have created numerous guidelines. In the current study, we use survey data from the U.S. and social cognitive theory (SCT) to examine the associations among self-efficacy, outcome expectancies, and willingness to perform recommended COVID-19 related health behavior. Considering the misinformation-filled information ecology during the pandemic, we also examine the moderating role of misperceptions in these relationships. Our findings show that in general the SCT hypotheses hold for COVID-19 related behavior willingness. The interaction effects with COVID-19 misperceptions show that self-efficacy is not enough to understand people's health behavior. Higher outcome expectancies are important and may be able to overcome even if people held high misperceptions. Our findings have direct implications for communication theory and for health organizations in the contemporary information ecology.


Subject(s)
COVID-19 , Pandemics , Humans , COVID-19/epidemiology , Health Behavior , Communication , Psychological Theory
4.
Am J Health Promot ; 37(7): 915-923, 2023 09.
Article in English | MEDLINE | ID: mdl-37309829

ABSTRACT

PURPOSE: To examine strategies that help motivate social correction behaviors to combat COVID-19-related health misinformation on social media. DESIGN: 2 (message types: narrative vs statistics) x 2 (social frames: individual vs collective) between-subjects experiment. SETTING: Qualtrics-based online experiment via Lucid. SUBJECTS: The final sample consisted of 450 participants (Mage = 45.31). MEASURES: Manipulation check, discussion and correction intentions, and need for cognition (NFC). ANALYSIS: ANCOVA and PROCESS model 3 were used to analyze the data. RESULTS: Significant interaction effects emerged between message types and social frames on discussion intention, F (1, 442) = 5.26, P = .022, and correction intention, F (1, 442) = 4.85, P = .028. Collectively framed narrative correction (Mdiscussion = 3.15, Mcorrection = 3.17) was more effective than individually framed narrative correction (Mdiscussion = 2.73, Mcorrection = 2.77). Individually framed statistical correction (Mdiscussion = 3.10, Mcorrection = 2.95) was more persuasive than collectively framed statistical correction (Mdiscussion = 2.89, Mcorrection = 2.69). The interaction effects were more evident for people low on NFC, P = .031. CONCLUSION: In motivating social correction behaviors, a story is better told with an emphasis on collective interests, and numbers are better presented with personal gains and losses. Future interventions should identify the target audience based on the level of NFC.


Subject(s)
COVID-19 , Social Media , Humans , Middle Aged , Pandemics , Communication , Intention , Cognition
5.
Curr Psychol ; : 1-16, 2023 Jun 02.
Article in English | MEDLINE | ID: mdl-37359635

ABSTRACT

Although there is enough scientific evidence to show the benefits and safety of vaccines, vaccine rates are low, while misperceptions about vaccines are on the rise. The main purposes of the current study are to 1) examine the effects of narrative vs. statistical messages on vaccine intention, 2) test the mediating role of perceived expectancies, and 3) examine the moderating roles of perceived susceptibility and misperceptions on vaccine intention. Data were collected with an online experiment through Amazon Mturk. The online experiment was conducted via Qualtrics once the study was considered exempt by the Institutional Research Board of a large University in the U.S. A total of 300 participants aged 18 and above completed the survey. Findings show that perceived expectancies mediate the relationship between message manipulation and vaccine intention. Our findings also show a three-way interaction which indicates that among individuals with high misperceptions, statistical messages are more persuasive for individuals with high perceived susceptibility, while narrative messages are more influential for individuals with low perceived susceptibility.

6.
Am J Health Promot ; 37(4): 464-470, 2023 05.
Article in English | MEDLINE | ID: mdl-36214531

ABSTRACT

PURPOSE: To assess how previous experiences and new information contributed to COVID-19 vaccine intentions. DESIGN: Online survey (N = 1264) with quality checks. SETTING: Cross-sectional U.S. survey fielded June 22-July 18, 2020. SAMPLE: U.S. residents 18+; quotas reflecting U.S. Census, limited to English speakers participating in internet panels. MEASURES: Media literacy for news content and sources, COVID-19 knowledge; perceived usefulness of health experts; if received flu vaccine in past 12 months; vaccine willingness scale; demographics. ANALYSIS: Structural equation modelling. RESULTS: Perceived usefulness of health experts (b = .422, P < .001) and media literacy (b = .162, P < .003) predicted most variance in vaccine intentions (R-squared=31.5%). A significant interaction (b = .163, P < .001) between knowledge (b = -.132, P = .052) and getting flu shot (b = .185, P < .001) predicted additional 3.5% of the variance in future vaccine intentions. An increase in knowledge of COVID-19 associated with a decrease in vaccine intention among those declining the flu shot. CONCLUSION: The interaction result suggests COVID-19 knowledge had a positive association with vaccine intention for flu shot recipients but a counter-productive association for those declining it. Media literacy and trust in health experts provided strong counterbalancing influences. Survey-based findings are correlational; thus, predictions are based on theory. Future research should study these relationships with panel data or experimental designs.


Subject(s)
COVID-19 , Influenza Vaccines , Humans , Trust , COVID-19 Vaccines , Intention , Cross-Sectional Studies , Literacy , COVID-19/prevention & control , Vaccination
7.
Health Commun ; 38(12): 2765-2773, 2023 12.
Article in English | MEDLINE | ID: mdl-36002351

ABSTRACT

Despite the sheer devastation caused by the COVID-19 pandemic in the United States, vaccine hesitancy is a major barrier to a successful implementation of the vaccine. We apply two moderators to examine the associations of efficacy and expectancies with COVID-19 vaccine intention. Specifically, we use national survey data collected online in 2020 (N = 1264) and a moderated moderated mediation PROCESS model to examine 1) the associations between self-efficacy about COVID-19 and vaccine intention mediated by positive outcome expectancies and 2) moderating roles of individual responsibility and partisan media use. The findings show that the path from efficacy to expectancies is moderated by individual responsibility, while the path from expectancies to vaccine intention is moderated by liberal media use. Our findings support the strategic application of SCT to emphasize the role of personal responsibility in campaigns to encourage vaccination for the COVID-19 virus.


Subject(s)
COVID-19 Vaccines , COVID-19 , Humans , COVID-19 Vaccines/therapeutic use , COVID-19/epidemiology , COVID-19/prevention & control , Intention , Pandemics , Vaccination , Cognition
8.
J Health Commun ; 27(9): 672-681, 2022 Sep 02.
Article in English | MEDLINE | ID: mdl-36444564

ABSTRACT

The COVID-19 pandemic has imposed many communication challenges for public health authorities, especially communicating the safety, effectiveness, and importance of the COVID-19 vaccine. This study takes an integrative approach that includes a content analysis of COVID-19 vaccine-related messages from the CDC Facebook page and an experimental test of the effectiveness of the same types of vaccine-related messages on participants' attitudes toward the COVID-19 vaccine. Our findings from the content analysis show that gain-frame was used significantly more than loss-frame, and statistical evidence was more prevalent than narrative evidence in the CDC's COVID-19 vaccine-related messaging. Results from the experiment indicated that loss-framed, and messages with statistical evidence, may be more successful in promoting positive attitudes toward the COVID-19 vaccine.


Subject(s)
COVID-19 , Vaccines , Humans , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Pandemics/prevention & control , Optimism , Communication
9.
Article in English | MEDLINE | ID: mdl-35954515

ABSTRACT

Smoking is more common among individuals with mental health issues than those who do not have mental illnesses. In particular, among individuals with an anxiety disorder, a high prevalence of smoking has been found. Mood adjustment theory suggests that individuals with negative moods could adjust their moods depending on the type of television they watched. To understand this relationship better, we aim to examine how different television viewing can moderate the tendency of smoking behavior for individuals with an anxiety disorder. We used national U.S. survey data and concepts from the mood adjustment theory to answer our research questions. Our main contributions were to: (1) extend the mood adjustment theory by focusing on the association between a diagnosed mental disorder (i.e., anxiety) and risky behavior (i.e., smoking), and (2) examine the nuances of television genres by dividing entertainment television into excitement-valenced and ambiguously-valenced entertainment programs, along with information programs. The primary findings show that individuals with an anxiety disorder were more likely to smoke and this association was significantly attenuated when they watched cartoons, sports, and health information programs, but the positive association between an anxiety disorder and the extent of smoking was intensified when they watched drama, music, sci-fi, and television news. Patients with an anxiety disorder may take advantage of excitement-valenced entertainment programs and health-related information but need to be cautious in choosing ambiguously-valenced entertainment programs and news.


Subject(s)
Drama , Television , Anxiety Disorders , Humans , Leisure Activities , Smoking/epidemiology
10.
Article in English | MEDLINE | ID: mdl-35805227

ABSTRACT

At the start of the COVID-19 pandemic, there was no vaccine to cure or slow its impact due to the novelty of the virus, nor were there were any other standardized measures to handle its spread. Yet, despite the detrimental consequences of the pandemic and its impact on people's lives, the behavior of individuals to combat the pandemic was not necessarily consistent with official guidelines. To make things worse, the pandemic was highly politicized in countries such as the U.S. With a help of a national survey from the U.S., we examine the associations between media literacy variables and willingness to perform recommended COVID-19 related health behavior. Moreover, we also examine the moderating role of conservative media use in this relationship. Our findings show that conservative media use was negatively associated with these protective behaviors, and that both media literacy variables were positively related with willingness to perform recommended COVID-19 related health behavior. Our results show that media literacy can mitigate some of the impact of conservative media use on individuals. Our findings help understand the complexity of protective behavior against the virus during a highly politicized pandemic.


Subject(s)
COVID-19 , Health Literacy , Social Media , COVID-19/epidemiology , Health Behavior , Humans , Literacy , Pandemics/prevention & control , SARS-CoV-2
11.
Curr Psychol ; : 1-10, 2022 Feb 03.
Article in English | MEDLINE | ID: mdl-35136329

ABSTRACT

One of the ways to overcome the sheer devastation of the COVID-19 pandemic is to get vaccinated. However, vaccine hesitancy could be a significant barrier. The main purposes of the current study are to examine the impact of four types of theory-driven messages on COVID-19 vaccination intention and to understand the moderating role of partisan media use and vaccination attitudes. The study used a between-subject randomized online experiment with four conditions. The manipulation messages were presented as screenshots from the CDC's Facebook page. The total number of participants were 387 (female 43%, mean age 37 years). The participants were from the U.S. and older than 18 years. The findings show that loss vs. gain message frames did not have any impact on COVID-19 vaccine intention. The moderating effects of conservative media and attitudes show that in general, those who consumed lower conservative media and held positive attitudes were higher on vaccine intention, and individual vs. collective frames did not have a strong impact. However, among those participants who scored high on conservative media use, and held negative vaccination attitudes, the individual frame had a higher impact on vaccine intention. The current study experimentally tested the intertwined relationships among message frames, partisan media use, and attitudes on vaccine intention. These relationships are critical considering the political nature of the pandemic. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-022-02851-3.

12.
Am J Health Promot ; 36(6): 923-933, 2022 07.
Article in English | MEDLINE | ID: mdl-35081757

ABSTRACT

PURPOSE: The main purposes of the current study are to examine 1) the influence of narrative vs statistics messages on COVID-19 related information seeking and COVID-19 vaccine intention and 2) the moderating role of perceived behavioral control (PBC). DESIGN: Data for a between-subject randomized experiment were collected online. The manipulation messages were presented as screenshots from the CDC's Facebook page. SETTING: The participants were recruited from Amazon MTurk. SUBJECTS: A total of 300 subjects participated in the study, who were 18 years and above (M = 38.40). MEASURES: Intention to seek information, COVID-19 vaccine intention, and PBC. ANALYSIS: To test the hypotheses, we utilized Hayes's (2014) PROCESS for SPSS (Model 1). For intention to seek information, the main effect of the message manipulation (narrative vs statistics) [b = -2.10, t (300) = -4.14, P < .001] and the interaction [b = .41, t (300) = 3.88, P < .001] were significant. For vaccine intention, the main effects of message manipulation [b = 1.64, t (300) = -2.61, P < .005] and the interaction [b = .34, t (300) = 2.64, P < .005] were significant. RESULTS: Our research found that narrative messages were more persuasive for both information seeking and vaccine intention. But this was true only in the case of individuals whose PBC was low. CONCLUSIONS: Our findings have critical implications for vaccine promotion research.


Subject(s)
COVID-19 Vaccines , COVID-19 , Adolescent , Adult , Behavior Control , COVID-19/prevention & control , Humans , Information Seeking Behavior , Intention
13.
Health Commun ; 37(11): 1423-1431, 2022 10.
Article in English | MEDLINE | ID: mdl-33685304

ABSTRACT

Although there is a wide variety of scientific evidence that demonstrates the benefits of vaccination on a multitude of diseases, vaccination rates remain low while misperceptions about vaccines are on the rise. The primary objective of the present study is to examine the role of doctor-patient communication and vaccination. We test the impact of doctor-patient communication on trust in doctors' vaccine recommendations as a mediator, to understand the mechanisms leading to positive vaccination attitudes, and ultimately leading to actual H1N1 vaccination behavior. We use data from a nationally representative U.S. sample from one of the Multimedia Audience Research Systems (MARS) data sets collected by Kantar Media. Our results demonstrate the crucial role of doctor-patient communication in building patients' trust in doctors, which in turn positively impact vaccination attitudes and H1N1 vaccination behavior. Unlike other preventive health measures, getting vaccines after a pandemic is a critical decision because these vaccines are previously unknown. Our finding implies that verified communication from the physician's office may be one of the effective strategies during or after a pandemic. Our findings have implications for public health organizations to incorporate effective vaccination communication and could have critical implications for the COVID-19 vaccination.


Subject(s)
COVID-19 , Influenza A Virus, H1N1 Subtype , Vaccines , COVID-19 Vaccines , Communication , Humans , Optimism , Trust , Vaccination
14.
Article in English | MEDLINE | ID: mdl-34948806

ABSTRACT

Although several theories posit that information seeking is related to better psychological health, this logic may not apply to a pandemic like COVID-19. Given uncertainty inherent to the novel virus, we expect that information seeking about COVID-19 will be positively associated with emotional distress. Additionally, we consider the type of news media from which individuals receive information-television, newspapers, and social media-when examining relationships with emotional distress. Using a U.S. national survey, we examine: (1) the link between information seeking about COVID-19 and emotional distress, (2) the relationship between reliance on television, newspapers, and social media as sources for news and emotional distress, and (3) the interaction between information seeking and use of these news media sources on emotional distress. Our findings show that seeking information about COVID-19 was significantly related to emotional distress. Moreover, even after accounting for COVID-19 information seeking, consuming news via television and social media was tied to increased distress, whereas consuming newspapers was not significantly related to greater distress. Emotional distress was most pronounced among individuals high in information seeking and television news use, whereas the association between information seeking and emotional distress was not moderated by newspapers or social media news use.


Subject(s)
COVID-19 , Psychological Distress , Social Media , Humans , Information Seeking Behavior , Pandemics , SARS-CoV-2
15.
J Health Commun ; 26(8): 523-533, 2021 08 03.
Article in English | MEDLINE | ID: mdl-34424140

ABSTRACT

The United States is one of the hardest-hit countries by the COVID-19 pandemic and yet there is widespread hesitancy to take the vaccine. In order to address vaccine hesitancy and foster public understanding of the COVID-19 vaccine, it is necessary to strategize public health messages based on evidence. To this end, we use experimental data to examine the effects of four message frames on participants' attitudes toward the COVID-19 vaccine and their vaccine intention. The primary purposes of this paper are to examine the 1) impact of loss vs. gain frames and individual vs. collective frames and 2) role of perceived benefits on participants' attitudes toward the COVID-19 vaccine and their vaccine intention. Our findings show that participants with higher perceived benefits and exposed to the loss frame showed higher positive attitudes toward the COVID-19 vaccine and greater intention to vaccinate. Similar patterns were revealed in case of the individual frame message. Implications are discussed.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Intention , Vaccination/psychology , Adult , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Pandemics/prevention & control , Patient Acceptance of Health Care , United States , Vaccination Refusal/psychology
16.
Article in English | MEDLINE | ID: mdl-34207964

ABSTRACT

BACKGROUND: Lockdown measures because of COVID-19 are likely to result in deteriorating physical and mental health. In this study, our aim was to assess the impact of media exposure on increases in substance use during the COVID-19 pandemic. METHODS: A nationally representative online survey of 1264 adults was collected during the pandemic in the United States. Logistic regression was used to explore the association between an increase in substance use since the beginning of the COVID-19 pandemic and exposure to cable news or social media together with COVID-19 knowledge, while controlling for covariates. RESULTS: In the multivariable-adjusted models, participants with the highest exposure to social media (at least daily) and low knowledge of COVID-19 were 9.9 times more likely to experience an increase in substance use since the pandemic began (OR = 9.90, 95% CI = 4.27-23.06). Participants with the highest exposure to cable news and low knowledge of COVID-19 were over 11 times more likely to experience an increase in substance use (OR = 11.64, 95% CI = 4.01-24.45). CONCLUSION: Based on our findings, we recommend that media organizations should aim to reduce uncertainty and also provide positive coverage to counter the negative information associated with pandemics.


Subject(s)
COVID-19 , Social Media , Substance-Related Disorders , Adult , Communicable Disease Control , Cross-Sectional Studies , Humans , Pandemics , SARS-CoV-2 , Substance-Related Disorders/epidemiology , Surveys and Questionnaires , United States/epidemiology
17.
Am J Health Promot ; 35(7): 1002-1014, 2021 09.
Article in English | MEDLINE | ID: mdl-33949203

ABSTRACT

OBJECTIVE: Numerous studies examined HPV vaccination promotional strategies. However, an overview of theory use, a synthesis of strategies' effectiveness and an examination of the moderating influence of theory are absent. DATA SOURCE: We retrieved studies from Academic Search Complete, Business Source Complete, PubMed, PsycINFO, Web of Science, CMMC, CINAHL, and MEDLINE. STUDY INCLUSION AND EXCLUSION CRITERIA: 1) peer-reviewed articles written in English, 2) experimental or quasi-experimental, 3) measure HPV vaccination-related outcomes, 4) had to contain a control condition and report statistics necessary for conversion (for meta-analysis only). DATA EXTRACTION: 70 and 30 studies were included for the systematic review and meta-analysis respectively. DATA SYNTHESIS: Four major categories were coded: study information, theory use, type of theory, and outcomes. Two independent coders coded the sample (Cohen's Kappa ranged from .8 to 1). RESULTS: Most of the studies were based in the U.S. (77%, k = 54) with convenient samples (80%, k = 56), targeted toward females (46%, k = 32), and around a quarter did not employ any theories (47%, k = 33). Among theory-driven studies, the most commonly used were Framing (22%, k = 19), Health Belief Model (HBM; 13%, k = 12), and Narrative (7%, k = 6). Among controlled studies, promotional strategies were significantly more effective compared to the control (r+ = .25, p < .001). Strategies guided by the information, motivation, behavioral skills model (IMB) were more effective (r+ = .75, p < .001) than studies guided by framing theory (r+ = -.23, p < .001), HBM (r+ = .01, p < .001), and other theories (r+ = .11, p < .001). CONCLUSION: This review contributes to HPV vaccination promotion literature by offering a comprehensive overview of promotional strategies and practical suggestions for future research and practices.


Subject(s)
Papillomavirus Infections , Papillomavirus Vaccines , Female , Humans , Immunization Programs , Papillomavirus Infections/prevention & control , Vaccination
18.
Public Underst Sci ; 30(8): 977-992, 2021 11.
Article in English | MEDLINE | ID: mdl-33663279

ABSTRACT

Since the beginning of the COVID-19 pandemic, misinformation has been circulating on social media and multiple conspiracy theories have since become quite popular. We conducted a U.S. national survey for three main purposes. First, we aim to examine the association between social media news consumption and conspiracy beliefs specific to COVID-19 and general conspiracy beliefs. Second, we investigate the influence of an important moderator, social media news trust, that has been overlooked in prior studies. Third, we further propose a moderated moderation model by including misinformation identification. Our findings show that social media news use was associated with higher conspiracy beliefs, and trust in social media news was found to be a significant moderator of the relationship between social media news use and conspiracy beliefs. Moreover, our findings show that misinformation identification moderated the relationship between social media news use and trust. Implications are discussed.

19.
Health Commun ; 36(12): 1476-1484, 2021 11.
Article in English | MEDLINE | ID: mdl-32452218

ABSTRACT

This research examines the influence of norm-based messages (positively worded descriptive vs. negatively worded descriptive vs. injunctive vs. basic information) on intentions and risk perceptions about receiving human papillomavirus (HPV) vaccination among young adults aged 18-29. Results from an experiment show that compared to the basic information condition, additional exposure to injunctive normative messages increased intention to seek further information about HPV vaccination, which in turn enhanced intention to get the vaccine. Negatively worded descriptive normative messaging should be used with caution since it resulted in the highest risk perceptions of the HPV vaccine, compared to positively worded descriptive norms and basic information messages. Theoretical and practical implications are further discussed.


Subject(s)
Papillomavirus Infections , Papillomavirus Vaccines , Health Knowledge, Attitudes, Practice , Humans , Immunization Programs , Intention , Papillomavirus Infections/prevention & control , Vaccination , Young Adult
20.
Contemp Clin Trials Commun ; 19: 100627, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32728650

ABSTRACT

BACKGROUND: Early adulthood is a critical developmental period when many youth transition from living at home to the relative autonomy of college. This transition results in increased opportunity for positive growth and identity development - and for risky substance use and sexual behaviors. Parents continue to influence young adult behavior even from a distance; however, few studies have rigorously tested parent-college student interventions. METHODS: This multi-arm hybrid type 2 trial tests the short- and long-term efficacy of a self-directed handbook for parents of first-year college students. In the summer before college, parent-student dyads are randomly assigned to one of three conditions: control, Parent Handbook, or Parent Handbook Plus. Handbook parents receive encouragement via phone calls to read the handbook and complete activities with their student before leaving for college. Handbook Plus parents also receive booster messages targeted at risky or stressful times. Participants complete surveys of intervention-targeted knowledge, attitudes, and behaviors at baseline and four months after baseline. Students complete three additional surveys at nine, 16, and 21 months after baseline. Dyads in the intervention conditions also reported on handbook utilization, perceived usefulness, and engagement with intervention materials. DISCUSSION: Self-directed family interventions may be a feasible strategy for involving parents of college students. This trial aimed to determine: 1) the efficacy of a self-directed handbook intervention for parents of first-year college students, including whether the addition of periodic booster messages enhanced efficacy; and 2) how variations in handbook utilization, perceived usefulness, and engagement were linked to student outcomes.

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