Jeff Niederdeppe

Fatalistic Beliefs about Cancer Prevention and Three Prevention Behaviors

Background: A substantial proportion of US adults hold fatalistic beliefs about cancer prevention. Although evidence suggests that fatalistic beliefs discourage people from engaging in screening behaviors that can reduce their cancer risk, far less is known about associations between cancer fatalism and other prevention behaviors. We examined sociodemographic correlates of these beliefs and their associations with regular exercise, smoking, and fruit and vegetable consumption with a national sample of American adults. Methods: Data were analyzed from the first wave of the Health Information National Trends Survey (HINTS 2003). HINTS used random-digit dialing to complete phone interviews with adult Americans (N = 6,369). Results: Nearly half of respondents (47.1%) agreed that “It seems like almost everything causes cancer,” 27.0% agreed that “Theres not much people can do to lower their chances of getting cancer,” and 71.5% agreed that “There are so many recommendations about preventing cancer, its hard to know which ones to follow.” These beliefs were stronger in subjects who were less educated but generally weaker among both African Americans and Hispanics relative to Whites. Fatalistic beliefs about cancer prevention were negatively associated with exercising weekly, not smoking, and eating five or more fruits and vegetables daily in multivariate analysis controlling for sociodemographic characteristics. Conclusions: Americans who hold fatalistic beliefs about cancer prevention may be at greater risk of cancer because they are less likely to engage in various prevention behaviors. Results have notable implications for future cancer communication and education efforts. (Cancer Epidemiol Biomarkers Prev 2007;16(5):998–1003)

Examining the dimensions of cancer-related information seeking and scanning behavior.

Recent decades have witnessed a growing emphasis on patients as active consumers of health information. The literature about cancer-related information focuses on active and purposeful information seeking, but a great deal of exposure to cancer-relevant information may happen less purposively (termed information scanning). This article presents results from an in-depth interview study that examined information seeking and scanning behavior in the context of cancer prevention and screening decisions among a diverse sample of people living in a major metropolitan area. Results suggest that information scanning is quite common, particularly for information related to screening tests. Information seeking is rarer and occurs primarily among those who also are information scanners. Respondents report using a greater variety of sources for information scanning than for information seeking, but participants were much more likely to report that their decisions were influenced by information received through seeking than through scanning. These findings shed new light on how individuals navigate the media environment and suggest future research should examine predictors and effects of less purposeful efforts to obtain cancer-related information.

Media campaigns to promote smoking cessation among socioeconomically disadvantaged populations: What do we know, what do we need to learn, and what should we do now?

Little is known about whether media campaigns are effective strategies to promote smoking cessation among socioeconomically disadvantaged populations or whether media campaigns may unintentionally maintain or widen disparities in smoking cessation by socioeconomic status (SES). This paper presents a systematic review of the literature on the effectiveness of media campaigns to promote smoking cessation among low SES populations in the USA and countries with comparable political systems and demographic profiles such as Canada, Australia and Western European nations. We reviewed 29 articles, summarizing results from 18 studies, which made explicit statistical comparisons of media campaign effectiveness by SES, and 21 articles, summarizing results from 13 studies, which assessed the effectiveness of media campaigns targeted specifically to low SES populations. We find that there is considerable evidence that media campaigns to promote smoking cessation are often less effective, sometimes equally effective, and rarely more effective among socioeconomically disadvantaged populations relative to more advantaged populations. Disparities in the effectiveness of media campaigns between SES groups may occur at any of three stages: differences in meaningful exposure, differences in motivational response, or differences in opportunity to sustain long-term cessation. There remains a need to conduct research that examines the effectiveness of media campaigns by SES; these studies should employ research designs that are sensitive to various ways that SES differences in smoking cessation media effects might occur.

Cancer Information Scanning and Seeking in the General Population

The amount of cancer-related information available in the media and other sources continues to increase each year. We wondered how people make use of such content in making specific health decisions. We studied both the information they actively seek (“seeking”) and that which they encounter in a less purposive way (“scanning”) through a nationally representative survey of adults aged 40–70 years (n = 2,489) focused on information use around three prevention behaviors (dieting, fruit and vegetable consumption, and exercising) and three screening test behaviors (prostate-specific antigen, colonoscopy, mammogram). Overall, respondents reported a great deal of scanning and somewhat less seeking (on average 62% versus 28% for each behavior), and they used a range of sources including mass media, interpersonal conversations, and the Internet, alongside physicians. Seeking was predicted by female gender, age of 55–64 vs. 40–44, higher education, Black race and Hispanic ethnicity, and being married. Scanning was predicted by older age, female gender, and education. Respondents were fairly consistent in their place on a typology of scanning and seeking across behaviors. Seeking was associated with all six behaviors, and scanning was associated with three of six behaviors.

Message design strategies to raise public awareness of social determinants of health and population health disparities.

CONTEXT Raising public awareness of the importance of social determinants of health (SDH) and health disparities presents formidable communication challenges. METHODS This article reviews three message strategies that could be used to raise awareness of SDH and health disparities: message framing, narratives, and visual imagery. FINDINGS Although few studies have directly tested message strategies for raising awareness of SDH and health disparities, the accumulated evidence from other domains suggests that population health advocates should frame messages to acknowledge a role for individual decisions about behavior but emphasize SDH. These messages might use narratives to provide examples of individuals facing structural barriers (unsafe working conditions, neighborhood safety concerns, lack of civic opportunities) in efforts to avoid poverty, unemployment, racial discrimination, and other social determinants. Evocative visual images that invite generalizations, suggest causal interpretations, highlight contrasts, and create analogies could accompany these narratives. These narratives and images should not distract attention from SDH and population health disparities, activate negative stereotypes, or provoke counterproductive emotional responses directed at the source of the message. CONCLUSIONS The field of communication science offers valuable insights into ways that population health advocates and researchers might develop better messages to shape public opinion and debate about the social conditions that shape the health and well-being of populations. The time has arrived to begin thinking systematically about issues in communicating about SDH and health disparities. This article offers a broad framework for these efforts and concludes with an agenda for future research to refine message strategies to raise awareness of SDH and health disparities.

Refining the tobacco dependence phenotype using the Wisconsin Inventory of Smoking Dependence Motives.

The construct of tobacco dependence is important from both scientific and public health perspectives, but it is poorly understood. The current research integrates person-centered analyses (e.g., latent profile analysis) and variable-centered analyses (e.g., exploratory factor analysis) to clarify the latent structure of nicotine dependence and to guide distillation of the phenotype. Using data from 4 samples of smokers, latent profiles were derived using the Wisconsin Inventory of Smoking Dependence Motives subscale scores. Across all 4 samples, results revealed a unique latent profile that had relative elevations on 4 subscales (Automaticity, Craving, Loss of Control, and Tolerance). Variable-centered analyses supported the uniqueness of these 4 subscales as they constituted a distinct common factor and were the strongest predictors of relapse and other dependence criteria. Conversely, the remaining 9 motives carried little unique predictive validity regarding dependence. Applications of a factor mixture model further supported the presence of a unique class of smokers in relation to a common factor underlying the 4 subscales. The results suggest that a pattern of smoking that is heavy, pervasive, automatic, and relatively unresponsive to instrumental contingencies is a necessary and sufficient condition for severe nicotine dependence.

Exploring differences in smokers' perceptions of the effectiveness of cessation media messages

Objective To examine which types of cessation-focused advertisements are associated with perceived advertisement effectiveness among smokers and to assess whether key smoker characteristics (ie, cigarette consumption, desire to quit and past quit attempts) influence perceived effectiveness of different types of cessation ads. Methods We used data from the New York Media Tracking Survey Online, a web survey of 7060 adult smokers in New York. Participants were exposed to four categories of cessation ads: (1) why to quit—graphic images, (2) why to quit—testimonial, (3) how to quit and (4) anti-industry. Perceived ad effectiveness was measured with a four-item scale assessing the degree to which participants thought the ads made them stop and think, grabbed their attention, were believable and made them want to quit smoking. We categorised smokers based on cigarette consumption, desire to quit and past quit attempts. We used multivariable analyses to examine how smoker characteristics and category of cessation ads predict perceived ad effectiveness. Results Ads using the ‘why to quit’ strategy with either graphic images or personal testimonials were perceived as more effective than the other ad categories. Smokers who had less desire to quit or had not tried quitting in the past 12 months responded significantly less favourably to all types of cessation ads tested. Greater cigarette consumption was also associated with lower perceived effectiveness, but this association was smaller in magnitude. Conclusions Tobacco control programmes that utilise cessation-focus advertising should focus relatively more on ads that adopt the ‘why to quit’ strategy with either graphic images or personal testimonials.

Cancer News Coverage and Information Seeking

The shift toward viewing patients as active consumers of health information raises questions about whether individuals respond to health news by seeking additional information. This study examines the relationship between cancer news coverage and information seeking using a national survey of adults aged 18 years and older. A Lexis-Nexis database search term was used to identify Associated Press (AP) news articles about cancer released between October 21, 2002, and April 13, 2003. We merged these data to the Health Information National Trends Survey (HINTS), a telephone survey of 6,369 adults, by date of interview. Logistic regression models assessed the relationship between cancer news coverage and information seeking. Overall, we observed a marginally significant positive relationship between cancer news coverage and information seeking (p < 0.07). Interaction terms revealed that the relationship was apparent only among respondents who paid close attention to health news (p < 0.01) and among those with a family history of cancer (p < 0.05). Results suggest that a notable segment of the population actively responds to periods of elevated cancer news coverage by seeking additional information, but they raise concerns about the potential for widened gaps in cancer knowledge and behavior between large segments of the population in the future.

The impact of anti-tobacco industry prevention messages in tobacco producing regions: evidence from the US truth® campaign

Background: Adolescents who live in tobacco producing regions may not respond favourably to anti-industry ads. Objective: To examine whether state level involvement in tobacco production appears to limit the effectiveness of anti-industry ads to prevent tobacco use among adolescents in the USA. Design: Time trend analyses were done using repeated cross sectional data from six waves of the Legacy Media Tracking Survey, which were collected between 1999 and 2003. Setting and participants: 28 307 adolescents, ages 12–17 years, were classified as living in: tobacco producing states (TPS) (n  =  1929); non-tobacco producing states (non-TPS) with low tobacco control funding comparable to TPS (n  =  5323); non-TPS with relatively high funding (n  =  15 076); and non-TPS with established anti-industry ad campaigns (n  =  5979). Main outcome measures: Reactions to anti-industry ads; strength of anti-industry attitudes/beliefs; changes in anti-industry attitudes/beliefs over time. Results: Ad reactions did not differ by state type. Multivariate adjusted time trend analyses indicated significant, comparable increases in anti-industry attitudes/beliefs since the onset of the truth® campaign, in both TPS and non-TPS. Mediation analyses indicated that these increases were due, in part, to campaign exposure. Conclusions: Adolescents who live in tobacco producing regions appear to be as responsive to anti-industry ads as their counterparts in non-tobacco producing regions. This study provides further evidence for the effectiveness of such ads.

Socioeconomic variation in recall and perceived effectiveness of campaign advertisements to promote smoking cessation.

There are large disparities in cigarette smoking rates by socioeconomic status (SES) in many countries. There is mixed evidence about the relative effectiveness of smoking cessation media campaigns in promoting quitting between lower and higher SES populations, and studies suggest that some types of ad content may have differential effects by SES. We analyzed data from five waves of the New York Media Tracking Survey Online (MTSO), a web survey involving over 7000 adult smokers conducted between 2007 and 2009, to assess SES variation in response to smoking cessation ads. Smokers with low levels of education and income less often recalled ads focused on how to quit, and perceived them as less effective, than ads using graphic imagery or personal testimonials to convey why to quit. Contrary to predictions offered by the Stages of Change Model, we found no evidence that variation in readiness to quit smoking explained patterns of response by education. Results offer guidance for theorists and campaign planners in developing campaigns that are likely to promote cessation among less educated populations.