1. Risk and Worry as Predictors of Cancer Screening Behavior: Results Using HINTS Data Richard P. Moser, Ph.D. 1, Kevin McCaul, Ph.D. 2, Ellen Peters, Ph.D. 3, Wendy Nelson, Ph.D. 1, Stephen Marcus, Ph.D. 1 1 NCI 2 North Dakota State University 3 Decision Research/University of Oregon HINTS Data Users Conference January 21, 2005

2. The Role of Susceptibility Key concept in Health Belief Model Key concept in Health Belief Model A cognition; can be assessed in several ways (Weinstein et al.) e.g.: A cognition; can be assessed in several ways (Weinstein et al.) e.g.: –Risk: Comprehension of the likelihood (probability/chance) of developing a disease As affect As affect –Importance in decision making (Loewenstein et al., 2001) –Worry: Signifies importance Signifies importance Serves as salient reminder through rumination Serves as salient reminder through rumination Motivates planning Motivates planning Both related to cancer screening (e.g., McCaul et al., 1996) Both related to cancer screening (e.g., McCaul et al., 1996)

3. Health Behavior Outcomes: Cancer Screening Reduces disease-related morbidity and mortality Reduces disease-related morbidity and mortality Increases cancer survival rates for certain types of cancer Increases cancer survival rates for certain types of cancer ACS/USPSTF Current screening guidelines ACS/USPSTF Current screening guidelines Coded for analyses: Coded for analyses: –Regular/Not Regular Mammography (Breast) Mammography (Breast) FOBT (Colorectal) FOBT (Colorectal) –Lifetime (Yes/No) Sigmoidoscopy Sigmoidoscopy Colonoscopy Colonoscopy PSA PSA

4. Analysis Plan Hierarchical Logistic Regression Hierarchical Logistic Regression –Predictors of interest-three blocks: 1) Sociodemographic variables 1) Sociodemographic variables –Gender (where appropriate) –Education –Race/Ethnicity –Age 2) Access to Care 2) Access to Care –Health care coverage –Regular provider 3) Risk, Worry and interaction 3) Risk, Worry and interaction Other Other –Log likelihood analyses for nested models –Correlate risk/worry

5. Results: Correlations Between Cancer Risk and Worry* Breast Cancer: r =.42 Breast Cancer: r =.42 Colorectal Cancer: r =.37 Colorectal Cancer: r =.37 Prostate Cancer: r =.34 Prostate Cancer: r =.34 *all significant at p <.05

6. Distribution of Risk/Worry Responses

7. Distribution of Risk/Worry Responses (cont.)

8. VariableOR95% CI Log Likelihood Risk1.181.04 to 1.33 Worry1.301.03 to 1.63 Risk x Worry0.970.82 to 1.16 Regular Provider Yes2.811.95 to 4.06 No1.00 --- Health Care Coverage Yes2.591.72 to 3.88 No1.00 --- Age1.011.00 to 1.02 Education College Grad2.171.41 to 3.33 Some College2.121.37 to 3.30 High School Grad1.711.07 to 2.73 Less than High School1.00 --- Race/Ethnicity Other1.050.77 to 1.43 White1.00 --- Outcome: Regular/Not Regular Mammography Screening (n=2150) (p <.01)

9. VariableOR95% CI Log Likelihood Risk1.160.99 to 1.35 (p<.06) Worry1.321.03 to 1.69 Risk x Worry0.940.80 to 1.11 Regular Provider Yes1.861.35 to 2.55 No1.00 --- Health Care Coverage Yes1.310.60 to 2.83 No1.00 --- Age1.031.02 to 1.05 Education College Grad2.901.87 to 4.51 Some College2.551.70 to 3.82 High School Grad1.210.79 to 1.85 Less than High School1.00 --- Race/Ethnicity Other0.910.62 to 1.35 White1.00 --- Gender Male1.381.05 to 1.82 Female1.00 --- Outcome: Ever/Never Sigmoidoscopy Screening (n=2078) (p <.01)

10. VariableOR95% CI Log Likelihood Risk1.231.09 to 1.38 Worry1.431.09 to 1.88 Risk x Worry0.940.80 to 1.11 Regular Provider Yes1.891.28 to 2.78 No1.00 --- Health Care Coverage Yes2.151.34 to 4.08 No1.00 --- Age1.031.02 to 1.05 Education College Grad1.050.65 to 1.70 Some College1.060.69 to 1.64 High School Grad0.930.64 to 1.35 Less than High School1.00 --- Race/Ethnicity Other0.900.62 to 1.29 White1.00 --- Gender Male1.250.97 to 1.61 Female1.00 --- Outcome: Ever/Never Colonoscopy Screening (n=2079) (p <.01)

11. VariableOR95% CI Log Likelihood Risk0.880.73 to 1.05 Worry1.000.70 to 1.42 Risk x Worry1.120.90 to 1.41 Regular Provider Yes1.721.05 to 2.82 No1.00 --- Health Care Coverage Yes1.830.71 to 4.74 No1.00 --- Age1.011.00 to 1.03 Education College Grad1.260.77 to 2.05 Some College1.270.73 to 2.18 High School Grad1.140.75 to 1.73 Less than High School1.00 --- Race/Ethnicity Other1.280.87 to 1.87 White1.00 --- Gender Male1.130.84 to 1.51 Female1.00 --- Outcome: Regular/Not Regular FOBT Screening (n=1878) (Not significant) (p <.01)

12. VariableOR95% CI Log Likelihood Risk1.070.86 to 1.34 Worry1.330.81 to 2.17 Risk x Worry0.880.56 to 1.40 Regular Provider Yes3.642.02 to 6.57 No1.00 --- Health Care Coverage Yes3.151.07 to 9.31 No1.00 --- Age1.061.02 to 1.11 Education College Grad0.810.30 to 2.21 Some College0.910.33 to 2.54 High School Grad2.060.74 to 5.74 Less than High School1.00 --- Race/Ethnicity Other0.730.36 to 1.49 White1.00 --- Outcome: Ever/Never PSA Screening (n=617) (Not significant) (p <.01)

13. Summary Both risk and worry are important predictors of some types of cancer screening Both risk and worry are important predictors of some types of cancer screening Seem to operate independently; no interaction Seem to operate independently; no interaction No curvilinear relationship with worry No curvilinear relationship with worry Do not predict FOBT/PSA screening; why not? Do not predict FOBT/PSA screening; why not?

14. Acknowledgements Kevin Dodd, Ph.D. Kevin Dodd, Ph.D. Lila Finney Rutten, Ph.D., M.P.H. Lila Finney Rutten, Ph.D., M.P.H. Helen Meissner, Ph.D. Helen Meissner, Ph.D.