What motivates information (non-)seeking behaviors about a healthy diet?

Previous research on health information seeking has primarily focused on individuals'intentions to seek or avoid information. However, limited empirical evidence exists regarding the actual behavioral patterns of information-seeking and non-seeking. To address this, we conducted a survey experiment manipulating cognitive load with mostly Belgian participants (N = 359). By integrating self-report and behavioral data, we investigated motivations and conditions associated with information (non)-seeking behaviors on a healthy diet. Guided by the risk information seeking and processing (RISP) model, we examined the roles of informational subjective norms and information insufficiency, as well as the moderating role of cognitive capacity. Neither informational subjective norms nor information insufficiency significantly correlated with information-seeking behaviors. However, a significant interaction between the predictors and cognitive capacity in predicting non-seeking behaviors was observed. These findings underscore the intricate nature of individuals' behavioral patterns in seeking or not seeking information about healthy eating.

Little Strokes Fell Big Oaks: How Repeated Recommendations for Suicide Reporting Drive the Quality of Suicide News in South Korea.

This study investigates how far repeated releases of recommendations for responsible reporting on suicide (RRS) are associated with changes in the quality of suicide reporting. A content analysis was conducted on suicide news articles (N = 606) by the Korean newspapers Hankyoreh Sinmun and Chosun Ilbo in four six-month periods from 2004 to 2019, which covered the periods before and after the releases of three versions of suicide reporting guidelines. Elements for RRS served as a proxy for the reporting quality, which includes both avoiding negative elements and providing positive ones. Not only the number of suicide news stories reduced by half in the last two observation periods, overall RRS scores and most individual RRS elements increased in the third period, compared to the first or second period. The avoidance RRS for headline, however, was not significantly improved. Korean news media also tended to be sensationalistic in using photos.

How Do Recommended Elements in Suicide News Coverage Work? An Investigation of the Effect of Responsible Reporting and Readers' Reflectiveness on Suicide Prevention.

To examine the effect of positive elements in suicide reporting guidelines, we assessed how responsible reporting on suicide (RRS) affect cognitive and intentional responses. We also investigated the moderating role of audience reflectiveness in news processing. Here, 308 individuals participated in a single-factor between-subject experiment conducted in South Korea. We manipulated the number of positive RRS features in news articles by adding suicide statistics, contact information for helplines, and efficacy-enforcing information. Overall, news articles containing multiple RRS elements had a stronger impact on behavioral intentions to help others in a suicidal crisis than a basic news article without RRS elements. Interestingly, reflectiveness had a stronger influence on individuals who read a suicide news report having the most RRS elements relative to those who read suicide news without any RRS elements, signifying an indirect impact of suicide news on intentions to help. The implications of this RRS effect identified are discussed in terms of suicide prevention.

Effects of Health Responsibility Frames: Testing a Mediation Model of Attributions, Emotions, and Social Support Intentions.

When news stories cover health and illness, they often address issues of responsibility. These responsibility frames can affect recipients' responsibility beliefs (i.e. attributions) and thereby indirectly affect emotions and motivation to support people affected by health problems. To date, it is not fully understood how responsibility frames affect social support intentions, and if attributions and emotions mediate this effect. In an online experiment with N = 1,088 German participants, we tested the effects of responsibility frames (individually controllable vs. non-controllable) for type 2 diabetes and depression on social support intentions through responsibility attributions and emotional reactions. Mediation analyses show that responsibility frames indirectly affect social support intentions through social-societal attributions and sympathy. This mediation effect was observed in both depression and type 2 diabetes, despite issue-specific differences in attributions, emotions, and social support intentions. We discuss these findings considering framing effects research and health reporting.

International students' psychosocial well-being and social media use at the onset of the COVID-19 pandemic: A latent profile analysis.

This study examined the link between the psychosocial well-being and social media use of international students in the US at the onset of the COVID-19 pandemic, when social isolation was mandated. Unlike prior research, which has typically focused on a single aspect of psychosocial well-being, we conceptualized international students' well-being as a multidimensional construct including internalizing symptoms (i.e., depression, anxiety, loneliness) as well as markers of intercultural difficulties. We then investigated social media use as a function of international students' idiosyncratic well-being vulnerabilities. A latent profile analysis revealed four groups with distinctive psychosocial profiles: well-adjusted students, interculturally adjusted students with internalizing symptoms, students with low internalizing symptoms but high intercultural difficulties, and maladjusted students with high internalizing symptoms and high intercultural difficulties. Supporting the social compensation perspective, maladjusted international students reported the highest engagement with social media compared to the other groups. These findings shed light on the unique and heterogenous experiences of international students at the onset of the pandemic. They also add nuance to the social compensation hypothesis by delineating person-specific associations between psychosocial well-being and social media use.

Family involvement in medical decision making in Europe and the United States: A replication and extension in five Countries.

BACKGROUND: In 2018, Alden et al. showed that the desired degree of family involvement in medical decisions is an individual preference that is largely independent from East-West cultural stereotypes. At the same time, individual-level interdependence influenced whether patients preferred more individual or more family involvement in their decision making together with their medical care provider. The present study provides empirical evidence and adds evidence for Europe for which no such data previously existed. METHODS: The present study is a direct replication and extension of the original Alden et al. (2018) study (N = 2031; Australia, China, Malaysia, India, South Korea, Thailand, United States [U.S.]), however, using survey data from four European countries (Austria, Belgium, Germany, Netherlands) and the United States (U.S.) with a total sample size of N = 2750. RESULTS: Random effects within-between models replicated the original primary finding that those with higher self-involvement in medical decision making preferred less family involvement. Furthermore, patients with lower self-independence, higher relational interdependence, and stronger beliefs in social hierarchy are more likely to want their families involved in medical decisions besides their health care provider. CONCLUSIONS: These observed relationships are largely consistent both within and across the four European countries and the U.S. In conclusion, the results point to the importance of avoiding cultural stereotypes and instead, recognizing that patient desires for family involvement in medical decision making vary dramatically within cultures depending on multiple individual differences. Furthermore, a growing body of evidence suggests that these antecedents of family involvement as well as the construct itself may be measurable in diverse cultures with high levels of confidence in their reliability and validity.

Social media, self-harm, and suicide.

Self-harm- and suicide-related (SHS) content on social media is not clearly defined, and therefore, audience effects remain scattered. This article makes three contributions: First, it offers a definition and taxonomy for SHS content on social media with potentially negative audience effects. SHS content on social media is either explicit, implicit or ambivalent in nature, which makes it hard to regulate, and challenging for media effects research. Second, different forms of social media use are discussed as antecedents to self-harm and suicide. And third, functional social media affordances that shape the exposure to problematic SHS content on social media are reviewed. The regulation of the shape-diverse, problematic SHS content on social media remains a pressing future challenge.

Suicidal Ideation During the COVID-19 Pandemic: Investigating Mental Health, COVID-19 Health Beliefs, and News Media Consumption in the United States Population in the Year 2020.

This study examines the role of general news media consumption during COVID-19 in aggravating mental health and suicide risk in the US population. In a sample of U.S. adults (N = 5,010), we investigated how mental health, COVID-19 health beliefs, and general news consumption influenced the odds of suicidal ideation using hierarchical logistic regression models. Both worsening mental health overall and specifically in regard to COVID-19 increased suicidal ideation. Perceived susceptibility to COVID-19 infection did not increase suicidal ideation, yet higher levels of COVID-19 self-efficacy reduced suicidal ideation. Overall news consumption did not affect suicidal ideation, but media-specific post-hoc analyses revealed that TV news watching decreased suicidal ideation as much as high levels of COVID-19 self-efficacy decreased suicidal ideation. Furthermore, online news consumption increased suicidal ideation as much as worsening mental health overall increased suicidal ideation. Further implications are discussed.

The populist hotbed: How political attitudes, resentment, and justice beliefs predict both exposure to and avoidance of specific populist news features in the United States.

A politics of resentment has shaped a low-dialogue political environment in the United States, feeding into populism, and characterized by perceived distributive injustice, detachment between politicians and "the people", and political polarization. In this political environment, independent of editorial lines, news can spread based on populist content features and drive the political divide even further. However, we still do not understand well, how the forces of political disconnect as well as potentially unifying elements such as political knowledge and the willingness to connect with the other (political) side predict audience interest in populist news featuring people-centrism, anti-elitism, restoring popular sovereignty, and the exclusion of others. To better understand what drives (dis-)interest in populist news features, we combined self-report data from a non-student US sample (N = 440) on political attitudes with unobtrusively measured data on their selective exposure to populist news. We analyzed the data using zero-inflated negative binomial regression models, in which we simultaneously modeled selective exposure to and avoidance of populist news. The findings indicate that especially the will to connect with others explained exposure to news about anti-elitism, especially among Democrats, while Republicans' news avoidance seems to be specifically geared toward people-centrism. Populist communication features promoting "us" vs. "them" dichotomies seem to not automatically resonate with the views of resentful voters and their motivated reasoning.

How search engines may help reduce drug-related suicides.

BACKGROUND AND AIMS: Numbers of drug-overdose deaths, both intentionally and unintentionally, have been increasing in the United States. Of interest, Google spotlights counselling services as helpful resources when users query for suicide-related search terms. However, the search engine does so at varying display rates, depending on terms used. Display rates in the drug-overdose deaths domain are unknown. METHODS: We emulated suicide-related potentially harmful searches at large scale across the U.S. to explore Google's response to search queries including or excluding additional drug-related terms. Employing agent-based testing we conducted 215,999 search requests with varying combinations of search terms. RESULTS: Counseling services such as helpline telephone numbers were displayed at high rates after suicide-related potentially harmful search queries (e.g., "how to commit suicide"). While this is a desirable outcome, display rates were substantially lower when drug-related terms, indicative of users' suicidal overdosing tendencies, were added (e.g., "how to commit suicide fentanyl"). Importantly, the addition of any drug-related search term to the suicide-related queries decreased the display frequency of helpful prevention-related resources substantially. CONCLUSIONS: Search queries such as "easy way to commit suicide fentanyl" may indicate acute suicidal crises. Helpful resources should be displayed right in such search moments. Search engines should adjust their algorithms to increase these display rates to direct users to such resources. By doing this, search engines may contribute to the prevention of drug-related suicides.

A Systematic Review of Responsibility Frames and Their Effects in the Health Context.

Responsibility frames potentially shape the public perception of health issues such as obesity, diabetes, or mental illness, specifically regarding responsibility attributions for their causes and treatment. Which responsibility frames prevail in the health context, and the responses they may elicit from audiences, has not been studied systematically. This systematic review includes studies with different methodological approaches published between 2004 and 2019 (N = 68). Content analyses (n = 56) show that different media attribute health responsibility most frequently, but not exclusively to individuals. Individual responsibility was especially emphasized for obesity, which was also the most studied health issue. Tendencies toward societal attributions of responsibility emerged over time, particularly regarding health risks for which the frames describe a specific cause (e.g., sugar, trans-fat). Experimental studies (n = 12) indicate that individual responsibility frames reduce policy support. The effects of responsibility frames were, however, not as clear-cut as expected with research gaps regarding behavioral and affective outcomes. Overall, there is a clear emphasis on noncommunicable diseases in this field. Finally, the conceptual focus on individual vs. societal health responsibility distracts from social network influences as another relevant health determinant. The implications for health communication are discussed.

Investigating Suicide-Related Subliminal Messages on Instagram.

Background: Suicide is the second-leading cause of death among 15-29-year-olds and Instagram is one of the most popular and fastest-growing social media platforms among this age group. A previous study presented preliminary evidence for suicide-related "subliminal messages" on Instagram, defined as very brief presentations of suicide-related content in video posts that users have no conscious awareness of. Aim: A systematic quantitative study was pending. Method: We conducted a quantitative content analysis of 100 Instagram video posts. A frame-by-frame coding procedure allowed for an assessment of whether suicide-related content was depicted in very brief segments, even when this content could not be consciously recognized when watched at regular speed. Results: Analysis indicates that a substantial amount of suicide-related content is presented in very brief shots. We identified 67 very brief shots that appeared in 21 video posts. Of interest, 13 of these video posts presented more than one very brief suicide-related shot. Limitation: The subjective threshold of conscious awareness differs inter-individually. This complicates the operationalization of subliminal messages. Conclusion: Subliminal messages are ethically highly problematic. There is a need for a greater awareness of possible suicide-related subliminal messages on Instagram.

News-stimulated public-attention dynamics and vaccination coverage during a measles outbreak: An observational study.

RATIONALE: Measles is a highly contagious disease that is responsible for about 110,000 annual deaths worldwide, even though a safe, effective, and inexpensive vaccine is available. Given that full vaccination coverage is below the desired threshold in many countries, increasing the vaccination coverage is an important public health goal, aiming to contribute to a reduction of measles deaths. OBJECTIVE: This study investigates the dynamics between media and public attention on measles and vaccination coverage during the 2015 measles outbreak in Berlin, Germany. It was hypothesized that the epicentral distance would influence the observed effects of the outbreak on public attention due to a higher perceived threat susceptibility in more proximal states. METHOD: Using observational macro-level data from German federal states, the study taps into news-stimulated public-attention dynamics around the outbreak. We assessed public attention, media attention, and vaccination coverage among 24-month-old children. RESULTS: Findings indicate that public attention increased exponentially as the epicentral distance lessened. Distance mattered more in states surrounding Berlin-a discovery we termed the "Rubicon effect." Importantly, within a small radius of the epicenter, the decay in public attention was slower, and higher rates of public attention were related to an increase in vaccination coverage among children aged 24 months. CONCLUSIONS: Given that full vaccination coverage for measles (after receiving the second dose) is below the desired value in Germany (and many other countries), the observed increase in vaccination coverage, in response to news-stimulated increases in public attention, can be deemed a beneficial public health outcome. The findings, including the Rubicon effect, are discussed in light of optimal resource allocation for vaccination programs.

COVID-19 pandemic, government responses, and public mental health: Investigating consequences through crisis hotline calls in two countries.

RATIONALE: The coronavirus disease (COVID-19) pandemic is an immense global health threat that has invoked unheard-of containment measures in numerous countries to reduce the number of new infections. OBJECTIVE: The sequential introduction of severe measures, intentionally aiming at reducing the number of new infections, also imposes sharp restrictions on populations with potentially unintended, detrimental effects on public mental health. METHOD: We used observational data reflecting the number of phone calls made to national crisis hotlines in Austria and Germany during the COVID-19 pandemic (January 2020-April 2020) to investigate the impact of government restrictions as well as their later revocations on public mental health. Importantly, both countries have comparable health care systems, are similar in their political and socio-economic idiosyncrasies, and took similar restrictive government measures in order to contain COVID-19-but implemented them at different points in time. RESULTS: Analysis indicated that the number of crisis hotline calls increased in both countries. This increase seemed to occur at around the same time as the implementation of restrictive governmental responses. Importantly, the revocation of these governmental restrictions (i.e., re-opening the economy, allowing more social contact) seemed to occur at around the same time as the decrease in the number of calls. CONCLUSIONS: The present study supports the notion that the implementation of severe measures affects public mental health. However, the negative mental health effects of COVID-19 may be reduced if severe governmental restrictions are kept in place as briefly as possible.

Association between suicide reporting in the media and suicide: systematic review and meta-analysis.

OBJECTIVE: To examine the association between reporting on suicides, especially deaths of celebrities by suicide, and subsequent suicides in the general population. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed/Medline, PsychInfo, Scopus, Web of Science, Embase, and Google Scholar, searched up to September 2019. REVIEW METHODS: Studies were included if they compared at least one time point before and one time point after media reports on suicide; follow-up was two months or less; the outcome was death by suicide; and the media reports were about non-fictional suicides. Data from studies adopting an interrupted time series design, or single or multiple arm before and after comparisons, were reviewed. RESULTS: 31 studies were identified and analysed, and 20 studies at moderate risk of bias were included in the main analyses. The risk of suicide increased by 13% in the period after the media reported a death of a celebrity by suicide (rate ratio 1.13, 95% confidence interval 1.08 to 1.18; 14 studies; median follow-up 28 days, range 7-60 days). When the suicide method used by the celebrity was reported, there was an associated 30% increase in deaths by the same method (rate ratio 1.30, 95% confidence interval 1.18 to 1.44; 11 studies; median follow-up 28 days, range 14-60 days). For general reporting of suicide, the rate ratio was 1.002 (0.997 to 1.008; five studies; median follow-up 1 day, range 1-8 days) for a one article increase in the number of reports on suicide. Heterogeneity was large and partially explained by celebrity and methodological factors. Enhanced funnel plots suggested some publication bias in the literature. CONCLUSIONS: Reporting of deaths of celebrities by suicide appears to have made a meaningful impact on total suicides in the general population. The effect was larger for increases by the same method as used by the celebrity. General reporting of suicide did not appear to be associated with suicide although associations for certain types of reporting cannot be excluded. The best available intervention at the population level to deal with the harmful effects of media reports is guidelines for responsible reporting. These guidelines should be more widely implemented and promoted, especially when reporting on deaths of celebrities by suicide. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019086559.

Investigating Google's suicide-prevention efforts in celebrity suicides using agent-based testing: A cross-national study in four European countries.

RATIONALE: Google can act as a "gatekeeper" for individuals who seek suicide-related information online (e.g., "how to kill oneself"). The search engine displays a "suicide-prevention result" (SPR) at the very top of some suicide-related search results. This SPR comes as an info box and contains supposedly helpful crisis help information such as references to a telephone counseling service. OBJECTIVE: It remains unknown, however, how Google has implemented the SPR in the especially dangerous context of celebrity suicide for which imitational copycat suicides in vulnerable individuals are most likely. METHOD: Relying on agent-based testing, a computational social science method, we emulated a total of 137,937 Google searches in April 2019, using both general suicide-related and specific celebrity suicide-related search terms. Given the recently discovered language-based differences in SPR display rates, we held the language constant and focused on German-speaking populations in four European countries. RESULTS: The SPR was never shown in searches for celebrities who died by suicide in all four countries. Furthermore, analyses indicated a digital divide in access to suicide-prevention information with moderately high SPR display rates in Germany and Switzerland, yet with no display in Austria and Belgium. CONCLUSION: Higher SPR display rates could support global suicide-prevention efforts at virtually no cost by providing preventive information to vulnerable users precisely at the moment when it is apparently needed.

Is a Self-Monitoring App for Depression a Good Place for Additional Mental Health Information? Ecological Momentary Assessment of Mental Help Information Seeking among Smartphone Users.

Mobile devices and apps offer promising opportunities for both patients and healthcare professionals, for example, to monitor and assess health status, and also to provide relevant health information. However, health information seeking within a mood-tracking app has not yet been addressed by research. To bridge this gap, the depression-related health information seeking of 6,675 users of a mood-tracking smartphone app was unobtrusively monitored. The study shows that self-monitored depressive symptoms are associated with higher depression-related information seeking within the app. Health information seeking was low in general, with differences across 12 depression-related topics (e.g., depressive thoughts, a depression diagnosis, or depression facts), but the findings are also promising as the smartphone app was shown to be a place where users can inform themselves about health topics related to the main purpose of the app. Smartphone apps would therefore seem to be a vehicle through which to provide additional health information about, for example, comorbidities, or pre- or post-interventions, even going beyond the original purposes of such mobile health (mHealth) monitoring apps.

Investigating an Issue-Attention-Action Cycle: A Case Study on the Chronology of Media Attention, Public Attention, and Actual Vaccination Behavior during the 2019 Measles Outbreak in Austria.

The present study investigated the chronology of media attention, public attention, and actual vaccinations during a recent measles outbreak in Austria. The analysis indicated that initial news coverage about the measles outbreak (the first wave of media attention) sparked public attention and led to additional heavy news coverage about measles (the second wave of media attention). The observed patterns of public and media attention reflect typical issue-attention cycles, as revealed by previous research. As a supplement to previous studies, the present study links media and public attention with a consecutive increase in the number of vaccinations, thereby supporting the notion of an issue-attention-action cycle. Additional curve-fitting analyses showed that the day-by-day variations in media and public attention resembled sharp, short-term "spotlight effects," whereas consequences on vaccination behavior represented a broader, long-term "echo effect." Above and beyond the theoretical contributions, we discuss practical implications: Surveilling the development of media and public attention in the immediate aftermath of a measles outbreak may be a cost-effective strategy to predict future patient load, thereby helping to effectively allocate resources for vaccination programs. A thorough understanding of the issue-attention-action cycle contributes to this aim.

Investigating harmful and helpful effects of watching season 2 of 13 Reasons Why: Results of a two-wave U.S. panel survey.

RATIONALE: The Netflix show 13 Reasons Why (2017) aroused widespread concern regarding potential contagious effects of its graphic depiction of an adolescent girl's suicide and the events that led to her death. OBJECTIVE: To explore the effects of the second season of the show in 2018. METHOD: We recruited a sample of young adults (ages 18-29; N = 729) with access to Netflix who completed surveys shortly before and one month after the release of the show's second season. Based on theories of narrative empathy, we hypothesized that those who discontinued watching the show would be most vulnerable to its adverse effects on suicide-relevant outcomes. We further identified a higher risk subset of viewers who were more likely to have stopped watching the first season (those currently enrolled in school) in order to observe if the show had more adverse effects on this audience. Finally, we examined effects of the show on all viewers' intentions to help a suicidal person as a prosocial consequence of viewing the entire second season. We used both covariance and "genetic" matching to control for selection effects. RESULTS: In support of predictions, viewers who stopped watching the second season exhibited greater suicide risk and less optimism about the future than those who continued to the end. However, unexpectedly, current students who watched the entire second season reported declines in suicide ideation and self-harm relative to those who did not watch the show at all (ps < .01). Moreover, those who watched the entire second season were also more likely to express interest in helping a suicidal person, especially compared to those who stopped watching. CONCLUSION: The results suggest that a fictional story with a focus on suicidal content can have both harmful and helpful effects.

Effectiveness of a Workshop Intervention on Responsible Reporting on Suicide Among Swiss Media Professionals.

Objective: There is limited knowledge about the effects of a workshop intervention on responsible reporting on suicide (RRS) by media professionals. The study aimed to test how a workshop can shape reporting-relevant attitudes and beliefs among media professionals. Method: A pre-postintervention survey of Swiss media professionals (N = 26, 55.7% male, Mage = 38.1, SDage = 12.8, all Swiss nationals) was conducted. All participants received the same intervention and survey questions. The analytical focus was on within-person changes caused by the workshop intervention. Results: Among media professionals, the workshop intervention increased perceived knowledge sufficiency about RRS, raised awareness that RRS can save lives, decreased insecurities related to RRS, and reduced the misperception that there are no clear recommendations about RRS. Limitations: Despite the missing randomization of workshop participants, the repeated measures design allows to speak to the short-term changes in RRS. Conclusion: An RRS workshop intervention has multifaceted positive effects on media professionals. The study found no evidence for unintended effects of the intervention.