ABSTRACTS

Volume 11, Supplement
2006

Vol. 11, Supplement: Contents | Editorial | Foreword | Abstracts

The Health Information National Trends Survey: Research From the Baseline
    Bradford W. Hesse A1, Richard P. Moser A1, Lila J. Finney Rutten A2, Gary L. Kreps A3

A1 National Cancer Institute, Bethesda, Maryland, USA
A2 SAIC, Rockville, Maryland, USA
A3 George Mason University, Fairfax, Virginia, USA

The decades surrounding the turn of the millennium will be remembered as a time of extraordinary opportunity in cancer communication. In 1990, the number of age-adjusted deaths due to cancer in the U.S. population began a slow steady decline after a century of disparaging increase. Reasons for this decline have been attributed to long-awaited successes in primary prevention, especially related to tobacco, and early detection for cervical, breast, prostate, and colorectal cancers, as well as advances in treatment. This was also a time of unparalleled change in the cancer communication environment. Scientific health discoveries escalated with the completion of the Human Genome project in 2003, and penetration of the Internet made health information available directly to consumers. To seize the opportunity afforded by these changes, the National Cancer Institute (NCI) launched the Health Information National Trends Survey (HINTS). Fielded for the first time in 2003, the HINTS is a nationally representative, general population survey of noninstitutionalized adults in the United States 18 years and older. This supplement contains a compilation of original research conducted using the data generated by the first administration of the HINTS telephone interviews. Covering topics in cancer knowledge, cancer cognition, risk perception, and information seeking, the articles represent an interdisciplinary view of cancer communication at the turn of the millennium and offer insight into the road ahead.

Cancer Knowledge and Disparities in the Information Age
   K. Viswanath A1, Nancy Breen A2, Helen Meissner A2, Richard P. Moser A2, Bradford Hesse A2, Whitney Randolph Steele A3, William Rakowski A4

A1 Harvard University School of Public Health and the Dana Farber Cancer Institute, Boston, Massachusetts, USA
A2 National Cancer Institute, Bethesda, Maryland, USA
A3 Westat, Rockville, Maryland, USA
A4 Brown University, Providence, Rhode Island, USA

Increasing information flow often leads to widening gaps in knowledge between different socioeconomic status (SES) groups as higher SES groups are more likely to acquire this new information at a faster rate than lower SES groups. These gaps in knowledge may offer a partial but robust explanation for differential risk behaviors and health disparities between different social groups. Drawing on the Health Information National Trends Survey (HINTS 2003), a national survey of communication behaviors conducted by the National Cancer Institute (NCI), we examine the relationship between publicity and knowledge gaps on two cancer topics that received different levels of publicity: knowledge about tobacco and sun exposure and their respective links to cancer. Analyses of the HINTS 2003 data suggest that differential knowledge levels of causes of cancer between SES groups are one potential explanation of cancer disparities that have been extensively reported in the literature. It is evident that high income and high education are associated with awareness about causes of major cancers such as lung and skin, and may allow people to protect themselves and minimize their risks. The data also show that heavier media attention could attenuate the knowledge gaps though moderate publicity or lack of news coverage may actually widen them. Last, the findings in this article suggest that it is necessary to take into account the SES variation within different racial and ethnic groups rather than mask them by treating the groups as one.

Knowledge of Colon Cancer Screening in a National Probability Sample in the United States
     Jennifer S. Ford A1, Elliot J. Coups A1, Jennifer L. Hay A1

A1 Memorial Sloan-Kettering Cancer Center, New York, New York, USA

This study examined colon cancer screening knowledge and potential covariates (demographic, health, health care, and cancer information seeking) among adults of at least 45 years of age. Data were analyzed from the 2003 National Cancer Institute's (NCI's) Health Information National Trends Survey (HINTS 2003), a U.S. random-digit dial study. Our sample consisted of 3,131 adults (53.6% female, 77.9% White). The colon cancer screening knowledge questions assessed whether participants had heard of the fecal occult blood test (FOBT; 73.7%), knew the recommended start age (26.1%), knew the frequency of FOBT (39.5%), had heard of flexible sigmoidoscopy or colonoscopy (84.3%), knew the start age (39.6%), and knew the frequency with which to test (12.8%). Factors associated with lower knowledge (all equal to p < .05 in a multivariate analysis) included being younger (45 to 49 years old) or older (70 years old or more), African American or non-Hispanic other, unmarried; had lower educational attainment; had not visited a health care provider in the past year; had not previously undergone FOBT; and had never looked for cancer information. This study documents low rates of colon cancer screening knowledge in the general population, and identifies subgroups where health communication interventions are most warranted.

Absolute and Comparative Risk Perceptions as Predictors of Cancer Worry: Moderating Effects of Gender and Psychological Distress
    Laura E. Zajac A1, William M. P. Klein A1, Kevin D. McCaul A2

A1 University of Pittsburgh, Pittsburgh, Pennsylvania, USA
A2 North Dakota State University, Fargo, North Dakota, USA

Risk perceptions for cancer measured on absolute scales (e.g., “What is the likelihood that you will get cancer?”) and on comparative scales (e.g., “How does your risk compare with that of someone similar to you?”) are independently associated with worry about cancer. We examined this finding in a large sample across several types of cancer, and explored whether these relationships are moderated by three clinically relevant variables–gender, levels of psychological distress, and cancer experience. Participants were respondents in a national survey who reported risk perceptions and worry regarding colon cancer (923 men, 1,532 women), breast cancer (2,154 women), and prostate cancer (860 men), and completed a validated measure of psychological distress. Analyses showed that absolute and comparative risk perceptions were independent predictors of worry across all cancer sites, but that absolute risk perceptions were significantly more predictive than comparative risk perceptions of worry for women (but not men). Among people who were more highly distressed, comparative risk perceptions were the only significant predictor of worry. Absolute risk and comparative risk were equally predictive of cancer worry among people who previously had been diagnosed with cancer. These findings imply that interventions highlighting the communication of comparative risk information may be differentially effective depending on the audience.

Perceived Ambiguity About Cancer Prevention Recommendations: Relationship to Perceptions of Cancer Preventability, Risk, and Worry
   Paul K. J. Han A1, Richard P. Moser A1, William M. P. Klein A2

A1 Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
A2 Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

In this study, we apply the concept of “ambiguity,” as developed in the decision theory literature, to an analysis of potential psychological consequences of uncertainty about cancer prevention recommendations. We used Health Information National Trends Survey (HINTS) 2003 data to examine how perceived ambiguity about cancer prevention recommendations relates to three other cognitive variables known to influence cancer-protective behavior: perceived cancer preventability, perceived cancer risk, and cancer-related worry. Using logistic regression analyses, we tested several predictions derived from a review of literature on the effects of ambiguity perceptions on decision making, cognitions, and emotions. We found perceived ambiguity to have a strong negative relationship with perceived cancer preventability, consistent with “ambiguity aversion”—a pessimistic bias in the interpretation of ambiguity. Cancer worry moderated this relationship; ambiguity aversion increased with higher levels of worry. At the same time, perceived ambiguity was positively related to both perceived cancer risk and cancer worry. Furthermore, perceived risk partially mediated the relationship between perceived ambiguity and worry. These findings suggest that perceived ambiguity about cancer prevention recommendations may have broad and important effects on other health cognitions. We discuss ethical implications of these findings for health communication efforts, and propose a tentative causal model to guide future research.

Predictors of Perceived Risk for Colon Cancer in a National Probability Sample in the United States
    Jennifer Hay A1, Elliot Coups A1, Jennifer Ford A1

A1 Memorial Sloan-Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, New York, USA

This study examines potential predictors of perceived risk for colon cancer in a U.S. sample of 2,949 individuals aged 45 and older with no colon cancer history. We examined perceived comparative risk for colon cancer as the outcome in ordinal regression analyses, and perceived absolute risk for colon cancer in linear regression analyses. Potential predictors included demographics, current risk behaviors, self-reported health, family and personal cancer history, emotion variables (colon cancer worry, general anxiety, and fear of positive screening findings), general cancer beliefs (causes, lack of preventability, information overload), and cancer information seeking. Those who had poorer self-reported health, a family cancer history, and increased colon cancer worry had higher perceived comparative and absolute colon cancer risk (all ps < .05). Those who were younger, interviewed in Spanish, had increased anxiety, and information overload had higher comparative risk; those with a personal history of cancer and fear that colon cancer screening would result in positive findings had higher absolute risk (all ps < .05). We determined that older individuals, those with risk factors, and those with good subjective health may not realize their colon cancer risk. Those distressed about colon cancer and who report cancer prevention information overload may require different messages.

Unrealistic Optimism in Smokers: Implications for Smoking Myth Endorsement and Self-Protective Motivation
   Amanda J. Dillard A1, Kevin D. McCaul A1, William M. P. Klein A2

A1 North Dakota State University, Fargo, North Dakota, USA
A2 University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Although some optimists may be accurate in their positive beliefs about the future, others may be unrealistic—their optimism is misplaced. Research shows that some smokers exhibit unrealistic optimism by underestimating their relative chances of experiencing disease. An important question is whether such unrealistic optimism is associated with risk-related attitudes and behavior.We addressed this question by investigating if one's perceived risk of developing lung cancer, over and above one's objective risk, predicted acceptance of myths and other beliefs about smoking. Hierarchical regressions showed that those individuals who were unrealistically optimistic (i.e., whose perceived risk was less than their objective risk) were more likely to endorse beliefs that there is no risk of lung cancer if one only smokes for a few years and that getting lung cancer depends on one's genes. Unrealistic optimists were also more likely to believe that a greater number of lung cancer patients are cured, but they were less likely to identify smoking cessation/avoidance as a way to reduce cancer risk. Most importantly, unrealistic optimists were less likely to plan on quitting smoking. Taken together, these data suggest that in the smoking arena, unrealistic optimism is a potentially costly cognitive strategy.

Lack of Acknowledgment of Fruit and Vegetable Recommendations Among Nonadherent Individuals: Associations With Information Processing and Cancer Cognitions
    Jennifer L. Cerully A1, William M. P. Klein A1, Kevin D. McCaul A2

A1 University of Pittsburgh, Pittsburgh, Pennsylvania, USA
A2 North Dakota State University, Fargo, North Dakota, USA

Inadequate consumption of fruits and vegetables is regarded as an important behavioral risk factor for multiple types of cancer. Nevertheless, adherence with the National Cancer Institute (NCI) guidelines to eat between five and nine servings of fruits and vegetables per day is remarkably low. The current study explored the extent to which nonadherent respondents in a national survey (N = 5,625) listed fruit and vegetable consumption as a method by which to decrease their own or others' cancer risk. We sought to determine whether respondents who listed fruit and vegetable consumption as a method by which to decrease their own or others' cancer risk (hereafter referred to as “listers”) differed from respondents who did not list fruit and vegetable consumption as a method by which to decrease their own or others' cancer risk (hereafter referred to as) “nonlisters” on measures of information processing and cancer cognitions. Nonlisters were more likely than listers to seek out cancer information but less likely to trust the information. The two groups did not differ in the amount of attention they paid to such information. Listers had lower absolute risk perceptions than nonlisters, but listers and nonlisters did not differ on measures of relative breast and colon cancer risk perceptions and worry for cancer in general. Female listers did perceive themselves to be at less relative risk for breast cancer than nonlisters. Respondents were more likely to list fruit and vegetable consumption as a cancer-risk reduction strategy for others than for themselves, suggesting a “double standard” in their beliefs. These findings suggest that communications designed to promote fruit and vegetable consumption need to account for biases in how nonadherent individuals respond to these communications.

Awareness of the National Cancer Institute's Cancer Information Service: Results from the Health Information National Trends Survey (HINTS)
    Linda Squiers A1, Mary Anne Bright A1, Lila J. Finney Rutten A2, Audie A. Atienza A3, Katherine Treiman A4, Richard P. Moser A5, Bradford Hesse A6

A1 Office of Cancer Information Service, National Cancer Institute, Bethesda, Maryland, USA
A2 Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Science, SAIC-Frederick, Inc., National Cancer Institute-Frederick, Frederick, Maryland, USA
A3 Health Promotion Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
A4 Cancer Information Service, National Cancer Institute, Bethesda, Maryland, USA
A5 Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
A6 Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, Maryland, USA

Established in 1975, the National Cancer Institute's (NCI's) Cancer Information Service (CIS) is a national information and education network that serves the nation by providing the latest scientific cancer information to the American public. The purpose of this study was to determine the public's awareness of the CIS and other national cancer and health organizations by analyzing data from the NCI's Health Information National Trends Survey (HINTS 2003). This study also examined sociodemographic, health, and communication correlates of awareness of CIS and other national health organizations: American Cancer Society (ACS), National Institutes of Health (NIH), and NCI. Results indicated that awareness of the CIS was low (32.8%). Some subgroups were more likely to be aware of the CIS than others. When comparing awareness levels of the four national health organizations, marked differences in patterns of awareness among specific subgroups emerged for many sociodemographic variables. For example, minority groups were significantly more aware of the CIS than Whites; however, for all three other organizations a greater percentage of Whites were aware of each organization. For the NIH, NCI, and ACS, respondents in the highest income group were most aware of each organization and, as income level increased awareness also increased. The CIS, respondents with the lowest income levels, however, were more aware of the CIS compared with middle- and high-income groups. A similar pattern was found for other sociodemographic variables. Results of this study will guide the development of a targeted promotional campaign for the CIS.

Factors Associated with Patients' Perceptions of Health Care Providers' Communication Behavior
    Lila J. Finney Rutten A1, Erik Augustson A2, Kay Wanke A3

A1 Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Science, SAIC-Frederick, Inc., National Cancer Institute–Frederick, Frederick, Maryland, USA
A2 Tobacco Control Research Branch, Division of Cancer Control and Population Science, SAIC-Frederick, Inc., National Cancer Institute–Frederick, Frederick, Maryland, USA
A3 Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA

We examined patients' ratings of communication with health care providers by sociodemographic characteristics, health care access, and health status. Data were from a national, population-based survey, the 2003 Health Information National Trends Survey (HINTS). The survey was administered to 6,369 adults from a representative sample of U.S. households. Linear regression analysis was conducted using SUDAAN. None of the sociodemographic variables were significantly associated with patients' ratings of providers' communication behavior in the linear model. Ratings of health care providers' communication behavior, however, were significantly higher among respondents with health insurance (p = 0.007) and those with a usual source of health care from whom they consistently sought care (p < 0.001). Ratings of provider communication were significantly lower among respondents who perceived their general health to be fair or poor (p < 0.001) and among those respondents with greater depressive symptoms (p < 0.001). Differences in patient ratings of health care providers' communication by health care access and health status suggest the potential for disparities in health outcomes.

Cancer-Related Information Seeking: Hints from the 2003 Health Information National Trends Survey (HINTS)
    Lila J. Finney Rutten A1, Linda Squiers A2, Bradford Hesse A3

A1 Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Science, SAIC-Frederick, Inc., National Cancer Institute-Frederick, Frederick, Maryland, USA
A2 Cancer Information Service, National Cancer Institute, Bethesda, Maryland, USA
A3 Health Communication and Informatics Research Branch, Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, Maryland, USA

Few nationally representative surveys have assessed the cancer-related information seeking behavior of the American public. Data for our analysis were from the 2003 Health Information National Trends Survey (HINTS). The goals of our analysis were to characterize cancer information seekers (3,011) and nonseekers (3,348) in terms of sociodemographic, health care access, and health status variables, and to describe the nature of the cancer-related information being sought by information seekers. Significant and independent associations with seeking status were identified for gender, age, race, income, education, personal and family history of cancer, and having a usual source of health care. Information seekers were less likely to be male (OR = .51); aged 65 or older (OR = .40); Hispanic (OR = .60); to have a usual source of health care (OR = .70); and more likely to have incomes greater than $50,000 (OR = 1.50), some college (OR = 1.87) or a college degree (OR = 2.95), a prior cancer diagnosis (OR = 3.57), or a family history of cancer (OR = 2.17). Among cancer information seekers, the most frequently searched topic was cancer site-specific information (50.2%). Individuals who reported searching for cancer site-specific information were most frequently looking for information about breast cancer (23.8%), prostate cancer (11.5%), and skin cancer (11.3%). The HINTS survey provides a unique opportunity to explore the characteristics of information seekers and nonseekers and the content of information being sought by the public in a nationally representative sample; understanding gained from this effort provides generalizable and policy-relevant information about the American public's information needs.

Cancer Information Scanning and Seeking Behavior is Associated with Knowledge, Lifestyle Choices, and Screening
    Minsun Shim A1, Bridget Kelly A1, Robert Hornik A1

A1 University of Pennsylvania, Philadelphia, Pennsylvania, USA

Previous research on cancer information focused on active seeking, neglecting information gathered through routine media use or conversation (“scanning”). It is hypothesized that both scanning and active seeking influence knowledge, prevention, and screening decisions. This study uses Health Information National Trends Survey (HINTS, 2003) data to describe cancer-related scanning and seeking behavior (SSB) and assess its relationship with knowledge, lifestyle behavior, and screening. Scanning was operationalized as the amount of attention paid to health topics, and seeking was defined as looking for cancer information in the past year. The resulting typology included 41% low-scan/no-seekers; 30% high-scan/no-seekers; 10% low-scan/seekers, and 19% high-scan/seekers. Both scanning and seeking were significantly associated with knowledge about cancer (B=.36; B=.34) and lifestyle choices that may prevent cancer (B=.15; B=.16) in multivariate analyses. Both scanning and seeking were associated with colonoscopy (OR = 1.38, for scanning and OR=1.44, for seeking) and with prostate cancer screening (OR=4.53, scanning; OR=10.01, seeking). Scanning was significantly associated with recent mammography (OR=1.46), but seeking was not. Individuals who scan or seek cancer information are those who acquire knowledge, adopt healthy lifestyle behaviors, and get screened for cancer. Causal claims about these associations await further research.

Cancer Information Seeking Preferences and Experiences: Disparities Between Asian Americans and Whites in the Health Information National Trends Survey (HINTS)
    Giang T. Nguyen A1 and Scarlett L. Bellamy A2

A1 Department of Family Medicine and Community Health, Center of Excellence in Cancer Communication Research, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
A2 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA

Little is known about cancer information needs and seeking patterns in the rapidly growing Asian American population. The purpose of this study is to characterize cancer information seeking behaviors and preferences in Asian Americans and to examine their cancer-related knowledge and risk perceptions. Data from the nationally representative Health Information National Trends Survey (HINTS) database were analyzed to compare non-Hispanic Asians and Whites. Asians had lower awareness of the National Institutes of Health and American Cancer Society, were less likely to think that not smoking or quitting smoking would reduce cancer risk, were less knowledgeable about colon cancer screening, and considered their personal cancer risk to be low. Asians and Whites had similar media usage rates. They also had similar rates of preference for cancer information from various sources, although Asians were significantly more likely to prefer print materials. The level of trust of cancer information from doctors was high overall. This study is limited by under-representation of some demographic subpopulations, future surveys should oversample Asians and strive to include higher-risk Asians (e.g., elderly, poorly educated, immigrants, and those with limited English proficiency).

Relationship of Communication and Information Measures to Colorectal Cancer Screening Utilization: Results From HINTS
    Bruce S. Ling A1, William M. Klein A2, Qianyu Dang A3

A1 Institute for Doctor–Patient Communication, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania, USA and the VA Center for Health Equity and Promotion, Pittsburgh, Pennsylvania, USA
A2 Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
A3 Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Utilization of colorectal cancer screening tests is suboptimal. Knowledge of colorectal cancer screening has been associated with completion of screening. Thus, increasing awareness of colorectal cancer screening may lead to significant improvements in screening rates. We assessed for the association among provider–patient interaction, information-seeking patterns, sources of information, trust in cancer information, and Internet usage on colorectal cancer screening behavior using data obtained by the Health Information National Trends Survey (HINTS). From a cohort of 2,670 respondents greater than 50 years of age, we found that they (1) desired cancer information from personalized reading materials, meeting in person with a health care professional, and published materials; and (2) had great trust of information from their provider. Having trust in cancer information from the doctor or other health care professional was most predictive (OR 2.08, 95% CI 1.49–2.94) of being up to date. Other predictive factors include having a desire for cancer information from personalized reading materials (OR 1.56, 95% CI 1.24–1.95) and using the Internet from home (OR 1.32, 95% CI 1.04–1.67). We conclude that personalized communications from a health care provider are desired and trusted. Another promising information delivery approach is the Internet. Dedicated efforts using these approaches for information exchange may be most beneficial toward increasing utilization of colorectal cancer screening.