Seeking cancer-related information from media and family/friends increases fruit and vegetable consumption among cancer patients

From Information Seeking and Scanning to the Practice of Healthy Habits: A Longitudinal Test of the Integrative Model of Behavioral Prediction in the Context of Fruit and Vegetable Consumption

Fruit and vegetable intake is essential for health, but global adherence to recommended levels remains insufficient. Health information exposure positively influences consumption, yet the underlying mechanisms are not fully understood. This study aims to explore the relationships between information seeking and scanning, attitudes, norms, perceived behavioral control (PBC), intentions, and fruit and vegetable intake, following the main tenets of the Integrative Model of Behavioral Prediction (IM). Data were collected through face-to-face surveys in Santiago, Chile, with a representative sample of individuals aged 25 and older in two waves. Findings revealed that intentions in Wave 1 predicted fruit and vegetable consumption in Wave 2, with positive associations between attitudes, norms, PBC, and intentions. Information seeking was positively associated with attitudes, norms, and PBC, and it had indirect effects on fruit and vegetable consumption through attitudes, norms, PBC, and intentions. Information scanning did not show significant indirect effects on fruit and vegetable consumption, even though the path between scanning and attitudes was significant. The study provides support for the IM and highlights the importance of information seeking in promoting fruit and vegetable consumption through its influence on attitudes, norms, and PBC. The findings have practical implications for health campaigns, educational programs, healthcare interactions, and public policies targeting healthier dietary habits.

Consumers' longitudinal health information needs and seeking: a scoping review

Needing and seeking health information often is a longitudinal everyday life information behavior that involves the use of technology. However, no reviews of consumers' longitudinal health information needs (HIN) and health information-seeking (HIS) behavior have been conducted. We performed a scoping review to address this gap. Specifically, we surveyed the characteristics, timeline construction and research findings of studies investigating consumers' longitudinal HIN and HIS. Initial searches were conducted in November 2019 and updated in July 2022. A total of 128 papers were identified, reviewed and analyzed using content and thematic analyses. Results showed that most papers were quantitative, conducted in the USA, related to cancer, conducted during the diagnosis and treatment phases, and followed preset time intervals. Findings concerning the development patterns of consumers' HIN degrees and HIS effort were mixed (i.e. increasing, decreasing or being consistent over time). They seemed to be shaped by factors such as health conditions, data collection methods and the length of data collection. Consumers' use of sources changes depending on health status and source accessibility; their medical terminologies seem to expand over time. HIS has a strong emotional dimension which may lead to adaptive or maladaptive information behaviors (e.g. information avoidance). Overall, the results revealed a lack of understanding of HIN and HIS from a longitudinal perspective, particularly along health condition progression and coping trajectories. There is also a lack of understanding of the role of technologies in the longitudinal HIS process.

Oppression by omission: An analysis of the #WhereIsTheInterpreter hashtag campaign around COVID-19 on Twitter

Critical to managing a crisis such as COVID-19 is the propagation of information to all vulnerable populations. Despite guidelines regarding communicating with people with differing accessibility needs during crises, some often find their needs unmet. Following a lack of assisted communications for d/Deaf people during the COVID-19 pandemic, a Twitter hashtag campaign, #WhereIsTheInterpreter, was launched in the UK, protesting the lack of accessibility during official press briefings around the epidemic. The campaign received support from across the globe. This study analyzes the discourse around the campaign in tweets published from March 1st, 2020 and September 30th, 2021 (N = 27,021) and analyzed the corpus using the Analysis of Topic Model Network (ANTMN) approach. We identified four major themes of discourse: discrimination, accessibility challenges, communication gaps and barriers, and Deaf rights. We analyze the discourse through the perspective of Critical Disability Theory (CDT) and hashtag activism, and discuss practical and theoretical implications.

Health information seeking on social media: the diversification approach

Purpose

Internet studies have rarely addressed gender and/or ethnic differences in health information seeking on social media. Moreover, the role of locality size in explanation of this phenomenon has been overlooked. This study proposed a diversification approach to address these issues. According to it, belonging to numerous disadvantaged groups increases the probability of health-related Internet/social media use.

Design/methodology/approach

The data were collected via telephone survey. The sample consisted of 798 Israeli Internet users who reported using social media for any purpose, gender, ethnic affiliation and locality of residence. The data were analysed using a logistic regression technique.

Findings

Arab female social media users, who resided in small localities, were more likely than the other studied social groups to seek both non-medical and medical information on social media. Furthermore, Arab female social media users were found having the highest likelihood among all studied social groups to seek information regarding physical activity and medications on social media.

Practical implications

The findings largely supported the diversification approach and signal a major need for a greater supply of public health information for members of minority groups, especially those residing in small localities.

Originality/value

The study investigates triple social disadvantage in health-related social media use.

[COVID-19 risk groups and their strategies for navigating information overload during the first year of the pandemic in Chile]

As a part of the EIS-COVID project on the access and use of information during the COVID-19 pandemic in Chile, the objective of this paper was to ascertain how people's informational environment was constructed during the first stage of the pandemic. It discusses the results of a qualitative study of people belonging to risk groups for COVID-19: people over 18 and under 65 with chronic diseases (hypertension and diabetes) and people 65 and over. Ninety semi-structured interviews were conducted in the Metropolitan and Valparaíso regions between September 2020 and January 2021. The results reveal the problematic nature of the information overload encountered by these groups and the strategies they used to navigate it: a) information avoidance; b) content corroboration and active search for reliable sources; and c) differentiated media use.

The associations among cognitive social factors, eHealth literacy and health-promoting behaviors in Chinese adolescents

The internet is a critical source of health information. It is important to understand online health information seeking related factors among college students, as modifications in this have the potentials to enhance their health-promoting behaviors in their transition into early adulthood. This study assessed the associations among cognitive social factors, eHealth literacy, online health information seeking and health-promoting behaviors; and examined the potential mediation effect of online health information seeking and eHealth literacy on the association between cognitive social factors and health-promoting behaviors. A cross-sectional, Internet-based survey was conducted in a sample of Chinese college students (n = 289) during April to June 2018. The structural model fitted the data well: X2/df = 2.27; CFI = 0.95; TLI = 0.94; RMSEA = 0.07 (95% CI: 0.06, 0.08); SRMR = 0.07 and the results showed that performance expectancy and health motivation were significantly and positively associated with health-promoting behaviors indirectly through eHealth literacy, adjusting for other cognitive social factors, frequency of online health information seeking and background factors. eHealth literacy is a strong mediator of the association between cognitive social factors (performance expectancy and health motivation) and health-promoting behaviors. Implications and potential interventions to promote eHealth literacy and health-promoting behaviors are discussed.

Nutrition and physical activity in cancer patients: a survey on their information sources

BACKGROUND

Many cancer patients suffer from problems concerning nutrition and physical activity (PA) during and after their treatment. Forwarding reliable health information could help to alleviate severe symptoms. The present study aimed to examine cancer patients' commonly used information sources on nutrition and PA.

METHODS

An anonymous questionnaire was developed and distributed to German cancer patients in different settings. In total, 90 questionnaires have been completed between October 2021 and March 2022. For analysis, descriptive statistics were used and associations between information sources and patients' lifestyle behaviour explored utilising Spearman's Rho, Mann-Whitney U, and Pearson's Chi Square tests.

RESULTS

The cancer patients received information on nutrition and PA most frequently from physicians (70.9%), family and friends (68%) and browsing the internet (61.3%). Half of the patients (51.1%) had questions concerning these topics during the time of their disease. The majority of those patients (81.8%) reported that their questions were answered. The topics were addressed primarily with outpatient oncologists (60.0%) and in rehabilitation clinics (53.3%). Just about half of the patients (55.3%) felt satisfactorily informed on nutrition and PA in their cancer disease, more so if they talked to their oncologist or family physician (Z = - 2.450, p = 0.014 and Z = - 3.425, p = 0.001 resp.).

CONCLUSION

Cancer patients receive information on nutrition and PA predominantly after their initial treatment. Since they might be missing significant information to alleviate severe symptoms during their treatment, the importance of nutrition and PA should be emphasised by clinicians early on in treatment.

TRIAL REGISTRATION

Trial Registration Number (May 7, 2021): 2021-2149-Bef.

Searched and found? The association between use of health information sources and success in getting the desired information

BACKGROUND

Although many health information seeking studies are concerned with longer range outcomes (e.g. patient-provider communication) the immediate outcomes for the searchers are whether they found the desired information, for whom and how successfully.

OBJECTIVES

To examine the association between health information seeking via various sources and the reported extent of success in getting the desired information the information needs perspective.

METHODS

Data were obtained from the 2017 Israel Social Survey and analysed using multinomial regression models. The sample included individuals who reported engaging in seeking health information prior to the survey and mentioned the extent of success in obtaining the desired health information (fully, partially, or not-at-all) (N = 2197). Multinominal regression technique served for the multivariable analysis.

DISCUSSION

Engagement in health information seeking via friends, family and using various websites (excluding those by Ministry of Health and Health Funds) was associated with the increased likelihood of partial success in getting the desired information. Education level and population group, affected level of success.

CONCLUSIONS

The (partial) success in meeting health consumers' information needs is associated with the turn to particular sources. Public health professionals and health provider institutions should improve provision and delivery of health information to meet consumer health information needs.

Factors associated with meeting cancer prevention guidelines in adults

BACKGROUND

Because much worldwide cancer incidence and mortality is related to modifiable risk factors, many global health organizations provide evidence-based recommendations on healthy weight, diet, and physical activity levels for cancer prevention. Even though adherence to such guidelines is reported to reduce cancer incidence and mortality, this adherence is often suboptimal. Identifying factors related to adherence to the guidelines can suggest interventions to improve health promoting lifestyle behaviors for cancer prevention.

OBJECTIVES

Examine a comprehensive set of potentially predictive factors in meeting American Cancer Society's guidelines for healthy weight, fruits and vegetables intake, and physical activity.

METHODS

Data used in the analysis were from adults aged 18 years and older without a history of a cancer diagnosis who participated in the Health Information National Trends Survey in 2019 (n = 3407). Multivariate logistic regression analyses were used to determine the significant predictors for meeting each of the healthy weight, fruits and vegetables intake, and physical activity guidelines.

RESULTS

Overall adherence to each guideline was low: 39.0% met the physical activity guideline, 30.4% met the healthy weight guideline, and 17.6% met the fruits and vegetables intake guideline. Meeting the healthy body weight guideline was greater in current smokers, females, those who had at least some college education, those who did not have a chronic health condition, and those who had very good self-rated health. Meeting the fruits and vegetables intake guideline was greater in females, those who had very good self-rated health, and those who talked to friends or family members regarding their health. Meeting the physical activity guideline was greater in males, those who had household incomes of at least $50,000, those who did not have a chronic health condition, and those who had very good self-rated health.

CONCLUSIONS

The current analyses identified a unique set of predictors for meeting each guideline among US adults who reported never having been diagnosed with cancer. Based on these findings, interventions related to each guideline should be especially targeted to individuals having characteristics that were less likely to meet them.

CLINICAL RELEVANCE

Findings from the current study can assist health care providers who counsel about cancer prevention in the clinical setting.

Who We Seek and What We Eat? Sources of Food Choice Inspirations and Their Associations with Adult Dietary Patterns before and during the COVID-19 Lockdown in New Zealand

Research shows the shaping of food choices often occurs at home, with the family widely recognised as significant in food decisions. However, in this digital age, our eating habits and decision-making processes are also determined by smartphone apps, celebrity chefs, and social media. The ‘COVID Kai Survey’ online questionnaire assessed cooking and shopping behaviours among New Zealanders during the 2020 COVID-19 ‘lockdown’ using a cross-sectional study design. This paper examines how sources of food choice inspirations (cooking-related advice and the reasons for recipe selection) are related to dietary patterns before and during the lockdown. Of the 2977 participants, those influenced by nutrition and health experts (50.9% before; 53.9% during the lockdown) scored higher for the healthy dietary pattern. Participants influenced by family and friends (35% before; 29% during the lockdown) had significantly higher scores for the healthy and the meat dietary patterns, whereas participants influenced by celebrity cooks (3.8% before; 5.2% during the lockdown) had significantly higher scores in the meat dietary pattern. There was no evidence that associations differed before and during the lockdown. The lockdown was related to modified food choice inspiration sources, notably an increase in ‘comforting’ recipes as a reason for recipe selection (75.8%), associated with higher scoring in the unhealthy dietary pattern during the lockdown. The lockdown in New Zealand saw an average decrease in nutritional quality of diets in the ‘COVID Kai Survey’, which could be partly explained by changes in food choice inspiration sources.

Mobile Health Apps and Health Management Behaviors: Cost-Benefit Modeling Analysis

BACKGROUND

Rising criticism about the risks associated with the use of mobile health apps necessitates a critical perspective to assess the use of these apps. A cost-benefit approach involving several moderating factors can be used to detect technology effects and individual-level push and pull factors related to health attitudes, lifestyle, and health management behaviors.

OBJECTIVE

We introduce a cost-benefit perspective to examine how health attitudes related to mobile health apps and health situational factors (health crises, health changes, and hospitalization) affect the likelihood of adopting lifestyle and health management behaviors among app users.

METHODS

The analysis is based on individuals' reported use of mobile health apps. The sample included 1495 US adults aged over 18 years who were contacted by landline or cellphone. A total of 50.96% (762/1495) of the participants were women. A set of logistic regression models was used to predict lifestyle and health management behaviors among users considering variations in the extent of use, health attitudes, health situation, and socioeconomic characteristics.

RESULTS

The findings indicate that the proposed models were reasonably adequate. In all, 88.76% (1327/1495) of the cases were correctly classified regarding lifestyle behaviors, but only 71.97% (1076/1495) of the cases were correctly classified regarding health management behaviors. Although a large percentage of individuals changed their attitudes following the use of mobile health apps, only a small proportion adopted health management behaviors. The use of mobile health apps affected up to 67.95% (1016/1495) of the users for consultation and 71.97% (1076/1495) of the users for decision making. The model was effective for 88.76% (1327/1495) of the cases regarding lifestyle behaviors but only 71.97% (1076/1495) regarding health management behaviors. The moderating effect of regular use of mobile health apps significantly affects lifestyle (Wald=61.795; B=2.099; P<.005) but not health management behaviors (Wald=12.532; B=0.513; P=.01). These results collectively indicate that the use of mobile health apps for health management is partially effective.

CONCLUSIONS

The use of mobile health apps is a main route to instigate the process of health empowerment and shape health attitudes. However, an accurate assessment of the effectiveness of mobile health apps necessitates distinguishing between lifestyle and health management behaviors and adopting a cost-benefit approach because individuals facing health concerns, such as a chronic disease, health emergency, health crisis, or health change, consider their affordances and situational effects. These moderators generate a push and pull framework in the decision-making process that balances the costs and benefits of use.

Preferences in trust regarding the provision of cancer information among adults

BACKGROUND

Disparities associated with trust in health information exist warranting a need for research assessing this relationship among adults. Therefore, the aim of this study was to assess trust of cancer information among U.S. adults.

METHODS

A weighted sample of 237,670,167 adults from the Health Information National Trends Survey (HINTS) from 2011-2014 was used for the analyses. Dependent variables were dichotomized answers to whether individuals trusted information from family/friends, the internet, or a doctor. Independent variables included age, sex, region, race/ethnicity, and cancer diagnosis to investigate associations between demographic factors and differences in trust. Logistic regression was run using R survey package.

RESULTS

There were statistically significant differences in trust based on race/ethnicity, age, and cancer diagnosis. Minorities were less likely to trust information from a doctor, with Hispanics more likely to trust information from the internet (OR=1.8 (95% CI 1.36,2.43)), and Non-Hispanic Blacks trusting information from family and friends (OR=1.5 (95% CI 1.06, 2.13)). Adults ≥45 years of age were less likely to trust the doctor 'a lot' (45-64 years: OR=0.6 (95% CI 0.50, 0.83); 65+ years (OR=0.7 (95% CI 0.54, 0.92)), but more likely to not trust information from family and friends or the internet. Patients with cancer were more likely to trust information from a doctor 'a lot' (78%; p=0.01).

DISCUSSION

Significant differences in preferences regarding trust in cancer information occurred based on sociodemographic characteristics.

CONCLUSION

These finding suggest targeting specific population subgroups for information from sources they trust could be helpful in reducing disparities in trust.

Impact of Information Exposure on Perceived Risk, Efficacy, and Preventative Behaviors at the Beginning of the COVID-19 Pandemic in the United States

This online survey took place on March 7, 2020 at the beginning of the COVID-19 outbreak in the United States. Participants (n = 698) completed an online survey in which they were asked to reflect on their mediated and interpersonal information consumption, in addition to reporting on risk perceptions, general efficacy perceptions, and preventative behaviors specific to COVID-19 in the past seven days. Participant age and chronic condition status were controlled for in all analyses. Time spent consuming news, social media, and health website information was not related to risk perceptions. Time spent on health websites predicted time spent having interpersonal conversations about COVID-19, as well as general efficacy levels. Following the Extended Parallel Process Model, perceived severity, perceived susceptibility, and general perceived efficacy predicted preventative behaviors. The vast majority of participants did report taking preventative action against COVID-19, most commonly in the form of hand washing, with many enacting stronger preventative behaviors that had yet to be recommended for the general population. Overall, mediated and interpersonal information exposure had minimal effects on perceived risk and perceived general efficacy, which in turn predicted 27.5% of the variance in preventative behavior. Efficacy was the most powerful among these predictors, and health websites, specifically governmental websites, appeared to be underutilized resources with the potential to promote efficacy during outbreaks. Further research is needed to understand causation in these relationships and to assist in successful message transmission.

Information Seeking and Scanning about Colorectal Cancer Screening among Black and White Americans, Ages 45-74: Comparing Information Sources and Screening Behaviors

Cancer information seeking and scanning predict a variety of preventive health behaviors. However, previous work has rarely gauged seeking and scanning of specific cancer screening information. Moreover, colorectal cancer prevalence and mortality rates are higher among black than white Americans and it remains unclear if these groups differ in their cancer screening information acquisition patterns. We surveyed black and white Americans between 45 and 74 years of age to investigate rates, sources, and correlates of colorectal cancer screening (CRCS) information seeking and scanning. Black and white Americans had similar likelihoods of engaging in information seeking and scanning regarding CRCS. However, black Americans reported using significantly more sources for CRCS information seeking and scanning than did white Americans. Both screening test-specific information seeking and scanning are associated with stool-based tests, but only information seeking is associated with flexible sigmoidoscopy or colonoscopy. We discuss study implications for reaching out to different racial groups to promote colorectal cancer screening behavior.

The Effects of Zika Virus Risk Coverage on Familiarity, Knowledge and Behavior in the U.S. - A Time Series Analysis Combining Content Analysis and a Nationally Representative Survey

This study assessed the effects of the February through September 2016 American news media's coverage of Zika Virus (ZIKV) risk on the U.S. public's familiarity, knowledge and behavior in the form of interpersonal discussions. A content analysis (N = 2,782 pieces) revealed that the Rio Olympic Games elicited a spike in coverage of Zika. We also found that newsworthy and easy- to- depict aspects of the disease, specifically its transmission by mosquitoes and its relation to microcephaly were covered more extensively than its sexual transmission and transmissibility from an infected person who is asymptomatic. Nevertheless, survey data over the same period of time (N = 37,180 respondents) revealed that the general amount of coverage, rather than the specifics about Zika transmission and its consequences, influenced the public's familiarity, knowledge, and behavior.

Engagement with medical cannabis information from online and mass media sources: Is it related to medical cannabis attitudes and support for legalization?

BACKGROUND

The legalization of medical and recreational cannabis is a topic of continued debate in countries around the world. It has been suggested that medical cannabis legalization influences cannabis legalization for recreational purposes through increased media attention toward the positive health effects of cannabis. However, the nature of media coverage is likely to vary across mass media and online sources (internet and social media). In addition, effects of information engagement on attitudes may vary depending on whether information was actively sought or obtained incidentally during patterns of regular media use (scanned).

METHODS

This study uses data from an online survey of Israeli adults (N = 554) to test the association between information seeking and scanning about medical cannabis (from mass media and online sources) and attitudes toward medical cannabis. Furthermore, we test indirect effects of media engagement on attitudes toward cannabis legalization through medical cannabis attitudes.

RESULTS

Seeking and scanning for information about medical cannabis from online sources, but not from mass media sources, were associated with positive attitudes toward medical cannabis. Engagement with medical cannabis information from online sources was also indirectly associated with greater support for cannabis legalization, through positive attitudes related to medical cannabis.

CONCLUSION

The results suggest that one mechanism through which medical cannabis legalization is associated with cannabis legalization for all purposes is public engagement with information about medical cannabis in the media, particularly from the internet and social media channels. As increasingly more jurisdictions are expected to legalize medical cannabis, with resulting increase in media attention, support for recreational cannabis legalization may be expected to grow.

Self-management in liver transplantation

BACKGROUND

Self-management is crucial for liver transplant (LT) recipients to maintain transplants and optimize health outcomes. However, previous literature has been primarily limited to examining medication adherence; there is a knowledge gap regarding self-management in the LT population.

AIM

The aims of this study were to 1) comprehensively describe self-management behaviors and activities in LT recipients, 2) explore levels of overall self-management, and 3) explore the relationships of self-efficacy, cognition, and health information seeking behavior with self-management.

METHODS

Adult LT recipients (n = 113) who had a functioning transplant for at least 6 months participated in this cross-sectional, descriptive study. Participants were asked to identify self-management behaviors and rate their performance of those behaviors, including symptom management and medication adherence. They also completed a cognitive assessment and questionnaires measuring self-efficacy and health information seeking behavior. Descriptive statistics, latent profile analysis, and probit model for path analysis were used for the data analysis.

RESULTS

LT recipients acknowledged engaging in various self-management behaviors including symptom management, physical activity, maintenance of positive attitudes, and communication with healthcare providers. Three levels of self-management (i.e., low, medium, and high) were found; a high level of self-management was related to self-efficacy and health information seeking behavior.

CONCLUSIONS

The findings indicate that self-management may be improved with interventions aimed at increasing self-efficacy and health information seeking behavior. Findings from this study will inform future interventions, to improve self-management and subsequent health outcomes in this population. Future longitudinal studies are necessary to confirm the causality of the identified relationships.

The impact of different strategies to handle missing data on both precision and bias in a drug safety study: a multidatabase multinational population-based cohort study

Background

Missing data are often an issue in electronic medical records (EMRs) research. However, there are many ways that people deal with missing data in drug safety studies.

Aim

To compare the risk estimates resulting from different strategies for the handling of missing data in the study of venous thromboembolism (VTE) risk associated with antiosteoporotic medications (AOM).

Methods

New users of AOM (alendronic acid, other bisphosphonates, strontium ranelate, selective estrogen receptor modulators, teriparatide, or denosumab) aged ≥50 years during 1998-2014 were identified in two Spanish (the Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria [BIFAP] and EpiChron cohort) and one UK (Clinical Practice Research Datalink [CPRD]) EMR. Hazard ratios (HRs) according to AOM (with alendronic acid as reference) were calculated adjusting for VTE risk factors, body mass index (that was missing in 61% of patients included in the three databases), and smoking (that was missing in 23% of patients) in the year of AOM therapy initiation. HRs and standard errors obtained using cross-sectional multiple imputation (MI) (reference method) were compared to complete case (CC) analysis - using only patients with complete data - and longitudinal MI - adding to the cross-sectional MI model the body mass index/smoking values as recorded in the year before and after therapy initiation.

Results

Overall, 422/95,057 (0.4%), 19/12,688 (0.1%), and 2,051/161,202 (1.3%) VTE cases/participants were seen in BIFAP, EpiChron, and CPRD, respectively. HRs moved from 100.00% underestimation to 40.31% overestimation in CC compared with cross-sectional MI, while longitudinal MI methods provided similar risk estimates compared with cross-sectional MI. Precision for HR improved in cross-sectional MI versus CC by up to 160.28%, while longitudinal MI improved precision (compared with cross-sectional) only minimally (up to 0.80%).

Conclusion

CC may substantially affect relative risk estimation in EMR-based drug safety studies, since missing data are not often completely at random. Little improvement was seen in these data in terms of power with the inclusion of longitudinal MI compared with cross-sectional MI. The strategy for handling missing data in drug safety studies can have a large impact on both risk estimates and precision.

Coverage of Epidemics in American Newspapers Through the Lens of the Crisis and Emergency Risk Communication Framework

The Centers for Disease Control and Prevention (CDC) Crisis and Emergency Risk Communication (CERC) framework has been used by the organization during recent outbreaks of infectious diseases. However, the dissemination of the organization's crisis messages depends largely on mass media coverage. This study analyzed 5,006 articles from leading American newspapers covering 3 epidemics: H1N1, Ebola, and Zika. Using a mixed method of automated and manual content analysis, it identified 3 distinct themes used to cover the diseases: pandemic, scientific, and social. Analysis of the themes based on CERC guidelines demonstrated substantial discrepancies between what CDC aims to communicate during epidemics and what the media actually disseminated to the public. Implications for public health organizations and communicators are discussed.

Who Persuades Who? An Analysis of Persuasion Choices Related to Antibiotic-Free Food

Personal communication, in which one person persuades another to engage in a particular behavior, is one means through which behaviors spread. To better understand how personal communication spreads behavior, we investigated adults' (N = 228) likelihood of persuading others in a fictitious social network to buy antibiotic-free food, and who they attempted to persuade, based on behavioral determinants, homophily, and superdiffuser traits. For potential consumers, the findings showed that behavioral determinants, behavioral intentions, and mavenism predicted intentions to persuade others. Homophily, mavenism, and connectivity predicted patterns of interpersonal persuasion. For vegetarians (without homophily in action), behavioral determinants and mavenism predicted persuasion intentions. Persuasiveness was associated with targeting more network members; mavenism was associated with selecting structurally central members.

Understanding Associations between Information Seeking and Scanning and Health Risk Behaviors: An Early Test of the Structural Influence Model

This study examined proposed direct and mediating relationships in the Structural Influence Model (SIM) of Communication within the chronic disease context. Using data from the Annenberg National Health Communication Survey (N = 14,472), we tested the potential mediating roles of information seeking, information scanning, and social capital between social determinants of health and four chronic disease risk behaviors: exercise level, fruit and vegetable intake, cigarette smoking, and excessive alcohol use. Information seeking, information scanning, and social capital received support as potential mediators. Our results are largely consistent with predictions of the SIM and highlight the important role of communication in reducing health risks and increasing healthy behaviors.

Prevalence and correlates of health information-seeking among Hispanic and non-Hispanic childhood cancer survivors

PURPOSE

Childhood cancer survivors (CCS) report high unmet information needs. This study examined the prevalence of cancer-related information-seeking among CCS and investigated associations between information-seeking behavior and positive health outcomes such as follow-up care.

METHODS

Participants (n = 193) were young adult CCS diagnosed with cancer in Los Angeles County, 54% of Hispanic ethnicity, with a mean age of 19.87, in remission, and at least 2 years from completion of treatment. CCS were asked where they accessed health information related to their cancer with response options categorized into four information domains: hospital resources, social media, other survivors, and family members. Multivariable logistic regression was used to assess variables associated with each information domain, including sociodemographics, post-traumatic growth (i.e., reporting positive changes since cancer diagnosis), health care engagement, level of education, and health insurance status.

RESULTS

Hospital resources were the most commonly accessed information domain (65.3%), and CCS of Hispanic ethnicity (vs. non-Hispanic) were more likely to access this source. Seeking information from other cancer survivors was positively associated with follow-up care and post-traumatic growth. Hispanic CCS were marginally less likely to seek information from other survivors and family than non-Hispanics.

CONCLUSIONS

While CCS obtain information from a variety of sources, hospital resources are an important site for access, particularly for individuals of Hispanic ethnicity. Information sharing between survivors may promote positive health care engagement; however, Hispanic CCS may be less likely to utilize this resource and may face barriers in information sharing with other cancer survivors.

The Use of Herbal Remedies among Mothers of Young Children Living in the Central Appalachian Region

Introduction

Women often use herbal remedies as a complement or alternative to traditional medicine. Guided by the Comprehensive Model of Information Seeking, this study examined use of herbal remedies among mothers of young children living in the Central Appalachian Region.

Methods

A cross-sectional study was conducted among mothers of young children (n = 178). The outcome measure of interest was the use of any herbal remedy in the past six months. Two scales were developed to measure information seeking channels and to measure beliefs about the safety/efficacy of herbal remedies.

Results

One-third reported using herbal remedies in the past six months, with fenugreek being the most common. Most reported using herbal remedies to increase breast milk production and to relieve cold/flu-like symptoms. Women scoring highest in information seeking channels were three times as likely to use herbal remedies. Women scoring highest in the beliefs about the safety/efficacy of herbal remedies were four times as likely to use herbal remedies.

Conclusion

Herbal remedies are commonly used among women living in the Central Appalachian Region, a region with lower education and income level. Therefore, public health interventions about the types, safety, and efficacy of herbal remedies may improve health within this population.

How we use the Internet matters for health: The relationship between various online health-related activities and preventive dietary behaviors

This study identified specific types of online health-related activities that may promote preventive dietary behaviors. Two cycles (Cycles 1 and 3) of the Health Information National Trends Survey 4 were analyzed ( N = 2606 and 2284, respectively; Internet users only). Similar types of activities were grouped to create three types of online activities: information seeking, engagement in health information technology, and social media use. In both cycles, online health information seeking and the engagement in health information technology were positively associated with two dietary behaviors (fruit/vegetable consumption and using menu information on calories) but not with soda consumption. Individuals may be exposed to new information or become more aware of their current health status through information seeking or health information technology engagement. However, social media use for health was not related to any of the dietary behavior. The results suggest that “how we use the Internet” may make a difference in health outcomes.

A comparison of multiple imputation methods for handling missing values in longitudinal data in the presence of a time-varying covariate with a non-linear association with time: a simulation study

Background

Missing data is a common problem in epidemiological studies, and is particularly prominent in longitudinal data, which involve multiple waves of data collection. Traditional multiple imputation (MI) methods (fully conditional specification (FCS) and multivariate normal imputation (MVNI)) treat repeated measurements of the same time-dependent variable as just another ‘distinct’ variable for imputation and therefore do not make the most of the longitudinal structure of the data. Only a few studies have explored extensions to the standard approaches to account for the temporal structure of longitudinal data. One suggestion is the two-fold fully conditional specification (two-fold FCS) algorithm, which restricts the imputation of a time-dependent variable to time blocks where the imputation model includes measurements taken at the specified and adjacent times. To date, no study has investigated the performance of two-fold FCS and standard MI methods for handling missing data in a time-varying covariate with a non-linear trajectory over time – a commonly encountered scenario in epidemiological studies.

Methods

We simulated 1000 datasets of 5000 individuals based on the Longitudinal Study of Australian Children (LSAC). Three missing data mechanisms: missing completely at random (MCAR), and a weak and a strong missing at random (MAR) scenarios were used to impose missingness on body mass index (BMI) for age z-scores; a continuous time-varying exposure variable with a non-linear trajectory over time. We evaluated the performance of FCS, MVNI, and two-fold FCS for handling up to 50% of missing data when assessing the association between childhood obesity and sleep problems.

Results

The standard two-fold FCS produced slightly more biased and less precise estimates than FCS and MVNI. We observed slight improvements in bias and precision when using a time window width of two for the two-fold FCS algorithm compared to the standard width of one.

Conclusion

We recommend the use of FCS or MVNI in a similar longitudinal setting, and when encountering convergence issues due to a large number of time points or variables with missing values, the two-fold FCS with exploration of a suitable time window.

Electronic supplementary material

The online version of this article (doi:10.1186/s12874-017-0372-y) contains supplementary material, which is available to authorized users.

Interactions and user-perceived helpfulness in diet information social questions & answers

BACKGROUND

Online health information seeking using social questions and answers (Social Q&A) sites has been increasingly popular in recent years. It calls for better understanding of health information seeking behaviour and interactions between information seekers and information providers.

OBJECTIVES

The study investigates how diet information seekers interact with information providers on WebMD Answers, which is a Social Q&A site devoted to health-related topics, and examines the factors that constitute a 'helpful' answer from an information seeker's perspective.

METHODS

Bales' interaction process analysis was applied as the framework to analyse 568 diet-related Q&As from WebMD Answers to identify interaction patterns.

RESULTS

Most diet information seekers post questions anonymously and without any detailed description. Individual experts or health organisations provide most answers. Overall, answers are positively received and had a high satisfaction rating. It was also found that information seeker-perceived helpfulness does not depend on who answered the question but to how an information seeker posted the question.

CONCLUSIONS

This study indicates that answers at WebMD Answers are helpful for diet information seekers. It sheds new light on the interactions during the Q&A process, preferred site functions and important factors that contribute to perceived helpful answers.

Are socioeconomic disparities in health behavior mediated by differential media use? Test of the communication inequality theory

OBJECTIVE

Communication inequality has been offered as one potential mechanism through which social determinants influence multiple health behaviors. The purpose of this study was to examine the underlying mechanisms between communication inequality and health behaviors.

METHODS

Data from a nationally representative cross-sectional survey of 18,426 people aged 18 years and above in the United States were used for secondary analysis. Measures included socio-demographic characteristics, social participation (structural social capital), health media use (TV, print, and the Internet), and five health behaviors (physical activity, cigarette smoking, alcohol use, and intake of fruit and vegetable). Path analysis was performed to examine the linkages between social determinants, health media use, social participation, and social gradients in health behaviors.

RESULTS

Path analysis revealed that socioeconomic gradients in health behaviors is mediated by: 1) inequalities in health media use; 2) disparities in social participation, which leads to differential media use; and 3) disparities in social participation that are not mediated by media use.

CONCLUSIONS

Consistent with the theory of communication inequality, socioeconomic disparities in media use partially mediate disparities in multiple health behaviors.

PRACTICE IMPLICATIONS

To address health inequalities, it is important to utilize health media to target populations with low socioeconomic statuses.

You Should Know Better: Can Self-Affirmation Facilitate Information-Seeking Behavior and Interpersonal Discussion?

This study explores whether self-affirmation has the capacity not merely to reduce the perceived threat associated with health-related information but also to facilitate interpersonal discussion and affect health information-seeking behavior. The context for the study is the ongoing California drought, which serves as suitable context to examine the intersection of self-affirmation and information-seeking behavior because it involves a threatening message (the destructive consequences of the drought) and highlights discrepancies between actual (water waste) and prosocial (water conservation) behavior. Results of a month-long longitudinal panel study demonstrate significant effects of self-affirmation on interpersonal discussion, information seeking, knowledge, and water-conserving behavior across time. Implications for theorizing longer term effects of self-affirmation and practical implications for promoting behavioral change through the enhancement of knowledge and self-esteem are considered.

Media Use and the Cancer Communication Strategies of Cancer Survivors

Communication related to health not only substantially affects perceptions and behaviors related to health but is also positively associated with the extent of health-information seeking and the practice of preventive behavior. Despite the fact that the number of cancer survivors has increased dramatically, there are few studies of the lack of health information, factors which act as barriers, and the difficulties in follow-up care experienced by cancer survivors. Therefore, we reviewed media utilization and the types of media used by cancer survivors with regard to risk communication and suggested appropriate strategies for cancer communication. According to the results, health communication contributed to health promotion by providing health-related information, consolidating social support factors such as social solidarity and trust, and reducing anxiety. In particular, participatory health communication may establish preventive programs which reflect the needs of communities, expand accessibility to better quality healthcare, and intensify healthy living by reducing health inequalities. Therefore, when people do not have an intention to obtain cancer screening, we need to intervene to change their behavior, norms, and degrees of self-efficacy. The findings of this study may help those involved in building partnerships by assisting in their efforts to understand and communicate with the public.

"What about diet?" A qualitative study of cancer survivors' views on diet and cancer and their sources of information

Given the abundance of misreporting about diet and cancer in the media and online, cancer survivors are at risk of misinformation. The aim of this study was to explore cancer survivors' beliefs about diet quality and cancer, the impact on their behaviour and sources of information. Semi-structured interviews were conducted with adult cancer survivors in the United Kingdom who had been diagnosed with any cancer in adulthood and were not currently receiving treatment (n = 19). Interviews were analysed using Thematic Analysis. Emergent themes highlighted that participants were aware of diet affecting risk for the development of cancer, but were less clear about its role in recurrence. Nonetheless, their cancer diagnosis appeared to be a prompt for dietary change; predominantly to promote general health. Changes were generally consistent with healthy eating recommendations, although dietary supplements and other non-evidence-based actions were mentioned. Participants reported that they had not generally received professional advice about diet and were keen to know more, but were often unsure about information from other sources. The views of our participants suggest cancer survivors would welcome guidance from health professionals. Advice that provides clear recommendations, and which emphasises the benefits of healthy eating for overall well-being, may be particularly well-received.

How Are Information Seeking, Scanning, and Processing Related to Beliefs About the Roles of Genetics and Behavior in Cancer Causation?

Understanding that cancer is caused by both genetic and behavioral risk factors is an important component of genomic literacy. However, a considerable percentage of people in the United States do not endorse such multifactorial beliefs. Using nationally representative cross-sectional data from the U.S. Health Information National Trends Survey (N = 2,529), we examined how information seeking, information scanning, and key information-processing characteristics were associated with endorsing a multifactorial model of cancer causation. Multifactorial beliefs about cancer were more common among respondents who engaged in cancer information scanning (p = .001), were motivated to process health information (p = .005), and reported a family history of cancer (p = .0002). Respondents who reported having previous negative information-seeking experiences had lower odds of endorsing multifactorial beliefs (p = .01). Multifactorial beliefs were not associated with cancer information seeking, trusting cancer information obtained from the Internet, trusting cancer information from a physician, self-efficacy for obtaining cancer information, numeracy, or being aware of direct-to-consumer genetic testing (ps > .05). Gaining additional understanding of how people access, process, and use health information will be critical for the continued development and dissemination of effective health communication interventions and for the further translation of genomics research to public health and clinical practice.

The Association Between Online Health Information-Seeking Behaviors and Health Behaviors Among Hispanics in New York City: A Community-Based Cross-Sectional Study

Background

Hispanics are the fastest-growing minority group in the United States and they suffer from a disproportionate burden of chronic diseases. Studies have shown that online health information has the potential to affect health behaviors and influence management of chronic disease for a significant proportion of the population, but little research has focused on Hispanics.

Objective

The specific aim of this descriptive, cross-sectional study was to examine the association between online health information–seeking behaviors and health behaviors (physical activity, fruit and vegetable consumption, alcohol use, and hypertension medication adherence) among Hispanics.

Methods

Data were collected from a convenience sample (N=2680) of Hispanics living in northern Manhattan by bilingual community health workers in a face-to-face interview and analyzed using linear and ordinal logistic regression. Variable selection and statistical analyses were guided by the Integrative Model of eHealth Use.

Results

Only 7.38% (198/2680) of the sample reported online health information–seeking behaviors. Levels of moderate physical activity and fruit, vegetable, and alcohol consumption were low. Among individuals taking hypertension medication (n=825), adherence was reported as high by approximately one-third (30.9%, 255/825) of the sample. Controlling for demographic, situational, and literacy variables, online health information–seeking behaviors were significantly associated with fruit (β=0.35, 95% CI 0.08-0.62, P=.01) and vegetable (β=0.36, 95% CI 0.06-0.65, P=.02) consumption and physical activity (β=3.73, 95% CI 1.99-5.46, P<.001), but not alcohol consumption or hypertension medication adherence. In the regression models, literacy factors, which were used as control variables, were associated with 3 health behaviors: social networking site membership (used to measure one dimension of computer literacy) was associated with fruit consumption (β=0.23, 95% CI 0.05-0.42, P=.02), health literacy was associated with alcohol consumption (β=0.44, 95% CI 0.24-0.63, P<.001), and hypertension medication adherence (β=–0.32, 95% CI –0.62 to –0.03, P=.03). Models explained only a small amount of the variance in health behaviors.

Conclusions

Given the promising, although modest, associations between online health information–seeking behaviors and some health behaviors, efforts are needed to improve Hispanics’ ability to access and understand health information and to enhance the availability of online health information that is suitable in terms of language, readability level, and cultural relevance.

Development of a Website Providing Evidence-Based Information About Nutrition and Cancer: Fighting Fiction and Supporting Facts Online

Background

Although widely available, the general public, cancer patients, and cancer survivors have difficulties accessing evidence-based information on nutrition and cancer. It is challenging to distinguish myths from facts, and sometimes conflicting information can be found in different places. The public and patients would benefit from evidence-based, correct, and clear information from an easily recognizable source.

Objective

The aim of this project is to make scientific information available for the general public, cancer patients, and cancer survivors through a website. The aim of this paper is to describe and evaluate the development of the website as well as related statistics 1st year after its launch.

Methods

To develop the initial content for the website, the website was filled with answers to frequently asked questions provided by cancer organizations and the Dutch Dietetic Oncology Group, and by responding to various fiction and facts published in the media. The website was organized into 3 parts, namely, nutrition before (prevention), during, and after cancer therapy; an opportunity for visitors to submit specific questions regarding nutrition and cancer was included. The website was pretested by patients, health care professionals, and communication experts. After launching the website, visitors’ questions were answered by nutritional scientists and dieticians with evidence- or eminence-based information on nutrition and cancer. Once the website was live, question categories and website statistics were recorded.

Results

Before launch, the key areas for improvement, such as navigation, categorization, and missing information, were identified and adjusted. In the 1st year after the launch, 90,111 individuals visited the website, and 404 questions were submitted on nutrition and cancer. Most of the questions were on cancer prevention and nutrition during the treatment of cancer.

Conclusions

The website provides access to evidence- and eminence-based information on nutrition and cancer. As can be concluded from the number of visitors and the number of questions submitted to the website, the website fills a gap.

Communication competence, psychological well-being, and the mediating role of coping efforts among women with breast cancer: cross-sectional and longitudinal evidence

Despite existing research identifying psychological benefits of patients' interpersonal competence in various contexts, little longitudinal research has addressed underlying mechanism(s). To address this limitation, we examined both the cross-sectional and longitudinal associations between cancer patients' communication competence in close relationships and psychological well-being, as well as the mediating role of coping efforts. Data came from a larger project with women with breast cancer (N = 661), recruited from April 2005 to May 2007 at three large university-affiliated cancer centers in the U.S. to study the effects of an Internet-based system providing patients and families with a range of services. The present study focused on survey data at baseline, 6 weeks, and 12 weeks after the intervention (controlling for the possible effects of the intervention). Results from both cross-sectional and longitudinal analyses indicated that competence in open communication between patients and their close support persons had a positive association with patients' psychological well-being and that approach coping efforts partially mediated this association. We discussed the implications and limitations of the study.

The role of patient-clinician information engagement and information seeking from nonmedical channels in fruit and vegetable intake among cancer patients

Previous research suggests positive effects of health information seeking on prevention behaviors such as diet, exercise, and fruit and vegetable consumption. The present study builds upon this research and strengthens causal claims from it by examining the lagged effect of patient-clinician information engagement on fruit and vegetable consumption as well as the indirect effect on the outcome through seeking information from nonmedical channels. The results are based on data collected from a randomly drawn sample of breast, prostate, and colorectal cancer patients from the Pennsylvania Cancer Registry who completed mail surveys in the Fall of 2006 and 2007. There was a 65% response rate for baseline subjects (resulting n = 2,013); of those, 1,293 were interviewed 1 year later, and 1,257 were available for our analyses. Results show a positive lagged main effect of patient-clinician information engagement at baseline on fruit and vegetable consumption at follow-up (B = 0.26, SE = 0.10, p = .01). The mediation analysis shows that patient-clinician information engagement leads to increased fruit and vegetable consumption among cancer patients, in part through patients' information seeking from nonmedical channels. Implications of these findings for the cancer patient population and for physicians are discussed.

Risk-reduction opportunities in breast cancer survivors: capitalizing on teachable moments

PURPOSE

With advancements in detection and treatment, the number of breast cancer survivors is growing. To reduce mortality among survivors, tailored health-promotion programs are needed to combat comorbidities. However, the demand for such programs exceed that which is available for a vastly diverse population of survivors. The goal of the present study was to describe the prevalence of comorbidities in a group of breast cancer survivors and to examine associations between biological proximal factors of and the more distal individual-level factors on the number and types of comorbidities.

METHODS

In addition to medical chart reviews, breast cancer survivors (N = 369) from hospitals in two urban locations completed self-report measures. Bivariate analyses examined the relationship between distal and proximal predictors and the outcomes: number of comorbidities and comorbidity types.

RESULTS

Both proximal and distal factors were associated with comorbidities. African American, women with lower education attainment, and older women were more likely to be obese and have more comorbidities than their counterparts. In particular, they were more at risk for cardiovascular disease. Those who initiated hormonal therapy, chemotherapy, and radiation therapy were more likely to have comorbidities. Several psychosocial variables were related to proximal psychosocial factors.

CONCLUSIONS

The present findings highlight the need for targeted health-promotion treatments for breast cancer survivors, particularly for African Americans, those with lower education attainment, those who are obese, and those who may be older. Given the relationships between specific comorbidities and proximal psychosocial factors, future interventions may benefit from tailored approaches.

IMPLICATIONS FOR CANCER SURVIVORS

Tailored interventions for survivors may be more effective when accounting for factors associated with health-promotion engagement.

Evaluation of two-fold fully conditional specification multiple imputation for longitudinal electronic health record data

Most implementations of multiple imputation (MI) of missing data are designed for simple rectangular data structures ignoring temporal ordering of data. Therefore, when applying MI to longitudinal data with intermittent patterns of missing data, some alternative strategies must be considered. One approach is to divide data into time blocks and implement MI independently at each block. An alternative approach is to include all time blocks in the same MI model. With increasing numbers of time blocks, this approach is likely to break down because of co-linearity and over-fitting. The new two-fold fully conditional specification (FCS) MI algorithm addresses these issues, by only conditioning on measurements, which are local in time. We describe and report the results of a novel simulation study to critically evaluate the two-fold FCS algorithm and its suitability for imputation of longitudinal electronic health records. After generating a full data set, approximately 70% of selected continuous and categorical variables were made missing completely at random in each of ten time blocks. Subsequently, we applied a simple time-to-event model. We compared efficiency of estimated coefficients from a complete records analysis, MI of data in the baseline time block and the two-fold FCS algorithm. The results show that the two-fold FCS algorithm maximises the use of data available, with the gain relative to baseline MI depending on the strength of correlations within and between variables. Using this approach also increases plausibility of the missing at random assumption by using repeated measures over time of variables whose baseline values may be missing.

Does the number of cancer patients' close social ties affect cancer-related information seeking through communication efficacy? Testing a mediation model

This study addresses whether having a broad social network of close friends equips cancer patients with increased efficacy to engage in communication about their cancer, which then leads to an increased likelihood of patients actively seeking cancer-related information. Guided by the theory of motivated information management, the study also tests whether the effect of the number of close social ties on information seeking is mediated, in part, by communication efficacy. Results are based on data collected from a randomly drawn sample from the Pennsylvania Cancer Registry of 2,013 cancer patients who completed mail surveys in the Fall of 2006. Results are consistent with a cross-sectional mediation effect in which the number of close social ties in one's social network is positively associated with communication efficacy (b = .17, p = .001), which, in turn, is positively associated with cancer-related information seeking (b = .13, p < .001).

Potential spillover educational effects of cancer-related direct-to-consumer advertising on cancer patients' increased information seeking behaviors: results from a cohort study

Spillover effects of exposure to direct-to-consumer advertising (DTCA) of cancer treatments on patients' general inquiry about their treatments and managing their illness are not well understood. This study examines the effects of cancer patients' exposure to cancer-related DTCA on subsequent health information seeking behaviors from clinician and non-clinician sources (lay media and interpersonal contacts). Using a longitudinal survey design over 3 years, data was collected from cancer survivors diagnosed with colorectal, breast, or prostate cancer who were randomly sampled from the Pennsylvania Cancer Registry. Study outcome measures include patients' information engagement with their clinicians and information seeking from non-medical sources about cancer treatment and quality of life issues, measured in the second survey. The predictor variable is the frequency of exposure to cancer-related DTCA since diagnosis, measured at the round 1 survey. The analyses utilized lagged-weighted multivariate regressions and adjusted for round 1 levels of patient-clinician engagement, information seeking from nonmedical sources, and confounders. Exposure to cancer-related DTCA is associated with increased levels of subsequent patient-clinician information engagement (B = .023, 95% CI = .005-.040, p = .012), controlling for confounders. In comparison, exposure to DTCA is marginally significant in predicting health information seeking from non-clinician sources (B = .009, 95% CI = -.001-.018, p = .067). Cancer-related DTCA has potentially beneficial spillover effects on health information seeking behaviors among cancer patients. Exposure to DTCA predicts (a little) more patient engagement with their physicians.

Evaluation of two-fold fully conditional specification multiple imputation for longitudinal electronic health record data

Most implementations of multiple imputation (MI) of missing data are designed for simple rectangular data structures ignoring temporal ordering of data. Therefore, when applying MI to longitudinal data with intermittent patterns of missing data, some alternative strategies must be considered. One approach is to divide data into time blocks and implement MI independently at each block. An alternative approach is to include all time blocks in the same MI model. With increasing numbers of time blocks, this approach is likely to break down because of co-linearity and over-fitting. The new two-fold fully conditional specification (FCS) MI algorithm addresses these issues, by only conditioning on measurements, which are local in time. We describe and report the results of a novel simulation study to critically evaluate the two-fold FCS algorithm and its suitability for imputation of longitudinal electronic health records. After generating a full data set, approximately 70% of selected continuous and categorical variables were made missing completely at random in each of ten time blocks. Subsequently, we applied a simple time-to-event model. We compared efficiency of estimated coefficients from a complete records analysis, MI of data in the baseline time block and the two-fold FCS algorithm. The results show that the two-fold FCS algorithm maximises the use of data available, with the gain relative to baseline MI depending on the strength of correlations within and between variables. Using this approach also increases plausibility of the missing at random assumption by using repeated measures over time of variables whose baseline values may be missing.

Health media use among childhood and young adult cancer survivors who smoke

PURPOSE

Promoting healthy behaviors may reduce the risk of co-morbidities among childhood and young adult (CYA) cancer survivors. Although behavioral interventions are one way to encourage such activities, there is increasing evidence that health media use-particularly health information seeking-also may influence health knowledge, beliefs, and behaviors. The current study explores patterns of health media use among survivors of CYA cancer. Our focus is on survivors who smoke and thus are at even greater risk of co-morbidities.

METHODS

We analyzed data from the Partnership for Health-2 study, a web-based smoking cessation intervention, to examine the prevalence of and factors associated with health media use (N = 329).

RESULTS

Nearly two thirds (65.3 %) of CYA survivors who smoke reported infrequent or no online health information seeking. Many reported never reading health sections of newspapers or general magazines (46.2 %) or watching health segments on local television news (32.3 %). Factors associated with health media use include education and employment, cancer-related distress, and smoking quit attempts.

CONCLUSIONS

Health information engagement is low among CYA survivors who smoke, particularly active seeking of health information online. Population subgroups differ in their media use patterns; some of these differences reflect communication inequalities, which have the potential to exacerbate health disparities. Clinicians have an opportunity to guide CYA survivors towards useful and reliable information sources. This guidance could help survivors fulfill their unmet information and support needs and may be particularly important for less educated survivors and other underserved populations.

Associations between cancer-related information seeking and receiving PET imaging for routine cancer surveillance--an analysis of longitudinal survey data

BACKGROUND

Routine cancer surveillance with positron emission tomography (PET) is not recommended for most patients who have completed curative treatment for cancer. Yet, recent trends suggest that PET is increasingly used for follow-up among patients with cancer. This study investigates whether information-seeking behaviors predicted self-reported utilization of PET for routine surveillance in patients with colorectal, breast, and prostate cancer.

METHODS

We conducted annual surveys for 3 years in a cohort of Pennsylvania cancer survivors diagnosed with colorectal, breast, or prostate cancer in 2005. The outcome was self-reported PET receipt for routine surveillance among 944 patients diagnosed with nonmetastatic disease (stages 0-III). Predictors included cancer-related information seeking from nonmedical sources and providers. Weighted multiple logistic regression analyses were performed.

RESULTS

In this population, 11% of patients reported receiving at least one PET scan for routine follow-up in a 12-month period several years after diagnosis. Seeking cancer-related information from nonmedical sources was associated with higher odds of subsequent reported PET use [OR, 3.7; 95% confidence interval (CI), 1.1-12.1; P = 0.032], after adjusting for potential confounders. Patient engagement with physicians about cancer-related information was not a significant predictor.

CONCLUSIONS

Overall reported PET utilization for routine surveillance of colorectal, breast, and prostate cancer is low. However, we found a significant association with information seeking from nonmedical sources but not from providers.

IMPACT

Exposure to cancer-related information through mass media and lay interpersonal sources may be driving inappropriate utilization of high-cost advanced imaging procedures. These findings have important implications for cancer survivors, healthcare providers, and health policy.

Knowledge gaps among public librarians seeking vaccination information: A qualitative study

Public libraries have been called the "first responders" to the specialized health information needs of the general public. The challenges inherent in consumer health information (CHI) service are centered around the Patron, the Librarian, the Information Resources, and the Library itself. The pilot study involved interviews with nine individual library workers in eight public libraries in four library systems: the District of Columbia, Montgomery and Prince George's Counties in Maryland, and Fairfax County in Virginia. Library workers were asked about common consumer health information requests, the nature of their collections, and the role of public libraries in meeting these information needs. The subjects were also presented with a hypothetical scenario, and their responses suggest knowledge gaps. The findings point to the increasing necessity and importance of training and support for public librarians, as well as the importance of understanding where the medical knowledge gaps exist. Public librarians need to commit to formal evaluation of their skill sets and knowledge gaps, in order to identify areas to which libraries can devote limited resources.

The influences of immigration on health information seeking behaviors among Korean Americans and Native Koreans

Korean Americans (KAs) have low screening rates for cancer and are often not well informed about their chronic diseases. Reduced access to health-related information is one reason for gaps in knowledge and the widening health disparities among minority populations. However, little research exists about KAs' health information seeking behaviors. Guided by the Structural Influence Model, this study examines the influence of immigration status on KAs' trust in health information sources and health information seeking behaviors. Cross-sectional surveys were conducted in the Washington, D.C., metropolitan area as well as in the Gwangju metropolitan city in South Korea during 2006-2007. Two hundred and fifty-four KAs and 208 native Koreans who were 40 years of age or older completed the surveys. When comparing native Koreans to KAs, we found KAs were 3 times more likely to trust health information from newspapers or magazines (odds ratio [OR] = 3.13; 95% confidence interval [CI] = 1.49-6.54) and 11 times more likely to read the health sections of newspapers or magazines (OR = 11.35; 95% CI = 3.92-32.91) in multivariate adjusted models. However, they were less likely to look for health information from TV (OR = 0.29; 95% CI = 0.12-0.72) than native Koreans. Our results indicate that immigration status has profound influences on KAs' health information seeking behaviors. Increasing the availability of reliable and valid health information from printed Korean language magazines or newspapers could have a positive influence on increasing awareness and promoting screening behaviors among KAs.

Reaching rural women: breast cancer prevention information seeking behaviors and interest in Internet, cell phone, and text use

The purpose of this study was to examine the breast cancer prevention information seeking behaviors among rural women, the prevalence of Internet, cell, and text use, and interest to receive breast cancer prevention information cell and text messages. While growing literature for breast cancer information sources supports the use of the Internet, little is known about breast cancer prevention information seeking behaviors among rural women and mobile technology. Using a cross-sectional study design, data were collected using a survey. McGuire's Input-Ouput Model was used as the framework. Self-reported data were obtained from a convenience sample of 157 women with a mean age of 60 (SD = 12.12) at a rural New Mexico imaging center. Common interpersonal information sources were doctors, nurses, and friends and common channel information sources were television, magazines, and Internet. Overall, 87% used cell phones, 20% had an interest to receive cell phone breast cancer prevention messages, 47% used text messaging, 36% had an interest to receive text breast cancer prevention messages, and 37% had an interest to receive mammogram reminder text messages. Bivariate analysis revealed significant differences between age, income, and race/ethnicity and use of cell phones or text messaging. There were no differences between age and receiving text messages or text mammogram reminders. Assessment of health information seeking behaviors is important for community health educators to target populations for program development. Future research may identify additional socio-cultural differences.

Talking (or not) about family health history in families of Latino young adults

Although individuals recognize the importance of knowing their family's health history for their own health, relatively few people (e.g., less than a third in one national survey) collect this type of information. This study examines the rates of family communication about family health history of cancer, and predictors of communication in a sample of English-speaking Latino young adults. A total of 224 Latino young adults completed a survey that included measures on family communication, cultural factors, religious commitment, and cancer worry. We found that few Latino young adults reported collecting information from their families for the purposes of creating a family health history (18%) or sharing information about hereditary cancer risk with family members (16%). In contrast, slightly more than half of the participants reported generally "talking with their mothers about their family's health history of cancer." Logistic regression results indicated that cancer worry (odds ratio [OR] = 2.31; 95% confidence interval [CI] = 1.08-4.93), being female (OR = 3.12; 95% CI = 1.02-8.08), and being older (OR = 1.33; 95% CI = 1.01-1.76) were associated with increased rates of collecting information from family members. In contrast, orientation to the Latino culture (OR = 2.81; 95% CI = 1.33-5.94) and religious commitment (OR = 1.54; 95% CI = 1.02-2.32) were associated with increased rates of giving cancer information. Results highlight the need for prevention programs to help further general discussions about a family's history of cancer to more specific information related to family health history.

An analysis of the association between cancer-related information seeking and adherence to breast cancer surveillance procedures

BACKGROUND

Breast cancer surveillance is important for women with a known history of breast cancer. However, relatively little is known about the prevalence and determinants of adherence to surveillance procedures, including associations with seeking of cancer-related information from medical and nonmedical sources.

METHODS

We conducted a longitudinal cohort study of breast cancer patients diagnosed in Pennsylvania in 2005. Our main analyses included 352 women who were eligible for surveillance and participated in both baseline (~1 year after cancer diagnosis) and follow-up surveys. Outcomes were self-reported doctor visits and physical examination, mammography, and breast self-examination (BSE) at 1-year follow-up.

RESULTS

Most women underwent two or more physical examinations according to recommended guidelines (85%). For mammography, 56% of women were adherent (one mammogram in a year) while 39% reported possible overuse (two or more mammograms). Approximately 60% of respondents reported regular BSE (≥ 5 times in a year). Controlling for potential confounders, higher levels of cancer-related information seeking from nonmedical sources at baseline was associated with regular BSE (OR, 1.52; 95% CI, 1.01-2.29; P, 0.046). There was no significant association between information-seeking behaviors from medical or nonmedical sources and surveillance with physical examination or mammography.

CONCLUSIONS

Seeking cancer-related information from nonmedical sources is associated with regular BSE, a surveillance behavior that is not consistently recommended by professional organizations.

IMPACT

Findings from this study will inform clinicians on the contribution of active information seeking toward breast cancer survivors' adherence to different surveillance behaviors.

A longitudinal study on engagement with dieting information as a predictor of dieting behavior among adults diagnosed with cancer

OBJECTIVE

This study explores cancer survivors' engagement with information about dieting to control weight from doctors, interpersonal, and media sources and examines whether engagement from these sources impacts subsequent dieting behavior.

METHODS

A total of 1128 respondents diagnosed with colorectal, breast, or prostate cancers were surveyed over three years following their cancer diagnoses. Using weighted logistic regression analyses, the authors predicted the odds of dieting based on earlier information engagement with sources, controlling for dieting in the previous year and confounders.

RESULTS

Participants reported talking with doctors more frequently (37%) than seeking or scanning from interpersonal and media sources about dieting (15-22%). Seeking from interpersonal and media sources, and discussion with physicians, significantly predicted dieting behavior. In addition, discussions with physicians increased the odds of subsequent dieting behavior by 2.32 times (95% CI: 1.50-3.61; p=.002), over and above the effects of other information engagement.

CONCLUSION

Cancer survivors reported engaging with a variety of information sources about dieting. Engagement with doctors and information-seeking from interpersonal or media sources predicted cancer survivors' dieting behavior a year later.

PRACTICE IMPLICATIONS

The results may inform strategies to encourage and empower cancer survivors to engage with information about healthy lifestyle changes for promoting long-term health.