THE PENNSYLVANIA STATE UNIVERSITY

SCHREYER HONORS COLLEGE

DEPARTMENT OF COMMUNICATIONS ARTS & SCIENCES

ANTIBIOTICS OR SELF-ISOLATION: CHANGING REACTIONS TO RESPIRATORY

INFECTIONS THROUH HEALTH MESSAGES
KATHARINE PECORINO
SPRING 2014
A thesis
submitted in partial fulfillment
of the requirements
for a baccalaureate degree
in Communications Arts & Sciences
with honors in Communications Arts & Sciences

Reviewed and approved* by the following:

Rachel Smith
Associate Professor of Communication Arts & Sciences and Human Development
& Family Studies
Thesis Supervisor
Lori Bedell
Senior Lecturer in Communications Arts & Sciences
Honors Adviser
* Signatures are on file in the Schreyer Honors College.

ABSTRACT

ii
This thesis aims to assess undergraduate students initial perceptions and responding health
behaviors when faced with a threat of a respiratory infection. The two levels of threat perceptions
measured are severity and susceptibility while the two health behaviors measured for are selfisolation and antibiotic use. Additionally, it was investigated whether health messages promoting
the efficacy (effectiveness) of a certain behavior would increase a persons intent to engage in
that behavior and whether a health message demoting a certain behavior would decrease a
persons intent to engage in that behavior. Messages regarding self-isolation were promoting and
messages regarding antibiotic were demoting. Results indicated that a high level of perceived
severity after a threat of a respiratory infection lead to a high intent to react. The relationship
between perceived susceptibility and an intent to act was insignificant. After undergraduate
students were exposed to health messages promoting the efficacy of self-isolation, they
experienced a positive significant change indicating an increase in intent to act in accordance to
self-isolating behaviors. Undergraduate students exposed to messages promoting messages of
self-isolation also experienced a more positive change in intent to engage in self-isolation
behaviors than those not exposed. After undergraduate students were exposed to health messages
demoting the efficacy of antibiotics, there was no significant change in an intent to engage in
antibiotic use. There was only a slight, yet insignificant difference in intention to engage in
antibiotic use between undergraduates exposed to demoting messages regarding antibiotics, than
those not exposed.

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TABLE OF CONTENTS
Introduction: The Current Health Situation regarding Antibiotic Use

...1-5

A Literature Review of EPPM Model and Application to Research

...6-9

Methods and Review of Administered Survey

..10-14

Results.........................................................................................................................................15-17
Discussion...................................................................................................................................18-24
Bibliography................................................................................................................................25-26

Introduction: The Current Health Situation regarding Antibiotic Use

Undergraduate college students show poor recognition of typical presentations of the
common cold and have misconceptions about effective treatment (Zoorob et al., 2001). This
tendency is a potential threat to the current and future health of college students and the general
population. People view antibiotics as an effective method of treatment for respiratory symptoms
and infections, when in some cases, do not require antibacterial drugs as means of treatment and
termination. Relatively small doses of antibiotics taken over long periods of time can harm
people, later showing up as cancer, diabetes, vasculitis or other diseases (Kaufman & Holland,
2003). Taking antibiotics when unnecessary can also be harmful by causing diarrhea and
digestive problems, reducing beneficial phytoestrogens, impairing immunity, and causing long
term changes in gut microflora (The Long-Term Effects of Antibiotics on Health and Immunity,
2009). Additionally, the overuse and misuse of antibiotics can lead to antibiotic-resistant
infections, which happens when microorganisms find a way to evade or resist the antimicrobial
agent. Resistance can occur wherever antimicrobials are used - in the community, on a farm, and
in healthcare. If undergraduate college students in a community choose to take antibiotics
inappropriately or too frequently, they could potentially perpetuate this problem. Antimicrobial
resistance has become a global problem, and some of our most significant global threats are
multi-drug resistant tuberculosis and drug-resistant malaria (Frieden, Thomas M.D, CDC 2010),
SARS, a viral respiratory disease [(Hong Kong, China, 2003) BMJ 2003;326:850] , and MRSA
[(United Kingdom, 2004) Murchan et al. 2004]; All were outbreaks during the past ten years. In
order to prevent further outbreaks, we need to know about college students intentions to either
perform recommended and appropriate actions for preventing respiratory infections, or take

2
antibiotics. Then, we will know if there is in fact a high intent for college students to use
antibiotics and measures can be taken by medical practitioners and health organizations to
persuade those antibiotic-seeking students away from overusing and misusing antibiotics. Some
general recommendations for preventing respiratory infections include safe hygienic practices
(frequent hand-washing, avoiding the sharing of cups, glasses, and eating utensils), and avoiding
contact with potentially infected respiratory secretions and saliva, and vaccinations (CDC
Recommendations & Reports, 49 (RR10);1-128). There are current campaigns to promote these
precautionary practices and reduce the use of antibiotics. The Center for Disease Control (CDC),
the Food and Drug Administration (FDA), and the National Institutes of Health (NIH)
Interagency Task Force, launched an antimicrobial resistance campaign that aims to extend the
useful life of antimicrobial drugs through appropriate use policies that discourage overuse and
misuse, improve diagnostic testing practices, prevent infection transmission through improved
infection control methods and use of vaccines. The campaign involves a wide variety of
nonfederal partners and the public so these programs can become part of a routine practice
nationwide [(CDC Framework for preventing infectious diseases: Sustaining the Essentials and
Innovating for the Future (October 2011)].
The current health situation creates a demand for this research. Undergraduate college
students show poor recognition of the typical presentation of a common cold and have
misconceptions about effective treatment. Antibiotic use, a practice previously mentioned as
having potentially long-term health effects on an individual and a population, is practiced
inaccurately and inappropriately by students who are engaging as means of dealing with
symptoms that, in some cases, can be alleviated by less harmful methods. Antibiotics are
typically recommended and needed for a strep throat caused by strep bacteria after exposure, a

3
previous infection, emphysema or other lung diseases, diabetes, heart diseases in elderly
individuals, upper respiratory infections lasting for more than one month, sinus infections,
bacterial infections and long term pain, discomfort and troubling symptoms (CDC, 2009).
Undergraduate students should be engaging in recommended practices and self-isolation
behaviors when faced with common respiratory symptoms and infections. These strategies have
less health threats than antibiotic use. Recommended reactions to respiratory infections include,
for general symptoms, drinking at least two quarts per day of water, tea, and/or soda, sleeping
with a vaporizer or humidifier filled with plain water and place it at your bedside, consuming a
zinc lozenge every two hours for a week and using over-the-counter herbs for aches, pains,
headaches and fever. For feeling like you have not slept, an individual is advised to take two
regular Tylenol or one Advil four times a day or Aleve every eight hours. For a runny or
congested nose, individuals are advised to take 30-60 mg of Pseudoephedrine four times a day as
needed, take Benedryl to aid sleep at night and use a 12 hour spray decongestant such as Afrin or
Dristan Mist. For a sore throat, an individual is advised to gargle every five to ten minutes with
water, tea or soda to rinse the irritating mucous from throat or to try throat lozenges available in a
pharmacy. Lastly for a persisting cough, an individual is advised to drink water, use a night time
vaporizer and take 30mg of Dextromethorphan (found in Delsym syrup) every eight hours
(Gagne, Jim M.D, 2009). For undergraduate students, self-isolation includes staying home,
staying in your room, visiting a health center, wearing a face mask, maintaining isolation until
one does not have a fever after 24 hours without using fever reducing medication, using a
thermometer, notifying your commons office, asking your commons office for guidelines
regarding meals, roommate issues, class absences, resting/sleeping , hydrating and taking
medicine (Middlebury College, Parton Health and Counseling Center, 2012), safe hygienic

4
practices (frequent hand-washing, avoiding the sharing of cups, glasses, eating utensils with
others), avoiding contact with potentially infected respiratory secretions and saliva and
vaccinations ((CDC Recommendations & Reports), 49(RR10);1-128). In addition to showing
poor recognition of typical presentations of the common cold and not engaging in recommended
treatment methods, undergraduate students have misconceptions about other treatment methods,
particularly antibiotic use. These misconceptions have driven them to engage in antibioticseeking behaviors that increase the use and misuse of antibiotics. Antibiotic use is defined as
taking the antibiotic exactly as the doctor instructs after prescription. This includes talking with
your healthcare provider about antibiotic resistance, completing the prescribed course even if
you are feeling better, and throwing away any leftover medication once you have completed your
prescription (CDC, 2009). Antibiotic-seeking behaviors include seeking the help of a physician,
visiting a physician and asking for antibiotics, refusing proper treatment, demanding specific
prescriptions, ceasing antibiotic use with intent to maintain a supply (Mangus, 2010), presenting
complaints to university health centers, seeking antibiotics prescribed for an earlier illness and
seeking antibiotics prescribed for another person (Haltiwanger, A. MD, 2010). Many antibioticseeking behaviors such as refusing proper treatment, demanding specific prescriptions, ceasing
antibiotic use before proper dosage is taken, seeking antibiotic use with intent to maintain a
supply and seeking antibiotics prescribed for an earlier illness or another person, all contradict
the practices of proper antibiotic use. There is an unknown component of the current health
situation regarding undergraduate college students initial intentions to engage in health
behaviors when faced with respiratory symptoms and infections. Whether or not they intend to
engage in self-isolation behaviors or take antibiotics is unknown.

A Literature Review of EPPM Model and Application to Research

The Extended Parallel Process Model (EPPM) is utilized to frame this study and measure
levels of perceived health threats, perceived efficacy of health behaviors and intentions to engage
in health behaviors. According to EPPM, reading a fear appeal message initiates two appraisals
of threat and efficacy. Threat is defined as a danger or harm that exists in the environment
whether an individual knows it or not. An actual threat is to be distinguished from perceived
threat, which is defined as cognitions or thoughts about the threat. Perceived threat in this study
is the extent to which a student believes they are at risk of getting a respiratory infection. The
threat is further defined on two levels, severity and susceptibility. Efficacy is defined as the
effectiveness, feasibility, and ease with which a recommended response (self-sxisolation or
antibiotic use) impedes or averts a threat. The greater the threat perceived, the more motivated an
individual is to begin the second appraisal, which is an evaluation of the efficacy of the
recommended response. Perceptions of efficacy that are greater than perceptions of threat will
lead to message acceptance and lead to actions consistent with health messages; this is labeled as
a danger control process. Danger control processes are primarily cognitive processes where
individuals realize they are at risk for a severe danger and believe they can effectively deter the
threat, become motivated to protect themselves, and deliberately and cognitively confront the
danger. Perceptions of efficacy that are lower than perceptions of threat will lead to message
rejection and lead to reactions that are inconsistent with health messages; this is labeled as a fear
control process. Fear control processes are primarily emotional processes where people respond
to and cope with their fear, not the danger. Fear processes focus on the control of internal
concerns such as emotions and physiological reactions, unlike danger control processes which
focus on the threat of an external object or event. EPPM states that perceived levels of threat and

6
efficacy determine whether an individual will intent to act in danger or fear control processes
after presentations of a health threat (Witte, 1994). What is unknown of EPPM is whether
demoting efficacy of a health behavior and promoting efficacy of another health behavior will
will change an individuals intentions after perceiving a threat. If so, demoting efficacy of taking
antibiotics should decrease an individuals intentions to take antibiotics. EPPM will be used to
change undergraduate students reactions to respiratory symptoms through specific health
messages that promote the efficacy of self-isolation and demote the efficacy of antibiotic use.
Implications of study for EPPM suggest that promoting the efficacy of a health strategy will
increase an individuals intentions to engage that behavior. Further implications suggest that
exposing individuals to messages promoting the efficacy of a health strategy will lead to higher
intentions of engaging in that strategy than those individuals not exposed. Additionally, after
exposure to a message demoting the efficacy of a health strategy, an individuals intentions to
engage in that behavior will decrease. Lastly, individuals exposed to health messages demoting
the efficacy of a health strategy will have lower intentions to engage in that strategy than
individuals not exposed. Polarizing the efficacy of health strategies through health messages can
be utilized to change behaviors, and more importantly utilized to decrease behaviors consistent
with the fear control process, a process identified by EPPM that aims to cope with internal
concerns such as emotions, rather than a present danger. Polarizing efficacy can also be utilized
to increase behaviors consistent with the danger control process, a process identified by EPPM
that aims to cope with external concerns such as an actual health threat. Previous research on the
most effective way to persuade audiences show that results of prior EPPM studies have found
that successful fear appeals for health messages should contain a high-threat message and even
higher amounts of efficacy (i.e., self and response) in order to promote danger control responses

7
(Gore & Bracken PhD, 2005). Polarizing threat and efficacy conditions to resemble messages
found in real-life situations will change reactions to a health threat. In this case, messages will
include high-threats of respiratory infections, and specific health behaviors (self-isolation
behaviors or antibiotic-seeking/taking behaviors). When promoting the efficacy of self-isolation
and demoting the efficacy of taking antibiotics the following hypothesis will be made:
H1: If an individual perceives a high threat from respiratory symptoms they will have
high intentions to react.
H2: After exposure to health messages promoting the efficacy of self-isolation, an
individuals intentions to engage in self-isolating behaviors will increase.
H3: Individuals exposed to health messages promoting the efficacy of self-isolation will
have higher intentions than individuals not exposed.
H4: After exposure to a message that demotes the efficacy of antibiotic use, an
individuals intentions to take antibiotics will decrease.
H5: Individuals exposed to health messages demoting the efficacy of antibiotics will have
lower intentions than individuals not exposed.
Using EPPM as a frame for this study and promoting and demoting efficacy of the given
strategies should change undergraduates reactions to respiratory infections by increasing the
intent to engage in self-isolation behaviors and decreasing the intent to use antibiotics. EPPM has
been tested using a variety of research methods such as experiments, focus groups, and surveys,
and has covered a multitude of topics, including skin cancer (Stephenson & Witte, 1998),
HIV/AIDS prevention (Casey, 1995; Murray, Hubbell,Witte, Sampson, & Morrison, 1998;
Murray-Johnson, Witte, Liu, & Hubbel, 2001; Witte,1992, 1994; Witte, Cameron, Lapinski, &
Nzyuko, 1998; Witte & Morrison, 1995), teen pregnancy (Witte, 1997), genital warts (Witte,

8
Berkowitz, Cameron, & McKeon, 1998;Witte, Cameron, McKeon, & Berkowitz, 1996), breast
cancer (Kline, 1995), radon awareness (Witte, Berkowitz, McKeon, et al., 1998), and even
tractor safety (Witte et al.,1993). In addition, EPPM studies have focused on many different
populations, including high school students (Murray et al., 1998), juvenile delinquents (Witte &
Morrison, 1995), college students (Witte, 1992, 1994; Witte, Berkowitz, Cameron, et al., 1998),
African Americans (Witte et al., 1996), farmers (Witte et al., 1993), and Kenyan prostitutes
(Witte, Cameron, et al., 1998).

Methods
Participants
A representative sample of 147 undergraduate college students enrolled in either CAS
204 or CAS 283 at The Pennsylvania State University was surveyed. Students enrolled in these
courses vary in all four class standings and accurately represent the subjects intended for this
study. Power analysis conducted for a correlation test is a G*Power t-test ( = .05, = .80, effect
= .10, .30), an independent t-test where ( = .05, = .40, power=.90, n=266), and paired t-test
(Table 2).
Design
The study was a 2 (antibiotic threat: yes or no) x 2 (self-isolation efficacy: yes or no)
factorial design, with random assignment to the message condition. All messages included
general information regarding the relevant health strategy. The control message did not pose any
health threat or mention/comment on any responding treatment behavior.
Procedures
A survey will be administered in order to accurately measure the levels of perceived risk
and efficacy: Risk Behavior Diagnosis Scale (RBD) to diagnose where the audience is in their
perceptions of threat and efficacy of respiratory infections and health reactions respectively. The
RBD scale format is filled with specific health threats and health reactions. Survey initially asks
if a student has taken antibiotics during their collegiate years, answer options (Y/N). Part I asks
students to choose out of a list of common respiratory symptoms, which symptoms they
associate with a respiratory infection. The survey continues by presenting definitions of selfisolation and antibiotic use, then asks them to imagine they are faced with respiratory symptoms

10

and choose whether they intent to self-isolate themselves as treatment or take antibiotics.
Participants are then presented with health strategies of both self-isolation and antibiotic use, and
are asked to rank perceived effectiveness of the strategies. Stimulus messages follow, randomly
varying between participants, and then the participants must re-rate the health strategies and
choose whether they will engage in self-isolation or antibiotic use after being posed with threats
of respiratory symptoms.
Measures
Respiratory symptoms. Participants marked any and all of the symptoms they associated
with the flu. The list of eleven symptoms included: headache, body aches/pains, fever, feeling
sleep deprived, runny nose, congested nose, sore throat, persistent cough, itchy eyes, redness of
eyes and fatigue.
Respiratory Infection Susceptibility. Participants rated the extent to which they believe
they are at risk of acquiring a respiratory infection in the next year. The three items (adapted
from Witte, Meyer, & Martell, 2001) used 5-point scales (1=strongly disagree, 5= strongly
agree). The three items were averaged into a composite score ( = .87).
Respiratory Infection Severity. Participants rated the severity of respiratory infections.
The three items (adapted from Witte, Meyer, & Martell, 2001) used 5-point scales (1=strongly
disagree, 5= strongly agree). The three items were averaged into a composite score ( = .84).
Self-isolation efficacy. Participants rated on a scale of 1-5 (strongly agree to strongly
disagree) the perceived efficacy of various self-isolation behaviors for 12 items.
Intention to self-isolate and Intention to take antibiotics. Participants are asked pre and
post stimulus message if they intend to either engage in self-isolation behaviors or engage in
antibiotic use when faced with a respiratory infection.

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In Part IIa, students rate, on a scale of 1-5 (strongly agree to strongly disagree) and the
severity of the risk. This section includes six items (See Appendix Items 1-6). Part IIb asks the
students to imagine they are currently faced with the symptoms they chose in Part I, read the
definitions of the two health behaviors (self-isolation and taking antibiotics) and if they intend to
engage in self-isolation or use antibiotics as means of treating the chosen symptoms. SelfIsolation is defined as social separation of a person who has or is suspected of having a
contagious disease (Collins English Dictionary, HarperCollins 2003). Antibiotic use is defined
as as taking the antibiotic exactly as the doctor instructs after prescription (CDC, 2009). The term
deter, to prevent confusion during the survey, is defined for students as to hinder
(dictionary.com, 2013). and the perceived efficacy of various antibiotic-seeking/taking strategies
for 12 items. Items testing efficacy include statements regarding both response efficacy, the
perceived effectiveness of either engaging in self-isolation or using antibiotics to successfully
treat the infection, and self-efficacy, the extent to which an individual believes they will be able
to carry out such behaviors. Part III is a stimulus of four health messages including a message on
the absence of health behaviors, a message promoting the efficacy of self-isolation behaviors, a
message demoting the efficacy of antibiotic use and a message that includes statements of both
promoting the efficacy of self-isolation and demoting the efficacy of antibiotic use. Students will
read all health messages and proceed to Part IV, where they are again asked to rate on a scale of
1-5 (strongly agree to strongly disagree) the perceived efficacy of various self-isolation strategies
for 12 items and the perceived efficacy of various antibiotic-seeking/taking strategies for 12
items. At the end of Part IV, students are asked if they intend to use antibiotics or engage in selfisolation when faced with a respiratory infection. After students are surveyed the sum of
numerical scores for the perceived efficacy items and the sum of the numerical scores for

12

perceived threat items are calculated and then subtracted from each other to determine the
discriminating value. A positive discriminating value indicates higher perceptions of efficacy
than perceptions of threat; This will lead to message acceptance of a given health message. A
negative discriminating value indicates higher perceptions of threat than perceptions of efficacy;
This will lead to message rejection of a given health messages. Values are placed into four
categories: acceptance of self-isolation messages, acceptance of antibiotic messages, rejection of
self-isolation messages and rejection of antibiotic messages. Categorization determines where
audience initially stands in their perceptions of each health behavior. Audience is re-tested and
presented with new health risk messages that demote the efficacy of taking antibiotics, and
discriminating values are re-measured and re-categorized to assess any changes in data. Postsurvey includes an open-ended question regarding the credibility of stimulus messages,
knowledge about the cause of respiratory infections (virus or bacteria?), a students experience
(if any) with a respiratory infection since January 2014, and demographics. Independent
variables measured for are Perceived efficacy of Antibiotics (EA) and Perceived efficacy of SelfIsolation (ESI), and dependent variables measured for are Intent to take antibiotics (IA) and Intent
of Self-Isolation (ISI). To controlling for confounding variables students asked at beginning of
survey if they have previously taken antibiotics during their collegiate years. If yes, resulting
data after they are surveyed will be stratified and measured for. Validity is achieved through
Pilot-Testing 10 undergraduate students who are briefed on the definition of measures for clarity
before administering the survey. Initial instructions asks students to choose which behavior they
intend to engage if when faced with respiratory infection. Options include a self-isolation
behavior, an antibiotic-seeking/taking behavior, or no behavior. Stimulus is then presented as a
health message promoting the efficacy of self-isolation and demoting the efficacy of antibiotic

13

use. Students are re-tested and are presented with the same initial instructions, to see if intent to
engage in behaviors has changed.

Results
Descriptive Statistics
On average, participants associated six symptoms with a respiratory infection, like
bronchitis or the flu (M = 6.18, SD = 2.92). About 9% did not associate any symptoms with a
respiratory infection while 11% associated all symptoms with a respiratory infection. Table 1

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shows the frequency with which participants reported symptoms to be a respiratory infection.
Table 1. Symptoms Associated With Respiratory Infections
Symptom
Sore throat
Persistent cough
Congested Nose
Body Aches/Pains
Fatigue
Fever
Runny Nose
Headache
Sleep Deprived
Redness of Eyes
Itchy Eyes

Frequency
80%
77%
70%
66%
66%
65%
60%
57%
49%
15%
14%

Hypothesis Testing
H1 stated that those who perceive respiratory infections as a greater threat will have
stronger intentions to react. The hypothesis was tested with correlations. Respiratory-infection
susceptibility was not associated with antibiotic use, r(176) = .06, ns or with self-isolation, r(176)
= .06, ns. Respiratory-infection severity was associated with antibiotic use, r(176) = .28, p<.05
and with self-isolation, r(176) = .19, p<.05. H1 received partial support.

Table 2. Correlations and descriptive statistics (N = 147)

M

SD

1
2
1 Severity 1
3.28
0.81
2 Susceptibility 1
3.38
0.96
-.05
3 Self-isolate 1
55.91
27.26
.26**
4 Antibiotic use 1
69.34
29.34
.30**
** Correlation is significant at the 0.01 level (2-tailed).

-.01
-.01.24**

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H2 stated that after exposure to messages promoting the efficacy of isolation, there would be a
positive change in intentions to self-isolate. To test this hypothesis, I created change scores by
subtracting the Pre-test from the Post-test. Positive scores indicate an increase while negative
scores indicate a decrease. A t-test was used to determine whether there was a difference
between the control group and the manipulated group. The difference was statistically
significant, t(147)=3.99,p<.001. The group that was isolated experienced a positive change
(M=14.78, SD=28.88) in intentions to engage in self isolation. H2 was supported. To test H3,
which states that those exposed to health messages promoting the efficacy of self-isolation will
have higher intentions to engage in self-isolating behaviors than those who were not exposed, I
used an independent samples t-test to determine if there is a difference in the post-test scores
between the two groups. The difference was statistically significant, t(147)=2.00,p<.05. The
group that received the pro-isolation message had higher intentions to isolate(M=65.70,
SD=24.68) than the control(M=-57.39, SD=27.40). H3 was supported. H4 stated that after
exposure to messages demoting the efficacy of antibiotics, there would be a decrease in
intentions to take antibiotics. To test this hypothesis, I created change scores by subtracting the
Pre-test from the Post-test. Positive scores indicate an increase while negative scores indicate a
decrease. A t-test was used to determine whether there was a difference between the control
group and the manipulated group. The difference was not statistically significant, t(147)=1.76,ns. The group that received the messages demoting antibiotics showed a decrease(M=9.13, SD=25.37), but so did the control group (M=-2.32, SD=21.93). H4 was not supported. To
test H5, which states that those exposed to health messages demoting the efficacy of antibiotics
would have lower intentions to take antibiotics than those not exposed, I used an independent
samples t-test to determine if there is a difference in the post-test scores between the two

16

groups. The difference was not statistically significant, t(147)=-0.78,ns. The group that received
the messages demoting the efficacy of taking antibiotics had slightly lower intentions to take
antibiotics(M=62.33, SD=28.65) in comparison to the control(M=-66.22, SD=33.13). H5 was
not supported.

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Discussion
Purpose and General Findings
The purpose of this study was to assess undergraduate students perceptions of respiratory
symptoms and infections in terms of severity and susceptibility, while also measuring their
intentions to either engage in self-isolation behaviors or antibiotic use when presented with a
threat of respiratory infection. Additionally, the study investigated whether health messages
promoting and demoting the efficacy of each treatment strategy would increase and decrease,
respectively, ones intentions to behave in ways consistent with each treatment strategy. General
findings were that undergraduate students perceptions of severity of respiratory symptoms are
associated with an intent to engage in self-isolation behaviors and antibiotic taking behaviors. In
other words, if undergraduate students perceive a respiratory health threat to be severe, it is likely
that they intend to react with treatment strategies. Undergraduate students perceptions of
susceptibility however are not associated with engagement in either health strategy.
Undergraduate students may or may not perceive themselves to be susceptible to respiratory
infections, but their perceptions of susceptibility do not play a role in determining whether they
will engage in self-isolation behavior and antibiotic use as reactive behaviors. H1 stated that
those who perceive respiratory infections as a greater threat will have stronger intentions to react.
Findings of the study partially support this hypothesis by indicating that severity, one component
of threat, is associated with intentions to react.
Self-Isolation
Self-Isolation, a health strategy referring to voluntary removal of one from potentially
contagious environments and situations paired with precautionary and hygienic practices,

18

experienced an increase in intent to engage after individuals were exposed to health messages
promoting the efficacy of the strategy. Additionally, it was found that individuals exposed to
messages promoting the efficacy of self-isolation experienced a more positive change in
intentions to engage than those who were not exposed. Those not exposed to health messages
promoting self-isolation experienced little to no change, which suggests that health messages
promoting effective and safe strategies need to be implemented in order to influence people to
act.
Antibiotic Use
Antibiotic Use, defined in this study as taking antibiotics as prescribed by a doctor, but
also including antibiotic-seeking behaviors and antibiotic overuse and misuse, did not experience
a significant change in intentions to engage after exposure to health messages demoting its
efficacy. After undergraduate students were exposed to health messages demoting the efficacy of
this health strategy, intentions to engage slightly decreased, but so did those of the control group,
resulting in an insignificant difference. When compared to those not exposed to demoting health
messages, intentions to engage of those individuals who were exposed were only slightly lower.
Implications for EPPM Model
The Extended Parallel Process Model (EPPM) which was used as the framework for this
study, measures levels of perceived health threats, perceived efficacy of health behaviors, and
intentions to engage in health behaviors. What is unknown of EPPM prior to this study was
whether promoting efficacy of a health behavior or demoting efficacy of a health behavior would
change an individuals initial behavioral intentions after perceiving a health threat. Implications
of study for EPPM from this study suggested that promoting the efficacy of a health strategy
will increase an individuals intentions to engage that behavior. Further implications suggest that

19

exposing individuals to messages promoting the efficacy of a health strategy will lead to higher
intentions of engaging in that strategy than those individuals not exposed. Demoting the efficacy
however, had no significant effects on an individuals intent to engage in the two health
behaviors. Additional implications for EPPM model revolve around the two appeals of a
perceived health threat: severity and susceptibility. Undergraduate students were more likely to
react to a health threat when they perceived the threat to be severe. Whether an undergraduate
student felt they were susceptible to the health threat, did not influence an intent to act. This
condition raises questions and demands further research to expand upon the EPPM model.
Apparently, individuals consider severity of a threat more of a reason to act than their own
susceptibility to the same threat. This raises concern and implies that individuals are not reacting
to health threats even if they believe that they are vulnerable and capable of becoming victims to
them. It also suggests that individuals who believe themselves to be susceptible to health threats
will not even take preventative measures as reactions, which will only help spread contagious
ailments in their surroundings and to people and places they come in contact with. The fact that
severity, over susceptibility, is the perceived aspect of a health threat that has influence over an
individual to react, raises concern as well. Diseases that are very severe are not as common as
than a cold, which according to this study, would suggest that individuals would be reacting
more often to only threats of a serious disease, not to threats of a common cold . Perhaps the
perceived severity of common, less threatening infections (i.e common cold), needs to be
increased in order to increase an individuals intentions to engage in reactive health behaviors
that will essentially keep them more healthy by preventing them from becoming sick of
infectious diseases and also help them treat such cases. Further research needs to be conducted to

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discover why severity has more of an impact than susceptibility when it comes to individuals
intent to react to health threats.
Implications for Practice
This studys implications for practice mainly concern the establishment and content of
health campaigns. Participants exposed to health messages promoting the efficacy of selfisolation experienced a significant positive change, resulting in an increase in an intent to engage
in the behavior when faced with a respiratory health threat. Those exposed to messages
demoting the efficacy of taking antibiotics did not experience any significant change - only an
insignificant slight decrease in the intent to engage in antibiotic taking behaviors. Based on these
results, it can be inferred that health campaigns consisting of positive messages, that promote a
health strategy, will be more effective in persuading people than messages consisting of negative
messages, frowning upon a certain strategy. If health and wellness corporations, centers for
disease control, medical institutions, etc, want to convince patients to partake in safer, more
effective methods of treatment for respiratory infections, they should aim to release campaigns
that positively portray the methods. According to this study, messages demoting alternative and
unfavored practices for the same respiratory threat will not be successful in decreasing the
unwanted behavior. A pro-active, positive approach is more likely to be effective when trying to
change a health behavior. Another implication for practice is that doctors may be
communicating messages to patients that are promoting certain behaviors, which may eventually
lead to a patient to believe a certain behavior is always appropriate for a health threat; This
would essentially increase the intent to engage in that behavior as the study suggests. Antibiotics,
as discussed in the introduction, is a treatment method that must be approached with caution
considering the threats it poses on a persons immune and digestive systems, along with its
capability of increasing bacterias tolerance to the drug. If the findings of this study are applied

21

to a doctor-patient interaction it can be assumed that if doctors are administering antibiotics and
portraying messages of their effectiveness in treatment and their success in curing infections, a
patients intent to engage in such behaviors will increase. An increase in antibiotic use will only
perpetuate the threat that antibiotics currently pose.
Limitations
There are several limitations to this study. A representative sample of 147 undergraduate
college students enrolled in either CAS 204 or CAS 283 at The Pennsylvania State University
was surveyed which poses potential problems regarding the desired population for the study. The
study experimented with only one sample of undergraduate students at one university. To
increase generalizability researchers could administer the survey used in this study to more
samples of undergraduate students at various universities. Additionally, students in
Communications Arts & Sciences classes were the only students observed and these students
have been educated in communication strategies and rhetoric, which may have made them more
aware of the purpose of the established health messages which increases the threat of demand
characteristics on internal validity, by which participants guess what the study is supposed to be
about and then change their behavior in the expected direction. A pre-test, post-test design, also
insinuates that change is being measured, and after exposure to the stimulus health messages, one
could pick up on the fact that the message is supposed to change their initial thoughts, and as a
result, a participant would act in alignment with that expectation. A participant's health while
taking the survey could have also effected the results of ones survey. If someone was currently
ill, or experiencing any kind of respiratory symptom, they may have choose different answers as
they would have if they were not ill. Personal experience with antibiotics will have also
significantly effected the results of the study. If people have previously taken antibiotics that

22

were effective in deterring and/or treating a respiratory infection, they may perceive them to be
more effective than self-isolation strategies and also would be less likely to be influenced to
decrease their intent to engage in antibiotic use. Lastly, as the researcher, I was mandated to
conduct this study for academic requirements, which also encompasses threats of observer bias. I
desired a certain outcome for the study, and my interpretation and discussion of results could
have been skewed in a certain direction. The same or similar studies should be conducted outside
of academic regulations and requirements.
Future Research
There are key aspects of this study that require further research for a better understanding
of undergraduate students perceptions of respiratory health threats and responding treatments.
Table 1. Symptoms Associated With Respiratory Infections, displays the frequency of a symptom
being chosen as associated with a respiratory infection. A high majority of all symptoms listed
have approximately a 50% and over frequency which indicated that undergraduate students do
associate common health symptoms with a respiratory infection. It is unknown why these
symptoms received such high frequencies in association to a respiratory infection, but did not
receive high rates in ones perception of a threat of susceptibility. It is concerning as to why
association does not also entail a perceived threat of ones susceptibility to a respiratory
infection. 66% of participants associated Body Aches/Pains with a respiratory infection. A
persistence of theses types of symptoms could be indicative of the flu, yet the measured level of
perceived threat on the level of susceptibility was insignificant, suggesting participants do not
actually believe they are able of being victimized by these respiratory symptoms, and essentially,
an infection. These beliefs could support a notion that undergraduate students are unmotivated to
engage in self-isolating behaviors that could prevent them from getting a respiratory infection.

23

Further research needs to be conducted by taking a more in depth approach where students
specific perceptions and reactions are observed for each symptom in order to discover which
symptoms actually cause people to act, and to discover what actions they are taking to react to
each symptom. Further research also needs to be conducted on the misinterpretation of health
symptoms. Many of the symptoms listed in Table 1 could very well suggest the presence of other
health threats like allergies. If undergraduate students are perceiving certain symptoms to be
associated with respiratory infections, when the symptoms are indicative of a different illness,
they may act in ways that are inappropriate and ineffective, which may lead to antibiotic misuse.
More research will discover why undergraduate students associate certain symptoms to
respiratory infections, opposed to other health threats. Undergraduate students may be jumping
to conclusions when they experience respiratory symptoms, which may lead them to engage in
behaviors of mistreatment.

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ACADEMIC VITA
Katharine Pecorino
15 Ridge Circle
Manhasset, NY 11030
kmp5426@psu.edu
_____________________________________________________

Education
The Pennsylvania State University, University Park, PA, Graduation May 2014
B.A., Communications Arts & Sciences, Psychology Minor
Arcadia University, Study Abroad, Sicily, Italy, Fall 2012

Professional Experience
Digital Research Intern, Discovery Communications, New York, NY, Summer 2012 &
2013

Volunteer Experience
THON fundraising, Club Lacrosse organization, 2010-2014
Soup Kitchen Volunteer, Sicily, Italy, Fall 2012
Taught English language, Sicily, Italy, Fall 2012

Activities
The Pennsylvania State Womens Club Lacrosse Team, Fall 2010 - Spring 2014

Honors and Awards

Paterno Fellow, Fall 2011 - Spring 2014