Media Multitasking in Medical Students: A Theory-Based Approach to Understanding this Behavior.

PHENOMENON: While technology is useful and encouraged in medical school, the effect of media multitasking on academic performance remains concerning. Past research has investigated performance and cognitions associated with college students' in-class media multitasking behavior, but the extent and correlates among medical students is relatively unknown. APPROACH: We surveyed medical students at our institution to quantify media multitasking behaviors and related beliefs, and we collected corresponding course grades. Our research applies the Integrative Model of Behavioral Prediction theory to analyze course and cognitive factors influencing media multitasking behavior in medical students. Correlation of media multitasking behavior with average and block grades assessed potential academic impact of the behavior. FINDINGS: Media multitasking was common among medical students. Reported extent of media multitasking among medical students (N = 119) was not related to course grades but was driven by an interplay of beliefs about the behavior and specific course factors. Based on our hierarchical regression model, concerns about boredom appear to be the major cognitive belief underlying behavior. INSIGHTS: Our findings, in the context of the Integrative Model of Behavioral Prediction theory, show influential factors that impact medical students' behavior regarding media multitasking. A campaign targeting these factors influencing behavior may be the most effective approach to limit students' media multitasking and its potential impact on performance. Though our research did not find an association between the extent of media multitasking and course grades, our study was limited by self-report of media multitasking and relatively crude measures of academic performance. Further research is required to measure these behaviors and potential outcomes.Supplemental data for this article is available online at.

Experimental Effects of Tweets Encouraging Social Distancing: Effects of Source, Emotional Appeal, and Political Ideology on Emotion, Threat, and Efficacy.

CONTEXT: Public health officials and celebrities use social media to provide guidance to reduce the spread of COVID-19. Messages apply different promotional strategies to motivate behavior change, likely yielding divergent reactions from partisan audiences. The Extended Parallel Process Model (EPPM) suggests that perceived threat for a negative outcome should impact perceived need for the advocated health behavior, which should be more appealing to an audience if perceived it to be efficacious and feasible. OBJECTIVE: This study examines the interactive effects of Tweet source, message emotional appeal, and audience political affiliation on US adults' perceptions of COVID-19 threat and social distancing efficacy during early months of the pandemic. DESIGN AND SETTING: This online survey experiment applies the EPPM to assess US adults' reactions to tweets encouraging social distancing. The experiment tests 3 emotional appeals (fear, humor, and neutral) and 2 sources (Centers for Disease Control and Prevention [CDC] and celebrity) on adults' emotional reactions and perceptions of COVID-19 threat and social distancing efficacy. PARTICIPANTS: The final sample included 415 US adults (242 Democrat and 173 Republican) recruited through Amazon's Mechanical Turk. MAIN OUTCOME MEASURES: Outcome measures were adapted from the EPPM and include perceived susceptibility to and severity of COVID-19, and response efficacy and self-efficacy regarding social distancing. Each was measured through the survey on a 7-point response scale. RESULTS: Humor and fear appeal messages evoked less fear and guilt responses than a neutral tweet from the CDC. Fear and guilt emotions predicted greater perceived threat, while hope and pride predicted efficacy constructs in relationships moderated by political ideology. CONCLUSIONS: Public health messages targeting a bipartisan audience through social media may increase perceived threat by inducing fear of COVID-19 infection. EPPM theory suggests boosting efficacy is also critical to message acceptance and behavior change; thus, inducing feelings of hope and pride in addition to fear may be particularly effective.

Child-Oriented Marketing on Cereal Packaging: Associations With Sugar Content and Manufacturer Pledge.

OBJECTIVE: To assess sugar content and child-oriented promotional features on packaging among cereals manufactured by companies with varying Children's Food and Beverage Advertising Initiative (CFBAI) participation. DESIGN: Ready-to-eat dry cereals (n = 159) were purchased from southeastern US grocery stores in September 2018. Content analysis of 159 ready-to-eat dry cereal boxes, coded for sugar content and presence of 8 child-oriented features. MAIN OUTCOME MEASURES: Frequencies of each promotional feature and number of features per box, level of participation in CFBAI, and sugar content by serving and ounce. ANALYSIS: Chi-square tests of independence analyzed correspondence between measures of sugar content. Extent of features per box based on sugar content and CFBAI participation were assessed with analyses of variance (ANOVAs). RESULTS: Most cereals (81%) contained <13 g of sugar per serving, meeting the sugar content requirement for child-directed advertising. Cereals' sugar content classifications varied between sugar per serving and sugar per ounce metrics (P < .001). Among low-sugar per serving cereals, 28% were classified as moderate-sugar per ounce, whereas 55% of moderate-sugar per serving cereals had high-sugar per ounce. Games/activities and trade characters were especially common (62% and 49%, respectively), particularly on high-sugar per ounce cereals (P < .001, respectively). Child-oriented features were rare on low-sugar cereals and highest on cereals with higher sugar content per ounce produced by CFBAI-participating companies (F8,158 = 12.33, P < .001). CONCLUSIONS AND IMPLICATIONS: Variable cereal-suggested serving sizes may contribute to consumers' misunderstanding of sugar content. CFBAI manufacturers continue to market cereals with high sugar to children. Food and beverage regulatory policy could be strengthened if CFBAI companies apply marketing pledges to brand mascots, adopt standardized metrics for sugar content, and limit added sugar content to the recommended <6 g/serving target used by the Special Supplemental Nutrition Program for Women, Infants, and Children program.

A mobile app identifies momentary psychosocial and contextual factors related to mealtime self-management in adolescents with type 1 diabetes.

Effective diabetes problem solving requires identification of risk factors for inadequate mealtime self-management. Ecological momentary assessment was used to enhance identification of factors hypothesized to impact self-management. Adolescents with type 1 diabetes participated in a feasibility trial for a mobile app called MyDay. Meals, mealtime insulin, self-monitored blood glucose, and psychosocial and contextual data were obtained for 30 days. Using 1472 assessments, mixed-effects between-subjects analyses showed that social context, location, and mealtime were associated with missed self-monitored blood glucose. Stress, energy, mood, and fatigue were associated with missed insulin. Within-subjects analyses indicated that all factors were associated with both self-management tasks. Intraclass correlations showed within-subjects accounted for the majority of variance. The ecological momentary assessment method provided specific targets for improving self-management problem solving, phenotyping, or integration within just-in-time adaptive interventions.

Mobile Momentary Assessment and Biobehavioral Feedback for Adolescents with Type 1 Diabetes: Feasibility and Engagement Patterns.

BACKGROUND: Integration of momentary contextual and psychosocial factors within self-management feedback may provide more specific, engaging, and personalized targets for problem solving. METHODS: Forty-four youth ages 13-19 with type 1 diabetes (T1D) were provided a Bluetooth meter and completed the 30-day protocol. Participants were randomized to "app + meter" or "meter-only" groups. App + meter participants completed mealtime and bedtime assessment each day. Assessments focused on psychosocial and contextual information relevant for self-management. Graphical feedback integrated self-monitored blood glucose (SMBG), insulin, and Bluetooth-transmitted blood glucose data with the psychosocial and contextual data. App + meter participants completed an interview to identify data patterns. RESULTS: The median number of momentary assessments per participant was 80.0 (range 32-120) with 2.60 per day. By 2 weeks participants had an average of 40.77 (SD 12.23) assessments. Dose-response analyses indicated that the number of app assessments submitted were significantly related to higher mean daily SMBG (r = -0.44, P < 0.05) and to lower% missed mealtime SMBG (r = -0.47, P < 0.01). Number of feedback viewing sessions was also significantly related to a lower% missed mealtime SMBG (r = -0.44, P < 0.05). Controlling for baseline variables, mixed-effects analyses did not indicate group × time differences in mean daily SMBG. Engagement analyses resulted in three trajectory groups distinguished by assessment frequencies and rates of decline. Engagement group membership was significantly related to gender, mean daily SMBG, and HbA1c values. CONCLUSIONS: Momentary assessment combined with device data provided a feasible means to provide novel personalized biobehavioral feedback for adolescents with T1D. A 2-week protocol provided sufficient data for self-management problem identification. In addition to feedback, more intensive intervention may need to be integrated for those patients with the lowest self-management at baseline.

Sharing and helping: predictors of adolescents' willingness to share diabetes personal health information with peers.

Objective: Sharing personal information about type 1 diabetes (T1D) can help adolescents obtain social support, enhance social learning, and improve self-care. Diabetes technologies, online communities, and health interventions increasingly feature data-sharing components. This study examines factors underlying adolescents' willingness to share personal T1D information with peers. Materials and Methods: Participants were 134 adolescents (12-17 years of age; 56% female) who completed an online survey regarding experiences helping others with T1D, perceived social resources, beliefs about the value of sharing information and helping others, and willingness to share T1D information. Hemoglobin A1c values were obtained from medical records. Results: Adolescents were more willing to share how they accomplished T1D tasks than how often they completed them, and least willing to share glucose control status. In multivariate analyses, sharing/helping beliefs (ß = 0.26, P < .01) and glucose control (HbA1c value; ß = -0.26, P < .01) were related to greater willingness to share personal health information. Glucose control moderated relationships such that adolescents with worse A1c values had stronger relationships between sharing/helping beliefs and willingness to share (ß = 0.18, P < .05) but weaker relationships between helping experience and willingness to share (ß = -0.22, P = .07). Discussion: Many adolescents with T1D are willing to share personal health information, particularly if they have better diabetes health status and a stronger belief in the benefits of sharing. Conclusion: Social learning and social media components may improve intervention participation, engagement, and outcomes by boosting adolescents' beliefs about the benefits of sharing information and helping others.

Use of Commonly Available Technologies for Diabetes Information and Self-Management Among Adolescents With Type 1 Diabetes and Their Parents: A Web-Based Survey Study.

BACKGROUND: For individuals with Type 1 diabetes (T1D), following a complicated daily medical regimen is critical to maintaining optimal health. Adolescents in particular struggle with regimen adherence. Commonly available technologies (eg, diabetes websites, apps) can provide diabetes-related support, yet little is known about how many adolescents with T1D use them, why they are used, or relationships between use and self-management. OBJECTIVE: This study examined adolescent and parent use of 5 commonly available technologies for diabetes, including proportions who use each technology, frequency of use, and number of different technologies used for diabetes. Analyses also investigated the reasons adolescents reported for using or not using technologies for diabetes, and factors correlated with adolescents' technology use. Finally, this study examined relationships between the type and number of technologies adolescents use for diabetes and their self-management and glycemic control. METHODS: Adolescents (12-17 years) and their parents (N=174 pairs), recruited from a pediatric diabetes clinic (n=134) and the Children with Diabetes community website (n=40), participated in this Web-based survey study. Glycosylated hemoglobin (A1C) values were obtained from medical records for pediatric clinic patients. Adolescents reported their use of 5 commonly available technologies for diabetes (ie, social networking, diabetes websites, mobile diabetes apps, text messaging, and glucometer/insulin pump software), reasons for use, and self-management behavior (Self-Care Inventory-Revised, SCI-R). RESULTS: Most adolescents and parents used at least one of the 5 technologies for diabetes. Among adolescents, the most commonly used technology for diabetes was text messaging (53%), and the least commonly used was diabetes websites (25%). Most adolescents who used diabetes apps, text messaging, or pump/glucometer software did so more frequently (≥2 times per week), compared to social networking and website use (≤1 time per week). The demographic, clinical, and parent-technology use factors related to adolescents' technology use varied by technology. Adolescents who used social networking, websites, or pump/glucometer software for diabetes had better self-management behavior (SCI-R scores: beta=.18, P=.02; beta=.15, P=.046; beta=.15, P=.04, respectively), as did those who used several technologies for diabetes (beta=.23, P=.003). However, use of diabetes websites was related to poorer glycemic control (A1C: beta=.18, P=.01). CONCLUSIONS: Adolescents with T1D may be drawn to different technologies for different purposes, as individual technologies likely offer differing forms of support for diabetes self-management (eg, tracking blood glucose or aiding problem solving). Findings suggest that technologies that are especially useful for adolescents' diabetes problem solving may be particularly beneficial for their self-management. Additional research should examine relationships between the nature of technology use and adolescents' T1D self-management over time.

Do Emotional Appeals in Public Service Advertisements Influence Adolescents' Intention to Reduce Consumption of Sugar-Sweetened Beverages?

Mass media campaigns are a commonly used approach to reduce sugary drink consumption, which is linked to obesity in children and adolescents. The present study investigated the direct and mediated effects of emotional appeals in public service advertisements (PSAs) that aired between 2010 and 2012 on adolescents' intention to reduce their sugar-sweetened beverage (SSB) consumption. An online randomized experiment was conducted with a national sample of adolescent respondents ages 13 to 17 years old (N = 805). Participants were randomly assigned to 1 of 4 conditions. Three experimental conditions represented PSAs with different emotional appeals: humor, fear, and nurturance, plus a fourth control condition. The outcome was adolescents' intention to cut back on SSBs. The direct effect of fear appeals on intention was mediated through adolescents' perception of the PSAs' argument strength; perceived argument strength was also the key mediator for the indirect effects of humor and nurturance on intention. Several hypothesized mediators influenced by the appeals were not associated with intention. This is the first study to test the effect of persuasive emotional appeals used in SSB-related PSAs. The perceived strength of the PSAs' arguments is important to consider in the communication of messages designed to reduce SSB consumption.

Predicting US Infants' and Toddlers' TV/Video Viewing Rates: Mothers' Cognitions and Structural Life Circumstances.

There has been rising international concern over media use with children under two. As little is known about the factors associated with more or less viewing among very young children, this study examines maternal factors predictive of TV/video viewing rates among American infants and toddlers. Guided by the Integrative Model of Behavioral Prediction, this survey study examines relationships between children's rates of TV/video viewing and their mothers' structural life circumstances (e.g., number of children in the home; mother's screen use), and cognitions (e.g., attitudes; norms). Results suggest that mothers' structural circumstances and cognitions respectively contribute independent explanatory power to the prediction of children's TV/video viewing. Influence of structural circumstances is partially mediated through cognitions. Mothers' attitudes as well as their own TV/video viewing behavior were particularly predictive of children's viewing. Implications of these findings for international efforts to understand and reduce infant/toddler TV/video exposure are discussed.

The Nature and Predictive Value of Mothers' Beliefs Regarding Infants' and Toddlers' TV/Video Viewing: Applying the Integrative Model of Behavioral Prediction.

Viewing television and video programming has become a normative behavior among US infants and toddlers. Little is understood about parents' decision-making about the extent of their young children's viewing, though numerous organizations are interested in reducing time spent viewing among infants and toddlers. Prior research has examined parents' belief in the educational value of TV/videos for young children and the predictive value of this belief for understanding infant/toddler viewing rates, though other possible salient beliefs remain largely unexplored. This study employs the integrative model of behavioral prediction (Fishbein & Ajzen, 2010) to examine 30 maternal beliefs about infants' and toddlers' TV/video viewing which were elicited from a prior sample of mothers. Results indicate that mothers tend to hold more positive than negative beliefs about the outcomes associated with young children's TV/video viewing, and that the nature of the aggregate set of beliefs is predictive of their general attitudes and intentions to allow their children to view, as well as children's estimated viewing rates. Analyses also uncover multiple dimensions within the full set of beliefs, which explain more variance in mothers' attitudes and intentions and children's viewing than the uni-dimensional index. The theoretical and practical implications of the findings are discussed.

Does the Effect of Exposure to TV Sex on Adolescent Sexual Behavior Vary by Genre?

Using the Integrated Model of Behavioral Prediction, this study examines the effects of exposure to sexual content on television by genre, specifically looking at comedy, drama, cartoon, and reality programs, on adolescents' sex-related cognitions and behaviors. Additionally, we compared the amount and explicitness of sexual content as well as the frequency of risk and responsibility messages in these four genres. Findings show that overall exposure to sexual content on television was not related to teens' engagement in sexual intercourse the following year. When examined by genre, exposure to sexual content in comedies was positively associated while exposure to sexual content in dramas was negatively associated with attitudes regarding sex, perceived normative pressure, intentions, and engaging in sex one year later. Implications of adolescent exposure to various types of content and for using genre categories to examine exposure and effects are discussed.

Games for learning: vast wasteland or a digital promise?

Research about emerging best practices in the learning sciences points to the potential of deploying digital games as one possible solution to the twin challenges of weak student engagement and the need for more robust achievement in literacy, science, technology, and math. This chapter reviews key cross-cutting themes in this special volume, drawing perspective from the context of the current United States program and policy reform. The authors conclude that digital games have some unique potential to address pressing educational challenges, but that new mechanisms for advancing purposeful research and development must be adopted by both policymakers and industry leaders.

Influence of licensed spokescharacters and health cues on children's ratings of cereal taste.

OBJECTIVE: To investigate whether licensed media spokescharacters on food packaging and nutrition cues affect young children's taste assessment of products. DESIGN: In this experimental study, children viewed 1 of 4 professionally created cereal boxes and tasted a "new" cereal. Manipulations included presence or absence of licensed cartoon spokescharacters on the box and healthy or sugary cereal name. SETTING: Shopping center in a large northeastern city in December 2007. PARTICIPANTS: Eighty children (mean [SD] age, 5.6 [0.96] years; 53% girls) and their parents or guardians. MAIN EXPOSURE: Licensed cartoon characters and nutrition cues in the cereal name. OUTCOME MEASURES: Children rated the cereal's taste on a 5-point smiley face scale (1, really do not like; 5, really like). RESULTS: Children who saw a popular media character on the box reported liking the cereal more (mean [SD], 4.70 [0.86]) than those who viewed a box with no character on it (4.16 [1.24]). Those who were told the cereal was named Healthy Bits liked the taste more (mean [SD], 4.65 [0.84]) than children who were told it was named Sugar Bits (4.22 [1.27]). Character presence was particularly influential on taste assessments for participants who were told the cereal was named Sugar Bits. CONCLUSIONS: The use of media characters on food packaging affects children's subjective taste assessment. Messages encouraging healthy eating may resonate with young children, but the presence of licensed characters on packaging potentially overrides children's assessments of nutritional merit.