Identifying promising themes and messages for youth vaping prevention: A national study.

Use of e-cigarettes and vapes among adolescents continues to be a major public health concern. Health communication efforts can discourage e-cigarette use among adolescents by influencing beliefs and behavior. However, to do so, studies need to identify the most promising themes and messages based on the latest evidence about the harms of e-cigarettes and vaping. Participants were a nationally representative sample of 1,603 US adolescents aged 13-17 years, recruited in the summer of 2022. Adolescents were randomly assigned to view 7 vaping prevention statements (one from each theme: nicotine addiction, chemical harms, health symptoms, mental health, organ effects, cosmetic effects, and monetary cost) and 1 control statement (vape litter theme) from a pool of 46 statements that were developed through a systematic process. Participants rated each statement on perceived message effectiveness (PME), awareness, and believability. Results of linear mixed models indicated that all vaping prevention themes out-performed control messages on PME, with chemical harms and organ effects having the largest effects, followed by nicotine addiction and then other themes. For most message themes, PME effects were stronger for youth susceptible to vaping compared to non-susceptible youth and users. Both awareness and believability predicted higher levels of PME. In secondary analyses, we found that statements specifying the target ("you") and longer statements were also rated higher on PME. Results suggests that the most potent vaping prevention messages for adolescents are those that focus on vape chemicals and the potential of vaping to damage organs and increase disease risk.

Associations between partisan media consumption, opioid use disorder stigma, and opioid policy support: An exploration of the media's role in the ongoing opioid epidemic.

We report on a preliminary investigation into the relationship between partisan media consumption (PMC) among U.S. adults and their (1) opioid use disorder (OUD) stigma, (2) national OUD policy support (e.g., Medicaid coverage for OUD treatment), (3) local OUD policy support (e.g., safe injection sites), (4) discriminatory OUD policies (e.g., denying housing), and (5) carceral OUD policies (e.g., jailing people who use opioids). We performed a cross-sectional survey of a nationally-representative sample of U.S. adults (n = 6,515) from October 1-November 19, 2021. We surveyed a sample of U.S. adults ages 18 and older drawn from NORC's AmeriSpeak® Panel. AmeriSpeak is a probability-based ongoing panel of over 40,000 households designed to represent the U.S. household population. Cross-sectional analyses revealed significant relationships between PMC and OUD stigma (b = 0.29, p <.001, CI95 = 0.14,0.43), support for national (b = -0.31, p <.01, CI95 = -0.54,-0.09) and local policy responses (b = -0.38, p <.001, CI95 = -0.59,-0.17), and support for discriminatory opioid use disorder policies (b = 0.27, p <.01, CI95 = 0.07,0.45). After controlling for self-reported political affiliation and other potential covariates, Republican-leaning media consumption was significantly associated with increased OUD stigma, less support for national and local harm reduction or rehabilitative policies, and more support for discriminatory policies against individuals experiencing OUD. The opposite associations were observed for Democratic-leaning media consumption. Markers for racism mediated the relationship between PMC and support for carceral policies (indirect path b = -0.41,p <.001, CI95 = -0.50,-0.31). Our results indicate that public health advocates must collaborate with conservative leaders to find bipartisan common ground for targeted communication campaigns.

Perceived effectiveness of objective elements of vaping prevention messages among adolescents.

INTRODUCTION: In recent years, vaping prevention campaigns have proliferated in response to a surge of e-cigarette use among adolescents in the USA. To date, the research literature has provided minimal guidance as to what vaping prevention message elements have the greatest potential for discouraging vaping, are ineffective or have unintended negative effects. The purpose of the current study was to identify and test a large set of vaping prevention ads used by federal, state, local and non-governmental agencies, examining how objectively coded message elements of vaping prevention messages might affect youth. METHODS: A convenience sample of adolescents (N=1501) completed an online survey with each participant rating seven randomly selected vaping prevention ads from a pool of 220 ads on perceived message effectiveness (PME) and vaping appeal. Ads were coded on 37 objective elements in three message categories: themes, imagery and other features. Analyses examined how objective elements predicted PME. RESULTS: Addiction, chemicals, negative health symptoms and effects, and cigarette comparison themes were associated with higher PME, as were graphic images and warning symbols. Industry targeting, environmental impact, flavour themes, images of food and people's faces were associated with lower PME, as were hashtags, statistics and first-person language or the word 'teen'. Most elements were not associated with appeal, but ads with a flavour theme were associated with increased vaping appeal. CONCLUSION: Promising vaping prevention messages focus on the adverse consequences of vaping, use negative imagery and avoid speaking for teens using their vernacular or perspective.

An Experimental Test of Pop Music Lyrics Referencing Anxiety on Female College Students' Audience Involvement and Peer Mental Health Empathy.

Empathy among this generation of students appears to be drastically lower than previous generations. Mental health empathy is inversely related to mental health stigma, and stigma persists as the most significant barrier to help-seeking among this population. Research suggests that pop songs that reference mental health difficulties may help to increase mental health empathy. This paper reports on an experimental test of music lyric and lyric video effects, comparing the influence of exposure to a pop song and lyric video with anxiety-themed lyrics, a pop song and lyric video without any mental health-themed lyrics, and a pop song instrumental and lyric video with no lyrics on female college students' involvement - perceived personal connection - with the song and their peer mental health empathy. Results suggest that a single exposure to a pop song and visual lyric video with anxiety-themed lyrics can influence peer mental health empathy. Further, these findings indicate that song lyrics are a significant gateway to audience involvement in this context. This study's findings are valuable to mental health communication practitioners struggling to reach female youth as empathetic reactions are often necessary to encourage positive health behavior change in the context of stigmatized health conditions, such as mental health.

What's in the message? An analysis of themes and features used in vaping prevention messages.

Introduction: Federal, state, local, and non-government officials have developed and implemented a variety of vaping prevention messages to curtail the vaping epidemic among youth in the US. This study sought to collect a comprehensive set of vaping prevention messages and characterize the themes and features of those messages. Methods: We used a two-fold search strategy to identify messages, utilizing the existing content database from Vaping Prevention Resource (vapingprevention.org) and supplementing those messages with web searches. Potential messages were included if they were vaping prevention-oriented, appropriate or relevant for youth, and in a static web or print format. Results: A total of 220 messages met criteria. Messages were coded on the presence or absence of 37 objective features within five categories: message themes, imagery, text features, message perspective, and other (e.g., source). The most common themes were nicotine addiction (32%), chemicals (30%), health effects (24%), and industry targeting (19%). Eighty-five percent of messages included imagery, with 27% showing a vaping device, 22% showing smoke or vapor, and 21% showing a person's face. Just over half (56%) included a message source. Conclusions: Vaping prevention messages for youth have commonly focused on addiction and health risks of vaping, and they vary on a series of text and image features. Further research is needed to understand the efficacy of messaging approaches in preventing vaping among youth.

A Review of Web-Based Tobacco Control Media Archives for Researchers and Practitioners.

Web-based resources for tobacco use prevention and control provide valuable tools for cancer education. This study sought to (a) identify existing websites that archive prevention and cessation media content and (b) characterize the content and features of those websites. We used a comprehensive search strategy to identify web-based resources. Websites were included if (1) the content was focused on tobacco; (2) a primary purpose of the website was to house a national or international historical archive of anti- or pro-tobacco media or communication content; and (3) the website was designed for researchers or practitioners. Of the 55 websites initially identified, N = 9 met criteria. All websites contained anti-tobacco media content (100%), although 56% also contained pro-tobacco content. Most websites focused on multiple tobacco products (89%), while 11% focused solely on cigarettes. The most common media content in the archives were print ads (67%), warning labels (56%), and video ads (33%). Most archives contained a search function or content filters (67%). While most websites provided free media content with no restrictions (78%), 22% contained paid or restricted content. Other website material included research reports (89%), newsfeeds (89%), fact sheets (67%), advocacy information (56%), and tools for practitioners (44%). This study provides a systematic summary of web-based tobacco prevention and control resources that archive communication and media content. The identified websites can assist researchers and practitioners in their tobacco control efforts, although additional archives focused specifically on vaping media and communication content are needed as the vaping epidemic among youth continues to intensify.

The Influence of Pop Songs Referencing Anxiety, Depression, and Suicidal Ideation on College Students' Mental Health Empathy, Stigma, and Behavioral Intentions.

U.S. college students' general mental health is rapidly declining, and scholars have observed significant increases in references to depression, suicide, and mental health metaphors in popular music. Given that college students are spending more time than ever before listening to popular music, this survey aimed to assess some of the potential implications. College students (N = 253) completed an online survey about their exposure to contemporary pop songs that reference mental health difficulties such as anxiety, depression, and suicidal ideation. Both college students' increased perceived personal connection (PPC) with the songs referencing mental health difficulties and parasocial relationships (PSR) with their performing artists were associated with increased mental health empathy. This increased mental health empathy mediated outcomes including reduced mental health stigma, increased support for public mental health resources, and increased willingness to support others struggling with their mental health. Neither PPC with the song nor PSR with the song's artist was associated with personal willingness to seek mental health help. However, post hoc analyses revealed that college students who reported stronger PPC to these songs also reported that they use music to "deal with their own mental health issues." This study's findings suggest that pop music artists who open up about mental health difficulties may have potential as novel message sources in communication campaigns designed to improve mental health outcomes among college students.

Copyright as a Barrier to Music Therapy Telehealth Interventions: Qualitative Interview Study.

BACKGROUND: Music therapy is a multifaceted discipline that harnesses the power of music to treat a wide range of patient populations. A therapist who plays music in a private room for a patient is not subject to copyright restrictions on public performances. However, in the wake of the COVID-19 pandemic, music therapy is no longer strictly confined to the face-to-face setting. This study explores music therapists' perceptions of copyright law with respect to their ability to provide mediated services to their clients. OBJECTIVE: The objectives of our study were two-fold. The first was to investigate whether concerns about copyright law are hampering the diffusion of telehealth innovations, and the second was whether these concerns are causing music therapists to avoid therapeutically beneficial telehealth interventions. METHODS: Semistructured interviews were conducted with credentialed music therapists (n=18) in the United States between May 2020 and June 2020. With participants' consent, we used video conference technology to record and transcribe the in-depth interviews. The median interview length was 45 (SD 16.37) minutes. This theoretically informed study employed thematic analysis of the interview data. RESULTS: The COVID-19 pandemic accelerated the adoption of telehealth interventions to facilitate therapy outside of private face-to-face environments: environments where music therapy practices are largely shielded from copyright infringement concerns. Five main themes emerged, including therapists' uncertainty about permissible uses of music and therapists' erring on the side of caution causing lost opportunities for care. Our interview data suggest music therapists have altered telehealth interventions in suboptimal ways to avoid copyright liability in a physically distanced environment. CONCLUSIONS: Some music therapists "drag their feet" on offering therapeutically appropriate telehealth services to clients because of copyright concerns. Our findings suggest innovative mediated therapies were shied away from or abandoned. These findings offer a novel contribution to the public health literature by highlighting copyright law as an unexpected and unwelcome barrier to the diffusion of music therapy practices in technology-mediated settings.

Comparison of Message and Effects Perceptions for The Real Cost E-Cigarette Prevention Ads.

Perceived message effectiveness (PME) is commonly used in health communication research and practice, yet there has been a dearth of studies comparing different operationalizations of the PME construct. In the present study, we compared the two major types of PME - message perceptions and effects perceptions - among N = 557 young adults. Participants were randomized to one of two conditions: 1) The Real Cost e-cigarette prevention ads developed by the Food and Drug Administration (FDA condition) or 2) information-only e-cigarette control ads developed by the Mayo Clinic (control ad condition). Study predictors were message and effects perceptions measures and actual message effectiveness (AME) outcomes were risk beliefs about vaping and intentions to vape. Results showed that both message perceptions (M = 3.82 vs M = 3.29; p < .001) and effects perceptions (M = 4.13 vs M = 3.82; p < .001) were higher in the FDA ad condition compared to control. Risk beliefs about vaping were also higher in the FDA ad condition than control (M = 3.95 vs M = 3.79; p =.022), but we found no differences in participants' intentions to vape, which were low overall (M = 1.59 in FDA vs M = 1.58 in control). In multivariate analyses adjusting for covariates and including both types of PME, only effects perceptions (not message perceptions) were associated with risk beliefs about vaping (b =.37, p < .001) and intentions to vape (b = -.26, p < .001). Our findings advance PME research by demonstrating the differing nature of message and effects perceptions, and suggest that effects perceptions should be utilized during message pretesting.

A Content Analysis of Mental Health Discourse in Popular Rap Music.

Importance: Rap artists are among the most recognizable celebrities in the US, serving as role models to an increasingly diverse audience of listeners. Through their lyrics, these artists have the potential to shape mental health discourse and reduce stigma. Objective: To investigate the prevalence and nature of mental health themes in popular rap music amid a period of documented increases in mental health distress and suicide risk among young people in the US and young Black/African American male individuals in particular. Design and Setting: Lyric sheets from the 25 most popular rap songs in the US in 1998, 2003, 2008, 2013, and 2018, totaling 125 songs, were analyzed by 2 trained coders from March 1 to April 15, 2019, for references to anxiety, depression, suicide, metaphors suggesting mental health struggles, and stressors associated with mental health risk. Main Outcomes and Measures: Mental health references were identified and categorized based on Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) and Mayo Clinic definitions. Stressors included issues with authorities, environmental conditions, work, and love life. Descriptive language and trend analyses were used to examine changes over time in the proportion of songs with mental health references. Stressors were analyzed for their co-occurrence with mental health references. Results: Most of the 125 analyzed songs featured lead artists from North America (123 [98%]). Most lead artists were Black/African American male individuals (97 [78%]), and artists' mean (SD) age was 28.2 (4.5) years. Across the sample, 35 songs (28%) referenced anxiety; 28 (22%) referenced depression; 8 (6%) referenced suicide; and 26 (21%) used a mental health metaphor. Significant increases were found from 1998 to 2018 in the proportion of songs referencing suicide (0% to 12%), depression (16% to 32%), and mental health metaphors (8% to 44%). Stressors related to environmental conditions (adjusted odds ratio, 8.1; 95% CI, 2.1-32.0) and love life (adjusted odds ratio, 4.8; 95% CI, 1.3-18.1) were most likely to co-occur with lyrics referencing mental health. Conclusions and Relevance: References to mental health struggles have increased significantly in popular rap music from 1998 to 2018. Future research is needed to examine the potential positive and negative effects these increasingly prevalent messages may have in shaping mental health discourse and behavioral intentions for US youth.

The Power of Celebrity Health Events: Meta-analysis of the Relationship between Audience Involvement and Behavioral Intentions.

Audience involvement processes - such as parasocial interaction and identification - may impact an individual's response to celebrity health events, yet to date, no synthesis of the literature exists. The present meta-analysis examined audience involvement processes and their influence on health behavior intentions in the context of celebrity health events. Fourteen studies (N = 5,718) met criteria and were analyzed using meta-analytic procedures. The weighted mean effect of the association between audience involvement and behavioral intentions was r = 0.20 (95% CI, 0.08-0.31, p <.001), indicating a statistically significant small-to-medium-sized positive association. Moderator analyses revealed that celebrity disclosures and events had greater effects than depictions of a media persona with a health condition; greater effects were also found for health behaviors not requiring a medical procedure. Our findings suggest that those who most feel a sense of attachment or affinity for a celebrity or media personae may be the ones who are most likely to modify their behavioral intentions in the wake of a celebrity health event. Results highlight the need for health practitioners to recognize the role of audience involvement in celebrity health events and to better assess how to harness these opportunities to promote healthy behaviors.

Evaluating the actual and perceived effectiveness of E-cigarette prevention advertisements among adolescents.

BACKGROUND: The efficacy of e-cigarette prevention ads among adolescents has seldom been studied. We examined the impact of ads from the The Real Cost vaping prevention media campaign on what adolescents think and believe about vaping. We also sought to test whether perceived message effectiveness (PME) served as a proxy for ad impact. METHODS: Participants were 543 U.S. adolescents ages 13-17. In an online experiment, we randomized participants to either: 1) persuasive e-cigarette prevention video ads from the Food and Drug Administration's The Real Cost campaign that was targeted to adolescents or 2) information-only e-cigarette harms control videos (control condition). Participants in each condition viewed 2 videos in a random order. After ad exposure, the survey assessed PME (message and effects perceptions), risk beliefs about vaping, attitudes toward vaping, and intentions to vape. RESULTS: The FDA's The Real Cost ads led to higher beliefs about the harms of vaping (p < .001), more negative attitudes toward vaping (p < .001), and lower intentions to vape (p < .05) compared to the control videos. The Real Cost ads also scored higher on both message perceptions (p < .001) and effects perceptions (p < .001) compared to control videos. Effects perceptions were associated with all three outcomes (all ps < 0.001, adjusting for both types of PME and covariates), but message perceptions did not offer additional predictive value. CONCLUSIONS: Exposure to The Real Cost vaping prevention ads gave adolescents a more negative view of vaping and lowered their intentions to vape compared to control videos. Effects perceptions may be superior to message perceptions as a proxy for e-cigarette prevention ad impact.

Content and effects of news stories about uncertain cancer causes and preventive behaviors.

This article presents findings from two studies that describe news portrayals of cancer causes and prevention in local TV and test the effects of typical aspects of this coverage on cancer-related fatalism and overload. Study 1 analyzed the content of stories focused on cancer causes and prevention from an October 2002 national sample of local TV and newspaper cancer coverage (n = 122 television stations; n = 60 newspapers). Informed by results from the content analysis, Study 2 describes results from a randomized experiment testing effects of the volume and content of news stories about cancer causes and prevention (n = 601). Study 1 indicates that local TV news stories describe cancer causes and prevention as comparatively more certain than newspapers but include less information about how to reduce cancer risk. Study 2 reveals that the combination of stories conveying an emerging cancer cause and prevention behavior as moderately certain leads to an increased sense of overload, while a short summary of well-established preventive behaviors mitigates these potentially harmful beliefs. We conclude with a series of recommendations for health communication and health journalism practice.