Exploring the effects of cannabis health warnings on protective health intentions among US adults in legal recreational states.

BACKGROUND: As cannabis policy trends toward liberalization, assessing cannabis health warning effects becomes increasingly important. This study investigated underlying mechanisms accounting for the effectiveness of cannabis health warnings on protective health intentions. METHOD: A sample of 1,095 adults (21+) living in legal recreational US states who reported using cannabis in the past 12 months participated in an online experiment. Participants were randomly assigned to view cannabis health warnings that described risks of impaired driving, mental health, and smoke exposure and varied pictures and text (vs. text-only) attributes in warnings. Outcomes were message reactions (cognitive elaboration, fear, and hope), attitudes and beliefs (perceived severity of cannabis harms and perceived susceptibility to cannabis harms, and perceived response and self-efficacy to prevent cannabis harms), and protective health intentions (information-seeking about cannabis health effects and having interpersonal discussions about cannabis harms with family, friends, and medical professionals). RESULTS: MANCOVA results showed no significant differences between text-only vs. pictorial attributes on protective health intentions; thus, warning conditions were controlled and analyzed using structural equation modeling (SEM). SEM results showed that attention to cannabis health warnings (text-only or pictorial) elicited higher cognitive elaboration, fear, and hope-an emotion associated with coping actions that motivate positive expectations of future events. These outcomes, in turn, were associated with greater perceived severity and susceptibility and greater perceived response efficacy, respectively. Hope, perceived severity, and perceived response and self-efficacy were independently associated with greater intentions to seek information about cannabis health effects and to discuss cannabis health harms. CONCLUSION: Attention to warnings impacted emotions, attitudes, and protective health intentions. Fear is commonly associated with health warning effects, and our results suggest that hope is also an important factor. This research contributes to understanding the effects of cannabis health warnings and can inform regulatory agencies that mandate warnings on cannabis products.

Independent and combined effects of very low nicotine cigarette messages and e-cigarette messages: a randomised clinical trial.

BACKGROUND: USA is considering reducing nicotine in cigarettes to non-addictive levels, coupled with promoting alternative nicotine delivery products (eg, e-cigarettes). However, effective communication is needed to reduce misperceptions about very low nicotine cigarettes (VLNCs) being less harmful than regular cigarettes. METHODS: In 2022-2023, we conducted a four-group randomised clinical trial with a national probability sample from an online panel (971 adults who smoked cigarettes exclusively, 472 adults who dual used cigarettes and e-cigarettes and 458 adults aged 18-29 who had never smoked). Participants were randomised (parallel assignment) to one message condition: (1) VLNCs as harmful but easier to quit than regular cigarettes (n=468), (2) those who are not ready to quit should consider switching to e-cigarettes as less harmful alternatives (n=484), (3) combined (VLNC and e-cigarette messages; n=476) or (4) control condition (ie, water ads), n=473. The primary outcome was perceived absolute harm of VLNCs. RESULTS: Perceived harm of VLNCs was higher in the VLNC condition compared with the e-cigarette and control conditions, and higher in the combined condition compared with the e-cigarette condition (adjusted p<0.05). Among adults who dual used, intention to switch to e-cigarettes was higher in the VLNC condition than the e-cigarette, combined or control conditions (adjusted p<0.05). CONCLUSIONS: VLNC messages reduced the misperception that VLNCs are less harmful than cigarettes, but adding messages about e-cigarettes did not enhance desired outcomes. These VLNC messages can be considered during the rollout of a reduced nicotine policy. TRIAL REGISTRATION: NCT05506046.

Reactions to Messages About a Nicotine Reduction Policy: A Focus Group Study Among People Who Use Little Cigars and Cigarillos.

INTRODUCTION: The U.S. Food and Drug Administration (FDA) has proposed rulemaking to reduce the nicotine content in cigarettes and other combusted tobacco products to non-addictive levels. This qualitative study documents reactions to messages communicating this policy among people who use little cigars and cigarillos (LCCs). AIMS AND METHODS: We conducted eight focus groups with participants from four populations with the highest prevalence of cigar use (African American males and females, white males and females). Participants described their reactions to eight messages about the policy: Three messages about the equal risk of LCCs with regular and low nicotine levels; three quit efficacy messages about low nicotine LCCs being easier to quit; one "compensation" message to correct misperceptions about the policy causing people to smoke more to get desired nicotine; and one message about using alternative nicotine sources (eg, e-cigarettes). RESULTS: Participants perceived risk messages as the most motivating to quit, whereas efficacy messages made some participants feel that the policy would cause former users of LCCs to relapse. Many participants expressed favorable responses to the compensation message. The message about using alternative nicotine sources sparked intense responses, with many participants expressing outrage and mistrust of the message. Participants' beliefs that they were not addicted to LCCs dampened their perceptions of the effectiveness of the policy. CONCLUSIONS: Perceptions of the addictiveness and relative harms of LCCS influenced responses to policy messages. The FDA should consider using different messages to communicate with people who use LCCs because they perceive LCCs as different from cigarettes. IMPLICATIONS: This is the first study to document affective and cognitive responses to the FDA's reduced nicotine policy among people who use LCCs. The false belief that cigar products are less harmful than cigarettes may be influencing people's lack of support for the reduced nicotine policy and difficulty in understanding its potential positive impact. To maximize the public health benefit of the reduced nicotine policy, the FDA should include LCC products in the policy; however, it is crucial that they use educational messaging to clarify misperceptions regarding nicotine and harm as it applies to LCCs.

Where Do Perceived Norms Supporting Child Corporal Punishment Come From? A Study of Low-Income Parents.

Although the influence of perceived norms on health behavior has been well researched, the sources of normative perceptions remain understudied. Drawing on the theory of normative social behavior, this study investigated factors shaping descriptive norms associated with child corporal punishment among a sample of low-income Black, Hispanic, and White parents (N = 260). Hierarchical regression results showed that childhood experiences of corporal punishment, direct observation, and interpersonal communication valence were significantly associated with descriptive norms. Path analysis confirmed the direct association between descriptive norms and behavioral intentions, as well as the mediating role of descriptive norms in linking the norm sources and behavioral intentions. Results also revealed that interpersonal network size and interpersonal communication valence jointly affected descriptive norms among parents who talked to others in their proximal networks about applying this disciplinary measure. Theoretical and practical implications were discussed.

Predicting Black Parents' Attitudes Toward Corporal Punishment: A Moderated-Mediation Model of Frequency and Valence of Childhood Experiences.

Child corporal punishment (CP) may lead to child physical abuse, which is a public health concern in the United States. The present study examined major risk factors predicting attitudes toward CP among a sample of Black parents (N = 394), including frequency and valence of experiences of CP during childhood, outcome expectancies of CP, and perceptions of self-efficacy and response efficacy of non-physical discipline strategies. Structural equation modeling results revealed that the indirect associations between CP frequency and attitudes through self-efficacy and response efficacy were moderated by CP valence. Results extend the literature and point to the need for incorporating information about efficacy of evidence-based non-physical discipline strategies into intervention messages targeting prevention of child physical abuse.

Before Omicron's Arrival: Effects of Negative Emotions and Comparative Optimism on COVID-19 Protection and Detection Behaviors.

This study examined the associations of emotions, cognitions, and behavioral intentions in response to exposure to news stories reporting on the arrival of Omicron variant in Vietnam. Outcomes included fear, anxiety, anger, comparative optimism, intentions to conduct prevention behavior (wash hands with soap), detection behavior (test for Omicron infection), and share health information. Two experiments were conducted with participants being randomized to either low-risk or high-risk condition that contained information promoting hand-washing with soap (Experiment 1, N = 303), or information promoting COVID-19 testing (Experiment 2, N = 303). Results indicated that viewing high-risk news stories led to higher fear, anxiety, and anger than low-risk news stories. Fear fully mediated the effect of news exposure on intentions to test for Omicron infection and share health information. Comparative optimism moderated the indirect effect of news exposure on intentions to wash hands with soap and share information about COVID-19 testing. Theoretical and practical implications were discussed.

"I Crave a Blunt, I Don't Crave a Cigarillo": A Focus Group Study on Perceptions of Nicotine and Addiction among US Adults Who Currently Smoke Little Cigars or Cigarillos.

While the US Food and Drug Administration (FDA)'s proposal to reduce the nicotine content in cigarettes is gaining traction, it is still undetermined whether the policy will also include other combustible tobacco products, such as little cigars and cigarillos (LCCs), and how such a policy should be communicated given the patterns of use and perceptions around LCCs. This study examined perceptions of nicotine and addiction related to LCC use and involved data collection from eight semi-structured virtual focus groups conducted in Summer 2021 in the US. Participants were adults who reported past-30-day use of LCCs, consisting of African American males (n = 9), African American females (n = 9), white males (n = 14), and white females (n = 11). Participants discussed their perceptions of nicotine and addiction in general and in relation to LCC use. Inductive thematic analysis of transcripts was conducted. Differences across race and sex groups were examined. Participants did not consider nicotine to be a characterizing feature of LCCs; rather, they generally associated nicotine with cigarettes. Participants' views of nicotine and addiction related to LCCs were discussed along four dimensions: context of use, frequency of use, the presence of cravings, and whether a product is modified (e.g., by adding marijuana). Social and infrequent use, a lack of cravings, and the use of LCCs for marijuana were considered indicative of a lack of addiction and reasons not to be concerned about nicotine in LCCs. Because perceptions of nicotine and addiction related to LCCs differ from those of cigarettes, communications about a reduced nicotine policy that includes LCCs should consider these differences to ensure the policy is understood by people who currently use LCCs and to prevent people who use cigarettes from switching to LCCs.

When Cigarette Smoking Meets COVID-19: How the Two Types of Threat and Efficacy Perceptions Interactively Predict Danger Control and Fear Control Processes.

Growing evidence indicates that communicating the combined risk of smoking and COVID-19 encourages smoking cessation. Guided by the Extended Parallel Process Model (EPPM), we examined how perceived threats of smoking and COVID-19 independently and interactively predicted danger control responses (i.e., quit intentions and COVID-19-protective behavioral intentions) and fear control responses (i.e., fear and fatalism). We also explored the direct and interactive impacts of perceived efficacy of quitting smoking and COVID-protective behaviors on message outcomes. Structural equation modeling results (N = 747 U.S. adults who smoke) indicated that the perceived efficacy of COVID-protective behaviors positively predicted quit intentions. Higher perceived threat of COVID-19 and greater quitting efficacy predicted higher quit intentions directly and indirectly via fear. As perceived COVID-protective efficacy increased, the positive association between perceived quitting efficacy and quit intentions also increased. Smoking-related threat and efficacy perceptions did not predict COVID-protective behavioral intentions. This study added to EPPM by considering how threat and efficacy perceptions deriving from two different yet closely related risks affect protective behaviors. Thus, combining multiple threats in a single message might be a promising strategy to motivate smoking cessation amid the pandemic.

Applying the Integrative Model to Predict Intention to Use Corporal Punishment Among Low-income Parents.

Child corporal punishment (CP) is associated with child physical abuse, which is a public health problem in the United States. Informed by the integrative model of behavioral prediction, this study surveyed low-income Black, Hispanic, and White parents who had children younger than 6 years old (N = 260) to identify major risk factors that determined intention to use CP to discipline children. Structural equation modeling revealed that attitudes, descriptive norms, and perceived efficacy of alternative discipline strategies were associated with intention to use CP. Additionally, parents' childhood CP frequency and past use of CP with their own children were influential distal variables that indirectly predicted CP intention. Results indicated the utility of the model in this behavioral context. Communication intervention programs targeting low-income parents should leverage perceived norms, perceived efficacy of alternative discipline strategies, and attitudes to change CP behavior.

Preventing the COVID-19 Outbreak in Vietnam: Social Media Campaign Exposure and the Role of Interpersonal Communication.

The present study focused on the success story of Vietnam's ability to control the COVID-19 outbreak in the early stages to examine the associations between exposure to the Vietnam Ministry of Health's COVID-19 prevention social media campaign messages, interpersonal communication, attitudes, perceived norms, self-efficacy, and intentions to stay at home. A cross-sectional survey was conducted with residents in Ho Chi Minh City (N = 360). Results from mediation analyses indicated that interpersonal communication mediated the effect of social media campaign exposure on intentions to stay at home. Moreover, interpersonal communication shaped injunctive norms and self-efficacy that were conducive to behavioral intentions. These results underscored the need to leverage the power of social media and interpersonal communication in public health campaigns to prevent infectious outbreaks.

Perceptions of Nicotine Reduction Policy in the United States: A Qualitative Study.

INTRODUCTION: Several countries are considering a reduced nicotine policy that would make cigarettes minimally or nonaddictive. This qualitative study documents reactions to the policy that should be addressed by future communication efforts. METHODS: In 2020, we recruited participants in Atlanta, GA and San Francisco, CA (27 people who exclusively smoke, 25 who dual use cigarettes and e-cigarettes, 32 who formerly smoked, and 31 young adults who do not smoke). We held 16 focus groups: 2 focus groups for each smoking status in each city. Participants viewed messages about very low nicotine content cigarettes (VLNCs) and were asked about their reactions to each message and their overall response to the reduced nicotine policy. RESULTS: While responses to the policy were predominantly positive, focus group discussion also revealed concerns, questions, and misunderstandings (referred to here collectively as "perceptions") that may need to be addressed if a reduced nicotine policy is enacted. Participants expressed perceptions related to the policy intent, including that the FDA has ulterior motives, adoption/ implementation, including that nicotine would have to be replaced with other chemicals if removed or that the policy would be unfeasible to implement, and effectiveness, including concern that VLNCs would still be addictive or the policy would backfire. CONCLUSIONS: Addressing perceptions about reduced nicotine policy intent, adoption/implementation, and effectiveness could be key in creating public support and political motivation to move forward with such a policy. Countries contemplating adopting such a policy should consider pairing it with communications that address these perceptions. IMPLICATIONS: This study is one of very few to use qualitative methods to explore potentially problematic perceptions about nicotine reduction policy among US adults. Results illuminated new policy-specific concerns, questions, and misunderstandings about the reduced nicotine policy intent, adoption/implementation, and effectiveness. Identifying, studying, and addressing relevant perceptions may play a key role in generating support in countries contemplating such a policy.

Examining reactions to smoking and COVID-19 risk messages: An experimental study with people who smoke.

BACKGROUND: Smoking cigarettes worsens COVID-19 outcomes, and news media and health agencies have been communicating about that. However, few studies have examined how these messages affect attitudes, beliefs, and behavioral intentions of people who smoke. These are critical variables that can inform public health campaigns to motivate quitting smoking during the COVID-19 crisis. METHODS: In August 2020, we conducted an online experiment in the U.S. with 1,004 adults who smoke. Participants were randomized to one of four message conditions: COVID-19 risk, smoking risk, combined risk of smoking for COVID-19 severity, or a non-risk control. Outcomes were message reactions (emotions and reactance), attitudes and beliefs (severity, susceptibility, self-efficacy, response efficacy for smoking and COVID-19, and conspiracy beliefs), and behavioral intentions (smoking intentions, COVID-protective intentions, and information-seeking). RESULTS: Multivariate analysis of covariance (MANCOVA) showed that combined risk messages elicited higher perceived severity of smoking-related disease than control messages. Similarly, the combined risk condition resulted in greater intentions to quit smoking in the next month (vs. COVID-19 risk condition) and intentions to reduce smoking in the next 6 months (vs. smoking risk and control; ps < .05). Multivariate logistic regression found that exposure to the combined risk messages (vs. control as referent) was associated with higher odds of mask-wearing intentions in the next 2 weeks (AOR = 1.97). CONCLUSIONS: Health agencies can possibly use messages that communicate about the combined risk of smoking and COVID-19 as a novel strategy to motivate people who smoke to quit and take protective action for COVID-19.

Childhood Experiences and Attitudes toward Corporal Punishment: The Mediating Role of Perceived Efficacy of Alternative Discipline Strategies among Low-income Black, Hispanic, and White Parents.

Corporal punishment (CP) is associated with harmful outcomes to child development. Favorable attitudes toward CP are a major predictor of CP use. Thus, identifying and changing factors influencing such attitudes help to prevent CP. Although research has confirmed the effect of childhood experiences of CP on attitudes toward CP, few studies have examined mechanisms underpinning this association. To fill this gap, this study investigated the role of perceived efficacy of alternative discipline strategies in mediating the association between childhood experiences of CP and attitudes toward CP among low-income Black, Hispanic, and White parents. A cross-sectional online survey was conducted with 230 parents (Mage = 31; Black = 62, Hispanic = 62; White = 106). Structural equation modeling results revealed that more positive childhood experiences of CP were associated with lower perceived efficacy of alternative discipline strategies. In turn, lower perceived efficacy of alternative discipline strategies was associated with more favorable attitudes toward CP. Mediation analysis performed by the bootstrapping methods confirmed the mediating effect of perceived efficacy of alternative discipline strategies. When race was considered, this mediation pathway was held for Hispanic and White parent groups. These results suggested that future research should pay more attention to the role of perceived efficacy of alternative discipline strategies. Additionally, public education campaigns should consider incorporating efficacy messages to effectively reduce positive attitudes toward CP among low-income parents.

'It brings light to what you really put into your body': a focus group study of reactions to messages about nicotine reduction in cigarettes.

OBJECTIVE: In 2017, the US Food and Drug Administration (FDA) announced a proposed regulation to lower nicotine in cigarettes to minimally addictive levels to help smokers quit. We sought to explore effective message strategies communicating about nicotine reduction in cigarettes across the different key audiences that the regulation is most likely to influence. METHODS: We designed four types of messages: efficacy messages, risk messages, a message about alternative sources of nicotine and a compensation message. Sixteen virtual focus groups were conducted in Atlanta and San Francisco in April-May 2020. Data were analysed in NVivo 12.0 using a thematic analysis approach. FINDINGS: Exclusive smokers were receptive to both efficacy messages and risk messages. Dual users were the only group that was open to resorting to alternative sources of nicotine. Former smokers were critical of these messages as promoting the new kinds of cigarettes and potentially encouraging initiation and relapse of smoking. Non-smokers felt that efficacy messages downplayed the risks of smoking and did not scare people away from smoking. Presenting information that very low nicotine cigarettes (VLNCs) still contain harmful chemicals made smokers question continued smoking in the absence of nicotine and view VLNCs as harmful. CONCLUSIONS: Messages communicating about nicotine reduction in cigarettes might help to motivate smokers to quit and can correct the misperceptions that VLNCs are less harmful. The FDA should consider specific target audiences and use different messages that complement each other in communicating about this regulation.

Examining Sources of Social Norms Supporting Child Corporal Punishment Among Low-Income Black, Latino, and White Parents.

Child corporal punishment is a prevalent public health problem in the US. Although corporal punishment is sustained through parents' perceptions of social norms supporting this discipline behavior, little research has investigated where these normative perceptions come from. To fill this gap, we conducted 13 focus groups including 75 low-income Black, Latino, and White parents across five states in the US. Results revealed that one influential source of Black and White parents' perceived norms was their positive framing of corporal punishment experiences during childhood. Furthermore, Black parents formed normative perceptions based on identification with parents in their racial/ethnic group, while White parents did so with parents sharing the same generation. Results are interpreted in light of the false consensus effect and self-categorization theory. In contrast, Latino parents viewed their childhood experience of corporal punishment as negative and distanced their parenting practices from those practiced in their countries of origin, suggesting an influence of acculturation. Their perceived norms were likely transmitted through interpersonal communication within their social networks. These findings shed light on how social norms are formed and in turn guide parents' use of corporal punishment as a tool to discipline children.

Addicted to smoking or addicted to nicotine? A focus group study on perceptions of nicotine and addiction among US adult current smokers, former smokers, non-smokers and dual users of cigarettes and e-cigarettes.

BACKGROUND AND AIMS: In 2017, the US Food and Drug Administration (FDA) proposed to reduce nicotine in cigarettes to minimally or non-addictive levels. This study qualitatively explored perceptions of nicotine and addiction, both independently and in response to messages communicating about nicotine reduction. DESIGN: Qualitative study using focus groups. Participants described their perceptions of nicotine and addiction and their responses to messages about the nicotine reduction. SETTING: Atlanta, GA and San Francisco, CA, USA. Semi-structured focus groups were conducted virtually in Spring 2020. PARTICIPANTS: Exclusive smokers (n = 27), dual users (of cigarettes and electronic cigarettes) (n = 25), former smokers (n = 32) and young adult non-smokers (n = 31). MEASUREMENT: Inductive thematic analysis of transcripts was conducted, and results were compared across smoking status groups. FINDINGS: Participants across all smoking status groups associated nicotine with tobacco products, but consistently misperceived that nicotine caused disease. Perceptions of addiction were largely negative and varied by smoking status. Experienced smokers (exclusive smokers, former smokers and dual users) differentiated tobacco use from other addictions and minimized their own experiences of addiction. Perceptions of addiction across experienced smokers included not only the chemical properties of nicotine, but also the behavioral aspects of tobacco use, including oral fixation, having a smoking routine and response to internal and external cues. In response to messages, many believed that removing the nicotine would not make cigarettes less addictive because of the multi-factorial nature of smoking addiction that includes non-pharmacological cues. CONCLUSIONS: Perceptions of nicotine and addiction among non-smokers, former smokers, exclusive smokers and dual users of cigarettes and e-cigarettes vary based on smoking status, but there is a common tendency to believe that nicotine is addictive, that addiction results from more than just nicotine, and that very low nicotine cigarettes will not necessarily reduce the addictiveness of cigarettes.

Serious Psychological Distress Is Associated with Higher Intentions to Quit among Smokers during the COVID-19 Pandemic.

COVID-19 has increased the rates of serious psychological distress (SPD) among the general population. However, the SPD among smokers during the pandemic remains understudied. In a parent study, 1,004 U.S. adult smokers with and without SPD were randomized to view messages about COVID-19 risk, smoking risk, combined COVID-19 and smoking risk, or control. Outcomes were smoking quit intentions and COVID-19 protective behavior intentions. We analyzed the prevalence of SPD among current smokers; the associations between SPD, personal characteristics, and smoking and COVID-19 protective behavioral intentions; and whether SPD moderated the effect of messages about risks of smoking and COVID-19.Thirty-six percent of smokers met the criteria for SPD. Odds of having SPD were higher for older, everyday smokers, who had COVID-19, had poor health and conservative ideology. Smokers with SPD were significantly more likely to report intentions to quit smoking and seek counseling than smokers without SPD, controlling for demographics, readiness to quit, and message condition. SPD was not significantly related to COVID-19 protective intentions. The interactions between SPD and messages were nonsignificant. During the pandemic, smokers with SPD may be motivated to quit smoking, which provides an opportunity for targeted interventions to increase quit attempts.

Are smokers scared by COVID-19 risk? How fear and comparative optimism influence smokers' intentions to take measures to quit smoking.

Research suggests that smoking may compound the risk of serious health problems to smokers who contract COVID-19. This study examines whether and how exposure to news stories reporting the severe COVID-19 risk to smokers may influence smokers' emotional responses (fear, anxiety, and sadness) and intentions to take measures to quit smoking. Current smokers in the US participated in an online experiment (N = 495) and were randomized to read smoking risk news stories or news stories reporting the combined risk of smoking and COVID-19. We found that combined risk news stories lead to participants feeling more fearful and sadder than when they viewed smoking risk news stories (M = 5.74; SD = 2.57 vs. M = 5.20; SD = 2.74; p < .05). Fear fully mediated the effect of news exposure on intentions to take measures to quit smoking (ß = .09; SE = 05; 95% CI [.010, .200]). Moreover, moderated-mediation analyses revealed that the mediating effect of fear was conditioned on the levels of comparative optimism, such that the association between fear and intentions to take measures to quit smoking was only significant among smokers whose comparative optimism was at the mean score (ß = .16; SE = 05; 95% CI [.071, .250]), and for those whose comparative optimism was high (ß = .27; SE = .06; 95% CI [.146, .395]). These results suggest that fear of the pandemic and optimism might play important roles in predicting and explaining the association between exposure to news stories and intentions to take measures to quit smoking. Messages about heightened risk of COVID-19 complications for smokers that increase fear might be an effective strategy to motivate smokers to quit. Such messages should be used to turn the adversity of COVID-19 pandemic into an intervention opportunity to reduce tobacco-related disease.

Identifying knowledge, self-efficacy and response efficacy of alternative discipline strategies among low-income Black, Latino and White parents.

Corporal punishment (CP) leads to detrimental mental and physical consequences for a child. One way to prevent CP is to encourage parents to apply alternative discipline strategies that do not involve violence. Based on the knowledge-behavior gap framework in public health education, this study analyzed the focus group data of 75 low-income Black, Latino and White parents to uncover commonalties and differences in their knowledge, self-efficacy and response efficacy of alternative discipline strategies. Findings revealed that parents knew several alternative discipline strategies and had confidence in their ability to conduct these strategies. However, parents reported that some strategies were hard to implement because they lacked the relevant resources. Moreover, parents did not perceive that alternative discipline strategies were effective without using some forms of CP. Knowledge, self-efficacy and response efficacy of alternative discipline strategies are risk factors for child physical abuse and addressing them will help prevent injury and health impacts on children, while providing safe, stable, nurturing relationships and environments for child development.

Influenced by Anonymous Others: Effects of Online Comments on Risk Perception and Intention to Communicate.

Guided by the health risk communication literature and the social identity model of deindividualization effects, this study examines whether and how concurrent exposure to health news articles and congruent/incongruent comments posted by anonymous others may affect news viewers' personal risk perception, societal risk perception, and intention to communicate about health risk issues. Two controlled experiments were conducted in Vietnam concerning two controversial health risk issues, including ear picking and child corporal punishment. Results showed a significant interaction effect between comments and perceived similarity on personal risk perception and societal risk perception, such that comments influenced both types of risk perception when viewers perceived that anonymous commenters were ingroup members. Results also indicated the joint effect of comments and perceived similarity on participants' intention to communicate, mediated by their personal risk perception and societal risk perception. Theoretical and practical implications were discussed.