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The human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (CDC, 2023). Although a vaccine for HPV exists, the vaccination rate in young adults is still staggeringly low. Therefore, the purpose of this study was to use Narrative Engagement Theory (NET; Miller- Day & Hecht, 2013) to examine what HPV videos young adults find most engaging and persuasive. Participants were 992 college students from a large Southwestern University who watched ten HPV videos designed to inform young adults about HPV. After each video, participants responded to questions that assessed engagement and persuasiveness and were provided space to write as much as they liked to elaborate on their answers. The results suggest that certain videos may be more effective in persuading young adults to receive the HPV vaccination.

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.

First responders, especially those without adequate support, are at heightened risk for experiencing adverse mental health outcomes. Workplace mental health interventions for first responders are becoming more common. However, systematic research within the field of communication has not typically informed the development of these workplace interventions. The current study conducted interviews with 26 first responders to examine the messages they receive about mental health from their organizations and how those messages affect their support-seeking decisions. Analysis of the interviews revealed that first responders receive inconsistent messages from their departments about whether to seek support for mental health-related problems, creating confusion and distrust. [ABSTRACT FROM AUTHOR]

Research tested interventions are seldom ready for wide spread use. Successful intervention adaptation to clinical settings demands an iterative process with target audience feedback. We describe the adaptation process of implementing an NCI research tested HPV vaccine intervention, Women's Stories, to a community clinic context (Planned Parenthood). Five phases are described for the adaptation of content and the development of a health kiosk intervention delivery system: (a) informant interviews with the target audience of young adult, predominantly African-American women, (b) translating HPV vaccine decision narratives into prevention messages, (c) health kiosk interface design, (d) conducting a usability study of the health kiosk intervention product, and (e) conducting a waiting room observational study. Lessons learned and challenges in adapting prevention interventions to clinical settings are discussed.

Despite having previous experience and extensive trauma training, the COVID-19 pandemic presented unprecedented challenges for nurses working in hospital settings. During the pandemic, nurses struggle to care for patients and protect themselves from infection, while navigating ongoing organizational changes. Guided by prior literature on social support and coping, this study explores nurses' experiences of coping with stress while treating COVID-19 patients during the pandemic. In-depth semi-structured interviews were conducted with 14 active staff nurses working in hospitals and one licensed practical nurse (LPN) at a rehabilitation center who treated COVID-19 patients during the pandemic. An inductive thematic analysis was employed to analyze those data, and three overarching themes emerged: (1) nurses' unique experiences in the [COVID-19] trenches, (2) nobody else understands, and (3) coping with stress together. Practically, this study is heuristic and generates an increased understanding of professional communication during times of healthcare crises, illuminating the need to enhance communication skills for both staff nurses and management. This study also extends our understanding of communal coping in the context of healthcare organizations. [ABSTRACT FROM AUTHOR]

A content analysis of early adolescent X-bar = 12.02 years) Latino girls' (n = 44) responses to open-ended questions embedded in an electronic survey was conducted to explore strategies girls may use to resist peer pressure with respect to sexual behavior. Analysis yielded 341 codable response units, 74% of which were consistent with the REAL typology (i.e., refuse, explain, avoid, leave) previously identified in adolescent substance use research. However, strategies reflecting a lack of resistance (11%) and inconsistency with communication competence (e.g., aggression) were also noted (15%). Frequency of particular strategies varied depending on the situation described in the open-ended question, suggesting a variety of strategies may be needed to resist the peer pressure that puts early adolescent girls at risk of engaging in sexual behavior. Study findings extend the typology of resistance strategies identified in adolescent substance initiation and use research to the context of early adolescent sexual behavior.

Enhancing the delivery quality of school-based, evidence-based prevention programs is one key to ensuring uniform program effects on student outcomes. Program evaluations often focus on content dosage when implementing prevention curricula, however, less is known about implementation quality of prevention content, especially among teachers who may or may not have a prevention background. The goal of the current study is to add to the scholarly literature on implementation quality for a school-based substance use prevention intervention. Twenty-five schools in Ohio and Pennsylvania implemented the original "keepin' it REAL" ("kiR)" substance use prevention curriculum. Each of the 10, 40-45 min lessons of the "kiR" curriculum was video recorded. Coders observed and rated a random sample of 276 videos reflecting 78 classes taught by 31 teachers. Codes included teachers' delivery techniques (e.g. lecture, discussion, demonstration and role play) and engagement with students (e.g. attentiveness, enthusiasm and positivity). Based on the video ratings, a latent profile analysis was run to identify typology of delivery quality. Five profiles were identified: holistic approach, attentive teacher-orientated approach, enthusiastic lecture approach, engaged interactive learning approach and skill practice-only approach. This study provides a descriptive typology of delivery quality while implementing a school-based substance use prevention intervention.

Narratives play a powerful role in sharing meaning and making sense of experiences. Specifically, health narratives convey storylines, characters, and messages about health-related behaviors and provide audiences with models for healthy behaviors, prompting audiences' health-related reflections and decision-making. Narrative engagement theory (NET) explains how personal narratives can be integrated into interventions to promote health. This study utilizes NET to test direct and indirect effects of teachers' narrative quality on adolescent outcomes during a school-based substance use prevention intervention that includes narrative pedagogy and an implementation strategy. Observational coding of teacher narratives in video-recorded lessons along with self-report student surveys (N = 1,683) were subjected to path analysis. Findings showed significant direct effects of narrative quality on student engagement, norms (i.e. personal, best-friend injunctive, and descriptive norms), and substance use behavior. The analysis also yielded support for indirect effects of narrative quality on adolescent substance use behavior via student engagement, personal norms, and descriptive norms. Findings highlight important issues related to teacher-student interaction during implementation and contributes implications for adolescent substance use prevention research. [ABSTRACT FROM AUTHOR]

Purpose: As interventions are disseminated widely, issues of fidelity and adaptation become increasingly critical to understand. This study aims to describe the types of adaptations made by teachers delivering a school-based substance use prevention curriculum and their reasons for adapting program content. Design/methodology/approach: To determine the degree to which implementers adhere to a prevention curriculum, naturally adapt the curriculum, and the reasons implementers give for making adaptations, the study examined lesson adaptations made by the 31 teachers who implemented the "keepin' it REAL" drug prevention curriculum in 7th grade classrooms ("n"=25 schools). Data were collected from teacher self-reports after each lesson and observer coding of videotaped lessons. From the total sample, 276 lesson videos were randomly selected for observational analysis. Findings: Teachers self-reported adapting more than 68 percent of prevention lessons, while independent observers reported more than 97 percent of the observed lessons were adapted in some way. Types of adaptations included: altering the delivery of the lesson by revising the delivery timetable or delivery context; changing content of the lesson by removing, partially covering, revising, or adding content; and altering the designated format of the lesson (such as assigning small group activities to students as individual work). Reasons for adaptation included responding to constraints (time, institutional, personal, and technical), and responding to student needs (students' abilities to process curriculum content, to enhance student engagement with material). Research limitations/implications: The study sample was limited to rural schools in the US mid-Atlantic; however, the results suggest that if programs are to be effectively implemented, program developers need a better understanding of the types of adaptations and reasons implementers provide for adapting curricula. Practical implications: These descriptive data suggest that prevention curricula be developed in shorter teaching modules, developers reconsider the usefulness of homework, and implementer training and ongoing support might benefit from more attention to different implementation styles. Originality/value: With nearly half of US public schools implementing some form of evidence-based substance use prevention program, issues of implementation fidelity and adaptation have become paramount in the field of prevention. The findings from this study reveal the complexity of the types of adaptations teachers make naturally in the classroom to evidence-based curricula and provide reasons for these adaptations. This information should prove useful for prevention researchers, program developers, and health educators alike. (Contains 1 table. A list of further reading is included.)

Effective interventions to promote human papillomavirus (HPV) vaccination are needed for all young adults across the globe. Yet, most public health efforts focus on HPV-related risks for females. Unfortunately, HPV-related cancers in men are also a concern, as is the potential for men to spread HPV to their partners. The HPV vaccine is highly effective in reducing risks related to these cancers. Yet, vaccination rates among young males are low and their vaccination concerns are not well understood. This project conducted 15 in-depth qualitative interviews with U.S. males aged 18–22 to hear their vaccine decision stories. Themes of HPV vaccination uncertainty and vaccination acceptance within these stories were then translated into prevention messages for the U.S.-based 'Men's Stories' (MS) HPV video intervention. This study illustrates the process of translating formative research findings into message content, tone, and structure through this intervention by communicating pro-vaccination messages to young men. [ABSTRACT FROM AUTHOR]

Rural adolescents are at risk for early initiation and problematic substance use, but to date few studies have examined the rural context of substance use. To better understand substance offers in the rural context, semi-structured interviews were conducted with 118, 12- to 19-year-old adolescents (M = 13.68, SD = 1.37) from Appalachian, rural school districts in Pennsylvania and Ohio. Interviews elicited stories about substance offer-response episodes, including where offers occurred, who offered substances, and how youth gained access to illicit substances. Findings describe the settings in which substance offers and use occur for these rural adolescents and advance prevention efforts for tailoring health messages to this target population. (Contains 1 note.)

This study seeks to identify how rural adolescents make health decisions and utilize communication strategies to resist influence attempts in offers of alcohol, tobacco, and other drugs (ATOD). Semi-structured interviews were conducted with 113 adolescents from rural school districts to solicit information on ATOD norms, past ATOD experiences, and substance offer-response episodes. Rural youths' resistance strategies were similar to previous findings with urban adolescents--refuse, explain, avoid, and leave (the REAL typology)--while unique features of these strategies were identified including the importance of personal narratives, the articulation of a non-user identity, and being "accountable" to self and others. (Contains 2 figures.)

This paper discusses the applied aspects of our Drug Resistance Strategies Project. We argue that a new definitional distinction is needed to expand the notion of "applied" from the traditional notion of utilizing theory, which we call "applied.1," in order to consider theory-grounded, theory testing and theory developing applied research. We label this new definition "applied.2" research. We then explain that our descriptive work describing the social processes of adolescent substance use, identity and use, and drug norms, as well as the subsequent development and dissemination of our "keepin' it REAL" middle school substance use curriculum are examples of "applied.1" work. In the "applied.2" realm, we include our theory testing (e.g., tests of multiculturalism, narrative and performance theories, the Focus Theory of Norms) and theory-developing (e.g., parent-child communication, cultural grounding) research as well our new directions in theory development (e.g., adaptation processes). We conclude with a call for space in the discipline for "applied.2" work that builds and tests theory through application to significant social issues that contribute to our communities. We note obstacles in departmental and scholarly norms but express optimism about the prospects for "applied.2" research in the future of communication research. (Contains 3 notes.)

Objective: Characterize the process of family vegetable selection (especially cruciferous, deep orange, and dark green leafy vegetables); demonstrate the usefulness of Exchange Theory (how family norms and experiences interact with rewards and costs) for interpreting the data. Design: Eight focus groups, 2 with each segment (men/women vegetable likers/dislikers based on a screening form). Participants completed a vegetable intake form. Setting: Rural Appalachian Pennsylvania. Participants: Sixty-one low-income, married/cohabiting men (n = 28) and women (n = 33). Analysis: Thematic analysis within Exchange Theory framework for qualitative data. Descriptive analysis, t tests and chi-square tests for quantitative data. Results: Exchange Theory proved useful for understanding that regardless of sex or vegetable liker/disliker status, meal preparers see more costs than rewards to serving vegetables. Experience plus expectations of food preparer role and of deference to family member preferences supported a family norm of serving only vegetables acceptable to everyone. Emphasized vegetables are largely ignored because of unfamiliarity; family norms prevented experimentation and learning through exposure. Conclusions and Implications: Interventions to increase vegetable consumption of this audience could (1) alter family norms about vegetables served, (2) change perceptions of experiences, (3) reduce social and personal costs of serving vegetables, and (4) increase tangible and social rewards of serving vegetables.

This research, comprised of 2 studies, extends current knowledge of parent-child communication about drugs. The first study developed a typology of parental strategies used to deter children's substance use. The second study examined relationships among the parental strategies identified in the first study, which included family communication environments and self-reported substance use. Results revealed that parental communication strategies to deter substance use may be employed in different ways by laissez-faire, pluralistic, consensual, and protective families. Of the 7 identified types of strategies, very few actually impacted substance use in the previous 30 days. The only strategy to have a significant effect on the use of all drug types was a "no tolerance rule." Prevention efforts and programs may target parents so as to enhance parental communication competence and offer parents an array of strategies to choose from that might best fit with their family communication environment. (Contains 3 tables and 1 figure.)

After being told in an end-of-year job review that performances are not considered valuable research outcomes, the author argues in this essay that performance matters. This essay makes a case for recognizing performance ethnographies as research, pedagogy, and active service and concludes with guidelines for performance ethnographers who are participating in action research. (Contains 3 figures and 2 notes.)

This paper tells the story of the multi-layered translational process of the Drug Resistance Strategies Project. The Drug Resistance Strategies Project provides an exemplar of translational scholarship, translating adolescent narratives about their substance use experiences into an efficacious, substance abuse prevention middle school curriculum. The curriculum, called "keepin' it REAL," was developed using the principle of cultural grounding and translational performances and has been found to reduce adolescent substance use. The authors tell the story of this project from its inception to its current role as a model substance abuse prevention program. (Contains 1 figure and 2 notes.)

Describes a study that questioned adolescents about their parent-adolescent conversations regarding alcohol, tobacco, and drug use. Notes that fewer than half had engaged in such a conversation and that more adolescents preferred talking with their mothers than with other family members. Advocates a clearer definition of the parent-adolescent conversation, discusses implications for targeting mothers as prevention agents, and introduces risk socialization theory. (Author)

This paper discusses the applied aspects of our Drug Resistance Strategies Project. We argue that a new definitional distinction is needed to expand the notion of 'applied' from the traditional notion of utilizing theory, which we call 'applied.1,' in order to consider theory-grounded, theory testing and theory developing applied research. We label this new definition 'applied.2' research. We then explain that our descriptive work describing the social processes of adolescent substance use, identity and use, and drug norms, as well as the subsequent development and dissemination of our keepin' it REAL middle school substance use curriculum are examples of 'applied.1' work. In the 'applied.2' realm, we include our theory testing (e.g., tests of multiculturalism, narrative and performance theories, the Focus Theory of Norms) and theory-developing (e.g., parent-child communication, cultural grounding) research as well our new directions in theory development (e.g., adaptation processes). We conclude with a call for space in the discipline for 'applied.2' work that builds and tests theory through application to significant social issues that contribute to our communities. We note obstacles in departmental and scholarly norms but express optimism about the prospects for ''applied.2' research in the future of communication research. Keywords: Applied Research; Substance Use; Adaptation; Developing Theory DOI: 10.1080/00909882.2010.490848

This paper tells the story of the multi-layered translational process of the Drug Resistance Strategies Project. The Drug Resistance Strategies Project provides an exemplar of translational scholarship, translating adolescent narratives about their substance use experiences into an efficacious, substance abuse prevention middle school curriculum. The curriculum, called keepin' it REAL, was developed using the principle of cultural grounding and translational performances and has been found to reduce adolescent substance use. The authors tell the story of this project from its inception to its current role as a model substance abuse prevention program. Keywords: Translational; Drug Resistance; Petronio

Social norms play an important role in adolescent substance use. Norm focus theory (Cialdini, Reno, & Kallgren, 1990) distinguishes three types of norms: injunctive, descriptive, and personal. This study examines the relative influences of these three norms, as well as the moderating effects of gender and ethnicity, on the concurrent substance use of 2,245 Mexican or Mexican-American students, 676 students of other Latino or multiethnic Latino origin, 756 non-Hispanic White students, and 353 African-American students. Personal norms appear to be the strongest significant predictor of substance use. Descriptive, parental injunctive, and friend injunctive norms also demonstrate significant, though weaker influences. Controlling for intentions reduces the predictive ability of each type of norm, especially personal norms. Gender moderates the relationship between norms and substance use with the relationships generally stronger for males. Personal norms act as stronger predictors of some types of substance use for Mexican/Mexican Americans.