# Presentation: 753849

## Perceived Ambiguity About Cancer Prevention Recommendations: Relationship to Perceptions of Cancer Preventability and of Cancer 

**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**

## 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.

## 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”

## 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?

## 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

## Analysis

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

## Analysis – Response Variables (separate regression models)

- Perceived cancer 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?”

## 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

## Questions

- Causal direction of relationships
- Theoretical explanations
- Predicted relationships between variables:  moderating, mediating effects

## Ambiguity and Perceived Preventability

- AMBIGUITY

- PERCEIVED RISK

- PERCEIVED
- PREVENTABILITY

- WORRY

- (+)

- (—)

- (+)

## 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

## Worry Moderates the Possible Effect of Ambiguity Upon Perceived Preventability

## 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

## Ambiguity and Worry

- AMBIGUITY

- PERCEIVED RISK

- PERCEIVED
- PREVENTABILITY

- WORRY

- (+)

- (—)

- (+)

## 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

## Perceived Risk Mediates the Possible Effect of Ambiguity Upon Cancer-related Worry

- AMBIGUITY

- PERCEIVED RISK

- WORRY

- p=.03

- 	      p=.23*
- *including perceived risk in the model

- P<.0000

- P=.01

## 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

## Tentative Model

- PERCEIVED
-       RISK

- WORRY

- PERCEIVED
- AMBIGUITY

- PERCEIVED
- PREVENTABILITY

- (+)

- (—)

- (+)

## 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