Message Framing for Health: Moderation by Perceived Susceptibility and Motivational Orientation

“Message Framing for Health: Moderation by Perceived Susceptibility

and Motivational Orientation in a Diverse Sample of Americans”

SUPPLEMENTARY MATERIALS

Pilot testing of videos. Both videos featured a middle-aged, female, Caucasian dentist, and took place in a dental office. A portion of the video featured the dentist instructing a young adult, male, Caucasian patient on how to floss correctly. Pilot testing of the videos with a sample of 142 young adults showed the videos to be easy to follow (M = 4.69; all pilot ratings on 1 – 5 scale), easy to understand (M = 4.62), informative (M = 4.52) and easy to pay attention to (M =

4.61); there were no significant differences between the gain- and loss-framed versions on any of these dimensions. Consistent with the framing manipulation, pilot participants viewed the gain- framed video as being significantly more positive in tone (p = .01) and less negative in tone (p

< .001) than the loss-framed video. However, there were no differences between the videos in how much they made participants feel afraid (p = .71). Thus, the videos successfully manipulated framing, but not fear. Gain-Framed Script (Blue text indicates gain-framed information)

SCENE 1: DENTIST ALONE

Doctor (D): Hi there! My name is Dr. Amy Guthrie, and I’m a dentist and today I’m going to talk with you about the importance of oral health, flossing, and taking good care of your teeth and gums. There are many reasons why is it important to floss, brush your teeth regularly, and get regular check-ups.

First, your teeth and gums will be with you for the rest of your life, and if you take care of them now, you can benefit by having teeth and gums that are healthy, attractive, and free of pain.

Second, scientists are increasingly observing a connection between oral health and important health outcomes.

In a recent study published in the International Journal of Cardiology, researchers found that people who had suffered a recent heart attack had noticeably worse oral health than people who had not. This study suggests a link between the health of your teeth and gums and your risk for heart attacks.

Heart disease is an important health concern for all people and in this video we will discuss the benefits of flossing your teeth regularly. We will show that regular flossing can lead to healthy teeth and gums, and can prevent gingivitis and gum disease and reduce the risk for heart disease.

In gingivitis, the milder form of gum disease, infection leads to chronic inflammation—gums are swollen, red, and sometimes bleeding. In periodontitis, the more severe form, the infection affects the bones that support the teeth, leading to tooth loss. In both cases, disease is caused by an accumulation of bacteria, or plaque, in the gums. These organisms release toxins that can circulate around the body.

If you brush your teeth daily and floss every day you can benefit by preventing gingivitis and periodontitis, and you’ll be more likely to have healthy teeth and gums.

In particular, health of your arteries and heart may also be affected by the health of your gums. Multiple studies, including a recent report in the Journal of Clinical Periodontology, found a startling relationship: The more severe the gum disease, the thicker and harder the walls of the arteries. Clear arteries are a key component of having a healthy heart. These are some of the important benefits of flossing regularly.

SCENE 2: PATIENT AND DENTIST

D: So now I’d like to introduce Geoffrey, a patient, and show you how to floss and give you some tips on how to actually make it happen.

Hi Geoffrey—how often do you floss your teeth?

Patient (P): Not too often, indeed, I’m not really sure how to.

[D shows P how to floss]

So, I’m going to show you how to floss your teeth. Here is your mirror. Start with about 18 inches. Wrap it around your middle fingers of both hands and then use your thumbs and index fingers to direct the floss where you want it to go.

Start in between your teeth and zig zag it in and out till it slides up underneath. Wrap it around the side of the two teeth so it wraps around the gum and wrap it the other direction under the gum.

When you do floss, does it hurt?

P: Sometimes.

D: Remember if you floss correctly and your gums are healthy, flossing should be painless.

It is also very important to go underneath the gum. Under the gum is where the bacteria that you are trying to clean hide. Wrap it to a clean place, to the next two zig zag it through. Wrap it around the sides of the tooth and then the other side of the tooth. Clean the piece of floss, and then floss the next tooth underneath.

Same thing on the other side of your mouth, and then do the same thing on the bottom.

So if you floss your teeth regularly, it is like washing your car—you want to wash the sides but also the front and the back. If you floss your teeth, bacteria won’t irritate the gum tissue. Even better, bacteria will be less likely to travel to other parts of your body and cause tissue and organ damage. Your gums will be healthy and comfortable and won’t recede from the teeth. And healthy gums will make sure you do not look “long in the tooth.” To keep your gums healthy, you need to floss your teeth every day because the plaque takes 24- 36 hours before it starts to damage the gums.

Would you like to try it now?

P: Sure.

D: I’ll hold a mirror where you can see.

Ok remember if you slow down then you won’t hurt yourself and your gums will feel much better after you floss.

So slow down, take your time. Much better, wrap it around the sides of the tooth. Ok, come back down where they touch. Go the other direction and back up.

P: When I floss it kind of hurts and it keeps bleeding.

D: Usually that is because you don’t floss on a regular basis. If you do floss everyday, then it will stop hurting and it will stop bleeding. It could also be that you’re flossing too hard, which is why I recommended that you slow down and take the floss up underneath.

D: Any other questions?

P: No, all good. Thank you,

D: You’re welcome.

D: I’m going to show you some pictures of some healthy gums and some unhealthy gums. Here we have some healthy gums that are nice and pink and shiny and flat. This is what it looks like underneath. The yellow part is the bone and the pink part is the gums and the white is the teeth.

If you floss your teeth and brush them well, then this is what your teeth will look like. The gums around the side of the teeth will look okay and you will prevent inflammation that is called gingivitis in between the teeth where the toothbrush doesn’t reach.

Gingivitis is the first stage to periodontal disease so you can see here that the bone looks healthy but there is a lot of inflammation between the teeth. That’s because of the bacteria sitting between the gums. There is a lot of inflammation and there’s a lot of bleeding.

For this reason, when people floss and regularly brush their teeth, they take advantage of the best method for preventing gingivitis.

Gingivitis can progress into periodontitis where the bone is involved. You can see that the gums have receded even further. And there are these big black holes between the teeth. That is because the bone is receding in order to protect itself from the bacteria. The top of the bone has been eaten away by the bacteria. The gum tissue is very puffy and the black stuff here is the tarter build up.

What the flossing does is remove the plaque before it has an opportunity to calcify and turn into tartar.

The tartar itself isn’t a problem but its makes a nice rough surface for the new layer of bacteria to stick to and it’s the bacteria that causes the problem, that is why you need to remove it every day.

Flossing can prevent getting to this stage, where you’ve lost most of the supporting structure of the teeth and the teeth can become very loose and they can even fall out.

If you floss daily, then you won’t get to this stage. You won’t need expensive gum surgery and you’ll be able to keep your teeth in your mouth for your lifetime.

So, if you see your dentist regularly, problems can be detected and treated early.

I encourage you to floss your teeth and if you do have a problem with it, then give your dentist a call to help you solve those problems on how to floss. Loss-Framed Script (Red text indicates loss-framed information)

Doctor (D): Hi there! My name is Dr. Amy Guthrie, and I’m a dentist and today I’m going to talk with you about the importance of oral health, flossing, and taking good care of your teeth and gums. There are many reasons why is it important to floss, brush your teeth regularly, and get regular check-ups.

First, your teeth and gums will be with you for the rest of your life, and if you don’t take care of them now, you can risk having teeth and gums that are unhealthy, unattractive, and painful.

Second, scientists are increasingly observing a connection between oral health and important health outcomes.

In a recent study published in the International Journal of Cardiology, researchers found that people who had suffered a recent heart attack had noticeably worse oral health than people who had not. This study suggests a link between the health of your teeth and gums and your risk for heart attacks.

Heart disease is an important health concern for all people and in this video we will discuss the risks of not flossing your teeth regularly. We will show that failure to floss regularly can lead to gingivitis and gum disease and increase the risk for heart disease.

In gingivitis, the milder form of gum disease, infection leads to chronic inflammation—gums are swollen, red, and sometimes bleeding. In periodontitis, the more severe form, the infection affects the bones that support the teeth, leading to tooth loss. In both cases, disease is caused by an accumulation of bacteria, or plaque, in the gums. These organisms release toxins that can circulate around the body. If you don’t brush your teeth daily and don’t floss every day you’ll be at risk for gingivitis and periodontitis, and you’ll be more likely to have unhealthy teeth and gums.

In particular, health of your arteries and heart may also be affected by the health of your gums. Multiple studies, including a recent report in the Journal of Clinical Periodontology, found a startling relationship: The more severe the gum disease, the thicker and harder the walls of the arteries.

Narrowing of the arteries is a key component of heart disease. These are some of the important consequences of not flossing regularly. SCENE 2: PATIENT AND DENTIST

So now I’d like to introduce Geoffrey, a patient, and show you how to floss and give you some tips on how to actually make it happen.

Hi Geoffrey—how often do you floss your teeth?

Patient (P): Not too often, indeed, I’m not really sure how to.

[D shows P how to floss]

So, I’m going to show you how to floss your teeth. Here is your mirror. Start with about 18 inches. Wrap it around your middle fingers of both hands and then use your thumbs and index fingers to direct the floss where you want it to go.

Start in between your teeth and zig zag it in and out till it slides up underneath. Wrap it around the side of the two teeth so it wraps around the gum and wrap it the other direction under the gum.

When you do floss, does it hurt?

P: Sometimes.

D: Remember, if you do not floss correctly and your gums are not healthy, flossing could cause you pain.

It is also very important to go underneath the gum. Under the gum is where the bacteria that you are trying to clean hide.Wrap it to a clean place, to the next two zig zag it through. Wrap it around the sides of the tooth and then the other side of the tooth. Clean the piece of floss, and then floss the next tooth underneath.

Same thing on the other side of your mouth, and then do the same thing on the bottom.

So if you don’t floss your teeth regularly, it is like washing your car—you’re only washing the sides and not the front and the back. If you don’t floss your teeth, the bacteria will irritate the gum tissue. Even worse, the bacteria could travel to other parts of your body and cause tissue or organ damage. Your gums will recede in order to protect themselves from bacteria. And if your gums recede you will look “long in the tooth.”

The plaque takes 24- 36 hours before it can do damage so if you fail to floss every day, it will build up quickly. Would you like to try it now?

P: Sure.

D: I’ll hold a mirror where you can see.

Ok the problem with that is that it’s too fast and you’re going to hurt yourself and you’re going to make your gums sore

So slow down, take your time. Much better, wrap it around the sides of the tooth. Ok, come back down where they touch. Go the other direction and back up.

P: When I floss it kind of hurts and it keeps bleeding.

D: Usually that is because you don’t floss on a regular basis. If you don’t floss every day, then it will hurt and bleed. It could also be that you’re flossing too hard, which is why I recommended that you slow down and take the floss up underneath.

D: Any other questions?

P: No, all good. Thank you,

D: You’re welcome.

D: I’m going to show you some pictures of some healthy gums and some unhealthy gums. Here we have some healthy gums that are nice and pink and shiny and flat. This is what it looks like underneath. The yellow part is the bone and the pink part is the gums and the white is the teeth.

If you don’t floss your teeth and brush them well, your teeth will not look like this. The gums around the side of the teeth may look okay but in between the teeth where the toothbrush doesn’t reach, there will be some inflammation that is called gingivitis.

Gingivitis is the first stage to periodontal disease so you can see here that the bone looks healthy but there is a lot of inflammation between the teeth. That’s because of the bacteria sitting between the gums. There is a lot of inflammation and there’s a lot of bleeding.

For this reason, when people do not floss and regularly brush their teeth, they fail to take advantage of the best method for preventing gingivitis.

Gingivitis can progress into periodontitis where the bone is involved. You can see that the gums have receded even further. And there are these big black holes between the teeth. That is because the bone is receding in order to protect itself from the bacteria. The top of the bone has been eaten away by the bacteria. The gum tissue is very puffy and the black stuff here is the tarter build up. So, if you don’t floss to remove the plaque, it will calcify and turn into tartar.

The tartar itself isn’t a problem but its makes a nice rough surface for the new layer of bacteria to stick to and it’s the bacteria that causes the problem, which will happen if you don’t floss.

If this failure to floss progresses, you get to this stage where you’ve lost most of the supporting structure of the teeth and the teeth can become very loose and they can even fall out.

If you don’t floss you can get to this stage. You may need expensive gum surgery and it is a lot more difficult to keep your teeth in your mouth for your lifetime.

So, if you do not see your dentist regularly, problems will not be detected and treated early.

I encourage you to floss your teeth and if you do have a problem with it, then give your dentist a call to help you solve those problems on how to floss. Additional Sample Characteristics

Most of the participants had all or nearly all of their teeth:

No missing teeth 55.74% Missing 1-5 teeth 34.78% Missing 6-10 teeth 5.04% Missing more than 10 teeth 4.45%

Frequency of flossing at baseline:

Never 15.14% Once per month 8.59% 2-3 times per month 11.39% Once per week 11.14% 2-6 times per week 22.11% Once per day 24.06% Two or more times per day* 7.57% * not included in analyses

Frequency of brushing at baseline:

Never .47% Once per month .35% 2-3 times per month 1.18% Once per week .35% 2-6 times per week 3.06% Once per day 38.07% Two or more times per day 56.52%

Have you visited the dentist in the past 6 months? (baseline)

Yes 58.62% No 41.38%

Have you visited the dentist in the past 2 months? (2-month survey)

Yes 27.58% No 72.42% Have you visited the dentist in the past 4 months? (6-month survey)

Yes 40.23% No 59.77%

“Would you say that in general your oral health (teeth, mouth, gums) is…” (asked at 6- month follow-up):

Poor 3.78% Fair 12.50% Good 34.01% Very good 39.68% Excellent 10.03%