The interplay of parenting style and family rules about video games on subsequent fighting behavior.

Due to ongoing concerns about adolescent interpersonal aggression and debates surrounding violent media, this study assesses the potential impacts of parental mediation and parenting style on mature video game play and fighting behaviors using a longitudinal, random-digit-dial survey of adolescents (N = 2722). By simultaneously considering fighting, M-rated video game play, parental restrictions on media use, parenting style, and important covariates, we aim to provide further nuance to existing work on risk and protective factors for interpersonal aggression. Our results show that parental restriction has a significant, linear relationship with later fighting, whereby higher restrictions on a child's M-rated video game play predict decreases in reported fighting behavior. Authoritative parenting, high in both warmth and supervisory attention, also relates to decreased levels of fighting compared to other styles. Parenting style also moderated the effects of restriction, such that restriction was not equally predictive of fighting behavior across all parenting styles. However, the association between restriction and fighting was similar for highly demanding parenting styles, suggesting that authoritative parenting is not inherently superior to authoritarian. The effects of restriction were significant despite controlling for multiple covariates. Parental restriction of media use may be an effective strategy for parents concerned about violent games. Given some limitations in our dataset, we call for continued study in this area.

Maternity Providers' Perspectives on Barriers to Utilization of Intermittent Fetal Monitoring: A Qualitative Study.

There are 2 approaches to fetal assessment during labor: continuous electronic fetal monitoring (EFM) and intermittent auscultation (IA). The vast majority of healthy labors in the United States use EFM, despite professional organization recommendations against its use for low-risk pregnancies. This qualitative investigation explores maternity care team members' perspectives on why EFM is the dominant approach to fetal assessment instead of IA. Focus groups comprised of nurses, midwives, and physicians were conducted using a semistructured interview guide. Transcripts were analyzed using directed content analysis to identify themes related to clinical and nonclinical factors influencing the type of fetal assessment employed during labor. Seven focus groups with a total of 41 participants were completed. Seven themes were identified: clinical environment; technology; policies, procedures, and evidence-based protocols; patient-centered influences; fear of liability; providers as members of healthcare team; and deflection of responsibility. All maternity care team members had knowledge of the evidence base supporting IA use for low-risk care. Nurses identified unique challenges in having agency over monitoring decision making and executing best practices. Improved communication among team members can facilitate evidence-based approaches to IA use, facilitating increased utilization for low-risk labor care.

Effects of self-transcendence on neural responses to persuasive messages and health behavior change.

Self-transcendence refers to a shift in mindset from focusing on self-interests to the well-being of others. We offer an integrative neural model of self-transcendence in the context of persuasive messaging by examining the mechanisms of self-transcendence in promoting receptivity to health messages and behavior change. Specifically, we posited that focusing on values and activities that transcend the self can allow people to see that their self-worth is not tied to a specific behavior in question, and in turn become more receptive to subsequent, otherwise threatening health information. To test whether inducing self-transcendent mindsets before message delivery would help overcome defensiveness and increase receptivity, we used two priming tasks, affirmation and compassion, to elicit a transcendent mindset among 220 sedentary adults. As preregistered, those who completed a self-transcendence task before health message exposure, compared with controls, showed greater increases in objectively logged levels of physical activity throughout the following month. In the brain, self-transcendence tasks up-regulated activity in a region of the ventromedial prefrontal cortex, chosen for its role in positive valuation and reward processing. During subsequent health message exposure, self-transcendence priming was associated with increased activity in subregions of the ventromedial prefrontal cortex, implicated in self-related processing and positive valuation, which predicted later decreases in sedentary behavior. The present findings suggest that having a positive self-transcendent mindset can increase behavior change, in part by increasing neural receptivity to health messaging.

A Tale of Two Stories: An Exploration of Identification, Message Recall, and Narrative Preferences Among Low-Income, Mexican American Women.

Additional research is needed to guide the design of narratives for use in practice-oriented, naturalistic settings to maximize health behavior change, particularly among populations affected by health disparities. This mixed-methods study explored the influence of cultural tailoring and emotional arousal on identification and message recall in narratives promoting childhood obesity prevention among 40 Mexican American mothers. Participants were also asked about narrative exposure, narrative preferences, and beliefs about the purpose of a story. Participants were randomly assigned to listen to two stories: (a) a story tailored on noncultural or cultural variables, and (b) a story designed to enhance or minimize emotional arousal. Participants reported high engagement and identification with all stories. Participants generally envisioned protagonists as Latina, despite limited cues, and identified with protagonists in four ways: sharing personal characteristics; having similar thoughts and feelings; engaging in similar actions; and experiencing similar situations. Mothers were most interested in narratives that helped them to improve their lives. Findings from this study yield several hypotheses for consideration in future study, including ways in which story setting and message enactment may moderate message recall.

Trends in Media Reports of Celebrities' Breast Cancer Treatment Decisions.

BACKGROUND: Although the increasing use of bilateral mastectomies is multifaceted, one source of influence may be the media, including coverage of celebrity breast cancer treatment. We examined trends in media reporting that might impact decision making among women with breast cancer. METHODS: We performed searches of two comprehensive online databases for articles from major U.S. print publications mentioning celebrities and terms related to the word "breast" and terms related to cancer treatment. Automated analysis using custom-created dictionaries was used to determine word frequencies over time. An analysis of net media tone was conducted using Lexicoder Sentiment Dictionaries. RESULTS: Celebrity breast cancer media reports significantly increased since 2004 (p < .05). Dramatic increases in bilateral mastectomy articles occurred in 2008-2009, with an increase in net positive tone. The surgical treatment was significantly more likely to be mentioned when a celebrity had bilateral mastectomies than unilateral mastectomy or breast conservation (44.8 vs 26.1 %, p < .001). The majority (60 %) of articles on celebrities undergoing bilateral mastectomy for cancer had no mention of genetics, family history, or risk. CONCLUSIONS: Media reports of celebrity breast cancer present a bias toward bilateral mastectomies in both frequency and tone. This may sway public opinion, particularly when factors such as risk and genetics are excluded. Surgeons need to work with the media to improve cancer reporting and identify methods to better educate patients prior to surgical consultations.

Impulsivity moderates the effects of movie alcohol portrayals on adolescents' willingness to drink.

This study examined impulsivity as a moderator of adolescents' reactions to positive versus negative portrayals of drinking in American movie clips. Impulsivity, along with willingness and intentions to drink in the future, were assessed in a pretest session. In the experimental sessions, adolescents viewed a series of clips that showed drinking associated with either positive outcomes (e.g., social facilitation) or negative outcomes (fights, arguments). A third group viewed clips with similar positive or negative outcomes, but no alcohol consumption. All participants then responded to an implicit measure of attentional bias regarding alcohol (a dot probe), followed by explicit alcohol measures (self-reports of willingness and intentions to drink). Hypotheses, based on dual-processing theories, were: (a) high-impulsive adolescents would respond more favorably than low-impulsive adolescents to the positive clips, but not the negative clips; and (b) this difference in reactions to the positive clips would be larger on the willingness than the intention measures. Results supported the hypotheses: Adolescents high in impulsivity reported the highest willingness to drink in the positive-clip condition, but were slightly less willing than others in the negative-clip condition. In addition, results on the dot probe task indicated that RTs to alcohol words were negatively correlated with changes in alcohol willingness, but not intention; that is, the faster their response to the alcohol words, the more their willingness increased. The results highlight the utility of a dual-processing perspective on media influence. (PsycINFO Database Record

Functional brain imaging predicts public health campaign success.

Mass media can powerfully affect health decision-making. Pre-testing through focus groups or surveys is a standard, though inconsistent, predictor of effectiveness. Converging evidence demonstrates that activity within brain systems associated with self-related processing can predict individual behavior in response to health messages. Preliminary evidence also suggests that neural activity in small groups can forecast population-level campaign outcomes. Less is known about the psychological processes that link neural activity and population-level outcomes, or how these predictions are affected by message content. We exposed 50 smokers to antismoking messages and used their aggregated neural activity within a 'self-localizer' defined region of medial prefrontal cortex to predict the success of the same campaign messages at the population level (n = 400,000 emails). Results demonstrate that: (i) independently localized neural activity during health message exposure complements existing self-report data in predicting population-level campaign responses (model combined R(2) up to 0.65) and (ii) this relationship depends on message content-self-related neural processing predicts outcomes in response to strong negative arguments against smoking and not in response to compositionally similar neutral images. These data advance understanding of the psychological link between brain and large-scale behavior and may aid the construction of more effective media health campaigns.

Exposure to smoking in movies and smoking initiation among black youth.

BACKGROUND: Black adolescents see more substance use in mainstream media but seem less responsive to it than other U.S. adolescents. Black-oriented media may be more personally relevant to them. PURPOSE: To determine smoking exposure separately for black-oriented (BSME) and mainstream (MMSE) movies and assess their longitudinal relationships with smoking among black and other-race adolescents. METHODS: Two-wave (2007-2009) national cohort survey of 2341 nonsmoking (at baseline) U.S. adolescents (aged 13-19 years), analyzed in 2012. The surveys determined BMSE and MMSE based on respondents' exposure to random subsets of 50 movies from a contemporary sample of 95 black-oriented and 288 mainstream movies previously content-coded for smoking. Outcome was smoking initiation. RESULTS: Black teens had significantly more BMSE and MMSE than other teens (p's <0.001). At follow-up, 23.5% of black and 29.0% of nonblack respondents had tried smoking. Among black respondents, BMSE was related to smoking initiation at follow-up but MMSE was not. For other adolescents, both BMSE and MMSE were related to smoking initiation. CONCLUSIONS: A prospective relationship was found between exposure to smoking in movies and smoking initiation. Among black adolescents in the U.S., this was only for black-oriented movies, suggesting the importance of personal relevance of the exposures. Parents, practitioners, and producers should be aware of these potential influences of media on black teen viewers.

When movies matter: exposure to smoking in movies and changes in smoking behavior.

The authors investigated the association between exposure to smoking in movies and the initiation and progression of adolescent smoking over time among 6,522 U.S. adolescents (between the ages of 10 and 14 years, at baseline) in a nationally representative, 4-wave random-digit-dial telephone survey. They conducted a hazard (survival) analysis testing whether exposure to movie smoking and demographic, personality, social, and structural factors predict (a) earlier smoking onset and (b) faster transition to experimental (1-99 cigarettes/lifetime) and established smoking (>100 cigarettes/lifetime). Results suggest that higher exposure to movie smoking is associated with less time to trying cigarettes for the first time (adjusted hazard ratio = 1.66; 95% CI [1.37, 2.01]) but not with faster escalation of smoking behavior following initiation (adjusted hazard ratio = 1.53; 95% CI [0.84, 2.79]). In contrast, age, peer smoking, parenting style, and availability of cigarettes in the home were predictors of earlier onset and faster transition to established smoking. Thus, the authors concluded that the effect of exposure to mass-mediated images of smoking in movies may decline once adolescents have started to smoke, whereas peers and access to tobacco remain influential.

Spontaneous action representation in smokers when watching movie characters smoke.

Do smokers simulate smoking when they see someone else smoke? For regular smokers, smoking is such a highly practiced motor skill that it often occurs automatically, without conscious awareness. Research on the brain basis of action observation has delineated a frontoparietal network that is commonly recruited when people observe, plan, or imitate actions. Here, we investigated whether this action observation network would be preferentially recruited in smokers when viewing complex smoking cues, such as those occurring in motion pictures. Seventeen right-handed smokers and 17 nonsmokers watched a popular movie while undergoing functional magnetic resonance imaging. Using a natural stimulus, such as a movie, allowed us to keep both smoking and nonsmoking participants naive to the goals of the experiment. Brain activity evoked by movie scenes of smoking was contrasted with nonsmoking control scenes that were matched for frequency and duration. Compared with nonsmokers, smokers showed greater activity in left anterior intraparietal sulcus and inferior frontal gyrus, regions involved in the simulation of contralateral hand-based gestures, when viewing smoking versus control scenes. These results demonstrate that smokers spontaneously represent the action of smoking when viewing others smoke, the consequence of which may make it more difficult to abstain from smoking.

Good self-control moderates the effect of mass media on adolescent tobacco and alcohol use: tests with studies of children and adolescents.

OBJECTIVE: To investigate whether self-control moderates the effect of media influences on tobacco and alcohol use among youth and if so how this effect occurs. DESIGN: In Study 1, a regional sample of 10-year olds (N = 290) was interviewed in households; attention to tobacco/alcohol advertising was assessed. In Study 2, a national sample of youth ages 10-14 years (N = 6,522) was surveyed by telephone; exposure to tobacco/alcohol use in movies was assessed. Good self-control was measured in both studies. MAIN OUTCOME MEASURES: Willingness to use substances and affiliation with peer substance users (Study 1); involvement in smoking or drinking (Study 2). RESULTS: In Study 1, the effect of tobacco/alcohol advertising on predisposition for substance use was lower among persons scoring higher on good self-control. In Study 2, the effect of movie smoking/alcohol exposure on adolescent tobacco/alcohol use was lower, concurrently and prospectively, among persons scoring higher on good self-control. Moderation occurred primarily through reducing the effect of movie exposure on positive smoking/alcohol expectancies and the effect of expectancies on adolescent use; some evidence for moderation of social processes was also noted. Covariates in the analyses included demographics, sensation seeking, and IQ. CONCLUSION: Good self-control reduces the effect of adverse media influences on adolescent tobacco and alcohol use. Findings on the processes underlying this effect may be useful for media literacy and primary prevention programs.

Narratives that address affective forecasting errors reduce perceived barriers to colorectal cancer screening.

Narratives from similar others may be an effective way to increase important health behaviors. In this study, we used a narrative intervention to promote colorectal cancer screening. Researchers have suggested that people may overestimate barriers to colorectal cancer screening. We recruited participants from the US, ages 49-60 who had never previously been screened for colorectal cancer, to read an educational message about screening for the disease. One-half of participants were randomly assigned to also receive a narrative within the message (control participants did not receive a narrative). The narrative intervention was developed according to predictions of affective forecasting theory. Compared to participants who received only the educational message, participants who received the message along with a narrative reported that the barriers to screening would have less of an impact on a future screening experience. The narrative also increased risk perception for colorectal cancer and interest in screening in the next year.

Parental R-rated movie restriction and early-onset alcohol use.

OBJECTIVE: The aim of this study was to determine if parental restriction regarding Restricted-rated movies (R movies) predicts lower rates of early-onset alcohol use. METHOD: Students from 15 northern New England middle schools were surveyed in 1999, and never-drinkers were resurveyed 13-26 months later to determine alcohol use. Drinking was determined by the question, "Have you ever had beer, wine, or other drink with alcohol that your parents didn't know about?" R-movie restriction was assessed by the question, "How often do your parents allow you to watch movies that are rated R?" RESULTS: The sample included 2,406 baseline never-drinkers who were surveyed at follow-up, of whom 14.8% had initiated alcohol use. At baseline, 20% reported never being allowed to watch R movies, and 21% reported being allowed all the time. Adolescents allowed to watch R-rated movies had higher rates of alcohol initiation (2.9% initiation among never allowed, 12.5% once in a while, 18.8% sometimes, and 24.4% all the time). Controlling for sociodemographics, personality characteristics, and authoritative parenting style, the adjusted odds ratios for initiating alcohol use were 3.0 (95% CI [1.7, 5.1]) for those once in a while allowed, 3.3 [1.9, 5.6] for those sometimes allowed, and 3.5 [2.0, 6.0] for those always allowed to watch R-rated movies. Alcohol initiation was more likely if R-rated movie restriction relaxed over time; tightening of restriction had a protective effect (p < .001). A structural model was developed that modeled two latent parenting constructs: (a) authoritative parenting and (b) media parenting. Both constructs had direct inverse paths to trying alcohol and indirect paths through lower exposure to R-rated movies. CONCLUSIONS: After accounting for differences in authoritative parenting style, adolescents reporting lesser restrictions for R movies have higher odds of future alcohol use. The structural model suggests that media parenting operates independently from authoritative parenting and should be incorporated explicitly into parenting prevention programs.

Media as social influence: racial differences in the effects of peers and media on adolescent alcohol cognitions and consumption.

Racial differences in the effects of peer and media influence on adolescents' alcohol cognitions and consumption were examined in a large-scale panel study. With regard to peer influence, results from cross-lagged panel analyses indicated that the relation between perceived peer drinking and own drinking was significant for both Black and White adolescents, but it was stronger for the White adolescents. With regard to media influence, structural modeling analyses indicated that exposure to drinking in movies was associated with more alcohol consumption 8 months and 16 months later. These effects were mediated by increases in the favorability of the adolescents' drinker prototypes, their willingness to drink, and their tendency to affiliate with friends who were drinking. Multiple group analyses indicated that, once again, the effects (both direct and indirect) were much stronger for White adolescents than for Black adolescents. The results suggest media influence works in a similar manner to social influence and that Whites may be more susceptible to both types of influence.

Movie character smoking and adolescent smoking: who matters more, good guys or bad guys?

OBJECTIVE: To assess the association between smoking onset and exposure to movie smoking according to character type. METHODS: A longitudinal, random-digit-dial telephone survey of 6522 US adolescents was performed with movie exposure assessed at 4 time points over 24 months. Adolescents were asked whether they had seen a random subsample of recently released movies, for which we identified smoking by major characters and type of portrayal (divided into negative, positive, and mixed/neutral categories). Multivariate hazard regression analysis was used to assess the independent effects of these exposures on the odds of trying smoking. RESULTS: By the 24-month follow-up survey, 15.9% of baseline never-smokers had tried smoking. Within the sample of movies, 3848 major characters were identified, of whom 69% were male. Smokers represented 22.8% of 518 negative characters, 13.7% of 2486 positive characters, and 21.1% of 844 mixed/neutral characters. Analysis of the crude relationship showed that episodes of negative character smoking exposure had the strongest influence on smoking initiation. However, because most characters were portrayed as positive, exposure to this category was greatest. When the full population effect of each exposure was modeled, each type of character smoking independently affected smoking onset. There was an interaction between negative character smoking and sensation-seeking with stronger response for adolescents lower in sensation-seeking. CONCLUSIONS: Character smoking predicts adolescent smoking initiation regardless of character type, which demonstrates the importance of limiting exposure to all movie smoking. Negative character portrayals of smoking have stronger impact on low risk-taking adolescents, undercutting the argument that greater exposure is a marker for adolescent risk-taking behavior.

Watching and drinking: expectancies, prototypes, and friends' alcohol use mediate the effect of exposure to alcohol use in movies on adolescent drinking.

OBJECTIVE: To investigate the psychological processes that underlie the relation between exposure to alcohol use in media and adolescent alcohol use. DESIGN: The design consisted of a structural equation modeling analysis of data from four waves of a longitudinal, nationally representative, random-digit dial telephone survey of adolescents in the United States. MAIN OUTCOME MEASURES: The main outcome measures were adolescent alcohol consumption and willingness to use alcohol. Tested mediators were alcohol-related norms, prototypes, expectancies, and friends' use. RESULTS: Alcohol prototypes, expectancies, willingness, and friends' use of alcohol (but not perceived prevalence of alcohol use among peers) were significant mediators of the relation between movie alcohol exposure and alcohol consumption, even after controlling for demographic, child, and family factors associated with both movie exposure and alcohol consumption. CONCLUSION: Established psychological and interpersonal predictors of alcohol use mediate the effects of exposure to alcohol use in movies on adolescent alcohol consumption. The findings suggest that exposure to movie portrayals may operate through similar processes as other social influences, highlighting the importance of considering these exposures in research on adolescent risk behavior.

An examination of the association between seeing smoking in films and tobacco use in young adults in the west of Scotland: cross-sectional study.

The objective is to examine the association between the amount of smoking seen in films and current smoking in young adults living in the west of Scotland in the UK. Cross-sectional analyses (using multivariable logistic regression) of data collected at age 19 (2002-04) from a longitudinal cohort originally surveyed at age 11 (1994-95) were conducted. The main outcome measure is smoking at age 19. No association was found between the number of occurrences of smoking estimated to have been seen in films (film smoking exposure) and current (or ever) smoking in young adults. This lack of association was unaffected by adjustment for predictors of smoking, including education, risk-taking orientation and smoking among peers. There was no association between film smoking exposure and smoking behaviour for any covariate-defined subgroup. Associations have been found between film smoking exposure and smoking initiation in younger adolescents in the United States. In this study, conducted in Scotland, no similar association was seen, suggesting that there may be age or cultural limitations on the effects of film smoking exposure on smoking. The lack of association could be due to methodological issues or greater sophistication of older adolescents and young adults in interpreting media images or the greater ubiquity of real-life smoking instances in Scotland. If the latter, film smoking exposure could become a more important risk factor for smoking uptake and maintenants in older adolescents following the recent ban on smoking in public places in Scotland.

Youth exposure to alcohol use and brand appearances in popular contemporary movies.

AIMS: To describe alcohol use and alcohol brand appearances in popular movies and estimate adolescents' exposure to this alcohol-related content. DESIGN AND SETTING: Nationally representative, random-digit dialed survey in the United States and content analysis of alcohol depictions in the top 100 US box office hits each year from 1998 to 2002 and 34 top movies from early 2003. PARTICIPANTS: A total of 6522 US adolescents aged 10-14 years. MEASUREMENTS: Frequency of alcohol use and brand appearances in movies by Motion Picture Association of America (MPAA) rating. Estimated exposure to minutes of movie alcohol use and brand appearances among US adolescents in this age group. FINDINGS: Most movies (83%, including 56.6% of G/PG-rated movies) depicted alcohol use and 52% (including 19.2% of G/PG movies) contained at least one alcohol brand appearance, which consisted of branded use by an actor 30.3% of the time. These movies exposed the average US adolescent 10-14 years of age to 5.6 [95% confidence interval (CI) 5.4, 5.7] hours of movie alcohol use and 243.8 (95% CI 238, 250) alcohol brand appearances (5 billion in total), mainly from youth-rated movies. Exposure to movie alcohol content was significantly higher among African American youth than youth of other races. CONCLUSIONS: Alcohol use and brand appearances are portrayed frequently in popular US movies (which are distributed world-wide). Children and adolescents in the United States are exposed to hours of alcohol use depictions and numerous brand appearances in movies and most of this exposure is from movies rated for this segment of the population.