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The severity of the 2014-2015 West African Ebola epidemic in Liberia was coupled with widespread misunderstanding about Ebola among Liberian citizens and the proliferation of rumors. Rumor control during outbreaks is imperative to reduce the public's fears about a disease. In Liberia, a rumor tracker system was developed to detect rumors as quickly as possible through SMS text messaging. The focus of this study was to assess rumor circulation in newspapers and radio and rumor control over time. The review relied on a content analysis of SMS messages, print and audio communications collected from Liberian newspapers, SMS messages from the "DeySay" tracker, and radio programs, during the time frame January 2014 to March 2015. Findings showed more rumors appeared in newspapers but were more likely to be overtly identified and characterized as rumors on radio. The "DeySay" rumor tracker accurately predicted rumors before they appeared in radio programs and newspaper articles, making the case for its usefulness and feasibility in future health epidemics.

Drawing from established theoretical traditions in cognitive consistency, motivated reasoning, heuristic–systematic processing, and the anger-activism model, we extend existing work linking anger with misperceptions by specifying three distinct ways anger might contribute to the formation of misperceptions: Increasing reliance on partisan heuristics, influencing political information-seeking behavior, and moderating the influence of partisan media exposure. Analyzing data from an original survey administered nationally via Qualtrics Panels during the first impeachment trial of President Donald Trump in January 2020, results indicate that high-anger partisans were more likely to express belief in claims supportive of their party and critical of the other party, regardless of the veracity of those claims. Further, anger was also linked with greater use of pro-attitudinal information sources and avoidance of counterattitudinal sources, with these differences in partisan media consumption subsequently influencing factual beliefs. However, we found no evidence that anger moderated the relationship between partisan media exposure and factual beliefs. We explore the implications of these findings in a political era defined increasingly by the experience of anger.

Purpose To date, no study has investigated the extent to which sleep-wake behaviour (SWB) influences match performance in junior tennis players. This study aimed to assess the influence of SWB for the week and night before on match performance, particularly match analytics and activity. Methods This study recruited 10 junior state grade tennis players who wore an actigraphy device and completed a sleep diary for the week before their match on two separate occasions throughout their competition season. Players wore a global positioning system device to track their movement during matches, and an experienced tennis coach recorded players' match analytics. Results This study showed that the sleep fragmentation index was significantly lower the week before matches in females who had won than those who had lost. Additionally, the sleep fragmentation index was significantly lower the night before a given match than the week before. Only sleep fragmentation index and sleep latency significantly influenced match performance in junior tennis players. The percentage of second serves points won differed between match wins and losses for male players, while winners and forced errors differed for female players. Conclusion These findings provide a detailed profile of tennis match play in junior state grade players. Despite individual differences, reduced restlessness the night before a match coincides with increased match performance.

BACKGROUND: Despite multiple efforts, African American women continue to be inadequately represented in clinical research while being overrepresented in disease, producing research results with limited generalizability to this specific population. Our understanding of the barriers to participation in clinical trials among racial/ethnic minority patients in general has evolved, but few studies have examined the reasoning behind African American women’s decision to not participate in clinical trials. OBJECTIVE: The primary aim was to conduct a systematic review to identify the barriers reported by African American women regarding participation in clinical research to help explain the low levels of enrollment. We also suggest strategies that can be implemented by the research community to lessen the effect of those barriers. METHODS: Searches were conducted through MEDLINE, SCOPUS, Web of Science, and Google Scholar. Following a set of eligibility criteria, a total of 18 peer-reviewed journal articles were selected and analyzed to render categories and themes. RESULTS: Across studies aimed at examining their unique perspective, the reasons mentioned by African American women for not participating in clinical research were grouped in three broad categories: 1) weak relationship with the medical and research community, 2) high cost to participation, and 3) personal and “out-of-reach” circumstances. Reasons pertaining to participants’ relationship with physicians/researchers were most salient. DISCUSSION: A targeted and comprehensive understanding of the barriers impacting African American women’s decision to participate in clinical research informs population-specific recruitment and research strategies for future studies. Additional studies assessing barriers to clinical trial research participation that intentionally report on disaggregated data by not only race/ethnicity but also sex are essential to improving the risk/benefit profile for a wide range of prevention and treatment efforts. This improved understanding of the differences between subgroups within minority populations has implications for bolstering culturally sensitive messages to enhance the engagement of minority communities in clinical trial research.

The COVID-19 outbreak presents a serious health challenges, with Australia enforcing tight restrictions, impacting sporting activities and sleep health of many Australians. Routine lifestyle patterns (physical activity and employment) are important to maintaining overall sleep health. Current literature indicates COVID-19 pandemic negatively affected the employment status and sport engagement. The aim of this study was to explore the effect of physical activity during COVID-19 on sleep health, and its association with employment and sport engagement of community-level athletes throughout Australia. Participants self-reported sleep health prior to COVID-19 (pre-sleep) and over the month prior to data collection (during-sleep) using the validated 5-item Satisfaction Alertness Timing Efficiency and Duration questionnaire (SATED). Wilcoxon Signed Rank Test assessed the difference in pre- and during perceived sleep health scores. A generalized linear model was used to assess the impact of sporting and demographic factors on a community athlete’s change in perceived sleep health score. A total of 139 community-level Australian athletes responded. The majority of participants were aged 18–30 and engaged in full-time employment prior to COVID-19 (n = 82, 54%). Eight percent of participants were unemployed prior to the COVID-19 pandemic (n = 12, 8%). Our findings show that sleep health values were higher during COVID-19, with 91.4% of respondents able to maintain some form of physical activity during the pandemic. Together, our results show better sleep health scores reported by the respondents who maintained or lost employment and maintained sporting engagements during the pandemic.

UNSTRUCTURED This study analyzed 25,018,086 tweets posted during the initial nine months of the COVID-19 pandemic between March to November 2020. Using a mixed method of automated (i.e., LDA topic model) and manual content analyses, results from this study point to debatable information as the most prevalent and diffused information category followed by credible information, general disinformation, trolling, biased or one-sided and conspiratorial disinformation. Contrary to mainstream understanding, the prevalence of credible information was double that of disinformation. Overall, General Users were the most prolific category of users (53.0%) involved in the spread of COVID-19 related disinformation. News media organizations (16.50%); Writers, Podcasters, Journalists or Media Personalities (9.93%), and Organizations such as Non-Profits, Pharmaceutical Manufacturers, Medical groups, and Businesses (6.64%); Researchers, Scholars, Scientists or Healthcare Professionals (6.09%) were among the top five categories of users tweeting COVID-19 disinformation on Twitter. Politicization of public health was an inherent trait within topics and targets associated with disinformation narratives. Debatable information also warrants further attention, resources, and remediation as the most diffused form of information during the initial nine months of the COVID-19 pandemic on Twitter. Considering the shaping and diffusion of disinformation narratives involved a participatory process, so too must the strategies that respond to this issue. Relevant stakeholders must adopt a whole-of-society lens when devising measures to ensure a healthy information ecosystem on Twitter and other similar social media platforms. They must also address politicization of public health, acknowledge, and clearly communicate scientific and situational uncertainty associated with novel or recurring infectious disease crises and emergencies such as the the COVID-19 pandemic.

Background Young adults are vulnerable to cigarette package marketing. Pictorial warning labels are recommended for tobacco control. Research should address questions raised in legal challenges including causal mechanisms. Evidence is mixed and understudied among young adults (e.g., discrete emotions and risk perceptions). Purpose This study investigated mediators of pictorial warning label effects on motivation to quit smoking among young adult smokers. Methods This study analyzed data from a randomized trial with a 4 week exposure to a cigarette pictorial warning among young adult smokers (N = 229) aged 18–30 with assessments at baseline, immediately post-intervention, and 3 months. Mediation analyses used latent change scores to test the effects post-intervention on fear, anger, and risk perceptions. We also examined whether post-intervention measures predicted change in motivation to quit smoking at 3 months. The first model assessed aggregate risk perceptions and the second model assessed discrete risk perceptions (deliberative, affective). Results Pictorial warning label exposure led to increases in fear which led to increased motivation to quit smoking for the first (B = 0.12, 95% CI = 0.04, 0.26) and second (B = 0.12, 95% CI = 0.03, 0.25) model. Exposure modestly increased motivation to quit by way of fear and affective risk perceptions (B = 0.01, 95% CI = 0.00, 0.04). Exposure had a direct relationship on increased motivation to quit as well. Conclusions Findings demonstrate factors contributing to change in motivation to quit smoking among young adult smokers after pictorial warning label exposure. Affective processes are mediators of pictorial warning label effects.

Purpose This study aims to use the anger activism model as an audience segmentation tool in the context of the anti-vaccination movement. Design/methodology/approach A cross-sectional survey was conducted with a national purposive sample (N = 438). Findings The group with high anger, strong efficacy (i.e. “activists”) was found to be more likely to engage in information seeking and was more accurate and defense-motivated when examining information about anti-vaxxers compared to other groups. Importantly, activists were more likely to engage in both low and high commitment behaviors to change vaccine policy. Originality/value As anti-vaxxers have proven to be difficult to change attitudinally, future campaigns are more likely to succeed if they leverage pro-vaccine audiences to fight for change. However, the understanding of the various segments within the pro-vaccination audience is limited. The data are discussed regarding leveraging high anger, strong efficacy audiences as change agents in future persuasive campaigns.

Breastfeeding is a health promoting social behavior but statistics suggest a persistent disparity of lower rates among African American mothers. The Theory of Normative Social Behavior (TNSB) explains when and how norms influence behaviors, but has produced inconsistent results with respect to proposed moderators group identity and injunctive norms (IN), limiting its predictive value in diverse cultural groups. Cultural norms are one of many influences on breastfeeding behaviors, yet little is known about their mechanisms of influence. The TNSB has not been tested in the breastfeeding context or within an exclusively African American cultural group. Given this knowledge gap, a survey of 528 African American mothers in the Washington, D.C. area was conducted to test the moderating effects of IN and subjective norms (SN) and social identity on the descriptive norms (DN) to intentions relationship as predicted by the TNSB. Structural equation modeling was used to show that when controlling for education and breastfeeding history, norms significantly predicted 26.4% of the variance in breastfeeding intentions. SN and DN interacted negatively to enhance breastfeeding intentions. Latent profile analysis using ethnic pride, collectivism, and religiosity scales detected four profiles of African American social identity. Social identity profile membership was a significant moderator on the DN to intentions pathway in the structural equation model. Profiles with the highest ethnic pride were significantly influenced by DN to intend to breastfeed. Implications from this study for public health intervention and communication messaging are discussed.

Research examining the effects of guilt appeals on attitudes and behavioral intentions has been inconsistent. Some scholars have found that guilt appeal intensity has a curvilinear relationship wit...

Objective:Discrepancies exist in reports of social cognition deficits in individuals with premanifest Huntington’s disease (HD); however, the reason for this variability has not been investigated. The aims of this study were to (1) evaluate group- and individual-level social cognitive performance and (2) examine intra-individual variability (dispersion) across social cognitive domains in individuals with premanifest HD.Method:Theory of mind (ToM), social perception, empathy, and social connectedness were evaluated in 35 individuals with premanifest HD and 29 healthy controls. Cut-off values beneath the median and 1.5 × the interquartile range below the 25th percentile (P25 – 1.5 × IQR) of healthy controls for each variable were established for a profiling method. Dispersion between social cognitive domains was also calculated.Results:Compared to healthy controls, individuals with premanifest HD performed worse on all social cognitive domains except empathy. Application of the profiling method revealed a large proportion of people with premanifest HD fell below healthy control median values across ToM (>80%), social perception (>57%), empathy (>54%), and social behaviour (>40%), with a percentage of these individuals displaying more pronounced impairments in empathy (20%) and ToM (22%). Social cognition dispersion did not differ between groups. No significant correlations were found between social cognitive domains and mood, sleep, and neurocognitive outcomes.Conclusions:Significant group-level social cognition deficits were observed in the premanifest HD cohort. However, our profiling method showed that only a small percentage of these individuals experienced marked difficulties in social cognition, indicating the importance of individual-level assessments, particularly regarding future personalised treatments.

This study introduces the concept of value-expressive communication and examines its relationship with behavioral intent. Value-expressive communication is conceptualized as the verbal output of a value-expressive attitude. Value-expressive communication about exercise is examined in relationship to strength of religious faith, exercise attitudes, communication frequency, and intentions to exercise among a sample of self-identified Christians. The data indicate a significant interaction between value-expressive communication and communication frequency explains significant variance in exercise intentions. Interact to and exercise attitudes is significantly associated with intentions to exercise. Suggestions for using value-expressive communication in health communication research and practice are discussed.

The rate of initial acceleration during the first steps of a maximal-effort (sprint) run often determines success or failure in prey capture and predator evasion, and is a vital factor of success in many modern sports. However, accelerative events are commonly performed after having already run considerable distances, and the associated fatigue should impair muscle force production and thus reduce acceleration rate. Despite this, the effects of running-induced fatigue on our ability to accelerate as well as the running technique used to achieve it has been incompletely studied. We recorded 3-D kinematics and ground reaction forces during the first three steps of the acceleration phase from a standing start before and after performing a high-speed, multi-directional, fatiguing run-walk protocol in well-trained running athletes who were habituated to accelerative sprinting. We found that the athletes were able to maintain their rate of initial acceleration despite changing running technique, which was associated with use of a more upright posture, longer ground contact time, increased vertical ground reaction impulse, decreased hip flexion and extension velocities, and a shift in peak joint moments, power, and positive work from the hip to the knee joint; no changes were detected in ankle joint function. Thus, a compensatory increase in knee joint function alleviated the reduction in hip flexor-extensor capacity. These acute adaptations may indicate that the hip extensors (gluteal and hamstring muscle groups) were more susceptible to fatigue than the ankle and knee musculature, and may thus be a primary target for interventions promoting fatigue resistance.

N = 182 posters) derived from 25 obesity-prevention campaigns shows 13.2% included stigmatizing elements. These stigmatizing advertisements were found in almost half (44%) of the 25 obesity-prevent...

Tennis match performance is often evaluated by a player's internal (heart rate) and external (match analytics) outcomes. Numerous factors could influence these outcomes, including the time of day, which may be advantageous or not depending on a player's chronotype. This study aimed to determine the influence time of day, chronotype and sleep–wake behaviour (SWB) had on internal and external outcomes of tennis matches. Twelve state-level male tennis players, with a mean age of 28 ± 7, stature of 183 ± 7 and body mass of 86.6 ± 17.4 wore an actigraph device and completed a sleep diary for the study duration. Based on rankings, players were paired against the same opponent and completed three tennis matches at 8:00 am, 2:00 pm and 8:00 pm, separated by a minimum of 48 h. Fatigue and chronotype, measured by the Fatigue Severity Scale, Morningness Eveningness Questionnaire and midsleep time, were assessed before matches; motivation, measured by the Intrinsic Motivation Inventory, was assessed after matches. During matches, players wore global positioning systems and heart rate monitors; the match analytics and players’ rate of perceived exertion were recorded. Increased unforced errors and decreased winners and forced errors were observed in the evening matches. Decreased total distance and rate of perceived exertion during the second set were found for the evening compared to morning and afternoon matches. Chronotype and sleep–wake behaviour had trivial to weak associations with internal and external outcomes. These results indicate that players and coaches should consider the match times when training for future tournaments.

The ability to shift from walking and jogging to sprinting gaits, even when fatigued after prolonged effort, would have been as useful to our hunter-gatherer ancestors as it is to modern athletes. During prolonged jogging, joint moment and work decrease in the distal (ankle) joint but increase at proximal (hip/knee) joints as fatigue progresses, and such adaptations might be expected to occur in sprinting. Fatigue is also thought to increase inter-limb kinematic and force production asymmetries, which are speculated to influence injury risk. However, the effects of running-related fatigue on sprint running gait have been incompletely studied, so these hypotheses remain untested. We studied 3-D kinematics and ground reaction force production in dominant (DL) and non-dominant (NDL) legs during both non-fatigued and fatigued sprinting in habitual but uncoached running athletes. Contrary to the tested hypotheses, relative between-leg differences were greater in non-fatigued than fatigued sprinting. When not fatigued, DL produced greater propulsive impulse through both greater positive and negative work being done at the ankle, whilst NDL produced more vertical impulse, possibly resulting from the greater hip flexion observed prior to the downwards acceleration of the foot towards the ground. Whilst few changes were detected in DL once fatigued, NDL shifted towards greater horizontal force production, largely resulting from an increase in plantarflexion (distal-joint) moments and power. After fatiguing running, therefore, inter-limb asymmetry was reduced during sprinting and no distal-to-proximal shift in work/power was detected. Speculatively, these adaptations may help to attenuate decreases in running speed whilst minimising injury risk.SignificanceThe ability to attain fast running speeds may critically determine success in tasks such as prey chase- and-capture in hunter-gatherer societies as well as success in modern sports competitions. At times, sprint running may have to be performed whilst fatigued from previous, longer-distance running, when speeds are reduced, and injury risk may be higher. Previous work indicated that fatigue prompts a proximal shift in joint work and power production and an increase in inter-limb asymmetry. On the contrary, we show that relative ankle positive and negative joint work was maintained in the face of fatigue and that inter-limb asymmetry was reduced in a group of runners experienced, but not formally instructed, in both long-distance and sprint running.

Tennis players’ success relies on tennis skills, such as groundstrokes and serves, and physical attributes, such as strength, speed and endurance. This study aimed to determine if players’ tennis skills and physical attributes are influenced by time of day, chronotype or sleep–wake behaviour (SWB). Twelve male tennis players (age (years): 28.17 ± 7.85) competing in state-level competitions wore a wrist-worn activity monitor (GT3X, Actigraph) and completed a modified version of the Consensus Sleep Diary to measure SWB. The Chalder Fatigue Scale and Morningness and Eveningness Questionnaire were used to measure players’ fatigue and preferred chronotype. Mid-sleep with a sleep correction was used to determine players’ current chronotype. After the baseline period, players were tested at 8:00 am, 2:00 pm and 8:00 pm, with the order of testing sessions randomised for each player. Testing sessions were separated by at least 48 hours. Players’ groundstrokes, serve speed, agility, overhead medicine ball throw and Hit and Turn Test performance were measured in each session. General linear modelling revealed that backhand consistency was less in the evening compared to the morning by 17% ( p = 0.020) and afternoon by 15% ( p = 0.040). Maximal service velocity was less in the evening compared to the afternoon by 10.5 km/h ( p = 0.041). Chronotype did not influence tennis skills or physical performance. Average and maximal backhand velocities were reduced for every hour that time at lights out, and sleep-onset time was postponed. Tennis skills, but not physical performance tests, were influenced by time of day and SWB.

Background Poorer sleep health outcomes have been documented in the general population during the COVID-19 outbreak. However, the impact of the COVID-19 outbreak on sleep health outcomes in specific population groups, including the sporting community, has not been extensively investigated. This study evaluated sleep health outcomes and their relationship with lifestyle behaviours during the initial COVID-19 lockdown period in Australian community tennis players. Methods This cross-sectional study evaluated sleep health outcomes and lifestyle behaviours using an online survey. The survey was disseminated online between the 24th of April and the 6th of June 2020 and comprised the Sleep Health Index, Sleep Satisfaction Tool and questions regarding weekly hours of tennis play, general physical activity, training location and alcohol consumption. Two-hundred and eighty-five individuals completed the survey. Results Compared to normative data, respondents displayed positive sleep health values during the initial COVID-19 lockdown period, with median values (IQR) of 85.3 (73.4, 91.7) and 64.8 (54.4, 73.4) for the Sleep Health Index and Sleep Satisfaction Tool, respectively. Sleep health outcomes were not significantly correlated (p > 0.05) with tennis play (Tb = 0.054–0.077), physical activity (Tb = −0.008 to 0.036), training location (Tb = −0.012 to −0.005) or alcohol consumption (Tb = −0.079 to −0.018). Conclusion Positive sleep health values were observed in Australian community-level tennis players during the initial COVID-19 pandemic. Sleep health values were not associated with lifestyle behaviours. Other unexplored factors may have influenced sleep health outcomes, including personal finances and socialisation, however these factors need to be investigated in future studies.

The anger activism model proposes that efficacy moderates the effect of anger on message processing and persuasion. This study tested the model’s predictions using a 2 (efficacy) × 2 (anger) × 2 (a...

Data indicate reversal of immune dysfunction with active treatment; however, the precise contribution of specific immune effector and immune suppressor components to achieve a minimal residual disease (MRD) state and immunomodulatory drug–mediated immunomodulatory effects in multiple myeloma (MM) patients remains poorly understood. In this prospective proof-of-principle study we sought to determine the dynamic alterations in natural killer (NK), NK-T, and T cells, including maturation and activating/inhibitory repertoire associated with MRDpos versus MRDneg status after autologous stem cell transplantation (ASCT) and during lenalidomide-based maintenance therapy. Of the 46MM patients enrolled, 36 had bone marrow MRD assessment 60+ days post-ASCT, 30 had longitudinal blood immunotyping during maintenance (pretherapy and after cycles 1, 3, and 6), and 20 had both MRD assessment and longitudinal immunotyping. Multicolor flow cytometry was used for MRD and immunotyping. Although the absolute number of NK cells was significantly lower in patients with MRDpos response, phenotypically NK cells in these patients displayed higher expression of activating receptors KIRDS4 and decreased expression of inhibitory molecules NKG2A compared with the MRDneg group. Furthermore, we observed significantly lower frequencies of T cells displaying KIR3DL1 in MRDpos versus MRDneg patients. Longitudinal immunotyping during lenalidomide maintenance showed loss of mature NK effector function, augmentation of NK-T effector function, and acquisition of PD1 independent anergic state. Our findings also suggest skewing of T cells toward an exhausted state during the maintenance phase in MRDpos patients. Put together, these observations provide a distinctive signature for MRDneg and MRDpos groups. These data support exploration of immune profiling in prospective clinical trials according to MRD-defined responses to identify patients that may benefit from maintenance intensification/modification or maintenance withdrawal.

Improving groundstroke velocity and accuracy is critical for tennis success. However, there is limited research available on the physical and cognitive attributes required for groundstroke performance. Therefore, the purpose of this study was to investigate the physical and cognitive characteristics and their association with groundstroke performance in junior tennis players. Thirty-four competitive junior tennis players, aged 12.59 ± 2.44 years, participated in this cross-sectional study. Cognitive tests assessing processing speed, complex attention, cognitive flexibility and problem-solving capacity and physical tests assessing flexibility, speed, agility, power, strength and anaerobic and aerobic capacity were performed. Tennis groundstroke performance was evaluated using a novel tennis groundstroke assessment. Tennis groundstroke performance was associated ( p

The purpose of this study was to describe social norms and salient social identities related to breastfeeding intentions among African American mothers in Washington, D.C. Five focus groups were held with 30 mothers who gave birth to a child between 2016 and 2019. Two coders conducted pragmatic thematic analysis. This study demonstrated that women hold different identities relevant to making infant feeding decisions, with mother being primary and race/ethnicity, age, and relationship status factoring into how they define themselves. Mothers drew their perceptions of what is common and accepted from family, friends, the “Black community,” and what they perceived visually in their geographic area and heard from their health care providers. Mothers believed breastfeeding to be increasing in popularity and acceptability in African American communities in Washington, D.C., but not yet the most common or accepted mode of feeding, with some variability by socioeconomic status group. Implications for public health communication and social marketing are discussed.

BACKGROUND Providers of on-demand care, such as those in urgent care centers, may prescribe antibiotics unnecessarily because they fear receiving negative reviews on web-based platforms from unsatisfied patients—the so-called Yelp effect. This effect is hypothesized to be a significant driver of inappropriate antibiotic prescribing, which exacerbates antibiotic resistance. OBJECTIVE In this study, we aimed to determine the frequency with which patients left negative reviews on web-based platforms after they expected to receive antibiotics in an urgent care setting but did not. METHODS We obtained a list of 8662 urgent care facilities from the Yelp application programming interface. By using this list, we automatically collected 481,825 web-based reviews from Google Maps between January 21 and February 10, 2019. We used machine learning algorithms to summarize the contents of these reviews. Additionally, 200 randomly sampled reviews were analyzed by 4 annotators to verify the types of messages present and whether they were consistent with the Yelp effect. RESULTS We collected 481,825 reviews, of which 1696 (95% CI 1240-2152) exhibited the Yelp effect. Negative reviews primarily identified operations issues regarding wait times, rude staff, billing, and communication. CONCLUSIONS Urgent care patients rarely express expectations for antibiotics in negative web-based reviews. Thus, our findings do not support an association between a lack of antibiotic prescriptions and negative web-based reviews. Rather, patients’ dissatisfaction with urgent care was most strongly linked to operations issues that were not related to the clinical management plan.

BACKGROUND The overuse of antibiotics has rapidly made antimicrobial resistance a global public health challenge. There is an emerging trend where providers who perceive that their patients expect antibiotics are more likely to prescribe antibiotics unprompted or upon request. Particularly, health care providers have expressed concern that dissatisfied patients will provide disparaging online reviews, therefore threatening the reputation of the practice. To better deal with the negative reviews and inform patients, some health care staff directly respond to patients’ online feedback. Engaging with patients’ online reviews gives providers an opportunity to prevent reputational damage and improve patients’ understanding of the antibiotic resistance problem. OBJECTIVE We aim to test the effectiveness of different response strategies to the negative patient online reviews on the readers’ perceptions of the health care provider and their perceptions related to antibiotics resistance. METHODS Two experiments were conducted to examine the impact of message tactics (apologizing, inducing fear or guilt) that can be employed by health care providers when responding to patients’ negative online feedback related to not receiving an antibiotic. RESULTS Overall, our results demonstrated positive impacts of responding to patients’ online reviews. In study 1, we found apologetic messaging and use of emotional appeals in the response were effective in making readers feel more favorable toward the message. Readers also expressed a greater credibility perception toward the provider and willingness to visit the clinic when emotional appeals were used. Findings from study 2 largely supported the effectiveness of a fear-based response in improving the readers’ credibility perceptions and willingness to visit the clinic. The fear-inducing information was particularly effective among parent readers. CONCLUSIONS This paper demonstrated that a strategic response to online patient complaints could prevent reputational damage and minimize the potential negative impacts of the review. The results also glean insight into the step toward developing a novel intervention—crafting a persuasive response to patients’ negative feedback that can help improve the understanding of antibiotic resistance problems.

Background The overuse of antibiotics has rapidly made antimicrobial resistance a global public health challenge. There is an emerging trend where providers who perceive that their patients expect antibiotics are more likely to prescribe antibiotics unprompted or upon request. Particularly, health care providers have expressed concern that dissatisfied patients will provide disparaging online reviews, therefore threatening the reputation of the practice. To better deal with the negative reviews and inform patients, some health care staff directly respond to patients’ online feedback. Engaging with patients’ online reviews gives providers an opportunity to prevent reputational damage and improve patients’ understanding of the antibiotic resistance problem. Objective We aim to test the effectiveness of different response strategies to the negative patient online reviews on the readers’ perceptions of the health care provider and their perceptions related to antibiotics resistance. Methods Two experiments were conducted to examine the impact of message tactics (apologizing, inducing fear or guilt) that can be employed by health care providers when responding to patients’ negative online feedback related to not receiving an antibiotic. Results Overall, our results demonstrated positive impacts of responding to patients’ online reviews. In study 1, we found apologetic messaging and use of emotional appeals in the response were effective in making readers feel more favorable toward the message. Readers also expressed a greater credibility perception toward the provider and willingness to visit the clinic when emotional appeals were used. Findings from study 2 largely supported the effectiveness of a fear-based response in improving the readers’ credibility perceptions and willingness to visit the clinic. The fear-inducing information was particularly effective among parent readers. Conclusions This paper demonstrated that a strategic response to online patient complaints could prevent reputational damage and minimize the potential negative impacts of the review. The results also glean insight into the step toward developing a novel intervention—crafting a persuasive response to patients’ negative feedback that can help improve the understanding of antibiotic resistance problems.

The role of mass media during a public health crisis is an ineluctable part of providing the public with critical information rapidly, particularly messages about self- and response efficacy. However, little is known about the role local news media play in disseminating efficacy information during infectious disease outbreaks. Here, we use the 2014 Ebola outbreak in Liberia as a case to explore this question. We content analyzed newspaper and radio messages disseminated between March 2014 and March 2015, during the midst of the outbreak. Results show that both radio programs and newspaper articles mentioned over 21 prevention steps at some point, with noticeable differences within which disease prevention messages were communicated most frequently to the public. At least 1 mention of self-efficacy was identified in 31.5% of radio content (n = 127), 23.6% of radio programming (n = 55), and 10.6% of newspaper content (n = 745). Response efficacy, signifying effectiveness of preventive methods, was detected in 25.2% of radio (n = 127), 16.4% of radio programming (n = 55), and 15% of newspaper content (n = 745). This is important as efficacy reporting can impact public readiness to adopt preventative measures and affect beliefs about self- and response efficacy, ultimately decreasing chances of spreading the infection and poorer health outcomes.

Purpose: There is a paucity of data on barriers to mental health treatment utilization among residents of Wards 7 and 8 in Washington, DC, despite exposure to many environmental factors that are associated with poor mental health outcomes and the high prevalence of mental health problems among residents. The objective of this study was to examine barriers to mental healthcare utilization among residents of Wards 7 and 8. Methods: This study included semi-structured, in-depth interviews with five key informants who lived or spent significant time in Wards 7 or 8 in Washington, DC, which are the wards served by Paving the Way MSI, a behavioral health clinic that served as a partner organization in the study. Results: Barriers to mental health treatment utilization existed at a variety of social-ecological levels, including the individual/interpersonal level, the provider/mental health system level, the community level, and the societal level. Major barriers included fear and trust/distrust in the medical system, lack of social support, the model of mental healthcare, lack of patient-centered care, limited access to mental health services, stigma of mental illness and mental health treatment, and poverty. Conclusion: This study highlights the need to address barriers to mental health treatment utilization at multiple social-ecological levels. Future studies should examine perspectives from residents with mental health problems in these wards to gain a more thorough understanding of the barriers to treatment. Funding is needed to support efforts to increase mental health treatment utilization among residents of Wards 7 and 8.

Objective The objective of this study was to assess health care professionals' knowledge of evidence-based guidelines for the nonsurgical treatment of obesity. Methods A nationally representative sample of internists, family practitioners, obstetricians/gynecologists, and nurse practitioners completed a web-based survey between June 9 and July 1, 2016 (n = 1,506). Results Only 16% of respondents indicated that obesity counseling should be provided approximately twice monthly in an individual or group setting for at least 6 months, in accordance with United States Preventive Services Task Force and Centers for Medicare and Medicaid Services guidelines. Only 15% of respondents identified BMI ≥ 27 kg/m2 with an obesity-associated comorbid condition as the appropriate indication to prescribe pharmacotherapy for patients. Two-thirds of respondents indicated that it is appropriate to continue long-term pharmacotherapy under conditions inconsistent with evidence-based guidelines, with nearly one-quarter indicating that obesity medications should never be prescribed beyond 3 months regardless of weight loss. Conclusions These findings suggest that provider understanding of appropriate clinical care for obesity is inconsistent with evidence-based recommendations. As coverage for behavioral counseling services and pharmacotherapy expands, it is imperative that health care professionals understand how to effectively leverage these treatment modalities to optimize health outcomes for patients with obesity.

Although tsunamis have the potential to be extremely destructive, relatively little research on tsunami messaging has taken place. Discovering whether tsunami warning messages can be written in a way that leads to increased protective response is crucial, particularly given the increased use of mobile message services and the role they play in notifying the public of imminent threats such as tsunami and other hazards. The purpose of this study was to examine the possibility of designing warning messages for tsunamis that improve upon message style and content used by public alerting agencies to date and to gain insight that can be applied to other hazards. This study tested the impact of tsunami messages that varied in length and content on six message outcomes—understanding, believing, personalizing, deciding, milling, and fear. Relative to the short message, revised messages resulted in significantly more understanding and deciding, known precursors to taking protective action under threat. The revised message also resulted in significantly more fear, which is believed to influence behavioral intentions. Findings suggest that shorter messages may not deliver enough content to inform message receivers about the threat they face and the protective actions they should perform. Longer messages delivered with more specific information about the location of impact, threat-associated risks, and recommended protective actions were associated with better message outcomes, including quicker intended response. Recommendations for future tsunami warnings are provided.

Background Providers of on-demand care, such as those in urgent care centers, may prescribe antibiotics unnecessarily because they fear receiving negative reviews on web-based platforms from unsatisfied patients—the so-called Yelp effect. This effect is hypothesized to be a significant driver of inappropriate antibiotic prescribing, which exacerbates antibiotic resistance. Objective In this study, we aimed to determine the frequency with which patients left negative reviews on web-based platforms after they expected to receive antibiotics in an urgent care setting but did not. Methods We obtained a list of 8662 urgent care facilities from the Yelp application programming interface. By using this list, we automatically collected 481,825 web-based reviews from Google Maps between January 21 and February 10, 2019. We used machine learning algorithms to summarize the contents of these reviews. Additionally, 200 randomly sampled reviews were analyzed by 4 annotators to verify the types of messages present and whether they were consistent with the Yelp effect. Results We collected 481,825 reviews, of which 1696 (95% CI 1240-2152) exhibited the Yelp effect. Negative reviews primarily identified operations issues regarding wait times, rude staff, billing, and communication. Conclusions Urgent care patients rarely express expectations for antibiotics in negative web-based reviews. Thus, our findings do not support an association between a lack of antibiotic prescriptions and negative web-based reviews. Rather, patients’ dissatisfaction with urgent care was most strongly linked to operations issues that were not related to the clinical management plan.

Descriptions of the implementation of community-based participatory mixed-methods research (CBPMMR) in all phases of the engagement approach are limited. This manuscript describes the explicit integration of mixed-methods in four stages of CBPR: (1) connecting and diagnosing, (2) prescribing-implementing, (3) evaluating, and (4) disseminating and refining an intervention that aimed to motivate Latino parents (predominantly Central American in the US) of infants and toddlers to replace sugary drinks with filtered tap water. CBPMMR allowed for co-learning that led to the identification of preliminary behavioral outcomes, insights into potential mechanisms of behavior change, and revisions to the intervention design, implementation and evaluation.

Studies examining the persuasive effects of guilt appeals have yielded mixed results. The current study hypothesizes that source motive (profit versus not for profit) is a key moderating variable u...

Summary Introduction Relatively few patients receive obesity counselling consistent with the USPSTF guidelines, and many health care professionals (HCPs) are biased in their attitudes towards obesity management. Methods A national sample of family physicians, internists, OB/GYN physicians, and nurse practitioners (NPs) completed a web-based survey of beliefs, practice, and knowledge regarding obesity management. Results A majority of HCPs believe that it is both the patient’s and the provider’s responsibility to ensure that the patient is counselled about obesity. Obesity (77%), obesity-related diseases (79%), or obesity-related risk factors (71%) prompt HCPs to offer obesity counselling; 59% of HCPs wait for the patient to broach the subject of their weight. Increased blood pressure (89%) and heart disease risks (90%) are the most common themes in counselling. Across all HCPs except NPs “exercise” is discussed more frequently than “physical activity” (85% vs 81%), “diet” more frequently than “eating habits” (77% vs 75%), and “obesity” more frequently than “unhealthy weight” (60% vs 45%). NPs are more likely to discuss physical activity, eating habits, and unhealthy weight instead. To improve counselling for obesity, HCPs reported needing more time (70%), training in obesity management (53%), improved reimbursement (53%), and better tools to help patients recognise obesity risks (50%). Obesity-related diseases, risk factors, or obesity alone predict obesity counselling amongst HCPs. Conclusion Better training in weight management and tools to help patients recognise risks appear to be key elements in helping patients compare the risks of what they may consider invasive therapy against the risks of continued obesity.

Obesity is prevalent among a third of US adults and a leading indicator for many chronic diseases. Self-efficacy is important for non-surgical weight loss interventions, but there is less information about the role of self-efficacy in the candidacy phase when there are discussions of side effects and decisions for uptake. This study conducted an experiment set within an online survey assessing risk aversion towards bariatric surgery as a weight loss intervention. The survey asked about hypothetical weight loss scenarios for bariatric surgery among a national probability-based sample of US adults aged 18 years and older. Participants answered their willingness to achieve different weight loss amounts within the context of bariatric surgery in varying risk scenarios. The analysis utilized a repeated-measures linear mixed model. A three-way interaction demonstrated that participants were more willing to take risks under ideal weight loss conditions even with the risk of death, particularly when considering self-efficacy (𝛽 = 1.20, P = .05). Margin projections showed that those with lower self-efficacy were more likely to take risks overall. This trend was significant for those with a body mass index of 30 and above in scenarios presenting one's ideal weight as the outcome of bariatric surgery. Adding a measure of self-efficacy within patient assessments could identify those eligible patients who are most likely to adopt bariatric surgery, particularly among those who may have negative post-surgical outcomes due to low self-efficacy levels. Addressing self-efficacy by way of providing support resources in tandem with candidacy consultations may enhance quality of life and post-surgical outcomes.

Summary Introduction Rates of obesity pharmacotherapy use, bariatric surgery and intensive behavioural counselling have been extremely low. Objectives The primary objective of this study was to survey healthcare provider beliefs, practice and knowledge regarding obesity management. Methods Primary care physicians (PCPs), OB-GYN physicians and nurse practitioners (NPs) responded to a web-based survey related to drug therapy practice, bariatric surgery referral and reimbursement coding practice. Results Rates of reported use of obesity pharmacotherapy appear to be increasing among PCPs, which is likely related to the approval of four new obesity pharmacotherapy agents since 2012. Rates of pharmacotherapy use among OB-GYNs and NPs appear much lower. Similarly, few PCPs are averse to recommending bariatric surgery, but aversion among OB-GYNs and NPs is significantly higher. Conclusion Together, these observations suggest that OB-GYN and NP populations are important targets for education about obesity management. Very few PCPs, OB-GYNs or NPs use behavioural counselling coding for obesity. Better understanding of why this benefit is not being fully used could inform outreach to improve counselling rates.

Encouraging bystanders to intervene safely and effectively in situations that could escalate to violence—known as bystander behavior programs—is a growing yet largely untested strategy to prevent dating violence. Using a quasi-experimental design, we evaluate a low-resource, low-intensity intervention aimed at preventing dating violence among college students. The integrated behavioral model (IBM) was used to guide the evaluation. We also assess which IBM variables were most strongly associated with bystander behaviors. Participants were drawn from two Virginia colleges that predominantly train females in the health profession sciences. The intervention group ( n = 329) participated in a university-wide bystander behavior intervention consisting of a 30-min presentation on dating violence at new-student orientation and a week-long “red flag” social marketing campaign on campus to raise awareness of dating violence. Controlling for changes at the comparison university, results showed an increase in bystander behaviors, such as encouraging a friend who may be in an abusive relationship to get help, after the intervention and adjusting for potential confounders (increase of 1.41 bystander behaviors, p = .04). However, no significant changes were found for bystander intentions, self-efficacy, social norms, or attitudes related to dating violence from pre- to post-intervention. Self-efficacy had a direct relationship with bystander behaviors. Results suggest that low-resource interventions have a modest effect on increasing bystander behaviors. However, higher resource interventions likely are needed for a larger impact, especially among students who already demonstrate strong baseline intentions to intervene and prevent dating violence.

Purpose Social media use is pervasive among young adults, and different sites have different purposes, features, and audiences. This study identified classes of young adults based on what combination of sites they use and how frequently, and compared their health risk factors and behaviors. Methods Latent profile models were developed based on frequency of using 10 sites from a national sample of young adults aged 18–24 years (n = 1,062). Bivariate analyses and multivariable regressions examined the relationship between class membership and alcohol, tobacco, and other drug (ATOD) use, and symptoms of depression and anxiety. Results The optimal model identified five classes: Low Users (7.9%), High Users (63.1%), Professional Users – high use of LinkedIn (10.1%), Creative Users – high use of Vine and Tumblr (11.5%), and Mainstream Users – high use of Facebook and YouTube (7.4%). Classes differed significantly on ATOD use and depressive symptoms. Compared to High Users, Creative Users had higher odds of using most substances and lower odds of depressive symptoms, Mainstream Users had higher odds of substances used socially (alcohol and hookah), Professional Users had higher odds of using alcohol, cigarettes, and cigars, and Low Users had higher odds of using other drugs (e.g., cocaine and heroin). Conclusions A young adult's social media site use profile is associated with ATOD use and depressive symptoms. Use and co-use of certain sites may influence the volume and nature of ATOD-related content and norms young adults experience in social media. Targeting interventions to sites selected based on use patterns associated with each health risk may be effective.

Shame and guilt are distinct emotional experiences that are often confused by lay people as similar. Yet, shame and guilt are aroused by distinct cognitive appraisals and lead to distinct emotional, cognitive, and behavioral outcomes. There are distinctions between shame and guilt in psychology and communication. Differences are correlated with personality and individual proneness for shame and/or guilt.

Church interventions can reduce obesity disparities by empowering participants with knowledge and skills within an established community. The purpose of this study was to evaluate the Biomedical/Obesity Reduction Trial (BMORe) and investigate changes in health beliefs among obese adult participants. Ten pre-/post-intervention focus groups applying the Health Belief Model conducted in two African-American churches in Tennessee (n = 20) and South Carolina (n = 20), and one rural Appalachian church in Kentucky (n = 21). Two independent coders using NVivo analyzed transcribed audio data and notes. Participants' health status of being overweight/obese and having comorbidities of diabetes and high blood pressure motivated enrollment in BMORe. Initially participants voiced low self-efficacy in cooking healthy and reading food labels. BMORe made participants feel "empowered" after 12 weeks compared to initially feeling "out of control" with their weight. Participants reported improvements in emotional health, quality of life, and fewer medications. During post-intervention focus groups, participants reported increased self-efficacy through family support, sharing healthy eating strategies, and having accountability partners. Solidarity and common understanding among BMORe participants led focus group attendees to comment how their peers motivated them to stay in the program for 12 weeks. Long-term barriers include keeping the weight off by maintaining habits of exercise and healthy eating. Implementation of pre-/post-intervention focus groups is an innovative approach to evaluate an obesity intervention and track how changes in health beliefs facilitated behavior change. This novel approach shows promise for behavioral interventions that rely on participant engagement for sustained effectiveness.

Abstract. This study examines the process of reactance induced by guilt appeals. Participants (N = 240 US high school students) received messages that advocated taking school seriously. The results of a 3 (guilt appeal level: low, moderate, high) × 2 (message referent: other, self) experiment indicated that guilt directly influenced the affective component of reactance – anger – but its effect on the cognitive component of reactance – relevant negative thoughts – was mediated via the awareness that messages used guilt to induce persuasion. Subsequently, reactance was negatively related to the advocated position. These findings suggest that employing guilt appeals in mass media campaigns for adolescents may be counterproductive: The guiltier the participants felt, the less positive were their attitudes toward taking school seriously. The study expands the scope of reactance theory by associating reactance with guilt appeals and examining the process by which reactance is induced. These and other results are discussed along with implications, limitations, and future research directions.

In social marketing, the use of guilt appeals can be effective for influencing healthy behaviors. Guilt, being a moral, other-based emotion, can spur people to think of others, act honestly, and be empathetic. Likewise, collective guilt, the feeling that arises when people believe their in-group caused illegitimate harm to others, can lead people to feel positively toward the victimized others and desire policies that will help them. We can see then, that guilt, though often considered “negative” can lead to an array of prosocial, constructive, behaviors. In that vein, a number of researchers have assessed the possibility that guilt based persuasive appeals can induce such positive behaviors. Clearly, guilt-appeals can be an effective tool for reducing risk (STI testing), increasing prevention practices (encouraging mammograms), and effecting altruistic health-related behaviors (donating blood). In the correct conditions, guilt appeals can induce guilty feelings, lead people to want to “right the wrong,” generate positive attitudes about the message’s advocacy, and intend to engage in a behavior.

This study (N =143) examined the effects of freedom threat on cognitive structures, using recycling as its topic. The results of a 2(Freedom Threat: low vs. high) ×2(Postscript: restoration vs. filler) plus 1(Control) experiment indicated that, relative to the control condition, high freedom threat created a boomerang effect for the targeted attitude (recycling) as the attitude and behavioral intention changed in the opposite direction to the one advocated in the message. For the associated but untargeted attitude (energy conservation), reactance effects were less pronounced. Furthermore, a restoration postscript was examined as a reactance mitigation strategy. The restoration postscript was effective for high- but not low-threat messages.

This study applied the extended parallel process model (EPPM) to evaluate the crisis messages employed by the mainstream media and the government during the 2006 diethylene glycol (DEG) poisoning crisis in Panama. Messages were content analyzed for its use of tenets of the EPPM. Overall, the findings reveal that the news coverage clearly emphasized the threat of DEG poisoning over the efficacy of avoiding being poisoned. In addition, quantitative analyses showed that the information provided by Ministry of Health of Panama (MINSA) and the local news outlets were widely divergent. These data indicate that the majority (82 per cent) of MINSA press releases included a balance of both threat and efficacy elements, compared with only 29 per cent of Panama newspapers. Panama newspapers tended to emphasize threat alone.

Research in a variety of contexts has shown that the mood or emotional state of receivers may affect responses to communication messages. This study tested the interaction between mood and message on persuasiveness in the context of political television advertising. Using a 2 (happy or sad mood) by 2 (hedonic consequences: negative or positive) experimental design, a two-way interaction between hedonic consequence and mood was predicted, such that happy people would be more persuaded by positive ads than negative ads. In addition, sad people, it was expected, would be equally persuaded by either ad. Cognitive processing measures, attitudes, and candidate evaluations were used for measuring effects. Data indicated that happy people were more persuaded by positive political advertisements than negative political advertisements. Sad people, however, were equally persuaded by both negative and positive appeals.