Pictorial warnings (PWs) have proven effective as a tobacco control strategy, particularly when implemented as warning labels on cigarette packages. However, China’s adoption of PWs on cigarette packages has been delayed, and it remains unclear which thematic categories and specific visual features within PWs would influence outcomes that are culturally sensitive in Chinese societies. Culturally sensitive outcomes (CSOs), including anticipated loss of face, intention to gift cigarettes in social settings, and intention to refrain from smoking after exposure, reflect concerns deeply embedded in Chinese social norms. Using a large set of 510 unique PWs (K = 510) randomly evaluated by 2,306 adult male smokers in China (N = 2,306), we examined which visual features predict these three CSOs. Each participant viewed six randomly presented PWs. The experimental data were merged with manually coded content features across 24 dimensions after recounting all the features and esthetic visual characteristics of each PW extracted through computer vision analysis. Multilevel regression models revealed that thematic categories, including oral health, fertility health, and cardiovascular health, as well as specific visual elements like depictions of diseased organs and medical equipment, consistently predicted all three outcomes. The effects of other features varied. Findings provide insights for designing tobacco control campaigns and implementing cigarette package warning labels in China. Our results show the importance of tailoring PWs to resonate with culturally specific concerns in tobacco control messaging, offering important implications for pictorial warnings targeting Chinese male smokers.

Black American mothers face disproportionately high maternal mortality rates. Despite evidence showing that doulas can reduce these adverse outcomes, a majority of Black mothers remain unaware of doula services. Through interviews with 22 participants in the Northeastern United States, this study identified key barriers to awareness, including institutional practices that intersect with racial, economic, and social factors affecting access to maternal health information. Findings reveal a dichotomy between “alternative seekers,” who actively question traditional healthcare systems, and “unquestioning conformers,” who accept standard medical care without exploring alternatives. Alternative seekers typically discovered doula services through community networks and social media, while conformers remained limited by institutional and socioeconomic constraints. Recommendations to close this gap include developing institutional “push/pull” strategies: healthcare providers can incorporate basic doula information into their standard communications. Community doula organizations can also improve outreach through social media testimonials and strategic partnerships. The study also highlights how postpartum care provided by doulas fosters mutually beneficial relationships with healthcare institutions.

Based on constructs from source credibility and narrative engagement theory, this research examines (a) the mediators or processes whereby celebrity (vs. non-celebrity) sources enhance narrative persuasion and (b) the moderators or conditions under which celebrity (vs. non-celebrity) sources persuade. The study employed a two-group (celebrity vs. non-celebrity) between-subjects experimental design with 360 participants. Results showed that, compared to the non-celebrity source, the celebrity source was perceived as more attractive, which increased narrative engagement, consequently led to more positive behavioral intentions and policy opinions, particularly among those with low involvement. These results practically suggest that health campaigns that aim at low involvement audiences could benefit from the use of celebrity sources in narrative messages. This research integrates theories of narrative transportation, source credibility, and the elaboration likelihood model (ELM) to examine how celebrity (vs. non-celebrity) sources influence health campaign effectiveness. By testing the sequential mediating effects of source credibility and narrative engagement, the study provides a more comprehensive understanding of narrative persuasion using celebrity sources, particularly in the context of health campaigns for cardiovascular diseases.

Readability formulas are prominent health communication assessment tools, but they can yield varying estimates. Such variation is often treated as error in computerized tools but can result from text preprocessing decisions in manual and computerized assessments alike. This study illustrates the effect of preprocessing on reading grade level estimates in short-form online content, thereby illustrating the importance of reporting these decisions and the limitations of these formulas. We manually counted words, sentences, and syllables in a sample of 100 Tweets by U.S. state health agencies from 2012 through 2022. We applied the Simplified Measure of Gobbledygook and Flesch-Kincaid formulas under 7 inclusive preprocessing scenarios, differentially including URLs, hashtags, and/or numbers in word counts. We compared resulting estimates to those from a restrictive baseline that excluded these elements. Wilcoxon signed-rank tests revealed significant differences in median grade level estimates. No significant differences were found in the percentage of Tweets meeting an 8th-grade benchmark. Linear regression showed that baseline estimates did not adequately explain observed variation. Despite the potential benefit of interpretability, we conclude that readability formulas are unreliable for short-form online content. Instead, we recommend directly using word, sentence, and syllable counts. We also recommend conducting sensitivity analyses for readability assessments.

This study examined the effects of opioid stigma marks (e.g. “dirty,” “unclean”) on stigma-related outcomes among a sample of Amazon Mechanical Turk workers (N = 371). Using a 2 (stigma mark: yes, no) by 3 (opioid type: prescription opioid, heroin, fentanyl) between subjects factorial experiment, results indicated that compared to those in the no mark conditions, participants in the mark conditions expressed greater desire for social distance from and behavioral regulation of people with opioid use disorders. Opioid stigma marks were also indirectly associated with more behavioral regulation, more stigma message sharing, and less support for opioid-related public health policies through stigma beliefs. Results advance theoretical understandings of the stigma message effects process and offer practical recommendations for public health communicators and journalists.

Female chronic pain patients often report perceiving that their character (i.e. credibility, reputation) has been attacked by clinicians during healthcare interactions. Although initially developed to examine political communication, we argue that character assassination (CA) is an inherently communicative phenomenon that also occurs within patient-clinician interactions. Utilizing CA as a sensitizing concept, this study examined experiences of CA among a racially, socioeconomically, and globally diverse sample of 450 female chronic pain patients during their interactions with clinicians. Our findings illuminate specific tactics employed by clinicians to attack patients’ character, including making false attributions, lying and misquoting, triggering stereotypes, bullying, and emphasizing alleged flaws. Our findings also illustrate how CA might catalyze other deleterious outcomes, including fueling self-doubt, delaying further help-seeking and diagnosis, intensifying physical and mental health conditions, and turning relationally close others against the patient. We offer theoretical implications for utilizing CA as a conceptual lens and practical implications for patients and clinicians.

Internet memes, viral and mutable messages online, have been used by individuals and organizations to disseminate health messages. Specifically, both companies and public health organizations have used memes to influence e-cigarette behaviors. How does exposure to e-cigarette memes on social media shape related perceptions and behaviors among youth? This study extracted data from restricted-use file of Wave 7 (2022–2023) of the Population Assessment of Tobacco and Health (PATH) study, a nationally representative study that collected information about tobacco use and associated health behaviors among adults (≥18 years) and youth (12–17 years) in the United States. Our analyses investigated the association between youth participants’ exposure to various sources of memes related to e-cigarette use and their e-cigarette-related expectancies, perceptions, use, and cessation, while controlling for parental and youth factors. Exposure to memes posted by friends and celebrities were all associated with lower perceived harmfulness, higher descriptive norms, more positive injunctive norms of using e-cigarettes, and more ease for purchasing e-cigarettes (ps<.05). For youth who do not use e-cigarettes, exposure to e-cigarette memes was associated with higher susceptibility of using e-cigarettes (ps<.01). Additionally, exposure to memes posted by friends was also associated with lower e-cigarette quit intentions. E-cigarette memes may influence youth’s perceptions about e-cigarettes and contribute to initiation among youth. Future research is needed for identifying strategies in using Internet memes for e-cigarette prevention and health campaigns.

Since 2021, the United States has experienced a significant increase in H5N1 (“avian flu”) infections, spreading from wild fowl to domestic poultry, dairy cattle, and some humans, primarily agricultural workers. This study examines urban-rural differences in willingness to receive an H5N1 vaccine and change dietary behavior based on potential CDC recommendations. A survey (Aug 5–15, 2024) sampled 5,000 urban and 5,000 rural participants via online panels and live operator calls. Key measures included willingness to vaccinate and change diet related to dairy or egg consumption in line with potential CDC recommendations, with residence classification as the main independent variable. Logistic regression assessed associations, controlling for demographics and health-related factors. Rural residents were more likely to have heard of bird flu but less likely to perceive it as a threat to humans generally or to themselves personally. After adjusting for sociodemographic characteristics, rural residents were less likely to be willing to change their diets due to potential CDC recommendations, but their vaccination intent relative to a potential H5N1 vaccine was on par with urban populations. Findings highlight the potential to modify behaviors in respect to consuming raw milk products and undercooked foods and accepting potential H5N1 vaccination may reflect institutional trust gaps and cultural dietary norms. Targeted public health messaging is needed to engage rural communities where the epicenters of the current outbreak are occurring.

This paper explores the impact of artificial intelligence (AI) on information seeking behavior research and practice, including the need to scrutinize existing information seeking theory, challenge the understood behavioral norms, and consider redefining information literacy and information retrieval education. The historical examination spans from the 1950s to the present, with a specific focus on recent developments in health information seeking and the evaluation of medical information sources. Key to this exploration are ongoing debates in healthcare, ethics, and AI and information literacy education, which represent important dimensions of the impact of emerging technology on information-seeking behavior. The insights provided by this research can be useful for both researchers and practitioners, aiding them in navigating the evolving landscape shaped by AI technology.

The 30th anniversary of the Journal of Health Communication: International Perspectives occurs at a pivotal moment. In our inaugural issue in 1996, founding editor Scott Ratzan described his vision “to promote global health with effective communication strategies to improve health outcomes and well-being.” Since then, JOHC has consistently championed rigorous and forward-thinking research and perspectives that have helped shape today’s multi-disciplinary practice. As we mark this milestone and honor the Journal’s legacy, we must also confront the pressing challenges that define the current landscape of health communication. We live in an era where scientific reasoning is increasingly questioned by policymakers, patients, and the public alike. The institutions that have traditionally upheld evidence-based practice have lost trust, respect and authority. In this evolving context, health communication cannot remain a static field. In the decades ahead, the Journal must take an active and unapologetic stance—maintaining the highest ethics while driving innovation in digital health communication, scientific methodology, data interpretation and translation for better uptake. Its mission must be to accelerate measurable global health gains by advancing communication strategies that not only inform, but inspire trust, foster agency, and empower individuals and populations to make evidence-based choices they willingly and confidently adopt.