Sally Dunlop

Pathways to Persuasion: Cognitive and Experiential Responses to Health-Promoting Mass Media Messages

The experience of transportation—being absorbed in a narrative—and its relationship to persuasion were considered in two studies exploring responses to health-promoting mass media messages. Following Epstein’s (1994) cognitive-experiential self-theory, two pathways to persuasion were considered: cognitive and experiential. In Study 1 ( n = 121), smokers who experienced increased transportation in response to antismoking messages reported that they would make a greater effort to quit smoking, and this effect was mediated by both experiential (emotional and self-referencing) and cognitive responses to the messages. In Study 2 (n = 110), experiential responses to magazine messages promoting skin protection were related to intentions to protect oneself, and this effect was mediated by feelings of risk.The implications of these results are discussed in terms of principles for effective health communication campaigns as well as theoretical advances in narrative persuasion in the context of health communication.

Where do youth learn about suicides on the Internet, and what influence does this have on suicidal ideation?

BACKGROUND Young people are susceptible to suicidal behavior as a result of learning about the suicidal behavior of others. This study was designed to determine whether Internet sites, such as online news and social networking websites, expose young people to suicide stories that might increase suicide ideation. METHOD We reinterviewed 719 young people ages 14 to 24 who had participated in a prior nationally representative survey. Respondents reported knowledge of persons they knew who had committed or attempted suicide as well as personal experiences of hopelessness and suicidal ideation on both occasions. On the second occasion one year later, they also reported use of various Internet platforms and how often they had been exposed to suicide stories on those sites, as well as from personal sources. Changes in ideation as a function of exposure to different sources of suicide stories were analyzed holding constant prior hopelessness and ideation. RESULTS While traditional sources of information about suicide were most often cited (79% were from friends and family or newspapers), online sources were also quite common (59%). Social networking sites were frequently cited as sources, but these reports were not linked to increases in ideation. However, online discussion forums were both cited as sources and associated with increases in ideation. CONCLUSIONS The Internet and especially social networking sites are important sources of suicide stories. However, discussion forums appear to be particularly associated with increases in suicidal ideation. Greater efforts should be undertaken to promote Internet sites directed to young people that enhance effective coping with hopelessness and suicidal ideation.

Can You Feel It? Negative Emotion, Risk, and Narrative in Health Communication

Eliciting emotional responses to mass media messages can be an effective means of changing public health attitudes, intentions and behaviors. This conceptual paper proposes that emotional responses to such media messages can be message-referent, plot-referent, and/or self-referent. Self-referent emotional responses are expected to have a direct effect in motivating behavior change, particularly as they are likely to be associated with an increase in perceived personal risk. Message-referent and plot-referent emotional responses are proposed to have indirect effects on the individual, primarily by stimulating self-referent emotions, and prompting interpersonal discussion about the message. In this paper, it is argued that narrative is a particularly effective message format with which to elicit self-referent emotional responses.

Adolescent and Young Adult Crash Risk: Sensation Seeking, Substance Use Propensity and Substance Use Behaviors

In a national youth sample, the propensity to use substances was more strongly related to motor vehicle crashes than use of any specific substance studied (cigarette, alcohol, marijuana). Substance use propensity was associated with sensation seeking, suggesting that increased crash risk for these youth is likely a result of general risk-taking tendencies.

Association between tobacco plain packaging and Quitline calls: a population-based, interrupted time-series analysis.

Objectives: To investigate whether the introduction of tobacco plain packaging in Australia from 1 October 2012 was associated with a change in the number of calls to the smoking cessation helpline, Quitline, and to compare this with the impact of the introduction of graphic health warnings from 1 March 2006.

The Contribution of Antismoking Advertising to Quitting: Intra- and Interpersonal Processes

This study explored the roles of transportability—the tendency to become absorbed in a narrative—and interpersonal discussion in the use of televised antismoking advertising in attempts to quit smoking. We used data from a representative population survey of adults (n = 2,999), examining responses from current smokers (n = 594) and former smokers who had quit in the last 5 years (n = 167). Logistic regression analysis revealed that current and former smokers higher in transportability were more likely to recall an antismoking ad (OR = 1.08, p < .001), and to perceive they had been helped by antismoking advertising in their attempts to quit smoking (OR = 1.05, p < .01). Transportability also was related to the recall of narrative antismoking advertisements (OR = 1.06, p < .05). Among current smokers, those who engaged in interpersonal discussion about any antismoking advertising were more likely to have made a quit attempt (OR = 2.76, p < .001). Finally, individuals were most likely to discuss advertising containing information about the negative health consequences of smoking using graphic images or simulations of bodily processes. These results suggest that the effectiveness of antismoking advertising is dependent upon both intra- and interpersonal processes that are triggered by the advertisements.

Predictors and Consequences of Conversations About Health Promoting Media Messages

Female college students (N=104) in friendship dyads were exposed to radio advertisements promoting the HPV vaccine—narrative or advocacy in format—after which they completed a questionnaire. Half the dyads were instructed to engage in a conversation about the advertisement prior to completing the questionnaire. Analyses showed that interpersonal discussion was related to normative perceptions, attitudes and intentions regarding the vaccine, but only under certain conditions. Conversation partner, conversation valence and positive opinion sharing were related to those outcomes. In a follow-up questionnaire, participants who discussed the ad in the days after exposure reported more positive intention change. Participants with stronger emotional reactions to the ads were more likely to discuss them during this period.

Why do smokers try to quit without medication or counselling? A qualitative study with ex-smokers

Objective When tobacco smokers quit, between half and two-thirds quit unassisted: that is, they do not consult their general practitioner (GP), use pharmacotherapy (nicotine-replacement therapy, bupropion or varenicline), or phone a quitline. We sought to understand why smokers quit unassisted. Design Qualitative grounded theory study (in-depth interviews, theoretical sampling, concurrent data collection and data analysis). Participants 21 Australian adult ex-smokers (aged 28–68 years; 9 males and 12 females) who quit unassisted within the past 6 months to 2 years. 12 participants had previous experience of using assistance to quit; 9 had never previously used assistance. Setting Community, Australia. Results Along with previously identified barriers to use of cessation assistance (cost, access, lack of awareness or knowledge of assistance, including misperceptions about effectiveness or safety), our study produced new explanations of why smokers quit unassisted: (1) they prioritise lay knowledge gained directly from personal experiences and indirectly from others over professional or theoretical knowledge; (2) their evaluation of the costs and benefits of quitting unassisted versus those of using assistance favours quitting unassisted; (3) they believe quitting is their personal responsibility; and (4) they perceive quitting unassisted to be the ‘right’ or ‘better’ choice in terms of how this relates to their own self-identity or self-image. Deep-rooted personal and societal values such as independence, strength, autonomy and self-control appear to be influencing smokers’ beliefs and decisions about quitting. Conclusions The reasons for smokers’ rejection of the conventional medical model for smoking cessation are complex and go beyond modifiable or correctable problems relating to misperceptions or treatment barriers. These findings suggest that GPs could recognise and respect smokers’ reasons for rejecting assistance, validate and approve their choices, and modify brief interventions to support their preference for quitting unassisted, where preferred. Further research and translation may assist in developing such strategies for use in practice.

Impact of Australia's introduction of tobacco plain packs on adult smokers’ pack-related perceptions and responses: results from a continuous tracking survey

Objectives To investigate the impact of Australias plain tobacco packaging policy on two stated purposes of the legislation—increasing the impact of health warnings and decreasing the promotional appeal of packaging—among adult smokers. Design Serial cross-sectional study with weekly telephone surveys (April 2006–May 2013). Interrupted time-series analyses using ARIMA modelling and linear regression models were used to investigate intervention effects. Participants 15 745 adult smokers (aged 18 years and above) in New South Wales (NSW), Australia. Random selection of participants involved recruiting households using random digit dialling and selecting the nth oldest smoker for interview. Intervention The introduction of the legislation on 1 October 2012. Outcomes Salience of tobacco pack health warnings, cognitive and emotional responses to warnings, avoidance of warnings, perceptions regarding ones cigarette pack. Results Adjusting for background trends, seasonality, antismoking advertising activity and cigarette costliness, results from ARIMA modelling showed that, 2–3 months after the introduction of the new packs, there was a significant increase in the absolute proportion of smokers having strong cognitive (9.8% increase, p=0.005), emotional (8.6% increase, p=0.01) and avoidant (9.8% increase, p=0.0005) responses to on-pack health warnings. Similarly, there was a significant increase in the proportion of smokers strongly disagreeing that the look of their cigarette pack is attractive (57.5% increase, p<0.0001), says something good about them (54.5% increase, p<0.0001), influences the brand they buy (40.6% increase, p<0.0001), makes their pack stand out (55.6% increase, p<0.0001), is fashionable (44.7% increase, p<0.0001) and matches their style (48.1% increase, p<0.0001). Changes in these outcomes were maintained 6 months postintervention. Conclusions The introductory effects of the plain packaging legislation among adult smokers are consistent with the specific objectives of the legislation in regard to reducing promotional appeal and increasing effectiveness of health warnings.

Impact of a mass media campaign linking abdominal obesity and cancer: a natural exposure evaluation

A mass media campaign aired in the Australian state of Victoria aimed to increase awareness and encourage identification of the abdominal circumference for men and women that placed them at increased risk of cancer. The evaluation assessed the extent to which ad exposure was associated with improvement in awareness, intentions and behaviours with respect to weight and cancer. Respondents were overweight or obese adults aged 30-69 years and exposure to the advertisement occurred via commercial television programmes in a natural setting. Questionnaire assessment occurred before, immediately after and 2 weeks following exposure to the advertising, and a comparison group who did not recall the ad completed the same interviews. For the main analyses, the exposure group was those who recalled the advertisement at post-exposure and follow-up (n = 101). Those who did not recall it at either stage comprised the unexposed group (n = 81). The campaign achieved its primary objective of increased awareness of the link between obesity and cancer and the specific waist sizes indicative of risk, as well as increased behavioural intentions with respect to weight and cancer. However, it did not have an effect on self-awareness of weight status, perceived personal risk of cancer or weight loss behaviour.