The impact of COVID-19 misinformation and trust in institutions on preventive behaviors.

Misinformation related to coronavirus disease 2019 (COVID-19) has the potential to suppress preventive behaviors that mitigate the spread of COVID-19. Early research on the behavioral consequences of COVID-19 misinformation is mixed, and most rely on cross-sectional data. We examined whether believing in COVID-19 misinformation at one time point influences engaging in preventive behaviors later. In addition, we investigated the role of trust in institutions. We conducted a two-wave survey in South Korea and examined the association between belief in COVID-19 misinformation at Wave 1 and preventive behaviors at Wave 2 controlling for preventive behaviors at Wave 1. We also analyzed whether there is an interaction between belief in COVID-19 misinformation and trust in institutions. Belief in COVID-19 misinformation at Wave 1 significantly increased avoidance of preventive behaviors at Wave 2, but after accounting for trust in institutions, this effect disappeared. Rather, trust in institutions significantly decreased avoidance of preventive behaviors. In addition, misinformation increased avoidance of preventive behaviors among those who trusted institutions the most. Results suggest that building trust in institutions is essential in promoting COVID-19 preventive behaviors. Belief in COVID-19 misinformation may have harmful effects, but these effects were pronounced for those who highly trust institutions.

Communication Networks and Individual Resilience for Individual Well-Being During a Time of Crisis.

The deprivation of offline communication necessitated by the COVID-19 pandemic raises questions about whether and how external social resources and internal ability lead individuals to maintain their well-being. However, most research on the two factors, especially during the COVID-19 pandemic, has been based on cross-sectional survey data during the early lockdowns and focused on each factor separately. Combining the two lines of research, this study investigates how individuals' communication networks and resilience interacted with each other and influenced individual well-being at two time points during the COVID-19 pandemic. Based on the two-wave online panel survey data gathered from 708 Korean adults, this study suggests that individual well-being depends on strong ties and emotional support, and that their offline support influences their well-being differently depending on their level of resilience. Implications for understanding the transformed roles of communication networks and the complex dynamics of offline support together with individual resilience on individual well-being are discussed.

Trust Matters: The Effects of Social Media Use on the Public's Health Policy Support Through (mis)beliefs in the Context of HPV Vaccination.

This study examines whether social media exposure is associated with the public's beliefs and misbeliefs about human papillomavirus (HPV) vaccination and how those (mis)beliefs are associated with the public's support for HPV vaccination-related policies. This study also explores whether trust in HPV vaccination-related regulatory organizations moderates the associations between social media exposure and public policy support through (mis)beliefs. We found that social media exposure was positively associated with misbeliefs about HPV vaccination. The findings also indicated that while beliefs about benefits were positively associated with policy support for HPV vaccination, misbeliefs were negatively associated with this support. More interestingly, our analysis revealed that the negative association of HPV-related misbeliefs with vaccination policy support was larger for those who had low levels of trust, compared to their high-trust counterparts.

Social Disparities in Online Health-Related Activities and Social Support: Findings from Health Information National Trends Survey.

It is important to examine gaps in online health-related activities (OHAs) between socially advantaged and disadvantaged groups, considering that emerging information and communication technologies may bring about social disparities in their adoption and possibly expand preexisting health disparities. We thus examined whether digital divide occurs in the area of OHAs, including engagement with a very recent technology. To be more specific, we explored the effects of education, income, and race/ethnicity on OHAs, such as online health information seeking, social media use for health, and health information technologies (HITs) utilization. Moreover, given the importance of socio-contextual factors in digital divide, we examined how social support interacts with education, income, and race/ethnicity, and jointly influences OHAs. Using data from the 2017 Health Information National Trends Survey, we found the effects of education on several OHAs. Income only affected HITs utilization that had just started to diffuse across the U.S. society. We also identified reinforcing effects of social support and education on HITs utilization, and reinforcing effects of social support and income on online health information seeking. The implications of these findings for health communication and public health research were discussed.

The Role of Deliberative Cognitive Styles in Preventing Belief in Politicized COVID-19 Misinformation.

Misinformation related to COVID-19 is a threat to public health. The present study examined the potential for deliberative cognitive styles such as actively open-minded thinking and need for evidence in deterring belief in misinformation and promoting belief in true information related to COVID-19. In addition, regarding how responses to the pandemic have been politicized, the role of political orientation and motivated reasoning were also examined. We conducted a survey in South Korea (N = 1466) during May 2020. Participants answered measures related to demographics, open-minded thinking, need for evidence, and accuracy perceptions of COVID-19 misinformation and true information items. Multi-level analyses of the survey data found that while motivated reasoning was present, deliberative cognitive styles (actively open-minded thinking and need for evidence) decreased belief in misinformation without intensifying motivated reasoning tendencies. Findings also showed a political asymmetry where conservatives detected COVID-19 misinformation at a lesser rate. Overall, results suggest that health communication related to COVID-19 misinformation should pay attention to conservative populations. Results also imply that interventions that activate deliberative cognitive styles hold promise in reducing belief in COVID-19 misinformation.

A comprehensive examination of association between belief in vaccine misinformation and vaccination intention in the COVID-19 context.

Misinformation about COVID-19 vaccines is widely available in the public communication environment. Exposure to the misinformation may increase perceived risk of and evoke negative emotions toward COVID-19 vaccines that may eventually reduce COVID-19 vaccination intentions. The negative influences of misinformation may vary by aspects of individuals' social networks. Expanding the reasoned action approach, we proposed a comprehensive model to examine the roles of misinformation beliefs, perceived risk, fear, worry, and social networks in explaining COVID-19 vaccination intentions. We tested the model using survey data of South Korean adults, collected when the Korean government launched its nationwide vaccination program in April 2021 (n = 744). The results from our step-by-step path analyses indicated that COVID-19 vaccination intentions had positive direct associations with vaccination-specific factors such as attitudes toward, injunctive norms on, and perceived behavioral control over COVID-19 vaccination. Perceived risk was also directly linked to intentions. Among these factors, attitudes and injunctive norms were most strongly related to intentions. Misinformation beliefs and worry had negative indirect relationships with intentions via the mediation of these variables directly connected to intentions. The negative influences of misinformation beliefs were greater among respondents reported stronger tie strengths. Theoretical and practical implications were discussed.

Communication about Suicide, Perceived Social Support, and Suicidal Intention in Korean Adults.

The present study investigates indirect effects of communication about suicide in interpersonal relationships and patient-provider relationships on suicidal intention via attitude, descriptive norm, injunctive norm, and self-efficacy in committing suicide among Korean adults, using longitudinal survey data. Moderation effects of perceived social support are also tested. As a result of path analysis (N = 984), communication about suicide with family, friends, and coworkers is significantly related to pro-suicide descriptive norm and pro-suicide injunctive norm. Positive attitude toward suicide, pro-suicide injunctive norm, and high self-efficacy in committing suicide are significantly related to suicidal intention. Interpersonal communication is positively related to pro-suicide injunctive norm, which in turn links to suicidal intention. Communication about suicide with healthcare professionals, however, did not show significant direct and indirect effects. Moderation effects of perceived social support are detected between interpersonal communication and pro-suicide attitude and pro-suicide injunctive norm, as well as between patient-provider communication and pro-suicide attitude.

Toward More Effective Public Health Interventions during the COVID-19 Pandemic: Suggesting Audience Segmentation Based on Social and Media Resources.

In response to the COVID-19 pandemic, public health communication campaigns have been targeted at reducing viral transmission, specifically among populations most vulnerable to infection and death from the virus (e.g. older adults). However, other individuals who have not been defined as vulnerable populations may also suffer from a decrease in health because of the measures aimed at reducing viral transmission, such as social distancing. To illuminate this issue, we investigate the role of social and media resources in complementing limited offline communication and supporting mental and physical health during this pandemic. We then suggest an alternative audience segmentation strategy based on social and media resources for public health interventions. Based on online survey data from 723 adults in South Korea, the regression analysis results indicated that individuals with lower levels of social resources suffered more during the pandemic. The cluster analysis results revealed that, contrary to the traditional definition of vulnerable populations, a cluster of younger people were unhealthier than a cluster of older people because of a lack of social resources. Clusters with different levels of ICT skills and uses for health-related activities also experienced the pandemic differently. These findings imply public health interventions should focus on social resources beyond the demographic factors to determine target audiences, and that they should take advantage of the target audiences' media resources to encourage them to forge intimate connections with others and to engage in health-related activities.

Exploring the Effect of Health App Use on Fruit and Vegetable Consumption.

People may use multiple health apps at the same time or in close sequence, and the effect of health apps may vary across different socioeconomic groups. However, in the context of healthy eating, studies have focused on the effect of using a single health app. This study aims to test the relationship of using multiple health apps with fruit and vegetable consumption, assessing moderation by education level. Employing longitudinal survey data from South Korean adults, we conducted regression analyses to test the lagged association between use of health apps and intake of fruits and vegetables, and whether education moderates the relationship. The results supported the positive lagged relationship of health app use with fruit and vegetable consumption, significant after controlling for confounders and baseline fruit and vegetable consumption. The association was smaller among respondents with higher education. Our findings suggest the positive effect of using multiple health apps on fruit and vegetable consumption, implying the importance of finding the best combination of health apps to maximize their effectiveness in promoting healthy eating. Also, the negative interaction of health app use and education support using mobile communication technology to improve the public health of low socioeconomic status individuals.

Prevalence, Predictors, and Psychosocial Mechanism of Cancer Information Avoidance: Findings from a National Survey of U.S. Adults.

The current study examined the prevalence, predictors, and psychosocial mechanism of cancer information avoidance (CIA). With a nationally representative sample, we sought to confirm the prevalence of CIA among Americans. Studies, based on crisis decision theory, have shown that a lack of personal or interpersonal resources to manage threat-related information leads to information avoidance. Cancer information overload (CIO) and cancer fatalism are known predictors of CIA, and these factors were viewed as a lack of personal resources. We measured interpersonal resources by an individual's network size. Then, to suggest a psychosocial mechanism of CIA, we tested how those personal resources interacted with interpersonal resources. A two-wave longitudinal survey was conducted using a nationally representative sample of U.S. adults (N = 795 at Wave 1 and 626 at Wave 2). Approximately, 4-5 out of 10 adults had low to high levels of CIA, and they avoided the Internet more than any other source. Items that positively predicted CIA included male gender, being non-Hispanic white, and CIO. Family and personal cancer history negatively predicted CIA. However, the positive relationship between CIO and CIA existed only for people with fewer close friends (i.e., a smaller network size). The lack of personal resources did not lead to CIA for those who had more interpersonal resources that could help them manage threat-related information. The results suggest that social support protects individuals from the emotional stress of cancer information exposure, confirming the buffering model of social support.

The impact of cancer information online on cancer fatalism: education and eHealth literacy as moderators.

One critical yet understudied concept associated with cancer information is cancer fatalism, i.e. deterministic thoughts about the cause of cancer, the inability to prevent it and the unavoidability of death upon diagnosis. The aim of this study is to understand how information seeking about cancer online influences cancer fatalism and whether and to what extent education and eHealth literacy moderate the relationship between them. Findings from an online survey of a nationally representative sample in the United States (N = 578) showed differential impacts of using the internet to search for information about cancer among the more and the less educated. For the less educated, more exposure to information about cancer via medical and health websites led to an increased level of cancer fatalism, whereas among the more educated, greater exposure lowered cancer fatalism. These differences were explained by the fact that the more educated were equipped with a higher level of eHealth literacy skills than the less educated. Findings show that only when one has necessary skills to apply digital resources can those resources help mitigate cancer fatalism. We suggest the need to enhance eHealth literacy skills among the less educated to reduce cancer fatalism.

A Communication Inequalities Approach to Disparities in Physical Activities: The Case of the VERB Campaign.

This study focuses on the VERB campaign and explores whether the campaign effects differed across socioeconomic status and race/ethnicity groups. Using a three-wave longitudinal survey dataset, this study found that the effects of exposure to the VERB campaign on behaviors were mediated by descriptive norms, perceived behavioral control (PBC), and intentions. More importantly, the VERB campaign increased intentions of being physically active by affecting PBC and descriptive norms across all social groups. When the link between intentions and behavior was taken into consideration, however, disparities between high and low SES, and majority and minority racial/ethnic group children emerged. The implications of this study for research on health disparities and public health communication campaigns are discussed.

A Moderated Mediation Model of the Relationship between Media, Social Capital, and Cancer Knowledge.

We combined insights from various theories and models of media learning, and advanced an indirect model accounting for the mechanisms underlying the media influences on knowledge acquisition. Our model was largely supported by the data from a two-wave longitudinal panel survey with a nationwide sample of Korean adults. It was found that both personal cancer history and cancer worry were positively associated with exposure to stomach cancer information from the media. In turn, exposure to media information was positively related to reflective integration of that information, which ultimately leads to stomach cancer knowledge only among people with high levels of social capital. These findings suggest that media uses and effects are not only an individual but also a contextually dependent experience.

Source-specific Exposure to Contradictory Nutrition Information: Documenting Prevalence and Effects on Adverse Cognitive and Behavioral Outcomes.

Communication scholars have raised concerns that the media present contradictory or conflicting information on health, science, and political issues, speculating that such information may have adverse effects on public cognitions, affect, and behaviors. However, the evidence base for the effects of contradictory messages remains thin. Using nutrition as a case example, this study builds upon this nascent literature by employing a three-wave panel dataset from a survey with a nationally representative sample of American adults. We found that exposure to contradictory nutrition messages from television increases nutrition confusion, whereas exposure from print media decreases confusion. Moreover, nutrition confusion was positively associated with nutrition backlash, and nutrition backlash decreased engagement in fruit and vegetable consumption. Implications for campaigns and other communication interventions are discussed.

To vape or not to vape? Effects of exposure to conflicting news headlines on beliefs about harms and benefits of electronic cigarette use: Results from a randomized controlled experiment.

News coverage of novel tobacco products including e-cigarettes has framed the use of these products with both positive and negative slants. Conflicting information may shape public knowledge, perceptions of e-cigarettes, and their harms. The objective of this study is to assess effects of exposure to conflicting news coverage on US adults' beliefs about harms and benefits of e-cigarette use. We conducted a one-way between-subjects randomized controlled experiment in 2016 to compare the effects of viewing either 1) positive, 2) negative, 3) both positive and negative (conflicting) news headlines about the safety of using e-cigarettes, or 4) no-message. Participants were 2056 adults aged 18 and older from an online survey panel. Outcomes were beliefs about harms (3-item scale, α=0.76) and benefits (3-item scale, α=0.82) of using e-cigarettes. Participants who viewed negative headlines reported increased beliefs about harms (B=0.164, p=0.039) and lower beliefs about benefits of e-cigarette use (B=-0.216, p=0.009), compared with those in the positive headlines condition. These differences were replicated in subgroup analyses among never e-cigarette users. In addition, never e-cigarette users who viewed conflicting headlines reported lower beliefs about benefits of e-cigarette use (B=-0.221, p=0.030) than the positive headlines condition. Valence of news coverage about e-cigarettes (positive, negative, or conflicting) could influence people's beliefs about harms and benefits of e-cigarette use.

An Initial Look at the Associations of a Variety of Health-Related Online Activities With Cancer Fatalism.

It has been an important public health goal to remove cancer fatalism because of its negative influence on both cancer screening and preventive behaviors. The present study examines roles of the Internet, as an emerging, crucial source of cancer information, in the effect of education on cancer fatalism. Based on our secondary analysis of a nationally representative survey (i.e., Health Information National Trends Survey 4 Cycle 1), we found that people with low levels of education are less likely than their more educated counterparts to engage in online health information seeking that is negatively linked to fatalistic beliefs about cancer prevention. In addition, the effect of education on online health information seeking was detected only among people who trust online health information. The implications of these findings for cancer control and for research on the digital divide and communication inequalities are discussed.

Correlates of Cancer Information Overload: Focusing on Individual Ability and Motivation.

The present study defined cancer information overload (CIO) as an aversive disposition wherein a person is confused and overwhelmed by cancer information, which occurs when he or she fails to effectively categorize new information due to a lack of resources for effective learning. Based on the definition and informed by previous studies on information overload and the cognitive mediation model, we hypothesized that low ability and motivation to process cancer information would lead to CIO. We used education level and trait anxiety as factors related to ability. Cancer history and the use of active media channels (such as the Internet and print media) were adopted as motivational factors. Four samples (three from the United States and one from South Korea) were used to explore the relationship between ability/motivation and CIO. Among them, only Sample 4 participants answered questions about stomach cancer, and other participants were asked about cancer in general. In all four samples, trait anxiety was positively associated with CIO. Health information use from active media channels (print or the Internet) was negatively associated with CIO in three samples. The associations between family history and CIO, and between education and CIO, were found in two samples. In short, the present study demonstrated that CIO partly depends on individual ability and motivation, thereby showing that CIO is influenced by personal characteristics as well as environmental factors.

Theorizing the Pathways From Seeking and Scanning to Mammography Screening.

This study combines insights from existing theories in mass communication and health communication, and builds an integrated model accounting for the mechanisms by which an individual's acquisition of mammogram-related media information becomes associated with intentions to obtain a mammogram. Our model was largely supported by a survey with a nationally representative sample of American females between the ages of 40 and 70 years. As expected, seeking and scanning mammogram-related information from the media were both positively associated with reflective integration of media health information, which in turn was positively related to behavioral attitudes and perceived normative pressures. Attitudes and normative pressures were then positively linked to the intention to get a mammogram. Based on these findings, we offer some suggestions for future research in this area.

Public support for selected e-cigarette regulations and associations with overall information exposure and contradictory information exposure about e-cigarettes: Findings from a national survey of U.S. adults.

OBJECTIVE: We assessed public support for six e-cigarette regulations and examined whether self-reported exposure to e-cigarette information and contradictory e-cigarette information were associated with support. METHOD: We conducted an online survey among a nationally representative sample of 527 U.S. adults in July 2014. Weighted, fully adjusted multinomial logistic regression models predicted support for banning e-cigarettes in smoke-free areas, prohibiting e-cigarette sales to youth, requiring addiction warnings, banning flavors, requiring labeling nicotine and harmful ingredients, and banning youth-targeted marketing. RESULTS: Between 34% and 72% supported these six policies (disagreed 6-24%; no opinion 18-38%). We found higher support for policies to protect youth (prohibit sales to youth and youth-targeted marketing) and to require labeling e-cigarette constituents (nicotine and harmful ingredients). Banning the use of flavors in e-cigarettes was the least supported. Overall information exposure predicted lower relative risk of support for three policies (prohibit sales to youth, nicotine and harmful ingredient labeling, addiction warnings). In comparison, contradictory information exposure predicted lower relative risk of support for two policies (prohibit sales to youth, nicotine and harmful ingredient labeling). CONCLUSIONS: Exposure to overall and conflicting information about e-cigarettes in the public sphere is associated with reduced support for certain proposed e-cigarette policies. These findings are important for policymakers and tobacco control advocates involved in promulgation of e-cigarette policies. The results provide insights on which policies may meet some public resistance and therefore require efforts to first gain public support.

Comparing local TV news with national TV news in cancer coverage: an exploratory content analysis.

The authors compared local TV news with national TV news in terms of cancer coverage using a nationally representative sample of local nightly TV and national network TV (i.e., ABC, CBS, NBC, and CNN) cancer news stories that aired during 2002 and 2003. Compared with national TV news, local TV cancer stories were (a) much shorter in length, (b) less likely to report on cancer prevention (i.e., preventive behaviors and screening tests), and (c) less likely to reference national organizations (i.e., National Cancer Institute, American Cancer Society, National Institutes of Health, Centers for Disease Control and Prevention, Food and Drug Administration) that have made clear recommendations about ways to prevent cancer. The implications of these findings for health communication research and cancer education were discussed.