Political Affiliation Moderates the Effect of Injunctive Norms on Freedom Threat and Behavioral Intentions: Limiting Indoor Gatherings to Flatten the COVID-19 Curve.

Although many states in the U.S. restricted indoor social gatherings to prevent the spread of COVID-19 in the Fall of 2020, college students' large social gatherings still caused many cluster infections. The present study aimed to explore whether perceived injunctive norms negatively influence behavioral intentions through perceived freedom threat and anger and to probe the ways that different political party affiliations interact with the normative effects. Undergraduate students were recruited to participate in an online survey (n = 170). Counter to predictions, perceived injunctive norms positively influenced Republican participants' behavioral intentions through perceived freedom threat and anger. They reported lower perceived freedom threat as perceived injunctive norms increased, whereas Democrat participants reported higher perceived freedom threat as perceived injunctive norms increased. The findings suggested that injunctive social norms campaigns would be more effective for Republican students to promote COVID-19 preventive behaviors as contrasted with Democrat students.

Social Media Use and Alcohol Consumption: A 10-Year Systematic Review.

Many studies have looked at the relationship between social media and alcohol consumption. There is a need for a comprehensive review that synthesizes the results of past research to systematically understand the relationship between social media use and alcohol consumption. The present systematic literature review synthesizes the findings from global social media and alcohol use studies (n = 206, 204 retained for analysis) between 2009 and 2019. Codes included type of study, methods, use of theory, and whether and how the relationship between social media and alcohol use was tested, among others. In addition to providing descriptive findings, the current study compared the findings across studies that primarily focused on advertising and marketing, self-generated user-generated content (UGC), other-generated UGC, social media uses and affordances, and a mixture of more than one type of content/focus. Most articles used quantitative methods (77.94%), which is followed by qualitative methods (15.20%), mixed methods (6.37%), and 0.49% that did not fit in any of the methods categories. Of the studies that tested the relationship between social media use and alcohol consumption, an overwhelming majority found that relationship to be positive (93.10%). The results of the present study provide a comprehensive understanding of past findings regarding social media and alcohol consumption and provide important future research suggestions.

Determining whether Public Communications Campaigns Based on the The Social Norms Approach are a Viable COVID-19 Prevention Strategy for College Campuses.

The purpose of this study is to (a) outline the formative steps that universities can follow to determine if a media campaign based on the social norms approach (SNA) is a viable method for increasing COVID-19 prevention behaviors among their students, (b) present formative research data collected at a large public land-grant university in the U.S., and (c) as a test case, apply that data to assess the SNA's viability for promoting COVID-19 prevention behaviors among students at that institution. Over time, a series of fast-track surveys were conducted to determine the descriptive and injunctive norms for four COVID-19 prevention strategies: wearing a mask in public, physical distancing, limiting the size of indoor gatherings, and receiving or planning to get a vaccination. The results demonstrated that, at this particular university, an SNA-based public communications campaign would be a promising strategy for promoting these protective behaviors. First, a clear majority of the survey respondents reported engaging in the behaviors. Second, the respondents perceived the behaviors to be less common than was actually the case, with one exception: wearing a mask. In all four cases, they perceived the behaviors to be less approved of than what the surveys documented.

Evaluating the Feasibility of Continuing Medical Education for Disseminating Emerging Science on the Breast Cancer and Environment Connection.

Developing continuing medical education (CME) training programs is a strategy for communicating emerging science to health practitioners. This research tests the feasibility of using CME modules for translating and disseminating research findings from the Breast Cancer and Environment Research Program. Recent findings have identified certain windows of susceptibility, like during puberty, in which exposure to endocrine-disrupting chemicals can increase breast cancer risk later in life. In order to reach pediatric patients and their caregivers, using a Diffusion of Innovations framework, pediatric health-care providers were identified as opinion leaders. Two CME modules informed by theory and formative research were tested with a sample of pediatricians and pediatric nurse practitioners. Participants completed knowledge, attitude, intention, and behavior items immediately before and after exposure to a randomly assigned module, and then again 3 weeks later. Quantitative and qualitative results indicate knowledge gain and strong links between practitioners' intentions to enact and implemented behavior learned from training recommendations with parents and caregivers in their practices. Results indicate that CMEs can be an effective strategy for translational activities targeted to health providers in order to change behavior within practice.

The long-term effectiveness of a social norming campaign to reduce high-risk drinking: The Michigan State University experience, 2000-2014.

OBJECTIVE: Evaluate effectiveness of a university-wide social norms marketing campaign to reduce high-risk drinking and its consequences among students at MSU. Participants: Campaign messages regarding descriptive and injunctive norms were distributed campus-wide from 2001 to 2014 to correct norm misperceptions. Methods: Random samples of students surveyed most semesters to monitor message saturation, dosage, and believability along with drinking attitudes, behaviors and harm related to celebratory events. NCHA conducted biennially since 2000 to assess overall progress. Results: Perceived drinking norms declined along with measures of actual drinking intensity, frequency, and frequency of intense drinking. Use of protective behaviors most often addressed in campaign messages increased while driving after drinking declined. Importantly, reported adverse effects of drinking on academic performance declined substantially. Conclusions: The evidence suggests the social norms approach has been effective at reducing adverse academic outcomes of drinking. Changes in perceptions, attitudes, behaviors and outcomes appear to be continuing.

Trick or Drink: Offline and Social Media Hierarchical Normative Influences on Halloween Celebration Drinking.

The current study examined the relationship between perceived societal and personal celebration drinking norms, social media use, and alcohol consumption during Halloween. The study used a survey of a nationally representative, convenience, and cross-sectional sample of underage youth (18-20 years old; N = 525). Participants self-reported their own drinking, perceived descriptive norms among peers and close friends, and alcohol-related social media posting and interaction during Halloween. Results revealed that underage youth's estimation of societal drinking norms related to their proximal close friends' drinking norms, which in turn, influenced self-reported number of drinks consumed during Halloween. Social media posting and interaction with alcohol-related content were associated with greater descriptive normative perceptions and self-reported drinking. Extending the hierarchical social norms approach, our findings showed that normative perceptions about proximal reference groups' drinking, along with alcohol-related social media activities, were associated with greater number of drinks consumed during Halloween.

Celebration Drinking around the Clock.

The fact that St. Patrick's Day (SPD) celebration drinking occurs during a specified, public, and socially-acceptable time frame which spans the better part of a day and evening makes it an important time to understand and attempt to influence celebration drinking behaviors among young adults. SPD has been identified as the celebration during which college students consume more alcohol than any other point during the school year. Intervention opportunities can be more successful with an understanding of the factors associated with alcohol consumption at specific times on particular celebrations. This study examined the factors associated with celebration drinking at different time periods on SPD which included perceived descriptive and injunctive norms, the numbers of close friends and acquaintances present, social media relationships, demographic variables, past drinking behavior, and intent to drink on SPD at the three time points of interest. Findings showed variability in the predictive factors on SPD celebration drinking at different times of the day. The theoretical and practical intervention implications of the findings are discussed.

Health-Care Provider Planned Responses to Patient Misunderstandings about End-of-Life Care.

This study examined health-care provider planned responses to patient misunderstandings about end-of-life care using a multiple goals framework. Plan topics and content alignment with task, identity, and relational goal types were coded. Findings suggested that content was predominately task-oriented and concerned implications of treatment options such as choice outcomes and efficacy rates. A substantial percentage of providers planned to refer further discussion about the misunderstanding to another team member or occupational resource. Despite the prompt of patient misunderstanding, little attention was given to literacy and/or avoidance of medical jargon. Implications for these findings are discussed.

Formative research identifying message strategies for a campus bicycle safety campaign using self-determination theory and the social norms approach.

This formative study investigates the utility of the social norms approach (SNA) and self-determination theory (SDT) in framing safe bicycling messages with the goal of increasing intention to use bicycle lanes on a university campus. In Study 1, observational data showed that the majority of campus bicyclists did not use designated bike lanes while cycling; thus, intention to use bicycle lanes was chosen as the dependent variable for Study 2. Survey data (n = 168) collected from college students measured SNA and SDT constructs related to intention to use bicycle lanes, including descriptive norms, injunctive norms, autonomy, competence, and relatedness. Results indicate that different aspects of both the SNA and SDT are viable approaches for developing bicycle safety campaign messages, as competence, relatedness, and injunctive norms were significant predictors of intention to use bicycle lanes. Implications for the development of campaign messages are discussed, and information is presented to assist other groups so they can use the same process to develop relevant campaign messages.

Hearing loss and quality of life.

OBJECTIVE: We sought to identify multidimensional factors associated with health-related quality of life (HRQoL) for use in developing an inventory in which HRQoL is a core concept in evaluating the impact of hearing loss and the efficacy of rehabilitative interventions. METHOD: A qualitative approach was used in which we posed two major questions to a focus group consisting of eight adults with self-reported, bilateral sensorineural hearing loss of varying degrees. In essence, those questions were: (1) How do you define quality of life?, and (2) Can you describe specific incidents in your everyday life in which your hearing loss has impacted your quality of life? The discussion was embedded within a framework that utilized a modification of the Critical Incident Technique (CIT). We used well-established analytic techniques to translate the data into unitized thought units, which we coded into meaningful categories. Response frequency was used to determine the salience of responses in addressing the research questions. RESULTS: Participants defined QoL in terms of a number of primary dimensions, most of which were directly or indirectly associated with specific recalled incidents in which those dimensions have played a notable role in contributing to their QoL. CONCLUSIONS: The use of well-established methods to gather and analyze qualitative data generated by self-report techniques offers a promising direction for developing a standardized inventory for identifying the factors that impact QoL for persons with hearing loss and for evaluating the success of intervention strategies aimed at improving their HRQoL.

Is the Nature of Communication Relevant to the Supportiveness of Women's Relationships With Probation and Parole Agents?

This article reports on a study of the connection of probation and parole agents' communication with relationship supportiveness as perceived by both women offenders and agents. For a sample of offenders and their agents, multilevel modeling was used to control for nonindependence of data for women assigned to the same agent. Consistent with communication theory, a conversational approach was positively related to measures of a supportive relationship, and an authoritarian/ conformity pattern of communication was negatively related to a supportive relationship. For low-risk offenders, attention to client-identified problems was positively related to more supportive relationships. For women with high risk for reoffending, the agents viewed themselves as less supportive if they addressed a high proportion of offender-identified needs. Findings suggest the efficacy of training to promote agents' conversational communication and attention to offender-identified problems. Findings also suggest the need to more fully explore agents' experience in working with very high-risk offenders.

Risk Belief and Attitude Formation From Translated Scientific Messages About PFOA, an Environmental Risk Associated With Breast Cancer.

Evidence regarding possible environmental causes of breast cancer is advancing. Often, however, the public is not informed about these advances in a manner that is easily understandable. This research translates findings from biologists into messages at two literacy levels about perfluorooctanoic acid (PFOA), a possible environmental contributor to breast cancer. The Heuristic Systematic Model (HSM) was used to investigate how ability, motivation, and systematic and heuristic processing lead to risk beliefs and, ultimately, to negative attitudes for individuals receiving translated scientific messages about PFOA. Participants (N = 1,389) came from the Dr. Susan Love Research Foundation's Army of Women. Findings indicated that ability, in the form of translated messages, predicted systematic processing, operationalized as knowledge gain, which was negatively associated with formation of risk beliefs that led to negative attitudes toward PFOA. Heuristic processing cues, operationalized as perceived message quality and source credibility, were positively associated with risk beliefs, which predicted negative attitudes about PFOA. Overall, more knowledge and lower literacy messages led to lower perceived risk, while greater involvement and ratings of heuristic cues led to greater risk perceptions. This is an example of a research, translation, and dissemination team effort in which biologists created knowledge, communication scholars translated and tested messages, and advocates were participants and those who disseminated messages.

A research coding method for the basic patient-centered interview.

OBJECTIVE: To develop a more reliable coding method of medical interviewing focused on data-gathering and emotion-handling. METHODS: Two trained (30h) undergraduates rated videotaped interviews from 127 resident-simulated patient (SP) interactions. Trained on 45 videotapes, raters coded 25 of 127 study set tapes for patient-centeredness. Guetzkow's U, Cohen's Kappa, and percent of agreement were used to measure raters' reliability in unitizing and coding residents' skills for eliciting: agenda (3 yes/no items), physical story (2), personal story (6), emotional story (15), using indirect skills (4), and general patient-centeredness (3). RESULTS: 45 items were dichotomized from the earlier, Likert scale-based method and were reduced to 33 during training. Guetzkow's U ranged from 0.00 to 0.087. Kappa ranged from 0.86 to 1.00 for the 6 variables and 33 individual items. The overall kappa was 0.90, and percent of agreement was 97.5%. Percent of agreement by item ranged from 84 to 100%. CONCLUSIONS: A simple, highly reliable coding method, weighted (by no. of items) to highlight personal elements of an interview, was developed and is recommended as a criterion standard research coding method. PRACTICE IMPLICATIONS: An easily conducted, reliable coding procedure can be the basis for everyday questionnaires like patient satisfaction with patient-centeredness.

Communication Style as an Antecedent to Reactance, Self-Efficacy, and Restoration of Freedom for Drug- and Alcohol-Involved Women on Probation and Parole.

This study extends research on psychological reactance theory by examining probation and parole officer (PO) communication style as an antecedent to female offenders' reactance and 2 indicators of subsequent drug and alcohol abuse while serving probation or parole sentences. Structural equation modeling was conducted to test a mediational path model, the results of which demonstrated that perceptions of PO conversational communication style were negatively associated with reactance but positively associated with self-efficacy to avoid drugs and alcohol. Conversely, women who perceived their POs as having a conformity communication style were more likely to report higher levels of reactance and lower self-efficacy to avoid drugs and alcohol. Psychological reactance led to desire to restore freedom, whereas self-efficacy to avoid drugs and alcohol did not. Desire to restore freedom was linked with reports of using drugs and alcohol and violations of parole or probation for using drugs and alcohol. These findings highlight the importance of communication style as an antecedent to reactance and in the relationship between POs and offenders.

A questionnaire identifying four key components of patient satisfaction with physician communication.

OBJECTIVE: To improve efficiency and retain the 4 factors of a reliable, valid interview satisfaction questionnaire (ISQ). METHOD: 105 residents conducted 301 patient-centered interviews with 10 simulated patients (SP). SPs portrayed three scenarios for each resident and completed the ISQ and the Communication Assessment Tool (CAT) after each. A confirmatory factor analysis (CFA) of the ISQ and CAT determined which items had >0.5 factor loadings and <0.1 error, criteria for retaining items in a shortened scale. RESULTS: After the CFA, 13 items were deleted resulting in a 12-item scale (RMSE=0.06) that confirmed the initial 4 factor structure of satisfaction with: open-endedness, empathy, confidence in the resident, and general. Scale reliability of each factor was high (Cronbach's alpha ranged from .74 to .93). Demonstrating concurrent validity, all four factors of the ISQ correlated highly with the one-factor CAT (r>.7, p<.001), and the second order unidimensional ISQ scale also correlated highly with the CAT (r=.83, p<.001). CONCLUSIONS: The ISQ is an efficient, reliable, and valid instrument that uniquely deconstructs satisfaction with the patient-physician interaction into 4 key components. PRACTICE IMPLICATIONS: The 4 components provide a means for better understanding poor satisfaction results.

An Effort to Increase Organ Donor Registration Through Intergroup Competition and Electronic Word of Mouth.

The effort to increase Web organ donation registrations in Michigan by enhancing 2 types of university campaigns with social media strategies informed by social identity theory is the focus of this research. The two campaigns focused on either ingroup or rivalry outgroup social identification, and each was enhanced with individually focused social media in the first year of the campaign and with electronic word of mouth in Year 2 of the campaign. Results indicated that individually focused social media such as Facebook ads worked well in rivalry campaigns (in which registrations increased two times over baseline) but not in ingroup identification campaigns (in which registrations decreased significantly over baseline when ads were introduced in the first year of each type of campaign). Electronic word-of-mouth strategies worked well in both ingroup identification campaigns (in which registrations increased two times over baseline) and rivalry campaigns (in which registrations rose almost eight times over baseline, when strategies were introduced in the second year of each type of campaign).

The effects of fear appeal message repetition on perceived threat, perceived efficacy, and behavioral intention in the extended parallel process model.

This study examined the effect of moderately repeated exposure (three times) to a fear appeal message on the Extended Parallel Processing Model (EPPM) variables of threat, efficacy, and behavioral intentions for the recommended behaviors in the message, as well as the proportions of systematic and message-related thoughts generated after each message exposure. The results showed that after repeated exposure to a fear appeal message about preventing melanoma, perceived threat in terms of susceptibility and perceived efficacy in terms of response efficacy significantly increased. The behavioral intentions of all recommended behaviors did not change after repeated exposure to the message. However, after the second exposure the proportions of both systematic and all message-related thoughts (relative to total thoughts) significantly decreased while the proportion of heuristic thoughts significantly increased, and this pattern held after the third exposure. The findings demonstrated that the predictions in the EPPM are likely to be operative after three exposures to a persuasive message.

Scientific Message Translation and the Heuristic Systematic Model: Insights for Designing Educational Messages About Progesterone and Breast Cancer Risks.

Results of ongoing scientific research on environmental determinants of breast cancer are not typically presented to the public in ways they can easily understand and use to take preventive actions. In this study, results of scientific studies on progesterone exposure as a risk factor for breast cancer were translated into high and low literacy level messages. Using the heuristic systematic model, this study examined how ability, motivation, and message processing (heuristic and systematic) influenced perceptions of risk beliefs and negative attitudes about progesterone exposure among women who read the translated scientific messages. Among the 1254 participants, those given the higher literacy level message had greater perceptions of risk about progesterone. Heuristic message cues of source credibility and perceived message quality, as well as motivation, also predicted risk beliefs. Finally, risk beliefs were a strong predictor of negative attitudes about exposure to progesterone. The results can help improve health education message design in terms of practitioners having better knowledge of message features that are the most persuasive to the target audiences on this topic.

Emerging issues and future directions of the field of health communication.

The interdisciplinary intersections between communication science and health-related fields are pervasive, with numerous differences in regard to epistemology, career planning, funding perspectives, educational goals, and cultural orientations. This article identifies and elaborates on these challenges with illustrative examples. Furthermore, concrete suggestions for future scholarship are recommended to facilitate compatible, coherent, and interdisciplinary health communication inquiry. The authors hope that this article helps current and future generations of health communication scholars to make more informed decisions when facing some of the challenges discussed in this article so that they will be able to seize the interdisciplinary and international potential of this unique and important field of study.

The effects of heuristic cues, motivation, and ability on systematic processing of information about breast cancer environmental factors.

The heuristic systematic model is used to investigate how ability, motivation, and heuristic message cues predict knowledge scores for individuals receiving messages written for different literacy levels about 3 environmental risk factors for breast cancer. The 3 risk factors were the roles of genetics, progesterone, and ingesting perfluorooctanoic acid in breast cancer risk. In this study, more than 4,000 women participated in an online survey. The results showed support for the hypotheses that ability (measured as education, number of science courses, and confidence in scientific ability) predict knowledge gain and that those individuals who presented with the lower literacy level message had significantly higher knowledge scores across all 3 message topics. There was little support for motivation or heuristic cues as direct predictors of knowledge gain across the 3 message topics, although they served as moderators for the perfluorooctanoic acid topic. The authors provide implications for health communication practitioners.