Predicting college students' COVID-19 vaccination behavior: an application of the extended parallel process model.

The two studies reported in the paper examined (1) the extended parallel process model's (EPPM; Witte 1992) ability to predict and explain college students' COVID-19 vaccination behavior, and (2) the EPPM-related reasons for college students' COVID-19 vaccine hesitancy. Study 1 was a longitudinal study that measured the EPPM constructs at Time 1 and COVID-19 vaccine behavior two months later at Time 2. For danger control, results indicate that perceived threat and perceived efficacy positively predicted intentions and that intentions positively predicted behavior. For fear control, results indicate that perceived threat positively predicted fear, that perceived efficacy did not predict fear, and that fear negatively predicted defensive avoidance, reactance, and fatalism. Study 2 was a cross-sectional survey that assessed EPPM-related reasons for vaccine hesitancy. Results indicate that the main reasons for vaccine hesitancy were related to response efficacy (i.e., participants were concerned about the safety and effectiveness of the vaccine). The theoretical and practical implications of these results are discussed.

College students' influenza vaccine hesitation: a reasoned action investigation with quantitative and qualitative data.

This two-wave longitudinal study (performed pre-COVID), using both quantitative and qualitative data, investigated college students' influenza vaccine hesitancy and confidence using the theory of planned behavior (TPB). At Time 1, college students (n = 277) completed TPB measures and reported past influenza vaccine behavior. At Time 2 (30 days later), participants indicated whether they received the influenza vaccine since Time 1. At Time 2, participants who indicated that they had not received the influenza vaccine since Time 1 also described their most important reasons for not doing so. The TPB model fit the quantitative data well; direct paths from attitude and norms to intention, and from intention to future behavior, were strong and significant. The TPB model explained 71% of the variance in intention and 28% of the variance in future behavior. Neither perceived behavioral control nor past behavior improved the model's ability to predict intentions or future behavior. From the qualitative data, participants' reasons for not getting vaccinated focused on perceived behavioral control (e.g., time cost) and attitudes (e.g., unimportance and low susceptibility). Theoretical implications for message development are discussed.

Understanding Online Health Risk Information Seeking and Avoiding during the COVID-19 Pandemic.

This study tested the utility of the Risk Information Seeking and Processing (RISP) model in understanding why people seek or avoid online information about COVID-19. Data collected at three different time points (i.e., February, April, and May 2020) showed the measured RISP model constructs explained between 70-78.8% of the variance for information seeking, and between 36.9-62.5% of the variance for information avoiding. Specifically, fear, information insufficiency, and relevant channel beliefs consistently predicted information seeking. Further, information insufficiency and relevant channel beliefs consistently predicted information avoidance. However, fear had no association with information avoidance. Longitudinally, the study found that within individuals, there were larger increases in most RISP model constructs between Time 1 and Time 2, and smaller changes occurred from Time 2 to Time 3. However, there was no significant change in information seeking over time.

Pot Song as a Novel Cancer Communication Intervention: Lessons Learned from Developing, Implementing, and Evaluating a Culturally Grounded Intervention for Breast Cancer Education in Rural Bangladesh.

Targeted public education may offer an approach to achieving more effective treatment in countries like Bangladesh, where breast cancer is a leading cause of cancer death in women. Effective cancer education interventions address the target population's cultural and contextual needs. However, there is little published literature to guide the development of educational cancer interventions in a region where lack of resources combined with cultural stigma about cancer contribute to poor breast health outcomes for women. The goal of the current study was to design, test, and evaluate a culturally grounded intervention to promote breast problem care among women in rural Bangladesh. The current manuscript first describes the process of formative evaluation that led to the development of the intervention, including decisions about the audience, message construction, and mode of intervention delivery. Second, we describe the testing process, including process and outcome evaluation. Finally, we describe the lessons learned from the process. We conclude with recommendations related to cultural grounding for message development, questionnaire design, data collection procedures, and analysis.

An Application of the Risk Information Seeking and Processing Model in Understanding College Students' COVID-19 Vaccination Information Seeking and Behavior.

This study tested the utility of risk information seeking and processing (RISP) model in understanding college students' information seeking about COVID-19 vaccines and their vaccination behavior. Participants (N = 158) completed a survey measuring the RISP constructs at Time 1 and their COVID-19 vaccination behavior at Time 2. The RISP model explained 71.1% of the variance in COVID-19 vaccine information seeking. Risk information seeking and attitude toward the COVID-19 vaccine positively influenced college students' intentions to get the vaccine, which positively predicted their vaccination behavior. Overall, these variables explained 33.4% of the variance in COVID-19 vaccine intention, and 37.2% of the variance in COVID-19 vaccination behavior.

The Effects of Perceived Threat and Efficacy on College Students' Social Distancing Behavior during the COVID-19 Pandemic.

This study was conducted to determine the impact of perceived threat and efficacy on college students' social-distancing behavior during COVID-19 pandemic. Guided by the extended parallel process model (EPPM), this longitudinal study included 164 participants who completed a survey at two points in time. Results were consistent with previous theory and research for all danger control hypotheses (i.e., perceived threat predicted fear, fear and self-efficacy predicted intention, and intention predicted future behavior). For fear control, however, results were inconsistent with EPPM predictions, but consistent with previous research (i.e., fear was either unrelated or inversely related to fear control, and efficacy was inversely related to fear control). Overall, the EPPM constructs explained 69% of the variance in intention, 64% of the variance in behavior, 55% of the variance in defensive avoidance, and 20% of the variance in message derogation. The theoretical and practical insights and implications of these findings are discussed.

"Fear the Flu, Not the Flu Shot": A Test of the Extended Parallel Process Model.

This study investigates the effects of manipulated threat and efficacy on college students' attitudes, intentions, and behavior toward receiving the influenza vaccine (flu shot). Meta-analysis results indicate that during the nearly 70-year history of fear-appeal research, as few as six studies have orthogonally manipulated threat and efficacy, randomly assigned participants to conditions, and included a behavioral dependent variable. While there may be several practical reasons for this, it is problematic theoretically. The primary goal of this study is to add to this small but important body of literature. We tested the Extended Parallel Process Model, utilizing a 2 (high threat/low threat) × 2 (high efficacy/low efficacy) between-subjects design with random assignment to conditions. Dependent variables were attitudes and intentions regarding the flu shot (measured immediately after reading the message at Time 1) and flu shot behavior (measured 30 days later at Time 2). Results indicate that participants in the high threat condition reported greater perceived severity, susceptibility, and fear than participants in the low threat condition; and that that participants in the high-efficacy condition reported greater self-efficacy and response-efficacy than individuals in the low efficacy condition. Nonetheless, the predicted threat × efficacy interaction was not observed for attitude, intention, or behavior. Instead, there was a main effect for efficacy (but not threat) on attitudes and intentions, and no effect for either efficacy or threat on behavior. The theoretical and practical implications of these findings are discussed.

When Do Friends Prevent Friends from Hooking Up Intoxicated? An Examination of Sex Differences and Hypothetical Intoxication in Peer Interventions.

Despite the risks involved when mixing alcohol with casual sexual activity, the majority of college students engage in hookups, and the majority of those hookups involve alcohol. This study focused on the protective role college students' peers can play and the situational factors that might influence their willingness to intervene when a close friend is about to hook up intoxicated. Drawing on the theory of planned behavior (TPB), this study investigated differences in students' (N = 1270) attitudes, norms, perceived behavioral control, and intentions to persuade a close friend not to engage in a hypothetical drunken hookup using a 2 (friend sex) × 2 (participant sex) × 2 (sober/intoxicated) factorial design. Results indicated significant differences in the TPB variables. Participants intended to intervene with female friends, but not male friends, and women were more likely to intervene than men. Participants in the sober condition had stronger intentions to intervene than those in the intoxicated condition, but this effect was driven by increases in men's intentions when sober. Implications for theory and prevention programming are discussed.

Theory-Based Formative Research on an Anti-Cyberbullying Victimization Intervention Message.

Cyberbullying is a common byproduct of the digital revolution with serious consequences to victims. Unfortunately, there is a dearth of empirically based methods to confront it. This study used social cognitive theory to design and test an intervention message aimed at persuading college students to abstain from retaliation, seek social support, save evidence, and notify authorities-important victim responses identified and recommended in previous research. Using a posttest-only control group design, this study tested the effectiveness of an intervention message in changing college students' perceived susceptibility to and perceived severity of cyberbullying as well as their self-efficacy, response efficacy, attitudes, and behavioral intentions toward each recommended response in future episodes of cyberbullying. Results indicated that the intervention message caused participants in the experimental condition to report significantly higher susceptibility, but not perceived severity, to cyberbullying than those in the control condition. The intervention message also caused expected changes in all outcomes except self-efficacy for not retaliating and in all outcomes for seeking social support, saving evidence, and notifying an authority. Implications for message design and future research supporting evidence-based anti-cyberbullying health communication campaigns are discussed.

Outcome evaluation results of school-based cybersafety promotion and cyberbullying prevention intervention for middle school students.

Guided largely by the Extended Parallel Process Model, the Arizona Attorney General's Social Networking Safety Promotion and Cyberbullying Prevention presentation attempts to shape, change, and reinforce middle school students' perceptions, attitudes, and intentions related to these important social issues. This study evaluated the short-term effects of this presentation in a field experiment using a posttest-only control-group design with random assignment to conditions. A total of 425 sixth, seventh, and eighth graders at a public middle school in a large Southwestern city participated in this study. Results reveal several interesting trends across grade levels regarding cyberbullying perpetration and victimization, and concerning access to various communication technologies. The intervention had the hypothesized main effect on eight of the dependent variables under investigation. Examination of condition by grade interaction effects offered further support for an additional four hypotheses (i.e., the intervention positively affected or reversed a negative trend on four dependent variables in at least one grade). Ideas and implications for future social networking safety promotion and cyberbullying prevention interventions are discussed.

What Influences the Credibility of Printed Nutrition Education Materials?

Objectives: In this study, we aimed to determine the influence of aesthetics and color of printed nutrition education materials on perceived credibility of the material content. Methods: A randomized 2 x 2 (aesthetics and color) factorial experimental design was completed on a university campus. Undergraduate and graduate students (N=204) were randomly assigned one of 4 types of flyers (high aesthetic-color, high aesthetic-black-and-white, low aesthetic-color, and low aesthetic-black-and-white). Perceptions on the flyer content (accurate, believable, biased, valuable, and trustworthy), perceptions of overall flyer quality (attractive, pleasant, confusing, and interesting), and knowledge of the content within the flyer were assessed via a survey after reading the flyer. Results: A statistically significant main effect of aesthetics was observed for perceived "trustworthiness" of the flyer information (p = .048). Flyers with high aesthetics, regardless of print color, had a higher mean score of "trustworthiness" (M = 6.01) than flyers with low aesthetics (M = 5.71). An interaction effect was seen for perception of the flyer being "confusing" (p = .02). The high aesthetic-black-and-white flyer had the highest mean score for "confusing" (M = 1.66) with the low aesthetic flyer printed in color having the second highest mean score for "confusing" (M = 1.56). Conclusions: The aesthetics of nutrition education materials appear to influence perceived trustworthiness of those materials.

Predicting pediatricians' communication with parents about the human papillomavirus (hpv) vaccine: an application of the theory of reasoned action.

This study examines the ability of the theory of reasoned action (TRA) and the theory of planned behavior (TPB) to predict whether or not pediatricians encourage parents to get their adolescent daughters vaccinated against the human papillomavirus (HPV). Four-hundred and six pediatricians completed a mail survey measuring attitudes, subjective norms, perceived behavioral control, intentions, and behavior. Results indicate that pediatricians have positive attitudes, subjective norms, and perceived behavioral control toward encouraging parents to get their daughters vaccinated, that they intend to regularly encourage parents to get their daughters vaccinated against HPV in the next 30 days, and that they had regularly encouraged parents to get their daughters vaccinated against HPV in the past 30 days (behavior). Though the data were consistent with both the TRA and TPB models, results indicate that perceived behavioral control adds only slightly to the overall predictive power of the TRA, suggesting that attitudes and norms may be more important targets for interventions dealing with this topic and audience. No gender differences were observed for any of the individual variables or the overall fit of either model. These findings have important theoretical and practical implications for the development of health communication messages targeting health care providers in general, and for those designed to influence pediatricians' communication with parents regarding the HPV vaccine in particular.

Human papillomavirus vaccine administration behaviors and influences among Arizona pharmacists and pharmacy interns.

This study assessed 27 Arizona community pharmacists' and pharmacy interns' human papillomavirus (HPV) vaccine administration behaviors and influences. We recruited community pharmacists and pharmacy interns from a statewide pharmacy conference to complete a 40-item cross-sectional survey. Informed by the Theory of Planned Behavior, the survey assessed pharmacists' HPV vaccine-related behaviors, intentions, attitudes, subjective norms, and perceived behavioral control to vaccinate against HPV. We analyzed all data using descriptive statistics and correlations. Overall, most pharmacists held positive attitudes about the HPV vaccine. However, the majority rarely administered the HPV vaccine. Intentions to vaccinate and subjective norms positively correlated with vaccine administration behavior. Pharmacists' positive attitudes about the vaccine, subjective norm to vaccinate, and behavioral control or self-efficacy to recommend the vaccine impacted their intentions to vaccinate against HPV. Most surveyed pharmacists believed that the most substantial HPV vaccine administration barriers include parental consent and parental stigma against the vaccine. The most common pharmacy-related barrier was the lack of a tracking and reminder system to encourage patients to return for additional HPV vaccine doses. This work highlights the need to increase public awareness that pharmacists can administer vaccines to adolescents. Study authors recommend offering communication training to increase pharmacists' perceived behavioral control to recommend the HPV vaccine.

The relationship between parents' verbal aggression and young adult children's intimate partner violence victimization and perpetration.

This study examines the relationships between perceived and self-reported parent verbal aggression and their young adult children's intimate partner violence (IPV) victimization and perpetration. Two hundred undergraduate students completed an in-person self-administered survey measuring IPV victimization and perpetration, as well as perceived parent verbal aggression. Three-hundred and eighty-six mail surveys were also sent to their parents; 79% of parents returned the surveys. Results indicate that perceived mother and father verbal aggression was related to higher levels of victimization and perpetration across several forms of IPV for both daughters and sons. The data appear to support theory that suggests parents of the same sex as their children are stronger models for aggressive behavior (Bandura, 1986). In addition, there were some differences in perceived and self-reported data for ratings of parent verbal aggression. Results of this investigation indicate that perceived parent communication has a significant impact on young adult children's victimization and perpetration of violence in intimate partner relationships. The findings also suggest that interventions aimed at developing and enhancing parent communication skills can help prevent or reduce the risk of young adult children becoming involved in violent relationships, as well as reducing risk factors for other adverse health problems.

Persuading physicians to test their patients' level of kidney functioning: the effects of message frame and point of view.

A two-part field experiment was conducted to determine the effects of message frame (gain vs. loss) and point of view (personal vs. impersonal) on physicians' intentions and behavior to test their patients' level of kidney functioning. One hundred and fifty-one physicians returned a survey that accompanied one of four different experimental cover letters or a generic control letter. One hundred and twelve (74%) of these physicians also completed and returned a follow-up survey sent approximately 4 months later. Physicians who received a letter (vs. the generic-letter control group) believed their patients were more susceptible to kidney disease, believed that kidney disease had more severe consequences, and also demonstrated greater intentions and behavior to test their patients' level of kidney functioning. Additionally, there was a significant frame by point of view interaction effect, in that physicians receiving the gain-framed personal letter or the loss-framed impersonal letter demonstrated greater intentions and behavior than physicians receiving other versions of the letter. These results extend the theoretical scope of the EPPM by suggesting that threat to other can motivate behavior change, and also can have significant practical application for the development of messages targeting physicians.

The Short-term Effects of a Cyberbullying Prevention Intervention for Parents of Middle School Students.

This study experimentally evaluated the short-term effects of the Arizona Attorney General's cybersafety promotion presentation, a key component of which is cyberbullying prevention. Fifty-one parents of children attending a middle school in the southwestern United States participated in the study. Results reveal parents who viewed the presentation believed their children to be more susceptible to cyberbullying, and indicated that they were more likely to talk to their children about saving evidence, not retaliating, and telling an adult compared to parents who had not viewed the presentation. The theoretical and practical implications of these results are discussed.

Predicting substance-abuse treatment providers' communication with clients about medication assisted treatment: a test of the theories of reasoned action and planned behavior.

The purpose of this investigation is to determine if the theory of reasoned action (TRA) and theory of planned behavior (TPB) can retrospectively predict whether substance-abuse treatment providers encourage their clients to use medicated-assisted treatment (MAT) as part of their treatment plan. Two-hundred and ten substance-abuse treatment providers completed a survey measuring attitudes, subjective norms, perceived behavioral control, intentions, and behavior. Results indicate that substance-abuse treatment providers have very positive attitudes, neutral subjective norms, somewhat positive perceived behavioral control, somewhat positive intentions toward recommending MAT as part of their clients' treatment plan, and were somewhat likely to engage in the actual behavior. Further, the data fit both the TRA and TPB, but with the TPB model having better fit and predictive power for this target audience and behavior. The theoretical and practical implications for the developing messages for substance-abuse treatment providers and other health-care professionals who provide treatment to patients with substance use disorders are discussed.

Predicting human papillomavirus vaccine intentions of college-aged males: an examination of parents' and son's perceptions.

OBJECTIVE: To examine male students' and their parents' human papillomavirus (HPV) vaccine communication in relation to males' willingness to discuss the vaccine with their health care provider and the likelihood of being vaccinated. PARTICIPANTS: Dyads (n = 111) of students and parents. METHODS: Participants completed a HPV vaccine survey based on the risk perception attitude framework in 2009. RESULTS: Male students' perceived susceptibility for HPV and self-efficacy to talk to their provider were directly related to their intention to discuss the HPV vaccine, and their intention was directly related to their likelihood of being vaccinated. Parents' perceived self-efficacy to talk to their son and response efficacy of the vaccine were directly related to their intention to talk to their son; however, parents' intention was not related to the likelihood of their son being vaccinated. CONCLUSIONS: College males may benefit from HPV vaccine educational programs that include communication skills training to discuss the HPV vaccine with their parents.