Art Advocacy: Applying a Public Memory Rhetorical Framework to Health Crisis Communication.

Health campaigns and public health messaging strategies often rely on text-based efforts to communicate with audiences. As research grows in the areas of health and visual media, this essay puts a rhetorical framework of public memory in conversation with health campaign communication to show possibilities for audiences who are less likely to be moved by traditional institutional health narratives. The artifact for analysis is an art installation by Domenic Esposito, who in 2018 designed and placed a large scale "Opioid Spoon" at the headquarters of Purdue Pharma in Stamford, Connecticut. After situating public art as an effective way to advance health crisis messaging, we then preview the next phase of this research project that analyzes COVID-19 art as a counterpublic health narrative. We conclude by suggesting future health communication scholarship engage with the intersections of public health art, memory, and advocacy in order to reflect more accurately how communities experience health inequity.

Raising Concussion Awareness among Amateur Athletes: An Examination of the Centers for Disease Control and Prevention's (CDC) Heads Up Campaign.

Attention to concussion prevention and management has grown in recent years due to the potentially long-term, debilitating effects a head injury can have on an individual. Although multiple campaigns have been designed to target this issue, there remains a need to evaluate the persuasive principles used to advocate for safety measures and protocols, specifically within youth sports. With this in mind, we applied the health belief model (HBM) in our content analysis of the Centers for Disease Control and Prevention's (CDC) Heads Up concussion awareness campaign. Campaign videos (N = 35) were coded for threat severity, threat susceptibility, benefits, barriers, self-efficacy, and cues to action. The majority of videos communicated the seriousness of concussions and attempts to communicate concussion susceptibility were driven by personal stories, rather than facts and statistics demonstrating concussion prevalence. Less than half of the videos communicated the benefits of following concussion protocols and only a third of the messages described barriers to following recommended protocols. The majority of videos aimed to elevate self-efficacy among athletes and parents, but not coaches, by focusing on identifying symptoms and concussion avoidance. The implications for concussion prevention and management among athletes, parents, and coaches are discussed.

A Social Ties-based Approach to Breast Cancer Patients' Quality of Life: Examining Group Ties and Individual Ties across Offline and Online Settings.

Supportive social ties positively impact cancer patients' health; however, little is known about the intertwined links between both offline and online ties, and individual and group ties. Using the common-identity/common-bond approach, we empirically tested the critical difference that individual and group ties exert on health across offline and online settings. Results from 356 female breast cancer patients showed group ties affect quality of life through sequential group identification and social support, while individual ties affect quality of life through sequential interpersonal bonds and social support. Offline group and online individual ties are stronger predictors of quality of life than online group and offline individual ties. A cluster analysis categorized participants into four distinguishable segments. People with stronger offline interpersonal bonds and online group identification reported a better quality of life. This offers insight into the social dynamics that are most consequential for health, and the potential theoretical pathways through which they operate.

Promoting Patient Portals: An Application of Social Cognitive Theory to Post-Adoption Patient Portal Use.

Many healthcare clinics encourage the use of online patient portals so that patients can have easier access to their health information, yet some patients are hesitant to interact with these portals. We used social cognitive theory to develop and test a theoretically grounded model that incorporates several (1) technological factors, (2) individual factors, and (3) social factors that influence individuals' post-adoption, active use of patient portals. Based on cross-sectional survey data from a sample of healthcare clinic patients (N = 431), we found that individuals' severity of illness predicted active use of patient portals and that trust in doctors predicted attitudes toward patient portals. Moreover, attitudes toward patient portals mediated the relationship between technology factors (i.e., perceived usefulness, ease of use, customization, and interactivity), and active use of patient portals. The paper concludes with a discussion of key findings, implications, and directions for future research.

Identifying #addiction concerns on twitter during the COVID-19 pandemic: A text mining analysis.

BACKGROUND: The 2019 Novel Coronavirus (COVID-19) is responsible for thousands of deaths and hospitalizations. To curb the spread of this highly transmissible disease, governments enacted protective guidelines for its citizens, including social distancing and stay-at-home orders. These restrictions on social interactions can be especially problematic for individuals managing or recovering from addiction given that treatment often involves access to services and resources that became limited or even unavailable at this time. Social media sites like Twitter serve as a space for users to post questions and concerns about timely topics and allow for researchers to track common themes among the public. The goal of this study was to identify how the public was discussing addiction on Twitter during the COVID pandemic. Methods: We performed a text mining analysis to analyze tweets that contained "addiction" and "covid" to capture posts from the public that illustrated comments and concerns about addiction during the COVID-19 pandemic. We report on 3,301 tweets captured between January 31 and April 23, 2020. The study was conducted in the United States, but contained tweets from multiple countries. Results: The most prevalent topics had to do with services offered by Acadia Healthcare and Serenity Healthcare Centers, attempts to manage time while home, difficulties of coping with alcoholism amidst rising sales of alcohol, and attention to ongoing health crises (e.g.,., opioids, vaping). Additional topics included affordable telehealth services, research from France on the relationship between nicotine and COVID-19, concerns about gambling addiction, and changing patterns in substance misuse as drug availability varies. Conclusions: Analyzing Twitter content enables health professionals to identify the public's concerns about addiction during the COVID-19 pandemic. Findings from text mining studies addressing timely health topics can serve as preliminary analyses for building more comprehensive models, which can then be used to generate recommendations for the larger public and inform policy.

Health Hyperbolism: A Study in Health Crisis Rhetoric.

The Ebola virus had only been in the United States for 2 months before it became a major national health concern. However, while some citizens panicked about the looming health crisis, others remained calm, offering explanations for why a rapid spread of the virus was unlikely. Examining the distinctions between these different reactions can contribute to a better understanding of the coping strategies citizens use when facing a health crisis. We consider how citizens respond to fear by focusing on whether or not hyperbolic rhetoric was used as a means for processing and managing fear. Approximately 400 tweets and Facebook posts from the Centers for Disease Control and Prevention, the White House, and The Alex Jones Show were examined to make conclusions about how citizens respond to messages from these mediated forums. At the intersection of health communication and critical rhetoric, we advance an operational definition of health hyperbolism derived from public response to opinion leaders. Ultimately, we find that health hyperbolism contains language illustrative of distrust, blame, anger, misrepresentation, conspiracy, and curiosity.

A text-mining analysis of the public's reactions to the opioid crisis.

BACKGROUND: Opioid abuse has become an epidemic in the United States. On August 25, 2016, the former Surgeon General of the United States sent an open letter to care providers asking for their help with combatting this growing health crisis. Social media forums like Twitter allow for open discussions among the public and up-to-date exchanges of information about timely topics like opioids. Therefore, the goal of the current study is to identify the public's reactions to the opioid epidemic by identifying the most popular topics tweeted by users. METHODS: We used a text-miner, algorithmic-driven statistical program to capture 73,235 original tweets and retweets posted within a two-month time span (August 15, 2016 through October 15, 2016). All tweets contained references to "opioids," "turnthetide," or similar keywords. We then analyzed the sets of tweets to identify the most prevalent topics. RESULTS: The most discussed topics had to do with public figures addressing opioid abuse, creating better treatment options for teen addicts, using marijuana as an alternative for managing pain, holding foreign and domestic drug makers accountable for the epidemic, promoting the "Rx for Change" campaign, addressing double-standards in the perceptions and treatment of Black and White opioid users, and advertising opioid recovery programs. CONCLUSIONS: Twitter allows users to find current information, voice their concerns, and share calls for action in response to the opioid epidemic. Monitoring the conversations about opioids that are taking place on social media forums like Twitter can help public health officials and care providers better understand how the public is responding to this health crisis.

HealthyhornsTXT: A Text-Messaging Program to Promote College Student Health and Wellness.

OBJECTIVE: Text-messaging interventions positively affect health behaviors, but their use on college campuses has been limited. Text messaging serves as a relatively affordable way to communicate with large audiences and is one of the preferred modes of communication for young adults. This study examined the feasibility and acceptability of a campus-wide, health text-messaging program. PARTICIPANTS: The subscriber pool consisted of approximately 6,000 undergraduate students from a large, southern university. From that pool, 1,095 participants (64% female; 41% White) completed a posttest survey. METHOD: Text messages covered a range of health topics and information about campus resources. Research was conducted from August through December 2015. Process data were collected throughout the semester; participants' attitudes were assessed via an online survey at the program's conclusion. RESULTS: Students demonstrated engagement with the messages throughout the semester as evidenced by replies to text-back keywords and clicks on website links embedded within messages. Messages about sleep, stress management, and hydration were considered most relevant. The majority of participants (61%) reported increased awareness regarding their health. CONCLUSIONS: Text-messaging interventions are a feasible strategy to improve college student health.

Public reactions to e-cigarette regulations on Twitter: a text mining analysis.

BACKGROUND: In May 2016, the Food and Drug Administration (FDA) issued a final rule that deemed e-cigarettes to be within their regulatory authority as a tobacco product. News and opinions about the regulation were shared on social media platforms, such as Twitter, which can play an important role in shaping the public's attitudes. We analysed information shared on Twitter for insights into initial public reactions. METHODS: A text mining approach was used to uncover important topics among reactions to the e-cigarette regulations on Twitter. SAS Text Miner V.12.1 software was used for descriptive text mining to uncover the primary topics from tweets collected from May 1 to May 17 2016 using NUVI software to gather the data. RESULTS: A total of nine topics were generated. These topics reveal initial reactions to whether the FDA's e-cigarette regulations will benefit or harm public health, how the regulations will impact the emerging e-cigarette market and efforts to share the news. The topics were dominated by negative or mixed reactions. CONCLUSIONS: In the days following the FDA's announcement of the new deeming regulations, the public reaction on Twitter was largely negative. Public health advocates should consider using social media outlets to better communicate the policy's intentions, reach and potential impact for public good to create a more balanced conversation.

Toward a Better Understanding of Patient Health Literacy: A Focus on the Skills Patients Need to Find Health Information.

While many health literacy assessments exist, this area of research lacks an instrument that isolates and reflects the four components driving this concept (abilities to find, understand, use, and communicate about health information). The purpose of this study was to determine what abilities comprise the first component, how a patient finds health information. Low ( n = 13) and adequate ( n = 14) health literacy patients, and health professionals ( n = 10) described their experiences when looking for health information and the skills they employed to complete these tasks. Major skills/themes elicited included knowing when to search, credibility assessments, finding text and numerical information, interpersonal seeking, technology and online search, and spatial navigation. Findings from this study suggest that each of the dimensions included in the definition of health literacy warrants specific attention and assessment. Given identification of the skills comprising each dimension, interventions targeting deficits across health literacy dimensions could be developed to improve patient health.

Targeting Type 2: Linguistic Agency Assignment in Diabetes Prevention Policy Messaging.

We explored the effects of linguistic agency assignment on the persuasive impact of a fictitious medical journal editorial about Type 2 diabetes. Participants (N = 422) read 1 of 4 versions of an editorial that differed in the language used to describe the health threat posed by the disease (threat agency) and to outline a program for preventing it (prevention agency). Threat agency was assigned either to the disease (e.g., diabetes puts individuals' lives at risk) or to humans (e.g., individuals who acquire diabetes put their lives at risk). Prevention agency was assigned either to the recommended prevention behaviors (e.g., a healthy diet and regular exercise protect children from Type 2) or to humans (e.g., children who eat a healthy diet and exercise regularly protect themselves from Type 2). Respondents' perceptions of disease severity were higher when threat agency was assigned to diabetes rather than humans. However, attitudes toward the proposed prevention program were higher when prevention agency was assigned to humans rather than to the recommended behaviors. The latter finding contrasts with agency effects observed in previous research on a viral threat, suggesting that the optimal pattern of agency assignment in prevention messaging may be different for acute and chronic lifestyle diseases.

Communication About Problematic Drinking Between Young Adults and their Parents: An Application of Inconsistent Nurturing as Control Theory.

Approximately 80% of college students drink, half of whom consume alcohol in the form of binge drinking. The current study applies Inconsistent Nurturing as Control Theory to examine the communication about excessive drinking that takes place between parents and their young adult children. Forty college students were asked to report on a moment or incident that led their parents to label their drinking as concerning and were then asked to report on how their parents acted towards the drinking before and after the moment of labeling. Interviews were transcribed and coded. The findings suggest that parents act with inconsistency when attempting to manage their children's drinking by enacting both reinforcing and punishing behaviors. Parents' reinforcing behaviors included drinking with their children and buying them alcohol, even after labeling the drinking as problematic. Parents' punishment behaviors included expressing concern about their children's sense of responsibility and making their children feel regretful about their drinking. Nearly 88% of the participants were able to recall the moment at which their parents labeled their drinking as problematic. Implications for using inconsistent messages in conversations about alcohol are discussed.

Developing a Communication Curriculum and Workshop for an Internal Medicine Residency Program.

OBJECTIVES: Learning effective communication is essential for physicians. Effective communication has been shown to affect healthcare outcomes, including patient safety, adherence rates, patient satisfaction, and enhanced teamwork. The importance of these skills has become even more apparent in recent years, with value-based purchasing programs and federal measures of patient satisfaction in the form of Hospital Consumer Assessment of Healthcare Providers and Systems scores becoming an important part of measuring the performance of a healthcare facility. METHODS: We conducted a communication workshop for internal medicine residents at the University of Texas. Topics covered included the Acknowledge, Introduce, Duration, Explanation, Thank You framework; managing up; resolving conflicts; error disclosure; new medication and discharge counseling; intercultural communication; understanding Hospital Consumer Assessment of Healthcare Providers and Systems scores; and avoiding burnout. Because it would have been logistically difficult to block whole days for the workshop, the various topics were offered to residents during their regular noon conference hour for several consecutive days. After the workshop, the residents completed an anonymous questionnaire regarding their perception of the importance of various aspects of communication in patient care. RESULTS: The majority of the participating residents perceived the various communication skills explored during the workshop to be highly important in patient care. Concurrently, however, most residents believed that they had initially overestimated their knowledge about these various communication issues. Some demographic differences in the responses also were noted. CONCLUSIONS: Our findings demonstrate a needs gap and an area of potential improvement in medical education. We anticipate that with the growing understanding of the importance of communication skills in the healthcare setting, there will be an enhanced role for teaching these skills at all levels of medical education. More studies are needed to further elucidate the specific areas of communication in health care where additional training is necessary.

Impact of trained champions of comprehensive school physical activity programs on school physical activity offerings, youth physical activity and sedentary behaviors.

OBJECTIVE: A quasi-experimental cluster-controlled design was used to test the impact of comprehensive school physical activity program (CSPAP) professional development on changes in school physical activity (PA) offerings, moderate-to-vigorous physical activity (MVPA) and sedentary behaviors of 9-14 year-old children during school. METHODS: Two groups of Louisiana elementary and middle school physical education teachers (N=129) attended a CSPAP summer workshop (95 in 2012=intervention, 34 in 2013=control) and were assessed on school PA offerings (teacher-reported; pre, mid, and post). During the 2012-2013 school year, intervention teachers received CSPAP support while implementing new school PA programs. MVPA and sedentary behaviors were assessed (accelerometry; baseline and post) on a sample of 231 intervention, 120 control students from 16 different schools. RESULTS: Multivariate analysis of covariance indicated that intervention teachers reported significantly more PA offerings during school (3.35 vs. 2.37) and that involve staff (1.43 vs. 0.90). Three-level, mixed model regressions (stratified by sex) indicated that students overall spent less time in MVPA and more time being sedentary during school, but the effects were significantly blunted among intervention students, especially boys. CONCLUSIONS: This study provides preliminary evidence for CSPAP professional development programs to influence school-level PA offerings and offset student-level declines in MVPA and increases in sedentary behavior.

VII. The history of physical activity and academic performance research: informing the future.

The study of physical activity, physical fitness, and academic performance research are reviewed from a historical perspective, by providing an overview of existing publications focused on children and adolescents. Using rigorous inclusion criteria, the studies were quantified and qualified using both meta-analytic and descriptive evaluations analyses, first by time-period and then as an overall summary, particularly focusing on secular trends and future directions. This review is timely because the body of literature is growing exponentially, resulting in the emergence of new terminology, methodologies, and identification of mediating and moderating factors. Implications and recommendations for future research are summarized.

Tailored texts: An application of regulatory fit to text messages designed to reduce high-risk drinking.

This study used the regulatory focus/fit framework to compare the impact of text message wording on college students' drinking behaviors. In this 2 × 3 × 2 pre-test/post-test experiment, participants (N = 279) were randomly assigned to one of the three groups: messages matching regulatory focus (congruent group), messages mismatching regulatory focus (incongruent group), and general health messages (control group). Messages were tailored by regulatory fit (prevention-oriented or promotion-oriented). Mixed factorial analyses of covariance revealed that prevention-oriented individuals who received text messages incongruent with their regulatory focus reported drinking alcohol for more hours and were more likely to consume a higher quantity of drinks than participants in the congruent or control group. These findings suggest that health messages mismatched to a receiver's regulatory focus might exacerbate unhealthy behavior.

Reactions to foodborne Escherichia coli outbreaks: A text-mining analysis of the public's response.

Foodborne illnesses caused by bacteria are being reported at an increasing rate in the United States. We performed a text-mining analysis to look at nearly 13,000 tweets from two foodborne Escherichia coli outbreaks in 2018. Concerns from the public included staying informed about contaminated lettuce, recognizing signs of infection, and holding responsible farms accountable. At the end of the second outbreak, comments were focused on assessing symptoms, using the traceback process to locate outbreak sources, and calling for better food labeling practices.

E-Cigarette Topics Shared by Medical Professionals: A Comparison of Tweets from the United States and United Kingdom.

Medical professionals are now relying on social media platforms like Twitter to express their recommendations for the use or avoidance of products like electronic cigarettes (e-cigs), which may have long-term health consequences for users. The goal of this study is to compare how physicians from the United States and the United Kingdom talk about e-cigs on Twitter and identify the topics that these groups perceive as salient. Comparing tweets from the U.S. and U.K. will allow for a better understanding of how medical professionals from these countries differ in their attitudes toward e-cigs. This information can be also used to inform policies designed to regulate the use of e-cigs. Using a text-mining program, we analyzed approximately 3,800 original tweets sent by physicians from the U.S. and the U.K. within a 1-year time span (June 2015 through June 2016). The program clustered the tweets by topics, which allowed us to categorize the topics by importance. Both sets of tweets contained debates about the degree to which e-cigs pose a threat to health, but the U.S. tweets emphasized the dangers of e-cig use for teens, while the U.K. tweets focused more on the potential that e-cigs have to be used as a smoking cessation aid. Doctors are using Twitter to share timely information about the potential risks, benefits, and regulations associated with e-cigs. Evaluating these tweets allows researchers to collect information about topics that doctors find important and make comparisons about how medical professionals from the U.S. and the U.K. regard e-cigs.

Prompting participation in health: Fostering favorable attitudes toward personal health records through message design.

OBJECTIVE: Personal health records (PHRs) offer many benefits. However, a relatively small amount of individuals take advantage of PHRs. This study examined how message composition influences attitudes toward electronic PHRs. METHODS: Participants (N=329) were randomly assigned to read one of two fictitious editorials proposing that all patients have PHRs. One version assigned linguistic agency (capacity for action) to PHRs (e.g.,PHRs can guard against long-term health problems) and the other to humans (e.g.,people can guard themselves against long-term health problems). RESULTS: One-way analyses of variance revealed significant main effects of agency on perceptions of PHR benefits. Respondents reported feeling more comfortable using PHRs and perceived them as more effective at protecting patients when agency was assigned to PHRs rather than to humans. CONCLUSION: Messages with PHRs as the primary acting agents elicited favorable reactions about PHR use. Patients may be more willing to engage with this technology if the emphasis is put on what PHRs can do for patients. PRACTICE IMPLICATIONS: Providers and staff can make strategic choices about wording when discussing PHRs and healthcare. Attention to linguistic agency can help providers better engage patients in discussions about this topic and enable patients to become more proactive.

Health Promotion Efforts as Predictors of Physical Activity in Schools: An Application of the Diffusion of Innovations Model.

BACKGROUND: Implementing a comprehensive school physical activity program (CSPAP) effectively addresses public health issues by providing opportunities for physical activity (PA). Grounded in the Diffusion of Innovations model, the purpose of this study was to identify how health promotion efforts facilitate opportunities for PA. METHODS: Physical and health education teachers (N = 256) nationwide were surveyed using a CSPAP Index to identify teacher's efforts for providing opportunities for PA within a school setting. RESULTS: A hierarchical regression analysis revealed total number of PA opportunities was significantly predicted by teachers' health promotion efforts, p < .001. Sex and years of experience were not significant covariates, p = .35, in the final step of the model. Accounting for teaching environments, the model was significant, p < .001. The strongest predictors were the promotional efforts of PA for family and community, p < .001, PA for staff members, p < .01, PA during the school day, p < .05, and PA before school, p < .05. CONCLUSIONS: To increase PA opportunities for children in schools, emphasis should be placed on health promotion. This study confirms the importance of teachers involving family, community, and staff members as co-health promoters when trying to increase PA engagement surrounding schools.