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Purpose: The public health burden caused by tobacco is heavy among first-generation Chinese immigrant men whose home country has significantly higher smoking rates than the United States. The current study is part of a larger effort to pilot an mHealth tobacco cessation intervention using MMS (graphic) mobile phone technologies to target East Asian immigrant populations. Grounded in the Extended Parallel Process Model (EPPM), our specific aims were to determine what message themes, level of graphic intensity, and types of efficacy information are most appropriate and useful for mHealth interventions targeting this population.

Methodology/Approach: A qualitative study utilizing a series of focus groups (k = 5) was conducted with male adult smokers who were born in China and currently reside in the United States. The primary aim of the focus groups was to solicit reactions to a series of preliminary messages developed by the research team. A secondary aim was to gauge receptivity to the use of MMS as a vehicle for smoking cessation intervention. Participants (n = 32) were recruited from local Chinese communities in a large Mid-Atlantic metropolitan area.

Findings: Opinions about different message strategies were mixed. However, participants tended to rate messages more positively when they focused on the impact of smoking on family and loved ones, particularly children. Messages with fear-arousing images were also perceived to be effective at low frequency of exposure, but there were concerns that they may backfire at high exposure. Awareness of and interest in Quitline were low, and concrete quitting tips were perceived as more effective. Participants reported a preference for receiving messages a few times a week, and an MMS message platform was generally preferred to WeChat (a Chinese social media platform).

Implications: Our results suggest that graphic MMS messaging holds promise as an effective intervention method for this population and that EPPM is an appropriate framework to develop, test, and analyze mHealth intervention messages. While messages that focused primarily on impact on children, health, and specific quitting tips were generally found to be more effective, a mix of different types of messages that address a wide range of issues may be most appropriate for this population.

Originality/Value: This study is the first to explore the utility of graphic text messaging as an intervention method to promote smoking cessation among male Chinese immigrants. Findings from the study provide important insights for future intervention work targeting this underserved population.

Successful social marketing campaign to promote COVID-19 vaccination for the unvaccinated relies on increasing positive reactions but also reducing negative responses to persuasive messages. This study aims to investigate the relative effects of narrative vs non-narrative public service announcements (PSAs) promoting COVID-19 vaccination on both positive and negative reactions. Using social media as a tool for disseminating marketing campaigns provides a great opportunity to examine the effectiveness of narrative PSAs on vaccination intention, especially among unvaccinated young adults, who were the target audience of the social marketing. This study explores the role of empathy and psychological reactance as underlying mechanisms.

An experiment involving unvaccinated young adults was conducted with a one-factor, two-condition (message type: narrative vs non-narrative) design.

Results indicated that the narrative (vs non-narrative) PSAs led to greater empathy. While no direct effects of message type emerged on psychological reactance or vaccination intention, results of a serial multi-mediator model confirmed that empathy and psychological reactance mediated the effects of message type on vaccination intention.

The study extends the understanding of narrative persuasion by examining an underlying mechanism behind narrative persuasion in a COVID-19 PSA. This study provides empirical evidence of the important role of empathy in processing narrative PSAs. Moreover, the current study expands narrative persuasion’s applicability to COVID-19 vaccination intervention messages for unvaccinated young adults, highlighting the effectiveness of narrative persuasion as a social marketing communication tool.

The purpose of this paper is to develop an in-depth understanding of the effectiveness, evolution and dynamism of the current health communication media used in Ghana.

This paper uses a multi-method approach which utilizes a combination of qualitative and quantitative approaches. In-depth interviews are conducted with health promotion professionals in Ghana and 150 members of the general public were surveyed.

The paper finds that the general public sees social media as an effective place for health professionals to share health-related messages. They also view health-related messages on social media seriously. Health professionals see social media as an effective tool for sending health-related messages to the public and are concerned about the fact that traditional media are losing their effectiveness as means to share health-related messages.

This study was conducted in Ghana. Future studies should be conducted across multiple countries to examine the conclusions developed in this paper and the possibility of multiple perspectives regarding the use of social media for sending health messages.

The results inform public health officials on developments in health communication and suggest prescriptions on how to adjust to the new media.

Health messaging is an area that has been relatively ignored in the literature and almost no research focusses on the effectiveness of social media and other health messaging technologies, particularly in developing countries. Although the study was conducted in Ghana, health professionals worldwide can use the findings to help improve their health messaging strategies.

This study aims to investigate whether the effect of exposure to video communication displaying physical activity (PA) would affect viewers’ snacking behavior depending on the type of message. Specifically, it is expected that food intake would be significantly higher when the message is labeled as a “commercial message” rather than a “health message”.

Two experimental studies are conducted that manipulate the type of message (commercial message vs health message). In Study 1, the participants’ level of involvement (low vs high) is also manipulated. In Study 2, the intensity of the PA displayed in the videos (low vs high) is manipulated, and a control group is included. The main dependent variable is the number of sweets eaten while watching the ad.

Results from both studies show that the influence of a PA exposure on food intake is influenced by the nature of the communication. Participants exposed to the commercial message eat more sweets than those exposed to the health message (ηp² = 0.06). Being exposed to a health message elicits self-regulated eating behaviors with no more sweets eaten than in the control group. In addition, the effect of the type of message is moderated by the intensity of the PA displayed. The difference of sweets consumed depending on the type of message is significant only when the physical intensity displayed is low.

The present research emphasizes the moderating role of the type of communication on food intake when recipients are exposed to a PA message. Further research must be conducted to enlarge the understanding of the phenomenon considering other critical variables such as inter-individual differences (e.g. body mass index and self-regulation skills), types of food (e.g. healthy vs unhealthy) and other contexts (e.g. watching sports events on television).

The present findings have implications for marketers, health practitioners, policymakers and consumers. They stress the significance of how the implicit goals of the messages are taken into account within consumers’ information processing and how this can affect subsequent consumption behaviors. PA displayed through a commercial message has the most negative impact on food intake, especially when the intensity of PA is low. PA displayed through a health message shows no impact on food intake, whatever the intensity of the PA. It emphasizes the importance of combining exposure to PA through advertising or sporting events to a message promoting healthy and balanced eating behaviors.

The value of the present research lies in an additional understanding of the complex effect of passive exposure to a PA message on subsequent food consumption. Furthermore, the present study expands research on persuasive communication and has critical implications for public health issues.

Clean cookstoves have emerged over the past half century as an important technological innovation to reduce indoor air pollution from cooking with traditional fuels. However, widespread adoption remains elusive, suggesting the need for other measures to accompany dissemination of clean cookstoves. Despite knowledge about health impacts of cookstove smoke and a body of evidence pointing to the efficacy of health education for supporting behaviour change, health messaging is relatively unexplored in the cookstove sector. This paper aims to present findings from action research in Cambodia that investigates how social innovation around positive and negative health messaging influences demand for clean biomass cookstoves.

An action research approach was taken, involving the design and implementation of a health marketing campaign alongside promotion of a clean burning biomass cookstove. Four communes were assigned as intervention communes and a fifth as the control group. Among the four intervention communes, two were provided with positive health messaging and the other two with negative health messaging. The methods included a baseline study of 381 households using structured surveys, roll-out of the health campaign, in-depth interviews with households and sales agents, ten focus group discussions with households and an endline structured survey of all 381 households.

Neither the type (positive/negative) nor the intensity of the health campaigns had a significant impact on stove sales. Sales results show no pattern in either variable, and sales in the control commune were not lower than in communes where health campaigns were used. However, health messaging did increase awareness about health impacts of cooking with traditional biomass burning stoves. For almost all communes, in particular those that received positive-tone messages, an increased awareness of the health impact of cooking with traditional biomass burning stoves was observed. Cookstove price and personal characteristics of individual sales agents were shown to be the strongest factors affecting sales.

The study relied on sales agents to deliver pre-assigned health messages. However, some sales agents did not follow instructions in delivering the messages, which made it difficult to compare the efficacy of the different campaign approaches. Due to a delay in the study, the campaign overlapped with the planting season when disposable incomes of famers is typically limited, reducing their ability to purchase a new cookstove. The 10-week duration of the campaign may not have been long enough to see an impact on sales, particularly for a product viewed as expensive for the average consumer.

The skill and motivation of individual sales agents can greatly affect cookstove marketing campaigns. The efficacy of individual sales agents appears to have been the strongest factor affecting sales, with the most successful sales agent using a combination of messages, including health information, to convince households to purchase the stoves. This warrants further study; designers of stove promotion campaigns might be able to learn from the behaviour and strategies of highly effective sales agents. Price continues to be an important factor influencing the adoption of clean cookstoves. In Cambodia, the main drivers of cookstove purchase (beside the sales agent) were availability of disposable income, time and fuel saved.

Health messaging was shown to have minimal effect on cookstove purchase. Indeed, it is clear that cookstove adoption is influenced by multiple factors linked in complex ways. This is a very important finding for public health workers, who need to think more broadly about how they achieve the public health goals associated with cleaner cooking through approaches that do not necessarily focus on individual health goals.

Although health messaging has shown promise as an approach for supporting behaviour change in other sectors, it has not been widely studies in the context of clean cookstove adoption. This paper contributes to filling this gap and suggests some lines of enquiry for future research. The study pioneered innovative methods such as action research, use of graphic images and using established local sales agents as means of communicating messages about the health risks of cooking smoke and the benefits of improved cookstoves.

The goal of this study was to assess the use of “health” messages in food advertising in the USA which target children. The aim was to determine if these messages indicate the promotion of a healthful product or are a marketing tactic to promote unhealthy items, potentially undermining nutrition education efforts.

A content analysis of food advertisements (n=534) in children's television shows (n=141) was performed to identify three types of health messages. The type of products promoted with such messages and the nutritional value of those products were assessed.

Over half of food advertisements targeting children use “health” messages, with commercials for fast foods and sugared cereals most likely to include them. The majority of advertisements for nutritionally poor foods include a “health” message.

The findings from this research cannot be used to predict the impact health messages have on young viewers, but rather describe the content. Quantification of this content then provides the basis for tracking changes to marketing practices over time.

This study raises concern that food advertisements targeting children may prime misleading perceptions of a food's actual nutritional value. Educators should be aware of the need to assist children in adequately interpreting “health” messages in advertising.

Little research to date has examined the “health” related messages presented in food advertisements targeting children. To our knowledge this is the first study to examine not only the presence of “health” messages but the actual nutritional quality of foods promoted to children with such messages.

The purpose of this paper is to explore consumer thinking about nutrition decisions and how firms can use consumers’ awareness of the links between nutrients and health generated by public health messages to market products, including ones, which have little nutritional value. We approach this issue by tracking the development of public health messages based on scientific research, dissemination of those messages in the popular press, and use of nutrition claims in food advertisements to assess whether firms are timing the use of nutrition claims to take advantage of heuristic-based decision-making. Our findings suggest that the timing of the development of nutrition information, its dissemination in the press, and use in advertising accords well with a heuristic processing model in which firms take advantage of associations between nutrient information and health in their advertisements. However, the demonstrated relationships may not be causal. Further research will be needed to provide stronger and more comprehensive evidence regarding the proposed message hijacking process. If the message hijacking framework is borne out: (1) simple overall health rating scales could significantly improve consumer decision-making, (2) the impact of misleading advertisements could be mitigated by encouraging a multidimensional view of nutrition, and (3) more intensive regulation of product labeling could limit the impact of hijacked messages.

Overall, this paper considers a novel hypothesis about the impact of public health messages on nutrition and health.

The author examined effects of endorser type and message framing on visual attention and ad effectiveness in health ads, including the moderator of involvement. This paper aims to discuss this issue.

An experiment was conducted with a 2 (celebrity vs. expert) × 2 (positive vs. negative framing) between-subject factorial design. Eye-tracking measured visual attention and a questionnaire measured ad effectiveness and product involvement.

Experimental data from 78 responses showed no vampire effect in the health advertisements. Celebrity endorsement with negative message framing received more attention and had less ad recall than that with positive message framing. Negative and positive message framing attracted the same amount of attention and ad recall in the expert endorsement condition. High involvement participants paid more attention to the ad message with the expert than that with the celebrity, but ad recall was not significantly increased. Low involvement participants exhibited the same attention to the ad message with the expert and with the celebrity, but had greater recall of the ad message with the expert. Visual attention to the endorser was associated with ad attitude but not with ad recall. Ad attitude impacted behavioral intention.

Studies examining influences of celebrity and message framing on ad effectiveness have focused on the response to advertising stimuli, not the information process. The author provides empirical evidence of the viewers' information processing of endorsers and health messages, and its relationship with ad effectiveness. The study contributes to the literature by combining endorser and message framing in health ads to promote public health communication from the information processing perspective.

Graphic health warnings (GHWs) on tobacco product packaging constitute one component within a multifaceted set of tobacco control measures. This study aims to understand whether consumers’ attention to GHWs will be associated with recall and quit intentions, using Australia as the case for this study.

Using the 14 GHWs currently in market as visual stimuli, non-probability intercept sampling was conducted, eye tracking and post-survey datasets were collected from a total of 419 respondents across three Australian cities.

Results show the front graphic image areas draw initial attention and the Quitline message area holds the longest attention duration. Attention is highly correlated with better quality of recall of health warning information, emotive responses, believability ratings among smokers and smokers’ perception of health risks and quit intentions. Associations are also noted with perceived health risk and quitting intentions.

To the best of the authors’ knowledge, this is the first study that has objectively tested the effectiveness of in-market tobacco GHWs in Australia and highlights eye tracking as a valid measurement approach that can enhance and drive new insights to evaluate consumer behaviour towards visual stimuli. This study extends new knowledge around the physiological relationships between viewing behaviours, health vulnerability perceptions and intentions to quit smoking, which has theoretical implications for the extended parallel process model which underpins this research.

Technology has eased access to information. During the ongoing COVID-19 pandemic, ease of access and transmission of information via social media has led to ambiguity, misinformation and uncertainty. This research studies the aforementioned behaviours of information sharing and verification related to COVID-19, in the context of social media.

Two studies have been carried out. Study 1, with Indian social media users, is a two-factor between-subjects experimental design that investigated the effect of message polarity (positive versus negative) and message type (news versus rumour) on the dissemination and verification behaviour of COVID-19-related messages. The study also investigated the mediation of perceived message importance and health anxiety. Study 2 is a replica study conducted with US users.

The study finding revealed significantly higher message sharing for news than rumour. Further, for the Indian users, message with positive polarity led to higher message sharing and message with negative polarity led to higher verification behaviour. On the contrary, for the US users, message with negative polarity led to higher message sharing and message with positive polarity led to higher verification behaviour. Finally, the study revealed message importance mediates the relationship of message type and message sharing behaviour for Indian and US users; however, health anxiety mediation was significant only for Indian users.

The findings offer important implications related to information regulation during a health crisis. Unverified information sharing is harmful during a pandemic. The study sheds light on this behaviour such that stakeholders get insights and better manage the information being disseminated.

The study investigates the behaviour of sharing and verification of social media messages between users containing health information (news and rumour) related to the ongoing COVID-19 pandemic.

The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-07-2020-0282