My colleagues and I explore how the cognitive and motivational processes engendered by the conscious and unconscious awareness of personal mortality exert a pervasive influence on a wide spectrum of health-related behaviors and judgments, especially those pertaining to cancer risk and promotion. In this work, we examine factors that influence the propensity for health scenarios to activate death-related fears and cognition, and how this in turn affects the health relevant behaviors in which people engage. Our research indicates that when mortality concerns are conscious, health decisions are guided in part by proximal motivational goals of reducing subjective vulnerability to a health threat and removing death-related thought from focal attention. In contrast, when concerns about mortality are active but outside of conscious awareness, health decisions are guided more by distal motivational goals of maintaining a sense of meaning and self-esteem, as well as denying the physicality of the body. In both cases, we explore the conditions under which reactions to conscious and unconscious death concerns have adaptive and maladaptive health implications. We have applied this analysis to better understand peoples' health behavior in such domains as risky and safe sun exposure, smoking, fitness, dieting and restrictive eating, and cancer screening exams.
I am continuing my program of basic research on the ways in which both positive and negative affect influence people's willingness and ability to process health-risk information, compared to neutral conditions. Most recently, we are examining these issues in the context of information about melanoma and other skin cancers. In our experimental studies, we are using health education information developed by the Huntsman Cancer Institute's Familial Melanoma Research Clinic to educate their high-risk patients.
In collaboration with the Familial Melanoma Research Clinic at HCI, we are currently conducting the first prospective longitudinal study of responses to genetic testing for familial melanoma. This study will examine how preexisting health cognitions, UV risk behavior, personality, and other factors influence responses to positive or negative results for a p16 gene change. Participants will be followed at one month, six months, one year, and two years in order to examine different patterns of adherence to photo-protective behaviors, self skin exams, and recommended total body skin exams over the length of the study. We will also examine multiple aspects of families' planning to regulate UV exposure, obtain necessary screenings, and seek additional information about both melanoma and an associated risk that the gene change carries for pancreatic cancer in some families. We also plan to examine participants' beliefs about the appropriateness of genetic testing for children in these high-risk families. This issue takes on special importance given the role of early childhood sun exposure in the development of melanoma.
My primary research interest is health communication. I recently have proposed a behavioral decision framework termed, Deviance Regulation, which I am using to construct a general model of social communication. The core mechanism that drives predictions in this model is termed the deviance-regulation principle. The deviance-regulation principle predicts that people give greater weight to the perceived consequences of deviating from social norms than they give to the perceived consequences of conforming to social norms. In accordance with this model, I have shown that health communications have their greatest influence when they are framed to map out the social consequences of deviating from social norms, rather than conforming to social norms. Thus, when individuals believe that most of their peers are making healthy choices, health communications will be most effective if they link negative images with unhealthy people. In contrast, when individuals believe that most of their peers are making unhealthy choices, health communications will be most effective if they link positive images with healthy people. Current work on this communication model has revealed a wide range of psychological moderators that alter the predictions of this model. These moderators are being documented so that we can develop a more flexible communication model that can guide interventions in a wide range of applied health settings.
My research focuses on exploring self-regulation processes identified by the Common-Sense Model of health and illness behavior. I am particularly interested in the cognitive representations and anxiety-related processes identified by this model and how they influence the processing of health threat information. One line of research involves the development of measures assessing both conceptual and imagery contents of illness risk representations. My colleagues and I are using these measures to explore beliefs and imagery relating to cancer risk and their influence on motivations to engage in protective behaviors. Another line of research, conducted with colleagues in Australia, New Zealand, and the U.K., involves a series of internet-based studies evaluating responses to risk information provided by genetic tests for disease susceptibility. We are examining this issue within the context of colon cancer, lung cancer, heart disease, and diabetes, and with a focus on how anxiety and worry shape interpretations of the genetic risk information. In a third line of research, my colleagues and I are examining the influences of cognitions and emotions on decisions to purchase private medical care rather than use New Zealand's public health system. Individuals often choose to pay substantial costs for private health care even when there are no clear advantages in doing so. We aim to identify the cognitive and affective factors guiding decisions to use private versus public services for treatment relating to gall bladder problems, breast cancer, and prostate cancer.
Meg Gerrard & Rick Gibbons
Our current research interests involve six projects. First, we are collecting data for the 4th wave of a panel study with 900 African American families, looking at socio-psychological factors related to their health behavior, both health promoting (e.g., nutrition, exercise) and health-impairing (e.g., drug and tobacco use). Second, along with colleagues at the University of Georgia, we are continuing a preventive-intervention with a sample of African American adolescents (10-years old at Wave 1) and their parents that is intended to delay onset of health-risk behavior, such as substance use, and promote healthy behavior (e.g., protected sex; delayed initiation of sex). Third, along with colleagues at UC San Diego, we are working on a series of lab and field studies that is examining and (hopefully) reducing UV exposure and increasing UV protection in college students and high-risk adults (e.g., highway workers; tanning booth users). Fourth, we are conducting a series of lab studies examining decision-making processes relevant to substance use and health behavior among African American and European American adolescents and young adults. Fifth, along with colleagues at Dartmouth Medical Center, we are working on a project that is examining factors (e.g., health cognitions) that mediate the impact of substance portrayal (e.g., smoking) in the movies on uptake and escalation of use in adolescents. Finally, we have joined with colleagues at the Oregon Research Institute to examine the role of community norms (for behavior and attitudes) and social images of smokers on the initiation and escalation of smoking.
I am currently conducting a series of studies concerning perceptions of risk and cancer-related beliefs and behavior. These projects include: (a) An examination of the relation between risk perceptions and worry regarding breast cancer, and how they are related to the processing of information about breast cancer risk (with Isaac Lipkus), (b) The relation between cancer risk perceptions and cancer-reducing behavior, (c) how social comparison information about breast cancer risk influences feelings and thoughts about personal risk (with Kevin McCaul), (d) how self-affirmation might reduce defensive response to threatening cancer messages, (e) how people make cancer-related decisions regarding behaviors/therapies that both increase and decrease cancer risk, and (f) how biases in cancer risk perceptions are related to the processing of cancer messages.
Major current research activities include the randomized controlled trial in the military, the Fogarty International Center project in India and Indonesia, and tobacco cessation initiatives in the local Vietnamese community. We are currently developing a proposal to promote smoking cessation in patients with peripheral artery disease. I am taking the lead in organizing a global tobacco reduction pre-conference immediately prior to the 2005 annual meeting of the Society for Research on Nicotine and Tobacco in Prague, Czech Republic. The National Cancer Institute has provided funds to help support this meeting.
We have three general research thrusts these days: 1) testing novel strategies to motivate quit attempts among cigarette smokers, 2) examining the "common sense beliefs" of cancer survivors and their family members, and 3) testing the role of risk perceptions and worry as predictors of self-protective health actions.
My colleagues and I are involved in a range of projects that all focus on issues concerning health judgment and behavioral decision-making. These projects include: (a) Specifying and testing predictors of behavioral initiation and behavioral maintenance: we have been developing a model of on-going behavioral decision-making and have been testing it in four community based interventions that target smoking cessation and weight loss. We have also begun to examine its applicability to new treatment approaches to smoking cessation (e.g., the development of a chronic care approach); (b) Message framing: we continue to work on delineating the processes that underlie the relative influence of gain- and loss-framed messages on health practices, with a particular emphasis on the development of messages to promote the use of screening behaviors; (c) Mental model of cancer: we have been working on developing measures to assess how lay people construe cancer and have begun to test these ideas with a series of questions included in HINTS II; (d) Health information processing: We continue to pursue a number of projects that examine the factors that regulate how new health risk information is processed; with a particular emphasis on the differential impact of one-sided vs. two-sided messages; (f) Theory development and its implications for practice: we continue to examine how health behavior theories develop and how to optimize the relation between theoretical and practical innovations.
At present, most of our research attention in the health promotion area concerns the effectiveness of health messages designed to promote cancer and HIV/AIDS prevention and early detection behaviors. The adoption of these healthy behaviors often depends on the persuasiveness of a public service announcement, brochure, print advertisement, educational program, or communication from a health professional. In community-based, field experiments, often with vulnerable populations, we compare the effectiveness of persuasive appeals and social psychological interventions that vary in terms of how information is framed (as benefits versus costs) and whether it is tailored to the health information processing styles and other characteristics of recipients. The goal of our research is to investigate the role of framing and other communication and social influence variables in developing maximally persuasive messages promoting cancer and HIV/AIDS prevention and early detection primarily in inner-city minority and other under-served populations. We are also concerned with the manner by which moods and emotions influence the processing of health information, shape health beliefs, and motivate subsequent health behaviors, and the role of emotional arousal in the persuasiveness of health communications.
With colleagues at the Arizona Cancer Center, the Southwest Division of the American Cancer Society, and the Arizona State Department of Health, I am participating in a multi-faceted effort to increase the rate of colorectal cancer screening in Arizona. A different project is attempting to develop risk information formats that maximize the ability of laypeople to understand numerical probabilities and to use them in making choices among treatments and in deciding whether to participate in clinical trials. The two specific risk communication problems under investigation are ones that impair laypeople's ability to understand their risks. First, people are often unable to understand and use quantitative information when health decisions involve both risks and benefits. In particular, people give undue weight to low-probability side effects. Second, people find it very difficult to accept individualized risk information if it differs from their prior expectations. A final research project seeks to understand how laypeople and experts interpret information about clusters of cancer cases to form judgments about the likelihood of environmental causation.