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AbstractColorectal cancer and breast cancer are among the most common types of cancer in the United States, and cancer screening is an effective way to detect and treat these cancers early. Health news stories, medical websites, and media campaigns regularly highlight the national lifetime risks of specific cancers and their screening rates, but recent research suggests that people tend to overestimate the prevalence of health problems but underestimate the prevalence of disease prevention behaviors in the absence of numerical information. This study featured two online experiments, one focused on breast cancer (N = 632) and one focused on colorectal cancer (N = 671), to examine the effects of communicating national cancer lifetime risks and screening rates among samples of screening‐eligible adults in the United States. Findings confirmed prior work in showing that people overestimated colorectal/breast cancer lifetime risks but underestimated colorectal/breast cancer screening rates. Communicating the national lifetime risk of dying from colorectal/breast cancer lowered people's national risk estimates, which in turn was associated with lower perceived cancer risks for themselves. In contrast, communicating the national colorectal/breast cancer screening rate increased people's estimates of the prevalence of cancer screening, which in turn was associated with higher perceived self‐efficacy to engage in cancer screening and greater screening intentions. We conclude that efforts to promote cancer screening may benefit from messages that include data on national cancer screening rates but may not benefit from including national rates of lifetime cancer risks.

This study uses data from systematic Web image search results and two randomized survey experiments to analyze how frames commonly used in public debates about health issues, oper- ationalized here as alternative word choices, influence public support for health policy reforms. In Study 1, analyses of Bing (N = 1,719), Google (N = 1,872), and Yahoo Images (N = 1,657) search results suggest that the images returned from the search query "sugar-sweetened beverage" are more likely to evoke health-related concepts than images returned from a search query about "soda." In contrast, "soda" search queries were more likely to incorporate brand-related concepts than "sugar-sweetened beverage" search queries. In Study 2, participants (N = 206) in a controlled Web experiment rated their support for policies to reduce consumption of these drinks. As expected, strong liberals had more support for policies designed to reduce the consumption of these drinks when the policies referenced "soda" compared to "sugar-sweetened beverage." To the contrary, items describing these drinks as "soda" produced lower policy support than items describing them as "sugar-sweetened beverage" among strong conservatives. In Study 3, participants (N = 1,000) in a national telephone survey experiment rated their support for a similar set of policies. Results conceptually replicated the previous Web-based experiment, such that strong liberals reported greater support for a penny-per-ounce taxation when labeled "soda" versus "sugar-sweetened beverages." In both Studies 2 and 3, more respondents referred to brand-related concepts in response to questions about "sugar-sweetened beverages" compared to "soda." We conclude with a discussion of theoretical and methodological implications for studying framing effects of labels.

Cultivation theory and research have been criticized for their failures to consider variation in effects by genre, employ appropriate third-variable controls, and determine causal direction. Recent studies, controlling for a variety of demographic characteristics and media use variables, have found that exposure to local television (TV) newscasts is associated with a variety of problematic "real-world" beliefs. However, many of these studies have not adequately assessed causal direction. Redressing this limitation, we analyzed data from a two-wave national representative survey which permitted tests of lagged association between overall TV viewing, local TV news viewing, and fatalistic beliefs about cancer prevention. We first replicated the original cultivation effect and found a positive association between overall TV viewing at Time 1 and increased fatalistic beliefs about cancer prevention at Time 2. Analyses also provided evidence that local TV news viewing at Time 1 predicts increased fatalistic beliefs about cancer prevention at Time 2. There was little evidence for reverse causation in predicting changes in overall TV viewing or local TV news viewing. The article concludes with a discussion of theoretical and practical implications of these findings.

Narratives can convey the need or community-level action to address social problems. Yet narratives often tell stories about specific individuals rather than the broader collectives these problems affect. Some theorists argue that individualizing collective problems inhibits audiences from recognizing upstream causes and solutions. This study tested how narrative individualization (whether a story focuses on an individual case or a larger collective) might produce trade-offs when mobilizing support for community-level policies to address childhood obesity. We also investigated whether narratives using language congruent with political partisans' morals (equity or loyalty) might minimize polarized responses to such narratives. A large, Web-based experiment with a national sample of U.S. adults demonstrated that both individual and collective narratives increased policy support relative to a no-message control group. Individual narratives promoted policy support via narrative engagement, tender emotions, and external thoughts about the issue. Against expectations, morally congruent narratives did not outperform morally incongruent ones.

This study attempts to advance theorizing about health policy advocacy with combinations of narrative focus and a statistical map in an attempt to increase state legislators' support for policies to address the issue of obesity by reducing food deserts. Specifically, we examine state legislators' responses to variations in narrative focus (individual vs. community) about causes and solutions for food deserts in U.S. communities, and a statistical map (presence vs. absence) depicting the prevalence of food deserts across the United States. Using a Web-based randomized experiment (N = 496), we show that narrative focus and the statistical map interact to produce different patterns of cognitive response and support for policies to reduce the prevalence of food deserts. The presence of a statistical map showing the prevalence of food deserts in the United States appeared to matter only when combined with an individual narrative, off- setting the fact that the individual narrative in isolation produced fewer thoughts consistent with the story's persuasive goal and more counterarguments in opposition to environmental causes and solutions for obesity than other message conditions. The image did not have an impact when combined with a story describing a community at large. Cognitive responses fully mediated message effects on intended persuasive outcomes. We conclude by discussing the study's contributions to communication theory and practice.

This study tests whether policy narratives designed to increase support for obesity-reducing public policies should explicitly acknowledge individual responsibility while emphasizing social, physical, and economic (social) determinants of obesity. We use a web-based, randomized experiment with a nationally representative sample of American adults (n = 718) to test hypotheses derived from theory and research on narrative persuasion. Respondents exposed to narratives that acknowledged individual responsibility while emphasizing obesity's social determinants were less likely to engage in counterargument and felt more empathy for the story's main character than those exposed to a message that did not acknowledge individual responsibility. Counterarguing and affective empathy fully mediated the relationship between message condition and support for policies to reduce rates of obesity. Failure to acknowledge individual responsibility in narratives emphasizing social determinants of obesity may undermine the persuasiveness of policy narratives. Omitting information about individual responsibility, a strongly-held American value, invites the public to engage in counterargument about the narratives and reduces feelings of empathy for a character that experiences the challenges and benefits of social determinants of obesity.

Researchers have increasingly focused on how social determinants of health (SDH) influence health outcomes and disparities. They have also explored strategies for raising public awareness and mobilizing support for policies to address SDH, with particular attention to narrative and image-based information. These efforts will need to overcome low public awareness and concern about SDH; few organized campaigns; and limited descriptions of existing message content. To begin addressing these challenges, we analyzed characteristics of 58 narratives and 135 visual images disseminated by two national SDH awareness initiatives: The Robert Wood Johnson Foundation's Commission to Build a Healthier America and the PBS-produced documentary film Unnatural Causes. Certain types of SDH, including income/wealth and one's home and workplace environment, were emphasized more heavily than others. Solutions for addressing SDH often involved combinations of self-driven motivation (such as changes in personal health behaviors) along with externally-driven factors such as government policy related to urban revitilization. Images, especially graphs and charts, drew connections among SDH, health outcomes, and other variables, such as the relationship between mother's education and infant mortality as well as the link between heart disease and education levels within communities. We discuss implications of these findings for raising awareness of SDH and health disparities in the US through narrative and visual means.

AbstractPast research has suggested that urban anglers are a group at high risk of being exposed to contaminants from fish consumption. Fish consumption advisories have been used in many regions to encourage healthy fish‐eating behaviors, but few studies have been designed to assess whether these advisories actually influence behavior as intended. We conducted a large‐scale, randomized experiment to test the influence of an advisory brochure on urban anglers' fish consumption. We collected detailed information on anglers' fish consumption in three urban counties in the Great Lakes region in the summers of 2014 and 2015. We provided a treatment group with fish consumption guidelines in an advisory brochure before the summer of 2015 and compared their change in fish consumption to a control group. The brochure led to a reduction in fish consumption for anglers who ate the most fish; these anglers reduced their consumption of high‐contaminant purchased fish (by ≥0.2 meals/summer for those in 72nd percentile of fish consumption or above), high‐contaminant sport‐caught fish (by ≥0.4 meals/summer for those in 87th percentile and above), and low‐contaminant sport‐caught fish (by ≥0.3 meals/summer by those in 76th percentile and above). The brochure also reduced sport‐caught fish consumption among those anglers who exceeded the advisories in 2014 (by 2.0 meals/summer). In addition, the brochure led to small increases in sport‐caught fish consumption (0.4–0.6 meals/summer) in urban anglers who ate very little sport‐caught fish (≤1 meal/summer).

AbstractAccurate estimates of the amount and type of fish people eat are necessary to determine the health benefits and risks of consuming fish, and to assess compliance with fish consumption guidelines issued for fish affected by chemical contaminants. We developed a web‐based and mobile‐phone‐enabled diary methodology to collect detailed fish consumption information for two 16‐week periods in the summers of 2014 and 2015. We recruited study participants from two populations living in the Great Lakes region—women of childbearing age (WCBA) and urban residents who had purchased fishing licenses. In this article, we describe the methodology in detail and provide evidence related to participation rates, the representativeness of our sample over time, and both convergent validity and reliability of the data collection methods. Overall, 56% of WCBA and 50% of urban anglers provided complete data across both data collection periods. Among those who provided information at the beginning of Year 2, 97% of both audiences provided information throughout the entire 16‐week period. Those who participated throughout the two‐year period were slightly older on average (1.9–2.5 years) than other members of our original samples. We conclude that using diaries with web and smartphone technology, combined with incentives and persistent communication, has strong potential for assessing fish consumption in other areas of the country or for situations where the potential risks associated with fish consumption are substantial and the cost can be justified.

Purpose: The study identifies the extent to which theoretical constructs drawn from well-established message effect communication theories are reflected in the content of alcohol-related public service announcements (PSAs) airing in the United States over a 16-year period. Design: Content analysis of 18 530 141 alcohol-abuse (AA) and drunk-driving (DD) PSAs appearing on national network and local cable television stations in the 210 largest designated marketing areas (DMAs) from January 1995 through December 2010. Measures: The authors developed a detailed content analytic codebook and trained undergraduate coders to reliably identify the extent to which theoretical constructs and other creative ad elements are reflected in the PSAs. We show these patterns using basic descriptive statistics. Results: Although both classes of alcohol-related PSAs used strategies that are consistent with major message effect theories, their specific theoretical orientations differed dramatically. The AA PSAs were generally consistent with constructs emphasized by the Extended Parallel Process Model (EPPM), whereas DD PSAs were more likely to use normative strategies emphasized by the Focus Theory of Narrative Conduct (FTNC) or source credibility appeals central to the Elaboration Likelihood Model. Conclusion: Having identified message content, future research should use deductive approaches to determine if volume and message content of alcohol-control PSAs have an impact on measures of alcohol consumption and/or measures of drunk driving, such as fatalities or driving while intoxicated/driving under the influence arrests.

Fish consumption advisories are issued by states, tribes, and federal agencies to provide guidance to consumers about eating sport‐caught fish potentially affected by chemical contaminants. Previous work has found that while anglers report being aware that advisories are available, awareness and use of specific advisory recommendations is low. This study uses the Integrative Model of Behavioral Prediction (IMBP) to identify beliefs with potential to increase intentions to follow fish consumption advisories in Great Lakes states. We conducted a mail survey of 1,712 licensed anglers in seven of eight Great Lakes states (excluding Ohio) to gauge advisory awareness, cognitive factors influencing fish consumption behaviors (informed by the IMBP), and sociodemographic characteristics. Results show that most anglers reported being generally or vaguely aware of fish consumption advisories and try to follow them, but far fewer report being aware of specific advice needed to decide whether or not to consume different types of sport‐caught fish. Informed by the IMBP, we also identify several behavioral, normative, and control beliefs that have sufficient room to change, strong associations with intentions to follow the advisories, and potential to be modified if targeted with strategic risk messages. Targeting these beliefs with strategic communication holds potential to increase the proportion of anglers intending to follow fish consumption advisory recommendations in choosing which fish to eat.

Policy PointsThe American public—both men and women and those with and without children in the household—holds parents highly responsible and largely to blame for childhood obesity.High attributions of responsibility to parents for reducing childhood obesity did not universally undermine support for broader policy action. School-based obesity prevention policies were strongly supported, even among those viewing parents as mostly to blame for childhood obesity.Americans who viewed sectors outside the family (such as the food and beverage industry, schools, and the government) as helping address childhood obesity were more willing to support a wider range of population-based obesity prevention policies.