Greater benefit of self-affirmation for prevention-focused individuals prior to threatening health messages

OBJECTIVE

Individuals are often defensive toward health messages that suggest they are putting their health at risk because such messages threaten their self-competence and integrity. Although self-affirmation can facilitate prevention behaviors in response to health messages, effects are variable. We examined whether disease prevention focus might strengthen self-affirmation's effects in response to disease prevention messages, given that prevention-focused individuals are likeliest to be persuaded by those messages after self-affirmation attenuates defensiveness.

DESIGN

In Study 1, participants were self-affirmed before a message about sexually transmitted infections. In Studies 2 and 3, individuals were self-affirmed prior to a message about alcohol and cancer risk.

MAIN OUTCOME MEASURES

Studies assessed intentions to use condoms, intentions to reduce alcohol, and willingness to drink alcohol in specific scenarios.

RESULTS

In Study 1, self-affirmation facilitated condom use intentions among those higher in prevention focus. In Studies 2 and 3, self-affirmation facilitated lower willingness to consume alcohol among those high in prevention focus. A meta-analysis across the three studies indicated that self-affirmation improved intentions and willingness under high, but not low, prevention focus (d = 0.20, p = .003).

CONCLUSION

These findings demonstrate that health prevention-focus can strengthen self-affirmation's effects, thereby improving responsiveness to health communications about behaviors that increase disease risk.

Evaluating an Operator Physical Fitness Test Prototype for Tactical Air Control Party and Air Liaison Officers: A Preliminary Analysis of Test Implementation

The U.S. Air Force asked the RAND Corporation to assist its development and validation of gender-neutral tests and standards for battlefield airmen (BA) specialties. The Air Force has conducted an extensive validation study of occupational relevance of physical fitness tests and standards. Following the fitness test validation study, one enlisted specialty (Tactical Air Control Party [TACP]) and one officer BA specialty (Air Liaison Officer [ALO]) moved forward with an implementation plan to further evaluate a set of recommended tests and continuation standards. This study describes RAND's assistance to the Air Force on two fronts: (1) conducting a preliminary evaluation of potential issues and concerns that might influence implementation effectiveness and (2) developing a framework for evaluating the implementation of occupationally relevant and specific tests and standards. This work provides the foundation for ongoing review and evaluation of Air Force fitness tests and standards, which are designed to ensure that airmen are capable of performing critical physical tasks associated with their assigned specialties.

What Words Convey: The Potential for Patient Narratives to Inform Quality Improvement

Policy Points Narratives about patients' experiences with outpatient care are essential for quality improvement because they convey ample actionable information that both elaborates on existing domains within patient experience surveys and describes multiple additional domains that are important to patients. The content of narrative feedback from patients can potentially be translated to improved quality in multiple ways: clinicians can learn from their own patients, groups of clinicians can learn from the experience of their peers' patients, and health system administrators can identify and respond to patterns in patients' accounts that reflect systemic challenges to quality. Consistent investment by payers and providers is required to ensure that patient narratives are rigorously collected, analyzed fully, and effectively used for quality improvement.

CONTEXT

For the past 25 years, health care providers and health system administrators have sought to improve care by surveying patients about their experiences. More recently, policymakers have acted to promote this learning by deploying financial incentives tied to survey scores. This article explores the potential of systematically elicited narratives about experiences with outpatient care to enrich quality improvement.

METHODS

Narratives were collected from 348 patients recruited from a nationally representative Internet panel. Drawing from the literature on health services innovation, we developed a two-part coding schema that categorized narrative content in terms of (a) the aspects of care being described, and (b) the actionability of this information for clinicians, quality improvement staff, and health system administrators. Narratives were coded using this schema, with high levels of reliability among the coders.

FINDINGS

The scope of outpatient narratives divides evenly among aspects of care currently measured by patient experience surveys (35% of content), aspects related to measured domains but not captured by existing survey questions (31%), and aspects of care that are omitted from surveys entirely (34%). Overall, the narrative data focused heavily on relational aspects of care (43%), elaborating on this aspect of experience well beyond what is captured with communication-related questions on existing surveys. Three-quarters of elicited narratives had some actionable content, and almost a third contained three or more separate actionable elements.

CONCLUSIONS

In a health policy environment that incentivizes attention to patient experience, rigorously elicited narratives hold substantial promise for improving quality in general and patients' experiences with care in particular. They do so in two ways: by making concrete what went wrong or right in domains covered by existing surveys, and by expanding our view of what aspects of care matter to patients as articulated in their own words and thus how care can be made more patient-centered. Most narratives convey experiences that are potentially actionable by those committed to improving health care quality in outpatient settings.

Improving Patients' Choice of Clinician by Including Roll-up Measures in Public Healthcare Quality Reports: an Online Experiment

BACKGROUND

Public reports on healthcare quality typically include complex data. To lower the cognitive burden of interpreting these data, some report designers create summary, or roll-up, measures combining multiple indicators of quality into one score. Little is known about how the availability of roll-ups affects clinician choice.

OBJECTIVE

To determine how presenting quality scores at different levels of aggregation affects patients' clinician choices.

DESIGN

We conducted a simulated clinician-choice experiment, randomizing participants to three versions of a public reporting website and comparing their clinician choices. One version aggregated all clinician-level quality measures into roll-ups, the second provided disaggregated (drill-down) scores only, and the third offered both roll-ups and drill-downs.

PARTICIPANTS

Five hundred fifty panelists drawn from a probability-based Internet panel.

MAIN MEASURES

We assessed the amount of effort participants exerted by tracking the length of time spent on the website and the number of concrete actions taken on the website (e.g., clicking items). We evaluated decision quality by measuring whether participants selected a clinician who performed more poorly than others and incongruence between participants' stated preferences for dimensions of quality and their chosen clinician's performance on those dimensions.

KEY RESULTS

Participants seeing drill-downs alone (mean = 14.9) or with roll-ups (mean = 19.2) took more actions than those who saw roll-ups alone (mean = 10.5) (ps < 0.05). However, participants seeing only drill-downs made poorer choices than those who saw roll-ups alone or with drill-downs. More participants seeing drill-downs chose a clinician who was outperformed (36.3% versus 23.4% [roll-up] and 25.6% [drill-down + roll-up], ps < 0.05) and made choices incongruent with stated preferences (51.2% versus 45.6% [roll-up] and 47.5% [drill-down + roll-up], ps < 0.05). The distinction between roll-up and drill-down was somewhat stronger for sicker participants.

CONCLUSIONS

Our results suggest that roll-ups in healthcare quality reports, alone or as a complement to drill-downs, can help patients make better decisions for themselves.

A Rigorous Approach to Large-Scale Elicitation and Analysis of Patient Narratives

Patient narratives have emerged as promising vehicles for making health care more responsive by helping clinicians to better understand their patients' expectations, perceptions, or concerns and encouraging consumers to engage with information about quality. A growing number of websites incorporate patients' comments. But existing comments have fragmentary content, fail to represent less vocal patients, and can be manipulated to "manage" providers' reputations. In this article, we offer the first empirical test of the proposition that patient narratives can be elicited rigorously and reliably using a five-question protocol that can be incorporated into large-scale patient experience surveys. We tested whether elicited narratives about outpatient care are complete (report all facets of patient experience), balanced (convey an accurate mix of positive and negative events), meaningful (have a coherent storyline), and representative (draw fulsome narratives from all relevant subsets of patients). The tested protocol is strong on balance and representativeness, more mixed on completeness and meaningfulness.

Effects of contact-based mental illness stigma reduction programs: age, gender, and Asian, Latino, and White American differences

PURPOSE

Mental illness stigma disproportionately affects help seeking among youth, men, and ethnic minorities. As part of a comprehensive statewide initiative to reduce mental illness stigma and discrimination in California, a broad set of contact-based educational programs were widely disseminated. This study examined whether the effects of contact-based educational programs varied depending on the age, gender, and race-ethnicity of participants.

METHODS

Participants (N = 4122) attended a contact-based educational program that was delivered as part of the statewide initiative to reduce mental illness stigma and discrimination. Self-administered surveys assessing beliefs, attitudes, and intentions toward mental illnesses and treatment were conducted immediately before and after participation in contact-based educational programs.

RESULTS

Participant age, gender, and race-ethnicity significantly moderated pre-post changes in mental illness stigma. Although all groups exhibited significant pre-post changes across most of the stigma domains assessed, young adults, females, and Asian and Latino American participants reported larger improvements compared to older adults, males, and Whites, respectively.

CONCLUSIONS

Findings suggest that contact-based educational programs can achieve immediate reductions in mental illness stigma across a variety of sociodemographic groups and may particularly benefit young adults and racial-ethnic minorities. Further research is needed to assess whether contact-based educational programs can sustain longer-term changes and aid in the reduction of disparities in mental illness stigma and treatment.

Differential response to contact-based stigma reduction programs: Perceived quality and personal experience matter

The aim of this study was to examine two under-studied factors integral to the theoretical underpinnings of contact-based mental illness stigma reduction programs: the quality of the contact and prior personal experience with persons with mental health problems. This study utilized pre- and post-survey data collected from 4122 individuals participating in a diverse set of contact-based educational programs implemented as part of California's statewide initiative to reduce mental illness stigma. Multi-level mixed regression models were used to determine whether pre-post changes in a variety of stigma-related measures varied depending on perceived quality of contact and prior personal experience with mental illness. Significant pre-post reductions in stigma were observed, but individual perceptions of contact quality strongly moderated program effects. Mean contact quality across all attendees at a presentation was rarely a moderator. Though effective for all participants, on average, contact-based educational programs were more effective for those without prior personal or family experience of mental illness. Program organizers may wish to target recruitment efforts to reach more individuals without such experience, given the greater effectiveness of contact among these individuals. More research should explore the factors underlying individual variation in perceived quality of contact-based stigma reduction programs.

Choosing Doctors Wisely: Can Assisted Choice Enhance Patients’ Selection of Clinicians?

We conducted a simulated clinician-choice experiment, comparing choices and decision-making processes of participants ( N = 688) randomized among four experimental arms: a conventional website reporting only quantitative performance information, a website reporting both qualitative (patient comments) and quantitative information, the second website augmented by a decision aid (labeling of patient comments), and the decision-aided website further augmented by the presence of a trained navigator. Introducing patient comments enhanced engagement with the quality information but led to a decline in decision quality, particularly the consistency of choices with consumers’ stated preferences. Labeling comments helped erase the decline in decision quality, although the highest percentage of preference-congruent choices was seen in the navigator arm. Engagement with the quality information and satisfaction with choices available were likewise highest in the navigator arm. Findings held for high- and low-skilled decision makers. Thus, navigator assistance may be a promising strategy for equitably promoting higher quality choices in information-rich contexts.

Using "roll-up" measures in healthcare quality reports: perspectives of report sponsors and national alliances

OBJECTIVES

To understand the views of prominent organizations in the field of healthcare quality on the topic of reporting roll-up measures that combine indicators of multiple, often disparate, dimensions of care to consumers.

STUDY DESIGN

This study used a semi-structured, qualitative interview design.

METHODS

We conducted 30- to 60-minute semi-structured telephone interviews with representatives of 10 organizations that sponsor public healthcare quality reports and 3 national alliances representing multiple stakeholder groups. We conducted a thematic analysis of interview transcriptions to identify common issues and concerns related to reporting roll-up measures.

RESULTS

Among sponsors reporting roll-up measures, current practices for calculating and reporting these measures are diverse. The main perceived benefit of reporting roll-up measures is that they simplify large amounts of complex information for consumers. The main concern is the potential for consumers to misunderstand the measures and what associated roll-up scores communicate about provider performance. Report sponsors and national alliances feel that more guidance and research on the methods for producing and reporting scores for roll-up measures are needed.

CONCLUSIONS

The results of the interviews elucidate the need for research focused on construction and reporting of roll-up measures. Studies are needed to determine if roll-up measures are indeed perceived by consumers as being less complex and easier to understand.

CAHPS and Comments: How Closed-Ended Survey Questions and Narrative Accounts Interact in the Assessment of Patient Experience

Objectives:

To investigate whether content from patient narratives explains variation in patients’ primary care provider (PCP) ratings beyond information from the closed-ended questions of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Survey and whether the relative placement of closed- and open-ended survey questions affects either the content of narratives or the CAHPS composite scores.

Methods:

Members of a standing Internet panel (N = 332) were randomly assigned to complete a CAHPS survey that was either preceded or followed by a set of open-ended questions about how well their PCP meets their expectations and how they relate to their PCP.

Results:

Narrative content from healthier patients explained only an additional 2% beyond the variation in provider ratings explained by CAHPS composite measures. Among sicker patients, narrative content explained an additional 10% of the variation. The relative placement of closed- and open-ended questions had little impact on narratives or CAHPS scores.

Conclusion:

Incorporating a protocol for eliciting narratives into a patient experience survey results in minimal distortion of patient feedback. Narratives from sicker patients help explain variation in provider ratings.

Effects of the Integrated Behavioral Health Project's Efforts to Promote Integrated Care Under Funding from the California Mental Health Services Authority

Describes the methods and results of a RAND evaluation of the Integrated Behavioral Health Project's efforts to promote the integration of mental and physical health care among various health care stakeholders in California.

Strategic Analysis of the 2014 Wounded Warrior Project Annual Alumni Survey: A Way Forward

Wounded Warrior Project® (WWP) provides support and raises public awareness for service members and veterans who incurred physical or mental injury, illness, or wound coincident to their military service on or after September 11, 2001, as well as their families and caregivers. Through WWP, members (Alumni) have access to programs that support four main areas of recovery-engagement, mind, body, and economic empowerment. Using 2014 WWP Annual Alumni Survey data, RAND researchers offer a detailed analysis of how Alumni of different genders, races and ethnicities, military service histories, and service-related health conditions fare in terms of mental health, physical health, and economic well-being. The study also offers recommendations for the organization's decisionmakers to consider in setting goals and creating programs to support WWP Alumni.

Effects of Stigma and Discrimination Reduction Trainings Conducted Under the California Mental Health Services Authority: An Evaluation of the National Alliance on Mental Illness Adult Programs

This study evaluated three National Alliance on Mental Illness (NAMI) programs aimed at reducing mental illness stigma and discrimination among adult audiences.

Effects of Stigma and Discrimination Reduction Programs Conducted Under the California Mental Health Services Authority: An Evaluation of Runyon Saltzman Einhorn, Inc., Documentary Screening Events

Describes the methods and results of a RAND evaluation of stigma and discrimination reduction efforts by Runyon Saltzman Einhorn, Inc., involving screenings of a documentary film called "A New State of Mind: Ending the Stigma of Mental Illness."

Breaking Narrative Ground: Innovative Methods for Rigorously Eliciting and Assessing Patient Narratives

OBJECTIVE

To design a methodology for rigorously eliciting narratives about patients' experiences with clinical care that is potentially useful for public reporting and quality improvement.

DATA SOURCES/STUDY SETTING

Two rounds of experimental data (N = 48 each) collected in 2013-2014, using a nationally representative Internet panel.

STUDY DESIGN

Our study (1) articulates and operationalizes criteria for assessing narrative elicitation protocols; (2) establishes a "gold standard" for assessment of such protocols; and (3) creates and tests a protocol for narratives about outpatient treatment experiences.

DATA COLLECTION/EXTRACTION METHODS

We randomized participants between telephone and web-based modalities and between protocols placed before and after a closed-ended survey.

PRINCIPAL FINDINGS

Elicited narratives can be assessed relative to a gold standard using four criteria: (1) meaningfulness, (2) completeness, (3) whether the narrative accurately reflects the balance of positive and negative events, and (4) representativeness, which reflects the protocol's performance across respondent subgroups. We demonstrate that a five-question protocol that has been tested and refined yields three- to sixfold increases in completeness and four- to tenfold increases in meaningfulness, compared to a single open-ended question. It performs equally well for healthy and sick patients.

CONCLUSIONS

Narrative elicitation protocols suitable for inclusion in extant patient experience surveys can be designed and tested against objective performance criteria, thus advancing the science of public reporting.

SimCoach Evaluation: A Virtual Human Intervention to Encourage Service-Member Help-Seeking for Posttraumatic Stress Disorder and Depression

This article describes RAND Corporation researchers' assessment of SimCoach, a computer program featuring a virtual human that speaks and gestures in a video game-like interface, designed to encourage service members, especially those with signs or symptoms of posttraumatic stress disorder (PTSD) or depression, to seek help to improve their psychological health. The assessment included a formative component assessing SimCoach's design, development, and implementation approaches and a summative component assessing outcomes among participants in a user experience survey and a randomized controlled trial (RCT). Results of the formative evaluation identified both strengths and opportunities for improvement. For example, although SimCoach development processes were well-aligned with best practices for software engineering, SimCoach content development and evaluation processes could have been more tightly coupled to best practices in psychological health. The summative evaluation RCT did not show any SimCoach-related benefit in intent to seek help compared with that of control users not exposed to any intervention. However, secondary outcomes indicated that SimCoach users had satisfying experiences without distress. If SimCoach development is continued, greater attention to clinical processes and outcomes is needed so that the program can have its intended impact on help-seeking for PTSD and depression.

Effects of Stigma and Discrimination Reduction Trainings Conducted Under the California Mental Health Services Authority: An Evaluation of NAMI's Ending the Silence

This article evaluates the short-term outcomes of students attending the National Alliance on Mental Illness' Ending the Silence presentations, delivered across three high schools in a Northern California school district.

The Mental Health Association of San Francisco Partner Organizations Meet Their Goals in Stigma Reduction Efforts: Results of a Qualitative Evaluation of the Technical Assistance Process

This article describes the results of RAND's evaluation of the San Francisco-based Center for Dignity, Recovery, and Empowerment's technical assistance program for stigma-reduction programs through interviews with community-partner participants.

CalMHSA Stigma and Discrimination Reduction Online Resources: Highlights from an Evaluation of Web Analytic Data

Reports on an evaluation of online resources developed by the California Mental Health Services Authority's stigma and discrimination reduction initiative program partners and provides an overview of these resources and the use of partner websites.

Effects of Stigma and Discrimination Reduction Trainings Conducted Under the California Mental Health Services Authority: An Evaluation of Disability Rights California and Mental Health America of California Trainings

Describes the methods and results of a RAND evaluation of stigma and discrimination reduction trainings delivered by two program partners, Disability Rights California and Mental Health America of California.

Stigma, Discrimination, and Well-Being Among California Adults Experiencing Mental Health Challenges

Presents results of the 2014 California Well-Being Survey, which tracks mental illness stigma and discrimination, well-being, and exposure to prevention and early intervention activities among Californians experiencing psychological distress.

Changes in Mental Illness Stigma in California During the Statewide Stigma and Discrimination Reduction Initiative

Presents results of a one-year follow-up to the 2014 California Statewide Survey, which was developed to track attitudes, beliefs, and behaviors related to mental illness. This article focuses on items measuring stigma.

Reviewing the Evidence Base for Mental Health First Aid: Is There Support for Its Use with Key Target Populations in California?

This article reviews the current state of evidence for Mental Health First Aid's effectiveness in key target populations, to help the California Mental Health Services Authority's planning for future prevention and early intervention activities.

Evaluation of the California Mental Health Services Authority's Prevention and Early Intervention Initiatives: Progress and Preliminary Findings

The California Mental Health Services Authority (CalMHSA) statewide Prevention and Early Intervention (PEI) program comprises three strategic initiatives: (1) reduction of stigma and discrimination toward those with mental illness, (2) prevention of suicide, and (3) improvement in student mental health. Community agencies serve as PEI program partners to perform activities intended to meet the goals of the initiatives. This article evaluates the progress of the PEI program partners in achieving their goals and establishes baseline population tracking of key risk factors and long-term outcomes targeted by the initiatives. Based on a model to assess the program partners' capacities and resources and a recent survey of California adults, this article shows that the partners have greatly expanded their abilities to launch numerous PEI activities and programs.

Beliefs Related to Mental Illness Stigma Among California Young Adults

This study examines mental illness stigma and related beliefs among young adults in California, especially whether levels of stigma are higher or lower than those observed in older adults.

Findings from the School-Based Theatrical Performance Walk In Our Shoes

This article examines the effects of a school-based theatrical performance, Walk In Our Shoes, designed to educate youth about and reduce stigma and discrimination toward mental illness.

Health and Economic Outcomes Among the Alumni of the Wounded Warrior Project: 2013

The Wounded Warrior Project (WWP) offers support and raises public awareness of service members who have experienced physical or mental health conditions associated with their service on or after September 11, 2001. In this study, the authors use WWP's 2013 survey of its members (alumni) to understand the physical, mental, and economic challenges that Wounded Warriors face. The researchers find that at least half of alumni reported dealing with mental health conditions such as depression and posttraumatic stress disorder, and many of these alumni reported difficulties or delays in seeking mental health care, or not doing so at all. Alcohol misuse also poses a problem. A large proportion of alumni are overweight or obese, conditions that negatively affect their daily lives, exercise routines, and overall health. Almost half of alumni are not working, and there is low participation in veteran-specific employment and education programs. This information can be used to better understand the needs of WWP alumni and the ways that WWP can serve and support this constituency.

Evaluation of the California Mental Health Services Authority's Prevention and Early Intervention Initiatives: Executive Summary and Commentary

In 2004, California voters passed Proposition 63, the Mental Health Services Act (MHSA), which includes a mandate that the state provide prevention and early intervention (PEI) services and education for people who experience mental illness in the state of California. The California Mental Health Services Authority (CalMHSA), a coalition of California counties formed to provide economic and administrative support to mental health service delivery, formed the Statewide PEI Implementation Program based on extensive recommendations from a large number of stakeholders statewide. The Statewide PEI program is made up of three strategic initiatives: (1) reduction of stigma and discrimination towards those with mental illness, (2) prevention of suicide, and (3) improvement in student mental health. This article provides a summary and commentary on a more detailed interim RAND evaluation of the CalMHSA Statewide PEI Program.

Interventions to Reduce Mental Health Stigma and Discrimination: A Literature Review to Guide Evaluation of California's Mental Health Prevention and Early Intervention Initiative

A number of programs aim to reduce the stigma and discrimination associated with mental illness, and they can include a variety of components such as training, education, media campaigns, and contact with people with mental illness. Stigma and discrimination reduction activities are evaluated in this article, using evidence from an extensive literature review. Specific areas reviewed include relevant theories of stigma and prejudice reduction, what is and is not known about the effectiveness of various approaches to reducing the stigma of mental illness, the kinds of methodologies previously used in evaluating these approaches, and the methodologies that should be employed in the future. The authors also introduce a conceptual model of mental health stigma reduction based on a variety of existing theories and evidence.

Interventions to Improve Student Mental Health: A Literature Review to Guide Evaluation of California's Mental Health Prevention and Early Intervention Initiative

The authors review data on the prevalence of youth mental health disorders and schools' use of student mental health (SMH) programs. They also describe the role of schools in addressing SMH concerns and outline a conceptual model for guiding evaluation of SMH programs. Finally, they touch on issues related to evaluation of cross-system collaborations that can influence students' access to resources and services and then review some of the challenges associated with evaluating SMH programs. They determine that SMH programs can be effective and can improve staff, faculty, and student knowledge of mental health problems; provide skills for identifying and referring students with mental health and social and emotional difficulties; and change attitudes toward mental health problems.

Self-affirmation moderates effects of unrealistic optimism and pessimism on reactions to tailored risk feedback

We examined whether self-affirmation would facilitate intentions to engage in colorectal cancer (CRC) screening among individuals who were off-schedule for CRC screening and who were categorised as unrealistically optimistic, realistic or unrealistically pessimistic about their CRC risk. All participants received tailored risk feedback; in addition, one group received threatening social comparison information regarding their risk factors, a second received this information after a self-affirmation exercise and a third was a no-treatment control. When participants were unrealistically optimistic about their CRC risk (determined by comparing their perceived comparative risk to calculations from a risk algorithm), they expressed greater interest in screening if they were self-affirmed (relative to controls). Non-affirmed unrealistic optimists expressed lower interest relative to controls, suggesting that they were responding defensively. Realistic participants and unrealistically pessimistic participants who were self-affirmed expressed relatively less interest in CRC screening, suggesting that self-affirmation can be helpful or hurtful depending on the accuracy of one's risk perceptions.

Lack of acknowledgment of fruit and vegetable recommendations among nonadherent individuals: associations with information processing and cancer cognitions

Inadequate consumption of fruits and vegetables is regarded as an important behavioral risk factor for multiple types of cancer. Nevertheless, adherence with the National Cancer Institute (NCI) guidelines to eat between five and nine servings of fruits and vegetables per day is remarkably low. The current study explored the extent to which nonadherent respondents in a national survey (N = 5,625) listed fruit and vegetable consumption as a method by which to decrease their own or others' cancer risk. We sought to determine whether respondents who listed fruit and vegetable consumption as a method by which to decrease their own or others' cancer risk (hereafter referred to as "listers") differed from respondents who did not list fruit and vegetable consumption as a method by which to decrease their own or others' cancer risk (hereafter referred to as) "nonlisters" on measures of information processing and cancer cognitions. Nonlisters were more likely than listers to seek out cancer information but less likely to trust the information. The two groups did not differ in the amount of attention they paid to such information. Listers had lower absolute risk perceptions than nonlisters, but listers and nonlisters did not differ on measures of relative breast and colon cancer risk perceptions and worry for cancer in general. Female listers did perceive themselves to be at less relative risk for breast cancer than nonlisters. Respondents were more likely to list fruit and vegetable consumption as a cancer-risk reduction strategy for others than for themselves, suggesting a "double standard" in their beliefs. These findings suggest that communications designed to promote fruit and vegetable consumption need to account for biases in how nonadherent individuals respond to these communications.