Who likely experiences reactance to quitting messages: How individual cultural identification moderates the effect of controlling language on psychological reactance.

OBJECTIVE: Psychological reactance can undermine the persuasiveness of smoking campaigns, but this effect may vary as a function of culture. Previous research has been conducted at the national level or examined the influence of one cultural variable. This study investigated whether the boomerang effect of controlling language varied across countries and whether individualism and power distance moderated the relationship between controlling language and psychological reactance. METHODS: A total of 400 Chinese and 441 American smokers were randomly assigned to either high or low controlling language. RESULTS: High controlling language elicited psychological reactance, which caused negative attitudes and eventually reduced intentions to quit smoking in both countries. Moreover, the effect of controlling language on reactance was stronger among low power distance Americans, Chinese of high individualism and high power distance as well as of low individualism and low power distance. CONCLUSION: The boomerang effect of controlling language held across cultures. Power distance moderated the relationship between controlling language and psychological reactance as well as the moderation effect of individualism on this relationship. PRACTICE IMPLICATIONS: Practitioners should be cautious to evoke reactance especially when targeting at the three groups mentioned above.

How Foods and Beverages Are Promoted Online: A Content Analysis of the Digital Food Environment in China.

Digital platforms such as social media and e-commerce platforms have become a major space where foods and beverages (F&B) are promoted. Prior research has found that online, unhealthy F&B receive more presence than healthy F&B. This obesogenic food environment may increase the obesity rate. Therefore, it is critical to understand how healthy and unhealthy F&B are promoted online. A content analysis of 2906 posts related to F&B via five digital platforms was conducted in China, where the obesity rate has increased in recent years. Firstly, the results show that unhealthy F&B received more presence on digital platforms than healthy F&B. Secondly, healthy F&B posts tended to highlight the healthiness of the products, whereas unhealthy F&B posts leveraged a wide range of promotional strategies, specifically use cues, food cues, chewing sounds, sensory descriptions, friend cues, local cultural appeal, nostalgia appeal, price information, discount information, and trending hashtags or topics. Next, use cues, chewing sounds, sensory descriptions, family cues, and friend cues increased the quantity of audience feedback, whereas price information and using trending hashtags or topics lowered the quantity of audience feedback. Moreover, local cultural appeal and social proof exhibited the opposite impact on audience feedback. Finally, health benefit statements lowered audience feedback for healthy F&B posts, whereas brand visibility and purchase links inhibited audience feedback for unhealthy F&B posts. In addition to describing the digital food environment in China, the present research provides implications on how to promote healthy F&B. Particularly, we suggest that healthy F&B businesses and healthy eating campaigns should leverage the strategies unhealthy F&B use to receive more consumer attention, in order to increase their own products' public visibility and attractiveness.

The more the better? How social support predicted perceived barriers to tuberculosis treatment across groups of different socioeconomic statuses.

OBJECTIVE: Social support can lower perceived barriers to medical treatment, but this relationship may vary in groups of different socioeconomic statuses (SES). This study examined whether different types of social support predicted different types of perceived barriers to tuberculosis (TB) treatment and whether these relationships varied across different levels of SES. METHOD: A paper-pencil survey covering 12 cities in Guangdong, China (N = 1386) was conducted in December 2020, which measured demographics, three types of perceived social support (informational, instrumental, and emotional) and barriers to TB treatment (cognitive, instrumental, and psychological). RESULTS: Informational support and instrumental support were negatively related to cognitive barriers and instrumental barriers. These relationships were stronger among more educated individuals and urban residents. However, emotional support predicted psychological barrier positively, and this relationship was stronger among less educated individuals and rural residents. CONCLUSION: High SES groups benefit more from individual-level support. Thus, there is a gap of social support, which reveals the power nature of social support exchanges. PRACTICE IMPLICATIONS: TB campaigns need provide support for low SES groups to compensate for their insufficient support. Campaigns need provide information about disease management and the legal and financial support for TB patients, and change tuberculosis-related norms.

Freedom as Right or Privilege? Comparing the Effect of Power Distance on Psychological Reactance Between China and the United States.

Previous research on cultural differences in psychological reactance focuses almost exclusively on individualism. The present study investigated how power distance might affect psychological reactance by comparing Chinese's (N = 400) and Americans' reactions (N = 441) to a quitting smoking message which included versus did not include controlling language. Results show that individuals reacted to the controlling language with more negative cognitive thoughts, more anger, and a higher level of state reactance, compared to the noncontrolling language. In addition, compared to Chinese, Americans reported more anger. Moreover, the country difference in state reactance was mediated through trait reactance and through power distance and subsequently trait reactance. Furthermore, controlling language caused more state reactance among Americans reporting a low level of power distance but among Chinese reporting a high level of power distance. Our findings extended prior research on cultural effects on psychological reactance to power distance and provided insights on the complex nature of this cultural factor.

How Parasocial Relationship and Influencer-Product Congruence Shape Audience's Attitude Towards Product Placement in Online Videos: The Mediation Role of Reactance.

Introduction: Social media enable advertisers to promote products by placing ads into videos posted by social media influencers. However, according to psychological reactance theory, any persuasive attempt may evoke reactance. Therefore, how to minimize the audience's potential resistance to product placements is important. This study investigated how the parasocial relationship (PSR) between audiences and influencers as well as the extent to which the influencer's expertise matched the product (termed as influencer-product congruence) shaped audience attitude towards the product placement and their purchase intention through reactance. Methods: The study conducted a 2 (PSR: high vs low) × 2 (influencer-product congruence: congruent vs incongruent) between-subjects online experiment (N = 210) to test hypotheses. SPSS 24 and PROCESS macro by Hayes were used to analyze the data. Results: The results demonstrate that PSR and influencer-product congruence enhanced the audience's attitude and purchase intention. Moreover, these positive effects were mediated by lowering levels of the audience's reactance. Additionally, we found preliminary evidence suggesting that PSR moderated the effect of perceived expertise of the influencer on reactance. Specifically, this effect was stronger among those reporting a low level of PSR compared to a high level. Conclusion: Our findings reveal how PSR and influencer-product congruence are intertwined to shape audience evaluation of product placement via social media and highlight the central role of reactance in this process. This study also provides advice on the selection of influencer when promoting product placement on social media.

Health Information Sharing via Social Network Sites (SNSs): Integrating Social Support and Socioemotional Selectivity Theory.

Despite its prevalence, research on health information sharing via social network sites (SNSs) is mostly descriptive and often lacks a coherent theoretical framework. By integrating social support and socioemotional selectivity theory, the present study takes a uses and gratifications approach to examining what factors affected health information sharing via WeChat, the most widely used SNS in China. Results of an online survey (N = 519) show that emotional and informational support provisions both predicted health information sharing via WeChat. In addition, age moderated the effects of both support provision. While the relationship between emotional support provision and health information sharing was stronger among older adults, the effect of informational support provision was marginally significantly stronger among younger adults. These findings provide additional understanding of health information sharing via SNSs by revealing its emotional meaning and demonstrating different sharing motivations in different age groups, which offers implications on health information design, dissemination, and discussions in different groups.

Differentiating the stress buffering functions of perceived versus received social support.

Drawing upon the stress buffering model of social support, this study investigated how perceived social support (PSS), defined as the amount of support individuals think they can mobilize from their network, and received social support (RSS), defined as the level of support individuals have received, moderated the direct and indirect relationships between COVID-19 news exposure (i.e., stressor) and stress via social trust. An online survey from six major cities in China (N = 636) revealed that PSS rather than RSS moderated the direct relationship between COVID-19 news exposure and stress such that this relationship was stronger at a low level of PSS than a high level. Additionally, RSS rather than PSS moderated the relationship between COVID-19 news exposure and social trust such that this relationship was stronger at a low level of RSS than a high level. These findings reveal the differential mechanisms by which PSS and RSS function to buffer against stress.

Motivating COVID-19 mitigation actions via personal norm: An extension of the norm activation model.

OBJECTIVE: Given the prosocial nature of COVID-19 mitigation actions, the norm activation model (NAM) provides a theoretical framework to understand how these mitigation behaviors may be driven by activating personal norms. Aimed at delineating the relationship between awareness of consequences and ascription of responsibility, two key variables in the model, the present study examined to what extent this relationship was moderated by political ideology, individual efficacy, and collective efficacy. METHOD: A cross-sectional online survey (N = 560) was implemented with a sample that matched the demographics of the national population in the U.S. RESULTS: The relationship between awareness of consequences and ascription of responsibility was stronger among liberals and those reporting low levels of individual efficacy and collective efficacy. CONCLUSION: Health behaviors such as COVID-19 mitigation actions can be motivated by activating individuals' sense of moral obligation, but the effectiveness of this approach depends on their political ideology and efficacy beliefs. PRACTICE IMPLICATIONS: Campaigns can promote health behaviors by triggering the moral responsibility of the target audience through emphasizing severity of the consequences. This approach can be more effective for liberals and those that lack confidence in individual and collective abilities to avert the threat.

How Do Social Network Sites Influence Workout Intentions: A Social Norm Approach.

People share their workout experiences on social network sites (SNSs). The present study examined how perceived exposure to these workout-related SNS posts may affect individuals' engagement in physical activities through perceived descriptive and injunctive norms of workout in their network, and how self-efficacy in workout moderated the effect of perceived descriptive norm on their workout intention, which was measured in general and specific ways. An online survey was conducted with a convenience sample of 807 responses in China. Results show that perceived descriptive norm of workout in one's network mediated the relationship between perceived exposure to workout-related SNS posts and perceived injunctive norm. In addition, self-efficacy in workout moderated the effect of perceived descriptive norm on workout intention-both general and specific-but the normative influence was stronger at a low level of self-efficacy compared to a high level. Furthermore, perceived injunctive norm only predicted the general rather than specific workout intention, suggesting that the perception of most people's approval might not be priority when people consider details about workout. These findings develop the theory of normative social behavior by illustrating the relationship between perceived descriptive and injunctive norm and shed light on the relative strength of the motivating factors of workout in different situations.

Information Sources, Risk Perception, and Efficacy Appraisal's Prediction of Engagement in Protective Behaviors Against COVID-19 in China: Repeated Cross-sectional Survey.

BACKGROUND: As the COVID-19 pandemic has become a major public health threat worldwide, it is critical to understand what factors affect individual engagement in protective actions. Because of its authoritarian political system and state-owned media system, how Chinese individuals engaged in protective actions against COVID-19 might be different compared to other countries. OBJECTIVE: The purpose of this study is to examine how the source of information about COVID-19, Chinese individuals' risk perception of COVID-19 (ie, perceived severity and perceived susceptibility), and their efficacy appraisal in controlling COVID-19 (ie, response efficacy and self-efficacy) affected their engagement in protective actions. Additionally, this study aims to investigate whether there is any difference in these relationships throughout the duration of this pandemic. METHODS: A six-wave repeated cross-sectional survey (N=1942) was conducted in six major cities in China between February 7 and April 23, 2020. Participants' reliance on expert versus inexpert sources for information about COVID-19, their perceived severity of and susceptibility to COVID-19, their response efficacy and self-efficacy, and their engagement in protective actions (staying at home, wearing a face mask, and washing hands) were measured. Demographic variables (sex, age, income, education, and city of residence), knowledge of COVID-19, and self-rated health condition were controlled. RESULTS: Reliance on expert sources did not become the major factor that motivated these actions until wave 3, and the negative effect of inexpert sources on these actions was limited to wave 2. Perceived severity encouraged some protective behaviors but its effect varied depending on the specific behavior. In addition, perceived severity exhibited a stronger effect on these behaviors compared to perceived susceptibility. The positive effect of response efficacy was only significant at waves 1 and 2, and limited to certain behaviors. CONCLUSIONS: Chinese individuals' engagement in protective behaviors might not entirely be their autonomous decision but a result of compliance with executive orders. After the early outbreak, expert sources started to facilitate protective behaviors, suggesting that it might take time to develop trust in these sources. The facilitating effect of perceived severity lasted throughout the duration of the pandemic, but that of response efficacy was limited to the early stage.

Alterations in the intestinal microbiome (dysbiosis) as a predictor of relapse after infliximab withdrawal in Crohn's disease.

BACKGROUND: Crohn's disease (CD)-associated dysbiosis could predispose patients to relapse. Gut microbiota composition of patients from the prospective cohort study designed to identify predictive factors of clinical relapse after infliximab discontinuation (STORI Study) was investigated to determine the impact of dysbiosis in CD relapse. METHODS: Fecal samples from 33 patients with CD in this cohort were collected at baseline, 2 months, 6 months, and at the end of the follow-up period (19 relapsers and 14 nonrelapsers). Healthy volunteers subjects (n = 29) were used as a control group. The fecal microbiota composition was assessed using quantitative PCR, and comparisons between the patient groups were made at different time points using the Wilcoxon test. The analysis of the time-to-relapse was performed according to the baseline median level of each bacterial signal. RESULTS: Dysbiosis was observed in patients with CD compared with healthy subjects, and it was characterized by low mean counts of Firmicutes (Clostridium coccoides [P = 0.0003], C. leptum [P < 0.0001], and Faecalibacterium prausnitzii [P = 0.003]). Lower rates of Firmicutes were seen in relapsers compared with nonrelapsers. Moreover, a low rate of F. prausnitzii (P = 0.014) and a low rate of Bacteroides (P = 0.030) predicted relapse independently from high C reactive protein level (P = 0.0001). CONCLUSIONS: In this work, we report that CD-associated dysbiosis, characterized by a decrease in Firmicutes, correlates with the time-to-relapse after infliximab withdrawal. A deficit in some bacterial groups or species, such as F. prausnitzii, may represent a predictive factor for relapse. Restoring normobiosis in CD could be a new goal for optimal CD management.

Coloseminal fistula complicating sigmoid diverticulitis.

We report on a 32-year-old man with a history of chronic lower abdominal pain and urogenital symptoms, leading to the diagnosis of coloseminal fistula complicating diverticular disease. We reviewed the literature on this rare clinical entity and would like to stress the role of pelvic imaging with rectal contrast to investigate complicated forms of diverticular disease.

Health organizations providing and seeking social support: a Twitter-based content analysis.

Providing and seeking social support are important aspects of social exchange. New communication technologies, especially social network sites (SNSs), facilitate the process of support exchange. An increasing number of health organizations are using SNSs. However, how they provide and seek social support via SNSs has yet to garner academic attention. This study examined the types of social support provided and sought by health organizations on Twitter. A content analysis was conducted on 1,500 tweets sent by a random sample of 58 health organizations within 2 months. Findings indicate that providing informational and emotional support, as well as seeking instrumental support, were the main types of social support exchanged by health organizations through Twitter. This study provides a typology for studying social support exchanges by health organizations, and recommends strategies for health organizations regarding the effective use of Twitter.

Enteropathy associated T cell lymphoma in celiac disease: a large retrospective study.

INTRODUCTION: Prognosis of enteropathy-associated T cell lymphoma is poor but predictors of survival remain ill-defined. How clinical presentation, pathological features and therapies influence outcome was evaluated in 37 thoroughly characterized patients with celiac disease and T-cell lymphoma. PATIENTS AND METHODS: Medical files were studied retrospectively. Lymphoma and intestinal mucosa were analysed by histopathology, multiplex PCR and intestinal intraepithelial lymphocytes phenotyping. Survival and prognostic factors were analysed using Kaplan-Meier curves with Logrank test and Cox Model. RESULTS: Lymphoma complicated non clonal enteropathy, celiac disease (n=15) and type I refractory celiac disease (n=2) in 17 patients and clonal type II refractory celiac disease in 20 patients. Twenty-five patients underwent surgery with resection of the main tumour mass in 22 cases. In univariate analysis, non clonal celiac disease, serum albumin level>21.6g/L at diagnosis, chemotherapy and surgical resection predicted good survival (p=0.0007, p<0.0001, p<0.0001, p<0.0001, respectively). In multivariate analysis, serum albumin level>21.6g/L, chemotherapy and reductive surgery were all significantly associated with increased survival (p<0.002, p<0.03, p<0.03, respectively). CONCLUSIONS: Our study underlines the prognostic value of celiac disease type in patients with T-cell lymphoma, and suggests that a combination of nutritional, chemotherapy and reductive surgery may improve survival.

Depressive mood and subsequent cancer diagnosis in patients undergoing a colonoscopy.

BACKGROUND: In patients with clinical signs that may indicate a colorectal cancer, physicians may interpret the presence of a comorbid depressive mood as either increasing or decreasing the likelihood of cancer diagnosis. This study examined the association between depressive mood in candidates for a colonoscopy and subsequent diagnosis of cancer. METHODS: Ninety-four outpatients [35 men, mean age ± standard deviation (SD) = 56.2 ± 9.8 years, 59 women, mean age ± SD = 54.2 ± 12.9 years] were given the 13-item Beck depression inventory to assess depressive mood before undergoing a colonoscopy. Additional psychological, demographic, and clinical data were collected prior to the colonoscopy. RESULTS: The colonoscopy found a cancer in 18 patients (19.1%). Cancer patients were older (P = 0.015) and more likely to present with anemia (P < 0.001) and unexplained weight loss (P = 0.046). Depressive mood was associated with a subsequent diagnosis of cancer in women (P = 0.007), but not in men (P = 0.985). This association remained significant after adjustment for potential confounders in women (i.e., anemia and unexplained weight loss) (P = 0.014). CONCLUSIONS: In women with clinical signs that warrant a colonoscopy, comorbid depressive mood may be associated with an increased likelihood of colorectal cancer and should not delay the receipt of a guideline-based diagnosis procedure.

Maintenance of remission among patients with Crohn's disease on antimetabolite therapy after infliximab therapy is stopped.

BACKGROUND & AIMS: It is important to determine whether infliximab therapy can be safely interrupted in patients with Crohn's disease who have undergone a period of prolonged remission. We assessed the risk of relapse after infliximab therapy was discontinued in patients on combined maintenance therapy with antimetabolites and identified factors associated with relapse. METHODS: We performed a prospective study of 115 patients with Crohn's disease who were treated for at least 1 year with scheduled infliximab and an antimetabolite and had been in corticosteroid-free remission for at least 6 months. Infliximab was stopped, and patients were followed up for at least 1 year. We associated demographic, clinical, and biologic factors with time to relapse using a Cox model. RESULTS: After a median follow-up period of 28 months, 52 of the 115 patients experienced a relapse; the 1-year relapse rate was 43.9% ± 5.0%. Based on multivariable analysis, risk factors for relapse included male sex, the absence of surgical resection, leukocyte counts >6.0 × 10(9)/L, and levels of hemoglobin ≤145 g/L, C-reactive protein ≥5.0 mg/L, and fecal calprotectin ≥300 µg/g. Patients with no more than 2 of these risk factors (approximately 29% of the study population) had a 15% risk of relapse within 1 year. Re-treatment with infliximab was effective and well tolerated in 88% of patients who experienced a relapse. CONCLUSIONS: Approximately 50% of patients with Crohn's disease who were treated for at least 1 year with infliximab and an antimetabolite agent experienced a relapse within 1 year after discontinuation of infliximab. However, patients with a low risk of relapse can be identified using a combination of clinical and biologic markers.

The V249I polymorphism of the CX3CR1 gene is associated with fibrostenotic disease behavior in patients with Crohn's disease.

OBJECTIVES: CX3CR1, the receptor of CX3CL1/fractalkine, is involved in regulation of inflammatory response and the CX3CR1-I249-M280 naturally occurring mutants are associated with altered binding to the ligand. Our aim was to evaluate the frequency of CX3CR1 V249I and T280M polymorphisms and NOD2/CARD15 mutations in Crohn's disease patients and to search for a relationship with phenotype. METHODS: Clinical data were retrospectively collected. V249I and T280M polymorphisms of CX3CR1 gene and NOD2/CARD15 mutations (R702W, G908R, 3020InsC) were identified. RESULTS: Two hundred and thirty-nine patients (140 females, 39.7+/-14.1 years) were included. About 37.4% were heterozygous and 8.8% were homozygous for the V249I CX3CR1 polymorphism, 18.1% were heterozygous and 1.3% homozygous for the T280M CX3CR1 polymorphism and 35.9% had at least one of the three mutations of NOD2/CARD15. The T280M CX3CR1 polymorphism was not associated with any phenotype. In univariate analysis, stenosis was significantly associated with both V249I CX3CR1 polymorphism and 3020InsC NOD2/CARD15 mutations. In smoker patients carrying the CX3CR1 allele I249, there was a significant increase in the frequency of fibrostenosing disease [P=0.005, odds ratio (OR): 3.25] whereas this relationship disappeared in the group of nonsmokers (P=0.72). In multivariate analysis, 3020InsC NOD2/CARD15 mutations and the V249I CX3CR1 polymorphism were independent risk factors for intestinal stenosis (P=0.046, OR: 1.8 and P=0.044, OR: 2.4, respectively). CONCLUSION: In Crohn's disease, V249I CX3CR1 polymorphism is associated with intestinal strictures, particularly in smokers. This association is independent of CARD15 mutations.

Over-expression of colonic K+ channels associated with severe potassium secretory diarrhoea after haemorrhagic shock.

A 67-year-old woman with end-stage renal disease (ESRD) was referred with chronic diarrhoea, severe hypokalaemia and recurrent colonic pseudo-obstructions following haemorrhagic shock. The cause of secretory diarrhoea was uncertain, but an ileostomy identified the colon as the source of the watery diarrhoea and potassium (K(+)) losses, and symptoms only resolved after colectomy. Immunohistochemistry of the colon revealed over-expression of high conductance K(+) (BK) channel protein in surface colonocytes and crypt cells compared with controls and other patients with ESRD. We hypothesize that colonic ischaemia during haemorrhagic shock led to increased BK channel expression and thus enhanced colonic K(+) and water secretion, resulting in severe hypokalaemia and colonic pseudo-obstruction.