# Presentation: 549408

## Cancer scanning and seeking is associated with knowledge, lifestyle choices andscreening behavior

- Minsun Shim, MA
- Bridget Kelly, MPH
- Robert C. Hornik, PhD
- Center of Excellence in Cancer Communication Research
- Annenberg School for Communication
- University of Pennsylvania

## Background

- Previous research on cancer information seeking has focused on active information seeking (i.e., calls to the Cancer Information Service).
- There have been some findings linking seeking with cancer decision-making (Baker, 2003; Czaja, Manfredi & Price, 2003).
- These studies exclude information gathered incidentally from sources in the environment.

**Notes:**
Today we've heard a number of presentations about how information impacts cancer decision making. 
Some of these studies have investigated information needs, quality of information and preference for certain types of sources.
 Most of these papers--and much of the literature so far--has focused on active information seeking.

## Information scanning

- Information gathered incidentally from sources in the environment.
- Examples:
- -a television program which is on while someone is engaged in another activity
- -an article one comes across through routine use of the newspaper

**Notes:**
We believe there is another very important type of information gathering which may affect cancer-related decisions. That is a construct we call scanning. Scanning, as we define it, is information gathered as part of routine media use--or in the normal flow of expostuer to mass media. Some examples might include a health segment you hear while watching the news or an article you happen across while reading the paper. 
It is our belief that both seeking and scanning may influence decision making. In this paper, we attempt to create a typology of scanning and seekimh and to classify people as to how they engage in both. 

## Research questions

- What patterns are found in individuals’ cancer scanning and seeking behavior?
- How does cancer SSB differ depending on individual characteristics?
- How is cancer SSB associated with knowledge about cancer?
- How is cancer SSB associated with lifestyle and screening behavior?

**Notes:**
Our research questions are as follows:

1. What patterns are found in indivs' scanning and seeking behavior

insert 2 through 4

Minsun will now describe the methods we used to answer these questions, as well as our results. 

## Methods

- Data: 2003 HINTS, RDD (N=6,369)
- Measurement
*   *-* Information Scanning. “*How much attention do you pay to information about health or medical topics on...:”
-    - *Information Seeking.  *Looking for cancer information within the last year.
*   **- Information Scanning and Seeking Behavior (SSB)*.  A typology of:  “Low Scan-No Seek,” “Low Scan-Seek,” “High Scan-No Seek” and “High Scan-Seek.”

**Notes:**
To answer to the research questions just explained, we analyzed the data from the 2003 Health Information National Trends Survey.

So, here are the measurements that we constructed from the questionnaire.

We categorized SSB into 4 types according to two dimension of information scanning and information seeking. These two were constructed from items about attention paid to health-related information and those about seeking behaviors of cancer information within the last year, respectively.

## Methods (cont.)

-    -* Individual Characteristics.  *Health status, the cancer history of respondents and family members, and socio-demographic characteristics (age, gender, race/ethnicity, education and marital status)
-    - *Knowledge about cancer.  *11 items including the impact of several risk factors for cancer, as well as knowledge about recommended daily allowances for fruit and awareness of specific screening tests.
-    - *Lifestyle Behavior.* Smoking, eating fruits and vegetables, and exercising.
-    - *Screening Behavior. *Colonoscopy, PSA, and mammogram

**Notes:**
And, items about various individual characteristics were also included in the analysis.

And, three variables were measured for health outcomes, which are knowledge about cancer, lifestyle behaviors, and cancer screening behaviors. 11 relevant items were selected to measure knowledge. Lifestyle behaviors measured included smoking, eating fruits and vegetables, and exercising. Screening behaviors included getting colonoscopy, PSA, and mammogram.   

## Results

**Socio-demographics**
- -**Gender:** 60% female
- -**Race/Ethnicity:** 67% non-Hispanic White,
-   12% Hispanic, 11% non-Hispanic Black
- -**Age:** 26% 18-34, 21% 35-44, 19% 45-54, 24% 55-74, 9% over 75.
- -**Education:** 31% four or more years of college, 27% some college, 30% high school degree or GED, 12% less than a high school degree.
- -**Marital status:** 53% married

**Notes:**
These were the socio-demographics of the sample, which you are already familiar to.

## Results (cont.)Cancer Information SSB

- (Gamma=.447,* p*<.001)

|  |  | Information Scanning  |  |
| --- | --- | --- | --- |
|  |  | Low Scan | High Scan |
| 
Information 
Seeking  | No Seek | 40.6%
(n=2,556)  | 30.4%
(n=1,913) |
|  | Seek | 9.8%
(n=617)  | 19.2 %
(n=1,207)  |

**Notes:**
Note: These percentages are of the total 6,293 valid data points, which is why they don’t sum to 100 across rows or down columns.

This table shows the patterns in individuals’ cancer information seeking and scanning behavior. 
There was a positive association between scanning and seeking, but individuals occupied all four quadrants of this SSB typology. As you can see, the low scan-no seekers occupied the largest cell (41%), and the smallest subgroup was that of low scan-seekers.

## Family history of cancer and SSB

- Those who had a family member with cancer experience were more likely to be scanners (OR= 1.14, 95% CI = 1.06-1.22) as well as seekers (OR= 1.85, 95% CI=1.63-2.09) according to logistic regression.
- Note: 62.9% of the total sample had had cancer patients among their family members.
*N= 6,298.*

**Notes:**
Several of the individual characteristics were found to be associated with this typology of SSB. 
First, [those who had a family member with cancer experience were more likely to be scanners as well as seekers].

The y-axis here implies the percentage of people who had a family member with a cancer history in each group.

## Gender and SSB

- Gender had a statistically significant association both with information scanning and with seeking (OR= 1.58, 95% CI= 1.48-1.70 and OR= 1.51, 95% CI=1.34-1.71, according to logistic regression).
- Note: 60.4% of the total sample was female.
*N= 6,359.*

**Notes:**
And, [gender had a statistically significant association both with information scanning and with seeking]. That is, females were more likely to pay attention to health information on media as well as to seek health-related information.

## Marital status and SSB

- Respondents’ marital status had a statistically significant association with cancer information scanning (OR= 1.44, 95% CI=1.18-1.77, according to logistic regression). Interestingly, an interaction of seeking and scanning is significant at *p*< .05.
- Note: 52.8 % of the sample was married.
*N= 6,126.*

**Notes:**
[Respondents’ marital status had a statistically significant association with cancer information scanning]. 

Interestingly, an interaction of seeking and scanning was significant. As shown in the graph, the patterns of the association between marital status and seeking were about the opposite in each group of low scanners and high scanners.  

## SSB and Cancer Knowledge 

- According to OLS multiple regression, both information scanning and seeking were positively associated with knowledge about cancer (**= .175, *p* <. 001 and **= .092, *p*< .001). Moreover, scanning and seeking had a negative interaction in their effects on knowledge about cancer        (**= -.041, *p*< .001).

- Note: Values are the mean of predicted values of cancer knowledge. Among the total sample, the mean was 7.27.

**Notes:**
The following slides are about the associations between SSB and its health outcomes.
[First, we conducted multiple regression and found both information scanning and seeking were positively associated with knowledge about cancer. Moreover, scanning and seeking had a negative interaction in their effects on knowledge about cancer.] This negative interaction implies that higher scanners tended to have much more knowledge about cancer, especially among non-seekers than among seekers. 

## SSB and Lifestyle Behavior 

- Respondents who paid more attention to health media were more likely to behave in healthy ways (**=.094, *p*<.001).* *Those who sought information for themselves were more likely to adopt healthy lifestyles* (***=.065, *p*<.001). No interaction between seeking and scanning.

- Note: Values are the mean of predicted values for 3 lifestyle behaviors. Among the total sample, the mean was 1.44.

**Notes:**
[Respondents who paid more attention to health media were more likely to behave in healthy ways. Those who sought information for themselves were more likely to adopt healthy lifestyles]. But, [no interaction between seeking and scanning was found here.]

## SSB and Screening Behavior 

- Both scanning and seeking were positively associated with colonoscopy
- Scanning, but not seeking, was associated with mammogram
-  Scanning and seeking were associated with PSA and there was a negative interaction between them

**Notes:**
Note: Values are 100 multiplied by the mean of predicted values. The mean of these values among all people was 21.3, 72.3, and 33.5, respectively.  

Lastly, the associations between SSB and screening behaviors are shown in these three graphs. 
[Both scanning and seeking were positively associated with getting colonoscopy].  
However, [scanning, but not seeking, was associated with getting mammograms].
[Scanning and seeking were associated with getting PSA tests and there was an interaction between them]. As you can see in the graph, scanning was strongly related to getting a PSA test among non-seekers, but not among seekers.

And now let’s move on to discussion.

## Discussion

- Scanning and seeking are distinct behaviors, often having different associations with demographics or outcome behaviors.
- Both scanning and seeking were positively associated with cancer knowledge.
- Both those who scanned and sought were more likely to engage in the healthy lifestyle behaviors.
- Those who did more scanning, were more likely to get screened.

**Notes:**
From these results, we conclude that scannning and seeking are separate behaviors which in some cases have different associations with demographics or outcomes. 

Both associated with cancer knowledge. Perhaps most interesting here was that the level of knowledge of seekers and scanners whi did not do the other behavior was about the same. 

Lifestyle behaviors were also associated with both scanning and seeking. 

And both scanning and seeking predicted cancer screening.
For all three cancers, those who did more scanning were more likely to be screened.

## Discussion (cont.)

- For PSA and colonoscopy (but not for mammograms), seeking was also associated with screening.
- For PSA, there was an interaction between scanning and seeking. Men who reported no information seeking were influenced by scanning while for those who were seekers, scanning had no predictive value.

**Notes:**
For PSA and colonoscopy, those who sought were more likely to screen. One possible explanation is that this cancer receives so much attention in the media, that active information seeking does not provide much additional information beyond that which can be obtained through the normal flow of information.
Another interesting  interaction between scanning and seeking in relation to PSA. Specifically, scanning was important for non seekers, but not for seekers. It may be that in some cases they substitute for each other. 

## Limitations

- No causal direction
- Construct validity: Scanning measure confounds attention to each medium with exposure to that medium.
- Only investigating SSB as a persistent style, when it might be context specific.
- Limited measures for lifestyle scale.

**Notes:**
While we did find associations between SSB and knowledge, lifestyle and screening behaviors, we recognize that we cannot make causal claims here due to the cross-sectional nature of the data. It may be that those who get screened are more likely to pay attention to information that reinforces their decision. 
 There are also three other major limitations of this study: 
 Our scanning measure confounds attention to each medium with exposure.
SSB as a persistent style
Outcomes limited to just a few health-related behaviors--including fruits and veggies and exercise, while others, such as alcohol use, red meat or fat consumption, which may be important, are left out. 

## Conclusion

- There are a number of unanswered questions, particularly regarding the interactions found in this study.
- HINTS II includes measures which might help to clarify some of these points.
- The CECCR at UPENN’s Annenberg School has an active research program aimed at further investigating questions regarding SSB and its association with knowledge, lifestyle and screening behavior.

**Notes:**
Fortunately, the next version of HINTS does include more specific constructs which should help to improve future analyses. 
 In addition, the CECCR at UPenn is currently involved in several projects which hope to address some of our unanswered questions. 
In the meantime, if there are any questions regarding this study, we would be happy to answer them at the end of the session. 

## Acknowledgements

- Jeffrey Niederdeppe, M.A.
- Dominick Frosch, PhD
- Giang Nguyen, MD
- Anca Romantan, PhD
- Judi Weiner, PhD
- Megan Kasimatis
- CECCR Center
- Annenberg School for Communication
- University of Pennsylvania