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.     

Avoiding Risk Information About Breast Cancer

Background

Learning about personal risk can provide numerous benefits yet people sometimes opt to remain ignorant.

Purpose

Two studies examined the role of perceived control, coping resources, and anticipated regret in women??s decision to avoid breast cancer risk information.

Methods

Women completed a health inventory and then read a brochure about either controllable or uncontrollable predictors of breast cancer, or received no brochure. Participants then received an opportunity to learn their lifetime risk for breast cancer based on their inventory responses.

Results

Reading about controllable predictors of breast cancer reduced avoidance of risk information compared with reading about uncontrollable predictors or receiving no information. In addition, fewer coping resources, anticipated greater regret over seeking breast cancer risk information, and less regret over avoiding breast cancer risk information predicted information avoidance.

Conclusion

Reading about controllable predictors of breast cancer reduces avoidance of breast cancer risk information.     

Using the Interdependence Model to Understand Spousal Influence on Colorectal Cancer Screening Intentions: A Structural Equation Model

Background

Although it is widely thought that the marital relationship plays a role in individuals?? decisions to have colorectal cancer screening, few studies have evaluated partner influences.

Purpose

We evaluated the role of marital relationship factors such as a relational perspective on the frequency of spouse discussions about screening and screening intentions. Individual-level factors were also evaluated.

Methods

One hundred sixty-eight couples with both members non-adherent with screening completed measures of perceived risk, screening benefits and barriers, marital quality, relational perspective, discussion frequency, and screening intentions.

Results

Couples?? attitudes about screening were interdependent and one partner??s attitudes and behavior were associated with the other partner??s intention. There was also evidence of joint effects in that intentions were associated with both one??s partner??s attitudes and one??s own attitudes.

Conclusions

Colorectal screening intentions are associated with both partners?? attitudes as well as whether or not couples have discussed screening with one another.     

Informed Decision Making About Prostate Cancer Testing in Predominantly Immigrant Black Men: A Randomized Controlled Trial

Background

Decision support interventions have been developed to help men clarify their values and make informed decisions about prostate cancer testing, but they seldom target high-risk black and immigrant men.

Purpose

This study evaluated the efficacy of a decision support intervention focused on prostate cancer testing in a sample of predominantly immigrant black men.

Methods

Black men (N?=?490) were randomized to tailored telephone education about prostate cancer testing or a control condition.

Results

Post-intervention, the intervention group had significantly greater knowledge, lower decision conflict, and greater likelihood of talking with their physician about prostate cancer testing than the control group. There were no significant intervention effects on prostate specific antigen testing, congruence between testing intention and behavior, or anxiety.

Conclusions

A tailored telephone decision support intervention can promote informed decision making about prostate cancer testing in black and predominantly immigrant men without increasing testing or anxiety.     

Effects of Patient-Provider Race Concordance and Smoking Status on Lung Cancer Risk Perception Accuracy Among African-Americans

Background

Communication of lung cancer risk information between providers and African-American patients occurs in a context marked by race-based health disparities.

Purpose

A controlled experiment assessed whether perceived physician race influenced African-American patients’ (n?=?127) risk perception accuracy following the provision of objective lung cancer risk information.

Methods

Participants interacted with a virtual reality-based, simulated physician who provided personalized cancer risk information.

Results

Participants who interacted with a racially discordant virtual doctor were less accurate in their risk perceptions at post-test than those who interacted with a concordant virtual doctor, F(1,94)?=?4.02, p?=?.048. This effect was amplified among current smokers. Effects were not mediated by trust in the provider, engagement with the health care system, or attention during the encounter.

Conclusions

The current study demonstrates that African-American patients’ perceptions of a doctor’s race are sufficient to independently impact their processing of lung cancer risk information.     

History of Major Depressive Disorder Prospectively Predicts Worse Quality of Life in Women with Breast Cancer

Background

Data are scarce about whether past history of major depressive disorder in the absence of current depression places breast cancer patients at risk for worse quality of life.

Purpose

The current study prospectively examined quality of life during chemotherapy in breast cancer patients with a history of resolved major depressive disorder (n?=?29) and no history of depression (n?=?144).

Methods

Women with Stages 0?CII breast cancer were assessed prior to and at the completion of chemotherapy. Major depressive disorder was assessed via structured interview and quality of life with the SF-36.

Results

Patients with past major depressive disorder displayed greater declines in physical functioning relative to patients with no history of depression (p????0.01).

Conclusions

Findings suggest that breast cancer patients with a history of resolved major depressive disorder are at increased risk for declines in physical functioning during chemotherapy relative to patients with no history of depression.     

Telephone-Delivered Motivational Interviewing Targeting Sexual Risk Behavior Reduces Depression, Anxiety, and Stress in HIV-Positive Older Adults

Background

Few studies have examined the secondary benefits of HIV risk reduction interventions to improve mental health functioning.

Purpose

This study aimed to examine the effectiveness of telephone-delivered motivational interviewing (MI) targeting sexual risk behavior to reduce depression, anxiety, and stress in HIV-positive older adults.

Methods

Participants were 100 HIV-positive adults 45+ years old enrolled in a sexual risk reduction pilot clinical trial of telephone-delivered MI. Participants were randomly assigned to a one-session MI, four-session MI, or standard of care control condition. Telephone interviews at baseline and 3- and 6-month follow-up assessed sexual behavior, depression, anxiety, and stress.

Results

Relative to controls, participants in the one- and four-session MI conditions reported lower levels of depression, anxiety, and stress at 6-month follow-up. No between group differences were observed at 3-month follow-up or between one- and four-session MI participants at 6-month follow-up.

Conclusions

Preliminary data suggest that telephone-delivered MI to reduce sexual risk behavior may confer secondary benefits of improving mental health functioning in HIV-positive persons.     

Effects of Undergoing Multiplex Genetic Susceptibility Testing on Parent Attitudes towards Testing Their Children

Background

Parents may pursue common disease risk information about themselves via multiplex genetic susceptibility testing (MGST) for their children.

Purpose

To prospectively assess whether parents who received MGST disclosed their test results to their child, intended to change the child's health habits, or have the child tested.

Methods

Eighty parents who opted for free MGST completed an online survey about a child in their household before undergoing MGST and a follow-up telephone survey 3 months after receiving results.

Results

Few parents (21 %) disclosed results to the child. Undergoing MGST was unrelated to intentions to change the child's health habits but did increase parental willingness to test the child. Greater willingness to test a child was associated with positive attitudes toward pediatric genetic testing and intentions to change the child's health habits.

Conclusion

The experience of receiving MGST had little impact on parents' perceptions or behaviors related to their minor child.     

Diaries for Observation or Intervention of Health Behaviors: Factors that Predict Reactivity in a Sexual Diary Study of Men Who Have Sex with Men

Background

Behavioral diaries for observation of health-related behaviors assume absence of reactivity (i.e., change in behavior resulting from observation), while self-monitoring diaries maximize reactivity for behavior change. Little is known about when and for whom behavioral diary studies become self-monitoring interventions.

Purpose

This study evaluated the moderating effects of social cognitive variables on reactivity in sexual risk behavior and risk appraisals in a diary study of men who have sex with men (MSM).

Methods

One hundred forty-three MSM completed weekly online sexual diaries for 3 months. Analyses were conducted with hierarchical linear modeling.

Results

There was no evidence of reactivity for the sample as a whole. Social cognitive variables (e.g., risk reduction motivation, condom use intentions, and social norms) moderated reactivity in study outcomes. For example, more highly motivated MSM experienced declines in serodiscordant unprotected anal intercourse over time.

Conclusions

Effectiveness of behavioral self-monitoring strategies may vary depending on social cognitive domains.     

Which Symptoms Come First? Exploration of Temporal Relationships Between Cancer-Related Symptoms over an 18-Month Period

Background

Anxiety, depression, insomnia, fatigue, and pain are frequently reported by cancer patients. These symptoms are highly interrelated. However, few prospective studies have documented the sequence with which symptoms occur during cancer care.

Purpose

This longitudinal study explored the temporal relationships between anxiety, depression, insomnia, fatigue, and pain over an 18-month period in a large population-based sample of nonmetastatic cancer patients (N?=?828), using structural equation modeling.

Methods

The patients completed a battery of self-report scales at baseline and 2, 6, 10, 14, and 18 months later.

Results

The relationships between the same symptom at two consecutive assessments showed the highest coefficients (β?=?0.29 to 0.78; all ps?≤?0.05). Cross-loading parameters (β?=?0.06 to 0.19; ps?≤?0.05) revealed that fatigue frequently predicted subsequent depression, insomnia, and pain, whereas anxiety predicted insomnia.

Conclusions

Fatigue and anxiety appear to constitute important risk factors of other cancer-related symptoms and should be managed appropriately early during the cancer care trajectory.     

Using Mental Imagery to Deliver Self-Regulation Techniques to Improve Sleep Behaviors

Background

Poor sleep habits and insufficient sleep represent significant workplace health issues.

Purpose

Applying self-regulation theory, we conducted a randomized, controlled trial testing the efficacy of mental imagery techniques promoting arousal reduction and implementation intentions to improve sleep behavior.

Method

We randomly assigned 104 business employees to four imagery-based interventions: arousal reduction, implementation intentions, combined arousal reduction and implementation intentions, or control imagery. Participants practiced their techniques daily for 21 days. They completed online measures of sleep quality, behaviors, and self-efficacy at baseline and Day 21; and daily measures of sleep behaviors.

Results

Participants using implementation intention imagery exhibited greater improvements in self-efficacy, sleep behaviors, sleep quality, and time to sleep relative to participants using arousal reduction and control imagery.

Conclusions

Implementation intention imagery can improve sleep behavior for daytime employees. Use of arousal reduction imagery was unsupported. Self-regulation imagery techniques show promise for improving sleep behaviors.     

Disgusted,Embarrassed, Annoyed: Affective Associations Relate to Uptake of Colonoscopy Screening

Background

Uptake of colorectal cancer screening is lower than desired. Screening decision making research has traditionally focused on benefits and barriers to screening. This study examines the relation of affective associations with screening (feelings and emotions associated with screening) to colonoscopy screening uptake.

Methods

Participants were 103 African American community adults. Participants completed a structured interview assessing perceived benefits of and barriers to colonoscopy screening, affective associations with colonoscopy, colonoscopy screening behavior, and intentions for future screening.

Results

Higher positive and lower negative affective associations with screening were both significant predictors of colonoscopy uptake. Affective associations fully mediated the relation of perceived benefits and barriers to screening uptake. Affective associations were associated with intentions for future screening.

Conclusions

Incorporation of affective associations into models of screening decision making and intervention approaches to address screening compliance has utility for advancing our understanding of screening adherence as well as increasing screening rates.     

Implementation Intentions for Physical Activity Behavior in Older Adult Women: An Examination of Executive Function as a Moderator of Treatment Effects

Background

Implementation intentions are effective for enhancing physical activity, but it is unknown how well these effects extend to older adults and/or are modified by cognitive variables.

Purpose

Our objective is to examine (1) the efficacy of an implementation intentions intervention for physical activity in older adult women and (2) to examine the moderating effects of executive function.

Methods

Participants (N?=?75, M _age?=?73.72) completed measures of executive function and were randomly assigned to weekly implementation intentions for physical activity (experimental condition), implementation intentions for an unrelated behavior (control condition), or no treatment. Baseline activity was measured by accelerometer and self-report; follow-up activity was measured by weekly self-report.

Results

Findings indicated a significant treatment effect for the experimental condition and a treatment by executive function interaction. Specifically, participants with relatively stronger executive function benefited most from the experimental intervention.

Conclusions

Implementation intentions are effective for enhancing physical activity among older adult women, and the effects may be especially pronounced for those with relatively stronger executive function.     

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.     

Stress, Coping, and Circadian Disruption Among Women Awaiting Breast Cancer Surgery

Background

Psychological distress and coping related to a breast cancer diagnosis can profoundly affect psychological adjustment, possibly resulting in the disruption of circadian rest/activity and cortisol rhythms, which are prognostic for early mortality in metastatic colorectal and breast cancers, respectively.

Purpose

This study aims to explore the relationships of cancer-specific distress and avoidant coping with rest/activity and cortisol rhythm disruption in the period between diagnosis and breast cancer surgery.

Methods

Fifty-seven presurgical breast cancer patients provided daily self-reports of cancer-specific distress and avoidant coping as well as actigraphic and salivary cortisol data.

Results

Distress and avoidant coping were related to rest/activity rhythm disruption (daytime sedentariness, inconsistent rhythms). Patients with disrupted rest/activity cycles had flattened diurnal cortisol rhythms.

Conclusions

Maladaptive psychological responses to breast cancer diagnosis were associated with disruption of circadian rest/activity rhythms. Given that circadian cycles regulate tumor growth, we need greater understanding of possible psychosocial effects in cancer-related circadian disruption.     

An Indirect Approach to the Measurement of Nutrient-Specific Perceptions of Food Healthiness

Background

Enhancing our understanding of food-related perceptions is critical to assist those with eating- and weight-related problems.

Purpose

This study investigated normative and person-specific aspects of perceived food healthiness in terms of nutritional characteristics and the relevance of nutritional knowledge to perceived healthiness.

Methods

Two hundred sixty-three undergraduate women judged the healthiness of 104 foods and completed nutrient knowledge tasks. Multilevel modeling estimated average and person-specific reliance on and knowledge about nutrients.

Results

Participants relied substantially on fat and fiber, moderately on sugar, and minimally on protein. Disordered eating symptoms moderately predicted greater reliance on fat. Nutritional knowledge was highest for sugar and lowest for fiber. Nutritional knowledge and utilization were unrelated.

Conclusions

Public health campaigns should educate college-aged women further on the health consequences of sugar and protein consumption. Explicit knowledge of nutrients may not be prioritized when judging food healthiness.     

A cross-sectional study of mental health and well-being and their associations in the UK veterinary profession

Background

Veterinary surgeons are at elevated risk of suicide, with a proportional mortality ratio around four times that of the general population and approximately twice that of other healthcare professions. There has been much speculation regarding possible mechanisms underlying increased suicide risk in the profession but little empirical research. We aimed to assess the contribution of mental health and well-being to the elevated risk, through a postal questionnaire survey of a large stratified random sample of veterinary surgeons practising within the UK.

Methods

A questionnaire was mailed twice to 3,200 veterinary surgeons. Anxiety and depressive symptoms, alcohol consumption, suicidal ideation, positive mental well-being, perceptions of psychosocial work characteristics, and work–home interaction were assessed using valid and reliable existing instruments and a series of bespoke questions previously developed through informal focus groups.

Results

Evaluable questionnaires were returned by 1,796 participants, a response rate of 56.1%. The demographic and occupational profile of respondents was representative of the UK veterinary profession. The prevalence of ‘caseness’ (i.e. HADS subscale score ≥8) for anxiety, depression, and co-morbid anxiety and depression was 26.3, 5.8 and 4.5%. 5.4% of respondents were non-drinkers, 32.0% low-risk drinkers, and 62.6% ‘at-risk’ drinkers (i.e. AUDIT-C score ≥4 for women, ≥5 for men). The 12-month prevalence of suicidal thoughts was 21.3%.

Conclusions

Compared to the general population, the sample reported high levels of anxiety and depressive symptoms; higher 12-month prevalence of suicidal thoughts; less favourable psychosocial work characteristics, especially in regard to demands and managerial support; lower levels of positive mental well-being; and higher levels of negative work–home interaction. The levels of psychological distress reported suggest ready access to and knowledge of lethal means is probably not operating in isolation to increase suicide risk within the profession.     

Distressed Partners and Caregivers Do Not Recover Easily: Adjustment Trajectories Among Partners and Caregivers of Cancer Survivors

Background

Although a number of cross-sectional studies document the distress experienced by partners and caregivers of cancer survivors, few have considered their potential differential patterns of adjustment over time.

Purpose

Identify distinct trajectories of anxiety and depression among partners and caregivers of cancer survivors and predictors of these trajectories.

Methods

Participants completed a survey to examine the impact of caring for, or living with, a cancer survivor at 6, 12, and 24?months post-survivor diagnosis. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (N _anxiety?=?510; N _depression?=?511).

Results

Anxiety trajectories included: no anxiety (15.1% scored <3; 37.8% scored 3?C5); chronic, borderline anxiety (33.2%); and chronic, clinical anxiety (13.9%). The depression trajectories were: no depression (38.9% scored <2; 31.5% scored around 3); a sustained score of 7 (25.5%); and chronic, clinical depression (4.1%). Variables associated with the trajectories included most of the psychosocial variables.

Conclusions

Findings highlight that most caregivers maintained their baseline level of distress, which is particularly concerning for participants reporting chronic anxiety or depression.     

Intention to Undergo Colonoscopy Screening Among Relatives of Colorectal Cancer Cases: a Theory-Based Model

Background

It is recommended that persons having familial risk of colorectal cancer begin regular colonoscopy screening at an earlier age than those in the general population. However, many individuals at increased risk do not adhere to these screening recommendations.

Purpose

The goal of this study was to examine cognitive, affective, social, and behavioral motivators of colonoscopy intention among individuals at increased risk of familial colorectal cancer.

Methods

Relatives of colorectal cancer cases (N?=?481) eligible for colonoscopy screening completed a survey assessing constructs from several theoretical frameworks including fear appeal theories.

Results

Structural equation modeling indicated that perceived colorectal cancer risk, past colonoscopy, fear of colorectal cancer, support from family and friends, and health-care provider recommendation were determinants of colonoscopy intention.

Conclusions

Future interventions to promote colonoscopy in this increased risk population should target the factors we identified as motivators. (ClinicalTrials.gov number NCT01274143).