Shelly R. Hovick

Predicting Cancer Risk Knowledge and Information Seeking: The Role of Social and Cognitive Factors

This study tests an expanded Structural Influence Model (SIM) to gain a greater understanding of the social and cognitive factors that contribute to disparities in cancer risk knowledge and information seeking. At the core of this expansion is the planned risk information seeking model (PRISM). This study employed an online sample (N = 1,007) of African American, Hispanic, and non-Hispanic White adults. The addition of four cognitive predictors to the SIM substantially increased variance explained in cancer risk knowledge (R2 = .29) and information seeking (R2 = .56). Health literacy mediated the effects of social determinants (socioeconomic status [SES] and race/ethnicity) on cancer risk knowledge, while subjective norms mediated their effects on cancer risk information seeking. Social capital and perceived seeking control were also shown to be important mediators of the relationships between SES and cancer communication outcomes. Our results illustrate the social and cognitive mechanisms by which social determinants impact cancer communication outcomes, as well as several points of intervention to reduce communication disparities.

Multiple Health Risk Perception and Information Processing Among African Americans and Whites Living in Poverty

We investigated the risk-information-processing behaviors of people living at or near the poverty line. Because significant gaps in health and communication exist among high- and low-income groups, increasing the information seeking and knowledge of poor individuals may help them better understand risks to their health and increase their engagement in health-protective behaviors. Most earlier studies assessed only a single health risk selected by the researcher, whereas we listed 10 health risks and allowed the respondents to identify the one that they worried about most but took little action to prevent. Using this risk, we tested one pathway inspired by the risk information seeking and processing model to examine predictors of information insufficiency and of systematic processing and extended this pathway to include health-protective action. A phone survey was conducted of African Americans and whites living in the southern United States with an annual income of ≤

Changes in screening behaviors and attitudes toward screening from pre-test genetic counseling to post-disclosure in Lynch syndrome families

35,000 (N= 431). The results supported the model pathway: worry partially mediated the relationship between perceived risk and information insufficiency, which, in turn, increased systematic processing. In addition, systematic processing increased health-protective action. Compared with whites and better educated respondents, African Americans and respondents with little education had significantly higher levels of information insufficiency but higher levels of systematic processing and health-protective action. That systematic processing and knowledge influenced health behavior suggests a potential strategy for reducing health disparities.

Cognitive and Emotional Health Risk Perceptions Among People Living in Poverty

The purpose of this study was to examine colonoscopy adherence and attitudes toward colorectal cancer (CRC) screening in individuals who underwent Lynch syndrome genetic counseling and testing. We evaluated changes in colonoscopy adherence and CRC screening attitudes in 78 cancer‐unaffected relatives of Lynch syndrome mutation carriers before pre‐test genetic counseling (baseline) and at 6 and 12u2009months post‐disclosure of test results (52 mutation negative and 26 mutation positive). While both groups were similar at baseline, at 12u2009months post‐disclosure, a greater number of mutation‐positive individuals had had a colonoscopy compared with mutation‐negative individuals. From baseline to 12u2009months post‐disclosure, the mutation‐positive group demonstrated an increase in mean scores on measures of colonoscopy commitment, self‐efficacy, and perceived benefits of CRC screening, and a decrease in mean scores for perceived barriers to CRC screening. Mean scores on colonoscopy commitment decreased from baseline to 6u2009months in the mutation‐negative group. To conclude, adherence to risk‐appropriate guidelines for CRC surveillance improved after genetic counseling and testing for Lynch syndrome. Mutation‐positive individuals reported increasingly positive attitudes toward CRC screening after receiving genetic test results, potentially reinforcing longer term colonoscopy adherence.

Health Behaviors in Patients and Families with Hereditary Colorectal Cancer

Many theories of risk perception and health behavior examine cognitive dimensions of risk (i.e., perceived susceptibility or severity) but not emotional dimensions. To address this gap, the authors examined the emotional component of risk perception (as worry) and its relation to cognitive assessments of risk, self-efficacy and response efficacy, and health protective action. Although people in poverty are at high risk for many health conditions, little is known about how concerned they are about these conditions or how their risk perceptions influence health actions. African Americans and Whites with incomes ≤

Gynecologic cancer screening and communication with health care providers in women with Lynch syndrome

35,000 were surveyed (N = 431). Participants reported their worry level for 10 health risks. Among their highest worry risks, they identified the risk they took the most action and the risk they took the least action to prevent. Worry was low or moderate for each health risk and chronic conditions were of the most concern. For high- and low-action risks, response efficacy moderated the relation between cognitive risk perception and health protective action. For low-action risks, decisions to act were affected independently by cognitive and emotional responses. The results support the Risk Perception Attitude Framework and indicate the importance of using cognitive and emotional dimensions of risk in behavior change models.

Family Support for Weight Management: Links between Perceived Quantity and Quality

It is estimated that 5 to 10% of all colorectal cancer (CRC) cases are attributed to a hereditary cause. The primary hereditary cancer syndromes that confer an increased risk for colorectal cancers are Lynch syndrome/hereditary nonpolyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP). Through genetic testing, health care providers can identify patients and families who carry gene mutations and subsequently are at a substantially greater risk for developing colorectal cancer than the general population. Genetic testing provides risk information not only about an individual patient, but also his or her biological relatives. A variety of risk-reduction behaviors (including screening, surgery, and health and lifestyle behaviors) have been examined in Lynch syndrome and FAP populations. The research indicates that screening behaviors are less than optimal, although the rates vary from study to study. Prophylactic colectomy is the primary course of treatment for individuals who test positive for a FAP mutation, but the results are inconclusive for cancer-unaffected Lynch syndrome mutation carriers. Although research suggests that the adoption of healthy lifestyles and behaviors (e.g., diet, physical activity, weight control, smoking cessation, limited alcohol consumption) could have a favorable impact on colon cancer burden, there is minimal data on how these behaviors may moderate cancer risk among those at risk of hereditary colon cancer. To date, we know very little about the actual health and lifestyle behaviors of those at risk of hereditary colon cancer. Genetic testing and counseling at risk individuals may resolve uncertainty about their personal and familial cancer risk and provide information to guide and personalize decisions about their future health care.

Abstract B10: Factors predicting decisional conflict and p53 genetic testing intention among those at risk of Li-Fraumeni syndrome

We evaluated knowledge of gynecologic cancer screening recommendations, screening behaviors, and communication with providers among women with Lynch syndrome (LS). Women aged ≥25u2009years who were at risk for LS‐associated cancers completed a semi‐structured interview and a questionnaire. Of 74 participants (mean age 40u2009years), 61% knew the appropriate age to begin screening, 75–80% correctly identified the recommended screening frequency, and 84% reported no previous screening endometrial biopsy. Women initiated discussions with their providers about their LS cancer risks, but many used nonspecific terms or relied on family history. Most were not offered high‐risk screening options. While many women were aware of risk‐appropriate LS screening guidelines, adherence was suboptimal. Improving communication between women and their providers regarding LS‐related gynecologic cancer risk and screening options may help improve adherence.

Peer Reviewed: Assessing Perceptions of and Responses to Multiple Health Risks Among the Southern Poor

Despite evidence of the positive effects of social support on weight management, researchers have not examined weight management support within the family. To address this gap, we explored factors associated with the perceived quality of four types of familial social support: instrumental, informational, companionship, and emotional. We found that study participants received instrumental support more than other types of support. Familial factors including mothers weight and family communication were significantly associated with the provision of perceived informational or emotional support. Personal factors including sex, race, income, and weight were significantly associated with perceived instrumental, informational, or companionship support. The results also suggest that the perceived quantity of support is an indicator of the support quality.

Subjective Norms Measure

Background: Li-Fraumeni syndrome (LFS) is a rare genetic condition that increases lifetime risk for a variety of cancers in children and adults. LFS is due to an inherited mutation in the p53 tumor suppressor gene. While genetic testing may help LFS families better understand their cancer risks, decisions to undergo testing may be difficult given the psychosocial implications of testing and the lack of clarity about screening and surveillance methods that are most appropriate for LFS-related cancers. Previous research has shown decisional conflict, or one9s perceived difficulty in making decisions about genetic testing, to be a strong predictor of p53 testing intention. However, little is known generally or specifically among LFS-affected families about the factors that predict decisional conflict. We tested a theoretical model of factors (Hall, Manne, Winkel et al., 2011) that contribute to decisional conflict, including genetic testing self-efficacy, genetics knowledge and testing pros and cons. Additionally, we expanded upon the model by assessing the contribution of risk perceptions and worry and the extent to which the model also predicts p53 genetic testing intentions. Methods: Participants (N=139) in this study were from 27 LFS-affected families enrolled in a longitudinal study offering p53 genetic counseling and testing, including those affected (N=29) and unaffected (N=110) by cancer. Results: Analysis using generalized estimating equations shows higher testing self-efficacy is associated with lower levels of decisional conflict (B=0.09, p Conclusions: These findings support previous research showing decisional conflict to be an important predictor of genetic testing intention among those at-risk of LFS and suggest decisional conflict may help further explain how psychological factors (e.g. perceived risk, self-efficacy, worry) impact genetic testing intention. Thus, these findings offer support for the development of decision aids for p53 genetic testing and suggest these aids should communicate risk and build self-efficacy in order to reduce uncertainty surrounding testing decisions. Additionally, results suggest that those with strong cognitive and emotional responses to risk will have more confidence in their decisions whether to test. Citation Information: Cancer Prev Res 2011;4(10 Suppl):B10.