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

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

Combining risk communication strategies to simultaneously convey the risks of four diseases associated with physical inactivity to socio-demographically diverse populations

A single risk factor can increase the risk of developing multiple diseases, but most risk communication research has been conducted in the context of a single disease. We explored which combination of three recommended risk communication strategies is most effective in simultaneously conveying risk estimates of four diseases associated with physical inactivity: colon cancer, stroke, diabetes, and heart disease. Participants (N = 1161, 50% no college experience, 50% racial/ethnic minority) were shown hypothetical risk estimates for each of the four diseases. All four diseases were placed at varying heights on 1 of 12 vertical bar charts (i.e., “risk ladders”) to indicate their respective probabilities. The risk ladders varied in a 2 (risk reduction information: present/absent) × 2 (numerical format: words/words and numbers) × 3 (social comparison information: none/somewhat higher than average/much higher than average) full factorial design. Participants were randomly assigned to view one of the risk ladders and then completed a questionnaire assessing message comprehension, message acceptance, physical activity-related risk and efficacy beliefs, and physical activity intentions. Higher message acceptance was found among (1) people who received risk reduction information versus those who did not (p = .01), and (2) people who did not receive social comparison information versus those told that they were at higher than average risk (p = .03). Further, absolute cognitive perceived risk of developing “any of the diseases shown in the picture” was higher among people who did not receive social comparison information (p = .03). No other main effects and only very few interactions with demographic variables were found. Combining recommended risk communication strategies did not improve or impair key cognitive or affective precursors of health behavior change. It might not be necessary to provide people with extensive information when communicating risk estimates of multiple diseases.     

Beyond the usual suspects: target group- and behavior-specific factors add to a theory-based sun protection intervention for teenagers

Sun protection standards among teenagers are low while sun exposure peaks in this age group. Study 1 explores predictors of adolescent protection intentions and exposure behavior. Study 2 tests the effectiveness of an intervention based on these predictors. Study 1(cross-sectional, N = 207, ages 15–18) and Study 2 (RCT, N = 253, ages 13–19) were conducted in schools. Path models were used to analyze data. Self-efficacy (β = .26, p < .001) and time perspective (β = .17, p = .014) were the strongest predictors of intentions; appearance motivation (β = .54, p < .001) and intention (β = ?.18, p = .015) predicted behavior. The intervention effected changes in all predictors except self-efficacy. Changes in outcome expectancies (β = .19, p < .001) and time perspective (β = .09, p = .039) predicted changes in intention, while changes in intention (β = ?.17, p = .002) and appearance motivation (β = .29, p < .001) predicted behavior changes. Target group- and behavior-specific intervention components are as important for changes in intentions and behavior as components derived from common health behavior theories.     

Monitoring style of coping with cancer related threats: a review of the literature

Building on the Cognitive–Social Health Information-Processing model, this paper provides a theoretically guided review of monitoring (i.e., attend to and amplify) cancer-related threats. Specifically, the goals of the review are to examine whether individuals high on monitoring are characterized by specific cognitive, affective, and behavioral responses to cancer-related health threats than individuals low on monitoring and the implications of these cognitive–affective responses for patient-centered outcomes, including patient–physician communication, decision-making and the development of interventions to promote adherence and adjustment. A total of 74 reports were found, based on 63 studies, 13 of which were intervention studies. The results suggest that although individuals high on monitoring are more knowledgeable about health threats, they are less satisfied with the information provided. Further, they tend to be characterized by greater perceived risk, more negative beliefs, and greater value of health-related information and experience more negative affective outcomes. Finally, individuals high on monitoring tend to be more demanding of the health providers in terms of desire for more information and emotional support, are more assertive during decision-making discussions, and subsequently experience more decisional regret. Psychoeducational interventions improve outcomes when the level and type of information provided is consistent with the individual’s monitoring style and the demands of the specific health threat. Implications for patient-centered outcomes, in terms of tailoring of interventions, patient–provider communication, and decision-making, are discussed.     

The role of anticipated regret and health beliefs in HPV vaccination intentions among young adults

Although cognitions have predicted young adults’ human papillomavirus (HPV) vaccine decision-making, emotion-based theories of healthcare decision-making suggest that anticipatory emotions may be more predictive. This study examined whether anticipated regret was associated with young adults’ intentions to receive the HPV vaccine above and beyond the effects of commonly studied cognitions. Unvaccinated undergraduates (N = 233) completed a survey assessing Health Belief Model (HBM) variables (i.e., perceived severity of HPV-related diseases, perceived risk of developing these diseases, and perceived benefits of HPV vaccination), anticipatory emotions (i.e., anticipated regret if one were unvaccinated and later developed genital warts or HPV-related cancer), and HPV vaccine intentions. Anticipated regret was associated with HPV vaccine intentions above and beyond the effects of HBM variables among men. Among women, neither anticipated regret nor HBM variables showed consistent associations with HPV vaccine intentions. Findings suggest that anticipatory emotions should be considered when designing interventions to increase HPV vaccination among college men.     

Role of religious social support in longitudinal relationships between religiosity and health-related outcomes in African Americans

This study tested a longitudinal model of religious social support as a potential mediator of the relationship between religious beliefs and behaviors, and multiple health-related outcomes (e.g., depressive symptoms, functioning, diet, alcohol use, cancer screening). A national probability sample of African Americans enrolled in the religion and health in African Americans study completed three waves of telephone interviews over a 5-year period (N = 766). Longitudinal structural equation models indicated that religious behaviors, but not beliefs, predicted the slowing of a modest overall decline in positive religious social support, while negative interactions with congregational members were stable. Positive religious support was associated with lower depressive symptoms and heavy drinking over time, while negative interaction predicted increases in depressive symptoms and decreases in emotional functioning. Positive religious support mediated the relationship between religious behaviors and depressive symptoms and heavy drinking. Findings have implications for mental health interventions in faith-based settings.     

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

Abstract

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

Externalizing religious health beliefs and health and well-being outcomes

Certain religious beliefs related to perceptions of internal or external health control (including belief in the existence of miraculous healing, and beliefs deferring responsibility for health outcomes from the self and onto God) may be related to health behaviors and in turn to health outcomes. Using data from a nationally representative US survey of religion and health (N = 2948) this study evaluates a series of two structural equation models of the relationships between religious activity, externalizing religious health beliefs (belief in healing miracles and divine health deferral), health outcomes, and life satisfaction. Believing in healing miracles was related to greater divine health deferral. Greater divine health deferral was associated with poorer symptoms of physical health. Belief in miracles was related to greater life satisfaction. Comparison of coefficients across models indicated that externalizing beliefs had a significant suppressor effect on the relationship between religious activity and physical symptoms, but did not significantly mediate its relationship with life satisfaction. Religious beliefs emphasizing divine control over health outcomes may have negative consequences for health outcomes, although the same beliefs may contribute to a better sense of life satisfaction.     

Factors influencing NCGENES research participants- requests for non-medically actionable secondary findings

PurposeGenomic sequencing can reveal variants with limited to no medical actionability. Previous research has assessed individuals- intentions to learn this information, but few report the decisions they made and why.MethodsThe North Carolina Clinical Genomic Evaluation by Next Generation Exome Sequencing (NCGENES) project evaluated adult patients randomized to learn up to six types of non-medically actionable secondary findings (NMASF). We previously found that most participants intended to request NMASF and intentions were strongly predicted by anticipated regret. Here we examine discrepancies between intentions and decisions to request NMASF, hypothesizing that anticipated regret would predict requests but that this association would be mediated by participants- intentions.ResultsOf the 76% who expressed intentions to learn results, only 42% made one or more requests. Overall, only 32% of the 155 eligible participants requested NMASF. Analyses support a plausible causal link between anticipated regret, intentions, and requests.ConclusionsThe discordance between participants- expressed intentions and their actions provides insight into factors that influence patients- preferences for genomic information that has little to no actionability. These findings have implications for the timing and methods of eliciting preferences for NMASF and suggest that decisions to learn this information have cognitive and emotional components.     

Drinking and exercise behaviors among college students: between and within-person associations

Prior work has suggested a paradoxical positive relationship between the risk behavior alcohol use and the health behavior exercise, particularly in young adults. Though seldom tested, different theoretical perspectives exist on the mechanisms that may explain the positive relationship. The aims of this study were to test theorized mechanisms of association, including common causes shared by both behaviors (e.g., personality, motives, affective), compensatory processes such as exercising to compensate for calories from alcohol consumption, and methodological confounds (e.g., between vs. within subject effects) in a college sample (N = 132; 56.3% male; 76% Caucasian; M _age = 19.15, SD = 0.99) using a cross-sectional design and time line follow back methods. A positive, between-subjects association between alcohol and exercise was found and explained by exercising to compensate for calories of alcohol consumption, enhancement motives, and physical activity enjoyment. However, we also observed a significant and negative within-subjects association between the two constructs, suggesting that, on a given day, individuals who exercise more tended to drink less. Furthermore, individuals who exercised more during the week tended to have declines in weekend drinking over time. Results suggest a complex relationship between exercise and alcohol use among young adults, and highlight the importance of distinguishing between and within subject processes, as well as the temporal ordering of the two behaviors. Implications are discussed in regard to theory, prevention, and intervention.     

The who,what, and why of research participants’ intentions to request a broad range of secondary findings in a diagnostic genomic sequencing study

PurposeIn a diagnostic exome sequencing study (the North Carolina Clinical Genomic Evaluation by Next-Generation Exome Sequencing project, NCGENES), we investigated adult patients’ intentions to request six categories of secondary findings (SFs) with low or no medical actionability and correlates of their intentions.MethodsAt enrollment, eligible participants (n = 152) completed measures assessing their sociodemographic, clinical, and literacy-related characteristics. Prior to and during an in-person diagnostic result disclosure visit, they received education about categories of SFs they could request. Immediately after receiving education at the visit, participants completed measures of intention to learn SFs, interest in each category, and anticipated regret for learning and not learning each category.ResultsSeventy-eight percent of participants intended to learn at least some SFs. Logistic regressions examined their intention to learn any or all of these findings (versus none) and interest in each of the six individual categories (yes/no). Results revealed little association between intentions and sociodemographic, clinical, or literacy-related factors. Across outcomes, participants who anticipated regret for learning SFs reported weaker intention to learn them (odds ratios (ORs) from 0.47 to 0.71), and participants who anticipated regret for not learning these findings reported stronger intention to learn them (OR 1.61–2.22).ConclusionIntentions to request SFs with low or no medical actionability may be strongly influenced by participants’ desire to avoid regret.     

Association With Deviant Peers Across Adolescence: Subtypes,Developmental Patterns,and Long-Term Outcomes

Indices of deviant peer group involvement are inconsistent and confound type, frequency, and severity of deviant peer behaviors. These measurement approaches thus obfuscate potential meaningful differences in deviant peer involvement in terms of subtypes, developmental patterns, and long-term outcomes. The current study employed latent class analysis to derive subtypes of deviant peer involvement and examined relations to substance use disorder in adulthood, a common outcome of deviant peer involvement. Youth (76% Caucasian) completed assessments across four time points: ages 10–12 years (Time 1; N = 775, 71% male), 12–14 years (Time 2; n = 649, 72% male), 16 years (Time 3; n = 613, 73% male), and 22 years (Time 4; n = 425, 71% male). At Times 1 to 3, participants completed an interview assessing deviant peer involvement. At Time 4, participants completed a structured interview assessing substance use disorder. Classes of youth with different profiles of deviant peer associations were derived at Times 1, 2, and 3. Classes varied by type (conduct problems vs. substance use) and severity of deviant peer behavior. Youth reported higher levels of involvement with deviant peers across adolescence, suggesting that some of these deviant peer behaviors may be normative. Earlier involvement with deviant peers and involvement with groups defined by severe conduct problems and substance use were related to the greatest risk for substance use disorder at Time 4. Type and severity of peer deviant behavior differentially relate to long-term risk for substance use disorder and should be included in screening and assessment for risk across adolescence.     

Application of Azjen's Theory of Planned Behavior to Predict Sunbathing, Tanning Salon Use, and Sunscreen Use Intentions and Behaviors

Ajzen's (1988) theory of planned behavior (TOPB) was used to examine psychological determinants of high-risk UV radiation exposure-related behaviors (sunbathing, tanning salon use, and sunscreen use). Undergraduates at a midsized southeastern university were assessed on their psychological and behavioral tendencies toward high-risk UV radiation exposure-related behaviors. The results generally supported the utility of the TOPB as an explanatory model for high-risk behavior. Attitudes were strongly associated with high-risk intentions (e.g., not utilize sunscreen, use salons), whereas subjective norms were less so. Perceived behavioral control was found to moderate the relationship among attitudes, norms, and intentions to sunbathe and tan at a salon. Implications for intervention strategies and future model building in this area are discussed.     

Pregnant women’s perceptions of weight gain,physical activity,and nutrition using Theory of Planned Behavior constructs

A better understanding of women’s perceptions of weight gain and related behaviors during pregnancy is necessary to inform behavioral interventions. We used the Theory of Planned Behavior (TPB) to examine pregnant women’s perceptions and intentions toward weight gain, physical activity (PA), and nutrition using a mixed methods study design. Women between 20 and 30 weeks gestation (n = 189) were recruited to complete an Internet-based survey. Salient beliefs toward weight gain, PA, and nutrition were captured through open-ended responses and content analyzed into themes. TPB constructs (attitude, subjective norm, perceived behavioral control, intentions) were examined using Pearson correlations and hierarchical linear regression models. Salient beliefs were consistent with the existing literature in non-pregnant populations, with the addition of many pregnancy-specific beliefs. TPB constructs accounted for 23–39 % of the variance in weight gain, PA, and nutrition intentions, and made varying contributions across outcomes. The TPB is a useful framework for examining women’s weight-related intentions during pregnancy. Study implications for intervention development are discussed.     

Predicting Self-Management Behaviors in Familial Hypercholesterolemia Using an Integrated Theoretical Model: the Impact of Beliefs About Illnesses and Beliefs About Behaviors

Purpose

Patients with familial hypercholesterolemia (FH) are at markedly increased risk of coronary artery disease. Regular participation in three self-management behaviors, physical activity, healthy eating, and adherence to medication, can significantly reduce this risk in FH patients. We aimed to predict intentions to engage in these self-management behaviors in FH patients using a multi-theory, integrated model that makes the distinction between beliefs about illness and beliefs about self-management behaviors.

Methods

Using a cross-sectional, correlational design, patients (N?=?110) diagnosed with FH from a clinic in Perth, Western Australia, self-completed a questionnaire that measured constructs from three health behavior theories: the common sense model of illness representations (serious consequences, timeline, personal control, treatment control, illness coherence, emotional representations); theory of planned behavior (attitudes, subjective norms, perceived behavioral control); and social cognitive theory (self-efficacy).

Results

Structural equation models for each self-management behavior revealed consistent and statistically significant effects of attitudes on intentions across the three behaviors. Subjective norms predicted intentions for health eating only and self-efficacy predicted intentions for physical activity only. There were no effects for the perceived behavioral control and common sense model constructs in any model.

Conclusions

Attitudes feature prominently in determining intentions to engage in self-management behaviors in FH patients. The prominence of these attitudinal beliefs about self-management behaviors, as opposed to illness beliefs, suggest that addressing these beliefs may be a priority in the management of FH.

     

Measuring risk perceptions of skin cancer: Reliability and validity of different operationalizations

Objective. Risk perceptions play a pivotal role in health behaviour theories. Accurate measurement is essential in order to investigate the explanatory value and effectiveness of interventions influencing these beliefs. This study investigated the reliability and predictive validity of different risk perception operationalizations related to skin cancer and sunscreen use in order to explain the inconsistent findings in literature regarding the relationship between risk perceptions and (cancer related) behaviours. Design and methods. Two on‐line surveys were conducted. Study 1 (N= 175) was conducted among university students to investigate the test–retest reliability of different operationalizations of perceived likelihood and perceived severity and to assess their correlations with sunscreen use. Study 2 (N= 418) was a prospective study among Dutch adults and assessed longitudinal correlations between the different operationalizations and sunscreen use. Results. Internal consistency (alpha) ranged between .13 and .90 for likelihood measures and between .37 and .88 for severity measures. Test–retest correlations (r/ICC) ranged between .51 and .82 for the likelihood measures and between .58 and .75 for the severity measures. Conditional likelihood estimates, particularly when phrased affectively (feeling at risk), and comparative severity questions were the strongest correlates of behaviour. Conclusion. Conditional likelihood and comparative severity might be better predictors of health behaviour than commonly used operationalizations of risk perception. These measures may be relevant for use in the development and evaluation of intervention programmes, and should be acknowledged by health behaviour theories. Suggestions for future research are discussed.     

Affective,cognitive and behavioral outcomes associated with a false positive ovarian cancer screening test result

While participation in cancer screening can facilitate early detection and improved prognosis, all screening tests yield some proportion of abnormal test results which are later determined benign. These false positive (FP) results can negatively impact affective, cognitive, and behavioral outcomes. Women participating in an ovarian cancer (OC) screening program receiving an abnormal screening test result (n = 375) were matched with women receiving normal results (n = 375). Both groups completed a baseline and 1- and 4-month follow-up assessments. FP test results were clearly associated with increased cancer-specific distress and increased perceptions of OC risk with more limited evidence for increased perceived positive consequences of screening and increased intentions to participate in future OC screening. FP OC screening test results negatively impact both affective and cognitive outcomes which may serve to reduce motivation to participate in future routine screening. The development and testing of brief, timely interventions to minimize this negative impact is warranted.     

Substituting activities mediates the effect of cognitive flexibility on physical activity: a daily diary study

Pursuit of physical activity goals often requires modifying plans, but research on these flexible processes is limited. Cognitive flexibility may heighten one’s likelihood of using flexible self-regulatory strategies (e.g., substitution), thereby increasing physical activity. This study used daily diary methodology to test the indirect effect of cognitive flexibility on physical activity via activity substitution. A sample of 128 college students (73% female, mean age 19.9) completed baseline measures and cognitive flexibility assessments, then logged physical activity daily for 2 weeks. Activity substitution was defined as adopting an alternate activity on a day another planned activity was unfulfilled. Controlling for baseline activity, intentions, and time, a multilevel mediation model revealed a significant indirect effect of cognitive flexibility on physical activity via activity substitution (b = 81.36, p = .041). Our results indicate that people with greater cognitive flexibility are more likely to use flexible self-regulation, leading to greater physical activity.     

Cancer patient knowledge about and behavioral intentions after germline genome sequencing

ObjectivesGermline genome sequencing (GS) is becoming mainstream in cancer diagnosis and risk management. Identifying knowledge gaps and determinants of health behavior change intentions will enable effective targeting of educational and management strategies to translate genomic findings into improved cancer outcomes.MethodsProbands diagnosed with cancer of likely genetic origin that consented to but not yet undergone GS, and their biological relatives, completed a cross-sectional questionnaire assessing GS knowledge and hypothetical intention to change behaviors.ResultsProbands (n = 348; 57% university educated) and relatives (n = 213; 38% university educated) had moderate GS knowledge levels, with greater knowledge associated with higher education. Both populations reported high behavioral change intentions, significantly associated with being female (p = 0.01) and greater perceived importance of GS (p < 0.001), and for probands: being from English-speaking households (p = 0.003), higher socio-economic status (p = 0.01) and greater self-efficacy (p = 0.02).ConclusionsIncreasing GS knowledge will enable realistic participant expectations surrounding germline GS. Actual behavior change should be monitored to determine whether increased cancer risk knowledge results in altered cancer-related behavior and ultimately, cancer outcomes.Practice implicationsEducational resources should target specific populations to ensure informed decision-making and expectation management. Support tools facilitating and maintaining behavioral change may be needed to achieve improved cancer patient outcomes.