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Background Residents report high levels of distress but low utilization of mental health services. Prior research has shown several barriers that prevent residents from opting into available mental health services. Objective To determine the impact of a mental health initiative centered around an opt-out versus an opt-in approach to help-seeking, on the use of psychotherapy. Methods Resident use of psychotherapy was compared between 2 time frames. During the first time frame (July 1, 2020 to January 31, 2021), residents were offered access to therapy that they could self-initiate by calling to schedule an appointment (opt-in). The second time frame (February 1, 2021 to April 30, 2021) involved the switch to an opt-out structure, during which the same residents were scheduled for a session but could choose to cancel. Additional changes were implemented to reduce stigma and minimize barriers. The outcome was psychotherapy use by residents. Results Of the 114 residents, 7 (6%) self-initiated therapy during the opt-in period. When these same residents were placed in an opt-out context, 59 of the remaining 107 residents (55%) kept their initial appointment, and 23 (39%) self-initiated additional sessions. Altogether, across both phases, a total of 30 of the 114 residents initiated therapy (ie, 7 during the opt-in and 23 during the opt-out). The differences in therapy use between the 2 phases are statistically significant ( P <.001 by McNemar's test). Conclusions There was a substantial increase in residents' use of psychotherapy after the opt-out initiative that included efforts to reduce stigma and encourage mental health services.

Background: Medical residents experiencing depression can cause life-threatening harm to themselves and their patients. Treatment is available, but many do not seek help., Methods: The current set of three studies investigated whether depressive symptomatology in and of itself served as a help-seeking barrier-and whether expectations of help-seeking benefits provided insight into why this occurred. Nine waves of cross-sectional data were collected from medical residents across several different hospitals in the United States., Results: There was a large negative association between levels of depressive symptomatology and help-seeking intentions (H1) in Studies 1 and 3. In Study 2, this association was significant for one of the two help-seeking measures. For all analyses, studies, and measures, there was a large negative association between residents' levels of depressive symptomatology and agreement that seeking help will lead to positive outcomes (H2). Likewise, there was a moderately large indirect effect for all analyses, studies, and measures such that the association between levels of depressive symptomatology and help-seeking intentions occurred through less favorable expectations of help-seeking benefits (H3). Lower agreement of the benefits associated with help-seeking explained between 43 and 65% of depressive symptomatology's negative association with help-seeking intentions across studies., Conclusions: The current findings indicate that depressive symptomatology itself represents a help-seeking barrier and underscore the importance of help-seeking expectations in explaining why this occurs. If future studies reveal a causal relationship between the perceived benefits of help-seeking and help-seeking intentions, then increasing such expectations could offer a potential path for increasing resident help-seeking., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The COVID-19 pandemic transformed the final year of undergraduate medical education for thousands of medical students across the globe. Out of concern for spreading SARS-CoV-2 and conserving personal protective equipment, many students experienced declines in bedside clinical exposures. The perceived competency of this class within the context of the pandemic is unclear. We designed and distributed a survey to measure the degree to which recent medical school graduates from the USA felt clinically prepared on 13 core clinical skills. Of the 1283 graduates who matched at HCA Healthcare facilities, 90% (1156) completed the survey. In this national survey, most participants felt they were competent in their clinical skills. However, approximately one out of four soon-to-be residents felt they were clinically below where they should be with regard to calling consultations, performing procedures, and performing pelvic and rectal exams. One in five felt they were below where they should be with regard to safely transitioning care. These perceived deficits in important skill sets suggest the need for evaluation and revised educational approaches in these areas, especially when traditional in-person practical skills teaching and practice are disrupted.

Background: Past research indicates that self-distancing through perspective-taking may increase help-seeking intentions among some people with depression., Aims: The current pre-registered study tested the effect of self-distancing through mental time-travel on help-seeking attitudes, intentions, outcome expectations, and self-stigma., Methods: Participants with elevated depressive symptomatology who had not yet sought help for current feelings of depression ( n  = 859) were randomly assigned to a self-distancing writing task, a self-immersive writing task, or a control condition., Results: Help-seeking attitudes were significantly higher in the distancing condition than in the immersive or control conditions. Additionally, self-distancing through mental time-travel resulted in higher help-seeking intentions compared to the control condition but was not significantly different from the immersive condition. The immersive condition was not significantly different from the control for any outcomes. Interactions show that both self-distancing and the immersive task weakened the negative relationship between depression severity and help-seeking attitudes and intentions., Conclusion: Extending scholarship investigating self-distancing and help-seeking intentions, results show that self-distancing through mental time-travel can result in more favorable help-seeking attitudes compared to a control.

Rationale: As over 90% of people who register to be organ donors do so at the Department of Motor Vehicles (DMV), DMVs are perceived as a key context for increasing donor registration rates. Scholars have recently noted that the driver's license application itself, including the placement of the donor registration item relative to other questions, can possibly influence donor registration behavior. The goal of the current study was to experimentally investigate this possibility., Method: We conducted an experiment using Amazon's Mechanical Turk (MTurk) between March and May of 2021 to investigate the influence of question order on donor registration willingness. Participants received a question regarding their willingness to register either before or after a series of health and legal questions often asked at DMVs., Results: The placement of the donor registration question had a positive effect on registration willingness for non-registered individuals (OR = 2.01, 95% CI [1.59, 2.54]) and previously registered donors (OR = 2.57, 95% CI [2.22, 2.99])., Conclusion: Changing the question order of driver's license applications has the potential to influence registration rates., (Published by Elsevier Ltd.)

Guided by vested interest theory, we assessed whether a lack of stake explains the discrepancy between people having positive attitudes toward their loved one's recovery from depression and the provision of support. We further investigated whether increasing the perceived personal consequences of providing support (i.e. stake) increased willingness to provide support. A stake-boosting message had no direct, but significant indirect effects on willingness to provide support when compared to a control and comparison condition. In summary, increasing stake in a loved one's recovery indirectly increases intentions to provide support.

Psychological reactance (PR) is a psychological state or trait typified by resistant responses to threats to behavioral freedom. PR has been linked with negative health behaviors, including risky substance use; however, factors that may foster approaches to mitigate the impact of PR on these behaviors, as well as rejection of other health promotion communications is less understood. The current studies examined relations between parental warmth and monitoring with trait PR and responses to preventive cannabis communications and usage intentions. Two in-school surveys were administered to two difference samples of middle school students (Study 1, N = 1,416; Study 2, N = 1,118). Path analytic models tested multivariable linkages among relevant parenting variables, PR, and outcomes associated with cannabis use. Follow-up regression analyses explored significant interaction effects. In Study 1 (p <0.001) and Study 2 (p <0.01), parental warmth moderated the relation between monitoring and trait PR: High monitoring was a protective factor only when combined with high warmth. In turn, PR mediated the relationships between parenting practices and cannabis intentions in both studies (p <0.001). In Study 2, PR also was linked with resistance to persuasion via more unfavorable reactions to anti-cannabis appeals (p <0.001). Findings indicated that low parental warmth combined with high parental monitoring was associated with high trait reactance in adolescents, which predisposed them to stronger resistance to preventive communications. Interventions might focus on counseling parents about the likely outcomes of parenting style, and ways to implement beneficial approaches., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The current research investigated two rarely used appeals for increasing organ donor registration-both with the potential to backfire. The three-in-1000 appeal explains that less than one percent of people will die in such a way that their organs can be donated. This appeal could heighten awareness that donor registration is needed, but it can also convey that registering is futile. The dynamic norms appeal emphasizes the increasing number of people who are becoming registered donors. This appeal could increase the perceived normative nature of registration, but doing so can also lead potential donors to conclude that enough people are already registered. In Studies 1 and 2, participants recruited from Amazon's Mechanical Turk were randomly assigned to either one of these appeals, and their attitudes toward donor registration and intentions to register as a donor were compared to participants in a no-message control group. Study 2 included a qualitative component where participants were asked to describe their perceptions as to why the message was or was not influential. In both experiments, intentions to register were higher for those in both messaging conditions compared to the control group. Positive attitudes toward organ donation were higher in the three-in-1000 condition compared to the control group for both studies. Those in the dynamic norms condition reported more positive attitudes than the control group in Study 1, but not Study 2. In both studies, there was scant evidence of the messages backfiring. In the qualitative component of Study 2, self-reported reasons for the influence of each method provided insight into how and why these appeals were influential, and indicated signs of underdetection for the dynamic norms message., (Copyright © 2022. Published by Elsevier Ltd.)

Introduction: Our aim was to determine the psychological and educational impact of the 2017 Las Vegas mass shooting on the graduate medical education (GME) mission within two cohorts of resident physicians and attending faculty at two nearby academic trauma centers., Methods: A cross-sectional survey assessed 55 resident physicians and attending faculty involved in the acute care of the patients from the mass shooting. We measured the psychological impact of the event, post-traumatic growth, team cohesion, social support, and known risk factors for post-traumatic stress disorder (PTSD). Additionally, we assessed the impact of the event on GME-specific tasks., Results: Attending faculty and physicians in training in GME residencies evaluated over 300 penetrating trauma patients in less than 24 hours, and approximately 1 in 3 physicians had a patient die under their care. Despite this potential for psychological trauma, the majority of clinicians reported minimal distress and minimal impact on GME activities. However, 1 in 10 physicians screened positive for possible PTSD. Paradoxically, the minority of physicians who sought psychological counseling after the event (20%) were not those who reported the highest levels of distress. Residents generally assessed the event as having an overall negative impact on their educational goals, while attendings reported a positive impact. Psychological impact correlated inversely with social support and the amount of prior education relating to mass casualty incidents (MCI) but correlated directly with the degree of stress prior to the event., Conclusion: Despite the substantial level of exposure, most resident physicians did not report significant psychological trauma or an impact on their GME mission. Some reported post-traumatic growth. However, a minority reported a significant negative impact; institutions should consider broad screening efforts to detect and assist these individuals after a MCI. Social support, stress reduction, and education on MCIs may buffer the effects of future psychologically traumatic events on physicians in training.

Rationale: Prior studies that used positive emotion infusions (PEIs) to increase help-seeking for depression found initial support for the approach (Siegel & Thomson, 2016; Straszewski & Siegel, 2018, 2020). However, as people with depression experience negative biases that may be maximized when self-relevance is high (Clark et al., 1999), a potential way to maximize the effect of the PEI approach may be to reduce self-focus., Objective: We used two preregistered studies (US; 2/19/19 to 9/25/19) to identify the strongest version of a savoring writing task for the current context (Study 1) and test it in the form of a savoring-public service announcement (Study 2; S-PSA)., Methods: Study 1 (N = 1308) compared five savoring writing tasks that varied in self-focus to a control writing task: vicarious, self-distanced, relational, combination, and personal savoring. Study 2 (N = 1238) compared a relational S-PSA to a comparison PSA and a basic control video on help-seeking attitudes, intentions, and behavior., Results: In Study 1, relational savoring was associated with greater help-seeking intentions than the combination savoring condition among all participants and greater help-seeking intentions than the control among participants who self-reported paying full attention during the study. In Study 2, the S-PSA did not perform better than the comparison PSA or basic control video on the outcome measures., Conclusions: The present research highlights three important takeaways. 1) Researchers should continue to explore relational savoring as an approach to increase help-seeking for depression. 2) Similar to findings of prior depression help-seeking studies, crowdsourcing platforms may be useful for testing informational videos but less appropriate for testing videos that require deep levels of thinking for people experiencing heightened depressive symptomatology. 3) From a theoretical and methodological standpoint, these studies underscore the value of conceptual replications using multiple methods., (Published by Elsevier Ltd.)

Objective: To reduce uncertainty about the effectiveness of Departments of Motor Vehicles (DMV) interventions, we assessed the influence of several DMV-based media campaigns on organ donor registration., Method: Across 4 studies, campaigns were implemented in 8 (Studies 1-3) or 9 (Study 4) New Mexico DMVs. Three theories guided message development (i.e., efficacy, altruism, vested interest). Donor registration was the outcome measure., Results: In Study 1, both the efficacy (OR = 1.14) and altruism (OR = 1.11) campaigns resulted in significantly more registrations than the control condition and the vested interest campaign. In Study 2, the efficacy campaign (OR = 1.13) again resulted in significantly more registrations than the control and vested interest campaign. In Study 3, a new version of the efficacy campaign (OR = 1.21) and 2 new versions of the vested interest campaigns (OR = 1.12; 1.14) all resulted in significantly more registrations than the control condition. In Study 4, neither the efficacy campaign (OR = 1.06) nor a campaign that combined efficacy and vested interest materials (OR = 1.03) significantly increased registrations. A single-paper meta-analysis assessing these studies indicated all 3 appeals resulted in significantly greater registrations than the control (OR ranged from 1.06 to 1.13)., Conclusion: Results indicate donor registration rates can be increased through DMV-based media campaigns; however, the appeal used, and the implementation of that appeal, can determine the likelihood of success. These results can guide the development and implementation of campaigns seeking to influence donor registration and other prosocial behaviors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Guided by vested interest theory, the impact of educating potential organ donors about the beneficial experiences afforded to families of deceased donors was assessed. Participants were informed about these benefits by taking a survey that asked them to indicate both their awareness, and the appeal, of numerous existing benefits (e.g. grief services). We employed a double-sided mixed design . Both the true experimental design and the quasi-experimental repeated assessment indicated increased registration intentions. Only the quasi-experimental design indicated significant attitude change. This study provides evidence supporting the potential utility of focusing interventions on the benefits afforded to donor families.

Background: The current set of pre-registered studies tested the effect of savoring a high-arousal (exciting) or low-arousal (calm) positive experience on help-seeking intentions among people with heightened depressive symptomatology., Methods: Across all three studies, participants with heightened depressive symptomatology who had not yet sought help were randomly assigned to complete a 6-minute writing task where they reflected on an exciting memory, a calm memory, or what they did today and yesterday., Results: Savoring an exciting memory was associated with significantly greater arousal than savoring a calm memory and the control condition (Study 1; N = 218). Both savoring conditions were associated with greater positive emotion than the control condition (Study 2; N = 193). In Study 3 (N = 1,238), savoring an exciting memory, when compared to the control condition, increased help-seeking intentions, whereas savoring a calm memory did not., Conclusions: The current studies support the use of high-arousal, rather than low-arousal, positive emotions to increase help-seeking intentions among people with depression., (© 2020 International Association of Applied Psychology.)

Vested interest theory (VIT) predicts that perceived importance and hedonic relevance of an expected behavioral outcome affects attitude-behavior consistency. Applied to college students' nonmedical use of prescription stimulants (NUPS), the theory posits that persuasive information that weakens vested perceptions regarding assumed advantages of stimulant misuse will reduce usage intentions. The current study developed and experimentally assessed persuasive messages that targeted perceptions of vested interest (VI), and examined if message effectiveness varied as a function of users' risk status. Appeals that focused on the physical harms of misuse served as the comparison condition. College student participants (N = 282) were randomly assigned to one of four message conditions. To examine group differences, data were analyzed in a 2 (VIT-based message: yes, no) × 2 (Physical harms emphasized: yes, no) × 3 (User status: resolute, vulnerable, user) between-subjects factorial design. Analyses showed that messages focused on lowering VI by convincing students that NUPS did not enhance cognitive functioning of non-ADD/ADHD students reduced perceived vested interest (p < .001) and attitude favoribility p = .005. In vulnerable nonusers, these messages also decreased NUPS intentions p = .006. The effect of exposure to the physical harm communication was not significant. Findings support the potential of VIT-guided messages in NUPS prevention, and the lack of effect of messages focused on physical consequences of misuse., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: Three studies explored whether self-distancing, a method where the self is treated as an other, can impact help-seeking among those with depression. Self-distancing was expected to reduce the negative biases associated with depression by minimizing self-relevance through taking the perspective of an objective other. We hypothesized that when thinking about a past experience of help-seeking, a selfdistancing prompt would cause increased help-seeking intentions and more favorable help-seeking outcome expectations. The influence of selfdistancing on the self-stigma of help-seeking was also explored., Methods: Participants were randomly assigned to write (Studies 1 and 3) or watch a video (Study 2) where they were prompted to think about helpseeking from their own perspective or an objective other's perspective. Studies 2 and 3 were pre-registered on the Open Science Framework., Results: In Study 1, self-distancing increased help-seeking intentions but did not influence help-seeking expectations or self-stigma. The a priori hypotheses were not supported in Study 2 or 3. However, exploratory analyses of Study 3 revealed an interaction between condition and level of depressive symptomatology indicating that the distancing condition weakened the relationship between higher levels of depressive symptomatology and lower help-seeking intentions, and between higher levels of depressive symptomatology and higher self-stigma. Additionally, analyses of written responses indicated participants in the distancing condition were significantly less likely to write responses void of positive content., Conclusion: Although a priori hypotheses were not supported, further research is warranted as results indicate the potential for using self-distancing approaches to increasing help-seeking among some people with depressive symptomatology., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: Attitudes of drug-abstinent youth considering marijuana initiation can be highly ambivalent. Invalidating pro-usage elements (i.e., opinions) of ambivalent marijuana attitudes, while leaving anti-marijuana elements intact, may create stronger, less ambivalent marijuana-resistant attitudes and lower usage intentions, while concurrently elucidating the role of ambivalence in persuasive prevention., Method: From an initial pool of marijuana-abstinent middle-school students (N = 538), the quintile expressing the most negative attitudes toward a marijuana prevention appeal (N = 101) were randomly assigned to one of three conditions designed to invalidate pro-marijuana opinions. Analyses then tested their susceptibility to a second marijuana prevention appeal., Results: Personally threatening messages were found ineffective, but appeals contesting resistant responses significantly decreased ambivalence (p < .01). Mediational analyses showed that this decreased ambivalence was associated with less favorable attitudes and lower marijuana usage intentions (both p < .001). An attribution-based manipulation increased ambivalence (p < .05), which was associated with positive usage intentions mediated through positive attitudes (both p < .001)., Conclusion: Analyses elucidated the role of attitude ambivalence in prevention, providing a more complete understanding of potential facilitative use of ambivalence in prevention models based on prevention. Results support the further examination and use of methods that invalidate pro-marijuana opinions, thereby leading to greater susceptibility to subsequent prevention appeals., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Scholars have warned that mental health anti-stigma campaigns targeting the general public can possibly be detrimental to some who are stigmatized. Scholars also have noted that people with depression respond to some public service announcements (PSAs) differently than those without. Accordingly, the current study explored whether anti-stigma PSAs targeting the general public could cause problematic outcomes for people with depression. Participants with ( n = 55) and without ( n = 133) heightened depressive symptomatology viewed two mental health anti-stigma PSAs. Participants provided thoughts about the PSAs through a single, open-ended question. To allow for an assessment of convergence, participants rated overall favorability toward each PSA through a close-ended item. Results indicated that most qualitative responses were favorable; however, 23.6% of respondents with heightened depressive symptomatology, compared to 1.5% without, provided responses coded as indicating that at least one PSA caused unintended negative affect, χ 2 (1) = 25.96, [Formula: see text] p < .001. Evidence of untoward effects primarily came from the Friend PSA and the qualitative responses indicate how this occurred. Moreover, complementing the qualitative coding, the Friend PSA was rated less favorably by participants with heightened depressive symptomatology ( M = 5.00, SD  = 1.67), than those without ( M = 5.64, SD  = 1.44), F (1, 186) = 6.99, p = .009, η p 2  = .036. There were no significant differences in quantitative favorability ratings regarding the Labeling PSA. Indicating that further investigation is warranted, results suggest it is possible for an anti-stigma PSA targeting the general public to cause unintended negative affect among some people with depression.

Background: Vested interest (VI) has been found to enhance attitude-behavior consistency in several contexts. With an eye toward a potentially novel method of prevention (i.e., reducing perceived VI to minimize attitude-behavior consistency among those positively inclined toward psychotropic substance use), the current investigation explores whether VI moderates attitude-intention consistency regarding nonmedical use of prescription stimulants (NUPS) and marijuana., Methods: Emphasizing prevention, the study focused exclusively on non-users. Study 1a assessed college students (N = 310) attitudes, VI, and intentions regarding NUPS among those with no prior NUPS experience. Respondents were sampled using Amazon's Mechanical Turk. Study 1b investigated marijuana-abstinent college students (N = 93), recruited from college classrooms., Results: The pattern of results was similar in both studies. In addition to an association between attitudes and VI, analysis revealed main effects for attitudes and VI on substance use intentions. Moreover, VI moderated the attitude-intention relationship (p < .01). Attitudes were most weakly associated with usage intentions when perceptions of VI were low (vs. moderate or strong)., Conclusion: Results of these studies replicate and expand prior findings relating VI to drug use, and suggest a potential path for future prevention efforts. The current study was cross-sectional, however if the causal pathways are as theorized, an intervention that reduces subjective VI has the potential to reduce positive attitudes while simultaneously reducing the influence of favorable attitudes on intentions., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Depression is a treatable condition; unfortunately, many do not seek help. Depression public service announcements (D-PSAs) are one means of increasing help-seeking behavior. However, as Beck's cognitive theory of depression indicates, it can be challenging to persuade people with depression. Although there have been successful D-PSAs, some have been ineffective or led to boomerang effects. With the goal of providing guidance for future messages, we use a mixed-methods approach to assess how people with heightened depressive symptomatology perceive motivations and barriers regarding help-seeking. Study 1 participants ( N = 186), with and without depressive symptomatology, provided motivations and barriers to seeking help for depression. Study 1's qualitative analysis determined 112 motivations and 124 barriers to help-seeking. Study 2 participants ( N = 214), all with heightened depressive symptomatology, rated the motivations and barriers from Study 1 on their attitude function, importance, awareness, and argument strength. This insight guided successful D-PSA creation in a follow-up study, reported elsewhere. The methodological approach utilized, and the specific motivations and barriers revealed, will ideally assist scholars and practitioners seeking to develop future D-PSAs.

Background: The current studies examined how positive affect (i.e. the blend of several positive feelings over time) and discrete positive emotions (i.e. a specific set of momentary thoughts and feelings) influence organ donor registration outcomes., Methods: In Study 1, participants were randomly assigned to a writing task intended to elicit positive or negative affect. In Study 2, participants received a discrete positively valenced emotion induction (i.e. elevation, humor, hubristic pride), or were in a control condition., Results: Study 1 (N = 503) indicated a causal relationship between general positive affect and registration attitudes. An indirect effect beginning with general positive affect, going through attitudes, and then intentions, to influence behavior was also indicated. Study 2a (N = 394) demonstrated that elevation, humor, and hubristic pride can be influenced using an online platform. Study 2b (N = 1,046) indicated a causal relationship between elevation and increased registration intentions and behavior. The humor recall task caused marginally significant greater registration intentions, but no significant behavioral differences. The hubristic pride task did not influence registration outcomes., Conclusion: Organ donor practitioners and scholars could benefit from increased focus on the emotional states likely to be experienced at different venues when considering intervention contexts., (© 2018 The International Association of Applied Psychology.)

Background: The current research effort used two experimental studies to assess whether a savoring-based, positive emotion infusion (PEI) could increase help-seeking intentions among individuals with elevated depressive symptomatology and whether this relationship would be mediated by positive emotion, arousal, and perceptions of personal control., Methods: In Study 1, participants with elevated depressive symptomatology, recruited from Amazon's Mechanical Turk (N = 135), were randomly assigned to complete a 6-minute savoring or control writing task followed by a help-seeking intentions scale. Study 2 participants (N = 136) were randomly assigned to the same tasks, but a scale assessing positive emotion, arousal, and personal control was added., Results: Study 1 indicated a direct effect; those who savored reported greater help-seeking intentions compared to control participants. Study 2 revealed an indirect effect of savoring on help-seeking intentions through greater positive emotion but not through greater arousal or perceptions of personal control., Conclusion: Together, these results offer additional support for continued research on PEIs, and specifically, savoring-based PEIs. Although the experimental manipulations may be limited in regard to their ecological validity, for those seeking to create interventions, these studies offer a novel and efficacious approach for motivating individuals with elevated depressive symptomatology to seek help., (© 2018 The International Association of Applied Psychology.)

Introduction: Guided by Beck's (1967) cognitive theory of depression, we assessed whether perceived family functioning (PFF) mediated the relationship between depressive symptomatology and help-seeking inclinations., Methods: Study 1 included 130 Spanish-Dominant Hispanics and Study 2 included 124 Non-Hispanic Whites obtained using online crowd sourcing. Participants completed measures of depressive symptomatology, PFF, and several scales measuring aspects of help seeking inclinations and self-stigma. Study 2 also included an experiment. With an eye toward potential future interventions, we assessed the malleability of PFF. Specifically, participants were randomly assigned to recall positive or negative family experiences and then PFF was measures for a second time., Results: Both studies found PFF mediates the relationship between depressive symptomatology and the help seeking scales. Among non-depressed people, the positive manipulation improved PFF; however, among participants with elevated depressive symptomatology, writing about a positive family experience worsened PFF., Limitation: With the exception of the experiment, most of the data were cross-sectional. For the experiment, it is possible that different manipulations or primes could have different effects., Conclusion: Whether investigating responses from Spanish-Dominant Hispanics or Non-Hispanic Whites, PFF mediates the negative relationship between heightened depressive symptomatology and familial help-seeking beliefs, as well as self-stigma. However, even though the mediation analysis offers preliminary support that increasing PFF can potentially increase help-seeking behaviors of Hispanic and Non-Hispanic White people with depression, the results of the interaction analysis, specifically the negative impact of writing about positive family memories on people with elevated depression, illustrates the challenges of persuading people with depression., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Rationale: The IIFF Model (Information, Immediate and Complete Registration Mechanism, Focused Engagement, Favorable Activation) offers a checklist of considerations for interventions seeking to influence organ donor registration behavior. One aspect of the model, favorable activation, recommends considering the emotional and motivational state of a potential donor registrant. Given that most donor registrations occur at the Department of Motor Vehicles (DMV), we considered whether emotions experienced while at the DMV could influence registration rates., Objective: The current research effort investigated the emotions people experience while visiting the DMV, explored whether these emotions are associated with donor registration intentions, and experimentally assessed whether DMV experiences influence donor registration., Methods: Three studies were conducted through Amazon's Mechanical Turk. In Study 1, we randomly assigned participants to either recall a prior DMV experience or to a comparison condition. Emotions associated with the recalled experiences were the dependent variable. Study 2 assessed the correlations between nine different emotions and donor registration intentions. Study 3 randomly assigned participants to recall a prior frustrating DMV experience or to a comparison condition. Intention to register to donate was the dependent variable., Results: Study 1 found that recalling a prior DMV experience was associated with more negative and less positive emotions than the comparison condition. Study 2 found that increased levels of negative emotion could be problematic, as negative emotions were associated with decreased donor intentions. Study 3 found that recalling a frustrating DMV experience resulted in significantly lower intentions to register as an organ donor (vs. a control condition)., Conclusion: Although not all DMV experiences are negative, these data indicated a relationship between the DMV and negative emotions; an association between negative emotions and lower donor registration intentions; and, a causal relationship between negative DMV experiences and decreased registration intentions., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Introduction: Research on vested interest theory (VIT) indicates that the importance and hedonic relevance of attitudes moderates the link between attitudes and attitude-congruent behavior. Though largely untested in prevention research, this relationship may prove crucial in determining the success or failure of prevention efforts. The current study was designed to determine if subjectively perceived vested interest maximized the association between attitudes and intentions regarding the nonmedical use of prescription stimulants (NUPS)., Methods: A cross-sectional survey was conducted with college student respondents (N=162) using Amazon's MTurk. Participant age ranged from 19 to 49years old. A subsample analysis (n=129) was also conducted with younger respondents, as the typical college student is usually under the age of 30., Results: Four-step hierarchical regression analysis indicated that both attitudes and perceived vested interest were significantly associated with NUPS behavioral intentions (p<.001). Further, vested interest moderated the relationship between stimulant-related attitudes and usage intentions (p<.001). Attitudes were significantly associated with intentions of moderately and highly vested respondents (p<.001), but not those of participants expressing low levels of perceived vested interest., Conclusions: Findings support the proposition that vested interest may be a useful target for attenuating NUPS. Rather than attempting to weaken positive attitudes toward NUPS, campaigns may prove more successful if designed to convince receivers that NUPS is not in their best interest., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: The frequency with which adolescents are offered marijuana has been investigated as a predictor of marijuana use. The current study was designed to test whether the number of marijuana offers received provides an indirect path between parental knowledge and adolescents' marijuana use., Methods: Data from the nationally representative National Survey of Parents and Youth were examined. Analysis 1 tested the association between frequency of being offered marijuana and adolescents' (N=4264) marijuana usage in the subsequent year. Analysis 2, spanning a three-year time frame, tested whether the frequency of marijuana offers at the second year of the panel study bridged the relationship between parental knowledge in Year 1 and marijuana use in Year 3., Results: Analysis 1 indicated that the frequency with which adolescents were offered marijuana predicted usage one year later, after controlling for previous usage and nine other common predictors of marijuana use. Analysis 2 revealed an indirect relationship between parental knowledge and use through the number of marijuana offers the adolescent received., Conclusion: There was a strong link between the number of offers received and adolescents' future marijuana use. Higher parental knowledge predicted reductions in offer frequency, which was associated with lower levels of marijuana use. Reducing the number of marijuana offers an adolescent receives could serve as a useful focus for intervention programs targeting parents., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Increased depression symptomatology results in a reduced willingness to seek help from family. Focusing on Mexican-Americans, the current study hypothesized that the a reduction in favorable perceptions of familial relations could be partially to blame for limited help seeking among people with depression. Data were collected from 84 Mexican-Americans. Measures assessed depression symptomatology, familism, perceptions of help seeking from family, and demographics. As predicted: (1) depression symptomatology was negatively associated with perceptions of help seeking from family; (2) familism was positively associated with perceptions of help seeking from family; and, (3) depression symptomatology was negatively associated with familism. Further, familism partially mediated the relationship between depression symptomatology and help seeking comfort, as well as between depression symptomatology and the perceived utility of familial help seeking. The results indicate a reduction in familistic values may be partially responsible for reduced help seeking among Mexican-Americans with depression.

Objective: The lack of consistency between peoples' attitudes toward organ donation and organ donation registration behavior has long perplexed scholars. Ajzen and Fishbein's principle of compatibility offers a potential explanation for the attitude-behavior discrepancy. This principle states that attitudes will better predict behavior if the specificity of a measured attitude matches the specificity of the behavior under consideration., Method: Two studies, using different samples and different modes of data collection, measured general attitudes toward organ donation and specific attitudes toward registering as a donor, while simultaneously offering a registration opportunity., Results: Compared with general attitudes about organ donation, attitudes specific to organ donor registration were superior predictors of registration intentions and behaviors. Specific attitudes explained at least 70% more variance in registration behaviors than general attitudes., Conclusion: The lack of attitude-behavior consistency in the organ donor domain can be partially explained by limited compliance with the principle of compatibility., ((PsycINFO Database Record (c) 2014 APA, all rights reserved).)

This study assessed the moderating effects of attitudinal ambivalence on adolescent marijuana use in the context of the theory of planned behavior (TPB). With data from the National Survey of Parents and Youth (N = 1,604), two hierarchical multiple regression models were developed to examine the association of ambivalent attitudes, intentions, and later marijuana use. The first model explored the moderating effect of ambivalence on intentions to use marijuana; the second tested the moderation of ambivalence on actual marijuana use 1 year later. Results across both analyses suggest that ambivalence moderated the association of friend norms and subsequent adolescent marijuana use: friend norms were better predictors of marijuana intentions (β = 0.151, t = 2.29, p = 0.02) and subsequent use when adolescents were attitudinally ambivalent about marijuana use (β = 0.071, t = 2.76, p = 0.006). These results suggest that preventive programs that affect the certainty with which adolescents holds pro- or antimarijuana attitudes may influence the likelihood of their resistance to, initiation, or continuance of marijuana use.

The authors combined the 2-step flow of communication model and the theory of planned behavior to create a framework to evaluate the effectiveness of a set of advertisements from the National Youth Anti-Drug Media Campaign promoting parent-child drug communication. The sample consisted of 1,349 pairs of parents and children who responded to the first and second annual rounds of the National Survey of Parents and Youth, and 1,276 pairs from Rounds 3 and 4. Parents' exposure to the campaign reported at Round 1 was indirectly associated with youth's lowered intentions to use marijuana at Round 2. Ad exposure was associated with positive changes in parental attitudes toward drug communication and perceived social approval of antidrug communications. These two beliefs, along with perceived behavioral control, predicted parents' intentions to discuss drugs with their children. Parental intentions to discuss drugs reported at Round 1 were associated with youth's report of actual drug communication with their parents at Round 2. Frequency and breadth of the topics in parent-child drug communication were associated with less positive attitudes toward marijuana use among youth who spoke with their parents. Together, the child's attitudes toward marijuana use and perceived ability to refuse marijuana use predicted youth's intentions to use marijuana. The proposed model fit well with the data and was replicated in a parallel analysis of the data from Rounds 3 and 4. Implications for future antidrug media campaign efforts are discussed.

The association of adolescents' appraisals of the antimarijuana TV ads used in the National Youth Antidrug Media Campaign with future marijuana use was investigated. The 12- to 18-year-old respondents (N = 2,993) were first classified as users, resolute nonusers, or vulnerable nonusers (Crano, Siegel, Alvaro, Lac, & Hemovich, 2008). Usage status and the covariates of gender, age, and attitudes toward marijuana were used to predict attitudes toward the ads (Aad) in the first phase of a multilevel linear analysis. All covariates were significantly associated with Aad, as was usage status: Resolute nonusers evaluated the ads significantly more positively than vulnerable nonusers and users (all ps < .001), who did not differ. In the second phase, the covariates along with Aad and respondents' usage status predicted intentions and actual usage 1 year after initial measurement. The lagged analysis disclosed negative associations between Aad and usage intentions and between Aad and actual marijuana use (both ps < .05); however, this association held only for users (p < .01), not vulnerable or resolute nonusers. Users who reported more positive attitudes toward the ads were less likely to report intention to use marijuana and to continue marijuana use at 1-year follow-up. These findings may inform designers of persuasion-based prevention campaigns, guiding preimplementation efforts in the design of ads that targeted groups find appealing and thus, influential., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)

This study was designed to determine whether the relation between parents' recency of (lifetime) marijuana use (RMU) and their adolescent children's subsequent marijuana initiation was mediated by the adolescents' expectancies regarding the consequences of usage, their anticipated severity of punishment for use, and their evaluative attitudes toward marijuana. Parents and their initially marijuana-abstinent adolescent children drawn from the National Survey of Parents and Youth were studied (N = 1,399). A bootstrapped multiple mediation analysis tested whether adolescents' expectations, anticipated punishment, and attitudes toward marijuana collected in the first year of the longitudinal study mediated the relationship between parents' RMU and their adolescent children's marijuana initiation 1 year later. Analysis revealed a statistically significant association between the parental measure and youths' subsequent initiation (p < .001). The three mediators were related significantly to parents' RMU and adolescents' usage. Individually, each variable mediated the association of the parental measure and that of their initially abstinent adolescents when usage was assessed 1 year later. The results offer insight into the positive association of parents' RMU with their child's marijuana use and provide insights that may be useful in future prevention efforts., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)

Despite research indicating that effective parenting plays an important protective role in adolescent risk behaviors, few studies have applied theory to examine this link with marijuana use, especially with national data. In the current study (N = 2,141), we hypothesized that parental knowledge (of adolescent activities and whereabouts) and parental warmth are antecedents of adolescents' marijuana beliefs-attitudes, subjective norms, and perceived behavioral control-as posited by the Theory of Planned Behavior (TPB; Ajzen 1991). These three types of beliefs were hypothesized to predict marijuana intention, which in turn was hypothesized to predict marijuana consumption. Results of confirmatory factor analyses corroborated the psychometric properties of the two-factor parenting structure as well as the five-factor structure of the TPB. Further, the proposed integrative predictive framework, estimated with a latent structural equation model, was largely supported. Parental knowledge inversely predicted pro-marijuana attitudes, subjective norms, and perceived behavioral control; parental warmth inversely predicted pro-marijuana attitudes and subjective norms, ps < .001. Marijuana intention (p < .001), but not perceived behavioral control, predicted marijuana use 1 year later. In households with high parental knowledge, parental warmth also was perceived to be high (r = .54, p < .001). Owing to the analysis of nationally representative data, results are generalizable to the United States population of adolescents 12-18 years of age.

Drug prevention campaigns commonly seek to change outcome expectancies associated with substance use, but the effects of violating such expectancies are rarely considered. This study details an application of the expectancy violation framework in a real world context by investigating whether changes in marijuana expectations are associated with subsequent future marijuana intentions. A cohort of adolescents (N = 1,344; age range = 12-18 years) from the National Survey of Parents and Youth was analyzed via secondary analysis. Nonusers at baseline were assessed 1 year later. Changes in expectancies were significantly associated with changes in intentions (p < .001). Moreover, in most cases, changes in expectancies and intentions had the strongest relationship among those who became users. The final model accounted for 31% of the variance (p < .001). Consistent with laboratory studies, changes in marijuana expectancies were predictive of changes in marijuana intentions. These results counsel caution when describing negative outcomes of marijuana initiation. If adolescents conclude that the harms of marijuana use are not as grave as they had been led to expect, intentions to use might intensify., (2008 APA, all rights reserved)

This research expands the user/nonuser dichotomy commonly used in research on marijuana. By conceptualizing nonusers as homogeneous, vital nuances in susceptibility to risk and protective factors may be overlooked. Research operations tested the predictive validity of a brief measure that divided nonusers into resolute and vulnerable subcategories; determined whether variables that distinguished nonusers and users were more informative when a tripartite classification was used; and with an eye on future prevention, examined variables on which resolute nonusers were similar to vulnerable nonusers or users, and on which they differed from both. A nationally representative sample of respondents (N = 2,111; ages 12-16 years) from the National Survey of Parents and Youth was used in this secondary analysis. Panel data gathered yearly over four rounds included information on intentions and use of marijuana and other illicit substances, along with social, demographic, intrapersonal, and parental variables. The three groups differed significantly on associates' marijuana use, participants' approval of others' use, and cigarette and alcohol use. Resolute nonusers differed from vulnerable nonusers and users alike on religiosity, delinquency (self and friends'), refusal strength, sensation seeking, parental monitoring and warmth, and adult supervision. Results support the utility of distinguishing vulnerable from resolute nonusers, counsel against considering nonusers as a homogeneous group, and provide insight into variables that might prove useful in future prevention efforts.

Objective: Approximately 6,000 Americans die every year awaiting an organ transplant. Health promotion interventions may alleviate the shortage of viable organs by increasing the number of registered organ donors. This study is the first to evaluate the differential effectiveness of various organ donor messages in naturalistic settings., Design: A 4 (Appeal)x4 (Exemplar)x4 (Location) counterbalanced quasi-experimental design was implemented., Main Outcome Measure: The behavioral outcome measure was the number of individuals who registered to be organ donors at computer kiosks., Results: A number of significant main effects and interactions emerged. Most notably, of the 4 different appeals (counterargument, emotional, motivating action, dissonance), counterargument was by far the most efficacious, especially in academic-type settings (library, university, community college); the emotional appeal was most successful in hospitals., Conclusions: The findings from this study have implications for both organ donor investigations and health campaign research in general. Statistical interactions highlight the importance of evaluating multiple exemplars in multiple locations for each type of appeal when conducting health campaign research., (Copyright (c) 2008 APA, all rights reserved.)

This research was concerned with factors that affect adolescents' evaluations of persuasive anti-inhalant messages and the association of these evaluations with usage intentions. Sixth and 7th graders (N=894) received anti-inhalant messages that varied as a result of the factorial combination of message source (doctor or peer), suggested harm (social or physical), and target (message was addressed directly or indirectly to receivers). Manipulated variables were crossed with inhalant-user status (resolute nonuser, vulnerable nonuser, and user). Significant (p<.01) target and status effects on message evaluation were found. Significant interactions of status with each of the manipulated variables also emerged. Users were resistant to threatened physical harms, but suggested harms did not differentially affect resolute nonusers or vulnerable nonusers. Users and vulnerable nonusers evaluated the message more positively when targeted indirectly (p<.05). Vulnerable nonusers were more receptive to peer sources, whereas users preferred adult sources. Message evaluation was significantly associated with inhalant usage intentions (r=-.22), and this association held even after the contributions of sex, sensation seeking, acculturation, prior use, familism, and assumed peer usage were accounted for in a multiple regression analysis (overall R(2)=.24).

There is little debate over Hispanics' need for viable organs. Although organ donor registries can potentially assist in alleviating this need, the U.S. Department of Health and Human Services (DHHS) has called on researchers to investigate methods to maximize such potential. This research effort answers the aforementioned call by surveying Hispanics, both those who prefer to use Spanish (SP, n=239) and those who prefer not to use Spanish (NSP, n=364) about the methods of donor registration that they would most likely utilize. When provided with different options for organ donor registration, signing up by applying for a driver's license, through a place of worship, or through a doctor's office were among the most popular methods; over the telephone, tax forms, or through the use of home computer were among the least popular. Furthermore, the DHHS-suggested idea of registering via organ donor kiosks was very well received.

This study assesses how adolescent nonsmokers, at-risk smokers, and smokers differ in perceptions of smoking harms, benefits, and safety. While small differences exist when comparing attitudes and knowledge concerning short- and long-term benefits of smoking, large differences arise when attitudes and knowledge concerning the short-term benefits and the safety of casual smoking are compared.

While a variety of steps have been taken to restrict youth access to tobacco, little has been done to explore adult attitudes, beliefs, and behaviors concerning this issue. To ameliorate this knowledge gap, 828 adults from Arizona's Maricopa and Pima counties were surveyed. Overall, adults perceived that the prevention of youth tobacco access was: an important issue, an issue they are willing to spend money on, and a responsibility shared by all adults. Further, when asked who was most responsible for keeping tobacco away from minors, 65.4% of adults surveyed perceived parents of the youth purchasing tobacco as most responsible. Responding to items soliciting opinions regarding appropriate penalties for minors purchasing tobacco and for those selling tobacco to minors, respondents recommended stiffer punishment for the sellers of tobacco. Almost 10% recommended a night in jail for vendors caught selling tobacco products to minors. Interestingly, respondents exhibited low perceived self-efficacy regarding the prevention of youth tobacco access. The majority of adults agreed that it is easy for minors to gain access to tobacco and that there is nothing they or the community can do to stop minors who wish to purchase tobacco. Future research efforts should investigate how adult self-efficacy can be increased and the impact that such a change would have on efforts to prevent youth tobacco access.