Health disparities in awareness of physical activity and cancer prevention: findings from the National Cancer Institute's 2007 Health Information National Trends Survey (HINTS)

Inequity in Cancer and Cancer Care Delivery in the United States

Inequity exists along the continuum of cancer and cancer care delivery in the United States. Marginalized populations have later stage cancer at diagnosis, decreased likelihood of receiving cancer-directed care, and worse outcomes from treatment. These inequities are driven by historical, structural, systemic, interpersonal, and internalized factors that influence cancer across the pathologic and clinical continuum. To ensure equity in cancer care, interventions are needed at the level of policy, care delivery, interpersonal communication, diversity within the clinical workforce, and clinical trial accessibility and design.

Perception of pharmacy students toward numeracy: An observational study from King Saud University, Riyadh Saudi Arabia

Background and objective

Numeracy is the branch of mathematics involved in understanding basic calculations, quantitation, estimation, reasoning, and execution of multistep operations. It is very imperative that pharmacists understand and apply numeracy skills in their routine work in the interest of their profession and patient care. This observational study was designed to assess the pharmacy student's perceptions of numeracy.

Methods

A prospective observational study was conducted by the Department of Pharmacy, King Saud University, Kingdom of Saudi Arabia, between December 2021 and February 2022. All the enrolled subjects pursued a 5-year Pharma degree course at the university using a 9-item instrument, which accessed the perception of students toward numeracy. The data were analyzed using the statistical software statistical package for social science (SPSS) version 26.0 (SPSS Inc., Chicago, IL, USA). Chi-square and Fisher's exact test were used to derive an association between various parameters of the study subjects. A P-value of < 0.05 was taken as statistically significant.

Results

A total of 550 pharmacy students were approached in this study, out of which 21 (3.8%) students were excluded due to incompleteness of the responses; thereupon, 529 students were included in the study. We learned that almost 90.0% of students had excellent and/or good mathematical ability, but at the same time, they were frequent users of calculators. Most of the students endorsed the importance of numeracy and showed their interest in attaining more knowledge of numeracy. Similarly rating the perceptions of mathematical ability is significantly associated with the frequency of use of a calculator for calculations (p = 0.0001).

Conclusion

Pharmacy students showed interest in numeracy and correspondingly showed excellent perceptions toward mathematical ability. Although the role of numeracy has been well accepted, inciting changes in teaching-learning practices through mathematically focused teaching approaches throughout the pharmacy program will increase its applicability in healthcare.

Middle-Aged and Older African Americans' Information Use During the COVID-19 Pandemic: An Interview Study

African Americans in the United States have been disproportionately affected by the COVID-19 pandemic in infection and mortality rates. This study examined how middle-aged and older African American individuals accessed and evaluated the information about COVID-19. Semi-structured interviews with 20 individuals (age: 41-72) were conducted during the first stay-at-home advisory period in late March and early April 2020. The phronetic iterative approach was used for data analysis. We found that these individuals primarily relied on information scanning based on their routine media consumption to acquire information about COVID-19 and seldom actively searched for information outside of their regular media use. Individuals used several strategies to assess the quality of the information they received, including checking source credibility, comparing multiple sources, fact-checking, and praying. These findings could inform media and governmental agencies' future health communication efforts to disseminate information about the COVID-19 pandemic and future infectious disease outbreaks among the African American communities.

Social and clinical determinants of physical activity in prostate cancer survivors

PURPOSE

Physical activity is important for enhancing quality of life and cancer control among prostate cancer survivors. The purpose of this study was to characterize adherence to physical activity guidelines among African American and white prostate cancer survivors based on social and clinical determinants and psychosocial factors.

METHODS

Observational study of meeting guidelines for moderate intensity physical activity in a retrospective cohort of African American and white prostate cancer survivors (n = 89).

RESULTS

Thirty-four percent of survivors met the recommended guidelines for moderate intensity physical activity. There were no racial differences in physical activity between African American and white prostate cancer survivors; however, the likelihood of meeting guidelines was associated significantly with stage of disease, self-rated health, and perceptions of stress. Survivors who had stage pT2c or higher disease had a significantly reduced likelihood of meeting recommended guidelines for physical activity (OR = 0.27, 95% CI = 0.08, 0.86, p = 0.03). The likelihood of meeting guidelines was also reduced among survivors who rated their health as being the same or worse than before they were diagnosed with prostate cancer (OR = 0.32, 95% CI = 0.11, 0.96, p = 0.04). As perceived stress increased, the likelihood of being physically active according to guidelines also decreased (OR = 0.48, 95% CI = 0.26, 0.89, p = 0.02).

CONCLUSION

The results of this study underscore the need to develop, implement, and evaluate strategies to enhance physical activity among prostate cancer survivors, regardless of their racial background. Complementary and alternative strategies for physical activity may be one strategy for enhancing activity levels and managing stress among prostate cancer survivors.

Investigating physical activity knowledge and beliefs as correlates of behaviour in the general population: a cross-sectional study

This study examines knowledge of physical activity (PA) guidelines for cancer prevention and beliefs of the role of PA in preventing cancer as correlates of moderate-to-vigorous intensity PA (MVPA) behaviour among adults. Measures assessing socio-demographic characteristics, knowledge of PA guidelines, and PA beliefs and behaviour were completed online by 654 adults (M_age = 36.92 ± 14.61 years) with no history of cancer. Data were analyzed descriptively and using unadjusted and adjusted logistic regression analysis. Approximately half the sample was aware of PA guidelines for cancer prevention (49.24%) and believed that PA was extremely effective in reducing the risk of developing cancer (48.93%). Knowledge of PA guidelines for cancer prevention was associated with a greater likelihood of being active (unadjusted odds ratio [OR]: 1.66, 95% confidence interval [95% CI]: 1.18-2.34; p <.01; adjusted OR: 2.05, 95% CI: 1.36-3.11; p <.001). Beliefs regarding the effectiveness of PA in preventing cancer was not associated with a greater likelihood of being active. There is a lack of awareness of current PA guidelines for cancer prevention. Experimental studies are needed to further explore if increasing adults' knowledge of PA guidelines for cancer prevention can enhance PA levels.

Impact of the Use of Electronic Health Tools on the Psychological and Emotional Well-Being of Electronic Health Service Users (The Seventh Tromsø Study - Part 3): Population-Based Questionnaire Study

Background

Electronic health (eHealth) has been described as a silver bullet for addressing how challenges of the current health care system may be solved by technological solutions in future strategies and visions for modern health care. However, the evidence of its effects on service quality and cost effectiveness remains unclear. In addition, patients’ psychological and emotional reactions to using eHealth tools are rarely addressed by the scientific literature.

Objective

This study aimed to assess how the psychological and emotional well-being of eHealth service users is affected by the use of eHealth tools.

Methods

We analyzed data from a population-based survey in Norway, conducted in the years 2015-2016 and representing 10,604 eHealth users aged over 40 years, to identify how the use of eHealth tools was associated with feeling anxious, confused, knowledgeable, or reassured. Associations between these four emotional outcomes and the use of four types of eHealth services (Web search engines, video search engines, health apps, and social media) were analyzed using logistic regression models.

Results

The use of eHealth tools made 72.41% (6740/9308) of the participants feel more knowledgeable and 47.49% (4421/9308) of the participants feel more reassured about their health status. However, 25.69% (2392/9308) reported feeling more anxious and 27.88% (2595/9308) reported feeling more confused using eHealth tools. A high level of education and not having a full-time job were associated with positive reactions and emotions (feeling more knowledgeable and reassured), whereas low self-reported health status and not having enough friends who could provide help and support predicted negative reactions and emotions (ie, feeling anxious and confused). Overall, the positive emotional effects of eHealth use (feeling knowledgeable and reassured) were relatively more prevalent among users aged over 40 years than the negative emotional effects (ie, feeling anxious and confused). About one-fourth of eHealth users reported being more confused and anxious after using eHealth services.

Conclusions

The search for health information on the internet can be motivated by a range of factors and needs (not studied in this study), and people may experience a range of reactions and feelings following health information searching on the Web. Drawing on prior studies, we categorized reactions as positive and negative reactions. Some participants had negative reactions, which is challenging to resolve and should be taken into consideration by eHealth service providers when designing services (ie, including concrete information about how users can get more help and support). There is a need for more studies examining a greater range of reactions to online health information and factors that might predict negative reactions to health information on the Web.

Awareness of breast cancer risk related to a positive family history and alcohol consumption among women aged 15-44 years in United States

Awareness of the link between breast cancer and risk factors such as family history of breast cancer and alcohol consumption may help modify health behaviors. To reduce risk factors for breast cancer among young women, it is important to understand overall levels of risk awareness and socioeconomic differences in awareness. Data from the National Survey of Family Growth 2011-2015 were used to examine awareness of two risk factors for breast cancer, positive family history and alcohol consumption, among women aged 15-44 years (n = 10,940) in the United States by presence of risk factors and by socioeconomic characteristics. Prevalence of positive family history, non-binge, and binge drinking was 30%, 29%, and 31%, respectively among women aged 15-44. Awareness of positive family history of breast cancer as a risk factor for breast cancer was 88%, whereas for alcohol consumption it was 25%. Awareness of family history as a risk factor was higher among women with positive family history of breast cancer compared to those without. Current drinkers were more likely to believe that alcohol was not a risk factor for breast cancer compared to those who did not drink. Racial/ethnic minority women and those with lower education and income had lower awareness of family history as a risk factor. Awareness of alcohol consumption as a risk factor for breast cancer was low across all socioeconomic groups. Evidence-based interventions to increase risk awareness and decrease excessive alcohol use among young women are needed to reduce the risk of developing breast cancer.

Physical activity: the relative associations with cognitive and affective risk beliefs

Objective: The role of affectively oriented risk beliefs in explaining health behaviors has not been examined in the context of physical activity or in diverse study populations. We evaluated whether affective risk beliefs account for unique variance in physical activity intentions and behavior above and beyond that accounted for by cognitive risk beliefs. Design: A cross-sectional survey of socio-demographically diverse US residents (N = 835; 46.4% no college training; 46.7% minority racial/ethnic ancestry; 42.6% men). Main outcome measures: Physical activity intentions and behavior. Results: Hierarchical linear regressions showed that affective risk beliefs accounted for variance in physical activity intentions beyond that predicted by socio-demographics and cognitive risk beliefs (F-change ps<.001). Specifically, intentions were higher among people with higher anticipated regret (ps<.001) and with higher absolute feelings of risk (ps<.05) or worry (ps<.05). There was an indirect relationship between perceived absolute likelihood and intentions through anticipated regret and feelings of risk. Neither cognitive nor affective risk beliefs accounted for variance in physical activity behavior (F-change ps>.05), but unsurprisingly, behavior was positively associated with physical activity intentions (p<.001). Conclusion: Future interventions could target affective risk beliefs-particularly anticipated regret-to increase intentions, and then add other intervention components to bridge the intention-behavior gap.

Examining the Interrelations Among Objective and Subjective Health Literacy and Numeracy and Their Associations with Health Knowledge

BACKGROUND

Health literacy and numeracy influence many health-related behaviors and outcomes. Health literacy and numeracy have been assessed objectively and subjectively, but interrelationships among the measures and the consistency of their association with health knowledge have not been examined.

OBJECTIVE

To increase understanding of the structure and interrelations among objective and subjective health literacy and numeracy and how these constructs relate to knowledge of risk factors of two major diseases.

DESIGN

Secondary analysis of cross-sectional survey data, weighted to be representative of the general US population of non-institutionalized adults.

PARTICIPANTS

Participants (N = 1005, 55.2% response rate) were recruited from GfK KnowledgePanel. The unweighted sample included 52% women, 26% racial/ethnic minorities, and 37% with no college experience.

MAIN MEASURES

Objective health literacy, subjective health literacy, objective numeracy, subjective numeracy. Objective and perceived knowledge of diabetes and colon cancer risk factors were also assessed.

KEY RESULTS

Confirmatory factor analyses indicated that a model with correlated (r = 0.16-0.56) but separate factors for each of the four literacy/numeracy constructs best fit the data (RMSEA = 0.055 (95% CI 0.049-0.061), CFI = 0.94). Consistency between measures in classifying people as having adequate or limited health literacy or numeracy was 60.9-77.1%, depending on the combination of measures. All four literacy/numeracy constructs were independently associated with objective diabetes knowledge and objective colon cancer knowledge (all ps < .04). Subjective (but not objective) literacy and numeracy measures were associated with diabetes perceived knowledge (all ps < .02). No literacy/numeracy measures were associated with perceived colon cancer knowledge.

CONCLUSIONS

We identified objective and subjective health literacy and numeracy as four distinct but related concepts. We also found that each construct accounts for unique variance in objective (but not subjective) disease knowledge. Until research uncovers what psychological processes drive subjective measures (e.g., motivation, self-efficacy), research investigating the relationship between health literacy and health outcomes should consider assessing all four measures.

Weight loss attempts in a racially diverse sample of primary care patients

Despite efforts to promote healthy weight, obesity is at epidemic levels among adults in the US. We examined the prevalence of weight loss attempts among a racially diverse sample of overweight and obese primary care patients (n = 274) based on sociodemographic, clinical and psychological factors, and shared decision-making (SDM) about weight loss/management. This observational study was conducted from December 2015 through January 2017. Data were obtained by self-report via survey. Overall, 64% of participants were attempting to lose weight at the time of survey. No significant differences in current weight loss attempts were found based on racial background, sociodemographic characteristics, or clinical factors. Participants who believed they were obese/overweight (OR = 6.70, 95% CI = 2.86, 15.72, p < 0.0001) or who were ready to lose/manage their weight (OR = 4.50, 95% CI = 1.82, 11.09, p = 0.001) had an increased likelihood of attempting to lose weight. The likelihood of attempting to lose weight increased with greater SDM with providers (OR = 1.54, 95% CI = 1.06, 2.22, p = 0.02). Patient perceptions about their weight, their readiness for weight loss/management, and SDM were associated significantly with weight loss attempts.

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Obesity is a significant clinical and public health issue.

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64% of obese/overweight primary care patients was trying to lose weight.

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Weight loss attempts did not differ based on race, SES, or clinical factors.

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Weight loss efforts were associated with perceived obesity status and readiness.

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Greater shared decision-making was associated with making weight loss efforts.

Awareness of Health Outcomes Associated with Insufficient Physical Activity and Associations with Physical Activity Intentions and Behavior

INTRODUCTION

Little is known about people's awareness of the link between insufficient physical activity and increased risk for multiple health outcomes.

METHODS

Of 1161 respondents to an online cross-sectional survey of the US population, we randomly selected 361 and used content analysis to code up to three responses to an open-ended question asking what illnesses are caused by insufficient physical activity. Chi-square and Fisher's exact tests examined relations between disease codes and socio-demographics; t-tests and Mann-Whitney U tests examined relations between codes and physical activity intentions and behavior.

RESULTS

Ten codes emerged: cardiovascular (63.5% of participants), metabolic (65.8%), musculoskeletal (10.5%), fatigue (2.0%), psychiatric (8.0%), respiratory (3.4%), gastrointestinal (0.9%), cancer (3.4%), other (2.8%), unexpected interpretation (1.4%). 55.6% of participants named < 3 diseases. Code frequencies were generally similar across demographic groups, ps > .05. Physical activity intentions and behavior were higher among people who either mentioned cardiovascular (p_intentions = .001, p_behavior = .001) or metabolic (p_intentions = .01, p_behavior = .005) conditions, or who named < 3 diseases (p_intentions = .006, p_behavior = .001).

CONCLUSION

In our socio-demographically diverse sample, awareness of diseases that are associated with insufficient physical activity was largely related to cardiovascular and metabolic problems. Future health communication efforts should raise awareness of the harms of insufficient physical activity for cancer and other diseases.

Racial and Ethnic Differences in Tobacco Information Seeking and Information Sources: Findings From the 2015 Health Information National Trends Survey

This article describes sources of health information, types of tobacco information sought, and trust in sources of tobacco information among U.S. racial/ethnic groups (Whites, Blacks, Hispanics, Asian and Pacific Islanders, and Other). Cross-sectional data (N = 3,788) from a nationally representative survey, HINTS-FDA 2015, were analyzed to examine unadjusted and adjusted associations between race/ethnicity and (a) first source of health information, (b) tobacco information seeking, and (c) trust in sources of tobacco information. Adjusted associations controlled for current tobacco product use and sociodemographic variables. Findings indicated that the Internet was the most common first source of health information while health care providers were the second most common source for all racial/ethnic groups. Tobacco-related health information seeking was more prevalent than other tobacco product information seeking. Unadjusted analyses indicated that a higher proportion of Whites sought other tobacco product information compared to Asians and Pacific Islanders. Trust was rated highest for doctors while trust for health organizations was rated second highest. Asians and Pacific Islanders had higher trust in the government compared to all other groups. Blacks had higher trust in religious organizations compared to all other groups besides Hispanics. Blacks had higher trust for tobacco companies compared to Whites and Other. Many of these differences were attenuated in adjusted analyses. This research has implications for tobacco control practice and policymaking by identifying potential dissemination strategies.

A comparative effectiveness education trial for lifestyle health behavior change in African Americans

Obesity and excess weight are significant clinical and public health issues that disproportionately affect African Americans because of physical inactivity and unhealthy eating. We compared the effects of alternate behavioral interventions on obesity-related health behaviors. We conducted a comparative effectiveness education trial in a community-based sample of 530 adult African Americans. Outcomes variables were physical activity (PA) and fruit and vegetable intake. Outcomes were evaluated at baseline and 1-month following interventions about shared risk factors for cancer and cardiovascular disease (CVD) (integrated, INT) or CVD only (disease-specific). Significant increases were found in the proportion of participants who met PA guidelines from baseline (47.4%) to follow-up (52.4%) (P = 0.005). In the stratified analysis that were conducted to examine interaction between education and intervention group assignment, this effect was most apparent among participants who had ≤high school education and were randomized to INT (OR = 2.28, 95% CI = 1.04, 5.00, P = 0.04). Completing the intervention was associated with a 1.78 odds of meeting PA guidelines (95% CI = 1.02, 3.10, P = 0.04). Education about risk factors for chronic disease and evidence-based strategies for health behavior change may be useful for addressing obesity-related behaviors among African Americans.

Role of Leisure Time Physical Activity in Cancer Prevention: Awareness and Practice among Medical Students at Cairo University

Background: Physical inactivity is accountable for a sizable proportion of breast and colorectal cancers and other non-communicable diseases. The higher the individual’s awareness about the protective role of physical activity (PA) in reducing chronic disease, the greater the adoption of PA will be. Objectives: To determine the level of leisure-time physical activity (LTPA) and awareness towards the role of LTPA in cancer prevention among a sample of Medical students at Cairo University, Egypt. Subjects and Methods: A cross-sectional study, with multistage sampling (a total of 519 students from second to six year students) and a self administered questionnaire covering the study objectives. Results: A significant decrease in the actual?? level of LTPA was noted with students’ year of enrollment at the medical school. However, their knowledge about roles of PA in preventing coronary heart, elevated blood pressure, and elevated cholesterol exceeded 80%, with steady increase in relation to the year of enrolment from the second to 6th years. Their knowledge about PA preventive influence for cancer was low irrespective of the year enrolment (32.2% for prevention of colon and 16.2% for breast cancers). The main sources of knowledge about the role of PA in cancer prevention were the internet and media (77%). Conclusion: The students demonstrated a decline in their LTPA coupled with poor knowledge about the role of LTPA in cancer prevention. Revision of the current curricula should be considered with inclusion of more information on the role of LTPA in cancer prevention to facilitate better awareness of medical students and through them their future patients.

Leveraging Social Media to Promote Public Health Knowledge: Example of Cancer Awareness via Twitter

Background

As social media becomes increasingly popular online venues for engaging in communication about public health issues, it is important to understand how users promote knowledge and awareness about specific topics.

Objective

The aim of this study is to examine the frequency of discussion and differences by race and ethnicity of cancer-related topics among unique users via Twitter.

Methods

Tweets were collected from April 1, 2014 through January 21, 2015 using the Twitter public streaming Application Programming Interface (API) to collect 1% of public tweets. Twitter users were classified into racial and ethnic groups using a new text mining approach applied to English-only tweets. Each ethnic group was then analyzed for frequency in cancer-related terms within user timelines, investigated for changes over time and across groups, and measured for statistical significance.

Results

Observable usage patterns of the terms "cancer", "breast cancer", "prostate cancer", and "lung cancer" between Caucasian and African American groups were evident across the study period. We observed some variation in the frequency of term usage during months known to be labeled as cancer awareness months, particularly September, October, and November. Interestingly, we found that of the terms studied, "colorectal cancer" received the least Twitter attention.

Conclusions

The findings of the study provide evidence that social media can serve as a very powerful and important tool in implementing and disseminating critical prevention, screening, and treatment messages to the community in real-time. The study also introduced and tested a new methodology of identifying race and ethnicity among users of the social media. Study findings highlight the potential benefits of social media as a tool in reducing racial and ethnic disparities.

Predictors of Online Cancer Prevention Information Seeking Among Patients and Caregivers Across the Digital Divide: A Cross-Sectional, Correlational Study

Background

The digital divide is a recognized public health problem caused by social determinants that exacerbate health disparities. Despite the “tectonic shift” in how most of the public obtains cancer information, underserved communities are at increased risk of being digitally marginalized. However, research that examines factors underlying eHealth information seeking in diverse health contexts is lacking.

Objective

The aim of this paper is to explore preferences and use of eHealth cancer prevention information (CPI) among patients and caregivers attending a minority-serving oncology clinic using the comprehensive model of information seeking as a theoretical framework. Specifically, the study examined the role of social determinants and prevention orientation in differences in preference and use of the Internet for CPI seeking among this diverse sample.

Methods

Survey methodology was used to identify social determinants and behavioral factors, including prevention orientation as correlates and predictors of respondents’ (n=252) preferences and use of eHealth for CPI seeking.

Results

Less than half (112/252, 44.4%) of respondents said that if faced with the need to seek CPI, they would seek this information online. In the final logistic regression model, education, ethnicity, age, and prevention orientation made significant contributions to the model (P<.05). Specifically, for each year increase in age, participants were 3% less likely to use the Internet for CPI seeking (P=.011). Compared to college graduates, respondents who did not complete high school were 11.75 times less likely to cite the Internet as a CPI carrier (P<.001) and those with a high school education were 3 times (2.99, P=.015) less likely. In addition, the odds that a Spanish speaker would cite the Internet as a CPI carrier were one-fifth (22%) of non-Hispanic whites (P=.032) and about one-quarter (26%) of English-speaking Latinos (P=.036). Finally, with each one point increase on the prevention orientation scale, respondents were 1.83 times less likely to cite online CPI seeking (P=.05).

Conclusions

Social determinants to health have profound influence on eHealth CPI seeking. Providers and policy makers should focus on meeting patients and family members’ CPI needs following diagnosis and increase eHealth accessibility and availability of evidence-based CPI to diverse populations. Future research is needed to unravel further differences in eHealth CPI seeking, including those among Native Americans that emerged as an additional digitally underserved racial/ethnic group. Finally, additional factors underlying these differences should be explored to better tailor CPI eHealth information to diverse communities’ information needs.

Physical activity and cancer prevention: awareness and meeting the recommendations among adult Saudis

BACKGROUND

There is a scarcity of information about the proportion of the adult Saudi population that meet the recommended guidelines of physical activity (PA) to reduce cancer risk. Moreover, their awareness about the role of PA in cancer prevention is unclear.

OBJECTIVES

This cross-sectional study aimed at estimating the proportion of adult Saudis meeting the PA guidelines, specifically those recommended by American Cancer Society (ACS) for cancer prevention, and to assess the public awareness about the role of PA in cancer prevention.

MATERIALS AND METHODS

Using a multistage sampling method, 2,127 adult Saudis of both genders were recruited from 6 urban and 4 rural primary health care centers in Al Hassa, Saudi Arabia. Participants were personally interviewed to gather information about their sociodemographic characteristics, searching activity about PA and cancer, and the time spent in leisure time PA (moderate and vigorous)/week using the Global Physical Activity Questionnaire with show cards. Finally, items about the role of PA in cancer risk reduction were inquired.

RESULTS

Of the included participants, 11.6% met the recommendations for cancer prevention (≥ 45 minutes of moderate-vigorous PA activity/≥ 5 days/week or 225 minutes/week). Multivariate regression showed that being male (AOR=1.49, CI=1.09-2.06), <20 years of age (AOR=3.11, CI=2.03-4.76), and unemployed (AOR=2.22, CI=1.57-3.18) were significant predictors for meeting PA recommendations for cancer prevention. Only 11.4% of the sample indicated correctly the frequency and duration of PA required for an average adult to be physically active and while >70% of them indicated the role of PA in prevention of hypertension, coronary heart disease and lowering elevated blood cholesterol, only 18.6% and 21.7% correctly mentioned the role of PA in reducing colon and breast cancer risk, respectively. Poor knowledge was found among those with less than college education and aged ≥ 50 years. The level of knowledge was significantly positively correlated with total leisure time PA of the participants.

CONCLUSIONS

A minority of adult Saudis in Al Hassa was aware about the role of PA in cancer prevention and engaged in sufficient LTPA for cancer risk reduction benefits, highlighting the need for public health actions to include policies and programs that address factors deterring their participation in LTPA and increasing their awareness with remedies to manage the prevalent misconceptions.

Physical activity in young adults: a signal detection analysis of Health Information National Trends Survey (HINTS) 2007 data

Many young adults are insufficiently active to achieve the health benefits of regular physical activity. Using signal detection analysis of data from the 2007 Health Information National Trends Survey, the authors examined distinct subgroups of 18-39 year-old adults who vary in their likelihood of not meeting physical activity recommendations. We randomly split the sample and conducted signal detection analysis on the exploratory half to identify subgroups and interactions among sociodemographic and health communication variables that predicted engaging in less than 150 minutes per week of moderate-intensity physical activity (low physical activity). We compared rates of low physical activity among subgroups with similarly defined subgroups in the validation sample. Overall, 62% of participants did not meet physical activity recommendations. Among 8 subgroups identified, low physical activity rates ranged from 31% to 90%. Predictors of low physical activity were general health, body mass index (BMI), perceived cancer risk, health-related Internet use, and trust in information sources. The least active subgroup (90% low physical activity) included young adults in poor to good health with a BMI of 30.8 or more (obese). The most active subgroup (31% low physical activity) comprised those in very good to excellent health, who used a website to help with diet, weight, or physical activity, and had little to no trust in health information on television. Findings suggest potential intervention communication channels and can inform targeted physical activity interventions for young adults.

Collective efficacy and obesity-related health behaviors in a community sample of African Americans

The social environment is important to body mass index and obesity. However, it is unknown if perceptions of the social environment are associated with obesity-related behaviors in populations at greatest risk for being overweight or obese. We evaluated the relationship between collective efficacy and diet and physical activity in a community-based sample of African American adults who were residents in an urban area. Data were collected as part of an academic-community partnership from November 2009 to 2011. We evaluated whether participants met the recommended guidelines for diet and physical activity based on collective efficacy and their sociodemographic background, health care variables, and self-efficacy in a community-based sample of African American adults (n = 338) who were residents in the Philadelphia, PA metropolitan area. Overall, many participants did not meet the recommended guidelines for fruit and vegetable intake or physical activity. The likelihood of meeting the recommended guidelines for fruit intake increased with greater levels of collective efficacy (OR 1.56, 95 % CI 1.18, 2.07, p = 0.002) and self-efficacy for diet (OR 1.56, 95 % CI 1.19, 2.04, p = 0.001). Collective efficacy was not associated with physical activity and the positive association between collective efficacy and vegetable intake was not statistically significant (OR 1.25, 95 % CI 0.94, 1.65, p = 0.12). It is important to determine the most effective methods and settings for improving diet and physical activity behaviors in urban African Americans. Enhancing collective efficacy may be important to improving adherence to recommended guidelines for obesity-related health behaviors.

Multifactorial beliefs about the role of genetics and behavior in common health conditions: prevalence and associations with participant characteristics and engagement in health behaviors

Purpose

Many common health conditions arise due to a combination of genetic factors and lifestyle-related behaviors. People’s understanding of the multifactorial nature of health conditions has implications for their receptivity to health messages regarding genomics and medicine, and may be related to their adoption of protective health behaviors. Although past work has investigated aspects of either genetic or behavioral causal beliefs, multifactorial beliefs have not been evaluated systematically.

Methods

Utilizing nationally-representative cross-sectional data from the Health Information National Trends Survey (HINTS), we examined the prevalence of multifactorial beliefs regarding the etiology of cancer, obesity, diabetes, heart disease, and hypertension, as well as associations between such beliefs and demographic, health history, and health behavior variables in the U.S. population.

Results

Among 3,630 participants, the vast majority (64.2-78.6%) endorsed multifactorial beliefs. The number of statistically significant associations were limited. Trends suggest that endorsement of multifactorial beliefs may differ by demographic and health history characteristics. Beliefs about the multifactorial etiology of cancer were associated with cancer screening behaviors. Multifactorial beliefs about other common health conditions were associated with few health promotion behaviors.

Conclusion

These findings and recommendations for future research provide preliminary guidance for developing and targeting genomics-related health messages and communications.

Self-Construal as a Predictor of Korean American Women's Intention to Vaccinate Daughters against Human Papillomavirus

Korean Americans represent one of the fastest growing Asian subpopulations in the United States. Despite a dramatic reduction in incidence nationwide, cervical cancer remains a major threat for Korean American women. By preventing the strains of the Human Papillomavirus (HPV) known to cause cervical cancer, the HPV vaccines appear to be a promising solution to reduce the persistent disparities in cervical cancer among not only Korean Americans, but also other racial and ethnic minorities more generally. However, current literature lacks a better understanding of how cultural and behavioral factors influence Korean American women's intention to vaccinate their adolescent daughters against HPV. This manuscript presents the results of testing the mechanisms through which interdependent self-construal (an orientation of self in which individuals define themselves primarily through their relationships with others), attitudes, and subjective norms impact Korean American mothers' intention to vaccinate their daughters. Our findings suggest that self-construal holds promise for health communication research to not only uncover the rich variance of health-related beliefs among individuals of shared cultural descent, but also to understand the context in which these beliefs are embedded.

Correlates and geographic patterns of knowledge that physical activity decreases cancer risk

While many lifestyle-related cancer risk factors including tobacco use, poor diet, and sun exposure are well recognized by the general public, the role of physical activity in decreasing cancer risk is less recognized. Studies have demonstrated gender-, race/ethnicity-, and age-based disparities in cancer risk factor knowledge; however, beliefs and geographic factors that may be related to knowledge are under-examined. In this study, we analyzed data from the 2008 Health Information National Trends Survey to determine correlates of knowledge of the relationship between physical activity and reduced cancer risk in the adult US population. We generated geographic information system maps to examine the geographic distribution of this knowledge. Results revealed that there is confusion among US adults about the relationship between physical activity and cancer risk: Respondents who believed that cancer is not preventable had significantly lower odds of knowing that physical activity reduces cancer risk (p < .001) whereas respondents who believed that cancer is caused by one's behavior had almost two times the odds of knowing that physical activity reduces cancer risk (p < .001). Those who were aware of current physical activity guidelines were also significantly more likely to know that physical activity reduces cancer risk (p < .01). Observed geographic variability in knowledge was consistent with geographic trends in obesity and physical inactivity. Correlates of cancer risk factor knowledge point to opportunities for targeted interventions.

Physical activity among Cambodian Americans: an exploratory study

Available data indicate that Asian Americans as a group have lower levels of physical activity than non-Latino whites. However, few studies have focused on physical activity among Asian American sub-groups. Our objectives were to describe levels of physical activity, as well as individual and environmental correlates of physical activity among Cambodian Americans. We conducted a telephone survey of Cambodians living in three geographic areas (Central California, Northern California, and the Pacific Northwest) during 2010. Physical activity levels were assessed using the International Physical Activity Questionnaire (IPAQ) short version. Survey items addressed demographic characteristics, knowledge about the health benefits of physical activity, social norms and supports with respect to physical activity, the availability of neighbourhood recreational facilities, and neighbourhood characteristics. Our study group included 222 individuals. Only 12% of the study group reported low levels of physical activity, 40% reported moderate levels, and 48% reported high levels. Physical activity was strongly associated with the availability of neighborhood recreational facilities such as parks, but not with neighborhood characteristics such as heavy traffic. Our results suggest that a majority of Cambodian Americans are adherent to current physical activity guidelines. Neighborhood recreational facilities that provide opportunities for leisure-time physical activity are associated with higher levels of physical activity in Cambodian communities. Future research should assess the reliability and validity of the IPAQ in a Cambodian American study group.

Exploring patient activation in the clinic: measurement from three perspectives

OBJECTIVE

To further conceptualize and operationalize patient activation (PA), using measures from patient, physician, and researcher perspectives.

DATA SOURCE/STUDY SETTING

Multimethod observation in 2010 within a family medicine clinic.

STUDY DESIGN

Part of an intervention with 130 patients with type 2 diabetes, this observational study further looked at PA in 19 physician-patient dyads. Data Collection. Observations occurred in a teaching hospital, which served as recruiting and study site.

PRINCIPAL FINDINGS

PA correlated with knowledge, self-efficacy, promotion orientation, and exercise intent. Patient-reported PA did not correlate with researcher-observed or physician-reported PA behavior. Researcher-observed PA correlated with physician-observation items.

CONCLUSIONS

Results provide evidence for measuring different perspectives in studies of PA. When patients report they are activated in self-management, behavior does not indicate they are active in clinical communication, a critical component of collaborative decision making.

Exploring the interaction of patient activation and message design variables: message frame and presentation mode influence on the walking behavior of patients with type 2 diabetes

Examining interpersonal (physician-patient) communication strategies for promoting walking exercise to patients with type 2 diabetes assigned to primary care clinics, the study evaluated two message design variables--frame and presentation mode--as influencers of communication and adoption success. The single-site, four-week, prospective intervention study followed a 2×3 factorial, non-equivalent comparison group quasi-experimental design. Results showed frame was significantly related to steps walked; however, when including patient activation as an interaction, frame was non-significant. The model including patient activation interactions, however, detected significant mode effects on behavior. Results provide evidence that statistics are most effectively used with activated patients.

Picking up the pace: changes in method and frame for the health information national trends survey (2011-2014)

Health communication and health information technology influence the ways in which health care professionals and the public seek, use, and comprehend health information. The Health Information National Trends Survey (HINTS) program was developed to assess the effect of health communication and health information technology on health-related attitudes, knowledge, and behavior. HINTS has fielded 3 national data collections with the fourth (HINTS 4) currently underway. Throughout this time, the Journal of Health Communication has been a dedicated partner in disseminating research based on HINTS data. Thus, the authors thought it the perfect venue to provide an historical overview of the HINTS program and to introduce the most recent HINTS data collection effort. This commentary describes the rationale for and structure of HINTS 4, summarizes the methodological approach applied in Cycle 1 of HINTS 4, describes the timeline for the HINTS 4 data collection, and identifies priorities for research using HINTS 4 data.