Effects of Added Emphasis and Pause in Audio Delivery of Health Information.

Health literacy is crucial to supporting good health and is a major national goal. Audio delivery of information is becoming more popular for informing oneself. In this study, we evaluate the effect of audio enhancements in the form of information emphasis and pauses with health texts of varying difficulty and we measure health information comprehension and retention. We produced audio snippets from difficult and easy text and conducted the study on Amazon Mechanical Turk (AMT). Our findings suggest that emphasis matters for both information comprehension and retention. When there is no added pause, emphasizing significant information can lower the perceived difficulty for difficult and easy texts. Comprehension is higher (54%) with correctly placed emphasis for the difficult texts compared to not adding emphasis (50%). Adding a pause lowers perceived difficulty and can improve retention but adversely affects information comprehension.

US state vaccine mandates did not influence COVID-19 vaccination rates but reduced uptake of COVID-19 boosters and flu vaccines compared to bans on vaccine restrictions.

During the COVID-19 pandemic, some US states mandated vaccination for certain citizens. We used state-level data from the CDC to test whether vaccine mandates predicted changes in COVID-19 vaccine uptake, as well as related voluntary behaviors involving COVID-19 boosters and seasonal influenza vaccines. Results showed that COVID-19 vaccine adoption did not significantly change in the weeks before and after states implemented vaccine mandates, suggesting that mandates did not directly impact COVID-19 vaccination. Compared to states that banned vaccine restrictions, however, states with mandates had lower levels of COVID-19 booster adoption as well as adult and child flu vaccination, especially when residents initially were less likely to vaccinate for COVID-19. This research supports the notion that governmental restrictions in the form of vaccination mandates can have unintended negative consequences, not necessarily by reducing uptake of the mandated vaccine, but by reducing adoption of other voluntary vaccines.

LGBTQ+ inequity in crowdfunding cancer costs: The influence of online reach and LGBTQ+ state policy.

BACKGROUND: Emerging literature suggests that LGBTQ+ cancer survivors are more likely to experience financial burden than non-LGBTQ+ survivors. However, LGBTQ+ cancer survivors experience with cost-coping behaviors such as crowdfunding is understudied. METHODS: We aimed to assess LGBTQ+ inequity in cancer crowdfunding by combining community-engaged and technology-based methods. Crowdfunding campaigns were web-scraped from GoFundMe and classified as cancer-related and LGBTQ+ or non-LGBTQ+ using term dictionaries. Bivariate analyses and generalized linear models were used to assess differential effects in total goal amount raised by LGBTQ+ status. Stratified models were run by online reach and LGBTQ+ inclusivity of state policy. RESULTS: A total of N = 188,342 active cancer-related crowdfunding campaigns were web-scraped from GoFundMe in November 2022, of which N = 535 were LGBTQ+ and ranged from 2014 to 2022. In multivariable models of recent campaigns (2019-2022), LGBTQ+ campaigns raised $1608 (95% CI: -2139, -1077) less than non-LGBTQ+ campaigns. LGBTQ+ campaigns with low (26-45 donors), moderate (46-87 donors), and high (88-240 donors) online reach raised on average $1152 (95% CI: -$1589, -$716), $1050 (95% CI: -$1737, -$364), and $2655 (95% CI: -$4312, -$998) less than non-LGBTQ+ campaigns respectively. When stratified by LGBTQ+ inclusivity of state level policy states with anti-LGBTQ+ policy/lacking equitable policy raised on average $1910 (95% CI: -2640, -1182) less than non-LGBTQ+ campaigns from the same states. CONCLUSIONS AND RELEVANCE: Our findings revealed LGBTQ+ inequity in cancer-related crowdfunding, suggesting that LGBTQ+ cancer survivors may be less able to address financial burden via crowdfunding in comparison to non-LGBTQ+ cancer survivors-potentially widening existing economic inequities.

An Investigation into the Portrayal of Organ Donation on Grey's Anatomy Seasons 1 Through 15.

The current project sought to extend prior research examining organ donation portrayals on Grey's Anatomy by examining the first fifteen seasons. Guided by the health belief model, content analysis revealed more attention was given to benefits of donation than barriers. Contrary to previous research, more attention was given to refuting rather than promoting commonly cited myths. The results also address attention to the health threat as well as Grey's Anatomy's representation of self-efficacy in registering to be an organ donor. Finally, proportion tests revealed significant differences between the types of organs transplanted on Grey's Anatomy compared to organs transplanted in the United States. The results are discussed with an emphasis on portrayal trends throughout Season 1 through 15 as well as the theoretical and practical implications of our findings.

The Effectiveness of Social Norm Appeals on Promoting COVID-19 Prevention Behaviors: A Multistudy Examination.

Recent research shows social norm perceptions predict people's adherence to COVID-19 preventative health practices. Nonetheless, additional empirical studies are necessary to evaluate the effectiveness of different types of social norm messages on behavioral outcomes with experimental designs. Guided by the social norm literature and frameworks, the current research addresses this need by examining the effects of descriptive and injunctive norm appeals promoting the practice of social distancing and mask-wearing with both a controlled experiment and social media campaigns. Results from this multistudy investigation showed the effectiveness of descriptive and injunctive norm messages (v. no message exposure) in promoting focal behaviors and highlighted the superiority of injunctive norm appeals in promoting behavioral intentions and increasing social media engagement. Theoretical implications and recommendations for practice are discussed.

Exploring Online Crowdfunding for Cancer-Related Costs Among LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer, Plus) Cancer Survivors: Integration of Community-Engaged and Technology-Based Methodologies.

BACKGROUND: Cancer survivors frequently experience cancer-related financial burdens. The extent to which Lesbian, Gay, Bisexual, Transgender, Queer, Plus (LGBTQ+) populations experience cancer-related cost-coping behaviors such as crowdfunding is largely unknown, owing to a lack of sexual orientation and gender identity data collection and social stigma. Web-scraping has previously been used to evaluate inequities in online crowdfunding, but these methods alone do not adequately engage populations facing inequities. OBJECTIVE: We describe the methodological process of integrating technology-based and community-engaged methods to explore the financial burden of cancer among LGBTQ+ individuals via online crowdfunding. METHODS: To center the LGBTQ+ community, we followed community engagement guidelines by forming a study advisory board (SAB) of LGBTQ+ cancer survivors, caregivers, and professionals who were involved in every step of the research. SAB member engagement was tracked through quarterly SAB meeting attendance and an engagement survey. We then used web-scraping methods to extract a data set of online crowdfunding campaigns. The study team followed an integrated technology-based and community-engaged process to develop and refine term dictionaries for analyses. Term dictionaries were developed and refined in order to identify crowdfunding campaigns that were cancer- and LGBTQ+-related. RESULTS: Advisory board engagement was high according to metrics of meeting attendance, meeting participation, and anonymous board feedback. In collaboration with the SAB, the term dictionaries were iteratively edited and refined. The LGBTQ+ term dictionary was developed by the study team, while the cancer term dictionary was refined from an existing dictionary. The advisory board and analytic team members manually coded against the term dictionary and performed quality checks until high confidence in correct classification was achieved using pairwise agreement. Through each phase of manual coding and quality checks, the advisory board identified more misclassified campaigns than the analytic team alone. When refining the LGBTQ+ term dictionary, the analytic team identified 11.8% misclassification while the SAB identified 20.7% misclassification. Once each term dictionary was finalized, the LGBTQ+ term dictionary resulted in a 95% pairwise agreement, while the cancer term dictionary resulted in an 89.2% pairwise agreement. CONCLUSIONS: The classification tools developed by integrating community-engaged and technology-based methods were more accurate because of the equity-based approach of centering LGBTQ+ voices and their lived experiences. This exemplar suggests integrating community-engaged and technology-based methods to study inequities is highly feasible and has applications beyond LGBTQ+ financial burden research.

Comprehensive Model of Information Seeking: A Meta-Analysis.

The comprehensive model of information seeking (CMIS) is a well-known framework to predict health information seeking by a combination of health beliefs and medium-related factors. Despite being proposed almost three decades ago, few efforts have been made to systematically summarize CMIS scholarship. To fill this gap in the literature, 36 meta-analyses were first conducted to identify the bivariate relationships between variables in the CMIS. These meta-analytic data were then used to test path models evaluating the role of health beliefs and medium-related factors. The results showed that the models containing only factors related to the communication medium, only health factors, and a modified version of the CMIS fit the data relatively well. The original CMIS did not demonstrate an acceptable model fit. Theoretical and practical implications are discussed.

Audio delivery of health information: An NLP study of information difficulty and bias in listeners.

Health literacy is the ability to understand, process, and obtain health information and make suitable decisions about health care [3]. Traditionally, text has been the main medium for delivering health information. However, virtual assistants are gaining popularity in this digital era; and people increasingly rely on audio and smart speakers for health information. We aim to identify audio/text features that contribute to the difficulty of the information delivered over audio. We are creating a health-related audio corpus. We selected text snippets and calculated seven text features. Then, we converted the text snippets to audio snippets. In a pilot study with Amazon Mechanical Turk (AMT) workers, we measured the perceived and actual difficulty of the audio using the response of multiple choice and free recall questions. We collected demographic information as well as bias about doctors' gender, task preference, and health information preference. Thirteen workers completed thirty audio snippets and related questions. We found a strong correlation between text features lexical chain, and the dependent variables, and multiple choice response, percentage of matching word, percentage of similar word, cosine similarity, and time taken (in seconds). In addition, doctors were generally perceived to be more competent than warm. How warm workers perceive male doctors correlated significantly with perceived difficulty.

Psycholinguistic Markers of COVID-19 Conspiracy Tweets and Predictors of Tweet Dissemination.

The adoption of conspiracy theories about COVID-19 has been fairly widespread among the general public and associated with the rejection of self-protective behaviors. Despite their significance, however, a gap remains in our understanding of the underlying characteristics of messages used to disseminate COVID-19 conspiracies. We used the construct of resonance as a framework to examine a sample of more than 1.8 million posts to Twitter about COVID-19 made between April and June 2020. Our analyses focused on the psycholinguistic properties that distinguish conspiracy theory tweets from other COVID-19 topics and predict their spread. COVID-19 conspiracy tweets were distinct and most likely to resonate when they provided explanations and expressed negative emotions. The results highlight the sensemaking functions served by conspiracy tweets in response to the profound upheaval caused by the pandemic.

Russian Troll Vaccine Misinformation Dissemination on Twitter: The Role of Political Partisanship.

Although vaccine misinformation has been a longstanding problem, the growth of social media and divides based on political ideology have raised novel concerns. One noteworthy example involves the Russian Internet Research Agency's deployment of operatives on Twitter (i.e., trolls) working to sow discord among the American public. We examine 1,959 tweets made by trolls between 2015 and 2017 about vaccination to better understand their efforts to spread vaccine misinformation. Our results indicate that misinformation was more likely to be perpetuated by left and right trolls than nonpartisan trolls. There was, however, relatively little user engagement with vaccine tweets containing misinformation and no differences in engagement with misinformation shared by partisan and nonpartisan trolls. Trends in the psycholinguistic properties of language in trolls' vaccine tweets suggest that right and left trolls were more likely to include cognitive process words (i.e., insight, causation, discrepancy, certainty, differentiation, and tentativeness) than were nonpartisan trolls.

Design and implementation of a health messaging protocol employed for use within a COVID-19 health dissemination platform.

Introduction: AZCOVIDTXT, a bilingual, two-way information sharing platform was created in April of 2020 in response to rising COVID-19 cases in Arizona. The aim of this paper is to delineate the protocol and processes used to develop and disseminate health messaging to serve as guidance for other groups, universities, or public health programs in the implementation or enhancement of health communication services. Methods: Health messaging formats included website articles, published on the system's website (azcovidtxt.org), infographics posted on social media, and SMS. Social media and SMS infographics were intended to highlight and augment the topics covered in the weekly website articles, to create a seamless multimodal source of reliable COVID-19 information for AZCOVIDTXT enrollees and the broader public. All health messaging information, text message and social media content was planned and reviewed collaboratively by the AZCOVIDTXT team topic experts for accuracy, efficacy, and content consistency. Results: As of July 2021, AZCOVIDTXT provided weekly COVID-19-related health communication to 3,747 participating households located across 225 Arizona zip codes. AZCOVIDTXT has developed and sent 446 unique, bilingual SMS for a total of 271,977 contact points. The team has produced and published 179 website articles, which averaged a combined 7,000-page views per month, and 173 social media posts were made available to 268 followers across three platforms. Discussion: Several programmatic aspects were deemed essential to the success of AZCOVIDTXT. These included (1) addressing community specific needs, (2) creating timely and relevant content, (3) developing an adaptable system, and (4) prioritizing system automation where possible, (5) having an interdisciplinary team approach to identifying and crafting key messages.

Psychological Reactance Theory and COVID-19 Vaccine Mandates: The Roles of Threat Magnitude and Direction of Threat.

The current study examines psychological reactance theory (PRT), focusing on the role of threat directness and threat magnitude in the context of a COVID-19 vaccine mandate. Students on two college campuses in the United States (N = 374) were informed that their university or the other university (i.e., threat directness manipulation) was considering a vaccinate mandate for the following semester that would or would not include sanctions for noncompliance (i.e., threat magnitude manipulation). Participants experienced significantly greater freedom threat perceptions when the mandate included sanctions compared to when it did not, but freedom threat perception did not differ when the mandate was on their own campus as to the other campus. An interaction effect was also observed in which perceived freedom threat and reactance was greatest among participants receiving an indirect (as opposed to direct) threat with sanctions. Findings are discussed with an emphasis on the theoretical contribution to PRT along with the practical implications for vaccine mandates.

State mask mandates and psychological reactance theory: The role of political partisanship and COVID-19 risk in mask adoption and resistance.

RATIONALE: Psychological reactance theory was applied to examine the implications of state-level mask mandates in the United States during the COVID-19 pandemic. We evaluated the role of political partisanship and COVID-19 risk on changes in self-reported mask wearing before and after the imposition and removal of state mask mandates. METHOD: Secondary data from several sources were aggregated about self-reported mask wearing behavior, state mandates, COVID-19 infection rates, and state-level political partisanship. Difference-in-differences tests were performed using logistic regression to evaluate whether change in mask wearing behavior following the imposition or removal of a mandate was greater in states based on state-level political partisanship and COVID-19 infection rates. RESULTS: Although mask adoption generally increased following mandates, the amount of increase was smaller in more Republican states compared to more Democratic states. Mask wearing generally decreased following the removal of mandates, with greater decreases when COVID-19 infection rates were lower. CONCLUSION: The results collectively offer insights about the nuanced role of contextual factors in the adoption and resistance to masks following state mask mandates. Partisanship was important in responses to the imposition of state mask mandates and COVID-19 risk played a critical role in responses to mandate removal.

Vaccine misinformation types and properties in Russian troll tweets.

OBJECTIVE: To identify the content of and engagement with vaccine misinformation from Russian trolls on Twitter. METHODS: Troll tweets (N = 1959) obtained from Twitter in 2020 were coded for vaccine misinformation (α = 0.77-0.97). Descriptive, bivariate, and multivariable negative binomial regressions were applied to estimate robust incidence rate ratios (IRRs) and 95% confidence intervals (95 %CI) of vaccine misinformation associations with tweet characteristics and engagement (i.e., replies, likes, retweets). RESULTS: Misinformation about personal dangers (43.0%), civil liberty violations (20.2%), and vaccine conspiracies (18.6%) were common. More misinformation tweets used anti-vaccination language (97.3% vs. 13.2%) and referenced symptoms (37.4% vs. 0.5%) than non-misinformation tweets. Fewer misinformation tweets referenced credible sources (14.0% vs. 19.5%), were formatted as headlines (39.2% vs. 77.0%), and mentioned specific vaccines (11.3% vs. 36.1%, all p < 0.01) than non-misinformation tweets. Personal dangers misinformation had 83% lower rate of retweets (95 %CI 0.04-0.66). Civil liberties misinformation had significantly higher rate of replies (IRR: 7.65, 95 %CI 1.06-55.46), but lower overall engagement (IRR: 0.38, 95 %CI 0.16-0.88) than non-misinformation tweets. CONCLUSIONS: Strategies used to promote vaccine misinformation provide insight into the nature of vaccine misinformation online and public responses. Our findings suggest a need to explore influences on whether users reject or entertain online vaccine misinformation.

Social Enhancement and Compensation in Online Social Support among Cancer Patients: The Role of Social Network Properties.

Although several researchers have reported evidence that the benefits of Internet use depend on users' offline resources, the factors responsible for this phenomenon are not well understood. We examined a network-based explanation for social enhancement (i.e., rich get richer) and social compensation (i.e., poor get richer) in the context of received social support among adults coping with cancer. After first controlling for support received offline, we tested the role of two offline network properties in predicting support received online. The results were mostly consistent with social enhancement. Offline group affiliation was associated with greater levels of support received online. Additionally, significant indirect effects were observed from offline group affiliation to support received online through online group affiliation as well as from offline tie strength to support received online through online tie strength.

Big Data, Computational Social Science, and Health Communication: A Review and Agenda for Advancing Theory.

Contemporary research on health communication has been marked by the presence of big data and computational social science (CSS) techniques. The relative novelty of these approaches makes it worthwhile to consider their status and potential for advancing health communication scholarship. This essay offers an introduction focusing on how big data and CSS techniques are being employed to study health communication and their utility for theory development. Key trends in this body of research are summarized, including the use of big data and CSS for examining public perceptions of health conditions or events, investigating network-related dimensions of health phenomena, and illness monitoring. The implications of big data and CSS for health communication theory are also evaluated. Opportunities presented by big data and CSS to help extend existing theories and build new communication theories are discussed.

The Paradoxical Outcomes of Observing Others' Exercise Behavior on Social Network Sites: Friends' Exercise Posts, Exercise Attitudes, and Weight Concern.

This study examined the implications of observing others' exercise behavior on social network sites (SNSs). Social cognitive theory and social comparison theory were used to make predictions about the conditions under which individuals' (N = 232) exposure to exercise-related SNS posts from others in their social network were related to their weight concerns and exercise attitudes. The results revealed a paradox in which observing others' exercise posts was associated with both adaptive and maladaptive responses. The number of exercise-related SNS posts received from members of respondents' social networks was associated with greater weight concern, and this relationship was stronger among respondents who viewed exercise-related posts from network members who were similar to respondents. Yet, among respondents who had a tendency to make appearance-related upward social comparisons, the number of others' exercise-related SNS posts received was associated with pro-exercise attitudes.

A Test of The Risk Perception Attitude Framework as a Message Tailoring Strategy to Promote Diabetes Screening.

The risk perception attitude (RPA) framework was tested as a message tailoring strategy to encourage diabetes screening. Participants (N = 602) were first categorized into one of four RPA groups based on their diabetes risk and efficacy perceptions and then randomly assigned to receive a message that matched their RPA, mismatched their RPA, or a control message. Participants receiving a matched message reported greater intentions to engage in self-protective behavior than participants who received a mismatched message or the control message. The results also showed differences in attitudes and behavioral intentions across the four RPA groups. Participants in the responsive group had more positive attitudes toward diabetes screening than the other three groups, whereas participants in the indifferent group reported the weakest intentions to engage in self-protective behavior.

A Systematic Review of Interventions to Enhance Healthy Lifestyle Behaviors in Adolescents Delivered via Mobile Phone Text Messaging.

OBJECTIVE: To systematically review healthy lifestyle interventions targeted to adolescents and delivered using text messaging (TM). DATA SOURCE: PubMed, Embase, CINAHL, PsycINFO, and Web of Science databases. Study Inclusion Criteria: Research articles published during 2011 to 2014; analyses focused on intervention targeting adolescents (10-19 years), with healthy lifestyle behaviors as main variables, delivered via mobile phone-based TM. DATA EXTRACTION: The authors extracted data from 27 of 281 articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. DATA SYNTHESIS: Adolescent and setting characteristics, study design and rigor, intervention effectiveness, challenges, and risk of bias. RESULTS: Across studies, 16 (59.3%) of 27 included non-Caucasians. The gender was split for 22 (81.5%) of 27 studies. Thirteen studies were randomized controlled trials. There was heterogeneity among targeted conditions, rigor of methods, and intervention effects. Interventions for monitoring/adherence (n = 8) reported more positive results than those for health behavior change (n = 19). Studies that only included message delivered via TM (n = 14) reported more positive effects than studies integrating multiple intervention components. Interventions delivered using TM presented minimal challenges, but selection and performance bias were observed across studies. CONCLUSION: Interventions delivered using TM have the potential, under certain conditions, to improve healthy lifestyle behaviors in adolescents. However, the rigor of studies varies, and established theory and validated measures have been inconsistently incorporated.