The ethics of distress: Toward a framework for determining the ethical acceptability of distressing health promotion advertising

Distressing health promotion advertising involves the elicitation of negative emotion to increase the likelihood that health messages will stimulate audience members to adopt healthier behaviors. Irrespective of its effectiveness, distressing advertising risks harming audience members who do not consent to the intervention and are unable to withdraw from it. Further, the use of these approaches may increase the potential for unfairness or stigmatization toward those targeted, or be considered unacceptable by some sections of the public. We acknowledge and discuss these concerns, but, using the public health ethics literature as a guide, argue that distressing advertising can be ethically defensible if conditions of effectiveness, proportionality necessity, least infringement, and public accountability are satisfied. We do not take a broad view as to whether distressing advertising is ethical or unethical, because we see the evidence for both the effectiveness of distressing approaches and their potential to generate iatrogenic effects to be inconclusive. However, we believe it possible to use the current evidence base to make informed estimates of the likely consequences of specific message presentations. Messages can be pre‐tested and monitored to identify and deal with potential problems. We discuss how advertisers can approach the problems of deciding on the appropriate intensity of ethical review, and evaluating prospective distressing advertising campaigns against the conditions outlined.     

Alternative factor structures of health-related psychological tendencies and their relationship to self-reported health seeking behaviors

Abstract

The MHQ-Multidimensional Health Questionnaire (Snell and Johnson, 1997) and a checklist of twenty Health Promoting Behaviors were administered to 1,011 Italian subjects aged 21 to 80 years. The MHQ measures twenty health related psychological tendencies (e.g, Health Efficacy, Locus of Control, Optimistic Expectations). A Principal Components Analysis was carried out on the twenty scales to study their internal structure. Both a four- and a two-factor solution are discussed, presenting different perspectives on the data. The former solution yielded a larger motivational factor, which we labeled Aspiration for Health, and three smaller factors, which we labeled Optimistic Expectations, Internal Control and Lack of Control. All factors, particularly the first one, discriminated self-reported health seeking behaviors. The latter solution yielded a Health Management factor and a Negative Thinking one, both discriminating health behaviors. Moreover, the two factors provide a useful model for distinguishing efficacy, optimism and internal control in terms of their cognitive and affective components.     

Narcissistic personality and risk perception among Chinese aviators: The mediating role of promotion focus

Optimism bias is a crucial feature of risk perception that leads to increased risk‐taking behaviour, which is a particularly salient issue among pilots in aviation settings due to the high‐stakes nature of flight. The current study sought to address the roles of narcissism and promotion focus on optimism bias in risk perception in aviation context. Participants were 239 male flight cadets from the Civil Aviation Flight University of China who completed the Narcissistic Personality Inventory‐13, the Work Regulatory Focus Scale, and an indirect measure of unrealistic optimism in risk perception, which measured risk perception for the individual and the risk assumed by other individuals performing the same task. Higher narcissism increased the likelihood of underestimating personal risks, an effect that was mediated by high promotion focus motivation, such that high narcissism led to high promotion focus motivation. The findings have important implications for improving the accuracy of risk perception in aviation risks among aviators.     

Relationships between stigma-identity constructs and psychological health outcomes among adults who stutter

PurposeIn the current study, stuttering was conceptualized as a concealable stigmatized identity (CSI). The purpose of this investigation was to determine if four specific stigma-identity constructs that contribute to variability in psychological distress among people in other CSI groups also contribute among adult who stutter (AWS).Method505 AWS completed an online survey that included measures of four stigma-identity constructs in addition to general demographics and measures of self-rated stuttering severity, distress, and adverse impact of stuttering on quality of life. Hierarchical regression was performed to determine the extent that stigma-identity constructs explained variability in psychological health outcomes among AWS. Self-rated stuttering severity was investigated as a moderator in these relationships.ResultsThe stigma-identity constructs accounted for a significant proportion of the variability in distress (∼25 %) and adverse impact of stuttering on quality of life (∼30 %) among AWS. Further, the constructs of salience, centrality, and concealment were positively predictive of distress and adverse impact of stuttering after controlling for demographics and neuroticism. Compared to the other predictor variables (self-rated stuttering severity, demographic characteristics, neuroticism, and the three other stigma-identity constructs), concealment was the strongest predictor of adverse impact of stuttering on quality of life. Finally, self-rated stuttering severity was a moderating variable.ConclusionsThe results from this study suggest that there are useful applications in conceptualizing stuttering as a type of CSI. Speech-language pathologists should be aware of the relationships that stigma has with psychological health outcomes among AWS and should consider the implications for intervention.     

Health behaviour and attitudes to publicity campaigns for health promotion

Abstract

A sample of 403 members of the public responded to a postal questionnaire concerning their own health behaviour and their attitudes towards health publicity. A principal components analysis of these attitudes revealed three factors, the first of which reflected a tendency to deny the “relevance” of health campaigns. This tendency was higher among those who smoked, took less exercise and had less healthy diets. It is inferred that the direct effects of such campaigns may be impeded by the fact that they appeal most to those people whose own behaviour (from the point of view of health) is in least need of change.     

Religious experience and mental health: anthropological and psychological approaches

ABSTRACT

Moreira-Almeida, Sharma, van Rensburg, Verhagen and Cook have written a very comprehensive position statement pertaining to religion and psychiatry. While presenting a good overview of studies of religion, spirituality and mental health it does not include the important area of the health implications of religious experience which is the focus of this piece. I begin by discussing definitions of religious experience before examining the work of William James. The second part of this paper focuses upon specific religious experiences and psychopathology with a focus on mysticism, hallucinations and culture.     

The Global Coherence Initiative: A global psychological paradigm for health promotion

This review proposes the value of a global psychology-oriented initiative to promote health and wellbeing. It discusses the concept of collective consciousness, especially heart-based, moral consciousness and related actions as resources for health promotion. The review draws on a collaborative South African Global Coherence Initiative to support communal coherence and interconnectedness in an indigenous community setting.     

Self-presentational determinants of health risk behavior among college freshmen

Abstract

This study examined adolescents' use of unhealthy and potentially dangerous behaviors for self-presentational reasons. At the start of their first semester at college, 110 freshmen (M age = 18.2) completed trait measures of self-presentational concern. At the end of the semester they were asked about their use of health risk behaviors as impression management tactics. Seventy-five percent of respondents reported performing at least 1 risky behavior for self-presentational reasons during their first college semester. The most common behaviors were smoking, drinking, driving recklessly and performing dangerous stunts. The desire to be perceived as “cool” or a “risk-taker” often prompted healdi risks. Modest correlations between the trait measures and health risk behaviors provided additional evidence that self-presentational motives sometimes play a role in adolescent health risk behavior.     

The psychological construal of health behaviors

IntroductionIn order to optimize the effectiveness of behavior change interventions, we need to understand how the construal level – how we mentally represent or construe events or behaviors – influences health-related choices.ObjectiveTo examine the impact of mental construal on health decisions. Based on the Construal Level Theory, we predicted that people would give more weight to “cognitive considerations” when making a choice after being primed with the high-level perspective, whereas they would give higher weights to “sensory considerations” after being primed with the low-level perspective.MethodIn the first experiment, ninety-nine participants were primed with either high-level or low-level perspective across decision scenarios about vaccination and physical safety. The second experiment investigated nutrition decisions, which asked seventy participants to taste food that either had no label or was labelled “organic”. Organic label should prime high-level construal as it implies outcomes (e.g., product quality and healthiness) that are more distant in time and uncertain, in contrast with sensory dimensions (e.g. taste and appearance), which are immediately present. Participants rated cognitive and sensory considerations as well as action intentions.ResultsThe first study revealed that after the priming with the high-level construal, cognitive considerations became more important than sensory considerations in predicting protective action intentions, whereas after priming with the low-level construal, sensory considerations became more important. The second study revealed that only sensory considerations predicted decisions to consume the non-labelled product and only the cognitive score predicted decisions to consume the organic-labelled product.ConclusionWe demonstrated a moderating effect of construal-level mindset in health-protective decisions. We also discuss the implications for health promotion and policy, such as optimizing the effectiveness of behavior change interventions.     

Testing the health promotion model for adherence and quality of life in individuals with multiple sclerosis

The nature of multiple sclerosis (MS) presents challenges to health-promoting behaviors (e.g. adherence) and quality of life. The Health Promotion Model (HPM) proposes that these outcomes are explained by individual characteristics (i.e. biological, social, psychological) and behavior-specific cognitions (e.g. self-efficacy). The current study sought to test the HPM in explaining self-reported adherence and MS quality of life among 121 MS patients receiving care in an MS clinic in the southeastern United States. Hierarchical regression models partially supported the HPM for adherence (R² = .27) and more fully for quality of life (QoL) (R² = .64). Depression and stigma were among the variables most strongly related to both adherence and QoL; contrary to HPM theory, self-efficacy was not significantly related to adherence but was to QoL. Thus, the HPM may help to guide strategies used to improve QoL among individuals living with MS; however, the model may need further refinement to be used with adherence.     

Intra-individual variability and psychological flexibility: Affect and health in a National US sample

Intra-individual variability (IIV) and psychological flexibility (PF) in affect both describe affective change over time (i.e., within-person variability). However, IIV and PF might differ from each other and predict different psychological and physical health outcomes. A large sample of adults (n = 793) completed two assessments of daily stress, daily affect, and health over a 10-year interval in The National Study of Daily Experiences (an 8-day daily diary portion of the Midlife Development in the United States study). IIV and PF in affect were modestly reliable within and between assessments. IIV, operationalized as total variability, predicted worse psychological and physical health concurrently and prospectively. PF, operationalized as changes in dimensionality, predicted better psychological and physical health concurrently and prospectively. Other operationalizations of PF were not consistently related to health. Within-person variability in affect could therefore be adaptive or maladaptive depending on how it was defined.     

Finding new ways to practise critically: applying a critical reflection model with Australian health promotion practitioners

Greater support is required in health promotion for practitioners to adopt critical approaches to their practice. Despite recognition of the role that critical reflection can play in supporting critical practice, it is underdeveloped in health promotion. This pilot study aimed to explore the use of critical reflection with health promotion practitioners. Critical postmodernism provided the theoretical perspective and critical reflection methodology guided the study. The data collection method involved the application of a critical reflection model via in-depth semi-structured interviews with two health promotion practitioners who were recruited using purposive sampling. Critical postmodernism and critical health promotion values and principles were the thematic frameworks used to analyse the data. Four types of assumptions were identified across both participants’ narratives: binary opposites and dichotomous thinking; identity and othering; professionalism; and power. Two key themes that evidenced these assumptions were conceptualising power as a commodity, and identity in the Aboriginal and Torres Strait Islander context. Both traditional and critical health promotion practice approaches were evident in participants’ practice. The process of engaging in critical reflection resulted in positive outcomes for the practitioners, including the identification of new, more critical ways of practising. Critical reflection provides a process for developing critical health promotion practice. The designation of critical reflection as a core health promotion competency may enhance the development of critical health promotion. Further research is needed to develop and test a critical reflection model incorporating the values and principles of health promotion with a larger sample of practitioners.