How sources of health information relate to knowledge and use of cancer screening exams

HPV self-sampling among women in the United States: preferences for implementation

PURPOSE

With the inclusion of primary HPV testing in 2018 U.S. Preventive Services Taskforce guidelines, at-home HPV self-sampling may provide a future option for cervical cancer screening, especially among hard-to-reach populations in the U.S. This study evaluated the association of implementation preferences with the willingness of at-home HPV self-sampling.

METHODS

We conducted a cross-sectional study in 2018 among U.S. women ages 30-65 years, without a hysterectomy (n = 812). The outcome was willingness to have at-home HPV self-sampling (yes/no). Primary predictor variables (i.e., information source, methods of payment, methods of sending or receiving self-sampling kits) measured self-sampling implementation preferences. Adjusted logistic regression identified associations with willingness to have at-home HPV self-sampling.

RESULTS

Participants who preferred receiving information from healthcare providers (OR = 2.64; 95% CI 1.54,4.52) or from media or other sources (OR = 2.30; 95% CI 1.51,3.48) had higher HPV self-sampling willingness than participants who did not prefer those sources. Participants who did not want to pay for self-sampling (OR = 0.21; 95% CI 0.14,0.32) or did not know if they would pay for self-sampling (OR = 0.35; 95% CI 0.22,0.54) had lower odds of HPV self-sampling willingness compared to participants willing to pay. Participants who did not know which method they preferred for receiving a self-sampling kit (OR = 0.15, 95% CI 0.07,0.31) or preferred delivering the sample to the lab themselves (OR = 0.59; 95% CI 0.36,0.96) had lower odds for self-sampling willingness compared to participants who preferred the mail.

CONCLUSION

Understanding the preferences of women regarding the implementation of HPV self-sampling can improve uptake in cervical cancer screening, especially among hard-to-reach populations.

Nutrition Information Resources Used by People With Systemic Sclerosis and Perceived Advantages and Disadvantages: A Nominal Group Technique Study

Objective

Where people with systemic sclerosis (SSc) (or scleroderma) obtain diet and nutrition information to manage their disease is not known. Objectives were to identify 1) resources used by people with SSc for nutrition and diet information and 2) perceived advantages and disadvantages of resources.

Methods

We conducted nominal group technique (NGT) sessions in which people with SSc reported nutrition and diet information resources they have used and perceived advantages and disadvantages of accessing and using resources. Participants indicated whether they had tried each resource. They rated helpfulness and importance of possible advantages and disadvantages. Items elicited across sessions were merged to eliminate overlap.

Results

We conducted four NGT sessions (three English language, one French language; 15 total participants) and identified 33 unique information resources, 147 resource‐specific advantages, and 118 resource‐specific disadvantages. Resource categories included health care providers, alternative and complementary practitioners, websites and other media platforms, events, and print materials. The most common themes for advantages and disadvantages included quality and individualization of information and accessibility of resources in terms of cost, location, and comprehensibility. Information provided by medical professionals was regarded as most credible and can be obtained through books, articles, and websites if individual consultation is not easily accessible. Web‐based information was considered highly accessible, although of variable credibility. In‐person events may be an important source of health information for people with SSc.

Conclusion

People with SSc obtain nutrition and diet information from multiple resources. They seek credible and accessible resources that provide SSc‐specific and individualized information.

Heart-Healthy Integrative Nutritional Counseling Group Education Sessions Among Chinese Americans With Cardiovascular Risk Factors or Disease: A Primary Care Quality Improvement Pilot

PURPOSE

Current biomedical cardiovascular disease nutrition counseling does not incorporate Chinese medicine principles.

METHODS

A heart-healthy integrative nutritional counseling (H2INC) curriculum consistent with Chinese medicine principles and biomedical nutrition guidelines was taught to Chinese Americans in group education sessions. Chinese-speaking patients with cardiovascular disease or risk factors from an urban general medicine practice were recruited to attend a 90-minute group session. Participants completed pre-post surveys to assess the impact of H2INC on their perceived heart-healthy nutrition knowledge and empowerment, as well as the cultural relevance of H2INC.

RESULTS

A total of 47 participants (mean age: 74 years; 63.8% female) attended a session. In response to the statement "I am able to choose heart-healthy Chinese foods to eat," on a 5-point Likert scale for which "strongly disagree" = 1 and "strongly agree" = 5, the presession survey mean response was 3.87 ± 0.69 and the postsession survey mean response was 4.13 ± 0.58 (P=0.05). Postsession, 87% of participants agreed or strongly agreed that they felt confident using what they learned and 94% agreed or strongly agreed that H2INC fit their culture.

CONCLUSIONS

H2INC had a positive impact on perceived heart-healthy nutrition knowledge and empowerment and rated high in cultural relevance. Culturally relevant education sessions like H2INC could be a promising primary care health education intervention.

Associations between Fatalistic Cancer Beliefs and Cancer-Screening Behaviors in Chinese American Immigrant Women

Chinese Americans have among the lowest rates of up-to-date cancer screening in the United States. Fatalistic health beliefs are also common in this population and can lead to decreased healthcare utilization. We sought to understand how these fatalistic beliefs are associated with cancer screening behaviors in this underserved population. A cross-sectional survey was conducted with 732 Chinese women from the greater Chinatown area of Chicago, Illinois. Surveyed questions included sociodemographic information, self-reported healthcare utilization and cancer screening behaviors. The majority of respondents were older than 50, spoke Chinese, had less than a college education, public or no medical insurance, and an annual income  < $20,000. Approximately 20% had never received Papanicolaou or mammogram screening. Fatalistic beliefs were common and associated with increased health-seeking behaviors and appropriate Pap and mammogram screening. In this cohort of Chinese American immigrant women in an urban Chinatown community, fatalistic cancer beliefs were prevalent and associated with increased health-seeking and positive cancer screening behaviors. This previously unreported relationship could be leveraged in improving health outcomes of an underserved population.

Hepatitis B knowledge among women and men in the upper west region of Ghana: What sources of health information matter?

Despite the vital role of accurate health information in reducing the spread of Hepatitis B virus (HBV) in endemic contexts such as Ghana, little is known about how health information sources may influence disparities in the knowledge of HBV transmission among women and men. This study examines the association between sources of health information and knowledge of HBV transmission in the Upper West Region (UWR) of Ghana. Data from a cross-sectional survey (n = 1061) was analyzed using gender-specific multivariate ordered logistic regression models. The results show that, women who obtained health information from religious-based programs (OR = 4.04, P < .05), higher-level facilities (OR = 2.37, P < .05), and primary health facilities (OR = 1.83, P < .1) were more likely to have good knowledge of HBV transmission compared to non-facility-based programs. Similarly, men who accessed health information from religious-based programs only, were more likely to have good knowledge of HBV transmission (OR = 2.14, P < .05) compared to non-facility-based programs. The results demonstrate the importance of health information sources on knowledge of disease transmission and prevention in a resource-poor context. Based on our findings, we suggest the scaling-up of information programs at health facilities in rural areas and the expansion of HBV services in the UWR in contribution towards the attainment of SDG #3.3.

Mass media and risk factors for cancer: the under-representation of age

BACKGROUND

Increasing age is a risk factor for developing cancer. Yet, older people commonly underestimate this risk, are less likely to be aware of the early symptoms, and are more likely to be diagnosed with advanced stage cancer. Mass media are a key influence on the public's understanding health issues, including cancer risk. This study investigates how news media have represented age and other risk factors in the most common cancers over time.

METHODS

Eight hundred articles about the four most common cancers (breast, prostate, lung and colorectal) published within eight UK national newspapers in 2003, 2004, 2013 and 2014 were identified using the Nexis database. Relevant manifest content of articles was coded quantitatively and subjected to descriptive statistical analysis in SPSS to identify patterns across the data.

RESULTS

Risk was presented in half of the articles but this was rarely discussed in any depth and around a quarter of all articles introduced more than one risk factor, irrespective of cancer site. Age was mentioned as a risk factor in approximately 12% of all articles and this varied by cancer site. Age was most frequently reported in relation to prostate cancer and least often in articles about lung cancer. Articles featuring personal narratives more frequently focused on younger people and this was more pronounced in non-celebrity stories; only 15% of non-celebrity narratives were about people over 60. Other common risks discussed were family history and genetics, smoking, diet, alcohol, and environmental factors. Family history and genetics together featured as the most common risk factors. Risk factor reporting varied by site and family history was most commonly associated with breast cancer, diet with bowel cancer and smoking with lung cancer.

CONCLUSION

Age and older adults were largely obscured in media representation of cancer and cancer experience. Indeed common risk factors in general were rarely discussed in any depth. Our findings will usefully inform the development of future cancer awareness campaigns and media guidelines. It is important that older adults appreciate their heightened risk, particularly in the context of help-seeking decisions.

Comparing Strategies for Health Information Dissemination: Messengers That Can Help or Hinder

PURPOSE

To test the effects of different messengers on the dissemination of health information.

DESIGN

An experimental study exposed participants to 12 news articles pertaining to 1 of 3 health topics framed from the perspective of 4 generic messengers: religious figures, doctors, celebrity patients, or ordinary patients. Participants select as many of the 12 articles as desired.

SETTING

A cancer clinic within a large, urban hospital serving a sociodemographically diverse patient population.

PARTICIPANTS

Eighty-nine patients with a history of cancer.

MEASURES

The primary outcome was the frequency with which each news story was selected.

ANALYSIS

Summary statistics and a general estimating equation model.

RESULTS

For each health topic, news articles using celebrity messengers were the least likely to be selected; almost half of the participants (36 [41.4%] of 87) rejected all such articles. Articles linked to religious figures were equally unpopular ( P = .59). Articles that used doctors or ordinary patients as the messenger were very likely to be selected: Nearly all women (84 [96.6%] of 87) selected at least one of these. Furthermore, the odds of choosing articles linked to celebrities or religious leaders were statistically significantly lower than the odds of choosing those linked to ordinary patients or doctors ( P < .01).

CONCLUSION

Commonly used generic messengers had large effects on the dissemination of information. Health materials linked to celebrities or religious figures were consistently less likely to be selected than those linked to ordinary patients, or doctors.

Mapping Sources of Food Safety Information for U.S. Consumers: Findings From a National Survey

This research examines the sources from which U.S. consumers obtain their food safety information. It seeks to determine differences in the types of information sources used by U.S. consumers of different sociodemographic background, as well as the relationships between the types of information sources used and food safety risk perceptions. Analyzing the 2010 Food Safety Survey (N = 4,568) conducted by the U.S. Food and Drug Administration, we found that age, gender, education, and race predicted the use of different sources for food safety information. Additionally, use of several information sources predicted perceived susceptibility to foodborne illnesses and severity of food contamination. Implications of the findings for food safety risk communication are discussed.

Gynecological Practice Represents the Ideal Setting for Early Opportunistic Cardiovascular Prevention: A Cross-Sectional Survey in an Urban Female Population

BACKGROUND

Cardiovascular diseases are the main cause of mortality for women worldwide, yet their impact is frequently underestimated. To raise awareness for preventative lifestyle measures other contacts with the healthcare system should be exploited. We analyzed access patterns to other healthcare specialists and population screening measures to identify options for opportunistic counseling on cardiovascular risk.

MATERIALS AND METHODS

We enrolled 1062 randomly selected German urban women aged 25-74 years in 2012-2013, divided into 5 age bands. Women were asked about sociodemographic characteristics, clinical and gynecological history, physician attendance patterns, screening behavior and primary sources of health and preventative information, and clinical examination attendance.

RESULTS

Obstetrician/gynecologists (OBGYN) were the most frequently consulted physicians within the last 12 months (75.3%), more than general practitioners (GP; 74%). Attendance rates to OBGYNs were not affected by education or income, solely a body mass index (BMI) >30 associated with significantly reduced rates of attendance (OR = 0.4, CI 95% = 0.17-0.78, p = 0.009). Women with low to medium Framingham risk scores were more likely to attend an OBGYN than a GP if they attended only one specialist. Attendance of population screening measures is limited (<60% for all offers) and hence unsuitable for systematic cardiovascular counseling.

CONCLUSION

OBGYN represent a very popular and equitable healthcare contact for women of all ages and this could be exploited for cardiovascular screening. Furthermore, the strikingly different sources of health information reported highlight a need for improved health communication and differentiation of messages.

Skin Cancer Prevention, Tanning and Vitamin D: A Content Analysis of Print Media in Germany and Switzerland

BACKGROUND

Print media are a major source of health information.

OBJECTIVES

To analyse press coverage related to skin cancer prevention.

METHODS

We conducted a content analysis of print media articles pertaining to skin cancer prevention, solaria and vitamin D published in Germany and Switzerland over a 1-year period between 2012 and 2013.

RESULTS

Overall, 2,103 articles were analysed. Applying sunscreen was by far the most common sun protection recommendation. A considerable number of articles on solaria and vitamin D advocated exposure to ultraviolet radiation to enhance physical appearance and vitamin D photosynthesis, often without mentioning any precaution measures. In total, 26.8% of the articles contained misleading or erroneous statements mostly related to sunscreen use and vitamin D issues.

CONCLUSIONS

Print media can serve as powerful education tools to foster skin cancer prevention. However, misleading or erroneous reports may negatively impact sun-safe behaviour.

Influence of information sources on hepatitis B screening behavior and relevant psychosocial factors among Asian immigrants

This study examines how different information sources relate to Health Belief Model constructs, hepatitis B virus (HBV) knowledge, and HBV screening. The Maryland Asian American Liver Cancer Education Program administered a survey of 877 Asian immigrants. The most common sources of information identified by the multiple-answer questions were newspapers (39.8 %), physicians (39.3 %), friends (33.8 %), TV (31.7 %), and the Internet (29.5 %). Path analyses-controlling for age, sex, educational level, English proficiency, proportion of life in U.S., health insurance coverage, and family history of HBV infection-showed that learning about HBV from physicians had the strongest direct effect; friends had a marginal indirect effect. Perceived risk, benefits, and severity played limited roles in mediation effects. Path analysis results differed by ethnicity. Physician-based HBV screening intervention would be effective, but should be complemented with community health campaigns through popular information sources for the uninsured.

Characteristics of genetics-related news content in Black weekly newspapers

BACKGROUND/AIMS/OBJECTIVES: The media are an important source of health information, especially for those with less access to regular health care. Black news outlets such as Black newspapers are a source of health information for African Americans. This study characterized media coverage of genetics-related information in Black weekly newspapers and general audience newspapers from the same communities.

METHODS

All health stories in a sample of 24 Black weekly newspapers and 12 general audience newspapers from January 2004 to December 2007 were reviewed for genetics-related stories. These stories were further coded for both journalistic and public health variables.

RESULTS

Of all health-related stories identified, only 2% (n = 357) were considered genetics related. Genetics-related stories in Black newspapers - compared to those in general audience newspapers - were larger, more locally and racially relevant, and more likely to contain recommendations or action steps to improve health or reduce disease risks and to mention the importance of knowing one's family history. Stories in general audience newspapers were more likely to discuss causes of disease, mention genetic testing or therapy, and suggest a high/moderate degree of genetic determinism.

CONCLUSIONS

Black newspapers are a viable communication channel to disseminate findings and implications of human genome research to African American audiences.

The social group influences of US health journalists and their impact on the newsmaking process

The news media play a vital role in disseminating health information, yet little is known about the social characteristics of health journalists or the impact they have on the newsmaking process. This study examines how the social group influences of US health journalists impact two important aspects of news production--'media agenda-setting' and 'framing'. Using data from a national survey of health and medical science journalists, the authors conducted multivariable logistic regression analyses to study the links between the gender, age and race/ethnicity of respondents, and the ways in which they utilized news sources, other resources, news priorities and story angles. Female respondents were more likely than males to say that educating people to make informed decisions and disseminating new, accurate information are important priorities. Female and minority journalists were more likely than white males to use a variety of sources, and to say it is important to develop the health and scientific literacy of audiences and influence public health behaviors. The gender and race/ethnicity of journalists play an important role in the production of health news. Health educators can foster improved coverage by learning more about the life experiences of health journalists and developing better working relationships with them.

Patterns of information behavior and prostate cancer knowledge among African-American men

The purposes of this study are to explore cancer information acquisition patterns among African-American men and to evaluate relationships between information acquisition patterns and prostate cancer prevention and control knowledge. A random sample of 268 men participated in a statewide interviewer-administered, telephone survey. Men classified as non-seekers, non-medical source seekers, and medical source seekers of prostate cancer information differed on household income, level of education, and beliefs about personal risk for developing prostate cancer. Results from multiple regression analysis indicated that age, education, and information-seeking status were associated with overall levels of prostate cancer knowledge. Results from logistic regression analyses indicated that men who included physicians as one of many information resources (medical source seekers) had superior knowledge over non-seekers and non-medical source seekers on 33% of individual knowledge details. The findings emphasize the need to connect lower-income and lower-educated African-American men to physicians as a source of prostate cancer control information.

A qualitative study of cancer information seeking among English-as-a-second-Language older Chinese immigrant women to canada: sources, barriers, and strategies

Little is known about the cancer information seeking experiences of Chinese immigrants despite reported disparities in cancer burden and use of cancer screening. This research used semi-structured interviews to the explore cancer information seeking preferences and experiences of 50 English-as-a-second-language older Chinese immigrant women to Canada with different levels of health literacy. Directed content analysis was used to identify three main themes: sources of cancer information, barriers to cancer information seeking, and strategies used during information seeking. Health literacy did not distinguish the women on any of the major themes. The women expressed strong preferences for interpersonal and interactive cancer information from their physician and trusted others, such as friends and family. Barriers to cancer information seeking included language difficulties and limited time with physicians. The results emphasize the need for cancer information that reinforces cultural norms, language familiarity, and other values specific to cultural identities, such as interpersonally oriented values.

Immunization safety in US print media, 1995-2005

OBJECTIVE

To identify and describe vaccine safety in US newspaper articles.

METHODS

Articles (1147) from 44 states and Washington, DC, between January 1, 1995, and July 15, 2005, were identified by using the search terms "immunize or vaccine" and "adverse events or safety or exemption or danger or risk or damage or injury or side effect" and were coded by using a standardized data-collection instrument.

RESULTS

The mean number of vaccine-safety articles per state was 26. Six (not mutually exclusive) topics were identified: vaccine-safety concerns (46%); vaccine policy (44%); vaccines are safe (20%); immunizations are required (10%); immunizations are not required (8%); and state/school exemption (8%). Three spikes in the number of newspaper articles about vaccine-safety issues were observed: in 1999 regarding rotavirus vaccine and in 2002 and 2003 regarding smallpox vaccine. Excluding articles that referred to rotavirus and smallpox vaccines, 37% of the articles had a negative take-home message.

CONCLUSION

Ongoing monitoring of news on vaccine safety may help the content and framing of vaccine-safety messages.

Validating a health consumer segmentation model: behavioral and attitudinal differences in disease prevention-related practices

While researchers typically have segmented audiences by demographic or behavioral characteristics, psychobehavioral segmentation schemes may be more useful for developing targeted health information and programs. Previous research described a four segment psychobehavioral segmentation scheme-and a 10-item screening instrument used to identify the segments-based predominantly on people's orientation to their health (active vs. passive) and their degree of independence in health care decision making (independent vs. dependent). This study builds on this prior research by assessing the screening instrument's validity with an independent dataset and exploring whether people with distinct psychobehavioral orientations have different disease prevention attitudes and preferences for receiving information in the primary care setting. Data come from 1,650 respondents to a national mail panel survey. Using the screening instrument, respondents were segmented into four groups-independent actives, doctor-dependent actives, independent passives, and doctor-dependent passives. Consistent with the earlier research, there were clear differences in health-related attitudes and behaviors among the four segments. Members of three segments appear quite receptive to receiving disease prevention information and assistance from professionals in the primary care setting. Our findings provide further indication that the screening instrument and corresponding segmentation strategy may offer a simple, effective tool for targeting and tailoring information and other health programming to the unique characteristics of distinct audience segments.

The relationship between health information sources and mental models of cancer: findings from the 2005 Health Information National Trends Survey

This study used data from the 2005 Health Information National Trends Survey, a national sample of U.S. households (N = 5,586), to (1) explore the extent to which specific sources of health information are associated with certain beliefs about cancer; and (2) examine whether the relationship between health information sources and beliefs about cancer is moderated by psychological distress. Health information on the local news was associated with greater ambiguity about cancer prevention recommendations (OR 1.22, 95% CI 1.02-1.46, p < .05), while less ambiguity was associated with cancer-specific information (OR 0.81, 95% CI 0.69-0.94, p < .05), health information in the newspaper (OR 0.82, 95% CI 0.69-0.97, p < .05), and health information on the Internet (OR 0.71, 95% CI 0.61-0.84, p < .001). Health information on the local news was also associated with lower likelihood of higher perceived relative risk of cancer (OR 0.67, 95% CI 0.52-0.86, p < .01). No source of information was associated with the belief that cancer is primarily caused by behavior/lifestyle factors. Psychological distress greatly increased the optimistic bias of those who read health information in the news (OR 3.68, 95% CI 1.69-8.03, p < .001) but had no other moderating effect. Findings suggest that information seeking using active channels of health information decreases ambiguity and corrects for optimistic bias.

Providing health messages to Hispanics/Latinos: understanding the importance of language, trust in health information sources, and media use

Health communication is critical to promoting healthy lifestyles and preventing unhealthy behaviors. However, populations may differ in terms of their trust in and use of health information sources, including mass media, the Internet, and interpersonal channels. We used the 2005 Health Information National Trends Survey (HINTS) to test the hypothesis that Hispanics who are less comfortable speaking English would differ from Hispanics who are comfortable speaking English with respect to trust in health information sources and media use. Hispanics/Latinos comprised 9% of the 2005 HINTS sample (n = 496). Respondents not born in the United States regardless of race/ethnicity and all Hispanics were asked, "How comfortable do you feel speaking English?" Responses of "completely," "very," or "native speaker" were combined into "comfortable speaking English": all other responses were categorized as "less comfortable speaking English." Those comfortable speaking English reported higher trust for health information from newspapers (p < .05), magazines (p < .05), and the Internet (p < .01) compared with those less comfortable speaking English. They also reported more media exposure: daily hours listening to the radio and watching television (both p < .05) and days per week reading newspapers (p < .05). Hispanics comfortable speaking English reported much higher levels of Internet use (54% versus 14%, p < .0001). Hispanics who are not comfortable speaking English may be difficult to reach, not only because of language barriers and lower trust in media, but also because they report relatively little use of various media channels. These findings have important implications for health communications toward non-native speakers of English in general and Hispanics in particular.

Topics and sources of memorable breast cancer messages and their impact on prevention and detection behaviors

Often, people are able to recall a message on a particular topic for a long period of time. These memorable messages have the ability to influence behavior when they are recalled from memory long after initial exposure. Knowing the topics and sources of the messages that are remembered about breast cancer can improve the efficacy of future breast cancer outreach. To this end, 359 women completed an online survey about memorable breast cancer messages. Most women (60%) recalled a memorable message, described it, identified its source, and noted whether it had resulted in prevention or detection behaviors. Four categories of message topics emerged: early detection (37.3%), awareness (30.9%), treatment (25.8%), and prevention (6%). Furthermore, five categories of sources of these memorable messages were found: media (35.5%), friends (22.2%), family (21.6%), medical professionals (15.2%), and others (5.5%). The media were a major source of all four topics of messages, although family members, friends, and the medical community were major sources for particular message topics as well. Memorable messages originating from medical professionals were substantially more likely to motivate detection behaviors than prevention behaviors. This research demonstrates that message topic and source both play roles in determining message recall as well as in determining how memorable messages impacted behavior.

Occupational practices and the making of health news: a national survey of US Health and medical science journalists

News media coverage of health topics can frame and heighten the salience of health-related issues, thus influencing the public's beliefs, attitudes, and behaviors. Through their routine coverage of scientific developments, news media are a critical intermediary in translating research for the public, patients, practitioners, and policymakers. Until now, little was known about how health and medical science reporters and editors initiate, prioritize, and develop news stories related to health and medicine. We surveyed 468 reporters and editors representing 463 local and national broadcast and print media outlets to characterize individual characteristics and occupational practices leading to the development of health and medical science news. Our survey revealed that 70% of respondents had bachelor's degrees; 8% were life sciences majors in college. Minorities are underrepresented in health journalism; 97% of respondents were non-Hispanic and 93% were White. Overall, initial ideas for stories come from a "news source" followed by press conferences or press releases. Regarding newsworthiness criteria, the "potential for public impact" and "new information or development" are the major criteria cited, followed by "ability to provide a human angle" and "ability to provide a local angle." Significant differences were seen between responses from reporters vs. editors and print vs. broadcast outlets.

Cancer coverage in general-audience and Black newspapers

This article presents findings from the first study of cancer news coverage in a national sample of Black and general-audience newspapers. We compared 2,439 health news stories from 23 weekly Black newspapers to 2,767 health news stories from a constructed week sample of 12 daily general-audience newspapers, both collected between April 1, 2004, and March 31, 2005. Analyses examined differences in the amount and nature of cancer coverage, specifically cancer sites, disparities, localization, and personally mobilizing health information for readers. Cancer was the main topic in a higher proportion of health stories in Black newspapers than in general-audience newspapers (13.6% vs. 9.6%; p = .001). Among cancer stories, those in Black newspapers had more localization (p = .004), disparity information (p = .001), and personal mobilization information (p = .001) than those in general-audience newspapers. In neither type of newspaper did the distribution of stories by cancer site accurately reflect the impact of different cancers on population mortality.

Effects of newspaper coverage on public knowledge about modifiable cancer risks

This study explores the relationship between cancer newspaper coverage and public knowledge about cancer prevention, confirming self-reported associations between news exposure and cancer prevention knowledge with descriptions of newspaper coverage of modifiable cancer risks. Content analyses (N = 954) revealed that newspapers pay relatively little attention to cancer prevention. However, there is greater newspaper attention to tobacco and diet than to exercise, sun, and alcohol. Survey analysis (the National Cancer Institute's Health Information National Trends Survey) revealed that after controlling for differences based on gender, race, age, income, and education, attention to health news was significantly associated with knowledge about cancer risks associated with food and smoking but not for knowledge about exercise, sun, or alcohol. These findings conform to the findings of the content analysis data and provide a validation of a self-reported measure of media exposure, as well as evidence suggesting a threshold below which news coverage may not generate public knowledge about cancer prevention.

Pap smear screening among women >/=40 years residing at the United States-Mexico border

Invasive cervical cancer is a preventable disease due to screening for precursor lesions using the Papanicolaou cytological testing (Pap smear). Participants were assessed regarding their access to and utilization of health care services, prevention orientation, history of chronic disease screening, and reproductive health history. Factors independently positively associated with Pap smear screening were age, clinical breast exam (CBE) in the last year, doctor recommendation of a Pap test, living in the United States, and checkup in the past year. Having a regular source of health care, as well as a doctor's recommendation for a Pap smear, appears to have a positive effect on women's Pap smear screening rates in U.S.-Mexico border communities.

Skin cancer coverage in a national newspaper: a teachable moment

BACKGROUND

The objectives of this study were to (1) identify the number of published articles related to skin cancer in The New York Times newspaper from 1980-2004; (2) assess the content of the articles related to skin cancer, and (3) examine the trends in media coverage of skin cancer over time.

METHODS

We performed a content analysis on articles related to skin cancer appearing in The New York Times during January 1, 1980, through December 31, 2004, using the ProQuest online content repository database and key words skin cancer. We conducted an advanced focus search of all "skin cancer" articles using key words "melanoma," "squamous cell carcinoma," "basal cell carcinoma," "sunscreen," "tanning," "sunbathing," and "tanning salon".

RESULTS

We identified 874 published articles relating to skin cancer. Melanoma was the primary subject of the 874 articles, with 29% of the articles focusing on some aspect of melanoma. Coverage of other major subjects included sunscreen (11%), tanning (9%), basal cell carcinoma (7%), squamous cell carcinoma (3%), sunbathing (2%), and tanning salon (2%). The remaining 37% of articles contained some mention of skin cancer, but skin cancer was not the main topic nor were any of the focus terms. Over the 25-year period we examined, there was a slight upward trend in the number of skin-cancer-related articles, although we observed year-to-year variation.

CONCLUSIONS

Understanding how the print media portrays skin cancer issues provides valuable feedback for federal agencies and cancer organizations and may ultimately help promote skin cancer prevention and education.

Uncovering differences across the cancer control continuum: a comparison of ethnic and mainstream cancer newspaper stories

OBJECTIVE

The use of the news media to disseminate control research could play a pivotal role in reducing the cancer burden. An important first step is to understand how newspapers cover cancer and if differences exist between mainstream and ethnic newspapers.

METHODS

Cancer news in the major U.S. (MAJN) (N=5327) and ethnic (ENW) newspapers (N=565) appearing in 2003 were content analyzed. Comparisons of mainstream and ethnic newspapers utilized Pearson x(2) tests of two-sided statistical significance and independent samples t tests for interval-level variables.

RESULTS

Breast cancer dominated coverage: 27% of MAJN and 35% of ENW stories mentioned breast cancer. Coverage focused primarily on cancer treatment (MAJN: 60%; ENW: 52%) rather than on primary or secondary prevention. Compared to mainstream newspapers, the ethnic newspapers required lower literacy levels for understanding news stories, were substantially more likely to cover primary and secondary cancer prevention, and paid more attention to cancer awareness and education.

CONCLUSIONS

The ethnic media are a promising vehicle for dissemination of cancer control messages. However, the successful utilization of any U.S. newspaper as a dissemination mechanism requires a greater understanding of the root causes for imbalances in cancer coverage and work with journalists to reframe cancer news coverage.

People's perceptions of cancer survivability: implications for oncologists

Individuals typically overestimate survival for lung cancer and underestimate it for melanoma. However, reporting of results generally masks the extent of disagreement between people on survival rates. Most methods used to question individuals are of little use and are not comparable across studies. The topic of people's perceptions of survival for various cancers is under-researched. A clearer definition is needed of survivability, as is a standard way to measure it and then present the information. We have undertaken a review of studies reporting public perceptions of cancer survival rates and compared the results, where possible, with actual survival rates. We also investigate some potential implications of people's underestimation or overestimation of survival for screening and prevention behaviours and delineate implications for oncologists.

Sources of health information among Vietnamese American men

Vietnamese American men face multiple health disparities compared to white men. Our study objective was to determine the sources of health information used by Vietnamese men in the United States. A population-based, in-person survey was conducted among Vietnamese men in Seattle during 2002. Our survey was completed by 509 Vietnamese men (79% response rate). The most commonly reported sources of health information included Vietnamese newspapers/magazines (73%), Vietnamese and English language television (64% and 67%, respectively), Vietnamese radio (51%), and friends and family members (51% and 63%, respectively). We found that sources of health information varied significantly among sociodemographic subgroups of the Vietnamese male population. Sources of health information among Vietnamese American men differ considerably from other racial/ethnic groups. Research findings should be used to guide the development of health education interventions for Vietnamese men and subgroups within the Vietnamese male population.

Toward a Model of Prostate Cancer Information Seeking

Public health actions to improve African American men's ability to make informed decisions about participation in prostate cancer control activities have a greater likelihood of success when they are theory driven and informed by members of the target population. This article reports on formative research to evaluate the usefulness of the theory of reasoned action as a model to explain and predict prostate cancer information-seeking behavior by African American men. Fifty-two men participated in eight focus group interviews. Positive behavioral beliefs for obtaining prostate cancer information from physicians included increasing awareness of and obtaining accurate information about the disease, early detection and screening, and treatment. Negative beliefs included fear, distrust, and inconvenience. Significant others, peers, siblings, and religious leaders were identified as individuals who could influence this behavior. These findings provide additional insight into ways to reach and intervene with African American men to influence this important cancer control activity.

Cancer in the mass print media: Fear, uncertainty and the medical model

Cancer is increasing in incidence and prevalence in North America and around the world. The mass print media play an important role in information provision about prevention, diagnosis and treatment of this disease, as well as informing health policy and personal experience. This paper reports on a content analysis of the portrayal of cancer in the highest circulating magazines available in Canada and published in Canada or the USA in 1991, 1996, 2001. It includes both manifest and latent analysis of the framing and content of cancer stories. Manifest analysis documented the dominance of the medical as compared to the lifestyle and political economy frames and the predominance of articles on breast as compared to other cancers. Latent themes included: an emphasis on fear of cancer in that: (1) cancer and fear are frequently conflated; cancer is said to grow outside of awareness; cancer is portrayed as (almost) inevitable; cancer is associated with normal experiences; early detection is associated with diagnosis; and scary statistics are emphasized; (2) contradictions and confusion exist within and between articles; and (3) metaphors of war and battle are used frequently. The paper concludes with a discussion of the implications of the linking of fear with cancer in the context of medicine as the solution.

The case of the missing person: Alzheimer's disease in mass print magazines 1991-2001

Alzheimer's disease is growing in incidence and prevalence in the developed world. Rates have been increasing as populations have been aging. There are still many unknowns regarding prevention, causes, and treatments. The purpose of this article is to analyze the portrayal of Alzheimer's in the highest-circulation mass print English-language magazines published in the United States and Canada over a period of a decade, specifically those for 1991, 1996, and 2001. This research investigates the portrayal of persons with Alzheimer's, the disease itself, caregivers and experts, and the dominant frames or discourses within which Alzheimer's is described. Twenty-five articles from the highest-circulation mass print magazines available in Canada were studied through qualitative and inductive research of both manifest and latent content. One of the most notable findings is the absence of the person with the disease as a person with a voice, with needs and desires. When the disease itself is described it is characterized as fearsome, relentless, and aggressive. Both the unquestioned duty of the individual caregiver and his or her (usually the caregiver is a woman) suffering are emphasized. The disease, its diagnosis, and potential treatments are framed almost exclusively within a medical rather than a political-economy or lifestyle frame. Minimal attention is paid to prevention, early stages of the disease, social support, options for care, or other alternative understandings of issues related to Alzheimer's. The theoretical and practical significance of these findings is considered.

Cancer knowledge and disparities in the information age

Increasing information flow often leads to widening gaps in knowledge between different socioeconomic status (SES) groups as higher SES groups are more likely to acquire this new information at a faster rate than lower SES groups. These gaps in knowledge may offer a partial but robust explanation for differential risk behaviors and health disparities between different social groups. Drawing on the Health Information National Trends Survey (HINTS 2003), a national survey of communication behaviors conducted by the National Cancer Institute (NCI), we examine the relationship between publicity and knowledge gaps on two cancer topics that received different levels of publicity: knowledge about tobacco and sun exposure and their respective links to cancer. Analyses of the HINTS 2003 data suggest that differential knowledge levels of causes of cancer between SES groups are one potential explanation of cancer disparities that have been extensively reported in the literature. It is evident that high income and high education are associated with awareness about causes of major cancers such as lung and skin, and may allow people to protect themselves and minimize their risks. The data also show that heavier media attention could attenuate the knowledge gaps though moderate publicity or lack of news coverage may actually widen them. Last, the findings in this article suggest that it is necessary to take into account the SES variation within different racial and ethnic groups rather than mask them by treating the groups as one.

The health information national trends survey: research from the baseline

The decades surrounding the turn of the millennium will be remembered as a time of extraordinary opportunity in cancer communication. In 1990, the number of age-adjusted deaths due to cancer in the U.S. population began a slow steady decline after a century of disparaging increase. Reasons for this decline have been attributed to long-awaited successes in primary prevention, especially related to tobacco, and early detection for cervical, breast, prostate, and colorectal cancers, as well as advances in treatment. This was also a time of unparalleled change in the cancer communication environment. Scientific health discoveries escalated with the completion of the Human Genome project in 2003, and penetration of the Internet made health information available directly to consumers. To seize the opportunity afforded by these changes, the National Cancer Institute (NCI) launched the Health Information National Trends Survey (HINTS). Fielded for the first time in 2003, the HINTS is a nationally representative, general population survey of noninstitutionalized adults in the United States 18 years and older. This supplement contains a compilation of original research conducted using the data generated by the first administration of the HINTS telephone interviews. Covering topics in cancer knowledge, cancer cognition, risk perception, and information seeking, the articles represent an interdisciplinary view of cancer communication at the turn of the millennium and offer insight into the road ahead.

Ethnicity, genetics, and breast cancer: media portrayal of disease identities

OBJECTIVE

To describe, compare, and analyze how the risk of breast cancer is framed in newspapers directed towards an ethnic minority population (Jewish) with higher risk of inherited breast cancer compared with newspaper coverage for the general population (Anglo-Canadian) without this risk.

DESIGN

This investigation utilized a mixed methods (quantitative and qualitative) approach. The design emphasized a content analysis conducted on ethnically specific and non-ethnic newspaper articles.

RESULTS

It is noteworthy that the 'Jewish' newspapers devote a substantially larger proportion of articles on breast cancer to genetic risk as the key risk factor for this disease. Articles in the Jewish newspapers tend to link being a Jewish woman with being at risk for a diagnosis of breast cancer. This ethnic 'identity' is reinforced through the repeated association of Jewish heritage and genetic breast cancer risk at the exclusion of other known risk factors. This isolated genetic link to breast cancer is not a message that is replicated within the provincial newsprint articles.

CONCLUSIONS

These findings assist in the facilitation of prevention and treatment of those with or at risk of breast cancer. The health policy implications of this portrayal as well as suggestions for change are considered.

Canadian Aboriginal people's experiences with HIV/AIDS as portrayed in selected English language Aboriginal media (1996–2000)

This paper describes the portrayal of HIV/AIDS in 14 mass print newspapers directed towards the Canadian Aboriginal population and published between 1996 and 2000. Based on qualitative content analysis the research examines both manifest and latent meanings. Manifest results of this study indicate that women and youth are under represented as persons with HIV/AIDS. The latent results note the frequent references to Aboriginal culture, and the political and economic position of Aboriginal Canadians when discussing the disease, the person with the disease, the fear of the disease and the reaction of the community to the person with the disease. Unlike mainstream media where the medical frame is dominant, HIV/AIDS are here contextualized by culture, identity, spirituality and political-economic issues.

Prostate and colon cancer screening messages in popular magazines

OBJECTIVES

To 1) compare the number of articles published about prostate, colon, and breast cancer in popular magazines during the past 2 decades, and 2) evaluate the content of in-depth prostate and colon cancer screening articles identified from 1996 to 2001.

DESIGN

We used a searchable database to identify the number of prostate, colon, and breast cancer articles published in three magazines with the highest circulation from six categories. In addition, we performed a systematic review on the in-depth (> or = 2 pages) articles on prostate and colon cancer screening that appeared from 1996 through 2001.

RESULTS

Although the number of magazine articles on prostate and colon cancer published in the 1990s increased compared to the 1980s, the number of articles is approximately one third of breast cancer articles. There were 36 in-depth articles from 1996 to 2001 in which prostate or colon cancer screening were mentioned. Over 90% of the articles recommended screening. However, of those articles, only 76% (25/33; 95% confidence interval [CI], 58% to 89%) cited screening guidelines. The benefits of screening were mentioned in 89% (32/36; 95% CI, 74% to 97%) but the harms were only found in 58% (21/36; 95% CI, 41% to 75%). Only 28% (10/36; 95% CI, 14% to 45%) of the articles provided all the necessary information needed for the reader to make an informed decision.

CONCLUSIONS

In-depth articles about prostate and colon cancer in popular magazines do not appear as frequently as articles about breast cancer. The available articles on prostate and colon cancer screening often do not provide the information necessary for the reader to make an informed decision about screening.

Coverage of breast cancer in the Australian print media--does advertising and editorial coverage reflect correct social marketing messages?

Early detection of breast cancer by mammographic screening has the potential to dramatically reduce mortality rates, but many women do not comply with screening recommendations. The media are an important source of health information for many women--through both direct social marketing advertisements and indirect dissemination of information via editorial content. This study investigated the accuracy of breast cancer detection messages in the top-selling Australian women's magazines and three weekend newspapers in the six-month period from December 2000 to May 2001 that included any reference to breast cancer and found that current coverage of breast cancer in the Australian print media conveys messages that are unlikely to encourage appropriate screening.

Prostate cancer: men's health and their prostate

This study aimed to describe men's knowledge of prostate cancer and the factors associated with these knowledge levels at selected regions in Western Sydney. The study was a descriptive, quantitative design using a postal survey of men over 40 years of age. A questionnaire consisting of 19 items that addressed areas of knowledge related to prostate cancer was used. The men in this study needed more information about risk factors for prostate cancer, screening techniques and treatment regimens and their side effects. This study has shown that if men are to make informed decisions about prostate cancer screening, it is important to have some form of decision aid on prostate cancer screening available to them.

Preventive health practices: comparison of family caregivers 50 and older

The purpose of this study was to describe adherence to recommended preventive health practices among middle-aged and older male and female family caregivers of individuals receiving home health services. Perceptions of the burden and benefit of caregiving, wellness orientation, social participation, and community resource use by the caregiving dyad (caregiver and carereceiver) were also explored using the t test and the chi2 test to detect gender differences. A sample of 319 participants 50 and older was recruited from a home health agency in southwestern Pennsylvania to participate in a telephone survey. Results revealed that caregivers had performed 86% of age- and gender-appropriate preventive health practices, but they currently adhered to guidelines for 63% of such behaviors, regardless of gender. Men experienced less burden than women, and were more likely to acknowledge that caregiving made them feel useful and appreciated and gave more meaning to their lives. The study suggests that family caregivers may be as vigilant in their preventive health behavior as the general population, despite their responsibilities. Nurses in contact with middle-aged and older family caregivers are well positioned to encourage health promotion and disease prevention behaviors in this accessible population.

News media coverage of human papillomavirus

BACKGROUND

Now that human papillomavirus (HPV) DNA testing is being incorporated into cervical cancer screening programs, salient and accurate media information about HPV will be crucial to inform women's screening choices and to manage psychosocial responses to HPV DNA test results.

METHODS

The authors conducted a content analysis of 111 news stories about HPV from the 10 most circulated newspapers and from 3 major television networks for the period from January 1995 through July 2002. Stories were assessed for predominant theme (STD, cancer, or new tests); information about symptoms, transmission, prevention, and cancer-causing properties of HPV; screening test descriptions; and recommended screening guidelines.

RESULTS

Thirty-six percent of stories primarily were about new tests for HPV or cervical cancer, 30% of stories focused on cervical cancer or its link to HPV, and 27% of stories emphasized sexually transmitted diseases (STDs) or genital warts. Seventy-nine percent of stories mentioned that HPV is an STD, and 50% of stories reported that HPV is very common. Twenty-six percent of stories reported that most women with HPV will not develop cervical carcinoma. Of 81 stories that mentioned a screening test for HPV or cervical carcinoma, 38% reported the sensitivity of the test; 30% mentioned wrong, uncertain, or unnecessary test results; and 25% mentioned consequences of such results.

CONCLUSIONS

Media coverage of HPV could better fulfill women's educational needs by including information about low-risk and high-risk types of HPV and their differing links to cervical cancer; describing HPV prevention, transmission, and symptoms; explaining the benefits and consequences of HPV testing; and outlining the latest screening guidelines in every story.

Media and marijuana: A longitudinal analysis of news media effects on adolescents' marijuana use and related outcomes, 1977-1999

This study examined how aggregate levels of news coverage about marijuana have impacted adolescents' marijuana behavior generally, and through the intervening variables of personal disapproval and perceived harmfulness of marijuana, two variables that existing research has identified as significant predictors of adolescent marijuana use at the aggregate level. It was hypothesized that news coverage of reasons why people should not use marijuana would cause increase in aggregate marijuana abstinence, perceived harmfulness, and personal disapproval. Conversely, news coverage of positive aspects of marijuana use would cause decreases in marijuana abstinence, perceived harmfulness, and personal disapproval. Results of distributed lagged time-series regression and non-linear modeling offered support for two of the three proposed hypotheses. Aggregate media coverage explained a significant portion of the variation in adolescents' abstinence from marijuana use over time. It also explained a significant portion of the variation in personal disapproval of marijuana. Personal disapproval was found to partially mediate the relationship between media coverage and marijuana abstinence. Implications for the conceptualization of media effects on health behaviors are discussed.

Inner-city African American women who failed to receive cancer screening following a culturally-appropriate intervention: the role of health insurance

Culturally-appropriate health promotion programs are thought to be more effective among minority groups than those designed for the population at large. We investigated factors associated with failure to obtain cervical and breast cancer screening among inner-city African American women who received a culturally-appropriate educational intervention. Women who completed the intervention, but did not obtain a Pap smear, a clinical breast examination, and/or a mammogram at follow-up were compared with those who did obtain these tests. Women with private health insurance were more likely to be screened following the intervention than those covered by Medicaid or Medicare or those who were not insured (P < 0.001). Post-intervention screening was not associated with age, education, income, employment, or marital status. The effectiveness of a culturally-appropriate intervention is likely to be reduced if women's ability to respond is limited by inadequate insurance coverage.

Sources of cancer information for seniors: a focus group pilot study report

BACKGROUND

Limited research has been conducted on older adults' sources of cancer information. Seniors require accurate and credible cancer information given that increased age is a major risk factor for most common, adult-onset cancers.

METHODS

To examine older women's sources of cancer information and their views on cancer as portrayed in mass print publications, three pilot focus groups were conducted in Toronto, Canada with community-dwelling senior women aged 50 and over (n = 18).

RESULTS

Results showed that the majority of participants obtained their cancer facts from two primary sources: physicians and the print media, although both sources were perceived to provide inadequate and unclear information. Medical journalists were rated as scientifically untrained members of the media who provided conflicting health information to the public. Cancer information was regarded as credible by participants if it came from authoritative sources including notable journals, government agencies, or health organizations.

CONCLUSIONS

These findings reflect senior women's concerns with cancer research information being disseminated through the media. To facilitate cancer prevention and early detection behaviors, it is important that the media impart accurate and understandable cancer information to our aging population.