"Influencing the influencers:" a field experimental approach to promoting effective mental health communication on TikTok.

A substantial body of social scientific research considers the negative mental health consequences of social media use on TikTok. Fewer, however, consider the potentially positive impact that mental health content creators ("influencers") on TikTok can have to improve health outcomes; including the degree to which the platform exposes users to evidence-based mental health communication. Our novel, influencer-led approach remedies this shortcoming by attempting to change TikTok creator content-producing behavior via a large, within-subject field experiment (N = 105 creators with a reach of over 16.9 million viewers; N = 3465 unique videos). Our randomly-assigned field intervention exposed influencers on the platform to either (a) asynchronous digital (.pdf) toolkits, or (b) both toolkits and synchronous virtual training sessions that aimed to promote effective evidence-based mental health communication (relative to a control condition, exposed to neither intervention). We find that creators treated with our asynchronous toolkits-and, in some cases, those also attending synchronous training sessions-were significantly more likely to (i) feature evidence-based mental health content in their videos and (ii) generate video content related to mental health issues. Moderation analyses further reveal that these effects are not limited to only those creators with followings under 2 million users. Importantly, we also document large system-level effects of exposure to our interventions; such that TikTok videos featuring evidence-based content received over half a million additional views in the post-intervention period in the study's treatment groups, while treatment group mental health content (in general) received over three million additional views. We conclude by discussing how simple, cost-effective, and influencer-led interventions like ours can be deployed at scale to influence mental health content on TikTok.

Public Attitudes, Inequities, and Polarization in the Launch of the 988 Lifeline.

CONTEXT: To address the considerable burden of mental health need in the United States, Congress passed the National Suicide Hotline Designation Act in 2020. The Act rebranded the national suicide prevention lifeline as 988 - a 3-digit number akin to 911 for individuals to call in the case of a mental health emergency. Surprisingly little is known about American attitudes towards this new lifeline. METHODS: We rely on a demographically representative sample of 5,482 US adults conducted from June 24-28, 2022. We examine the influence of mental health status, partisan identification, and demographic characteristics on public awareness, public support, and intended use of the new 988 lifeline. FINDINGS: We find that while only a quarter of Americans are aware of the lifeline, support for the 988 lifeline is widespread, with over 75% of Americans indicating they would be likely to use the new number if needed. We identify key disparities in awareness, support, and intended use, with Republicans, individuals with low socio-economic status, and Blacks less supportive and in some cases less likely to use the 988 lifeline. CONCLUSIONS: Our results point to the need for additional interventions that increase public awareness of 988 and reduce disparities in program knowledge, support, and intended use.

What Goes Down Must Come Up? Pandemic- Related Misinformation Search Behavior During an Unplanned Facebook Outage.

Pundits and scholars alike suspect that Facebook plays a role in not only exposing Americans to misinformation, but also encouraging them to seek out misinformation from other sources. Whether or not Facebook is responsible for stimulating misinformation search beyond the social networking site, however, is an open question. If Facebook encourages misinformation search behavior, we might expect search volume on other websites to simultaneously decrease when web traffic to Facebook is comparatively low. Here, we exploit a naturally-occurring and exogenous interruption to Facebook's service to study the site's impact on misinformation search. Difference-in-difference analyses reveal that minute-by-minute Google searches for pandemic misinformation (e.g., unproven COVID-19 remedies, vaccine conspiracy theories) tended to increase during the outage period, in comparison to a typical day (and vs. a placebo). These findings are less consistent with views that the site stimulates misinformation search, and more consistent with a steady and transferable demand for health misinformation. Our results showcase the importance of examining not only the supply side of misinformation, but also the demand side.

Sick as a dog? The prevalence, politicization, and health policy consequences of canine vaccine hesitancy (CVH).

Canine vaccine hesitancy (CVH) can be thought about as dog owners' skepticism about the safety and efficacy of administering routine vaccinations to their dogs. CVH is problematic not only because it may inspire vaccine refusal - which may in turn facilitate infectious disease spread in both canine and human populations - but because it may contribute to veterinary care provider mental/physical health risks. In a nationally representative survey of US adults (N = 2200), we introduce a novel survey-based instrument for measuring CVH. We document pervasive CVH in dog owner subpopulations. Troublingly, we find that CVH is associated with rabies non-vaccination, as well as opposition to evidence-based vaccine policies. We conclude by discussing the human and animal health consequences of CVH, and outline a research agenda for future opinion-based research on this important topic.

How pandemic-related changes in global attitudes toward the scientific community shape "post-pandemic" environmental opinion.

Low public concern about anthropogenic climate change (ACC)-due in part to distrust in the scientific community-may decrease demand for policies aimed at mitigating its deleterious effects. Encouragingly, though, recent research finds that experiences with the COVID-19 pandemic has elevated trust in scientific expertise worldwide. We explore the possibility that positive attitudes toward the medical community are "spilling over" to increase ACC acceptance via globally representative survey data from 107 countries (N = 119,088) conducted during the COVID-19 pandemic. We show that trust in medical experts' handling of the COVID-19 pandemic is associated with increased ACC acceptance, worldwide. Problematically, though, we also show that the effects of trust in medical professionals is strongest in countries experiencing the most positive change in attitudes toward the scientific community, which tend to be disproportionately wealthy, and less likely to bear the unequal effects of climate change.

The pre-political origins and policy consequences of environmental justice concern.

While the effects of climate change will impact most Americans, they will likely have a disproportionate influence on the socioeconomic well-being of marginalized communities. Few researchers, however, have investigated public support for policies aimed at ameliorating climate-related disparities. Fewer still have considered how political and (critically) pre-political psychological dispositions might shape environmental justice concern (EJC) and subsequently influence policy support-both of which, I argue, could present roadblocks for effective climate communication and policy action. In this registered report, I (1) propose and validate a new measure of EJC, (2) explore its political correlates and pre-political antecedents, and (3) test for a link between EJC and policy support. In addition to psychometrically validating the EJC scale, I find that pre-political value orientations are associated with EJC, which, in turn, mediates the effects of pre-political values on taking action to mitigate the unequal effects of climate change.

Erroneous Consonance. How inaccurate beliefs about physician opinion influence COVID-19 vaccine hesitancy.

Throughout the COVID-19 pandemic, researchers have studied how Americans' attitudes toward health experts influence their health behaviors and policy opinions. Fewer, however, consider the potential gap between individual and expert opinion about COVID-19, and how that might shape health attitudes and behavior. This omission is notable, as discrepancies between individual and expert opinion could help explain why some Americans fail to take action to protect themselves and others from the virus. In novel demographically representative surveys of the US adult population (N = 5,482) and primary care physician subpopulations (PCPs; N = 625), we contrast the relationship between: (1) Americans' and (2) PCPs' preferences regarding who ought to be responsible for taking action to combat the spread of COVID-19, as well as (3) Americans' perceptions of PCP preferences ("PCP meta-opinion"). In the aggregate, we find that Americans are far less likely than PCPs to see a role for both private and state actors in taking action to combat COVID-19. Interestingly, though, this disjuncture is not reflected in individual-level PCP meta-opinion; as most Americans think that PCPs share their views on state and private intervention (τb = 0.44-0.49). However, this consonance is often erroneous, which we show can have problematic health consequences. Multivariate models suggest that Americans who both see little place for individual responsibility in taking action to stop viral spread and who think that PCPs share those views are significantly less likely to vaccinate against COVID-19. We conclude by discussing the public health benefits of efforts to bring public opinion in line with expert opinion.

Physician Trust in the News Media and Attitudes toward COVID-19.

CONTEXT: Previous research has established the importance of primary care physicians in communicating public health directives. The implicit assumption is that, because of their expertise, doctors provide accurate and up-to-date information to their patients independent of partisan affiliation or media trust. METHODS: The authors conducted an online survey of 625 primary care physicians and used the results to test (1) whether physician trust in media outlets is consistent with their political partisanship, and (2) whether trust in media outlets influences (a) personal concern that someone in their family will get sick, (b) perceptions about the seriousness of the pandemic as portrayed in the media, and (c) trust in federal government agencies and scientists. FINDINGS: Physicians are better positioned to critically evaluate health-related news, but they are subject to the same biases that influence public opinion. Physicians' partisan commitments influence media trust, and media trust influences concern that a family member will get sick, perceptions regarding the seriousness of the pandemic, and trust in federal government agencies and scientists. CONCLUSIONS: Physician trust in specific media outlets shapes their understanding of the pandemic, and-to the extent that they trust conservative media outlets-it may limit their effectiveness as health policy messengers.

The Correlates & Public Health Consequences of Prospective Vaccine Hesitancy among Individuals Who Received COVID-19 Vaccine Boosters in the U.S.

Supplemental "booster" vaccines may prove vital in combating variant waves of endemic COVID-19. Given relatively low levels of booster vaccine uptake, Americans' willingness to receive a second booster shot is unclear. In a demographically representative survey of N = 3950 US adults (limited to a "boosted" subsample of N = 1551 who had not yet received a second booster), 49% [95% CI: 47, 51] of Americans report having received an initial booster shot, while just 34% [33, 36] report that they would be "very likely" to do so again. Concerns about missing work to vaccinate (−10%; B = 0.53, p = 0.05) and being unconvinced that additional boosters will be necessary (−47%; B = 2.24, p < 0.01) are significantly and negatively associated with being very likely to receive a second COVID-19 booster. These findings can help inform discussions about policies aimed at increasing vaccine uptake in the U.S., and broaden researchers' understanding of vaccine reluctance among those who might otherwise hold positive views toward vaccination.

Can a COVID-19 vaccine live up to Americans' expectations? A conjoint analysis of how vaccine characteristics influence vaccination intentions.

OBJECTIVE: A vaccine for the novel coronavirus (COVID-19) could prove critical in establishing herd immunity. While past work has documented the prevalence and correlates of vaccine refusal, I assess how a less explored topic -- properties of vaccines themselves (e.g., national origin, efficacy, risk of side effects) -- might influence vaccination intentions. This information can help public health officials preempt differential intentions to vaccinate, and inform health communication campaigns that encourage vaccine uptake. RATIONALE: Previous research suggests that Americans should be more likely to intend to vaccinate if presented with a US-made vaccine that carries a low risk of minor side effects, is highly effective, is administered in just one dose, and has spent significant time in development. METHODS: I administered a conjoint experiment (N = 5940 trials) in a demographically representative survey (N = 990) of US adults to assess how variation in vaccine properties influence self-reported public vaccination intentions. RESULTS: I find that respondents prefer vaccines that are US-made, over 90% effective, and carry a less than 1% risk of minor side effects. This is potentially problematic, as some leading vaccine candidates are produced outside the US, and/or may be more likely to produce minor side effects than respondents would otherwise prefer. Worryingly, intended vaccine refusal rates exceed 30% for a vaccine meeting these optimal characteristics. Encouragingly, though, Americans show no clear preference for vaccines administered in one dose, or developed in under a year, and do not appear to draw a distinction between weakened viral vs. mRNA-based vaccines. CONCLUSION: Americans' preferences for a novel coronavirus vaccine may be at odds with the vaccine that ultimately hits the market, posing both policy and health communication challenges for vaccination uptake.