EPIC research was recently featured at two conferences of the American Association for Cancer Research (AACR). In November, EPIC researchers Giang Nguyen and Amy Leader presented a paper titled Awareness of Anti-cancer Vaccines among Asian American Women with Limited English Proficiency: An opportunity for improved public health communication. This research was presented in Atlanta at the AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved. The study represents the first report on awareness of cervical and liver cancer preventive vaccines in a diverse sample of Asian American women. Study results indicate that among the 34% of women in the sample that reported awareness of cancer vaccines, those with limited English proficiency were less likely to have accurate knowledge of a vaccine against cervical cancer and were more likely to incorrectly believe that vaccines could prevent cancers for which there is no prevention vaccine available. Results suggest that public health communication efforts should address knowledge of cancer preventive vaccines among linguistically isolated, at-risk communities.

EPIC Researcher Stacy Gray presented her research at the AACR Frontiers in Cancer Prevention Meeting on December 8, 2007 in Philadelphia. Dr. Gray’s presentation, titled Cancer Prevention Online? Decision Making in the Context of Direct to Consumer Cancer Genetics, features results from her EPIC CECCR pilot project, which is supported by the American Society of Clinical Oncology (ASCO). In this project Dr. Gray investigates the effects of exposure to risk information for direct to consumer (DTC) genetic testing for breast cancer gene mutations on women’s attitudes about and intentions to purchase DTC genetic testing. The goals of this study are to determine the factors that might influence women to purchase online genetic testing and to understand how risk information should be incorporated into existing websites to improve informed medical decision making.

Please see the full citation information for these recent presentations below:

Nguyen, G.T., Leader, A.E., Hung, W.L. (2007, November). Awareness of anti-cancer vaccines among Asian American women with limited English proficiency: An opportunity for improved public health communication.

Gray, S. (2007, December). Cancer Prevention Online? Decision Making in the Context of Direct to Consumer Cancer Genetics.

Research supported by the EPIC CECCR was recently published online in the Journal of General Internal Medicine. This study, led by EPIC researcher Giang Nguyen, includes results from Dr. Nguyen’s CECCR pilot project titled Cancer-Related Information Seeking and Scanning Behaviors among Vietnamese Immigrants. Dr. Nguyen and fellow researchers interviewed 20 Vietnamese immigrants aged 50-70 to learn about the cancer-related communication experiences of older Asian immigrants. From these interviews, researchers identified three categories of themes concerning informants’ experiences with cancer communication in the healthcare setting: (1) attitudes about addressing screening with providers, (2) issues/problems communicating with physicians about cancer, and (3) language/translation difficulties. There was substantial overlap between informants who mentioned each theme category, and 40% of the participants mentioned all 3 categories.

Study results indicate that healthcare systems must address the needs of an increasingly multi-ethnic and linguistically diverse patient population, and clinicians should be especially aware of and act upon specific cancer communication challenges of older immigrant patients. EPIC Researchers Katrina Armstrong, Fran Barg and Robert Hornik also contributed to this study.

Nguyen, G.T., Barg, F., Armstrong, K., Holmes, J.H., & Hornik, R. (In Press). Cancer and communication in the healthcare setting: Experiences of older Vietnamese immigrants, a qualitative study. Journal of General Internal Medicine. Available via Online First publications at http://www.springerlink.com/content/9651q67862344l05/?p=3a1c7485b1cb486996b8db00e0ca8595&pi=2

We are excited to announce the launching of a website dedicated to the Annenberg National Health Communication Survey (ANHCS), a tool designed to capture national trends relating health behavior and behavioral intentions to media exposure and health and policy knowledge and beliefs. Since it’s inception in January 2005, ANHCS has collected data monthly from a nationally representative sample of adults in the United States. These data have been archived and will be made publicly available on the website each year. The 2005 Data Set is currently available online for download, and the 2006 Data Set will be available in January 2008.

ANHCS is co-sponsored by the Annenberg Schools for Communication at the University of Pennsylvania and the University of Southern California, with additional support from the Annenberg Foundation Trust at Sunnylands. Knowledge Networks, a web-based research company, is responsible for sample recruitment and survey administration.

Please visit the new website at http://anhcs.asc.upenn.edu.

The National Human Genome Research Institute (NHGRI) of the National Institutes of Health has announced an award to Joseph Cappella and Vincent Price (co-PIs) of the Annenberg School for Communication in the amount of $1,254,326. The three-year project titled Public Opinion Deliberation and Decision-Making about Genetics Research (R01HG004318-01) will study four issues: (1) the changing nature of public opinion about issues surrounding genes, disease, and genetics research as it takes shape through public discourse and deliberation; (2) the impact of information framing on opinions about uses of genetic data, including privacy, data sharing, racial and genetic discrimination, and informed consent; (3) public decision making in the context of authentic choice scenarios regarding genetic medicine and research, and (4) predictive factors shaping citizens’ intentions to participate in genetics research, including emotional factors and anticipated positive and negative consequences. The transdisciplinary research will involve Penn researchers from genetic medicine, bioethics, behavioral genetics, psychiatry and law.

CECCR pilot researcher Andrew Strasser was recently awarded two grants for research related to his CECCR pilot project titled Quest® Cigarette Ad Manipulation.

In March 2007, Dr. Strasser was awarded funding by the National Cancer Institute for a new R01 project titled Smoking Topography and Harm Exposure in a New PREP. This study will explore how people use potentially reduced exposure products (PREPs) and assess how this relates to their harm exposure. Quest® cigarettes are a new PREP that uses genetically modified tobacco to provide a "step-down approach to becoming nicotine-free" by marketing cigarettes with progressively lower levels of nicotine. The primary aim of the study is to investigate the effect of progressive decreases in cigarette nicotine levels on smoking topography and harm exposure measures using Quest® cigarettes. CECCR Co-Director Dr. Caryn Lerman is also involved in this new study.

In August 2007, Dr. Strasser also received funding from the Robert Wood Johnson Substance Abuse Policy Research Program for a second study titled Investigation of Smokers’ False Inferences from Marketing of Potentially Harm Reducing Products. This study is a collaboration of CECCR researchers Caryn Lerman and Joseph Cappella as well as Dan Romer of the Annenberg Public Policy Center. The specific aims of the study are: to investigate the effect of manipulating advertisement information on false inferences smokers make about the safety of Quest® cigarettes; to utilize eye-tracking measures to determine association of dwell time and fixation with false inferences and correct recall of information; and to investigate whether smokers’ inferences from Quest® advertisements influence smoking behavior when using Quest® cigarettes.

CECCR pilot researcher Daniel Langleben was also recently awarded funding for new research related to his CECCR pilot project. In September 2007, Dr. Langleben was awarded funding from the National Institute on Drug Abuse for his study titled Functional MRI of Anti-Tobacco Public Service Announcements. This research will use neuro-imaging to study brain response to anti-tobacco public service announcements (PSAs). This study will test the effects of measures of PSA format (message sensation value) and content (message argument strength) within and between subjects. Brain activity will be the primary outcome measure.

This study will also explore the relationship of brain activation patterns to surrogate outcomes of persuasive impact, such as attitudes, perceived effectiveness, and recall. Bridging the fields of addiction, communication and cognitive neuroscience research, this project will set the stage for development of an evidence-based methodology to evaluate and design anti-addiction PSAs and more effective public health communications in general. CECCR researchers Joseph Cappella and Caryn Lerman will also collaborate on this study.

EPIC Research recently appeared in Health Communication and the Annals of Behavioral Medicine.

The Information Seeking and Scanning Group published the first major report from their in-depth interview study, which examined information seeking and scanning behavior in the context of cancer prevention and screening decisions. The study, Exploring the Dimensions of Cancer-Related Information Seeking and Scanning Behavior, appeared in Health Communication in August 2007. Results from the study suggest that information scanning is common, particularly for information related to screening tests. Information seeking is more rare, and occurs primarily among those who are also information scanners. These findings shed new light on how individuals navigate the media environment, suggesting that future research should examine predictors and effects of less purposeful efforts to obtain cancer-related information.

In addition, research from the Narrative Communication Working Group, a collaboration of investigators from all four CECCRs, was recently published in Annals of Behavioral Medicine in an article titled Narrative Communication in Cancer Prevention and Control: A Framework to Guide Research and Application. To stimulate critical thinking about the role of narrative in cancer communication and promote a more focused, systematic program of research to understand its effects, this research proposes a typology of narrative application in cancer control. This article describes the empirical evidence and theoretical rationale supporting propositions in the typology, identifies variables likely to moderate narrative effects, raises ethical issues to be addressed when using narrative communication in cancer prevention and control efforts, and discusses potential limitations of using narrative in this way.

Full citations for these recent EPIC publications appear below.

Niederdeppe, J., Hornik, R.C., Kelly, B., Frosch, D.L., Romantan, A., Stevens, R., Barg, F. Weiner, J., & Schwartz, J.S. (2007). Exploring the dimensions of cancer-related information seeking and scanning behavior. Health Communication, 22 (2), 153-167.

Kreuter, M., Green, M.C., Cappella, J.N., Slater, M., Wise, M., Storey, D., Clark, E., O’Keefe, D., Erwin, D., Holmes K., Hinyard, L., Houston, T., & Woolley, S. (2007). Narrative Communication in Cancer Prevention and Control: A Framework to Guide Research and Application. Annals of Behavioral Medicine, 33(3), 221-235.

EPIC research was recently featured at the Centers for Disease Control’s (CDC) Annual Cancer Conference, held this past August in Atlanta, Georgia. Research Director Amy Leader and doctoral candidate Cabral Bigman presented their research titled “How Supportive Are Americans Towards HPV Vaccine Policies About Access, Funding, and Parental Choice?”, at a poster session. Dr. Joseph Cappella also collaborated on the study.

Their presentation used data from two Annenberg National Health Communication Survey (ANHCS) studies. The first was a June 2006 module, completed at the time of FDA approval of the HPV vaccine, in which 634 participants were surveyed about their vaccination intentions and policy opinions. The second used data from January through June 2007, where a new sample was recruited each month to answer one question about mandatory vaccination (number of participants ranged from 81 in May 2007 to 179 in February 2007).

Data from the June 2006 study showed that nearly half of all participants were opposed to mandatory vaccinations in schools, while about 15% supported such policies. However in the January-June 2007 data, support for mandatory vaccination ranged from 27.4% to 44%. About half of participants (45.4%) from the June 2006 study opposed vaccinating girl under age 18 without parental consent.

Respondents were, on the other hand, generally supportive of vaccination policies that would aid parental choice. Participants mostly supported physician recommendations of the vaccine to eligible patients (60.2%), the government covering the vaccine for the uninsured (57.1%), insurance companies covering the vaccine for members (64.7%), and the government sponsoring an educational campaign about the vaccine (58.2%). The research concluded that persuasive communication and institutional measures that encourage parents to voluntarily choose vaccination may be especially vital to vaccine adoption.

So far, this research has also been featured by various media outlets, including Philadelphia’s KYW Newsradio and The Patriot News. The press release for this study can be found at http://www.asc.upenn.edu/news/PressReleaseDetail.asp?id=25.

In June 2006, the FDA approved a vaccine to prevent human papillomavirus (HPV), the most common sexually transmitted infection (STI) in the US and the leading cause of cervical cancer. In response, the EPIC Center added a module to the Annenberg National Health Communication Survey (ANHCS) that sought to understand the effects of information framing on beliefs of disease susceptibility and intentions to vaccinate self or female children. This study involved a collaboration of EPIC researchers including Amy Leader, Judith Weiner, Bridget Kelly, Cabral Bigman, Stacy Gray, Robert Hornik, and Joseph Cappella. Study results indicate that intentions to vaccinate are highest when the vaccine is framed solely to prevent cervical cancer and lowest when it is framed to prevent cervical cancer and an STI. Also, women had higher intentions to vaccinate themselves when the vaccine was available at little or no cost. Intentions to vaccinate female children were mixed.

The American Association for Cancer Research (AACR) selected this research as one of 3 studies featured at a press conference at its Fifth Annual Frontiers in Cancer Prevention Research Conference. The press conference, titled “New vaccines to prevent cancer,” was held on November 12, 2006. Amy Leader, a research director at the EPIC CECCR, presented this research in a poster presentation and represented the EPIC CECCR during the press event. Following the press conference, the study was featured on over 40 websites including Infection Control Today, Medical News Today, Newswise, and , as well as in the Washington Post. For access to the Annenberg School press release click here.

Dominick Frisch, Ph.D., Assistant Professor of Medicine at the University of California, Los Angeles was recently featured on NPR reporting results from his EPIC CECCR pilot study titled Marketing Prescription Drugs: A Content Analysis of Television Direct-to-Consumer Advertising. Study results indicate that, despite claims that prescription drug advertisements serve an educational purpose, they provide limited information about the causes of a disease or who may be at risk; show characters that have lost control over their social, emotional or physical lives without the medication; and minimize the value of health promotion through lifestyle changes.

The full study appeared in the January/February 2007 issue of the Annals of Family Medicine. The broadcast can be accessed at: NPR story.

A study conducted by EPIC Researcher Jeff Niederdeppe, PhD, a Robert Wood Johnson Health and Society Scholar at the University of Wisconsin, Madison, was recently featured in a press release picked up by many news sources including HealthDay, Forbes, Discovery Health, CNN, CBS, WebMD, and the Washington Post. In this study, Dr. Niederdeppe and his co-author examined the associations between fatalistic beliefs about cancer and prevention behaviors with a national sample of American adults. Data were analyzed from the first wave of the Health Information National Trends Survey (HINTS 2003). “We found that almost half of the American public believes that 'it seems that almost everything causes cancer,' about 1 in 4 feel there's not much one can do to lower the chances of getting cancer, and 3 out of 4 felt there were so many recommendations, it's hard to know which ones to follow," said Dr. Niederdeppe. “We took this as evidence that there is widespread confusion and helplessness in the American adult population in terms of cancer prevention..." Study results indicate that fatalistic beliefs about cancer prevention were negatively associated with exercising weekly, not smoking, and eating 5 or more fruits and vegetables daily, indicating that 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. The study appeared in the May 2007 issue of Cancer, Epidemiology, Biomarkers & Prevention. An interview with Dr. Niederdeppe about this study can be heard on NPR’s Talk of the Nation from Wednesday, May 23, 2007.

EPIC Center Post-Doctoral Fellow Stacy Gray, MD, MaP, was recently awarded grant funding from both the Robert Wood Johnson Health & Society Scholars Program and the American Society for Clinical Oncology (ASCO) for her upcoming pilot project titled “Interest in Direct to Consumer Sales for BRCA 1 and BRCA 2 Mutation Testing Among Women with a Family History of Cancer.”

The purpose of this pilot project is to elicit beliefs about direct-to-consumer (DTC) genetic testing for BRCA mutations among women at increased risk for breast/ovarian cancer and to evaluate the effects of exposure to risk/benefit information for DTC genetic testing on women’s beliefs, perceptions of social norms, and intentions to purchase DTC genetic testing. The long term goals of the project are to understand the factors that might motivate high risk women to pursue online testing rather than clinic based testing and to start to understand how risk/benefit information on DTC genetic testing should be presented to patients online in order for them to be able to accurately evaluate the risks and benefits of DTC BRCA testing. This line of research will help to determine key standards of care that policy makers should consider as they formulate regulations for the DTC industry.

Dr. Gray received funding to support this project from the Robert Wood Johnson Health and Society Scholars Program’s Research and Education Fund in February 2006. The Robert Wood Johnson Health & Society Scholars Program at the University of Pennsylvania sets aside its Competitive Research and Education Fund to promote interdisciplinary research and education in population health at Penn. One of the goals of the fund is to encourage the entry of new investigators to the field of population health.

In March 2006 Dr. Gray was also the recipient of an ASCO Young Investigator Award for this project. This grant provides funding to promising investigators to encourage and promote quality research in clinical oncology. The purpose of this award is to fund physicians during the transition from a fellowship program to a faculty appointment.

Dr. Gray’s project is in the developmental phase and is expected to be launched in the field in April 2006.

Presentations:

• Bleakley, A., Hennessey, M., Fishbein, M. (2006, February) Condoms in the Classroom? Policy preferences for sex education in American schools. Presented at the Annenberg National Health Communication Survey Conference, Los Angeles, CA.
• Cappella, J., Shim, M., Price, V. (2006, February) The Health Confidence Index (HCI): Reliability, Validity and Temporal Trends from January to October, 2005. Presented at the Annenberg National Health Communication Survey Conference, Los Angeles, CA.
• Frosch, D., Hornik, R. (2006, February) Do Television Pharmaceutical Ads Prompt More Than Just Prescription Requests? Presented at the Annenberg National Health Communication Survey Conference, Los Angeles, CA.
• Henderson, V. (2006, February) Television and Lifestyle Factors Associated with BMI in the ANHCS. Presented at the Annenberg National Health Communication Survey Conference, Los Angeles, CA.
• Hennessy, M., Bleakley, A., Fishbein, M. (2006, February) What is the Appropriate Policy Response to Wardrobe Malfunctions? Fining stations for TV sex and violence. Presented at the Annenberg National Health Communication Survey Conference, Los Angeles, CA.
• Jeong, S., Cappella, J. (2006, February) Effects of Genetic Information in News About Obesity. Presented at the Annenberg National Health Communication Survey Conference, Los Angeles, CA.
• Kelly, B., Stevens, R.S. (2006, February) Obesity-related Media Content is Associated with Weight-loss Behavior. Presented at the Annenberg National Health Communication Survey Conference, Los Angeles, CA.
• Lee, C. (2006, February)The Effects of Media Use for Health Information on Health Professional Contacts: The Moderating Role of Trust in Health Information Channels. Presented at the Annenberg National Health Communication Survey Conference, Los Angeles, CA.
• Niederdeppe, J. (2006, February) Do the Media Cultivate Fatalistic and Confused Beliefs about Cancer Preventability? Presented at the Annenberg National Health Communication Survey Conference, Los Angeles, CA.
• Ramirez, S. (2006, February) Source Characteristics Influencing Health Information Seeking Among Latino and White U.S. Adults. Presented at the Annenberg National Health Communication Survey Conference, Los Angeles, CA.
• Shim, M., Cappella, J. (2006, February) Effects of prescription drug ads employing genetic cues: Priming on health-related belief, efficacy, and behavioral intention. Presented at the Annenberg National Health Communication Survey Conference, Los Angeles, CA.
• Wong, N. (2006, February) Influence of Cancer Worry and Genetic Determinism on an Individual’s Adherence or Non Adherence to Cancer Screening and Adoption of Healthy Lifestyle Behaviors. Presented at the Annenberg National Health Communication Survey Conference, Los Angeles, CA.

A new study by conducted by researchers at the Transdisciplinary Tobacco Use Research Center of the School of Medicine and the EPIC Center of Excellence in Cancer Communication Research found that many smokers make false inferences about the safety of new low nicotine Quest® cigarettes. This research appears in the March issue of Psychology of Addictive Behaviors. “This study is the first to evaluate how regular smokers responded to a print ad for Quest® cigarettes, a newly developed cigarette marketed as a way to gradually reduce nicotine exposure via smoking cigarettes that are lower in nicotine,” said author, Caryn Lerman, PhD, Associate Director for Cancer Control and Population Science at the Abramson Cancer Center of the University of Pennsylvania and Professor in Penn’s School of Medicine and the Annenberg Public Policy Center Quest® cigarettes are a brand of low-nicotine cigarettes manufactured by Vector Tobacco Inc and currently marketed in eight U.S. states. Quest® cigarettes (both non- and mentholated) are manufactured with three progressively lower nicotine levels and marketed as allowing smokers to “step-down” nicotine levels to enjoy “nicotine-free smoking”. However, Quest® cigarettes do not have progressively less tar and thus, likely still pose health risks. Given evidence that many smokers misinterpret the information contained in marketing campaigns for such “light” cigarettes it is important to understand how smokers perceive this newly marketed low nicotine cigarette. Dr. Lerman led a research team the examined the response of 200 regular smokers to a Quest ® cigarette print advertisement using a mall intercept survey approach. Participants viewed a single Quest® cigarette print advertisement and then were asked to answer a series of questions about their smoking and quitting history, beliefs about Quest® cigarettes, perceived vulnerability to the health effects of smoking and need for cognition (how much people like to think critically about information). Researchers found that, as many as 45% of smokers made false inferences about the tar content of Quest® cigarettes. Also, smokers who felt less vulnerable to the health effects of smoking and who do not enjoy thinking critically about issues made more false inferences about the potential harms of Quest® cigarettes. “These results reinforce the need for public health awareness campaigns to relay the message that smoking any cigarettes –regardless of nicotine content- can have deleterious health effects,” said co-author Dr. Andrew Strasser. This research was funded by the National Cancer Institute and was conducted by the University of Pennsylvania Transdisciplinary Tobacco Use Research Center and the Center of Excellence in Cancer Communication Research.

In February 2007, EPIC CECCR investigators, Andrew Strasser, PhD, and Amy Leader, MPH, attended the Society for Research on Nicotine and Tobacco (SRNT) Annual Meeting in Austin, Texas.

Amy Leader presented a poster, titled A vaccine against nicotine addiction: Which smokers will take a shot at quitting? This poster featured results from a recent CECCR pilot study that evaluated smokers’ interest in the nicotine vaccine and assessed whether information about genetic susceptibility to nicotine addiction affected that interest. The nicotine vaccine, which is not yet available, would stimulate the production of nicotine antibodies in humans, undermining the pleasurable effects of smoking. Study results indicate that interest in the vaccine as a cessation method overall is relatively favorable among smokers, and beliefs about the root cause of nicotine addiction appear to have little effect on intentions to vaccinate.

Dr. Strasser presented the two studies highlighted in the LDI Issue Brief at the SRNT Meeting. The first, a poster presentation, is titled Effect of advertisement manipulations on smokers’ false inferences about Quest cigarettes. The second, an oral paper, is titled False perceptions, compensatory smoking, and harm exposure related to Quest cigarettes.

Research conducted by investigators at the EPIC CECCR and the Tran disciplinary Tobacco Use Research Center (TTURC) was featured in the October/November 2006 Issue Brief of the Leonard Davis Institute for Health Economics (LDI). Through the Issue Brief Series, LDI disseminates key policy findings from timely health services research to health care decision makers. This Issue Brief, titled Lower Nicotine Cigarettes May Not Lower Harm, presented findings from two separate studies led by CECCR Investigator Andrew Strasser, Ph.D. Results from the first study suggest that smokers make false inferences about the relative safety of Quest® cigarettes, a new reduced-nicotine cigarette, based on the Quest® advertisement. The second study provides evidence that when smokers use the lower-nicotine Quest® products, they may change their smoking behavior by taking larger or more frequent puffs, thus increasing their harm exposure. These studies suggest that public health awareness campaigns should warn that smoking any cigarettes, including low-nicotine cigarettes, has serious health effects.

A copy of the issue brief can be accessed at http://www.upenn.edu/ldi/publications.html.

A new study by EPIC pilot investigators Chanita Hughes-Halbert PhD and Oscar Gandy PhD found that 58 % of African American smokers surveyed would be likely to participate in research to identify genetic risk factors for smoking. This study suggests that recruitment strategies designed to address the benefits of research participation as well as the possible risks/limitations associated with genetic testing may increase research participation among African American smokers. For more information on this study click here.