Advocating, Unlearning, Tearing It All Down? How BIPOC Young Adults with Mental Health Concerns Perceive and Engage with the Media.

The COVID-19 pandemic has increased the salience of issues related to social justice, mental health, and health equity. During this time, the media have been instrumental in amplifying social movements but also in spreading mis/disinformation, violence, and hatred. Among communities who have been affected heavily during this time are Black, Indigenous, and People of Color (BIPOC) young adults who have a mental illness/significant mental health concerns. As frequent engagers and creators of media, their perspectives are critical to informing what aspects of the media should be leveraged to promote the health, well-being, and safety of people who have been marginalized. Thus, our study asks: How do BIPOC young adults (in the United States) who have a behavioral health diagnosis or significant mental health concerns perceive the media? Guided by intersectionality and grounded theory, we conducted in-depth interviews with 20 participants. The results reveal participants' 1) deep recognition of how the media uphold oppressive structures and 2) identification of ways that people have used and can use the media to fight those same structures. Researchers and media leaders should listen to, center the experiences of, collaborate with, and follow the lead of people who have been marginalized. This is critical to transforming the media such that they promote the well-being of all people.

Tough Talks COVID-19 Digital Health Intervention for Vaccine Hesitancy Among Black Young Adults: Protocol for a Hybrid Type 1 Effectiveness Implementation Randomized Controlled Trial.

BACKGROUND: Interventions for increasing the uptake of COVID-19 vaccination among Black young adults are central to ending the pandemic. Black young adults experience harms from structural forces, such as racism and stigma, that reduce receptivity to traditional public health messaging due to skepticism and distrust. As such, Black young adults continue to represent a priority population on which to focus efforts for promoting COVID-19 vaccine uptake. OBJECTIVE: In aims 1 and 2, the Tough Talks digital health intervention for HIV disclosure will be adapted to address COVID-19 vaccine hesitancy and tailored to the experiences of Black young adults in the southern United States (Tough Talks for COVID-19). In aim 3, the newly adapted Tough Talks for COVID-19 digital health intervention will be tested across the following three southern states: Alabama, Georgia, and North Carolina. METHODS: Our innovative digital health intervention study will include qualitative and quantitative assessments. A unique combination of methodological techniques, including web-based surveys, choose-your-own-adventures, digital storytelling, user acceptability testing, and community-based participatory approaches, will culminate in a 2-arm hybrid type 1 effectiveness implementation randomized controlled trial, wherein participants will be randomized to the Tough Talks for COVID-19 intervention arm or a standard-of-care control condition (N=360). Logistic regression will be used to determine the effect of the treatment arm on the probability of vaccination uptake (primary COVID-19 vaccine series or recommended boosters). Concurrently, the inner and outer contexts of implementation will be ascertained and catalogued to inform future scale-up. Florida State University's institutional review board approved the study (STUDY00003617). RESULTS: Our study was funded at the end of April 2021. Aim 1 data collection concluded in early 2022. The entire study is expected to conclude in January 2025. CONCLUSIONS: If effective, our digital health intervention will be poised for broad, rapid dissemination to reduce COVID-19 mortality among unvaccinated Black young adults in the southern United States. Our findings will have the potential to inform efforts that seek to address medical mistrust through participatory approaches. The lessons learned from the conduct of our study could be instrumental in improving health care engagement among Black young adults for several critical areas that disproportionately harm this community, such as tobacco control and diabetes prevention. TRIAL REGISTRATION: ClinicalTrials.gov NCT05490329; https://clinicaltrials.gov/ct2/show/NCT05490329. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41240.

Exploring Motivations for COVID-19 Vaccination Among Black Young Adults in 3 Southern US States: Cross-sectional Study.

BACKGROUND: Few studies have focused on attitudes toward COVID-19 vaccination among Black or African American young adults (BYA) in the Southern United States, despite high levels of infection in this population. OBJECTIVE: To understand this gap, we conducted an online survey to explore beliefs and experiences related to COVID-19 vaccination among BYA (aged 18-29 years) in 3 southern states. METHODS: We recruited 150 BYA to participate in an online survey as formative research for an intervention to address vaccine hesitancy in Alabama, Georgia, and North Carolina from September 22, 2021, to November 18, 2021. Participants were recruited through social media ads on Facebook, Twitter, Instagram, and YouTube. Additionally, we distributed information about the survey through organizations working with BYA in Alabama, Georgia, and North Carolina; our community partners; and network collaborations. We used measures that had been used and were previously validated in prior surveys, adapting them to the context of this study. RESULTS: Roughly 28 (19%) of the participants had not received any doses of the COVID-19 vaccine. Half of the unvaccinated respondents (n=14, 50%) reported they wanted to wait longer before getting vaccinated. Motivators to get vaccinated were similar between unvaccinated and vaccinated respondents (eg, if required, to protect the health of others), but the main motivator for those vaccinated was to protect one's own health. Among unvaccinated individuals, reasons for not receiving the COVID-19 vaccine included concern about vaccine side effects (n=15, 54%) and mistrust of vaccine safety (n=13, 46%), of effectiveness (n=12, 43%), and of the government's involvement with vaccines (n=12, 43%). Experiences of discrimination (n=60, 40%) and mistrust of vaccines (n=54, 36%) were common overall. Among all respondents, those who said they would be motivated to get vaccinated if it was required for school, work, or travel were more likely to endorse negative beliefs about vaccines compared to those motivated for other reasons. CONCLUSIONS: Mistrust in COVID-19 vaccine safety and efficacy is common among BYA in the Southern United States, irrespective of vaccination status. Other motivators, such as safety of family and community and vaccination requirements, may be able to tip the scales toward a decision to be vaccinated among those who are initially hesitant. However, it is unclear how vaccine requirements among BYA in the South affect trust in the government or health care in the long term. Interventions that include BYA in vaccination messaging and programs may more proactively build feelings of trust and combat misinformation.

Concept Test of a Smoking Cessation Smart Case.

Background: Wearable/portable devices that unobtrusively detect smoking and contextual data offer the potential to provide Just-In-Time Adaptive Intervention (JITAI) support for mobile cessation programs. Little has been reported on the development of these technologies. Introduction: To address this gap, we offer a case report of users' experiences with a prototype "smart" cigarette case that automatically tracks time and location of smoking. Small-scale user-experience studies are typical of iterative product design and are especially helpful when proposing novel ideas. The purpose of the study was to assess concept acceptability and potential for further development. Materials and Methods: We tested the prototype case with a small sample of potential users (n = 7). Participants used the hardware/software for 2 weeks and reconvened for a 90-min focus group to discuss experiences and provide feedback. Results: Participants liked the smart case in principle but found the prototype too bulky for easy portability. The potential for the case to convey positive messages about self also emerged as a finding. Participants indicated willingness to pay for improved technology (USD $15-$60 on a one-time basis). Discussion: The smart case is a viable concept, but design detail is critical to user acceptance. Future research should examine designs that maximize convenience and that explore the device's ability to cue intentions and other cognitions that would support cessation. Conclusions: This study is the first to our knowledge to report formative research on the smart case concept. This initial exploration provides insights that may be helpful to other developers of JITAI-support technology.

Acknowledgment Correction of: Impact of Game-Inspired Infographics on User Engagement and Information Processing in an eHealth Program.

[This corrects the article DOI: 10.2196/jmir.5976.].

Impact of Game-Inspired Infographics on User Engagement and Information Processing in an eHealth Program.

BACKGROUND: Online interventions providing individual health behavior assessment should deliver feedback in a way that is both understandable and engaging. This study focused on the potential for infographics inspired by the aesthetics of game design to contribute to these goals. OBJECTIVE: We conducted formative research to test game-inspired infographics against more traditional displays (eg, text-only, column chart) for conveying a behavioral goal and an individual's behavior relative to the goal. We explored the extent to which the display type would influence levels of engagement and information processing. METHODS: Between-participants experiments compared game-inspired infographics with traditional formats in terms of outcomes related to information processing (eg, comprehension, cognitive load) and engagement (eg, attitudes toward the information, emotional tone). We randomly assigned participants (N=1162) to an experiment in 1 of 6 modules (tobacco use, alcohol use, vegetable consumption, fruit consumption, physical activity, and weight management). RESULTS: In the tobacco module, a game-inspired format (scorecard) was compared with text-only; there were no differences in attitudes and emotional tone, but the scorecard outperformed text-only on comprehension (P=.004) and decreased cognitive load (P=.006). For the other behaviors, we tested 2 game-inspired formats (scorecard, progress bar) and a traditional column chart; there were no differences in comprehension, but the progress bar outperformed the other formats on attitudes and emotional tone (P<.001 for all contrasts). CONCLUSIONS: Across modules, a game-inspired infographic showed potential to outperform a traditional format for some study outcomes while not underperforming on other outcomes. Overall, findings support the use of game-inspired infographics in behavioral assessment feedback to enhance comprehension and engagement, which may lead to greater behavior change.

Cancer Survivors Who Play Recreational Computer Games: Motivations for Playing and Associations with Beneficial Psychological Outcomes.

OBJECTIVE: Playing recreational videogames is a common activity, yet little is known about its role in the lives of people who are coping with serious illness. These individuals may experience depression and isolation and may turn to games to help alleviate negative experiences and support well-being. We explored these possibilities in the context of cancer survivors. The study aimed to discover motivations underlying game play and the extent to which motivations are associated with psychological health and well-being. METHODS: We conducted a cross-sectional online survey of survivors who play recreational games (N = 794). Key variables were motivations and indicators of psychological health, including self-efficacy in cancer communications, resilient coping, and beliefs that one is living a fulfilling and meaningful life (flourishing). RESULTS: Participants were most likely to be motivated to play for stimulation and a sense of accomplishment (intrinsic rewards), followed by development of self, sense of community, and personal affirmation. Multiple regression analyses revealed positive associations between playing for intrinsic rewards and all three psychological health outcomes. Playing for a sense of community was also positively associated with coping and flourishing. CONCLUSION: Playing recreational videogames, particularly to receive intrinsic rewards and to connect with others, may play a supportive role in the psychological health of survivors. Findings suggest future areas for research and implications for development of serious games.

Identity as a Moderator and Mediator of Communication Effects: Evidence and Implications for Message Design.

Advertisements, movies, and other forms of media content have potential to change behaviors and antecedent psychological states by appealing to identity. However, the mechanisms that are responsible for persuasive effects of such content have not been adequately specified. A recently proposed model of communication effects (the prism model) advances the study of mechanisms and argues that identity can serve as both a moderator and mediator of communication effects on behavior-relevant outcomes. These intervening roles are made possible by the complex nature of identity (including multiple self-concepts and sensitivity to cues) and messages that cue the importance of and activate particular self-concepts. This article builds on development of the model by presenting empirical support based on re-analysis of an experiment in which participants viewed either a more-stigmatizing or less-stigmatizing portrayal of a recovering drug addict. In line with the model's propositions, exposure to the less-stigmatizing condition led to increases in perspective taking which then led to more acceptance (mediation by identity), while level of perspective taking also changed the effect of condition on acceptance (moderation by identity). These results provide support for the model's proposition of simultaneous intervening roles. The authors discuss implications for strategic communication research and practice.

How Does Gameplaying Support Values and Psychological Well-Being Among Cancer Survivors?

OBJECTIVE: This qualitative study examined the extent to which playing recreational computer games and videogames is perceived by cancer survivors as supporting personal values. Values serve as behavioral guides and may thus impact health outcomes; therefore activities that have the potential to support values deserve further attention so their role in promoting health may be better understood. MATERIALS AND METHODS: We asked a sample of survivors who play recreational games (n = 73) open-ended questions about the types of recreational games they play, about something they really value in life, and the extent to which playing games supports the value. Data analysis used a grounded theory approach, supported by computer-assisted qualitative analysis software. RESULTS: Three major themes emerged linking gameplaying to survivors' values: the need to create and maintain social connections, the desire to help others, and the need to experience alternate realities (including escape and exploration). CONCLUSIONS: The present study offers a unique perspective by focusing on the intersection of values and gameplay among survivors. The findings suggest that playing recreational computer games and videogames may be congruent with survivors' personal values and may have potential to influence positive health outcomes among survivors. The findings have implications for developing effective values-based interventions for cancer survivors.

How does a risk-oriented "future-self" influence behavior? A structural-equation-modeling approach with marijuana-related outcomes.

A study was conducted to examine the influence of a risk-oriented future self on self-reported marijuana use among college students. Drawing on theoretical work on possible selves, it was hypothesized that the extent to which a future self is viewed as risk-oriented will be associated with reported marijuana use and that effects of a risk-oriented future self on use would be partially mediated by risk-oriented attitudes and perceived attractiveness of users. Analysis of data from an online survey of college students supported hypotheses, with the additional finding that the effect of user attractiveness on use is mediated by attitudes.

Comparing effects of "my anti-drug" and "above the influence" on campaign evaluations and marijuana-related perceptions.

Two national campaigns--My Anti-Drug and Above the Influence--have been implemented to prevent youth substance use. Although Above the Influence was conceptualized as a major shift in messaging from My Anti-Drug, no studies have reported head-to-head tests of message effects on behavior-relevant outcomes. An experiment was conducted in which participants viewed ads from one of the campaigns and answered questions about ad appeal and emotional tone; campaign appeal; and marijuana-related beliefs. Compared to My Anti-Drug ads, Above the Influence ads were associated with more positive emotional tone and with lower perceptions of marijuana risk. Implications for message design and evaluation are discussed.

Effects of adverts from a drug and alcohol prevention campaign on willingness to engage in alcohol-related risky behaviors.

Behavioral willingness is conceptualized as a pathway to behavior that is non-deliberative, yet traditional measures require thoughtful deliberation to complete. This study explored non-deliberative measures of alcohol-related willingness to complement recent work on marijuana-related willingness. The study also examined whether adverts from a field-tested drug and alcohol prevention campaign may have operated by influencing alcohol-related willingness. Participants viewed campaign adverts or consumer adverts (control). Outcomes were reaction times to make speeded judgments about whether one would engage in risky alcohol-related behaviors. Results showed that campaign advertisements lowered willingness to play drinking games and (for males) to drive while intoxicated.

Characterizing drug non-users as distinctive in prevention messages: implications of optimal distinctiveness theory.

Optimal distinctiveness theory (ODT) posits that highly valued groups are those that can simultaneously satisfy needs to belong and to be different. The success of drug-prevention messages with a social-identity theme should therefore depend on the extent to which the group is portrayed as capable of meeting these needs. Specifically, messages that portray non-users as a large and undifferentiated majority may not be as successful as messages that emphasize uniqueness of non-users. This prediction was examined using marijuana prevention messages that depicted non-users as a distinctive or a majority group. Distinctiveness characterization lowered behavioral willingness to use marijuana among non-users (Experiment 1) and served as a source of identity threat (contingent on gender) among users (Experiment 2).

Assessing media campaigns linking marijuana non-use with autonomy and aspirations: "Be Under Your Own Influence" and ONDCP's "Above the Influence".

Two media-based interventions designed to reduce adolescent marijuana use ran concurrently from 2005 to 2009. Both interventions used similar message strategies, emphasizing marijuana's inconsistency with personal aspirations and autonomy. "Be Under Your Own Influence" was a randomized community and school trial replicating and extending a successful earlier intervention of the same name (Slater et al. Health Education Research 21:157-167, 2006). "Above the Influence" is a continuing national television, radio, and print campaign sponsored by the Office of National Drug Control Policy (ONDCP). This study assessed the simultaneous impact of the interventions in the 20 U.S. communities. Results indicate that earlier effects of the "Be Under Your Own Influence" intervention replicated only in part and that the most plausible explanation of the weaker effects is high exposure to the similar but more extensive ONDCP "Above the Influence" national campaign. Self-reported exposure to the ONDCP campaign predicted reduced marijuana use, and analyses partially support indirect effects of the two campaigns via aspirations and autonomy.

The effects of drug-prevention messages on the accessibility of identity-related constructs.

Recent theoretical work has posited that the self-system guides behavior via currently activated self-concepts. The authors adopted this framework to the study of drug-prevention messages by examining the extent to which messages can alter the accessibility of views of self and of drugs that would support nonuse. Participants were exposed to 1 of 3 print-ad conditions: autonomy-themed prevention messages (treatment), health-information themed prevention messages (comparison), and informational consumer ads (control). Outcomes were reaction times to make dichotomous judgments. Relative to comparison and control ads, treatment ads were more successful at activating a self-view as a nonuser, a view that marijuana use is inconsistent with autonomy, and unwillingness to use marijuana. Post-hoc analysis revealed that the effect of ad condition on unwillingness was partially mediated by the accessibility of self-view as a nonuser.

The Belief that Alcohol Use is Inconsistent with Personal Autonomy: A Promotive Factor for Younger Adolescents.

This study explored an understudied promotive factor, a belief that alcohol use is inconsistent with personal autonomy, which may reduce adolescent intention to drink and subsequent alcohol use. Autonomy was examined as an attitudinal construct within the Theory of Reasoned Action. Longitudinal data from 2,493 seventh grade students nested in 40 schools were analyzed using a structural equation model. Autonomy was negatively correlated with intention to use alcohol and subsequent alcohol use at a later wave, and intention to use fully mediated the effect of autonomy on subsequent alcohol use. These results are consistent with the proposition that when personal autonomy is perceived as inconsistent with alcohol use among younger adolescents, students indicate a lower intention to use alcohol and use less alcohol during the following school year.

Smoking correlates among Hispanic and non-Hispanic white adolescents in the US southwest.

We examined smoking correlates among Hispanic and white students in 6-12th grades in small communities in three states in the southwestern United States. Data were collected in 2002 from 8,479 participants, who completed surveys measuring a wide range of potential smoking correlates from individual, family, and peer domains. Logistic regression analyses showed that peer factors were the most robust correlates across both ethnicities and grade groups. An unexpected finding was the posited protective effect of male gender for older white students. Limitations and implications for prevention are discussed. This work was supported by the National Institute on Drug Abuse.

Examining marijuana user and non-user prototypes in formative research for prevention campaigns.

We report on research-both quantitative and qualitative-conducted to explore perceptions of prototypes of marijuana users, as well as the extent to which self-prototype congruence predicted marijuana use intention. Results of a survey of undergraduates (N = 139) showed that prototypes of users and non-users differed in terms of key attributes, and that a greater match between one's self and user prototype would be associated with greater intention to use marijuana. In addition, exploratory analysis showed that males had higher ratings of user prototype social attractiveness compared to females overall, with the most pronounced differences between non-White males and non-White females. To probe these findings, two focus groups consisting of African-American males and females (N = 12) were conducted. Results indicated that social attractiveness of users was a common theme among males but not females. Implications for prevention programs and future research are discussed.

Media influence on alcohol-control policy support in the U.S. adult population: the intervening role of issue concern and risk judgments.

Data from a national random-digit dial survey (N = 1,272) were analyzed to examine the influence of news media use on alcohol-control policy support, and to test whether risk judgments and concern about alcohol-related risks mediated effects of news media use variables on support for various types of alcohol-control public policies. In so doing, we test the proposition that perceptions influenced by routine coverage of events such as crime or accidents may in part explain news effects on public policy support in the domain of health policy. Analyses indicated that the (positive) influence of attention to news about crime and accidents on support for increasing enforcement of existing alcohol control laws and militing marketing of alcohol products was mediated by concern about risks of alcohol-related injuries and by perceptions of the alcohol-attributable fraction of homicides and unintended injury fatalities. Tests of model fit suggest that concern precedes the more cognitive risk judgment in the mediation model.

Tobacco counteradvertisements aimed at bicultural Mexican American youth: the impact of language and theme.

The growing population of Mexican American youth and the increasing smoking rates in this population present a considerable public health challenge. Tobacco counteradvertisements have demonstrated their ability to shape attitudes, behavior, and public policy, but little is known about the most effective ways to adapt messages aimed at this audience. To explore key variables that can affect success, a study was conducted with 249 Mexican American middle-school youth from a U.S./Mexico border community to examine the effectiveness of language (English, Spanish, or a combination of English and Spanish) and theme (secondhand smoke, antitobacco social norms, and tobacco industry manipulation) in print tobacco counteradvertisements. Measures included ad preferences, acculturation, and tobacco-related attitudes and behavior. Results showed that although a large percentage identified with the Mexican American rather than the Anglo American culture and spoke Spanish in selected contexts, readability was greater for ads in English, and participants rated the English ads as most effective. The social norms counteradvertisement was preferred overall. Potential implications for health communication and policy are discussed.