# Presentation: 670032

## Awareness of National Cancer Information Resources

**Awareness of ****National Cancer Information Resources**

- Linda Squiers, Ph.D.
- Lila Finney Rutten, Ph.D., MPH
- Audie Atienza, Ph.D.
- Mary Anne Bright, R.N., M.N.
- Madeline La Porta, M.S.

## What is the CIS?

- A program of the National Cancer Institute
- A national information and education network with three fully integrated components:
- Information Service
- Partnership Program
- Research Program
- Operated through government contracts with academic institutions, Comprehensive Cancer Centers & Hospitals

## Background of CIS

- Providing service since 1976
- 278,332 contacts to Information Service in 2003
- 90.5% Telephone (n=251,666)
- 4.6%   LiveHelp (n=12,923)
- 2.0%   Smoking Cessation (n=5,565)
- 1.8%   Email (n=5,097)
- 1.1%   Written response (n=3,082)

**Notes:**
Telephone includes recorded messages.  1) IS; 2) POS; 3) smoking; 4) recorded info.

## Gender, Ethnicity & Race of CIS Users Compared to Information Seekers and Population 

| Characteristic | Percent CIS Callers | Percent of Cancer Information Seekers (HINTS) | Percent Population |
| --- | --- | --- | --- |
| FEMALE | 73.8 | 60.0 | 50.9 |
| HISPANIC | 9.6 | 7.3 | 12.5 |
| RACE |  |  |  |
|   White | 82.6 | 82.1 | 75.1 |
|   African American | 11.5 | 10.0 | 12.3 |
|   AI/AN | 1.7 | 2.2 | 0.9 |
|   Asian | 2.5 | 2.8 | 3.6 |
|   NH/PI | 0.4 | 0.6 | 0.1 |
|   Other | NA | NA | 5.5 |
|   Two or more races | 1.3 | 2.3 | 2.4 |

**Notes:**
HINTS: Cancer information seekers (n=3077) are those who said they had ever looked for cancer information or had someone else look for them.
CIS total n = 75,128 for 2003 sampled for demographic.  Question specific n’s are as follows: 70,134 for sex, 63,612 for ethnicity, and 59,581 for race.

## Partnership Program

- Collaborates with trusted organizations to reach minority & medically underserved populations with cancer information
- Participates in cancer control efforts
- 15 regional offices
- Over 70 staff nationwide

**Notes:**
Organizations may be national, state, or regional.

## Consumer-Oriented Health Communication

**Stage 1**
**Health **
**Awareness**
**Building**

**Health Outcomes**
**Beliefs**
**Attitudes**
**Behaviors**
**Knowledge**

**Awareness**
**Communication Sources**
*Formal (e.g. physicians)*
*Informal (e.g. family)*
*Commercial (e.g. media)*

**Stage 2****	**
-  **Information **
**Seeking**

*Perceived*
*information*
*need*

*Person Characteristics*
*Structure Characteristics*
*Channel Characteristics*

**Awareness of National Cancer Information Resources**

- Adapted from Nelson et al. (2004)

**Notes:**
The conceptual framework that guided the selection and development of HINTS survey items, described by Nelson et al. (in press), proposes that health behaviors are nested within a two-stage process of consumer-oriented health communication. Within this two-stage process of health awareness building and health information seeking, health behaviors (such as cancer screening) are influenced by relevant structural, communication source, person, and communication channel characteristics.  

## Research Questions

- Which socio-demographic characteristics are associated with awareness of the CIS or other national cancer information resources?
- Is personal history of cancer associated awareness of the CIS or other national cancer information resources?
- Is “information seeking” associated with awareness of the CIS or other national cancer information resources?

## Independent Variables

**Demographics**
- Gender
- Age
- Ethnicity/race
- Marital status
- Education
- Income
- Employment status
**Cancer History**
- Ever had cancer?

**Health Care Access**
- Health insurance?
- Usual provider?
**Information Seeking**
- Ever looked for cancer information?
- Ever had someone look for cancer information for you?

## Dependent Variables

## Methods

**Created a CIS Composite Measure:**
- Those who had heard of either the CIS or the 1-800-4-CANCER information number
- 25.4% had heard of CIS based on this composite (n=1,120)
- Excluded: Those who said yes to fake organization (n=1,966)

## Analyses

- Cross-tabulation
- Logistic regression

**Sociodemographic**
**Cancer history**
**Access to health care**
**Information seeking**

**Awareness**
** ****- CIS**
** ****- ACS**
** ****- NIH**
** ****- NCI**

**Notes:**
The response patterns among all dependant variables were assessed to determine if responses followed a response set  (e.g., respondents say “yes” to everything.)  Respondents who said “yes” to indicate recognition of all the organizations, including the bogus organization (n=) were eliminated from all analyses. Cross tabulations were conducted to review differences in awareness by different demographic subgroups. Signal detection was used identify different subgroups that are aware and unaware of the Cancer Information Service as well as other national cancer resources.  A signal is a binary outcome and the detection is the set of predictor variables (Kiernan, Kraemer, Winkleby, King, and Taylor, 2001).  Signal detection has been found to be especially useful in exploratory analyses in which predictors are likely to be highly collinear and interactions between independent variables exist (Kiernan, Kramemer, Windleby, King, and Taylor, 2001).  Logistic regression will also be used to examine demographic predictors of awareness of the CIS, 1-800-4-CANCER, and other national cancer resources.

## Results

**Cross-tabulation**
- Logistic regression

**Notes:**
The response patterns among all dependant variables were assessed to determine if responses followed a response set  (e.g., respondents say “yes” to everything.)  Respondents who said “yes” to indicate recognition of all the organizations, including the bogus organization (n=) were eliminated from all analyses. Cross tabulations were conducted to review differences in awareness by different demographic subgroups. Signal detection was used identify different subgroups that are aware and unaware of the Cancer Information Service as well as other national cancer resources.  A signal is a binary outcome and the detection is the set of predictor variables (Kiernan, Kraemer, Winkleby, King, and Taylor, 2001).  Signal detection has been found to be especially useful in exploratory analyses in which predictors are likely to be highly collinear and interactions between independent variables exist (Kiernan, Kramemer, Windleby, King, and Taylor, 2001).  Logistic regression will also be used to examine demographic predictors of awareness of the CIS, 1-800-4-CANCER, and other national cancer resources.

## Awareness of Organizations

**Notes:**
NIH = 57.2%, NCI = 72.2%, CIS = 25.3% and ACS = 95.9%

## Awareness of Organizations by Gender

**Notes:**
CIS:  Females 28.3%, males 22.8%

## Awareness of Organizations by Age

**Notes:**
Differences between age groups were statistically significant for all organizations.  CIS =21.9% 18-34; 26.6% 35-64; 28.3% 65+

## Awareness of Organizations by Race/Ethnicity

**Notes:**
CIS:  Hispanics 41.3%, African Americans 36%, Multiracial and Other 24.2%, and whites 22.3%.

## Awareness of Organizations by Income

**Notes:**
CIS:  37% vs. 25% vs. 19.5%

## Awareness of Organizations by Education

**Notes:**
CIS:  37.1% vs. 29.8% vs. 23.3% vs. 16.7%

## Awareness of Organizations by Rural-Urban Continuum 

**Notes:**
Non metro Rural County = completely rural county or county with less than 2,500 urban population.
CIS: 24.3% vs. 32.1% vs. 29.5%
NIH (p=.09)
Source for code:  2003 Rural Urban continuum county level code from Economic Research Service, USDA

## Awareness of Organization by Regular Health Care Provider

**Notes:**
NCI (p=.0008)

## Awareness of Organizations by Personal Cancer History

**Notes:**
NIH (p =.09)
NCI (p=.08)
CIS:  35% vs. 24.5%

## Awareness of Organizations by Familial Cancer History

**Notes:**
CIS:  25.6% vs. 25.8% vs. 4%
NIH (p=.09)

CIS (not significant)
NCI (p=.002)

## Awareness of Organizations by Health Care Coverage

**Notes:**
CIS: 24.3% vs. 34.9%

## Awareness of Organizations by History of Going On-Line

**Notes:**
CIS: 19.6% vs. 36.5%

## Awareness of Organizations by Ever Looked for Cancer Information

**Notes:**
CIS: 27.7% vs. 23.9%

## Awareness of Organizations by Ever Had Someone Look for Cancer Information for You

**Notes:**
CIS:  33.8% vs. 24.0%

## Other Variables Not Associated with Awareness of CIS

- Self-efficacy in finding cancer information
- Trust in cancer information provided by a health care professional
- Having cable or satellite TV in home
- Attending to health information on all media except TV

**Notes:**
Media channels include:  TV, radio, newspaper, magazines, internet

## Results

- Cross-tabulation
**Logistic regression**

**Notes:**
The response patterns among all dependant variables were assessed to determine if responses followed a response set  (e.g., respondents say “yes” to everything.)  Respondents who said “yes” to indicate recognition of all the organizations, including the bogus organization (n=) were eliminated from all analyses. Cross tabulations were conducted to review differences in awareness by different demographic subgroups. Signal detection was used identify different subgroups that are aware and unaware of the Cancer Information Service as well as other national cancer resources.  A signal is a binary outcome and the detection is the set of predictor variables (Kiernan, Kraemer, Winkleby, King, and Taylor, 2001).  Signal detection has been found to be especially useful in exploratory analyses in which predictors are likely to be highly collinear and interactions between independent variables exist (Kiernan, Kramemer, Windleby, King, and Taylor, 2001).  Logistic regression will also be used to examine demographic predictors of awareness of the CIS, 1-800-4-CANCER, and other national cancer resources.

## Covariates 

| Gender | Health Coverage |
| --- | --- |
| Age | Cancer History |
| Race/Ethnicity | Go on-line |
| Marital Status | Attend to Health Information (Internet) |
| Employment Status | Looked for cancer info |
| Salary | Else looked for cancer info |
| Education | Hours watch TV |
| MSA | Hours listen to radio |

**Notes:**
Outcome/Dependent Variable:  Awareness of CIS

## 						OR		95% CI
Race/Ethnicity
  Non-Hispanic/White			1.00		1.00-1.00
  Hispanic				2.15		1.47-3.14
  Non-Hispanic Black/AA		1.85		1.30-2.65
  Non-Hispanic Other/Multiple		1.21		0.73-2.00
Education
  <HS					1.00		1.00-1.00
  HS						0.99		0.74-1.34
  Some college				0.87		0.59-1.29
  College graduate			0.66		0.45-0.97

- <date/time>

- _	__	__	__	__	__	__OR__	__	__95% CI_
**Race/Ethnicity**
-   Non-Hispanic/White			1.00		1.00-1.00
-   Hispanic				**2.15****	****	****1.47-3.14**
-   Non-Hispanic Black/AA		**1.85****	****	****1.30-2.65**
-   Non-Hispanic Other/Multiple		1.21		0.73-2.00
**Education**
-   <HS					1.00		1.00-1.00
-   HS						0.99		0.74-1.34
-   Some college				0.87		0.59-1.29
-   College graduate			**0.66****	****	****0.45-0.97**

- Aware of CIS

- Overall Model:  Adjusted Wald F=22.62, df=28, p=.00001

## 						OR		95% CI
MSA
  County in metro area			1.00		1.00-1.00
  Non-metro county w/ urban pop.		1.41		1.02-1.96
  Non-metro county, rural or <25,000
	urban				1.30		0.60-2.83
Cancer history
   Yes					1.00		1.00-1.00
   No						0.67		0.46-0.99

**MSA**
-   County in metro area			1.00		1.00-1.00
-   Non-metro county w/ urban pop.		**1.41****	****	****1.02-1.96**
-   Non-metro county, rural or <25,000
- 	urban				1.30		0.60-2.83
**Cancer history**
**   **Yes					1.00		1.00-1.00
**   **No		**	****	****	****	****0.67****	****	****0.46-0.99**

- Aware of CIS

## 						OR		95% CI
Go Online 
  Yes					1.00		1.00-1.00
  No						1.96		1.53-2.53
Attend to Information on Internet
  No						1.00
  Yes					1.96		1.53 – 2.53
Ever Looked for Cancer Info
  Yes					1.00		1.00-1.00
  No						0.76		0.59-0.99
Anyone Else Looked for Cancer Info
  Yes					1.00		1.00-1.00
  No						0.61		0.46-0.82

**Go Online **
-   Yes					1.00		1.00-1.00
-   No						**1.96****	****	****1.53-2.53**
**Attend to Information on Internet**
**  **No						1.00
-   Yes				**	****1.96****	****	****1.53 – 2.53**
**Ever Looked for Cancer Info**
-   Yes					1.00		1.00-1.00
-   No						**0.76****	****	****0.59-0.99**
**Anyone Else Looked for Cancer Info**
-   Yes					1.00		1.00-1.00
-   No						**0.61****	****	****0.46-0.82**

- Aware of CIS

**Notes:**
Attend to Information on the Internet:  Yes = those that said “a lot, some, or a little”.  No = those that said “not at all”.

## 						OR		95% CI
Gender
  Male					1.00		1.00-1.00
  Female					0.70		0.59-0.83
Race/Ethnicity
  Non-Hispanic/White			1.00		1.00-1.00
  Hispanic				0.61		0.44-0.84
  Non-Hispanic Black/AA			0.67		0.49-0.93
  Non-Hispanic Other/Multiple		0.52		0.34-0.80
Age
  18-34					1.00		1.00-1.00
  35-64					1.67		1.33-2.08
  65+					1.44		1.00-2.09

**Gender**
**  **Male					1.00		1.00-1.00
**  **Female**	****	****	****	****	****0.70****	****	****0.59-0.83**
**Race/Ethnicity**
-   Non-Hispanic/White			1.00		1.00-1.00
-   Hispanic				**0.61****	****	****0.44-0.84**
-   Non-Hispanic Black/AA			**0.67****	****	****0.49-0.93**
-   Non-Hispanic Other/Multiple		**0.52****	****	****0.34-0.80**
**Age**
-   18-34					1.00		1.00-1.00
-   35-64				**	****1.67****	****	****1.33-2.08**
-   65+	**	****	****	****	**1.44		1.00-2.09

- Aware of NIH

*Overall Model:  Adjusted Wald F=21.68, df=28, p=.00001*

## 						OR		95% CI
Employment Status
  Employed				1.00		1.00-1.00
  Out of work				0.87		0.54-1.41
  Retired, student, homemaker		0.90		0.72-1.12
  Unable to work			0.61		0.39-0.96
Education level
  <HS					1.00		1.00-1.00
  HS						0.88		0.63-1.23
  Some college				1.37		0.98-1.93
  College graduate			2.53		1.72-3.70

**Employment Status**
-   Employed				1.00		1.00-1.00
-   Out of work				0.87		0.54-1.41
-   Retired, student, homemaker		0.90		0.72-1.12
-   Unable to work			**0.61****	****	****0.39-0.96**
**Education level**
-   <HS					1.00		1.00-1.00
-   HS						0.88		0.63-1.23
-   Some college				1.37		0.98-1.93
-   College graduate			**2.53****	****	****1.72-3.70**

- Aware of NIH

## Aware of NIH

- _	__	__	__	__	__	__OR__	__	__95% CI_
**Attend to health information on Internet**
**  **No					1.00		1.00-1.00
-   Yes					**1.36****	****	****1.07-1.72**
**Ever looked for cancer info****	****	**
-   Yes					1.00		1.00-1.00
-   No					**0.76****	****	****0.61-0.94**

## 						OR		95% CI
Race/Ethnicity
  Non-Hispanic/White			1.00		1.00-1.00
  Hispanic				0.71		0.52-0.97
  Non-Hispanic Black/AA		1.18		0.82-1.70
  Non-Hispanic Other/Multiple		0.66		0.41-1.06
Age
  18-34					1.00		1.00-1.00
  35-64					1.41		1.07-1.86
   65+					1.21		0.77-1.89

**Race/Ethnicity**
-   Non-Hispanic/White			1.00		1.00-1.00
-   Hispanic				**0.71****	****	****0.52-0.97**
-   Non-Hispanic Black/AA		1.18		0.82-1.70
-   Non-Hispanic Other/Multiple		0.66		0.41-1.06
**Age**
-   18-34					1.00		1.00-1.00
-   35-64				**	****1.41****	****	****1.07-1.86**
-    65+	**	****	****	****	**1.21		0.77-1.89

- Aware of NCI

*Overall Model:  Adjusted Wald F=14.76, df=28, p=.00001*

## 						OR		95% CI
Employment Status
  Employed				1.00		1.00-1.00
  Out of work				0.54		0.33-0.88
  Retired, student, homemaker		0.89		0.71-1.12
  Unable to work				0.82		0.53-1.27

Ever Looked For Cancer Info.
  Yes					1.00		1.00-1.00
  No						0.69		0.56-0.85
Anyone Else Looked for Cancer Info.	
  Yes					1.00		1.00-1.00
  No						0.74		0.56-0.99

**Employment Status**
-   Employed				1.00		1.00-1.00
-   Out of work				**0.54****	****	****0.33-0.88**
-   Retired, student, homemaker		0.89		0.71-1.12
-   Unable to work				0.82		0.53-1.27
**Ever Looked For Cancer Info.**
**  **Yes					1.00		1.00-1.00
**  **No	**	****	****	****	****	****0.69****	****	****0.56-0.85**
**Anyone Else Looked for Cancer Info.****	**
-   Yes					1.00		1.00-1.00
-   No						**0.74****	****	****0.56-0.99**

- Aware of NCI

## 						OR		95% CI
Race/Ethnicity
  Non-Hispanic/White			1.00		1.00-1.00
  Hispanic				0.10		0.10-0.35
  Non-Hispanic Black/AA		0.82		0.30-2.23
  Non-Hispanic Other/Multiple		0.53		0.15-1.89
Employment Status
  Employed				1.00		1.00-1.00
  Out of work				0.84		0.26-2.69
  Retired, student, homemaker		0.40		0.18-0.86
  Unable to work			0.49		0.14-1.72

**Race/Ethnicity**
-   Non-Hispanic/White			1.00		1.00-1.00
-   Hispanic				**0.10****	****	****0.10-0.35**
-   Non-Hispanic Black/AA		0.82		0.30-2.23
-   Non-Hispanic Other/Multiple		0.53		0.15-1.89
**Employment Status**
-   Employed				1.00		1.00-1.00
-   Out of work				0.84		0.26-2.69
-   Retired, student, homemaker		**0.40****	****	****0.18-0.86**
-   Unable to work			**0.49****	****	****0.14-1.72**

- Aware of ACS

*Overall Model:  Adjusted Wald F=19.12, df=28, p=.00001*

## Summary

- Compared to Whites, **Hispanics** were more likely to be aware of CIS and less likely to be aware of each of the other organizations
**African Americans** were more likely than Whites to be aware of CIS and less likely than Whites to be aware of NIH
- “**Other**” or **Multiracial** were less likely than Whites to be aware of NIH

## Summary

- Compared to respondents <34 years of age:
- Respondents 35-64 were:
- more likely to be aware of NCI
- more likely to be aware of NIH
- Respondents 65+ were:
- more likely to be aware of NIH

## Summary

- Respondents who **never went on-line **were** **more likely to be aware of CIS
- Respondents who **attend to information on the Internet **were** **more likely to be aware of NIH
- Respondents who **never looked for cancer information **were less likely to be aware of CIS, NCI & NIH
- Respondents who **never had someone else look for cancer information **were less likely to be aware of CIS & NCI

## Summary:  Awareness of CIS

**INCREASE the odds:**
- Hispanic
- African American
- Non-metro county w/ urban pop.
- Never going on-line
- Attending to health information on the Internet
**DECREASE the odds:**
- No history of cancer
- College graduate
- Never looking for cancer info
- No one else looking for cancer info

## Interpretation?

- CIS needs to improve awareness of its services
- CIS may be doing a better job at reaching:
- some minority groups
- the uninsured
- those who do not use the Internet
- those in non-metropolitan areas with urban populations

## Next Steps for the CIS

**Promotion of the CIS**
- Stronger association with NCI “brand”
- Messages designed to promote “use” to Hispanics and African Americans
- Identify barriers to use
- Promote to/partner with providers
- Preferred source for cancer information
- CIS can aid patient-provider interactions
**HINTS II**
- Measure use of the CIS and
- Measure reasons for not using
- Continue to track trends in awareness over time