Multi-method Study Research Articles

Development of a framework for community health workers to contribute to interprofessional learning teams

Background. Community health workers’ knowledge, skills and training seem to affect their contribution to 4th-year health sciences student teams who are following an interprofessional learning programme aimed at improving two South African rural communities’ health outcomes related to diabetes. Objective. To develop a framework for community health workers to contribute to interprofessional learning teams. Methods. The framework development forms part of previous phases of a multi-method study. The theory of change logic model guided the development of the draft framework, informed by data from two ecogram sessions, five nominal group technique discussions and a scoping review. The final framework was validated by experts during a workshop using forward and backward mapping. Results. The framework addresses the need for community health workers to gain knowledge, skills and training related to diabetes to effectively contribute to interprofessional learning teams. The theory of change process identified community needs and assets, desired results, influential factors, evidence-based strategies and assumptions required to address the problem. Conclusion. The framework focuses on a problem within specific interprofessional learning teams. Collaboration with stakeholders contributed to a rigorous research process, and the validation, refinement and future implementation of the framework. The framework eventually led to the development of an evidence-based training programme comprising knowledge, skills and training strategies related to diabetes. It is predicted that once community health workers have completed this training programme, they will be able to contribute effectively to the interprofessional learning teams.

The HEALthy Brain and Child Development Study (HBCD) experience: Recruiting and retaining diverse families in a longitudinal, multi-method early childhood study

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. Given its aim to examine the impact of adversity and protective factors on children’s outcomes, the recruitment and retention of families who have a wide diversity in experiences are essential. However, the unfortunate history of inequitable treatment of underrepresented families in research and the risks with which some participants will contend (e.g., substance use) makes their recruitment and retention in social science and neuroscience research particularly challenging.This article explores strategies that the HBCD Study has developed to recruit and retain participants, including marginalized, underserved, and hard-to-reach populations, capitalizing on the extant literature and the researchers’ own experiences. In this paper, we address strategies to recruit and retain families within HBCD, including: 1) creating experiences that engender trust and promote relationships; 2) maintaining connections with participants over time; 3) ensuring appropriate compensation and supports; 4) considerations for study materials and procedures; and 5) community engagement. The implementation of these strategies may increase representation and inclusiveness, as well as improve the quality of the resulting data.

A Multi-Method Exploration of Older Adults' Technology Use During the Pandemic in Two Canadian Provinces.

The pandemic caused a rapid shift to reliance on technology to meet basic daily needs related to both health and social interaction. As social isolation is known to be a major contributing factor to physiologic decline and psychological morbidity amongst older adults, we sought to study this shift, and conducted a multi-method study including; (1) a cross-sectional telephone survey and in-depth interviews with community dwelling older adults; and (2) interviews with community organizations supporting technology use for older adults. Quantitative data were analysed using descriptive, inferential statistics; qualitative data were analyzed using thematic analysis. Over 800 older adults completed surveys; 41 completed interviews. 26 community organizations shared their perceptions of supporting the rapid shift to virtual technology. Our results emphasize that social pressure plays a core role in adoption of new technology skills. These results are critical to appraise as reliance on digital technologies continues and look to support older adults.

Shared decision-making endorses intention to follow through treatment or vaccination recommendations: a multi-method survey study among older adults

BackgroundPrevious studies have shown that shared decision-making (SDM) between a practitioner and a patient strengthens the ideal of treatment adherence. This study employed a multi-method approach to SDM in healthcare to reinforce the theoretical and methodological grounds of this argument. As the study design, self-reported survey items and experimental vignettes were combined in one electronic questionnaire. This technique aimed to analyze the effects of previous experiences and the current preferences regarding SDM on the intentions to follow-through with the medical recommendations.MethodUsing quantitative data collected from the members of the Finnish Pensioners’ Federation (N = 1610), this study focused on the important and growing population of older adults as healthcare consumers. Illustrated vignettes were used in the evaluation of expected adherence to both vaccination and the treatment of an illness, depending on the decision-making style varying among the repeated scenarios. In a within-subjects study design, each study subject acted as their own control.ResultsThe findings demonstrated that SDM correlates with expected adherence to a treatment and vaccination. Both the retrospective experiences and prospective aspirations of SDM in clinical encounters supported the patients’ expected adherence to vaccination and treatment while decreasing the probability of pseudo-compliance. The association between SDM and expected adherence was not affected by the perceived health of the respondents. However, the associations among the expected adherence and decision-making styles were found to differ between the treatment and vaccination scenarios.ConclusionsSDM enables expected treatment adherence among older adults. Thus, the multi-method study emphasizes the importance of SDM in various healthcare encounters. The findings further imply that SDM research benefits from questionnaires combining self-report methods and experimental study designs. Further cross-validation studies using various types of written and illustrated scenarios are encouraged.

Human-AI Teaming in Critical Care: A Comparative Analysis of Data Scientists' and Clinicians' Perspectives on AI Augmentation and Automation.

Artificial intelligence (AI) holds immense potential for enhancing clinical and administrative health care tasks. However, slow adoption and implementation challenges highlight the need to consider how humans can effectively collaborate with AI within broader socio-technical systems in health care. In the example of intensive care units (ICUs), we compare data scientists' and clinicians' assessments of the optimal utilization of human and AI capabilities by determining suitable levels of human-AI teaming for safely and meaningfully augmenting or automating 6 core tasks. The goal is to provide actionable recommendations for policy makers and health care practitioners regarding AI design and implementation. In this multimethod study, we combine a systematic task analysis across 6 ICUs with an international Delphi survey involving 19 health data scientists from the industry and academia and 61 ICU clinicians (25 physicians and 36 nurses) to define and assess optimal levels of human-AI teaming (level 1=no performance benefits; level 2=AI augments human performance; level 3=humans augment AI performance; level 4=AI performs without human input). Stakeholder groups also considered ethical and social implications. Both stakeholder groups chose level 2 and 3 human-AI teaming for 4 out of 6 core tasks in the ICU. For one task (monitoring), level 4 was the preferred design choice. For the task of patient interactions, both data scientists and clinicians agreed that AI should not be used regardless of technological feasibility due to the importance of the physician-patient and nurse-patient relationship and ethical concerns. Human-AI design choices rely on interpretability, predictability, and control over AI systems. If these conditions are not met and AI performs below human-level reliability, a reduction to level 1 or shifting accountability away from human end users is advised. If AI performs at or beyond human-level reliability and these conditions are not met, shifting to level 4 automation should be considered to ensure safe and efficient human-AI teaming. By considering the sociotechnical system and determining appropriate levels of human-AI teaming, our study showcases the potential for improving the safety and effectiveness of AI usage in ICUs and broader health care settings. Regulatory measures should prioritize interpretability, predictability, and control if clinicians hold full accountability. Ethical and social implications must be carefully evaluated to ensure effective collaboration between humans and AI, particularly considering the most recent advancements in generative AI.

To reveal the unseen low-hanging fruit: A multi-method study of Indonesian hospital pharmacist perception regarding the implementation of injection-to-oral conversion activity.

Previous studies have demonstrated that the adoption of injection-to-oral conversion strategies in hospitalised patient yields both clinical and economic benefits. The objective of this study was to provide a comprehensive description of the current state of implementation and evaluate the perspectives of hospital pharmacists to guide future initiatives towards conversion implementation in Indonesia. A multi-method design was utilised. Quantitative approach used cross-sectional study design in which data were collected online using Google Form from August to October 2021. Qualitative analysis employed a phenomenological approach by performing in-depth interviews from July to August 2021. Each approach's data were compared to discover connections and discrepancies, and the final interpretation was done simultaneously. A total of 204 pharmacists participated in the survey, with 64.2% of them reporting no previous experience in conversion. An in-depth interview included seven hospital pharmacists, with three themes were emerged: (1) strategic roles of the pharmacist; (2) key considerations; and (3) potential barriers and enablers of conversion implementation. Based on the elaboration of quantitative and qualitative data, the study found that pharmacist had strong perception regarding pharmacist role in conversion despite their little experience in implementing the activity. For future improvement, a platform that taking into account the pharmacist current conditions and insights should be created. Pharmacists appreciated conversion activity and grasped its concepts despite little clinical experience. Consider possible enabling and barrier factors and essential considerations before taking action. Local guidelines and instructional materials that emphasise application or implementation are encouraged. Furthermore, the implementation project must be piloted and evaluated for clinical and economic outcomes.

Palliative Care Needs of Women With Advanced Chronic Obstructive Pulmonary Disease: A Mixed Methods Study.

Individuals with chronic obstructive pulmonary disease (COPD) experience high symptom burden, severe illness, and frequent deterioration in quality of life. Women with COPD represent a unique population with potential unmet care needs yet remain underrepresented in palliative care (PC) literature. The purpose of this study was to investigate specific needs of women with COPD, learn how COPD symptoms impact women, and explore factors related to PC knowledge, access, and barriers. A total of 30 individuals were enrolled in this prospective, single-arm multimethod study, using an adapted Maslow's hierarchy of needs framework. Fifteen participated in semistructured interviews. Women with advanced COPD identified care needs and barriers including access to medications/oxygen and resources (pulmonary rehabilitation/support groups), information about disease/treatment, and effect of weather conditions on symptoms. Some participants were not under the direct care of a pulmonologist but recognized the importance of their services. None of the participants had been referred to or received PC. This study provides evidence that women have unmet care needs, high symptom burden, and disease uncertainty. Women with COPD should have the opportunity to have the supportive care that PC offers. Palliative care and hospice nurses have opportunities to address unmet care needs, increased symptom burden, and disease uncertainty.

The Usage of a Chat-Based Help Service for Young People: A Nationwide Descriptive Study

Adolescents with subclinical depression are at high risk of developing mental disorders. Early interventions are effective but expensive. Affordable and accessible mental health services are needed. This multimethod study obtained its sample from the database of the Finnish national chat room service and describes the usage of the service among young people in Finland. All chats between 1.1-31.12.2018 were extracted and analysed using quantitative and qualitative methods. The usage frequency was analysed with descriptive statistics, while the specific content of the chat topics was first categorised with content analysis and then quantified and analysed using descriptive statistics. The association between the demographic characteristics and the usage were analysed. A total of 839 young people used chat room services. The great majority of the chat users were girls, and half were 12-14 years old. The use of the chat room varied in terms of the number of words and the duration of the chat discussions. Based on the chat room topics, young people had complex life situations with psychological distress, difficulties related to their social living environment, or they were involved in risky behaviour. The gender and the age of the users influenced their chat room usage. The results of this study can be used in the development of mental health services for young people.

Leadership Development Program for Public Health Nurses: An Evaluation of Workplace Application.

Public health nurses (PHNs) are vital in the local implementation of the provisions of the Universal Healthcare (UHC) Act of 2019. However, they need adequate competencies in health systems approach to successfully implement the provisions of the law. In response to this, a leadership development course for public health nurses (LDC-PHN), anchored on the building blocks of health systems, was developed and implemented. This paper aims to describe the extent to which training participants have applied the competencies acquired from the LDC-PHN as manifested by the workplace application of their capstone projects. Following Kirkpatrick's Model of Evaluation, we used a multi-method study design to evaluate the extent of the participants' workplace application of acquired competencies. Sources of data included the Workplace Application Plan (WAP) accomplished by each participant, a questionnaire to determine the perceived implementation status of the participants' capstone project, interviews, and focus group discussions (FGDs) conducted with selected participants and their supervisors, and observation visits. Data were collected from May to December 2022. Data from the semistructured interviews and FGDs were analyzed through content analysis, while the participants' perceived status of their capstone project implementation was summarized as frequencies. Majority of the participants (61.9%) reported partial implementation of their capstone project while 16.77% reported full implementation. Capstone project implementation was facilitated by the support received from their supervisors and local chief executives. Barriers identified included the demands of the COVID-19 pandemic and the challenges imposed by the events before and after the 2022 Philippine National elections. Major themes emerged from the interviews conducted among participants and their supervisors. The workplace application of the training program outcomes, based on participants' perspectives, yielded increased capacity to lead and innovate, improved ability to advocate for capstone project implementation, transferability of acquired skill sets, and improved population outcomes. From supervisors' perspectives, workplace application of training program outcomes include increased ability of PHNs to deliver health services, and visible enhancement of leadership and supervision skills among PHNs. Given ample support and opportunities, and despite the barriers and challenges they faced, LDC-PHN participants, in general, utilized and applied the competencies they gained from the course in their actual work setting. Course graduates participated in health systems strengthening at various capacities by acting upon their capstone projects that addressed UHC challenges within their particular work settings.

The Use of Immersive Virtual Reality Training for Developing Nontechnical Skills Among Nursing Students: Multimethods Study.

Immersive virtual reality (IVR) is a niche technology rising in popularity in nursing education. Although there is an abundance of evidence to demonstrate the effect of virtual reality (VR) on desired learning outcomes, this evidence is limited to technical or procedural skills or managing a single patient with clinical problems. Nontechnical skills (NTS), such as communication, decision-making, teamwork, situation awareness, and managerial skills, have not been explored using IVR technology. This study aimed to (1) investigate the potential efficacy of the IVR system virtual reality hospital (VR-Hospital, or VR-Hosp), a single-user game we developed, on nursing students' NTS, sense of presence in the virtual clinical environment, and satisfaction and self-confidence in learning; (2) identify variables that predict NTS; and (3) explore students' experience in using VR-Hosp. A multimethods design with a quantitative and qualitative approach was adopted. Participants were provided with VR-Hosp with 3 scenarios in training. VR-Hosp adopted a multibed, multipatient, multitask approach and was embedded with various clinical situations. Learning outcomes were measured after the training, followed by group interviews. In total, 202 students joined the study. Results revealed high levels of satisfaction and self-confidence in learning. Significant achievement in NTS was perceived by the students. The levels of satisfaction and self-confidence in learning and the involvement and sensory fidelity domains in the sense of presence were positive predictors of NTS. The promising results offer a basis for designing IVR activities for nursing education. Further investigations are imperative to determine the impact of IVR technology on learning outcomes in clinical practice.

"Nobody Here Likes Her"-The Impact of Parental Verbal Threat Information on Children's Fear of Strangers.

Parental verbal threat (vs. safety) information about strangers may induce fears of these strangers in adolescents. In this multi-method experimental study, utilizing a within-subject design, parents provided standardized verbal threat or safety information to their offspring (N=77, Mage=11.62 years, 42 girls) regarding two strangers in the lab. We also explored whether the impact of parental verbal threat information differs depending on the social anxiety levels of parents or fearful temperaments of adolescents. Adolescent's fear of strangers during social interaction tasks was assessed using cognitive (fear beliefs, attention bias), behavioral (observed avoidance and anxiety), and physiological (heart rate) indices. We also explored whether the impact of parental verbal threat information differs depending on the social anxiety levels of parents or fearful temperaments of adolescents. The findings suggest that a single exposure to parental verbal threat (vs. safety) information increased adolescent's self-reported fears about the strangers but did not increase their fearful behaviors, heart rate, or attentional bias. Furthermore, adolescents of parents with higher social anxiety levels or adolescents with fearful temperaments were not more strongly impacted by parental verbal threat information. Longitudinal research and studies investigating parents' naturalistic verbal expressions of threat are needed to expand our understanding of this potential verbal fear-learning pathway.

A conceptual framework from the Philippines to analyse organizational capacities for health policy and systems research.

Organizations that perform Health Policy and Systems Research (HPSR) need robust capacities, but it remains unclear what these organizations should look like in practice. We sought to define 'HPSRIs' (pronounced as 'hip-srees', i.e. 'Health Policy and Systems Research Institutions') as organizational models and developed a conceptual framework for assessing their capacities based on a set of attributes. We implemented a multi-method study in the Philippines that comprised: a qualitative analysis of perspectives from 33 stakeholders in the HPSR ecosystem on the functions, strengths and challenges of HPSRIs; a workshop with 17 multi-sectoral representatives who collectively developed a conceptual framework for assessing organizational capacities for HPSRIs based on organizational attributes; and a survey instrument development process that determined indicators for assessing these attributes. We defined HPSRIs to be formally constituted organizations (or institutions) with the minimum essential function of research. Beyond the research function, our framework outlined eight organizational attributes of well-performing HPSRIs that were grouped into four domains, namely: 'research expertise' (1) excellent research, (2) capacity-building driven; 'leadership and management' (3) efficient administration, (4) financially sustainable; 'policy translation' (5) policy orientation, (6) effective communication; and 'networking' (7) participatory approach, (8) convening influence. We developed a self-assessment instrument around these attributes that HPSRIs could use to inform their respective organizational development and collectively discuss their shared challenges. In addition to developing the framework, the workshop also analysed the positionality of HPSRIs and their interactions with other institutional actors in the HPSR ecosystem, and recommends the importance of enhancing these interactions and assigning responsibility to a national/regional authority that will foster the community of HPSRIs. When tailored to their context, HPSRIs that function at the nexus of research, management, policy and networks help achieve the main purpose of HPSR, which is to 'achieve collective health goals and contribute to policy outcomes'.

Sex education against the algorithm: the algorithmically enforced deplatforming of YouTube sex edutainment

ABSTRACT Deplatforming of sexual content has increased across social media, usually operationalized by commercially charged, and algorithmically enforced, platform policies. This paper extends work on the algorithmic deplatforming of sex through the case study of how sex education content, or ‘sex edutainment’ on YouTube, is impacted by the platform’s algorithmic structures. Enrolling actor-network theory, we demonstrate the delegation work YouTube enacts through algorithms by presenting empirical findings from a multi-method study examining the assemblage of YouTube, sex edutainment influencers, and young people. The findings highlight that despite YouTube’s curated platform imaginary as an amplifier of voices, algorithmic delegation of platform governance creates significant barriers for influencers creating sex edutainment on YouTube. Although not contravening YouTube’s policies, influencers regularly battle demonetization, age-restrictions and algorithmic bias. This undermines the benefits of sex edutainment by limiting access to content, creates precarious financial environments for influencers and risks erosion of audience trust. Meanwhile, algorithms designed to protect users enact this governance without adequately protecting influencers themselves, predominantly women and LGBTQ+ individuals, from harm. Despite YouTube’s veneer of democratization, the social discourses and protectionist narratives that have destabilized traditional sex education efforts permeate our digital environments and can be seen in the algorithmic enactment of YouTube’s policies.

“Wait … did you just call me fat?”: A multimethod study of U.S. Americans’ facework in an intercultural face-threatening act

ABSTRACT This study examines the facework of U.S. Americans in an intercultural interaction where one party unknowingly violates the U.S. cultural norm. Through data collected from both participants’ self-reported surveys and researchers’ observations of 103 U.S. Americans, the study found that the participants primarily rely on avoidance when dealing with an unexpected norm-violating intercultural encounter. U.S. Americans’ avoiding facework is characterized mainly by brief verbal explanations and nonverbal cues such as withdrawing eye contact and displaying smiles. Results from structural equation modeling (SEM) revealed that situational face threats mediate the relationship between individuals’ face needs and facework. The study provides both theoretical and methodological implications for facework research and offers practical suggestions for effective intercultural communication.

The experiences of gender and sexually diverse parents using support and services for their young children: An integrative review.

To address: What are the experiences of 2SLGBTQQIA+ parents using parenting supports and services to meet their children's early childhood development needs (<5 years of age)? Whittemore and Knafl's (2005) integrative review methodology. Electronic databases were searched from 2000 to October 14, 2022 for empirical studies or reviews addressing the research question. The title and abstract of 12,158 articles were screened for inclusion in the review by two independent researchers; 175 of these articles underwent full-text review. Studies selected were critically appraised using a Joanna Briggs Institute Critical Appraisal tool. Relevant key findings were extracted from each study and entered into N-VIVO-12. Thematic content analysis was employed and PRISMA guidelines were adhered to. A total of 18 articles (15 qualitative and three multi-method studies) met the inclusion criteria and were selected for the review. Seven themes were revealed from analysis of the studies: (1) 2SLGBTQQIA+ Status kept a secret; (2) Forced to come out; (3) Heteronormative messaging; (4) Feeling excluded; (5) Stigmatised; (6) Parents act as educators; and (7) Positive experiences. This integrative review provides nurses with insight into the experiences of 2SLGBTQQIA+ parents using health care services for their young child. This article highlights what changes nurses need to make to their practice to ensure appropriate, inclusive care for clients of diverse sexual and gender identities and their families. Health care providers, especially nurses, have an opportunity to improve the experiences of these families and positively impact their health and well-being. Additionally, there is a need for research with the 2SLGBTQQIA+ parent community and the use of rigorous methodological techniques, including clearly linking participants' gender and sexual identities with study findings, to improve our understanding of 2SLGBTQQIA+ parent experiences. Although there was no direct patient contribution to the work since it was an integrative review of the literature, indirectly patient contributions are incorporated from the original research results of studies incorporated into this review.

Body image and psychosocial outcomes in youth and young adults with differences of sex development: a multi-method study.

Differences of sex development (DSD) can affect the physical health, appearance, and psychosocial functioning of affected individuals, but little is known about how subjective appearance perceptions (body image) impact psychosocial outcomes. This study evaluated body image and its associations with psychosocial outcomes including quality of life, resilience, and psychosocial adjustment. This cross-sectional, multi-method study assessed body image and psychosocial outcomes including quality of life, adjustment, and resilience in 97 youth and young adults with DSD (mean age = 17 ± 3.7 years; 56% assigned female in infancy) using psychometrically sound instruments. A subsample (n = 40) completed qualitative interviews. Quantitative results indicated that overall, participants were satisfied with their physical appearance, although less so with their primary sex characteristics. Body image dissatisfaction was associated with poorer psychosocial adjustment, quality of life, and resilience. Qualitatively, youth and young adults reported a variety of perceptions, both positive and negative, related to their body image and the impact of living with a DSD condition. Themes identified included appearance management; effects of DSD on body image; diagnostic factors and features; attitudes about diagnosis; and treatment. Body image is significantly associated with psychosocial outcomes in youth and young adults with DSD, with qualitative findings highlighting both positive and negative body image experiences. Results have implications for clinical care including screening for appearance concerns, normalization of appearance variations, and intervention development to better support healthy body image and psychosocial functioning in youth and young adults with DSD.

Feasibility of Holographic Team Training Simulation: An Information Technology (IT) Perspective for Healthcare and Educational Institutions.

Introduction This study examines the feasibility and practicality of holographic display technology (HDT) in health professions educationfrom an information technology (IT) support staff perspective. Considering a lack of feasibility studies for introducing newer technologies, it focuses on feasibility's acceptance and practicality dimensions during a simulation-based team training workshop. Method A multimethod design feasibility study assessed the acceptability and practicality of HDT for the IT staff through a Unified Theory of Acceptance and Use of Technology (UTAUT)-based survey and a focus group discussion after a team training simulation workshop. Results Quantitative results showed a reliability coefficient (α=0.83) and a positive correlation between facilitating conditions (FC) and effort expectancy (EE), self-efficacy (SE) and social influence (SI), SI and attitude toward technology (AT), SE and attitude to use, and behavioral intention (BI) and EE. Negative correlations included SE and performance expectancy (PE), comfort with technology and FC, comfort and anxiety, and attitude to use and experience. Qualitative findings yielded four key themes from the focus group discussions that corroborated the quantitative findings. Discussion The study findings highlight the promising potential for HDT feasibility in educational settings. Future research should extend to diverse contexts to validate these preliminary findings and explore broader educational applications.

Exploring fidelity of enactment in a cluster randomised controlled trial testing the effectiveness of ‘gatekeeper’ training for pesticide vendors in reducing self-poisoning in rural Sri Lanka: protocol for a multimethod qualitative study

IntroductionPesticide self-poisoning causes severe health and socioeconomic hardship in low- and middle-income countries, including Sri Lanka. A stepped-wedge cluster randomised controlled trial (cRCT) has been designed to test whether ‘gatekeeper’...

Multimethods study to develop tools for competency-based assessments of implementation research training programmes in low and middle-income countries

IntroductionMethods and validated tools for evaluating the performance of competency-based implementation research (IR) training programmes in low–middle-income countries (LMICs) are lacking. In this study, we developed tools for assessing the...

The role of positive emotion in harmful health behavior: Implications for theory and public health campaigns

Meta-analyses have concluded that positive emotions do not reduce appetitive risk behaviors (risky behaviors that fulfill appetitive or craving states, such as smoking and excessive alcohol use). We propose that this conclusion is premature. Drawing on the Appraisal Tendency Framework and related theories of emotion and decision-making, we hypothesized that gratitude (a positive emotion) can decrease cigarette smoking, a leading cause of premature death globally. A series of multimethod studies provided evidence supporting our hypothesis (collective N = 34,222). Using nationally representative US samples and an international sample drawn from 87 countries, Studies 1 and 2 revealed that gratitude was inversely associated with likelihood of smoking, even after accounting for numerous covariates. Other positive emotions (e.g., compassion) lacked such consistent associations, as expected. Study 3, and its replication, provided further support for emotion specificity: Experimental induction of gratitude, unlike compassion or sadness, reduced cigarette craving compared to a neutral state. Study 4, and its replication, showed that inducing gratitude causally increased smoking cessation behavior, as evidenced by enrollment in a web-based cessation intervention. Self-reported gratitude mediated the effects in both experimental studies. Finally, Study 5 found that current antismoking messaging campaigns by the US Centers for Disease Control and Prevention primarily evoked sadness and compassion, but seldom gratitude. Together, our studies advance understanding of positive emotion effects on appetitive risk behaviors; they also offer practical implications for the design of public health campaigns.