# Presentation: 245488

## The impact of health information overload on attention to information and cancer risk reduction behavior

**Andrea D. Gurmankin, Ph.D.**
- Dana-Farber Cancer Institute
- Harvard School of Public Health
**Vish Viswanath, Ph.D.**
- Dana-Farber Cancer Institute
- Harvard School of Public Health

## Aspirin Is Seen As Preventing Breast Tumors 
PERSONAL HEALTH; Another Study Finds a Link Between Excess Weight and Cancer 
Vitamin E Found to Cut Cancer Risk For Prostate
Lean Diet in Childhood May Cut Risk of Cancer 
Studies Confirm Relationship Of Alcohol to Breast Cancer    

- _[Aspirin Is Seen As Preventing Breast Tumors](http://query.nytimes.com/gst/health/article-page.html?res=9D0DEEDA153EF935A15756C0A9629C8B63&n=Top%2FNews%2FHealth%2FTopics%2FCancer)__[ ](http://query.nytimes.com/gst/health/article-page.html?res=9D0DEEDA153EF935A15756C0A9629C8B63&n=Top%2FNews%2FHealth%2FTopics%2FCancer)_
**PERSONAL HEALTH; Another Study Finds a Link Between Excess Weight and Cancer**
**Vitamin E Found to Cut Cancer Risk For Prostate**
**Lean Diet in Childhood May Cut Risk of Cancer**
**Studies Confirm Relationship Of Alcohol to Breast Cancer**  _[ ](http://query.nytimes.com/gst/health/article-page.html?res=9406E5DF1330F935A15750C0A9629C8B63&n=Top%2FNews%2FHealth%2FTopics%2FCancer)__ _

## 
Google search of “cancer risk” yielded 12.8 million links
In the past 3 yrs, CNN, ABC, NBC and CBS have done 472 stories on cancer (does not include local news stories or morning/afternoon newscasts)
Lexis Nexis search for “cancer risk” in last month in NY news sources generated articles on association between cancer and: 
Folate
Family history
Nicotine
Alcohol
PCBs (polychlorinated biphenyls)
Hormone therapy
Vaccine for HPV
Exposure to asbestos
Onions and shallots (phenolics and flavonoids)

- Google search of “cancer risk” yielded 12.8 million links
- In the past 3 yrs, CNN, ABC, NBC and CBS have done 472 stories on cancer (does not include local news stories or morning/afternoon newscasts)
- Lexis Nexis search for “cancer risk” in last month in NY news sources generated articles on association between cancer and:
- Folate
- Family history
- Nicotine
- Alcohol
- PCBs (polychlorinated biphenyls)
- Hormone therapy
- Vaccine for HPV
- Exposure to asbestos
- Onions and shallots (phenolics and flavonoids)

**Notes:**
It, seems that nearly every time we open the newspaper or switch on the news these days, a story about health issues, and specifically, about cancer appears. Add to that the vast and increasing amounts of health information on the internet and you have what amounts to an unbelievable number of health news stories.  Just to give you a sense of the magnitude of this-
A google search of cancer risk yielded 12.8 million links. 
In the past 3 years, the 4 major networks have done 472 stories on cancer in their evening broadcasts alone!
A lexis nexis search of cancer risk in NY news sources in the past month generated articles on the association between cancer and all of these risks. 

## Benefit of increased health information in media

**Exposure to cancer risk info**

**Increase in knowledge, awareness, empowerment**

**Increase in preventive health behavior**

**Notes:**
Now, without question, there is great benefit to the increase in health information disseminated in the media. Exposure to this information facilitates people’s awareness and knowledge. This of course can then increase preventive health behavior, which we all know is underutilized but very effective way to reduce the burden of disease.

## Information presented on many causes of cancer and potential cancer risk reduction behaviors
Evidence is inconclusive for many causes and preventive behaviors
Contradictory recommendations:
Pro apples: recommendation for 5 a day (now 9?)
	Anti apples: pesticides
Anti fat: causes heart disease
	Pro fat: red meat (despite the fat) is better than carbs
Overwhelming: amount and demand on layperson to make sense of it all

- Information presented on **many** causes of cancer and potential cancer risk reduction behaviors
- Evidence is** inconclusive** for many causes and preventive behaviors
**Contradictory** recommendations:
- Pro apples: recommendation for 5 a day (now 9?)
- 	Anti apples: pesticides
- Anti fat: causes heart disease
- 	Pro fat: red meat (despite the fat) is better than carbs
*Overwhelming: amount and demand on layperson to make sense of it all*

**Notes:**
The problem here is that all of this information- all of these websites, all of these news stories and the increasing numbers of them, might lead to information overload and confusion

The different media sources present information on MANY different causes of cancer and potential risk reduction behaviors.  The evidence that they discuss is often inconclusive and sometimes even contradictory.  One report may highlights the value of apples, consistent with the 5 a day recommendation for fruits and vegetables. Another broadcast may warn about pesticides on your fruit. 
So all of this information may be overwhelming both because of the amount and the extent to which it places considerable demand on the layperson to make sense of it all.

## 
“The public is now suffering from a serious case of information overload...The changes in health communications [every minor development being broadcast] have added up to massive public confusion about the causes of cancer and how cancer might be prevented or treated.”
Jane Brody from NY Times in JNCI Monographs 1999

- “*The public is now suffering from a serious case of information overload...The changes in health communications [every minor development being broadcast] have added up to massive public confusion about the causes of cancer and how cancer might be prevented or treated*.”
- Jane Brody from NY Times in JNCI Monographs 1999

**Notes:**
Jane Brody of the NY Times summarizes this well:

## Slide 7

**Notes:**
This cartoon also displays this problem very nicely-
The anchorman spins the wheels to decide what the medical report says today- what seemingly risk factor causes what disease in whom?  Now, cartoons are often reflections of public opinion and our concern here is the extent to which the public thinks of media health reports this way – so numerous and contradictory that they seem almost random and therefore, not worthy of attention.

## Possible unintended consequence

**Exposure to cancer risk info**

**Overwhelmed/ confused/ fatalistic**

**Increase in knowledge, awareness, empowerment**

**Information avoidance / less preventive behavior**

**Increase in preventive behavior**

**x**

**x**

**Notes:**
Specifically, we are concerned that exposure to all this cancer information in the media might not increase preventive health behavior through increased awareness, rather it may decrease attention to this information and behavior by making people feel overwhelmed and almost fatalistic about cancer risk. 

## How much attention is paid? 
What is the person’s ability to process the information?
If have difficulty processing:
 may ignore and be shielded from becoming overwhelmed
 or may become even more overwhelmed
What is personal experience?
May override media effects
E.g. “My dad smoked for 50 years and never got cancer.”
E.g. “My grandmother did everything right and still got cancer.”

- How much attention is paid?
- What is the person’s ability to process the information?
- If have difficulty processing:
-  may ignore and be shielded from becoming overwhelmed
-  or may become even more overwhelmed
- What is personal experience?
- May override media effects
- E.g. “My dad smoked for 50 years and never got cancer.”
- E.g. “My grandmother did everything right and still got cancer.”

**Notes:**
Now it’s important to note that this issue may differentially impact certain groups.  How much attention you pay to health news will certainly impact the extent to which you get overwhelmed by it. Your ability to process the information will have an effect too- if you have difficulty processing the information, you may ignore it and be shielded from becoming overwhelmed or you might be susceptible to becoming even more overwhelmed. Finally, your personal experiences may override what you hear about in the media. If you wathced your grandmother do everything right her whole life and she still got cancer, you may disregard what you hear on the news about risk reduction strategies.

## Majority of Latinas expressed feeling lack of control over cancer prevention (Carpenter & Colwell 1995)
Minorities (Latinas, African-Americans) more fatalistic about risk than Caucasians (Powe 1995)
Latinas (but not Anglo) women who believed that “there’s nothing one can do to prevent cervical cancer” were less likely to have had Pap smear (Chavez et al 1997)
Fatalistic beliefs significantly increase with nonadherence to colorectal screening (Powe 1995)

- Majority of Latinas expressed feeling lack of control over cancer prevention (Carpenter & Colwell 1995)
- Minorities (Latinas, African-Americans) more fatalistic about risk than Caucasians (Powe 1995)
- Latinas (but not Anglo) women who believed that “there’s nothing one can do to prevent cervical cancer” were less likely to have had Pap smear (Chavez et al 1997)
- Fatalistic beliefs significantly increase with nonadherence to colorectal screening (Powe 1995)

**Notes:**
So what do we know at this point? Minorities express these fatalistic feelings about cancer prevention and risk more than caucasians and there is a little bit of evidence showing that these beliefs are associated with nonadherence to cancer screening guidelines- which again, is our concern.

## To examine information overload and fatalistic beliefs about cancer risk in the general public
Individual differences (selectivity in media effects)
Whether endorsement of these beliefs is associated with 
Greater health information avoidance 
Decreased trust of health information in media
Less healthy behavior
Less cancer screening

- To examine information overload and fatalistic beliefs about cancer risk in the general public
- Individual differences (selectivity in media effects)
- Whether endorsement of these beliefs is associated with
- Greater health information avoidance
- Decreased trust of health information in media
- Less healthy behavior
- Less cancer screening

**Notes:**
So our objective was to examine feelings of information overload and fatalism about cancer risk, the individual differences in these beliefs and whether they are stronger in those who avoid health information in the media, those who trust this information less, and those who engage in less healthy behavior and less cancer screening.

## HINTS I data
All subjects (N=6,369) included in analyses of 
attention to health news
trust in cancer risk information in media
preventive health behaviors (e.g., exercise)
Subjects aged ≥50 yrs (N=2,760) included in analyses of cancer screening behavior
Gender appropriate (e.g., only males for PSA test)

- HINTS I data
- All subjects (N=6,369) included in analyses of
- attention to health news
- trust in cancer risk information in media
- preventive health behaviors (e.g., exercise)
- Subjects aged ≥50 yrs (N=2,760) included in analyses of cancer screening behavior
- Gender appropriate (e.g., only males for PSA test)

**Notes:**
We of course used the HINTS sample, the full sample for analyses of attention to health news, trust in cancer risk information in the media and preventive health behaviors. We used gender-appropriate subjects over the age of 50 to examine adherence to cancer screening.

## “It seems like almost everything causes cancer”
“There’s not much people can do to lower their chances of getting cancer”
“There are so many different recommendations about preventing cancer, it’s hard to know which ones to follow.” 

- “*It seems like almost everything causes cancer*”
- “*There’s not much people can do to lower their chances of getting cancer*”
- “*There are so many different recommendations about preventing cancer, it’s hard to know which ones to follow*.”

## Attention to health news
Average of attention to health news in media sources
Trust in cancer risk information
Average of trust in cancer risk information in media sources
Health behaviors (yes/no)
Smoker
Plan to quit smoking 
Exercise in past month
Work up a sweat exercising at least once a week
Cancer screening (ever had / never had)
Colon screening (FOBT, colonoscopy or sigmoidoscopy)
Pap smear
Mammogram
PSA test

- Attention to health news
- Average of attention to health news in media sources
- Trust in cancer risk information
- Average of trust in cancer risk information in media sources
- Health behaviors (yes/no)
- Smoker
- Plan to quit smoking
- Exercise in past month
- Work up a sweat exercising at least once a week
- Cancer screening (ever had / never had)
- Colon screening (FOBT, colonoscopy or sigmoidoscopy)
- Pap smear
- Mammogram
- PSA test

## Prevalence of these beliefs

|  | % strongly agreed or agreed |
| --- | --- |
| “It seems like almost everything causes cancer” | 46 |
| “There’s not much people can do to lower their chances of getting cancer” | 27 |
| “There are so many different recommendations about preventing cancer, it’s hard to know which ones to follow.” | 
71 |

## Individual differences

|  | Agreement with... |  |  |
| --- | --- | --- | --- |
|  | “Everything causes cancer” | “Not much can do to lower chances” | “Too many recommendations” |
| Education | ↑ with less edu | ↑ with less edu | ↑ with less edu |
| Gender | Females > males | NS | NS |
| Race | Blacks > Whites
Spanish speaking Hispanics > Whites | Blacks > Whites
Spanish speaking Hispanics > Blacks, Whites
English speaking Hispanics > Whites | NS |

**Notes:**
We found that there are some individual differences in agreement with these statements.  Those with less education more strongly agree with these statements. Females more strongly agree than males that everything causes cancer.  Blacks compared to whites and Hispanics compared to Whites more strongly agree that everything causes cancer and there’s not much you can do to lower your chances of getting cancer. 

## “It seems like almost everything causes cancer” stronger in those who:
did not exercise in past month (p<.0001)
do not work up a sweat exercising at least once/week (p=.003)
never got screened for colon cancer (p=.050)

- “*It seems like almost everything causes cancer*” stronger in those who:
- did not exercise in past month (p<.0001)
- do not work up a sweat exercising at least once/week (p=.003)
- never got screened for colon cancer (p=.050)

**Notes:**
The belief that everything seems to cause cancer is stronger in those who have never been screened for colon cancer and who don’t exercise.

## “Not much can do to lower chances” stronger in those who:
Pay less attention to health news (p<.0001)
Less trusting of health news (p<.0001)
Smoke (p=.034)
Smokers who do not plan to quit (p<.0001)
Did not exercise in past month (p<.0001)
Do not work up a sweat exercising at least once/week (p<.0001)
Never had a pap smear (p<.0001)
Never had a mammogram (p=.027)

- “*Not much can do to lower chances*” stronger in those who:
- Pay less attention to health news (p<.0001)
- Less trusting of health news (p<.0001)
- Smoke (p=.034)
- Smokers who do not plan to quit (p<.0001)
- Did not exercise in past month (p<.0001)
- Do not work up a sweat exercising at least once/week (p<.0001)
- Never had a pap smear (p<.0001)
- Never had a mammogram (p=.027)

**Notes:**
The belief that there’s not much you can do to lower your chances of getting cancer is stronger in those who pay less attention to health news, who are less trusting of health news, those who smoke and don’t plan to quit, those who don’t exercise, and those who have never had a pap smear or mammogram.

## “Too many recommendations” stronger in those who:
Pay less attention to health news (p=.040)
Less trusting of health news (p.008)
Smoke (p<.0001)
Did not exercise in past month (p<.0001)
Do not work up a sweat exercising at least once/week (p<.0001)
Never had colon cancer screening (p=.039)

- “*Too many recommendations*” stronger in those who:
- Pay less attention to health news (p=.040)
- Less trusting of health news (p.008)
- Smoke (p<.0001)
- Did not exercise in past month (p<.0001)
- Do not work up a sweat exercising at least once/week (p<.0001)
- Never had colon cancer screening (p=.039)

**Notes:**
Finally, the belief that there are so many recommendations, it’s difficult to know which ones to follow are stronger in those who pay less attention to health news, who are less trusting of health news, who smoke, don’t exercise and never had colon screening.

## Feelings of information overload/fatalism regarding cancer risk are prevalent
Individual differences in beliefs:
Stronger in minorities with less education  
Those who more strongly endorse these beliefs: 
Pay less attention to health news
May miss important new information
Less trusting of health news
May not believe important, credible information
Less likely to engage in cancer risk reduction and screening behaviors
Places them at higher cancer risk (and other risks)

- Feelings of information overload/fatalism regarding cancer risk are prevalent
- Individual differences in beliefs:
- Stronger in minorities with less education
- Those who more strongly endorse these beliefs:
- Pay less attention to health news
- May miss important new information
- Less trusting of health news
- May not believe important, credible information
- Less likely to engage in cancer risk reduction and screening behaviors
- Places them at higher cancer risk (and other risks)

**Notes:**
What we found is that these feelings of information overload and fatalism are prevalent in the general population, they are stronger in minorities and those with less education and stronger endorsement of these beliefs is associated with less attention of health news, which may mean they miss important new information and less trust of health news, which may mean they don’t believe important, credible information.  And those who endorse these beliefs are less likely to engage in cancer risk reduction and screening behavior, placing them at higher risk of cancer and other disease.

## Exposure to cancer risk information

**Exposure to cancer risk information**

**Overwhelmed/ confused/ fatalistic**

**Less attention to health information**

**Less trust in health information **

**Less adherence to cancer screening guidelines**

**Less healthy behavior**

**Notes:**
So this is the model that we are talking about. 

## Reverse pathway is possible

**Exposure to cancer risk information**

**Overwhelmed/ fatalistic/ helpless**

**Less attention to health information**

**Less trust in health information **

**Less adherence to cancer screening guidelines**

**Less healthy behavior**

**Reverse pathway is possible**

**Notes:**
But of course the reverse pathway here is possible- it may also be that subjects were engaging in post-hoc rationalization of their lack of attention to health information and poor health behavior and adherence to cancer screening guidelines by endorsing the beliefs that there’s nothing they can do to reduce their risk of cancer, etc..  So it is entirely possible that the reverse pathway is at play here and in all likelihood both pathways are at play- this is likely a bidirectional relationship. In fututre work, it would be great to tease this apart. 

## Suggests need for regular summaries and updates released by professional organizations to media for dissemination to the public
To consolidate and organize cancer risk information for the public
Resolve inconsistencies
Facilitate appropriate conclusions from data
To update public on what is known

- Suggests need for regular summaries and updates released by professional organizations to media for dissemination to the public
- To consolidate and organize cancer risk information for the public
- Resolve inconsistencies
- Facilitate appropriate conclusions from data
- To update public on what is known

**Notes:**
Nevertheless, these results suggest the need for regular summaries and updates generated and released by professional organizations for dissemination to the public.not just on obscure academic websites but also on the 5:00 news. This would help to organize the information for laypeople (and the media) to resolve inconsistencies, facilitate appropriate conclusions and keep the public up to date.