Health-promotion interventions targeting multiple behaviors: A meta-analytic review of general and behavior-specific processes of change.

Although health-promotion interventions that recommend changes across multiple behavioral domains are a newer alternative to single-behavior interventions, their general efficacy and their mechanisms of change have not been fully ascertained. This comprehensive meta-analysis (6,878 effect sizes from 803 independent samples from 364 research reports, N = 186,729 participants) examined the association between the number of behavioral recommendations in multiple-behavior interventions and behavioral and clinical change across eight domains (i.e., diet, smoking, exercise, HIV [Human Immunodeficiency Virus] prevention, HIV testing, HIV treatment, alcohol use, and substance use). Results showed a positive, linear effect of the number of behavioral recommendations associated with behavioral and clinical change across all domains, although approximately 87% of the samples included between 0 and 4 behavioral recommendations. This linear relation was mediated by improvements in the psychological well-being of intervention recipients and, in several domains (i.e., HIV, alcohol use, and drug use), suggested behavioral cuing. However, changes in information, motivation, and behavioral skills did not mediate the impact of the number of recommendations on behavioral and clinical change. The implications of these findings for theory and future intervention design are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The impact of multiple-behavior HIV interventions as a function of regional disadvantages: An analysis of syndemics.

OBJECTIVE: Disadvantaged populations, including inhabitants of developing countries as well as racial/ethnic and sexual minorities in the United States, are disproportionally burdened by human immunodeficiency virus (HIV) infection, delayed HIV diagnosis, and unfavorable HIV-treatment outcomes. HIV interventions targeting single behaviors (e.g., testing) in these populations have shown to be efficacious at producing behavioral and clinical change but have been unable to eliminate the social health disparities associated with syndemics (i.e., a set of connected risks, interacting synergistically, and contributing to excess burden of disease in a population). METHOD: This meta-analysis of 331 reports (clusters; number of effect sizes [k] = 1,364) assessed whether multiple-behavior interventions that target clusters of syndemic risks are more efficacious for those in disadvantaged regions and social groups. RESULTS: Across the board, multiple-behavior interventions were more efficacious than single-behavior ones as well as passive control groups among samples from countries with lower log gross domestic product (GDP), lower Human Development Index (HDI), and lower Healthcare Access and Quality (HAQ) Index. CONCLUSIONS: Within the United States, the efficacy of multiple-behavior interventions was similar across different levels of representation of racial/ethnic and sexual minorities. The analyses used robust variance estimation with small-sample corrections to assess the differential effects of multiple-behavior interventions and Egger Sandwich test with the multilevel meta-analysis approach to detect selection biases. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A meta-analysis of correction effects in science-relevant misinformation.

Scientifically relevant misinformation, defined as false claims concerning a scientific measurement procedure or scientific evidence, regardless of the author's intent, is illustrated by the fiction that the coronavirus disease 2019 vaccine contained microchips to track citizens. Updating science-relevant misinformation after a correction can be challenging, and little is known about what theoretical factors can influence the correction. Here this meta-analysis examined 205 effect sizes (that is, k, obtained from 74 reports; N = 60,861), which showed that attempts to debunk science-relevant misinformation were, on average, not successful (d = 0.19, P = 0.131, 95% confidence interval -0.06 to 0.43). However, corrections were more successful when the initial science-relevant belief concerned negative topics and domains other than health. Corrections fared better when they were detailed, when recipients were likely familiar with both sides of the issue ahead of the study and when the issue was not politically polarized.

Spatial accessibility to HIV testing, treatment, and prevention services in Illinois and Chicago, USA.

Accomplishing the goals outlined in "Ending the HIV (Human Immunodeficiency Virus) Epidemic: A Plan for America Initiative" will require properly estimating and increasing access to HIV testing, treatment, and prevention services. In this research, a computational spatial method for estimating access was applied to measure distance to services from all points of a city or state while considering the size of the population in need for services as well as both driving and public transportation. Specifically, this study employed the enhanced two-step floating catchment area (E2SFCA) method to measure spatial accessibility to HIV testing, treatment (i.e., Ryan White HIV/AIDS program), and prevention (i.e., Pre-Exposure Prophylaxis [PrEP]) services. The method considered the spatial location of MSM (Men Who have Sex with Men), PLWH (People Living with HIV), and the general adult population 15-64 depending on what HIV services the U.S. Centers for Disease Control (CDC) recommends for each group. The study delineated service- and population-specific accessibility maps, demonstrating the method's utility by analyzing data corresponding to the city of Chicago and the state of Illinois. Findings indicated health disparities in the south and the northwest of Chicago and particular areas in Illinois, as well as unique health disparities for public transportation compared to driving. The methodology details and computer code are shared for use in research and public policy.

Testing a digitally distributed method to recruit a network of community organizations to fight the consequences of the drug epidemic: A study in 13 American states.

To mitigate the opioid epidemic, a concerted effort to educate, prevent, diagnose, treat, and engage residents is required. In this study, a digitally distributed method to form a large network of organizations was tested with 99 counties in regions with high vulnerability to hepatitis C virus (HCV). The method involved a cascade of contacts going from email to phone calls, to videoconferencing and measuring the number of contacts required, amount of time taken, and the proportion of success at recruiting at least one community organization per county. A recruitment period of 5 months and 2118 contact attempts led to the recruitment of organizations from 73 out of our 99 target counties. Organizations belonging to health departments required more attempts and time to recruit but ultimately enrolled at higher rates than did other organizations such as coalitions and agencies. Organizations from counties more (vs. less) vulnerable to HCV outbreaks required more attempts to recruit and, using multiple recruitment methods (e.g., emails, phone calls, and Zoom meetings), improved enrollment success. Overall, this method proved to be successful at remotely engaging a large-scale network of communities with different levels of risk within a large geographic region.

Religious affiliation and philosophical and moral beliefs about vaccines: A longitudinal study.

How do religious affiliation and beliefs shape vaccine attitudes and behaviors? This study examined the associations of attitudes and behaviors relevant to the flu, measles-mumps-rubella (MMR), and human-papillomavirus (HPV) vaccines with religious affiliations, as well as philosophical, spiritual, and moral beliefs. Respondents were 3005 adults from a probability-based, four-wave panel survey in the United States. Longitudinal structural equation modeling examined how religious affiliations and philosophical/moral beliefs shaped attitudes toward vaccines and actual vaccination. Stronger philosophical beliefs predicted more negative attitudes toward each vaccine and stronger moral beliefs more negative attitudes toward the HPV vaccine. Negative vaccine attitudes then predicted weaker intentions to encourage others to vaccinate and lower probability of receiving a vaccine. Theoretical and public health messaging implications are discussed.

State health policies and interest in PrEP: evidence from Google Trends.

This study investigated the association between interest in Pre-exposure Prophylaxis (PrEP) in the US using Google Health Trends as a source of big data and state policy variables of Medicaid expansions under the Affordable Care Act (ACA) and initiation of PrEP Assistance Programs (PrEP-AP). As of December 2019, thirty-three states and the District of Columbia have accepted federal Medicaid funding provided through the ACA to expand eligibility to low-income adults. Among these expansion states, eight states also implemented PrEP-AP, a program that finances PrEP. A difference-in-differences approach estimated how changes in Google search for PrEP before and after the expansion differed across expansion and non-expansion states. Analyses also gauged whether the magnitude of the correlation between Medicaid expansions and Google searches was higher in states that also initiated PrEP-AP. Findings indicated that the Medicaid expansions were associated with a higher share of Google searches for PrEP keywords (ß=1.536, S.E. =.36, p<.001). Moreover, the magnitude of correlation for some keywords was higher in states that also implemented PrEP-APs.

Estimating the influence of Twitter on pre-exposure prophylaxis use and HIV testing as a function of rates of men who have sex with men in the United States.

OBJECTIVES: Acceptance of pre-exposure prophylaxis (PrEP) and testing for HIV is likely to vary as a function of the norms and communications within a geographic area. This study examined associations involving county tweets, in person communications, and HIV prevention and testing in regions with higher (vs. lower) estimated rates of men who have sex with men (MSM). DESIGN AND METHODS: Ecological analyses examined (a) tweets about HIV (i.e. tweet rates per 100 000 county population and topic probabilities in 1959 US counties); (b) individual-level survey data about HIV prevention and testing and communications about PrEP and HIV (N = 30 675 participants); and (c) estimated county-level MSM rates (per 1 000 adult men). RESULTS: In counties with higher rates of MSM, tweet rates were directly associated with PrEP use and HIV testing (rs = .06, BF10 > 10). Topics correlated with PrEP use (rs = -0.06 to 0.07, BF10 > 10) and HIV testing (rs = -0.05 to 0.05, BF10 > 10). Mediation analyses showed that hearing about and discussing PrEP mediated the relations between tweet rates and PrEP use (bi∗ = 0.01-0.05, BF10 > 100) and between topics and PrEP use (bi∗ = -0.04- 0.05, BF10 > 10). Moreover, hearing about PrEP was associated with PrEP use, which was in turn associated with tweet rates (bi∗ = 0.01, BF10 > 100) and topics (bi∗ = -0.03 - 0.01, BF10 > 10). CONCLUSIONS: Rates of MSM appear to lead to HIV tweets in a region, in person communications about PrEP, and, ultimately, actual PrEP use. Also, as more men hear about PrEP, they may use PrEP more and may tweet about HIV.

The effects of scientific messages and narratives about vaccination.

A fundamental challenge complicates news decisions about covering vaccine side effects: although serious vaccine side effects are rare, less severe ones do occur occasionally. The study was designed to test whether a side effect message could induce vaccine hesitancy and whether that could be countered by pro-vaccine messages about vaccine safety. A large (N = 2,345), nationally representative experiment was conducted by randomly exposing participants to one of six videos about the measles, mumps, and rubella (MMR) vaccine edited from news programs produced during the 2019 measles outbreak in the United States. The design was a 2x3 factorial crossing the presence or absence of a hesitancy-inducing narrative message with a pro-vaccine science-supporting message (i.e., no message, science-supporting expert message, or pro-vaccine narrative message), leading to a total of six conditions. A general linear model was used to assess the effects of these videos on respondents' (1) vaccine risk perceptions, (2) policy views on vaccination, (3) willingness to encourage others to vaccinate their children, and (4) intention to send a pro-vaccine letter to their state representative. Findings indicated that the science-supporting expert message about vaccine safety led to higher pro-vaccine evaluations relative to other conditions [e.g., b = -0.17, p < .001, a reduction in vaccine risk perceptions of 0.17 as compared to the control]. There was also suggestive evidence that the hesitancy-inducing narrative may limit the effectiveness of a science-supporting expert message, although this finding was not consistent across different outcomes. When shown alone the hesitancy-inducing narrative did not shift views and intentions, but more research is needed to ascertain whether exposure to such messages can undercut the pro-vaccine influence of science-supporting (expert) ones. All in all, however, it is clear that science-supporting messages are effective and therefore worthwhile in combating vaccine misinformation.

Prospective associations of regional social media messages with attitudes and actual vaccination: A big data and survey study of the influenza vaccine in the United States.

OBJECTIVE: Using longitudinal methods to assess regional associations between social media posts about vaccines and attitudes and actual vaccination against influenza in the US. METHODS: Geolocated tweets from U.S. counties (N = 115,330) were analyzed using MALLET LDA (Latent Dirichlet allocation) topic modeling techniques to correlate with prospective individual survey data (N = 3005) about vaccine attitudes, actual vaccination, and real-life discussions about vaccines with family and friends during the 2018-2019 influenza season. RESULTS: Ten topics were common across U.S. counties during the 2018-2019 influenza season. In the overall analyses, two of these topics (i.e., Vaccine Science Matters and Big Pharma) were associated with attitudes and behaviors. The topic concerning vaccine science in November-February was positively correlated with attitudes in February-March, r = 0.09, BF10 = 3. Moreover, among respondents who did not discuss the influenza vaccine with family and friends, the topic about vaccine fraud and children in November-February was negatively correlated with attitudes in February-March and with vaccination in February-March, and April-May (rs = -0.18 to -0.25, BF10 = 4-146). However, this was absent when participants had discussions about the influenza vaccine with family and friends. DISCUSSION: Regional vaccine content correlated with prospective measures of vaccine attitudes and actual vaccination. CONCLUSIONS: Social media have demonstrated strong associations with vaccination patterns. When the associations are negative, discussions with family and friends appear to eliminate them. Programs to promote vaccination should encourage real-life conversations about vaccines.

HIV messaging on Twitter: an analysis of current practice and data-driven recommendations.

OBJECTIVES: Social media messages have been increasingly used in health campaigns about prevention, testing, and treatment of HIV. We identified factors leading to the retransmission of messages from expert social media accounts to create data-driven recommendations for online HIV messaging. DESIGN AND METHODS: We sampled 20 201 HIV-related tweets (posted between 2010 and 2017) from 37 HIV experts. Potential predictors of retransmission were identified based on prior literature and machine learning methods, and were subsequently analyzed using multilevel negative binomial models. RESULTS: Fear-related language, longer messages, and including images (e.g. photos, gif, or videos) were the strongest predictors of retweet counts. These findings were similar for messages authored by HIV experts, and also messages retransmitted by experts, but created by nonexperts (e.g. celebrities or politicians). CONCLUSIONS: Fear appeals affect how much HIV messages spread on Twitter, as do structural characteristics, like the length of the tweet and inclusion of images. A set of five data-driven recommendations for increasing message spread is derived and discussed in the context of current centers for disease control and prevention social media guidelines.

Legacy and social media respectively influence risk perceptions and protective behaviors during emerging health threats: A multi-wave analysis of communications on Zika virus cases.

OBJECTIVE: Both legacy media, such as television and newspapers, and online social media are potentially important but incompletely understood sources of information in the face of emerging public health risks. This research aimed to understand media effects on risk perceptions and behaviors concerning the Zika virus in the United States. METHODS: We analyzed a multi-wave nationally representative survey (N = 29,062) and the volume of communications in social and legacy media (i.e., legacy media data from news sources and databases, N = 2,660 and social media data from Twitter, N = 1,605,752) in the United States between April and October 2016, dates coinciding with the early cases of local transmission of Zika in the United States (i.e., 25 weeks). The present study conducted econometric analyses (i.e., Granger causality tests) to assess the associations of legacy and social media coverage with risk perceptions and protective behaviors in the total sample and specific groups separated by pregnancy status/intent, geographic region, income, education level, age, and ethnicity. RESULTS: The results from the overall sample suggested that changes in the volume of information in legacy and social media (i.e., Twitter) were followed by different changes in community risk perceptions and protective behaviors. Specifically, social media coverage correlated with the level of risk perceptions, whereas the legacy media coverage correlated with the level of protective behaviors. Analyses across different subpopulations, including those of different pregnancy status/intent, geographic Zika risk, income, education level, age, and ethnicity, replicated the social media associations with risk perceptions in most cases. However, legacy media and protective behaviors were linked only in some vulnerable subpopulations (e.g., the less-educated populations). CONCLUSION: Understanding how media coverage relates to Zika risk perceptions and protective behaviors will help to facilitate effective risk communications by healthcare professionals and providers, particularly when a health risk emerges.

Sources affecting knowledge and behavior responses to the Zika virus in US households with current pregnancy, intended pregnancy and a high probability of unintended pregnancy.

Background: This study examined the influences of information sources on Zika-relevant knowledge and behaviors in US households containing members who are pregnant, intend to become pregnant, or have a higher probability of unintended pregnancy in Zika-affected regions (i.e. respondents who are younger, are black, have less education, are unmarried, and reside in the southern USA). Methods: Over 32 000 US adults completed a survey measuring Zika-relevant knowledge and behaviors along with information sources (e.g. discussing Zika with practitioners), general media usage (e.g. TV) and demographic information over 30 weeks. Results: Respondents in the group with (versus without) either pregnancy or intended pregnancy were more likely to use all information sources, which in turn created differences in knowledge and behavior responses. To gauge information sources in US-South respondents with a high probability of having a household member with unintended pregnancy based on demographics, younger, less-educated, unmarried, black respondents had fewer Zika discussion with practitioners than another group. Conclusions: Efforts to increase Zika-related knowledge and protective behaviors should target households with members who are pregnant or intending to become pregnant via practitioners, family and friends. Additional efforts should target information channels to reach younger, less educated, unmarried, black respondents, which are at risk for unintended pregnancy.

Associations of Topics of Discussion on Twitter With Survey Measures of Attitudes, Knowledge, and Behaviors Related to Zika: Probabilistic Study in the United States.

BACKGROUND: Recent outbreaks of Zika virus around the world led to increased discussions about this issue on social media platforms such as Twitter. These discussions may provide useful information about attitudes, knowledge, and behaviors of the population regarding issues that are important for public policy. OBJECTIVE: We sought to identify the associations of the topics of discussions on Twitter and survey measures of Zika-related attitudes, knowledge, and behaviors, not solely based upon the volume of such discussions but by analyzing the content of conversations using probabilistic techniques. METHODS: Using probabilistic topic modeling with US county and week as the unit of analysis, we analyzed the content of Twitter online communications to identify topics related to the reported attitudes, knowledge, and behaviors captured in a national representative survey (N=33,193) of the US adult population over 33 weeks. RESULTS: Our analyses revealed topics related to "congress funding for Zika," "microcephaly," "Zika-related travel discussions," "insect repellent," "blood transfusion technology," and "Zika in Miami" were associated with our survey measures of attitudes, knowledge, and behaviors observed over the period of the study. CONCLUSIONS: Our results demonstrated that it is possible to uncover topics of discussions from Twitter communications that are associated with the Zika-related attitudes, knowledge, and behaviors of populations over time. Social media data can be used as a complementary source of information alongside traditional data sources to gauge the patterns of attitudes, knowledge, and behaviors in a population.

An Online Risk Index for the Cross-Sectional Prediction of New HIV Chlamydia, and Gonorrhea Diagnoses Across U.S. Counties and Across Years.

The present study evaluated the potential use of Twitter data for providing risk indices of STIs. We developed online risk indices (ORIs) based on tweets to predict new HIV, gonorrhea, and chlamydia diagnoses, across U.S. counties and across 5 years. We analyzed over one hundred million tweets from 2009 to 2013 using open-vocabulary techniques and estimated the ORIs for a particular year by entering tweets from the same year into multiple semantic models (one for each year). The ORIs were moderately to strongly associated with the actual rates (.35 < rs < .68 for 93% of models), both nationwide and when applied to single states (California, Florida, and New York). Later models were slightly better than older ones at predicting gonorrhea and chlamydia, but not at predicting HIV. The proposed technique using free social media data provides signals of community health at a high temporal and spatial resolution.

Action and inaction in multi-behaviour recommendations: a meta-analysis of lifestyle interventions.

This meta-analysis examined theoretical predictions about the effects of different combinations of action (e.g., start an exercise regime) and of inaction (e.g., reduce screen time, rest in between weight lifting series) recommendations in smoking, diet, and physical activity multiple-domain interventions. The synthesis included 150 research reports of interventions promoting multiple behaviour domain change and measuring change at the most immediate follow-up. The main outcome measure was an indicator of overall change that combined behavioural and clinical effects. There were two main findings. First, as predicted, interventions produced the highest level of change when they included a predominance of recommendations along one behavioural dimension (i.e., predominantly inaction or predominantly action). Unexpectedly, within interventions with predominant action or inaction recommendations, those including predominantly inaction recommendations had greater efficacy than those including predominantly action recommendations. This effect, however, was limited to interventions in the diet and exercise domains, but reversed (greater efficacy for interventions with predominant action vs. inaction recommendations) in the smoking domain. These findings provide important insights on how to best combine recommendations when interventions target clusters of health behaviours.

Debunking: A Meta-Analysis of the Psychological Efficacy of Messages Countering Misinformation.

This meta-analysis investigated the factors underlying effective messages to counter attitudes and beliefs based on misinformation. Because misinformation can lead to poor decisions about consequential matters and is persistent and difficult to correct, debunking it is an important scientific and public-policy goal. This meta-analysis ( k = 52, N = 6,878) revealed large effects for presenting misinformation ( ds = 2.41-3.08), debunking ( ds = 1.14-1.33), and the persistence of misinformation in the face of debunking ( ds = 0.75-1.06). Persistence was stronger and the debunking effect was weaker when audiences generated reasons in support of the initial misinformation. A detailed debunking message correlated positively with the debunking effect. Surprisingly, however, a detailed debunking message also correlated positively with the misinformation-persistence effect.

Coping flexibility and psychological adjustment to stressful life changes: a meta-analytic review.

Compared with the large body of literature on coping, coping flexibility has received relatively scant research attention, although more such studies have begun to emerge recently. Researchers have conceptualized coping flexibility in diverse ways: as a broad coping repertoire, a well-balanced coping profile, cross-situational variability in strategy deployment, a good strategy-situation fit, or the perceived ability to cope with environmental changes. This meta-analysis is the first to provide a summary estimate of the overall effect size and investigate cross-study sources of variation in the beneficial role of coping flexibility. The analysis covers all available studies conducted between 1978 and 2013 that empirically tested the relationship between coping flexibility and psychological adjustment. The results of a random-effects model revealed a small to moderate overall mean effect size (r = .23, 95% CI [.19, .28], 80% CRI [-.02, .49], k = 329, N = 58,946). More important, the magnitude of the positive link between coping flexibility and psychological adjustment varied with the conceptualization of such flexibility. Studies adopting the perceived ability or strategy-situation fit conceptualization yielded moderate effect sizes, whereas those adopting the broad repertoire, balanced profile, or cross-situational variability conceptualization yielded small effect sizes. In addition, the positive link between coping flexibility and psychological adjustment was stronger in samples from countries lower (vs. higher) in individualism and samples with higher (vs. lower) average ages. Individualism and age explained 10% and 13% of the variance, respectively. We discuss the conceptual problems and implications and propose a synthesized conceptualization of coping flexibility.

Cultural meaning of perceived control: a meta-analysis of locus of control and psychological symptoms across 18 cultural regions.

Integrating more than 40 years of studies on locus of control (LOC), this meta-analysis investigated whether (a) the magnitude of the relationship between LOC and psychological symptoms differed among cultures with distinct individualist orientations and (b) depression and anxiety symptoms yielded different patterns of cultural findings with LOC. We included studies that examined global self-ratings of LOC and at least 1 of the criterion variables in nonclinical samples (age range: 18-80 years). Data were analyzed on the basis of 152 independent samples, representing the testing of 33,224 adults across 18 cultural regions. Results revealed moderately strong relationships for external LOC with depression symptoms (k = 123, N = 28,490, r = .30, 95% confidence interval [CI] [.27, .32]) and anxiety symptoms (k = 65, N = 13,208, r = .30, 95% CI [.27, .33]). Individualism explained 20% of unique variance only in the external LOC-anxiety relationship: The link between external LOC and anxiety symptoms was weaker for collectivist societies (k = 8, N = 2,297, r = .20, 95% CI [.13, .28]) compared with individualist societies (k = 54, N = 9,887, r = .32, 95% CI [.29, .34]). Such cultural differences were attributed to the reduced emphasis on agentic goals in more collectivist societies. It is noteworthy that external LOC does not carry the same negative connotations across cultures, and members of collectivist societies may be more ready to endorse such items. Culture has been examined at the country level, and the findings may not be applicable to any particular person in a cultural region. Implications for integrating cultural meaning of perceived control into formulation of theories, research design, and intervention programs are discussed.