Patterns of Antiseizure Medication Use Following Meningioma Resection: A Single-Institution Experience.

OBJECTIVE: To investigate antiseizure medication (ASM) practice behavior for patients who present with seizures before meningioma resection and to review postoperative ASM management. METHODS: A retrospective study was performed of 112 consecutive patients with meningiomas who underwent resection at a single institution between October 2016 and January 2020. Data were collected through detailed chart review. RESULTS: Of 112 patients, 35 (31%) had a preoperative seizure, and 43 (38%) were prescribed a preoperative ASM. At discharge, 96 patients (86%) were prescribed an ASM, most often 1000 mg daily of levetiracetam (64%, 61/96) and less often higher doses of levetiracetam or other ASMs. By the 6-month postoperative visit, 55 patients (49%) were taking at least 1 ASM, most commonly levetiracetam monotherapy (65%) at 500 mg twice daily (47%). This number further decreased to 45 (40%) patients by 1-year follow-up and 36 (32%) patients by last-known follow-up. By last follow-up (median 27.3 months; range 5.4-57.4 months), 24 patients (21%) had experienced a postoperative seizure, and 36 patients (32%) were never able to discontinue ASMs. Of patients remaining on levetiracetam monotherapy, only 36% remained on levetiracetam 500 mg twice daily. CONCLUSIONS: Approximately two thirds (68%) of patients who underwent surgical resection of meningioma were eventually able to completely discontinue their postoperative ASM regimen. However, nearly one third (32%) of patients required long-term ASM management. Levetiracetam monotherapy was the most common ASM prescribed during the postoperative period, and the proportion of patients requiring either higher doses of levetiracetam or alternative ASMs increased over time.

Long-term antiseizure medication use in patients after meningioma resection: identifying predictors for successful weaning and failures.

OBJECTIVE: To define risk factors for meningioma-related seizures and predictors of successful weaning of antiseizure medications following meningioma resection. METHODS: This is a retrospective study of 95 patients who underwent meningioma resection at a single institution. Primary outcome analyzed was ability to achieve seizure freedom without the use of anti-seizure medication at 6-months, 1-year, and last known follow up. Secondary outcome was postoperative seizure freedom. RESULTS: Preoperative seizures (OR: 11.63, 95% CI [3.64, 37.17], p < 0.0001), non-skull base tumor location (OR: 3.01, 95% CI [1.29, 7.02], p = 0.0128), and modified STAMPE score of 3-5 (OR: 5.42, 95% CI [2.18, 13.52], p = 0.0003) were associated with greater likelihood of remaining on antiseizure medication at 6-month follow up. Preoperative seizures (OR: 4.93, 95% CI: [2.00, 12.16 ], p = 0.0008), intratumoral calcifications (OR: 4.19, 95% CI: [1.61, 14.46], p = 0.0055), modified STAMPE score of 3-5 (OR: 5.42, CI [2.18, 13.52], p = 0.0003), and Ki67 greater than 7% (OR: 5.68, CI [1.61, 20.10], p = 0.0060) were significant risk factors for inability to discontinue ASMs by last follow up. Preoperative seizures (OR: 4.33, 95% CI [1.59, 11.85], p = 0.0050) and modified STAMPE score of 3-5 (OR: 6.09, 95% CI [2.16, 17.20], p = 0.0007) were significant risk factors for postoperative seizures. CONCLUSIONS: Preoperative seizures, modified STAMPE2 score of 3-5, non-skull base tumor location, intratumoral calcifications, and Ki67 > 7% were significant risk factors for inability to achieve seizure freedom without ASMs. In addition, the modified STAMPE2 score successfully predicted increased seizure risk following meningioma resection for patients with a score of 3 or higher.

Impact of Postoperative Stereotactic Body Radiation Therapy on Survival of Patients with Spinal Metastases in the Context of Additional Systemic Adjuvant Therapy.

BACKGROUND: Stereotactic body radiotherapy (SBRT) has been established as a safe and effective treatment modality for control of long-term pain and tumor growth. However, few studies have investigated the efficacy of postoperative SBRT versus conventional external beam radiation therapy (EBRT) in extending survival within the context of systemic therapy. METHODS: A retrospective chart review of patients who underwent surgery for spinal metastasis at our institution was conducted. Demographic, treatment, and outcome data were collected. SBRT was compared with EBRT and non-SBRT, and analyses were stratified by whether patients received systemic therapy. Survival analysis was conducted using propensity score matching. RESULTS: Bivariate analysis in the nonsystemic therapy group revealed longer survival with SBRT compared with EBRT and non-SBRT. Further analysis also showed that primary cancer type and preoperative mRS significantly affected survival. Within patients who received systemic therapy, overall median survival for patients receiving SBRT was 22.7 months (95% confidence interval [CI] 12.1-52.3) versus 16.1 months (95% CI 12.7-44.0; P = 0.28) for patients who received EBRT and 16.1 months (95% CI: 12.2-21.9; P = 0.07) for patients without SBRT. Within patients who did not receive systemic therapy, overall median survival for patients with SBRT was 62.1 months (95% CI 18.1-unknown) versus 5.3 months (95% CI 2.8-unknown; P = 0.08) for patients with EBRT and 6.9 months (95% CI 5.0-45.6; P = 0.02) for patients without SBRT. CONCLUSIONS: In patients who do not receive systemic therapy, treatment with postoperative SBRT may increase survival time compared with patients not receiving SBRT.

Meningeal defects and focal cortical dysplasia: an unrecognized relationship? Illustrative case.

BACKGROUND: Focal cortical dysplasias (FCDs) are a heterogenous cluster of histopathologic entities classically associated with medically refractory epilepsy. Because there is substantial histopathologic variation among different types of FCD, there are likely multiple pathogenic mechanisms leading to these disorders. The meninges are known to play a role in cortical development, and disruption of meningeal-derived signaling pathways has been shown to impact neurodevelopment. To our knowledge, there has not yet been an investigation into whether genetic pathways regulating meningeal development may be involved in the development of FCD. OBSERVATIONS: The authors reported a patient with refractory epilepsy and evidence of FCD on imaging who received surgical intervention and was found to have an unusual dural anomaly overlying a region of type Ic FCD. To the authors' knowledge, this was the first report describing a lesion of this nature in the context of FCD. LESSONS: The dural anomaly exhibited by the patient presented what could be a potentially novel pathogenic mechanism of FCD. Resection of the cortical tissue underlying the dural anomaly resulted in improvement in seizure control. Although the pathogenesis is unclear, this case highlighted the importance of further investigation into the developmental origins of FCD, which may help elucidate whether a connection between meningeal development and FCD exists.

Characteristics of Scientific Evidence Informing Changed U.S. Preventive Services Task Force Insufficient Evidence Statements.

INTRODUCTION: The U.S. Preventive Services Task Force (USPSTF) issues "Insufficient Evidence" (I) statements when scientific evidence is inadequate for making recommendations about clinical preventive services. Insufficient Evidence statements may be changed to definitive recommendations if new research closes evidence gaps. This study examines the characteristics of evidence that informed changes from I statements to definitive recommendations, including NIH's role as a funder. METHODS: A total of 11 USPSTF Insufficient Evidence statements that were changed between 2010 and 2019 were assessed. Study designs, bibliometric influence, and funding sources for scientific articles cited in USPSTF evidence reviews were characterized for each I statement. Data were analyzed in 2019-2020. RESULTS: Most I statements (82%) changed to a B grade; an average of 8.4 years elapsed between issuing the I statement and releasing the definitive recommendation. An average of 63 (range=19-253) articles were included in each USPSTF evidence review. NIH support was cited in 28.8% of articles, on average. The proportion of NIH-funded articles reporting RCT designs was similar to that of non-NIH-funded articles (64.5% vs 59.5%). A higher proportion of NIH-funded articles were rated good quality for study design (39.0%) than the proportion of non-NIH-funded articles (24.4%). Bibliometric influence measured by relative citation ratios was higher for NIH-funded (mean=14.78) than for non-NIH-funded (mean=5.07) articles. CONCLUSIONS: Study designs and funding supports varied widely across topics, but overall, NIH was the largest single funder of evidence informing 11 changed USPSTF I statements. Enhanced efforts by NIH and other stakeholders to address I statement evidence gaps are needed.

Association of e-Cigarette Use With Discontinuation of Cigarette Smoking Among Adult Smokers Who Were Initially Never Planning to Quit.

Importance: Cigarette smokers not planning to quit are often overlooked in population studies evaluating the risk-benefit potential of electronic nicotine delivery products (e-cigarettes). Objective: To evaluate whether e-cigarette use is associated with discontinuing cigarette smoking among smokers who were initially never planning to quit. Design, Setting, and Participants: This cohort study used US nationally representative data from the longitudinal Population Assessment of Tobacco and Health Study (waves 2-5 conducted between October 2014 and November 2019), with participants evaluated in 3 pairs of interviews. Adult daily cigarette smokers initially not using e-cigarettes and with no plans to ever quit smoking for good (2489 observations from 1600 individuals) were included. Exposures: e-Cigarette use (ie, daily use, nondaily use, or no use) at follow-up interview among smokers not using e-cigarettes at baseline interview. Main Outcomes and Measures: The main outcomes were discontinuation of cigarette smoking (ie, no cigarette smoking) and discontinuation of daily cigarette smoking (ie, no daily cigarette smoking) at follow-up interview. Generalized estimating equations were used to evaluate the association between the exposure and each outcome, controlling for demographic characteristics and cigarettes smoked per day at baseline interview; all estimates were weighted. Results: The weighted population of adult daily cigarette smokers who were not using e-cigarettes and had no plans to ever quit smoking, based on data from 1600 participants, was 56.1% male (95% CI, 53.4%-58.7%), 10.1% Hispanic (95% CI, 8.2%-12.3%), 10.1% non-Hispanic Black (95% CI, 8.7%-11.7%), 75.6% non-Hispanic White (95% CI, 72.9%-78.2%), and 4.2% of other non-Hispanic race (95% CI, 3.3%-5.4%); 29.3% were aged 55 to 69 years (95% CI, 26.2%-32.6%), 8.9% were aged 70 years or older (95% CI, 6.8%-11.5%), 36.8% did not graduate from high school (95% CI, 34.1%-39.6%), 55.2% had an annual household income of less than $25 000 (95% CI, 52.3%-58.1%), 37.6% smoked 20 to 29 cigarettes per day (95% CI, 34.7%-40.6%), and 12.7% smoked 30 or more cigarettes per day (95% CI, 10.9%-14.7%). Overall, 6.2% of the population (95% CI, 5.0%-7.5%) discontinued cigarette smoking. Discontinuation rates were higher among those who used e-cigarettes daily (28.0%; 95% CI, 15.2%-45.9%) compared with not at all (5.8%; 95% CI, 4.7%-7.2%; adjusted odds ratio [aOR], 8.11; 95% CI, 3.14-20.97). Furthermore, 10.7% (95% CI, 9.1%-12.5%) discontinued daily cigarette smoking, with higher rates of discontinuation observed among those who used e-cigarettes daily (45.5%; 95% CI, 27.4%-64.9%) compared with not at all (9.9%; 95% CI, 8.2%-11.8%; aOR, 9.67; 95% CI, 4.02-23.25). Nondaily e-cigarette use was not associated with cigarette discontinuation (aOR, 0.53; 95% CI, 0.08-3.35) or daily cigarette discontinuation (aOR, 0.96; 95% CI, 0.44-2.09). Conclusions and Relevance: In this cohort study, daily e-cigarette use was associated with greater odds of cigarette discontinuation among smokers who initially had no plans to ever quit smoking. These findings support the consideration of smokers who are not planning to quit when evaluating the risk-benefit potential of e-cigarettes for smoking cessation in the population.

New NIH Primary and Secondary Prevention Research During 2012-2019.

INTRODUCTION: This manuscript characterizes primary and secondary prevention research in humans and related methods research funded by NIH in 2012‒2019. METHODS: The NIH Office of Disease Prevention updated its prevention research taxonomy in 2019‒2020 and applied it to a sample of 14,523 new extramural projects awarded in 2012-2019. All projects were coded manually for rationale, exposures, outcomes, population focus, study design, and type of prevention research. All results are based on that manual coding. RESULTS: Taxonomy updates resulted in a slight increase, from an average of 16.7% to 17.6%, in the proportion of prevention research awards for 2012‒2017; there was a further increase to 20.7% in 2019. Most of the leading risk factors for death and disability in the U.S. were observed as an exposure or outcome in <5% of prevention research projects in 2019 (e.g., diet, 3.7%; tobacco, 3.9%; blood pressure, 2.8%; obesity, 4.4%). Analysis of existing data became more common (from 36% to 46.5%), whereas randomized interventions became less common (from 20.5% to 12.3%). Randomized interventions addressing a leading risk factor in a minority health or health disparities population were uncommon. CONCLUSIONS: The number of new NIH awards classified as prevention research increased to 20.7% in 2019. New projects continued to focus on observational studies and secondary data analysis in 2018 and 2019. Additional research is needed to develop and test new interventions or develop methods for the dissemination of existing interventions, which address the leading risk factors, particularly in minority health and health disparities populations.

Knowledge of and beliefs about palliative care in a nationally-representative U.S. sample.

Palliative care aims to improve quality of life for people with serious illness and their families. One potential barrier to palliative care uptake is inaccurate knowledge and/or negative beliefs among the general population, which may inhibit early interest in, communication about, and integration of palliative care following subsequent illness diagnosis. We explored knowledge and beliefs about palliative care among the general public using nationally-representative data collected in 2018 as part of the cross-sectional Health Information National Trends Survey. Only individuals who had heard of palliative care (n = 1,162, Mage = 51.8, 64% female) were queried on knowledge and beliefs. We examined whether self-assessed level of awareness of palliative care (i.e., knowing a little vs. enough to explain it) was associated with the relative likelihood of having accurate/positive beliefs, inaccurate/negative beliefs, or responding "don't know" to questions about palliative care. Respondents who indicated knowing a lot about palliative care had more accurate versus inaccurate knowledge than those who knew a little on only two of six items and more positive attitudes on only one of three items. In particular, respondents with greater awareness were equally likely to report that palliative care is the same as hospice and requires stopping other treatments, and equally likely to believe that palliative care means giving up and to associate palliative care with death. Those with higher awareness were less likely than those with lower awareness to respond "don't know," but greater awareness was not necessarily associated with having accurate or positive beliefs about palliative care as opposed to inaccurate or negative beliefs. Thus, even members of the general public who perceived themselves to know a lot about palliative care were often no less likely to report inaccurate knowledge or negative beliefs (versus accurate and positive, respectively). Findings suggest a need to improve awareness and attitudes about palliative care.

Social support, loneliness, eating, and activity among parent-adolescent dyads.

We examined associations of social support and loneliness with eating and activity among parent-adolescent dyads (N = 2968) using actor-partner interdependence modeling. Loneliness had several actor associations with health behaviors (adolescents: less physical activity [PA], p < .001, more sedentariness, p < .001; parents: less fruit/vegetable consumption [FVC], p = .029, more hedonic food consumption [HFC], p = .002, and sedentariness, p < .001), but only one dyadic association (adolescent loneliness with less parent FVC, p = .039). Visible support was associated with less HFC, p < .001, and sedentariness, p < .001, but less FVC, p = .008, among adolescents. Invisible support was associated with less HFC, p = .003, but also less PA, p = .028, among adolescents. Both support types were associated with less HFC among parents, p < .001, but invisible support was also associated with less FVC, p = .029, and PA, p = .012, and more sedentariness, p = .013, among parents. When examining health behavior among parents and adolescents, it may be important to consider social support (but perhaps not loneliness) at a dyadic level.

Awareness of Palliative Care among a Nationally Representative Sample of U.S. Adults.

Background: Palliative care can alleviate symptom burden, reduce psychosocial distress, and improve quality of life for patients suffering from serious or life-threatening illnesses. However, the extent to which U.S. adults are aware of or understand the goals and benefits of palliative care is not well understood. Public awareness of palliative care is necessary to change norms and create demand, and as such, limited awareness may be a significant barrier to palliative care uptake. An assessment of current palliative care awareness in the United States is needed to inform the health care sector's improving palliative care communication and delivery. Objective: To examine the prevalence of palliative care awareness among a nationally-representative sample of U.S. adults and to identify sociodemographic and health-related characteristics associated with palliative care awareness. Design: Weighted data from the Health Information National Trends Survey (HINTS 5, Cycle 2 [2018], N = 3445) were used to produce frequencies of the characteristics, and associations with palliative care awareness were determined through multiple logistic regression. Results: An estimated 71% of U.S. adults reported having never heard of palliative care. Older individuals, those with higher educational attainment, women, and whites (vs. nonwhites) had greater odds of palliative care awareness. Conclusions: These data suggest there is limited awareness of palliative care in the United States, despite its documented benefits. Addressing this awareness gap is a priority to change norms around using palliative care services. Community- and population-based interventions are necessary to raise awareness and inform the public about palliative care.

Patient-provider care goal concordance: implications for palliative care decisions.

Objective: Goal-concordant care is an important feature of high quality medical treatment. Patients' care goals may focus on curative and/or palliative outcomes. Patients rarely communicate their care goals, and providers' predictions of patient goals are often inaccurate, corresponding most closely to their own treatment goals. This projection of own goals onto patients introduces the potential for bias, leading to goal-discordant care. Design and Main Outcomes: We examined goal discordance using data from a U.S. sample of healthcare providers (N = 492) recruited online in 2017 using GfK Knowledge Panel. Providers reported their perceptions of their patients' care goals (curative relative to palliative), their own care goals if they were to become ill, and their willingness to deliver palliative care. Results: For 28% of providers, their own care goals differed from their patients'. Providers were more likely to prioritise palliative care (relative to curative) in their own goals than in their predictions about patients' goals. Providers were more willing to deliver palliative care when their own goals prioritised more palliative relative to curative care, but their perceptions of patient goals were unassociated with willingness to provide it. Conclusions: Efforts to improve goal communication and reduce projection biases among providers may facilitate goal-concordant care.

Toward a Conceptual Model of Affective Predictions in Palliative Care.

CONTEXT: Being diagnosed with cancer often forces patients and families to make difficult medical decisions. How patients think they and others will feel in the future, termed affective predictions, may influence these decisions. These affective predictions are often biased, which may contribute to suboptimal care outcomes by influencing decisions related to palliative care and advance care planning. OBJECTIVES: This study aimed to translate perspectives from the decision sciences to inform future research about when and how affective predictions may influence decisions about palliative care and advance care planning. METHODS: A systematic search of two databases to evaluate the extent to which affective predictions have been examined in the palliative care and advance care planning context yielded 35 relevant articles. Over half utilized qualitative methodologies (n = 21). Most studies were conducted in the U.S. (n = 12), Canada (n = 7), or European countries (n = 10). Study contexts included end of life (n = 10), early treatment decisions (n = 10), pain and symptom management (n = 7), and patient-provider communication (n = 6). The affective processes of patients (n = 20), caregivers (n = 16), and/or providers (n = 12) were examined. RESULTS: Three features of the palliative care and advance care planning context may contribute to biased affective predictions: 1) early treatment decisions are made under heightened emotional states and with insufficient information; 2) palliative care decisions influence life domains beyond physical health; and 3) palliative care decisions involve multiple people. CONCLUSION: Biases in affective predictions may serve as a barrier to optimal palliative care delivery. Predictions are complicated by intense emotions, inadequate prognostic information, involvement of many individuals, and cancer's effect on non-health life domains. Applying decision science frameworks may generate insights about affective predictions that can be harnessed to solve challenges associated with optimal delivery of palliative care.

Direct and indirect associations of cognitive reappraisal and suppression with disease biomarkers.

OBJECTIVE: Habitual use of emotion regulation strategies may influence physical health. We examined whether the tendencies to employ cognitive reappraisal and suppression were associated with health biomarkers, and whether stress and sleep quality mediated these associations. Design & main outcome measures: Using data from the Biomarkers substudy (n = 1255) of the national Midlife in the U.S. Study, we tested the hypothesis that there would be indirect, but not direct, associations of cognitive reappraisal and suppression to biomarker indicators of multisystem physiological dysregulation, that is, allostatic load (AL). We computed the proportion of biomarkers in the highest risk quartile within seven biological systems, and summed these scores to compute AL. Associations with the biological systems were also examined separately. RESULTS: Neither reappraisal nor suppression was directly associated with AL or biomarker function in the seven biological systems. Suppression was indirectly associated with higher AL and greater dysregulation in the inflammatory, metabolic, and hypothalamic-pituitary-adrenal systems via its relations to stress and sleep, p < 0.05. Reappraisal was indirectly associated with lower AL and less metabolic and inflammatory dysregulation, ps<0.05. CONCLUSIONS: Suppression and reappraisal may have different downstream health effects via stress, sleep, and biomarker expression, suggesting malleable emotion regulation strategies may be an important intervention target.

Moving beyond categorization to understand affective influences on real world health decisions.

This paper provides an overview of affect and health decision-making research, with a focus on identifying gaps, opportunities, and challenges to guide future research. We begin by defining common categorical distinctions of affective processes that influence health decisions: integral (i.e., related to the decision) and incidental (i.e., normatively unrelated to the decision) influences, and current (experienced in the moment) and anticipated ("cognitive representations" of future affect) affect. We then summarize key discoveries within the most common categories of affective influences on health decision making: current integral affect, current incidental affect, and anticipated integral affect. Finally, we highlight research gaps, challenges, and opportunities for future directions for research aimed at translating affective and decision science theory to improve our understanding of, and ability to intervene upon, health decision making.

Trajectories of Current and Predicted Satisfaction With One's Life Following a Cancer Diagnosis.

Background: Poor physical and mental health is common among cancer survivors, but little is known about how cancer influences life satisfaction and expectations about one's future, both of which may subsequently influence health decisions and outcomes. Purpose: The current study examined how a cancer diagnosis influences current and predicted future life satisfaction in seven domains, including family, finances, work, and health. Methods: We leveraged data from three waves of the Midlife in the United States study (N = 6,389) and examined the relation between new and past cancer diagnoses on satisfaction using generalized estimating equations. We also compared participants' predicted satisfaction to the actual satisfaction they reported at later waves of data collection, and examined whether concordance between the two differed by cancer history. Results: A cancer diagnosis was associated with a decline in satisfaction about one's present health and sex life, ps < .05, but satisfaction with all other domains remained steady or improved. In contrast, predictions about the future became and remained less optimistic than the predictions of those without cancer across all life domains except relationships with children, ps < .05. Within-subjects comparisons of predicted and actual satisfaction suggest those without a cancer history were optimistic in their predictions across all life domains except health whereas survivors were more accurate in their predictions. Conclusions: Given the many ways in which expectations about the future can influence decision making, behavior, and health, survivors' attenuated optimistic outlooks may influence their health and well-being.

Factors beyond Lack of Knowledge That Predict "I Don't Know" Responses to Surveys That Assess HPV Knowledge.

Accurately assessing the public's knowledge about the human papilloma virus (HPV) and the HPV vaccine remains critical for informing health education interventions aimed at increasing vaccine uptake. Responding "don't know" (DK) to survey questions that assess knowledge is common and DK responders are often systematically different from other responders, resulting in potential for bias. This study aimed to advance our understanding of DK responding to HPV knowledge items. Data from the nationally representative Health Information National Trends Survey Wave 5 Cycle 1 (N = 2,034) were used. Information seeking about cancer, information avoidance, health-related self-efficacy, and several cancer beliefs were examined as predictors of DK responding to six items that assessed HPV knowledge. DKs represented nearly half of responses. Adjusting for demographic factors, lower health-related self-efficacy, and greater information avoidance, cancer-mortality salience, and perceived ambiguity were associated with more DK responding, ps < .05. Even participants with incorrect responses had greater health-related self-efficacy, and less information avoidance, perceived ambiguity, and cancer-mortality salience than those who responded with DK. DK responding to HPV knowledge items is common and reflects factors beyond insufficient knowledge or motivation. Addressing causes of DK responding may reduce bias and improve interventions informed by surveys.

Effects of Emotion on Medical Decisions Involving Tradeoffs.

Risk perceptions for a disease can motivate use of medications that reduce disease risk. However, these medications are often accompanied by elevated risks for other adverse health effects, and perceived risk of these side effects may also influence decisions. Emotions experienced at the time of a decision influence risk judgments and decision making, and they may be important to examine in these tradeoff contexts. This study examined the effect of experimentally induced fear and anger on risk perceptions and willingness to use a hypothetical medical treatment that attenuates risk of one condition but increases the risk for another. Participants ( N = 1948) completed an induction of fear, anger, or neutral emotion and then read about a hypothetical medication that reduced risk for one health condition but increased risk for another, and they indicated their willingness to use it. Deliberative, experiential, and affective risk perceptions about both health conditions were measured, conditional on taking and not taking the medication. Fear condition participants were more willing to take the medication than those in the neutral condition (ß = 0.14; P = 0.009; 95% confidence interval, 0.036-0.25). Fear also increased deliberative, experiential, and affective risk when conditioned on not using the medication, Ps < 0.05. In contrast, anger did not influence willingness to use the medication ( P = 0.22) and increased deliberative and affective risk of side effects when conditioned on using the medication ( P < 0.05). As one of the first studies to examine how emotion influences tradeoff decision making, these findings extend our understanding of how fear and anger influence such decisions.

Sex Differences in the Association of Perceived Ambiguity, Cancer Fatalism, and Health-Related Self-Efficacy with Fruit and Vegetable Consumption.

Adequate fruit and vegetable (FV) consumption is promoted as a means of preventing chronic health conditions, such as cardiovascular disease and cancer. This study investigated whether perceived ambiguity about cancer prevention recommendations, fatalistic beliefs about cancer, and health-related self-efficacy were associated with FV consumption and whether sex moderated these associations. Data from the five most recent waves (spanning 2011 to 2017) of the nationally representative Health Information National Trends Survey (N = 16,965) were used. Participants reported levels of perceived ambiguity, cancer fatalism, health-related self-efficacy, and daily FV consumption. Perceived ambiguity and cancer fatalism were negatively associated with FV consumption, ps <.001, whereas health-related self-efficacy was positively associated with FV consumption, b = 0.34, p < .001. Sex moderated these associations, ps <.05. Perceived ambiguity and cancer fatalism were more strongly associated with less FV consumption for men, bs < -0.31, ps <.001, than women, bs < -0.14, ps <.01. In contrast, health-related self-efficacy was more strongly associated with more FV consumption for women, b = 0.43, p < .001, than men, b = 0.26, p < .001. These results suggest that tailoring health messaging to target sex-specific barriers may improve their effectiveness.

Interventions to Engage Affective Forecasting in Health-Related Decision Making: A Meta-Analysis.

Background: People often use affective forecasts, or predictions about how a decision will make them feel, to guide medical and health decision making. However, these forecasts are susceptible to biases and inaccuracies that can have consequential effects on decision making and health. Purpose: A meta-analysis was performed to determine the effectiveness of intervening to address affective forecasting as a means of helping patients make better health-related choices. Methods: We included between-subjects experimental and intervention studies that targeted variables related to affective forecasting (e.g., anticipated regret, anticipated affect) as a means of changing health behaviors or decisions. We determined the overall effect of these interventions on targeted affective constructs and behavioral outcomes, and whether conceptual and methodological factors moderated these effects. Results: A total of 133 independent effect sizes were identified from 37 publications (N = 72,020). Overall, affective forecasting interventions changed anticipated regret, d = 0.24, 95% confidence interval (CI) (0.15, 0.32), p < .001, behavior, d = 0.29, 95% CI (0.13, 0.45), p < .001, and behavioral intentions, d = 0.19, 95% CI (0.11, 0.28), p < .001, all measured immediately postintervention. Interventions did not change anticipated positive and negative affect, and effects on intentions and regret did not extend to follow-up time points, ps > .05. Generally, effects were not moderated by conceptual model, intervention intensity, or behavioral context. Conclusions: Affective forecasting interventions had a small consistent effect on behavioral outcomes regardless of intervention intensity and conceptual framework, suggesting such constructs are promising intervention targets across several health domains.

Relationship of "don't know" responses to cancer knowledge and belief questions with colorectal cancer screening behavior.

OBJECTIVE: Answering "I don't know" (DK) to survey questions that assess risk perceptions is common and occurs more often among disenfranchised groups. Because these groups also are at greater disease risk, statistically omitting or recoding DK responses may disproportionately exclude or misrepresent responses from marginalized groups and misinform intervention efforts. Because little is known about how the DK response is related to health behaviors, we examined whether the relation between DK response and colorectal cancer (CRC) screening behavior differed, depending on the construct queried (knowledge vs. beliefs). METHOD: Data from the Awareness and Beliefs about Cancer survey of U.S. adults aged 50 years or older (N = 1406) were used. Cancer symptom knowledge, cancer beliefs, and CRC screening history were assessed. DK response options were not offered but were recorded if spontaneously provided. Logistic regression tested whether DK response on knowledge and belief scales were associated with CRC screening. RESULTS: Adjusting for demographic factors, responding DK on ≥1 belief item was associated with lower odds of having been screened for CRC in the last 5 years, p < .001, whereas DK response on ≥1 knowledge item was unassociated with screening, p = .48. DK responders to belief items were even less likely to have been screened than participants with negative beliefs about cancer, p = .011. CONCLUSION: DK responses are differentially associated with CRC screening, depending on the construct queried, suggesting different mechanisms may underlie DK responding or its relationship with screening. Addressing construct-specific causes of DK response may improve survey research and the interventions based on them. (PsycINFO Database Record