1
|
Hong YR, Wheeler M, Wang R, Karanth S, Yoon HS, Meza R, Kaye F, Bian J, Jeon J, Gould MK, Braithwaite D. Patient-Provider Discussion About Lung Cancer Screening by Race and Ethnicity: Implications for Equitable Uptake of Lung Cancer Screening. Clin Lung Cancer 2024; 25:39-49. [PMID: 37673782 DOI: 10.1016/j.cllc.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Physician-patient discussions regarding lung cancer screening (LCS) are uncommon and its racial and ethnic disparities are under-investigated. We examined the racial and ethnic disparities in the trends and frequency of LCS discussion among the LCS-eligible United States (US) population. METHODS We analyzed data from the Health Information National Trends Survey from 2014 to 2020. LCS-eligible individuals were defined as adults aged 55 to 80 years old who have a current or former smoking history. We estimated the trends and frequency of LCS discussions and adjusted the probability of having an LCS discussion by racial and ethnic groups. RESULTS Among 2136 LCS-eligible participants (representing 22.7 million US adults), 12.9% (95% CI, 10.9%-15%) reported discussing LCS with their providers in the past year. The frequency of LCS discussion was lowest among non-Hispanic White participants (12.3%, 95% CI, 9.9%-14.7%) compared to other racial and ethnic groups (14.1% in Hispanic to 15.3% in non-Hispanic Black). A significant increase over time was only observed among non-Hispanic Black participants (10.1% in 2014 to 22.1% in 2020; P = .05) and non-Hispanic Whites (8.5% in 2014 to 14% in 2020; P = .02). In adjusted analyses, non-Hispanic Black participants (14.6%, 95% CI, 12.3%-16.7%) had a significantly higher probability of LCS discussion than non-Hispanic Whites (12.1%, 95% CI, 11.4%-12.7%). CONCLUSION Patient-provider LCS discussion was uncommon in the LCS-eligible US population. Non-Hispanic Black individuals were more likely to have LCS discussions than other racial and ethnic groups. There is a need for more research to clarify the discordance between LCS discussions and the actual screening uptake in this population.
Collapse
Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL; UF Health Cancer Center, Gainesville, FL.
| | - Meghann Wheeler
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Ruixuan Wang
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Shama Karanth
- UF Health Cancer Center, Gainesville, FL; Department of Surgery, College of Medicine, University of Florida, Gainesville, FL
| | - Hyung-Suk Yoon
- UF Health Cancer Center, Gainesville, FL; Department of Surgery, College of Medicine, University of Florida, Gainesville, FL
| | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada; Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - Frederick Kaye
- Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL
| | - Jiang Bian
- UF Health Cancer Center, Gainesville, FL; Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - Michael K Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Dejana Braithwaite
- UF Health Cancer Center, Gainesville, FL; Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL; Department of Surgery, College of Medicine, University of Florida, Gainesville, FL.
| |
Collapse
|
2
|
Colorectal cancer lifetime risk accuracy and behavior change intentions before and after risk assessment. Cancer Causes Control 2021; 32:423-428. [PMID: 33515130 DOI: 10.1007/s10552-021-01394-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE This study examined accuracy of perceived lifetime risk of colorectal cancer prior to and following receipt of cancer risk assessment (CRA) feedback among average risk adults. The specific aims were to identify predictors of improved risk perceptions and assess whether improvement in perceived lifetime risk accuracy was associated with changes in behavioral intentions for physical activity, diet, and colorectal cancer screening. METHODS Adults with no known history of colorectal cancer (n = 419) were enrolled in a study examining the impact of colorectal cancer risk assessment feedback. Risk perceptions and behavioral intentions were ascertained before and after risk assessment administration. RESULTS Accuracy of perceived lifetime risk significantly improved after CRA feedback, often as a result of lowered perceived risk. Those who were White, married, attended some college, and had higher numeracy were more likely to report accurate lifetime risk post-CRA. No differences in behavioral intentions were reported between those with and without improved accuracy. CONCLUSION Minorities and those with low numeracy were less likely to report accurate perceptions post-CRA. Although improved accuracy was not associated with increased behavioral intentions as expected, it is reassuring that intentions for health behaviors were not inhibited as perceived risk decreased.
Collapse
|
3
|
Daniel C, Aly S, Bae S, Scarinci I, Hardy C, Fouad M, Demark-Wahnefried W. Differences Related to Cancer Screening by Minority and Rural/Urban Status in the Deep South: Population-based Survey Results. J Cancer 2021; 12:474-481. [PMID: 33391444 PMCID: PMC7738985 DOI: 10.7150/jca.49676] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/01/2020] [Indexed: 01/20/2023] Open
Abstract
Objective: Cancer mortality in the U.S. Deep South exceeds national levels. A cross-sectional survey was undertaken across Alabama to discern cancer beliefs and screening practices, and compare data from racial/ethnic minority versus majority and rural versus urban respondents. Methods: Using population-based methods, we approached 5,633 Alabamians (ages 50-80) to complete a 58-item survey (administered in-person, via telephone, or the web). Descriptive statistics were used to summarize findings; two-tailed, chi-square and t-tests (α<0.05) were used to compare minority-majority and rural-urban subgroups. Results: The response rate was 15.2%; respondents identified as minority (n=356) or majority (n=486), and rural (n=671) or urban (n=183). Mean (SD) age was 63.7 (10.2) and >90% indicated stable housing, and healthcare coverage and access. Rural and minority versus urban and majority respondents were significantly more likely to have lower education, employment, and income, respectively. Most respondents equated cancer as a "death sentence" and were unable to identify the age at which cancer screening should begin. Few rural-urban subgroup differences were noted, though significant differences were observed between minority versus majority subgroups for mammography (36.7% versus 49.6%, p<.001) and colorectal cancer screening (34.5% vs. 47.9%, p<0.001). Furthermore, while minorities were significantly more likely to report ever having a colonoscopy (82.1% versus 76.1%, p=0.041) and to have received fecal occult blood testing within the past year (17.2% versus 12.2%, p=0.046), routine adherence to screening was <20% across all subgroups. Discussion: Cancer early detection education is needed across Alabama to improve cancer screening, and particularly needed among racial/ethnic minorities to raise cancer awareness.
Collapse
Affiliation(s)
| | - Salma Aly
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sejong Bae
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, AL
| | - Isabel Scarinci
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, AL
| | - Claudia Hardy
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, AL
| | - Mona Fouad
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, AL
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, AL
| |
Collapse
|
4
|
Kiviniemi MT, Ellis EM, Orom H, Waters EA, Hay JL. ‘Don’t know’ responding and estimates of perceived risk: failing to provide a ‘don’t know’ response systematically biases laypeople’s perceived risk estimates. HEALTH RISK & SOCIETY 2020. [DOI: 10.1080/13698575.2020.1714557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Marc T. Kiviniemi
- Department of Health, Behavior, and Society, University of Kentucky, Lexington, KY, USA
| | - Erin M. Ellis
- Office of Disease Prevention, National Cancer Institute, Rockville, MD, USA
| | - Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Erika A. Waters
- Department of Surgery, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Jennifer L. Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
5
|
Riley KE, Hay JL, Waters EA, Biddle C, Schofield E, Li Y, Orom H, Kiviniemi MT. Lay beliefs about risk: relation to risk behaviors and to probabilistic risk perceptions. J Behav Med 2019; 42:1062-1072. [PMID: 31093806 PMCID: PMC7234841 DOI: 10.1007/s10865-019-00036-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/23/2019] [Indexed: 01/29/2023]
Abstract
Lay illness risk beliefs are commonly held philosophies about how risk works. These include beliefs that one's personal illness risk is unknowable and beliefs that thinking about one's risk can actually increase that risk. Beliefs about risk may impact risk behaviors and thereby subsequent health status. However, limited research examines the relation between lay risk beliefs and health behavior. This paper explores this possible relation. A nationally representative sample of adults (N = 1005) recruited from an internet panel were surveyed about lay risk beliefs and risk perceptions regarding diabetes and colorectal cancer, psychosocial factors (i.e., health literacy, need for cognition, locus of control), demographics, and current health behaviors (i.e., cigarette smoking, red meat intake, physical activity). In separate sets of regressions controlling for either demographics, psychosocial factors, or risk perceptions, lay risk beliefs remained significantly related to health behaviors. It may be important to consider how to address lay risk beliefs in intervention content and targeting in order to increase adaptive health behaviors and thereby prevent chronic disease.
Collapse
Affiliation(s)
- Kristen E Riley
- Graduate School of Applied and Professional Psychology, 152 Frelinghuysen Rd, Piscataway, NJ, 08854, USA.
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY, 10022, USA.
| | - Erika A Waters
- Washington University in St. Louis, Saint Louis, MO, USA
| | - Caitlin Biddle
- Community Connections of New York, Inc., Buffalo, NY, USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY, 10022, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY, 10022, USA
| | - Heather Orom
- University of Buffalo- State University of New York, Buffalo, NY, USA
| | | |
Collapse
|
6
|
Orom H, Schofield E, Kiviniemi MT, Waters EA, Biddle C, Chen X, Li Y, Kaphingst KA, Hay JL. Low Health Literacy and Health Information Avoidance but Not Satisficing Help Explain "Don't Know" Responses to Questions Assessing Perceived Risk. Med Decis Making 2019; 38:1006-1017. [PMID: 30403579 DOI: 10.1177/0272989x18799999] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND People who say they don't know (DK) their disease risk are less likely to engage in protective behavior. PURPOSE This study examined possible mechanisms underlying not knowing one's risk for common diseases. METHODS Participants were a nationally representative sample of 1005 members of a standing probability-based survey panel who answered questions about their comparative and absolute perceived risk for diabetes and colon cancer, health literacy, risk factor knowledge and health information avoidance, and beliefs about illness unpredictability. Survey satisficing was a composite assessment of not following survey instructions, nondifferentiation of responses, haphazard responding, and speeding. The primary outcomes were whether a person selected DK when asked absolute and comparative risk perception questions about diabetes or colon cancer. Base structural equation modeling path models with pathways from information avoidance and health literacy/knowledge to DK responding for each DK outcome were compared to models that also included pathways from satisficing or unpredictability beliefs. RESULTS Base models contained significant indirect effects of health literacy (odds ratios [ORs] = 0.94 to 0.97, all P < 0.02) and avoidance (ORs = 1.05 to 1.15, all P < 0.01) on DK responding through risk factor knowledge and a direct effect of avoidance (ORs = 1.21 to 1.28, all P < 0.02). Adding the direct effect for satisficing to models resulted in poor fit (for all outcomes, residual mean square error estimates >0.17, all weighted root mean square residuals >3.2, all Comparative Fit Index <0.47, all Tucker-Lewis Index <0.49), indicating that satisficing was not associated with DK responding. Unpredictability was associated with not knowing one's diabetes risk (OR = 1.01, P < 0.01). LIMITATIONS The data were cross-sectional; therefore, directionality of the pathways cannot be assumed. CONCLUSIONS DK responders may need more health information, but it needs to be delivered differently. Interventions might include targeting messages for lower health literacy audiences and disrupting defensive avoidance of threatening health information.
Collapse
Affiliation(s)
- Heather Orom
- University at Buffalo, Buffalo, NY (HO, MTK, CB, XC).,Memorial Sloan Kettering Cancer Center, New York, NY (ES, YL, JLH).,Washington University in St. Louis, St. Louis, MO (EAW).,University of Utah, Salt Lake City, UT (KAK)
| | - Elizabeth Schofield
- University at Buffalo, Buffalo, NY (HO, MTK, CB, XC).,Memorial Sloan Kettering Cancer Center, New York, NY (ES, YL, JLH).,Washington University in St. Louis, St. Louis, MO (EAW).,University of Utah, Salt Lake City, UT (KAK)
| | - Marc T Kiviniemi
- University at Buffalo, Buffalo, NY (HO, MTK, CB, XC).,Memorial Sloan Kettering Cancer Center, New York, NY (ES, YL, JLH).,Washington University in St. Louis, St. Louis, MO (EAW).,University of Utah, Salt Lake City, UT (KAK)
| | - Erika A Waters
- University at Buffalo, Buffalo, NY (HO, MTK, CB, XC).,Memorial Sloan Kettering Cancer Center, New York, NY (ES, YL, JLH).,Washington University in St. Louis, St. Louis, MO (EAW).,University of Utah, Salt Lake City, UT (KAK)
| | - Caitlin Biddle
- University at Buffalo, Buffalo, NY (HO, MTK, CB, XC).,Memorial Sloan Kettering Cancer Center, New York, NY (ES, YL, JLH).,Washington University in St. Louis, St. Louis, MO (EAW).,University of Utah, Salt Lake City, UT (KAK)
| | - Xuewei Chen
- University at Buffalo, Buffalo, NY (HO, MTK, CB, XC).,Memorial Sloan Kettering Cancer Center, New York, NY (ES, YL, JLH).,Washington University in St. Louis, St. Louis, MO (EAW).,University of Utah, Salt Lake City, UT (KAK)
| | - Yuelin Li
- University at Buffalo, Buffalo, NY (HO, MTK, CB, XC).,Memorial Sloan Kettering Cancer Center, New York, NY (ES, YL, JLH).,Washington University in St. Louis, St. Louis, MO (EAW).,University of Utah, Salt Lake City, UT (KAK)
| | - Kimberly A Kaphingst
- University at Buffalo, Buffalo, NY (HO, MTK, CB, XC).,Memorial Sloan Kettering Cancer Center, New York, NY (ES, YL, JLH).,Washington University in St. Louis, St. Louis, MO (EAW).,University of Utah, Salt Lake City, UT (KAK)
| | - Jennifer L Hay
- University at Buffalo, Buffalo, NY (HO, MTK, CB, XC).,Memorial Sloan Kettering Cancer Center, New York, NY (ES, YL, JLH).,Washington University in St. Louis, St. Louis, MO (EAW).,University of Utah, Salt Lake City, UT (KAK)
| |
Collapse
|
7
|
Perez GK, Gareen IF, Sicks J, Lathan C, Carr A, Kumar P, Ponzani C, Hyland K, Park ER. Racial Differences in Smoking-related Disease Risk Perceptions Among Adults Completing Lung Cancer Screening: Follow-up Results from the ACRIN/NLST Ancillary Study. J Racial Ethn Health Disparities 2019; 6:676-685. [PMID: 30737732 PMCID: PMC6660997 DOI: 10.1007/s40615-019-00566-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
Abstract
Previous work suggests that, compared to white adults, black adults have lower perceived risk for smoking-related diseases (SRDs), which may influence cessation behavior and health outcomes; however, racial differences in SRD risk perceptions among high-risk patients (i.e., a group that exhibits elevated risk for SRDs) following lung screening remain unknown. This paper thus examined differences in risk perceptions for lung cancer and other SRDs among black and white National Lung Screening Trial (NLST) participants. We administered a 10-item measure of perceived lifetime risk of lung cancer and other SRD (Smoking Risk Perceptions Scale; SRPS) to NLST participants at 1 year following lung screening to (1) establish the internal consistency of the SRPS for both black and white participants, (2) compare smoking-related disease risk perceptions between black and white participants, and (3) identify predictors of risk perceptions for black and white participants using multivariable linear regression models. We determined the SRPS items loaded onto two factors (personal and comparative risks; Cronbach's alpha = 0.93 and 0.95 for 1743 white and 194 black participants, respectively), thus demonstrating high internal consistency for both black and white adults. Compared to white participants, black adults demonstrated lower SRD risk perceptions (SRPS range = 10-50, mean difference = 2.55, SE = 0.50, p < 0.001), even after adjusting for smoking status and sociodemographics. Younger age, female gender, higher education, white race, and current smoking status were independently associated with high risk perceptions. Sociodemographic factors associated with lower risk perceptions resemble factors related to continued smoking. Findings suggest current and former black smokers are at risk of having lower risk perceptions for lung cancer and SRDs than white adults following lung cancer screening; these differences may explain observed racial differences in cessation outcomes. Although similar factors influence black and white adults' beliefs, risk perceptions may differentially impact smoking behavior among these groups. Behavior change models that guide tobacco treatment approaches, particularly for high-risk black smokers, should consider the influence of cultural factors on risk perceptions and cessation efforts.
Collapse
Affiliation(s)
- Giselle K Perez
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 100 Cambridge Street, 15th floor, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Ilana F Gareen
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - JoRean Sicks
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Christopher Lathan
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alaina Carr
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 100 Cambridge Street, 15th floor, Boston, MA, 02114, USA
| | - Pallavi Kumar
- Abramsom Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Kelly Hyland
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 100 Cambridge Street, 15th floor, Boston, MA, 02114, USA
- University of South Florida and Moffitt Cancer Center, Tampa, FL, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 100 Cambridge Street, 15th floor, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
8
|
Assari S, Khoshpouri P, Chalian H. Combined Effects of Race and Socioeconomic Status on Cancer Beliefs, Cognitions, and Emotions. Healthcare (Basel) 2019; 7:E17. [PMID: 30682822 PMCID: PMC6473681 DOI: 10.3390/healthcare7010017] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 12/24/2022] Open
Abstract
AIM To determine whether socioeconomic status (SES; educational attainment and income) explains the racial gap in cancer beliefs, cognitions, and emotions in a national sample of American adults. METHODS For this cross-sectional study, data came from the Health Information National Trends Survey (HINTS) 2017, which included a nationally representative sample of American adults. The study enrolled 2277 adults who were either non-Hispanic Black (n = 409) or non-Hispanic White (n = 1868). Race, demographic factors (age and gender), SES (i.e., educational attainment and income), health access (insurance status, usual source of care), family history of cancer, fatalistic cancer beliefs, perceived risk of cancer, and cancer worries were measured. We ran structural equation models (SEMs) for data analysis. RESULTS Race and SES were associated with perceived risk of cancer, cancer worries, and fatalistic cancer beliefs, suggesting that non-Hispanic Blacks, low educational attainment and low income were associated with higher fatalistic cancer beliefs, lower perceived risk of cancer, and less cancer worries. Educational attainment and income only partially mediated the effects of race on cancer beliefs, emotions, and cognitions. Race was directly associated with fatalistic cancer beliefs, perceived risk of cancer, and cancer worries, net of SES. CONCLUSIONS Racial gap in SES is not the only reason behind racial gap in cancer beliefs, cognitions, and emotions. Racial gap in cancer related beliefs, emotions, and cognitions is the result of race and SES rather than race or SES. Elimination of racial gap in socioeconomic status will not be enough for elimination of racial disparities in cancer beliefs, cognitions, and emotions in the United States.
Collapse
Affiliation(s)
- Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48104, USA.
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| | - Pegah Khoshpouri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | - Hamid Chalian
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
| |
Collapse
|
9
|
Chalian H, Khoshpouri P, Assari S. Demographic, Social, and Behavioral Determinants of Lung Cancer Perceived Risk and Worries in a National Sample of American Adults; Does Lung Cancer Risk Matter? MEDICINA (KAUNAS, LITHUANIA) 2018; 54:E97. [PMID: 30513895 PMCID: PMC6306727 DOI: 10.3390/medicina54060097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/20/2018] [Accepted: 11/29/2018] [Indexed: 12/19/2022]
Abstract
Background: Perceived risk and worries of developing cancer are important constructs for cancer prevention. Many studies have investigated the relationship between health behaviors and subjective risk perception. However, factors correlated with lung cancer risk perception and worries in individuals more susceptible to lung cancer have rarely been investigated. Objective: To determine demographic, social, and behavioral determinants of cancer perceived risk and worries and to explore heterogeneities in these associations by the level of lung cancer risk in a nationally representative sample of American adults. Methods: For this cross-sectional study, data came from the Health Information National Trends Survey (HINTS) 2017, which included a 2277 representative sample of American adults. Smoking status, cancer perceived risk, cancer worries, age, gender, race, education, income, and insurance status were measured. We ran structural equation models (SEMs) for data analysis. Results: "Ever smoker" status was associated with higher cancer perceived risk (b = 0.25; 95% CI = 0.05⁻0.44, p = 0.013) and worries (b = 0.34, 95% CI = 0.18⁻0.50, p < 0.001), suggesting that "ever smokers" experience higher levels of cancer perceived risk and worries regarding cancer, compared to "never smokers". Other factors that correlate with cancer perceived risk and worries were race, age, income, and insurance status. Blacks demonstrated less cancer perceived risk and worry (b = -0.98, 95% CI = -1.37⁻0.60, p < 0.001) in both low and high risk lung cancer groups. However, the effects of social determinants (income and insurance status) and age were observed in low but not high risk group. Conclusions: Determinants of cancer perceived risk and worries vary in individuals depending on the level of lung cancer risk. These differences should be considered in clinical practice and policy makings with the goal of improving participation rates in lung cancer screening programs.
Collapse
Affiliation(s)
- Hamid Chalian
- Department of Radiology, Duke University Medical Center, Durham, NC 27705, USA.
| | - Pegah Khoshpouri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA.
| | - Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48104, USA.
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| |
Collapse
|
10
|
Rasmussen V, Forrest LE, Rogasik M, Girodet M, Meeus P, Sunyach MP, Blay JY, Bally O, Brahmi M, Ballinger ML, Niedermayr E, Thomas DM, Halliday J, James P, Ray-Coquard I, Young MA. A comparison of Australian and French families affected by sarcoma: perceptions of genetics and incidental findings. Per Med 2018; 15:13-24. [PMID: 29714116 DOI: 10.2217/pme-2017-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM To compare Australian and French perceptions of genetics and preferences regarding the return of incidental findings. METHODS Participants from the International Sarcoma Kindred Study received a survey at intake to cancer referral units. A total of 1442 Australian and 479 French individuals affected by sarcoma and their unaffected family members responded to four hypothetical scenarios depicting hereditary conditions of varying treatability and severity. RESULTS Australians' preference for the return of incidental findings was consistently higher than French for all scenarios. Country group differences were significant for two scenarios when individual characteristics were controlled through multivariable analyses. CONCLUSION Findings support the need for guidelines that are sensitive to sociocultural context and promote autonomous decision-making.
Collapse
Affiliation(s)
- Victoria Rasmussen
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Laura E Forrest
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Muriel Rogasik
- Centre Léon Bérard, University Lyon 1, Lyon, France.,EURACAN (European network for Rare adult solid Cancer), Centre Léon Bérard, University Lyon 1, Lyon, France
| | - Magali Girodet
- Centre Léon Bérard, University Lyon 1, Lyon, France.,HESPER (Health Services and Performance Research) Lab EA 4128, University Lyon 1, Lyon, France
| | - Pierre Meeus
- Centre Léon Bérard, University Lyon 1, Lyon, France
| | | | - Jean-Yves Blay
- Centre Léon Bérard, University Lyon 1, Lyon, France.,EURACAN (European network for Rare adult solid Cancer), Centre Léon Bérard, University Lyon 1, Lyon, France
| | - Olivia Bally
- Centre Léon Bérard, University Lyon 1, Lyon, France
| | - Mehdi Brahmi
- Centre Léon Bérard, University Lyon 1, Lyon, France
| | - Mandy L Ballinger
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, Australia
| | - Eveline Niedermayr
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - David M Thomas
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, Australia
| | - Jane Halliday
- Public Health Genetics, Murdoch Children's Research Institute, Melbourne, Australia
| | - Paul James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Isabelle Ray-Coquard
- Centre Léon Bérard, University Lyon 1, Lyon, France.,HESPER (Health Services and Performance Research) Lab EA 4128, University Lyon 1, Lyon, France
| | - Mary-Anne Young
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia.,The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, Australia
| | -
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, Australia
| |
Collapse
|
11
|
Taber JM, Klein WMP, Suls JM, Ferrer RA. Lay Awareness of the Relationship between Age and Cancer Risk. Ann Behav Med 2017; 51:214-225. [PMID: 27752991 DOI: 10.1007/s12160-016-9845-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cross-sectional studies suggest many people are unaware that cancer risk increases with age, but this misbelief has rarely been studied prospectively, nor are its moderators known. PURPOSE To assess whether people recognize that cancer risk increases with age and whether beliefs differ according to gender, education, smoking status, and family history of cancer. METHODS First, items from the cross-sectional Health Information National Trends Survey (n = 2069) were analyzed to examine the association of age and perceived cancer risk. Second, the prospective National Survey of Midlife Development in the United States (n = 3896) was used to assess whether perceived cancer risk changes over a decade. Third, beliefs about the age at which cancer occurs were analyzed using the US Awareness and Beliefs about Cancer survey (n = 1080). As a comparator, perceived risk of heart disease was also examined. RESULTS Cross-sectionally, older age was associated with lower perceived cancer risk but higher perceived heart disease risk. Prospectively, perceived cancer risk remained stable, whereas perceived heart attack risk increased. Seventy percent of participants reported a belief that cancer is equally likely to affect people of any age. Across three surveys, women and former smokers/smokers who recently quit tended to misunderstand the relationship between age and cancer risk and also expressed relatively higher perceived cancer risk overall. CONCLUSIONS Data from three national surveys indicated that people are unaware that age is a risk factor for cancer. Moreover, those who were least aware perceived the highest risk of cancer regardless of age.
Collapse
Affiliation(s)
- Jennifer M Taber
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - William M P Klein
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA.
| | - Jerry M Suls
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| | - Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, USA
| |
Collapse
|
12
|
Passmore SR, Williams-Parry KF, Casper E, Thomas SB. Message Received: African American Women and Breast Cancer Screening. Health Promot Pract 2017; 18:726-733. [DOI: 10.1177/1524839917696714] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
African American women are more likely than other women to be diagnosed with breast cancer at a young age, to be diagnosed at a late stage, and to die from the disease. Yet we see evidence of irregular screening and follow-up. Previous research on psychosocial factors influencing decisions to screen reveals barriers: fear, fatalistic perceptions of cancer, inaccurate perceptions of risk, and associations with stigma. The current qualitative research with, largely, insured African American women ( n = 26), health navigators ( n = 6), and community stakeholders ( n = 24) indicates both positive and negative factors influencing decision making. The women in our sample believe in the value of early detection and are motivated to screen in response to encouragement from health providers. However, they also report several factors that contribute to their decisions to delay or not screen. These include (1) perceptions that the health community itself is confused about the need for screening, (2) perceptions that White women are the priority population for breast cancer, (3) family roles that prohibit self-care and encourage secrecy, and (4) fear of diagnosis. Participants report not feeling included in national-level health promotion campaigns. It is argued that African American women, in particular, may benefit from more nuanced health information about their risk.
Collapse
|
13
|
Hay JL, Zabor EC, Kumar J, Brennessel D, Kemeny MM, Lubetkin EI. Cancer beliefs and patient activation in a diverse, multilingual primary care sample. Psychooncology 2016; 25:1071-8. [PMID: 27317127 DOI: 10.1002/pon.4196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 05/18/2016] [Accepted: 06/13/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Greater patient activation, defined as having the knowledge, skills, and confidence to manage one's health, is associated with cancer control behaviors. Cancer risk beliefs may be associated with patient activation, and delineating this relationship could inform cancer control interventions across diverse patient subgroups. This study examines associations between cancer risk beliefs, language preference, and patient activation within a multilingual urban primary care setting. DESIGN Patients 18 years and older within a New York City public hospital serving a large proportion of non-native-born Americans were surveyed regarding their cancer risk beliefs and patient activation in Haitian Creole, Spanish, or English based on language preference during a health care visit. RESULTS The sample (N = 460) included 150 Haitian Creole speakers, 159 Spanish speakers, and 151 English speakers and was primarily non-White (92%). Most participants (84%) had not been born in the United States. Cancer risk beliefs differed across language preference. Beliefs that cancer could be avoided by minimizing thoughts about cancer risk were significantly higher in Haitian Creole speakers than in others; reported negative emotion when thinking about cancer risk was higher in Spanish and English than in Haitian Creole speakers. These cancer risk beliefs were positively related to patient activation, even when controlling for language preference. CONCLUSION Cancer risk beliefs differ across language preference and are related to patient activation, making them potentially important in cancer control. Consideration of language represents important demographic stratification for understanding the frequency and relevance of different beliefs about cancer and patient activation.
Collapse
Affiliation(s)
- Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emily C Zabor
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Julie Kumar
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Debra Brennessel
- Department of Medicine, Division of Ambulatory Care, Queens Hospital Center, Jamaica, New York
| | | | - Erica I Lubetkin
- Department of Community Health and Social Medicine, The Sophie Davis School of Biomedical Education at The City College of New York, New York, New York
| |
Collapse
|
14
|
Taber JM, Klein WMP. The role of conviction in personal disease risk perceptions: What can we learn from research on attitude strength? SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2016; 10:202-218. [PMID: 27127537 DOI: 10.1111/spc3.12244] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Perceived risk for disease is included as a predictor of intentions and behavior in many health behavior theories. However, perceived risk is not always a strong predictor of intentions and behaviors. One reason may be suboptimal conceptualization and measurement of risk perceptions; in particular, research may not capture the conviction and certainty with which a risk perception is held. The rich and independent literature on attitudes might be leveraged to explore whether conviction is an important moderator of the effects of risk perceptions on intentions and behavior. Attitudes are more predictive of intentions when they are high in multiple aspects of attitude strength, including attitude certainty and being more accessible and stable over time. Working from the assumption that risk perceptions have a similar structure and function to attitudes, we consider whether factors known to strengthen the attitude-behavior correspondence might also strengthen the risk perception-behavior correspondence. Although by strict definition risk perceptions are not evaluations (a critical component of attitudes), the predictive validity of risk perceptions may be increased by attention to one's "conviction" or certainty of perceived risk. We also review recent strategies designed to improve risk perception measurement, including affective and experiential assessments of perceived risk and the importance of allowing people to indicate that they "don't know" their disease risk. The aim of this paper is to connect two disparate literatures-attitudes and persuasion in social psychology with risk perceptions in health psychology and decision science-in an attempt to stimulate more work on characteristics and proper measurement of risk perceptions.
Collapse
|
15
|
Hay JL, Ramos M, Li Y, Holland S, Brennessel D, Kemeny MM. Deliberative and intuitive risk perceptions as predictors of colorectal cancer screening over time. J Behav Med 2016; 39:65-74. [PMID: 26280754 PMCID: PMC4724274 DOI: 10.1007/s10865-015-9667-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/31/2015] [Indexed: 02/05/2023]
Abstract
Cancer risk perceptions may involve intuitions-including both affect as well as gut-level thoughts about risk-and deliberative risk magnitudes. Yet, little research has examined the potentially diverse relations between risk perceptions and behavior across time. A highly diverse primary care sample (N = 544, aged ≥50) was utilized to compare how deliberative and intuitive perceptions of risk relate to chart-confirmed colorectal cancer screening at cross-sectional and prospective time points. At baseline, deliberative and intuitive risk perceptions were negatively associated with chart-confirmed colorectal cancer screening adherence in bivariable but not multivariable analyses. Among those who were non-adherent with colorectal cancer screening at baseline, deliberative and intuitive risk perceptions were positively associated with prospective uptake of chart-confirmed colorectal cancer screening adherence at 12-months in bivariable analyses; only deliberative risk perceptions remained significant in the multivariable model. This study indicates that diverse risk perceptions are differentially important for screening at different time points.
Collapse
Affiliation(s)
- Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Seventh Floor, New York, NY, 10022, USA.
| | - Marcel Ramos
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Seventh Floor, New York, NY, 10022, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Seventh Floor, New York, NY, 10022, USA
| | - Susan Holland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Seventh Floor, New York, NY, 10022, USA
| | - Debra Brennessel
- Mount Sinai Medical Center, Queens Hospital Center, New York, NY, 11432, USA
| | - M Margaret Kemeny
- Mount Sinai Medical Center, Queens Hospital Center, New York, NY, 11432, USA
| |
Collapse
|