Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Although women seek information online about how to reduce breast cancer risk, they may not be obtaining scientifically-based information. Social media platforms, like blogs, offer a way to disseminate health information, educate the public, and promote healthy behavior. Blogs written by mothers are increasingly recognized as a channel that women utilize to make personal and family health-related decisions. Objective: We developed and evaluated a blog intervention to disseminate breast cancer and environmental risk information to mothers. We teamed with “mommy bloggers” to disseminate a message that we developed and tailored for mothers and daughters based on scientific evidence from the Breast Cancer and the Environment Research Program (BCERP). We posited that the social media intervention would influence women’s exposure to, acceptance of, and beliefs about environmental risks while promoting their intention to adopt risk-reducing behaviors. We also explored women’s social media preferences for this type of information. Methods: Using a quasi-experimental design, we recruited 75 mommy bloggers to disseminate the breast cancer risk/prevention message on their respective blogs and examined the impact of the intervention on 1) readers exposed to the intervention (n = 445) and 2) readers not exposed to the intervention (comparison group; n = 353). Results: Following the intervention, blog reader scores indicating exposure to the breast cancer risk/prevention information (M = 3.92, SD = .85) were greater than scores of blog readers who were not exposed (or did not recall seeing the message) (M = 3.45, SD = .92). Readers who recalled the intervention messages also had higher breast cancer risk/prevention information satisfaction scores (M = 3.97, SD = .75) compared to readers who didn’t see (or recall) the messages (M = 3.57, SD = .94). Blog readers who recalled seeing the intervention messages were significantly more likely to share the breast cancer risk/prevention information they read, and with daughters specifically, than readers who did not recall seeing them, χ2 (1) = 8.071, P = .004. Those who recalled seeing the intervention messages reported significantly higher breast cancer risk/prevention information influence scores (M = 11.22, SD = 2.93), indicative of behavioral intentions, than participants who did not recall seeing them (M = 10.14, SD = 3.24). Most women ranked Facebook as their first choice for receiving breast cancer risk/prevention information. Conclusions: Results indicated that blog readers who were exposed to (and specifically recalled) the BCERP-adapted intervention messages from mommy bloggers had higher breast cancer risk/prevention information exposure scores and higher breast cancer risk/prevention information satisfaction and influence scores than those who did not see (or recall) them. Mommy bloggers may be important opinion leaders for some women and key to enhancing the messaging, delivery, and impact of environmental breast cancer risk/prevention information on mothers. Clinical Trial: NA

Dissemination of public health information plays an essential role in communicable disease control and prevention. However, widespread and repeated messaging could become counterproductive if it leads to avoidance and disengagement due to message fatigue. Americans have been inundated with accurate and inaccurate COVID-19 information from myriad sources since the start of the pandemic. Using the health belief model (HBM) as a guiding framework, this study examines COVID-19-related message fatigue among adults in the United States who have gotten at least one dose of a COVID-19 vaccine and the association between message fatigue and COVID-19 booster uptake and intentions. A special survey module of The COVID States Project was fielded between August and September 2022 (n = 16,546). Results showed moderately high levels of message fatigue among vaccinated individuals. Message fatigue was negatively associated with the likelihood of having gotten a COVID-19 booster and intentions to do so among those who had not yet received a booster, above and beyond variance explained by the HBM constructs. These findings underscore the importance of monitoring and mitigating COVID-19-related message fatigue in encouraging the public to stay up to date with COVID-19 vaccination.

Vaping is the most prevalent form of tobacco use among youth in the United States. Motivated by the certainty effect in prospect theory, this study investigated the role of uncertainty tolerance as a potential moderator of the effects of gain- vs. loss-framed text messages for youth vaping prevention. Youth susceptible to future vaping (N = 536) were randomized to view a series of eight gain- or loss-framed text messages about the health consequences of vaping. Cognitive and affective responses to the messages as well as beliefs, attitude, and intentions about vaping were assessed post-exposure. Results showed an overall advantage of the loss frame on several outcomes. Additionally, an interaction between framing and uncertainty tolerance was observed for most outcomes such that the loss frame was more effective for those high in uncertainty tolerance, while the gain frame held a slight edge for those low in uncertainty tolerance. Findings from this study have implications for further engaging prospect theory in message framing research. They may also inform audience segmentation and targeted message design for youth vaping prevention efforts.

Electronic cigarettes are the most widely used tobacco product among youth in the United States. Although rapidly growing, research on effective message strategies for e-cigarette use prevention is still limited. This study examined the relative effectiveness of gain framing versus loss framing in youth-targeting prevention text messages delivered either as individual expository texts or simulated text exchanges between a youth patient and a pediatrician. A national sample of 1,084 youth susceptible to future e-cigarette use was randomized to condition in an online message testing experiment featuring a 2 (framing: gain vs. loss) × 2 (format: individual texts vs. simulated exchange) factorial design. Results revealed a consistent interaction between framing and messaging format in message liking, positive affect, attitude toward e-cigarette use, and future e-cigarette use intentions. The gain frame outperformed the loss frame in the simulated exchange conditions while the reverse trend was true for the individual text conditions. Furthermore, the main effect of messaging format was significant on multiple outcomes in favor of simulated text exchanges. The main effect of framing was only significant on negative affective response with the loss frame eliciting stronger responses. These findings suggest that the relative effectiveness of gain framing versus loss framing depends on how messages are presented in youth-targeting text messaging interventions. When messages are likely to be delivered in a discrete manner, the loss frame should be preferred. When greater interactivity and narrative development are possible, the gain frame should be favored. E-cigarette prevention efforts should leverage these insights to enhance message effectiveness.

This study compared the ads on for-profit and non-profit Web sites for children in light of privacy concerns. A content analysis of 751 advertisements displayed on 196 popular children's Web sites was conducted. The results showed that, compared to for-profit Web sites for children, non-profit Web sites hosted fewer ads, and such ads were less likely to contain prompt words and enticements. Findings also indicated, however, that non-profit Web sites still carried ads that would link children to for-profit Web sites that collected personal information. Results are discussed in terms of the need for non-profit Web sites to make more efforts to fully protect children's privacy online.