Using Communication Research to Design Effective Messages for Public Health: The cases of HPV vaccine and anti-smoking P

1. Using Communication Research to Design Effective Messages for Public Health: The cases of HPV vaccine and anti-smoking PSAs Joseph N. Cappella Annenberg School for Communication University of Pennsylvania Presented OBSSR, NIH June 15, 2009 Effects of Public Information in Cancer an NCI Center of Excellence in Cancer Communication Research at the Annenberg School for Communication, University of Pennsylvania

2. Message: Effects versus Design • Effects: content and consequents • Design: • Components • Analysis • Chosen: theoretically & based on real world content • Target audience:  effects • Translation: Re-engineer for public health • Avoid • Select 2

3. Message Components • Content: what the message is about • Persuasive  • Claims • Offer reasons for and reject reasons against • Implicit or explicit • Format: how the “what” is presented • Equivalence • Logical • Topical, conceptual, propositional

4. Message Effects via Design • Choose content & format • To achieve acceptance • (by target audience)

5. Conventional (theoretical) Wisdom • Strong arguments (involved targets) • Attention-getting messages • Public education overcomes resistance • Psychological • Social

6. For Example • Content • Strong, weak arguments (Petty & Cacioppo, 1986) • Altruistic versus self-interested • Format • Framing: effective 70%; ineffective 30% • Sensation value

7. Goals for Today • Are hi sensation value PSAs effective for smokers? • Are PSAs using smoking cues effective? • Are there arguments about smoking that appeal to all smokers? • How do health messages about the HPV vaccine interact with public discourse about the vaccine?

8. MSV X AS(Strasser, Cappella et al 2009) • H: Outcomes enhanced for Hi-hi • Especially for hi SS smokers • Physio, intention, beliefs re smoking

9. Message Sensation Value(Morgan et al, 2003) • Content: Acted out, narrative, unexpected format, twist ending, • Visual: cuts, edits, faces, unusual colors, intense moments (implicit, explicit) • Auditory: music, sound saturation, unusual sounds, esp slow or fast voices • Validity?

10. DESIGN • 200 adult smokers (lowest M=19/day) • MSV (2) X Arg Strg (2) X SS (2) • 4 ads per condition (16) • Careful selection from set of 600, 100 tested • Method: real ads, multiple per condition

11. Key Results • For high MSV • Corrugator Hi > Lo (p < .02) • Personal efficacy • (low SS) Lo > Hi (p < .04); • (hi SS = lo SS, hi MSV) • For high AS ads • Skin conductance strong > weak (p = .05) • Heart rate (strong > weak) (p=.02)

14. Believable MSV? • Subtle test • Recall accuracy • Recall RT • Brain response

15. fMRI, MSV, & Recall(Langleben, Loughead, Hakun, Ruparel, Strasser, Halloway, Cappella, & Lerman, 2009) • Sample: 18 regular smokers, 18-48, 13 cigs/day, 12 M • PSAs: 8 pre-selected from set of 99; anti-smoking • Design: 2 arg strength X 2 MSV, w/i subjects, 2 examples of each • Procedures: 8 PSAs, 8 control, pseudo-random order, recognition

17. Results: Recognition

18. Results: Brain response • The hiMSV PSAs were associated with extensive activation in the occipital (including the fusiform gyrus) cortex and the parahippocampus, while the loMSV PSAs were accompanied by higher orbitofrontal, superior and inferior frontal, temporal and posterior parietal activation. • Thus, the activations associated with loMSV PSA are suggestive of deeper cognitive processing than the hiMSV PSA. Moreover, absence of differences between the loMSV and hiMSV in the anterior cingulate cortex and higher posterior parietal activation suggests that higher MSV does not translate to higher endogenous attention.

19. Conclude • High MSV can distract • Cognitive resources to irrelevant features • Consistent with Kang, Cappella, & Fishbein (2006)

20. Kang, Cappella & Fishbein 2006 • 60 Anti-marijuana Ads • Adolescents • Two ad features • Message sensation Value (MSV, Morgan et al., 2003) • Argument strength • MSV -- attention • Focus on argument, stronger argument  more persuasive • Focus on stylistic features, distracter, weak argument  more persuasive • MSV as a moderator of argument quality on ad effectiveness

21. Key Finding

22. Why? • Dominant thoughts disrupted by hi MSV ads • MSV features distracting from core processing • Which features? • Under what conditions? • What else could distract?

23. Smoking Cues • In anti-smoking PSAs • 40% roughly • When outside PSAs create urge • What about inside PSAs • When args vs smoking are strong • Approach -- avoid

24. Methods • Participants • Screening criteria • N=96, 54% male, age =33, 14 yrs edu, 59% Caucasian, 17 cig/day, 29 days smoking in the previous 30 days • N=82 follow-up Yahui Kang Kang, et al,2009

25. Smoking Urge

26. Learning

27. Eye Tracking Smoking Cues

28. Design • 3(I-squared high vs. I-squared low vs. smoking) x 43 (repeats of cues in each category taken from the 16 PSAs available) • Participants (N=84) • 44 male • 47 African American, 27 white • Age 18 to 65 years, mean=36.9

29. F(2,62)=3.59, p<0.05 Sanders-Jackson, et al, unpublished

30. Conclusions • Variance of looking is less with smoking cues (and hi Information Introduced, I2) • Cue—Visual Correlation: • Mean Pearson r = .37 (range: -23 to .98) • For active smoking scenes (more urge), hi arg strength lowers attention to cues (smaller r)

31. Next Steps • Three cue (none, peripheral, central) X two argument (high, low) factorial, smokers • Urge, physio, eye tracking (Strasser, Lerman & Cappella, CECCR II) • fMRI (Loughead, NCI CECCR II) • Former smokers

32. The Problem with Arguments • Argument strength important in acceptance in previous work • Strong-weak is rated by smokers • No a priori predictions • Are there structural diffs between effective and ineffective anti-smoking arguments?

33. Anti-smoking Arguments Young Min Baek • Archive of > 1000 ads • 199 selected: English, 30 sec, adult targets, neg consequences, treatment seeking • Argument “extraction” • 8 item arg strength (Zhao et al under review) • 2004 • 99 arguments, 300 adult smokers, 12 of 99 random, mall intercept • 2008 • 100 args, 487 adult smokers, 8 of 100 random, KN sample

34. Data • Texts of arguments (10 predictors) • Automap (Carley) and LIWC (Pennebacker) • Synonym sets • Individual differences (9 predictors) • Demographic characteristics (5) • # of cigarettes/last seven days • Need for cognition • Perceived vulnerability (2) • SOC, intention to quit combined

35. Note. * p < .05 ** p < .01 *** p < .001. 99 arguments are evaluated in 2004; and 100 arguments in 2008.

36. Data Analysis Strategy • Arg, Person, Arg X Person  AS • MLM, specifically HCM • Retention of interaction terms only if replicated

37. Key Findings

38. Variance(in rated AS) • Mostly individual (49%) • Significant argument (9%) • Little interactions (< 1%) • Implications:

39. Argument Effects • Positive • People (Close) • SHS • Death • Negative • People (distant) • Cosmetic (lifestyle)

40. Person X Argument • SHS • For females (+) • For younger (+) • Disease/body • For educated (+) • Chemical/Poison • For educated (+)

41. Person Effects • Stage of Change (+++) • Perceived vulnerability to disease (++)

42. Conclusions • Argument strength highly individualized but • Early SOC • Perceived invulnerability to smoking harm • Effective arguments focus on • intimates, death, and second hand smoke • Some targeting: • Young & women: SHS • Educated: disease, poison, chemicals

43. Other Studies • Emery Collaboration: into the field • Death PSAs: PSAs with death themes  • more fear, perceived risk & effectiveness (adults) • Narrative & efficacy (print news):  • transportation  intention to quit • Fear X efficacy  intention to quit • both nec’y for early SOC • efficacy only for later SOC

44. HPV • Resistance is social, political (also) • Rolling cross section re HPV • One year, rep sample, monthly • Knowledge and news coverage • Two experiments • HPV, STIs, promiscuity, rep sample • HPV, pos-neg frame, rep sample

45. Conclusions re HPV • Public and public health agendas diverged • Message framing mattered • Ideology mattered • Ideology affected message interpretation

46. The Public Debate • Kelly et al • Media coverage  (+) knowledge

47. HPV Vaccine • The FDA approved June 8, 2006 • Vaccine prevents infection against 4 strains of HPV • Recommendation: vaccination to girls and women ages 9-26 • The vaccine effective only if prior to infection with HPV

48. HPV Vaccine Debate • Being vaccinated allows for increased and riskier sexual behavior • Anti-cancer vs. Anti-STI vaccine • Voluntary vs. Mandatory vaccination

49. U.S. Approves Use of Vaccine for Cervical Cancer By GARDINER HARRIS • Liberals in Congress and elsewhere have warned that the Bush administration and religious groups should not interfere with Gardasil's approval or required use. In response, many conservative groups have made statements supporting the vaccine. • "Despite rumors to the contrary, our organization doesn't oppose the vaccine and we have taken no position regarding mandatory laws," said Wendy Wright, president of Concerned Women of America, a conservative group based in Washington. • Some groups support the vaccine but oppose mandatory vaccinations because cervical cancer is caused by a sexually transmitted virus. • "We can prevent it by the best public health method, and that's not having sex before marriage," said Linda Klepacki of Focus on the Family, a Christian advocacy organization based in Colorado Springs.

50. | February 17, 2007 Furor on Rush to Require Cervical Cancer Vaccine By STEPHANIE SAUL and ANDREW POLLACK • Groups wary of drug industry motives find themselves on the same side of the anti-vaccination debate with unexpected political allies: religious and cultural conservatives who oppose mandatory use of the vaccine because they say it would encourage sexual activity by young girls. • And in Illinois, a bill introduced by a legislator who had the virus the vaccine is intended to prevent prompted a conservative group’s blog to speculate that she had been promiscuous. • “I’m offended by their ignorance, but if I have to take a hit to educate people, I’m willing to do it,” said the bill’s sponsor, Debbie Halvorson, the Democratic majority leader in the Illinois Senate.