Out-of-pocket expenditure for services in a national health system: the rationale for new pricing strategies in the Italian healthcare sector

Public Policy Conference

Marketing, Public Policy and Moral Courage

in a Diverse, Rapidly Changing World

May 28-30

PROCEEDINGS

Volume 30

Copyright © 2020, American Marketing Association Printed in the United States of America

ISBN-13: 978-0-87757-007-3

All rights reserved. No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, including photocopying and recording, or by any information storage and retrieval system without the written permission of the American Marketing Association.

Conference Awards

Best Conference Paper

“Working Memory Capacity as an Under-Explored Moderator of Information Processing and Consumer Response: Implications for Marketing and Public Policy”

Adria Mankute, University of Oregon Cristel Antonia Russell, Pepperdine University

Anne Hamby, Boise State University

Runner-Up

“Untapped Education: Exploring the Relationship of Political Ideology and Water Reuse” Anjala S. Krishen, University of Nevada, Las Vegas

Han-fen Hu, University of Nevada, Las Vegas Jesse L. Barnes, University of Nevada, Las Vegas

Brenda M. Derby Memorial Award

The Brenda M. Derby Memorial Award is presented nationally to an outstanding doctoral student who demonstrates excellence as an emerging policy researcher. The award honors a

strong advocate of the public policy and marketing subdiscipline.

“The Power to Make a Difference: Consumer Reactions to Alternative Meat Products” Megan J. Baran, Wayne State University

Andrea H. Tangari, Wayne State University

Runner-Up

“Investigating the Role of Shopping Medium on Consumer Food Evaluations: Mobile vs. In-Store Grocery Shopping”

Ashley Thomas, University of Mississippi Christopher Newman, University of Mississippi

Reviewers

Kathryn Aikin, U.S. Food and Drug Administration Rafaela Almeida Cordeiro, Escola Superior de

propaganda e Marketing Sharmin Attaran, Bryant University

Nadeesha Bandara, University of Massachusetts Amherst Michelle Barnhart, Oregon State University

Lauren Beitelspacher, Babson College

Monique Bell, California State University, Fresno Aronte Bennett, Villanova University

Debora Bettiga Politecnico di Milano Mia Birau, SKEMA Business School Wendy Boland, American University Edward Bond, Bradley University Mary Brennan, University of Edinburgh Jennifer Burton, University of Tampa

E. Vince Carter, California State University, Bakersfield Kealy Carter, University of South Carolina

Jesse Catlin, California State University, Sacramento Pilsik Choi, Austin Peay State University

Miri Chung, Walsh University

Marius Claudy, University College Dublin Sarah Cornell-Maier, Pacific Lutheran University Sandra Costa, University of Liverpool

Charlene Dadzie, University of South Alabama Prakash Das independent scholar

Edith Davidson, Central State University

Karen Dickman, Institute for Multi-Track Diplomacy Hilary Downey, Queen's University Belfast

Kimberly Duval, Concordia University

Christine Eckert, University of Technology Sydney Meike Eilert, University of Kentucky

Mohammed El Hazzouri, Mount Royal University Hossein Eslami, Lebanese American University Tatiana Fajardo, Florida State University Stacey Finkelstein, Stony Brook University M. Paula Fitzgerald, West Virginia University Andrea Flynn, University of San Diego Alexa Fox, University of Akron Meryl Gardner, University of Delaware Aaron Gleiberman, Louisiana State University Alexei Gloukhovtsev, Aalto University

Agu Godswill, Agu Abia State University, Uturu Gabriel Gonzales, SUNY New Paltz

Ashley Goreczny, Iowa State University Jamie Grigsby, Missouri State University Pamela Grimm, Kent State University

Damien Hallegatte, Université du Québec à Chicoutmi Courtney Hatch, Butler University

John Healey, Tulane University

Jillian Hmurovic, University of Pittsburgh Stefan Hock, University of Connecticut Karen Hopkins, Auburn University Iina Ikonen, Vrije Universiteit Amsterdam Rama Jayanti, Cleveland State University Seema Kadam, Gujarat Technological University,

Ahmedabad

Begum Kaplan, Southern Connecticut State University Corinne Kelley, University of Kentucky

Saejoon Kim, California State University Kaeun Kim, University of Scranton

Young Kim, Southern Connecticut State University Christine Kowalczyk, East Carolina University GV Abhinav Kumar, Institute of Public Enterprise Anvita Kumar, Coventry University

Smriti Kumar, University of Massachusetts Amherst Jeff Langenderfer, Meredith College

Wonkyong Beth Lee, University of Western University Seonjeong Ally Lee, Kent State University

Yong Kyu, Lee York College (CUNY) Phillip Lewis, Rowan University Katherine Loveland, Xavier University Michael Luchs, College of William & Mary Renaud Lunardo, Kedge Business School Matthew Lunde, Ithaca College

Jane Machin, Radford University Valerie Manna, Lincoln University

Veronica Martin Ruiz, Iowa State University Matthew D. Meng, Utah State University

Katie Mercurio, California State University Chico D. Anthony Miles, Miles Development Industries

Corporation

Elizabeth Miller, University of Massachusetts Amherst Junhong Min, Michigan Technological University Simha Mummalaneni, University of Washington Mitchel Murdock, Utah Valley University Frank Murphy, George Fox University

Abigail Nappier Cherup, University of Nebraska-Lincoln Alexandre Neto, Federal University of Piauí UFPI Raphaelle Pandraud, ESCP Europe

Stephanie Pankiw, University of Saskatchewan Adrian Peretz, Oslo Metropolitan University Hoa Hong Pham, University of Economic HCMC Deidre Popovich, Texas Tech University

Debra Ringold, Willamette University

Spencer Ross, University of Massachusetts Lowell Herbert Jack Rotfeld, Auburn University

Rosalyn Rufer, SUNY Empire State College Carol Scarborough, Rutgers University Tracey Schaller, Georgia Gwinnett College Nancy Schmitt, Westminster College

Kristin Scott, Minnesota State University, Mankato Joon Yong Seo, State University of New York,

Brockport

Nuket Serin, Florida International University Tiebing Shi, Northwest Missouri State University Anton Siebert, Newcastle University

Surendra Singh, University of Kansas Mona Sinha, Kennesaw State University Johanna Slot, Penn State University

Chan Ho Song, California State University, San Bernardino

Scot Squires, Ferris State University

Arun Sreekumar, University of Illinois, Urbana– Champaign

Julie Stanton The Pennsylvania State University

Andrea Tangari, Wayne State University Emily Tanner, West Virginia University Ashley Thomas, University of Mississippi Lauren Trabold, Manhattan College

Vasu Unnava, University of California Davis Beth Vallen, Villanova University

Helen Van der Sluis, Arizona State University Sangeetha Venkataramani, University of Arizona Jorge Villegas, University of Ilinois at Springfield Maarten Volkers, University of Hagen

Tiffany Vu, Saint Mary's University Rory Waisman, University of Alberta

David Waller, University of Technology Sydney Qizhou Wang, University of Connecticut Nathan Warren, University of Oregon

Marina Wieluch, Bundeswehr University Munich Lan Wu, California State University, East Bay Chang Seob Yeo, Dominican University of California Daniel Zane, University of Miami

Gail Zank, Texas State University Liang Zhao, St. Ambrose University

American Marketing Association: “2020 AMA Marketing and Public Policy Conference” Keynote Remarks

Thank you to Dave Stewart….

This talk begins with a personal commentary and then offers ten ideas to consider. It is primarily a memoir—a narrative framed by personal experiences.

Both the commentary and ten ideas are connected to two important assumptions, namely that marketing influences public policy and that public policy influences marketing.

To begin, I was a long time local elected official: 33 years, 19 as Mayor of Riverside and 14 as a Council member. Equally important, I have taught political science courses at UC Riverside for the past 56 years.

When Mayor, I was President of League of California Cities and President of the National League of Cities.

Currently, I am Vice President of the Ontario International Airport Authority and Chair of the National Civic League’s efforts to update their Model City Charter. I am also

honored to be a Fellow in the National Academy of Public Administration. At this time in my life—ninth decade, I am swinging for the policy fences. Three regional examples-first, working with Brookings Metropolitan Division, I initiated and helped lead a regional economic study called IEGO, Inland Economic Growth & Opportunity. With many regional leaders, we are now involved in implementing its recommendations.

Second, I championed the revision of a UCR research center. It is now called the Inland Center for Sustainable Development. Each year this Center will focus on one major regional policy issue. In 2020 the issue is housing. I serve as the Deputy Director for this Center.

And third, I co-chair Solar Valley, a UCR Consortium. Our objective is to make the counties of Riverside and San Bernardino a national center for solar power installation, storage and research. The Consortium’s special focus is on public policy to encourage solar development.

In brief, I have dedicated my life to making a difference, to making good things happen. My political hero is Robert Kennedy. He often quoted Bernard Shaw: “Some men see

Politics is the way we make policy choices. It is neither good or bad. Policy making should be viewed as a process to be understood.

I frequently ask students what is the law of land? My answer is five votes. Five votes made by justices of the Supreme Court. The answer emphasizes that laws, policies, rules can change, that people can make a difference.

How to make a difference? How to influence, to shape laws, policies, and rules? Here is my leadership framework. You need to have a vision. You need to look for best practices, best research. You need to have a game plan, centered on effective

strategies. You need to set the table. You need to stay involved—aspirations must be implemented. And you need a narrative to tell the story. Good things happen

intentionally, not accidentally.

Many years ago, after a breakfast talk, Knox Mellon, former CA State Preservation Officer, remarked, “ Loveridge is different from other politicians. He reads books.” When I was Mayor, weekly staff meetings were concluded with at least two book reports. We were especially looking for big picture directions, ideas, and/or recommendations.

The Metropolitan Revolution by Bruce Katz and Jennifer Bradley is on my top ten list of most important books. In their last chapter, A Revolution Realized, they highlight five steps for transformative change in a metropolitan region. Here are their steps: 1) Build your network; 2) Set your vision; 3) Find your game changer; 4) Bankroll the revolution; and 5) Sustain the gain. In my view, these big picture steps can work in many different circumstances.

For a city mayor, there are markers of success. How do you evaluate what difference a mayor makes? I agree with a Governing magazine column by publisher Mark

Funkhouser. He wrote, ”…success means leaving the community in better shape than you found it….it is possible to apply a fairly rigorous evidence-based,

outcome-focused assessment of the extent to which public officials accomplish that goal by evaluating the community along five dimensions: finances, social capital, infrastructure, shared prosperity, and involvement in a regional network.” I always remember Ronald Reagan’s powerful question, “Are you better off now than you were four years ago.” A final personal comment—marketing is central to the identity, and activities, of elected officials. Voting is the currency of democracy. Voter support is the quest of political campaigns. Resources are always scarce. What to do? What messages? Choices are difficult. We conduct surveys. We talk to consultants. We knock on doors. We

increasingly focus on the social media. We send out mailers. Stakes are high. There are specific winners, and losers. We ask what can I do to win? Choices are both art and

A personal example of a successful marketing idea—in retrospect, my political career began in college when I ran for Sophomore Representative. A widely tacked up poster was central to my winning the election. Below my picture were these words, “Ron Loveridge looks like this. Vote for him anyway.”

Now, let me highlight ten ideas related to politics and policy making. These are big picture points to making a difference.

1) Public policy is the result of the great game of politics. Politics sets priorities, sets funding. Politics is about choices among values, including which values get

emphasis and which don’t. Politics is about conflict over scarce resources. An often repeated definition of politics is that of Harold Lasswell: “Who gets, what, when, and how.”

2) For public policy, local governments are important but too often overlooked. The United States has a federal system of government. There are over 85,000 local governments and over 500,000 local elected officials. In California, there are 58 counties, 482 cites, 5,000 or so special districts, and over 1,200 school districts. Money is spent locally, note the services delivered—education, transportation, welfare, criminal justice, health, physical environment, et cetera. There are more than 12 million local officials as opposed to 3 million federal officials. The critical quality of life

measures are local—place is where you live, work, play, and raise a family. The greatest advantage of local government is access. You can directly participate. Local

governments are policy laboratories. You can look for best practices. The 21st Century is the century of regions. Regions are engines of economic development. Let me conclude with the often quoted observation that “all politics is local.” A politician’s success is directly tied to the ability to understand and influence the issues of his or her constituents.

3) Among local governments, cities are especially important. Quick story—my

roommate when I was a senior at University of Pacific was Ted Olson. Ted is one of the nation’s outstanding attorneys. He was the Bush lawyer before the Supreme Court when the Court decided for Bush rather than Gore. Ted was Solicitor General. And he has appeared over 75 times before the Supreme Court. When having dinner with Ted, he asked why devote your life to cities. To Ted, local politics did not matter.

Cities are exciting places in which to make a difference, to dedicate your best efforts. I would call out Harvard Economist Edward Gleaser’s book, “The Triumph of the City.” Its subtitle reads, “”How Our Greatest Invention Makes Us Richer, Smarter, Greener, Healthier, and Happier.” Cities are the wealth of nations. They are where quality of life is experienced. They are where services are delivered. They are where people live. As explained by Benjamin Barber in If Mayors Ruled the World: cities are “where you learn and love, work and sleep, pray and play, grow and eat, and finally die.”

4) Public policy is made in a process that can be divided into three stages: formulation, adoption, and implementation. Both elected officials and appointed officials are

involved at each stage. The politics of these stages are quite different. We focus almost exclusively on adoption (i.e., the legislative vote), yet the other stages are equally

important. Different stages require different strategies to make a difference. And marketing can play a major role at each stage.

5) Public policy making is a complex process. There are many definitions of public policy. I like the definition of Political Scientist Thomas Dye: “Public policy is the study of what governments do, why they do it, and what difference it makes.”

Well, how then do you study public policy? You can study the issues, actors,

resources, public institutions, and the sharing of power among governments. Across the country, major universities now have large schools of public policy. It is true for UCLA, USC, UCI, UCSD, and UCR. At UCR—where I teach, public policy is the fastest growing undergraduate major.

One of my favorite quotes—Political Scientist Larry Gerston writes: “Welcome to the world of public policy making, where more times than not the political environment is framed in confusion, contradictions, and consternation. In order to make policy,

decision makers often merge conflicting objectives into acceptable outcomes. It’s not a pretty process; yet, whatever difficulties….it is a process that must be reckoned with.” I would note, and emphasize, that every major organization has a governmental

relations/public affairs office. These offices continually advocate, monitor, and study public policy and its effects on their organization.

Example—I was a member of the SCAQ Board for over 20 years and the CA Air Resources Board for eight years. Before and after these board meetings, I frequently met with governmental relations/public affairs representatives, and particularly those from businesses being regulated. They carefully argued and pleaded for policy choices to advance their own interests or objectives.

6) After formulation and adoption, public policies must be implemented. This stage is not fully recognized. Yet, in practice, public policies only gain their meaning in the ways that they are executed.

As Mayor, you quickly understand the importance, and difficulty, of going from

aspirations to results. How can a mayor make good things happen, especially in a city where the city manager hires and supervises city employees.

I aways asked for 90 day or 180 day reports on what has happened. And third, I found it helpful to have regular oversight meetings, usually involving the stakeholders, inside and outside of city hall.

7) Public policy leaders make a difference. It is not true that if you have seen one you have seen them all. Their abilities, priorities, skills, and visions importantly shape

outcomes. Let me draw on two COVID-19/Shelter in Place examples. I watched for the first time, Parks and Recreation. It is a seven season political satire, starring Amy Poehler as Leslie Knope. In the first season, Knope is described as a perky, mid-level bureaucrat in the Parks Department of Pawnee, a fictional town in Indiana. She commits herself, and others, to transforming an neighborhood construction pit into a neighborhood park. It is a wonderful, and funny, illustration of what differences leaders can make in local policy making.

I just finished reading Erik Larson’s The Splendid and the Vile: A Saga of Churchill, Family, and Defiance During the Blitz. He writes about one year, May 1940 to May 1941. The framework is public decision making at the highest level. Hitler decided to stop his tanks and not push into Dunkirk. Hitler chose to attack Russia before Britain. Churchill rallied a nation by rhetoric and will power. His key appointments for

manufacturing fighter planes and making scientific decisions changed the trajectory of the war and made victory possible. Page after page reminds you that policy choices made by leaders can result in extraordinary differences, in this case, the fate of the Western World.

8) The local policy making scene is changing, and this change is dramatic and

important. The local news media, especially print, is going, going, almost gone. Their economic model no longer works. Increasingly, there are no newspapers to cover local communities. Their role as watchdogs has nearly disappeared. Mediated news sources are replaced by the social media. It is a new ball game, in which every group or

organization promotes what it is doing in the best possible light. Marketing has

replaced news reporting. Let me repeat, marketing has replaced news reporting at the local level.

At the local level, there may be, at best, some reporting on the adoption of major policies but there is almost no reporting on their formulation or implementation.

The obvious question—how does local democracy work when there is no news sources to inform voters and to hold public leaders accountable? Who then defines and enhances a sense of community, who then encourages an active citizenry? Last Sunday (May 24), the LA Times had a full length editorial titled, “Local

Newspapers Are Dying.” It concluded, “According to the Pew Research Center, a solid majority of Americans say their local news outlets report the news accurately, hold

damage to our democracy will be severe and irreversible.”

9) Rather than abstractions, let’s briefly focus on examples of public policies that I championed as Mayor. These policies made important differences in the life and times of Riverside.

The City developed a strategic vision called Seizing Our Destiny. Kudos to David Stewart for inspiring this initiative. We focused on the City’s assets and how we could invent our future. FYI—Riverside has three universities and a community college, with over 65,000 full time students. Seizing our Destiny centered on a four part vision: Intelligent Growth, Catalyst for Innovation, Location of Choice, and Unified City. In 2005, Riverside committed itself by a unanimous council vote to become the greenest city in Southern California. This commitment came after the good work of a task force and more importantly, a marketing campaign that we called a community parade. A senior staff member from Public Utilities—our green guy— coordinated efforts across many departments. The City took many steps. We received many awards. Riverside was selected, for instance, as the first Emerald City in California. In my last year in office, we were competing with other cities—including Santa Monica— for the title of the greenest middle size city in the United States.

Working with UCR, we developed an innovative City program called SmartRiverside. It was focused on digital and high tech initiatives. For instance, we provided over 5,000 computers, with training, to low income families. And the City offered free internet access to all residents. In 2012, the New York based Intelligent Community Forum selected Riverside as the Intelligent Community of the Year. The Forum focuses

worldwide on cities and their economic development in the broadband economy. Over 435 cities applied. The Forum has a very sophisticated jury system. For seven finalists, it included a three day site visit. Final cities included three from Canada, one from Taiwan, one from Finland, and Austin, Texas. Noteworthy, Riverside was the first U.S. city selected since the beginning of the competition in 2000.

Since first elected in 1979, I emphasized that neighborhoods are the building blocks of a good city. I proposed a comprehensive Good Neighborhood Program—most its 22 proposals were approved and implemented. As Mayor, I held 163 monthly Mayor’s Night Outs, rotated among the City’s 28 identified neighborhoods. I looked for best practices in cities across the country. In 2012, I received the highest possible award from Neighborhoods USA, Who’s Who in American Neighborhoods.

I take pride in Riverside’s downtown, and the initiatives taken over many years. Exit the 91 freeway and take a look. Downtown is every body’s neighborhood. I do not know of a good city that does not have a good downtown. Downtown Riverside is increasingly an active and vital center. In 2020—before COVID-19, anchored by the Mission Inn,

or will shortly be built. Name your marker, downtown Riverside can now compete with any downtown in Southern California.

Finally, let me close by highlighting my two most important emphases for policy making. The first emphasis is to set policy goals. You know the expression, “If you don’t know where you are going, any path will get you there.” Without goals, you become the victim of events. The next demand, the next crisis controls the agenda. Both as Council member and Mayor, I set goals, especially for the coming year. Goals offer a policy and political agenda for making a difference.

And the second emphasis is to bring people to the table for civil discussion. Social capital is important. As Harvard Political Scientist Robert Putnam explains, “Social capital makes us smarter, healthier, safer, richer, and better able to govern a just and stable democracy.” Good things happen when people talk together. Networks, reciprocity, and trust are increased. There is the African expression, “To go fast, go alone; to go far, go together.” We are better together.

Table of Contents

An Exploratory Study on Social Media Addiction 2

Dr . Samer Elhajjar (University of Balamand )

Devil in Disguise? How Content Marketing is Designed to Make Kids Gamble. 18 Mr . Raffaello Rossi (University of Bristol ), Dr . Nikolaos Stylos (University of Bristol ), Prof . Agnes Nairn (University of Bristol )

Digital Dads and Sharenting: An Exploration of First Time Fathers With Implications for Children’s Online

Privacy 22

Dr . Mariea Hoy (University of Tennese ), Dr . Alexa Fox (The University of Akron ), Mr . Alexander Carter (University Tennessee )

Education, Engagement, and the Internet: Analyzing Museum Business Goals 26 Dr . David Waller (University of Technology Sydney ), Ms . Helen Waller (Art Gallery of New South Wales )

Illusion of Safety: How Consumers Underestimate Manipulation and Deception in Online (vs. Offline)

Shop-ping Contexts 28

Dr . Nora Moran (California State University, Northridge )

Political Twitter and Brand Personality: Trump v. Clinton 2016 30

Dr . Erika Fischer (California Lutheran University ), Dr . Jose Marichal (California Lutheran University )

Social media and Well-being: when Instagram makes us grateful and more altruistic 34 Dr . Monica Mendini (University of Applied Sciences and Arts of Southern Switzerland ), Dr . Paula Peter (San Diego State University ), Mr . Salvatore Maione (Università della Svizzera italiana )

Entrepreneurship/Innovation

Broadening the Impact of Transformative Consumer Research: Converting Research Insights into Action 37 Dr . Melissa Bublitz (University of Wisconsin Oshkosh ), Dr . Brennan Davis (California Polytechnic State University ), Dr . Laura Peracchio (University of Wisconsin-Milwaukee ), Dr . Maura Scott (Florida State University ), Dr . Shikha Upadhyaya (California State University, Los Angeles ), Dr . Beth Vallen (Villanova University )

Stepping In Stigmatized Shoes 44

Dr . Jane Machin (Radford University ), Dr . Ann Mirabito (Baylor University ), Dr . Natalie Adkins (Drake University ), Dr . Elizabeth Crosby (University of Wisconsin-La Crosse, La Crosse )

The Effect of Skeuomorphic Digital Interfaces on Illusions of Control Over Gambling Outcomes 47 Dr . Matthew D. Meng (Utah State University ), Dr . R. Bret Leary (University of Nevada, Reno )

The Impacts of Emerging Automation Technologies on Marketing and Public Policy – Robotic Service

Assis-tants and Artificial Intelligence 50

Dr . Nobuyuki Fukawa (Missouri University of Science and Technology ), Dr . Marat Bakpayev (University of Minnesota Duluth ), Ms . Nadia Danienta (University of Illinois, Urbana-Champaign ), Dr . Ilana Shanks (Stony Brook University ), Dr . Aric Rindfleisch (University of Illinois, Urbana-Champaign ), Dr . Martin Mende (Florida State University ) Entertainment, Multicultural Marketing and Consumption

Are Blind Bags Similar to Loot Boxes, and Should Regulators Care? 62 Dr . Jennifer Siemens (Clemson University ), Prof . Lura Forcum (Clemson University ), Mrs . Carter McElveen (Clemson University )

Children as consumers of online gaming: The role of parental attachment 65 Prof . Ambika Nanda (SPJAIN INSTITUTE OF MANAGEMENT RESEARCH ), Dr . Anjali Malik (Bennett University ), Dr . Rajeev Kumra (IIM Lucknow )

Compared to what? Examining the prevalence of categorization bias for within-category product evaluations

despite the presence of objective reference points 68

Ms . Monique Breaz (University of Goettingen ), Dr . Steffen Jahn (University of Oregon ), Prof . Yasemin Boztug (University of Goettingen )

Education, Engagement, and the Internet: Analyzing Museum Business Goals 71 Dr . David Waller (University of Technology Sydney ), Ms . Helen Waller (Art Gallery of New South Wales )

Extending A Model of Luxury Branding with Antecedents: Incorporating Corporate Social Responsibility 73 Ms . Stephanie Pankiw (University of Saskatchewan )

Feminism and Marketing: Conceptualizing Empowering Advertising for Women 75 Ms . Stephanie Pankiw (University of Saskatchewan )

LUXURY HOTEL CONSUMPTION - EXAMINING THE EFFECTS OF PERSONALITY AND CONSPICUOUS

CON-SUMPTION ORIENTATION ON LUXURY HOTEL VALUATIONS. 77

Ms . Aihoor Aleem (ISCTE-IUL ), Dr . Vera Herédia-Colaço (Católica Lisbon School of Business and Economics )

Situational Differences in Snacking Behavior 81

Dr . Marina Girju (California Baptist University ), Dr . Kelly Moore (Duquesne University ), Dr . Doug Walker (Kansas State University )

The Effect Of Mindfulness Intervention On Waiting Time Satisfaction 84 Ms . Ellen Campos Sousa (Florida International University ), Prof . Jayati Sinha (Florida International University ), Prof . Luciana Freire (Centro Universitário Christus - UNICHRISTUS )

Global Trade

A Market-Oriented Proposal for a New International Prescription Drug Development Funding Mechanism 89 Dr . Lance Gentry (University of Mary Washington )

Fur Babies and Pet Parents: The Impact of Humanized Pets on Owners’ Spending 101 Prof . Lura Forcum (Clemson University ), Prof . Kurt Gray (University of North Carolina, Chapel Hill )

Navigating Health Care Services: Experiences of Women with Chronic Reproductive Health Conditions 105 Dr . Edna Ndichu (Whitworth University ), Dr . Shikha Upadhyaya (California State University, Los Angeles )

Opioid Crisis: Stakeholder Framing, Shaming and Blaming through Communications 108 Ms . Elizabeth Gratz (West Virginia University ), Dr . M. Paula Fitzgerald (West Virginia University ), Dr . Matthew Sarkees (Villanova University )

Stepping In Stigmatized Shoes 110

Dr . Jane Machin (Radford University ), Dr . Ann Mirabito (Baylor University ), Dr . Natalie Adkins (Drake University ), Dr . Elizabeth Crosby (University of Wisconsin-La Crosse, La Crosse )

Sticking to alternative medicine: the role of psycho-immunology 113

Mr . Mesay Menebo (University of South Eastern Norway ) Role(s) of Government and Markets

A Market-Oriented Proposal for a New International Prescription Drug Development Funding Mechanism 118 Dr . Lance Gentry (University of Mary Washington )

Anti-Vaping Messaging: The Missing Case of Moral Values 130

Dr . Elizabeth Minton (University of Wyoming ), Dr . Paige Gardiner (Utah Valley University )

Critical Review and Comparison of Stakeholder and Ecological Systems Approaches to Daily Fantasy Sports

Policy 132

Dr . Ray Cho (Rutgers University School of Social Work ), Dr . Lia Nower (Rutgers University School of Social Work ) EXPERIENTIAL LEARNING METHODOLOGIES ADVANCING CONSUMER FINANCIAL KNOWLEDGE: USING THE FEDERAL RESERVE CHALLENGE COMPETITION AS A MODEL OF BEHAVIORAL THEORY 135 Prof . Monisha Das (University of Maryland Eastern Shore ), Dr . Andrew Schiff (Towson University )

Fur Babies and Pet Parents: The Impact of Humanized Pets on Owners’ Spending 144 Prof . Lura Forcum (Clemson University ), Prof . Kurt Gray (University of North Carolina, Chapel Hill )

Illegal Markets and the Marketing Mix 148

Mr . Alec Slepchuk (University of Massachusetts, Amherst )

Illusion of Safety: How Consumers Underestimate Manipulation and Deception in Online (vs. Offline)

Shop-ping Contexts 151

Dr . Nora Moran (California State University, Northridge )

Material Hardship – How to Better Deliver Aid Using the Power of Choice 153 Ms . Nea North (University of California Irvine ), Dr . Cornelia (Connie) Pechmann (University of California Irvine )

Out-of-pocket expenditure for services in a National Health System: the rationale for new pricing strategies

in the Italian healthcare sector 157

Dr . elena bellio (Università Cà Foscari Venezia ), Prof . Luca Buccoliero (Bocconi University )

Political Activity and Marketing: A Panel Discussion Devoted to the JPPM Special Issue 169 Dr . Kelly Martin (Colorado State University ), Dr . Gautham Vadakkepatt (George Mason University ), Dr . Daniel Korschun (Drexel University ), Dr . Mark Peterson (University of Wyoming )

Pushing the Envelope? The Intersection of Brand Vulgarity & Trademark Law 175 Dr . Laurel Cook (West Virginia University ), Dr . Merlyn Griffiths (University of North Carolina, Greensboro ), Dr . Sarah Lefebvre (Murray State University ), Dr . Andrea Scott (California Baptist University ), Dr . Channelle James (University of North Carolina at Greensboro )

Re-Envisioning Retail Theories: Vertical Restraints and Resale Price Maintenance 178 Mr . Riley Krotz (University of Tennessee ), Prof . Gregory Gundlach (University of North Florida )

Social Media as a Political Branding Platform: The Case of President Donald J. Trump 181 Prof . Ron Hill (American University ), Prof . Aronte Bennett (Villanova University )

Testing the Relative Effectiveness of Four Forms of Choice Architecture to Increase Consumer Preference for

Green Packaging 183

Mr . JAISANG KIM (University of Hawai’i ), Ms . Sakawrat Kitkuakul (University of Hawai’i ), Dr . Dana Alden (Uni-versity of Hawai’i )

The Impact of Political Shocks and Political Homelessness on Political Activism 187 Ms . Elizabeth Gratz (West Virginia University ), Dr . M. Paula Fitzgerald (West Virginia University ), Dr . Emily Tanner (West Virginia University )

The Nutrition Elite Revisited: The Role of Chilean-Style and Traffic Light Front-of-Pack Nutrition Labels 189 Dr . Craig Andrews (Marquette University ), Dr . Scot Burton (University of Arkansas ), Dr . Jeremy Kees (Villanova University ), Dr . Richard Netemeyer (University of Virginia )

Marketing’s Contribution to Quality of Life

A Behind the Scenes Look on Studies of Vulnerability: The Importance of Contextualizing Vulnerability 193 Dr . Laurel Steinfield (Bentley University ), Prof . Ron Hill (American University ), Prof . Diane Holt (Leeds University ), Dr . Charlene Dadzie (University of South Alabama ), Dr . Kofi Dadzie (Georgia State University ), Dr . Charles Blankson (University of North Texas ), Prof . Madhu Viswanathan (Loyola Marymount University ), Dr . Robert Arias (John Carroll University ), Dr . Arun Sreekumar (University of Illinois, Urbana-Champaign ), Dr . Roland Gau (National Chiao Tung University ), Dr . Vanessa Perry (George Washington University ), Prof . Sonya Grier (American University - Kogod School )

A Business School with Loans: Empowering Women through Microfinance 203 Dr . Kristin Scott (Minnesota State University, Mankato ), Dr . Leslie Koppenhafer (Boise State University ), Dr . Mark Mulder (Pacific Lutheran University ), Dr . Todd Weaver (Point University )

Addressing the Stigma of Mental Health 207 Prof . Cristel Russell (Pepperdine University ), Prof . Ronald Hill (American University - Kogod School ), Ms . Sonja Prentovic (University of Lyon ), Dr . Chethana Achar (Northwestern University ), Prof . Itir Karaesmen (American University - Kogod School )

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Untapped education: Exploring the relationship of political ideology and water reuse 365 Dr . Anjala Krishen (University of Nevada, Las Vegas ), Dr . Han-fen Hu (University of Nevada, Las Vegas ), Mr . Jesse Barnes (University of Nevada, Las Vegas )

AN EXPLORATORY STUDY ON SOCIAL MEDIA ADDICTION AND CONSUMER BEHAVIOR

Samer Elhajjar

University of Balamand, Lebanon

Samer.hajjar@balamand.edu.lb

ABSTRACT

This study investigates the influence of social media addiction on the consumer behavior. While the research done so far focus on the study of the effect of the psychological effects of the addiction to social media, this paper underlines the impacts on the buyer behavior. Based on a cross-cultural study, the authors show that the addiction to social media has an impact on the buying behavior and attitudes towards the brands. The authors consequently draw some implications from their findings.

KEYWORDS: Social Media, Addiction, Well-Being, Consumer Behavior.

DESCRIPTION: This study investigates the influence of social media addiction on the consumer behavior.

INTRODUCTION

Social media addiction has become a very popular term, not only in the academic literature but also in professional publications. It refers to an excessive or poorly controlled preoccupation, urges or behaviors regarding social media use that leads to distress (Cabral, 2008).

Research on Internet addiction and social media addiction increased substantially over the last years. Scholars have mainly examined the psychological vulnerabilities of the addiction (Kuss and

Griffiths, 2011). Regardless this growth in the research on social medial addiction, there are still some elements not studied in the literature. In fact, the buying behavior of social media addicts was completely ignored by the researchers. More precisely, no scholars have evoked how the addiction to social media influence the buying behavior? How does the addiction to social media impact the attitudes and perceptions toward the brands? The present study seeks to address these questions that are still unanswered in social media research.

Our paper is organized as follows; first, we explore the literature on social media addiction. Second, we describe the methodology used in our study. Third, we summarize and discuss the findings obtained. Finally, we develop the implications and note some limitations and potential avenues for further research.

LITERATURE REVIEW

Traditionally, the concept of “addiction” was based on a medical model and properly reserved for psychological dependence on a physical substance. Researchers have argued that the concept of addiction should be widened to cover broader range of behaviors (Shaffer 1996; Orford 2001; Lemon 2002). Peele (1985) suggested that any compulsive or overused activity could be considered as addiction. Actually, several habits that pervade everyday life can be described as addictive (Gruber and Köszegi, 2001). While the extent of addictiveness varies from activity to activity and person to person, habits such as smoking, drinking, eating, and others meet the two conditions required for addiction: reinforcement, in that the more you partake of the activity, the more you want to partake; and tolerance, in that the more that you partake of the activity, the lower your future utility given the amount of future consumption (Becker and Murphy 1988; Gruber and Köszegi, 2001). Most of the literature in the area of addiction modeled it as habit formation, capturing the reinforcement aspect of the process through an impact of lagged consumption on the

taste for today’s consumption of the good (Murray and Hobbos, 1981; Gruber and Köszegi, 2001). According to Thomas and Miller (2006), addiction is fundamentally a problem of motivation. For example, shopping addicts are motivated mainly by escape (Elliott et al. 1996). Other researchers argued that people may engage in harmful behaviors because of an abnormality that manifests itself as mental illness (Ersche et al., 2012). Also, other people could learn unhealthy behavior in response to their environment (May et al., 2007). Finally, people's thoughts and beliefs are one of the main origins of any addictions (Hall and Parsons, 2001).

Since 1996, many researchers have examined Internet addiction, studying the relationships among heavy online use, social-psychological factors, and computer-related factors. Research into Internet addiction has emerged into four main tracks: (1) Internet use and time, (2) problems and consequences of Internet addiction, (3) impact of Internet addiction on social-psychological factors, and (4) impact of personal factors on Internet addiction. These studies concluded that Internet itself is not addictive, but that some Internet applications, especially those with interactive functions, appear to contribute to the development of pathological Internet use (Chen and Chou, 1999; Chou and Hsiao, 2000 ; Kenyon, 2008; Anderson et al., 2017). Also, some research indicated that heavy use of the Internet has negative impact on: time-disruption, leading to interference with academic work, professional performance, and social life (Brenner, 1997; Lin and Tsai, 1999; Yen et al., 2007; Kalaitzakiand Brichtnell, 2014). Moreover, previous research confirmed that the Internet addiction results in increased symptoms of depression, low self-esteem, poor motivation, fear of rejection, and loneliness (Lavin et al., 1999; Chou and Hsiao, 2000; Banjanin et al., 2015). Personality factors such as high harm-avoidance, novelty seeking, reward dependence, low self-directedness, and low cooperativeness were also positively correlated with Internet addiction in the past studies (June et al., 2007; Liu and Kuo, 2007; Mottram and Fleming, 2009).

Griffiths (1998) has proposed that Internet addiction could originate from one or more aspects of Internet use, including the process of typing, the medium of communication, and the lack of face-to-face contact, Internet contents, or online social activities. Other researchers also suggested that Internet addiction could further be categorized into online game addiction, cyber-sexual addiction, cyber relationship addiction, online information addiction, and online shopping addiction (Liang 2006; Tao et al. 2007). Other scholars have confirmed that people are addictive to the Internet applications and not for the Internet itself. One of the most using applications in Internet are the social media platforms. Like any other addictions, social media addiction means spending an excessive amount of time on it. Signs and symptoms of social media addiction vary. For example, a Facebook addiction scale was developed by Andreassen et al. (2012) and includes six items related to: 1) time spent on Facebook; 2) feeling of the urge to use Facebook; 3) the need of escape from the personal problems; 4) the attempt to cut down on the use of Facebook without success; 5) the negative emotions when prohibited from using Facebook; and 6) the negative impact of Facebook.

The last decade has witnessed a large increase in research on Internet addiction and social media addiction exploring the associations between psychological vulnerabilities and the addictions. Rather than looking at the negative impacts of these addictions on mental health and the psychological motives, this study focuses on the effects of social media addiction on the consumer behavior.

METHODOLOGY

A web-based survey and convenient sampling were employed in order to measure the addictiveness of the respondents. To measure addiction, we used social media addiction scale by Andreassen et al. (2012). The respondents included undergraduate and graduate students,

executives, managers, and entrepreneurs in France and Lebanon. We have received 220 responses. In the process of data mining, 84 incomplete responses were removed, resulting in a study sample 136 people. The main objective of this quantitative study was to explore who are the social-media addicts. 27 people (25 %) were determined to be social media-addicted. Then, these 27 respondents were contacted for an interview by phone. 5 people refused to participate and 22 accepted to be interviewed. The semi structured interviews lasted about one hour and covered the conceptual underpinnings of addiction and the behavior of the interviewee. During our interviews, we were based on a guideline that aims to identify the reasons and the impacts of the addiction to social media. The qualitative data were collected on those who have been identified as social media addictive, followed by a thematic analysis. Thematic analysis gives an opportunity to understand the potential of any issue more widely (Marks and Yardley, 2004) and to code and categorize data into themes. Our data coding continued the logic proposed by Strauss et al. (2004): A logic based on condensation and data coding. It was done using the Nvivo 10. The condensation of the text concerns the reduction of a text by assigning one or more codes to text segments. The principle of the software is based on the decontextualisation-recontextualisation of the corpus. Decontextualisation allows us to create themes, called codes; It is a matter of consolidating all the excerpts dealing with a subject. The recontextualisation is obtained by the amalgamation of the decontextualized codes to make it a completely intelligible and meaning-bearing (Deschenaux, 2007). In fact, thematic coding is characterized by the possibility of combining emerging categories and predefined categories by the researcher. In the end, two steps followed the codification, the presentation of the data and the formulation of a conclusion (Miles and Huberman, 2003).

Who is a social media addict?

A social media addict is a person who spends a lot of time thinking about social media and how to use it, “I think that I spend more than 8 hours a day, using social media” (Jessica, 55 years, France). The addicts reach the phone when they wake up to check social media. They simply cannot imagine their lives without social media, “Sometimes, I fell that I neglected everything in my life

and devoted all my life for Internet and social media” (Antonin, France, 21 years). Other

interviewees claimed that they tried to stop using social media but they failed, “I tried many times

to cut down on the use of snapchat without success” (Jennifer, Lebanon, 26 years). Almost all of

our interviewees did not have any hobbies but social media. They even link all their visits and actions with social media, “I go to bars and restaurants in order to take some selfies there, I

became obsessed with my number followers and likes I get” (Sandy, Lebanon, 36 years). When in

classes or work, the addicts feel troubled because they cannot use social media, “Honestly, in some

classes, the tutor prohibits us to use our phones…. In these classes. I feel that I am under pressure and in trouble as well” (Dany, France, 19 years). Our interviewees actually act like life is more

happening on social media than in reality, “I admit it, I eat with Instagram, I drink with Instagram,

I sleep with Instagram, I live with it and anyone who is not active in social media is an alien”

(Bernard, Lebanon, 46 years). Other participants in our study declared that they believe that social media addiction could have negative impact on their lives but they keep using it “In last months, I

had some problems in work because of social media, but I cannot but check my phone every 3 to 4 minutes, it became like a habit for me” (Serena, Lebanon, 34 years).

There was no one type of personality that sets the interviewees up for addiction. However, there were several distinct and separate personality traits that are common among the participants,

including: lack of patience; inability to deal with pressure; low self-esteem; and lack of intimacy with others.

Reasons of Addiction to Social Media

One of the main reasons for addiction to social media is the social anxiety. There are some people who face challenges to interact with others. Thus, they may develop social media addiction because meeting people on social media seems less intimidating than face-to-face communication. Other addicts believe that they can control how they are perceived by people when they communicate online, “Social media helps me to be more positively perceived in the community”; “I want to be

perceived in a positive way, I doubt that I could leave a positive impact in social life without using social media” (Henry, Lebanon, 33 years).

Many interviewees claimed that they intensively use social media in order to escape from the reality. For the addicts, social media platforms allow them to escape from their problems and to fulfill their needs for emotional contacts and things that they don't get in real life, “On Facebook,

I can live another life, this is what I want right now, I want to live another life” (Jessica, 55 years,

France). Also, social media platforms are viewed as tool to avoid pain, “I seek fun and pleasure.

In my real life, there is no fun, very sadly” (Bernard, Lebanon, 46 years). So, because of depression

and lack of emotional support, some participants they turn to the social media to fill these needs.

Some addicts feel the need for information about the world and about other people. They actually look very curious about what people are doing and posting. Social media platforms have made information about others public that would typically be kept private. In a sense, this allows people to "spy" on others and to gain information that they would otherwise not be privy to, “I keep

me” (Dany, France, 19 years). In social media, users receive new content from other people, such

as status updates, pictures, and videos. This leads to log in to Facebook many times daily to catch up on what has been missed, “I don’t want to miss any update; I want to know what’s happening

and get immediate information about everything and everyone” (Sarah, France, 26 years).

Many of our participants declared that they want to feel connected with others. They have not had enough social contact with other people and are feeling lonely. They decided to interact with others on social media in order provide relief from loneliness, “Facebook became a necessity for me.

Almost all the time I am alone. So, I need to connect with other even virtually” (Peter, France, 34

years). The addicts believe that they connect to social media in order to feel better when they are stressed and anxious. The boost in mood come from the feeling to be more connected, “being

connected with others makes me happier”; “to think of not even having Internet on my phone scares me because I want to be always connected” (Antonin, France, 21 years).

Moreover, participants try to silence their boredom with social media, “I don’t think that I have a

very entertaining life like others. I use social media to add more entertainment and fun to my life”

(Daniel, Lebanon, 23 years). In fact, the reason why addiction to social media is so powerful is that the use of these platforms taps into that place in the hearts of people. These addictive habits on social media either dull and deaden the yearnings for a satisfaction people fear they will never find, or they provide a counterfeit fulfillment that addicts think will bring long-term happiness. So, the internal trigger of the social media intensive use is boredom. People believe that they can alleviate the boredom, just by scrolling through the newsfeeds in social media platforms.

Finally, it seemed to many interviewees so much easy to justify excessive use of social media. Actually, they don’t think that they are wasting their time on social media, “I don’t have a reason

looked even healthy for other participants, “the only way to form new friends and build good

relationships is social media now, that’s why I don’t mind intensively use it” (Marc, France, 25

years).

Impact of Social Media Addiction on the Consumer Behavior

The emergence of social media has created a drastic change in the world today. This specific change amid the recent decade or so has radically reformed the traditional marketing system and has brought the population to a more revolutionized era. In this new revolutionary period, social media has prone to change the connections marketers have with retailers, channels of dispersion, their buyers, and so forth. We now live in a society where information is available at the click of a button and this has created transparency whereby consumers cannot be fooled in terms products prices and quality. Social Media addicts are exposed to an immense amount of data everyday which has made them knowledgeable regarding what they want to buy and hence, their decision process can be influenced by a number of factors. As for the first stage in consumer decision process; problem recognition; The gap between the actual and desired state creates a problem or need which ought to be satisfied. Social media is a major source of information which acts as an agent in triggering the addicts; “It became a trend that consumers post their recent purchases on their

social networking profiles to impress their friends and followers. In return, I personally feel the constant pressure to prove myself as being up-to-date, which fuels my consumerism behavior and trick them to buy the product even when I don’t really need it, all in the name of fitting in and living up to expectations defined by family, friends or co-workers” (Maya, Lebanon, 27 years).

After social media addicts are able to recognize a need for a product, the search for information begins. Social media has an enormous impact in this process; “Before buying anything, I tend to

brands, and eventually pick up the best one” (Melanie, France, 38 years); “I usually use social media to access to many diverse sources of information and experiences, which have been enabled by other customers’ data and reviews” (Antonin, France, 21 years). After the consumers have

searched for information regarding the product, the evaluation of which product best suits their criteria is filtered while other options are dropped out; “My presence in social media allows me to

assess the performance of the brands in the market” (Jessica, 55 years, France). After identifying

all the criteria for the decision the addicts now decide on what they will buy. They may have had prior experience with this product/brand or maybe they succumbed to advertising on social media about it. Actually, all our interviewees had purchased many times as a result of advertisements on social media websites. Also, the attitudes of others towards the product act as a huge influence to his/her decision; “If the attitudes of other users portrayed negativity in the product then this lead

me to readjust my decision and go for another brand” (Karine, France, 49 years). Also, social

media influencers and celebrities are being much more impactful on social media addicts. Just by posting a picture using or buying from a specific product or service, they are promoting the product whether they work for this company producing this product or they are just customers that used it and loved it; “Since influencers nowadays dominate all the platforms of social media, they are

considered a part of almost every user on the social media. I am becoming more interested to see what these influencers post about fashion, designs, art, sports, healthy living and even food”

(Maya, Lebanon, 27 years). The interviewees claimed as well that they discuss and give feedback with other followers of the brand; “After all my purchases, I leave a review on social medial

because I know that based on these reviews, other users might become more excited or more discouraged to buy the product” (Sarah, France, 26 years).

Moreover, the addiction to social media leads to a more spending. In fact, digital media made it easier to spend larger amounts of money than previously imaginable through the use of credit and similar payment options. One of the most efficient tactics used to boost spending is pushing customized ads, sometimes without the consumer even being aware of it; “A growing trend on

social media platforms like Instagram and Facebook where ads that appear on a user’s feed are actually customized based upon search history and cookies gathered from web browsers. Now the ads that occupy my timeline are more adapt to things you might actually buy instead of being random, this push me to check more these ads and to buy more” (Melanie, France, 38 years).

Furthermore, addiction to social media looks to have a huge impact on brand attitudes. Actually, social media platforms are the main way that these addicts access information on brands. Even if social media addicts do not generally trust the news they see there; but the more positive comments, feedback and higher ratings lead to a higher level of trust in a brand; “I don’t trust

everything on social media” (Marc, France, 25 years); “I should have a positive image in my mind about a brand that has positive reviews and comments on social media” (Henry, Lebanon, 33

years). One of the interviewees admit that “credible and honest content provide a positive attitude

toward the product” (Antonin, France, 21 years). On one hand, social media addicts seem to

appreciate and like emotional and entertaining content. On the other hand, they are more loyal to the brand that they always follow on social media “some brands are really creative and innovative

in social media and I really like to follow their posts…. And definitely, thanks to that, I like to buy from these brands” (Michael, Lebanon, 23 years).

DISCUSSION

In regard to social media addiction, the findings discussed in this study paint the following picture: individuals with low self-esteem, lonely, bored anxious or depressed, are motivated to intensively