Robert C. Hornik

We often rely on descriptive norm perceptions as a mental shortcut for decision making. However, less is known about how such perceptions are shaped and modified by our experiences in day-to-day life. The interactive nature of the current media environment offers opportunities for individuals to access others' health behavior choices through online user-generated content. Within a setting of online comment boards, the current study examined the descriptive norm perception modification process toward vaping with a large-scale experiment that systematically varied levels of exposure to online commenters' vaping behavior choice indications. Findings revealed a significant positive effect of behavior prevalence on descriptive norm perceptions, which in turn were positively associated with vaping intention. This set of results was observed only when a sufficient total amount of comment exposures was ensured. The study provided empirical evidence for the underlying mechanism of the "quasi-statistical sense," which helps people draw conclusions about behavior prevalence and may influence their behavioral decision making. Theoretical and practical implications are discussed.

Key Messages Operational research is not only about data collection but also about knowing what questions are worth addressing and how to incorporate results into program decisions in a timely way. There is likely to be value in specifying program conceptual and logistical models that will lay out possible foci for operational research and generate potential lists of activities to monitor and expectations for paths of effect that can be tested. Research should be prioritized where doubt about component success is higher and projects are open to modification while balancing rigor of research designs with the utility of results.

In today’s complex media environment, does media coverage influence youth and young adults’ (YYA) tobacco use and intentions? We conceptualize the “public communication environment” and effect mediators, then ask whether over time variation in exogenously measured tobacco media coverage from mass and social media sources predicts daily YYA cigarette smoking intentions measured in a rolling nationally representative phone survey (N = 11,847 on 1,147 days between May 2014 and June 2017). Past week anti-tobacco and pro-tobacco content from Twitter, newspapers, broadcast news, Associated Press, and web blogs made coherent scales (thetas = 0.77 and 0.79). Opportunities for exposure to anti-tobacco content in the past week predicted lower intentions to smoke (Odds ratio [OR] = 0.95, p < .05, 95% confidence interval [CI] = 0.91–1.00). The effect was stronger among current smokers than among nonsmokers (interaction OR = 0.88, p < .05, 95% CI = 0.77–1.00). These findings support specific effects of anti-tobacco media coverage and illustrate a productive general approach to conceptualizing and assessing effects in the complex media environment.

Introduction Efforts to prevent youth tobacco use are critical to reducing smoking-related deaths in the USA. Anti-tobacco messaging often focuses on the severe long-term consequences of smoking (eg, fatal lung disease, cancer). It is unclear whether these long-term consequences are more likely to deter youth use than shorter term consequences (eg, headaches, friend disapproval). Methods A nationally representative 3-year rolling survey of adolescents and young adults (ages 13–26 years) measured belief in potential consequences of two types of tobacco products: combustible cigarettes (n=11 847) and electronic cigarettes (n=4470) as well as intentions and current use. Independent coders classified 23 consequences as either short or long term. Logistic regression tested the associations between short-term (vs long-term) beliefs and current intentions, as well as non-smoking behaviour at 6-month follow-up. Results Believing in both short-term and long-term consequences was associated with outcomes, but short-term beliefs were more highly associated with anti-smoking (OR=1.40, 95% CI (1.30 to 1.51)) and anti-vaping (OR=2.10, 95% CI (1.75 to 2.52)) intentions and better predicted non-smoking behaviour at follow-up, controlling for prior use (OR=1.75, 95% CI (1.33 to 2.31)). Conclusions These results support temporal discounting by adolescents and young adults and suggest health communication efforts aiming to reduce youth tobacco use should emphasise shorter term consequences.

COVID vaccination intentions vary among the US population. We report the results of a nationally representative survey undertaken in July 2020 (N=889) that examined the association of six vaccine-specific beliefs with intentions to vaccinate. We find that four of the six beliefs have substantial associations with intention (Gammas between .60 and .77), that the associations mostly do not vary with gender, age, race/ethnicity, or misinformation (even though intentions do vary with each of those variables). Also, once adjusted for the vaccine-specific beliefs, level of misinformation is not related to intentions. We consider the implications of these results and argue both that persuasive campaigns can be informed by these specific results, and given rapid changes in vaccine availability, that there is a substantial need for elaborated and repeated follow-up studies.

Wide-spread misinformation about the COVID-19 pandemic has presented challenges for communicating public health recommendations. Should campaigns to promote protective behaviors focus on debunking misinformation or targeting behavior-specific beliefs? To address this question, we examine whether belief in COVID-19 misinformation is directly associated with two behaviors (face mask wearing and social distancing), and whether behavior-specific beliefs can account for this association and better predict behavior, consistent with behavior-change theory. We conducted a nationally representative two-wave survey of U.S. adults from 5/26/20-6/12/20 (n = 1074) and 7/15/20-7/21//20 (n = 889; follow-up response 83%). Scales were developed and validated for COVID-19 related misinformation beliefs, social distancing and face mask wearing, and beliefs about the consequences of both behaviors. Cross-lagged panel linear regression models assessed relationships among the variables. While belief in misinformation was negatively associated with both face mask wearing (B = −.27, SE =.06) and social-distancing behaviors (B = −.46, SE =.08) measured at the same time, misinformation did not predict concurrent or lagged behavior when the behavior-specific beliefs were incorporated in the models. Beliefs about behavioral outcomes accounted for face mask wearing and social distancing, both cross-sectionally (B =.43, SE =.05; B =.63, SE =.09) and lagged over time (B =.20, SE = 04; B =.30, SE =.08). In conclusion, belief in COVID-19-related misinformation is less relevant to protective behaviors, but beliefs about the consequences of these behaviors are important predictors. With regard to misinformation, we recommend health campaigns aimed at promoting protective behaviors emphasize the benefits of these behaviors, rather than debunking unrelated false claims.

The development of a COVID-19 vaccine is a critical strategy for combatting the pandemic. However, in order for vaccination efforts to succeed, there must be widespread willingness to vaccinate. Prior research has found that Black Americans, who have already been disproportionately impacted by the pandemic, report lower intentions to get a vaccine than do other populations. In this study, we investigate potential causes of this disparity, focusing on vaccine-related behavioral beliefs and trust in four COVID-19 information sources (mainstream media, social media, President Trump, and public health officials and agencies). Using a nationally-representative survey (n=889), we demonstrate that differences in vaccine beliefs explain the lower vaccine intentions reported by Black participants compared to non-Black participants. However, while we find associations between trust in information sources and vaccine beliefs, we do not find evidence that differences in trust accounted for the observed differences in vaccine beliefs by race. Furthermore, we found evidence of moderation; the association of trust in two sources, Trump and public health officials and agencies, with beliefs were smaller among Black participants. Overall, our results suggest that trust in information sources alone does not explain the observed relationship between race and vaccine beliefs. This relationship warrants further investigation.

Flavored e-cigarettes have received high attention across social and news media. How does exposure to e-cigarette flavors across multiple sources in the media environment influence youth e-cigarette perceptions? To address this question, we identified e-cigarette flavor mentions on 24.3 million Twitter posts and 11,691 longform texts (newspapers, broadcast news, and websites) disseminated over 3 years (2014–2017). During the same period, we measured e-cigarette beliefs through a nationally representative randomly sampled rolling survey of 13–26-year-olds (N = 4,470, 1013 days). We estimated the association between flavor-specific content on Twitter and longform sources in the 28 days prior to each survey date and perceptions that e-cigarettes taste good. The interaction of coverage on Twitter and longform sources was significantly associated with more favorable perceptions of e-cigarette taste (OR = 1.21; 95% CI, 1.04–1.41); the main effects of each source type were not significant. This study presents a novel approach to evaluating the effects of cross-source coverage in today’s complex media landscape and may strengthen claims for media influence on e-cigarette use.