Reframing the experience of childbirth: Black doula communication strategies and client responses during delivery hospitalization.

Doulas, or birth coaches, are said to be "changing the world, one birth at a time." Black doulas have been suggested to mitigate against lack of representation in obstetric care, limited identity acknowledgement and accommodation, and obstetric racism. However, scientific inquiry into the specific communication strategies and messages used by Black doulas to advocate for clients was non-existent in extant literature. Guided by the Agency-Identity Model, we analyzed 20 diary-interviews of nine Black doulas who recently served Black clients. Specifically, we explored Black doulas' communication strategies and whether these strategies had an impact on client agency. We found that Black doulas prepare their clients for patient-provider interactions, including conversations about certain medical treatments and procedures and the risks for Black women and birthing people, the importance of informed consent, how to be heard, and how to resist neglect or abuse. We found that, in turn, most Black clients were able to enact agentic responses. We describe the specific doula messages, and contextualize our findings, considering how these collective interpersonal communication strategies of Black doulas, and their clients' agentic transformations, may index a sociopolitical movement to reframe the experience of childbirth in America.

The Impact of Celebrity and Influencer Illness Disclosures.

When celebrities, political figures, influencers, or anyone with a large following publicly disclose an illness or die, the news becomes a de facto public health campaign. Until health communicators began studying such disclosures and the effects of the following waves of media coverage, however, it was not known to what extent these events impacted the public. A growing body of research has empirically documented these events and examined the factors that predict which types of audiences are most affected and why. Beyond motivating research opportunities, celebrity and influencer health disclosures or deaths can impact calls to hotlines, views on health-related websites, discussions of related topics on social media, behavioral changes relevant to the disclosure, increased news coverage of celebrity health research, integration of celebrity health narratives into strategic health campaigns, and even policy changes. We provide an overview of research conducted in this area and detail examples of the impact that celebrity health disclosures and studies about those disclosures have had on public discourse and public health.

Engagement With a Youth Community Advisory Board to Develop and Refine a Facebook HPV Vaccination Promotion Intervention (#HPVvaxtalks) for Young Black Adults (18-26 years old).

Human papillomavirus (HPV) vaccination rates remain suboptimal among young Black adults (18-26 years). Research focused on HPV vaccination among young Black adults is limited. Guided by the Theory of Planned Behavior, we developed #HPVvaxtalks, a theoretically grounded and culturally appropriate Facebook intervention in collaboration with a youth community advisory board (YCAB) to increase awareness of HPV risk factors, risk perception, HPV vaccine-related knowledge, vaccination intention, and uptake for Black individuals. Engagement with YCAB members fostered opportunity to discuss priorities reflecting the community's interest and make #HPVvaxtalks more relevant. This article describes the YCAB engagement and collaborative process in the development and refinement of posts/messages for #HPVvaxtalks. Five young Black adults (18-26 years of age) were invited to become members of a YCAB. YCAB reviewed the preliminary version of #HPVvaxtalks intervention materials and provided critiques and suggestions for refinement. Following the completion of the collaborative process, YCAB members completed individual interviews to reflect on the process. Feedback from YCAB participants focused on the relevance, engagement, clarity, and organization of the content and the media utilized. Participants suggested using "memes" to improve cultural relevance and engagement for young Black individuals. All YCAB members expressed satisfaction with the development process. Collaboration with a YCAB was crucial in developing a culturally relevant and acceptable #HPVvaxtalks intervention, which includes 40 messages/posts for young Black adults. Undergoing the iterative process of intervention development and refinement with the priority population can be an essential component in the design and implementation of health promotion activities.

Understanding COVID-19 Vaccine Knowledge, Beliefs, and Trusted Information Sources Among Black Women in Kentucky: Implications for Vaccine Uptake.

To optimize COVID-19 vaccination rates among Black women in the United States, it is crucial to understand their vaccine beliefs and determine the most effective communication sources and messages to encourage vaccination. Consequently, we conducted seven focus groups with 20 Black women from Kentucky (aged 18-37 years) between October and November 2020. We identified five themes reflecting the participants' level of awareness, knowledge of the vaccine and vaccine development process; their uncertainty about vaccine safety and clinical trials; their willingness to get vaccinated, and their preferences for trusted sources and persuasive messages to motivate vaccine uptake. Despite the participants' high level of awareness about the vaccine's development, significant concerns were identified regarding the speed of the vaccine's development and clinical trials, known medical injustices against Black people, political influence, vaccine efficacy, and potential side effects that fed their unwillingness to vaccinate. Based on our findings, we recommend vaccination campaigns targeting Black women should prioritize messaging highlighting the benefits and limitations of the vaccine while emphasizing its protective benefits for self, family, and community. Campaigns should also include Black healthcare providers as sources of messages. The findings have additional implications for encouraging continued confidence in the vaccine and improving uptake.

Beliefs Underlying Colorectal Cancer Information Seeking Among Young Black Adults: a Reasoned Action Approach Elicitation Study.

Colorectal cancer in younger adults is more likely to be diagnosed at an advanced stage. Furthermore, younger Black adults are more likely to be diagnosed with and die from colorectal cancer than younger White adults. Given these persistent racial disparities, urgent attention is needed to increase colorectal cancer awareness and information seeking among young Black adults. Guided by the reasoned action approach, the purpose of this study was to identify behavioral, normative, and control beliefs that influence general colorectal cancer information seeking, talking to a healthcare provider about colorectal cancer, and talking to family about cancer history. The sample included N = 194 participants; Mage = 28.00 (SD = 5.48). Thirty-one percent had ever searched for colorectal cancer information. We identified salient educational advantages to seeking information about colorectal cancer and talking to healthcare providers and family members about cancer history. Barriers included fear, misinformation, low priority, inaccessibility of information, and lack of interest or willingness. This is one of the few studies to investigate cancer communication behaviors among young Black adults. The findings can inform interventions to motivate engagement in cancer communication behaviors.

Improving African Americans' Intentions to Enroll in a Health Registry: Message Development and Evaluation.

African Americans' enrollment in health registries is low, negatively affecting their representation in clinical research. Young African Americans are particularly underrepresented. Because medical discoveries are typically based on findings from research that lacks minority representation, new treatments may not be equally effective with members of the African American community. This may further exacerbate health disparities. In this two-phase study, we first collected data from five focus groups to (a) investigate young African Americans' knowledge about and attitudes toward health registries and (b) explore their perceptions about current messages used to recruit participants into health registries. The findings from the first phase of our research showed that participants had limited awareness and understanding of health registries' functions and held negative attitudes toward research participation. In Phase 2, we conducted an experiment to compare the effects of a current message, a new message designed based on the findings from our Phase 1 study, and a control. Results showed mixed findings on the impact of the new targeted message. Based on the findings from both phases of this study, we present and discuss future strategies.

Young African Americans' Communication with Family Members About COVID-19: Impact on Vaccination Intention and Implications for Health Communication Interventions.

Communication with family members about the COVID-19 vaccine may play an important role in vaccination decisions, especially among young people. This study examined the association between family communication about the COVID-19 vaccine and vaccination intention. Participants were Black/African Americans aged 18-30 years (N = 312) recruited through an online survey in June 2020. We assessed family communication, vaccine attitudes, perceived norms, outcome expectancies, and vaccination intention. More than half (62%) of the participants had talked to family members about the vaccine. Females were more likely than males to have engaged in family communication (63% vs. 59%) (p. > .05). Family communication, injunctive norms, and descriptive norms were significantly (p. < .01) associated with vaccination intention. Family communication was the strongest predictor of intention.Promoting discussions about vaccinations between young Black adults and their families may increase the likelihood of adopting positive vaccination beliefs and influencing vaccine decision-making.

Health Information Seeking as a Coping Strategy to Reduce Alzheimer's Caregivers' Stress.

Individuals with Alzheimer's disease and other forms of dementia (referred to as AD) deteriorate over time, and there will likely be a corresponding increase in levels of burden and stress for caregivers. Despite the significant contributions made by informal caregivers, there are no widely available mechanisms that meet the information needs of informal caregivers. Using a qualitative approach, the current study focuses on AD caregiver information seeking. The study involved conducting interviews to answer the following research questions: (1) What motivating factors lead informal caregivers of people with AD to seek out information?; (2) Is there a relationship between information seeking and resulting perceived stress levels?; and (3) Why do informal caregivers choose to utilize certain resources more than others during their information seeking process? Findings revealed that caregivers' largest motivation for seeking information is to learn how to better care for their loved one. Caregivers tend to rely on mediated resources that they find credible, and interpersonal resources such as people with similar experiences to their own. Many participants were satisfied with information available, but others felt that their interactions with healthcare professionals created more stress and emotional anguish than anticipated. This study offers an initial step in finding ways to meet the needs of those who seek to mitigate their stress through information seeking. By studying the information needs of the caregiving population, healthcare workers and communicators will be more knowledgeable about the relationship between information seeking and stress and coping.

SARS-CoV-2 (COVID-19) Vaccine Intentions in Kentucky.

Background: At the time of our writing, the COVID-19 pandemic continues to cause significant disruption to daily lives. In Kentucky, the burdens from this disease are higher, and vaccination rates for COVID-19 are lower, in comparison to the U.S. as a whole. Understanding vaccine intentions across key subpopulations is critical to increasing vaccination rates. Purpose: This study explores COVID-19 vaccine intentions in Kentucky across demographic subpopulations and also investigates the influences on vaccine intention of attitudes and beliefs about COVID-19. Methods: A population-based survey of 1,459 Kentucky adults was conducted between January 26 and March 20, 2021, with over-sampling of black/African American and Latino/a residents, using online and telephonic modalities. Descriptive statistics characterize the sample and overall vaccine intentions and beliefs. Multivariable linear regression models probed relationships between demographics and vaccination intentions, as well as relationships between vaccination beliefs and vaccination intention. Results: Of the 1,299 unvaccinated respondents, 53% reported intent to get vaccinated, 16% had not decided, and 31% felt they would not get vaccinated. Lower vaccination intention was independently associated with age, lower educational attainment, black/African American race, lower income, Republican political affiliation, rural residence, and several beliefs: low vaccine safety, low vaccine efficacy, the rapidity of vaccine development, and mistrust of vaccine producers. Implications: Increasing COVID-19 vaccination rates will help end this pandemic. Findings from this study can be used to tailor information campaigns aimed at helping individuals make informed decisions about COVID-19 vaccination.

A Theoretically Based Analysis of Twitter Conversations about Trauma and Mental Health: Examining Responses to Storylines on the Television Show Queen Sugar.

Entertainment programming in the United States has long addressed major public health issues. In the present study, we used a culture-centric approach to systematically investigate the role of television storylines in facilitating health-related conversations on social media. In particular, we examined Twitter conversations about sexual and police-involved trauma prompted by portrayals on the fictional television drama Queen Sugar. Guided by the culture-centric model of narratives in health promotion, we classified the tweets (N = 1,671) into four main thematic categories: identification, social proliferation, emotions, and intentions. The analysis also revealed several subthemes, including identification with characters and cultural elements, expressions of pain and joy, information seeking and sharing, and the need to address intergenerational trauma and promote intergenerational conversations. The data suggests that Twitter may provide a vehicle for engaging in difficult conversations. We discuss the theoretical and practical implications of the study for mental health communication with Black Americans.

"Twitter is Really Therapeutic at Times": Examination of Black Men's Twitter Conversations Following Hip-Hop Artist Kid Cudi's Depression Disclosure.

Mental illness affects a considerable number of African Americans, and Black men bare a heavy burden. Over the past few years, more and more Black male celebrities have publicly discussed their struggles with mental illness, aiming to raise awareness, educate the public, and reduce stigma around mental health in the Black community. In this exploratory study, I investigated Twitter conversations following hip-hop artist Scott "Kid Cudi" Mescudi's October 2016 depression disclosure. Following the disclosure, the hashtag #YouGoodMan was created to engage Black men on Twitter in conversations about mental health. I used thematic analysis to analyze a sample of 1,482 tweets from the hashtag. Three distinct themes emerged from this study, with implications for mental health communication. The three themes are (a) advocating for mental health disclosure, (b) providing online and offline support, and (c) acknowledging the role and impact of culture and society. The findings are discussed relevant to social representations theory, celebrity influence, and health campaigns.

Black College Women's Interpersonal Communication in Response to a Sexual Health Intervention: A Mixed Methods Study.

We investigated interpersonal communication generated from a successful sexual health intervention for Black college women attending a Historically Black College/University (HBCU). Guided by the integrative model of behavioral prediction and the theory of gender and power, the intervention combined point-of-access health messages with condom distribution via condom dispensers. Using a mixed-methods approach, we examined communication partners, content, mode, valence, and perceived impact. Data were gathered from surveys (N = 105) and interviews (n = 10) with young adult women at an HBCU campus, conducted three months after the intervention. The findings revealed that 43% of women engaged in interpersonal communication and 21% engaged in online interactions about the dispensers. Friends were the most common conversation partners, and the conversations were mainly about condoms and the dispensers themselves. In general, the discussions were positive, showing support for the dispensers. Regression analyses revealed positive, significant associations between interpersonal communication and two key outcomes: condom acceptability and condom intentions. Overall, this study adds to research linking health communication interventions to interpersonal communication and subsequent attitudes and beliefs. Health communication interventions should actively encourage young Black women to share health-promoting information within their social networks to extend both the reach and impact of those interventions.

Cancer Fatalism and Cancer Information Seeking Among Black Women: Examining the Impact of Aretha Franklin's Death on Cancer Communication Outcomes.

Information seeking is often heightened following news coverage of cancer announcements from prominent celebrities or public figures. While scholars have sought to explicate the mechanisms influencing cancer information seeking following celebrity health announcements, the focus has primarily been on cognitive and emotional factors. Other influences such as sociocultural constructs have largely been ignored in this domain. Additionally, few studies have examined the health communication behaviors of minority individuals. The purpose of this study was to examine Black women's information seeking behaviors as a response to the death of the singer Aretha Franklin from pancreatic cancer and the role of fatalistic beliefs about cancer in the information seeking process. Using a survey conducted a few weeks after Franklin's death (N = 164), we found moderate amounts of pancreatic cancer information seeking, with almost 30% of women looking for information. Younger Black women were much more likely to search for information after Franklin's death than older women. Moreover, while we found fatalistic beliefs to be associated with pancreatic cancer information seeking, the findings were driven by younger women. In particular, younger women were more likely to seek pancreatic cancer information regardless of their beliefs about cancer. This study advances the understanding of cancer information seeking among Black women. Implications for cancer communication with Black women are discussed.

Values of cancer survivors and the supportive role of recreational video games.

Value-affirming activities have been linked to positive health outcomes and improved ability to cope. For cancer survivors who regularly play video games, might the games have potential to affirm values? We surveyed gameplaying survivors and included an open-ended question asking about values and the extent to which they perceived gameplaying as supporting values. A content analysis of responses (N = 533) using Schwartz's value typology revealed that a majority perceived gameplaying as supporting values or offering other benefits. Self-transcendence followed by openness to change were the most frequently coded higher-order categories. The results contribute to a richer understanding of survivors who gameplay.

Information-Seeking and Use of Primary Care Mental Health Services Among Gulf Coast Survivors of Natural Disasters.

OBJECTIVES: This study sought to understand factors related to weather-related disaster survivors' health information and mental health-care-seeking behaviors. METHODS: In November 2017, we conducted a quantitative survey of 170 Gulf Coast residents who experienced weather-related disasters. The survey assessed how individual and psychosocial factors affect health-care-seeking behavior. RESULTS: Nearly 66% of participants reported a high frequency of depression and/or anxiety symptoms, yet only 39% saw a medical professional. Of participants who visited a medical professional, 76% sought information from nonmedical sources. Seeking medical care was strongly correlated with seeking information from nonmedical sources and previous healthcare experiences, but not with fear and stigma. CONCLUSIONS: Positive communication and strong support systems have the potential to mitigate the reluctance people have in seeking help for mental health problems. Although it is discouraging that few people seek professional care, it is promising that participants were not avoiding care due to fear of being stigmatized. Less opposition to mental health care by survivors offers opportunity for mental health professionals to treat the psychological problems survivors experience. Providing necessary information may make headway to mental health care where it is greatly needed.

Impact of tobacco-pack pictorial warnings on youth and young adults: A systematic review of experimental studies.

INTRODUCTION: We conducted a systematic review of the experimental literature on the impact of tobacco-pack pictorial warning labels (PWLs) on youth and young adults. METHODS: We systematically searched computerized databases and the reference lists of relevant articles. We included studies that used an experimental protocol to assess PWLs. Studies had to report findings for youth or young adult samples (aged <30 years). Thirty-one studies met the inclusion criteria, with a total sample size of 27506. Two coders independently coded all study characteristics and outcomes. RESULTS: Twenty-eight studies experimentally evaluated PWLs for cigarette packs while three studies evaluated PWLs for smokeless tobacco packs. Generally, PWLs led to higher attention, stronger cognitive and affective reactions, more negative pack attitudes and smoking attitudes, and increased intentions not to use tobacco products compared to text warnings. PWLs were perceived to be more effective than text warnings for both cigarette packs and smokeless tobacco packs. CONCLUSIONS: The systematic review showed that PWLs on tobacco products are effective across a wide range of tobacco-related outcomes among young people. Gaps in the literature include a lack of research on tobacco initiation and cessation and a dearth of literature on non-cigarette tobacco products.

Young Black Men's Information Seeking following Celebrity Depression Disclosure: Implications for Mental Health Communication.

Celebrity health disclosures motivate people to seek information about various health topics. However, limited systematic evaluations exist on effects of celebrity disclosures of mental illness, despite observations that this is a growing phenomenon and have important implications for public health education. Further, research has rarely examined the impact of such disclosures on minority populations. This study sought to understand factors associated with young Black men's information seeking following exposure to a depression disclosure by Scott Mescudi. Mescudi is a well-known Black male hip-hop artist who shared his depression diagnosis and subsequent treatment plans with his fans in October 2016. For this study, I surveyed 182 Black males aged 18-34, 1 month after the disclosure. Fifty percent sought general information about depression, and 16% sought information to ascertain whether they themselves were at risk for depression. Feeling emotional distress following the disclosure and having current depression symptoms were significantly associated with information seeking behaviors. Identification was indirectly related to information seeking through emotional distress. Thus, emotional distress appears to play an important role in information seeking behaviors following celebrity health disclosures. The findings suggest celebrity health disclosures are associated with proactive health behaviors among this sample. Implications of the results for theorization of celebrity health effects and research on mental health communication with young Black men are discussed.

"Be Straight Up and So Will He": Evaluation of a Novel HIV Prevention Condom Distribution and Health Communication Intervention Targeting Young African American Females.

This study evaluated a novel 3-month campus-based HIV prevention condom distribution and health communication intervention for African American females attending a historically Black college in North Carolina. The theoretical framework for study incorporated the integrative model of behavioral prediction and the theory of gender and power. The intervention provided free condoms via condom dispensers with point-of-access messaging on the dispensers. We assessed 195 individuals before and 118 three months after the intervention. Almost 90% of participants were exposed to the intervention. Forty-four percent used the dispensers, 70% of whom reported using the condoms for sexual intercourse. Perceptions of condom availability and accessibility increased significantly after the intervention. In a multiple regression analysis controlling for covariates, dispenser use was significantly associated with greater condom use. These findings show the promise of a low-cost, broad-reach HIV/STI prevention intervention for young African American women.

Systematic Review of Measures Used in Pictorial Cigarette Pack Warning Experiments.

BACKGROUND: We sought to describe characteristics and psychometric properties of measures used in pictorial cigarette pack warning experiments and provide recommendations for future studies. METHODS: Our systematic review identified 68 pictorial cigarette pack warning experiments conducted between 2000 and 2016 in 22 countries. Two independent coders coded all studies on study features, including sample characteristics, theoretical framework, and constructs assessed. We also coded measurement characteristics, including construct, number of items, source, reliability, and validity. RESULTS: We identified 278 measures representing 61 constructs. The most commonly assessed construct categories were warning reactions (62% of studies) and perceived effectiveness (60%). The most commonly used outcomes were affective reactions (35%), perceived likelihood of harm (22%), intention to quit smoking (22%), perceptions that warnings motivate people to quit smoking (18%), and credibility (16%). Only 4 studies assessed smoking behavior. More than half (54%) of all measures were single items. For multi-item measures, studies reported reliability data 68% of the time (mean α = 0.88, range α = 0.68-0.98). Studies reported sources of measures only 33% of the time and rarely reported validity data. Of 68 studies, 37 (54%) mentioned a theory as informing the study. CONCLUSIONS: Our review found great variability in constructs and measures used to evaluate the impact of cigarette pack pictorial warnings. Many measures were single items with unknown psychometric properties. Recommendations for future studies include a greater emphasis on theoretical models that inform measurement, use of reliable and validated (preferably multi-item) measures, and better reporting of measure sources. IMPLICATIONS: Robust and consistent measurement is important for building a strong, cumulative evidence base to support pictorial cigarette pack warning policies. This systematic review of experimental studies of pictorial cigarette warnings demonstrates the need for standardized, theory-based measures.

Believability of new diseases reported in the 2014 Surgeon General's Report on smoking: Experimental results from a national survey of US adults.

BACKGROUND: Tobacco use is the leading cause of preventable disease and death globally. The 2014 Surgeon General's Report included new diseases linked to smoking, including liver and colon cancer, diabetes and tuberculosis. As more diseases are linked to smoking, which diseases should we communicate to the public and what message source has the most impact? METHODS: Data were collected through a nationally representative phone survey of US adults (N=5014), conducted from September 2014 through May 2015. We experimentally randomized participants to a 2 (new smoking disease messages - liver and colon cancers compared to diabetes and tuberculosis) by 4 (message sources - CDC, FDA, Surgeon General, and none) experiment. The outcome was message believability. RESULTS: About half the sample was female (51.5%) and 17.8% were a current smoker. Overall, 56% of participants said the messages were very believable. Cancer messages (liver and colon cancer) were significantly more believable than messages about chronic disease (tuberculosis and diabetes), 61% vs. 52%. Smokers were less likely to report both sets of new disease messages as very believable compared to non-smokers. Significantly more smokers intending to quit (44.5%) found the messages to be very believable compared to smokers not intending to quit (22.6%). Believability did not differ by message source. CONCLUSION: Important differences exist in believability of disease messages about new tobacco-related information. Messages emphasizing the causal link between smoking and new diseases should be considered for use in mass media campaigns.