Psychometric properties and predictive validity of the PP-ACT.

OBJECTIVE: The Parent Proxy Asthma Control Test (PP-ACT) is a self-report measure of asthma control completed by caregivers on behalf of a child. We examined the psychometric properties and the reliability and predictive validity of the PP-ACT. METHODS: We conducted two studies (one cross-sectional, one longitudinal over three months) that surveyed caregivers (N = 1622) of children with asthma. Caregivers completed the PP-ACT and a variety of other measures, including child health outcomes. RESULTS: We found clear evidence that the five-item PP-ACT assesses two distinct constructs: Items 1-4 (which we call the PP-ACT4) assess symptoms, impairment, and use of a short acting beta-2 blocker (albuterol); Item 5 assesses caregivers' global subjective assessment of their child's asthma control. In addition, the two constructs function as unique predictors of asthma outcomes. Both the PP-ACT4 and Item 5 predicted unique variance in ED visits, the number of symptom-free days, and child quality of life. Only the PP-ACT4 predicted frequency of ICS use and only at Time 1 in Study 1. Conversely, Item 5 predicted exacerbation frequency whereas the PP-ACT4 did not. CONCLUSION: Our findings suggest that researchers and clinicians should treat the PP-ACT4 and Item 5 as distinct indicators of asthma control because they differentially predict asthma outcomes and likely have distinct meanings to caregivers.Supplemental data for this article is available online at https://doi.org/10.1080/02770903.2022.2036755 .

Linking cognitive and affective heuristic cues to interpersonal risk perceptions and behavior.

People often use cognitive and affective heuristics when judging the likelihood of a health outcome and making health decisions. However, little research has examined how heuristics shape risk perceptions and behavior among people who make decisions on behalf of another person. We examined associations between heuristic cues and caregivers' perceptions of their child's asthma risk, the frequency of caregivers' asthma management behaviors, and child health outcomes. We used Ipsos KnowledgePanel to recruit 814 U.S. adult caregivers of children with asthma of the age <18 years. Participants completed a survey at baseline (T1) and 3 months later (T2). Caregivers who, at T1, reported greater negative affect about their child's asthma (affect heuristic cue), greater ease of imagining their child experiencing asthma symptoms (availability heuristic cue), and greater perceived similarity between their child and a child who has ever experienced asthma symptoms (representativeness heuristic cue) reported statistically significantly (p < 0.05) higher interpersonal perceived risk of their child having an exacerbation or uncontrolled asthma at T1. They also indicated at T2 that their child had poorer asthma control and more frequent exacerbations. Greater T1 negative affect was associated with more frequent T2 actions to reduce inflammation, manage triggers, and manage symptoms, and with poorer T2 child health outcomes. Heuristic cues are likely important for interpersonal-not just personal-risk perceptions. However, the interrelationship between caregivers' ratings of heuristic cues (in particular, negative affect) and risk judgments may signify a struggle with managing their child's asthma and need for extra support from health care providers or systems.

Guidelines for Conducting Virtual Cognitive Interviews During a Pandemic.

The COVID-19 pandemic has challenged researchers working in physical contact with research participants. Cognitive interviews examine whether study components (most often questionnaire items) are worded or structured in a manner that allows study participants to interpret the items in a way intended by the researcher. We developed guidelines to conduct cognitive interviews virtually to accommodate interviewees who have limited access to the internet. The guidelines describe the essential communication and safety equipment requirements and outline a procedure for collecting responses while maintaining the safety of the participants and researchers. Furthermore, the guidelines provide suggestions regarding training of participants to use the technology, encouraging them to respond aloud (a potential challenge given that the researcher is not physically present with the participant), and testing and deploying the equipment prior to the interview. Finally, the guidelines emphasize the need to adapt the interview to the circumstances and anticipate potential problems that might arise.

Belief in a Loving Versus Punitive God and Behavior.

We examined the extent to which beliefs in a loving God and punitive God correspond with self-reported behavior in an online, longitudinal survey involving three waves of data collection, each separated by 6 months. Adolescents (N = 760) reported the extent to which they believed in a loving God and a punitive God (Times 1 and 3) and reported their engagement in benevolent (helping and forgiveness) and aggressive behavior (Times 2 and 3). Participants strongly endorsed a loving God but not a punitive God. In addition, belief in a loving God corresponded with reports of less aggressive and more benevolent behavior, whereas belief in a punitive God corresponded with more aggressive and less benevolent behavior.

Assessing the consequences of unrealistic optimism: Challenges and recommendations.

Of the hundreds of studies published on unrealistic optimism (i.e., expecting a better personal future than is reasonably likely), most have focused on demonstrating the phenomenon, examining boundary conditions, or documenting causes. Few studies have examined the consequences of unrealistic optimism. In this article, we provide an overview of the measurement of unrealistic optimism, review possible consequences, and identify numerous challenges confronting investigators attempting to understand the consequences. Assessing the consequences of unrealistic optimism is tricky, and ultimately probably impossible when researchers assess unrealistic optimism at the group level (which reveals if a group of people is displaying unrealistic optimism on average) rather than the individual level (which reveals whether a specific individual displays unrealistic optimism). We offer recommendations to researchers who wish to examine the consequences of unrealistic optimism.

Perspective Taking Explains Gender Differences in Late Adolescents' Attitudes Toward Disadvantaged Groups.

Adolescents' attitudes toward disadvantaged groups are surprisingly understudied. What we know from these few studies is that adolescents' attitudes tend to become more favorable over time and that adolescent girls display more favorable attitudes than do adolescent boys. However, researchers have not offered explanations for why these effects occur. We proposed that changes in social-cognitive abilities that accompany adolescent development increase perspective taking and that the increased perspective taking facilitates more favorable attitudes toward disadvantaged groups. Because girls develop social-cognitive abilities earlier than boys, girls should show greater perspective taking and thus more positive attitudes toward disadvantaged groups than should boys. Importantly, we propose that these more positive attitudes are explained better by perspective taking than by gender. Participants were late adolescents (n = 803, 53.3 % female, ages 15-19) from high schools in north-central Florida (United States) participating in an ongoing, multi-wave study. Participants completed a measure of perspective-taking and reported their attitudes toward three disadvantaged groups (Black, gay, and poor people) during their third year of high school and, again, 6 months later during their fourth year of high school. Our findings provided strong support for our theorizing. Girls generally reported warmer attitudes than did boys toward disadvantaged groups, with the gender differences in warmth tending to diminish across time. Similarly, girls were higher than boys in perspective-taking abilities at both time points, although boys increased over time whereas girls did not. Crucially, perspective taking mediated observed gender differences in attitudes, suggesting that perspective taking is a mechanism for improving attitudes toward disadvantaged groups during late adolescence.

Determinants of First-Time Cancer Examinations in a Rural Community: A Mechanism for Behavior Change.

OBJECTIVES: After conducting a media campaign focusing on the importance of oral and pharyngeal cancer (OPC) examinations, we assessed mechanisms of behavior change among individuals receiving an OPC examination for the first time. METHODS: We used data from 2 waves of telephone surveys of individuals residing in 36 rural census tracts in northern Florida (n = 806). The second survey occurred after our media intervention. We developed media messages and modes of message delivery with community members via focus groups and intercept interviews. We performed a mediation analysis to examine behavior change mechanisms. RESULTS: Greater exposure to media messages corresponded with heightened concern about OPC. Heightened concern, in turn, predicted receipt of a first-time OPC examination, but only among men. CONCLUSIONS: We extended earlier studies by measuring an outcome behavior (receipt of an OPC examination) and demonstrating that the putative mechanism of action (concern about the disease) explained the link between a media intervention and engaging in the target behavior. Improving the quality of media campaigns by engaging community stakeholders in selecting messages and delivery methods is an effective strategy in building public health interventions aimed at changing behaviors.

Predicting Avoidance of Skin Damage Feedback Among College Students.

BACKGROUND: Showing people a personal ultraviolet (UV) photograph depicting skin damage can be an effective method for changing sun protection cognitions and behaviors. PURPOSE: We examined whether people opt not to see their UV photograph if given a choice. We also examined predictors of avoidance of skin damage feedback. METHODS: College students (N = 257) completed questionnaires, viewed example UV photographs, and received the opportunity to see a UV photograph of their face. RESULTS: Over one-third of participants opted not to see their UV photograph. Greater perceived risk of sun damage and having fewer coping resources corresponded with greater avoidance, particularly among participants who reported infrequent sun protection behavior. CONCLUSION: The health benefits of UV photography are realized only if people are willing to view the photograph. Our findings suggest the need for interventions that increase receptivity to viewing one's UV photograph.

Predicting Scheduling and Attending for an Oral Cancer Examination.

BACKGROUND: Oral and pharyngeal cancer is highly treatable if diagnosed early, yet late diagnosis is commonplace apparently because of delays in undergoing an oral cancer examination. PURPOSE: We explored predictors of scheduling and attending an oral cancer examination among a sample of Black and White men who were at high risk for oral cancer because they smoked. METHODS: During an in-person interview, participants (N = 315) from rural Florida learned about oral and pharyngeal cancer, completed survey measures, and were offered a free examination in the next week. Later, participants received a follow-up phone call to explore why they did or did not attend their examination. RESULTS: Consistent with the notion that scheduling and attending an oral cancer exam represent distinct decisions, we found that the two outcomes had different predictors. Defensive avoidance and exam efficacy predicted scheduling an examination; exam efficacy and having coping resources, time, and transportation predicted attending the examination. Open-ended responses revealed that the dominant reasons participants offered for missing a scheduled examination were conflicting obligations, forgetting, and confusion or misunderstanding about the examination. CONCLUSIONS: The results suggest interventions to increase scheduling and attending an oral cancer examination.

Information Avoidance Tendencies, Threat Management Resources, and Interest in Genetic Sequencing Feedback.

BACKGROUND: Information avoidance is a defensive strategy that undermines receipt of potentially beneficial but threatening health information and may especially occur when threat management resources are unavailable. PURPOSE: We examined whether individual differences in information avoidance predicted intentions to receive genetic sequencing results for preventable and unpreventable (i.e., more threatening) disease and, secondarily, whether threat management resources of self-affirmation or optimism mitigated any effects. METHODS: Participants (N = 493) in an NIH study (ClinSeq®) piloting the use of genome sequencing reported intentions to receive (optional) sequencing results and completed individual difference measures of information avoidance, self-affirmation, and optimism. RESULTS: Information avoidance tendencies corresponded with lower intentions to learn results, particularly for unpreventable diseases. The association was weaker among individuals higher in self-affirmation or optimism, but only for results regarding preventable diseases. CONCLUSIONS: Information avoidance tendencies may influence decisions to receive threatening health information; threat management resources hold promise for mitigating this association.

Realizing the promise of social psychology in improving public health.

The theories, phenomena, empirical findings, and methodological approaches that characterize contemporary social psychology hold much promise for addressing enduring problems in public health. Indeed, social psychologists played a major role in the development of the discipline of health psychology during the 1970s and 1980s. The health domain allows for the testing, refinement, and application of many interesting and important research questions in social psychology, and offers the discipline a chance to enhance its reach and visibility. Nevertheless, in a review of recent articles in two major social-psychological journals (Personality and Social Psychology Bulletin and Journal of Personality and Social Psychology), we found that only 3.2% of 467 studies explored health-related topics. In this article, we identify opportunities for research at the interface of social psychology and health, delineate barriers, and offer strategies that can address these barriers as the discipline continues to evolve.

Religiousness and aggression in adolescents: The mediating roles of self-control and compassion.

Although people have used religion to justify aggression, evidence suggests that greater religiousness corresponds with less aggression. We explored two explanations for the religion-aggression link. First, most major religions teach self-control (e.g., delaying gratification, resisting temptation), which diminishes aggression. Second, most major religions emphasize compassionate beliefs and behavior (i.e., perspective taking, forgiveness, a broader love of humanity) that are incompatible with aggression. We tested whether self-control and compassion mediated the relationship between religion and aggression (direct and indirect) in a longitudinal study of 1,040 adolescents in the United States. Structural equation analyses revealed that self-control and compassion together completely mediated the religion-aggression relationship for both types of aggression.

A survey of barriers to screening for oral cancer among rural Black Americans.

OBJECTIVE: Research documents a disparity between Black and White Americans in mortality for oral cancer that appears to result in part from behaviors such as lower oral cancer screening among Black Americans. We examined barriers to oral cancer screening among Black Americans. METHODS: We surveyed Black Americans (N = 366) living in rural Florida to identify barriers to getting screened for oral cancer. RESULTS: Low knowledge/social attention, lack of resources, and fear/defensive avoidance predicted screening intentions, with lack of resources emerging as the largest barrier. Participants also reported that a recommendation from their provider was most likely to increase screening intentions, whereas encountering financial barriers was most likely to decrease screening intentions. CONCLUSIONS: Low knowledge/social attention, lack of resources, and fear/defensive avoidance emerged as independent barriers to oral cancer screening, with the latter two barriers accounting for the most variance in intentions to get screened.

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. The possibility for broad population reach warrants further testing.

Managing children's asthma: what role do caregivers' mental representations of trigger and symptom management behaviors play?

OBJECTIVE: Pediatric asthma management is challenging for parents and guardians (hereafter caregivers). We examined (1) how caregivers mentally represent trigger and symptom management strategies, and (2) how those mental representations are associated with actual management behavior. METHODS: In an online survey, N = 431 caregivers of children with asthma rated 20 trigger management behaviors and 20 symptom management behaviors across 15 characteristics, and indicated how often they engaged in each behavior. RESULTS: Principal components analysis indicated 4 dimensions for trigger management behaviors and 3 for symptom management behaviors. Bayesian mixed-effects models indicated that engagement in trigger management behavior was more likely for behaviors rated as affirming caregiver activities. However, trigger management behavior did not depend on how highly the behavior was rated as challenging for caregiver, burdensome on child, or routine caregiving. Engagement in symptom management behavior was more likely for behaviors rated as affirming and common and harmless to the child, but was unrelated to how highly a behavior was rated as challenging for caregivers. CONCLUSION: These results suggest that interventions might be particularly useful if they focus on the affirming nature of asthma management behaviors. However, such interventions should acknowledge structural factors (e.g. poverty) that constrain caregivers' ability to act.

Reducing health-information avoidance through contemplation.

Despite the importance of learning about one's health, people sometimes opt to remain ignorant. In three studies, we investigated whether prompting people to contemplate their reasons for seeking or avoiding information would reduce avoidance of personal health information. In Study 1, people were more likely to opt to learn their risk for type 2 diabetes if they had completed a motives questionnaire prior to making their decision than if they had not. In Study 2, people were more likely to opt to learn their risk for cardiovascular disease if they had first listed and rated reasons for seeking or avoiding the information than if they had not. Study 3 replicated Study 2 but also showed that contemplating reasons for avoiding versus seeking reduced avoidance of personal-risk information only when the risk condition was treatable.

Barriers to oral cancer screening: a focus group study of rural Black American adults.

OBJECTIVE: Mortality from mouth and throat cancer (MTC) is higher among Black Americans than White Americans partially because of late stage detection through screening. The disparity in mortality is particularly problematic among Black Americans living in rural areas who have limited access to preventative resources. Our study explored barriers to screening for MTC among Black Americans. METHODS: We conducted nine focus groups among rural Black Americans age 40 years and older (N = 80). RESULTS: Content coding of the transcripts of the focus groups revealed three primary barriers to screening. Lack of knowledge (e.g., not knowing about MTC and not knowing MTC symptoms) accounted for 31.8% of all barriers mentioned, lack of resources (e.g., lack of money and health insurance) accounted for 25.0% of all barriers mentioned, and fear (e.g., fear of screening and diagnosis) accounted for 22.9% of all barriers mentioned. CONCLUSIONS: We placed these barriers within the Theory of Planned Behavior and conclude that interventions aimed at increasing MTC screening among rural Black Americans should first focus on changing people's attitudes about screening by increasing knowledge about MTC and reducing fear.

Behavioral obligation and information avoidance.

BACKGROUND: Although knowledge can be powerful and bring a variety of important benefits, people often opt to remain ignorant. PURPOSE: We propose that people are particularly inclined to remain ignorant when learning information could obligate undesirable behavior. METHOD: In three studies, participants completed an online risk calculator and then learned that receiving high-risk feedback from the calculator would obligate them to engage in a behavior that was either highly undesirable (e.g., undergoing a cervical exam and taking medication for the rest of their life) or only slightly undesirable (e.g., having their cheek swabbed and taking medication for 2 weeks). We then offered participants the opportunity to receive risk feedback from the calculator. RESULTS: Across all studies, participants more often avoided feedback when it could obligate highly undesirable behavior compared with mildly undesirable behavior. CONCLUSION: People decline learning their risk information more often when doing so obligates undesirable behavior in response.

Increasing screening intentions for oral and pharyngeal cancer.

BACKGROUND: Oral and pharyngeal cancer is a serious health threat that goes unnoticed by most people. Increasing screenings for oral and pharyngeal cancer is essential to achieving early detection when the disease is most treatable. PURPOSE: We tested the effectiveness of a media campaign designed to increase intentions to seek an oral and pharyngeal cancer screening. We further examined whether concern and knowledge of oral and pharyngeal cancer mediated screening intentions. METHODS: Participants in the intervention condition received messages on posters, handheld fans, pamphlets, and magnets displayed on the sides of cars or trucks. Participants in the intervention and comparison conditions (N = 1,790) were surveyed prior to and after the intervention. RESULTS: Intervention participants reported greater intentions to seek free oral and pharyngeal cancer screenings. Concern about oral and pharyngeal cancer partially mediated the effect whereas knowledge did not. CONCLUSIONS: Our media campaign successfully increased screening intentions by heightening concerns.