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.

Reasons people avoid colorectal cancer information: a mixed-methods study.

OBJECTIVE: With screening, colorectal cancer can be detected when treatable, or even prevented. However, approximately one in five people tend to avoid colorectal cancer information, and avoidance is associated with being less likely to have been screened for the disease. Crucial to developing strategies to reduce information avoidance, we sought a comprehensive understanding of reasons people avoid colorectal cancer information. METHODS AND MEASURES: In a mixed methods study, we surveyed 200 participants who varied with respect to avoidance and interviewed 15 people who tended to avoid colorectal cancer information (all aged 40-75) about reasons for avoiding. RESULTS: In both survey and interviews, primary reasons for information avoidance were: (1) shielding from anxiety and other aversive emotion, (2) perceived information sufficiency and (3) feelings of information overload. Trait anxiety, fear of diagnosis, anticipating negative interactions with healthcare, and negative associations with screening procedures exacerbated avoidance. Participants justified information non-relevance by attributing risk to other people's characteristics such as family history, gastrointestinal symptoms, being male, or living an unhealthy lifestyle. CONCLUSION: Novel findings include the triggering influence of trait anxiety and financial constraints on information avoidance. Also, information overload and incorrect understanding of risk factors may exacerbate perceptions of information sufficiency and avoidance.

A qualitative analysis of Black men's attitudes toward obesity and bariatric surgery.

BACKGROUND: Metabolic and bariatric surgery (MBS) is a safe and highly effective treatment for morbid obesity and related co-morbidities. While MBS access and insurance coverage have greatly improved, sex and racial disparities remain in utilization of MBS. OBJECTIVE: To identify novel intrinsic factors that may explain Black underutilization of surgical treatments for weight management. SETTING: This study was conducted in metropolitan communities of Western New York. METHODS: We conducted semistructured face-to-face interviews with 27 adult Black men with a history of obesity and at least 2 obesity-related conditions (diabetes, hypertension, and/or chronic kidney disease [CKD]), about their attitudes, beliefs, behaviors, and habits related to obesity and obesity management. Interview transcripts were reviewed using thematic analysis for patterns and themes. RESULTS: Most participants did not perceive obesity as a serious health condition and those who had weight-loss goals did not aim for a healthy body mass index (BMI). Trust and respectful communication with physician were very important in making healthcare decisions. MBS was perceived as extreme and dangerous option for weight loss, and only participants with severe symptoms such as chronic pain were open to discussing MBS with their providers. Participants acknowledged lack of role models of similar background who had successfully undergone MBS for obesity. CONCLUSIONS: This study identified misinformation about risks and benefits of MBS and lack of community role models as important factors contributing to Black men's unwillingness to consider MBS. Further research is needed to facilitate patient-provider communication about weight and improve provider's ability and motivation for weight management in primary care settings.

Moving beyond the "Health Halo" of Alcohol: What Will it Take to Achieve Population Awareness of the Cancer Risks of Alcohol?

We discuss the implications of Seidenberg and colleagues' report confirming low levels of accurate awareness of the cancer harms associated with alcohol use, including wine, beer, and liquor consumption. The authors propose that academic and lay messaging describing consumption of wine and other forms of alcohol as reducing heart disease risk has created generalized beliefs about the health benefits of drinking alcohol. This "health halo" surrounding alcohol consumption leads the public to overgeneralize alcohol health benefits to other diseases, including cancer. We discuss the need to address high levels of perceived risk uncertainty to help the public distinguish between the impact of alcohol on heart disease versus cancer, and to overcome other barriers to including alcohol use reduction as a cancer prevention strategy. Given recent increases in U.S. population drinking rates, as well as morbidity and mortality associated with alcohol use, the time is right to marshal multilevel efforts to educate the public regarding the fact that alcohol is carcinogenic. If successful, these efforts will have multiple downstream benefits, including the ability of the lay public to use the most up-to-date scientific evidence to make informed decisions about whether, and how much, to engage in a risky behavior. See related article by Seidenberg et al., p. 46.

Examining beliefs and information-seeking behaviors of young adults aged 20-39 to help inform cancer prevention communication.

Successfully reaching young adults with cancer early detection information is urgently important given the rising rates of cancer in this age group. We sought to describe to describe the 'when, who, where, what and how' of young adult cancer information seeking and how it differs from that of older participants. We analyzed information seeking and beliefs among young adult (aged 20-39 years) and middle aged and older (aged 40-75 years) respondents to the Health Information National Trends Survey (HINTS) 5, cycle 4 (N = 2784). A little less than half of young adults had searched for cancer information (44%), which was just as often as middle aged and older adults. Seeking cancer information was greater among young adults more worried about the disease (aOR = 1.39, 95% CI = 1.04, 1.86, p = .026). Like middle aged and older adults, young adults most often chose a doctor as their first choice for cancer information; however, they were more likely than their older counterparts to make the internet their first choice (38.9% vs. 28.5%, p = .013) and more frequently sought health information from YouTube (p = .010). They were more trusting of cancer information from government organizations than older adults (p = .019). Communicators may be able to better persuade young adults with early detection information framed around cherished values. Though respondents of all ages were most likely to choose protecting family as their top value, young adults valued happiness over safeguarding their health more than middle aged and older adults.

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.

Worldview Orientations and Personal and Social Risk Perceptions for COVID-19 in a U.S. Population-Based Sample.

Adoption of COVID-19 preventive behaviors involves considering personal risk and the risk to others. Consequently, many COVID-19 prevention measures are intended to protect both the individual engaging in the behavior and others in the population. Yet, the preponderance of research is focused on perceptions of an individual's personal risk, making risk perception for others a critical area for investigation. Two worldview orientations describing values regarding how society should be organized, hierarchy-beliefs prioritizing social hierarchy, and individualism-beliefs prioritizing personal autonomy, have been linked to a range of risk perceptions. This study objective is to examine the association of worldview orientations with COVID-19 risk perceptions for oneself and others in a United States context. Using a national sample of 410 U.S. adults, we examined the associations between worldview orientations and six facets of risk (absolute risk, risk certainty, comparative risk, risk severity, fear, feelings of risk) using demographics-adjusted multivariable regression models. We conducted separate analyses for each of the following referents: (1) personal risk, (2) risk for the average person within the United States, and (3) risk to people within specific social groups (e.g., family, co-workers). Results indicate that stronger hierarchical and individualistic orientations were associated with lower COVID-19 risk perceptions for all three referents. The results were particularly consistent for fear and feelings of risk. Individualism was related to higher risk perception certainty for personal risk and the risk to people within specific social groups. Hierarchy was related to lower perceived severity for all referents. Findings suggest that U.S. public health messaging sensitive to worldview orientations may be needed to optimize acceptance of recommendations for protective behaviors, including vaccination. The relationship of worldview orientations to health risk perceptions may help guide messaging for future infectious outbreaks where risk perceptions are t drivers of protective behavior.

I don't know my child's asthma risk: evidence against satisficing as an explanation for 'don't know' responses.

Several studies suggest that "don't know" (DK) responses to risk perception items may represent meaningful expressions of uncertainty about disease risk. However, researchers are often discouraged from including a DK response option in survey items due to concerns about respondents overusing it to minimize cognitive effort-a phenomenon often referred to as satisficing. Our objective was to investigate whether patterns of DK responses to risk perception survey items were consistent with satisficing behavior. We conducted a secondary analysis of survey data from 814 parents and guardians (hereafter caregivers) of children with asthma. Caregivers answered 18 items assessing their perceived risk of their child experiencing two types of poor asthma outcomes: asthma exacerbation, and low asthma control. We examined differences in the frequency and distribution of DK responses across all 18 items and by type of risk perception item (i.e., 2 vs. 5 response options, absolute vs. comparative risk). We found that 32% (n=548) of respondents marked DK at least once. Of the 266 caregivers who provided any DK response, most did so for only 1 or 2 items (51.9%, n=138), and only 6% (n=15) answered DK to more than half of the items. Using random coefficient Poisson models, we found more DK responding for dichotomous absolute (30.1%) than ordinal absolute items (5.3%), b=1.72, p<.001. We also found fewer DK responses to the ordinal absolute items than the comparative items (8.2%), b=-0.49, p<.001. Using Chi-square tests, we found that inattentive responding was not associated with responding DK. Our findings suggest that satisficing is unlikely to completely explain DK responding to perceived risk survey items. Researchers who exclude DK response options from risk perception survey items may obtain an incomplete understanding of their study sample's beliefs about risk.

Race/Ethnicity, Nativity Status, and Patient Portal Access and Use.

We examined whether patient portals (online medical records) access and use differed between groups of various races/ethnicities and nativity status. We used data from the nationally representative Health Information National Trends Survey (N=3,191). We used logistic regression to examine associations between nativity status and the following three binary outcomes: (1) being offered access to patient portals by patients' health care providers/insurers, (2) being encouraged to use one by their health care providers, and (3) having used one within the past 12 months. We also investigated whether race/ethnicity moderated the relation between nativity status and these three outcomes. Among Asians, the likelihood of being offered access to a patient portal depended on nativity status. U.S.-born Asians had the highest rate of being offered access to a portal (66%) and foreign-born Asians had the lowest rate (38%). There were no differences as a function of nativity status for other races/ethnic groups.

A community-university run conference as a catalyst for addressing health disparities in an urban community.

The African American population of Buffalo, New York experiences striking race-based health disparities due to adverse social determinants of health. A team of community leaders and university faculty determined that a community dialogue was needed to focus research and advocacy on the root causes of these disparities. In response, we organized the annual Igniting Hope conference series that has become the premier conference on health disparities in the region. The series, now supported by an R13 conference grant from NCATS, has been held four times (2018-2021) and has attracted community members, community leaders, university faculty, and trainees. The agenda includes talks by national leaders and breakout/working groups that led to a new state law that has reduced disproportionate traffic-ticketing and drivers' license suspensions in Black neighborhoods; mitigation of the disproportionate COVID-19 fatalities in Black communities; and the launching of a university-supported institute. We describe the key elements of success for a conference series designed by a community-university partnership to catalyze initiatives that are having an impact on social determinants of health in Buffalo.

Barriers to HIV Pre-Exposure Prophylaxis Uptake and Ways to Mitigate Them: Perspectives of Ghanaian Immigrants in the United States.

African immigrants in the United States experience disparities in HIV incidence. Pre-exposure prophylaxis (PrEP) effectively prevents HIV infection, yet uptake is low among racial and ethnic minorities. To better understand PrEP adoption among African immigrants, in March 2020, we conducted interviews with Ghanaian immigrants (N = 40) to explore the barriers and ways to overcome these barriers to PrEP adoption. Participants described several barriers (e.g., low HIV knowledge and risk perception, fear of social judgment, cultural values, and norms), which may impede PrEP adoption. We categorized these barriers according to the levels of the socioecological model (individual, interpersonal, community, and organizational/structural factors). Participants also identified strategies to overcome the barriers, such as providing comprehensive education on HIV and PrEP. Our research provides foundational knowledge that can inform future PrEP research with Ghanaian and other African immigrants and offers important insights into factors that may impact PrEP adoption in this population.

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.

A pilot school-based health center intervention to improve asthma chronic care in high-poverty schools.

OBJECTIVE: To test the feasibility and effectiveness of a multifaceted intervention administered through school-based health centers (SBHCs) to improve asthma control for children in high-poverty schools with not well controlled asthma. METHODS: Students 4-14 years old with persistent asthma were enrolled from three SBHCs. The centers' advanced practice providers received training on evidence-based asthma guidelines. Students randomized to the intervention received directly observed therapy of their asthma controller medication, medication adjustments as needed by the centers' providers, and daily self-management support. Students randomized to usual care were referred back to their primary care provider (PCP) for routine asthma care. RESULTS: We enrolled 29 students. Students in the intervention group received their controller medication 92% of days they were in school. Ninety-four percent of follow-up assessments were completed. During the study, 11 of 12 intervention students had a step-up in medication; 2 of 15 usual care students were stepped up by their PCP. Asthma Control Test scores did not differ between groups, although there were significant improvements from baseline to the 7 month follow-up within each group (both p < .01). Both FEV1% predicted and FEV1/FVC ratio significantly worsened in the usual care group (both p = .001), but did not change in the intervention group (p = .76 and .28 respectively). CONCLUSIONS: Our pilot data suggest that a multifaceted intervention can be feasibly administered through SBHCs in communities with health disparities. Despite the small sample size, spirometry detected advantages in the intervention group. Further study is needed to optimize the intervention and evaluate outcomes. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT03032744.

Alcohol mixed energy drink usage and risk-taking among college students in Western New York State.

Alcohol mixed energy drinks (AmED) may promote excessive alcohol intake and risk-taking among college students. Objective: To understand the relationship between AmED use and risky behavior as well as attitudes and motivations for AmED use. Participants: Undergraduate college students N = 422 (Study 1), N = 37 (Study 2). Methods: Using a mixed-methods approach, we first surveyed undergraduate students about their AmED and alcohol consumption and a series of risk behaviors, self-efficacy, and beliefs (Study 1). We then conducted focus groups within the same population to better understand attitudes, knowledge, and motivations for using AmED (Study 2). Results: Recent AmED use was significantly associated with an increased number of reported binge drinking occasions and self-reported driving while intoxicated events. Our qualitative data analyses revealed two major themes associated with AmED consumption: factors encouraging AmED use and decisions about driving while under the influence of alcohol. Conclusions: These findings add to the literature of beliefs and motivations for AmED use among college students.

Racial/Ethnic Differences in Prosocial Beliefs and Prevention Behavior During the COVID-19 Pandemic.

Controlling the COVID-19 pandemic has required communities to engage in prosocial action, including behaviors that may inconvenience individuals, but protect the collective (e.g., mask wearing, social distancing). The purpose of this study was to understand to what extent COVID-19 prosocial beliefs and behavior differ by race/ethnicity and why this might be the case. A US nationally representative sample of 410 adults completed a survey about COVID-19 beliefs and prevention behaviors between June 12 and 18, 2020. Compared to White respondents, Black respondents perceived the risk of COVID-19 to be greater to the US population; and both Black and Latinx respondents thought it was more important to protect a variety of non-close others (e.g., people in their city or state). Black and Latinx respondents engaged in several prevention behaviors, including social distancing, to a greater extent than White respondents. There were indirect effects of Black vs. White race on engaging in protective behaviors through greater perceived risk to others and beliefs in the importance of protecting distal others. Results indicate that targeted messages promoting prevention, including vaccination with pro-social messages, may resonate with communities of color. They also suggest that lower levels of prosocial beliefs among White people have likely hindered the US response to the epidemic.

Dismissing "Don't Know" Responses to Perceived Risk Survey Items Threatens the Validity of Theoretical and Empirical Behavior-Change Research.

Since the middle of the 20th century, perceptions of risk have been critical to understanding engagement in volitional behavior change. However, theoretical and empirical risk perception research seldom considers the possibility that risk perceptions do not simply exist: They must be formed. Thus, some people may not have formulated a perception of risk for a hazard at the time a researcher asks them, or they may not be confident in the extent to which their perception matches reality. We describe a decade-long research program that investigates the possibility that some people may genuinely not know their risk of even well-publicized hazards. We demonstrate that indications of not knowing (i.e., "don't know" responses) are prevalent in the U.S. population, are systematically more likely to occur among marginalized sociodemographic groups, and are associated with less engagement in protective health behaviors. "Don't know" responses are likely indications of genuinely limited knowledge and therefore may indicate populations in need of targeted intervention. This body of research suggests that not allowing participants to indicate their uncertainty may threaten the validity and generalizability of behavior-change research. We provide concrete recommendations for scientists to allow participants to express uncertainty and to analyze the resulting data.

Exploring Awareness, Perceptions, and Willingness to Use HIV Pre-Exposure Prophylaxis: A Qualitative Study of Ghanaian Immigrants in the United States.

HIV/AIDS disproportionately burdens African immigrants in the United States. Oral pre-exposure prophylaxis (PrEP) is an effective prevention tool for people at high HIV risk, yet uptake is low among racial and ethnic minorities-particularly immigrants. This study explores the awareness, perception, and willingness to use PrEP among Ghanaian immigrants in the United States. WhatsApp, a social media platform, was used to recruit and conduct semi-structured oral interviews with 40 Ghanaian immigrants in March 2020. Interview questions explored awareness of PrEP (whether the participants knew or had knowledge of PrEP before the study), perceptions of PrEP and PrEP users, and willingness to use PrEP. Interviews were audiorecorded, and transcribed. We used NVivo-12 Plus to analyze transcripts for emergent themes. Our sample consisted of Ghanaian adult immigrants (N = 40, 57% male, 71% college educated, age = 32.8 ± 5.7 years, 68% had lived in the United States between 1 and 10 years) residing in 12 US cities. Four major themes emerged: (1) low awareness of PrEP; (2) positive perception of PrEP for HIV prevention; (3) divergent views on PrEP users; and (4) mixed views on willingness to use PrEP. This study presents formative qualitative work, which suggests that Ghanaian immigrants, despite having low awareness of PrEP, may be willing to use PrEP. A key study implication was that stigma reduction interventions might facilitate PrEP scale-up in this population.

Health Literacy, Education, and Internal Consistency of Psychological Scales.

BACKGROUND: Measurement error might lead to biased estimates, causing ineffective interventions and service delivery. Identifying measurement error of health-related instruments helps develop accurate assessment of health-related constructs. OBJECTIVE: We compared the internal consistency of eight psychological scales used in health research in groups with adequate versus limited health literacy and in groups with higher versus lower education. METHODS: Participants (N = 1,005) from a nationally representative internet panel completed eight self-report scales: (1) information avoidance, (2) cognitive causation, (3) unpredictability, (4) perceived severity, (5) time orientation, (6) internal health locus of control, (7) need for cognition, and (8) social desirability. The first four assess beliefs about diabetes and colon cancer. We used the Newest Vital Sign to categorize participants' health literacy (limited vs. adequate). We also categorized participants' education (high school or less vs. more than high school). We compared the Cronbach's alpha for each psychological scale between groups with different health literacy and education levels using the Feldt test. KEY RESULTS: Among all the 13 subscales, scale internal consistency was significantly lower among people with limited health literacy than those with adequate health literacy for five subscales: information avoidance for colon cancer (0.80 vs. 0.88), unpredictability of diabetes (0.84 vs. 0.88), perceived severity for diabetes (0.66 vs. 0.75), need for cognition (0.63 vs. 0.82), and social desirability (0.52 vs. 0.68). Internal consistency was significantly lower among people who had a high school education or less than among those with more than a high school education for four scales: perceived severity of diabetes (0.70 vs. 0.75), present orientation (0.60 vs. 0.66), need for cognition (0.73 vs. 0.80), and social desirability (0.61 vs. 0.70). CONCLUSIONS: Several psychological instruments demonstrated significantly lower internal consistency when used in a sample with limited health literacy or education. To advance health disparities research, we need to develop new scales with alternative conceptualizations of the constructs to produce a measure that is reliable among multiple populations. [HLRP: Health Literacy Research and Practice. 2021;5(3):e244-e255.] Plain Language Summary: We compared the internal consistency of several psychological scales in groups with adequate versus limited health literacy and higher versus lower education. For several scales, internal consistency was significantly lower among (1) people with limited health literacy compared those who have adequate health literacy and/or (2) people who had a high school education or less compared to those with more than a high school education.

Limitations in American adults' awareness of and beliefs about alcohol as a risk factor for cancer.

Alcohol is a carcinogen. Recommendations to reduce alcohol use to lower cancer risk are increasingly common. However, neither the beliefs of US adults about alcohol consumption and cancer risk, nor factors influencing those beliefs, are well understood. We used data from the 2019 Health Information National Trends Survey (analysis N = 4,470) to examine beliefs about whether drinking too much alcohol increases cancer risk. We compared those beliefs to beliefs for three other health problems, and examined whether believing alcohol is a cancer risk factor was related to demographics, risk perceptions, other beliefs about the nature of cancer, and alcohol consumption behavior. Only 33% of US adults reported believing that alcohol is a cancer risk factor; 27% stated that it was not, and the highest proportion (40%) reported they did not know. Misbeliefs and lack of knowledge about alcohol and health outcomes were higher for cancer than other outcomes. Higher age, education, seeking health information, risk perceptions, and pessimistic beliefs about cancer predicted both lack of knowledge and misbeliefs about alcohol use and cancer. However, misbeliefs and lack of knowledge were not limited to those who reported alcohol consumption. Demographic and psychosocial factors are associated with problematic beliefs about alcohol's role as a risk factor for cancer. Because perceived risk for health problems is a driver of behavior change, cancer prevention and control efforts to reduce alcohol consumption must attend to and address both the misperceptions about and lack of knowledge of alcohol's role in increasing risk for cancer.

Race/Ethnicity, Nativity Status, and Patient Portal Access and Use.

We examined whether patient portal (online medical records) access and use differed between groups of various races/ethnicities and nativity status. We used data from the nationally representative Health Information National Trends Survey (N=3,191). We used logistic regression to examine associations between nativity status and the following three binary outcomes: (1) being offered access to patient portals by health care providers/insurers, (2) being encouraged to use one by their health care providers, and (3) having used one within the past 12 months. We also investigated whether race/ethnicity moderated the relation between nativity status and these three outcomes. Among Asians, the likelihood of being offered access to a patient portal depended on nativity status. U.S.-born Asians had the highest rate of being offered access to a portal (66%) and foreign-born Asians had the lowest rate (38%). There were no differences as a function of nativity status for other racial/ethnic groups.