Predicting perceived vulnerability to tobacco-related health risks and future intentions to use tobacco among pediatric cancer survivors

OBJECTIVE: To examine predictors of perceived vulnerability to tobacco-related health risks and future intentions to use tobacco among pre-adolescents and adolescents previously treated for cancer. METHODS: Written self-report measures of tobacco knowledge, perceived vulnerability, perceived positive value of tobacco use, past and present tobacco use, and intentions to use tobacco were completed by 103 cancer survivors, 10-18 years of age (51.5% males, 78.6% Caucasians). Patient reports of peer and parent tobacco use were also obtained. RESULTS: Perceived vulnerability was influenced by demographic variables, knowledge, and gender-related past tobacco use. Fifty-seven percent of non-smoking survivors reported some intention to use tobacco. Survivors who perceived some positive value associated with tobacco use and who used tobacco in the past reported greater intentions for future tobacco use. CONCLUSION: Modifiable cognitive-motivational variables directly associate with smoking-related outcomes among pediatric survivors of childhood cancer. PRACTICE IMPLICATIONS: Preventive tobacco interventions with this vulnerable cohort are warranted and should inform about tobacco-related health risks and attempt to modify misperceptions of the positive value associated with tobacco use.     

A comparison of tobacco-related risk factors between adolescents with and without cancer

OBJECTIVE: To compare adolescents with and without cancer on current smoking status, intentions to smoke, and tobacco-related risk factors. METHODS: Ninety adolescents undergoing treatment for cancer (median time since diagnosis was 2.4 months) and a comparison sample of 279 adolescents without cancer, ages 12 to 18 years, completed questionnaires that asked about their smoking habits, intentions to smoke, and tobacco-related psychosocial risk factors. RESULTS: Approximately 2% of adolescents with cancer and 22% of adolescents without cancer reported current smoking. Compared to nonsmoking adolescents without cancer, nonsmoking adolescents with cancer were one third less likely to report intentions to smoke. No significant interactions were detected between group (having cancer or not) and each of the tobacco-specific and psychosocial variables tested in two separate multivariable models. Intentions to smoke were best predicted by variables most proximal to smoking. Adolescents who smoked in the past and who had lower tobacco knowledge and greater perceived instrumental value were more likely to report intentions to smoke. Adolescents who were less optimistic were also more likely to intend to smoke. CONCLUSIONS: Tobacco-related risk factors for intentions to smoke appeared to be similar among adolescents with and without cancer. Implications of these findings for tobacco control among adolescents with cancer are discussed.     

Children's beliefs about long-term health effects of alcohol and cocaine use

OBJECTIVE: To assess age differences in children's beliefs about the long-term health effects of alcohol and cocaine, to use such beliefs to predict attitudes toward and intentions to use these substances, and to establish whether accurate beliefs are more predictive than inaccurate ones. METHODS: Children ages 6 to 12 (N: = 217) responded to an open-ended question about the effects of long-term alcohol and cocaine use and to 12 structured questions asking whether each produces alcohol-like, cocaine-like, and tobacco-like effects. RESULTS: Differentiation among alcohol, cocaine, and tobacco effects was limited but increased with age. Beliefs about health effects had no impact on alcohol attitudes and intentions, but intentions to drink were stronger among older and white children. Anti-cocaine attitudes and intentions were associated with being older and non-White and with having accurate knowledge of cocaine's true health effects-but also with believing falsely that cocaine has tobacco-like effects and that drugs in general have catastrophic effects. CONCLUSIONS: With age, and as predicted by Werner's orthogenetic principle, children differentiated more sharply between substances. Although negative misconceptions can contribute to anti-drug attitudes and intentions, children should nonetheless be taught about the distinct effects of different substances on health.     

Predicting perceived vulnerability for breast cancer among women with an average breast cancer risk

Objectives. The purpose of the present study was to investigate predictors of perceived vulnerability for breast cancer in women with an average risk for breast cancer. On the basis of empirical findings that suggested which variables might be associated with perceived vulnerability for breast cancer, we investigated whether knowledge of breast cancer risk factors, cancer worry, intrusions about breast cancer, optimism about not getting cancer and perceived health status have a predictive value for perceived breast cancer vulnerability. Design. In a 3‐step approach, we recruited 292 women from the general public in Germany who had neither a family history of breast cancer nor breast cancer themselves. After receiving an initial informational letter about study objectives, the women were interviewed by telephone and then asked to fill in a self‐administered questionnaire. Methods. We used structural equation modelling and hypothesized that each of the included variables has a direct influence on perceived vulnerability for breast cancer. Results. We found a valid model with acceptable fit indices. Optimism about not getting cancer, intrusions about breast cancer and women's perceived health status explained 32% of the variance of perceived vulnerability for breast cancer. Cancer worry and knowledge about breast cancer did not influence perceived vulnerability for breast cancer. Conclusion. Perceived vulnerability for breast cancer is associated with health‐related variables more than with knowledge about breast cancer risk factors.     

Brief report: health beliefs among survivors of childhood cancer

OBJECTIVE: To describe interest in cancer screening and tobacco-control procedures (nicotine-addiction susceptibility testing) among survivors of childhood cancer and to identify psychosocial modifying and readiness factors associated with survivors' interest, based on the children's health belief model. METHODS: Twenty-eight survivor-mother dyads were interviewed as part of a preliminary study (mean age of survivors = 15.4 years at time of interview, 10.1 years at time of diagnosis, and 12.0 years at end of treatment); interviews consisted of well-validated self-report items and measures of health beliefs. RESULTS: In sum, 57% and 61% of survivors were interested in screening and susceptibility testing, respectively. Survivors who rated themselves as more competent, more concerned about cancer, and more vulnerable to cancer were more interested in participating in screening. Regarding interest in nicotine-addiction susceptibility testing, survivors were more interested when they perceived greater vulnerability to the harm of smoking and when they had mothers who perceived themselves to be in better health. CONCLUSIONS: Preliminary data suggest that psychosocial modifying and readiness factors are associated with survivors' interest in cancer screening and tobacco-control procedures and that additional research in this area is warranted.     

Colorectal cancer risk perceptions and screening intentions in a minority population

This is a 2-year follow-up to a previously reported baseline paper. We focused on a predominantly low-income African-American population from a community health center and investigated the relationships among perceptions of perceived risks for colorectal cancer (CRC), concerns about getting CRC, screening intentions, and whether participants had a fecal occult blood test (FOBT) on schedule at follow-up. Baseline absolute risk did not predict screening intentions or being on schedule (15% of sample), nor did it predict follow-up perceived absolute risk, comparative risk, or CRC concerns. Participants who expressed greater perceived absolute risk, comparative risk, and concerns at follow-up were more likely to report thinking about or definitely planning to get an FOBT within the next 2 years (49% of the sample). In addition, baseline absolute risk and whether or not a person had an FOBT on schedule at baseline did not predict being on schedule at follow-up. A significant percentage of the population (20%) were not able to state whether their CRC risk was below average, average, or above average. In addition, 44% of the population viewed their risks as lower than their peers, and 58% reported being not at all or slightly concerned about getting CRC. These results suggest that educational efforts are needed especially for low-income minority populations to enhance knowledge and accuracy of risk perceptions for CRC and interventions that explicitly manipulate risk are needed to assess to what extent risk perceptions can be modified and subsequently affect screening.     

Appearance matters: The frame and focus of health messages influences beliefs about skin cancer

Objectives. This study sought to ascertain whether the health message ‘framing effect’, which has been observed for several diseases, occurs for messages concerning the consequences of skin cancer for one's appearance or one's health. Specifically, the effect of the frame and focus of health messages on intentions to perform skin protection behaviours and the perceived threat of skin cancer was investigated. Design. Consistent with previous research and to avoid carry‐over effects, a two‐factor, between‐groups (message frame: gain vs. loss × message focus: appearance vs. health) design was used. Methods. Participants (N= 390) were recruited using convenience sampling and presented with one of four health messages, which were embedded in a questionnaire concerning beliefs about skin cancer (intentions to perform different skin protection behaviours, the perceived threat of skin cancer) and body consciousness. The health messages were framed in terms of loss (risks of sun exposure) or gain (benefits of skin protection) and focused on the consequences of sun exposure for one's appearance or one's health. The primary outcome measures were responses on rating scales concerning the perceived threat of skin cancer, intentions to perform different skin cancer protection behaviours, and body consciousness. Results. Perceived threat of skin cancer was found to be greater for appearance‐focused messages and intentions to perform different skin protection behaviours were greater for loss‐framed messages. These findings held when individual differences in body consciousness were controlled for. Conclusions. These findings suggest that, for the communication of information about skin cancer to be effective, messages must focus on the impact of sun exposure and inadequate skin protection for people's appearance, not just their health. Moreover, to maximize effectiveness, health messages about skin cancer should take account of dispositional differences in the importance placed upon one's appearance.     

Family history and perceived vulnerability to some common diseases: a study of young people and their parents.

During the last two decades, health promotion has concentrated on lifestyle factors. However, recent research in genetics has shown that inherited susceptibility may be important in many common conditions. This raises questions about how these two different messages are integrated into people's beliefs about their own susceptibility. We report a study based on interviews with 58 young people, who had all recently completed the National Curriculum science course including basic human genetics, and 54 of their parents. We aimed to examine the extent to which people take account of family history when considering their susceptibility to health risks, with comparisons being made between generations, gender, and between different diseases. Family health histories were compared between generations and the relationship between reported family history and perceived vulnerability was examined. Family health history was seen as more relevant for a perceived vulnerability to heart disease and diabetes than cancer, while actions and behaviour were seen as important in determining the chance of developing heart disease and cancer but less so for diabetes. Chance was seen as an important factor in the risk of cancer and diabetes, but was barely mentioned in connection with heart disease. Nearly half of those who reported affected family members with heart disease or cancer did not perceive this to have any effect on their own susceptibility. Notably, women were much more likely than men to see the presence or absence of affected relatives as being relevant to the chances of developing cancer. Differences were found between generations in the reporting of the family tree and in knowledge of health of family members. Although words such as genes, chromosomes, and DNA were used by both generations there was no evidence of any understanding of the process of inheritance in scientific terms.     

Factors associated with intention to use hormone replacement therapy among Thai middle-aged women

OBJECTIVES: To examine the differences among those who express their intentions to use hormone replacement therapy (intenders), those who express their intentions not to use hormone replacement therapy (non-intenders), and those who are undecided, and to examine the factors associated with hormone replacement therapy (HRT) intention among Thai middle-aged women. METHODS: A total of 420 women aged 40-59 years, recruited from one hospital in Bangkok were asked to complete a self-administered questionnaire. RESULTS: Compared to intenders and non-intenders, the undecided were significantly less knowledgeable about menopause and HRT, and perceived the highest level of decisional uncertainty. Being inadequately informed was the most important factor that distinguished the undecided from intenders and non-intenders. When looking at intenders and non-intenders, no significant differences in perceived information inadequacy, level of knowledge, and perceived risks of HRT were found. However, it was found that intenders perceived higher benefit over risk of HRT (OR = 1.05, 95% CI = 1.02, 1.07), held more negative beliefs towards menopause (OR = 1.61, 95% CI = 1.03, 2.53), and were approximately two times more likely to have ever used oral contraceptives (OR = 1.99, 95% CI = 1.13, 3.47) than non-intenders. CONCLUSION: The findings reveal the importance of being informed about menopause and HRT in making decision about HRT use. Changes in knowledge, and beliefs are promising avenues to study to see how these impacts HRT use.     

Posttraumatic growth in adolescent survivors of cancer and their mothers and fathers

OBJECTIVE: To describe posttraumatic growth (PTG) following childhood cancer survival and its association with demographic and disease/treatment variables, perceived treatment severity and life threat, and posttraumatic stress symptoms (PTSS). METHOD: Adolescent survivors of cancer (N = 150, ages 11-19), at least 1 year after treatment, and their mothers (N = 146) and fathers (N = 107) completed self-report measures of perceived treatment intensity and PTSS and a semistructured interview designed to identify posttraumatic responses and indicators of PTG including perceived positive changes for self, relationships, and life goals. RESULTS: A majority of adolescents and their mothers and fathers reported PTG. Greater perceived treatment severity and life threat, but not objective disease severity, was associated with PTG. PTG and PTSS were positively associated for the adolescent cancer survivors. Diagnosis after age 5 resulted in more perceived benefit and greater PTSS for adolescent survivors. CONCLUSION: Clarification of the concept and measurement of PTG after childhood cancer is warranted, as are prospective studies of the association of PTG and PTSS and the role of demographic variables and illness-specific appraisals.     

Risk of posttraumatic stress symptoms: a comparison of child survivors of pediatric cancer and parental bereavement

OBJECTIVE: To compare the risk of posttraumatic stress (PTS) symptoms and the mediating effect of perceived future threat on the risk of PTS symptoms among survivors of pediatric cancer and children who had a parent die. METHODS: Seventy-eight children (39 survivors of cancer, 39 bereaved) completed self-report measures of PTS symptoms, depression, anxiety, and perceived risk of future threat for the event they experienced. RESULTS: The children who lost a parent reported significantly more PTS symptoms than the survivors of cancer. The effect of group status (survivor of cancer vs. bereaved) on PTS symptomatology was partly mediated by the children's perceived risk of future threat. CONCLUSIONS: The rate of PTS symptoms was found to be higher among children who had lost a parent than among survivors of pediatric cancer. This difference may partly be explained by their perceived risk of a future threat. Clinical implications are discussed.     

Tobacco-related knowledge following a comprehensive tobacco-free workplace program within behavioral health facilities: Identifying organizational moderators

ObjectiveAlthough smoking prevalence rates among behavioral health consumers is nearly five times that of the general population, evidence-based policies and practices to address tobacco use are uncommon within behavioral health settings. This study assessed changes in non-clinical, general staff and clinician tobacco-related knowledge following brief education provided as part of a comprehensive tobacco-free workplace program implementation and explored organizational moderators of pre- to post-education knowledge change.MethodsFifteen behavioral health facilities, comprising hundreds of individual clinics in Texas, participated in a one (for general staff) or two (for clinicians) hour educational session.ResultsThere were large effect sizes in general staff knowledge gain within each consortium, and large effect sizes in clinician knowledge gain in all but one consortium. Knowledge of the requirements for change, perceived availability of resources, and total number of client contacts moderated general staff knowledge gain. Value in the change and total number of client contacts moderated training effectiveness among clinicians.ConclusionsWe conclude that a brief tobacco-related education for behavioral health employees was effective in increase attendee knowledge.Practice implicationsAttention to organization-level factors moderating knowledge gain has the potential to guide and improve program implementation.     

Physical activity in child and adolescent cancer survivors: a review

Abstract

Childhood cancer survivors are at increased risk for future health problems. As such, physical activity (PA) has been targeted as a health promotion priority in child and adolescent cancer survivors. Research indicates that a large portion of pediatric survivors do not meet PA recommendations. Using Bronfenbrenner's ecological theory as a framework, this review presents a conceptual model to explain child and adolescent survivors' PA. The model considers predictors of PA across six domains: (1) demographic, (2) medical, (3) cognitive/emotional, (4) behavioural, (5) social/cultural and (6) environmental. A structured literature review found 14 empirical articles examining those predictors of PA among child and adolescent cancer survivors. Much existing research is cross-sectional, but suggests multiple factors work together to encourage or discourage PA among survivors of child/adolescent cancer. The conceptual model, which is based in empirical findings to date, can be used to understand the process through which PA is promoted and maintained, to inform the development of empirically-supported clinical interventions, and to guide future research objectives and priorities.     

Psychological and genetic counseling implications for adolescent daughters of mothers with breast cancer

Adolescent daughters of women with breast cancer (BC) are themselves at risk for heritable BC. Although some preliminary evidence suggests this group is at an increased risk for emotional problems, evidence is limited to studies with small samples and no comparison groups. This study examined psychological and family functioning, health attitudes and beliefs about genetic risks in adolescent females. A case-comparison design was used to compare 55 mother-daughter pairs in which the mother had been treated for BC (BC group) to 55 families from the general population (GP). Participants completed an assessment battery measuring perceptions of personal risk for BC and attitudes about gene testing for BC susceptibility, family functioning, and adolescent psychological adjustment. Based on manova, no significant differences were found between the two groups on measures of the psychological functioning. However, BC group adolescents reported significant (p < 0.01) worries about their future health and genetic risk for BC. About 68% of BC adolescents compared with 12% of GP adolescents reported being moderately to greatly concerned about their susceptibility to genetic mutations. Further, 85% of BC group adolescents believed they were susceptible to BC compared with 10% of GP adolescents. The results indicated no evidence of emotional, behavioral, or familial distress in these families. However, BC adolescents have significant worries about their future health. The results of this study demonstrate the need to develop a comprehensive model of care where accurate information about genetics and health risks can be provided. The adolescents also need support to help them cope and communicate with their mothers their worries about BC.     

Smokeless tobacco use in adolescent females: Prevalence and psychosocial factors among racial/ethnic groups

From a stratified, random sampling of Southeastern, nonurban high schools, survey data on smokeless tobacco use and potential psychosocial risk factors were obtained from 5683 adolescent females. Of the 15.3% who reported trying smokeless tobacco, most (75%) reported only experimental use. Factor analysis of the psychosocial items resulted in four factors: perceived negative consequences, substance use, modeling, and active lifestyle. Discriminant analysis on use indicated that modeling influences and use of other substances were the strongest predictors of initial smokeless tobacco use. Level of use, however, was most strongly associated with lower perceived negative consequences for use and the use of other substances. Separate analyses on American Indian, Black, and White subgroups suggested that factors associated with initial use were similar but that substantial differences exist between subgroups on risk factors for level of smokeless tobacco use.The research was funded by a grant from the American Society of Dentistry for Children.     

Familial adenomatous polyposis: mental health, psychosocial functioning and reactions to genetic risk in adolescents

Familial adenomatous polyposis (FAP) in a parent requires diagnostic follow-up and treatment from adolescence in possible gene carriers in order to prevent cancer development. A nationwide sample (n = 22) of adolescent FAP offspring including 85% of eligible individuals aged 11-20 years and their parents were interviewed with regard to adolescent mental health, psychosocial functioning, knowledge about FAP and genetic risk, and experiences with testing and surgery. Thirty-six percent of the FAP offspring fulfilled criteria for a psychiatric diagnosis. For adolescents older than 15 years, this was increased relative to a comparison group with Hirschprung's disease and a general population sample. Neither genetic testing nor FAP diagnosis in adolescent FAP-offspring differentiated significantly between those who fulfilled the criteria and those who did not for psychiatric diagnosis, while a global score of chronic family difficulties did. This may imply that experiencing parental illness more than inheriting FAP is a perceived stressor for adolescent FAP offspring.     

Areas of intervention for genetic counselling of dementia: cross-cultural comparison between Italians and Americans

OBJECTIVE: Purposes of this study are: (1) to evaluate attitudes, beliefs and experiences towards dementia among relatives of Italian familial cases; (2) to perform a cross-cultural comparison between Italian and American samples; (3) to identify predictors of intentions to undergo hypothetical genetic testing. METHODS: Participants were 134 relatives of patients affected by familial forms of dementia. We administered tests measuring health psychological styles, social variables, illness perceptions, intentions regarding genetic testing, and perceptions of the pros and cons of genetic testing. RESULTS: Respondents had a poor Alzheimer's disease knowledge and a low perceived dementia threat. When compared to Americans, Italians reported greater willingness to undergo genetic testing and perceived a different subset of benefits and risks. The strongest predictors of test intention were decisional balance, homemaker status and two beliefs concerning dementia causes. CONCLUSIONS: Italians had a poor knowledge of the disease and a low awareness of personal risk of developing dementia. As compared to Americans, they expressed higher intentions to undergo genetic testing and they have a different perception of benefits and risks. PRACTICE IMPLICATIONS: Understanding of cultural differences in knowledge, attitudes and perception of the disease is important to design optimal health services and education programs for dementia.     

Attitudes about genetic testing and genetic testing intentions in African American women at increased risk for hereditary breast cancer.

PURPOSE: To evaluate attitudes about the benefits, limitations, and risks of genetic testing for BRCA1 and BRCA2 (BRCA1/2) mutations and explore testing intentions in African American women at increased risk for hereditary breast cancer. METHODS: Attitudes and intentions were evaluated by telephone in African American women (n = 74) at moderate and high risk for having a BRCA1/2 mutation. RESULTS: Attitudes about the benefits of genetic testing were endorsed at a higher rate relative to limitations and risks; however, only 30% of respondents indicated that they would definitely have testing. In regression analysis, women most likely to be considering testing were those with fatalistic beliefs about cancer and those who believed they had a BRCA1/2 mutation. Women who had two or more affected relatives were also most likely to be considering testing. Women who had a personal history of cancer and those who believed they were at high risk for developing breast cancer were most likely to report greater limitations and risks. Pros scores were higher among women older than age 50 and those who were unemployed. CONCLUSION: Although African American women at moderate and high risk for BRCA1/2 mutations report favorable attitudes about genetic testing, interest in testing may be limited. Women affected with cancer and those who believe they are at a higher risk for developing breast cancer may be most concerned about the negative consequences of testing. Increased attention may need to be given to beliefs about genetic testing and testing motivations during genetic counseling with African American women.     

Areas of intervention for genetic counselling of dementia: Cross-cultural comparison between Italians and Americans

ObjectivePurposes of this study are: (1) to evaluate attitudes, beliefs and experiences towards dementia among relatives of Italian familial cases; (2) to perform a cross-cultural comparison between Italian and American samples; (3) to identify predictors of intentions to undergo hypothetical genetic testing.MethodsParticipants were 134 relatives of patients affected by familial forms of dementia. We administered tests measuring health psychological styles, social variables, illness perceptions, intentions regarding genetic testing, and perceptions of the pros and cons of genetic testing.ResultsRespondents had a poor Alzheimer's disease knowledge and a low perceived dementia threat. When compared to Americans, Italians reported greater willingness to undergo genetic testing and perceived a different subset of benefits and risks. The strongest predictors of test intention were decisional balance, homemaker status and two beliefs concerning dementia causes.ConclusionsItalians had a poor knowledge of the disease and a low awareness of personal risk of developing dementia. As compared to Americans, they expressed higher intentions to undergo genetic testing and they have a different perception of benefits and risks.Practice ImplicationsUnderstanding of cultural differences in knowledge, attitudes and perception of the disease is important to design optimal health services and education programs for dementia.     

Canadian menopause study-I: Understanding women's intentions to utilise hormone replacement therapy

OBJECTIVES: This research examines women's intentions to use or to continue to use HRT, as a function of perceived advantages and disadvantages of HRT and perceived social support for utilising HRT. METHODS: A cross-national sample of 205 pre-, peri-, and postmenopausal women convened in 33 'Women's Health Discussion Groups' in small, mid-sized, and large cities across the regions of Canada. Participants completed close-ended questionnaires assessing perceptions of advantages, disadvantages, and social support for HRT, and intentions to utilise or to continue to utilise HRT in the future. RESULTS: Women who intended to utilise or to continue to utilise HRT, compared with women who did not, perceived significantly more advantages of HRT and significantly more social support for utilising HRT, and did not, in general, differ in their perceptions of the negative side effects of HRT. Regression analysis indicated that perceived advantages of HRT and perceived social support for using HRT, but not perceived negative side effects of HRT, were significantly associated with intentions to utilise or to continue to utilise therapy and explained 46% of the variance in these intentions. CONCLUSIONS: Findings suggest that the importance of perceived health benefits of HRT and perceived social support for HRT may be substantially underestimated, and that the importance of perceived negative side effects of HRT may be substantially overestimated, in understanding women's HRT decision making and in counselling women about initiation or maintenance of therapy.