Marc T. Kiviniemi

Exploring the Link Between Racial Discrimination and Substance Use: What Mediates? What Buffers?

The relation between perceived racial discrimination and substance use was examined in 2 studies that were based on the prototype-willingness model (Gibbons, Gerrard, & Lane, 2003). Study 1, using structural equation modeling, revealed prospective relations between discrimination and use 5 years later in a panel of African American adolescents (M age 10.5 years at Time 1 [T1]) and their parents. For both groups, the relation was mediated by anger and/or hostility. For the adolescents, it was also mediated by behavioral willingness, and it was moderated by supportive parenting. Study 2 was a lab experiment in which a subset of the Study 1 adolescents (M age = 18.5 years) was asked to imagine a discriminatory experience, and then their affect and drug willingness were assessed. As in the survey study, discrimination was associated with more drug willingness, and that relation was again mediated by anger and moderated by supportive parenting. Implications of the results for research and interventions involving reactions to racial discrimination are discussed.

Perceived Cancer Risk: Why Is It Lower Among Nonwhites than Whites?

Background: We explored racial/ethnic differences in perceived cancer risk and determinants of these differences in a nationally representative sample of whites, blacks, Hispanics, and Asians. Methods: Multiple regression techniques, including mediational analyses, were used to identify determinants and quantify racial/ethnic differences in the perception of the risk of developing cancer among 5,581 adult respondents to the 2007 Health Information Trends Survey (HINTS). Results: Blacks, Hispanics, and Asians reported lower perceived cancer risk than whites [Bs = −0.40, −0.34, and −0.69, respectively; (Ps < 0.001)]. Contributing factors included relatively lower likelihood of reporting a family history of cancer, lower likelihood of having smoked, and a less strong belief that everything causes cancer among nonwhites than among whites. Racial/ethnic differences in perceived risk were attenuated in older respondents because perceived cancer risk was negatively associated with age for whites but not for nonwhites. Conclusions: Nonwhites had lower perceptions of cancer risk than whites. Some of the racial/ethnic variability in perceived risk may be due to racial and ethnic differences in awareness of ones family history of cancer and its relevance for cancer risk, experiences with behavioral risk factors, and salience of cancer risk information. Cancer Epidemiol Biomarkers Prev; 19(3); 746–54

The Effect of Online Chapter Quizzes on Exam Performance in an Undergraduate Social Psychology Course

Assigned textbook readings are a common requirement in undergraduate courses, but students often do not complete reading assignments or do not do so until immediately before an exam. This may have detrimental effects on learning and course performance. Regularly scheduled quizzes on reading material may increase completion of reading assignments and therefore course performance. This study examined the effectiveness of compulsory, mastery-based, weekly reading quizzes as a means of improving exam and course performance. Completion of reading quizzes was related to both better exam and course performance. The discussion includes recommendations for the use of quizzes in undergraduate courses.

Too Many of a Good Thing? The Effects of Multiple Motivations on Stress, Cost, Fulfillment, and Satisfaction

Individuals engage in behaviors to satisfy motivations and can engage in the same behavior to satisfy a variety of different motivations. Previous research has examined how differences in the overall amount of motivation influence outcomes but has not addressed how differences in the number of conceptually distinct motivations one has for a particular action influence outcomes. In two longitudinal field studies, individuals with more than one motivation for volunteering experienced greater negative outcomes than did those who volunteered to satisfy a single motivation. A laboratory study manipulated the number of motivations individuals had for engaging in a volunteer activity. Individuals with two motivations reported greater negative outcomes than did those with one motivation. The importance of these findings for understanding the linkages of motivation and action in self-regulated behaviors is discussed.

Don't know responses to risk perception measures: implications for underserved populations.

Background: Risk perceptions are legitimate targets for behavioral interventions because they can motivate medical decisions and health behaviors. However, some survey respondents may not know (or may not indicate) their risk perceptions. The scope of “don’t know” (DK) responding is unknown. Objective: Examine the prevalence and correlates of responding DK to items assessing perceived risk of colorectal cancer. Methods: Two nationally representative, population-based, cross-sectional surveys (2005 National Health Interview Survey [NHIS]; 2005 Health Information National Trends Survey [HINTS]), and one primary care clinic-based survey comprised of individuals from low-income communities. Analyses included 31,202 (NHIS), 1,937 (HINTS), and 769 (clinic) individuals. Measures: Five items assessed perceived risk of colorectal cancer. Four of the items differed in format and/or response scale: comparative risk (NHIS, HINTS); absolute risk (HINTS, clinic), and “likelihood” and “chance” response scales (clinic). Only the clinic-based survey included an explicit DK response option. Results: “Don’t know” responding was 6.9% (NHIS), 7.5% (HINTS-comparative), and 8.7% (HINTS-absolute). “Don’t know” responding was 49.1% and 69.3% for the “chance” and “likely” response options (clinic). Correlates of DK responding were characteristics generally associated with disparities (e.g., low education), but the pattern of results varied among samples, question formats, and response scales. Limitations: The surveys were developed independently and employed different methodologies and items. Consequently, the results were not directly comparable. There may be multiple explanations for differences in the magnitude and characteristics of DK responding. Conclusions: “Don’t know” responding is more prevalent in populations affected by health disparities. Either not assessing or not analyzing DK responses could further disenfranchise these populations and negatively affect the validity of research and the efficacy of interventions seeking to eliminate health disparities.

The Association of Perceived Provider–Patient Communication and Relationship Quality With Colorectal Cancer Screening

Background. Two-thirds of adults aged 50 years and older are adherent to recommendations for colorectal cancer screening. Provider–patient communication and characteristics of the patient–provider relationship may relate to screening behavior. Methods. The association of provider communication quality, relationship, and colorectal cancer screening was examined within data from the 2007 Health Information National Trends Survey. Results. Perceived provider communication and relationship quality were associated with both adherence to colonoscopy and with ever having been screened. Predictive margins analyses indicated that increasing perceptions from lowest to highest levels of communication and relationship quality would be associated with increases in screening rates approaching 16 percentage points. Conclusion. Improving provider–patient communication and relationship quality could potentially improve colorectal cancer screening behaviors among adults aged 50 years and older. Future research and clinical practice should focus on understanding the role of these factors in screening behavior and enhance the provider–patient interaction.

Awareness of the 2009 US Preventive Services Task Force recommended changes in mammography screening guidelines, accuracy of awareness, sources of knowledge about recommendations, and attitudes about updated screening guidelines in women ages 40–49 and 50+

BackgroundThe US Preventive Services Task Force updated mammography recommendations in 2009, recommending against routine screening for women ages 40–49 and reducing recommended frequency for women 50+. The recommendation changes were highly controversial and created conflicting recommendations across professional organizations. This study examines overall awareness of the changes, accuracy of knowledge about changes, factors related to both overall awareness and accuracy, sources of knowledge about changes, and attitudes about the new recommendations.MethodNational telephone survey of 508 women, half aged 40–49 and half 50+, conducted one year after the update (November/December 2010; cooperation rate was 36%). Measures include awareness, accuracy, source of knowledge, interactions with providers, and attitudes about the changes.ResultsFewer than half of women were aware of the guideline changes. Younger, more educated, and higher income women were more aware. Of those who were aware, only 12% correctly reported both change in age and frequency. Accuracy was not associated with demographics. The majority learned of changes through the media and the majority had negative attitudes about the changes.ConclusionsDespite widespread coverage of the recommendation changes, overall awareness in the relevant population is low. Increasing awareness and addressing attitudes about the changes is necessary to ensure the use of recommendations to impact screening behavior.

Psychological distress and smoking behavior: the nature of the relation differs by race/ethnicity.

OBJECTIVE We explored how the relation between psychological distress and smoking behavior differed as a function of race/ethnicity of respondents to a representative national survey. METHODS Data from the 2007 Health Information National Trends Survey were analyzed. Participants reported experiences of psychological distress in the past 30 days, race/ethnicity, current smoking status (smoker/nonsmoker), and number of cigarettes smoked per day. Logistic regression and linear regression analyses were used to examine the influence of race, distress, and their interaction on smoking behavior using survey weighting techniques to account for sampling strategy and nonresponse. RESULTS For current smoking status, there was a significant interaction between race and psychological distress. Follow-up analyses indicated that psychological distress was related to smoking status for White but not for Black or Hispanic respondents. Similar results were found for number of cigarettes smoked per day among current smokers. CONCLUSIONS The results suggest that the often-reported association between psychological distress and smoking is relatively specific to White individuals. The relation does not appear to characterize either Black or Hispanic individuals.

Selective memory biases in individuals’ memory for health-related information and behavior recommendations

Behavior change is central to both prevention and treatment of many chronic diseases. Frequently, however, individuals do not initiate the behavior change recommendations suggested by health professionals. One explanation for low rates of compliance with such recommendations may be selective memory biases in favor of information supporting the idea that one is healthy. Two studies examined whether memory for health information would be biased by preexisting health beliefs. In the first study (N = 113), individuals’ attitudes about the value of alcohol consumption influenced their memory for pro- versus anti-alcohol information. Participants showed better memory for information supporting their attitudes. In Study 2 (N = 50), memory for behavioral recommendations depended on participants’ behavioral practices. Participants displayed better memory for behavioral recommendations consistent with the idea that they were healthy than for recommendations which challenged those beliefs. These findings illustrate an additional manner in which selective processing can affect health promotion efforts, suggest that a motivation to maintain existing health beliefs may underlie the memory differences, and demonstrate that there may be value in developing efforts to ensure that people remember potentially threatening health recommendations.

Perceived risk for breast cancer and its relationship to mammography in Blacks, Hispanics, and Whites

A challenge for health behavior science is to develop theory and best practices that take cultural diversity into account. Using data from Black, Hispanic, and White respondents to the 2003 Health Information National Trends Survey, we examined racial/ethnic differences in: (1) breast cancer risk perceptions/worry; (2) the associations between perceived risk/worry and ever having received a mammogram; and (3) perceived risk/worry and having had at least 2 mammograms over a 4-year period (consecutive mammography). Compared to White race/ethnicity, Black race/ethnicity was associated with lower perceived absolute risk and comparative risk for developing cancer. For the sample as a whole, higher perceived risk (both absolute risk and comparative risk) and worry predicted greater odds of mammography use; however, this was not true for Hispanics. In stratified analyses, perceived risk and worry were not associated with mammography use for either Hispanics or Blacks whereas they were for Whites; however, this interaction effect was significant only for Hispanics vs. Whites. Results support the need for formative research to identify determinants of health behavior prior to cancer prevention message planning for diverse audiences in order to accommodate racial/ethnic differences not only in the level of perceived risk, but also the association between risk perception to behavior change in that community.