Emotions for a novel health food: Is there an impact bias and can it be reduced?

Eating decisions may be influenced by an impact bias, or the tendency to overestimate the intensity and duration of emotions for future events or outcomes. In this study, we tested the impact bias, among college students, for eating a novel health food - kale chips. We also examined how an emotion adaptation recall exercise influenced emotions and eating behavior. After reading about the health benefits of kale, college students (N = 80) reported their anticipated emotions (e.g., how intensely they would experience each emotion) for eating kale chips. Following a control (n = 40) or emotion adaptation (n = 40) writing exercise, they were asked to eat these chips. They then reported their experienced emotions (e.g., how intensely they experienced each emotion) as well as their intentions to eat kale in the future. Findings indicated that participants showed a negative impact bias in which they anticipated more intense negative emotions than they experienced. However, they showed an opposite effect for positive emotions, anticipating lower positive emotion than they experienced. Relative to the control group, those who did an emotion adaptation exercise experienced lower levels of disgust after eating kale chips and reported higher intentions to eat them in the future. Subsequent analyses of consumption revealed that those in the emotion adaptation condition also ate more of the kale chips. Findings suggest that affective forecasting theory may be a useful framework through which to develop and test ideas about emotions and eating in the context of novel health foods.

Development and Validation of the Single-Item Mindfulness Scale (SIMS)

Mindfulness is a focused attention to and acceptance of present experiences. Although several reliable and valid multi-item measures of trait mindfulness exist, researchers may sometimes want a short and quick measure of mindfulness. In this project, we developed and validated the Single-Item Mindfulness Scale (SIMS) to assess trait mindfulness. We conducted eight studies involving 3,125 adult and adolescent participants. The studies consisted of cross-sectional, short longitudinal, and daily diary designs. We first developed the wording of the SIMS in Studies 1 and 2 and then examined the validity and reliability in Studies 3-8. The SIMS was found to be reliable and valid. It correlated with several multi-item measures of mindfulness at effect sizes in the medium to large range. It also correlated in expected ways with variables known to be related to existing multi-item measures of mindfulness such as self-compassion, anxiety, negative affect, positive affect, depression, neuroticism, empathy, prosocial behavior, and self-consciousness. Furthermore, it correlated positively with daily reports of mindfulness in a two-week diary study. Although existing multi-item trait mindfulness scales should be used, when possible, the SIMS is recommended in situations when time, question quantity, or researcher focus is constrained.

Getting COVID-19: Anticipated negative emotions are worse than experienced negative emotions

OBJECTIVE

When people think about negative events that may occur in the future, they tend to overestimate their emotional reactions, and these "affective forecasts" can influence their present behavior (Wilson and Gilbert, 2003). The present research examined affective forecasting for COVID-19 infection including the associations between emotions and preventive intentions and behavior.

METHODS

In two studies, we compared individuals' anticipated emotions and recalled emotions for COVID-19 infection. Study 1 asked college students (N = 219) and Study 2 asked general adults (N = 401) to either predict their emotions in response to a future COVID-19 infection or to recall their emotions associated with a previous infection.

RESULTS

In both studies, reliable differences in negative emotions emerged. Those who were predicting their feelings associated with a future infection anticipated more negative emotion than those who were recalling their feelings associated with a past infection reported. Greater negative emotion in both studies was significantly associated with being more likely to have been vaccinated as well as higher intentions to get the booster vaccine.

CONCLUSIONS

These findings suggest that compared to those who have had a COVID-19 infection, those who have not yet experienced infection anticipate they will experience greater negative emotion, and this may have implications for preventive behaviors. In general, these findings suggest that people may have an impact bias for COVID-19 infection.

Religiosity and the Naturalness Bias in Drug and Vaccine Choices

Research reveals a bias for natural versus synthetic drugs. We sought to determine if this bias is associated with religiosity. Three cross-sectional studies (N = 1399 U.S. participants) were conducted to examine the impact of religiosity on the naturalness bias in the drug and vaccine domains. We assessed measures of religiosity, preferences for natural versus synthetic drugs and vaccines in hypothetical scenarios, and a health-related behavior (COVID-19 vaccination status). The results revealed that participants high versus low in religiosity had stronger preferences for natural versus synthetic drugs and vaccines. Furthermore, participants high versus low in religiosity were less likely to have taken the COVID-19 vaccine, and the natural drug bias was a mediator of this effect. Overall, participants higher in religiosity had a stronger preference for natural versus synthetic drugs and vaccines, and this preference had implications for health behavior.

Do Physicians Prefer Natural Drugs?

Abstract. Background: There is a bias for natural versus synthetic drugs in general populations. Aims: We investigated whether physicians who have advanced medical and scientific training and routinely prescribe drugs exhibit this bias. Methods: Physicians and non-physicians were presented with a hypothetical medical situation in which pharmacological therapy was required. Participants were asked if they would prefer a natural or synthetic drug for treatment. Physicians were also asked which drug they would prescribe to a patient. Results: In a forced-choice paradigm, non-physicians (87.5%) and physicians (79.2%) had an equally strong bias for the natural drug, with physicians (74.3%) also preferring the natural drug for patients. When a 9-point drug choice scale was used, including a “no preference” choice (5), non-physicians ( M = 6.91) and physicians ( M = 5.41) again showed a preference for the natural drug compared to the mid-point of the scale, but the non-physicians’ bias was stronger. Physicians no longer preferred the natural drug for patients ( M = 5.15). Limitations: The participants do not represent a random sample and therefore may not represent physicians/non-physicians in general. Additionally, the responses were hypothetical and may not represent behavior in actual medical contexts. Conclusion: These data indicate that physicians and non-physicians exhibit a bias for natural drugs, with physicians also demonstrating a bias for prescribing natural drugs. However, the bias is reduced in physicians compared to non-physicians when a “no preference” option is available, suggesting that advanced medical and/or scientific training may be beneficial in minimizing this bias.

Associations between COVID-19 risk perceptions, behavior intentions and worry

BACKGROUND

Risk perceptions are central to health behavior, but some types of risk perceptions may be more strongly connected to behavior than others. This research examined different risk perceptions of COVID-19 and their respective associations with behavior intentions and worry.

PARTICIPANTS AND PROCEDURE

U.S. college students (N = 248) and general adults (N = 300) reported their risk perceptions of COVID-19 - including absolute numerical, verbal, comparative, and feelings of risk - as well as their worry and intentions to do things such as get vaccinated.

RESULTS

Although most risk perceptions related to intentions and worry, feelings of risk were the most strongly and consistently related. The associations showed that the higher people's feelings of risk were, the greater were their intentions and worry.

CONCLUSIONS

Assessing feelings of risk of COVID-19 may provide the best insight into people's perceived threat of this virus.

Perceptions of the COVID-19 Pandemic among Women with Infertility: Correlations with Dispositional Optimism

People who are more optimistic may experience better psychological health during stressful times. The present study examined the perceptions and emotions surrounding the COVID-19 pandemic among American women who were experiencing fertility problems. We tested if dispositional optimism in these women was associated with less negative perceptions and emotions. We conducted a cross-sectional survey of patients from a single private infertility and reproductive clinic in an urban area in the Midwest, United States. Women, age 18 or older, primarily White and educated, who presented for an appointment to the clinic were invited to participate in an email-based survey. Respondents (N = 304) reported their perceived impact of the COVID-19 pandemic on fertility treatment, emotions associated with this impact, and perceived stress and depressive symptoms. They also completed measures of dispositional optimism and expectations for a future pregnancy. Findings indicated that women perceived an overall negative impact of the pandemic on their treatment plans, which was associated with more negative emotions, lower expectations of future pregnancy, and greater stress and depressive symptoms during the pandemic. However, further correlational analyses revealed that being higher in trait optimism was associated with perceiving a less negative impact of the pandemic, experiencing fewer negative emotions, and less overall stress and depressive symptoms. Although women with fertility problems have perceived the pandemic as negative and disruptive, those who are higher in optimism may be less affected.

Trait mindfulness is negatively associated with distress related to COVID-19

Research suggests that mindfulness is associated with psychological health including a healthier response to stressors.

Objective

This research tested associations between trait mindfulness and mental health factors related to the novel coronavirus (COVID-19).

Methods

Two studies (Study 1 N = 248 college students; Study 2 N = 300 U.S adults) assessed trait mindfulness, perceived stress and anxiety, worry about the coronavirus, and anticipated negative affect of a coronavirus diagnosis. Additionally, Study 2 assessed depressive symptoms and coping with the coronavirus.

Results

In both studies, findings indicated that individuals higher in trait mindfulness reported less stress and anxiety. Higher mindfulness in both studies was also associated with less worry about the virus and anticipating less negative affect if one gets the virus. In Study 2, trait mindfulness was negatively related to depression, and numerous associations between mindfulness and coping emerged, showing higher trait mindfulness was associated with healthier strategies in coping with coronavirus.

Conclusions

These data are consistent with research that has revealed that those who think and act more mindfully are less stressed and anxious. By revealing these associations with mindfulness in the context of a real-world, novel stressor, this research makes an important contribution to the literature.

Predictors of the intention to receive a SARS-CoV-2 vaccine

Background

It is imperative to understand the predictors of vaccine hesitancy for current and future pandemics.

Methods

A representative sample (age, race & gender) of 1054 US adults was collected in October 2020 to examine the predictors of vaccine hesitancy. Participants were asked several questions including their intention to receive a vaccine for the novel coronavirus.

Results

Predictors significantly associated with a greater intention to receive a COVID-19 vaccine included greater perceived feelings of vulnerability to COVID-19, having received a flu vaccination at the time the question was asked, more liberal political orientation, non-Black race, male gender, and a lower naturalness bias.

Conclusions

Vaccines are essential for mitigating current and future pandemics. Multiple strategies are important in encouraging people to be vaccinated and the predictors highlighted here and elsewhere are likely to be useful targets.

You won't regret it (or love it) as much as you think: impact biases for everyday health behavior outcomes

When predicting the future, people tend to overestimate the intensity of their emotions, a phenomenon known as the impact bias. Design: In two studies, we examined the impact bias for health outcomes. In Study 1, participants were randomized to think about a negative health outcome in the future or one in the past. In Study 2, participants came to the laboratory and were asked to predict and report their emotions surrounding an actual health outcome (consuming an unhealthy food). Results: In both studies, an impact bias emerged. In Study 1, participants thinking about an outcome in the future estimated more negative emotion than those thinking about an outcome in the past. In Study 2, when facing an actual health outcome, participants anticipated more negative and positive emotion than they experienced. Impact biases were also associated with behavioral motivation - desire to change the outcome (Study 1) and increased preventive intentions (Study 2). Additional analyses revealed that regret was a particularly important emotion. Conclusion: Although research has highlighted an impact bias for severe health outcomes like disease, these studies provide evidence of an impact bias for health outcomes generally. They also suggest that the bias may have implications for behavior intentions.

A Behavioral Confirmation and Reduction of the Natural versus Synthetic Drug Bias

Research reveals a biased preference for natural v. synthetic drugs; however, this research is based on self-report and has not examined ways to reduce the bias. We examined these issues in 5 studies involving 1125 participants. In a pilot study (N = 110), participants rated the term natural to be more positive than the term synthetic, which reveals a default natural-is-better belief. In studies 1 (N = 109) and 2 (N = 100), after a supposed personality study, participants were offered a thank you "gift" of a natural or synthetic pain reliever. Approximately 86% (study 1) and 93% (study 2) of participants chose the natural v. synthetic pain reliever, which provides a behavioral choice confirmation of the natural drug bias. In studies 3 (N = 350) and 4 (N = 356), participants were randomly assigned to a control or experimental condition and were asked to consider a scenario in which they had a medical issue requiring a natural v. synthetic drug. The experimental condition included a stronger (study 3) or weaker (study 4) rational appeal about the natural drug bias and a statement suggesting that natural and synthetic drugs can be good or bad depending on the context. In both studies, the natural bias was reduced in the experimental condition, and perceived safety and effectiveness mediated this effect. Overall, these data indicate a bias for natural over synthetic drugs in preferences and behavioral choices, which might be reduced with a rational appeal.

Positive excessive drinker prototypes predict greater drinking and alcohol problems

OBJECTIVES

According to the prototype willingness model, risky behaviours such as heavy drinking may be influenced by images of others who engage in this behaviour. In this study, we examined whether college students' prototypes of an individual who frequently drinks "over the limit" were associated with their own alcohol consumption and experience of alcohol-related problems during their first 2 years in college.

METHODS

We assessed students' (N = 340) prototypes of excessive drinkers and their own alcohol consumption and problems at four time points, across their first 2 years in college. Along with examining the trajectory of prototypes, consumption, and problems, we tested whether prototypes significantly predicted consumption and problems across the 2 years. Additional analyses examined whether the predictive value of prototypes was unique from related variables including perceived descriptive norms, perceived injunctive norms, and peer pressure to drink alcohol.

RESULTS

Primary analyses indicated that more positive prototypes of an excessive drinker were significantly associated with greater alcohol consumption in both year 1 and year 2. More positive prototypes were also significantly associated with experiencing more alcohol-related problems in year 2. These findings held when controlling for perceived descriptive and injunctive norms, and peer pressure.

CONCLUSIONS

Findings further support the importance of drinker prototypes to one's own drinking behaviour. By examining prototypes over time and their relationship to alcohol-related problems, this study makes a novel contribution to the existing research. Statement of contribution What is already known on this subject? Perceived norms (beliefs about how much others drink and what they approve of) are associated with own drinking. Individuals construct "risk prototypes," or images of people who engage in risky behaviours like drinking alcohol. Positive risk prototypes of drinkers have been associated with own willingness to drink and subsequent drinking. What does this study add? This study shows the trajectory of drinker prototypes across the first 2 years of college. Findings highlight consistent patterns of positive associations between drinker prototypes and own drinking. More positive drinker prototypes are associated with a greater number of problems with alcohol.

Associations between narrative transportation, risk perception and behaviour intentions following narrative messages about skin cancer

OBJECTIVE

Narrative messages may be an effective strategy to increase risk perceptions and motivate preventive behaviours related to cancer. The aim of this research was to examine associations between narrative transportation (i.e. psychological absorption into a narrative), risk perceptions, and intentions following narrative messages about skin cancer.

DESIGN

In two studies, women who reported indoor tanning read first-person narrative messages about skin cancer. We examined associations between narrative transportation and the women's responses to the narratives, including risk perceptions for skin cancer and behaviour intentions to reduce risk. Associations between transportation, knowledge and worry were also examined.

RESULTS

Greater transportation was associated with higher intentions to perform skin self-examination, talk to one's doctor about skin cancer, and look for more information. Greater transportation was also associated with higher gut feelings of risk and higher worry about skin cancer, but not deliberative risk perceptions or knowledge from the message. Additional analyses showed that after controlling for risk perception and worry, transportation had unique associations with some behaviour intentions.

CONCLUSION

Findings suggest that narrative transportation may be an important component to the persuasion of cancer narratives. Future research should explore ideas such as the role of the experiential system in narratives' influence.

Anxiety symptoms prior to a prostate cancer diagnosis: Associations with knowledge and openness to treatment

AIM

Research suggests that anxiety may be a common response to a cancer diagnosis, but research is needed to examine anxiety before diagnosis. Anxiety before diagnosis may relate to the comprehension of relevant health information or openness to potential treatments. This study examined anxiety and these outcomes in men who were waiting to learn of a prostate cancer diagnosis.

OBJECTIVES

One goal of this study was to determine whether anxiety would increase as men came closer to learning the results of their prostate cancer biopsy. Another goal was to test whether anxiety was associated with knowledge about prostate cancer or openness to different treatments.

METHODS

Men (N = 265) who were facing a prostate cancer diagnosis were surveyed at two time points. Time 1 occurred at the time of biopsy, and Time 2 occurred immediately before men received their biopsy result. At each time point, men reported their anxiety about prostate cancer and their biopsy result. At Time 2, they completed a knowledge test of information about prostate cancer and reported their openness to different potential treatments.

RESULTS

Anxiety symptoms increased as men came closer to learning their diagnosis. Also, higher anxiety was associated with lower knowledge and greater openness to particular treatments like surgery. Interactions showed that when anxiety increased from Time 1 to Time 2, having high or low knowledge mattered less to treatment openness.

CONCLUSION

Waiting for a cancer diagnosis is an important time period in which anxiety may increase and relate to information processing and openness to treatments. Statement of contribution What is already known on this subject? Men undergoing prostate cancer screening have been found to experience high and low levels of anxiety. Research has shown that negative emotions like anxiety are common following a cancer diagnosis, but little research has examined emotions right before diagnosis. Anxiety has been associated with information processing and motivation to engage in preventive behaviours. What does this study add? Applies and tests a theoretical idea related to how anxiety may change as one approaches personally relevant threatening health feedback. Shows relationships between changes in anxiety and knowledge in the context of waiting for actual health feedback. Associates increased anxiety in the prostate cancer context with knowledge and openness to different treatments.

Health numeracy: the importance of domain in assessing numeracy

BACKGROUND AND OBJECTIVE

Existing research concludes that measures of general numeracy can be used to predict individuals' ability to assess health risks. We posit that the domain in which questions are posed affects the ability to perform mathematical tasks, raising the possibility of a separate construct of "health numeracy" that is distinct from general numeracy. The objective was to determine whether older adults' ability to perform simple math depends on domain.

METHODS

Community-based participants completed 4 math questions posed in 3 different domains: a health domain, a financial domain, and a pure math domain. Participants were 962 individuals aged 55 and older, representative of the community-dwelling US population over age 54.

RESULTS

We found that respondents performed significantly worse when questions were posed in the health domain (54% correct) than in either the pure math domain (66% correct) or the financial domain (63% correct). Our experimental measure of numeracy consisted of only 4 questions, and it is possible that the apparent effect of domain is specific to the mathematical tasks that these questions require.

CONCLUSIONS

These results suggest that health numeracy is strongly related to general numeracy but that the 2 constructs may not be the same. Further research is needed into how different aspects of general numeracy and health numeracy translate into actual medical decisions.

Do personal stories make patient decision aids more effective? A critical review of theory and evidence

Background

Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others’ experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions.

Methods

A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people’s healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings.

Results

Of 734 citations identified, 11 were included describing 13 studies. All studies found participants’ judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both “system 1” (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and “system 2” (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real-world studies.

Conclusions

There is insufficient evidence that adding personal stories to decision aids increases their effectiveness to support people’s informed decision making. More rigorous research is required to elicit evidence about the type of personal story that a) encourages people to make more reasoned decisions, b) discourages people from making choices based on another’s values, and c) motivates people equally to engage with healthcare resources.

Perceptions of smokers influence nonsmoker attitudes and preferences for interactions

In two studies, we examined nonsmokers' perceptions of smokers and consequences of the perceptions. In Study 1, smokers answered questions about their sense of self, dependence on smoking, and motivation to quit. Nonsmokers answered questions about their perceptions of these characteristics. Differences between smokers' self-descriptions and nonsmokers' perceptions were observed. Study 2 asked nonsmokers to judge two types of smokers for which the descriptions were based on Study 1 findings. Results showed that nonsmokers held a more negative attitude about and were less willing to engage in different close relationships with the smoker who was described in terms of nonsmokers' perceptions rather than smokers' reports. Attitude mediated the relationship between type of smoker and willingness to date a smoker.

Using a health message with a testimonial to motivate colon cancer screening: associations with perceived identification and vividness

Research suggests that testimonials, or first-person narratives, influence health behavior and health-related decision making, but few studies have examined conceptual factors that may be responsible for these effects. In the current study, older adults who were due for colorectal cancer screening read a message about screening that included a testimonial from a similar other who had previously made the screening decision. We assessed participants' identification with the testimonial character and the degree to which they found the message to be vivid. We explored associations between these factors and participants' knowledge following the message, mood, certainty about screening, and their behavioral intentions to look for more information about screening and to have a test in the next year. In bivariate analyses, identification and vividness were both significantly, positively associated with knowledge and behavioral intentions to have screening in the next year. However, multivariate analyses revealed that only vividness remained significantly associated with knowledge and intentions to be screened.

Giving to others and the association between stress and mortality

OBJECTIVES

We sought to test the hypothesis that providing help to others predicts a reduced association between stress and mortality.

METHODS

We examined data from participants (n = 846) in a study in the Detroit, Michigan, area. Participants completed baseline interviews that assessed past-year stressful events and whether the participant had provided tangible assistance to friends or family members. Participant mortality and time to death was monitored for 5 years by way of newspaper obituaries and monthly state death-record tapes.

RESULTS

When we adjusted for age, baseline health and functioning, and key psychosocial variables, Cox proportional hazard models for mortality revealed a significant interaction between helping behavior and stressful events (hazard ratio [HR] = 0.58; P < .05; 95% confidence interval [CI] = 0.35, 0.98). Specifically, stress did not predict mortality risk among individuals who provided help to others in the past year (HR = 0.96; 95% CI = 0.79, 1.18), but stress did predict mortality among those who did not provide help to others (HR = 1.30; P < .05; 95% CI = 1.05, 1.62).

CONCLUSIONS

Helping others predicted reduced mortality specifically by buffering the association between stress and mortality.

Self-monitoring effects of ecological momentary assessment on smokers' perceived risk and worry

Using ecological momentary assessment (EMA), we sought to determine whether differences in reporting would exist for smokers who self-monitored their smoking-related negative thoughts five times daily in comparison to a non-EMA control group. One hundred seventeen smokers were randomly assigned to two conditions. Eighty-eight smokers carried personal digital assistants (PDAs) for 2 weeks and monitored negative thoughts each day, and 29 smokers did not self-monitor their negative thoughts. All smokers completed pretest and posttest assessments reporting their perceived risk and worry associated with smoking consequences. The data revealed evidence of self-monitoring effects, as smokers in the EMA condition reported less worry after 2 weeks of self-monitoring compared to smokers in the control condition. The two conditions did not differ in their reports of perceived risk of smoking consequences. These data suggest that EMA procedures asking respondents to self-monitor their thoughts about smoking may influence feelings about their smoking behavior.

Breast cancer anxiety's associations with responses to a chemoprevention decision aid

Few studies have examined how specific emotions may affect decision-making processes. Anxiety may be especially relevant in health decisions such as those related to cancer in which thoughts of illness or death may be abundant. We examined associations between women's anxiety about developing breast cancer and variables related to their decision to take a medication that could reduce their chances of the disease. Six-hundred and thirty-two American women, who had an increased risk of breast cancer, reviewed a web-based decision aid about tamoxifen. We examined associations between their baseline, self-reported anxiety about developing the disease and post decision aid measures including knowledge about tamoxifen, attitude toward the medication, and behavioral intentions to look for more information and take the medication. Results showed that anxiety was not associated with knowledge about tamoxifen, but it was associated with attitude toward the medication such that women who were more anxious about developing breast cancer were more likely to think the benefits were worth the risks. Greater anxiety was also associated with greater behavioral intentions to look for additional information and take the medication in the next few months. Secondary analyses showed that behavioral intentions were related to knowledge of tamoxifen and attitude toward the medication only for women who were reporting low levels of anxiety. Overall, the findings suggest that anxiety about breast cancer may motivate interest in tamoxifen and not necessarily through affecting knowledge or attitudes.

Projection, conformity and deviance regulation: a prospective study of alcohol use

We examine how alcohol-related attitudes and behaviour are related to injunctive and descriptive norms over time, and how these perceptions are linked to the experience of alcohol-related problems. In a longitudinal study of alcohol use (n=239, over three time points), we explored the presence of projection, conformity and deviance in college students--a group in the process of identity formation and redefining peer relationships. We found that the first year of college was characterised by both conformity and projection, and that positive attitudes towards alcohol, greater drinking, and higher descriptive norms were associated prospectively with more alcohol-related problems. However, in the second year, the pattern changed such that alcohol consumption behaviour was characterised by deviance such that those who believed others engaged in more drinking reported relatively lower consumption. The longitudinal findings support deviance regulation theory (Blanton, H., & Christie, C. (2003). Deviance regulation: A theory of action and identity. Review of General Psychology, 7, 115-149), which states that individuals form identities by deviating from peers in ways they perceive as desirable. In general, one must consider the role and stage of identity development when making predictions about how attitudes and perceived norms influence alcohol use and the experience of alcohol-related problems.

The distinct role of comparative risk perceptions in a breast cancer prevention program

BACKGROUND

Comparative risk perceptions may rival other types of information in terms of effects on health behavior decisions.

PURPOSE

We examined associations between comparative risk perceptions, affect, and behavior while controlling for absolute risk perceptions and actual risk.

METHODS

Women at an increased risk of breast cancer participated in a program to learn about tamoxifen which can reduce the risk of breast cancer. They reported comparative risk perceptions of breast cancer and completed measures of anxiety, knowledge, and tamoxifen-related behavior intentions. Three months later, the women reported their behavior.

RESULTS

Comparative risk perceptions were positively correlated with anxiety, knowledge, intentions, and behavior 3 months later. After controlling for participants' actual risk of breast cancer and absolute risk perceptions, comparative risk perceptions predicted anxiety and knowledge, but not intentions or behavior.

CONCLUSIONS

Comparative risk perceptions can affect patient outcomes like anxiety and knowledge independently of absolute risk perceptions and actual risk information.

Risk perception measures' associations with behavior intentions, affect, and cognition following colon cancer screening messages

OBJECTIVE

Risk perception is important for motivating health behavior (e.g., Janz & Becker, 1984), but different measures of the construct may change how important that relationship appears. In two studies, we examined associations between four measures of risk perception, health behavior intentions and possible behavioral determinants.

METHODS

Participants in these studies, who were due for colorectal cancer screening, read an online message about the importance of screening to reduce the chance of cancer. We examined bivariate and multivariate associations between risk perception measures, including absolute, comparative, and feelings-of-risk, and behavioral intentions to screen, general worry, and knowledge and attitudes related to screening.

RESULTS

Results across the two studies were consistent, with all risk perception measures being correlated with intentions and attitudes. Multivariate analyses revealed that feelings-of-risk was most predictive of all variables, with the exception of general worry, for which comparative measures were the most predictive.

CONCLUSIONS

Researchers interested in risk perception should assess feelings-of-risk along with more traditional measures. Those interested in influencing health behavior specifically should attempt to increase feelings of vulnerability rather than numerical risk.

Women's interest in taking tamoxifen and raloxifene for breast cancer prevention: response to a tailored decision aid

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.

Perceived risk of cancer and patient reports of participation in decisions about screening: the DECISIONS study

BACKGROUND

Health behavior theories suggest that high perceived risk for cancer will be associated with screening, but few studies have examined how perceived risk relates to the screening decision process.

OBJECTIVE

To examine relationships between perceived risk of cancer and behaviors during decision making for 3 screening tests.

DESIGN

Cross-sectional survey conducted between November 2006 and May 2007.

SETTING

Nationwide random-digit dial telephone survey.

PARTICIPANTS

A total of 1729 English-speaking US adults aged 40 y and older who reported making a cancer screening decision (about breast, colon, or prostate tests) in the previous 2 y.

MEASUREMENTS

Participants completed measures of perceived risk, information seeking, and shared decision-making tendencies.

RESULTS

As perceived risk for cancer increased, patients were more likely to seek information about screening on their own (e.g., 35% of participants who perceived a high risk of cancer searched the Internet compared with 18% for those who perceived a low risk, P < 0.001) and in interactions with their physicians. As perceived risk increased, patients were also more likely to consult with more than 1 provider. Gender moderated the shared decision-making preference such that men with high perceived risks were more likely than women with high perceived risks to report they would have preferred more involvement in the decision (35% v. 9%, P = 0.001).

LIMITATIONS

Cross-sectional data limit causal inferences.

CONCLUSIONS

Higher perceived risk was associated with greater patient participation, as shown by more information seeking and greater desire for decisional involvement (moderated by gender). The results suggest that perceived risk of cancer could influence patient behavior when deciding about screening.

Narratives that address affective forecasting errors reduce perceived barriers to colorectal cancer screening

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.

Smokers' thoughts and worries: a study using ecological momentary assessment

OBJECTIVE

The purpose of this study was to investigate smokers' thoughts and worries about their smoking behavior. Researchers have sometimes asked smokers to make such self-assessments but typically using retrospective summary judgments.

DESIGN

Using ecological momentary assessment, community and student smokers reported five times daily during two separate 1-week intervals.

MAIN OUTCOME MEASURES

Smokers reported their thoughts about smoking, worries about smoking, and level of contemplation to quit smoking.

RESULTS

Smokers reported thinking negatively about their smoking 26.8% of the time they had a cigarette. The most frequent thoughts reported by smokers related to immediate reinforcement of smoking (e.g., "How I smell like cigarettes"). However, smokers reported more intense worry about thoughts related to health concerns (e.g., "Symptoms I'm having because of smoking"). The occurrence of negative thoughts was significantly and positively related to contemplation about quitting, worry about smoking, and risk perceptions. Finally, self-reported worry intensity was more strongly related to contemplation of quitting than negative thought occurrence.

CONCLUSION

Our results show that thoughts about smoking (i.e., cognitions) and feelings about smoking (i.e., worry) are loosely connected and it is feelings rather than cognitions that are most related to contemplation to quit.

The dark side of optimism: unrealistic optimism about problems with alcohol predicts subsequent negative event experiences

College students were identified who were unrealistically optimistic about the likelihood they would experience severe problems due to alcohol consumption. These individuals were then followed over a 2-year period to determine whether they were more likely to report experiencing a range of alcohol-related negative events. Unlike the majority of studies on unrealistic optimism, this study (a) assessed bias at the individual rather than group level and (b) used a prospective rather than cross-sectional design. Participants completed measures at four times, each separated by 4-6 months. Findings showed that unrealistic optimism at Time 1 was associated with a greater number of negative events at Times 2, 3, and 4. Similarly, unrealistic optimism at Time 2 was associated with more negative events at Times 3 and 4. In all cases, the relationships were significant when controlling for previous negative events, suggesting the effects of unrealistic optimism can mount over time.

Unrealistic optimism in smokers: implications for smoking myth endorsement and self-protective motivation

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

Resisting good news: reactions to breast cancer risk communication

Many women overestimate their percentage risk of breast cancer, even after they have received careful estimates from health professionals. In 2 experiments with 134 young adult women, 6 variables were explored that might influence such risk perception persistence. In Study 1, each of the following explanations was unrelated to persistence: public commitment, self-consistency, and unique causal risk models. In Study 2, two individual difference measures, pessimism and differences in understanding percentages, were unrelated to risk perception persistence. However, providing a "risk anchor" based on downward social comparison processes resulted in better risk acceptance at posttest that persisted at a 2-week follow-up assessment. This article discusses why comparison anchors might be important in risk feedback situations and concludes with recommendations for professionals who wish to provide accurate risk information and have patients adopt that information.