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 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.

Theory of Planned Behavior explains gender difference in fruit and vegetable consumption.

A gender difference in fruit and vegetable intake (FVI) is widely documented, but not well understood. Using data from the National Cancer Institute's Food Attitudes and Behavior Survey, we assessed the extent to which gender differences in FVI are attributable to gender differences in constructs from the Theory of Planned Behavior (TPB). Females reported more favorable attitudes and greater perceived behavior control regarding FVI than males, and these beliefs mediated the observed gender difference. Males reported greater perceived norms for FVI, but norms did not predict FVI. Gender did not moderate the influence of TPB constructs on FVI. Thus, TPB constructs substantially explained the gender difference. Interventions targeted toward adult males may benefit by promoting favorable attitudes and perceived behavioral control over FVI.

Dispositional mindfulness moderates the effects of stress among adolescents: rumination as a mediator.

Recent research has demonstrated that higher levels of mindfulness are associated with greater psychological and physical health. However, the majority of this research has been conducted with adults; research is only beginning to examine the effects of mindfulness among adolescents. Further, research into adolescent mindfulness has typically conceptualized mindfulness as a unidimensional phenomenon and has not yet examined multidimensional models of mindfulness that have emerged in the adult literature. Further, the mechanisms through which mindfulness influences these outcomes are presently unclear. The present study examined the effects of three facets of mindfulness among adolescents. Seventy-eight adolescents (61% female, 94% Caucasian, M age = 16) completed a measure of dispositional mindfulness at baseline. Participants then completed measures of daily stress, dysphoric affect, and state rumination over a 7-day period. Multilevel modeling analyses revealed that facets of mindfulness (i.e., nonreactivity and nonjudgment) were associated with lower levels of dysphoric mood. Mindfulness interacted with daily stress to predict later dysphoria; less mindful individuals were particularly vulnerable to the negative effects of stress. Finally, analyses demonstrated that the effect of the Mindfulness × Stress Moderation was significantly mediated by increases in daily rumination. These findings support the importance of mindfulness among adolescents and help to elucidate the mechanisms through which mindfulness influences psychological health.

Education differences in cancer fatalism: The role of information-seeking experiences.

Cancer fatalism is the belief that cancer is uncontrollable and lethal. Individuals with less education are more likely to hold fatalistic beliefs about cancer, but the mechanism accounting for the relationship is unknown. We tested whether negative health information seeking experiences explain this relationship. Structural equation modeling was used to test this relationship across three datasets from the Health Information National Trends Survey. Across all datasets, the model showed good fit: Cycle 1 (coefficient of determination = .11, comparative fit index = .96, root mean square error of approximation = .047), Cycle 2 (coefficient of determination = .06, comparative fit index = .96, root mean square error of approximation = .046), and Cycle 3 (coefficient of determination = .08, comparative fit index = .95, root mean square error of approximation = .052). The link between lower education level and higher cancer fatalism was partially mediated by negative health information seeking experiences.

Dental Visits Mediate the Impact of Smoking on Oral Health.

OBJECTIVES: We explored the mediational relationships among smoking, dental visits, and oral health in a longitudinal study. METHODS: We selected a sample of adult residents of rural communities of North Central Florida and followed them for 3 years (final N = 1170). We examined the impact of smoking on oral health across time and conducted mediation analysis to quantify the effect of dental visits on the relationship between smoking and poor oral health. RESULTS: Our results showed that oral health declined across time for smokers but not for nonsmokers. The mediation analysis found that 18.3% of the difference in followup oral health between smokers and non-smokers was explained by smokers not having any dental visits in the last year. CONCLUSIONS: Our findings suggest that, given the low success rate of quitting smoking, promoting dental visits can help limit the negative effects of smoking on oral health. Future community prevention studies could encourage dental visits among smokers and provide educational materials that aim to increase knowledge of oral self-care.

Spontaneous self-affirmation is associated with psychological well-being: Evidence from a US national adult survey sample.

Emerging evidence suggests that individuals spontaneously self-affirm, by reflecting on values and strengths, in response to daily threats. We examined the prevalence and demographic and well-being correlates of spontaneous self-affirmation in the general population. Participants ( n = 3185) completed the cross-sectional, nationally representative 2013 Health Information National Trends Survey (HINTS 4, Cycle 3), and answered questions about spontaneous self-affirmation, demographic factors, well-being, and affect. The majority of the population reported spontaneously self-affirming. Black and Hispanic respondents reported engaging in more spontaneous self-affirmation. Engaging in spontaneous self-affirmation was related to greater happiness, hopefulness, optimism, subjective health, and personal health efficacy, and less anger and sadness.

The reliability of psychological instruments in community samples: A cautionary note.

Although researchers norm and validate measures of psychological constructs largely on educated samples, they often use these instruments more broadly, assuming generalizability. We examined whether the assumption of generalizability is warranted. We administered three commonly used psychological measures-the Behavioral Activation/Behavioral Inhibition Scale, the Regulatory Focus Questionnaire, and the Need for Cognition Scale-to a community sample (N = 332) with limited education. For the three instruments, five of seven scales/subscales had unsatisfactory reliabilities. Internal consistency was lowest among participants with less education. The results suggest that instruments normed on educated samples may not generalize to uneducated samples.

Associations of spontaneous self-affirmation with health care experiences and health information seeking in a national survey of US adults.

OBJECTIVE: Self-affirming--such as by reflecting on one's strengths and values--reduces defensiveness to threatening information, reduces negative effects of stereotype threat and promotes prosociality. These outcomes may promote physical health, highlighting a need to examine the role of self-affirmation in medical and health contexts. DESIGN: Data were collected as part of the nationally representative, cross-sectional, 2013 Health Information National Trends Survey. Items were completed by 2731 respondents. MAIN OUTCOME MEASURES: Respondents answered questions about spontaneous self-affirmation tendencies, perceptions of providers and health care, involvement in medical appointments, health information seeking and engagement in medical research. RESULTS: Spontaneous self-affirmation was associated with more positive perceptions of communication with one's provider, better perceived quality of care, greater likelihood of asking questions in a medical appointment, greater information seeking for oneself and multiple indices of surrogate information seeking (i.e. seeking information for others). Four of eight significant associations remained significant when controlling for optimism. The associations of self-affirmation with aspects of the patient-provider relationship were not modified by factors likely to be associated with stereotype threat (e.g. race or BMI). CONCLUSION: Spontaneous self-affirmation was related to positive outcomes in health contexts. Experimental research is needed to further explore the causal nature of these associations.

Message framing for health: moderation by perceived susceptibility and motivational orientation in a diverse sample of Americans.

OBJECTIVE: The present study examined how gain- and loss-framed informational videos about oral health influence self-reported flossing behavior over a 6-month period, as well as the roles of perceived susceptibility to oral health problems and approach/avoidance motivational orientation in moderating these effects. METHOD: An age and ethnically diverse sample of 855 American adults were randomized to receive no health message, or either a gain-framed or loss-framed video presented on the Internet. Self-reported flossing was assessed longitudinally at 2 and 6 months. RESULTS: Among the entire sample, susceptibility interacted with frame to predict flossing. Participants who watched a video where the frame (gain/loss) matched perceived susceptibility (low/high) had significantly greater likelihood of flossing at recommended levels at the 6-month follow-up, compared with those who viewed a mismatched video or no video at all. However, young adults (18-24) showed stronger moderation by motivational orientation than by perceived susceptibility, in line with previous work largely conducted with young adult samples. CONCLUSION: Brief informational interventions can influence long-term health behavior, particularly when the gain- or loss-frame of the information matches the recipient's beliefs about their health outcome risks.

Avoiding cancer risk information.

RATIONALE: Perceived risk for health problems such as cancer is a central construct in many models of health decision making and a target for behavior change interventions. However, some portion of the population actively avoids cancer risk information. The prevalence of, explanations for, and consequences of such avoidance are not well understood. OBJECTIVE: We examined the prevalence and demographic and psychosocial correlates of cancer risk information avoidance preference in a nationally representative sample. We also examined whether avoidance of cancer risk information corresponds with avoidance of cancer screening. RESULTS: Based on our representative sample, 39% of the population indicated that they agreed or strongly agreed that they would "rather not know [their] chance of getting cancer." This preference was stronger among older participants, female participants, and participants with lower levels of education. Preferring to avoid cancer risk information was stronger among participants who agreed with the beliefs that everything causes cancer, that there's not much one can do to prevent cancer, and that there are too many recommendations to follow. Finally, the preference to avoid cancer risk information was associated with lower levels of screening for colon cancer. CONCLUSION: These findings suggest that cancer risk information avoidance is a multi-determined phenomenon that is associated with demographic characteristics and psychosocial individual differences and also relates to engagement in cancer screening.

Framing flu prevention--an experimental field test of signs promoting hand hygiene during the 2009-2010 H1N1 pandemic.

OBJECTIVE: During the 2009-2010 H1N1 flu pandemic, many institutions installed alcohol-based hand sanitizer dispensers in public settings in an effort to prevent the spread of the virus. Yet, usage of these dispensers remained low. METHOD: Point-of-use reminder signs were designed to emphasize four theoretically grounded health beliefs: perceived susceptibility, social norms, consequences of the behavior framed as gains, and consequences of the behavior framed as losses. From October 2009 to March 2010, 58 sanitizer dispensers in public buildings were randomly assigned to have one of the four signs placed next to it, and dispenser usage was continually monitored. RESULTS: All signs were associated with greater sanitizer usage compared to no sign. The gain-framed sign was associated with greatest usage (66% over no sign). Signs emphasizing susceptibility to H1N1 were associated with the lowest usage (41% over no sign). Although usage declined over time and closely mirrored trends in public interest about H1N1, the influence of the signs was not dependent on degree of public interest. CONCLUSION: This experimental field study shows how simple, theoretically grounded signs can serve as cues to action in promoting the adoption of preventive behaviors. Gain-framed signage is particularly effective in promoting hand hygiene in a flu pandemic.

Sheltering the self from the storm: self-construal abstractness and the stability of self-esteem.

Self-construal abstractness (SCA) refers to the degree to which people construe important bases of self-esteem in a broad, flexible, and abstract rather than a concrete and specific manner. This article hypothesized that SCA would be a unique predictor of self-esteem stability, capturing the degree to which people's most important bases of self-worth are resistant to disconfirmation. Two studies using a daily diary methodology examined relationships between SCA, daily self-esteem, and daily emotions and/or events. In Study 1, individual differences in SCA emerged as the most consistent and unique predictor of self-esteem stability. Furthermore, SCA contributed to self-esteem stability by buffering the influence of daily negative emotions on self-esteem. Study 2 manipulated SCA via a daily self-construal task and found an abstract versus concrete self-focus to buffer the influence of daily negative events on self-esteem. Implications of these findings for the study of the self and well-being are discussed.