Overcoming Health Information Inequities: Valley fever Information Repertoires Among Vulnerable Communities in California.

Although Valley fever represents a growing public health challenge for Central and Southern Californian residents, awareness remains severely limited. The California Department of Public Health (CDPH) ran a cross-platform campaign to mitigate this awareness gap and impact prevention behavior. This study evaluates exposure to the CDPH campaign, followed by an examination of the information consumption patterns associated with key health outcomes. Results suggest that the CDPH campaign successfully improved knowledge accuracy, reduced misperceptions, and increased the likelihood of prevention behavior. Using an information repertoire lens revealed a more nuanced account. Most information repertoires positively influenced accurate knowledge retention and prevention behavior compared to those who were not exposed. The most diverse information repertoire, including interpersonal and media channels, was associated with increased knowledge accuracy, affective risk concerns, personal susceptibility, and prevention behavior. However, exposure to this repertoire was also associated with greater misperceptions. In addition, medical professional and radio-based repertoires positively influenced personal susceptibility perceptions. Overall, this research illustrates the importance of examining not only the general outcomes of health campaigns but also the patterns of information acquisition - particularly when working with underserved communities whose health information consumption preferences may not be comprehensively reflected in the literature.

"I Can See a Story from the Warning": Understanding the Role of Perceived Narrativity in Pictorial Warning Labels.

This study examined the role of perceived narrativity in pictorial warning labels (PWLs) in countering warning reactance and increasing warning effectiveness and support in the context of communicating the cancer risk of alcohol. Findings from a randomized experiment (N = 1,188) showed that PWLs with imagery of lived experience were perceived higher in narrativity than those with imagery of graphic health effects. Adding a one-sentence narrative (vs. non-narrative) text statement to PWLs with imagery of lived experience did not affect perceived narrativity. Perceived narrativity predicted lower reactance to warnings and subsequently higher intentions to stop drinking and higher policy support. Total effects showed that PWLs with imagery of lived experience and non-narrative text led to the lowest reactance, the highest intentions to stop drinking, and the highest level of policy support. This study adds to a growing body of evidence that PWLs featuring narrative content are promising in communicating health risks.

"You are Telling the Story Yourself": Defining and Developing Narrative Pictorial Warning Labels.

Pictorial warning labels (PWLs) featuring narrative content are promising strategies for communicating health risks and motivating behavior change. The objectives of this study were to (1) identify what intrinsic features a PWL must have to be constructed as a narrative and (2) uncover in what ways narrative PWLs are perceived as being (in)effective. Seven online focus groups were conducted via Zoom with moderate and heavy drinkers (n = 30). Participants discussed a series of mockup PWLs designed to communicate the cancer risk of alcohol. The discussion revealed that a static image must include character, causality, and setting to help individuals construct the story. Specifically, the character should be discernible and believable so that individuals can infer risk information. Moreover, the connection between the image and text should imply a causal relationship between alcohol drinking and cancer risks. Lastly, there should be sufficient relevant background or context information. When discussing the label effectiveness, most participants thought narrative PWLs were more effective than graphic, non-narrative PWLs at informing consumers about the cancer risk of alcohol. Their reasoning included narrative PWLs (1) being easy to understand, (2) evoking curiosity and imagination, (3) eliciting sympathy for the character, (4) not causing aversion, and (5) increasing risk perceptions. This study contributes to the narrative persuasion research and offers practical implications for designing image-based narratives.

Designing Cancer Warning Labels for Alcoholic Beverages: Examining the Impact of Visual Elements.

Alcohol is a known carcinogen. However, public awareness of cancer risk associated with alcohol use is low. A promising approach to raising awareness is to include cancer warning labels on alcohol-containing products, but there is limited knowledge of the design and effect of such warnings. The present study investigated the impact of visual elements on the effectiveness of cancer warning labels. In a randomized online experiment, alcohol consumers (N = 1,190) were randomly assigned to one of three conditions: exposure to (a) text-only warning labels, (b) pictorial warning labels showing graphic health effects (e.g., diseased organs), and (c) pictorial warning labels showing lived experience (e.g., cancer patients in a medical setting). The results showed that whereas the three warning types did not differ significantly in behavioral intentions, pictorial warnings featuring health effects led to greater disgust and anger than text-only warnings and pictorial warnings featuring lived experience. Moreover, anger predicted lower intentions to reduce alcohol use and was a significant mediator of the effects of warning type on behavioral intentions. The findings highlight the role of emotions in responses to health warning labels with different visual elements and suggest that text-only warnings and pictorial warnings with lived experience may be useful in preventing boomerang effects.

How are we going to treat Chinese people during the pandemic? Media cultivation of intergroup threat and blame.

This study integrates cultivation and intergroup threat theories to examine media cultivation effects during the COVID-19 pandemic. We argue that U.S. media have consistently portrayed China as a threat and target of blame. The cultivation of media has thus resulted in perceived threat of and blame on Chinese people for the COVID-19 pandemic. Results of a cross-sectional survey in two samples (MTurk: N = 375; college: N = 566) showed that the amount of media consumption predicted stronger perceptions that Chinese people were a health threat, and also predicted blame on Chinese people for the COVID-19 outbreak. Threat perception and blame were further associated with support of media content that derogated China, stronger intentions to attack, and weaker intentions to help Chinese people. The findings have profound implications for intergroup threat and cultivation research, and practical importance for intergroup relations, especially when the global community finds itself in a public crisis.

Is My Story Better Than His Story? Understanding the Effects and Mechanisms of Narrative Point of View in the Opioid Context.

Sharing the stories of people whose lives are impacted by Opioid Use Disorders (OUDs) can be a promising strategy to reduce stigma and increase support for beneficial public policies. Since a story can be told from a first-person or third-person point of view (POV), this study sought to (1) determine the relative persuasive effects of narrative POV and (2) identify the underlying psychological mechanisms, including character identification and psychological reactance, of such narratives. A one-way between-subjects experiment was conducted among a college student sample (N = 276). Narrative POV was manipulated by describing a college student's OUD experience from either the first- or third-person POV. Findings demonstrated that POV did not influence identification but had a significant effect on reactance. Specifically, the first-person (vs. third-person) POV narrative led to lower reactance, which was associated with participants' decreased desire to socially distance themselves from people with OUDs and stronger support for public health-oriented policies regarding OUDs. This study sheds light on the mixed findings revealed in the literature and has practical importance in health message design in the current opioid epidemic.

How Information Repertoire Affects Vaccine Hesitancy: Processes of Information Verification and Cognitive Elaboration.

As information consumption plays a critical role in addressing vaccine hesitancy in the hybrid media environment, it becomes crucial to understand how individuals' use of a combination of channels and sources affects their vaccine hesitancy. Based on information repertoire approaches emphasizing the multiplicity of channels and sources, we investigated different patterns of information repertoire related to the COVID-19 pandemic and how these patterns affected vaccine hesitancy through different informational mechanisms. Our results based on a U.S. sample suggest that while a richer information repertoire related to increased confidence in vaccines through increased information verification, this richness also corresponded with deepened vaccine hesitancy through heightened cognitive elaboration and perceived information inconsistency. Our findings support the utility of repertoire approaches for better understanding health information acquisition in the complex media ecology.

"You Know Nothing about How Alcohol Might Lead to Cancer!" Effects of Threatening and Hedging Languages on Intentions to Reduce and Stop Drinking.

Alcohol causes cancer, but many alcohol consumers are not aware of this risk. Research is needed to identify effective communication strategies to increase risk perceptions and decrease alcohol consumption. This study examined the effects of threatening and hedging languages in communicating the cancer risk associated with alcohol use. Results from a between-subjects experiment (N = 584) revealed a significant interaction effect: Threatening language combined with lexical hedges led to a higher perceived threat to drinker identity competence, which predicted higher intentions to reduce and stop drinking. Moreover, threatening language increased perceived threat to freedom, predicting greater reactance and lower behavioral intentions. Lastly, hedging increased perceived message tentativeness, predicting lower risk perceptions and behavioral intentions. Implications of our study were discussed.

Social Media Use and Demographics Predicted Knowledge About Alcohol as a Cancer Risk Factor.

PURPOSE: To determine whether social media use, alcohol consumption, and sociodemographic factors predicted Americans' knowledge about alcohol-related cancer risk. DESIGN: Health Information National Trends Survey (2020). SETTING: United States. SUBJECTS: A nationally representative sample (N = 3865; response rate = 36.7%). MEASURES: Knowledge about cancer risk of beer, wine, and liquor; social media use; demographics; smoking status; alcohol consumption; and cancer history. ANALYSIS: Data were analyzed using multinomial multiple logistic regression with jackknife replicate weights. RESULTS: Less than a third of U.S. adults (20.34-31.20%) were aware of cancer risk of alcohol. People who watched health-related YouTube videos were more likely to be well-informed (odds ratio [OR] = 1.55 [95% confidence interval 1.01, 2.36] for beer) and misinformed (OR = 1.68 [1.17, 2.43] for wine). Alcohol consumption predicted higher likelihoods of being misinformed about cancer risk of beer (OR = 1.03 [1.003, 1.05]). People who were older and had less education were less likely to be well-informed for all types of alcohol. Females (for liquor) and Blacks (for beer) were less likely to be well-informed and misinformed. CONCLUSION: Social media can be a source of both correct information and misinformation about alcohol and cancer risk. Health promotion should target older adults, people with less education, racial minorities, females, and people who consume alcohol.

Show Me a Photo of the Character: Exploring the Interaction between Text and Visuals in Narrative Persuasion.

The use of narrative text in health messaging has been ubiquitous. With the popularity of promoting public health on social media, it becomes critical to investigate what visual images should be used to maximize the impact of narrative health-related posts. This study focused on messages designed to communicate the breast cancer risk associated with alcohol use. We conducted a 2 (text: narrative vs. non-narrative) x 2 (visuals: exemplar vs. non-exemplar) between-subjects online experiment (N = 299). Our results showed that narrative (vs. non-narrative) text led to greater attention, stronger negative emotions, and higher intentions to seek information about alcohol use and cancer among female drinkers. The visual exemplar (vs. non-exemplar) also produced higher intentions to seek information and reduce alcohol use. More importantly, including a visual exemplar (vs. non-exemplar) significantly increased negative emotions and subsequently behavioral intentions when the text was a narrative, but the visual content did not make a difference when the text was a non-narrative. The results of this study show the importance of adding a relevant visual exemplar to narrative text, such as a photo of the character, to improve message effectiveness.

The use of immersive stories to influence college students' attitudes and intentions related to drinking and driving.

ObjectiveCollege students are at risk of drinking and driving. The current study examines the use of immersive stories to prevent college students from drinking and driving.Participants107 college students participated in the study.MethodsParticipants were randomly assigned to watch an immersive 360° video, which featured a story of a young female driver who caused a fatal car crash due to impaired driving, either in head-mounted displays (HMDs) or in tablets.ResultsThe story viewed through HMDs (vs. tablets) led to lower intentions to drink and drive only among female participants. Moreover, female participants' perceived similarity to the protagonist mediated the effect of modality on their intentions to drink and drive.Conclusions360° video stories experienced through high immersion (via HMDs) have the potential to prevent risky behavior. It is important to consider the protagonist's gender when adopting immersive stories in alcohol education programs on college campuses.

Impact of Self-Affirmation on Responses to Health Warning Messages: Does Consideration of Future Consequences Matter?

Self-affirmation theory has inspired numerous studies that have tried to understand the effects of self-affirmation on defensive processing of threatening health messages and subsequent behavior. Despite the overall positive effects of self-affirmation, psychological processes through which self-affirmation exerts such impact remain unclear. We examined Consideration of Future Consequences (CFC) as a potential moderator of the effects of self-affirmation on responses to graphic cigarette warning warnings, in an attempt to shed light on the psychological processes. We conducted an experimental study in which 925 African American smokers were instructed to self-affirm (or not) prior to viewing graphic cigarette warning labels. We found that smokers with stronger present time orientation (PTO) experienced higher defensive responses as measured by anger, perceived message manipulation, and message derogation, after viewing graphic cigarette warning labels; whereas smokers with stronger future time orientation (FTO) reported less message derogation. PTO interacted with self-affirmation in predicting defensive processing measures, such that self-affirmation reduced message derogation at lower levels of PTO and increased message derogation and perceived message manipulation at higher levels of PTO. Self-affirmation also had a conditional indirect effect on smoking intentions and intention to quit smoking through measures of defensive processing. We discuss implications of our study.

Predicting Intentions to Vaccinate against COVID-19 and Seasonal Flu: The Role of Consideration of Future and Immediate Consequences.

Understanding the social-psychological determinants of the public's perceptions and intentions related to vaccination is key to promoting vaccination. The current study examines how individual differences in consideration of future and immediate consequences (CFC-F and CFC-I) impact risk perceptions of, and intentions to vaccinate against, COVID-19 and seasonal flu. A survey of 395 adults on Amazon Mechanical Turk during April and May of 2020 showed that CFC-F predicted vaccination intentions, whereas CFC-I did not. Moreover, CFC-F and CFC-I positively predicted affective risk perceptions, perceived susceptibility, and perceived severity of both COVID-19 and seasonal flu. Last, both CFC constructs had a positive indirect effect on vaccination intentions of COVID-19 and seasonal flu through increasing perceived severity of the corresponding disease. This study makes theoretical contributions to the CFC literature and offers valuable insights for the design of effective vaccine promotion messages.

The Role of Narrative Pictorial Warning Labels in Communicating Alcohol-Related Cancer Risks.

This study examined the role of pictorial warning labels (PWLs) featuring narrative content in communicating alcohol-related cancer risks. In an online experiment, 169 adult alcohol consumers were randomly assigned to view two narrative PWLs, two non-narrative PWLs, or control. Results showed that exposure to narrative PWLs significantly increased participants' worry about, feelings of risk of, and perceived severity of harm of getting alcohol-related cancer, but did not affect their comparative likelihood of getting alcohol-related cancer or intentions to reduce alcohol use. Exposure to narrative PWLs also indirectly influenced intentions through increased worry. Moreover, participants' risk perceptions and intentions in non-narrative PWLs condition did not differ from those in narrative PWLs and control conditions. Therefore, these findings suggest that narrative PWLs are a promising strategy in informing consumers about the cancer risks of alcohol.

Public Health Messaging during the COVID-19 Pandemic and Beyond: Lessons from Communication Science.

The COVID-19 pandemic has made it clear that effective public health messaging is an indispensable component of a robust pandemic response system. In this article, we review decades of research from the interdisciplinary field of communication science and provide evidence-based recommendations for COVID-19 public health messaging. We take a principled approach by systematically examining the communication process, focusing on decisions about what to say in a message (i.e., message content) and how to say it (i.e., message executions), and how these decisions impact message persuasiveness. Following a synthesis of each major line of literature, we discuss how science-based principles of message design can be used in COVID-19 public health messaging. Additionally, we identify emerging challenges for public health messaging during the COVID-19 pandemic and discuss possible remedies. We conclude that communication science offers promising public health messaging strategies for combatting COVID-19 and future pandemics.

Determination of ethyl carbamate in wine by matrix modification-assisted headspace single-drop microextraction and gas chromatography-mass spectrometry technique.

A novel method for the analysis of ethyl carbamate in wine has been developed by coupling matrix modification-assisted headspace single-drop microextraction and gas chromatography-mass spectrometry (GC-MS) techniques. The method was developed by optimizing the matrix modifier and extraction parameters. The calibration method was followed by quantifying the internal isotope standard. The results suggested that the method was linear in the concentration range of 2-1000 ng/mL (R2 = 0.9996). The method presents a detection limit of 1.5 ng/mL, and the quantification limit is 5 ng/mL. The accuracy ranged between 94.9 and 99.9%, and the precision of the method was less than 5%. The method was applied for the detection of wine samples, and the results exhibited no significant difference when compared to the solid phase extraction method.

Self-Affirmation Does Not Change Smokers' Explicit or Implicit Attitudes toward Smoking Following Exposure to Graphic Cigarette Warning Labels.

Self-affirmation has shown promise in promoting pro-health attitudes following exposure to threatening health messages by reducing defensive processing of such messages. We examine the impact of self-affirmation prior to viewing graphic cigarette warning labels on implicit and explicit attitudes toward smoking in a sample of African American smokers (N = 151). Participants held negative explicit and implicit attitudes toward smoking. We found no direct effect of self-affirmation on either implicit or explicit attitudes. Self-affirmation and risk level did not interact to predict either attitude type. We discuss findings in terms of self-affirmation theory, attitude measurement, and the meta-cognitive model of attitude change.

What if I Tell You E-Cigarette Users are Inferior? An Investigation of Social Identity Threat in Health Messaging.

Drawing on the literature on social identity threat, this study examined how threatening ecigarette users' identities in a narrative impacts their perceived behavioral control regarding ecigarette use, and how this effect can be moderated by de-emphasizing the story character's user identity. In an experiment, current e-cigarette users (N = 395) read a conversation between the main character (an e-cigarette user) and their friend. Identity threat was manipulated using negative descriptions of e-cigarette users, and identity emphasis was manipulated through the main character's self-description. Results showed identity threat in a message could influence perceived behavioral control to reduce e-cigarette use through two routes. First, attacking ecigarette users' identity led to perceived threat, which predicted lower perceived behavioral control. Furthermore, character identity emphasis moderated the effect of identity threat: For a character with low identity emphasis, attacking (vs. not attacking) e-cigarette users' identity led to stronger perceived behavioral control; for a character with high identity emphasis, attacking (vs. not attacking) users' identity led to weaker perceived behavioral control. The findings extend the social identity perspective and contribute to health communication research by examining a health behavior-specific social identity and demonstrating the utility of social identity threat as a persuasion strategy.

Feasibility of a Computer Role-Playing Game to Promote Empathy in Nursing Students: The Role of Immersiveness and Perspective.

Empathy is considered a cornerstone of high-quality health care and a required element of nursing education. Although computer role-playing games (CRPGs) are a promising tool to promote clinical empathy, little is known about how and why it is effective at improving empathy. The goal of the current study is to investigate the feasibility and effectiveness of a CRPG on nursing students' empathy with a focus on immersiveness and perspective. Results from a 2 × 2 (virtual reality [VR] vs. non-VR × patient's family's perspective vs. health care provider's perspective) between-subjects experiment (N = 69) showed that playing the game in VR (vs. non-VR) led to greater spatial presence and empathy. Moreover, playing from the health care provider's (vs. patient's family's) perspective elicited greater empathy. A moderated mediation effect was found, suggesting that users' attention allocation significantly mediated the effect of immersiveness on empathy in the patient's family's perspective condition. These findings show the feasibility of using a role-playing game for nursing education. Both theoretical and practical implications involving empathy training were discussed, along with suggestions for further research.

Investigating the Interplay of Self-Construal and Independent Vs. Interdependent Self-Affirmation.

This study examines how the relative effects of independent and interdependent self-affirmation might be influenced by individuals' self-construal. A controlled experiment involving 186 Chinese adult smokers revealed a significant interactive effect of self-affirmation type and self-construal on message derogation and posttest attitudes toward smoking. For individuals with a dominant independent self-construal, independent self-affirmation (i.e., affirming the most important value to the self) led to less message derogation and more negative attitudes toward smoking than interdependent self-affirmation (i.e., affirming the most important value to the self and the family). In contrast, for individuals with a dominant interdependent self-construal, interdependent self-affirmation resulted in less message derogation and more negative attitudes toward smoking than independent self-affirmation. In addition, the interaction between self-affirmation type and self-construal had an indirect effect on perceived susceptibility to smoking-related diseases through message derogation. Theoretical and practical implications are discussed.