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ObjectivesStudies examining perceptions of ‘modified risk tobacco product’ (MRTP) messages for e-cigarettes and smokeless tobacco have indicated consumers want statistics and quantification of harm reduction. However, limited research exists on reactions to quantitative MRTP messages.DesignWe conducted 12 focus groups in the USA in 2019—6 focused on e-cigarette messages and 6 on snus messages. Eight groups were with current smokers (ages 21–66) and four with young adult (ages 18–25) non-smokers (n=57). Participants discussed messages stating that use of snus and vaping products have been estimated by scientists to be about 90% and 95% less harmful than smoking cigarettes, respectively.ResultsSeveral participants agreed the messages strongly communicated that the products are less harmful than cigarettes, were attention getting and could be ‘convincing’. However, participants expressed scepticism about the source and accuracy of the stated figures, and some noted the claims could be misleading and attractive to young people. Comments also reflected some claim misunderstandings (eg, that e-cigarettes only pose a 5% chance of harm). Participants also agreed that stating e-cigarette risks ‘are unlikely to exceed 5% of cigarette smoking harms’ was confusing and less impactful than the ‘95% less harmful’ wording.ConclusionsQuantitative claims suggesting high levels of reduced risk when comparing e-cigarettes or smokeless tobacco/snus relative to cigarettes may be successful in gaining attention and being persuasive for some audiences, particularly, if from more credible sources. However, message developers, users and evaluators should be mindful of message limitations and aim to mitigate unintended consequences.

PurposeEngagement is a critical metric to the effectiveness of online health messages. This paper explores how people engage in youth-generated prevention messages in social media.Design/methodology/approachThe data sample consisted of engagement measures of 82 youth-generated messages hosted in a social media channel and a follow-up survey on content creators' motivation for promoting their messages and their dissemination strategies. A comparative analysis of engagement metrics along with qualitative analysis of the message types was performed.FindingsTwo types of messages were considered: stop messages and prevent messages. Our analyses found that people interacted with stop messages on social media more frequently than prevent messages. On analyzing the youth's motivation and promotion strategies, no significant difference was observed between stop message creators and prevent message creators.Social implicationsThis work has implications for programs promoting prevention and health information in social media.Originality/valueThis is the first study in social media-based prevention programs the authors are aware of that differentiated between the strategies of youth-produced prevention messages.

Prevention curricula rely on audience engagement to effectively communicate their messages. However, to date, measurement of engagement has primarily focused on self-report that is often an indicator of liking or satisfaction. Emerging technologies for intervention delivery hold promise not only for additional engagement indicators but also for dissemination outside of traditional vehicles such as classroom delivery. The present study, grounded in the Theory of Active Involvement (Greene 2013), explores the role of engagement (as measured by self-report, program analytics, and observation) with short term substance use prevention outcomes such as self-efficacy to counter-argue and descriptive and injunctive norms. The study tracks 4-H youth (N = 310) engaged with a media literacy focused e-learning substance prevention curriculum, REAL media. Results indicate that self-reports of engagement predicted self-efficacy to counter-argue, but a program-analytic indicator of dosage predicted lower injunctive and descriptive norms, all at three months. The observational indicator was correlated with self-efficacy to counter-argue but not significant in the predictive models. The implications and directions for future research regarding how engagement is measured in prevention and included in studying program effects are discussed. Clinical trial: NCT03157700, May 2017

Engagement is central to the effectiveness of online health messages and the related educational programs that aim to deliver these messages to the intended audience (Li et al. in Educ Tech Res Dev. https://doi.org/10.1007/s11423-019-09709-9 , 2019). Drawing from health communication and social learning theories, the Theory of Active Involvement (TAI) (Greene in Health Commun 28:644–656. https://doi.org/10.1080/10410236.2012.762824 , 2013) posits that an online prevention program’s impact depends on how engaged participants are. In practice, measuring engagement in this context has relied primarily on self-report measures (e.g., Hamutoglu et al. in Educ Tech Res Dev. https://doi.org/10.1007/s11423-019-09705-z , 2019). However, the emergence and growth of online learning platforms to deliver health-specific information offers other options for assessing engagement. This includes program analytics that capture interaction with content and facilitate examination of patterns via multiple indicators such as responses to interactive questions and time spent in the program (Herodotou et al. in Educ Technol Res Devel 67:1273. https://doi.org/10.1007/s11423-019-09685-0 , 2019; Li et al. 2019; van Leeuwen in Educ Tech Res Dev 67:1043. https://doi.org/10.1007/s11423-018-09639-y , 2019). However, little is known about the relationships between these different indicators of engagement as it applies to health curricula. This study uses self-report, observational, and program analytic data collected on a small (N = 38) sample using REAL media, an online substance use prevention program, to examine relationships among various indicators of engagement. Findings suggest a cluster of indicators across the three modalities that provide a useful way of measuring engagement. A cluster centered around complexity suggests a separate factor to be considered when designing engaging interventions.

Health care providers routinely advise cancer patients to involve support persons in oncology care to fulfill critical support roles. This qualitative descriptive study explored alignment of triadic perceptions of support person involvement in oncology treatment visits and cancer-related care from the perspectives of patients with gynecologic cancer ( n = 18), regular visit-attending support people ( n = 16), and health care providers ( n = 10), including oncologists, nurses, and medical assistants. Semi-structured interviews ( N = 44) captured perceptions of facilitation and interference of support persons' roles within and outside appointments with oncology providers. Thematic analyses revealed alignment and divergence regarding support persons' instrumental, informational, and emotional support behaviors. Perspectives aligned regarding what support functions companions provide. However, patients and support persons emphasized the significance of instrumental followed by informational and emotional support, whereas oncology providers highlighted informational, followed by emotional and instrumental support. Discussion provides insight into each role’s perspective in the triad.

Smoking research demonstrates that parents can influence their adolescent's tobacco smoking perceptions and behaviors, but little is known about the protective effects of different parenting practices on adolescent vaping. In this study we investigate how adolescent perceptions of parents' knowledge of their activities and parental media mediation are associated with adolescents' perceptions of vaping and adolescent vaping behaviors.Six hundred thirty-nine youth (65.7% female, average age: 14.71 years old) recruited through 4-H clubs in nine states participated in a study evaluating a substance use intervention program. Because the evaluation design could influence participants, we used only baseline data. An online self-reported survey was administrated. Most youth self-identified as White (87.3%) and only handful youth indicated Asian (3.4%), African American (3.4%), American Indian (1.1%), and other or unreported (4.8%). Approximately 60% of youth lived in small town or rural areas in US.Analyses revealed that parental knowledge was positively related with adolescent perceived harm of vaping and perceived prevalence of vaping, but was negatively related with perceived acceptability of vaping and social expectancy of vaping. In addition, youth who reported greater parental media mediation were more likely to perceive the harm of vaping and less likely to vape compared with youth with lower parental media mediation.These findings suggest that parental education about vaping, including those promoting conversations regarding vaping and vaping ads, may be important to the prevention of adolescent vaping.

We initiated the use of a replicated, remote-video, artificial stream system to determine the effects of conspecific cue, refuge availability, and day/night conditions on movement, aggression, dominance, downstream preference, and refuge use by the crayfish Procambarus clarkii. In line with previous research, we found that walking on the gravel substrate was greatly increased and refuge use decreased in the dark. Conspecific cue (macerated crayfish filtrate) increased walking, contrary to our prediction but consistent with cue as a signal of food availability or of risk either from cannibalism or from visual predators. Exposure to conspecific cue in the streams resulted in a reduced degree of dominance in subsequent pairwise dominance trials. We developed and implemented a new and broadly applicable way of determining the extent of linearity (consistency of dominance ranks) for incomplete dominance; for our data, this method found a lack of evidence for linear hierarchies in these stream systems. Our results suggest that streams may tend to feature weaker dominance and reduced linearity of social hierarchies, relative to standing-water systems, a hypothesis that requires further testing.

PURPOSE To examine patients' with gynecologic cancer and supporters' reports of sharing and withholding cancer-related information during oncology visits, with a focus on navigating communication encounters more effectively. PARTICIPANTS A SETTING 18 women who were recently diagnosed with gynecologic cancer and their supporters (N = 16) were recruited from the Rutgers Cancer Institute of New Jersey in New Brunswick. METHODOLOGIC APPROACH Data were collected via audio-recorded semistructured interviews and analyzed to determine the types of information that patients and supporters share or withhold during oncology visits. FINDINGS Thematic analyses revealed two major themes. IMPLICATIONS FOR NURSING Probing patients and supporters separately on topics that they may not feel comfortable discussing can help nurses to identify unaddressed concerns and better assist patients and their supporters during oncology visits.

Adolescent-produced anti-substance use messaging is an increasingly popular and effective prevention strategy. However, little is known about the content of these messages and the production elements adolescents use to bring that content to life. In this article, we present a content analysis of 95 anti-substance use messages developed by 4-H club members across nine U.S. states as part of their participation in the media literacy program REAL media. Posters and videos were content-analyzed for target substance, prevention goal, message form, message content, persuasion strategies, and production elements. Results of the content analysis revealed that combustible tobacco (smoking) was the most popular target substance in the sample among the choices of alcohol, marijuana, e-cigarettes, and chewing tobacco. More youth developed messages with the goal of preventing substance use, rather than stopping current use. Slogans were used in the majority of messages, and nearly all messages took an informational form, rather than narrative or statistical form. Persuasion strategies covered in the curriculum, including fun with the group, unexpected, style, and endorsement were scantily used. Finally, results showed that production value was high in this sample, reflected by the extensive use of color and variety of fonts and font sizes. Implications for future media literacy interventions and research are discussed.

Although no tobacco products are safe, tobacco companies in the United States may request regulatory authorization to make certain &ldquo, modified risk tobacco product&rdquo, (MRTP) claims in their marketing. However, few qualitative studies have explored consumer perceptions and understanding of comparative risk messages and wordings. We examined consumer perceptions of statements indicating reduced risks and exposure to chemicals from snus and e-cigarettes relative to smoking. We conducted 12 focus groups with adult smokers (ages 21&ndash, 66) and young adult (YA) non-smokers (ages 18&ndash, 25) (n = 57) in the USA in 2019. Participants shared reactions to modified risk and exposure messages and message variations. Participants largely understood claims, including language about &ldquo, switching completely.&rdquo, However, participants expressed desire for more message specificity, evidence, risk reduction reasons, and statistics/quantitative information. Claim believability and acceptance was also limited by existing negative product beliefs and experiences, negative media reports, and skepticism about message source. YAs did not express product interest based on message exposure. Some YAs suggested the included &ldquo, smoker&rdquo, language made the messages less interesting/relevant. Given existing proposals for and use of MRTP messages, additional research on their wording, framing, delivery, and effects may help inform regulatory or organizational decisions about such messages, optimize potential benefits, and mitigate unintended consequences.

This study aimed to elucidate whether gynecologic cancer patients and their support persons have certain expectancies for emotion and whether these expectancies, if they exist, affect cancer-related communication. Semi-structured interviews ( N = 34) were conducted separately with 18 patients and one of their support persons ( n = 16). Thematic analysis revealed a subset of patients and support persons expected patients to not have any negative emotions, which patients also reported they perceived from support persons, and that these expectancies could affect cancer-related communication. These results have implications and can facilitate appropriate recommendations for how cancer patients and support persons co-manage patients’ emotions.

Background The primary aim of this study was to evaluate the short-term effects of testing an e-learning program to reduce adolescent substance use and abuse. Early initiation of substance use is linked to a variety of negative outcomes, thus effective intervention programs are needed. One approach is to use media literacy to capitalize on adolescents’ immersion with media in a variety of forms. We developed, implemented, and tested an engaging substance use prevention program by collaborating with a youth-oriented community partner (4-H). Methods 639 middle adolescents from nine U.S. states participated in an RCT of REAL media. Participants completed a series of online surveys and were randomized to use an online substance prevention program (REAL media) or serve as control (delayed program use). Self-report surveys were administered at three points in time. This short-term evaluation uses data from the pretest (Time 1) and short-term posttest three-month surveys, which measured demographics, self-efficacy to counterargue, and injunctive and descriptive substance use norms. Results Participants who completed the REAL media program reported increased self-efficacy to counterargue and decreased positive injunctive norms compared to control participants who did not complete the program. No significant differences were observed for descriptive norms. Conclusions We found support for the REAL media program in changing key predictors of youth substance use demonstrating (1) the efficacy of media literacy interventions targeting adolescents and (2) that e-learning substance use prevention efforts can be adapted for and implemented through community organizations.

This article describes formative research (a pilot study, interviews, and focus groups) conducted as part of a feasibility test of 2 versions (Analysis vs. Planning) of a brief media literacy intervention titled Youth Message Development (YMD). The intervention targets high school student alcohol use with activities to understand persuasion strategies, increase counter-arguing, and then apply these new skills to ad analysis or a more engaging ad poster planning activity. Based on the theory of active involvement (Greene, 2013), the Planning curriculum is proposed to be more effective than the Analysis curriculum. Overall, results of the formative research indicated that students (N = 182) and mentors/teachers (N = 53) perceived the YMD Planning curriculum as more interesting, involving, and novel, and these ratings were associated with increased critical thinking about the impact of advertising, lower alcohol use intentions, and fewer positive expectations about the effects of alcohol use. Qualitative feedback indicated a need to supplement alcohol-focused ad stimuli with ads targeting other advertising images, use incentives and competition-based activities to further enhance student motivation, and provide flexibility to enhance the appropriateness of the curriculum to various settings. These concerns led to the development of a revised curriculum and plans for further study.

This study applied the disclosure decision-making model (DD-MM) to explore how individuals plan to disclose nonvisible illness (Study 1), compared to planning to disclose personal information (Study 2). Study 1 showed that perceived stigma from the illness negatively predicted disclosure efficacy; closeness predicted anticipated response (i.e., provision of support) although it did not influence disclosure efficacy; disclosure efficacy led to reduced planning, with planning leading to scheduling. Study 2 demonstrated that when information was considered to be intimate, it negatively influenced disclosure efficacy. Unlike the model with stigma (Study 1), closeness positively predicted both anticipated response and disclosure efficacy. The rest of the hypothesized relationships showed a similar pattern to Study 1: disclosure efficacy reduced planning, which then positively influenced scheduling. Implications of understanding stages of planning for stigmatized information are discussed.

HIV remains a significant health concern entering the fourth decade of the epidemic [Centers for Disease Control and Prevention. 2014. HIV basics. Retrieved from http://www.cdc.gov/hiv/basics/index.html], and people living with HIV continue to grapple with stigma. This study uses Leary and Schreindorfer's [1998. The stigmatization of HIV and AIDS: Rubbing salt in the wound. In V. J. Derlega & A. P. Barbee (Eds.), HIV and social interaction (pp. 12–29). Thousand Oaks, CA: Sage] conceptualization of stigma to explore prior stigmatization on reasons for and against future disclosures. We interviewed HIV+ individuals (N = 59) and used a combination of deductive and inductive coding to analyze participants’ responses. Deductive codes consisted of four stigma characteristics (pose a threat to others’ health and safety, deviate from group standards, create negative emotional reactions in others, and failure to contribute), experiences of feeling stigmatized due to HIV status (yes or no), and the degree t...

BACKGROUND There is a need for evidence-based substance use prevention efforts that target high school-aged youth that are easy to implement and suitable for dissemination in school and community groups. The Youth Message Development (YMD) program is a brief, four-lesson, in-person curriculum that aims to prevent youth substance use through the development of youth media literacy. Specifically, YMD aims to increase understanding of advertising reach and costs, along with the techniques used to sell products; develop counterarguing and critical thinking skills in response to advertisements; and facilitate application of these skills to the development of youth-generated antisubstance messages. Although YMD has demonstrated evidence of success, it is limited by its delivery method and focus on alcohol and smoking. OBJECTIVE Study objectives were two-fold: (1) to adapt the YMD curriculum to a self-paced, interactive, electronic-learning (e-learning) format and expand its content to cover alcohol, combustible cigarettes, e-cigarettes, smokeless tobacco, marijuana, and prescription drugs, and (2) to test the feasibility of the adapted curriculum in partnership with a national youth organization. METHODS An iterative process was employed in partnership with the 4-H youth development organization and a technology developer and consisted of six phases: (1) focus groups to guide adaptation, (2) adaptation to an e-learning format renamed REAL media, (3) pilot-testing of the REAL media prototype to determine feasibility and acceptability, (4) program revisions, (5) usability testing of the revised prototype, and (6) final revisions. Focus groups and pilot and usability testing were conducted with 4-H youth club members and adult club leaders. RESULTS Focus group feedback guided the build of an e-learning prototype of REAL media, which consisted of five online levels and interactive content guided by a mix of narration and on-screen text. Results of a pilot test of the prototype were neutral to positive, and the program was refined based on end-user feedback. An independent usability test indicated that youth 4-H members felt favorably about navigating REAL media, and they reported high self-efficacy in applying skills learned in the program. Additional refinements to the program were made based on their feedback. CONCLUSIONS The iterative build process involving the end user from the outset yielded an overall successful technology-driven adaptation of an evidence-based curriculum. This should increase the likelihood of effectively impacting behavioral outcomes as well as uptake within community organizations.

Rates of melanoma and nonmelanoma skin cancers are on the rise in the USA with data revealing disproportionate increase in female young adults. The popularity of intentional skin tanning among U.S. adolescents is attributed to several factors, including prioritization of physical appearance, media images of tanned celebrities, ease of availability of artificial tanning facilities, and more recently, the prevalence and celebration of tanned skin on social media. Pinterest, as the third most popular social media platform, was searched for “pins” about skin tanning. The resultant “pins” were examined to understand the extent and characteristics of skin tanning portrayed on Pinterest. We analyzed pins on Pinterest about skin tanning (n = 501) through a quantitative content analysis. Overall, results indicated an overwhelmingly protanning characteristic of pins about skin tanning on Pinterest, with over 85% of pins promoting tanning behavior. The pins were generally characterized by the portrayal of a female subject (61%) and provided positive reinforcement for tanning (49%). Use of tanning for enhancing appearance was the main positive outcome expectancy portrayed in the pins (35%), and nudity or exposure of skin on arms (32%) and legs (31%) was evident in about a third of pins. With overwhelmingly positive pins promoting tanning, use of female subjects, exhibiting nudity, and appearance enhancement, there seems be to a consistent targeting of female users to accept tanning as a socially acceptable and popular behavior. The findings indicate a need for developing sun protection messages and the leveraging of social media for dissemination of skin cancer prevention and detection messages.

In efforts to better understand the intricate nature of response, we tested a four-dimension structure of response patterns (measured as support, reciprocity, emotional reaction, and avoidance) as well as four single dimension models within the context of couples managing cancer. All models incorporate dyadic data, including both patient and partner perceptions that relational quality influences response patterns, and response patterns influence ongoing disclosure (measured as breadth and depth). Participants were 95 dyads in which one partner had been diagnosed with cancer. We conducted multilevel analyses using an actor-partner interdependence model (APIM). Results supported the four-dimension model as well as individual dimension models. All response types predict within person disclosure. However, only reciprocity predicts the other person’s disclosure, and only patient’s reports of partner reciprocity predict partner disclosure.

The purpose of this survey study was to evaluate a model of body image influences on indoor tanning behavior. Participants were 823 young adult women recruited from a probability-based web panel in the United States. Consistent with our hypothesized model, tanning-related sociocultural experiences were indirectly associated with lifetime indoor tanning use and intentions to tan as mediated through tan surveillance and tan dissatisfaction. In secondary analyses, tan dissatisfaction was positively associated with recent indoor tanning. Findings suggest the need for targeting body image constructs as mechanisms of behavior change in indoor tanning behavioral interventions.

Previous findings from our laboratory highlighted marked ethnic differences in volatile organic compounds (VOCs) from cerumen among individuals of Caucasian, East Asian, and African-American descent, based, in part, on genetic differences in a gene that codes for a transport protein, which is a member of the ATP-binding cassette transporter, sub-family C, member 11 (ABCC11). In the current work, we hypothesized that axillary odorants produced by East Asians would differ markedly from those obtained from individuals of European or African descent based on the pattern of ethnic diversity that exists in ABCC11. Using gas chromatography/mass spectrometry (GC/MS) we examined differences in axillary odorant VOCs among 30 individuals of African-American, Caucasian, and East Asian descent with respect to their ABCC11 genotype. While no qualitative differences in the type of axillary odorants were observed across ethnic groups, we found that characteristic axillary odorants varied quantitatively with respect to ethnic origin. We propose that ABCC11 is not solely responsible for predicting the relative amounts of volatiles found in axillary secretions and that other biochemical pathways must be involved.

Social penetration theory describes the role of disclosure in relationship development, focusing specifically on how self-disclosure functions in developing relationships. The onion model serves as a framework for describing the process of social penetration. In developing relationships, people use self-disclosure to increase intimacy including through breadth, depth, and the norm of reciprocity. Social penetration progresses through several stages to develop relationships. The theory also incorporates rewards and costs in relation to social penetration and has influenced the development of a number of theories in relationship development and information management. Keywords: communication theory; interpersonal communication; relational communication

Results of national epidemiologic surveys indicate that substance use rates among adolescents remain relatively steady or even show slight declines; however, some substance use rates, such as electronic cigarettes, are actually rising. Thus, the need for efficacious drug prevention efforts in the United States remains high. Active Involvement (AI) interventions are a promising avenue for preventing and reducing adolescent substance use, and they create opportunities for adolescents to experience a core feature of engagement that is common to these interventions, such as producing videos, posters, or radio ads; or generating themes and images for messages such as posters. Existing interventions grounded in theories of Active Involvement include programs delivered face-to-face and via e-learning platforms. Narrative Engagement Theory and the Theory of Active Involvement guide the components of change in AI interventions. Youth develop message content during participation in Active Involvement interventions. Advanced analytic models can be applied to address new research questions related to the measure of components of AI interventions.

Objectives We describe the unique selling propositions (USPs) (propositions used to convince customers to use a particular brand/product by focusing on the unique benefit) of print tobacco ads. Methods A qualitative content analysis was conducted of print tobacco ads (N = 171) selected from August 2012 to August 2013 for cigarettes, moist snuff, e-cigarettes, cigars, and snus to determine the content and themes of USPs for tobacco ads. Results Cigarette ad USP themes focused on portraying the product as attractive; moist snuff ads focused on portraying product as masculine; cigar ads focused on selling a "high end product;" and new and emerging tobacco products (e-cigarette, snus) focused on directly comparing these products to cigarettes. Conclusions Whereas traditional tobacco product ads used USPs focused on themes of enjoyment and pleasure (eg, attractive for cigarettes, "high end product" for cigars), new and emerging tobacco product ads offered the unique benefit (USP) of their product being a better and "safer" alternative to traditional tobacco products. Snuff's USPs focused nearly exclusively on the masculinity of their products. Our results provide targets for potential tobacco regulatory actions that could be implemented to reduce demand for tobacco products by reducing their perceived unique benefits.

Americans are living longer, and many are managing at least one chronic illness. Having people with whom to disclose health information is a salient component of managing a chronic health condition, such as heart disease. The purpose of this study is to explore differences in elderly patients' health disclosures by target (i.e. disclosing to a partner vs. another person). Elderly patients (age 60) with a diagnosed heart-related condition (n = 273) completed a survey regarding sharing information about their health condition. Results indicated significant differences between the two groups in perceived support; breadth, depth, and frequency of disclosures; and disclosure of psychological/emotional symptoms, physical symptoms, and talk about heart-healthy behaviors. No significant differences were found between the two groups for relationship quality and efficacy. Patients who reported sharing information with a partner reported significantly more health information disclosures compared to patients who reported sharing information with another person.