Alexander Persoskie

Association of cancer worry and perceived risk with doctor avoidance: an analysis of information avoidance in a nationally representative US sample

Fear of receiving bad news about one’s health can lead people to avoid seeking out health information that, ironically, may be crucial for health maintenance. Using a nationally representative US sample, the present study examined whether perceived likelihood of developing cancer and worry about cancer were associated with reports of avoiding visits to one’s doctor, in respondents under and over age 50. Cancer worry, but not perceived risk of cancer, predicted doctor avoidance in respondents aged 50 and older, whereas the opposite pattern held for respondents under age 50. Moreover, in respondents aged 50 and older, cancer worry and perceived cancer risk interacted such that cancer worry was linked to doctor avoidance only when respondents also perceived a high likelihood of cancer. The latter result is consistent with the notion that worry may motivate information seeking when people expect information to dispel worry and information avoidance when the information is seen as highly likely to confirm one’s fears. Findings suggest a need for communication strategies that can influence worry and perceived risk differentially. Research should also assess the effectiveness of other behavioral strategies (e.g., automatic scheduling of appointments) as a means for reducing doctor avoidance.

Why do People Avoid Medical Care? A Qualitative Study Using National Data

BackgroundMany studies have examined barriers to health care utilization, with the majority conducted in the context of specific populations and diseases. Less research has focused on why people avoid seeking medical care, even when they suspect they should go.ObjectiveThe purpose of the study was to present a comprehensive description and conceptual categorization of reasons people avoid medical care.DesignData were collected as part of the 2008 Health Information National Trends Survey, a cross-sectional national survey.ParticipantsParticipant-generated reasons for avoiding medical care were provided by 1,369 participants (40% male; Mage=48.9; 75.1% non-Hispanic white, 7.4% non-Hispanic black, 8.5% Hispanic or Latino/a).Main MeasuresParticipants first indicated their level of agreement with three specific reasons for avoiding medical care; these data are reported elsewhere. We report responses to a follow-up question in which participants identified other reasons they avoid seeking medical care. Reasons were coded using a general inductive approach.Key ResultsThree main categories of reasons for avoiding medical care were identified. First, over one-third of participants (33.3% of 1,369) reported unfavorable evaluations of seeking medical care, such as factors related to physicians, health care organizations, and affective concerns. Second, a subset of participants reported low perceived need to seek medical care (12.2%), often because they expected their illness or symptoms to improve over time (4.0%). Third, many participants reported traditional barriers to medical care (58.4%), such as high cost (24.1%), no health insurance (8.3%), and time constraints (15.6%). We developed a conceptual model of medical care avoidance based on these results.ConclusionsReasons for avoiding medical care were nuanced and highly varied. Understanding why people do not make it through the clinic door is critical to extending the reach and effectiveness of patient care, and these data point to new directions for research and strategies to reduce avoidance.

Mode Effects in Assessing Cancer Worry and Risk Perceptions: Is Social Desirability Bias at Play?

Background. Risk perceptions and worry are important determinants of health behavior. Despite extensive research on these constructs, it is unknown whether people’s self-reports of perceived risk and worry are biased by their concerns about being viewed negatively by others (social desirability). Methods. In this study, we examined whether reports of perceived risk and worry about cancer varied across survey modes differing in the salience of social desirability cues. We used data from the National Cancer Institute’s 2007 Health Information National Trends Survey, which assessed perceived cancer risk and worry in 1 of 2 survey modes: an interviewer-administered telephone survey (higher likelihood of socially desirable responding; n = 3678) and a self-administered mail survey (lower likelihood of socially desirable responding; n = 3445). Data were analyzed by regressing perceived risk and worry on survey mode and demographic factors. Results. Analyses showed no effect of survey mode on cancer risk perceptions (B = 0.02, P = 0.55, d = 0.02). However, cancer worry was significantly higher in the self-administered mode than in the interviewer-administered mode (B = 0.24, P < 0.001, d = 0.26). Education moderated this effect, with respondents lower in education exhibiting a stronger mode effect. When cancer worry was dichotomized, the odds of reporting cancer worry were approximately twice as high in the self-administered mode compared with the interviewer-administered mode (OR = 2.13, P < 0.001). Conclusions. These results bolster the veracity of self-reported cancer risk perceptions. They also suggest that interviewer-administered surveys may underestimate the frequency of cancer worry, particularly for samples lower in socioeconomic status. Studies are needed to test for this effect in clinical contexts.

Blacks Smoke Less (and More) than Whites: Simpson's Paradox in U.S. Smoking Rates, 2008 to 2012

In what is known as Simpson’s Paradox, a statistical association present within different groups becomes reversed when the groups are aggregated. Because race is confounded with socioeconomic status (SES) in the U.S., the overall smoking rate among Blacks may exceed that among Whites, even while the reverse is true within SES strata (or when adjusting for SES). Indeed, in the most recent five iterations of the Behavioral Risk Factor Surveillance System (2008–2012), a nationwide dataset, unadjusted models found that non-Hispanic Blacks were more likely than non-Hispanic Whites to report current smoking (e.g., in 2012: OR=1.14, p<.0001). However, Blacks were less likely than Whites to report smoking across all five years when models adjusted for income (e.g., in 2012: OR=0.85, p<.0001) and in 2008–2010 when models adjusted for education. This reversal of association reflects racial disparities in SES, which cause Black Americans to be disproportionately affected by smoking risk factors associated with low income and education.

Precancer Risk Perceptions Predict Postcancer Subjective Well-Being

OBJECTIVE The present study used longitudinal data to explore whether subjective well-being in cancer survivors was related to predisease judgments of their likelihood of getting cancer. METHOD Subjective well-being was assessed in terms of affective well-being (frequency of positive and negative affective states) and satisfaction with ones life overall. The sample consisted of 158 participants in the National Survey of Midlife Development in the U.S. (MIDUS) who developed cancer during the 8-10 years between the first and second waves of the survey (average time since diagnosis = 3.37 years; SD = 2.48), and 3,243 control participants who reported no history of cancer at either wave. RESULTS Controlling for demographic variables and well-being at Wave 1, the effect of cancer on well-being depended on whether, prior to being diagnosed, people judged themselves to be at low or high risk of cancer. For those perceiving a high risk, a cancer diagnosis had a modest but significant negative impact on affect and life satisfaction, whereas no negative impact emerged for those perceiving a low risk. Similar effects were not observed for heart attack risk perceptions, or for measures of trait optimism or depression, suggesting that the effect was domain-specific. CONCLUSIONS Low precancer risk perceptions were associated with long-term benefits for subjective well-being in people who developed cancer.

US Consumers’ Understanding of Nutrition Labels in 2013: The Importance of Health Literacy

Introduction We examined US adults’ understanding of a Nutrition Facts panel (NFP), which requires health literacy (ie, prose, document, and quantitative literacy skills), and the association between label understanding and dietary behavior. Methods Data were from the Health Information National Trends Survey, a nationally representative survey of health information seeking among US adults (N = 3,185) conducted from September 6, 2013, through December 30, 2013. Participants viewed an ice cream nutrition label and answered 4 questions that tested their ability to apply basic arithmetic and understanding of percentages to interpret the label. Participants reported their intake of sugar-sweetened soda, fruits, and vegetables. Regression analyses tested associations among label understanding, demographic characteristics, and self-reported dietary behaviors. Results Approximately 24% of people could not determine the calorie content of the full ice-cream container, 21% could not estimate the number of servings equal to 60 g of carbohydrates, 42% could not estimate the effect on daily calorie intake of foregoing 1 serving, and 41% could not calculate the percentage daily value of calories in a single serving. Higher scores for label understanding were associated with consuming more vegetables and less sugar-sweetened soda, although only the association with soda consumption remained significant after adjusting for demographic factors. Conclusion Many consumers have difficulty interpreting nutrition labels, and label understanding correlates with self-reported dietary behaviors. The 2016 revised NFP labels may address some deficits in consumer understanding by eliminating the need to perform certain calculations (eg, total calories per package). However, some tasks still require the ability to perform calculations (eg, percentage daily value of calories). Schools have a role in teaching skills, such as mathematics, needed for nutrition label understanding.

Receiving and Adhering to Lifestyle Modification Counseling for Hypertension: Disparities Between Smokers and Nonsmokers

Hypertensive patients who smoke are in particular need of lifestyle modification counseling because they are at increased risk for poorer outcomes. The authors examined whether hypertensive smokers were more or less likely than nonsmokers to report receiving recommendations for diet, salt intake, exercise, alcohol use, and medication and whether receipt of recommendations was differentially associated with lifestyle changes among smokers vs nonsmokers. In an analysis of data from the 2011 Behavioral Risk Factor Surveillance System on a representative sample of hypertensive adults from 9 US states (N=23,093), smokers were less likely than nonsmokers to report being told by a provider to exercise (odds ratio [OR], 0.66; P<.001) and change their diet (OR, 0.83; P<.05). Receiving dietary recommendations was more strongly associated with self‐reported dietary improvements among smokers (OR, 7.08; P<.001) compared with nonsmokers (OR, 4.17; P<.001) P<.01. Delivery of counseling may vary by smoking status. When provided, lifestyle counseling may be equally or more effective for smokers compared with nonsmokers.