Parental Nonadherence to Health Policy Recommendations for Prevention of COVID-19 Transmission Among Children.

This survey study assesses whether parents had ever engaged in specific misrepresentation and nonadherence behaviors regarding public health measures for preventing COVID-19 transmission among children.

Misrepresentation and Nonadherence Regarding COVID-19 Public Health Measures.

Importance: The effectiveness of public health measures implemented to mitigate the spread and impact of SARS-CoV-2 relies heavily on honesty and adherence from the general public. Objective: To examine the frequency of, reasons for, and factors associated with misrepresentation and nonadherence regarding COVID-19 public health measures. Design, Setting, and Participants: This survey study recruited a national, nonprobability sample of US adults to participate in an online survey using Qualtrics online panels (participation rate, 1811 of 2260 [80.1%]) from December 8 to 23, 2021. The survey contained screening questions to allow for a targeted sample of one-third who had had COVID-19, one-third who had not had COVID-19 and were vaccinated, and one-third who had not had COVID-19 and were unvaccinated. Main Outcomes and Measures: The survey assessed 9 different types of misrepresentation and nonadherence related to COVID-19 public health measures and the reasons underlying such behaviors. Additional questions measured COVID-19-related beliefs and behaviors and demographic characteristics. Results: The final sample included 1733 participants. The mean (SD) participant age was 41 (15) years and the sample predominantly identified as female (1143 of 1732 [66.0%]) and non-Hispanic White (1151 of 1733 [66.4%]). Seven hundred twenty-one participants (41.6%) reported misrepresentation and/or nonadherence in at least 1 of the 9 items; telling someone they were with or about to be with in person that they were taking more COVID-19 preventive measures than they actually were (420 of 1726 [24.3%]) and breaking quarantine rules (190 of 845 [22.5%]) were the most common manifestations. The most commonly endorsed reasons included wanting life to feel normal and wanting to exercise personal freedom. All age groups younger than 60 years (eg, odds ratio for those aged 18-29 years, 4.87 [95% CI, 3.27-7.34]) and those who had greater distrust in science (odds ratio, 1.14 [95% CI, 1.05-1.23]) had significantly higher odds of misrepresentation and/or nonadherence for at least 1 of the 9 items. Conclusions and Relevance: In this survey study of US adults, nearly half of participants reported misrepresentation and/or nonadherence regarding public health measures against COVID-19. Future work is needed to examine strategies for communicating the consequences of misrepresentation and nonadherence and to address contributing factors.

Assessment of Patient Nondisclosures to Clinicians of Experiencing Imminent Threats.

Importance: Patient disclosure to their clinician about experiencing an imminent threat is a critical step toward receiving support or assistance. Objective: To examine the frequency of patients not disclosing their experience of imminent threats to their clinician and their reasons for doing so. Design, Setting, and Participants: Survey study incorporating results from 2 national, nonprobability samples of 2011 US adults recruited from Amazon's Mechanical Turk (MTurk) from March 16 to 30, 2015, and 2499 recruited from Survey Sampling International (SSI) from November 6 to 17, 2015. Data analysis was conducted from December 20 to 28, 2018. Main Outcomes and Measures: Self-reported nondisclosure of 4 types of imminent threats (depression, suicidality, abuse, and sexual assault) to their clinician and reasons for nondisclosure. Results: There were 2011 participants in the MTurk sample (1210 [60.3%] female; 1696 [60.2%] white; mean [SD] age, 35.7 [12.4] years; age range, 18-79 years) and 2499 participants (1273 [51.0%] female; 1968 [78.8%] white; mean [SD] age, 61.0 [7.6] years; age range, 50-91 years) in the SSI sample. Among those who reported experiencing at least 1 of the 4 imminent threats, 613 of 1292 MTurk participants (47.5%) and 581 of 1453 SSI participants (40.0%) withheld information from their clinician. The most commonly endorsed reasons for withholding this information included being embarrassed (MTurk: 72.7%; SSI: 70.9%), not wanting to be judged or lectured (MTurk: 66.4%; SSI: 53.4%), and not wanting to engage in a difficult follow-up behavior (MTurk: 62.4%; SSI: 51.1%). Respondents who experienced at least 1 of the 4 imminent threats had significantly higher odds of nondisclosure in both samples if they were female (MTurk: odds ratio [OR], 1.66 [95% CI, 1.30-2.11]; and SSI: OR, 1.33 [95% CI, 1.07-1.67]) or younger (MTurk: OR, 0.99 [95% CI, 0.98-1.00]; and SSI: OR, 0.98 [95% CI, 0.97-1.00]). Worse self-rated health was also associated with nondisclosure, but only in the SSI sample (OR, 0.85 [95% CI, 0.74-0.96]). Conclusions and Relevance: This study suggests that many people withhold information from their clinicians about imminent health threats that they face. A better understanding of how to increase patients' comfort with reporting this information is critical to allowing clinicians to help patients mitigate these potentially life-threatening risks.

Prevalence of and Factors Associated With Patient Nondisclosure of Medically Relevant Information to Clinicians.

Importance: Patient failure to disclose medically relevant information to clinicians can undermine patient care or even lead to patient harm. Objective: To examine the frequency of patients failing to disclose to their clinicians information that is relevant to their care and their reasons for doing so. Design, Setting, and Participants: Two national nonprobability samples were recruited to participate in an online survey, one using Amazon's Mechanical Turk (MTurk) from March 16 to 30, 2015 (2096 respondents), followed by one using Survey Sampling International (SSI) from November 6 to 17, 2015 (3011 respondents). Data analysis was conducted from September 28 to October 8, 2018. After dropping respondents meeting the exclusion criteria, the final sample sizes were 2011 (MTurk) and 2499 (SSI). Main Outcomes and Measures: The primary outcome measures were self-reported nondisclosure of 7 types of information to their clinician (eg, did not understand instructions, medication use) and reasons for nondisclosure (eg, embarrassment, not wanting to be judged). Results: There was a total of 4510 overall respondents. Of 2096 respondents, 2013 completed the MTurk survey (96.0% completion rate) and 2011 were included in the analysis. Of 3011 respondents, 2685 completed the SSI survey (89.2% completion rate) and 2499 were included in the analysis. The mean (SD) age of the participants was 36 (12.4) years for MTurk and 61 (7.59) years for SSI. Both samples were predominantly white (MTurk: 1696 [84.3%]; SSI: 1968 [78.8%]). A total of 1630 MTurk participants (81.1%) and 1535 SSI participants (61.4%) avoided disclosing at least 1 type of information. Disagreeing with the clinician's recommendation (MTurk: 918 of 2010 respondents [45.7%]; SSI: 785 of 2497 respondents [31.4%]) and not understanding the clinician's instructions (MTurk: 638 of 2009 respondents [31.8%]; SSI: 607 of 2497 respondents [24.3%]) were the most common occurrences. The most commonly reported reasons for nondisclosure included not wanting to be judged or lectured (MTurk: 81.8% [95% CI, 79.8%-83.9%]; SSI: 64.1% [95% CI, 61.5%-66.7%]), not wanting to hear how harmful the behavior is (MTurk: 75.7% [95% CI, 73.5%-78.0%]; SSI: 61.1% [95% CI, 58.5%-63.8%]), and being embarrassed (MTurk: 60.9% [95% CI, 58.9%-62.9%]; SSI: 49.9% [95% CI, 47.8%-52.1%]). In both samples, participants who were women (MTurk: odds ratio [OR], 1.88 [95% CI, 1.49-2.37]; SSI: OR, 1.38 [95% CI, 1.17-1.64]), younger (MTurk: OR, 0.98 [95% CI, 0.97-0.99]; SSI: OR, 0.98 [95% CI, 0.97-0.99]), and with worse self-rated health (MTurk: OR, 0.87 [95% CI, 0.76-0.99]; SSI: OR, 0.80 [95% CI, 0.72-0.88]) were more likely to report withholding information. Conclusions and Relevance: Many respondents in these surveys intentionally withhold important information from their clinicians and were most likely to do so when they disagreed with or misunderstood their clinician's instructions. A better understanding of how to increase patients' comfort with reporting this information may improve the clinician-patient relationship and patient care.

Disseminating a smoking cessation intervention to childhood and young adult cancer survivors: baseline characteristics and study design of the partnership for health-2 study.

BACKGROUND: Partnership for Health-2 (PFH-2) is a web-based version of Partnership for Health, an evidence-based smoking cessation intervention for childhood cancer survivors. This paper describes the PFH-2 intervention and baseline data collection. METHODS: 374 childhood and young adult cancer survivors were recruited from five cancer centers and participated in the baseline assessment. At baseline, participants completed measures of their smoking behavior, self-efficacy and stage of change for quitting smoking as well as psychological and environmental factors that could impact their smoking behavior. RESULTS: At baseline, 93% of survivors smoked in the past seven days; however, 89% smoked a pack or less during this period. Forty-seven percent were nicotine dependent, and 55% had made at least one quit attempt in the previous year. Twenty-two percent of survivors were in contemplation for quitting smoking; of those 45% were somewhat or very confident that they could quit within six months. Sixty-three percent were in preparation for quitting smoking; however, they had relatively low levels of confidence that they could quit smoking in the next month. In multivariate analyses, stage of change, self-efficacy, social support for smoking cessation, smoking policy at work and home, fear of cancer recurrence, perceived vulnerability, depression, BMI, and contact with the healthcare system were associated with survivors' smoking behavior. DISCUSSIONS/CONCLUSIONS: A large proportion of the sample was nicotine dependent, yet motivated to quit. Individual- interpersonal- and environmental-level factors were associated with survivors' smoking behavior. Smoking is particularly dangerous for childhood and young adult cancer survivors. This population may benefit from a smoking cessation intervention designed to build self-efficacy and address other known predictors of smoking behavior.

The transition from breast cancer 'patient' to 'survivor'.

BACKGROUND: While much is now known about breast cancer survivors' long-term health, quality of life, and psychological state, relatively little is known about the period immediately following completion of treatment, when women transition out of the role of breast cancer 'patient' to life as 'survivor'. OBJECTIVE: To explore women's fears regarding risk of cancer recurrence, sense of loss of medical monitoring, and social support from health-care providers and other patients, and the strategies they use to cope with these issues. METHOD: Focus group interviews were conducted with women who had completed adjuvant chemotherapy or radiation for new stage I or II breast cancer in the prior 12 months. Interviews were audio-taped, transcribed, and analyzed using a constant comparative analysis approach. RESULTS: Of 216 women identified as eligible, over half (155) were reached by telephone and invited to participate. Of those invited, 47 (30%) agreed. Findings suggest that while women acknowledge positive life changes as a result of the cancer experience, emotional and physical stresses are prevalent following the completion of treatment. CONCLUSION: The period of time when women who have been treated for breast cancer transition to life without treatment presents numerous emotional and physical challenges. By illuminating patients' experience during this transition period, this study provides insights into the development of interventions to support women after treatment.

Lay and expert interpretations of cancer cluster evidence.

Conflict frequently occurs between community members and environmental/public health officials when an unusual number of cancer cases is reported. This conflict may result from different ways in which laypeople and experts interpret facts to judge whether there is an environmental cause of the cancer cases, but little is known about this issue. Volunteer laypeople (N= 551) and epidemiologists (N= 105) read a hypothetical scenario about cases of cancer on one neighborhood block. Participants judged whether each of the 23 facts about the situation made it "much more likely" to "much less likely" that something in town was causing the cancer cases (7-point scale). The facts were designed to be "alarming,""reassuring," or "neutral" (i.e., according to epidemiological principles, should increase, decrease, or have no impact on the likelihood of an environmental cause). The laypeople were alarmed by most of the facts (mean response significantly greater than the scale midpoint), including all of the neutral facts and over half of the reassuring facts. The experts were more balanced: they were alarmed by none of the neutral or reassuring facts. Their responses showed significantly less alarm than the laypeople's responses (p < 0.0001 for all comparisons). This study reveals that laypeople are not reassured by information that substantially lowers the chance of an environmental cause for cancer cases. Lay responses differ significantly and systematically from experts who are far less alarmed by relevant facts. These findings may help explain the conflicts between the two groups in situations where concern about cases of cancer arises in a community.

Value-induced bias in medical decision making.

BACKGROUND: People who exhibit value-induced bias- distorting relevant probabilities to justify medical decisions- may make suboptimal decisions. OBJECTIVE: The authors examined whether and in what conditions people exhibit value-induced bias. DESIGN: Volunteers on the Web imagined having a serious illness with 2 possible diagnoses and a treatment with the same "small probability'' of success for each diagnosis. The more serious diagnosis was designed as a clear-cut decision to motivate most subjects to choose treatment; the less serious diagnosis was designed to make the treatment a close-call choice. Subjects were randomized to estimate the probability of treatment success before or after learning their diagnosis. The "after group'' had the motivation and ability to distort the probability of treatment success to justify their treatment preference. In study 1, subjects learned they had the more serious disease. Consistent with value-induced bias, the after group was expected to give higher probability judgments than the ;;before group.'' In study 2, subjects learned they had the less serious disease, and the after group was expected to inflate the probability if they desired treatment and to reduce it if they did not, relative to the before group. RESULTS: In study 1, there was no difference in the mean probability judgment between groups, suggesting no distortion of probability. In study 2, the slope of probability judgment regressed on desire for treatment was steeper for the after group, indicating that distortion of probability did occur. CONCLUSION: In close-call but not clear-cut medical decisions, people may distort relevant probabilities to justify their preferred choices.

Making sense of cancer risk calculators on the web.

OBJECTIVE: Cancer risk calculators on the internet have the potential to provide users with valuable information about their individual cancer risk. However, the lack of oversight of these sites raises concerns about low quality and inconsistent information. These concerns led us to evaluate internet cancer risk calculators. DESIGN: After a systematic search to find all cancer risk calculators on the internet, we reviewed the content of each site for information that users should seek to evaluate the quality of a website. We then examined the consistency of the breast cancer risk calculators by having 27 women complete 10 of the breast cancer risk calculators for themselves. We also completed the breast cancer risk calculators for a hypothetical high- and low-risk woman, and compared the output to Surveillance Epidemiology and End Results estimates for the average same-age and same-race woman. RESULTS: Nineteen sites were found, 13 of which calculate breast cancer risk. Most sites do not provide the information users need to evaluate the legitimacy of a website. The breast cancer calculator sites vary in the risk factors they assess to calculate breast cancer risk, how they operationalize each risk factor and in the risk estimate they provide for the same individual. CONCLUSIONS: Internet cancer risk calculators have the potential to provide a public health benefit by educating individuals about their risks and potentially encouraging preventive health behaviors. However, our evaluation of internet calculators revealed several problems that call into question the accuracy of the information that they provide. This may lead the users of these sites to make inappropriate medical decisions on the basis of misinformation.

Fatalistic beliefs about cancer prevention and three prevention behaviors.

BACKGROUND: A substantial proportion of US adults hold fatalistic beliefs about cancer prevention. Although evidence suggests that fatalistic beliefs discourage people from engaging in screening behaviors that can reduce their cancer risk, far less is known about associations between cancer fatalism and other prevention behaviors. We examined sociodemographic correlates of these beliefs and their associations with regular exercise, smoking, and fruit and vegetable consumption with a national sample of American adults. METHODS: Data were analyzed from the first wave of the Health Information National Trends Survey (HINTS 2003). HINTS used random-digit dialing to complete phone interviews with adult Americans (N = 6,369). RESULTS: Nearly half of respondents (47.1%) agreed that "It seems like almost everything causes cancer," 27.0% agreed that "There's not much people can do to lower their chances of getting cancer," and 71.5% agreed that "There are so many recommendations about preventing cancer, it's hard to know which ones to follow." These beliefs were stronger in subjects who were less educated but generally weaker among both African Americans and Hispanics relative to Whites. Fatalistic beliefs about cancer prevention were negatively associated with exercising weekly, not smoking, and eating five or more fruits and vegetables daily in multivariate analysis controlling for sociodemographic characteristics. CONCLUSIONS: Americans who hold fatalistic beliefs about cancer prevention may be at greater risk of cancer because they are less likely to engage in various prevention behaviors. Results have notable implications for future cancer communication and education efforts.