EXPLORING THE EFFECTS OF MODALITY ON ATTITUDINAL AND BEHAVIORAL RESPONSES IN THE CONTEXT OF SKIN CANCER COMMUNICATION: A MIXED METHODS APPROACH TO THE COMMUNICATION OF SKIN CANCER by YIYI YANG SHUHUA ZHOU, COMMITTEE CHAIR ANDREW BILLINGS KIM BISSELL SCOTT PARROTT JAMES LEEPER A DISSERTATION Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the College of Communication and Information Sciences in the Graduate School of The University of Alabama TUSCALOOSA, ALABAMA 2018 Copyright Yiyi Yang 2018 ALL RIGHTS RESERVED ABSTRACT Visual communication has been identified as an important area both in research and in practice in health communication. In the context of skin cancer, previous work predominantly focused on the individual contribution of visuals or texts to the effects on comprehension and behavioral intentions. However, communication about skin cancer is usually multimodal – using more than one type of semiotic messages, such as picture, music and language, to convey information and meaning. Few studies have examined the relationship between different semiotic messages, such as the congruency between language and picture. In addition, little is known about the effects of multimodal portrayals on attitudes and behavioral intentions. To address the gap in the literature, a study was created to examine the multimodal portrayal of skin cancer in women’s popular magazines and the effects of such portrayals on attitudes and behavioral intentions of indoor tanning. The study presented in the dissertation employed mixed research methods and was composed of two studies. The first drew on a lens of multimodal discourse analysis and examined how pictures and texts interactively constructed a multimodal discourse about skin cancer in women’s popular magazines. The findings suggested that pictures and texts conveyed two competing discourses about skin cancer. Drawing on the findings of the first study, the second study was created to examine the effects of such multimodal portrayals on attitudes and behaviors. Incorporating a perspective of pictorial superiority effects, the experiment aimed to find out whether visual messages are more powerful than words in shaping people’s attitudes and behavioral intentions, especially when ii words and images are incongruent in terms of message orientation. Overall, findings of the second study revealed that PSE was context-specific and was only observed when picture and text were viewed in isolation. Overall, findings from the experiment did not provide sufficient evidence to support PSE since participants across text-picture combination conditions uniformly reported high levels of intentions of tanning bed uses (6-10 times) in the next three months. Theoretical and practical implications of the two studies were discussed. iii DEDICATION This dissertation is dedicated to my family and friends. I give special thanks to my loving parents, whose encouragement and unconditional support made me feel motivated throughout the entire doctoral program. I appreciate my dissertation committee and many friends for your help in the process of writing my dissertation. iv ACKNOWLEDGEMENTS There have been many people who walked alongside with me during my doctoral study in the past four years. They have guided me, supported me, and put opportunities in front of me. I would like to express my deepest gratitude to Dr. Shuhua Zhou, my advisor and the chair of this dissertation committee. Without his guidance, persistent help, and unwavering support, this dissertation would not have been possible. I would like to give my special thanks to Dr. Andrew Billings for his teaching, guidance, and support throughout my doctoral journey. In the past four years, I made sure that I had all the opportunities to take his doctoral seminars. It has been a great honor and joy to be his student and co-author of academic projects. I also would like to thank Dr. Kim Bissell for making me a member of the health communication lab, which provided me valuable opportunities to participate in cutting-edge research projects and making connections with many health communication scholars, including Drs. Kim Baker, Sarah Pember, and Xueying Zhang. I would also like to thank the rest of my committee members, Dr. Scott Parrott and Dr. James Leeper, for their depth of knowledge and guidance throughout my doctoral journey. I am also grateful for the teaching opportunities that were made possible by the support of faculty members and distinguished department chairs, including Dr. Beth Bennett and Dr. Cory Armstrong. In addition, prior to teaching as instructor of record, I have also had the opportunity to serve as teaching assistant to Dr. Jason Black and Angela Billings, who provided me outstanding examples of student mentoring and teaching excellence. They inspired me to be a v more effective teacher through their patience, dedication, and passion for higher education. I look forward to applying what I have learned from them in my future teaching endeavors. Last but not least, I would like to thank my loving parents. Thank you for always being there, listening to me and encouraging me. Thank you for your love, trust, and tremendous support throughout my doctoral journey. vi CONTENTS ABSTRACT .................................................................................................................................... ii DEDICATION ............................................................................................................................... iv ACKNOWLEDGEMENTS .............................................................................................................v LIST OF TABLES ......................................................................................................................... ix LIST OF FIGURES .........................................................................................................................x CHAPTER 1 INTRODUCTION TO THE STUDY ........................................................................1 CHAPTER 2 A MULTIMODAL DISCOURSE ANALYSIS OF THE PORTRAYALS OF SKIN CACANER IN WOMEN’S POPULAR MAGAZINES .......................................................5 Literature Review ........................................................................................................................ 7 Skin cancer and prevention in the United States ..................................................................... 7 Sociocultural discourses about tanning in the United States ................................................... 9 Skin Cancer in Women’s Magazines ..................................................................................... 12 Methods ..................................................................................................................................... 14 Data Collection ...................................................................................................................... 14 Multimodal Discourse Analysis ............................................................................................ 16 Findings ..................................................................................................................................... 19 Discussions ................................................................................................................................ 34 CHAPTER 3 AN EXPERIMENT EXPLORING THE EFFECTS OF MODALITY ON ATTITUDES AND BEHAVIORAL INTENTIONS IN THE CONTEXT OF SKIN CANCER .43 Literature Review ...................................................................................................................... 44 Visuals in Health Communication Research ......................................................................... 44 vii Theoretical Foundation: Pictorial Superiority Effect ............................................................ 50 Methods ..................................................................................................................................... 56 Design .................................................................................................................................... 56 Participants ............................................................................................................................ 61 Procedure ............................................................................................................................... 61 Measures ................................................................................................................................ 62 Manipulation checks .............................................................................................................. 64 Discussion ................................................................................................................................. 73 Revisiting the Theory Of PSE ............................................................................................... 77 Limitations and Directions for Future Research .................................................................... 80 CHAPTER 4 GENERAL DISCUSSION AND CONCLUSION ............................................. 82 Competing Discourses Surrounding Tanning and Skin Cancer ............................................ 85 Theoretical and Practical Implications .................................................................................. 93 REFERENCES ..............................................................................................................................99