A Hybrid Pragmatic and Factorial Cluster Randomized Controlled Trial for an Anti-racist, Multilevel Intervention to Improve Mental Health Equity in High Schools.

Systemic racism is pervasive in US society and disproportionately limits opportunities for education, work, and health for historically marginalized and minoritized racial and ethnic groups, making it an urgent issue of social justice. Because systemic racism is a social determinant of health prevalent across multiple social and institutional structures, it requires multilevel intervention approaches using effective designs and analytic methods to measure and evaluate outcomes. Racism is a fundamental cause of poor health outcomes, including mental health outcomes; thus, mental health services and programs that address racism and discrimination are key to promoting positive mental health of racial and ethnic minority youth. While multilevel interventions are well-suited for improving outcomes like youth mental health disparities, their evaluation poses unique methodological challenges, requiring specialized design and analytic approaches. There has been limited methodological guidance provided to researchers on how to test multilevel interventions using approaches that balance methodological rigor, practicality, and acceptability across stakeholder groups, especially within communities most affected by systemic racism. This paper addresses this gap by providing an example of how to rigorously evaluate a hypothetical, theoretically based, multilevel intervention promoting mental health equity in three US school systems using an anti-racist approach intervening at the macro- (i.e., school system), meso- (i.e., school), and micro- (i.e., family and student) levels to improve mental health in adolescents. We describe the design, sample size considerations, and analytic methods to comprehensively evaluate its effectiveness while exploring the extent to which the components interact synergistically to improve outcomes. The methodological approach proposed can be adapted to other multilevel interventions that include strategies addressing macro-, meso-, and micro-levels of influence.

Exploring motivation to quit and risk appraisals of hookah tobacco smoking for self and partner among a member of single and dual smoker couples.

Negative health effects of waterpipe tobacco smoking (WTS) are likely more pronounced in dual rather than single smoker couples. Data on how smokers' perceived harms for self and partner differ between couple types and how these perceptions are associated with motivation to quit are needed. We examined these associations by surveying one member of dual smoker (i.e., both partners smoke) and single smoker (i.e., one partner smokes) couples who engages in WTS. We enrolled online adults ages 18-32 who engaged in WTS during the last month and were in a committed relationship of at least six months. Participants rated their harm to self and, when relevant, to partner, how much they were harming their partner due to their WTS, and partner's smoke exposure. Participants reported their motivation to quit. Of the 323 participants, 215 (67%) were in dual smoker couples. Participants in dual smoker couples reported lower own perceived risk, which correlated highly with perceived partner risk, than participants in single smoker couples; they also reported harming their partners more even though they downplayed how frequency of smoke exposure was harming the partner. Motivation to quit did not differ by couple type. Across couple types, motivation to quit increased with greater perceived harms. Smokers in dual compared to single smoker couples downplay their risks and perceived harms their smoking causes their partner. Interventions focused on harms to self and partner may be effective to increase motivation to quit and cessation in both couple types.

Perceptions of physical activity and sedentary behaviour guidelines among end-users and stakeholders: a systematic review.

BACKGROUND: Many of the world's population, across all age groups and abilities, are not meeting or even aware of internationally recommended physical activity (PA) and sedentary behaviour (SB) guidelines. In order to enhance awareness and uptake, guidelines should be perceived positively by targeted users. The purpose of this study was to review the literature on end-user and stakeholder perceptions of PA and SB guidelines. METHODS: The electronic databases APA PsycInfo, CINAHL, MEDLINE, and SPORTDiscus, using EBSCOhost Research Platform, and Web of Science were searched from inception to June, 2021 with keyword synonyms for "perceptions", "PA guidelines", and "SB guidelines". Studies of any design that collected stakeholder and/or end-user responses to a PA and/or SB guideline were included and assessed for risk of bias. The PA and/or SB guideline could be any type of official form (e.g., national documents, organizational guidelines, expert consensus statements, etc.) from any country, that targets individuals at the regional, provincial/statewide, national, or international level, and includes all types of guidelines (e.g., strength, aerobic, clinical, nonclinical, screen-time, sitting, etc.). Data were extracted and analyzed using thematic synthesis. RESULTS: After screening 1399 abstracts and applying citation screening, 304 full-texts were retrieved. A total of 31 articles met the inclusion criteria. End-users and stakeholders for PA guidelines across all age groups expressed the need for simplified language with more definitions, relatable examples and imagery, and quantification of PA behaviours. There was concern for the early years and child PA guidelines leading to guilt amongst parents and the SB guidelines, particularly the recommendations to limit screen-time, being unrealistic. General age group PA guidelines were not perceived as usable to populations with differing abilities, clinical conditions, and socioeconomic status. Guidelines that targeted clinical populations, such as persons with multiple sclerosis and persons with spinal cord injury, were well received. CONCLUSIONS: There is a clear need to balance the evidence base with the pragmatic needs of translation and uptake so that the guidelines are not ignored or act as a barrier to actual engagement.

Influencing Perceptions of Harm of Waterpipe Tobacco Smoking Among One Member of Couples Who Use Waterpipe.

INTRODUCTION: Waterpipe tobacco smoking (WTS) often occurs socially, increasing health risks for the smoker and others through secondhand smoke effects. While messages on WTS harms enhance perceived risks for self, whether these messages elevate perceived risks for others, such as one's romantic partner who engages in WTS, is unclear. We tested this idea by surveying one member of dual-smoking couples who engages in WTS. AIMS AND METHODS: As part of an online study, we enrolled adults ages 18-30 who engaged in WTS and were in a committed relationship of at least 6 months whose partner engaged in WTS. Participants were randomized to a control arm or to one of two arms consisting of watching a brief video on health harms or overcoming myths about WTS, respectively. Outcomes were perceived harms and measures of desire and probability of quitting for self and partner. RESULTS: Participants (N = 238) who watched either video, compared with participants who did not watch a video, reported greater perceived health risks for self and partner and that their own WTS harmed their partner. Participants who watched either video reported a greater desire to quit for themselves, perceived that their partner had a greater desire to quit, and reported a higher likelihood of quitting together in the next 6 months. CONCLUSIONS: Brief videos containing risk-based messaging increase young adult waterpipe tobacco smokers' perceived harms and desire to quit for self and partner. This can be a useful strategy to motivate cessation in couples who engage in WTS. IMPLICATIONS: This study shows for the first time that at least among one member of dual-smoking couples who engages in WTS, brief videos on harms of WTS influences perceived harms and motivation to quit for the self and one's partner. This can be a useful strategy to promote cessation.

Effects of mental simulation of future waterpipe tobacco smoking on attitudes, perceived harms and intended use among young adults.

The desire to engage in waterpipe tobacco smoking (WTS) may occur when smokers and nonsmokers conjure positive mental simulations of WTS. However, effects of these simulations on desire to smoke waterpipe tobacco and potential mediators are unexplored. This research addressed these effects among young adult waterpipe tobacco smokers and nonsmokers. Two online studies were conducted with adults ages 18-30. In Study 1, 200 smokers, 190 susceptible nonsmokers, and 182 nonsusceptible nonsmokers were randomized to mentally simulate or not WTS in the future. In Study 2, 234 smokers and 241 susceptible nonsmokers were randomized to four arms: no simulation or simulations that varied valence of experience (positive, negative or no valence provided). Main outcomes were immediate desire to smoke waterpipe tobacco, cognitive and affective attitudes, and perceived harms. In Study 1, mental simulations increased the desire to smoke waterpipe tobacco among smokers. In Study 2, asking participants to simulate WTS positively or with no valence instruction increased desire to smoke relative to negative valence instruction or no simulation. Negative simulations reduced perceived probability of smoking within a month compared to positive simulations. Effects on desire to engage in WTS were mediated by cognitive and affective attitudes among susceptible nonsmokers and by cognitive attitudes among smokers. These findings suggest that exploring when and how often mental simulations about WTS are evoked and their potency for promoting prevention and cessation of WTS merit further attention.

Effects of Educational Materials About Harms of Waterpipe Tobacco Charcoal use on Adult Smokers' Risk Perceptions.

A prospective online study, consisting of 203 participants ages 18 and older who smoked waterpipe (hookah) within the last 30 days, examined how brief messaging about harms of burning charcoal to heat waterpipe tobacco (shisha) influenced knowledge of toxicants released by using charcoal and perceived harms of using charcoal. Participants were randomized to either a control or to an educational arm that reviewed toxicants released by burning charcoal and the health consequences. Participants in the educational relative to the control arm perceived charcoal as more harmful, were more knowledgeable of toxicants released by burning charcoal, and expressed a stronger desire to quit. Effects were sustained a week later. Brief messages about the harms of burning charcoal were effective and may be used to educate the public about the harms of waterpipe tobacco smoking.

Tailored Mobile Messaging Intervention for Waterpipe Tobacco Cessation in Young Adults: A Randomized Trial.

Objectives. To test a tailored mobile health (i.e., mHealth) intervention for waterpipe tobacco cessation in young adults. Methods. From 2018 to 2020 at 2 US sites, we conducted a randomized trial with 349 waterpipe tobacco smokers aged 18 to 30 years randomized to control (no intervention), untailored, or tailored intervention arms. Intervention arms received a 6-week mHealth intervention conveying risks of waterpipe tobacco through text and images and strategies to enhance motivation and support quitting. The tailored intervention was personalized to baseline measures and intervention text message responses. Risk appraisals, motivation to quit, waterpipe smoking frequency, and cessation were assessed at 6 weeks, 3 months, and 6 months. Results. At 6 months, cessation was higher in the tailored (49%) than the control arm (29%; odds ratio = 2.4; 95% confidence interval = 1.3, 4.2) and smoking frequency was lower in the tailored (mean = 3.5 days) than the control arm (mean = 4.3 days; P = .006). At interim follow-ups, significant differences in other outcomes favored the tailored intervention. Conclusions. Tailored mobile messaging can help young adult waterpipe tobacco smokers quit. This scalable intervention is poised for population implementation.

Illness uncertainty, partner support, and quality of life: A dyadic longitudinal investigation of couples facing prostate cancer.

OBJECTIVE: Prostate cancer (PC) and its treatment often result in chronic, negative side-effects that affect both patients and their romantic partners. Illness uncertainty is a chronic stressor that impacts PC patients and their partners and, if left unmanaged, predicts decreased interpersonal functioning and quality of life (QOL) after treatment is complete. This study explored associations among psychosocial constructs, measured from both partners during the first year following a PC diagnosis, to better understand both partners' experiences and identify potential intervention targets for improving QOL. METHODS: Couples (N = 165) in which one partner was undergoing treatment for PC were recruited from the Duke University Medical Center of Urology. Patients and their partners were surveyed at four time points: diagnosis and 1-, 6-, and 12-months post treatment. An Actor-Partner Interdependence Model (APIM) framework was used to examine associations among perceived partner support, nonsupportive behaviors, illness uncertainty, relationship satisfaction, and physical and mental QOL. RESULTS: Partners feeling more supported at diagnosis was related to patients feeling more supported at 6 months. When patients' illness uncertainty decreased between diagnosis and 1 month, partners reported feeling more supported and engaging in fewer nonsupportive behaviors at 6-months post-treatment. Finally, partners' reports of support at 6 months predicted patients' 12-month ratings of physical and mental QOL and relationship satisfaction. CONCLUSIONS: Findings highlight psychological interdependence between PC patients and their partners. Future interventions to improve long-term QOL in couples facing PC may benefit by targeting both partner support and illness uncertainty.

Predicting Colorectal Cancer Screening among Adults Who Have Never Been Screened: Testing the Interaction between Message Framing and Tailored Risk Feedback.

Providing adults tailored risk estimates of getting colorectal cancer (CRC) can increase screening. A concern is that receipt of lower risk estimates will demotivate screening; this effect may be curbed by matching level of risk with message framing. Theoretically, pairing lower risk estimates with gain-frame messages, and higher risk estimates with loss-frame messages, should increase screening and screening intentions more than pairing lower risk estimates with loss-frame messages/higher risk estimates with gain-frame messages. These effects may be mediated by how screening is construed (e.g., to find health problems vs. to reaffirm one is healthy). These predictions were tested experimentally among 560 men and women ages 50-75 who have never screened. Participants at baseline received online a tailored comparative risk estimate with gain- or loss-frame information on screening. Screening was assessed six months later. Among the 400 reached at six months, 9.5% reported screening. There were no main effects or interactions between risk feedback and framing predicting construals, screening intentions, or screening. Worry about getting CRC and screening intentions predicted screening. While hypothesized interactions were not found, future research should explore further mechanisms through which online interventions utilizing risk feedback and framing motivate screening among adults who have never screened.

Reactions to online colorectal cancer risk estimates among a nationally representative sample of adults who have never been screened.

Data on the public's reactions to online tailored colorectal cancer (CRC) risk estimates are sparse. We assessed among 560 men and women aged 50-75 with no CRC screening history reactions to online tailored CRC estimated comparative risk (i.e., self vs. other their age and sex). Assessed were reactions to estimate (i.e., repeating back estimate, match between perceived comparative risk and estimate, accuracy and usefulness of estimate, emotional reactions), risk appraisals and screening intentions. 73% of the sample accurately repeated back their estimate; the match between perceived comparative risk and the estimate was lowest among those informed of being at higher risk. Higher estimates were viewed as less useful and evoked more negative emotions. Viewing the estimate as more useful and experiencing more negative emotions were related with higher risk appraisals and, in turn, screening intentions. These data indicate that adults at higher comparative risk resist accepting a higher risk status.

Patient's lung cancer diagnosis as a cue for relatives' smoking cessation: evaluating the constructs of the teachable moment.

BACKGROUND: To understand whether patient-reported experiences with lung cancer may create teachable moments (TM) for their relatives as evidenced by shifts in their risk perceptions, affective response, and self-image and in turn, motivation to quit smoking. METHODS: Patients at a comprehensive cancer center (n = 152) completed a survey within 6 months of lung cancer diagnosis to assess their cancer-related symptoms and openness and enumerated relatives who were smokers. Relative smokers (n = 218) then completed a survey assessing their risk perceptions, affective response, and self-image as a smoker related to the patient's diagnosis (TM mechanisms), and their motivation to quit smoking. Cross-sectional mediation and moderation analyses were conducted to explore the links between patient-reported experiences, and relatives' TM mechanisms, and motivation to quit smoking. RESULTS: Relative-reported affect was a significant mediator of the association between patient-reported symptoms and relative smoker's desire to quit. Relatives' self-image was a significant moderator of the association between patient-reported symptoms and relative smoker's desire to quit, such that patients' reported symptoms were associated with relatives' desire to quit only when the relative smoker reported a generally positive self-image as a smoker. No evidence was found for moderated mediation. However, the link between symptoms and negative affect was moderated by perceptions of risk. CONCLUSION: Whether smokers experience a family member's lung cancer as a TM is influenced by multiple interrelated cognitive and affective factors that warrant further exploration. Clearer understanding of these factors could inform how to re-invigorate and sustain this motivation to promote concrete actions toward smoking cessation. Copyright © 2015 John Wiley & Sons, Ltd.

Characterizing Young Adults' Susceptibility to Waterpipe Tobacco Use and Their Reactions to Messages About Product Harms and Addictiveness.

INTRODUCTION: There is very little insight into the psychosocial characteristics of young adults susceptible to waterpipe tobacco use and their reactions to messages about harms of waterpipe tobacco smoking (WTS). We investigated how young adults who were or were not susceptible to WTS differed on various characteristics and their reactions to messages about WTS harms. METHODS: Young adults ages 18 to 30 who had never used waterpipe tobacco were recruited through an online crowdsourcing site. Participants were stratified on susceptibility status (susceptible or not) and randomized to receive messages about harms and addictiveness of WTS or a control condition that received no messages. Participants' perceptions of risk and worry, their attitudes toward, and willingness/curiosity to try WTS were assessed. RESULTS: Compared to nonsusceptible participants, susceptible participants perceived themselves to be at lower risk and worried less about harms and addictiveness of WTS, had more positive attitudes toward use, and expressed a greater willingness and curiosity to try it. Among susceptible participants, messages decreased willingness/curiosity to try WTS; messages had no effect on nonsusceptible participants. The message effects among susceptible participants were explained by more negative attitudes and less ambivalence toward WTS. CONCLUSIONS: Susceptible young adults' psychosocial characteristics place them at high risk for future uptake of WTS. Brief public health messages about harm and addiction may deter susceptible young adults' willingness to try WTS and prevent WTS initiation and progression. IMPLICATIONS: Findings suggest that in order to curb the initiation of WTS among susceptible young adults, interventions should target risk appraisals and attitudes toward WTS.

Effects of physical and mental health on relationship satisfaction: a dyadic, longitudinal examination of couples facing prostate cancer.

OBJECTIVES: Prostate cancer may affect quality of life in men diagnosed as well as their spouses. Changes in health may disrupt the couple's relationship functioning which disrupts recovery. This study examined how mental and physical health relates to relationship satisfaction for couples at diagnosis through the year following treatment. METHODS: Patients with stage I-II prostate cancer and their spouses (N = 159 couples) were recruited from a urology clinic and completed questionnaires at diagnosis, 1 month, 6 months, and 12 months post prostatectomy on demographics, mental and physical health quality of life, and relationship satisfaction. The Actor-Partner Interdependence Model was employed to examine effects of each partners' mental and physical health on their own and their partner's relationship satisfaction. RESULTS: Patients and spouses had declined mental and physical health at 1 month post-surgery. Health improved at 6 and 12 months but did not fully return to pre-surgery levels. Actor effects showed that patient's physical health consistently predicted own relationship satisfaction. Both patient's and spouse's mental health consistently related to their own relationship satisfaction. Partner effects showed that patient's and spouse's physical health had an effect on each other's relationship satisfaction at 1 month. Spouse's mental health predicted patient's relationship satisfaction throughout the year following treatment. CONCLUSION: The effects of patient and spouse mental and physical health quality of life on their own as well as their partner's relationship satisfaction differed across time which will inform psychosocial interventions for couples with prostate cancer. Copyright © 2015 John Wiley & Sons, Ltd.

The Effects of Brief Waterpipe Tobacco Use Harm and Addiction Education Messages Among Young Adult Waterpipe Tobacco Users.

INTRODUCTION: This study investigated the immediate effects of brief education messages delivered online about harms and addictiveness of waterpipe tobacco use among young adult waterpipe users aged 18 to 30 years. METHODS: Participants (n = 327, mean age 24.8 years, 62.1% male, 77.6% white, 67.8% used waterpipe monthly, 26.4% weekly, 5.8% daily) were recruited online and randomized to one of three experimental conditions: (1) Control condition viewing no messages; (2) Harms condition viewing messages about harms of waterpipe tobacco; (3) Harms and addiction condition viewing messages about harms and addictiveness of waterpipe tobacco. Outcomes included perceived harm and addictiveness of waterpipe, worry about harm and addiction, and desire to quit. RESULTS: Compared to the control condition, participants in the harms condition reported significantly greater perceived harm and addictiveness of waterpipe relative to cigarettes, perceived risk of harm and addiction, worry about harm and addiction, and desire to quit. There were few significant differences in these outcomes between participants in the harms condition and the harms and addiction condition. Mediation analyses suggest waterpipe tobacco use harm messages may increase desire to quit by producing greater worry about harm and addiction. CONCLUSIONS: Brief education messages about waterpipe tobacco use harm increased young adult's perceptions of harm and addictiveness of waterpipe tobacco use and generated stronger desire to quit. The waterpipe tobacco use addiction messages tested had little added impact. Studies should prospectively examine the real-world impact of waterpipe tobacco use harm messages and investigate more effective strategies for designing addiction messages. IMPLICATIONS: This study demonstrates that brief education messages about waterpipe tobacco use harm can increase young adult waterpipe tobacco user's perceptions of harm and addictiveness of waterpipe tobacco use and generate stronger desire to quit. The findings indicate messages on addictiveness of waterpipe tobacco use have no added impact on these outcomes.

Does Quitting Smoking Make a Difference Among Newly Diagnosed Head and Neck Cancer Patients?

INTRODUCTION: To determine if smoking after a cancer diagnosis makes a difference in mortality among newly diagnosed head and neck cancer patients. METHODS: Longitudinal data were collected from newly diagnosed head and neck cancer patients with a median follow-up time of 1627 days (N = 590). Mortality was censored at 8 years or September 1, 2011, whichever came first. Based on smoking status, all patients were categorized into four groups: continuing smokers, quitters, former smokers, or never-smokers. A broad range of covariates were included in the analyses. Kaplan-Meier curves, bivariate and multivariate Cox proportional hazards models were constructed. RESULTS: Eight-year overall mortality and cancer-specific mortality were 40.5% (239/590) and 25.4% (150/590), respectively. Smoking status after a cancer diagnosis predicted overall mortality and cancer-specific mortality. Compared to never-smokers, continuing smokers had the highest hazard ratio (HR) of dying from all causes (HR = 2.71, 95% confidence interval [CI] = 1.48-4.98). Those who smoked at diagnosis, but quit and did not relapse-quitters-had an improved hazard ratio of dying (HR = 2.38, 95% CI = 1.29-4.36) and former smokers at diagnosis with no relapse after diagnosis-former smokers-had the lowest hazard ratio of dying from all causes (HR = 1.68, 95% CI = 1.12-2.56). Similarly, quitters had a slightly higher hazard ratio of dying from cancer-specific reasons (HR = 2.38, 95% CI = 1.13-5.01) than never-smokers, which was similar to current smokers (HR = 2.07, 95% CI = 0.96-4.47), followed by former smokers (HR = 1.70, 95% CI = 1.00-2.89). CONCLUSIONS: Compared to never-smokers, continuing smokers have the highest HR of overall mortality followed by quitters and former smokers, which indicates that smoking cessation, even after a cancer diagnosis, may improve overall mortality among newly diagnosed head and neck cancer patients. Health care providers should consider incorporating smoking cessation interventions into standard cancer treatment to improve survival among this population. IMPLICATIONS: Using prospective observational longitudinal data from 590 head and neck cancer patients, this study showed that continuing smokers have the highest overall mortality relative to never-smokers, which indicates that smoking cessation, even after a cancer diagnosis, may have beneficial effects on long-term overall mortality. Health care providers should consider incorporating smoking cessation interventions into standard cancer treatment to improve survival among this population.

A preliminary exploration of college smokers' reactions to nicotine dependence genetic susceptibility feedback.

INTRODUCTION: Many young smokers underestimate their risk for becoming addicted to cigarettes. We explored whether informing light college smokers (i.e., fewer than 5 cigarettes/day) of their genetic predisposition to nicotine dependence influenced their perceived risks and worry about becoming addicted, their ability to quit (i.e., self-efficacy), their desire to quit, and smoking cessation. METHODS: College smokers (n = 142) received educational materials on mechanisms and consequences of nicotine addiction and were offered genetic susceptibility testing for nicotine dependence. Participants who accepted testing were randomized to receive feedback or no feedback (i.e., control). Tested participants learned they were above or not above average genetic risk for nicotine dependence. All participants responded to questions about perceived risks and worry about becoming addicted, efficacy to quit, and desire to quit. Cessation was assessed during a 1-month follow-up. RESULTS: Efficacy beliefs, worry about becoming addicted, and desire to quit did not differ by study condition or feedback. Perceived risk for becoming addicted was highest among tested participants informed they were above average risk for nicotine dependence. Overall, self-reported 30- but not 7-day quit rate was higher among participants who underwent genetic testing compared with control participants. CONCLUSIONS: This pilot study is the first to show that among light college smokers, receipt of genetic susceptibility feedback to nicotine dependence potentially curbs smoking without producing detrimental effects.

Assessing and Predicting Susceptibility to Waterpipe Tobacco Use Among College Students.

INTRODUCTION: College youth susceptible to waterpipe tobacco smoking (WTS) represent an important target to intervene upon in order to prevent their uptake of this product. This study examined the performance of a 4-item susceptibility measure to WTS to predict future waterpipe use and correlates of susceptibility. METHODS: A cohort of college students from 11 university campuses in North Carolina and Virginia completed an online survey in 2012 and again in 2013 that assessed WTS susceptibility and subsequent waterpipe use. Tobacco use, marijuana use, binge drinking, and sensation seeking were also assessed. RESULTS: Overall, 964 students who reported having never used waterpipe tobacco in 2012 completed the online surveys both years. Overall, about 27% of college youth were susceptible to WTS each year. Participants susceptible in 2012 were 2.5 times more likely to report having used waterpipe tobacco the subsequent year than non-susceptible participants after controlling for significant correlates of waterpipe use. Correlates of susceptibility were: being male, past 30 day cigarette smoking, use of other tobacco products, binge drinking and marijuana use, as well as higher sensation seeking. CONCLUSIONS: A 4-item WTS susceptibility measure predicts future WTS. This measure can be used to identify and intervene upon susceptible college youth to curb further exploration of WTS. Indeed, a nontrivial proportion of college students found susceptible go on to use waterpipe tobacco within a year.

Effects of Numerical Versus Foreground-Only Icon Displays on Understanding of Risk Magnitudes.

The aim of this work is to advance knowledge of how to measure gist and verbatim understanding of risk magnitude information and to apply this knowledge to address whether graphics that focus on the number of people affected (the numerator of the risk ratio, i.e., the foreground) are effective displays for increasing (a) understanding of absolute and relative risk magnitudes and (b) risk avoidance. In 2 experiments, the authors examined the effects of a graphical display that used icons to represent the foreground information on measures of understanding (Experiments 1 and 2) and on perceived risk, affect, and risk aversion (Experiment 2). Consistent with prior findings, this foreground-only graphical display increased perceived risk and risk aversion; however, it also led to decreased understanding of absolute (although not relative) risk magnitudes. Methodologically, this work shows the importance of distinguishing understanding of absolute risk from understanding of relative risk magnitudes, and the need to assess gist knowledge of both types of risk. Substantively, this work shows that although using foreground-only graphical displays is an appealing risk communication strategy to increase risk aversion, doing so comes at the cost of decreased understanding of absolute risk magnitudes.

Daughters and Mothers Against Breast Cancer (DAMES): main outcomes of a randomized controlled trial of weight loss in overweight mothers with breast cancer and their overweight daughters.

BACKGROUND: Few studies to date have used the cancer diagnosis as a teachable moment to promote healthy behavior changes in survivors of cancer and their family members. Given the role of obesity in the primary and tertiary prevention of breast cancer, the authors explored the feasibility of a mother-daughter weight loss intervention. METHODS: A randomized controlled trial of a mailed weight loss intervention was undertaken among 68 mother-daughter dyads (n = 136), each comprised of a survivor of breast cancer (AJCC stage 0-III) and her adult biological daughter. All women had body mass indices ≥ 25 kg/m(2) and underwent in-person assessments at baseline, 6 months, and 12 months, with accelerometry and exercise capacity performed on a subset of individuals. All women received a personalized workbook and 6 newsletters over a 1-year period that promoted weight loss; exercise; and a nutrient-rich, low-energy density diet. A total of 25 dyads received individually tailored instruction (individual), 25 dyads received team-tailored instruction (TEAM), and 18 dyads received standardized brochures (control). RESULTS: The trial met its accrual target, experienced 90% retention, and caused no serious adverse events. Significant differences in baseline to 12-month changes were observed between individual versus control mothers for body mass index, weight, and waist circumference (WC); significant differences also were observed in the WC of corresponding daughters (P < .05). Significant differences were found between individual versus control and team versus control dyads for WC (P = .0002 and .018, respectively), minutes per week of physical activity (P = .031 and .036, respectively), and exercise capacity (P = .047 for both). CONCLUSIONS: Significant improvements in lifestyle behaviors and health outcomes are possible with tailored print interventions directed toward survivors of cancer and their family members. For greater impact, more research is needed to expand this work beyond the mother-daughter dyad.