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Introduction Alcohol use increases cancer risk, yet awareness of this association is low. Alcohol control policies have the potential to reduce alcohol-caused cancer morbidity and mortality. Research outside the U.S. has found awareness of the alcohol–cancer link to be associated with support for alcohol control policies. The purpose of this study is to estimate the prevalence of support for 3 communication-focused alcohol policies and examine how awareness of the alcohol–cancer link and drinking status are associated with policy support among U.S. residents. Methods Investigators analyzed data from the 2020 Health Information National Trends Survey 5 Cycle 4. Analyses were performed in 2021. The proportion of Americans who supported banning outdoor alcohol advertising and adding warning labels and drinking guidelines to alcohol containers was estimated. Weighted multivariable logistic regression was used to examine how awareness of the alcohol–cancer link and drinking status were associated with policy support. Results Most Americans supported adding warning labels (65.1%) and drinking guidelines (63.9%), whereas only 34.4% supported banning outdoor alcohol advertising. Americans reporting that alcohol had no effect/decreased cancer risk had lower odds of support for advertising ban (OR=0.56), warning labels (OR=0.43), and guidelines (OR=0.46) than Americans aware of the alcohol–cancer link. Moreover, heavier drinkers had lower odds of support for advertising ban (OR=0.41), warning labels (OR=0.59), and guidelines (OR=0.60) than nondrinkers. Conclusions Awareness of the alcohol–cancer link was associated with policy support. Increasing public awareness of the alcohol–cancer link may increase support for alcohol control policies.

Adopting a multi-level perspective that considers the many interrelated contexts influencing health could make health communication interventions more effective and equitable. However, despite increasing interest in the use of multi-level approaches, multi-level health communication (MLHC) interventions are infrequently utilized. We therefore sought to conduct a modified Delphi study to better understand how researchers conceptualize MLHC interventions and identify opportunities for advancing MLHC work. Communication and health behavior experts were invited to complete two rounds of surveys about the characteristics, benefits, pitfalls, best practices, barriers, and facilitators of MLHC interventions; the role of technology in facilitating MLHC interventions; and ways to advance MLHC intervention research (46 experts completed the first survey, 44 completed both surveys). Survey data were analyzed using a mixed-methods approach. Panelists reached consensus on two components of the proposed definition of MLHC interventions and also put forward a set of best practices for these interventions. Panelists felt that most health intervention research could benefit from a multi-level approach, and generally agreed that MLHC approaches offered certain advantages over single-level approaches. However, they also expressed concern related to the time, cost, and complexity of MLHC interventions. Although panelists felt that technology could potentially support MLHC interventions, they also recognized the potential for technology to exacerbate disparities. Finally, panelists prioritized a set of methodological advances and practical supports that would be needed to facilitate future MLHC intervention research. The results of this study point to several future directions for the field, including advancing how interactions between levels are assessed, increasing the empirical evidence base demonstrating the advantages of MLHC interventions, and identifying best practices for the use of technology. The findings also suggest that researchers may need additional support to overcome the perceived practical challenges of conducting MLHC interventions.Considering the factors that affect health across multiple levels (e.g., individual, family, community, and policy) could make health communication interventions more effective and equitable. The goal of this study was to better understand how researchers characterize multi-level health communication (MLHC) interventions and to identify opportunities for advancing work in this area.Communication and health behavior experts were invited to complete two rounds of surveys about MLHC interventions.Panelists reported that most health communication interventions could benefit from a multi-level approach, and generally agreed that MLHC approaches offer certain advantages over single-level approaches. However, they also expressed concern related to the time, cost, and complexity of MLHC interventions. Although panelists felt that technology could potentially support MLHC interventions, they also recognized that the use of technology could have unintended consequences. Using input from the panel of experts recruited for the study, we propose a working definition of MLHC interventions and a set of best practices for conducting these types of interventions.Results suggest the need to improve methods, conduct additional research demonstrating the advantages of MLHC interventions, and identify how technology can best be used to support these interventions.

To analyze communication-focused grants funded by the National Cancer Institute (NCI) between fiscal years 2013 and 2019 to provide insight into the characteristics of funded projects and identify promising areas for future research. iSearch, a portfolio analysis tool, was queried to identify communication-related grants funded by NCI. Abstracts and specific aims were coded for key study characteristics. 344 unique competing grants with a substantial communication component were included in the final analysis. SAS version 9.4 was used to calculate code frequencies. Most communication grants focused on cancer prevention (n = 197), with fewer targeting diagnosis, treatment, survivorship, or end-of-life. Tobacco product use was the most frequently addressed topic (n = 128). Most grants targeted or measured outcomes at the individual (n = 332) or interpersonal level (n = 127). Cancer patients/survivors (n = 101) and healthcare providers (n = 63) were often the population of focus, while caregivers or those at increased risk for cancer received less attention. Studies were often based in healthcare settings (n = 125); few studies were based in schools or worksites. Many grants employed randomized controlled trials (n = 168), but more novel methods, like optimization trials, were uncommon. NCI’s support of health communication research covers a diverse array of topics, populations, and methods. However, the current analysis also points to several promising opportunities for future research, including efforts focused on communication at later stages of the cancer control continuum and at multiple levels of influence, as well as studies that take advantage of a greater diversity of settings and leverage novel methodological approaches.

The purpose of this study was to describe the proportion of U.S. adults who support, oppose, or are neutral toward a policy designating R-ratings for movies depicting cigarette smoking and to identify predictors of policy opposition or neutrality among a nationally representative sample.Data from the 2020 Health Information National Trends Survey 5 Cycle 4 (fielded in 2020; N=3,865) were used to estimate the prevalence of support, neutrality, and opposition to a policy designating R-ratings for movies containing depictions of cigarette smoking. Weighted, multivariable logistic regression was used to assess the predictors of policy opposition or neutrality.The analysis showed that 47.0% of U.S. adults were supportive, 20.3% opposed, and 30.3% were neutral toward designating R-ratings for movies depicting cigarette smoking. Older adults were significantly less likely to be neutral to or opposed to an R-rating policy than adults aged 18-34 years: age 50-64 years (OR=0.56; 95% CI=0.35, 0.87), age 65-74 years (OR=0.39; 95% CI=0.24, 0.64), and age ≥75 years (OR=0.27; 95% CI=0.16, 0.45). In addition, non-Hispanic Asians were significantly less likely than non-Hispanic Whites to be neutral to or opposed the policy (OR=0.46; 95% CI=0.25, 0.84).Study findings show that a near majority of U.S. adults support a policy that would designate R-ratings for movies depicting cigarette smoking and that there is greater neutrality than opposition toward the policy. Assessing public opinion toward a policy designating R-ratings for movies depicting cigarette smoking may inform efforts to educate the public about the value of such policies for preventing youth tobacco initiation.

UNSTRUCTURED Correction: Tracking Healthy People 2020 Internet, Broadband, and Mobile Device Access Goals: An Update Using Data From the Health Information National Trends Survey

Background: Hispanics are differentially burdened by inequities in cancer outcomes. Increasing knowledge about cancer and cancer services among Hispanics may aid in reducing inequities, but little is known about what information sources are considered most effective or most trusted by this diverse population. The goal of this study was to examine heterogeneity in trust of cancer information from various media sources among U.S. Hispanic adults. Methods: Using data from the Health Information National Trends Survey (HINTS) 4, Cycles 2 and 4 and HINTS 5, Cycle 2, we examined nine trust questions, divided into four domains of health communication sources [doctor, government health/charitable organizations, media (including Internet), and family/friends and religious organizations]. Independent variables examined were gender, Hispanic ethnic categories (Mexican American, Cuban/Puerto Rican, and other Hispanics), age, education, income, language, and nativity. We used multivariable logistic regression with survey weights to identify independent predictors of cancer information source use and trust. Results: Of the 1,512 respondents, trust in sources ranged from 27% for radio to 91% for doctors. In multivariable models, Cubans/Puerto Ricans were twice as likely to trust cancer information from print media compared with Mexican Americans. Hispanics 75 years and older were nearly three times as likely to trust cancer information from religious organizations compared with those ages 18 to 34. Hispanic women were 59% more likely to trust cancer information from the Internet compared with men. Conclusions: Subgroup variability in source use and trust may be masked by broad racial and ethnic categories. Impact: Among Hispanics, there is significant variation by ethnicity and other sociodemographics in trust of sources of cancer information across multiple constructs, with notable implications for disseminating cancer information.

The Healthy People 2020 (HP 2020) initiative delineates objectives for improving population health in the United States. The National Cancer Institute's Health Information National Trends Survey (HINTS) has served as an important data source for tracking several HP 2020 Health Communication and Health Information Technology objectives, including patient perceptions of involvement in health-care decisions. We analyzed data from six cross-sectional administrations of HINTS (2008 to 2017; N = 25,410) to assess progress toward the HP 2020 objective of increasing the proportion of persons reporting that their health-care providers always involved them in decisions about their health care. In each survey year, just over half the population (range = 51.6 to 54.6) reported that their health-care providers always involved them in health-care decisions; the observed percentages over a 10-year period remained below the HP 2020 goal of 56.8% and did not show significant improvement. Results show a lack of progress toward this HP 2020 goal despite increased attention to patient engagement in health care over the last several decades.

Many of Appalachia’s premature deaths are attributable to preventable causes, such as smoking behaviors, obesity and healthcare avoidance. This chapter presents surveillance data from multilevel sources (i.e., local, regional, state, and national) on prominent and modifiable health behaviors contributing to the region’s disease burden. The text highlights tobacco use, lack of physical activity (and its relation to poor diet and obesity), and healthcare avoidance in outlining areas for future public health intervention. It explores why these detrimental behaviors are more common in Appalachia than elsewhere, giving particular attention to the region’s economic and educational deprivation. The chapter then highlights promising evidence-based programs working to reduce negative health behaviors in Appalachia today. It uses this abundance of data—both quantitative and qualitative—to argue that Appalachia’s health challenges, while profound, are surmountable.

Introduction Patient-centered communication (PCC) is one important component of patient-centered care and seen as a goal for most clinical encounters. Previous research has shown that higher PCC is related to an increase in healthy behaviors and less morbidity, among other outcomes. Given its importance, the National Cancer Institute (NCI) commissioned a monograph in 2007 to synthesize the existing literature on PCC and determine measurement objectives and strategies for measuring this construct, with a particular focus on cancer survivors. Based on this effort, a seven-item PCC scale was included on the Health Information National Trends Survey (HINTS), a probability-based survey of the US adult population. This study used HINTS data collected in 2018 to evaluate the psychometric properties of the PCC scale for the general US adult population including measures of reliability and validity. Results Through an exploratory factor analysis, the seven-item PCC scale was shown to be unidimensional with good internal consistency (Cronbach’s alpha = .92). A confirmatory factor analysis verified the factor structure. Other construct validity metrics included known groups and discriminant validity. Known group comparisons were conducted for several sociodemographic factors and health self-efficacy confirming a priori assumptions. Discriminant validity tests with measures of social support and anxiety/depression showed relatively weak associations. Conclusions The psychometric properties of this scale demonstrate its scientific utility for both surveillance research and other smaller-scale studies. Given its association with many health outcomes, it can also be used to better understand the dynamics in a clinical encounter.

Objective:To describe US adults’ levels of support, neutrality and opposition to restricting junk food advertising to children on social media and explore associations with socio-demographic and health-related characteristics.Design:In 2020–2021, we used cross-sectional data from the National Cancer Institute’s 2020 Health Information National Trends Survey to estimate the prevalence of opinions towards advertising restrictions and correlates of neutrality and opposition using weighted multivariable logistic regression.Setting:United States.Participants:Adults aged 18+ years.Results:Among the analytic sample (n 2852), 54 % of adults were neutral or opposed to junk food advertising restrictions on social media. The odds of being neutral or opposed were higher among Non-Hispanic Black adults (v. non-Hispanic White; OR: 2·03 (95 % CI 1·26, 3·26)); those completing some college (OR: 1·68 (95 % CI 1·20, 2·34)) or high school or less (OR: 2·62 (95 % CI 1·74, 3·96)) (v. those with a college degree); those who were overweight (v. normal weight; OR: 1·42 (95 % CI: 1·05, 1·93)) and those reporting a moderate (OR: 1·45 (95 % CI 1·13, 1·88)) or conservative (OR: 1·71 (95 % CI 1·24, 2·35)) political viewpoint (v. liberal). Having strong (v. weaker) weight and diet-related cancer beliefs was associated with 53 % lower odds of being neutral or opposed to advertising restrictions (OR: 0·47 (95 % CI 0·36, 0·61)).Conclusions:The current study identified subgroups of US adults for whom targeted communication strategies may increase support for policies to improve children’s food environment.

Background. The use of videos for patient and public health education has been widely adopted and well documented in the literature. Aims. To conduct a systematic review of empirical studies that used video-based interventions for cancer prevention and control to document study designs, settings, approaches, targeted cancer sites and behaviors, and outcomes and to identify gaps in research and practice. Method. PubMed, PsychINFO, CINAHL, SCOPUS, and Web of Science were searched for studies published in the 30-year period from 1984 to 2014. Of 1,521 articles identified, duplicates were removed, and titles and abstracts of 779 were examined for eligibility. In all, 315 articles met the inclusion criteria and were coded by three independent coders. Interrater reliability was assessed. Descriptive frequencies and proportions were calculated. Results. Studies evaluating video interventions for cancer prevention and control have increased over time. The majority used randomized controlled trial designs (54%), followed by single-group pre–posttest designs (18%). Most were delivered in health care settings (39%). Detection (30%) and treatment (16%) were the cancer control continuum stages most frequently addressed, with breast cancer (29%) being the most frequently targeted cancer site. The behavior most commonly targeted was screening/early detection (39%). Topics such as caregiving, coping, palliative care, and end of life were rarely addressed. The majority (69%) reported being successful at achieving their stated objectives, though outcomes varied across studies. Conclusions. Video interventions have been widely utilized for cancer prevention and control, with demonstrated successes. Future research should test innovative designs and new delivery platforms and should include underrepresented topics and cancer sites.

Objective: During the past decade, the availability of health information online has increased dramatically. We assessed progress toward the Healthy People 2020 (HP2020) health communication and health information technology objective of increasing the proportion of health information seekers who easily access health information online. Methods: We used data from 4 administrations of the Health Information National Trends Survey (HINTS 2008-2017) (N = 18 103). We conducted multivariable logistic regression analysis to evaluate trends over time in experiences with accessing health information and to examine differences by sociodemographic variables (sex, age, race/ethnicity, education, income, metropolitan status) separately for those who used the internet (vs other information sources) during their most recent search for health information. Results: Among US adults who looked for health information and used the internet for their most recent search, the percentage who reported accessing health information without frustration was stable during the study period (from 37.2% in 2008 to 38.5% in 2017). Accessing information online without frustration was significantly and independently associated with age 35-49 (vs age 18-34) (odds ratio [OR] = 1.34; 95% confidence interval [CI], 1.03 -1.73), non-Hispanic black (vs non-Hispanic white) race/ethnicity (OR = 2.15; 95% CI, 1.55-2.97), and annual household income $75 000) (OR = 0.66; 95% CI, 0.47-0.93). The percentage of adults who used an information source other than the internet and reported accessing health information online without frustration ranged from 31.3% in 2008 to 42.7% in 2017. Survey year 2017 (vs 2008) (OR = 1.61; 95% CI, 1.09-2.35) and high school graduate education (vs college graduate) (OR = 0.69; 95% CI, 0.49-0.97) were significantly and independently associated with accessing health information without frustration from sources other than the internet. Conclusions: The percentage of online health information seekers reporting easily accessing health information did not meet the HP2020 objective. Continued efforts are needed to enable easy access to online health information among diverse populations.

Objective To assess progress toward Healthy People 2020 health information technology objectives using nationally representative data. Methods We used data from six administrations (2003–2017) of the Health Information National Trends Survey (HINTS) to examine trends in the proportion of Americans who manage electronic Personal Health Information (ePHI) and email their healthcare providers. Two targets were evaluated: (1) a goal to exceed 15.7% of the general population for accessing ePHI (10% improvement), and (2) a goal to exceed 15% for communicating with health providers (10% improvement). Analyses included bivariate and multivariable logistic regression models, including assessing predicted marginal for key sociodemographic variables to explain observed digital divides in health information technology use over time. Results Self-reported management of ePHI online significantly increased between 2008 and 2017 from 14.2% to 70.9% (p Conclusions Targets set forth in HP2020 were exceeded for these health information technology objectives. Though an increase in adoption of these tools was seen across all sociodemographic categories, disparities persist and have even widened for certain groups. As efforts move forward to set targets for HP2030, the persistence of the digital divide amongst these groups should be considered.

Introduction The US Food and Drug Administration issued a final rule requiring new warnings for cigarette packages and advertisements. This study examines population-level characteristics of support for—versus neutrality or opposition toward—cigarette pack warnings that use text and images to portray the negative health effects of smoking. Methods We used nationally representative cross-sectional data of US adults age 18 and older from the 2020 Health Information National Trends Survey (n = 3865). Frequencies and weighted proportions were calculated for neutrality toward, opposition to, and support for pictorial warnings across sociodemographics and other predictors. Weighted, multivariable logistic regression examined predictors of being neutral or opposed versus supportive of pictorial warnings. Results In 2020, an estimated 69.9% of US adults supported pictorial warnings, 9.1% opposed, and 20.9% neither supported nor opposed them. In fully adjusted models, current smokers had almost twice the odds of being neutral or opposed to pictorial warnings as never smokers (odds ratio [OR] = 1.99, confidence interval [CI] 1.12, 3.52). Adults 75 years and older (vs. 18–34) (OR = 0.55, CI 0.33, 0.94) and those with children under 18 in their household (vs. no children) (OR = 0.67, CI 0.46, 0.98) were less likely to be neutral or opposed. Conclusions In advance of the Food and Drug Administration’s implementation of pictorial warnings on cigarette packages, nearly 70% of American adults support this policy. Disseminating information about the effectiveness of pictorial warnings may further strengthen support among current smokers who are less supportive than never smokers. Furthermore, framing messages around the benefits of pictorial warnings for protecting youth may increase public support. Implications While public support for pictorial warnings on cigarette packages is high in the United States, it may increase further after policy implementation and be strengthened by utilizing information campaigns that convey the evidence that pictorial warnings are an effective public health strategy.

BACKGROUND Sharing data from wearable health and activity trackers (wearables) with others may improve the health and behavioral outcomes of wearable users by generating social support and improving their ability to manage their health. Investigating individual factors that influence US adults’ willingness to share wearable data with different types of individuals may provide insights about the population subgroups that are most or least likely to benefit from wearable interventions. Specifically, it is necessary to identify digital health behaviors potentially associated with willingness to share wearable data given that the use of and engagement with various technologies may broadly influence web-based health information–sharing behaviors. OBJECTIVE This study aims to identify sociodemographic, health, and digital health behavior correlates of US adults’ willingness to share wearable data with health care providers and family or friends. METHODS Data for the analytic sample (N=1300) were obtained from the 2019 Health Information National Trends Survey of the National Cancer Institute. Digital health behavior measures included frequency of wearable device use, use of smartphones or tablets to help communicate with providers, use of social networking sites to share health information, and participation in a web-based health community. Multivariable logistic regression analysis of weighted data examined the associations between digital health behaviors and willingness to share wearable device data, controlling for sociodemographics and health-related characteristics. RESULTS Most US adults reported willingness to share wearable data with providers (81.86%) and with family or friends (69.51%). Those who reported higher health self-efficacy (odds ratio [OR] 1.97, 95% CI 1.11-3.51), higher level of trust in providers as a source of health information (OR 1.98, 95% CI 1.12-3.49), and higher level of physical activity (OR 2.00, 95% CI 1.21-3.31) had greater odds of willingness to share data with providers. In addition, those with a higher frequency of wearable use (OR 2.15, 95% CI 1.35-3.43) and those who reported use of smartphones or tablets to help communicate with providers (OR 1.99, 95% CI 1.09-3.63) had greater odds of willingness to share data with providers. Only higher level of physical activity was associated with greater odds of willingness to share wearable data with family or friends (OR 1.70, 95% CI 1.02-2.84). Sociodemographic factors were not significantly associated with willingness to share wearable data. CONCLUSIONS The findings of this study suggest that, among US adult wearable users, behavior-related factors, rather than sociodemographic characteristics, are key drivers of willingness to share health information obtained from wearables with others. Moreover, behavioral correlates of willingness to share wearable data are unique to the type of recipient (ie, providers vs family or friends). Future studies could use these findings to inform the development of interventions that aim to improve the use of patient-generated data from wearable devices in health care settings. CLINICALTRIAL

To analyze communication-focused grants funded by the National Cancer Institute (NCI) between fiscal years 2013 and 2019 to provide insight into the characteristics of funded projects and identify promising areas for future research.iSearch, a portfolio analysis tool, was queried to identify communication-related grants funded by NCI. Abstracts and specific aims were coded for key study characteristics. 344 unique competing grants with a substantial communication component were included in the final analysis. SAS version 9.4 was used to calculate code frequencies.Most communication grants focused on cancer prevention (n = 197), with fewer targeting diagnosis, treatment, survivorship, or end-of-life. Tobacco product use was the most frequently addressed topic (n = 128). Most grants targeted or measured outcomes at the individual (n = 332) or interpersonal level (n = 127). Cancer patients/survivors (n = 101) and healthcare providers (n = 63) were often the population of focus, while caregivers or those at increased risk for cancer received less attention. Studies were often based in healthcare settings (n = 125); few studies were based in schools or worksites. Many grants employed randomized controlled trials (n = 168), but more novel methods, like optimization trials, were uncommon.NCI's support of health communication research covers a diverse array of topics, populations, and methods. However, the current analysis also points to several promising opportunities for future research, including efforts focused on communication at later stages of the cancer control continuum and at multiple levels of influence, as well as studies that take advantage of a greater diversity of settings and leverage novel methodological approaches.

Cancer mortality rates are approximately 8% higher in rural populations and mortality rates are falling more slowly in rural communities, resulting in widening rural-urban health disparities in the United States. The NCI has a long history of supporting health disparities research, including research to understand the health needs, strengths, and opportunities in rural communities. However, the portfolio analysis described in this article underscores the need to significantly accelerate rural cancer control research in partnership with state and local communities. This commentary outlines NCI's efforts over the last four years to address gaps in rural cancer control research and improve cancer prevention, control, and care delivery in rural populations. Future directions, challenges, and opportunities are also discussed.

Introduction Emerging tobacco products have become increasingly popular, and the US Food and Drug Administration extended its authority to all products meeting the definition of a tobacco product in 2016. These changes may lead to shifts in public perceptions about tobacco products and regulation, and national surveys are attempting to assess these perceptions at the population level. This article describes the item development and cognitive interviewing of the tobacco product and regulation perception items included in two tobacco-focused cycles of the Health Information National Trends Survey (HINTS-FDA), referred to as HINTS-FDA. Methods Cognitive interviewing was used to investigate how respondents comprehended and responded to tobacco product and regulation perception items. Adult participants (n = 20) were selected purposively to oversample current tobacco users and were interviewed in two iterative rounds. Weighted descriptive statistics from the fielded HINTS-FDA surveys (N = 5474) were also calculated. Results Items were generally interpreted as intended, and participants meaningfully discriminated between tobacco products when assessing addiction perceptions. Response selection issues involved inconsistent reporting among participants with little knowledge or ambivalent opinions about either government regulation or tobacco products and ingredients, which resolved when a “don’t know” response option was included in the survey. The fielded survey found that a non-negligible proportion of the population do not have clear perceptions of emerging tobacco products or government regulation. Conclusions A “don’t know” response option is helpful for items assessing many emerging tobacco products but presents several analytic challenges that should be carefully considered. Multiple items assessing specific tobacco product and regulation perception items are warranted in future surveys. Implications The findings from this study can serve as a foundation for future surveys that assess constructs related to emerging tobacco products, harm perceptions across multiple tobacco products, and tobacco-related government regulatory activities. The data provide unique insight into item-specific motivation for selecting a “don’t know” response option for tobacco survey items.

Objective Patient-provider communication has been found to be less patient centred, on average, with patients who are members of stigmatized or minority groups. Obesity is a stigmatized condition, and thus, people with obesity may experience less patient-centred communication (PCC). The objective of this study was to assess the association between patient body mass index (BMI) and self-reported quality of PCC experienced over a 12-month period and whether that relationship differed for men and women. Methods Data collected for the National Cancer Institute's Health Information National Trends Survey were analysed. Respondents who reported a BMI ≥ 18.5 kg/m2 and indicated having seen a healthcare provider outside of an emergency room in the last 12 months were included. PCC was measured using a validated six-item scale. Multivariate logistic regression was used to model the odds of reporting PCC greater than the sample median. Results Compared with people with normal weight BMIs, no associations were found between overweight (odds ratio [OR] = 0.84, p = 0.17), class I & II obesity (OR = 0.94, p = 0.68) or class III obesity (OR = 0.86, p = 0.47) and PCC. There was a significant interaction (p = 0.015) such that for men, but not women, higher BMI was associated with less PCC. Conclusion Unlike evidence that women experience more weight stigma, in the healthcare domain, men may be at elevated risk of experiencing communication influenced by weight stigma.

In May 2016, the NCI announced supplemental funding for NCI-Designated Cancer Centers to conduct research to better characterize populations within cancer center catchment areas. The initiative was intended to support primary data collection efforts to better define and describe cancer center catchment areas using a multilevel population health framework. The long-term goal was to facilitate collaborations in which researchers, providers, public health practitioners, and nonprofit organizations could utilize the data to develop or expand applied cancer control research, planning, and implementation, with an emphasis on local health disparities and communication inequalities. This CEBP Focus issue on “Population Health Assessment in Cancer Center Catchment Areas” highlights the results from those catchment area data collection efforts. Articles highlight research from surveys conducted to define and describe cancer center catchment areas using both probability and nonprobability designs and a variety of sampling techniques, survey modes, and data linkages. Some articles report pooled analyses of data collected by multiple cancer centers to highlight local versus national comparisons based on standardized behavioral and demographic measures. Others examine rural–urban differences in measures relevant to cancer prevention and control. The studies published in this Focus will provide the field with a myriad of methodologic approaches for defining and describing cancer center catchment areas.

Background Sharing data from wearable health and activity trackers (wearables) with others may improve the health and behavioral outcomes of wearable users by generating social support and improving their ability to manage their health. Investigating individual factors that influence US adults’ willingness to share wearable data with different types of individuals may provide insights about the population subgroups that are most or least likely to benefit from wearable interventions. Specifically, it is necessary to identify digital health behaviors potentially associated with willingness to share wearable data given that the use of and engagement with various technologies may broadly influence web-based health information–sharing behaviors. Objective This study aims to identify sociodemographic, health, and digital health behavior correlates of US adults’ willingness to share wearable data with health care providers and family or friends. Methods Data for the analytic sample (N=1300) were obtained from the 2019 Health Information National Trends Survey of the National Cancer Institute. Digital health behavior measures included frequency of wearable device use, use of smartphones or tablets to help communicate with providers, use of social networking sites to share health information, and participation in a web-based health community. Multivariable logistic regression analysis of weighted data examined the associations between digital health behaviors and willingness to share wearable device data, controlling for sociodemographics and health-related characteristics. Results Most US adults reported willingness to share wearable data with providers (81.86%) and with family or friends (69.51%). Those who reported higher health self-efficacy (odds ratio [OR] 1.97, 95% CI 1.11-3.51), higher level of trust in providers as a source of health information (OR 1.98, 95% CI 1.12-3.49), and higher level of physical activity (OR 2.00, 95% CI 1.21-3.31) had greater odds of willingness to share data with providers. In addition, those with a higher frequency of wearable use (OR 2.15, 95% CI 1.35-3.43) and those who reported use of smartphones or tablets to help communicate with providers (OR 1.99, 95% CI 1.09-3.63) had greater odds of willingness to share data with providers. Only higher level of physical activity was associated with greater odds of willingness to share wearable data with family or friends (OR 1.70, 95% CI 1.02-2.84). Sociodemographic factors were not significantly associated with willingness to share wearable data. Conclusions The findings of this study suggest that, among US adult wearable users, behavior-related factors, rather than sociodemographic characteristics, are key drivers of willingness to share health information obtained from wearables with others. Moreover, behavioral correlates of willingness to share wearable data are unique to the type of recipient (ie, providers vs family or friends). Future studies could use these findings to inform the development of interventions that aim to improve the use of patient-generated data from wearable devices in health care settings.

Addiction beliefs about tobacco use are associated with intentions to use and use of tobacco products. Exposure to information about tobacco products in media sources may affect addiction beliefs.To examine the relationship between media exposure and tobacco product addiction beliefs.A nationally representative sample of US adults (n=3738) from the 2015 National Cancer Institute's Health Information National Trends Survey was used to examine addiction beliefs about cigarettes, cigars, smokeless tobacco, electronic cigarettes, hookah/waterpipe tobacco, and roll-your-own cigarettes. We used logistic regression to examine the relationship between media exposure and addiction beliefs. We defined media exposure by hours exposed, as well as exposure to tobacco use health effects information through media sources including social media. We categorized media sources by whether respondents actively or passively engaged with the source.A majority (60.6% to 87.3%) of respondents believed that cigarettes, cigars, roll-your-own cigarettes and smokeless tobacco are addictive. Less than half of respondents believed that electronic cigarettes or hookah/waterpipes are addictive (45.2% and 49.8%, respectively). Respondents exposed to messages about tobacco use health effects on active media channels (e.g., social media) had greater odds of believing that smokeless tobacco (adjusted odds ratio [AOR]=1.48), hookah/waterpipe (AOR=1.69), and roll-your-own cigarettes (AOR=1.61) are addictive. Respondents exposed to tobacco use health effects messages on passive media channels (e.g., television), had greater odds of believing that cigarettes (AOR=2.76) and electronic cigarettes (AOR=2.12) are addictive.US adult exposure to information about the health effects of tobacco use was associated with addiction beliefs about tobacco products.

Introduction Harm perceptions about tobacco products may influence initiation, continued use, and cessation efforts. We assessed associations between adult traditional tobacco product use and absolute harm perceptions of traditional and alternative tobacco products. We also described the topics individuals looked for during their last search for information, their beliefs about chemicals in cigarettes/cigarette smoke, and how both relate to harm perceptions. Methods We ran multivariable models with jackknife replicate weights to analyze data from the 2015 administration of the National Cancer Institute's Health Information National Trends Survey (N = 3376). Results Compared to never users, individuals reported lower perceived levels of harm for products they use. Among current tobacco users, ethnicity, thinking about chemicals in tobacco, and information-seeking were all factors associated with tobacco product harm perceptions. In the full sample, some respondents reported searching for information about health effects and cessation and held misperceptions about the source of chemicals in tobacco. Conclusions This study fills a gap in the literature by assessing the absolute harm perceptions of a variety of traditional and alternative tobacco products. Harm perceptions vary among tobacco products, and the relationship among tobacco use, information seeking, thoughts about chemicals in tobacco products, and harm perceptions is complex. Data suggest that some individuals search for information about health effects and cessation and hold misperceptions about chemicals in tobacco products. Future inquiry could seek to understand the mechanisms that contribute to forming harm perceptions and beliefs about chemicals in tobacco products.

We conducted a nonresponse bias analysis of the Health Information National Trends Survey (HINTS) 4, Cycles 1 and 3, collected in 2011 and 2013, respectively, using three analysis methods: comparison of response rates for subgroups, comparison of estimates with weighting adjustments and external benchmarks, and level-of-effort analysis. Areas with higher concentrations of low socioeconomic status, higher concentrations of young households, and higher concentrations of minority and Hispanic populations had lower response rates. Estimates of health information seeking behavior were higher in HINTS compared to the National Health Interview Survey (NHIS). The HINTS estimate of doctors always explaining things in a way that the patient understands was not significantly different from the same estimate from the Medical Expenditure Panel Survey (MEPS); however, the HINTS estimate of health professionals always spending enough time with the patient was significantly lower than the same estimate from MEPS. A level-of-effort analysis found that those who respond later in the survey field period were less likely to have looked for information about health in the past 12 months, but found only small differences between early and late respondents for the majority of estimates examined. There is some evidence that estimates from HINTS could be biased toward finding higher levels of health information seeking.

Introduction: Appalachian communities experience elevated rates of cancer incidence and mortality relative to other regions in the U.S. Specifically, melanoma mortality rates are higher in Appalachia compared to the national average, despite comparable incidence rates. Purpose: To examine differences in self-reported history of skin cancer and prevalence of two UV exposure behaviors between Appalachian and non-Appalachian adults in a nationally representative sample. Methods: Data are from four cross-sectional cycles of the Health Information National Trends Survey (2011–2014) (N=14,451). We examined sunscreen use and tanning bed use, and self-reported history of melanoma and non-melanoma skin cancer. Descriptive and weighted multivariable analyses were conducted to examine sunscreen and tanning bed use, controlling for sociodemographic characteristics. Results: Approximately 8% of the study sample resided in Appalachia (n=1,015). Self-reported melanoma (0.6%) and non-melanoma (3.2%) skin cancer histories were low among Appalachians and did not differ statistically from non-Appalachians (p>0.05). Only 21.2% of Appalachians reported using sunscreen often or always when going outside for more than one hour on a warm, sunny day compared to 27.4% of non-Appalachians (p, Copyright © 2020 Minal Patel, Katrina Serrano, Elise Rice, Chan Thai, Kelly Blake, and Robin C. Vanderpool This work is licensed under a Creative Commons Attribution 4.0 License.

Background Three major US tobacco companies were recently ordered to publish corrective statements intended to prevent and restrain further fraud about the health effects of smoking. The court-ordered statements began appearing in newspapers and on television (TV) in late 2017. Objective The objective of this study was to examine the social media dissemination of the tobacco corrective statements during the first 6 months of the implementation of the statements. Methods We conducted a descriptive content analysis of Twitter posts using an iterative search strategy through Crimson Hexagon and randomly selected 19.74% (456/2309) of original posts occurring between November 1, 2017, and March 27, 2018, for coding and analysis. We assessed post volume over time, source or author, valence, linked content, and reference to the industry (eg, big tobacco, tobacco industry, and Philip Morris) and media outlet (TV or newspaper). Retweeted content was coded for source/author and prevalence. Results Most posts were published in November 2017, surrounding the initial release of the corrective statements. Content was generally neutral (58.7%, 268/456) or positive (33.3%, 152/456) in valence, included links to additional information about the statements (94.9%, 433/456), referred to the industry (87.7%, 400/456), and did not mention a specific media channel on which the statements were aired or published (15%). The majority of original posts were created by individual users (55.2%, 252/456), whereas the majority of retweeted posts were posted by public health organizations (51%). Differences by source are reported, for example, organization posts are more likely to include a link to additional information compared with individual users (P=.03). Conclusions Conversations about the court-ordered corrective statements are taking place on Twitter and are generally neutral or positive in nature. Public health organizations may be increasing the prevalence of these conversations through social media engagement.

Purpose: To assess the public’s trust in health information sources (ie, government health agencies, doctors, family/friends, charitable organizations, and religious leaders/organizations) from 2005 to 2015 and identify sociodemographics factors associated with high trust. Design: Cross-sectional. Setting: Health Information National Trends Survey, a US nationally representative publicly available data on health-related knowledge, behaviors, and attitudes. Participants: Data included 5 iterations (2005-2015) of US adults (2005: N = 5586, 2008: N = 7764, 2011: N = 3959, 2013: N = 3185, and 2015: N = 3738). Measures: Outcome variables were high trust in health information sources and independent variables were sociodemographics. Analysis: A descriptive analysis was conducted to track changes in trust over the past decade. The χ2 and multivariable logistic regression were conducted to assess sociodemographic associations in 2015. Results: Trust in health information across all sources remained stable from 2005 to 2015. Doctors were the most trusted source, followed by government health agencies. Sociodemographics were independently associated with trust. For example, non-Hispanic blacks were more likely to trust charitable organizations (odds ratio [OR] = 2.32, confidence interval [CI] = 1.42-3.79) and religious leaders/organizations (OR = 3.57, CI = 1.20-10.57) compared to non-Hispanic whites. In addition, those with less than high school education (OR = 2.44, CI = 1.32-4.52) were more likely than college graduates to report trust in religious leaders/organizations. Conclusion: Although there are analytic limitations to the specific time periods, the findings demonstrate that public health communication practitioners must consider the role of source credibility among priority populations when disseminating and promoting information.

ObjectiveTo describe the population prevalence and predictors of self-reported exposure to court-ordered tobacco-related corrective statements in 2017–2018, when they were first implemented in newspapers and on television.MethodsNationally representative data from the 2018 Health Information National Trends Survey were used (n=3504). Frequencies and weighted proportions were calculated for seeing any corrective statement and for each of the five court-ordered corrective statements. Weighted, multivariable logistic regression was used to examine sociodemographic and smoking status predictors of reported exposure to any corrective statement.ResultsIn 2018, an estimated 40.6% of US adults had seen messages in newspapers or on television in the past 6 months stating that a federal court has ordered tobacco companies to make statements about the dangers of smoking cigarettes. Reported exposure to topic-specific statements ranged from 11.4% (manipulation of cigarette design) to 34.7% (health effects). Those with a high school education were significantly less likely than those with a college degree to report seeing the statements (OR=0.69, CI 0.50 to 0.95) and current smokers were significantly more likely than never smokers to report seeing them (OR=1.68, CI 1.12 to 2.53).ConclusionsIn the first 6 months of corrective statement implementation, an estimated 40.6% of US adults reported at least one exposure to any corrective statement, and current smokers were more likely than never smokers to report exposure. Traditional media channels can be effective for tobacco-related message dissemination; however, they may fail to reach more than half of the adult population without additional targeted communication efforts.

Purpose: Less than half of US adults meet the recommended guidelines of 150 minutes of exercise each week. Health promotion messages are frequently used to promote physical activity (PA); however, this messaging may be ineffective if it does not resonate with the target audience. The purpose of this exploratory study is to understand how women respond to examples of PA promotion messages. Approach/Design: A qualitative study. Setting: Washington DC Metro Area. Participants: Forty women, stratified by race/ethnicity (white, black, Latina) and level of self-reported PA (active, inactive). Method: Eight focus groups were conducted in which participants were shown 3 PA promotion messages representative of typical messaging strategies. Three researchers conducted a thematic analysis to code the data for emergent themes. Results: Current PA promotion messaging strategies do not resonate with women. Women want to see individuals with “realistic” bodies who look similar to them (eg, body shape, age, race/ethnicity), and for PA messaging to include daily activities as a way to be active. Conclusions: Public health practitioners who promote PA to women should consider developing messages that better resonate with women’s dynamic roles and lifestyles. Successful strategies may include depicting busy lifestyles that PA may be physically and logistically difficult to fit into and using models with diverse body shapes.

Purpose The increase in use of health information technologies (HIT) presents new opportunities for patient engagement and self-management. Patients in rural areas stand to benefit especially from increased access to health care tools and electronic communication with providers. We assessed the adoption of 4 HIT tools over time by rural or urban residency. Methods Analyses were conducted using data from 7 iterations of the National Cancer Institute's Health Information National Trends Survey (HINTS; 2003-2014). Rural/urban residency was based on the USDA's 2003 Rural-Urban Continuum Codes. Outcomes of interest included managing personal health information online; whether providers maintain electronic health records (EHRs); e-mailing health care providers; and purchasing medicine online. Bivariate analyses and logistic regression were used to assess relationships between geography and outcomes, controlling for sociodemographic characteristics. Findings In total, 6,043 (17.6%, weighted) of the 33,749 respondents across the 7 administrations of HINTS lived in rural areas. Rural participants were less likely to report regular access to Internet (OR = 0.70, 95% CI = 0.61-0.80). Rural respondents were neither more nor less likely to report that their health care providers maintained EHRs than were urban respondents; however, they had decreased odds of managing personal health information online (OR = 0.59, 95% CI = 0.40-0.78) and e-mailing health care providers (OR = 0.62, 95% CI = 0.49-0.77). Conclusions The digital divide between rural and urban residents extends to HIT. Additional investigation is needed to determine whether the decreased use of HIT may be due to lack of Internet connectivity or awareness of these tools.

Healthy People 2020 (HP2020) aims to improve population health outcomes through several objectives, including health communication and health information technology. We used 7 administrations of the Health Information National Trends Survey to examine HP2020 goals toward access to the Internet through broadband and mobile devices (N = 34 080). We conducted descriptive analyses and obtained predicted marginals, also known as model-adjusted risks, to estimate the association between demographic characteristics and use of mobile devices. The HP2020 target (7.7% of the US population) for accessing the Internet through a cellular network was surpassed in 2014 (59.7%), but the HP2020 target (83.2%) for broadband access fell short (63.8%). Sex and age were associated with accessing the Internet through a cellular network throughout the years (Wald F test, P

The National Cancer Institute (NCI) developed the Health Information National Trends Survey (HINTS) to monitor population trends in cancer communication practices, information preferences, health risk behaviors, attitudes, and cancer knowledge. The U.S. Food and Drug Administration (FDA) recognized HINTS as a unique data resource for informing its health communication endeavors and partnered with NCI to field HINTS-FDA 2015. HINTS-FDA 2015 was a self-administered paper instrument sent by mail May 29 to September 8, 2015, using a random probability-based sample of U.S. postal addresses stratified by county-level smoking rates, with an oversampling of high and medium-high smoking strata to increase the yield of current smokers responding to the survey. The response rate for HINTS-FDA 2015 was 33% (N = 3,738). The yield of current smokers (n = 495) was lower than expected, but the sampling strategy achieved the goal of obtaining more former smokers (n = 1,132). Public-use HINTS-FDA 2015 data and supporting documentation have been available for download and secondary data analyses since June 2016 at http://hints.cancer.gov . NCI and FDA encourage the use of HINTS-FDA for health communication research and practice related to tobacco-related communications, public knowledge, and behaviors as well as beliefs and actions related to medical products and dietary supplements.

BACKGROUND As the year 2020 approaches, there is a need to evaluate progress toward the United States government’s Healthy People 2020 (HP2020) health information technology and communication objectives to establish baselines upon which Healthy People 2030 objectives can be based. OBJECTIVE The aim of this study was to use the National Cancer Institute’s (NCI) Health Information National Trends Survey (HINTS) to benchmark progress toward HP2020 goals related to increasing internet access using broadband, and to assess the state of the digital divide for various sociodemographic groups. METHODS We merged and analyzed data from 8 administrations of HINTS (2003-2017). Descriptive statistics were generated, and predicted marginals were calculated using interaction terms between survey year and selected sociodemographic variables of interest, including age, sex, race and ethnicity, income, education, and geography (rural versus urban), to test for differential change over time. RESULTS The number of users having access to the internet increased between 2003 and 2014 (63.15% [3982/6358] to 83.41% [2802/3629]); it remained relatively steady from 2014 to 2017 (81.15% [2533/3283]). Broadband access increased between 2003 and 2011 (from 32.83% [1031/3352] to 77.87% [3375/4405]), but has been declining since (55.93% [1364/2487] in 2017). Access via cellular network increased between 2008 and 2017 (from 6.86% [240/4405] to 65.43% [1436/2489]). Statistically significant disparities in overall internet access were noted in the predicted marginals for age, sex, race and ethnicity, income, and education; for age, sex, income, and geography for broadband access; and for age and sex for cellular network. CONCLUSIONS The targets set forth in HP2020 were met for overall internet access and for internet access via cellular network; however, the target was not met for internet access via broadband. Furthermore, although the digital divide persisted by sociodemographic characteristics, the magnitude of many disparities in access decreased over time.

BACKGROUND Three major US tobacco companies were recently ordered to publish corrective statements intended to prevent and restrain further fraud about the health effects of smoking. The court-ordered statements began appearing in newspapers and on television (TV) in late 2017. OBJECTIVE The objective of this study was to examine the social media dissemination of the tobacco corrective statements during the first 6 months of the implementation of the statements. METHODS We conducted a descriptive content analysis of Twitter posts using an iterative search strategy through Crimson Hexagon and randomly selected 19.74% (456/2309) of original posts occurring between November 1, 2017, and March 27, 2018, for coding and analysis. We assessed post volume over time, source or author, valence, linked content, and reference to the industry (eg, big tobacco, tobacco industry, and Philip Morris) and media outlet (TV or newspaper). Retweeted content was coded for source/author and prevalence. RESULTS Most posts were published in November 2017, surrounding the initial release of the corrective statements. Content was generally neutral (58.7%, 268/456) or positive (33.3%, 152/456) in valence, included links to additional information about the statements (94.9%, 433/456), referred to the industry (87.7%, 400/456), and did not mention a specific media channel on which the statements were aired or published (15%). The majority of original posts were created by individual users (55.2%, 252/456), whereas the majority of retweeted posts were posted by public health organizations (51%). Differences by source are reported, for example, organization posts are more likely to include a link to additional information compared with individual users (P=.03). CONCLUSIONS Conversations about the court-ordered corrective statements are taking place on Twitter and are generally neutral or positive in nature. Public health organizations may be increasing the prevalence of these conversations through social media engagement.

Early stage diagnosis strongly predicts cancer survival. Recognition of potential symptoms of cancer may improve survival by reducing time to seeking care.Telephone interviews with a population-representative sample of English-speaking adults (aged ≥50 years) in the U.S. (N=1,425) were conducted in 2014 using an instrument adapted from the International Cancer Benchmarking Partnership Awareness and Beliefs about Cancer survey. Anticipated time to seeking care for four cancer symptoms (persistent cough, rectal bleeding, mole changes, and breast changes) was assessed, and delay was defined as waiting2 weeks. Recognition of symptoms as potential cancer signs was assessed dichotomously. Multivariate logistic regression models were used to assess associations between symptom recognition and anticipated delay, adjusting for demographics, cancer experience, self-reported health, and healthcare access. Analyses were weighted and conducted in 2017.Symptom recognition varied but was relatively high across all symptoms (76.9%-95.5%). Anticipated delay varied by symptom and was highest for persistent cough (41.2%) and lowest for rectal bleeding (9.1%). For rectal bleeding (AOR=2.65, 95% CI=1.31, 5.36) and mole changes (AOR=3.30, 95% CI=1.48, 7.33), anticipated delay was more likely among individuals who did not recognize the symptom as a warning sign. Adults with lower education levels (p0.05) and African Americans (p0.05) were less likely to delay for some symptoms.Lack of symptom recognition was associated with anticipated delay in seeking care for some cancer symptoms. Differences in recognition and delays by symptom could be driven partly by screening messaging or by ambiguity and functional impact of each symptom.

Purpose: Previous research has found that people’s trust in a source of information affects whether they will expose themselves to information from that source, pay attention to that source, and the likelihood that they will act on the information obtained from that source. This study tracked trends in levels of trust in different health information sources over time and investigated sociodemographic predictors of trust in these sources. Methodology/Approach: Data were drawn from the Health Information National Trends Survey (HINTS), a nationally representative, cross-sectional survey of adults in the USA. Weighted percentages, means, and standard errors for trust in health information sources were computed using data from four iterations of the survey (2005, 2009, 2012, and 2013). Weighted multivariable logistic regression models were employed to investigate associations between sociodemographic variables and level of trust in health information sources using HINTS 2013 data. Findings: Trend analyses revealed declining trust in “traditional” mass media channels, such as television and radio, for health information and consistently high trust in interpersonal sources, like physicians, over the past decade. Regression analyses showed that those with more education (ORs 2.93–4.59, p < 0.05) and higher incomes (ORs 1.65–2.09, p < 0.05) were more likely to trust the Internet for health information than those with less education and lower incomes. Non-Hispanic Blacks and Hispanics were more likely to trust mass media channels in comparison to Non-Hispanic Whites (ORs 1.73–2.20, p < 0.05). Implications: These findings can be used to inform the strategic selection of channels for disseminating health information to certain demographic groups.

The populations of many Appalachian communities have high rates of unhealthy body weight. This study aimed to identify differences in beliefs about obesity between Appalachians and non-Appalachians. Our analyses explored health beliefs and behaviors among US adults aged ≥18 (n = 14 451) who responded to the Health Information National Trends Survey (2011-2014), of whom 1015 (8%) resided within the 420 counties recognized as Appalachian by the Appalachian Regional Commission. Using weighted regression analyses and controlling for sociodemographic characteristics and general health, we determined that self-reported body mass index was higher among Appalachians than among non-Appalachians ( B = 0.75, P = .03, 95% confidence interval, 0.08-1.47) and that Appalachians were less likely than non-Appalachians to believe that lifestyle factors were related to obesity ( B = –0.37, P = .03, 95% confidence interval, –0.04 to –0.71). Results suggest that Appalachians may regard behavioral prevention differently from non-Appalachians, perhaps with less confidence in the effectiveness of certain behaviors to reduce obesity risk. Future research may determine whether such beliefs could complicate efforts to encourage healthy lifestyles throughout the region.

There is a positive correlation between recall of tobacco-related television news and perceived risks of smoking and thoughts about quitting. The authors used Cision US, Inc., to create a sampling frame (N = 61,027) of local and national television news coverage of tobacco from October 1, 2008, to September 30, 2009, and to draw a nationally representative sample (N = 730) for content analysis. The authors conducted a descriptive study to determine the frequency and proportion of stories containing specified tobacco topics, frames, sources, and action messages, and the valence of the coverage. Valence was generally neutral; 68% of stories took a balanced stance, with 26% having a tenor supportive of tobacco control and 6% opposing tobacco control. The most frequently covered topics included smoking bans (n = 195) and cessation (n = 156). The least covered topics included hookah (n = 1) and menthol (n = 0). The majority of coverage lacked quoting any source (n = 345); government officials (n = 144) were the most quoted sources. Coverage lacked action messages or resources; 29 stories (4%) included a message about cessation or advocacy, and 8 stories (1%) contained a resource such as a quitline. Television news can be leveraged by health communication professionals to increase awareness of underrepresented topics in tobacco control.

Background Nearly 80 million people in the U.S. are currently infected with at least one of two strains of human papillomavirus (HPV), which is associated with 70% of cervical cancers. Greater cervical cancer mortality has been observed among women of lower SES and those living in rural, versus urban, areas. African American and Hispanic women are significantly more likely to die from cervical cancer than non-Hispanic white women. Purpose To assess current population awareness of and knowledge about HPV and the HPV vaccine, as well as the contribution of sociodemographic characteristics to disparities in HPV awareness and knowledge. Methods Cross-sectional data were obtained from the National Cancer Institute's 2013 Health Information National Trends Survey (HINTS; N=3,185). Multivariable logistic regression was employed to identify gaps in awareness and knowledge by sex, education, income, race/ethnicity, geographic area, and other important sociodemographic characteristics. Analyses were conducted in 2014. Results Sixty-eight percent of Americans had heard of HPV and the HPV vaccine. Consistent with the Knowledge Gap Hypothesis, awareness and knowledge were patterned by sex, age, education, and other important sociodemographic factors. Those in rural areas were less likely than those in urban areas to know that HPV causes cervical cancer. Less than 5% of Americans were aware that HPV often clears on its own without treatment. Conclusions Although awareness and knowledge of HPV is increasing, there are opportunities to target communication with populations for whom knowledge gaps currently exist, in order to promote dialogue about the vaccine among patients and their providers.

The demonstrated benefits of information seeking for cancer patients, coupled with increases in information availability, underscore the importance of monitoring patient information seeking experiences over time. We compared information seeking among cancer survivors to those with a family history of cancer and those with no history of cancer. We identified characteristics associated with greater information seeking among cancer survivors, key sources of cancer-related information, and changes in information source use over time. Data from five iterations of the Health Information National Trends Survey (HINTS) spanning 2003 to 2013 were merged and analyzed. Frequencies, cross-tabulations, multivariate logistic regression, and multinomial regression analyses were conducted. All data were weighted to provide representative estimates of the adult US population. Cancer information seeking was reported most frequently by cancer survivors (69.8 %). The percentage of cancer survivors who reported information seeking increased from 66.8 % in 2003 to 80.8 % in 2013. Cancer information seeking was independently associated with age, education, and income; seeking was less likely among older adults, those with less education, and those with lower incomes. Compared to respondents in 2003, those in 2005 (odds ratio (OR) = 0.40, 95 % confidence interval (CI) = 0.24-0.65) and 2008 (OR = .43, 95 % CI = 0.26-0.70) were about half as likely to use the Internet as the first source of cancer information compared to a healthcare provider. Despite overall increases in cancer information seeking and access to health information from a variety of sources, healthcare providers remain a key source of health information for cancer survivors.

INTRODUCTION Research has documented growing availability and use of e-cigarettes in the United States over the last decade. METHODS We conducted a national panel survey of current adult cigarette smokers to assess attitudes, beliefs, and behaviors relating to e-cigarette use in the United States (N = 2,254). RESULTS Among current cigarette smokers, 20.4% reported current use of e-cigarettes on some days and 3.7% reported daily use. Reported reasons for e-cigarette use included: quit smoking (58.4%), reduce smoking (57.9%), and reduce health risks (51.9%). No significant differences in sociodemographic characteristics between e-cigarette users and nonusers were observed. Prior quit attempts were reported more frequently among e-cigarette users (82.8%) than nonusers (74.0%). Intention to quit was reported more frequently among e-cigarette users (64.7%) than nonusers (46.8%). Smokers intending to quit were more likely to be e-cigarette users than those not intending to quit (odds ratio [OR] = 1.90, CI =1.36-2.65). Those who used e-cigarettes to try to quit smoking (OR = 2.25, CI = 1.25-4.05), reduce stress (OR = 3.66, CI = 1.11-12.09), or because they cost less (OR = 3.42, CI = 1.64-7.13) were more likely to report decreases in cigarette smoking than those who did not indicate these reasons. Smokers who reported using e-cigarettes to quit smoking (OR = 16.25, CI = 8.32-31.74) or reduce stress (OR = 4.30, CI = 1.32-14.09) were significantly more likely to report an intention to quit than those who did not indicate those reasons for using e-cigarettes. CONCLUSIONS Nearly a quarter of smokers in our study reported e-cigarettes use, primarily motivated by intentions to quit or reduce smoking. These findings identify a clinical and public health opportunity to re-engage smokers in cessation efforts.

The Healthy People initiative outlines a comprehensive set of goals aimed at improving the nation's health and reducing health disparities. Health communication has been included as an explicit goal since the launch of Healthy People 2010. The Health Information National Trends Survey (HINTS) was established as a means of exploring how the changing information environment was affecting the public's health, and is therefore an ideal tool for monitoring key health communication objectives included in the Healthy People agenda. In this article, the authors apply an integrative data analysis strategy to more than 10 years of HINTS data to demonstrate how public health surveillance can be used to evaluate broad national health goals, like those set forth under the Healthy People initiative. The authors analyzed just one item from the HINTS survey regarding Internet access in order to illustrate what public health surveillance tools, like HINTS, can reveal about important indicators that are of interest to all those who work to improve the health of the public. Results show that reported Internet penetration has exceeded the Healthy People 2020 target of 75.4%. HINTS data also allowed modeling of the effects of various sociodemographic factors, which revealed persistent differences on the basis of age and education, with the oldest age groups and those with less than a college education falling short of the Healthy People 2020 target as of 2013. Furthermore, although differences by race/ethnicity were observed, the analyses suggest that race in itself accounts for very little of the variance in Internet access.

A large proportion of the 14 million cancer survivors in the USA are actively seeking health information. This study builds on the informed- and shared-decision making literature, examining cancer survivors' health information seeking behaviors to (1) quantify the number of health information sources used; (2) create a demographic profile of patients who report seeking cancer information from numerous sources versus fewer sources in five areas: cancer information overall, disease/treatment, self-care/management, health services, and work/finances; and (3) examine whether seeking cancer information from numerous sources is associated with self-efficacy, fear of recurrence, perceptions of information seeking difficulty, and resultant patient-provider communication. Data came from a survey of post-treatment cancer survivors (N = 501) who responded to a mailed questionnaire about health information seeking. Participants were divided into two groups using a median split: those who sought health information from more than five sources (numerous source seekers) and those that sought information from less than five sources (fewer source seekers). Multivariable logistic regression was used to model differential information seeking behaviors and outcomes for numerous versus fewer source seekers. On average, survivors sought cancer-related information from five different sources. Numerous source seekers were more likely to be women, have higher levels of education, and report fewer problems with cancer information-seeking. Overall, numerous source seekers were no more or less likely to discuss information with their providers or bring conflicting information to their providers. Understanding the characteristics, behaviors, and experiences of survivors who seek cancer-related information from numerous sources can contribute to informed decision making and patient-centered care.

ObjectiveTo describe the number and proportion of accredited, degree-granting institutions with 100% smoke-free and 100% tobacco-free protections across the USA and by state.MethodsData on postsecondary education institutions from the US Department of Education National Center for Education Statistics Integrated Postsecondary Education Data System 2015, and smoke-free and tobacco-free campus protections from the American Nonsmokers’ Rights Foundation’s Smokefree and Tobacco-Free Colleges and Universities List 2017, were integrated to calculate the number and proportion of: (1) smoke-free and tobacco-free accredited, degree-granting institutions and (2) students and staff protected by campus policies and state laws. Campus protections are given a 100% smoke-free designation if smoking is not allowed on campus anywhere, at any time; 100% tobacco-free designations extend smoke-free protections to include non-combustible products such as smokeless tobacco.Results823 accredited, degree-granting institutions (16.7%) representing 1816 individual campuses, sites and schools have either 100% smoke-free or 100% tobacco-free protections. An estimated 14.9 million college students (26.9%) and 8.9 million faculty and staff (25.4%) are protected by campus policies and state laws. Only three states and two territories have 100% smoke-free or 100% tobacco-free protections in over half of their institutions; four states and six territories have no known 100% smoke-free or 100% tobacco-free campus protections.ConclusionsIn 2017, just 16.7% of accredited, degree-granting institutions in the USA had 100% smoke-free or 100% tobacco-free protections. Despite progress, more efforts can ensure that students and staff benefit from comprehensive 100% smoke-free and 100% tobacco-free protections at US colleges and universities.