Objectives: Indoor tanning, which is most common among 18-25-year-old white women, increases the ... more Objectives: Indoor tanning, which is most common among 18-25-year-old white women, increases the risk of skin cancer. To address this problem, we developed and tested messages with a national sample of indoor tanners to determine beliefs that would encourage them to quit. Methods: Messages discouraging indoor tanning using different persuasive themes (skin cancer risk, appearance risk, well-being enhancement) were developed based on formative research and a review of intervention efforts. We conducted an online experiment to test the final messages with a national sample of 480 indoor tanners. Results: Messages that emphasized skin cancer risk out-performed messages that focused on well-being enhancement or damage to appearance in terms of intention to quit indoor tanning. Analyses revealed 2 key mediators: perceived argument strength and beliefs related to the effects of indoor tanning. Conclusions: Theory- and evidence-informed public health communications can contribute to improving health-related behaviors. Focusing on the risk of skin cancer may be the most effective strategy to reduce indoor tanning among young white women.
American adolescents consume more sugar-sweetened beverages (SSBs) than any other age group. Spor... more American adolescents consume more sugar-sweetened beverages (SSBs) than any other age group. Sports and energy drinks consumption among adolescents is higher than other SSBs. For sports drinks, there is uncertainty about their “healthiness” and also beliefs that these drinks may provide health benefits such as hydration, enhanced athletic performance, heightened mental alertness, and rapid recovery after exercise. Confusion about relative healthiness and expectations of health benefits suggest that factors that may encourage youth to avoid drinking sports and energy drinks, such as athletic status, psychological reactance, and SSB media literacy, may necessitate different approaches to promoting avoidance of sports drinks compared with avoidance of energy drinks. Using a nationally representative U.S. probability-based web panel augmented by a volunteer nonprobability-based web panel of 500 adolescent participants aged 14 to 18 years, we used the reasoned action approach to model intention to avoid sports and to avoid energy drinks. The result show there are similarities and differences in the determinants associated with adolescents’ avoidance of sports and energy drinks: attitudes and descriptive normative pressure are both related to increased avoidance for both types of drinks and perceived control over the avoidance behavior is positively associated for with intention to avoid for energy drinks. Sport identification, psychological reactance, and SSB media literacy also play a different role in the sports and energy drink models. Based on our results, the content of prevention messages in interventions to limit sports drinks will need to be quite different from those targeted at reducing energy drink consumption.
Using a longitudinal web-based survey of adolescents 14-16 years of age, we estimate regression m... more Using a longitudinal web-based survey of adolescents 14-16 years of age, we estimate regression models where self-reported sexual behavior and content analytic-based exposure to sex in the media are related cross-sectionally and longitudinally. We find evidence for both cross-sectional non-recursive and prospective longitudinal relationships even after adjusting for both established predictors of sexual behavior (e.g., physical development, having a romantic partner, parental monitoring, peer and parental norms, respondent's age) and of exposure to sexual media content (e.g., time the respondent goes to bed, extracurricular activities, television in the bedroom, total time spent with television, music, videogames, and magazines). Sexually active adolescents are more likely to expose themselves to sex in the media and those exposed to sex in the media are more likely to progress in their sexual activity. These findings are consistent with others in the literature that demonstrate a causal effect of exposure to sexual content on sexual behavior but extend established results by also looking at the causal effect of sexual behavior on exposure both cross-sectionally and over time.
American Journal of Preventive Medicine, Dec 1, 2018
Introduction: Skin cancer prevention guidelines recommend practicing multiple behaviors to protec... more Introduction: Skin cancer prevention guidelines recommend practicing multiple behaviors to protect against harmful ultraviolet rays, yet few adults report practicing more than one recommended behavior. This study examines the extent to which skin cancer prevention behaviors are combined and may follow a pattern of compensation in which an individual's performance of one behavior (e.g., wearing sunscreen) precludes performing other protective behaviors (e.g., wearing a hat). Methods: Data from qualitative semi-structured interviews (n=80) in 2015 and a quantitative online national survey (n=940) in 2016 with non-Hispanic white adults aged 18−49 years from the U.S. were used to examine combinations of skin cancer prevention behaviors. Data were analyzed in 2017. Results: Protective behaviors like wearing sunglasses and sunscreen were a common approach to prevention, but protective, avoidant (i.e., seeking shade, avoiding outdoor tanning), and coveringup (i.e., wearing a hat, shirt) strategies were rarely used in combination. Regression analyses to determine correlates of protection, avoidance, and covering-up showed that age was positively associated with practicing each strategy; positive attitudes about tanning were negatively associated with avoidance and covering-up; and positive body image was positively associated with protection and negatively associated with avoidance. Demographics such as education, employment, and gender, but not skin cancer risk, were also related to the various strategies. Conclusions: Although a full evaluation of compensation theory and skin cancer prevention was limited by the available data, the results suggest that application of the theory may yield clues for how to improve sun protection behaviors.
Although skin cancer incidence is highest among non-Hispanic Whites, minority populations are oft... more Although skin cancer incidence is highest among non-Hispanic Whites, minority populations are often diagnosed with more advanced stage disease and are more likely to experience poor outcomes. Fewer people of color do not practice primary prevention of skin cancer according to recommendations, but public health education and interventions to promote sun protection behaviors have consistently targeted non-Hispanic Whites. This study examines performance of sun protection behaviors in a multiethnic sample and whether demographic, lifestyle and psychosocial predictors of these behaviors differ by race and ethnicity. In this study, a probability-based sample of 1742 adults completed an online survey in 2015. Main outcomes of interest included sunscreen use, wearing a sleeved shirt, and seeking shade. We stratified the sample into racial/ethnic groups (White, Black, Hispanic, Asian) and investigated demographic, lifestyle and psychosocial correlates of these behaviors in each group. Differences in adjusted estimates from each behavior-specific model were tested across strata. Racial/ ethnic groups were significantly different in regards to sunscreen use and wearing a sleeved shirt, but similarly engaged in seeking shade. Results from multivariate ordered logistic regression models for each behavior revealed important demographic, lifestyle and psychosocial predictors and the importance of some demographic correlates varied between racial/ethnic groups. This study provides insight into the practice and correlates of skin cancer prevention among a multiethnic sample. Our findings suggest that targeting public health education efforts and interventions to promote sun protection in minority populations may be a beneficial approach to addressing heightened skin cancer morbidity and mortality in these groups.
The authors have indicated they have no financial relationships relevant to this article to discl... more The authors have indicated they have no financial relationships relevant to this article to disclose.
The COVID-19 pandemic forced closure of most U.S. university campuses in March 2020, obliging mil... more The COVID-19 pandemic forced closure of most U.S. university campuses in March 2020, obliging millions of students to finish their semesters via remote learning. This study examines whether and how students' prior and current experiences of digital inequality-defined as constrained access to the internet and internet-connecting devices-were associated with their remote learning experiences. Method An anonymous, online survey of 2,913 undergraduate college students from 30 U.S. universities completing their spring term remotely was conducted between April and May 2020. Hypothesis testing utilized a structural equation model with cluster-bootstrapped standard errors and p-values, to account for students being clustered by university. Results Findings revealed that students' challenges with internet connectivity and digital devices during remote learning were associated with lower remote learning proficiency (RLP). Difficulty communicating with professors and teaching assistants was also associated with lower RLP. Prior experience with online coursework was associated with higher RLP, and digital inequality challenges during the year prior to the pandemic with lower RLP. Moreover, students who reported greater financial hardship since the start of the pandemic experienced significantly more connectivity, device, and faculty communication challenges during remote learning, and had significantly lower RLP. Conclusions Many students will continue to learn remotely in some form until the pandemic recedes. We identify key factors associated with students' remote learning proficiency: (1) consistent,
Journal of the Dermatology Nurses’ Association, Apr 9, 2022
ABSTRACT This study examines beliefs about sunscreen use among non-Hispanic white adults aged 50 ... more ABSTRACT This study examines beliefs about sunscreen use among non-Hispanic white adults aged 50 years or older using online survey data (n = 237). Multiple logistic regression analyses were conducted to examine beliefs associated with sunscreen use, adjusted by age, gender, education, geographic location, and skin cancer risk score. Those who believed sunscreen use would prevent them from getting sunburned (odds ratio [OR] = 1.84) and those who believed that their romantic partners thought they should use sunscreen (OR = 1.72) were more likely to report sunscreen use. Those who believed sunscreen use would “take too much time” were less likely to report sunscreen use (OR = 0.65). These findings can inform future research and messaging efforts, including the evaluation of intervention approaches that highlight the immediate benefits of sunscreen use, address concerns about sunscreen use taking too much time, and tap into the potential influence that older adults may have on the sunscreen use of their romantic partners.
Background Recommendations for skin cancer prevention include behaviors such as using sunscreen, ... more Background Recommendations for skin cancer prevention include behaviors such as using sunscreen, seeking shade, and wearing a shirt with sleeves, but the best way to persuasively communicate this information to the public is not clear. Purpose To test whether a messaging strategy using videos that focus on one specific behavior at a time versus a more general or multibehavior sun protection message is effective at changing attitudinal beliefs and intention with regard to sun protection behaviors. Methods Online experiment among non-Hispanic white 18–49 year old adults in the USA. Participants were randomly assigned to one of four conditions, each one with health messages on a different sun protection prevention behavior: “using sunscreen” (Condition 1, n = 259), “seeking shade” (Condition 2, n = 245), or “covering up” (Condition 3, n = 289). Condition 4 (the control, n = 251) is a multibehavior message that equally promotes sunscreen, seeking shade, and covering up and features a general message on sun safety. Results ANOVA and path analysis results suggest that messages which emphasize a single sun protection behavior compared with general sun safety messaging could potentially be a promising approach. The effectiveness of the videos in influencing attitudinal beliefs varied by behavior, with some gender and age moderation. There was an indirect effect on intention to use sunscreen. Conclusions This study advances our understanding of strategies for skin cancer prevention campaigns. Specifically, it suggests that focusing on a single sun protection behavior with targeted beliefs may be valuable as a first step in encouraging sun safety.
Abstract This chapter examines the changing relationship children have with media as technologies... more Abstract This chapter examines the changing relationship children have with media as technologies become digital, portable, and widely accessible. Specifically, we consider public policies designed to protect children from harmful content, and whether they are useful to parents navigating the new media environment. Despite concerns over children's exposure to harmful content, there are many ways in which mobile media provide opportunities for connection and learning. Although much research is needed to fully understand the unique ways in which mobile media uses (such as apps) lead to different outcomes than traditional media (such as television), there is evidence of benefits such as literacy and problem-solving development. The chapter concludes with resources that we see as reflective of best learning practices and best content in the mobile media domain.
Research indicates that media campaigns targeting weight-related behaviors can make overweight in... more Research indicates that media campaigns targeting weight-related behaviors can make overweight individuals feel stigmatized and may create backlash effects in weight-related health behavior. Using weight-based identity threat theory as a guiding framework, this study investigates the role of prior weight stigmatization in adults’ reactions to public service advertisements (PSAs) encouraging sugar-sweetened beverage (SSB) reduction. In an online survey experiment among 807 U.S. parents, participants were randomly assigned to view anti-SSB PSAs containing one of three persuasive appeals (fear, humor, or nurturance). Emotional responses, evaluation of argument strength, and intention to reduce SSB consumption were measured following PSA exposure. Non-stigmatized parents felt less empowerment and hope and perceived weaker arguments if they viewed humorous PSAs instead of fear-based PSAs. Argument strength and empowerment or hopeful emotions predicted increased intention to reduce SSB consumption, regardless of whether participants had been stigmatized. There was weak support for the moderation of emotional responses on intentions by stigmatization history such that negative emotions were associated with lower SSB-reduction intentions only among stigmatized participants. Experiences of stigmatization can shape audiences’ responses to health-related messages in unintended ways. The findings suggest that campaign designers should choose empowering messages with strong arguments and avoid evoking negative emotions.
Objectives: Indoor tanning, which is most common among 18-25-year-old white women, increases the ... more Objectives: Indoor tanning, which is most common among 18-25-year-old white women, increases the risk of skin cancer. To address this problem, we developed and tested messages with a national sample of indoor tanners to determine beliefs that would encourage them to quit. Methods: Messages discouraging indoor tanning using different persuasive themes (skin cancer risk, appearance risk, well-being enhancement) were developed based on formative research and a review of intervention efforts. We conducted an online experiment to test the final messages with a national sample of 480 indoor tanners. Results: Messages that emphasized skin cancer risk out-performed messages that focused on well-being enhancement or damage to appearance in terms of intention to quit indoor tanning. Analyses revealed 2 key mediators: perceived argument strength and beliefs related to the effects of indoor tanning. Conclusions: Theory- and evidence-informed public health communications can contribute to improving health-related behaviors. Focusing on the risk of skin cancer may be the most effective strategy to reduce indoor tanning among young white women.
American adolescents consume more sugar-sweetened beverages (SSBs) than any other age group. Spor... more American adolescents consume more sugar-sweetened beverages (SSBs) than any other age group. Sports and energy drinks consumption among adolescents is higher than other SSBs. For sports drinks, there is uncertainty about their “healthiness” and also beliefs that these drinks may provide health benefits such as hydration, enhanced athletic performance, heightened mental alertness, and rapid recovery after exercise. Confusion about relative healthiness and expectations of health benefits suggest that factors that may encourage youth to avoid drinking sports and energy drinks, such as athletic status, psychological reactance, and SSB media literacy, may necessitate different approaches to promoting avoidance of sports drinks compared with avoidance of energy drinks. Using a nationally representative U.S. probability-based web panel augmented by a volunteer nonprobability-based web panel of 500 adolescent participants aged 14 to 18 years, we used the reasoned action approach to model intention to avoid sports and to avoid energy drinks. The result show there are similarities and differences in the determinants associated with adolescents’ avoidance of sports and energy drinks: attitudes and descriptive normative pressure are both related to increased avoidance for both types of drinks and perceived control over the avoidance behavior is positively associated for with intention to avoid for energy drinks. Sport identification, psychological reactance, and SSB media literacy also play a different role in the sports and energy drink models. Based on our results, the content of prevention messages in interventions to limit sports drinks will need to be quite different from those targeted at reducing energy drink consumption.
Using a longitudinal web-based survey of adolescents 14-16 years of age, we estimate regression m... more Using a longitudinal web-based survey of adolescents 14-16 years of age, we estimate regression models where self-reported sexual behavior and content analytic-based exposure to sex in the media are related cross-sectionally and longitudinally. We find evidence for both cross-sectional non-recursive and prospective longitudinal relationships even after adjusting for both established predictors of sexual behavior (e.g., physical development, having a romantic partner, parental monitoring, peer and parental norms, respondent's age) and of exposure to sexual media content (e.g., time the respondent goes to bed, extracurricular activities, television in the bedroom, total time spent with television, music, videogames, and magazines). Sexually active adolescents are more likely to expose themselves to sex in the media and those exposed to sex in the media are more likely to progress in their sexual activity. These findings are consistent with others in the literature that demonstrate a causal effect of exposure to sexual content on sexual behavior but extend established results by also looking at the causal effect of sexual behavior on exposure both cross-sectionally and over time.
American Journal of Preventive Medicine, Dec 1, 2018
Introduction: Skin cancer prevention guidelines recommend practicing multiple behaviors to protec... more Introduction: Skin cancer prevention guidelines recommend practicing multiple behaviors to protect against harmful ultraviolet rays, yet few adults report practicing more than one recommended behavior. This study examines the extent to which skin cancer prevention behaviors are combined and may follow a pattern of compensation in which an individual's performance of one behavior (e.g., wearing sunscreen) precludes performing other protective behaviors (e.g., wearing a hat). Methods: Data from qualitative semi-structured interviews (n=80) in 2015 and a quantitative online national survey (n=940) in 2016 with non-Hispanic white adults aged 18−49 years from the U.S. were used to examine combinations of skin cancer prevention behaviors. Data were analyzed in 2017. Results: Protective behaviors like wearing sunglasses and sunscreen were a common approach to prevention, but protective, avoidant (i.e., seeking shade, avoiding outdoor tanning), and coveringup (i.e., wearing a hat, shirt) strategies were rarely used in combination. Regression analyses to determine correlates of protection, avoidance, and covering-up showed that age was positively associated with practicing each strategy; positive attitudes about tanning were negatively associated with avoidance and covering-up; and positive body image was positively associated with protection and negatively associated with avoidance. Demographics such as education, employment, and gender, but not skin cancer risk, were also related to the various strategies. Conclusions: Although a full evaluation of compensation theory and skin cancer prevention was limited by the available data, the results suggest that application of the theory may yield clues for how to improve sun protection behaviors.
Although skin cancer incidence is highest among non-Hispanic Whites, minority populations are oft... more Although skin cancer incidence is highest among non-Hispanic Whites, minority populations are often diagnosed with more advanced stage disease and are more likely to experience poor outcomes. Fewer people of color do not practice primary prevention of skin cancer according to recommendations, but public health education and interventions to promote sun protection behaviors have consistently targeted non-Hispanic Whites. This study examines performance of sun protection behaviors in a multiethnic sample and whether demographic, lifestyle and psychosocial predictors of these behaviors differ by race and ethnicity. In this study, a probability-based sample of 1742 adults completed an online survey in 2015. Main outcomes of interest included sunscreen use, wearing a sleeved shirt, and seeking shade. We stratified the sample into racial/ethnic groups (White, Black, Hispanic, Asian) and investigated demographic, lifestyle and psychosocial correlates of these behaviors in each group. Differences in adjusted estimates from each behavior-specific model were tested across strata. Racial/ ethnic groups were significantly different in regards to sunscreen use and wearing a sleeved shirt, but similarly engaged in seeking shade. Results from multivariate ordered logistic regression models for each behavior revealed important demographic, lifestyle and psychosocial predictors and the importance of some demographic correlates varied between racial/ethnic groups. This study provides insight into the practice and correlates of skin cancer prevention among a multiethnic sample. Our findings suggest that targeting public health education efforts and interventions to promote sun protection in minority populations may be a beneficial approach to addressing heightened skin cancer morbidity and mortality in these groups.
The authors have indicated they have no financial relationships relevant to this article to discl... more The authors have indicated they have no financial relationships relevant to this article to disclose.
The COVID-19 pandemic forced closure of most U.S. university campuses in March 2020, obliging mil... more The COVID-19 pandemic forced closure of most U.S. university campuses in March 2020, obliging millions of students to finish their semesters via remote learning. This study examines whether and how students' prior and current experiences of digital inequality-defined as constrained access to the internet and internet-connecting devices-were associated with their remote learning experiences. Method An anonymous, online survey of 2,913 undergraduate college students from 30 U.S. universities completing their spring term remotely was conducted between April and May 2020. Hypothesis testing utilized a structural equation model with cluster-bootstrapped standard errors and p-values, to account for students being clustered by university. Results Findings revealed that students' challenges with internet connectivity and digital devices during remote learning were associated with lower remote learning proficiency (RLP). Difficulty communicating with professors and teaching assistants was also associated with lower RLP. Prior experience with online coursework was associated with higher RLP, and digital inequality challenges during the year prior to the pandemic with lower RLP. Moreover, students who reported greater financial hardship since the start of the pandemic experienced significantly more connectivity, device, and faculty communication challenges during remote learning, and had significantly lower RLP. Conclusions Many students will continue to learn remotely in some form until the pandemic recedes. We identify key factors associated with students' remote learning proficiency: (1) consistent,
Journal of the Dermatology Nurses’ Association, Apr 9, 2022
ABSTRACT This study examines beliefs about sunscreen use among non-Hispanic white adults aged 50 ... more ABSTRACT This study examines beliefs about sunscreen use among non-Hispanic white adults aged 50 years or older using online survey data (n = 237). Multiple logistic regression analyses were conducted to examine beliefs associated with sunscreen use, adjusted by age, gender, education, geographic location, and skin cancer risk score. Those who believed sunscreen use would prevent them from getting sunburned (odds ratio [OR] = 1.84) and those who believed that their romantic partners thought they should use sunscreen (OR = 1.72) were more likely to report sunscreen use. Those who believed sunscreen use would “take too much time” were less likely to report sunscreen use (OR = 0.65). These findings can inform future research and messaging efforts, including the evaluation of intervention approaches that highlight the immediate benefits of sunscreen use, address concerns about sunscreen use taking too much time, and tap into the potential influence that older adults may have on the sunscreen use of their romantic partners.
Background Recommendations for skin cancer prevention include behaviors such as using sunscreen, ... more Background Recommendations for skin cancer prevention include behaviors such as using sunscreen, seeking shade, and wearing a shirt with sleeves, but the best way to persuasively communicate this information to the public is not clear. Purpose To test whether a messaging strategy using videos that focus on one specific behavior at a time versus a more general or multibehavior sun protection message is effective at changing attitudinal beliefs and intention with regard to sun protection behaviors. Methods Online experiment among non-Hispanic white 18–49 year old adults in the USA. Participants were randomly assigned to one of four conditions, each one with health messages on a different sun protection prevention behavior: “using sunscreen” (Condition 1, n = 259), “seeking shade” (Condition 2, n = 245), or “covering up” (Condition 3, n = 289). Condition 4 (the control, n = 251) is a multibehavior message that equally promotes sunscreen, seeking shade, and covering up and features a general message on sun safety. Results ANOVA and path analysis results suggest that messages which emphasize a single sun protection behavior compared with general sun safety messaging could potentially be a promising approach. The effectiveness of the videos in influencing attitudinal beliefs varied by behavior, with some gender and age moderation. There was an indirect effect on intention to use sunscreen. Conclusions This study advances our understanding of strategies for skin cancer prevention campaigns. Specifically, it suggests that focusing on a single sun protection behavior with targeted beliefs may be valuable as a first step in encouraging sun safety.
Abstract This chapter examines the changing relationship children have with media as technologies... more Abstract This chapter examines the changing relationship children have with media as technologies become digital, portable, and widely accessible. Specifically, we consider public policies designed to protect children from harmful content, and whether they are useful to parents navigating the new media environment. Despite concerns over children's exposure to harmful content, there are many ways in which mobile media provide opportunities for connection and learning. Although much research is needed to fully understand the unique ways in which mobile media uses (such as apps) lead to different outcomes than traditional media (such as television), there is evidence of benefits such as literacy and problem-solving development. The chapter concludes with resources that we see as reflective of best learning practices and best content in the mobile media domain.
Research indicates that media campaigns targeting weight-related behaviors can make overweight in... more Research indicates that media campaigns targeting weight-related behaviors can make overweight individuals feel stigmatized and may create backlash effects in weight-related health behavior. Using weight-based identity threat theory as a guiding framework, this study investigates the role of prior weight stigmatization in adults’ reactions to public service advertisements (PSAs) encouraging sugar-sweetened beverage (SSB) reduction. In an online survey experiment among 807 U.S. parents, participants were randomly assigned to view anti-SSB PSAs containing one of three persuasive appeals (fear, humor, or nurturance). Emotional responses, evaluation of argument strength, and intention to reduce SSB consumption were measured following PSA exposure. Non-stigmatized parents felt less empowerment and hope and perceived weaker arguments if they viewed humorous PSAs instead of fear-based PSAs. Argument strength and empowerment or hopeful emotions predicted increased intention to reduce SSB consumption, regardless of whether participants had been stigmatized. There was weak support for the moderation of emotional responses on intentions by stigmatization history such that negative emotions were associated with lower SSB-reduction intentions only among stigmatized participants. Experiences of stigmatization can shape audiences’ responses to health-related messages in unintended ways. The findings suggest that campaign designers should choose empowering messages with strong arguments and avoid evoking negative emotions.
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