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Background The promise of precision medicine could be stymied if people do not accept the legitimacy of personalized risk information. We tested 4 explanations for skepticism of personalized diabetes risk information. Method We recruited participants ( N = 356; Mage = 48.6 [ s = 9.8], 85.1% women, 59.0% non-Hispanic white) from community locations (e.g., barbershops, churches) for a risk communication intervention. Participants received personalized information about their risk of developing diabetes and heart disease, stroke, colon cancer, and/or breast cancer (women). Then they completed survey items. We combined 2 items (recalled risk, perceived risk) to create a trichotomous risk skepticism variable (acceptance, overestimation, underestimation). Additional items assessed possible explanations for risk skepticism: 1) information evaluation skills (education, graph literacy, numeracy), 2 ) motivated reasoning (negative affect toward the information, spontaneous self-affirmation, information avoidance); 3) Bayesian updating (surprise), and 4) personal relevance (racial/ethnic identity). We used multinomial logistic regression for data analysis. Results Of the participants, 18% believed that their diabetes risk was lower than the information provided, 40% believed their risk was higher, and 42% accepted the information. Information evaluation skills were not supported as a risk skepticism explanation. Motivated reasoning received some support; higher diabetes risk and more negative affect toward the information were associated with risk underestimation, but spontaneous self-affirmation and information avoidance were not moderators. For Bayesian updating, more surprise was associated with overestimation. For personal relevance, belonging to a marginalized racial/ethnic group was associated with underestimation. Conclusion There are likely multiple cognitive, affective, and motivational explanations for risk skepticism. Understanding these explanations and developing interventions that address them will increase the effectiveness of precision medicine and facilitate its widespread implementation.

In May 2021, U.S. states began implementing "vaccination lotteries" encouraging COVID-19 vaccination. Drawing from Prospect Theory and math cognition research, we tested several monetary lottery structures and their framing to determine which would best motivate unvaccinated adults.In two online experiments, U.S. adults were asked to imagine that their state implemented a vaccination lottery. In Experiment 1, participants (Intentions did not differ across conditions (Experiment 1:Multiple lottery structures could be equally (un)motivating for unvaccinated adults. Structures that distribute incentives across more people or alternative public health strategies should be considered. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

During the COVID-19 pandemic, the U.S. public was encouraged to practice good hand hygiene, such as hand washing or the use of hand sanitizer. Young adults reported lower levels of hand hygiene compared to adults of other ages. The aim of the current study was to test the effectiveness of different messages to promote hand sanitizer use among young adults.Over a 6-week period, we examined whether 3 brief messages (gain-frame, static descriptive norms, dynamic descriptive norms), placed next to sanitizer dispensers in university residence halls, predicted dispenser use in comparison to dispensers with no sign. Amount of sanitizer usage was measured 3 times per week via the weight of dispenser units. We tracked and controlled for the number of positive COVID-19 cases in residence halls because we expected it might influence sanitizer usage.Compared to no signage, dispensers with signs had 35% greater usage, with the static descriptive norms sign associated with greatest usage (46% compared to no sign), although differences did not reach conventional levels of significance. The strongest predictor of sanitizer use was a residence hall's degree of COVID-19 risk based on the hall's case positivity.Dispensers with signs had higher use than those without signs, but this difference was not statistically significant. We conclude that compared to prior research, "nudges" such as evidence-based messaging may have had less of an effect on health behavior engagement due to methodological differences across studies or characteristics of the COVID-19 context. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

This study (NIMH RO1 MH095750; ClinicalTrials.gov Identifier: NCT02543359) evaluated the effectiveness of three training models to implement a well-established evidence-based treatment, Parent-Child Interaction Therapy (PCIT).Fifty licensed outpatient clinics, including 100 clinicians, 50 supervisors, and 50 administrators were randomized to one of three training conditions: 1) Learning Collaborative (LC), 2) Cascading Model (CM) or 3) Distance Education (DE). Data to assess training and implementation outcomes were collected at 4 time points coinciding with the training period: baseline, 6- (mid), 12- (post), and 24-months (1-year follow-up).Multi-level hierarchical linear growth modeling was used to examine changes over time in training outcomes. Results indicate that clinicians in CM were more likely to complete training, reported high levels of training satisfaction and better learning experiences compared to the other training conditions. However, supervisors in the LC condition reported greater learning experiences, higher levels of knowledge, understanding of treatment, and satisfaction compared to supervisors in other conditions. Although clinicians and supervisors in the DE condition did not outperform their counterparts on any outcomes, their performance was comparable to both LC and CM in terms of PCIT use, supervisor perceived acceptability, feasibility, system support, and clinician satisfaction.Through the use of a randomized controlled design and community implementation, this study contributes to the current understanding of the impact of training design on implementation of PCIT. Results also indicate that although in-person training methods may produce more positive clinician and supervisor outcomes, training is not a one-size-fits-all model, with DE producing comparable results on some variables.

At the onset of the coronavirus disease (COVID-19) global pandemic, our interdisciplinary team hypothesized that a mathematical misconception-whole number bias (WNB)-contributed to beliefs that COVID-19 was less fatal than the flu. We created a brief online educational intervention for adults, leveraging evidence-based cognitive science research, to promote accurate understanding of rational numbers related to COVID-19. Participants from a Qualtrics panel (N = 1,297; 75% White) were randomly assigned to an intervention or control condition, solved health-related math problems, and subsequently completed 10 days of daily diaries in which health cognitions and affect were assessed. Participants who engaged with the intervention, relative to those in the control condition, were more accurate and less likely to explicitly mention WNB errors in their strategy reports as they solved COVID-19-related math problems. Math anxiety was positively associated with risk perceptions, worry, and negative affect immediately after the intervention and across the daily diaries. These results extend the benefits of worked examples in a practically relevant domain. Ameliorating WNB errors could not only help people think more accurately about COVID-19 statistics expressed as rational numbers, but also about novel future health crises, or any other context that involves information expressed as rational numbers. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Visual displays, such as icon arrays and risk ladders, are often used to communicate numerical health information. Number lines improve reasoning with rational numbers but are seldom used in health contexts. College students solved ratio problems related to COVID-19 (e.g., number of deaths and number of cases) in one of four randomly assigned conditions: icon arrays, risk ladders, number lines, or no accompanying visual display. As predicted, number lines facilitated performance on these problems-the number line condition outperformed the other visual display conditions, which did not perform any better than the no visual display condition. In addition, higher performance on the health-related ratio problems was associated with higher COVID-19 worry for oneself and others, higher perceptions of COVID-19 severity, and higher endorsement of intentions to engage in preventive health behaviors, even when controlling for baseline math skills. These findings have important implications for effectively presenting health statistics. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Self-care behaviors aimed at maintaining physical and mental health are often recommended during stressful contexts. We tested emotional predictors of self-care behaviors (healthy eating, exercise, engaging in a hobby, relaxation/meditation, time spent with a supportive person, talking online with friends/family) during the COVID-19 pandemic and their emotional consequences. We hypothesized a reciprocal within-person process whereby positive affect increases self-care behaviors (Hypothesis 1) and self-care behaviors increase positive affect while decreasing negative affect (Hypothesis 2).A 10-day daily diary was completed by 289 adult participants in the United States during spring 2020 when counties in 40 out of 50 states had some form of stay-at-home orders.Lagged analyses for Hypothesis 1 suggested that positive affect did not significantly predict residualized change in self-care behaviors; however, more intense negative affect predicted increased self-care behaviors from one day to the next. Concurrent analyses for Hypothesis 2 indicated most self-care behaviors were associated with more positive affect and some with less negative affect on the same day. Lagged analyses for Hypothesis 2 indicated that self-care behaviors largely did not predict residualized change in positive or negative affect from one day to the next. At the between-person level, people who experienced more positive affect engaged in more self-care behaviors across the sampling period.Self-care behaviors continue to have mental health benefits during stressful environments such as the COVID-19 pandemic and stay-at-home orders. Negative affect can play an adaptive role during times of stress by facilitating self-care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Risk behaviors like substance use and binge eating are often used to cope with negative emotions. Engagement in these behaviors has been exacerbated by the COVID-19 pandemic. Past research suggests that complex emotion conceptualizations captured as emotion differentiation (ability to discriminate between emotional states) and polarity (ability to integrate positive and negative features of emotional experience) may be protective. We examined associations of mean affect intensity, emotion differentiation, and emotion polarity with frequency of daily substance use and binge eating across 10 days in a demographically diverse sample of U.S. adults (

Information about the health effects of alcohol consumption can be ambiguous (i.e., lacking in reliability, credibility, or adequacy) and thus may promote maladaptive health behavior. Guided by Construal Level Theory and a conceptual taxonomy of uncertainty in health care, we tested the hypothesis that manipulating construal level would promote adaptive responses to ambiguous health information. We examined the effects of ambiguous health information about alcohol on health cognitions, message responses, and intentions, as well as whether manipulating construal moderated these effects. Alcohol users (

People frequently encounter numeric information in medical and health contexts. In this paper, we investigated the math factors that are associated with decision-making accuracy in health and non-health contexts. This is an important endeavor given that there is relatively little cross-talk between math cognition researchers and those studying health decision making. Ninety adults (M = 37 years; 86% White; 51% male) answered hypothetical health decision-making problems, and 93 adults (M = 36 years; 75% White; 42% males) answered a non-health decision-making problem. All participants were recruited from an online panel. Each participant completed a battery of tasks involving objective math skills (e.g., whole number and fraction estimation, comparison, arithmetic fluency, objective numeracy, etc.) and subjective ratings of their math attitudes, anxiety, and subjective numeracy. In separate regression models, we identified which objective and subjective math measures were associated with health and non-health decision-making accuracy. Magnitude comparison accuracy, multi-step arithmetic accuracy, and math anxiety accounted for significant variance in health decision-making accuracy, whereas attention to math, as illustrated in open-ended strategy reports, was the only significant predictor of non-health decision-making accuracy. Importantly, reliable and valid measures from the math cognition literature were more strongly related to health decision-making accuracy than were commonly used subjective and objective measures of numeracy. These results have a practical implication: Understanding the math factors that are associated with health decision-making performance could inform future interventions to enhance comprehension of numeric health information.

Background & Purpose Primary prevention of COVID-19 has focused on encouraging compliance with specific behaviors that restrict contagion. This investigation sought to characterize engagement in these behaviors in U.S. adults early during the pandemic and to build explanatory models of the psychological processes that drive them. Methods US adults were recruited through Qualtrics Research Panels (N = 324; 55% female; Mage = 50.91, SD = 15.98) and completed 10 days of online reports of emotion, COVID-19 perceived susceptibility and worry, and recommended behaviors (social distancing, hand washing, etc.). Factor analysis revealed behaviors loaded on two factors suggesting distinct motivational orientations: approach and avoidance. Results Changes in approach and avoidance behaviors over the 10 days indicated large individual differences consistent with three types of participants. Discrete emotions, including fear, guilt/shame, and happiness were associated with more recommended behaviors. Fear and COVID-19 worry indirectly influenced each other to facilitate more behavioral engagement. While emotions and worry strongly predicted individual differences in behavior across the 10 days, they did not predict as well why behaviors occurred on one day versus another. Conclusions These findings suggest how daily affective processes motivate behavior, improving the understanding of compliance and efforts to target behaviors as primary prevention of disease., Daily diaries revealed U.S. adults exhibit diverse patterns of engagement in COVID-19 preventive behaviors. Emotions and COVID-19-related worry�but not estimates of perceived disease risk�drive recommended behaviors.

Although romantic couple concordance has been demonstrated across a wide array of health behaviors, little research has examined dyadic concordance in health beliefs. This study examined the extent to which cohabitating romantic dyads’ attitudes and beliefs coincide (i.e., dyadic concordance) in addition to how well they predict intentions to learn genomic sequencing results. The actor-partner interdependence model was applied to cross-sectional data from 81 dyads in an exome sequencing study who were surveyed about their risk perceptions, worry, information avoidance, attitudes, and intentions toward learning carrier results. Information avoidance tendencies were positively correlated between partners, but there was low concordance on other beliefs. Individuals’ attitudes and information avoidance predicted their own intentions to learn results. Additionally, partners’ information avoidance tendencies predicted their partner’s intentions to learn results. Future research should explore mechanisms through which one’s partner’s information avoidance may affect one’s own intentions and behaviors.

Cancer risk prediction models such as those published in Cancer Epidemiology, Biomarkers, and Prevention are a cornerstone of precision medicine and public health efforts to improve population health outcomes by tailoring preventive strategies and therapeutic treatments to the people who are most likely to benefit. However, there are several barriers to the effective translation, dissemination, and implementation of cancer risk prediction models into clinical and public health practice. In this commentary, we discuss two broad categories of barriers. Specifically, we assert that the successful use of risk-stratified cancer prevention and treatment strategies is particularly unlikely if risk prediction models are translated into risk assessment tools that (i) are difficult for the public to understand or (ii) are not structured in a way to engender the public's confidence that the results are accurate. We explain what aspects of a risk assessment tool's design and content may impede understanding and acceptance by the public. We also describe strategies for translating a cancer risk prediction model into a cancer risk assessment tool that is accessible, meaningful, and useful for the public and in clinical practice.

Many daily activities require a basic understanding of math. Numeracy, which refers to individual differences in the ability to understand numerical concepts and work with probabilities, has been linked to health-related decision-making and medical and financial outcomes. Whether affective influences impact numeracy has not been experimentally assessed, although research has shown that emotions impact judgments and decision-making. Stress is one commonly experienced affective influence that could impact numeracy. We examined whether objective and subjective numeracy were influenced by stress induced from anticipating giving a speech in a laboratory setting. We also examined the association of self-reported math anxiety, or apprehension pertaining to mathematics, with objective and subjective numeracy. Two experiments were conducted; the second was a direct replication. Undergraduate students (Experiment 1, n = 99; Experiment 2, n = 139) were randomly assigned to one of two conditions: a stress induction or a neutral condition. Whereas neither objective nor subjective numeracy significantly differed across conditions, math anxiety was a consistent predictor of objective and subjective numeracy. Math anxiety and baseline perceived stress did not consistently moderate any effects. These findings have implications for health care, educational, and financial contexts in which people must make decisions that involve complex numbers. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective: Appetitive risk behaviors (ARB), including tobacco use, alcohol consumption, consumption of calorie dense/nutrient-poor foods, and sexual risk behavior contribute substantially to morbidity and mortality. Affective states that arise from a wide array of unrelated circumstances (i.e., incidental affect) may carry over to influence ARB. A meta-analysis is needed to systematically examine causal evidence for the role of incidental affect (including specific emotions) in influencing ARB. Method: Integrating effect sizes from 91 published and unpublished experimental studies that include both an incidental-affect induction and neutral-control condition (k = 271 effect sizes: k = 183 negative affect, k = 78 positive affect), this meta-analysis examines how negative and positive affective states influenced ARB and related health cognitions (e.g., intentions, evaluations, craving, perceived control). Results: Negative affective states reliably increased ARB, in analyses where all negative affective states were analyzed (d = .29) and in stratified analyses of just negative mood (d = .30) and stress (d = .48). These effects were stronger among study populations coded as clinically at risk. Positive affective states generally did not influence ARB or related health cognitions, except in the presence of a craving cue. Design issues of extant literature largely precluded conclusions about the effects of specific positive and negative affective states. Conclusion: Taken together, findings suggest the importance of strategies to attenuate negative affect incidental to ARB to facilitate healthier behavioral patterns, especially among clinically at-risk individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background: Patients with advanced disease often overestimate their life expectancy, which potentially impacts decision making. Objective: To examine the nature and source of hospice patients’ life expectancy estimates, about which little is known. Design: Using semi-structured interviews, patients were asked to estimate their life expectancy and elaborate on their response. Setting/Subjects: Participants were hospice patients ( n = 20, 55% male; 60% cancer). Measurement: We conducted thematic analysis using open and focused coding. Results: Many participants had difficulty answering the life expectancy question and expressed uncertainty about when they would die. One-third overestimated their length of life relative to actual survival. The most common source of patients’ prognostic beliefs was knowledge about their body, including physical symptoms and change over time. Half of patients reported that a provider had given them a prognostic estimate, and one-third agreed with, or gave estimates consistent with, the provider’s estimate. Some patients said providers do not know prognosis or that time of death was unknowable. Conclusions: Key findings were that 1) many hospice patients had difficulty estimating life expectancy, and 2) hospice patients’ life expectancy estimates were frequently based on their body and not on information from medical providers. These findings have implications for measuring prognostic awareness, as valid assessment is a necessary component of determining whether prognostic awareness is beneficial for patients. Future research should examine how life expectancy estimates are associated with well-being and whether results extend to larger samples of patients with advanced disease not in hospice.

Background Understanding multiple components of risk perceptions is important because perceived risk predicts engagement in prevention behaviors. Purpose To examine how multiple components of risk perceptions (perceived magnitude of and worry about risk, prioritization of the management of one’s risk) changed following genetic counseling with or without test reporting, and to examine which of these components prospectively predicted improvements in sun-protection behavior 1 year later. Methods A prospective, nonrandomized study design was used. Participants were 114 unaffected members of melanoma-prone families who (i) underwent genetic testing for a CDKN2A/p16 mutation (n = 69) or (ii) were at comparably elevated risk based on family history and underwent genetic counseling but not testing (no-test controls, n = 45). Participants reported risk perception components and sun-protection behavior at baseline, immediately following counseling, and 1 month and 1 year after counseling. Results Factor analysis indicated three risk components. Carriers reported increased perceived magnitude and priority of risk, but not cancer worry. No-test controls showed no changes in any risk perception. Among noncarriers, priority of risk remained high at all assessments, whereas magnitude of risk and cancer worry decreased. Of the three risk components, greater priority of risk uniquely predicted improved self-reported sun protection 1 year post-counseling. Conclusions Priority of risk (i) seems to be a component of risk perceptions distinguishable from magnitude of risk and cancer worry, (ii) may be an important predictor of daily prevention behavior, and (iii) remained elevated 1 year following genetic counseling only for participants who received a positive melanoma genetic test result.

Links among poor sleep and cancer risk behaviors have been largely overlooked in the context of cancer prevention and behavioral medicine. The goal of this scoping review was to determine the extent and nature of experimental studies conducted with healthy adult populations that tested the associations among poor sleep and cancer risk behaviors. Electronic databases and major sleep journals were searched to identify experimental studies in healthy adult samples published through January 2018. Studies examined associations among eight pairings of manipulated behaviors and outcomes (“independent variable (IV)-outcome pairs”): the impact of sleep manipulations on physical activity (PA), diet, alcohol consumption, and tobacco use outcomes; and the impact of PA, diet, alcohol consumption, and tobacco use manipulations on sleep outcomes. Studies were characterized in terms of sample characteristics; study design; IV type, dose, and duration; and outcome measurement and duration. Abstracts of 5697 papers and 345 full texts were screened. Eighty-eight studies describing 125 comparisons met inclusion criteria. Only two studies tested the association between tobacco use and sleep; none tested whether sleep influenced alcohol consumption. Sample sizes were typically small, most studies used crossover designs, and studies tended to include younger and more male participants. Within each IV-outcome pair, there was substantial heterogeneity in how behaviors were manipulated, outcome measurement, and type of control group. Few studies assessed mechanisms. There is a need for larger experimental studies with more representative samples. Overall, heterogeneity and limitations in study designs make it difficult to synthesize evidence across studies.

The advent of COVID-19 highlighted widespread misconceptions regarding people's accuracy in interpreting quantitative health information. How do people judge whether they accurately answered health-related math problems? Which individual differences predict these item-by-item metacognitive monitoring judgments? How does a brief intervention targeting math skills-which increased problem-solving accuracy-affect people's monitoring judgments? We investigated these pre-registered questions in a secondary analysis of data from a large Qualtrics panel of adults (The online version contains supplementary material available at 10.1007/s11409-022-09300-3.

Background: In May, 2021, U.S. states began implementing “vaccination lotteries” to encourage vaccine-hesitant individuals to get a COVID-19 vaccine. Purpose: Drawing on theories from math cognition and behavioral economics, we tested several monetary lottery structures and their framing to determine which would best motivate unvaccinated individuals. Methods: In two online experiments conducted in May, 2021, U.S. adults were asked to imagine that their state had implemented a vaccination lottery. In Experiment 1, participants (n=589) were randomly assigned to 1 of 12 conditions that varied the monetary amount and number of winners, holding constant the total payout ($5 million). In Experiment 2, participants (n=274) were randomly assigned to 1 of 4 conditions in a 2 (Message Framing: Gain versus Loss) by 2 (Numeric Framing: 5 total winners versus 1 winner for 5 weeks) factorial design; in all four conditions, 5 people would each win $1 million. Following the manipulation, participants rated their COVID-19 vaccination intentions, perceived likelihood of winning, and anticipated regret. Results: Vaccination intentions did not differ across conditions in either experiment, and post-manipulation vaccination intentions were strongly associated with baseline vaccination willingness. When asked to choose from 12 different lottery structures, participants tended to prefer options that awarded less money to more people, with 41.9% of participants across experiments indicated they would not vaccinate for any lottery-based monetary incentive. Conclusion: Findings suggest that multiple lottery structures could be equally motivating for unvaccinated adults, although states could consider structures that distribute incentives across more people.

Visual displays, such as icon arrays and risk ladders, are often used to communicate numerical health information. Number lines improve reasoning with rational numbers but are seldom used in health contexts. College students compared rates for information related to COVID-19 (e.g., number of deaths and number of cases) in one of four randomly-assigned conditions: icon arrays, risk ladders, number lines, or no accompanying visual display. As predicted, number lines facilitated performance on these problems – the number line condition outperformed the other visual display conditions, which did not perform any better than the no visual display condition. In addition, higher performance on the health-related math problems was associated with higher COVID-19 worry for oneself and others, higher perceptions of COVID-19 severity, and higher endorsement of intentions to engage in preventive health behaviors, even when controlling for baseline math skills. These findings have important implications for effectively presenting health statistics.

Background Information avoidance tendencies have been found to be associated with lower intentions to pursue medically actionable genomic sequencing results, but less so among individuals who engage more in spontaneous self-affirmation. Yet these results were obtained with a largely non-Hispanic White, high-SES cohort. Purpose To assess these variables, their magnitude, and their associations in an African-descent cohort as part of the same ClinSeq® exome sequencing program. Methods Participants reported levels of spontaneous self-affirmation, information avoidance, and intentions to receive three types of results – medically actionable, non-medically actionable, and carrier status as part of a baseline survey. Results Relative to the original, non-Hispanic White cohort, those in the African-descent cohort had higher levels of spontaneous self-affirmation and lower intentions of learning about carrier genomic results; they reported comparable levels of information avoidance and intentions to receive other results. Information avoidance was negatively associated with intention to receive non-actionable results in the African-descent cohort, as found in the initial cohort, with no moderating effect of spontaneous self-affirmation. Information avoidance, spontaneous self-affirmation, and their interaction were not associated with intentions to receive actionable results (contrary to findings in the initial cohort), or carrier results. Conclusions Individuals of African descent may engage in relatively more spontaneous self-affirmation, and do not appear to engage in more information avoidance. Their information avoidance tendencies were associated with pursuit of non-actionable sequencing results, with no moderating effect of self-affirmation, and were not associated with pursuit of actionable results or carrier results.

Perceiving ambiguity in health information—that is, uncertainty elicited from believing information lacks credibility, reliability, or adequacy—is typically associated with pessimistic appraisals (e.g., high perceived disease risk) and behavioral avoidance. We examined the effect of ambiguous health information about COVID-19 on health cognitions and vaccination intentions, and tested a “normalized-uncertainty” intervention. Two studies with identical methodology (online adult sample: n = 299, undergraduate sample: n = 150) were conducted in March to April 2020. Participants were randomly assigned to read one of three health messages about COVID-19 that emphasized what was currently unknown (ambiguity condition), what was currently unknown but that scientific uncertainty is expected (intervention condition), or what was currently known (control condition). The ambiguity condition led to greater perceived ambiguity than the control condition and perceived ambiguity in the intervention condition was comparable to the ambiguity condition. There were few differences in health cognitions, and no differences in vaccination intentions, when examining pairwise comparisons across the three conditions. Correlational analyses collapsing across condition indicated evidence of pessimistic appraisal but not behavioral avoidance among individuals who perceived greater ambiguity. Future research should examine longer, more detailed normalized-uncertainty interventions.

This study investigated whether genetic counseling and test reporting for the highly penetrant CDKN2A melanoma predisposition gene promoted decreases in sun exposure. A prospective, nonequivalent control group design compared unaffected participants (N = 128, Mage = 35.24, 52% men) from (1) families known to carry a CDKN2A pathogenic variant, who received counseling about management recommendations and a positive or negative genetic test result and (2) no-test control families known not to carry a CDKN2A pathogenic variant, who received equivalent counseling based on their comparable family history. Changes in daily ultraviolet radiation (UVR) exposure (J/m2), skin pigmentation (melanin index), and sunburns between baseline and one year following counseling were compared among carriers (n = 32), noncarriers (n = 46), and no-test control participants (n = 50). Both carriers and no-test control participants exhibited a decrease one year later in daily UVR dose (B = −0.52, −0.33, p

Many cigarette smokers make multiple attempts to quit before they are successful. Implicit theories of smoking (ITS)-beliefs about whether smoking behavior is something that is changeable (incremental belief) or fixed (entity belief)-may play a role in quitting. Four iterations of the cross-sectional, nationally-representative Health Information National Trends Survey (HINTS) were used in logistic regression analyses to examine how smokers' ITS relates to (1) attempts to quit in the past 12 months; (2) considering quitting in the next 6 months; and (3) the interaction between ITS and past quit attempts on considering quitting. Greater incremental beliefs were not significantly associated with having tried to quit in the past year (β = .27, p = .055); however, greater incremental beliefs were associated with greater likelihood of considering quitting in the next 6 months (β = .22, p = .04). Past quit attempts did not moderate the association between ITS and considering quitting (β = .59, p = .10). Results suggest that incremental beliefs are associated with increased intentions to quit.

Objective: Self-care behaviors aimed at maintaining or improving physical and mental health are often recommended during stressful contexts. We tested emotional experiences as potential drivers of self-care behaviors during the COVID-19 pandemic and explored their emotional impacts. We hypothesized a reciprocal within-person process whereby both positive and negative affect increase self-care behaviors (Aim 1) and self-care behaviors increase positive affect while decreasing negative affect (Aim 2). Methods: A 10-day daily diary was completed by 324 adult participants in the United States during spring 2020 when national stay-at-home orders were in effect. Results: Lagged analyses for Aim 1 suggested that positive affect did not significantly predict changes in self-care behaviors; however, greater negative affect predicted increased self-care behaviors from one day to the next. Lagged analyses for Aim 2 indicated that self-care behaviors did not predict changes in positive or negative affect from one day to the next. Concurrent analyses indicated self-care behaviors were associated with more positive affect and less negative affect on the same day. At the between-person level, people who experienced more positive affect on average engaged in more self-care behaviors across the sampling period, whereas no association was found for negative affect. Conclusions: We discuss the ways negative affect might foster self-care behaviors that promote health and well-being within stressful environments such as the COVID-19 pandemic and stay-at-home orders. We conclude self-care behaviors potentially have a short-term (i.e., within a day only) impact on positive and negative affect but not from one day to the next.

Introduction Individuals with early life adversity (ELA) experience a greater likelihood of sleep disturbance. Sleep disturbance is a hypothesized mechanism underlying the association between ELA and adverse health outcomes. However, it is unclear whether sleep disturbance presents differently in individuals with ELA when compared to individuals without ELA. Network analysis provides an analytic framework to examine the relationships and magnitudes of association between symptoms of sleep disturbance. Using a network framework, we investigated the differences in sleep disturbance symptoms between individuals with ELA and individuals without ELA. Methods College students (N=507; age=18±1, Female=72%) completed demographic measures, the Childhood Trauma Questionnaire (CTQ), and the Pittsburgh Sleep Quality Index using an online data collection platform from March-December 2020. Using clinical cutoffs, individuals with ELA were separated from individuals without ELA. Using the Pittsburgh Sleep Quality Index (PSQI; alpha=0.79), sleep disturbance was assessed. Two 7-node ELA-specific networks were generated using raw values for the 7 components of the PSQI. To assess network accuracy, stability coefficients were estimated using the ‘bootnet’ and ‘qgraph’ packages in R. The strength of association between each component and all other components of sleep disturbance were estimated using expected influence (EI). Network structures and measures of EI were examined for differences between exposure groups. Results Overall, the average global PSQI score was 7.50±3.37. Individuals with ELA had larger global PSQI scores when compared to individuals without ELA (8.18 versus 6.97, t=3.8, p Conclusion For individuals with ELA, duration and efficiency strongly underly sleep disturbance. Moreover, most symptoms had greater measures of EI in individuals with ELA when compared to individuals without ELA, suggesting that symptoms of sleep disturbance may be more likely to co-occur in individuals with ELA. Future research may explore the utility of these symptoms in predicting adverse health outcomes. Support (if any)

BACKGROUND Internet-based risk assessment tools offer a potential avenue for people to learn about their cancer risk and adopt risk-reducing behaviors. However, little is known about whether internet-based risk assessment tools adhere to scientific evidence for what constitutes good risk communication strategies. Furthermore, their quality may vary from a user experience perspective. OBJECTIVE This study aims to understand the extent to which current best practices in risk communication have been applied to internet-based cancer risk assessment tools. METHODS We conducted a search on August 6, 2019, to identify websites that provided personalized assessments of cancer risk or the likelihood of developing cancer. Each website (N=39) was coded according to standardized criteria and focused on 3 categories: general website characteristics, accessibility and credibility, and risk communication formats and strategies. RESULTS Some best practices in risk communication were more frequently adhered to by websites. First, we found that undefined medical terminology was widespread, impeding comprehension for those with limited health literacy. For example, 90% (35/39) of websites included technical language that the general public may find difficult to understand, yet only 23% (9/39) indicated that medical professionals were their intended audience. Second, websites lacked sufficient information for users to determine the credibility of the risk assessment, making it difficult to judge the scientific validity of their risk. For instance, only 59% (23/39) of websites referenced the scientific model used to calculate the user’s cancer risk. Third, practices known to foster unbiased risk comprehension, such as adding qualitative labels to quantitative numbers, were used by only 15% (6/39) of websites. CONCLUSIONS Limitations in risk communication strategies used by internet-based cancer risk assessment tools were common. By observing best practices, these tools could limit confusion and cultivate understanding to help people make informed decisions and motivate people to engage in risk-reducing behaviors.

Background: Internet-based risk assessment tools offer a potential avenue for people to learn about their cancer risk and adopt risk-reducing behaviors. However, little is known about whether internet-based risk assessment tools adhere to scientific evidence for what constitutes good risk communication strategies. Furthermore, their quality may vary from a user experience perspective. Objective: This study aims to understand the extent to which current best practices in risk communication have been applied to internet-based cancer risk assessment tools. Methods: We conducted a search on August 6, 2019, to identify websites that provided personalized assessments of cancer risk or the likelihood of developing cancer. Each website (N=39) was coded according to standardized criteria and focused on 3 categories: general website characteristics, accessibility and credibility, and risk communication formats and strategies. Results: Some best practices in risk communication were more frequently adhered to by websites. First, we found that undefined medical terminology was widespread, impeding comprehension for those with limited health literacy. For example, 90% (35/39) of websites included technical language that the general public may find difficult to understand, yet only 23% (9/39) indicated that medical professionals were their intended audience. Second, websites lacked sufficient information for users to determine the credibility of the risk assessment, making it difficult to judge the scientific validity of their risk. For instance, only 59% (23/39) of websites referenced the scientific model used to calculate the user’s cancer risk. Third, practices known to foster unbiased risk comprehension, such as adding qualitative labels to quantitative numbers, were used by only 15% (6/39) of websites. Conclusions: Limitations in risk communication strategies used by internet-based cancer risk assessment tools were common. By observing best practices, these tools could limit confusion and cultivate understanding to help people make informed decisions and motivate people to engage in risk-reducing behaviors.

At the onset of the COVID-19 global pandemic, our interdisciplinary team hypothesized that a mathematical misconception--whole number bias (WNB)--contributed to incorrect beliefs that COVID-19 was less fatal than the flu. We created a novel, five-minute online educational intervention, leveraging evidence-based cognitive science research, to encourage accurate COVID-19 and flu fatality rate calculations and comparisons. As predicted, adults (N = 1,297) randomly assigned to the intervention were more likely to correctly answer health decision-making problems and were less likely to report WNB errors in their problem-solving strategies relative to control participants. There were no immediate effects of condition on COVID-19 risk perceptions and worry; however, those in the intervention group did exhibit increased perceived risk and worry across 10 days of daily diaries. The intervention did not cause distress; instead, it increased positive affect. Ameliorating WNB errors could impact people’s risk perceptions about future health crises.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion regulation strategy which modifies how one thinks about a situation. Participants from 87 countries/regions (N = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vs. both control conditions) had consistent effects in reducing negative emotions and increasing positive emotions across different measures. Reconstrual and repurposing had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world to build resilience during the pandemic and beyond.

BACKGROUND Most smokers attempt to stop using cigarettes numerous times before successfully quitting. Cigarette cravings may undermine perceived competence to quit and thus constitute psychological threats to the individual’s self-concept. Self-affirmation may promote smoking cessation by offsetting these threats. OBJECTIVE This study examines whether self-affirmation is associated with smoking cessation in the context of a cessation app. Two types of self-affirmation are examined: tendency to spontaneously self-affirm, and self-affirmation inductions added to a publicly available smoking cessation app (Smoke-Free Quit Smoking Now). In addition, this study explores whether optimism and emotional states (happiness, anger, anxiousness, hopefulness, sadness) predict smoking cessation. METHODS All users who met the inclusion criteria, provided consent to participate, and completed a baseline assessment, including all individual difference measures, were randomized to 1 of 4 conditions. Half of the participants were randomly assigned to complete a self-affirmation induction upon study entry. Orthogonally, half of the participants were randomly assigned to receive self-affirming text notifications during their quit attempt or to receive conventional notifications. The induction and the text notifications were fully automated, and all data were collected through self-assessments in the app. Self-reported smoking cessation was assessed 1 month and 3 months following study entry. RESULTS The study enrolled 7899 participants; 647 completed the 1-month follow-up. Using an intent-to-treat analysis at the 1-month follow-up, 7.2% (569/7899) of participants self-reported not smoking in the previous week and 6.4% (503/7899) self-reported not smoking in the previous month. Greater tendency to spontaneously self-affirm predicted a greater likelihood of cessation (P CONCLUSIONS Spontaneous self-affirmation may be an important psychological resource for managing threats to self-concept during the smoking cessation process. Sadness may hinder quit attempts. Future research can explicate how spontaneous versus induced self-affirmation can promote smoking cessation and examine boundary conditions for the effectiveness of disseminated self-affirmation interventions. CLINICALTRIAL ISRCTN Registry 56646695; https://www.isrctn.com/ISRCTN56646695

The problem of divine hiddenness, currently a much-discussed topic in analytic philosophy of religion, can be (roughly) summarized in the question, ‘Why is God not more obvious or apparent?’ Sometimes the problem is used to undermine theistic belief. Here we seek to add a unique contribution to the growing debate on this theme from the perspective of Reformed epistemology, particularly Alvin Plantinga’s construal; moreover, we do so in a way that is theologically relevant. We conclude, with assistance from Scripture and from Plantinga, that the problem of divine hiddenness is not a problem for the Reformed epistemologist.

The National Cancer Institute's Skin Cancer Intervention across the Cancer Control Continuum model was developed to summarize research and identify gaps concerning skin cancer interventions. We conducted a mapping review to characterize whether behavioral interventions addressing skin cancer prevention and control from 2000 to 2015 included (1) technology, (2) environmental manipulations (policy and/or built environment), and (3) a theoretical basis. We included 86 studies with a randomized controlled or quasi-experimental design that targeted behavioral intervention in skin cancer for children and/or adults; seven of these were dissemination or implementation studies. Of the interventions described in the remaining 79 articles, 57 promoted only prevention behaviors (e.g., ultraviolet radiation protection), five promoted only detection (e.g., skin examinations), 10 promoted both prevention and detection, and seven focused on survivorship. Of the 79 non-dissemination studies, two-thirds used some type of technology (n=52; 65.8%). Technology specific to skin cancer was infrequently used: UVR photography was used in 15.2% of studies (n=12), reflectance spectroscopy was used in 12.7% (n=10), and dermatoscopes (n=1) and dosimeters (n=2) were each used in less than 3%. Ten studies (12.7%) targeted the built environment. Fifty-two (65.8%) of the studies included theory-based interventions. The most common theories were Social Cognitive Theory (n=20; 25.3%), Health Belief Model (n=17; 21.5%), and the Theory of Planned Behavior/Reasoned Action (n=12; 15.2%). Results suggest that skin cancer specific technology and environmental manipulations are underutilized in skin cancer behavioral interventions. We discuss implications of these results for researchers developing skin cancer behavioral interventions.