Citation
Carryover Effects of Deceptive Advertising

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Title:
Carryover Effects of Deceptive Advertising
Creator:
Jaisle, Alyssa M
Place of Publication:
[Gainesville, Fla.]
Florida
Publisher:
University of Florida
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Language:
english
Physical Description:
1 online resource (76 p.)

Thesis/Dissertation Information

Degree:
Master's ( M.Adv.)
Degree Grantor:
University of Florida
Degree Disciplines:
Advertising
Journalism and Communications
Committee Chair:
RAUP-KRIEGER,JANICE
Committee Co-Chair:
CLEARY,JOHANNA L
Committee Members:
KALYANARAMAN,SRIRAM
Graduation Date:
12/18/2015

Subjects

Subjects / Keywords:
Advertising research ( jstor )
Brands ( jstor )
Clinical trials ( jstor )
False advertising ( jstor )
Fear ( jstor )
Health information ( jstor )
Marketing ( jstor )
Medical research ( jstor )
Photography ( jstor )
Websites ( jstor )
Journalism and Communications -- Dissertations, Academic -- UF
advertising -- communication -- deception -- health
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bibliography ( marcgt )
theses ( marcgt )
government publication (state, provincial, terriorial, dependent) ( marcgt )
born-digital ( sobekcm )
Electronic Thesis or Dissertation
Advertising thesis, M.Adv.

Notes

Abstract:
Affordable devices and widespread Internet service allow people to seek online medical information at rates higher than ever (Pew Research, 2013). Online users rely on peripheral cues such as structural features and message characteristics to decipher between credible and noncredible information (Rains & Karmikel, 2009). Unfortunately, these screening mechanisms are insufficient when credible websites unknowingly publish incorrect information. This inadvertent deception has negative implications for not only the source and topic involved but also has potential to generate negative carryover effects. Interpersonal deception theory (IDT) helps guide understanding for the potential attitude and behavior changes of the audience exposed to deception (Buller & Burgoon, 1996). The effects of deception may be compounded by other message elements such as gruesome images, vivid language, or emotionally arousing features (Witte, 1992). Prior research suggests that fear appeals may cause an individual to discard the message, decrease message decoding, and limit cognitive skills (Leshner, Bolls, & Wise, 2015). Therefore, this study asked whether deception discovery and the presence of vivid imagery will increase negative attitudes toward the source; decrease subsequent engagement with the source; if deception discovery will increase skepticism in subsequent content related to the topic used in the article; and whether or not the inclusion of a fear appeal in the deception discovery is significant. Results indicate the presence of a fear appeal significantly increased perceptions of information accuracy. ( en )
General Note:
In the series University of Florida Digital Collections.
General Note:
Includes vita.
Bibliography:
Includes bibliographical references.
Source of Description:
Description based on online resource; title from PDF title page.
Source of Description:
This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Thesis:
Thesis (M.Adv.)--University of Florida, 2015.
Local:
Adviser: RAUP-KRIEGER,JANICE.
Local:
Co-adviser: CLEARY,JOHANNA L.
Statement of Responsibility:
by Alyssa M Jaisle.

Record Information

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UFRGP
Rights Management:
Copyright Jaisle, Alyssa M. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
Classification:
LD1780 2015 ( lcc )

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CARRYOVER EFFECTS OF DECEPTIVE ADVERTISING By ALYSSA JAISLE A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ADVERTISING UNIVERSITY OF FLORIDA 2015

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2015 Alyssa Jaisle

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To my parents, Andrew and Judy

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ACKNOWLEDGMENTS I thank my chair, Janice Krieger, Ph.D., for her time, expertise, and passion. I also thank Johanna Cleary, Ph.D., and Sri Kaly anaraman, Ph.D., for their ongoing assistance and encouragement. 4

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TABLE OF CONTENTS page ACKNOWLEDGMENTS .................................................................................................. 4 LIST OF FIGURES .......................................................................................................... 7 ABSTRACT ..................................................................................................................... 8 CHAPTER 1 INTRODUCTION .................................................................................................... 10 2 LITERATURE REVIEW .......................................................................................... 14 Consumers’ Tenuous Relationship with Media ....................................................... 14 Evolution of Deceptive Communication .................................................................. 16 Deceptive Health Information .................................................................................. 19 Interpersonal Deception Theory (IDT) ..................................................................... 23 Carryover Effects of Deception Discovery .............................................................. 25 Fear Appeals .......................................................................................................... 26 Marketing Fear ........................................................................................................ 28 3 METHOD ................................................................................................................ 32 Participants ............................................................................................................. 32 Procedure ............................................................................................................... 32 Independent Variables ............................................................................................ 35 Fear A ppeal . ..................................................................................................... 35 Deception Discovery . ....................................................................................... 35 Dependent Measures .............................................................................................. 35 Recall of Information . ....................................................................................... 35 Issue Involvement. ........................................................................................... 35 Message Credibility . ......................................................................................... 36 Source C redibility ............................................................................................. 36 Information Accuracy. ....................................................................................... 36 Carryover Effects. ............................................................................................. 36 Topic Skep ticism. ............................................................................................. 37 Fear Arousal. .................................................................................................... 37 4 RESULTS ............................................................................................................... 38 Manipulation Check ................................................................................................ 38 Fear Arousal. .......................................................................................................... 38 Message Credibility. ................................................................................................ 38 Issue In volvement. .................................................................................................. 38 Perceived Accuracy of Cancer Clinical Trial Information (H1) ................................. 39 5

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Attitudes Toward Secondary Medical Sources (H2) ................................................ 40 Willingness to Participate in Cancer Clinical Trials (H3) .......................................... 40 5 DISCUSSION ......................................................................................................... 41 Contribution to Existing Knowledge ........................................................................ 44 Strengths and Limitations ....................................................................................... 45 APPENDIX A QUESTIONNAIRE .................................................................................................. 47 B STIMULI .................................................................................................................. 59 LIST OF REFERENCES ............................................................................................... 65 BIOGRAPHICAL SKETCH ............................................................................................ 76 6

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LIST OF FIGURES Figure page B 1 Florida Healthy Living vivid imagery article ......................................................... 59 B 2 Florida Healthy Living data visualization article .................................................. 60 B 3 Florida Healthy Living deception discovery article .............................................. 61 B 4 Florida Healthy Living article without deception discovery. ................................. 62 B 5 Time 1 control group stimulus ............................................................................. 63 B 6 Time 2 control group stimulus ............................................................................. 64 7

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Abstract of Thesis Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Advertising CARRYOVER EFFECTS OF DECEPTIVE ADVERTISING By Alyssa Jaisle December 2015 Chair: Janice Krieger Major: Advertising Affordable devices and widespread Internet service allow people to seek online medical information at rates higher than ever (Pew Research, 2013). Online users rely on peripheral cues such as structural features and message characteristics to decipher between credible and noncredible information (Rains & Karmikel, 2009). Unfortunately, these screening mechanisms are insufficient when credible websites unknowingl y publish incorrect information. This inadvertent deception has negative implications for not only the source and topic involved but also has potential to generate negative carryover effects. Interpersonal deception theory (IDT) helps guide understanding for the potential attitude and behavior changes of the audience exposed to deception (Buller & Burgoon , 1996). The effects of deception may be compounded by other message elements such as gruesome images , vivid language, or emoti onally arousing features (Witte, 1992) . P rior research suggests that fear appeals may cause an ind ividual to discard the message, decrease message decoding , and limit cognitive skills (Leshner, Bolls, & Wise, 2015). Therefore, this study asked whether deception discovery and the presence of vivid imagery will increase negat ive attitudes toward the source; decrease subseq uent engagement with the source; if deception discovery will 8

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increase skepticism in subsequent content related t o the topic used in the art icle; and whether or not the inclusion of a fear appeal in the deception discovery is significant. Results indicate the presence of a fear appeal significantly increased perceptions of information accuracy. 9

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CHAPTER 1 INTRODUCTION Health information, once primarily discussed with a family physician or dispersed via traditional news outlets, has become fragmented to the extent that people hav e begun to doubt its validity (Hesse et al., 2005) . The public’s confidence in t raditional news media (i.e. newspaper, radio, and television) has declined sharply throughout the past decade (Gronke & Cook, 2007). According to a Gallup poll conducted in 2010, only 40% of Americans have confidence in the accuracy of the media. Individuals claim they can no longer rely on the news for accurate information (Pew, 2007). Though the Internet appears to be a logical information source alternative, the World Wide Web produces a unique set of challenges. Limited accountability, anonymity, and th e ease of creating and disseminating false information are issues that continue to emerge and remain largely unaddressed due to their evolving and diverse nature (Adams, 2010; Risk & Petersen, 2002) . Despite the numerous obstacles that arise when searching for reliable medical information, Internet users have been able to adapt the way they search and validate information. Cues such as information source, professional design, scientific or official touch, language, and ease of use d etermine whether an Inter net user deems messages as credible (Eysenbach & Khler, 2002) . These cues have become increasingly vital in assessing information as reliance on traditional news media dwindles. A vast majority of websites that offer health information fail to meet even the most basic guidelines of credibility. A poll conducted by Pew Research (2000) found a mere 58% of online health information seekers check the source of information they found. Many websites publish articles proclaiming miracle cures and other unfounded 10

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information in order to drive attention to their web site. Fortunately, users have additional tools available to help them decipher between health websites reporting authentic information and web sites fabricating material in order to generate traffic and advertisement clicks. Users rely on cues including structural features such as t he presence of a privacy policy, third party endorsements , and message characteristics , namely statistics and testimonials , to decide whether to perceive a health website as credible (Rains & Karmikel, 2009) . These website aspects have been proven to directly increase perceived credibility (Burkell, 2004). Structural cues and message characteristics are rendered ineffective when previous experiences or website features limit a person’s capability to accurately analyze a message or when an otherwise reputable website publishes false information. One example that may render user’s ability to accurately judge infor mation , is a prior experience encountering deceptive health inform ation online. Interpersonal deception theory (IDT) posits that an individual will underestimate truthfulness if they approach a situation with increas ed levels of suspicion (Burgoon et al., 1994) . Another reason a user may not accurately perceive source or message credibility is the presence of graphic, fear arousing language or images. The extended parallel processing model (EPPM) suggests that an individual faced with a threat may become defensive (Witte, 1992) . Activated defense mechanisms draw cognitive resources away from encoding and message recognition (Leshner, Bolls, & Wise, 2015). Many online health campaigns include fear appeal aspects in an attempt to arouse emotions and stress the importance of message. McCornack and Levine ( 1990) found that t h e combination of aroused emotions and deception discovery is particularly volatile . The ir study, guided by 11

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IDT, discovered that the degree of relational involvement and importance of information lied about determined the severity of negative emotional resp onse when participants discovered deception. Emotional responses and attitudes towards a topic dictate how subsequent stories about that topic are perceived (Hall, 1993). Similarly, attitude carryover can occur from one product to another within a brand family, within a product category (Balachander & Ghose, 2003), across product categories , (Erdem, 1998; Erdem & Sun, 2002) and from one attribute to another of the same brand (Ahluwalia, Rao, & Burnkrant, 2001). Roehm and Tybout (2006) found increased negative attitudes toward Enron and the energy industry as a whole after Enron’s astoundingly deceptive practices were revealed. Alternately, positive attitude carryover effects can benefit a brand and is the reason why many brands choose to use their name on multiple product lines such as Crest toothpaste and Crest toothbrushes (Janakiraman, Sismeiro, & Dutta, 2009). The purpose of this study is to determine if a causal relationship exists between deception discovery, fear, and attitudes toward secondary sources, as well as perceived accuracy toward the topic involved in the deception. Multiple studies affirm the existence of a direct link between consumer’s trust in a brand and favorable attitudes and purchase behavior (Morgan & Hunt, 1994; Chau dhuri & Holbrook, 2001). Within the medical context, Raines and Karmikel (2009) found that, “message characteristics and structural features of websites were related to perceptions of website credibility and a ttitudes about the health topic ” (p. 551). This suggests perceptions of website credibility influence subsequent behaviors, such as following healthy recommendations. 12

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If trustworthy websites unwittingly publish false information and then are forced to publish a retraction or apology, the website may lose credibility. Reputable websites are responsible for educating the public about a variety of meaningful topics. If perceptions of web site credibility decrease, people may be less willing to visit the website or heed the directives on the web site. The consequences that may arise when online health seekers can no longer depend on qualified websites have many negative implications. If users do not make a point to visit these credible web sites , they may click on the first website they see on a search engine r esults page. Th e page might contain false or exaggerated information. Patients who have used online resources to inform themselves have had their questions and opinions dismissed by the practitioner (Henwood et al., 2003) . Broom (2005) found when doctors encounter patients who have done previous research on the Internet , the doctor may feel like his power is threatened and alienate the patient by reinforcing traditional physicianpatient roles . This study advances the field by looking beyond the immediate e ffects of deceptive information and examining the broader, longterm implications. 13

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CHAPTER 2 LITERATURE REVIEW To understand the importance of reliable information outlets, one must understand the history and evolution of the public’s relationship with media. The majority of people no longer turn to their newspaper or preferred nightly news to keep up with current events. For a number of reasons, people of all ages now turn to social media, websites , and other fragmented, ever evolving sources , to get information (Duggan et al., 2015) . One reason for this shift is the decreased levels of trust in major media outlets (McCarthy, 2014) . Deception in and surrounding the media has damaged consumers’ confidence. Unfortunately, the shift in the way information is disseminated allows false information to proliferate at high rates ( Castillo, Mendoza, & Poblete, 20 11) . It is important for people to be able to identify and rely on certain sources for information they can trust , especially in a health care context . When those trusted sources produce false information deliberately or by oversight, the consequences for the general public and health sector may be harmful. Consumers’ Tenuous Relationship with Media According to Kimmel (2005) , the average American consumer is exposed to approximately 3,000 advertising messages a day. Repeated studies have demonstrated that a wear out effect takes place after prolonged exposure to the same advertising message or tactic (Bass, Bruth, & Murthi, 2007). These factors are ample motivation for companies to come up with innovative, nontraditional ways to reac h the public. However, Aytekin and Nardali (2010) concluded that many of these creative techniques often employ deceptive practices that raise ethical and legal questions. It is likely that 14

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the large number of entities willing to engage in questionable tactics is a result of the public’s d ecreased attention and increased levels of skepticism. Another form of nontraditional marketing that has qui etly emer ged in recent years are messages disseminated under the guise of a genuine news story, entertainment clip or user generated content, but are actually fabricated by a company or organization. This type of advertising is similar to guerilla marketing in the way that it is nontraditional, unexpected, and typically generates a significant amount of buzz. Unlike guerilla marketing, it can be costly, deceptive, and the brand or product being promoted is not immediately apparent. T his specific form of deceptive promotion has only recently become prominent , which means research on the topic is limited . F or the purpose of the current study, the term duplicitous promotion will be used to describe any behavior that distorts or exaggerates information as a way to generate buzz or other results for monetary gai n . T his new, uncharted type of advertising is evolving faster than the legal system. Companies and individuals remain free to employ tactics such as this as well as buzz advertising, ambush marketing, and guerilla marketing without fear of legal repercussions. This study refers to that practice as duplicitous promotion. Negative consequences such as decreased purchase intentions or perceived trustworthiness for brands or news topics are likely to result if deception is uncovered (Dyer & Kuehl, 1974) . The s taggering 200% year over year increase in false advertising complaints registered with the Federal Trade Commission reinforces the belief that companies continue to push ethical and legal boundaries. According to Hutter and Hoffman (2011) , companies continue to find new ways to get the public’s attention. One example of 15

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duplicitous promotion is a time when actress Lauren Bacall casually mentioned a friend’s macular degeneration and a new drug treatment by Novartis during an interview on ABC . Unbeknownst to viewers, she was paid by Novartis to do so (Holguin, 2002). This may come as no surprise to people familiar with network or broadcast television. When compared to four other top morning news shows, ABC’s Good Morning America is the most li kely to air promotional content related to its parent company, Disney, and least likely to be critical of that promotional content (Cleary & Adams Bloom, 2009). This example may appear innocuous , but these campaigns manipulate viewer’s emotions and vulner ability by executing marketing tactics in settings or sources that people rely on for unbiased reporting. Companies are aware of the increasingly limited effect traditional techniques have on consumers and , in turn, are relying more heavily on innovative t actics such as guerilla marketing in order to garner attention (Kim, Bhargava, & Ramaswami, 2001). However, deceptive advertising is likely to increase negative attitudes toward subsequent advertising and have a negative impact on product perceptions (Dark e & Ritchie, 2007). Evolution of Deceptive Communication Elevated level s of public suspicion in journalism and advertising may be reflected in the extreme measures marketers and media continue to take in order to reach an increasingly desensitized audience (Balasubramanian, 2006). The same might be said about medical research, a field where competition for prestige and funding is at an all time high . According to Van Noorden (2010) , the average acceptance for American Cancer Society grant applications has d ecreased over in the past two years to roughly 15% . Success rates for grant applications submitted to the National Institute of Health are also at an all time low, with only 21% of proposals funded in 2009 (Van Noorden, 16

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2010). Van Noorden (2010) cites a decrease in donations, flat funding from the government , and increased competition as causes for these dismal figures. The direct relationship between funding and professional advancement may tempt researchers to engage in unscrupulous behavior. Academics a re not alone in facing increased competition and decreased budgets. The recovering economy coupled with an increasingly difficulty to reach audiences has led individuals and institutions alike to scrutinize their spending (Ayetkin & Nardali, 2010) and look for new ways to achieve maximum impact with limited funds. One tactic many health organizations have experimented with is guerilla marketing. Guerilla marketing is a category that utilizes creativity, effort, ene rgy , and time with a limited budget (Levinson, 1998). An example of guerilla marketing in health communication is the campaign launched by The American Legacy Foundation, The Truth Campaign. The American Legacy Foundation spreads awareness of the potential consequences of smoking in a variety of ways, including guerilla marketing. The Truth’s most memorable campaigns involve humans lying still in the street to represent the amount of smoking deaths each hour. Despite the novelty, specific types of this new wave of marketing are likely to be ineffective and occasionally detrimental (Hutter & Hoffman, 2011). Furthermore, these nontraditional campaigns may elicit negative emotional arousal, which causes audiences to become irritated, anxious , or suffer from lowered self esteem, which in turn fos ters negative feelings toward the advertisement or brand (Hutter & Hoffman, 2011). A prime example of duplicitous promotion is a blog that appeared to be written by a 12year old girl about her upcoming nuptials to a 37year old man (Griner, 2014) . The 17

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bl og skyrocketed in popularity and became the most highly viewed website in Norway over the course of a single day. The public remained unaware that the blog was completely fictitious until well after conversations, articles , and debates generated about chi ld brides died down. Once it was discovered that the blog was a marketing campaign launched by Plan, an international aid organization working to increase awareness about child brides, the public resumed its discussion about child brides and consequently, Plan. Thus, it can be assumed that other companies, for profit or not, noticed the overwhelming attention this strategy spawned, and will look to utilize a similar campaign in the future. The advent of social media allows companies to publish content on a social media platform under the guise of an average user , unaffiliated with the company . Companies then rely on the public to eng age and share the information with hundreds or thousands of other social media users at little or no cost, allowing duplicitous information to proliferate faster than ever before. This trend is troubling due to the fact that teenagers, a highly coveted demographic, rely on social media websites, friends , and family to get their news (Marchi, 2012). Compounding that fact is a study that revealed over 84% of teenagers have sought medical information online. The researchers discovered “medical websites were responsible for providing health information to 31% of those surveyed, followed by YouTube (20%), Yahoo (11%), Facebook (9%) and Twitter (4%)” (Lauricella, Rideout, & Wartella, 2015, p. 9 ). This demonstrates over half of the health information found by the participants was gathered from social media websites instead of medical sources. Young people are not only seeking information online but disseminating it as well. 71% of teenagers use Facebook 18

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and 92% of teens report going online daily (Lenhart, 2015). These habits lead to thousands of likes, comments, messages, and status updates every hour. In another study, e ighth grade students were asked to create public service announcements about a substance use program they recently completed in school. Fear appeal (33%) or negative consequences (33%) were the most frequently incorporated social influence strategie s used (Krieger et al., 2013). The belief that messages containing fear appeals would be the most effective way to communicate the PSA to their peers suggests that that is the type of content they are most likely to share via social media. This underlies the serious consequences of deliberately falsified health information circulating online . In the case of deceptive health communication, researchers rely on reputable websites or medical journals in the sam e way. By depending on well respected sources to disseminate their falsified data, researchers take advantage of the public’s trust that these sources take measures to ensure information they publish is reliable, accurate and thoroughly vetted. Furthermor e, content that appeal s to a large audience will likely be shared across social media platforms and proliferate the false information. Unfortunately, despite best efforts, inaccurate information is occasionally published on otherwise reputable websites. A lthough strategically disseminating duplicitous information is still in the early stages of existence, individuals and brands have been successful in terms of attention gained from the campaigns. Deceptive Health Information The term deception is primaril y used to describe intentional acts of misleading communication (Miller, 1983; Kozlowski & O’Conner, 2003; Petty & Andrews, 2008) . According to Miller (1983), deceptive advertising is “message distortion resulting from deliberate falsification or omission of information by a communicator with the intent of 19

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stimulating in another, or others, a belief that the communicator himself or herself does not believe” (pp. 923 ). In recent years, scholars have proposed broadening the concept of deception in media to adhere by the standards in which scholarly research is held (Kozlowski & O’Conner, 2003). Currently, advertisers must follow a strict set of guidelines intended to alleviate deception. These guidelines are easily amenable to health communication. Though no consensus has been drawn regarding a correct definition of deceptive advertising, the Federal Trade Commission has identified three factors that an advertisement must contain in order to be deemed deceptive (Miller, 1983) . The first parameter needed to qualify an advertisement as deceptive, is that the advertisement must contain a representation, omission , or practice that is likely to mislead the consumer. Secondly, the advertisement must be viewed from a reasonable person’s perspective. L astly, the representation, omission, or practice is likely to affect the consumer’s choice or conduct toward the product (Petty & Andrews, 2008). It is not unreasonable to apply these guidelines to health communication as well. Scholars have established four subcat egories of deceptive advertising ( Petty & Andrews, 2008; Ay, Aytekin, & Nardali, 2010; Johar, 1995; Grewal & Compeau, 1992). The four types of deceptive marketing are comparative advertising, implication advertising, guerilla marketing, and covert marketing. Misleading comparative and inference claims occur primarily in traditional media. To illustrate, a deceptive comparative claim may state , “The best teeth whitener on the market!” This is a deceptive practice since there is no evidence provided to substantiate that claim. Not all deception is intentional and not all advertising is for monetary gain. One instance of a trusted source engaging in unintentional deceptive communication as a public health 20

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campaign instead of for profit is the Center for Disease Control (CDC) . In 2002 , a CDC webpage stated, “Is smokeless tobacco safer than cigarettes?NO WAY!” ( Phillips, Wang, & Guenzel, 2005). This stateme nt is untrue according to a Mayo Clinic article citing evidence proving that smok eless tobacco is less dangerous than smoking tobacco (“Chewing Tobacco,” 2014) . Assuredly, this statement was unintentionally misleading , yet qualifies as deceptive communication under the FTC’s three stipulations (Miller, 1983) . The first stipulation is t hat the statement is likely to mislead the consumer. Secondly, it must be viewed from a reasonable person’s perspective. Finally, to be considered deceptive, the message is like ly to affect the consumer’s choice or conduct. A teenager may continue to smoke cigarettes instead of switching to smokeless tobacco because they believe there is no benefit in the alternative. By applying these rules to scholarly medical publications, concise guidelines can be in place to evaluate accuracy of information and outline legal consequences for those who intentionally deceive, or publications that fail to do a thorough review of information. Consequences of Deception Discovery This study seeks to look beyond the quantity of attention generated by these deceptive campaigns by examining the effects they have on attitude and trust toward the information and topic. When an individual becomes emotionally invested in a story or report and then discovers it was falsified for monetary, professional , or other self satisfying interes ts, the reader may feel irritated, angry , or embarrassed. Negative attitudes generated by deception discovery are long lasting and will increase toward source and secondary sources (Darke & Ritchie, 2007) . The same study also found that individual s might a lter their belief s about subsequent st ories related to the topic involved 21

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in the deception, which could potentially result in him dismissing credible information. This potential outcome is known as a carryover effect ( Roehm & Tybout , 2006). Unfortunately, the Federal Trade Commission (Miller, 1983) or the American Marketing Association’s Statement of Ethics (AMA Statement of Ethics, n.d.) have not yet answered these distasteful tactics with increased regulation or moderation. These two organizations tasked with protecting the public may feel like they do not have the authority to regulate falsified news stori es. P roducing empirical evidence that proves deception results in increased negative attitudes and decreased trust might dissuade individuals and corporations from this type of promotion in the future. For example, a researcher at Duke University created falsified data about cancer treatments and successfully submit ted it to scientific journals and medical websites (Pelley , 2012) . Journalists and other news outlets should be required to closely examine the study they are publishing or reporting on. Best practices should include accessing the study’s Internal Review Board form, reading related studies, and engaging in indep th conversation with the study authors. A story about research about a cancer treatment may initially gain significant attention, but what are the consequences when deception is discovered? Darke, Ashworth, and Ritchie (2008) examined carryover effects of deception correction on retail brands and found that the deception discovery “can diminish the persuasiveness of subsequent advertising both from the offending firm and from unrelated firms” ( p. 199). S carce literature exists examining the effects on perceptions of truth regarding a medical topic involved in deception or deception correction. Individuals may feel angry, irritated , or betrayed once they discover the information was fabricated. Long term 22

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consequences may arise, such as increased negativ e attitudes toward the once trusted source or similar secondary sources. These negative emotions may result in an individual doubting future information published by the source, decrease their interest in the topic, and approach ensuing stories with increased skepticism. At present, it is unknown whether an individual who is exposed to duplicitous information, particularly one involving a health related topic, will develop and transfer negative feelings into increased negative attitudes toward source or topic , and if it will result in increased skepticism. Interpersonal Deception Theory (IDT) One theoretical perspective for understanding duplicitous communication is interpersonal deception theory (Buller & Burgoon, 1996). A main tenet of interpersonal deception theory is information management. Senders knowingly manipulate messages in order to make them appear more believable. These falsified messages appear less complete, direct, relevant, clear , and personalized than truthful messages (Buller et al., 1996). Interactions with others are almost always influenced by expecta ncies about how they will act or perform (Miller & Turnbull, 1986). For receivers, an inverse relationship exists between honesty expectation levels and deception detection apprehension (Buller & Burgoon, 1996; Burgoon & Buller, 1994). In the context of duplicitous promotion, this theory helps explain why individuals who fabricate stories about serious health topics attempt to get these stories published by respectable sources. The theory guides our understanding about why individuals or organizations engage in this practice, why the public is particularly susceptible to this type of deception, and finally, why the potential consequences of deception discovery are important. The source of the fabricated information is described by interpersonal 23

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deception theory as a goal driven and strategic sender. The receiver, in the context of duplicitous advertising, is the individual exposed to information and then made aware of the deception. Bull er and Burgoon (1996) define deception as , “a message knowingly transmitted by a sender to foster a false belief or conclusion by the receiver” ( p. 205). These characteristics, as well as many others found in duplicitous communication, are highly compatibl e with the theory of interpersonal deception. Consumers trust websites that appear to provide unbiased and informative content more than websites that appear to be run by a corporation (Sillence et al., 2007). The consequences of deceptive practices in t raditional media have been studied extensively. Carlson, Grove, and Kangun (1993) found that individuals had increased negative attitudes and decreased purchase intentions toward the brand when faced with high levels of deception. When a customer suspects he is being deceived, he can activate one or more defense mechanisms to decode messages, process signals , and otherwise protect himself from making an uninformed decis ion. This statistic helps provide insight as to why individuals responsible for creating fake information rely on outlets rat her than themselves to publish fabricated data. Individuals approach user generated or nonprofit content with higher trust levels and lowered deception detection, making them vulnerable to deception. Trust has been re peatedly linked to brand attitude and purchase behavior (Chaudhuri & Holbrook, 2001; Lau & Lee, 1999) . When consumers suspect an organization is using manipulative tactics , their attitude toward the brand is negatively impacted and purchase intentions are lowered (Campbell, 1995; Lut z, 1985; MacKenzie & Lutz, 1989). Mitchell and Olsen (1981) defined c onsumer attitude s toward the brand 24

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as an “individual’s int ernal evaluation of the brand” (p. 318) . However, medical information credibility may be more difficult to identify due to the fact that it is not associated with known brands (Luo & Najwadi, 2004). Consumers are forced to rely on secondary cues such as source and message q uality to decide whether the information they are presented with is accurate . If a source or information is judged to be credible, the receiver will elevate honesty expectations and lower deception detection (Burgoon et al., 1994) . Technology now provides websites with the ability to predict what lifestyle an online user engages in and display personally relevant content or advertisements to that person ( Bauman , Schmidt , & Preuss , 2006) . This may become problematic for health seekers if dishonest online medical sources employ this technology to display deceptive personalized messa ges . Websites that display personalized content have higher perceived relevance and perceived involvement (Kalyanaraman & Sundar, 2006). These website characteristics may lead the user to increase perceptions of source credibility and believe the falsified content is accurate. Deception discovery would be especially detrimental in online medical information since source credibility is a key factor in evaluating a message (Rains & Karmikel, 2009) . Therefore, interpersonal deception theory can be used to understand why deception discovery is likely to increase negative attitudes towards the source and topic involved. Though previous studies have examined other types of deceptive communication, duplic itous communication has not been tested. Carryover Effects of Deception Discovery Negative results stemming from the admission of false communication can carry over to other products advertised by the same firm and firms in the same industry 25

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(Roehm & Tybout, 2006; Ahluwali, Unnava, & Burnkrant, 2001). What makes duplicitous promotion unique, and exceptionally problematic, is the fact that people are unaware t hey need to be on the lookout for deception since they believe they are reading or watching genuine content, a practice that is much less likely to evoke perceived deception. There is a likelihood that a person who became emotionally invested in a story then discovered it was fabricated may have higher levels of increased negative attitudes and behavior intentions than someone who suspects deception from the beginning. All of these emotions may be compounded when a user is duped by a source they believe to be reliable. These effects extend beyond the single entity involved and are sustained for extended periods of time. This leads to the proposition that duplicitous communication results in consequences that reach beyond the source or institution. In addition to initial spillover effects, studies have shown that even if companies come forward to correct false claims, inaccurate beliefs about other product benefits persist (Dyer & Kuehl, 1978; Mazis & Adkinson, 1976) and damage the brand’s reputation. This concept is crucial to examine within the context of health communication, as the public’s health is at stake. Interpersonal deception theory posits that receivers approach situations with a trust bias based on context and previous experiences. Using the IDT framework and utilizing the findings of past research, it is likely that negative feelings toward the deceptive source will spill over to the topic involved in the deception. Fear Appeals When companies create false content, they generally do so using topics that are emotionally arousing. One type of persuasive messages is a fear appe al. Fear appeals 26

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typically contain vivid language, personalistic language, or gory photographs (Witte, 1992). This is likely due to the fact that those characteristics are appealing to audiences, a notion that is referr ed to as “if it bleeds it leads” ( Cooper & Roter, 2000, p. 332). The extended parallel processing model describes the concurrent cognitive and emotional processes an individual experiences when faced with a fear appeal (Witte, 1994). Messages are likely to generate fear and elevate levels of arousal if the r e ceiver perceives the threat as significantly and personally relevant ( Witte, 1992). When a threat is perceived as moderate to high, fear may be elicited. Once fear is elicited, a person may upgrade the threat and begin to seek out potential solutions to d eter a threat . W hen increased threat is accompanied by increased efficacy , the message is more likely to be accepted (Witte, 1992) . The use of fear appeals in message design is a technique that has long drawn the attention of scholars due to ethical concer ns. The EPPM has been made more robust in recent years. Many recent developments pertaining to fear appeal theory have emerged in the health communication field. RoskosEwoldsen et al. (2004) found that presenting a more efficacious solution alongside a message containing a fear appeal increased the accessibility of attitudes toward the behavior and increase d intentions to adapt behaviors. Fear as a marketing tactic is not limited to health campaigns. Hass et al. (1975) conducted an experiment to test the effectiveness of fear in a campaign to encourage energy conservation. Fear appeal did not significantly increase perceptions of an energy crisis , but did elevate people’s beliefs about the sev erity of an energy shortage. In a study testing the effects of fear on pessimism in the years following the terrorist attacks of September 11th, 2001, participants exposed to an image and audio 27

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clip manipulated to arouse fear generated higher levels of pessimistic beliefs about the future of terrorist attacks on the United States of America compared to the anger or sadness condition. Males reported less pessimism than females (Lerner et al., 2003) . This difference may be attributed to perceived efficacy si nce perhaps the male participants viewed joining the military as a viable solution to alleviate fear , compared to females who are less likely to enlist. This logic leads to the hypothesis that increasing a perceived threat , such as lung cancer, using fear appeals , will cause people to be more willing to believe a solution , such as a medical breakthrough that can cure lung cancer , presented to them. H1: Presence of a vivid imagery will increase perceived accuracy of cancer clinical trial information. Market ing Fear Corporations, individuals, and nonprofit groups identify what topics represent a personally relevant threat to their target audience and build a duplicitous promotion strategy based on that information. Corporations use varying levels of fear appeals in advertising for monetary or other gain. Negative emotional appeals such as fear, guilt, and shame have been used in advertisements for decades (Sivulka, 2008) . An example of this tactic in the health communication field is a health scare manufactured by The Natural Resources Defense Council in 1989 (Wildavsky, 1997) . T he Council publicized information purportedly linking apples treated with chemical growth regulator to serious health consequences. A reputable politician was interviewed on a major news stati on and associated the chemic al with “bald, wasting away children” (p. 202) . As the story grew, so did the public’s fear that their children were eating these tainted apples. Absent 28

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from the media frenzy , was accurate information about the chemical. The che mical was harmless and disseminating that information would have assuaged the public’s fears. Despite the facts, politicians and activists lobbied to get the chemical out of all apples. In the end, the chemical was removed, the truth about the harmless nat ure of the chemical was never revealed, and The Natural Resource Defense Council, the organization responsible for hyping the story, benefitted socially and financially for appearing as a fierce consumer advocate (“Activist Facts,” n.d.) . Various aspects of fear appeal campaigns have been scrutinized and the overall effectiveness of these campaigns is a contentious issue. Many scholars continue to dismiss fear appeals as ineffective and detrimental (Job, 1988; Kohn et al., 1982) while others have found ev idence of their effectiveness ( Lennon, Rentfro, & O’Leary, 2010; Morales , Wu, & Fitzsimons, 2012). In experiments where a fear appeal was shown to be an effective way of motivating changes in behavior, the researchers measured credibility, attitudes , and b ehavior change. According to K eller (1999) , individuals who encounter fear appeals may engage in counter arguing, dismissal, or “freezing”, a tactic used when the person viewing the message stops processing the message and moves on to other tasks (p. 403) . This may negate any message because people do not want to acknowledge serious issues ( Kassarjian & Cohen, 1965; Keller & Block, 1997; Kunda, 1987). Janis and Feshbach (1953) argue that three distinct forms of counter arguing typically occur when an indiv idual is exposed to a message that evokes high levels of fear or anxiety . The three types of resistance are inattentiveness to message, aggression toward the sender for generating the unpleasant emotions , and “subsequent defensive avoidance motivated by residual emotional tension” (p. 88). 29

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Sensationalizing stories is a longstanding tradition in the journalism field. Salient issues such as cancer or Ebola are likely to capture the public’s attention and support due to the fear and uncertainty surrounding them. Prominent academic journals have been criticized for publishing articles that are exciting or trendy without performing diligent background checks (Schekman, 2013) . Increased competition for funding and tenure positions has also elevated the pressure to get published. S kewing data in order to have a groundbreaking study related to a popular topic may appeal to some researchers and journals that look for a way to stand out in their field. From 20002005 , the average number of papers retracted from scienti fic journals numbered roughly 30 per year. In 2011, the number of retractions reached over 300 (Van Noorden, 2011). Once prominent medical researchers Sheng Wang at Boston University and Dipak Das of the University of Connecticut are just two of many who m anaged to get their falsified data published in premier journals around the world (Wade, 2012; Johnson, 2011) . Whether these individuals s ought monetary, professional or other personal gain, their tactics follow the same logic that corporations guilty of duplicitous advertising do. Both parties created false content and relied on secondary outlets to believe and promote them. This dilutes the quality of otherwise reputable journals and diminishes achievements of honest research. Studies have been conducted that examine the effect of fear appeals on attitude toward the message and attitude toward the brand (Moore & Harris, 2013; Holbrook & Batra, 1987), but there is scarce literature available that considers the carryover effects of fear appeals on the health topic involved in deception or on secondary sources. Previous scholars have also long overlooked consequences of deception within health communication. 30

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This logic leads us to the final two hypotheses: H2: Presence of vivid photographic imagery will decrease positive att itudes toward secondary medical sources . H3: Deception discovery involving vivid photographic imagery will decrease willingness to participate in cancer clinical trials. Next, I describe an experiment designed to evaluate the consequences of deception discovery and inclusion of fear appeals in online health information. A primary purpose was to explore potential carryov er and immediate effects that might result from decreased attitudes or credibility. 31

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CHAPTER 3 METHOD Based on the importance of establishing and maintaining reliable online medical sources, this experiment was structured to analyze and report the direct impact and carryover effects of deception discovery and fear appeals with in a health context. A fictitious online health source was used to present stimulus articles. The results explore whether deception discovery or vivid photographic imagery increased or decreased a variety of attitudes and intentions related to cancer drug trials. Participants A total of 206 adults recruited via social media, word of mouth, or email participated in this experiment for no compensation. The study was restricted to individuals aged 18 and older with Internet access . Participants were diverse in race, ethnicity , and geographic location, although they were predominantly female (82%, n = 167), White (82%, n = 168), and age 2544 (68%, n = 141). The majority of participants reported being employed for wages (53%, n = 109) while relatively few were students (8%, n = 17). Procedure A 2 x 2 betweensubjects experimental design with two types of images (presence of vivid photo image ry or graph of data visualization) and deception discovery (present or absent) was used to test the proposition. The vivid photographic imagery stimulus included a photograph of a deteriorating cancer patient and a photograph of a seve rely damaged smoker’s lung. The data visualization article had the same layout and message content but replaced the graphic photos with line graphs illustrating an increase in patient health. After subjects completed reading the first article, they were 32

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a sked to respond to mid experiment statements. Upon completion participants were either exposed to the deception discovery article or the non deception discovery article. Subjects in the deception discovery condition were presented with a second article on the using the same Florida Healthy Living website layout. The article explained that the drug trial was a failure due to the fact that the main researchers on the project misled the public and the institution about results from the trial’s conception. Non deception discovery subjects were presented an article that also appeared to be on the Florida Healthy Living website that explained that the drug trial was a failure but did not mention deception. Both deception discovery and nondeception discovery articles had the same page layout, same single photo , and were roughly the same word count. Appendix A outlines the sample articles used in the study. After completion of the second article, participants were asked to respond to a final set of questions. Participants were randomly assigned to one of four experimental groups: exposure to vivid photographic imagery article followed by presence of deception discovery article ( n = 41); exposure to vivid photographic imagery article followed by presence of nondecep tion discovery article ( n = 39); exposure to data visualization article followed by deception discovery article ( n = 42); exposure to the data visualization article follo wed by nondecept ion discovery article ( n = 42) ; or to the control article about hydration followed by the second control article about healthy living ( n = 42). Stimuli All stimulus material presented to the subjects was designed to look like news article s on a Florida Healthy Living webpage. Florida Healthy Living is a fictitious 33

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org anization, but the website structure, secondary content , and logo were modeled after a prominent medical website. The initial articles ( vivid photographic imagery and data visualization) presented to subjects contained identical content about a pote ntial cancer drug breakthrough. The vivid photographic imagery manipulation consisted of inserting two graphic photos in the article. One photo depicted an emaciated patient in a hospital bed with advanced stage cancer and the other photo was of a blackened lung of a heavy smoker. The data visualization manipulation consisted of two line graphs illustrating an increase in patient health (See Appendix A for article detail). After s ubjects answered midexperiment questions , they were then shown one of two follow up articles based on their condition (deception discovery or absence of deception discovery). These articles also appeared as if they were published on the Florida Healthy Li ving website. The deception discovery article reported the supposed breakthrough in lung cancer treatment was false and the researcher was responsible for the deception. The article also stated that this researcher provided falsified data to the Florida He althy Living as well as his peers, superiors and other medical publications. It went on to clarify that the cancer drug was ineffective and the medical trial volunteers did not see any improvements to their health following the trial’s completion. The abse nce of deception discovery article did not mention any deception and only conveyed that the study mentioned in the previous article was ineffective. An article about the benefits of drinking water with generic photographs of people biking and drinking water and a follow up article about the benefits of healthy living was used to control for threats to validity. 34

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Independent Variables Fear A ppeal Witte (1992) defines a f ear appeal as content that includes vivid or personalistic language and graphic images. Fear appeals have also been found to decrease ability to accurately decode a message. Thus, article 1, vivid photographic imagery, included two graphic photos. Basic line graphs were used i n the other article as a data visualization (See Appendix A for article detail). Deception D iscovery A second article was presented to all subjects . Depending on condition, the article was either about deception discovery or was absent of any mention of deception. Interpersonal deception theory states that deception discovery may lead to decreased positive attitudes, and carryover effects in the form of a lie bias and increased skepticism. Dependent Measures Recall of I nformation Recall of information is determined using a free response text box . Subjects’ first step after reading the article ( vivid photographic imagery or data visualization) was to write down anything from the article they just read. We used recall as a way to determine participant skepticism. Individuals who expressed doubt about the validity of the article were then removed from the pool of participants ( n = 15) . Issue I nvolvement Issue involvement was measured using four statements with response choices ranging from strongly agree to strongly disagree on a 7point Likert type scale ( Petty & Cacioppo, 1979) . These bipolar adjective scales used statements such as , “I actively 35

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seek the most recent information about treatments available for cancer” ( = .77 , M = 4.23, SD = 1.25). Message C redibility M essage credibility of the article was measured using Meyer’s (1988) 7point scale of news credibility. This variable is measured using five semantic differential items including unfair/fair, biased/unbiased, doesn’t/does tell the whole story, inaccurate/accurate, cannot/can be trusted ( = .88 , M = 4.43, SD = 1.16). Source Credibility Source credibility were measured using an eight item, 7point Likert scale ranging from strongly disagree to strongly agree (Newell & Goldsmith , 2001). Four items measured corporate trustworthiness and four items measured corporate expertise. An example of a statement about trustworthiness is , “ Florida Healthy Living is honest . ” An example of a statement about expertise is “ Florida Healthy Living has great expertise” ( = . 97, M = 4.28, SD = .61 ). Information Accuracy Perceived accuracy of a topic was adapted from Kohring and Matthes’ Trust in News Media scale (2007) and was measured using eight sevenpoint differential format statements. An example statement is “We can depend on getting the truth about most cancer research drug trials” ( = . 92, M = 4.18 , SD = 1.04 ). Carryover Effects Attitude toward a brand is defined as an, “individual’s internal evaluation” of a brand ( Mitchell & Olson , 1981 , p. 318) and was measured using four sevenpoint differential format statements. These four statements were, unappealing/appealing, 36

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bad/good, unpleasant/pleasant, unfavorable/favorable, and unlikeable/likeable ( = .81 , M = 4.90, SD = 1.29). Topic S kepticism Topic skepticism was measured using an adapted version of Obermiller’s (1998) Consumer Skepticism Toward Advertising scale. This five point scale ranged from strongly disagree to somewhat agree. An example statement on the scale is , “A clinical trial is a good way for people to treat cancer” ( = .87 , M = 3.82, SD = .92 ). Fear A rousal Fear arousal was measured using a 7point scale developed by Rogers and Thistlethwaite (1970). Items on the scale included frightened, tense, nervous, and anxious , and response options ranged from strongly disagree to strongly agree ( = .95 , M = 2.49, SD = 1.31) 37

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CHAPTER 4 RESULTS Manipulation Check Fear Arousal Participants were asked to answer questions about any fear arousal they experienced during the initial article. Fear arousal did not differ among the conditions , F (4, 175) = .475, p = 0.754. The vivid photographic imagery article ( M = 2.37, SD = 1.28) also did not differ significantly from the control ( M = 2.55, SD = 1.43). Message Credibility Participants who viewed the control article about hydrating regularly ( M = 5.17, SD = 1.24) perceived the message as significantly more credible than the vivid photographic imagery article ( M = 4.32, SD = 1.1) conditions; t (107) = 3.64, p <.001, d = 0.704. There were no significant differences in any group regarding perceived source credibility. The vivid photographic imagery article ( M = 4.32, SD = .58) did not l ead participants to perceive the source as any more credible than the data visualization article ( M = 4.21, SD = .61). Issue Involvement We asked participants to answer questions about cancer clinical trial involvement. None of the experimental conditions predicted levels of issue involvement, F (4, 176) = .42. Participants who viewed the vivid photographic imagery article did not have signi ficantly different benefit recall than those who viewed the data visualization article. Participants who viewed the control article did not report significantly lower cancer trial issue involvement than participants who viewed the vivid photographic 38

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imager y article. There was no evidence that onetime exposure to vivid photographic imagery increased involvement in issues related to cancer clinical trials. Perceived Accuracy of Cancer Clinical Trial I nformation (H1) The first hypothesis was exposure to a vivid photographic imagery would increase perceived accuracy of cancer clinical trial information. As predicted, participants exposed to a message containing a graphic photo were more likely to perceive the information about the cancer trial article as bei ng accurate, F (2, 178) = 3.63, p < 0.05. There was a significant difference in perceived cancer trial information accuracy for participants who were exposed to a vivid photographic imagery followed by the deception discovery article ( M = 4.63, SD = .95) an d participants who were exposed to a vivid photographic imagery followed by no deception discovery ( M = 3.99, SD = 1.04), t (71) = 2.72, p < .01. By contrast, participants who viewed the vivid photographic imagery article followed by deception discovery art icle ( M = 4.63, SD = .95) were more likely to believe they perceive the information as accurate about cancer clinical trials compared to those who received the data visualization article followed by deception discovery ( M = 3.83, SD = 1.16) condition, t (71 ) = 3.25, p < .01. Participants viewing a vivid photographic imagery article followed by a deception discovery article ( M = 4.63, SD = .95) also differed significantly from those seeing only the data visualization article followed by nondeception discover y article ( M = 4.04, SD = .93) in their perceived accuracy of cancer clinical trial information, p < .01. In other words, the most apparent effect of exposure to vivid photographic imagery on belief about the accuracy of cancer clinical drug trial (relative to exposure to the data visualization article) appears to be when a deception discovery article follows the vivid photographic imagery article. 39

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Attitudes Toward Secondary Medical S ourc es (H2) The second hypothesis predicted that exposure to vivid photographic imagery would decrease positive attitudes toward secondary medical sources. This hypothesis was not supported. Contrary to our predictions, part icipants who were exposed to vivid p hotographic imagery had significantly increased positive attitudes toward a secondary medical source, F (2,176) = 4.82, p < .05. Participants who viewed the data visualization article ( M = 4.61, SD = 1.40) did not differ significantly in their attitudes tow ard the secondary online medical source than those who viewed the control article ( M = 5.15, SD = 1.21) condition. The vivid photographic imagery appeared to have increased participants’ attitudes in secondary medical sources. Willingness to Participate in Cancer Clinical Trials (H3) The third hypothesis predicted that deception discovery involving vivid photographic imagery would decrease willingness to participate in cancer trials. This hypothesis was not supported. There were no significant differences among the message conditions F (4, 176) = .23. Neither exposure to the vivid photographic imagery article ( M = 4.18, SD = 1 .69) nor data visualization article ( M = 4.20, SD = 1.66) had a significant impact on willingness to participate in a cancer clinical trial. 40

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CHAPTER 5 DISCUSSION The goal of this study was to analyze the effects of the deception discovery and fear appeals on a medical website. Webpages that appeared under a fictitious source, Florida Healthy Living, were displayed to participants. Depending on condition, vivid photographic imagery article , deception discovery or control articles were displayed at time one and time two of the study. The purpose of the experiment was to determine if perceptions of credibility, behavioral intentions , and attitudes would increase or decrease based on exposure to deception discovery, vivid photographic imagery , or a combination of the two. Overal l, study results suggest that the presence of vivid photographic imagery in an online health article about cancer clinical trials will increase perceptions of perceived accuracy of topic information. Participants who were expos ed to the article containing vivid photographic imagery were more likely to report that they believed they received accurate information about cancer clinical trials. This supports the first hypothesis and suggests that people use the extended parallel processing model when analyzing information. According to EPPM, messages are accepted when an increased threat is met with increased perceptions of self efficacy. The article containing the vivid photographic imagery also contained information about a potential lung cancer cure. The cure likely assuaged the elevated feelings of fear and led people to accept the message with less resistance. Using EPPM may help explain why there was not a significant difference in reported fear arousal between the vivid photographic imagery article and the data visualization article. If participants who viewed the vivid photographic imagery felt fearful they only had to read the article to discover that any 41

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fear generated by graphic images of lung cancer can be dismissed because there is a solution available to help them avoid getting sick or dying from the disease. Journalists reporting on topics related to health and me dicine should refer to these findings when writing a headline or story content. Publishing a fear arousing h eadline without an equivalent solution in the text of an article is detrimental and may cause readers to feel anxious or irritated. F uture studies should examine whether exposure to graphic images of a smoker’s lung and a deteriorating cancer patient will cause participants to perceive the threat of lung cancer as more serious than readers not exposed to the graphic images. These results point toward potential benefits of including graphic images when reporting on medical breakthroughs , or in campaigns to raise awareness for various health issues , as long as an appropriate solution is also presented. For example, if a community is skeptical about a new screening program being promoted by a local hospital they may skim or doubt the information describing the importance of getting screened. However, if the messages contains vivid photographic imagery , community members may perceive the threat as more severe, seek out a solution, and be more likely to accept the message. The results of this study may be unders tood by revisiting the results of hypotheses one and understanding that the study examines a medical specific context opposed to the broader cont ext of the retail industry in which the majority of carryover studies have been conducted. The study found that when vivid photographic imagery w as present in the article, participants were more likely to report higher positive attitudes toward a secondary medical source. Following the rationale of the previous 42

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finding, participants may have been emotionally aroused and less critical of the article and those positive perceptions may have carried over to the secondary source. An additional possibility behind these findings , is that people who were exposed to the vivid photographic imagery may have felt a greater moti vation to seek out a solution to alleviate the fear, which caused them greater dependence on medical resources. We also focused on deception discovery , and predicted that discovering a deceptive practice involving cancer clinical trials after viewing the vivid photographic imagery article would result in decreased willingness to participate in cancer clinical trials. We did not find a significant difference between any conditions. There was no evidence that exposure to information about medical fraud decreased intentions to participate in cancer clinical trials. These results suggest that despite the reported deception in the second article, participants still understand the benefits of cancer clinical trials and were not deterred by one negative incident. This finding further exemplifies the benefit and alleviates concern about potential consequences of utilizing vivid photographic imagery in messages that the previous two hypotheses have revealed. It also demonstrates the advantage of coming forward with c orrective information when necessary. Hospitals and other medical sources can refer to these results if they consider employing fear appeal components in their messaging but are concerned about potential negative consequences of doing so. Additionally, thi s specific finding is helpful in understanding the value of being forthright regarding errors in medical reporting, as it appears that individuals appear to perceive the admission of the error as an honest act rather than focusing on the previous deception. 43

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Contribution to Existing Knowledge Previous inquiry on deceptive claims has been largely restricted to paid advertisements. This study builds upon prior research by providing evidence regarding consequences of deceptive content, outcomes of utilizing fe ar appeals in medical articles, and what happens when the two intersect. Few researchers have tested effects of fear appeals on the source, such as a magazine or webpage, or the broader carryover effects to secondary sources. This is a pertinent concern for online health resources as 88% of Americans have relied on the Internet to gather health information (Pew, 2012). Pri marily, it was found that when vivid photographic imagery is present in the message, there is a reported increase in perceived truthfulness of topic information and increase attitudes toward a related secondary source. This helps bridge the gap between deception literature and fear appeal research and also contributes to the literature by examining the carryover effects of deception discovery. Prior studies focused on carryover effects have focused on deceptive print advertising or corrective advertising. We sought to determine the broader effects of deceptive message content. Interestingly, it was found that upon discovery of deception by a cancer clinical trial researcher published in an online medical website, participants were not deterred in their willingness to participate in a cancer clinical trial. This adds to a broad and divided body of literature pertaining to the benefits and cons equences of corrective advertising. Additionally, findings demonstrate that if a source comes forward to correct previously published information, the public is likely to perceive the admission as either insignificant or as a positive act. Our specific st udy brings the sobering consequences of deceptive information to the forefront. A study by Harris Interactive (2010) found that that 98% of people have 44

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some degree of skepticism toward information they read on the Internet yet many Americans trust and act on information found on medical websites. The results found in this study emphasize the benefits of utilizing appropriate levels of fear in health messages and the benefits of coming forward with corrections. Strengths and Limitations This study was unique to many other deceptive communication studies due to the fact that the majority of the participants were employed adults. This older, more diverse participant pool suggests a wider range of experiences and backgrounds that lead to higher external validity . The scenario described in the study is based on actual deception that occurred at Duke University involving a cancer researcher who fabricated significant amounts of data, gained funding, and held an ineffective cancer drug trial. The opportunity to moni tor public backlash to the event provided insight as to what relevant variables to include in the study. Various limitations were also present in this study. The manipulation was intended to create fear for the participant, but there were no differences. F urther studies may benefit by presenting vivid, detailed, text about the consequences of lung cancer. The deception discovery manipulation also needs strengthening. Subsequent studies should consider using a nonmedical source to present information and deception discoveries as a way to eliminate any indirect halo effects of a medical source. Using the theory of fear appeals and interpersonal deception was useful in predicting behavior yet fell short in accurately predicting outcomes . Examining this same st udy using expectancy violation theory may provide more precise hypotheses. Participants were exposed to the deception detection almost immediately after they viewed the initial article. Though it is conceivable that any effects might have deteriorated over time, a 45

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more realistic setting would allow for days or weeks to pass between learning about the promising cancer breakthrough and then the deception. The duration would allow people to discuss it with friends or loved ones who may be interested in the topic , and therefore increase the participants’ expectations and issue involvement with the subject. Another limitation is the use of a fictitious source. Though the webpage was modeled after an authentic medical webpage , the source was not real , and therefore unfamiliar to study participants. Use of a familiar source may have added credibility to the study or increased the level of engagement for the participants . Finally, the topic of lung cancer may not be pertinent to each participant. In order to gauge realistic fear arousal and deception discovery consequences , each participant would need to be exposed to a topic that was personally relevant. A wide variety of health specific insights have been brought to attention in this paper. The potential benefits of the inclusion of fear appeals and admission of inadvertent deception are clear. Further research into the role of fear appeals and outcomes of varying strengths of fear appeals is needed to better understand when and how these message components should be used. Findings also make it apparent that information sources should not hesitate to proactively correct any previously published incorrect or deceptive information since users will not decrease future behavior intentions after learning of the deception. 46

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APPENDIX A QUESTIONNAIRE Health News Comprehension Q1 Informed Consent Form Please read this consent document carefully before you decide to participate in this stu dy. Purpose of the research study: The purpose of this study is to examine ease of comprehension of two recently published health related articles. What you will be asked to do in the study: You will be asked to view the messages and indicate your thoughts and feelings about the stimuli in a confidential questionnaire. Time required: 1520 minutes Risks and Benefits: We do not anticipate there will be any risks or direct benefits to you as a consequence of your decision to complete the survey. Confidentiality: Every person’s answer from this study will remain confidential. No names will be used in any part of the study. Your identity will be kept confidential to the extent provided by law. Voluntary participation: Your participation in this study is entirely voluntary. There is no penalty for not participating. You can choose not to answer any question you do not wish to answer. Compensation: You are not being compensated in any way for the participation in this study. Right to withdraw from the study: You have the right to withdraw from the study at anytime without consequence. Whom to contact if you have questions about the study: Principle Investigator: Alyssa Jaisle, Masters Student College of Journalism and Communications Issy26@ufl.edu Whom to contact about your rights as a research participant in the study: UFIRB Office IRB02 Office, Box 112250, University of Florida Gainesville, FL 326112250; phone 3920433 114 Q2 I have read, unders tood, and printed a copy of, the above consent form and desire of my own free will to participate in this study. Yes (1) No (2) If No Is Selected, Then Skip To End of Survey Q3 What is your gender? Male (1) Female (2) Q4 What is your age? 1824 (1) 2544 (2) 4565 (3) 65+ (4) 47

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Q6 What is your race? White (1) Hispanic or Latino (2) Black or African American (3) Native American or American Indian (4) Asian / Pacific Islander (5) Other (6) Q7 Where are you located? (City, State, Country) Q35 How did you hear about this survey? Instagram (1) Email (2) Word of Mouth (3) Other (4) Q8 Employment Status Employed for wages (1) Self employed (2) Out of work and looking for work (3) Out of work but not currently looking for work (4) A homemaker (5) A student ( 6) Military (7) Retired (8) Unable to work (9) 48

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Q36 Next, I would like you to read the short article carefully and then we would like you to answer some general questions about various aspects of health. Q28 Q14 Write down your thoughts and opinions about the message you just read using complete sentences Q15 Please indicate how much you agree or disagree with each of the following statements. Strongly Disagree (1) Disagree (2) Somewhat Disagree (3) Neither Agree nor Disagree (4) Somewhat Agree (5) Agree (6) Strongly Agree (7) I think about cancer research a great deal. (1) I consider myself at risk of developing cancer. (2) Cancer research is a personally relevant topic for me. (3) I actively seek the most recent information about medical advances for cancer. (4) 49

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Q16 Please indicate how much you agree or disagree with each of the following statements "Florida Healthy Living..." Strongly Disagree (1) Disagree (2) Somewhat Disagree (3) Neither Agree nor Disagree (4) Somewhat Agree (5) Agree (6) Strongly Agree (7) Has a great amount of experience (1) Does not have much experience (2) Is skilled in what they do (3) Has great expertise (4) Is honest (5) Makes truthful claims (6) I trust the American Medical Association (7) I do not believe what they tell me (8) 50

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Q40 Please indicate how much you agree or disagree with each of the following statements 51

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Strongly Disagree (1) Disagree (2) Somewhat Disagree (3) Neither Agree nor Disagree (4) Somewhat Agree (5) A clinical trial is a good way to for people to treat their cancer. (1) A cancer drug trial provides effective treatment for people with cancer. (2) A cancer drug trial offers people the best treatment possible for their cancer. (3) If I had cancer, participating in a cancer clinical trial would be a serious threat to my quality of life. (7) If I had cancer, participating in a cancer clinical trial would have serious negative consequences. (8) 52

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If I had cancer, participating in a cancer clinical trial would be extremely harmful. (9) Cancer clinical trials offer people the best treatment possible for their cancer. (11) Cancer clinical trials are a good way to test new treatments for cancer. (12) Cancer clinical trials are the best way to find a cure for cancer. (10) Q18 To me this article is _______ 1 (1) 2 (2) 3 (3) 4 (4) 5 (5) 6 (6) 7 (7) Unbelievable:Believable (1) Inaccurate:Accurate (2) Untrustworthy:Trustworthy (3) Biased:Unbiased (4) \201 \201 \201 \201 \201 \201 Incomplete:Complete (5) \201 \201 \201 \201 \201 \201 \201 53

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Q19 When reading this article I felt... Strongly Disagree (1) Disagree (2) Somewhat Disagree (3) Neither Agree nor Disagree (4) Somewhat Agree (5) Agree (6) Strongly Agree (7) Frightened (1) Tense (2) Nervous (3) Anxious (4) Uncomfortable (5) Nauseous (6) \201 \201 \201 \201 \201 \201 Q23 To me, the American Medical Association is _______” 1 (1) 2 (2) 3 (3) 4 (4) 5 (5) 6 (6) 7 (7) Unappealing:Appealing (1) Bad:Good (2) Unpleasant:Pleasant (3) Unfavorable:Favorable (4) Unlikeable:Likeable (5) \201 \201 \201 \201 \201 \201 54

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Q37 Next, I would like you to read the last short article carefully and then we would like you to answer some general questions about various aspects of health. 55

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Strongly Disagree (1) Disagree (2) Somewhat Disagree (3) Neither Agree nor Disagree (4) Somewhat Agree (5) Agree (6) Strongly Agree (7) We can depend on getting the truth about most cancer research drug trials. (1) Cancer research drug trials aim to inform the patient. (2) I believe cancer research drug trials are informative. (3) Cancer research drug trials are generally truthful. (4) Cancer research drug trials are a reliable source of information about research. (5) 56

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In general, cancer research drug trials present a true picture of the research being conducted. (6) I feel I’ve been accurately informed after viewing most cancer research drug trials articles. (7) Most cancer research drug trials provide patients with essential information. (8) 57

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Q24 Strongly Agree (1) Agree (2) Somewhat Agree (3) Neither Agree nor Disagree (4) Somewhat Disagree (5) Disagree (6) Strongly Disagree (7) I would be willing to participate in a clinical drug trial (1) Q41 Thank you for participating in this survey. Please note that these articles are fictitious as is the source/website, “Florida Health Group”. The researchers conducting this study are interested in whether reading about deceptive practices in the medical field influence attitudes toward the medical field as a whole. Please remember that you are free to exi t the study and have your data discarded even at this late point by selecting “discard my data” below this statement. If you have any questions please contact Principal Investigator: Alyssa Jaisle, Masters Student College of Journalism and Communications I ssy26@ufl.edu Please discard my data (1) Q33 Q30 Q31 Q34 58

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APPENDIX B STIMULI Figure B 1. Florida Healthy Living vivid imagery a rticle 59

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Figure B 2 . F lorida Healthy Living data visualization a rticle 60

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Figure B 3 . Florida Healthy Living deception discovery article 61

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Figure B 4. Florida Healthy Living article without deception discovery. 62

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Figure B 5. Time 1 c ontrol group s timulus 63

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Figure B 6. Time 2 control group s timulus 64

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BIOGRAPHICAL SKET CH Alyssa Jaisle completed her bachelor’s degree in English at Texas A&M University in 2010. She then worked for Hearst Media/The Houston Chronicle as an account planner for 3 years before returning to school to pursue her master ’ s degree. She completed her Master of Advertising at the University of Florida in 2015. 76