With bases in the Socio-Ecological Model (SEM), Protection Motivation Theory, and the Extended Parallel Process Model, this study builds a multilevel model including neighborhood risk factors, cognitive appraisals, and media information use with research hypotheses and questions developed at the individual, community, and cross levels. The research expectations are tested with 2020 individual-level survey data (N = 995) and 2019 and 2020 neighborhood-level data (N = 41) in New York City. In the context of COVID-19, multilevel modeling documented that the bulk of variance in the outcome variables was at the individual level. At the individual level, perceived efficacy, as well as its interaction with perceived threat, significantly predicted preventive behaviors, information scanning was significantly associated with perceived efficacy and threat, and information seeking was significantly associated with efficacy. At the community level, poverty rate was significantly associated with perceived efficacy and threat and preventive behaviors. At the cross level, community-level risk factors (e.g., poverty rate, crime rate) significantly moderated the effects of individual-level factors (i.e., perceived efficacy and information scanning) on preventive behaviors, which are indicative of the interdependence of factors at different levels in the SEM.

While there is ample research on the influence of retracted scientific publications on author reputation, less is known about how a health organization's retraction of scientific guidance can impact public perceptions of the organization. This study centers on the aerosol guidance retraction of the Centers for Disease Control and Prevention (CDC) in 2020. X/Twitter social media data were collected via ForSight from September 15 to October 8, 2020, with a machine learning algorithm specifically developed and used to detect sentiment toward the CDC. Regression analyses of the non-bot sample (N = 265,326) tested for differences in CDC sentiment across four stages: 1) baseline; 2) CDC guidance change; 3) CDC retraction of the prior guidance change; and 4) CDC reversion to a tempered form of the initial guidance change. The results show that sentiment toward the CDC increased from Time 1 to Time 2, then decreased for Time 3 with the "posted in error" retraction, but then increased for Time 4 back to a level similar to Time 2. That public perceptions of the CDC could improve after these changes in scientific guidance may be attributed to its self-report of the retraction and reporting that the retraction was a result of unintentional error. This study connects theories of reputation management and trust repair with the growing empirical research on retractions of published scientific research to provide a theoretical explanation for how a major public health organization can mitigate damage to its reputation in the short term.

In Nigeria, approximately 10% of women of reproductive age report experiencing sexual violence in the past year, with potentially enduring health and social consequences. The effects can be especially severe for younger women and adolescents. MTV Shuga Naija utilizes an entertainment-education TV serial drama to promote gender equality and challenge norms around sexual violence. Using a two-wave panel survey of Nigerian youth (574 females; 317 males) aged 15 to 24 years, this study explores the impact of MTV Shuga Naija on disclosing experiences of sexual violence, reducing stigma, and fostering dialogue. Baseline data were collected in person, while endline data were collected by telephone due to the COVID-19 pandemic. The survey, informed by the Theory of Planned Behavior (TPB), examined shifts in self-reported sexual harassment and attitudes toward victims of sexual violence. A doubly robust, difference-in-differences (DID) analysis compares changes in outcomes in treatment versus comparison areas, adjusting for observed and unobserved differences and using inverse probability weighting to enhance the precision of impact estimates. DID models show significant attitude shifts and increased disclosure of sexual violence among youth exposed to MTV Shuga Naija. Agreement with victim-blaming statements dropped significantly for both men and women in treatment versus comparison areas. However, contrary to hypotheses, respondents in comparison areas were more likely to discuss sexual violence with family, although the context and content of these discussions could not be examined. This study therefore confirms that MTV Shuga Naija’s entertainment-education effectively improves attitudes and behaviors concerning sexual violence. Even so, victim-blaming norms and experiences of sexual violence remain prevalent. While the program has made progress in addressing this sensitive issue in Nigeria, further research is needed to improve family and community dialogues and to enhance support for victims.

This study builds a multilevel model of the influence of media information use and neighborhood risk factors on preventive behaviors. In the context of the COVID-19 pandemic in New York City, multilevel modeling was implemented with individual-level survey data from 2020 ( N = 995) and community-level data from 2019 and 2020 from databases ( N = 41). The predominant effects were at the individual level, including information scanning having more common significant effects on the behavioral outcomes than information seeking. Community-level crime and poverty rates also had significant effects, and four significant cross-level interactions show how community-level risk factors moderate the effects of information scanning.

With the evolution of media technologies, social media have developed as a means to purposive and incidental use and subsequent benefits and detriments. This study investigates how individuals' use of information via social media helps them achieve psychological and behavioral advances in the context of the COVID-19 pandemic. This study's novelty lies in its positioning of social media information seeking (SMIS) as a precursor to the staged behavioral processes of the Theory of Planned Behavior. This novel extension entails the testing of a conceptual model of the influence of SMIS on three psychological factors (i.e., attitudes, subjective norms, perceived behavioral control), which, in turn, predict behavioral intention. It implements cross-sectional data from a survey of adults in New York City in 2020 (N = 1,021). The structural equation models were well-fitting and generally validated by the data, including the posited two steps from SMIS to psychological factors to behavioral intention. Structural equation modeling underscores the role of SMIS as a core driver of wearing a facemask, with positive effects on attitudes and perceived behavioral control and subsequent mediated positive effects on behavioral intention. In terms of sheltering in place, there was evidence of positive effects of SMIS on perceived behavioral control and, in turn, from the three psychological factors to behavioral intention, but the mediation role of the psychological factors was weaker in this model. Theoretical and practical implications are discussed.

In the immersive environment of an online serious video game designed to depict social norms about excessive alcohol consumption, this study examines the effects of real-world and virtual-world social norms on alcohol use outcomes, centering on the persuasive elements of the One Shot game and its social psychological effects. This study implements a one-group, pretest-posttest, quasi-experimental design. Using a national sample of young adults aged 21–25 (N = 550) who reported recent binge drinking, OLS regression analyses documented that virtual-world norms were more predictive of alcohol-related outcomes than real-world norms. Specifically, virtual-world descriptive norms paired with severe consequences of hazardous drinking predicted improvements from pre-game to post-game in drinking refusal self-efficacy and attitudes toward drinking. Likewise, virtual-world social disapproval had a similar effect on drinking refusal self-efficacy, but not on attitudes toward drinking. Neither measure of virtual-world social norms had a significant effect on changes in intention to drink less from pre-game to post-game. Real-world descriptive norms and social disapproval had no significant effects on any of the alcohol use outcomes. Each of the three alcohol use outcomes improved significantly from pre-game to post-game. Implications for norms-based research and online serious video games are discussed.

Background In Nigeria, approximately one in ten women of reproductive age report experiences of sexual violence in the past year, with potentially enduring consequences. The impact of sexual violence can be particularly devastating for younger women and adolescents, who may face long-lasting physical, psychological, and social effects. To address this, MTV Shuga Naija utilizes entertainment education programming, anchored by a TV serial drama, to promote gender equality and challenge sexual violence norms and behaviors. This research examines the impact of MTV Shuga Naija on disclosure of sexual violence, stigma and victim-blaming attitudes, and greater dialogue about sexual violence. Methods This evaluation uses a panel survey of Nigerian youth aged 15-24 (574 females; 317 males) with data collected before and after the airing of MTV Shuga Naija programming. The baseline wave was conducted in person, while the endline wave was conducted via telephone due to the COVID-19 pandemic. Using the Theory of Planned Behavior, survey questions focused on norms, attitudes, beliefs, and behaviors related to sexual harassment and sexual violence, we analyze changes in self-reported sexual harassment, attitudes towards victims, and discussions with adults and family members about sexual violence for those in in MTV Shuga Naija program areas relative to those in two comparator states. The analysis uses a fixed-effects, doubly robust difference-in-differences (DID) estimation strategy to improve the comparability of treatment and control groups by adjusting for observed differences, thereby allowing for more precise estimation of the causal effects of MTV Shuga Naija . Results At baseline, the majority of both males and females across all study areas reported attitudes blaming victims rather than perpetrators for experiences of sexual violence. However, results from the doubly-robust DID models reveal significant changes in these attitudes among youth in areas exposed to MTV Shuga Nija programming, as well as greater disclosure of incidents of sexual violence to interviewers, possibly due to greater awareness of what constitutes sexual violence. For example, agreement with the statement, “women who wear clothes that expose their bodies are asking to be raped,” decreased by 36.6 percentage points [95% CI: -46.8pp, -26.3pp] for women and by 31.8 pp [95% CI: -45.6pp, -18.1pp] for men in areas with MTV Shuga Naija sexual violence programming relative to those in comparison areas. Similarly, acceptance of the attitude that "it is not rape if a woman does not fight back” declined by 28.3 pp [95% CI: -40.2pp, -16.4pp] for women and by 19.3 pp [95% CI: -35.6pp, -3.0pp] for men in treatment versus comparison areas. Contrary to hypotheses, respondents in comparison areas showed larger increases in the likelihood of talking with parents and family about sexual violence than respondents in areas targeted by MTV Shuga Naija , although no information was collected on the initiators, circumstances, nor content of dialogue with parents and family members, rendering difficult the interpretation of this unexpected finding. Conclusion This study provides evidence that the entertainment education approach of MTV Shuga Naija can indeed bring about significant progress in shifting attitudes and behaviors related to sexual violence. Even with this progress, however, victim-blaming norms and attitudes, as well as experiences of sexual violence among women -- and men -- are still widely prevalent. While MTV Shuga Naija has made headway in shifting the landscape surrounding this often-taboo subject in Nigeria, more work is needed to understand how communication and dialogue within families, schools, and communities, alongside greater efforts to support victims of sexual violence, can be improved and enhanced to ensure continued progress.

Abstract This entry offers an introduction to social capital and its functions in regards to health communication, including health media campaigns and health media messaging. Common operational definitions of social capital include group membership, social trust, neighborliness, perceptions of place, and social and community ties. Social capital has been found to be positively associated with beneficial health outcomes at both individual and collective levels. With this basis, research has implemented three different general frameworks to model how health communication functions in tandem with social capital. First, using an audience segmentation framework, people with different levels of social capital tend to have different patterns of health communication. Second, using a mediation framework, health communication can spur increases in social capital, which, in turn, can influence improvements in health outcomes. Third, using a moderation framework, social capital moderates the effects of health communication on health outcomes. Research in these three areas underscores the importance of health communication in social capital processes, deriving important implications for research and practice. Future research can help advance knowledge on how these three frameworks function in general and across health contexts and health outcomes.

Background COVID-19 preventive perceptions and behaviors, especially among US millennials, are an important means by which the pandemic can be slowed and negative health outcomes can be averted. Objective This manuscript aims to advance knowledge on COVID-19 preventive perceptions and behaviors and their main predictors, including digital health information–seeking behavior (HISB), political party identification, and COVID-19 testing status. Methods Two cross-sectional online surveys of US millennials were conducted from April 10 to 14, 2020 (N=274) (ie, Study 1), and from April 27 to May 7, 2020 (N=1037) (ie, Study 2). In the regression models, dependent variables included preventive behaviors (eg, wearing a face mask and social distancing) as well as four preventive perceptions: severity (ie, a person’s conception of the seriousness of COVID-19), susceptibility (ie, a person’s conception of the likelihood of being infected with COVID-19), self-efficacy (ie, a person’s perception that he or she can wear a face mask and perform social distancing to prevent COVID-19 infection), and response efficacy (ie, a person’s perception of whether wearing a face mask and social distancing can prevent COVID-19 infection). Key independent variables included digital HISB for self, digital HISB for another person, political party identification, and COVID-19 testing status. Results Millennials reported lower levels of perceived susceptibility than the other three preventive perceptions (ie, severity, self-efficacy, and response efficacy), as well as fairly high levels of preventive behaviors. Unlike HISB for another person, digital HISB for self was positively associated with preventive perceptions and behaviors. In Study 1, respondents with higher levels of digital HISB for self had significantly higher perceptions of severity (β=.22, P<.001), self-efficacy (β=.15, P=.02), and response efficacy (β=.25, P<.001) as well as, at nearing significance, higher perceptions of susceptibility (β=.11, P=.07). In Study 2, respondents with higher levels of digital HISB for self had significantly higher perceptions of severity (β=.25, P<.001), susceptibility (β=.14, P<.001), and preventive behaviors (β=.24, P<.001). Preventive behaviors did not vary significantly according to political party identification, but preventive perceptions did. In Study 1, respondents who identified as being more Republican had significantly lower perceptions of self-efficacy (β=−.14, P=.02) and response efficacy (β=−.13, P=.03) and, at nearing significance, lower perceptions of severity (β=−.10, P=.08) and susceptibility (β=−.12, P=.06). In Study 2, respondents who identified as being more Republican had significantly lower perceptions of severity (β=−.08, P=.009). There were mixed effects of COVID-19 testing status on preventive perceptions, with respondents who had tested positive for COVID-19 having significantly higher perceptions of susceptibility in Study 1 (β=.17, P=.006) and significantly lower perceptions of severity in Study 2 (β=−.012, P<.001). Conclusions As the largest and most digitally savvy generation, US millennials saw COVID-19 as a severe threat, but one that they were less susceptible to. For millennials, digital HISB for self, but not for another person, was critical to the development of preventive perceptions and behaviors.

This study tested whether a cancer education intervention affected promotores' self-efficacy to deliver an intervention to Hispanics and which psychosocial determinants of promotores influenced the number of Hispanic residents reached by promotores in the subsequent education intervention. A quasi-experimental, pre/post-design with a treatment group (no control) assessed differences for promotores (n = 136) before and after exposure to the cancer education intervention. The design also included a cross-sectional evaluation of the number of residents promotores reached with the educational intervention. After being trained, the promotores delivered the intervention to Hispanic residents (n = 1,469). Paired t-tests demonstrated increases in promotores' self-efficacy from pre- to post-intervention. Regression models assessed associations between the numbers of residents reached and select psychosocial determinants of promotores. Age and promotores' years of experience influenced their delivery of a cervical cancer education intervention to Hispanics, but not their delivery of breast or colorectal cancer education interventions. This is the first study to examine which psychosocial determinants influence promotores delivery of cancer education interventions. The outcomes potentially have implications for CHW interventions and training by examining this potential connection between CHWs' psychosocial determinants and intervention outcomes.

Increasingly, people are turning to digital and social media to address health threats. While research has commonly investigated the psychosocial antecedents of digital health information seeking behavior (digital HISB) and social media use (SMU), there has been limited research on the independent effects of emotions and no research on the interactive effects of emotions. In the context of the coronavirus COVID-19 pandemic, this study investigates the affective, personal relevance, and socio-demographic antecedents of digital HISB and SMU, using data from an online survey of U.S. Millennials (N = 1037) in April-May 2020. Linear regression results show the effects of socio-demographic and personal relevance factors. For the independent effects of emotions, fear and sadness were associated with digital HISB; fear, joy, and disgust were associated with high-informational SMU; and joy and disgust were associated with low-informational SMU. Three interactive effects of discrete negative emotions suggest that an increase in one emotion can amplify the effect of another emotion on a measure of digital and social media use. In the fourth interaction of two negative emotions with strong biological regulatory processes, there is evidence that an increase in one emotion can diminish the effect of another emotion. Implications for theory and practice are discussed.

Background Although binge drinking peaks at age 21 to 25 years, there is limited research on the effects of serious games in this population, as well as on the process by which playing serious games impacts alcohol-related outcomes. Designed with both health behavioral theory and game theory, One Shot is an online serious game that aims to prevent binge drinking. Objective This study utilized a conceptual model for serious video game processes. Using One Shot, the model assessed the following process stages: (1) Alcohol Use Disorders Identification Test-Concise (AUDIT-C); (2) in-game factors of game time and risky alcohol decisions; (3) game enjoyment; and (4) postgame outcomes of intention to drink less and drinking refusal self-efficacy. Methods In a one-group pretest-posttest quasi-experimental design, a sample (N=550) of young adults (age 21-25 years) who reported recent binge drinking played the One Shot game. Intention to drink less and drinking refusal self-efficacy were measured at pregame and postgame, with their effects lagged in statistical analysis. Participants were presented with various scenarios in the game that pertained to risky alcohol decisions, which, along with game time, were unobtrusively recorded by the server. A structural equation model (SEM) was used to test the conceptual model, with assessments made to determine if enjoyment mediated the effects of game time and risky alcohol decisions on the 2 postgame alcohol-related outcomes. Results A well-fitting SEM demonstrated support for the multistep model, with AUDIT-C predicting risky alcohol decisions (β=.30). Risky alcohol decisions (β=−.22) and game time (β=.18) predicted enjoyment, which, in turn, predicted intention to drink less (β=.21) and drinking refusal self-efficacy (β=.16). Enjoyment significantly (P<.001) mediated the effects of game time and risky alcohol decision on intention to drink less and drinking refusal self-efficacy. Conclusions The results support a conceptual model in which staggered individual and in-game factors influence alcohol-related outcomes. Enjoyment is important for participants’ intentions to drink less and beliefs that they can refuse alcohol.

This study theoretically develops a three-stage model in which certain types of health behavior functions (i.e., health-affirming vs. health-detection/treatment) prime individuals to process information with either a defensive or accuracy motivation. Such information-processing motivations, in turn, are expected to influence the contribution and consumption of user-generated health content. The three-stage model was tested with data from an online sample of American adults ( N = 767). A well-fitting structural equation model provided evidence for each of the hypothesized paths except for that from health-detection/treatment behavior to accuracy motivation. Individuals’ information search for health-affirming behaviors instigated a defensive motivation. Moreover, while both information-processing motivations influenced user-generated content consumption, only defensive motivation had a significant effect on user-generated content contribution. Finally, there was also one significant cross-stage path in which health-affirming behavior had a direct effect on content contribution, thus, overstepping defensive and accuracy motivations.

The current study identified the antecedents of being an Internet scam victim and how it impacts online privacy concerns and privacy protection behaviors. Structural equation modeling on data from a survey of 11,534 Internet users revealed that one indicator of weak self-control (i.e., willingness of risky investments) and two indicators of routine Internet activities (i.e., online shopping and opening emails from unknown sources) positively predicted being an Internet scam victim. Subsequently, being an Internet scam victim predicted increased online privacy concerns, which, in turn, predicted elevated privacy protection behaviors. Moreover, we found that being an Internet scam victim mediated the effects of routine Internet activities on privacy protection behaviors and that online privacy concerns mediated the effect of being an Internet scam on privacy protection behaviors. Unlike most Internet privacy studies using protection motivation theory only, the current study contributes to the understanding of the Internet scam victimization by incorporating three new theories—extended parallel process model, self-control theory, and routine activity theory. The research findings provided valuable implications for theory and practice related to Internet scam processes and prevention.

This paper evaluates the effectiveness of community health workers/promotores (CHWs) in promoting cancer preventive behaviors in the 2011–2013 Education to Promote Improved Cancer Outcomes (ÉPICO) project. The ÉPICO project utilized CHWs to disseminate cancer education to predominately Spanish-speaking Hispanics living in colonias in the Lower Rio Grande Valley of Texas. The CHWs received training to become Texas-certified CHW instructors and specialized training in message tailoring, and they delivered more than 5000 units of resident education on cancer prevention/detection, treatment, and survivorship for breast, cervical, and colorectal cancer. Using panel data to examine overtime changes in cancer knowledge among Lower Rio Grande Valley residents, the evaluation found significant changes from baseline to both times 1 and 2. Additional individual-level analysis indicated that the increase in resident cancer knowledge was predicted by residents’ perceptions of CHW credibility and intention to change their lifestyles. Multilevel analysis also showed that the increase in cancer prevention knowledge among residents was predicted by attributes of the CHWs who taught them. In particular, CHWs with higher education levels had the most impact on residents’ increased knowledge over time. Unexpectedly, CHWs with more years of experience were less effective teachers than their early-career counterparts.

Health literacy rates among American and European adults remain low, with almost half of adults having only basic levels in 2012. In this digital era, the Internet has been recognized as an important medium for improving health literacy. However, little is known about the mechanisms that underlie its impact on health literacy. With a general basis in the Cognitive Mediation Model, this study empirically tested a model that included motivation for health-related Internet use, health-related Internet use, perceived health information overload, and health literacy. Structural equation modeling was used to analyze the US-based Health Information National Trends Survey (HINTS) 2013 dataset. The results support for all the paths in our posited model. The effects of motivation for health-related Internet use on health literacy were completely mediated by health-related Internet use and perceived health information overload. The findings extend the Cognitive Mediation Model to the context of health literacy and provide significant implications for the design and dissemination of online health information. Recommendations are made for future research, including further validation of the five-item scale of health literacy.

With a general basis in protection motivation theory, this study builds a three-stage model from online negative privacy experiences to online privacy protection motivation to online privacy protection behaviors. With 2013 survey data ( N = 528), a well-fitting structural equation model was tested, indicating general support for the model’s progression. There was support in only one instance, however, for the mediation role of online privacy protection motivation. In that case, awareness of online information disclosure mediated the effects of information stolen on contact management. The other protection motivation—online privacy concerns—had stronger effects on the four online privacy protection behaviors.