Development of an Intervention Targeted to Patients with Cancers Not Typically Perceived as Smoking-Related.

Smoking by cancer patients impairs treatment outcomes and prognoses across cancer types. Previous research shows greater smoking cessation motivation and quit rates among patients with cancers strongly linked to smoking (i.e., thoracic, head and neck) compared to other cancer types (e.g., melanoma). Therefore, there is a need to increase cessation motivation among patients with malignancies less commonly associated with smoking. Yet, no targeted educational materials exist to meet this information gap. This manuscript describes the development of theory-based self-help educational materials, targeted by cancer type, to increase motivation to quit smoking among patients with cancers not widely perceived as smoking-related (i.e., breast, melanoma, bladder, colorectal, gynecological). Using a three-phase iterative process, we first conducted in-depth interviews with our intended audience (N = 18) to identify information needs and nuanced content. Themes included patients' low knowledge about the connection between smoking and cancer etiology and outcomes; negative affect, habit, dependence, and weight gain as quitting barriers; and a preference for positive and non-judgmental content. Second, content creation was based on interview findings, the scientific literature, and framed following the teachable moment model. Last, learner verification and revisions via interviews with 22 patients assessed suitability of draft materials, with generally favorable responses. Resulting edits included tailoring cost savings to the cancer context, explaining cessation medications, and increasing appeal by improving the diversity (e.g., race) of the individuals in the photographs. The final booklets are low cost, easy to disseminate, and-pending efficacy studies-may expand smoking cessation to a wider spectrum of cancer patients.

Testing Theory-Based Messages to Encourage Women at Average Risk for Breast Cancer to Consider Biennial Mammography Screening.

BACKGROUND: The US Preventive Services Task Force does not recommend routine annual mammography screening for women aged 40-49 at average risk. Little research has been done to develop theory-based communication interventions to facilitate informed decision-making about reducing potentially low-value mammography screening. PURPOSE: Evaluate the effects of theory-based persuasive messages on women's willingness to consider delaying screening mammography until age 50 or have mammograms biennially. METHODS: We conducted a randomized controlled communication experiment online with a population-based sample of U.S. women aged 40-49 (N = 383) who screened to be at average risk for breast cancer. Women were randomly assigned to the following messaging summaries: annual mammography risks in 40s (Arm 1, n = 124), mammography risks plus family history-based genetic risk (Arm 2, n = 120), and mammography risks, genetic risk, and behavioral alternatives (Arm 3, n = 139). Willingness to delay screening or reduce screening frequency was assessed post-experiment by a set of 5-point Likert scale items. RESULTS: Women in Arm 3 reported significantly greater willingness to delay screening mammography until age 50 (mean = 0.23, SD = 1.26) compared with those in Arm 1 (mean = -0.17, SD = 1.20; p = .04). There were no significant arm differences in willingness to reduce screening frequency. Exposure to the communication messages significantly shifted women's breast cancer-related risk perceptions without increasing unwarranted cancer worry across all three arms. CONCLUSIONS: Providing women with screening information and options may help initiate challenging discussions with providers about potentially low-value screening.

The US Preventive Services Task Force does not recommend routine annual mammography screening for women aged 40­49 at average risk. This study aimed to assess the impact of theory-based persuasive messages on women's willingness to delay mammography screening until age 50 or opt for biennial screenings. In a randomized online experiment, 383 U.S. women aged 40­49 at average risk for breast cancer were assigned to three different message groups. The results showed that women exposed to messaging that included mammography risks, family history-based genetic risk, and behavioral alternatives were significantly more willing to delay screening until age 50. However, there were no significant differences in willingness to reduce screening frequency. The tested communication messages effectively shifted women's breast cancer-related risk perceptions without causing unnecessary worry. Providing women with screening information and options may help initiate challenging discussions with providers about potentially low-value screening.

Evaluating fertility preservation interventions for alignment with ASCO Guidelines for reproductive aged women undergoing cancer treatment: a systematic review.

PURPOSE: While cancer treatment advancements have increased the number of reproductive-aged women survivors, they can harm reproductive function. Despite national guidelines, oncofertility service uptake remains low. This review explores interventions for fertility preservation alignment with American Society of Clinical Oncology (ASCO) guidelines and consideration of a multilevel framework. METHODS: We systematically reviewed literature from 2006 to 2022 across four databases. Identified interventions were assessed and scored for quality based on CONSORT and TREND statement checklists. Results were synthesized to assess for intervention alignment with ASCO guidelines and four multilevel intervention framework characteristics: targeted levels of influence, conceptual clarity, methodologic pragmatism, and sustainability. RESULTS: Of 407 articles identified, this review includes nine unique interventions. The average quality score was 7.7 out of 11. No intervention was guided by theory. Per ASCO guidelines, most (n=8) interventions included provider-led discussions of treatment-impaired fertility. Fewer noted discussions on fertility preservation approaches (n=5) and specified discussion timing (n=4). Most (n=8) referred patients to reproductive specialists, and few (n=2) included psychosocial service referrals. Most (n=8) were multilevel, with five targeting three levels of influence. Despite targeting multiple levels, all analyses were conducted at the individual level. Intervention strategies included: educational components (n=5), decision aids (n=2), and nurse navigators (n=2). Five interventions considered stakeholders' views. All interventions were implemented in real-world contexts, and only three discussed sustainability. CONCLUSIONS: This review identifies key gaps in ASCO guideline-concordant fertility preservation that could be filled by updating and adhering to standardized clinical practice guidelines and considering multilevel implementation frameworks elements.

Psychosocial factors associated with genetic testing status among African American women with ovarian cancer: Results from the African American Cancer Epidemiology Study.

BACKGROUND: Racial disparities in the uptake of cancer genetic services are well documented among African American (AA) women. Understanding the multiple social and psychological factors that can influence the uptake of genetic testing among AA women is needed. METHODS: Data came from 270 AA women diagnosed with ovarian cancer and participating in a population-based, case-control study of ovarian cancer who were asked about genetic testing. Logistic regression analyses tested the associations of predisposing, enabling, and need factors with reported genetic testing uptake. RESULTS: One-third of the sample (35%) reported having had genetic testing. In the multivariable model, AA women with higher incomes had more than double the odds of being tested than those with the lowest income (odds ratio [OR] for $25,000-$74,999, 2.04; 95% confidence interval [CI], 1.06-3.99; OR for ≥$75,000, 2.32; 95% CI, 0.92-5.94). AA women who reported employment discrimination were significantly less likely to report genetic testing than those who did not report job discrimination (OR, 0.39; 95% CI, 0.14-0.95). Marital status, Medicaid versus other insurance, prayer frequency, and perceived social support were significantly associated with genetic testing uptake in bivariate analyses but were not significant contributors in multivariable analyses. CONCLUSIONS: Consistent with other studies of AA women, a minority of African American Cancer Epidemiology Study participants had undergone genetic testing. Having a lower income and experiencing job discrimination decreased the likelihood of testing. These results provide foundational evidence supporting the need for interventions to improve the uptake of genetic testing among AA women by reducing cost barriers and providing credible assurances that genetic results will be kept private and not affect social factors such as employability.

Optimal Integration of Behavioral Medicine into Clinical Genetics and Genomics.

Clinical genetics and genomics will exert their greatest population impact by leveraging the rich knowledge of human behavior that is central to the discipline of behavioral medicine. We contend that more concerted efforts are needed to integrate these fields synergistically, and accordingly, we consider barriers and potential actions to hasten such integration.

Predictors of Discussing Lung Cancer Screening with a Health Care Provider Among Current and Former Smokers in HINTS: A Secondary Data Analysis.

INTRODUCTION: Lung cancer screening is greatly underutilized among those who may benefit from early detection. METHODS: We analysed data from a subsample (n = 929) of the 2020 Health Information National Trends Survey. We tested multivariable logistic regression models of associations of cancer worry, information insufficiency, and perceived information gathering capacity with reports of having discussed lung cancer screening with a health care provider. RESULTS: Among former smokers, no factors were associated significantly with lung cancer screening information seeking. However, for current smokers, extreme cancer worry was positively and significantly associated with having discussed lung cancer screening with a health care provider (OR: 12.95; 95% CI: 2.11, 79.39). CONCLUSION: To increase uptake of lung cancer screening, public health campaigns and healthcare providers will face the dual challenge of increasing perceived need for screening among former smokers while directing current smokers with high levels of worry to see the benefits of early detection.

Exploring the Role of Community Health Workers in Improving the Collection of Family Health History: A Pilot Study.

Community health workers (CHWs) have been successful partners in addressing public health and health care challenges but have yet to be engaged in efforts to promote family health history (FHH) collection. FHH information is a key factor in determining disease risk and supporting screening and prevention across multiple diseases. The collection of FHH information could be facilitated by the existing cadre of CHWs already working alongside clients and families. In this qualitative study, we interviewed 30 CHWs from Georgia to better understand the current level of knowledge about FHH, perceptions of how FHH collection aligns with their role, and barriers and facilitators in order to support more active involvement of CHWs in FHH collection. Interviews were completed, transcribed, and double coded by three study team members. More than half of CHWs reported knowing their own FHH information. CHWs showed a strong interest and support for collecting FHH in their job, despite limited current engagement in this role. CHWs acknowledged the collection of FHH as being an opportunity to empower clients to have conversations with their providers. To better support this work, CHWs requested training in using and integrating FHH tools into their workflow and support in communicating about FHH with their clients. Our findings suggest that with support and training, CHWs are uniquely positioned to improve FHH collection among their client base. Ultimately, improving FHH collection skills among the population could allow for better integration of risk-stratified approaches that are informed by FHH information for the prevention, management, and treatment of disease.

A Public Health of Consequence: Shifting the Cultural Narrative From Churning Grants to a Scholarship of Consequence.

A confluence of challenges is impeding faculty members' ability to prioritize research with the goal of achieving a public health of consequence: research designed to improve conditions to produce a healthier society. Together, these challenges create a "churn" culture in which faculty focus on generating new business (i.e., grant funding and associated incentives) to replace lost revenue (i.e., expiring grants); this culture can relegate public health impact to a back seat.We share three strategies and related insights from our efforts to shift our department's cultural narrative from churn to a "scholarship of consequence": crafting research proposals of consequence, fostering thought leadership through collaborative writing, and mentoring faculty with a view to a scholarship of consequence.We describe each of the strategies and interim progress. Although they are a work in progress, we conclude that despite initial concerns, our evaluation metrics indicate improvement.

Associations Between Objective Television Exposure and Cancer Perceptions in a National Sample of Adults.

The expanding sources of media coverage of cancer may have a powerful impact on emotions, cancer knowledge, information seeking, and other health behaviors. We explored whether television advertisements were associated with cancer worry, perceived risk, and perceived ability to prevent cancer using cross-sectional data from the Health Information National Trends Survey (HINTS) linked to television advertisement data from Kantar Media. We conducted hierarchical linear modeling assessing 2-level models for each of the 3 outcomes of interest. The most common content included advertisements for cancer clinics (54.4%), public service announcements about cancer (22.0%), and advertisements about cancer organizations (9.1%). Most variance in cancer perceptions was due to individual-level characteristics and not exposure to television advertisements, which aligns with previous literature suggesting a small, but significant, association of television exposure with health beliefs. Higher levels of exposures to cancer-specific television advertisements were associated with higher levels of risk perceptions. Additionally, older adults' levels of perceived worry and risk were more likely to be associated with television exposure than younger adults. Given the substantial investments being made in cancer advertisements on television, the differences in exposure are important to consider in future efforts to understand predictors of beliefs about cancer and in the development of interventions designed to target risk-reducing behaviors.

Modeling Dynamic Food Choice Processes to Understand Dietary Intervention Effects.

Background: Meal construction is largely governed by nonconscious and habit-based processes that can be represented as a collection of in dividual, micro-level food choices that eventually give rise to a final plate. Despite this, dietary behavior intervention research rarely captures these micro-level food choice processes, instead measuring outcomes at aggregated levels. This is due in part to a dearth of analytic techniques to model these dynamic time-series events. Purpose: The current article addresses this limitation by applying a generalization of the relational event framework to model micro-level food choice behavior following an educational intervention. Method: Relational event modeling was used to model the food choices that 221 mothers made for their child following receipt of an information-based intervention. Participants were randomized to receive either (a) control information; (b) childhood obesity risk information; (c) childhood obesity risk information plus a personalized family history-based risk estimate for their child. Participants then made food choices for their child in a virtual reality-based food buffet simulation. Results: Micro-level aspects of the built environment, such as the ordering of each food in the buffet, were influential. Other dynamic processes such as choice inertia also influenced food selection. Among participants receiving the strongest intervention condition, choice inertia decreased and the overall rate of food selection increased. Conclusions: Modeling food selection processes can elucidate the points at which interventions exert their influence. Researchers can leverage these findings to gain insight into nonconscious and uncontrollable aspects of food selection that influence dietary outcomes, which can ultimately improve the design of dietary interventions.

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.

Imagining roles for epigenetics in health promotion research.

Discoveries from the Human Genome Project have invigorated discussions of epigenetic effects-modifiable chemical processes that influence DNA's ability to give instructions to turn gene expression on or off-on health outcomes. We suggest three domains in which new understandings of epigenetics could inform innovations in health promotion research: (1) increase the motivational potency of health communications (e.g., explaining individual differences in health outcomes to interrupt optimistic biases about health exposures); (2) illuminate new approaches to targeted and tailored health promotion interventions (e.g., relapse prevention targeted to epigenetic responses to intervention participation); and (3) inform more sensitive measures of intervention impact, (e.g., replace or augment self-reported adherence). We suggest a three-step process for using epigenetics in health promotion research that emphasizes integrating epigenetic mechanisms into conceptual model development that then informs selection of intervention approaches and outcomes. Lastly, we pose examples of relevant scientific questions worth exploring.

Identifying eating behavior phenotypes and their correlates: A novel direction toward improving weight management interventions.

Common reports of over-response to food cues, difficulties with calorie restriction, and difficulty adhering to dietary guidelines suggest that eating behaviors could be interrelated in ways that influence weight management efforts. The feasibility of identifying robust eating phenotypes (showing face, content, and criterion validity) was explored based on well-validated individual eating behavior assessments. Adults (n = 260; mean age 34 years) completed online questionnaires with measurements of nine eating behaviors including: appetite for palatable foods, binge eating, bitter taste sensitivity, disinhibition, food neophobia, pickiness and satiety responsiveness. Discovery-based visualization procedures that have the combined strengths of heatmaps and hierarchical clustering were used to investigate: 1) how eating behaviors cluster, 2) how participants can be grouped within eating behavior clusters, and 3) whether group clustering is associated with body mass index (BMI) and dietary self-efficacy levels. Two distinct eating behavior clusters and participant groups that aligned within these clusters were identified: one with higher drive to eat and another with food avoidance behaviors. Participants' BMI (p = 0.0002) and dietary self-efficacy (p < 0.0001) were associated with cluster membership. Eating behavior clusters showed content and criterion validity based on their association with BMI (associated, but not entirely overlapping) and dietary self-efficacy. Identifying eating behavior phenotypes appears viable. These efforts could be expanded and ultimately inform tailored weight management interventions.

Population-Attributable Risk Percentages for Racialized Risk Environments.

Research about relationships between place characteristics and racial/ethnic inequities in health has largely ignored conceptual advances about race and place within the discipline of geography. Research has also almost exclusively quantified these relationships using effect estimates (e.g., odds ratios), statistics that fail to adequately capture the full impact of place characteristics on inequities and thus undermine our ability to translate research into action. We draw on geography to further develop the concept of "racialized risk environments," and we argue for the routine calculation of race/ethnicity-specific population-attributable risk percentages.

Community Health Workers: An Untapped Resource to Promote Genomic Literacy.

Poor understanding of gene-environment contributors to health conditions can lead the public to misinterpretations that overemphasize genetics as determinants of health. The present commentary calls for engaging the national community health worker (CHW) workforce to use community elicitation methods such as mental models approaches as a means to enhance the public's literacy regarding genetic and environmental or genomic contributions to health. We discuss three needs related to genomic literacy and suggest how CHWs are uniquely positioned to address these needs among diverse target audiences. We conclude by offering directions for the future of CHWs working to build genomic literacy.

Drivers of overweight mothers' food choice behaviors depend on child gender.

BACKGROUND: National data suggest a higher prevalence of obesity among boys. One possible cause could be the food choices made by parents on behalf of their children. OBJECTIVES: This study sought to determine whether and how mothers' food choices for their children differ by child gender and to understand the drivers of these differences. DESIGN: Data were analyzed from a randomized controlled trial conducted using a virtual reality-based buffet restaurant. Overweight mothers filled out questionnaires and received an information module. They were then immersed in a virtual buffet restaurant to select a lunch for their 4- to 5-year-old child. RESULTS: Of the 221 overweight mothers recruited, 55% identified their daughters as the child for whom they would be choosing the food. The caloric content of boys' meals was 43 calories higher than girls' (p = .015). This difference was due to extra calories from the less healthy food category (p = .04). Multivariate analyses identified more predictors of calorie choices for daughters' than sons' meals. Predictors of calories chosen for girls included: having both biological parents overweight (ß = 0.26; p = .003), mother's weight (ß = 0.17; p = .05), mother's education (ß = -0.28; p = .001), her restriction of her child's food intake (ß = -0.20; p = .02), and her beliefs about the importance of genetics in causing obesity (ß = 0.19; p = .03). Mother's weight was the sole predictor of boys' meal calories (ß = 0.20; p = .04). CONCLUSIONS: Differences in dietary choices made for young girls and boys may contribute to lifelong gender differences in eating patterns. A better understanding of differences in feeding choices made for girls versus boys could improve the design of childhood obesity prevention interventions.

Effects of undergoing multiplex genetic susceptibility testing on parent attitudes towards testing their children.

BACKGROUND: Parents may pursue common disease risk information about themselves via multiplex genetic susceptibility testing (MGST) for their children. PURPOSE: To prospectively assess whether parents who received MGST disclosed their test results to their child, intended to change the child's health habits, or have the child tested. METHODS: Eighty parents who opted for free MGST completed an online survey about a child in their household before undergoing MGST and a follow-up telephone survey 3 months after receiving results. RESULTS: Few parents (21 %) disclosed results to the child. Undergoing MGST was unrelated to intentions to change the child's health habits but did increase parental willingness to test the child. Greater willingness to test a child was associated with positive attitudes toward pediatric genetic testing and intentions to change the child's health habits. CONCLUSION: The experience of receiving MGST had little impact on parents' perceptions or behaviors related to their minor child.

Contemplating genetic feedback regarding lung cancer susceptibility.

BACKGROUND AND PURPOSE: We examined three theoretical models (self-enhancement theory, consistency theory, and a combined model) for understanding how expectations and test result favorability influence smokers' desire for a retest following hypothetical genetic test results. METHOD: College smokers (N = 128) read a brochure describing a biomarker for lung cancer (the GSTM1 gene) then reported whether they thought they had the gene (indicating lower lung cancer risk) or were missing the gene (indicating higher lung cancer risk). Participants then reported whether they would get retested if they received favorable GSTM1 results versus unfavorable GSTM1 results. RESULTS: Participants were most likely to want a retest, suggesting rejection of the results, if they expected favorable news yet received unfavorable news. CONCLUSION: The findings supported the combined model such that smokers expressed greatest interest in a retest when they imagined genetic risk feedback that challenges both enhancement and consistency motives.

Testing a Population-Based Outreach Intervention for Ovarian Cancer Survivors to Encourage their Close Relatives to Consider Genetic Counseling.

BACKGROUND: Most relatives of women with ovarian cancer are unaware of their increased risk for cancer and their eligibility for genetic counseling. State cancer registries offer a platform to communicate about inherited risk to this population. METHODS: We conducted a two-arm randomized trial to test a theory-based communication intervention-Your Family Connects (YFC)-compared to the standard Georgia Cancer Registry (GCR) contact. A total of 1,938 eligible ovarian cancer survivors were randomly assigned to either the YFC arm (n = 969) or the Standard Care arm (n = 969). We assessed the number of ovarian cancer survivors and their close relatives who logged on to the study website by arm. RESULTS: Survivor reach was significantly higher in the Standard Care arm than YFC (20.8% vs. 15.2%, respectively; P < 0.001). However, reach to relatives was limited to listed relatives in the YFC arm (n = 20, 13.2%), with little participation from those in the Standard Care arm (n = 1, 0.4%). Pooling across arms, minority race, longer time since diagnosis, and older age were all significantly associated with a decreased likelihood that the survivor accessed the website. CONCLUSIONS: The YFC intervention showed lower effectiveness for engaging survivors but was more effective than Standard Care in engaging at-risk relatives. Other factors (e.g., time since diagnosis) associated with lower reach must be considered in refining future outreach approaches. IMPACT: Partnering with a state cancer registry to foster family communication about inherited cancer risk is feasible but the possibility for broad population reach warrants further testing.