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Paul Han, MD, MA, MPH Cancer Prevention Fellowship Program Division of Cancer Prevention

Perceived Ambiguity About Cancer Prevention Recommendations: Relationship to Perceptions of Cancer Preventability and of Cancer Risk and Worry. Paul Han, MD, MA, MPH Cancer Prevention Fellowship Program Division of Cancer Prevention Division of Cancer Control and Population Sciences, NCI

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Paul Han, MD, MA, MPH Cancer Prevention Fellowship Program Division of Cancer Prevention

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  1. Perceived Ambiguity About Cancer Prevention Recommendations: Relationship to Perceptions of Cancer Preventability and of Cancer Risk and Worry Paul Han, MD, MA, MPH Cancer Prevention Fellowship Program Division of Cancer Prevention Division of Cancer Control and Population Sciences, NCI Richard Moser, PhD & Whitney Randolph Steele, PhD Division of Cancer Control and Population Sciences, NCI William Klein, PhD Department of Psychology, University of Pittsburgh

  2. Ambiguity • Ellsberg (1961): “…a quality depending on the amount, type, reliability and ‘unanimity’ of information …’Ambiguity’ may be high when there are questions of reliability and relevance of information, and particularly where there is conflicting opinion and evidence.” Ellsberg, D. (1961) Risk, Ambiguity and the Savage Axioms. Quart J Econ, 75, 643-69.

  3. Perceived Ambiguity About Cancer Prevention Recommendations • “There are so many different recommendations about preventing cancer, it’s hard to know which ones to follow” (CK14cTooManyRecommendations) • 77% of HINTS respondents agreed “somewhat” or “strongly”

  4. Ambiguity About Cancer Prevention Recommendations • Possible causes: multiple • An expected outcome of Informed Decision Making (IDM)? • Possible consequences: does increasing ambiguity affect other cognitions and emotions related to cancer prevention?

  5. Research Questions • How does perceived ambiguity about cancer prevention recommendations relate to other cancer-related cognitions and emotions? • Perceived preventability of cancer • Cancer-related worry • Perceived cancer risk • How do these factors relate to one another? • An exploratory, hypothesis-generating study

  6. Analysis • Logistic regression – SUDAAN • Subpopulation: age >=40 • Adjusted for gender, race, education • Predictor variable in all models: “Ambiguity” (CK14cTooManyRecommendations)

  7. Analysis – Response Variables (separate regression models) • Perceivedcancer preventability(CK14bCannotLowerChances) “There is not much people can do to lower their chances of getting cancer” • Cancer-related worry(CK9WorryGetCancer) “How often do you worry about cancer?” • Perceived cancer risk(CK8ChanceGetCancer) “How likely do you think it is that you will develop cancer in the future?”

  8. Results: Main Effects • Perceived ambiguity negatively related to perceived cancer preventability • OR .30 (95% CI: .22-.40) • p=.00 • Perceived ambiguity positively related to cancer-related worry • OR 1.55 (95% CI: 1.03-2.33) • p=.03 • Perceived ambiguity positively related to perceived cancer risk • OR 1.45 (95% CI: 1.18-1.77) • p=.00

  9. Questions • Causal direction of relationships • Theoretical explanations • Predicted relationships between variables: moderating, mediating effects

  10. Ambiguity and Perceived Preventability PERCEIVED RISK (+) (—) PERCEIVED PREVENTABILITY AMBIGUITY (+) WORRY

  11. Perceived Ambiguity and Perceived Preventability • Hypothetical causal direction: Ambiguity  Perceived preventability • Theoretical support: “ambiguity aversion”—pessimistic / threatening interpretation bias • Predicted relationships with other variables—cancer-related worry: • Moderating effect of emotion on processing of ambiguous information

  12. Worry Moderates the Possible Effect of Ambiguity Upon Perceived Preventability

  13. Ambiguity x Worry Interaction • Worry about cancer moderates extent of ambiguity aversion • Worry may bias people towards more pessimistic / threatening interpretations of ambiguity (i.e., lower preventability beliefs) • Findings consistent with past research

  14. Ambiguity and Worry PERCEIVED RISK (+) (—) PERCEIVED PREVENTABILITY AMBIGUITY (+) WORRY

  15. Ambiguity Aversion and Cancer-related Worry • Hypothetical causal direction: Ambiguity  Cancer-related worry • Theoretical support: perceived ambiguity activates emotion; intolerance of ambiguity associated with affective states and traits (worry, anxiety, depression) • Predicted relationships with other variables: • Effect of cancer risk perceptions on worry about cancer—may suggest mediating role of perceived risk

  16. Perceived Risk Mediates the Possible Effect of Ambiguity Upon Cancer-related Worry p=.03 AMBIGUITY WORRY p=.23* *including perceived risk in the model P=.01 P<.0000 PERCEIVED RISK

  17. Conclusion: Preliminary Hypotheses • Perceived ambiguity about cancer prevention recommendations may have broad effects on cancer-related cognitions and emotions: • Perceived ambiguity may decrease perceived preventability of cancer • Cancer-related worry may moderate this effect • Perceived ambiguity may increase perceived cancer risk • Perceived ambiguity may increase cancer-related worry • Perceived cancer risk may mediate this effect

  18. Tentative Model (+) (—) PERCEIVED RISK PERCEIVED AMBIGUITY PERCEIVED PREVENTABILITY (+) WORRY

  19. Implications and Future Directions • Relevance for risk communication and IDM interventions: increasing ambiguity may influence health-related cognitions and emotions • Prospective and experimental studies • Confirm causal directions • Link to actual cancer-protective behaviors • Integrate ambiguity into health behavior theories

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