Search

The U.S. Food and Drug Administration (FDA) currently requires a warning about the addictive nature of nicotine to be placed on electronic cigarette advertisements and packaging. To consider the value of additional warning messages on public health outcomes, this study examines the additive effect of new warnings that are based on recent claims from U.S. federal authorities. We conducted a secondary analysis of recent data from 1,202 U.S. youth ages 14-17 to test the impact of exposure to additional warnings placed on advertisements for vaping products on cognitive elaboration, fear, and willingness to vape and smoke. This investigation also looked closely at effects on youth who may have increased risk of future vaping due to prior vaping experiences or having friends who vape. Exposure to the alternative warnings did not amplify cognitive elaboration compared to the current FDA warning alone, but it did increase fear. Youth elaboration on both the benefits and risks of vaping was associated with willingness to both vape and smoke, but fear was not associated with either outcome. The effects of warning label exposure and cognitive elaboration varied by prior vaping experience and having at least one friend who vapes. We conclude by discussing the implications of this contingent pattern of effect and association.

There are significant racial disparities in obesity and diabetes such that prevalence rates are higher among Black Americans than White Americans. This study examined effects of communicating the prevalence of obesity/diabetes and comparing race-specific prevalence rates between White and Black Americans to highlight racial health disparities. We conducted two preregistered, between-subjects randomized online experiments with an analytic sample of 1,232 U.S. adults ( n  = 609 for the obesity study and n  = 623 for the diabetes study) stratified by race. In each experiment, we randomly assigned respondents to read an obesity/diabetes message 1) without disease prevalence information, 2) with the national obesity/diabetes prevalence rate, 3) with the race-specific obesity/diabetes prevalence rate among White Americans, 4) with the race-specific prevalence rate among Black Americans, or 5) comparing the race-specific prevalence rates between White and Black Americans, or 6) to a no-message condition. Results showed that diabetes prevalence information reduced the overestimation of race-specific diabetes prevalence. Comparing the obesity prevalence rate among White Americans to that of Black Americans increased support for policies to reduce racial health disparities, but also made Black respondents less likely to cut calories. Race-specific disease prevalence information and intergroup disease prevalence comparisons may have both positive and unintended consequences on message recipients. Health educators should be more cautious when communicating disease prevalence information.

E-cigarette use among youth presents a public health risk. Yet, cigarette smokers who substantially reduce their smoking or switch completely from traditional combustible cigarettes could benefit. As science about e-cigarettes is continually emerging, any potential warnings are likely to contain uncertain language. Hedged verbiage may impact decision making. To assess reactions, we conducted 16 online focus groups; 8 with youth ( n  = 32, grouped by gender and by vaping experience) and 8 with adult tobacco users ( n  = 37, grouped by smokers, dual users of e-cigarettes and cigarettes, and former smokers who switched to e-cigarettes). Each focus group viewed and discussed 8 potential warnings messages. We conducted an inductive thematic analysis of the reactions to warning messages that contain uncertain language. Respondents' reactions were often negative, but varied based on specific usages of uncertainty, existing beliefs about uncertainty in law and science, and smoking/vaping use patterns that supported the use of uncertainty related to e-cigarettes. Many youth (and some adults) believed that uncertain language enabled audiences to minimize the likelihood of harm or interpreted it as meaning there are both healthy and unhealthy e-cigarettes. This qualitative study provides evidence that the use of types of uncertain language, the frequency of that use, and/or the selection of particular words in warnings, might not achieve the intended public health aims of increasing understanding of risk, deterring youth uptake, and/or facilitating a substantial switch from cigarettes. The use of certain types of uncertain language appears to have significant potential to bring unintended consequences. Suggestions for research and policy are included.

Obesity and diabetes are widespread health conditions with rising prevalence rates in the United States. News stories and health campaign messages frequently feature prevalence rates of obesity and diabetes, at times under the expectation that such messages will increase readers' disease awareness, health behaviors, and policy support. At the same time, American adults overestimate the prevalence of obesity and diabetes in the absence of prevalence information, raising important questions about the implications of communicating accurate prevalence information that may be lower than baseline estimates. The current study examines the effects of communicating information about the prevalence of obesity and diabetes, varying the format of this information (using qualitative terms, raw frequencies, or percentages). Results from two pre-registered, web-based randomized experiments suggest that only prevalence statistics in percentage formats shift readers' prevalence estimates, though in some percentage formats these estimates were lower than observed in a no-message control group. Prevalence estimates, in turn, were positively associated with perceived social causes of obesity/diabetes, intensions for healthy behaviors, and support for policy-level solutions. These findings offer guidance for health communication campaigns that seek to increase healthy behavior and support for policies to address health conditions.

Health communicators in the United States face substantial challenges in their efforts to increase parent uptake of the measles, mumps, and rubella (MMR) vaccine for their children. One major set of challenges involves low levels of trust in medical science behind vaccination safety and effectiveness, pharmaceutical companies who produce these vaccines, and government health agencies who promote vaccination. We conducted a two-wave randomized experiment ( N = 1,000 at time 1, t 1, N = 803 at time 2, t 2) to test whether messages designed to convey the expertise, trustworthiness, or caring/goodwill of a governmental source of information (the Centers for Disease Control and Prevention) increased perceived source credibility, increased parent intentions to vaccinate their children, and/or reduced vaccine hesitancy. We found no support for any of the study's original, pre-registered hypotheses. However, post-hoc analyses reveal a variety of promising directions for future work on strategic messaging to increase source credibility in the context of vaccine hesitancy. A message designed to convey source expertise produced greater perceived caring/goodwill among parents overall. Furthermore, among parents who were vaccine hesitant at baseline, a message originally designed to convey source expertise produced greater perceived trustworthiness and reduced vaccine hesitancy among this group.

While health communicators often study strategic health messages, investigations of how visual message elements complement or inhibit persuasive efforts are sparse in the literature. Visual juxtapositions, which refer to one visual presentation featuring two images placed next to each other, are one such visual element. In the context of improving public communication efforts related to promoting healthy dietary choices, we use visual persuasion theory and exemplification theory to test whether different visual juxtapositions influence message recipients' expectations to share message content and reduce their consumption of unhealthy products (i.e., sugary drinks and salty foods). We carried out two studies, each a two-wave, longitudinal randomized experiment, to test for direct effects and assess the potential for indirect or delayed associations of visual persuasion appeals using visual juxtapositions. We consistently observed that a similarity visual juxtaposition evoked higher levels of surprise and expectations to share message content than a comparison juxtaposition or control condition immediately following message exposure; however, visual juxtapositions had no direct effects on unhealthy consumption expectations immediately following exposure or one-week following exposure. Levels of surprise were associated with both intended outcomes in the short-term (increased message sharing expectations) and unintended outcomes in the longer-term (increased consumption expectations). Overall, the study offers insights into the effects and associations of visual juxtapositions on message processing and persuasion outcomes, as well as raises questions about how to apply visual persuasion concepts and improve theorizing related to visual persuasion in health communication contexts.

Public stigma characterizes three leading health issues: prescription opioid addiction, obesity, and cigarette smoking. Attributions of individual responsibility are often embedded in negative public attitudes around these issues and can be important to stigma's development and reduction. Research suggests that narrative messages may hold promise for influencing attributions and stigma in these health contexts. Using a national sample of American adults from an online panel (N = 5,007), we conducted a survey-embedded randomized experiment, assigning participants to read one of six messages about one of three health issues. All participants read a statement detailing the magnitude of their assigned health problem, after which some respondents received a short inoculation message (serving as a comparison group) or a narrative message emphasizing external factors while acknowledging personal responsibility for the issue. Some participants also read a counter message emphasizing personal responsibility for the health issue to replicate competitive messaging environments surrounding these issues. Relative to those who received only the magnitude of problem message (comparison group 1) or the magnitude of problem and inoculation messages (comparison group 2), the narrative message reduced prescription opioid addiction stigma and increased attributions of responsibility to groups beyond the individual. Narrative effects were mixed for obesity, had no effect on attributions or stigma around cigarette smoking, and were generally consistent whether or not respondents received a counter message. Narrative messages may be a promising approach for shifting responsibility attributions and reducing public stigma around prescription opioid addiction, and may have some relevance for obesity stigma-reduction efforts.

Women of childbearing age (WCBA) can attain health benefits of fish consumption while minimizing risks by following state and federal fish consumption guidelines, but many women avoid fish out of concerns about mercury exposure. This study tested the impact of brochures, informed by communication theory and research, to promote healthy fish consumption among licensed female anglers. We conducted a randomized, two-wave longitudinal experiment between May 2014 and September 2015 among 1,135 women ages 18-48 years (at baseline), drawn from a sample of licensed anglers in the Great Lakes region of the United States. We randomly assigned women to one of five groups, to either be sent one of four brochures in spring 2015 using a two (including a short personal narrative or not) by two (using certain or uncertain language) factorial design, or to a no-exposure control arm. Participants reported their fish consumption in summer 2014 and summer 2015 via an online diary. Exposure to brochure versions that included a short personal narrative helped move women whose baseline levels of fish consumption were furthest from federal recommendations closer to these guidelines; effects were clearest among women confirmed, by self-report or web tracking, to have seen the brochure. Narratives hold promise as a strategy to communicate effectively about the benefits of healthy fish consumption and risks of overconsumption among WCBA, but widespread dissemination may be necessary to achieve these effects.

The U.S. Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) of 2009 paved the way for the Food and Drug Administration (FDA) to propose nine different graphic warning labels (GWLs) intended for prominent placement on the front and back of cigarette packs and on cigarette advertisements. Those GWLs were adjudicated as unconstitutional on the ground that they unnecessarily infringed tobacco companies' free speech without sufficiently advancing the government's public health interests. This study examines whether less extensive alternatives to the original full-color GWLs, including black-and-white GWLs and text-only options, have similar or divergent effects on visual attention, negative affect, and health risk beliefs. We used a mobile media research lab to conduct a randomized experiment with two populations residing in socioeconomically disadvantaged communities: biochemically confirmed adult smokers (N = 313) and middle school youth (N = 340). Results indicate that full-color GWLs capture attention for longer than black-and-white GWLs among both youth and adult smokers. Among adults, packages with GWLs (in either color or black-and-white) engendered more negative affect than those with text-only labels, while text-only produced greater negative affect than the packages with brand imagery only. Among youth, GWLs and text-only labels produced comparable levels of negative affect, albeit more so than brand imagery. We thus offer mixed findings related to the claim that a less extensive alternative could satisfy the government's compelling public health interest to reduce cigarette smoking rates.

Research on front-of-package (FOP) labeling demonstrates that nutrient content claims (e.g., "low fat") can lead consumers to perceive foods as healthier in general-effects that have been interpreted using halo effect theories of impression formation. Extending this work, the present study investigates whether these effects may depend on whether nutrient information comes in the form of a nutrient content claim ("good source of protein") or embedded within the product title itself ("protein" bar)-an important question given the popularity of energy/nutrition bars and ongoing policy debates over food-labeling regulation. Results from a between-subjects experiment (n = 274) revealed that although both conditions increased perceived protein content for a nutritional bar, only the product title condition increased overall perceptions of product healthfulness-an effect mediated by increased perceptions of additional non-claimed "healthy" nutrients (fiber, iron). Finally, although the presence of a traffic light warning label increased perceived sugar and calorie content, it did not counteract the effect of the product title on perceived healthfulness. We conclude with a discussion focused on implications for policy and health halo effects in the context of food labeling.

The Patient Protection and Affordable Care Act (ACA) continues to be the subject of fierce political debate in the United States. Drawing on issue framing theory, together with research on wording effects in survey responding, we tested how common differences in the wording of ACA surveys relate to apparent public support for the law. We report on a content analysis of N = 376 U.S. national opinion surveys fielded during a more than six-year period, beginning 23 March 2010 (when President Obama signed the bill into law) and ending 8 November 2016 (Election Day), and use ordinary least squares (OLS) regression models to predict public support for the law as a function of variation in question wording. We coded questions gauging general sentiment toward the law for differences in issue labeling (e.g., Obamacare, Affordable Care Act), whether or not they referenced particular political entities (e.g., President Obama, Congress) or segments of the public (e.g., You, Your Family), various opinion metrics (e.g., Support, Favor), and different response options (e.g., Repeal, Expand) which we used to model aggregate levels of support. The results revealed several key differences in question wording-for example, generic references to the Healthcare Law were employed much more frequently than Obamacare or Affordable Care Act-a number of which reliably predicted aggregate levels of public support. The discussion considers possible explanations for these patterns and reiterates the value of attending to questionnaire design features when interpreting survey data about politically contentious health policy issues.

This study examines whether exposure to direct-to-consumer advertising (DTCAs) for statin drugs is associated with non-pharmaceutical behaviors to prevent cardiovascular disease. We focus on the relationship between statin drug DTCA exposure and the frequency of (a) visits to fast-food restaurants and (b) exercise. We combine data on the televised broadcast availability of statin drug DTCAs in large media markets in the United States with 18 waves of the Simmons National Consumer Survey (NCS; n = 120, 229) from 2001 to 2009. We find that statin drug DTCA exposure is associated, in a dose-response pattern, with modest increases in the frequency of exercise and large increases in the frequency of fast-food-restaurant visits. The relationship between statin DTCA exposure and fast-food-restaurant visits were largely consistent in direction but differed in magnitude between those without a previous diagnosis of high cholesterol and those treating high cholesterol with a statin. We conclude with a discussion of the implications of these results for future research on pharmaceutical DTCA and population health.

This study uses data from systematic Web image search results and two randomized survey experiments to analyze how frames commonly used in public debates about health issues, operationalized here as alternative word choices, influence public support for health policy reforms. In Study 1, analyses of Bing (N = 1,719), Google (N = 1,872), and Yahoo Images (N = 1,657) search results suggest that the images returned from the search query "sugar-sweetened beverage" are more likely to evoke health-related concepts than images returned from a search query about "soda." In contrast, "soda" search queries were more likely to incorporate brand-related concepts than "sugar-sweetened beverage" search queries. In Study 2, participants (N = 206) in a controlled Web experiment rated their support for policies to reduce consumption of these drinks. As expected, strong liberals had more support for policies designed to reduce the consumption of these drinks when the policies referenced "soda" compared to "sugar-sweetened beverage." To the contrary, items describing these drinks as "soda" produced lower policy support than items describing them as "sugar-sweetened beverage" among strong conservatives. In Study 3, participants (N = 1,000) in a national telephone survey experiment rated their support for a similar set of policies. Results conceptually replicated the previous Web-based experiment, such that strong liberals reported greater support for a penny-per-ounce taxation when labeled "soda" versus "sugar-sweetened beverages." In both Studies 2 and 3, more respondents referred to brand-related concepts in response to questions about "sugar-sweetened beverages" compared to "soda." We conclude with a discussion of theoretical and methodological implications for studying framing effects of labels.

This study attempts to advance theorizing about health policy advocacy with combinations of narrative focus and a statistical map in an attempt to increase state legislators' support for policies to address the issue of obesity by reducing food deserts. Specifically, we examine state legislators' responses to variations in narrative focus (individual vs. community) about causes and solutions for food deserts in U.S. communities, and a statistical map (presence vs. absence) depicting the prevalence of food deserts across the United States. Using a Web-based randomized experiment (N=496), we show that narrative focus and the statistical map interact to produce different patterns of cognitive response and support for policies to reduce the prevalence of food deserts. The presence of a statistical map showing the prevalence of food deserts in the United States appeared to matter only when combined with an individual narrative, offsetting the fact that the individual narrative in isolation produced fewer thoughts consistent with the story's persuasive goal and more counterarguments in opposition to environmental causes and solutions for obesity than other message conditions. The image did not have an impact when combined with a story describing a community at large. Cognitive responses fully mediated message effects on intended persuasive outcomes. We conclude by discussing the study's contributions to communication theory and practice.

This study examined psychosocial and sociodemographic factors associated with pregnant women's use of Web-based tools to set and monitor personal goals for healthy diet and physical activity. These tools were made available to women participating in a randomized trial testing a Web-based intervention to promote appropriate gestational weight gain. We used data from a baseline survey of pregnant women assigned to the intervention group and log data on women's use of various intervention features (N = 873). Women who believed that appropriate gestational weight gain would lead to healthy outcomes for their child were more likely to engage in online goal-setting and self-monitoring. Less positive outcome expectancy beliefs about the relationship between their own weight and baby's health partially explains why some at risk subpopulations (e.g., African-American women) were less likely to utilize online self-regulatory tools. This study specifies key psychosocial and motivational factors that guide the construction and monitoring of goals among pregnant women. These findings offer guidance for the design of interventions to promote self-regulatory techniques by identifying groups for whom those features are most likely to be useful, as well as psychological determinants of their use.

This research used the Integrative Model of Behavioral Prediction (IMBP) to examine cognitive predictors of intentions to engage in healthy sleep behavior among a population of college students. In doing so, we identify promising message strategies to increase healthy sleep behavior during college. In Phase 1, members of a small sample of undergraduates (n = 31) were asked to describe their beliefs about expected outcomes, norms, and perceived behavioral control associated with sleep on an open-ended questionnaire. We analyzed these qualitative responses to create a closed-ended survey about sleep-related attitudes, perceived norms, control beliefs, behavioral intentions, and behavior. In Phase 2, a larger sample of undergraduate students (n = 365) completed the survey. Attitudes and perceived behavioral control were the strongest predictors of both intentions to engage in sleep behavior and self-reported sleep behavior. Control beliefs associated with time management and stress also had substantial room to change, suggesting their potential as message strategies to better promote healthy sleep behavior in college. We conclude with a broader discussion of the study's implications for message design and intervention.

Three studies provide empirical, social scientific tests of alternatives to the originally proposed U.S. Food and Drug Administration (FDA) cigarette package warning labels on health risk beliefs, perceived fear, and effectiveness. Our research addresses questions at the root of the legal disputes surrounding FDA regulation of cigarette package warning labels. Specifically, we describe results from three studies that investigate the mediating role of health beliefs and perceived fear in shaping message effectiveness and intentions to quit. The first study featured nonsmoking young adults, while the second and third studies sampled adult daily smokers. Each study was a randomized experiment with five warning-label image conditions: full-color graphic warning labels, black-and-white graphic warning labels, warning text (no graphic image), Surgeon General's warning labels, and no warning. Results consistently indicate that graphic warning labels (in both color and black-and-white) promote increased perceptions of fear, which in turn are associated with greater (perceived and actual) effectiveness. We conclude with a discussion of the results, highlighting implications, public policy considerations, and suggestions for future research.

Health communication researchers have become increasingly interested in factors that predict support for health-related policy. Previous studies have shown that judgments about issues that are influenced by political ideology can be modified by the depth with which receivers process messages related to that issue. In this study, we test whether the same pattern is found for causal attributions about obesity and, ultimately, support for policies to reduce obesity. A national, random sample of U.S. adults read a story about both individual and societal causes of obesity. The longer the time participants spent on the study, and the more words they generated in a thought-listing procedure (operationalizations of depth of processing), the more likely participants were to support policies to reduce obesity, a traditionally liberal position. The same measures of depth of processing did not influence causal explanation of obesity overall, but the more time political moderates spent on the study, the more likely they were to both attribute societal explanations for obesity's causes and to support policies to combat obesity. We conclude with a discussion of this study's application to health communication campaigns and future research directions.

This article presents findings from two studies that describe news portrayals of cancer causes and prevention in local TV and test the effects of typical aspects of this coverage on cancer-related fatalism and overload. Study 1 analyzed the content of stories focused on cancer causes and prevention from an October 2002 national sample of local TV and newspaper cancer coverage (n = 122 television stations; n = 60 newspapers). Informed by results from the content analysis, Study 2 describes results from a randomized experiment testing effects of the volume and content of news stories about cancer causes and prevention (n = 601). Study 1 indicates that local TV news stories describe cancer causes and prevention as comparatively more certain than newspapers but include less information about how to reduce cancer risk. Study 2 reveals that the combination of stories conveying an emerging cancer cause and prevention behavior as moderately certain leads to an increased sense of overload, while a short summary of well-established preventive behaviors mitigates these potentially harmful beliefs. We conclude with a series of recommendations for health communication and health journalism practice.

Narrative messages have the potential to convey causal attribution information about complex social issues. This study examined attributions about obesity, an issue characterized by interrelated biological, behavioral, and environmental causes. Participants were randomly assigned to read one of three narratives emphasizing societal causes and solutions for obesity or an unrelated story that served as the control condition. The three narratives varied in the extent to which the character in the story acknowledged personal responsibility (high, moderate, and none) for controlling her weight. Stories that featured no acknowledgment and moderate acknowledgment of personal responsibility, while emphasizing environmental causes and solutions, were successful at increasing societal cause attributions about obesity and, among conservatives, increasing support for obesity-related policies relative to the control group. The extent to which respondents were able to make connections between individual and environmental causes of obesity (complex integration) mediated the relationship between the moderate acknowledgment condition and societal cause attributions. We conclude with a discussion of the implications of this work for narrative persuasion theory and health communication campaigns.

Previous research suggests that direct-to-consumer (DTC) advertisements for pharmaceutical drugs have the potential to influence consumers' perceptions of whether symptoms should be treated medically and/or through behavior change. However, the relative frequency of messages emphasizing these approaches in pharmaceutical advertising remains largely unknown. A content analysis of print and television advertisements for cholesterol management medication between 1994 and 2005 (for print) and between 1999 and 2007 (for television) was conducted. First, the extent to which established theoretical constructs drawn from health communication scholarship are depicted in the content of DTC cholesterol advertisements is quantified. Second, specific claims about behavior change inefficacy when a pharmaceutical alternative is available are identified. Findings indicate that DTC ads offer many mixed messages about the efficacy of diet and exercise in reducing cholesterol and risk of heart disease. Theoretical and practical implications of this work are discussed.

This article explores public responses to narratives and statistical images, predominantly graphs and maps, designed to raise awareness of social determinants of health and health disparities. We focus particular attention on respondents' interpretation of the complexity of health causality and the typicality of the situations described. We conducted 24 focus groups with liberal and conservative adults (n = 180 participants) living in a large U.S. northeastern state. Although some narratives showed potential for communicating the complex causality connecting social determinants of health (SDH) to health outcomes, contextual details sometimes disrupted generalization to a broader thematic message. Statistical images often prompted useful speculation about how the factors portrayed might be related, but tended to be regarded with suspicion and criticized for oversimplifying what were perceived to be extremely complex issues. These findings lend theoretical insight to narrative and visual persuasion in the context of social issues with complex causation. We discuss practical implications for those seeking to communicate about the social determinants of health.

Recent decades have witnessed a growing emphasis on patients as active consumers of health information. The literature about cancer-related information focuses on active and purposeful information seeking, but a great deal of exposure to cancer-relevant information may happen less purposively (termed information scanning). This article presents results from an in-depth interview study that examined information seeking and scanning behavior in the context of cancer prevention and screening decisions among a diverse sample of people living in a major metropolitan area. Results suggest that information scanning is quite common, particularly for information related to screening tests. Information seeking is rarer and occurs primarily among those who also are information scanners. Respondents report using a greater variety of sources for information scanning than for information seeking, but participants were much more likely to report that their decisions were influenced by information received through seeking than through scanning. These findings shed new light on how individuals navigate the media environment and suggest future research should examine predictors and effects of less purposeful efforts to obtain cancer-related information.