Colorectal cancer information avoidance is associated with screening adherence.

Colorectal cancer (CRC) is the fourth most common cancer among U.S. men and women and the second deadliest. Effective screening modalities can either prevent CRC or find it earlier, but fewer than two thirds of U.S. adults are adherent to CRC screening guidelines. We tested whether people who defensively avoid CRC information have lower adherence to CRC screening recommendations and weaker intentions for being screened and whether CRC information avoidance adds predictive ability beyond known determinants of screening. Participants, aged 45-75 years, completed a survey about known structural determinants of CRC screening (healthcare coverage, healthcare use, provider recommendation), CRC information avoidance tendencies, and screening behavior (n = 887) and intentions (n = 425). Models were tested with multivariable regression and structural equation modeling (SEM). To the extent that participants avoided CRC information, they had lower odds of being adherent to CRC screening guidelines (OR = 0.55) and if non-adherent, less likely to intend to be screened (b=-0.50). In the SEM model, avoidance was negatively associated with each known structural determinant of screening and with lower screening adherence (ps < 0.01). Fit was significantly worse for nested SEM models when avoidance was not included, (i.e., the paths to avoidance were fixed to zero). Information avoidance was associated with screening behavior and other known structural determinants of screening adherence, potentially compounding its influence. Novel strategies are needed to reach avoiders, including health communication messaging that disrupts avoidance and interventions external to the healthcare system, with which avoiders are less engaged.

Palliative care use and utilization determinants among patients treated for advanced stage lung cancer care in the community and academic medical setting.

PURPOSE: Despite clinical guidelines, palliative care is underutilized during advanced stage lung cancer treatment. To inform interventions to increase its use, patient-level barriers and facilitators (i.e., determinants) need to be characterized, especially among patients living in rural areas or those receiving treatment outside academic medical centers. METHODS: Between 2020 and 2021, advanced stage lung cancer patients (n = 77; 62% rural; 58% receiving care in the community) completed a one-time survey assessing palliative care use and its determinants. Univariate and bivariate analyses described palliative care use and determinants and compared scores by patient demographic (e.g., rural vs. urban) and treatment setting (e.g., community vs. academic medical center) factors. RESULTS: Roughly half said they had never met with a palliative care doctor (49.4%) or nurse (58.4%) as part of cancer care. Only 18% said they knew what palliative care was and could explain it; 17% thought it was the same as hospice. After palliative care was distinguished from hospice, the most frequently cited reasons patients stated they would not seek palliative care were uncertainty about what it would offer (65%), concerns about insurance coverage (63%), difficulty attending multiple appointments (60%), and lack of discussion with an oncologist (59%). The most common reasons patients stated they would seek palliative care were a desire to control pain (62%), oncologist recommendation (58%), and coping support for family and friends (55%). CONCLUSION: Interventions should address knowledge and misconceptions, assess care needs, and facilitate communication between patients and oncologists about palliative care.

Associations between social COVID-19 exposure and psychological functioning.

The negative consequences of the COVID-19 pandemic on mental health have been widely reported, but less is known about how the impact of COVID-19 on others in one's social circle shapes these high distress levels. This study examines associations between social COVID-19 exposure-knowing someone who had a COVID-19 infection-and psychological functioning, as well as whether socio-demographic factors moderate these relationships. In June 2020, respondents (N = 343) from clinics in Tampa, Florida, U.S.A. reported whether they had social COVID-19 exposure, anxiety, depression, and stress, and other COVID-19-related concerns. Social COVID-19 exposure was associated with increased anxiety, stress, and concerns about a family member getting sick, and concerns about drinking and substance use. Several associations between exposure and psychological functioning were stronger in women, younger people, and people with lower income, implying these groups face elevated psychological risks due to the pandemic, and should be prioritized in mental health recovery efforts.

Prevention is political: political party affiliation predicts perceived risk and prevention behaviors for COVID-19.

BACKGROUND: Many US politicians have provided mixed messages about the risks posed by SARS-CoV-2/COVID-19 and whether and to what extent prevention practices should be put in place to prevent transmission. This politicization of the virus and pandemic may affect individuals' risk perceptions and willingness to take precautions. We examined how political party affiliation relates to risk perception for one's own and other people's likelihood of SARS-CoV-2 infection/COVID-19 illness. METHODS: We surveyed members of a nationally-representative, probability-sampling based survey panel (N = 410) to examine their risk perceptions, precautionary behaviors, and political party affiliation. RESULTS: The more strongly one identified as a Republican, the less risk one perceived to oneself from SARS-CoV-2/COVID-19 and the less risk one perceived other people faced. Moreover, those identifying as more strongly Republican engaged in fewer preventive behaviors. CONCLUSIONS: This differential response may affect virus transmission patterns and poses a considerable challenge for health communications efforts.

Is it disgusting or am I just easily disgusted? The relation between situational disgust, dispositional disgust, and colonoscopy intentions.

OBJECTIVE: While early detection is an effective way to reduce mortality from colorectal cancer, screening rates are low. An underlying factor in screening completion failure may be experiences of disgust when learning about screening and/or dispositional disgust. METHOD: Participants recruited via Amazon MTurk (N = 296) read information about colonoscopy and completed an online survey assessing both dispositional forms of disgust (i.e. trait disgust and disgust sensitivity) and situational forms, including state disgust and disgust associated with colonoscopy. Participants reported intentions to discuss colonoscopy with a provider and to prepare for and complete screening. RESULTS: Greater state disgust and the degree to which one associated disgust with colonoscopy predicted lower screening, preparation and provider discussion intentions. By contrast, neither trait disgust nor disgust sensitivity was associated with intentions. Both disgust sensitivity and trait disgust moderated the state disgust to intentions relation. CONCLUSIONS: This is one of few investigations of disgust examining the relation between specific types and colonoscopy intentions. Screening uptake may be improved by identifying specific components of disgust that have an effect on colonoscopy intentions. Future work focusing on the interplay between different disgust mechanisms as they relate to colonoscopy behaviour is important for intervention development.

Affective components of perceived risk mediate the relation between cognitively-based perceived risk and colonoscopy screening.

Perceived risk is a common component of health decision making theory. When affective components of risk are assessed as predictors of a behavior, they are usually examined separately from cognitive components. Less frequently examined are more complex interplays between affect and cognition. We hypothesized that cognitive and affective risk components would both have direct effects on colonoscopy behavior/intentions and that affective components would mediate the relationship of cognitively-based perceived risk to colonoscopy screening. In two secondary analyses, participants reported their cognitive and affective perceived risk for colorectal cancer, past colonoscopy behavior, and future screening intentions. In both studies, cognitive and affective risk components were associated with increased screening behavior/intentions and cognitive risk components were mediated through affective risk. Given the impact of early detection on colorectal cancer prevention, educational strategies highlighting both components of risk may be important to increase screening rates.

Lay beliefs about risk: relation to risk behaviors and to probabilistic risk perceptions.

Lay illness risk beliefs are commonly held philosophies about how risk works. These include beliefs that one's personal illness risk is unknowable and beliefs that thinking about one's risk can actually increase that risk. Beliefs about risk may impact risk behaviors and thereby subsequent health status. However, limited research examines the relation between lay risk beliefs and health behavior. This paper explores this possible relation. A nationally representative sample of adults (N = 1005) recruited from an internet panel were surveyed about lay risk beliefs and risk perceptions regarding diabetes and colorectal cancer, psychosocial factors (i.e., health literacy, need for cognition, locus of control), demographics, and current health behaviors (i.e., cigarette smoking, red meat intake, physical activity). In separate sets of regressions controlling for either demographics, psychosocial factors, or risk perceptions, lay risk beliefs remained significantly related to health behaviors. It may be important to consider how to address lay risk beliefs in intervention content and targeting in order to increase adaptive health behaviors and thereby prevent chronic disease.

Predicting Colonoscopy Screening Behavior and Future Screening Intentions for African Americans Older than 50 Years.

African Americans experience a disproportionate burden of morbidity and mortality from colorectal cancer, which may be due to low adherence to screening recommendations. Previous studies have found relationships between decision-making factors and screening behavior, but few have looked at both cognitive and affective factors or within a specifically African American sample. To better understand determinants that drive screening behavior, this study examines affective, cognitive, and social variables as predictors of colonoscopy in an age-eligible African American population. Participants completed surveys assessing affective associations with colonoscopy, perceived benefits and barriers, self-efficacy, knowledge, fear of colonoscopy, perceived risk, and colorectal cancer worry and fear. Regression analysis was used to model decision-making constructs as predictors of screening behavior/intentions. Affective, cognitive, and health care experience variables predicted colonoscopy completion and intentions. Provider-level factors and previous cancer screenings predicted prior screening only, but not intentions. Affective and cognitive components of perceived risk were associated with decreased likelihood of colonoscopy behavior, but increased likelihood of colonoscopy intentions. These findings suggest that colonoscopy decision making involves a complex array of both cognitive and affective determinants. This work extends our knowledge of colorectal cancer screening decision making by evaluating the effects of these multiple determinants on screening behavior in an African American sample. Future work exploring the interplay of affect and cognitions as influences on colonoscopy decision making and how health care experiences may moderate this effect is needed to develop effective intervention approaches and reduce screening disparities.

Examining the Interrelations Among Objective and Subjective Health Literacy and Numeracy and Their Associations with Health Knowledge.

BACKGROUND: Health literacy and numeracy influence many health-related behaviors and outcomes. Health literacy and numeracy have been assessed objectively and subjectively, but interrelationships among the measures and the consistency of their association with health knowledge have not been examined. OBJECTIVE: To increase understanding of the structure and interrelations among objective and subjective health literacy and numeracy and how these constructs relate to knowledge of risk factors of two major diseases. DESIGN: Secondary analysis of cross-sectional survey data, weighted to be representative of the general US population of non-institutionalized adults. PARTICIPANTS: Participants (N = 1005, 55.2% response rate) were recruited from GfK KnowledgePanel. The unweighted sample included 52% women, 26% racial/ethnic minorities, and 37% with no college experience. MAIN MEASURES: Objective health literacy, subjective health literacy, objective numeracy, subjective numeracy. Objective and perceived knowledge of diabetes and colon cancer risk factors were also assessed. KEY RESULTS: Confirmatory factor analyses indicated that a model with correlated (r = 0.16-0.56) but separate factors for each of the four literacy/numeracy constructs best fit the data (RMSEA = 0.055 (95% CI 0.049-0.061), CFI = 0.94). Consistency between measures in classifying people as having adequate or limited health literacy or numeracy was 60.9-77.1%, depending on the combination of measures. All four literacy/numeracy constructs were independently associated with objective diabetes knowledge and objective colon cancer knowledge (all ps < .04). Subjective (but not objective) literacy and numeracy measures were associated with diabetes perceived knowledge (all ps < .02). No literacy/numeracy measures were associated with perceived colon cancer knowledge. CONCLUSIONS: We identified objective and subjective health literacy and numeracy as four distinct but related concepts. We also found that each construct accounts for unique variance in objective (but not subjective) disease knowledge. Until research uncovers what psychological processes drive subjective measures (e.g., motivation, self-efficacy), research investigating the relationship between health literacy and health outcomes should consider assessing all four measures.

Health Literacy and Use and Trust in Health Information.

There is a need to investigate which health information sources are used and trusted by people with limited health literacy to help identify strategies for addressing knowledge gaps that can contribute to preventable illness. We examined whether health literacy was associated with people's use of and trust in a range of potential health information sources. Six hundred participants from a GfK Internet survey panel completed an online survey. We assessed health literacy using the Newest Vital Sign, the sources participants used to get health information, and the extent to which participants trusted health information from these sources. We performed multivariable regressions, controlling for demographic characteristics. Lower health literacy was associated with lower odds of using medical websites for health information and with higher odds of using television, social media, and blogs or celebrity webpages. People with lower health literacy were less likely to trust health information from specialist doctors and dentists, but more likely to trust television, social media, blogs/celebrity webpages, friends, and pharmaceutical companies. People with limited health literacy had higher rates of using and trusting sources such as social media and blogs, which might contain lower quality health information compared to information from healthcare professionals. Thus, it might be necessary to enhance the public's ability to evaluate the quality of health information sources. The results of this study could be used to improve the reach of high-quality health information among people with limited health literacy and thereby increase the effectiveness of health communication programs and campaigns.

Military veteran cancer survivors' preferences for a program to address lifestyle change and psychosocial wellness following treatment.

This study aimed to understand military veteran cancer survivors' preferences regarding the delivery of post-treatment wellness services. Thirty-three military veteran cancer survivors were interviewed about their perceptions of three models of health service delivery (home-, primary care-, and oncology-based services). Conventional qualitative content analysis revealed strengths and weaknesses of each service delivery model's content and structure (e.g., program location, inclusion of emotional support, access to clinical experts). All service delivery programs had strengths, with clinic-based programs offering the greatest breadth of services deemed important for wellness by cancer survivors.

Where people look for online health information.

OBJECTIVES: To identify health-related websites Americans are using, demographic characteristics associated with certain website type and how website type shapes users' online information seeking experiences. METHODS: Data from the Health Information National Trends Survey 4 Cycle 1 were used. User-identified websites were categorised into four types: government sponsored, commercially based, academically affiliated and search engines. Logistic regression analyses examined associations between users' sociodemographic characteristics and website type, and associations between website type and information search experience. RESULTS: Respondents reported using: commercial websites (71.8%), followed by a search engines (11.6%), academically affiliated sites (11.1%) and government-sponsored websites (5.5%). Older age was associated with the use of academic websites (OR 1.03, 95% CI 1.02, 1.04); younger age with commercial website use (OR 0.97, 95% CI 0.95, 0.98). Search engine use predicted increased levels of frustration, effort and concern over website information quality, while commercial website use predicted decreased levels of these same measures. DISCUSSION: Health information seekers experience varying levels of frustration, effort and concern related to their online searching. CONCLUSION: There is a need for continued efforts by librarians and health care professionals to train seekers of online health information to select websites using established guidelines and quality criteria.

"I don't know" My Cancer Risk: Implications for Health Behavior Engagement.

BACKGROUND: Many people report uncertainty about their cancer risk. We examined whether such uncertainty was related to cancer prevention and detection behaviors. METHODS: National Health Interview Survey data from 2005 to 2010 were analyzed. Participants reported their perceived risk for colorectal and breast cancers. Responses were coded as "valid" (i.e., less/as/more likely than average) or "don't know." RESULTS: In bivariate analyses for both cancer sites and survey years, "don't know" responders (DKR) engaged in less physical activity than "valid" responders (p < 0.05). DKR had lower mammography adherence than "valid" responders in 2005 and lower colorectal screening adherence in 2010 (p < 0.05). DKR had marginally lower colorectal screening adherence and fruit/vegetable consumption in 2005 (p < 0.06). Multivariable models indicated that the DKR-behavior relationship could be largely accounted for by education. CONCLUSION: Interventions that help people understand their cancer risk may provide particular benefit to people with low education and might consequently reduce health disparities.

Prostate cancer survivors' beliefs about screening and treatment decision-making experiences in an era of controversy.

OBJECTIVE: Controversy about the costs and benefits of screening and treatment of prostate cancer (PCa) has recently intensified. However, the impact of the debate on PCa patients has not been systematically studied. METHODS: We assessed knowledge of, and attitudes toward, the U.S. Preventive Services Task Force's (USPSTF) May 2012 recommendation against PSA-based screening among men diagnosed with clinically localized PCa, and tested whether exposure to the recommendation and associated controversy about overtreatment of PCa predicted treatment decisional conflict, affected treatment choice, or increased regret about PSA testing. RESULTS: Accurate knowledge of the USPSTF recommendation was uncommon (19.1%). Attitudes toward the recommendation were negative, and the vast majority (86.5%) remained highly supportive of annual PSA testing in men ≥50. Although exposure to the recommendation and controversy about treatment was associated with lower enthusiasm for screening and treatment, it was not associated with treatment decisions, or greater decisional-conflict, or regret. CONCLUSIONS: Findings may alleviate concern that exposure to PSA-based screening and overtreatment controversies has adversely affected recent cohorts of PCa patients. However, patients remain highly supportive of PSA-based screening. As survivor anecdotes often influence people's medical decisions, it is important to appreciate the scale of opposition to the new recommendation.

Affective associations and cognitive beliefs relate to individuals' decisions to perform testicular or breast self-exams.

Affective associations with behavioral practices play an important role in individuals' uptake of a variety of health behaviors. Most work has looked at individual behavioral practices with a direct impact on health; because screening behaviors are conceptually distinct from such behaviors, it is important to examine the interplay of affect and cognition in screening decision making. The current research explored affective and cognitive predictors of testicular and breast self-examination behavior. Young adult participants (N = 184) reported cognitive beliefs and affective associations with testicular self-exam behavior (male participants) and breast self-exam behavior (female participants) and reported their own current screening behavior. In univariable models, affective associations were related to screening behavior for both testicular self-exams and breast self-exams. When examining affective associations and cognitive beliefs as simultaneous predictors, affective associations (but not cognitive beliefs) predicted testicular self-exams, and neither affective associations nor cognitive beliefs were uniquely related to breast self-exams. Moreover, for testicular self-exams, affective associations mediated the relation between cognitive beliefs and screening behavior; no mediation was present for breast self-exam behavior. These findings suggest three potential outcomes: first, that greater consideration of affective associations in testicular self-exam screening decisions may be warranted; second, that breast and testicular self-exams may have different antecedents; and third, that incorporation of affective factors in intervention design might have merit for increasing engagement in some cancer screening behaviors.

Perceived cancer risk and risk attributions among African-American residents of a low-income, predominantly African-American neighborhood.

OBJECTIVE: In some national surveys, African-Americans have had lower scores on perceived cancer risk items than whites. Our goals were to confirm low perceptions of cancer risk in an African-American community sample and explore participants' attributions for their perceived cancer risk. DESIGN: Data were from three cross-sectional surveys. We report levels of perceived absolute and comparative cancer risk in a community sample of African-Americans (N = 88), and African-Americans (Ns = 655, 428) and whites (Ns = 5262, 1679) from two nationally representative Health Information National Trends Surveys (HINTS). We analyzed the content of spontaneously-provided explanations for perceived risk from the community sample. RESULTS: Perceived absolute and comparative cancer risk were lower in the community and national samples of African-Americans than in the national sample of whites. Participants' spontaneous attributions for low or lower than average risk included not having family history or behavioral risk factors, classes of attributions noted elsewhere in the literature. However, participants also explained that they wanted to avoid wishing cancer on themselves (positive affirmations) and hoped their risk was low (wishful thinking), responses rarely reported for majority-white samples. CONCLUSIONS: Results provide further evidence that cancer risk perceptions are lower among African-Americans than whites. Some participant explanations for low perceived risk (wishful thinking, affirmations) are inconsistent with behavioral scientists' assumptions about perceived risk questions. Results reveal a need to expand cancer risk attribution typologies to increase applicability to diverse populations, and may indicate that perceived cancer risk questions have lower validity in African-American populations.

Deficiencies in public understanding about tobacco harm reduction: results from a United States national survey.

BACKGROUND: Tobacco products differ in their relative health harms. The need for educating consumers about such harms is growing as different tobacco products enter the marketplace and as the FDA moves to regulate and educate the public about different products. However, little is known about the patterns of the public's knowledge of relative harms. METHODS: Data were analyzed from the Health Information National Trends Survey (HINTS) 4 Cycle 2, a population-representative survey of US adults conducted between October 2012 and January 2013 (N = 3630). Participants reported their perceptions of the relative risks of e-cigarettes, smokeless tobacco, and different types of cigarettes compared to "traditional" cigarettes. Relative risk perceptions for each product type, as well as the consistency and accuracy of harm reduction beliefs, were analyzed. RESULTS: About 65% of the respondents accurately reported that no cigarettes were less harmful than any others. Slightly more than half of U.S. adults perceived e-cigarettes to be safer than regular cigarettes, a belief in line with current scientific evidence. By contrast, only 9% of respondents perceived some smokeless tobacco products to be safer, a belief strongly supported by the evidence. Only 3.5% of respondents had patterns of relative risk perceptions in line with current scientific evidence for all three modalities. CONCLUSIONS: The discrepancy between current evidence and public perceptions of relative risk of various tobacco/nicotine products was marked; for most tobacco types, a large proportion of the population held inaccurate harm reduction beliefs. Although there was substantial awareness that no cigarettes were safer than any other cigarettes, there could be benefits from increasing the percentage of the public that appreciates this fact, especially among current smokers. Given the potential benefits of tobacco risk reduction strategies, public health education efforts to increase understanding of basic harm reduction principles are needed to address these misperceptions.

Disgusted, embarrassed, annoyed: affective associations relate to uptake of colonoscopy screening.

BACKGROUND: Uptake of colorectal cancer screening is lower than desired. Screening decision making research has traditionally focused on benefits and barriers to screening. This study examines the relation of affective associations with screening (feelings and emotions associated with screening) to colonoscopy screening uptake. METHODS: Participants were 103 African American community adults. Participants completed a structured interview assessing perceived benefits of and barriers to colonoscopy screening, affective associations with colonoscopy, colonoscopy screening behavior, and intentions for future screening. RESULTS: Higher positive and lower negative affective associations with screening were both significant predictors of colonoscopy uptake. Affective associations fully mediated the relation of perceived benefits and barriers to screening uptake. Affective associations were associated with intentions for future screening. CONCLUSIONS: Incorporation of affective associations into models of screening decision making and intervention approaches to address screening compliance has utility for advancing our understanding of screening adherence as well as increasing screening rates.

Worry about skin cancer mediates the relation of perceived cancer risk and sunscreen use.

Preventive health behaviors are believed to be motivated in part by a person's perception of risk for a particular health problem. Risk contains a cognitive component, beliefs about the chances of a health problem occurring, and an affective component, fear or worry about the health problem. Although both have been shown to influence behavior, the nature of their interrelation as an influence on behavior has not been examined. Data from the 2005 Health Information National Trends Survey, a US nationally-representative telephone survey was analyzed. Participants reported perceived absolute and comparative risk for skin cancer, feelings of worry about skin cancer, and sunscreen use behavior. Analyses examined main effects models for the relation between perceived risk, worry, and sunscreen use, as well as both moderated and mediated models. For both absolute and comparative risk, the relation between cognitively-based perceived risk for skin cancer and sunscreen use was fully mediated by feelings of worry, as evidenced by significant direct effects of worry (bs > 0.046, ps < 0.01) and indirect effects of risk through worry (bs > 0.19, ps < 0.01). When worry was included in the models, direct effects of risk perceptions were non-significant (bs < 0.11, ps < 0.10). No evidence was found for moderated effects of worry on the relation between risk and behavior. While cognitive risk appraisals do influence decision making and may be addressed by interventions, these findings demonstrate that affectively-based risk components play a key role in behavior regulation. Affectively-based risk might be an effective target for interventions and should be incorporated more fully in decision-making models.

Changing how I feel about the food: experimentally manipulated affective associations with fruits change fruit choice behaviors.

Fewer than half of Americans meet current recommendations for fruit and vegetable intake. The behavioral affective associations model posits that feelings and emotions associated with a behavior are a proximal influence on decision making. Cross-sectional evidence supports the model and suggests that affective associations predict fruit and vegetable consumption. The purpose of this study was to test whether a causal relation exists between affective associations about fruits and future fruit consumption behavior, as measured by a snack selection task. Following a baseline assessment of cognitive and affective variables, participants' (N = 161) affective associations about fruits were experimentally manipulated with an implicit priming paradigm. Images of fruits were repeatedly paired with positive, negative, or neutral affective stimuli. The key outcome measure was a behavioral choice task in which participants chose between fruit and a granola bar. Participants in the positive prime condition were three times more likely than those in the negative condition to select a piece of fruit over the granola bar alternative in the snack selection task. They were also twice as likely as those in the neutral condition to select fruit. There were no changes in self-reported affective associations or cognitive beliefs. These findings provide further evidence of the implicit and direct influence of affective associations on behavior, suggesting the need to both incorporate the role of affect in health decision making models, as well as the potential utility of intervention strategies targeting affective associations with health-related behaviors.