PRISM and Emotions: Understanding the Role of Fear and Hope toward Vaccine Information Seeking Intentions.

Vaccines represent one of the greatest health efforts to help combat diseases, yet they often evoke emotional responses among individuals. These emotional responses can influence an individual's desire to seek information about vaccines. The purpose of this research was to examine these relationships further using the Planned Risk Information Seeking Model (PRISM) and explore the role of emotions, specifically fear and hope, on vaccine-related information seeking intentions. Two separate models were tested using the PRISM model, one for fear and one for hope. Results suggest fear did not have a significant direct effect on vaccine information seeking, while hope had a positive and significant relationship. Interestingly, both attitude toward seeking and perceived current knowledge each had a positive relationship with information seeking intentions in the fear and hope models. Future research should continue to examine the role of specific emotions within the PRISM model to better predict information seeking intentions.

Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging.

BACKGROUND: As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages. OBJECTIVE: Recognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages. METHODS: We conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads. RESULTS: Of the 711 messages coded from the 384 messaging threads, 52.5% (373/711) were sent by patients and 47.5% (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6%, 308/373 vs 89.1%, 301/338), were neutral in tone (70.2%, 262/373 vs 82.0%, 277/338), and respectful in nature (25.7%, 96/373 vs 33.4%, 113/338). Secure messages from health care team members sometimes appeared hurried (25.4%, 86/338) but also displayed friendliness or warmth (18.9%, 64/338) and reassurance or encouragement (18.6%, 63/338). Most patient messages involved either providing or seeking information; however, the majority of health care team member messages involved information provision in response to patient questions. CONCLUSIONS: This evaluation is an important step toward understanding the content and socioemotional tone that is part of the secure messaging exchanges between patients and health care team members. Our findings were encouraging; however, there are opportunities for improvement. As health care organizations seek to supplement traditional encounters with virtual care, they must reexamine their use of secure messaging, including the patient centeredness of the communication, and the potential for more proactive use by health care team members.

African American Veterans Storytelling: A Multisite Randomized Trial to Improve Hypertension.

BACKGROUND: Disparities in hypertension control persist for African American Veterans. OBJECTIVE: To enhance cultural relevance of hypertension control self-management education, in a multisite, stratified randomized trial, we tested an interactive Veteran-to-Veteran storytelling digital video disk (DVD) intervention created with Veteran partners, versus an education-only DVD comparison. METHODS: At 3 VA facilities, African American Veterans with uncontrolled hypertension were randomized to storytelling DVD intervention or didactic comparison DVD and followed for 6 months. We hypothesized that follow-up blood pressure (BP) would be lower among Veterans in the intervention group. RESULTS: African American Veterans (N=619) were 92% male, 39% over age 65, most had a high-school education, over 50% of both the intervention and comparison group reported a household income of <$20,000, and 40% had less than adequate health literacy. At baseline, mean intervention and comparison group BPs were 138/80 and 139/81 mm Hg, respectively; at 6 months, mean systolic BP (SBP) increased by 0.1 in the intervention group and by 1.9 for the comparison group; diastolic BP fell by 0.1 in the intervention group and rose by 0.2 in the comparison group. No differences between the intervention and control groups were statistically significant (all P>0.3). Site differences were large; at one, the intervention group improved while the comparison groups deteriorated, resulting in 6.3 and 3.9 mm Hg more improvement for the intervention group in SBP and diastolic BP (P=0.06 and 0.04), respectively; at the other 2 sites, there were positive and negative changes, all small, in the 2 measures, with minimal differences-one site favored the comparison group and the other, the intervention (these comparisons did not approach statistical significance (all P>0.20). In a secondary analysis stratified by baseline BP, there was no intervention effect among those with uncontrolled BP, but intervention patients who were in control at baseline were more likely to stay in control, compared with comparison [SBP increase by 6.3 mm Hg (SD=14.4) among intervention, and by 10.9 mm Hg (SD=16.9) in comparison, P=0.02]. CONCLUSIONS: In this multisite trial, we did not find a significant overall storytelling intervention effect (Clinicaltrials.gov Reg. #NCT01276197).

Smoking Status and Pain Intensity Among OEF/OIF/OND Veterans.

OBJECTIVE: Pain and smoking are highly prevalent among Veterans. Studies in non-Veteran populations have reported higher pain intensity among current smokers compared with nonsmokers and former smokers. We examined the association of smoking status with reported pain intensity among Veterans of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). DESIGN: The sample consisted of OEF/OIF/OND Veterans who had at least one visit to Veterans Affairs (2001-2012) with information in the electronic medical record for concurrent smoking status and pain intensity. The primary outcome measure was current pain intensity, categorized as none to mild (0-3); moderate (4-6); or severe (≥7); based on a self-reported 11-point pain numerical rating scale. Multivariable logistic regression analyses were used to assess the association of current smoking status with moderate to severe (≥4) pain intensity, controlling for potential confounders. RESULTS: Overall, 50,988 women and 355,966 men Veterans were examined. The sample mean age was 30 years; 66.3% reported none to mild pain; 19.8% moderate pain; and 13.9% severe pain; 37% were current smokers and 16% former smokers. Results indicated that current smoking [odds ratio (OR) = 1.29 (95% confidence intervals (CI) = 1.27-1.31)] and former smoking [OR = 1.02 (95% CI = 1.01-1.05)] were associated with moderate to severe pain intensity, controlling for age, service-connected disability, gender, obesity, substance abuse, mood disorders, and Post Traumatic Stress Disorder. CONCLUSIONS: We found an association between current smoking and pain intensity. This effect was attenuated in former smokers. Our study highlights the importance of understanding reported pain intensity in OEF/OIF/OND Veterans who continue to smoke.

Health information-seeking on behalf of others: characteristics of "surrogate seekers".

Understanding the behaviors of surrogate seekers (those who seek health information for others) may guide efforts to improve health information transmission. We used 2011-2012 data from the Health Information National Trends Survey to describe behaviors of online surrogate seekers. Respondents were asked about use of the Internet for surrogate-seeking over the prior 12 months. Data were weighted to calculate population estimates. Two thirds (66.6%) reported surrogate-seeking. Compared to those who sought health information online for only themselves, surrogate seekers were more likely to live in households with others (weighted percent 89.4 vs. 82.5% of self-seekers; p < 0.05); no significant differences in sex, race, income or education were observed. Surrogate seekers were more likely to report activities requiring user-generated content: email communication with healthcare providers; visits to social networking sites to read and share about medical topics and participation in online health support groups. On multivariate analysis, those who had looked online for healthcare providers were more likely to be surrogate seekers (OR 1.67, 95% CI 1.08-2.59). In addition to seeking health information, surrogate seekers create and pass along communications that may influence medical care decisions. Research is needed to identify ways to facilitate transmission of accurate health information.

The National Cancer Institute's Health Information National Trends Survey [HINTS]: a national cross-sectional analysis of talking to your doctor and other healthcare providers for health information.

BACKGROUND: The need to understand preferred sources of health information remains important to providing patient-centered care. The Internet remains a popular resource for health information, but more traditional sources may still be valid for patients during a recent health need. This study sought to understand the characteristics of patients that turn to their doctor or healthcare provider first for a recent health or medical information need. METHODS: Using the national cross-sectional survey, Health Information National Trend Study [HINTS], characteristics of those who sought a doctor or healthcare provider for a recent health information need were compared to other sources. Weighted survey responses from Cycle 1 and Cycle 2 of the HINTS survey were used for multivariable logistic regression. RESULTS: A total 5,307 patient responses were analyzed. Overall, those who seek a doctor or healthcare provider first for a health need are female, 46-64 years, White non-Hispanic, educated, in good health and users of the Internet. Yet, adjusted logistic regressions showed that those who sought a doctor or healthcare provider first during a recent health information need compared to other sources were most likely to be 65+ years, in poor health, less educated and have health insurance. CONCLUSIONS: Patients who seek their doctor or healthcare provider first for health information rather than other sources of information represent a unique population. Doctors or healthcare providers remain an important resource for these patients during recent needs, despite the wide use of the Internet as a source of health information.

College students' use of energy drinks, social problem-solving, and academic performance.

Energy drink (ED) use among college students to improve academic performance (AP) has skyrocketed. A growing body of literature indicates that the risks associated with ED use may outweigh the perceived benefits. In this study, 486 undergraduates were surveyed on their general substance and ED usage, Social Problem-Solving (SPS) ability, and AP. It was hypothesized that: (1) ED use would be a negative predictor of AP; (2) SPS would be a positive predictor of AP; (3) SPS would be a negative predictor of ED use; and (4) SPS and ED use would account for a significant amount of the variance in AP. A linear multiple regression for AP was conducted, with predictor variables entered in the following order: total drug use, non-ED caffeine use, SPS, and ED use. The overall model was significant and accounted for approximately 7% of the variance in AP. The hypotheses of the study were supported, indicating that ED use may be related to decreased AP, SPS ability may be related to increased AP, or that students with poor AP and less effective SPS skills are more likely to use EDs. Implications of these findings are important for college students and other users of ED products.

The importance of 'dread risk' for vaccine communication.

BACKGROUND: Perceptions of 'dread risk,' information source beliefs, and trust in these sources are important variables towards understanding vaccine attitudes. The main objective of this research was to learn the associations among these phenomena and, particularly, how these variables may impact our understanding of vaccine attitudes. METHODS: In the summer of 2020, a total of 336 (Mage = 53.55; SDage = 18.58) participants answered an online Qualtrics survey about their 'dread risk' perceptions of vaccines, their information source beliefs (e.g. credible, easy-to-access, etc.), trust in information sources, and vaccine attitudes. RESULTS: Results suggest participants had generally low levels of negative vaccine attitudes (M = 3.27; SD = 1.40). Regression analyses to predict negative vaccine attitudes found 'dread risk' perceptions to be the most significant predictor (beta = .61, p < .001), over and above information source beliefs and trust in information sources (F (9, 320) = 75.07, p < .001; adjusted R2 = .67). Age was also significantly and negatively correlated with 'dread risk' (r = -.22, p < .001). CONCLUSIONS: Results suggest that vaccine communication efforts should continue to identify individuals' 'dread risk' perceptions about vaccines and emphasize this content in messaging. Future research should aim to understand more about the relationships between negative vaccine attitudes, 'dread risk' perceptions, information source beliefs, and trust in information sources to better predict vaccine-related decisions, (in)actions, and to support effective vaccine communication.

The influence of uncertainty and social support on information seeking concerning illicit stimulant use among young adults.

Using the Theory of Motivated Information Management (TMIM) and the concept of desired informational support as a framework, this project examined factors in the information management process young adults employ in potential information seeking about illicit stimulant drug use with members of their social networks. One hundred and seventy-three individuals participated in the study. Results indicated that (a) uncertainty discrepancy and the desire for informational support covaried, and (b) uncertainty discrepancy, anxiety, and outcome expectancy had significant impacts on the efficacy judgments made by individuals with regard to potential information seeking with their social networks about their stimulant drug use. The study thus provides further evidence for the utility of TMIM as a framework for understanding health communication in regard to drug use, and suggests that desired informational support may be a useful addition to the model for this health issue.

Cluster-randomized trial of a web-assisted tobacco quality improvement intervention of subsequent patient tobacco product use: a National Dental PBRN study.

BACKGROUND: Brief clinician delivered advice helps in tobacco cessation efforts. This study assessed the impact of our intervention on instances of advice given to dental patients during visits on tobacco use quit rates 6 months after the intervention. METHODS: The intervention was cluster randomized trial at the dental practice level. Intervention dental practices were provided a longitudinal technology-assisted intervention, oralcancerprevention.org that included a series of interactive educational cases and motivational email cues to remind dental provides to complete guideline-concordant brief behavioral counseling at the point of care. In all dental practices, exit cards were given to the first 100 consecutive patients, in which tobacco users provided contact information for a six month follow-up telephone survey. RESULTS: A total of 564 tobacco using dental patients completed a six month follow-up survey. Among intervention patients, 55% reported receiving advice to quit tobacco, and 39% of control practice patients reported receiving advice to quit tobacco (p < 0.01). Six-month tobacco use quit rates were not significantly between the Intervention (9%) and Control (13%) groups, (p = 0.088). CONCLUSION: Although we increased rates of cessation advice delivered in dental practices, this study shows no evidence that brief advice by dentist's increases long-term abstinence in smokers. TRIAL REGISTRATION: ClinicalTrials.gov NCT00627185.

Using communication theory for health promotion: practical guidance on message design and strategy.

According to the U.S. Department of Health and Human Services, health communication is "the study and use of communication strategies to inform and influence individual and community decisions that enhance health." The purpose of this article is to look at how health educators can use communication theory to create messages that are innovative, relatable, and motivating to intended audiences. Three specific communication theories are presented, along with examples of how they have been successfully used in behavior change initiatives. These three theories are offered in an effort to stimulate further investigation into how theory supports the creation of targeted, tailored, and effective communication strategies.

Predictors of Online Patient Portal Use Among a Diverse Sample of Emerging Adults: Cross-sectional Survey.

BACKGROUND: Health self-management is increasingly being influenced by emerging health information technologies (IT), especially online patient portals. Patient portals provide patients with direct access to their health information, electronic tools to manage their health, and additional opportunities to engage with their care team. Previous studies have found that patient portal use is highest among patients with high eHealth literacy, the ability to find health information from electronic sources and apply the knowledge gained to solve a health problem. The role of eHealth literacy on patient portal use appears to be especially strong among older adults with chronic diseases. The use of patient portals among emerging adults (ages 18-29) is much less understood. Although generally healthy, emerging adults are more regular IT users and just beginning to independently navigate the health care system. A good understanding of how emerging adults are using online patient portals and what factors, including eHealth, impact portal use is lacking. OBJECTIVE: The aim of this study is to describe patient portal use and explore the predictors of portal use among a diverse sample of emerging adults. METHODS: A cross-sectional survey study that used convenience sampling was conducted at two universities. Data on demographics, health care encounters, eHealth literacy, patient engagement, and use of patient portal features (administrative and clinical) were obtained via self-report and summarized. Logistic regression models were used to examine factors associated with portal use. RESULTS: Of the 340 emerging adults, 257 (76%) were female, 223 (65%) White, 156 (47%) low income, and 184 (54%) reported having patient portal access. Of those reporting access, 142 (77%) used at least 1 portal feature and 42 (23%) reported using none. Significant predictors were patient engagement (odds ratio [OR] 1.08, 95% CI 1.04-1.13, P=.001) and total encounters (OR 1.23, 95% CI 1.05-1.44, P=.009) but not eHealth literacy. Hispanic and Asian emerging adults were more likely to be frequent users of clinical portal features than White emerging adults (Hispanic: OR 2.97, 95% CI 1.03-8.52, P=.04; Asian: OR 4.28, 95% CI 1.08-16.89, P=.04). CONCLUSIONS: We found that about half of emerging adults had access to a patient portal. Among those with access, a majority reported using at least one portal feature. Factors associated with increased portal use included increased patient engagement and total clinical encounters. Self-reported eHealth literacy was not associated with patient portal use in this diverse sample of emerging adults. This may have been due to high overall eHealth literacy levels in this population of frequent IT users. There may also be racial/ethnic differences that are important to consider, as we found Hispanic and Asian emerging adults reported more frequent portal use than White emerging adults. Interventions to promote patient portal use among emerging adults should include strategies to increase awareness of portal access and engagement among patients with fewer clinical encounters, with a focus on preventative health management.

Using geographic information systems to promote community involvement in comprehensive cancer control.

Geographic information systems (GIS) for cancer control present an innovative approach to health communication for comprehensive cancer control (CCC) planning. The ability to spatially depict multivariate views of cancer incidence, treatment site locations, transportation routes, and even environmental exposures within a map represents opportunities to involve communities in novel ways with cancer control. Communities may be involved strategically and/or as a goal in planning efforts. The experiences and perceptions of a near census of U.S. CCC program managers (N = 49) were examined to gain their insights about the compatibility of GIS mapping for CCC, the target audiences to be reached with maps as a CCC message, and relative advantages of this technology in its diffusion. Analysis includes a quantitative assessment of interviews and qualitative statements to illustrate these issues. Results suggest that GIS use for cancer control has the potential to build community capacity and social capital for communities as a way to reduce the cancer burden.

A national survey of state comprehensive cancer control managers: implications of geographic information systems.

The growth of geographic information systems (GIS) for comprehensive cancer control (CCC) planning activities has been documented. We examined concerns about use and derived principles for practice. A national survey of US CCC program managers (n = 49) was conducted. Results include statements and frequency of barriers to use GIS mapping for CCC. Uses of GIS for CCC activities have benefits, but must be considered within organizational frameworks designed to safeguard confidentiality of health information and community relationships. Education to guide understanding of and input into the decisions linked to GIS mapping can limit possible harms while advancing CCC aims.

A portrait of food and drink in commercial TV series.

This study examines the content and presentation of food and drink on fictional, commercial television. It provides the first comparison of food and drink consumption across different television program genres designated for different age groups. Data originated with a random sample of 50 taped episodes of children's shows, 50 episodes of "tween" programs (shows targeted for 9- to 14-year-olds), 40 episodes of afternoon soaps, and 50 episodes of prime time shows. The choice of TV series was based solely on the strength of Nielsen audience ratings. The study coded the foods for nutritional content and the drinks for alcoholic/nonalcoholic content, how they were used, and in what context. Findings indicate that foods were more commonly offered and consumed on children's shows, and that problematic foods (defined as oils, solid fats, and foods with added sugars) were significantly more prevalent in youth-oriented shows than in adult-oriented shows. Although there was only a negligible presence of alcohol on children's shows, the average hourly use of alcohol on the tween shows matched that of the adult programs; therefore, alcohol was as common in the shows directed at young audiences as in shows for adults. Negative outcomes were largely absent from food and drink behaviors on these TV series.

Cancer registry policies in the United States and geographic information systems applications in comprehensive cancer control.

OBJECTIVES: Through a long history of cancer policies, public health has a foundation for cancer research and data to use in applying technological advancements for U.S. cancer control efforts. Geographic information systems (GIS) are one technology enabling the visualization of cancer risk patterns associated with incidence, mortality, and accessibility to care. METHODS: U.S. Comprehensive Cancer Control (CCC) program directors were interviewed from 49 of 50 states to assess use and function of GIS tools for mapping data related to cancer control policies and practices. Interviews were coded to obtain frequencies of response associated with content domains mapped using GIS tools and the perceived relative advantages. RESULTS: Significant relationships were found between the mapping of behavioral risk factors, health care services, transportation access, and policy advantages identified by program managers. The mapping of cancer incidence, mortality, and staging, transportation access, and multiple layers of content were found to have significant associations with perceived research advantages. CONCLUSIONS: U.S. CCC program managers recognize several important advantages relating to health policy and research for use of GIS tools in cancer control efforts. The application of GIS in U.S. cancer control efforts is employed unevenly, suggesting the need for innovative policies to support accessibility.

Adolescent females and their mothers: examining perceptions of the environment and breast cancer.

Recent research indicates environmental factors and personal behaviors are related to breast cancer risk, but adopting a healthy lifestyle as early as adolescence can serve a protective function. To investigate perceptions of breast cancer risk and the environment, 10 focus groups (N = 91) were conducted with adolescent females (n = 55) and mothers (n = 36) across four counties in the Midwest, USA. The Uncertainty Management Theory provides a framework for discussing statements, and results suggest that uncertainty is maintained through ambiguity about environmental risk factors and breast cancer. Recommendations for prevention messages are presented.

Exploring Online Asynchronous Counseling With Tobacco Treatment Specialists in the QUIT-PRIMO and National Dental PBRN HI-QUIT Studies: Who Uses It and What Do They Say?

PURPOSE: To describe the content of messages sent by smokers through asynchronous counseling within a Web-based smoking cessation intervention. DESIGN: Qualitative. SETTING: National community-based setting of patients who had been engaged by the medical or dental practices at which they attended or via Google advertisements. PARTICIPANTS: Adults older than 19 years who were current smokers and interested in quitting. Participants throughout the United States referred to a Web-based cessation intervention by their medical or dental provider or by clicking on a Google advertisement. METHODS: We conducted a qualitative review of 742 asynchronous counseling messages sent by 270 Web site users. Messages were reviewed, analyzed, and organized into qualitative themes by the investigative team. RESULTS: The asynchronous counseling feature of the intervention was used most frequently by smokers who were white (87%), female (67%), aged 45 to 54 (32%), and who had at least some college-level education (70%). Qualitative analysis yielded 7 basic themes-Talk about the Process of Quitting, Barriers to Quitting, Reasons to Quit, Quit History, Support and Strategies for Quitting, Quitting with Medication, and Quit Progress. The most common theme was Support and Strategies for Quitting with 255 references among all messages. CONCLUSION: We found rich communication across the spectrum of the quit process, from persons preparing to quit to those who had successfully quit. Asynchronous smoking cessation counseling provides a promising means of social support for smokers during the quit process.

Formative research on adolescent and adult perceptions of risk factors for breast cancer.

This study uses the Health Belief Model (HBM) as a framework to guide formative research of the lay public's perceptions of risks associated with breast cancer. Data were collected from adolescent females and adult females across four counties in Michigan, US. Ten focus groups (N=91) were conducted and analyzed with a coding scheme based on the HBM. Participants' responses to focus group questions (N=5168 thought units) reveal beliefs about severity, susceptibility, and efficacy pertaining to breast cancer, nutrition, activity, environment, and the role of government and industry. Chi-squares examined the distribution of statements across categories between adult females and adolescent females. Results revealed that both adolescent and mother groups recognized gender and heredity as relevant risk factors related to susceptibility, and detection as a strategy to decrease severity of breast cancer through early treatment. Beliefs about environmental factors were characterized by uncertainty for both groups. Also, while adolescent girls communicated more about efficacy issues, mothers focused significantly more than adolescent girls on the role of government and industry in breast cancer prevention and treatment. Representative qualitative thought units are included based on their frequency, salience, and relevance to HBM message design guidelines. Formative research is the first phase in the development of health campaigns, informing the creation of health messages for target audiences.