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Rehfeldt RA, Tyndall I. Why We Are Not Acting to Save Ourselves: ACT, Health, and Culture. Behav Anal Pract 2022; 15:55-70. [PMID: 34306541 PMCID: PMC8280594 DOI: 10.1007/s40617-021-00592-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2021] [Indexed: 12/02/2022] Open
Abstract
Chronic health conditions are increasing at an alarming rate worldwide, and many could be prevented if people were to engage in specific lifestyle behaviors. Intervening on lifestyle behaviors is challenging due to the fact that the consequences associated with unhealthy behaviors are temporally distant and probabilistic, and the aversive functions of covert stimuli may interfere with people's engagement in healthy, preventative behaviors. This article explores the role of relational framing in the promotion of healthy lifestyle behaviors and summarizes research supporting the use of acceptance and commitment training (ACT) as a framework for prevention and intervention. We explore how ACT alters the context in which rigid patterns of rule following occur. ACT loosens the literal functions of stimuli so that experiential-avoidance behaviors are weakened, and healthy, values-consistent behaviors are strengthened. We propose culture-wide interventions inspired by contextual behavior science so that healthier societies can be cultivated.
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Affiliation(s)
- Ruth Anne Rehfeldt
- The Chicago School of Professional Psychology, Chicago, 325 N. Wells St, Chicago, IL 60654 USA
| | - Ian Tyndall
- Department of Psychology, University of Chichester, Chichester, West Sussex UK
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Abstract
Metastatic cancers impose significant burdens on patients, affecting quality of life, morbidity, and mortality. Even during remission, microscopic metastases can lurk, but few therapies directly target tumor cell metastasis. Agents that interfere with this process would represent a new paradigm in cancer management, changing the 'waiting game' into a time of active prevention. These therapies could take multiple forms based on the pathways involved in the metastatic process. For example, a phenome-wide association study showed that a single nucleotide polymorphism in the gene TBXA2R is associated with increased metastasis in multiple primary cancers (P = 0.003), suggesting clinical applicability of TBXA2R antagonists. Emerging data related to the role of platelets in metastasis are concordant with our sense that these pathways present significant opportunities for therapeutic development. However, before real progress can be made toward clinical targeting of the metastatic process, foundational work is needed to define informative measures of critical elements such as circulating tumor cells and tumor DNA, and circulatory vs. lymphatic spread. These challenges require an expansion of team science and composition to obtain competitive funding. At our academic medical center, we have implemented a Cancer Metastasis Inhibition (CMI) program investigating this approach across multiple cancers.
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What's in a Name? Perceptions of the Terms Sexually Transmitted Disease and Sexually Transmitted Infection Among Late Adolescents. Sex Transm Dis 2018; 44:707-711. [PMID: 28876297 DOI: 10.1097/olq.0000000000000682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There has been a shift from using the term sexually transmitted disease (STD) to sexually transmitted infection (STI), primarily based on conjecture that STI is less stigmatizing. However, there is a dearth of evidence regarding how the public actually perceives these terms. METHODS Students at a Midwestern university participated in an online survey and were randomized to the open-ended question "What comes to mind when you think of the term sexually transmitted disease (STD)?" (n = 205) or "What comes to mind when you think of the term sexually transmitted infection (STI)?" (n = 208). Conventional content analysis was conducted to identify response themes. Cross tabulations with the χ statistic determined the number of participants that endorsed each theme and any differences between the STD and STI responses. RESULTS Almost all themes occurred in similar numbers across the STD and STI responses. Overarching themes for both terms were contracted through sex; specific STDs/STIs; severe; negative emotional affect; types of people who get STDs/STIs; physical symptoms; preventable; common; and treatable/curable. However, participants were more likely to mention that STDs were common (P = 0.030) and reported less negative emotional affect for STIs (P = 0.024). Two themes emerged only in the STI group: STDs (P = 0.001) and site of infection (P = 0.003). CONCLUSIONS With some exceptions, late adolescents have overlapping conceptualizations of the terms STD and STI. The most commonly reported themes revealed likely areas of misinformation. Although language is an important aspect of health communication, more than a terminology change is needed to reduce the stigma associated with STDs/STIs.
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Modeling the Detection of Early-Evolving Melanoma Symptoms: Role of Cancer Information and Delay Discounting. PSYCHOLOGICAL RECORD 2016. [DOI: 10.1007/s40732-016-0190-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Critchfield TS, Reed DD. Does Hearing About Cancer Influence Stimulus Control? An Exploratory Study of Verbal Modulation of Stimulus Generalization. Anal Verbal Behav 2016; 32:46-59. [PMID: 27606221 PMCID: PMC4883557 DOI: 10.1007/s40616-016-0055-5] [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] [Indexed: 11/27/2022] Open
Abstract
Participants first became familiar with an image showing moderate symptoms of the skin cancer melanoma. In a generalization test, they indicated whether images showing more and less pronounced symptoms were "like the original." Some groups (cancer context) were told that the images depicted melanoma and that the disease is deadly unless detected early. Control groups were not told what the images depicted. For control groups, generalization gradients were fairly typical of what is normally reported in the generalization literature, but for cancer context groups, gradients were shifted such that highly symptomatic moles were identified as "like the original" more than normal and subtly symptomatic ones were endorsed less than normal. These results may have implications for melanoma education efforts and, more generally, illustrate the possible importance of studying interactions between verbal behavior and primary stimulus control.
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Affiliation(s)
| | - Derek D. Reed
- />Department of Applied Behavioral Science, University of Kansas, 4048 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS 66045 USA
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Kim S, Shin DW, Yang HK, Kim SY, Ko YJ, Cho B, Lee YS, Lee D, Park K, Park JH. Public Perceptions on Cancer Incidence and Survival: A Nation-wide Survey in Korea. Cancer Res Treat 2015; 48:775-88. [PMID: 26044162 PMCID: PMC4843741 DOI: 10.4143/crt.2014.369] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 04/13/2015] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of this study was to compare the public perceptions of the incidence rates and survival rates for common cancers with the actual rates from epidemiologic data. MATERIALS AND METHODS We conducted a survey of Korean adults without history of cancer (n=2,000). The survey consisted of questions about their perceptions regarding lifetime incidence rates and 5-year survival rates for total cancer, as well as those of eight site-specific cancers. To investigate associated factors, we included questions about cancer worry (Lerman's Cancer Worry Scale) or cared for a family member or friend with cancer as a caregiver. RESULTS Only 19% of Korean adults had an accurate perception of incidence rates compared with the epidemiologic data on total cancer. For specific cancers, most of the respondents overestimated the incidence rates and 10%-30% of men and 6%-18% of women had an accurate perception. A high score in "cancer worry" was associated with higher estimates of incidence rates in total and specific cancers. In cancers with high actual 5-year survival rates (e.g., breast and thyroid), the majority of respondents underestimated survival rates. However, about 50% of respondents overestimated survival rates in cancers with low actual survival rates (e.g., lung and liver). There was no factor consistently associated with perceived survival rates. CONCLUSION Widespread discrepancies were observed between perceived probability and actual epidemiological data. In order to reduce cancer worry and to increase health literacy, communication and patient education on appropriate risk is needed.
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Affiliation(s)
- Soyeun Kim
- Department of Family Medicine, Korean Cancer Center Hospital, Seoul, Korea
| | - Dong Wook Shin
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea.,Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Hyung Kook Yang
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - So Young Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Regional Cardiocerebrovascular Center, Chungbuk National University, Cheongju, Korea
| | - Young-Jin Ko
- Department of Family Medicine, Korean Cancer Center Hospital, Seoul, Korea
| | - BeLong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea.,Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Young Sung Lee
- Department of Health Informatics and Management, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Dukhyoung Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Keeho Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jong Hyock Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Department of Health Informatics and Management, College of Medicine, Chungbuk National University, Cheongju, Korea.,Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea
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Korfage IJ, Fuhrel-Forbis A, Ubel PA, Zikmund-Fisher BJ, Greene SM, McClure JB, Smith DM, Alford SH, Fagerlin A. Informed choice about breast cancer prevention: randomized controlled trial of an online decision aid intervention. Breast Cancer Res 2014; 15:R74. [PMID: 24004815 PMCID: PMC3978729 DOI: 10.1186/bcr3468] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 05/08/2013] [Accepted: 09/03/2013] [Indexed: 11/26/2022] Open
Abstract
Introduction Tamoxifen and raloxifene are chemopreventive drugs that can reduce women's relative risk of primary breast cancer by 50%; however, most women eligible for these drugs have chosen not to take them. The reasons for low uptake may be related to women's knowledge or attitudes towards the drugs. We aimed to examine the impact of an online breast cancer chemoprevention decision aid (DA) on informed intentions and decisions of women at high risk of breast cancer. Methods We conducted a randomized clinical trial, assessing the effect of a DA about breast cancer chemoprevention on informed choices about chemoprevention. Women (n = 585), 46- to 74-years old old, completed online baseline, post-test, and three-month follow-up questionnaires. Participants were randomly assigned to either an intervention group, a standard control group that answered questions about chemoprevention at baseline, or a three-month control group that did not answer questions about chemoprevention at baseline. The main outcome measures were whether women's intentions and decisions regarding chemoprevention drugs were informed, and whether women who viewed the DA were more likely to make informed decisions than women who did not view the DA, using a dichotomous composite variable 'informed choice' (yes/no) to classify informed decisions as those reflecting sufficient knowledge and concordance between a woman's decision and relevant attitudes. Results Analyses showed that more intervention than standard control participants (52.7% versus 5.9%) made informed decisions at post-test, P <0.001. At the three-month follow-up, differences in rates of informed choice between intervention (16.9%) and both control groups (11.8% and 8.0%) were statistically non-significant, P = 0.067. Conclusions The DA increased informed decision making about breast cancer chemoprevention, although the impact on knowledge diminished over time. This study was not designed to determine how much knowledge decision makers must retain over time. Examining informed decisions increases understanding of the impact of DAs. A standard for defining and measuring sufficient knowledge for informed decisions is needed. Trial registration ClinicalTrials.gov: NCT00967824
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Donnelly LS, Evans DG, Wiseman J, Fox J, Greenhalgh R, Affen J, Juraskova I, Stavrinos P, Dawe S, Cuzick J, Howell A. Uptake of tamoxifen in consecutive premenopausal women under surveillance in a high-risk breast cancer clinic. Br J Cancer 2014; 110:1681-7. [PMID: 24594998 PMCID: PMC3974072 DOI: 10.1038/bjc.2014.109] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/31/2014] [Accepted: 02/01/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Randomised trials of tamoxifen versus placebo indicate that tamoxifen reduces breast cancer risk by approximately 33%, yet uptake is low. Approximately 10% of women in our clinic entered the IBIS-I prevention trial. We assess the uptake of tamoxifen in a consecutive series of premenopausal women not in a trial and explore the reasons for uptake through interviews. METHODS All eligible women between 33 and 46 years at ≥17% lifetime risk of breast cancer and undergoing annual mammography in our service were invited to take a 5-year course of tamoxifen. Reasons for accepting (n=15) or declining (n=15) were explored using semi-structured interviews. RESULTS Of 1279 eligible women, 136 (10.6%) decided to take tamoxifen. Women >40 years (74 out of 553 (13.4%)) and those at higher non-BRCA-associated risk were more likely to accept tamoxifen (129 out of 1109 (11.6%)). Interviews highlighted four themes surrounding decision making: perceived impact of side effects, the impact of others' experience on beliefs about tamoxifen, tamoxifen as a 'cancer drug', and daily reminder of cancer risk. CONCLUSIONS Tamoxifen uptake was similar to previously ascertained uptake in a randomised controlled trial (IBIS-I). Concerns were similar in women who did or did not accept tamoxifen. Decision making appeared to be embedded in the experience of significant others.
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Affiliation(s)
- L S Donnelly
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - D G Evans
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
- Department of Genomic Medicine, MAHSC, St Mary's Hospital, Manchester M13 9WL, UK
| | - J Wiseman
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - J Fox
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - R Greenhalgh
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - J Affen
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - I Juraskova
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
| | - P Stavrinos
- Manchester Academic Health Science Centre, University Hospital of South Manchester, University of Manchester, Manchester M23 9LT, UK
| | - S Dawe
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
| | - A Howell
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
- Department of Medical Oncology, Christie Hospital, Manchester M20 4BX, UK
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Takahashi M, Kai I, Muto T. Discrepancies Between Public Perceptions and Epidemiological Facts Regarding Cancer Prognosis and Incidence in Japan: An Internet Survey. Jpn J Clin Oncol 2012; 42:919-26. [DOI: 10.1093/jjco/hys125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
AbstractDespite significant improvement in cancer survival, the fear of death still remains rooted in individuals' beliefs about cancer. Existential fears pertaining to cancer cut across the cancer control continuum and taint decisions related to prevention, screening, surveillance, and follow-up recommendations, as well as the overall management of cancer-related issues. However, individuals are innately predisposed to cope with their cancer-related fears through mechanisms such as reliance on the process of meaning making. To better appreciate the potential impact of existential concerns across the cancer control continuum, the Temporal Existential Awareness and Meaning Making (TEAMM) model is proposed. This tripartite model depicts three types of perceived threats to life related to cancer including a “social awareness” (i.e., cancer signals death), “personalized awareness” (i.e., I could die from cancer), and the “lived experience” (i.e., It feels like I am dying from cancer). This construal aims to enhance our understanding of the personal and contextual resources that can be mobilized to manage existential concerns and optimize cancer control efforts. As such, existential discussions should be considered in any cancer-related supportive approach whether preventive, curative, or palliative, and not be deferred only until the advanced stages of cancer or at end of life. Further delineation and validation of the model is needed to explicitly recognize and depict how different levels of existential awareness might unfold as individuals grapple with a potential, actual, or recurrent cancer.
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Fagerlin A, Dillard AJ, Smith DM, Zikmund-Fisher BJ, Pitsch R, McClure JB, Greene S, Alford SH, Nair V, Hayes DF, Wiese C, Ubel PA. Women's interest in taking tamoxifen and raloxifene for breast cancer prevention: response to a tailored decision aid. Breast Cancer Res Treat 2011; 127:681-8. [PMID: 21442198 PMCID: PMC3742062 DOI: 10.1007/s10549-011-1450-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 03/10/2011] [Indexed: 01/03/2023]
Abstract
Although tamoxifen can prevent primary breast cancer, few women use it as a preventive measure. A second option, raloxifene, has recently been approved. The objective of the study was to determine women's interest in tamoxifen and raloxifene after reading a decision aid (DA) describing the risks and benefits of each medication. Women with 5-year risk of breast cancer ≥ 1.66 from two large health maintenance organizations were randomized to receive a DA versus usual care. After reading an on-line DA that discussed the risks and benefits of tamoxifen and raloxifene, women completed measures of risk perception, decisional conflict, behavioral intentions, and actual behavior related to tamoxifen and raloxifene. 3 months following the intervention, 8.1% of participants had looked for additional information about breast cancer prevention drugs, and 1.8% had talked to their doctor about tamoxifen and/or raloxifene. The majority, 54.7%, had decided to not take either drug, 0.5% had started raloxifene, and none had started tamoxifen. Participants were not particularly worried about taking tamoxifen or raloxifene and did not perceive significant benefits from taking these drugs. Over 50% did not perceive a change in their risk of getting breast cancer if they took tamoxifen or raloxifene. After reading a DA about tamoxifen and raloxifene, few women were interested in taking either breast cancer prevention drug.
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Affiliation(s)
- Angela Fagerlin
- Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA.
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Dillard AJ, Fagerlin A, Dal Cin S, Zikmund-Fisher BJ, Ubel PA. Narratives that address affective forecasting errors reduce perceived barriers to colorectal cancer screening. Soc Sci Med 2010; 71:45-52. [PMID: 20417005 PMCID: PMC4033575 DOI: 10.1016/j.socscimed.2010.02.038] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 01/04/2010] [Accepted: 02/22/2010] [Indexed: 12/22/2022]
Abstract
Narratives from similar others may be an effective way to increase important health behaviors. In this study, we used a narrative intervention to promote colorectal cancer screening. Researchers have suggested that people may overestimate barriers to colorectal cancer screening. We recruited participants from the US, ages 49-60 who had never previously been screened for colorectal cancer, to read an educational message about screening for the disease. One-half of participants were randomly assigned to also receive a narrative within the message (control participants did not receive a narrative). The narrative intervention was developed according to predictions of affective forecasting theory. Compared to participants who received only the educational message, participants who received the message along with a narrative reported that the barriers to screening would have less of an impact on a future screening experience. The narrative also increased risk perception for colorectal cancer and interest in screening in the next year.
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Affiliation(s)
- Amanda J Dillard
- University of Michigan, Center for Behavioral and Decision Sciences in Medicine, 300 N Ingalls, 7B02, Ann Arbor, MI, United States.
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Donovan RJ, Carter OBJ, Byrne MJ. People's perceptions of cancer survivability: implications for oncologists. Lancet Oncol 2006; 7:668-75. [PMID: 16887484 DOI: 10.1016/s1470-2045(06)70794-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Individuals typically overestimate survival for lung cancer and underestimate it for melanoma. However, reporting of results generally masks the extent of disagreement between people on survival rates. Most methods used to question individuals are of little use and are not comparable across studies. The topic of people's perceptions of survival for various cancers is under-researched. A clearer definition is needed of survivability, as is a standard way to measure it and then present the information. We have undertaken a review of studies reporting public perceptions of cancer survival rates and compared the results, where possible, with actual survival rates. We also investigate some potential implications of people's underestimation or overestimation of survival for screening and prevention behaviours and delineate implications for oncologists.
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Affiliation(s)
- Robert J Donovan
- Centre for Behavioural Research in Cancer Control, Curtin University, Bentley, WA 6102, Australia.
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