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Guided by social cognitive theory (SCT), we investigated whether exercise self-regulatory efficacy beliefs can be activated nonconsciously in individuals experienced and inexperienced in exercise self-regulation, and whether these beliefs are automatically associated with exercise self-regulation processes. The study used a 2 (Exercise Self-Regulation Experience Group) × 3 (Prime Condition) between-subjects design in which individuals experienced and inexperienced in exercise self-regulation were randomly assigned to receive subliminal, supraliminal, or no priming of exercise self-regulatory efficacy beliefs. Participants completed hypothetical diary entries, which were assessed for exercise self-regulatory efficacy and self-regulation expressions using content analyses with a SCT coding system and the Linguistic Inquiry and Word Count (LIWC) text analysis program. For both exercise self-regulation experience groups, self-efficacy priming led to more expressions of low exercise self-regulatory efficacy and dysfunctional exercise self-regulation strategies compared with the control prime. For participants experienced in exercise self-regulation, supraliminal priming (vs. control priming) led to more expressions of high exercise self-regulatory efficacy and functional exercise self-regulation strategies. For the experienced groups, priming led to automaticity of exercise expressions compared with the control condition. For inexperienced participants in the subliminal prime condition, priming led to automaticity of self-regulatory efficacy beliefs and work-related goals compared with the control condition. Automatic activation of exercise self-regulatory efficacy and exercise self-regulation processes suggests that self-regulation of exercise behavior can occur nonconsciously. [ABSTRACT FROM AUTHOR]

Using a Protective Motivation Theory (PMT) framework, this study examined whether colon cancer is a meaningful source of exercise motivation. Participants were (N = 173) teaching and school staff randomly assigned into one of three treatment conditions: PMT present, PMT absent (attention control) and no information (non-contact control). Two separate DVD videos were developed (one incorporating the four major components of PMT; perceived vulnerability (PV), perceived severity (PS), response efficacy (RE) and self-efficacy (SE) featured colon cancer and exercise information while the other DVDs featured cancer and nutritional information). Following treatment, participants completed questionnaires which assessed their beliefs towards colon cancer and exercise as well as their intentions to do more exercise. Two weeks later (T1), self-reported measures of exercise behaviour were assessed and then repeated at 1 month (T2). Only physically inactive participants were used in subsequent analyses (n = 72). Results indicated that compared to the two control groups, the PMT present group scored significantly higher on RE and intention to engage in more exercise (p-values = 0.001). A trend effect in the expected direction also was noted for T1 exercise behaviour (p = 0.09). RE, SE and PV made significant and unique contributions to exercise intention scores, explaining 44% of the response variance. Intention was the only variable to show an association with T1 exercise behaviour, explaining 10% of the response variance. Overall, these findings suggest that a single exposure of media intervention grounded in theory can influence people's beliefs, motivation and initial behaviour. [ABSTRACT FROM AUTHOR]

This study assessed the unique associations of risk perceptions and worry with attitudes about genetic testing for breast cancer susceptibility. Women (general practitioner clinic attenders, university students, and first-degree relatives of breast cancer survivors; N=303) read information about genetic testing and completed measures assessing perceived cancer risk, cancer worry, and genetic testing attitudes and beliefs. Worry was associated with greater interest in genetic testing, stronger beliefs that testing has detrimental emotional consequences, and positive beliefs about benefits of testing and risk-reducing surgeries. Perceived risk was unrelated to interest and associated with more skeptical beliefs about emotional consequences and benefits of testing and risk-reducing surgeries. At low worry levels, testing interest increased with more positive beliefs about testing benefits; at high worry levels, interest was high regardless of benefits beliefs. The findings support Leventhal's Common-Sense Model of self-regulation delineating interactive influences of risk-related cognitions and emotions on information processing and behavior. [ABSTRACT FROM AUTHOR]

We examined symptom experiences, symptom attributions, and causal attributions reported by patients hospitalized for a first-time myocardial infarction (MI). We also explored the roles of symptoms, negative affect, and risk factors in promoting stress and other causal attributions. Patients (N = 65) completed measures of symptom experiences and attributions, perceived causes of their MI, state and trait negative affect, and risk factors. Patients attributed most of their symptoms to the heart condition, although rates varied from 48% (headaches) to 97% (nausea). The most common causal attribution was stress, followed by high cholesterol, heredity, fat consumption, and hypertension. Stress attributions were positively associated with state anxiety and specific, stress-related symptoms (e.g., fatigue and breathlessness). Anxious mood and stress-related symptoms appear to enhance the plausibility of stress as a cause of MI. Risk factors were moderately correlated with associated causal attributions. For many patients, however, attributions to hypertension, cholesterol, and family history of heart disease were discordant with their clinical data. Causal attributions remained stable over the subsequent 6 months. [ABSTRACT FROM AUTHOR]

This study evaluated whether trait negative affectivity (NA) moderates the effects of an illness perceptions-based education programme on worry, disability and health behaviours following a first-time myocardial infarction (MI). The intervention targeted problem-focused regulation with minimal attention to emotion-focused regulation. The hospitalized MI patients (n = 65) completed measures of NA, heart attack worry and exercise, and they were randomized to a three-session intervention condition or standard care condition. Worry was assessed at hospital discharge, and disability, dietary fat intake and exercise were assessed 3 months and 6 months later. Cardiac rehabilitation attendance was recorded by the staff. Regression analyses revealed NA x condition interaction effects indicating that the intervention (relative to standard care) led to: (1) reduced worry only for patients with higher NA levels; (2) higher cardiac rehabilitation attendance and lower disability after three months, but only for patients with lower NA levels; and (3) lower exercise rates and higher dietary fat intake after six months for patients with higher NA levels. This intervention may benefit low NA patients, but it may have negligible or detrimental effects on disability and health behaviours for high NA patients. [ABSTRACT FROM AUTHOR]

Research testifies that images of tobacco use in popular films are highly pervasive and typically glamorised. There are concerns that these images may promote motivations to smoke in adolescents, but little is known about how these images are interpreted by members of this age group. A qualitative study was conducted to explore how older teenagers interpret and decode smoking imagery in film. This study builds on earlier work with a younger age group (12 and 13 years) to explore how various interpretations of smoking imagery shape and support common understandings about smoking among older teenagers.Data were collected through focus groups. Eighty-eight 16 and 17 year old students were interviewed at school. Participants discussed their recollections of and responses to recently viewed films. Older teens were receptive to smoking imagery when it was used in a credible manner to portray an emotional state, sub-culture affiliation, and lifestyle. Experience as a smoker appeared to inflate the credibility of realistic smoking images, particularly those presented in gritty realism/drama film. Older teens perceived realistic images, as opposed to stereotypical images, as a salient reference to their own lives. Stereotypical images were also readily recalled and appeared to perform an important role in supporting misconceptions about smoking and contributing to popular ideologies about tobacco use. Stereotypical images presented in comedy and action genre also serve to present paradoxical and contradictory messages about tobacco use. In particular, participants recalled tobacco use in film as associated with stress and anxiety, drug use, and seduction. Film images of tobacco use in specific contexts appear to hold specific and significant meanings for older teens. Realistic images offered salient representations of the perceived reality of smoking for this group. Pervasive and credible smoking scenes in film may offer support and reassurance to older teens who currently smoke or hold ambivalent views about smoking. Consistent with younger adolescents, older teens presented a predominantly nonchalant response to smoking imagery in film, which is a powerful indicator of the pervasiveness and acceptability of smoking in general. In contrast with younger adolescent, older teens tend to draw upon their own experience with tobacco use when interpreting smoking images in film. [ABSTRACT FROM AUTHOR]

The current study tested contextual features (product design, imagery, and use) of e-cigarette advertisements on responses to the mandated U.S. FDA addiction text warning. In a within-subjects experimental design, young adults (aged 18-24) living in California were categorized into those who use e-cigarettes ( n = 149), use cigarettes ( n = 66), and dual use ( n = 204). They provided affective and cognitive responses to the addiction warning and e-cigarette products in advertisements. Cognitive and affective responses overall were moderately strong, and this pattern was generally consistent across product design and imagery. Those who use cigarettes (versus dual use) reported stronger feelings that they learned new information and lower perceptions that e-cigarettes help reduce cigarette consumption. Those who smoke also reported greater worry, discouragement, and perceived health benefits associated with e-cigarettes and lower perception of harmfulness of e-cigarettes than those who dual use, and evaluated the warning lowest on eliciting encouragement to use and feeling e-cigarettes are a healthy alternative to smoking. Few differences emerged between those who use e-cigarettes and dual use or smoke. The varied response patterns by the use group underline the regulatory challenges of developing strong e-cigarette warnings to deter e-cigarette use.

Objective: We outline the development of a narrative intervention guided by the Common-Sense Model of Self-Regulation (CSM) to promote Human Papillomavirus (HPV) vaccination in a diverse college population., Methods: We adapted the Obesity-Related Behavioral Intervention Trials (ORBIT) model to guide the development, evaluation, and refinement of a CSM-guided narrative video. First, content experts developed a video script containing information on HPV, HPV vaccines, and HPV-related cancers. The script and video contents were evaluated and refined, in succession, utilizing the think-aloud method, open-ended questions, and a brief survey during one-on-one interviews with university students., Results: Script and video content analyses led to significant revisions that enhanced quality, informativeness, and relevance to the participants. We highlight the critical issues that were revealed and revised in the iterative process., Conclusions: We developed and refined a CSM guided narrative video for diverse university students. This framework serves as a guide for developing health communication interventions for other populations and health behaviors., Innovation: This project is the first to apply the ORBIT framework to HPV vaccination and describe a process to develop, evaluate, and refine comparable CSM guided narrative interventions that are tailored to specific audiences., Competing Interests: 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. S.F.P. is funded by The Ruth L. Kirschstein NRSA Institution Research Training Grant (T32; 5T32CA251064-03) in Cancer Training in Disparities and Equity (C-TIDE)., (© 2024 The Authors.)

Objective: To understand the extent to which people who smoke, people who vape and nonsmokers would switch between smoking cigarettes and vaping in response to policies (price increases, restrictions on nicotine, places, and information on addictiveness and/or health risks) aimed at decreasing tobacco use by people who smoke and vaping by nonsmokers., Design: A total of 525 adults aged 18 to 88 years completed a discrete choice survey of 16 choices between two smoking/vaping alternatives. Analysis was conducted using conditional logistic regression for the entire sample and stratified by nonsmokers, people who smoke, and people who vape., Results: The results suggest that most people who vape also smoke. Nonsmokers were more favorable to vaping and were concerned about long-term health risks and cost associated with vaping. Marginal analysis suggests that price increases will have only modest success in moving people who smoke to start vaping or encouraging people who vape to vape rather than use cigarettes. Nonsmokers are not very sensitive to price changes but are sensitive to information about health impacts., Conclusions: Findings indicate that increasing the price of cigarettes would lead to a limited increase in the probability of people who smoke switch to vaping. The study advances our understanding of the views of current nonsmokers toward cigarettes and vaping, suggesting that price increases and increased knowledge of addiction would likely deter nonsmokers from vaping. Changing the amount of nicotine associated with smoking would increase the probability of vaping slightly and have little impact on nonsmokers or vaping preferences, but the most significant change would come from increasing the perceptions of the risk of smoking., (© 2023. The Author(s).)

Whether to undergo genome sequencing in a clinical or research context is generally a voluntary choice. Individuals are often motivated to learn genomic information even when clinical utility-the possibility that the test could inform medical recommendations or health outcomes-is low or absent. Motivations to seek one's genomic information can be cognitive, affective, social, or mixed (e.g., cognitive and affective) in nature. These motivations are based on the perceived value of the information, specifically, its clinical utility and personal utility. We suggest that motivations to learn genomic information are no different from motivations to learn other types of personal information, including one's health status and disease risk. Here, we review behavioral science relevant to motivations that may drive engagement with genome sequencing, both in the presence of varying degrees of clinical utility and in the absence of clinical utility. Specifically, we elucidate 10 motivations that are expected to underlie decisions to undergo genome sequencing. Recognizing these motivations to learn genomic information will guide future research and ultimately help clinicians to facilitate informed decision making among individuals as genome sequencing becomes increasingly available., (© 2023 The Authors. Clinical Genetics published by John Wiley & Sons Ltd.)

Background: A variety of intervention strategies to improve Human Papillomavirus (HPV) vaccination rates in adults exist; however, they have shown varying efficacy and inconsistent outcomes., Purpose: This meta-analysis tested the efficacy of HPV vaccination interventions for adults in increasing vaccine intentions, rates of initiation of the vaccine series, and completion rates. The study also tested potential moderators (intervention strategy, theory-based versus nontheory-based interventions, race/ethnicity, gender, study quality) of relationships between intervention receipt and vaccine intentions., Method: Electronic databases (PsychINFO, Web of Science, Scopus, EBSCO, JSTOR, PubMed) were searched for English-language articles published up to September 2021. Eligible studies included outcomes of vaccine intentions, receipt of the first dose, or vaccine series completion and included intervention and comparison conditions., Results: The search yielded 38 eligible studies reporting 78 effect sizes. Random effects, multilevel, meta-analytic models revealed a significant, small effect of interventions on vaccine intentions (OR = 0.36, 95% CI [0.07, 0.65]); a nonsignificant effect on vaccine initiation rates (OR = 1.29; 95% CI [0.87, 1.91]); and significant effects on vaccine completion rates (OR = 1.58, 95% CI [1.18, 2.11]). Race/ethnicity, gender, intervention strategy, theory-based interventions, and study quality did not moderate the intervention effects on vaccine intentions., Conclusion: Evidence supports the efficacy of interventions to increase intentions to receive the HPV vaccine and completion of the HPV vaccine series in adults. However, evidence did not support the efficacy of interventions to increase HPV vaccine initiation. Findings highlight directions for developing more efficacious HPV vaccine interventions for adults., (© Society of Behavioral Medicine 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Rationale: Mitigating the spread of COVID-19 requires that people understand the need for and engage in protective behaviors. Given the complexity and rapid progression of media information about the pandemic, health literacy could be essential to acquiring the accurate beliefs, concern for societal risks, and appreciation of restrictive policies needed to motivate these behaviors. Yet with the increasingly politicized nature of COVID-related issues in the United States, health literacy could be an asset for those with more liberal views but less so for those with more conservative views., Objective: This study tested a hypothesized model proposing that political views moderate the associations of health literacy with COVID-19 protective behaviors as well as the mediational roles of accurate and inaccurate COVID-19 beliefs, concern for society, and governmental control attitudes., Methods: We surveyed residents in three diverse regions of California in June 2020 (N = 669) and February 2021 (N = 611). Participants completed measures of health literacy, political views, and COVID-19 beliefs and behaviors., Results: Moderated mediational analyses largely supported the proposed model with both samples. Health literacy was associated with more accurate COVID-19 beliefs, less inaccurate COVID-19 beliefs, greater concern for societal risks, more positive attitudes regarding restrictive government control, more protective behavior, less risky behavior, and stronger vaccine intentions; beliefs, concern for society, and governmental control attitudes mediated the health literacy-behavior relationships. As predicted, however, these associations of health literacy with adaptive beliefs, attitudes, and behaviors varied according to political views. The direct and mediated relationships were held for participants with more liberal views and, to a lesser extent, for those with moderate views, but they were weaker or absent for participants with more conservative views., Conclusions: These findings contribute new evidence of processes linking health literacy with adaptive beliefs, attitudes, and behaviors and how social and political contexts can shape those processes., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Rates of Type 1 diabetes are rising, and diabetes management often deteriorates during adolescence. Adolescent disclosure to parents is a key factor for effective diabetes management, and parent affective responses to disclosures affect the timing of future disclosures in healthy populations, but no studies to our knowledge have examined parent affective behaviors that facilitate or inhibit disclosure in the context of managing Type 1 diabetes. The present study examined how observed parental affective responses to adolescent disclosures predict the timing of subsequent disclosures during a discussion task in a sample of adolescents with Type 1 diabetes and their parents ( N = 66 dyads). Generalized linear mixed models were used to test whether increased or decreased levels of parent affect relative to their emotional baseline response to adolescent disclosures predicted the timing of subsequent disclosures. Adolescents took longer to disclose again when parents responded to prior adolescent disclosures with higher levels of anger and of positive affect relative to their baseline levels of these emotions. Findings suggest that parental affective responses to disclosures have implications for adolescent disclosure in the context of chronic illness management. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objectives: Based on the common-sense model of self-regulation, this study aimed to explicate the mechanism underlying the effect of illness representations on self-care behaviours and anxiety symptoms among patients with type 2 diabetes., Methods: A telephone survey was administered to 473 patients in Hong Kong. Structural equation modelling was used to test if threat and control perceptions regarding diabetes would be associated with self-reported self-care behaviours and anxiety symptoms through adoption of adaptive/maladaptive coping strategies and diabetes-related self-efficacy., Results: Control perceptions but not threat perceptions were positively associated with self-care behaviours. Control perceptions had a positive indirect association with self-care behaviours through more problem-focused coping and diabetes-related self-efficacy. Threat perceptions simultaneously had a positive indirect association through more problem-focused coping and a negative indirect association through more avoidant coping and lower diabetes-related self-efficacy. In contrast, threat and control perceptions were positively and negatively, respectively, associated with anxiety symptoms. Problem-focused and avoidant coping consistently mediated the indirect association between threat perceptions and anxiety symptoms., Conclusion: Threat and control perceptions were associated with diabetes self-care behaviours and anxiety symptoms through different self-regulation pathways., Practice Implications: Our findings inform possible targets for self-management interventions to simultaneously enhance self-care behaviours and alleviate diabetes-associated anxiety., Competing Interests: Declarations of interest None., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Evidence supports the use of graphic warnings to educate the public about the health harms of smoking and suggests warnings eliciting negative emotional responses may be more effective. This study aimed to replicate a preliminary theory-based model whereby perceived new knowledge promotes discouragement from smoking through its impact on worry about smoking with a different sample and using a new set of cigarette graphic warnings. We explored if the pattern extended to encouragement to use e-cigarettes, and if age and user group moderated the indirect effects of these models. Exclusive smokers, dual/e-cigarette users and nonusers (N = 412) evaluated graphic cigarette warnings on perceived new knowledge and worry about health harms of smoking, discouragement to smoke, and encouragement to use e-cigarettes. Perceived new knowledge was both directly and indirectly associated with discouragement to smoke through worry about health harms of smoking, and did not vary as a function of age or user group. In contrast, perceived new knowledge was not directly or indirectly associated with encouragement to use e-cigarettes, and this pattern largely did not vary as a function of age or user group. Graphic cigarette warnings that enhance knowledge may discourage smoking both directly and indirectly through worry elicited by them, and may have less impact on encouraging e-cigarette use. These findings replicate prior work and generalize to different user groups and new warnings planned for implementation in the U.S., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Marijuana use among pregnant and breastfeeding women is on the rise and carries risks for infant health and well-being. Decisions to use marijuana while pregnant and breastfeeding are motivated by beliefs that use poses minimal risk to infants and offers benefits to maternal users. Misperceptions and usage trend higher among disadvantaged populations. This study surveyed 401 community residents on beliefs about risks and benefits of marijuana use by pregnant and breastfeeding women. The study utilized techniques to enhance recruitment of Latino and disadvantaged residents of rural communities in California, a state where recreational marijuana use is legal. Analyses revealed substantial endorsement of beliefs about benefits and low risks of marijuana use while pregnant and breastfeeding, many of which run counter to current evidence. Misperceptions were particularly prevalent for cannabis users and male respondents. Trends in valid beliefs, while modest, were higher for Latinos and parents., (© 2022. The Author(s).)

Climate change poses a multifaceted, complex, and existential threat to human health and well-being, but efforts to communicate these threats to the public lag behind what we know how to do in communication research. Effective communication about climate change's health risks can improve a wide variety of individual and population health-related outcomes by: (1) helping people better make the connection between climate change and health risks and (2) empowering them to act on that newfound knowledge and understanding. The aim of this manuscript is to highlight communication methods that have received empirical support for improving knowledge uptake and/or driving higher-quality decision making and healthier behaviors and to recommend how to apply them at the intersection of climate change and health. This expert consensus about effective communication methods can be used by healthcare professionals, decision makers, governments, the general public, and other stakeholders including sectors outside of health. In particular, we argue for the use of 11 theory-based, evidence-supported communication strategies and practices. These methods range from leveraging social networks to making careful choices about the use of language, narratives, emotions, visual images, and statistics. Message testing with appropriate groups is also key. When implemented properly, these approaches are likely to improve the outcomes of climate change and health communication efforts., (© Society of Behavioral Medicine 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: (1) Test whether a mental imagery-based self-regulation intervention increases physical activity behaviour over 90 days; (2) Examine cognitive and affective precursors of change in physical activity behaviour., Design: A randomized control trial with participants (N = 500) randomized to one of six intervention conditions in a 3 (risk communication format: bulleted list, table, risk ladder) x 2 (mental imagery behaviour: physical activity, active control [sleep hygiene]) factorial design., Methods: After receiving personalized risk estimates via a website on a smartphone, participants listened to an audiorecording that guided them through a mental imagery activity related to improving physical activity (intervention group) or sleep hygiene behaviour (active control). Participants received text message reminders to complete the imagery for 3 weeks post-intervention, 4 weekly text surveys to assess behaviour and its cognitive and affective precursors, and a mailed survey 90 days post-baseline., Results: Physical activity increased over 90 days by 19.5 more minutes per week (95%CI: 2.0, 37.1) in the physical activity than the active control condition. This effect was driven by participants in the risk ladder condition, who exercised 54.8 more minutes (95%CI 15.6, 94.0) in the physical activity condition than participants in the active control sleep hygiene group. Goal planning positively predicted physical activity behaviour (b = 12.2 minutes per week, p = 0.002), but self-efficacy, image clarity, and affective attitudes towards behaviours did not (p > 0.05)., Conclusions: Mental imagery-based self-regulation interventions can increase physical activity behaviour, particularly when supported by personalized disease risk information presented in an easy-to-understand format., (© 2021 The British Psychological Society.)

The desire to engage in waterpipe tobacco smoking (WTS) may occur when smokers and nonsmokers conjure positive mental simulations of WTS. However, effects of these simulations on desire to smoke waterpipe tobacco and potential mediators are unexplored. This research addressed these effects among young adult waterpipe tobacco smokers and nonsmokers. Two online studies were conducted with adults ages 18-30. In Study 1, 200 smokers, 190 susceptible nonsmokers, and 182 nonsusceptible nonsmokers were randomized to mentally simulate or not WTS in the future. In Study 2, 234 smokers and 241 susceptible nonsmokers were randomized to four arms: no simulation or simulations that varied valence of experience (positive, negative or no valence provided). Main outcomes were immediate desire to smoke waterpipe tobacco, cognitive and affective attitudes, and perceived harms. In Study 1, mental simulations increased the desire to smoke waterpipe tobacco among smokers. In Study 2, asking participants to simulate WTS positively or with no valence instruction increased desire to smoke relative to negative valence instruction or no simulation. Negative simulations reduced perceived probability of smoking within a month compared to positive simulations. Effects on desire to engage in WTS were mediated by cognitive and affective attitudes among susceptible nonsmokers and by cognitive attitudes among smokers. These findings suggest that exploring when and how often mental simulations about WTS are evoked and their potency for promoting prevention and cessation of WTS merit further attention., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Managers and customers often expect individuals to be "ideal workers" devoted entirely to work, and this devotion is typically displayed through being available to work at any time, on any day (Reid, 2015). During the COVID-19 pandemic, many individuals in lower-paid, customer-facing jobs were expected to not only be available but also to take on physical risk. However, the ideal worker literature has paid relatively little attention to how risk relates to ideal worker expectations, reflecting in part the extant literature's focus on professionals who face relatively little physical and financial uncertainty. In this article, we draw upon the experiences of nonprofessional "gig" workers (TaskRabbit workers) to examine how they manage customers' ideal worker expectations-including risk-using data from interviews (n = 49), postings from online worker forums social media, and offical company communications. We show how these workers engage in different tactics to manage risk in response to customers' expectations, including two tactics-covering and withdrawing-that have not been discussed in prior ideal worker literature. In doing so, we expand scholarly understanding by showing how concerns about risk shape workers' responses to ideal worker expectations, particularly in customer-facing service work outside of traditional organizations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background: In August 2019, the U.S. Food and Drug Administration proposed a set of 13 new graphic warnings for cigarette packaging and advertisements., Purpose: We evaluated these warnings relative to text-only equivalents for their ability to educate the public regarding harms of smoking and influence outcomes associated with quitting., Methods: In an experimental within-subjects design, U.S. adult nonsmokers, smokers, and dual smoker/electronic cigarette (e-cigarette) users (N = 412) recruited from an online internet platform evaluated the newly proposed graphic warnings and corresponding text-only warnings on understandability, perceived new knowledge, worry elicited about the content of the warning, discouragement from smoking, and encouragement to use e-cigarettes., Results: Graphic warnings were generally rated as providing better understanding, more new knowledge, eliciting more worry about harms of smoking, and providing more discouragement from smoking relative to text-only warnings., Conclusions: The newly proposed graphic warnings could influence important responses to warnings associated with motivation to reduce smoking., (© Society of Behavioral Medicine 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Personalized medicine may increase the amount of probabilistic information patients encounter. Little guidance exists about communicating risk for multiple diseases simultaneously or about communicating how changes in risk factors affect risk (hereafter "risk reduction")., Purpose: To determine how to communicate personalized risk and risk reduction information for up to 5 diseases associated with insufficient physical activity in a way laypeople can understand and that increases intentions., Methods: We recruited 500 participants with <150 min weekly of physical activity from community settings. Participants completed risk assessments for diabetes, heart disease, stroke, colon cancer, and breast cancer (women only) on a smartphone. Then, they were randomly assigned to view personalized risk and risk reduction information organized as a bulleted list, a simplified table, or a specialized vertical bar graph ("risk ladder"). Last, they completed a questionnaire assessing outcomes. Personalized risk and risk reduction information was presented as categories (e.g., "very low"). Our analytic sample ( N = 372) included 41.3% individuals from underrepresented racial/ethnic backgrounds, 15.9% with vocational-technical training or less, 84.7% women, 43.8% aged 50 to 64 y, and 71.8% who were overweight/obese., Results: Analyses of covariance with post hoc comparisons showed that the risk ladder elicited higher gist comprehension than the bulleted list ( P = 0.01). There were no significant main effects on verbatim comprehension or physical activity intentions and no moderation by sex, race/ethnicity, education, numeracy, or graph literacy ( P > 0.05). Sequential mediation analyses revealed a small beneficial indirect effect of risk ladder versus list on intentions through gist comprehension and then through perceived risk ( b IndirectEffect = 0.02, 95% confidence interval: 0.00, 0.04)., Conclusion: Risk ladders can communicate the gist meaning of multiple pieces of risk information to individuals from many sociodemographic backgrounds and with varying levels of facility with numbers and graphs.

Objective: Suboptimal self-care by individuals with diabetes mellitus (DM) is a significant public health concern. The common-sense model (CSM) proposes that illness representations are associated with coping and health outcomes across various conditions. The present study examined the efficacy of a CSM-based intervention in improving illness representations, self-care, self-care self-efficacy, use of adaptive coping strategies, and glycated hemoglobin among individuals with type 2 DM (T2DM)., Methods: A two-arm randomized controlled trial was used. A total of 455 T2DM patients were recruited from an outpatient DM clinic and randomized to an intervention group that consisted of five weekly group-based education sessions or a control group that received five weekly educational booklets. Evaluation was conducted at baseline and at 1- and 6-month follow-up., Results: The 2 × 3 linear mixed-model analysis using a modified intention to treat revealed a significant time by condition interaction effect on level of self-care (F(2,840) = 7.78, p < .001), self-care self-efficacy (F(1.89,794.57) = 14.40, p < .001), and use of adaptive coping strategies (F(1.94,812.93) = 4.75, p = .010) in which participants in the intervention group reported greater improvement in such aspects compared with those in the control group. A significant time effect was observed in some dimensions of illness representations. No significant effect was found in glycated hemoglobin. Participants reported positive feedback to the intervention and perceived improvement in various domains., Conclusions: The CSM-based intervention was effective in improving self-care and coping among DM patients. The intervention also demonstrated high feasibility and acceptability. Findings provided important insights in improving health-related outcomes for patients with T2DM using the CSM framework., (Copyright © 2020 by the American Psychosomatic Society.)

Objective: Appetitive risk behaviors (ARB), including tobacco use, alcohol consumption, consumption of calorie dense/nutrient-poor foods, and sexual risk behavior contribute substantially to morbidity and mortality. Affective states that arise from a wide array of unrelated circumstances (i.e., incidental affect) may carry over to influence ARB. A meta-analysis is needed to systematically examine causal evidence for the role of incidental affect (including specific emotions) in influencing ARB. Method: Integrating effect sizes from 91 published and unpublished experimental studies that include both an incidental-affect induction and neutral-control condition ( k = 271 effect sizes: k = 183 negative affect, k = 78 positive affect), this meta-analysis examines how negative and positive affective states influenced ARB and related health cognitions (e.g., intentions, evaluations, craving, perceived control). Results: Negative affective states reliably increased ARB, in analyses where all negative affective states were analyzed ( d = .29) and in stratified analyses of just negative mood ( d = .30) and stress ( d = .48). These effects were stronger among study populations coded as clinically at risk. Positive affective states generally did not influence ARB or related health cognitions, except in the presence of a craving cue. Design issues of extant literature largely precluded conclusions about the effects of specific positive and negative affective states. Conclusion: Taken together, findings suggest the importance of strategies to attenuate negative affect incidental to ARB to facilitate healthier behavioral patterns, especially among clinically at-risk individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Risk perception is an important construct in many health behavior theories. Smoking risk perceptions are thoughts and feelings about the harms associated with cigarette smoking. Wide variation in the terminology, definition, and assessment of this construct makes it difficult to draw conclusions about the associations of risk perceptions with smoking behaviors. To understand optimal methods of assessing adults' cigarette smoking risk perceptions (among both smokers and nonsmokers), we reviewed best practices from the tobacco control literature, and where gaps were identified, we looked more broadly to the research on risk perceptions in other health domains. Based on this review, we suggest assessments of risk perceptions (1) about multiple smoking-related health harms, (2) about harms over a specific timeframe, and (3) for the person affected by the harm. For the measurement of perceived likelihood in particular (ie, the perceived chance of harm from smoking based largely on deliberative thought), we suggest including (4) unconditional and conditional items (stipulating smoking behavior) and (5) absolute and comparative items and including (6) comparisons to specific populations through (7) direct and indirect assessments. We also suggest including (8) experiential (ostensibly automatic, somatic perceptions of vulnerability to a harm) and affective (emotional reactions to a potential harm) risk perception items. We also offer suggestions for (9) response options and (10) the assessment of risk perception at multiple time points. Researchers can use this resource to inform the selection, use, and future development of smoking risk perception measures., Implications: Incorporating the measurement suggestions for cigarette smoking risk perceptions that are presented will help researchers select items most appropriate for their research questions and will contribute to greater consistency in the assessment of smoking risk perceptions among adults., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

Emergency responders (police, fire, ambulance and defence force personnel) risk exposure to dangerous and traumatic events, and the possible subsequent development of post-traumatic stress disorder. Consequently, partners of these emergency responders risk developing secondary traumatic stress (STS) from vicarious exposure to the trauma through communication and engagement with their responders. A mixed-methods study of the partners of emergency responders in New Zealand examined the extent of such partner-associated STS. This article focuses on two research questions: to what extent were risk factors for STS identified within that population, and what did the participants believe may help them to mitigate the impact of STS. An online anonymous survey was developed and eligible participants completed a 17-item STS scale, a social support measure, and answered several open-ended questions. Of the 646 participants, twenty percent appear to be experiencing intrusion, arousal, and avoidance symptoms related to the trauma experienced by their responder. Almost half stated they have little or no emotional/informational support related to their responder's work. Thematic analysis of free-text responses identified the need for additional support and more direct communication/engagement from the organisations for partners to navigate their experiences of STS and the level of social support received and required. The authors conclude with recommendations to emergency responder organisations.

Greater habitual emotional suppression (ES)-assessed by the suppression subscale of the emotion regulation questionnaire (ERQ-ES; Gross & John, 2003) and the Courtauld emotion control scale (CECS; Watson & Greer, 1983)-is associated with a range of negative outcomes, which are assumed to arise because habitual ES measures capture the tendency to use ES in response to emotions. The current studies directly test whether habitual ES measures actually capture the response-focused use of ES when emotions arise within social interactions. We conduct these validation tests by integrating measures of habitual ES with naturalistic assessments of negative emotions and the situational use of ES during emotionally relevant interactions with romantic partners (Study 1, N = 200; Study 3, N = 170) and social interactions with close others in daily life (Study 2, N = 430). Greater ERQ-ES and CECS scores predicted greater average levels of situational ES, but only greater scores on the ERQ-ES consistently predicted greater situational ES in response to negative emotions, including greater situational ES for people who experienced more negative emotions than others and when people experienced greater negative emotions than their own average. These results support that the ERQ-ES captures a response-focused pattern of situational ES that is sensitive to varying negative emotions within specific interactions. The CECS may capture a more pervasive, consistent use of ES across situations. Our novel tests offer an important framework for how to validate emotion regulation assessments to advance both theory and methodology. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

An expanded Common-Sense Model (CSM) contextualised to the self-regulation of cancer recurrence risk identifies risk representational attributes and recurrence worry as primary processes motivating protective behaviours in cancer survivors. A systematic review examined evidence for CSM hypotheses regarding how these processes influence diet and physical activity (PA) among survivors. A research agenda is outlined and used to evaluate the evidence base. Common databases were searched for eligible, peer-reviewed, English language reports, yielding 18 studies quantitatively testing hypothesised relationships among representations of prior cancer, recurrence risk representations, recurrence worry, and diet and PA. The findings provide promising, but mixed and limited evidence for some of the hypothesised associations of specific risk recurrence attributes with recurrence worry, and risk recurrence attributes and recurrence worry with diet and PA. Findings support the distinction of recurrence risk representations and illness representations of the prior cancer, with each showing different relationships with recurrence worry and behaviours. We discuss the status of the evidence base in relation to assessment, design, and analysis priorities and propose strategies that can yield more sensitive, rigorous tests of the CSM for cancer recurrence risk as applied to diet and PA.

Conceptual frameworks are useful in research because they can highlight priority research domains, inform decisions about interventions, identify outcomes and factors to measure, and display how factors might relate to each other to generate and test hypotheses. Discovery, translational, and implementation research are all critical to the overall mission of genomic medicine and prevention, but they have yet to be organized into a unified conceptual framework. To fill this gap, our diverse team collaborated to develop the Genomic Medicine Integrative Research (GMIR) Framework, a simple but comprehensive tool to aid the genomics community in developing research questions, strategies, and measures and in integrating genomic medicine and prevention into clinical practice. Here we present the GMIR Framework and its development, along with examples of its use for research development, demonstrating how we applied it to select and harmonize measures for use across diverse genomic medicine implementation projects. Researchers can utilize the GMIR Framework for their own research, collaborative investigations, and clinical implementation efforts; clinicians can use it to establish and evaluate programs; and all stakeholders can use it to help allocate resources and make sure that the full complexity of etiology is included in research and program design, development, and evaluation., (Copyright © 2019 American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.)

Widespread messages use metaphoric language and imagery to prompt recipients to interpret health-related concepts in terms of dissimilar, familiar concepts (e.g., " fight the war on cancer"). When do these messages work? According to Conceptual Metaphor Theory, thinking metaphorically involves looking past concepts' superficial differences to identify their similarities at a structural level. Thus, we hypothesized that when people's general construal mindset is oriented to focus on information's abstract meaning, not its concrete details, they would process a metaphor's target health concept in ways that correspond to the dissimilar concept. Accordingly, after priming an abstract, but not concrete, construal mindset: framing sun exposure as enemy confrontation (vs. literally) increased cancer risk perceptions and sun-safe intentions (Study 1; N =186); and framing smoking cessation as an arduous journey (vs. literally) increased appreciation of quitting difficulties and interest in cessation tools (Study 2; N =244). We discuss practical and theoretical implications for improving health communication.

Background: Parents can influence their children's use of marijuana and other substances through targeted parent-child discussions. Little is known about what factors motivate parents' decisions to discuss marijuana use with their children., Purpose: Guided by an elaborated prototype-willingness model, we tested hypotheses that: (a) parental perceived risk of harms and negative prototypes of youth who use marijuana positively predict worry about their child using marijuana; (b) higher perceived risk and worry predict higher intentions to discuss marijuana use with one's child; (c) negative prototypes and worry positively predict willingness to have discussions; and (d) higher intentions and willingness predicts having discussions., Method: We administered a longitudinal survey to 499 American parents of youth ages 10 to 17 assessing risk perceptions, prototypes, worry, discussion intentions, and willingness. One month later, 409 participants completed another survey assessing whether they had discussed marijuana use with their child., Results: At follow-up, 40% of participants reported having marijuana use discussions in the previous month. Structural-equation modeling revealed that perceived risks and negative prototypes positively predicted worry about their child using marijuana. Worry positively predicted intentions and willingness to discuss marijuana use with children. Worry mediated the relationship between perceived risks and intentions, but not the relationship between prototypes and willingness. Intentions positively predicted likelihood of marijuana use discussions, whereas willingness did not., Conclusions: These findings support most predictions of the adapted model and identify cognitive and affective factors that could be targeted in health communications promoting parental discussions of marijuana use with children.

The way emotions are expressed during relationship conflict should play an important role in facilitating conflict resolution, but the risk of rejection that conflict poses may promote expressive suppression, which could impede conflict resolution. In the current research, the authors applied a risk regulation perspective to understand when expressive suppression will occur during conflict. They predicted that (a) perceiving lower regard from the partner during conflict would predict greater expressive suppression, and (b) greater expressive suppression would undermine conflict resolution. In Study 1, individuals engaged in a conflict discussion with their romantic partner ( N = 180 couples) and then reported the degree to which they felt regarded by their partner and generated a solution to the conflict during the discussion. Independent coders rated how much individuals attempted to suppress their emotional expressions during the conflict. In Study 2, individuals reported on their relationship conflict, perceived regard, expressive suppression, and conflict resolution every day across a 3-week period ( N = 73 couples). In both studies, perceiving lower positive regard during conflict was associated with greater expressive suppression. Greater expressive suppression was, in turn, associated with lower conflict resolution. These associations were not due to greater stress/upset or negative emotions, greater withdrawal, greater attachment insecurity, or lower positive regard for the partner. These within-situation associations suggest that expressive suppression may often arise to bypass the risk of rejection that occurs when people feel less positively regarded by their partner, but expressive suppression may also put relationships at further risk by undermining conflict resolution. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Emotional suppression and expression both occur frequently in daily social interactions, yet research examining these emotion regulation processes simultaneously in naturalistic contexts remains limited. Although theory and research tend to reflect an implicit assumption that suppression and expression represent opposite sides of the same construct, they are likely to occur independently and exert different influences on intrapersonal and interpersonal experiences. In 4 experience-sampling and longitudinal studies, we assessed the personal and interpersonal consequences of daily emotional suppression and expression within romantic and close relationships. Mixed-model analyses revealed that suppression and expression consistently predicted independent and distinct outcomes across the studies. When individuals suppressed their emotions, they experienced more intrapersonal costs such as greater depressed mood, greater fatigue, lower self-esteem, and lower life satisfaction. Interpersonally, they also felt less acceptance from others, more distancing by others, and less relationship satisfaction. Greater suppression in daily life also predicted increases in depressive symptoms and reductions in relationship satisfaction 3 months later. In contrast, when individuals were more emotionally expressive during daily interactions, they experienced interpersonal benefits such as greater acceptance from others, greater relatedness and relationship satisfaction, and less distancing by others. Greater emotional expression in daily life also predicted increases in self-esteem and relationship satisfaction across time. Meta-analyses of the 4 studies confirmed the reliability and significance of these relationships; |r's| = .12-.33. These studies demonstrate that suppression and expression are distinct processes used to manage emotions within social relationships and operate differently in shaping personal well-being and relationship functioning. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Objective: To report on the cost-effectiveness of BRECONDA (Breast RECONstruction Decision Aid), a web-based decision aid to facilitate decisions regarding breast reconstruction surgery, with usual care for women with breast cancer., Methods: The economic evaluation was conducted alongside a randomized controlled trial. Women diagnosed with breast cancer or ductal carcinoma in situ and eligible for breast reconstruction following mastectomy were randomized to access BRECONDA for 6 months + usual care (n = 106) or usual care (n = 116) and were assessed at baseline preintervention, and then 1-month and 6-months post-randomization. Decisional conflict, satisfaction with information, decisional regret, and utilities were assessed by using maximum-likelihood linear mixed effects models. Costs included the fixed costs of BRECONDA, health care provider time, and health care resource use. Nonparametric bootstrapping was used to estimate incremental cost-effectiveness ratios., Results: BRECONDA resulted in significantly less decisional conflict and greater satisfaction with information over time. Quality-adjusted life years did not differ between participants who received the decision aid compared with usual care. The cost of BRECONDA was estimated to be small (AUD$10) relative to other health care interventions and resulted in decreased health care costs overall (AUD$764). Based on the point estimates, the decision aid was more effective and less costly (dominant) for all measures of effectiveness. It was estimated that the decision aid has an 87% probability of being cost-effective at $60 000 per quality-adjusted life year gained., Conclusions: The BRECONDA web-based intervention designed to facilitate decisions regarding breast reconstruction surgery is likely to be cost-effective compared with usual care for women with breast cancer., (Copyright © 2018 John Wiley & Sons, Ltd.)

This phase II trial evaluated psychosocial and health outcomes of an intervention designed to improve emotion regulation skills in adults suffering from Adverse Childhood Experiences (ACEs). The study utilized a pretest-posttest design in which 92 adults enrolled in the community-based program completed pretest measures, attended either a faith-based or secular version of the 12-week ACE Overcomers program, and then completed posttest measures. The theory-guided program involved group sessions providing education and skills training to improve emotion regulation, self-awareness, resilience, and social functioning. Pretest and posttest surveys included measures of emotional regulation (suppression, rumination, cognitive reappraisal, and mindfulness), resilience (ego resilience and general self-efficacy), emotional experiences (perceived stress, moods, and depressive symptoms), quality of life (the SF-36 domains), and physical symptoms and illness (symptom load and sick days). Analyses revealed significant improvements from pretest to posttest in all facets of emotion regulation (p < .01), psychological resilience (p < .001), mental well-being (p < .001) and physical symptoms and illness (p < .001), and in specific facets of quality of life (p < .001). The faith-based and secular versions of the program yielded comparable improvements in well-being. Improvements were comparable for older versus younger participants, except that younger participants reported greater improvements in perceived stress (p < .05). These preliminary findings support the application of an emotion regulation perspective to interventions for adults with high ACEs. The study, with its single-group design, represents a promising step in the translational research pathway and provides support for further studies utilizing comparison groups., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: An integration of message framing and sociocultural literature suggests that ethnic health disparities may be reduced by incorporating minority groups' cultural values into persuasive health messages. Framing messages with metaphors represents one promising strategy for harnessing cultural values to change health outcomes. Still, the effectiveness of metaphoric health messages in minority populations has received virtually no empirical attention., Purpose: To fill this gap, the present study tested whether a health message using a cancer-screening metaphor targeting collectivism and familism values would engage individual differences in these values to predict Papanicolaou (Pap) smear intentions among Latinas., Methods: Latina women (N = 168) completed an online survey including measures of collectivism and familism. They were randomized to read a message about Pap smears featuring the metaphor the body is a family or no metaphor before reporting their Pap smear intentions., Results: Regression analyses revealed a pattern of interactions suggesting metaphoric messages engage targeted cultural values: For Latinas reading the family metaphor message, collectivism and familism positively predicted Pap smear intentions, whereas for Latinas reading the no-metaphor message, these values did not predict intentions., Conclusions: This study offers a foundation for further examination of the potential for metaphoric health messages that connect to cultural values to reduce ethnic health disparities. Implications and directions for future research are discussed.

Health communicators publicize messages that use metaphors to compare abstract health-related concepts to concrete concepts in other domains. Such messages aim to change health attitudes and behavior, but do they work? According to Conceptual Metaphor Theory, metaphors can shape thought by transferring personalized knowledge of a concrete concept to understand and relate to an abstraction, despite their superficial differences. The authors extend this claim to specify emotional and cognitive factors potentially moderating the productivity (and counter-productivity) of metaphoric health messages. A source resonance hypothesis predicts that when a message frames a health risk metaphorically in terms of a concrete hazard (versus literally), individual differences in fear surrounding that particular hazard will differentially predict risk-related worry and thus prevention intentions. A metaphoric fit hypothesis predicts that a risk metaphor will be more persuasive when the recommended prevention response is itself framed metaphorically as addressing the concrete hazard (versus literally). These hypotheses were supported in three experiments conducted with online, undergraduate, and community samples ( N = 539). With skin cancer as a case study, the studies tested the impact of messages framing sun exposure and sun-safe practices with or without metaphors of enemy combat. Findings illuminate how, when, and for whom metaphoric messages are persuasive, with theoretical and practical implications for health communication and metaphoric construal.

Background: Physical activity confers numerous health benefits, yet few adults meet recommended physical activity guidelines., Purpose: The impact of brief messages providing descriptive and injunctive social norm feedback on physical activity was tested in this conceptual pilot study., Methods: Young adults (N = 111) were randomly assigned to one of three conditions: descriptive norm feedback, descriptive-plus-injunctive norm feedback, or no social feedback (control condition). Participants used pedometers for eight weekdays and recorded their step counts each evening. The descriptive norm group received feedback about the average number of steps taken by group members the previous day. The descriptive-plus-injunctive norm group received feedback about the group average, as well as a sad face if the participant was below the average or a happy face if the participant was above the average. The control group received no feedback throughout the study., Results: By days 7 and 8, the descriptive-plus-injunctive norm group reported significantly more steps relative to the control group, whereas the descriptive norm group showed a trend toward higher step counts relative to the control group. These effects did not differ for participants above versus below the group average at baseline., Conclusion: The combined use of descriptive and injunctive social norms increased physical activity over a short period. This simple feedback strategy has potential for achieving wide reach and dissemination on its own or combined with more comprehensive interventions. This initial evidence can guide larger trials of longer duration., Trial Registration Number: The trial was registered with the ClinicalTrials.gov database (NCT02710201).

Advances in theory and research on self-regulation and decision-making processes have yielded important insights into how cognitive, emotional, and social processes shape risk perceptions and risk-related decisions. We examine how self-regulation theory can be applied to inform our understanding of decision-making processes within the context of genomic testing, a clinical arena in which individuals face complex risk information and potentially life-altering decisions. After presenting key principles of self-regulation, we present a genomic testing case example to illustrate how principles related to risk representations, approach and avoidance motivations, emotion regulation, defensive responses, temporal construals, and capacities such as numeric abilities can shape decisions and psychological responses during the genomic testing process. We conclude with implications for using self-regulation theory to advance science within genomic testing and opportunities for how this research can inform further developments in self-regulation theory.

Objective: Although graphic cigarette warnings have important benefits that may aid in motivating smoking quit attempts and discouraging smoking initiation, 1 possible negative consequence might be psychological reactance to graphic warnings. Reactance to warnings might be shaped by stereotypical views of smokers. This research examined the associations of positive and negative smoker stereotypes with perceptions of the educational value of warnings as well as affective and motivational responses to them., Method: Using a cross-sectional design, young adult smokers and nonsmokers (N = 396) completed an online questionnaire assessing positive and negative smoker stereotypes and then evaluated a series of graphic-plus-text and text-only cigarette warnings on perceived new knowledge gained from the warning, understandability of the warning, worry about the consequences of smoking elicited by the warning, and discouragement from smoking elicited by the warning., Results: Negative smoker stereotypes were associated with all warning perceptions-more negative stereotypes were associated with higher levels of perceived new knowledge, perceived understandability, worry, and discouragement from smoking. Positive smoker stereotypes were only associated with more perceived new knowledge. Neither smoking status nor warning type moderated the relationships between smoking stereotypes and warning evaluations., Conclusions: Focusing on enhancing negative smoker portrayals, rather than reducing positive portrayals, may be more effective for antismoking campaigns. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Hispanics represent a critical target for culturally adapted diet interventions. In this formative research, we translated HealthyYouTXT, an mHealth program developed by the U.S. National Cancer Institute, into HealthyYouTXT en Español, a linguistically and culturally appropriate version for Spanish speakers in the United States. We report a three-stage, mixed-methods process through which we culturally adapted the text messages, evaluated their acceptability, and revised the program based on the findings. In Stage 1, we conducted initial translations and adaptations of the text libraries using an iterative, principle-guided process. In Stage 2, we used mixed methods including focus groups and surveys with 109 Hispanic adults to evaluate the acceptability and cultural appropriateness of the program. We used survey data to evaluate whether self-determination theory (SDT) factors (used to develop HealthyYouTXT) of autonomous motivation, controlled motivation, and amotivation and Hispanic cultural beliefs about familism, fatalism, and destiny predict program interest and its perceived efficacy. Mixed-methods analyses revealed substantial interest in HealthyYouTXT, with most participants desiring to use it and viewing it as highly efficacious. Both cultural beliefs (i.e., beliefs in destiny and, for men, high familism) and SDT motivations (i.e., autonomy) predicted HealthyYouTXT evaluations, suggesting utility in emphasizing them in messages. Higher destiny beliefs predicted lower interest, suggesting that they could impede program use. In Stage 3, we implemented the mixed-methods findings to finalize HealthyYouTXT en Español. The emergent linguistic principles and multistage, multimethods process can be applied in health communication adaptations.

Background: Social media provides unprecedented opportunities for enhancing health communication and health care, including self-management of chronic conditions such as diabetes. Creating messages that engage users is critical for enhancing message impact and dissemination., Purpose: This study analyzed health communications within ten diabetes-related Facebook pages to identify message features predictive of user engagement., Method: The Common-Sense Model of Illness Self-Regulation and established health communication techniques guided content analyses of 500 Facebook posts. Each post was coded for message features predicted to engage users and numbers of likes, shares, and comments during the week following posting., Results: Multi-level, negative binomial regressions revealed that specific features predicted different forms of engagement. Imagery emerged as a strong predictor; messages with images had higher rates of liking and sharing relative to messages without images. Diabetes consequence information and positive identity predicted higher sharing while negative affect, social support, and crowdsourcing predicted higher commenting. Negative affect, crowdsourcing, and use of external links predicted lower sharing while positive identity predicted lower commenting. The presence of imagery weakened or reversed the positive relationships of several message features with engagement. Diabetes control information and negative affect predicted more likes in text-only messages, but fewer likes when these messages included illustrative imagery. Similar patterns of imagery's attenuating effects emerged for the positive relationships of consequence information, control information, and positive identity with shares and for positive relationships of negative affect and social support with comments., Conclusions: These findings hold promise for guiding communication design in health-related social media.