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Background: The U.S. Food and Drug Administration authorized the sale and marketing of two very low nicotine cigarettes (VLNC) as modified risk tobacco products. The misperception that VLNC are healthier than regular cigarettes is common. This study explores effective message strategies to inform the public about health risks associated with VLNC use, encourage cigarette smokers to try VLNC, and prevent other tobacco users and non-users from product initiation. Methods: Following the Reasoned Action approach, a VLNC educational message was developed based on the salient beliefs associated with behavioral intention. The message was tested in an online survey conducted in 2018, where 410 participants were randomly assigned to one of the two message conditions (no-message, VLNC message). Message effects were assessed across four tobacco-use groups (non-tobacco users, cigarette-only smokers, cigarette dual/poly smokers, other tobacco users). Results: Compared to the no-message control, the VLNC message condition showed lower nicotine risk perception for all participants, lower misbelief in VLNC safety for non-users and cigarette-only smokers, higher belief in VLNC carcinogenicity for other tobacco users, stronger belief in second-hand smoke harm for cigarette dual/poly smokers and other tobacco users, and higher VLNC intention for cigarette-only smokers. Conclusions: Different messages are needed for different types of tobacco users. Both cigarette smokers and other tobacco users could benefit from messages that acknowledge the non-addictiveness but emphasize the health risks of VLNC. Regulators could consider making physical harm statements a requirement for VLNC packaging and marketing. New strategies need to be explored to inform cigarette dual/poly smokers.

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BACKGROUND: Stigma, lack of trust in authorities, and poor knowledge can prevent health-seeking behaviour, worsen physical and mental health, and undermine efforts to control transmission during disease outbreaks. These factors are particularly salient with diseases such as mpox, for which 96% of cases in the 2022-2023 UK outbreak were identified among gay, bisexual, queer and men who have sex with men (MSM). This study explored stigma and health-seeking behaviour in Liverpool through the lens of the recent mpox outbreak. METHODS: Primary sources of data were interviews with national and regional key informants involved in the mpox response, and participatory workshops with priority populations. Workshop recruitment targeted Grindr users (geosocial dating/hookup app) and at risk MSM; immigrant, black and ethnic minority MSM; and male sex workers in Liverpool. Data were analysed using a deductive framework approach, building on the Health Stigma and Discrimination Framework. RESULTS: Key informant interviews (n = 11) and five workshops (n = 15) were conducted. There were prevalent reports of anticipated and experienced stigma due to mpox public health messaging alongside high demand and uptake of the mpox vaccine and regular attendance at sexual health clinics. Respondents believed the limited impact of stigma on health-seeking behaviour was due to actions by the LGBTQ + community, the third sector, and local sexual health clinics. Key informants from the LGBTQ + community and primary healthcare felt their collective action to tackle mpox was undermined by central public health authorities citing under-resourcing; a reliance on goodwill; poor communication; and tokenistic engagement. Mpox communication was further challenged by a lack of evidence on disease transmission and risk. This challenge was exacerbated by the impact of the COVID-19 pandemic on the scientific community, public perceptions of infectious disease, and trust in public health authorities. CONCLUSIONS: The LGBTQ + community and local sexual health clinics took crucial actions to counter stigma and support health seeking behaviour during the 2022-2023 UK mpox outbreak. Lessons from rights based and inclusive community-led approaches during outbreaks should be heeded in the UK, working towards more meaningful and timely collaboration between affected communities, primary healthcare, and regional and national public health authorities.

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The health promotion literature that considers how scientific evidence can be effectively communicated tends to focus on evaluating the effectiveness of communication materials. This has resulted in a knowledge gap regarding effective knowledge translation processes. This study explores the process, reasoning and practices for developing books for children that incorporate evidence-based information to aid understanding of scientific evidence about health and environmental or natural disasters. This study is informed by a systematic review of the literature combined with responses to an email interview with authors of books for children. Nine published studies were included in the systematic review. Twenty-two authors responded to the email survey (25% response rate, following 86 invitations). We report seven key findings to guide the development of health-promoting books for children: (i) understand the needs and expectations of the audience, (ii) articulate the topic and research evidence, (iii) assemble a team with a mix of content knowledge and creative expertise, (iv) format should be chosen to suit the user group and guided by the creative team, (v) early testing with children and their support system is crucial, (vi) develop a dissemination strategy to reach the user group and (vii) engage in reflexivity through evaluation of effectiveness of messaging. The current investigation can guide the process, reasoning and practice of developing books for children that incorporate evidence about health and environmental disasters.

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OBJECTIVES: To explore how the use of, and trust in, different sources of advice and information on COVID-19 differed across the four UK nations and between different sociodemographic groups and their associations with COVID-19 vaccination status. METHODS: We used a UK-wide representative survey conducted in July 2021, which included data on uptake of COVID-19 vaccination, trust in information sources, use of sources and geographical and sociodemographic variables. We used multivariate logistic regression to identify factors associated with completed or planned COVID-19 vaccination. RESULTS: Trust in the NHS, followed by trust in scientists, were the strongest predictors of vaccination intention. NHS websites were the most used (56% across the UK); only the Scottish government website had a higher level of reported use (58%). Using either source was associated with a positive vaccination status as were use of the GP and television as sources of advice. Use of social media, family and friends, and 'none' of the sources enquired about, were all linked to a lower likelihood of being or intending to get vaccinated. Compared to those in England, respondents in other UK nations were less likely to trust the central UK government for advice on COVID-19. There was considerable variation by age in trust and use of some, but not all, sources of advice, with predicted probabilities ranging from 35% among the youngest age group to 62% among those aged 65 years or older. There were also significant differences by annual household income and by occupational class for trust in government, with higher incomes correlating with greater likelihood of trust. CONCLUSIONS: This study demonstrates high levels of trust in the key sources of public health advice and there was a positive association between using official sources of advice and vaccination intentions, even in the context of overall high vaccination rates. Our findings highlight the need for the UK and devolved governments to value the importance of public trust in the health system and take appropriate measures to avoid undermining such trust.

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Background: Conflicting messages and misleading information related to the coronavirus (COVID-19) pandemic (SARS-CoV-2) have hindered mitigation efforts. It is important that trust in evidence-based public health information be maintained to effectively continue pandemic mitigation strategies. Officials, researchers, and the public can benefit from exploring how people receive information they believe and trust, and how their beliefs influence their behaviors. Methods: To gain insight and inform effective evidence-based public health messaging, we distributed an anonymous online cross-sectional survey from May to July, 2020 to Virginia residents, 18 years of age or older. Participants were surveyed about their perceptions of COVID-19, risk mitigation behaviors, messages and events they felt influenced their beliefs and behaviors, and where they obtained information that they trust. The survey also collected socio-demographic information, including gender, age, race, ethnicity, level of education, income, employment status, occupation, changes in employment due to the pandemic, political affiliation, sexual orientation, and zip code. Analyses included specific focus on the most effective behavioral measures: wearing a face mask and distancing in public. Results: Among 3,488 respondents, systematic differences were observed in information sources that people trust, events that impacted beliefs and behaviors, and how behaviors changed by socio-demographics, political identity, and geography within Virginia. Characteristics significantly associated (p < 0.025) with not wearing a mask in public included identifying as non-Hispanic white, male, Republican political identity, younger age, lower income, not trusting national science and health organizations, believing one or more non-evidence-based messages, and residing in Southwest Virginia in logistic regression. Similar, lesser in magnitude correlations, were observed for distancing in public. Conclusions: This study describes how information sources considered trustworthy vary across different populations and identities, and how these differentially correspond to beliefs and behaviors. This study can assist decision makers and the public to improve and effectively target public health messaging related to the ongoing COVID-19 pandemic and future public health challenges in Virginia and similar jurisdictions.

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The coronavirus disease 2019 (COVID-19) pandemic revealed the importance of improving the accessibility of quality public health messaging especially among underserved communities. By establishing a robust communication infrastructure, communities may begin to address the disparities exacerbated by misinformation. In this article, we describe the work done by Worth a Shot, a community-led organization that partnered with trusted, informed county residents; the county residents served as "public health ambassadors" who provided accurate, timely information to their communities in a culturally sensitive approach. This youth-led work may serve as a model for other communities that seek to improve outreach to underserved communities.

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PURPOSE: The Rio Grande Valley in South Texas comprises 5% percent of Texas's population yet 17%of Texas's COVID-19 deaths. We aimed to address underlying mistrust and systemic racism in our Hispanic community that contributes to health inequities by developing a cultural competence guide for public health messaging. METHODS: We employed a mixed method design (e.g., focus groups, surveys, interviews) to develop and implement a cultural competence guide in an iterative community-informed process. We created a general cultural competence guide, one for the Hispanic community and one for the hard-of-hearing community. RESULTS: Our cultural competence guides provide an interpretation as to whether the message is culturally competent or requires revisions. The guides have the following five categories: content and clarity, emotions and values, audience and inclusivity, call to action, and gestalt. CONCLUSIONS: The Hispanic community needs more culturally competent public health messaging to address a key root cause of health inequities surrounding COVID-19. Our novel, concise guides can help organizations and individuals seeking to create culturally sensitive and, therefore, more effective public health messaging for Hispanic or deaf and hard-of-hearing communities.

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Understanding the reception of public health messages in public-facing communications is of key importance to health agencies in managing crises, pandemics, and other health threats. Established public health communications strategies including self-efficacy messaging, fear appeals, and moralising messaging were all used during the Coronavirus pandemic. We explore the reception of public health messages to understand the efficacy of these established messaging strategies in the COVID-19 context. Taking a community-focussed approach, we combine a corpus linguistic analysis with methods of wider engagement, namely, a public survey and interactions with a Public Involvement Panel to analyse this type of real-world public health discourse. Our findings indicate that effective health messaging content provides manageable instructions, which inspire public confidence that following the guidance is worthwhile. Messaging that appeals to the audience's morals or fears in order to provide a rationale for compliance can be polarising and divisive, producing a strongly negative emotional response from the public and potentially undermining social cohesion. Provenance of the messaging alongside text-external political factors also have an influence on messaging uptake. In addition, our findings highlight key differences in messaging uptake by audience age, which demonstrates the importance of tailored communications and the need to seek public feedback to test the efficacy of messaging with the relevant demographics. Our study illustrates the value of corpus linguistics to public health agencies and health communications professionals, and we share our recommendations for improving the public health messaging both in the context of the ongoing pandemic and for future novel and re-emerging infectious disease outbreaks.

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RESEARCH QUESTION/OBJECTIVE: In the US, child fatalities in hot cars [i.e., pediatric vehicular heatstroke (PVH)] occur on average once every 10 days. Despite national campaigns and recurring media attention, there has been little change in the rate of PVH deaths annually. The objective of this study was to characterize caregivers' beliefs, behaviors, and attitudes related to PVH risk factors and potential mitigating technologies. METHODS/DATA SOURCES: We conducted a national survey of US caregivers to: (1) determine caregivers' perceptions of PVH risk for children in their care, as well as their thoughts about adopting risk mitigating technologies, (2) characterize scenarios in which caregivers intentionally leave children unattended in vehicles, and (3) assess caregiver awareness of national PVH campaigns. We used a variety of question formats (select all that apply, multiple choice, free response). Data were analyzed data using descriptive statistics and caregiver responses related to PVH event behaviors were compared across selected demographic characteristics using chi-square tests. RESULTS: Exactly 1,500 caregivers completed the survey; 60% were female and 60% were non-Hispanic White. Most, or 88%, of our respondents reported they do not leave their child(ren) alone in vehicles for any amount of time. However, there were differences in who engages in this behavior by caregivers' gender, education, income, and number of children. Few, or 12%, believed they were at any risk for having a child overheat in a vehicle, and most caregivers described negative and/or judgmental views of those who were at-risk. Nearly all participants indicated it was important that caregivers receive education about PVH (95%), and the majority, or 90%, responded they would be willing to adopt risk mitigating technology themselves, many believing they and others would be perceived as better caregivers if they did so. SIGNIFICANCE OF RESULTS: This is the first nationally representative study to the authors' knowledge that characterizes caregivers' attitudes, behaviors, and perceived risk of PVH, along with their willingness to adopt mitigating technologies. Our dissonant finding that caregivers view those who may be at risk for PVH negatively while simultaneously viewing those who adopt risk mitigating strategies positively provides stakeholders with unique insight for future efforts. Specifically, messaging utilizing themes of positive caregiving might be more effective at increasing caregivers' adoption than threat-based campaigns focused on communicating risk. Additionally, our findings of demographic differences in behaviors related to PVH are a helpful first step to inform the development of tailored interventions (e.g., public messaging) and potential risk mitigating technologies that may be more likely to be widely adopted.

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BACKGROUND: Vaccines are a strong public health tool to protect against severe disease, hospitalization, and death from COVID-19. Still, inequities in COVID-19 vaccination rates and health outcomes continue to exist among Black and Latino populations. Boston Medical Center (BMC) has played a significant role in vaccinating medically underserved populations, and organized a series of community-engaged conversations to better understand community concerns regarding the COVID-19 vaccine. This paper describes the themes which resulted from these community-engaged conversations and proposes next steps for healthcare leaders. METHODS: We accessed nine publicly available recordings of the community-engaged conversations which were held between March 2021 and September 2021 and ranged from 8 to 122 attendees. Six conversations prioritized specific groups: the Haitian-Creole community, the Cape Verdean community, the Latino community, the Black Christian Faith community, guardians who care for children living with disabilities, and individuals affected by systemic lupus erythematosus. Remaining conversations targeted the general public of the Greater Boston Area. We employed a Consolidated Framework for Implementation Research-driven codebook to code our data. Our analysis utilized a modified version of qualitative rapid analysis methods. RESULTS: Five main themes emerged from these community-engaged conversations: (1) Structural factors are important barriers to COVID-19 vaccination; (2) Mistrust exists due to the negative impact of systemic oppression and perceived motivation of the government; (3) There is a desire to learn more about biological and clinical characteristics of the COVID-19 vaccine as well as the practical implications of being vaccinated; (4) Community leaders emphasize community engagement for delivering COVID-19 information and education and; (5) Community leaders believe that the COVID-19 vaccine is a solution to address the pandemic. CONCLUSION: This study illustrates a need for community-engaged COVID-19 vaccine messaging which reflects the nuances of the COVID-19 vaccine and pandemic without oversimplifying information. In highlighting common concerns of the Greater Boston Area which contribute to a lack of confidence in the COVID-19 vaccine, we underscore important considerations for public health and healthcare leadership in the development of initiatives which work to advance health equity.

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This paper will explore the multi-modal semiotic properties of a selection of key public health information posters issued by the UK Westminster government on the use of masks and face coverings during the first year of the COVID-19 pandemic. Using multi-modal critical discourse analysis, we show how the posters featuring masks sustained consistent government-led branding, while drawing upon what we describe as "synthetic personalisation" to manage the orientation of the crisis as the pandemic progressed. Through this analysis, the article will highlight the possible contribution of these posters to an environment characterised by political confusion and enabling of a relatively widespread rejection of mask-wearing as a public health responsibility. Examining this within a broader decline in trust in government, we suggest the various attempts to produce a positive message about mask-wearing contributed instead to the appropriation of masks as symbols of individual alignment within a contested political field.

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OBJECTIVE: The National Heart Foundation's Warning Signs Campaign (2009-2013) aimed to raise awareness amongst the public of Acute Coronary Syndrome (ACS), encouraging people to recognise suggestive symptoms and seek immediate medical attention. This study explores the impact of the campaign on the characteristics of patients presenting to hospitals around Australia with ACS. DESIGN: Retrospective cohort analysis Setting: 10 Australian Hospitals recruiting for the CONCORDANCE registry continuously throughout the campaign period. PARTICIPANTS: Patients presenting with ACS to hospitals before, during and after the campaign ran in their jurisdiction. MAIN OUTCOME MEASURES: Whether an ambulance was called, time between onset of symptoms to first medical contact, as well as time between onset of symptoms to primary percutaneous intervention or lysis. RESULTS: Time to first medical contact did not improve during or post-campaign for NSTEACS medical hours (IQI) 1.6 (0.5-4.8) pre, 2.2 (0.7-7.6) during, 2 (0.7-6.9) post (p < 0.001) or STEMI, 1.1 (0.4-3.5) pre, 1.6 (0.6-5.1) during, 1.4 (0.5-4.3) post (p = 0.0113). In STEMI, time from symptom onset to pPCI (p = 0.256) and time to lysis (p = 0.387) were also unchanged. The proportion of ambulance arrivals remained stable (pre 55% vs. during 58%, p = 0.493). Patients presenting during the campaign were more likely to be born in Australia 56% pre, 69% during, 68% post (p < 0.001), to report English as a first language 67% pre, 84% during, 79% post (p < 0.001), and had lower likelihood of prior MI or revascularization but greater likelihood of cardiovascular risk factors compared to those presenting prior. CONCLUSION: Among patients with ACS, we detected no increase in proportion of ambulance presentations nor earlier presentations among NSTEACS or STEMI during the campaign. There was an increase in the proportion of patients for whom English was the first language and those without a prior cardiac history but with cardiovascular risk factors, suggesting that the campaign impacted preferentially on certain strata in the community.

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INTRODUCTION: Stigma has inhibited public health practitioners' influence during the COVID-19 pandemic. We explore the experienced and anticipated stigma of people affiliated with a large university in the United States, using the Health Stigma and Discrimination Framework. METHODS: We conducted a qualitative secondary substudy of 20 people who tested SARS-CoV-2 positive and 10 who tested negative in the summer of 2020, selected from a study of 3,324 university students and employees. FINDINGS: No participants reported anticipated stigmatization prior to testing positive. However, eight of 20 participants recounted stigma marking (being marked by COVID-19 diagnosis or membership in a "high-risk" group) or manifestations of stigma after testing positive, including feelings of guilt or shame, and concerns about being judged as selfish or irresponsible. Three described being denied services or social interactions as a result of having had COVID-19, long after their infectiousness ended. Participants noted that clear public health messaging must be paired with detailed scientific information, rather than leaving people to resort to non-experts to understand the science. DISCUSSION: Public health messaging designed to mitigate spread of SARS-CoV-2 and protect the community may perpetuate stigma and exacerbate inequities. As a result, people may avoid testing or treatment, mistrust public health messaging, or even use risk-increasing behavior as coping mechanisms. IMPLICATIONS FOR PRACTICE: Intentional use of language that promotes equity and deters discrimination must be high priority for any COVID-19-related public health messaging. Partnership with community leaders to co-create programs and disseminate messaging is a critical strategy for reducing stigma, especially for historically mistreated groups.

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Social distancing reduces the transmission of COVID-19 and other airborne diseases. To test different ways to increase social distancing, we conducted a field experiment at a major US airport using a system that presented color-coded visual indicators on crowdedness. We complemented those visual indicators with nudges commonly used to increase COVID-19-preventive behaviors. Analyzing data from 57,146 travelers, we find that visual indicators and nudges significantly affected social distancing. Introducing visual indicators increased the share of travelers practicing social distancing, and this positive effect was enhanced by introducing nudges focused on personal benefits ("protect yourself") and public benefits ("protect others"). Conversely, an authoritative nudge referencing the Centers for Disease Control and Prevention ("don't break CDC COVID-19 guidelines") did not change social distancing behavior. Our results demonstrate that visual indicators and informed nudges can boost social distancing and potentially curb the spread of contagious diseases.

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BACKGROUND: COVID-19 public health measures like handwashing and social distancing can help stem the spread of the virus. Adherence to guidelines varies between individuals. This study aims to identify predictors of non-adherence to social distancing and handwashing guidelines. METHODS: A cross-sectional weekly telephone survey was conducted over eight weeks (11/06/2020-05/08/2020). The sample included adults resident on the island of Ireland (75:25 split between ROI and NI). Data were collected on demographics, threat perceptions, fear of COVID-19, response efficacy and self-efficacy, response cost and social norms, COVID-19 behaviours, mood, loneliness, and self-reported health. RESULTS: 3011 participants were surveyed. Handwashing non-adherers were more likely to be male (OR: 5.2, 95% CI: 2.4 - 11.3), to have higher levels of loneliness (OR: 1.86, 95% CI: 1.1 - 3.1), and higher perceptions of handwashing costs (OR: 3.4, 95% CI: 2.2 - 5.2). Those reporting rarely engaging in social distancing were more likely to be members of lower socioeconomic groups, to be younger (OR: 0.97, 95% CI: 0.96 - 0.98), male (OR: 1.67, 95% CI: 1.1 - 2.5), healthcare workers (OR: 1.98, 95% CI: 1.1 - 3.4), to report lower mood (OR: 1.72, 95% CI: 1.3 - 2.2), were less likely to live in households with people aged under-18 (OR: 0.75, 95% CI: 0.6 - 0.9), and to have lower fear of COVID-19 (OR: 0.79, 95% CI: 0.6 - 0.9). CONCLUSIONS: Non-adherers to handwashing differ to social distancing non-adherers. Public health messages should target specific demographic groups and different messages are necessary to improve adherence to each behaviour.

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Conspiracy beliefs are ubiquitous in the current COVID-19 pandemic. This may be because they directly affect own and others' health and economic outcomes due to detrimental effects on preventive behaviour. We aimed to (a) test key hypotheses on the correlates of generic beliefs in conspiracy theories in this high-threat real-life setting, (b) examine the role of trust in mediating effects of conspiracy beliefs on preventive behaviour, and (c) thereby inform the public health response. Using cross-sectional data (N = 1013) from the German COVID-19 monitoring we tested the relationships between conspiracy beliefs and (a) social and economic worries, (b) trust in media, the government, public health institutions, and science, and (c) hygiene-related and contact-related preventive behaviour. Results were in line with expectations apart from null findings for the relationships with social worries and hygiene-related preventive behaviour. Trust in government mediated effects of conspiracy beliefs on contact-related preventive behaviour.

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Public health (PH) messaging can have an enormous impact on shaping how individuals within society behave, and can ensure it is in a safe and responsible way, consistent with up-to-date evidence-based PH guidelines. If done effectively, messaging can save lives and improve the health of those within society. However, unfortunately, those within Government PH bodies typically have little training about how to effectively represent PH messages in a way that is consistent with psychological theories of cognitive bias, in order to avoid cognitively biasing the public through their messages. As a result of this, inadequate representation of PH messages can result, which can often lead to cognitive bias in those from the public who read or listen to the message information. This can lead to poor decision making of the pubic as a whole, which can then further lead to harm and even death of public members as a result of these poor decisions. One way to minimize the problem of bias in decision making is to explore psychology theories that model how bias can occur from PH messaging, and identify ways in which PH agencies can utilize such approaches to improve the effectiveness of their messages. Previous focus has been largely on behavioral economic theories, however, here, other accounts are offered in addition to these. These include theories of heuristics and theories from the behavior analysis domain, which may increase the predictive power of modeling bias, and have applications for how best to represent PH message information which minimize bias.

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BACKGROUND: Latino communities in the United States and Latin America are disproportionately affected by the COVID-19 pandemic. We analyzed information shared on Twitter in Spanish language for insights into the public's communication and information needs about the COVID-19 pandemic. METHODS: We performed a mixed-methods analysis using a text mining approach. We used SAS Text Miner, an algorithmic-driven statistical program to capture 10,000 tweets posted between June 3, 2020, and June 10, 2020. We used the following search terms to capture relevant Twitter messages in Spanish language: "coronavirus," "covid-19," "corona," and the hash tags "#COVID19" and "#Coronavirus." Key text topics were identified and categorized into themes using an emergent content analysis. RESULTS: We identified 12 text topics and six themes: (1) prevention measures, (2) epidemiology/surveillance, (3) economic impact, (4) optimizing nursing workforce, (5) access to reliable information, and (6) call for a response from the local government. Top trending hashtags from our search included #COVID19 (n = 7,098), #Coronavirus (n = 6,394), and #SNTESALUD (n = 2,598). CONCLUSIONS: Spanish-language Tweets related to the COVID-19 pandemic contained information from health departments and labor unions on the surveillance, prevention, and impact of COVID-19. Public health officials should consider increasing their use of Twitter to ensure a wide dissemination of messages about COVID-19 in Spanish outlets.

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