Grant Number:	1R01CA190391-01A1 Interpret this number
Primary Investigator:	Waters, Erika
Organization:	Washington University
Project Title:	Communicating Multiple Disease Risks: a Translation of Risk Prediction Science
Fiscal Year:	2015

¿ DESCRIPTION (provided by applicant): Epidemiology seeks to improve public health by identifying risk factors for cancer and other diseases. Yet, the public does not always use that information to make appropriate health decisions. One reason might be that, even though a single risk factor can affect the risk of multiple diseases, this information is seldom communicated in a way that optimizes people's understanding of the importance of engaging in a single healthy behavior. Helping people understand how a single behavior could affect their risk of multiple diseases could foster a more coherent and meaningful picture of the behavior's importance in reducing health risks, increase motivation and intentions to engage in the behavior, and eventually improve public health. The objective of this study is to translate epidemiological data about five major health consequences of insufficient physical activity (i.e., colon cancer, breast cancer [women], heart disease, diabetes, and stroke) into a visual display that conveys individualized risk estimates in a way that is understandable and meaningful to diverse lay audiences. The aims are to 1) Identify which combination of four risk communication strategies most effectively conveys risk estimates of five diseases associated with physical inactivity, and 2) Incorporate these strategies into a visual display and compare its effectiveness to alphanumeric text. The study design, including identification and prioritization of primary and secondary outcomes, was guided by health behavior theory. The sample will be comprised of approximately 50% members of racial/ethnic minority groups and 50% with no more than a high school diploma. Participants will be enrolled from two sources: the GfK Knowledge Networks Internet Panel (N=1130) and a large Midwestern city (N=392). Participants in Aim 1 will be randomly assigned to one of eight experimental conditions in a 2x2x2 full factorial design. The conditions will vary according the whether the risk estimate is conveyed as a qualitative descriptor (e.g., high risk) vs. a numerical estimate, the presence/absence of social comparison information (i.e., how their risk compares to the average person), and the presence/absence of risk reduction information. Aim 2 will utilize a randomized controlled trial. Primary outcomes for both aims will be risk comprehension and intentions to increase physical activity. Secondary outcomes will be cognitive and affective perceived likelihood, response efficacy, perceived severity, and worry (Aims 1 and 2), and engagement in physical activity at 90-day follow-up (Aim 2). Potential moderators (i.e., race/ethnicity, education, numeracy) and mediators (e.g., response efficacy) will be examined for both aims. Completing the aims will impact public health by providing: 1) a versatile visual display that can be adapted to communicate multiple health risks in several domains, 2) a functional risk assessment tool that can be integrated into individual, community, or clinical interventions, and 3) increased basic and applied scientific knowledge. This research may also contribute to the reduction of health disparities; its focus on understanding demographic moderators will increase the applicability of the display to underrepresented groups.




Testing Explanations for Skepticism of Personalized Risk Information.
Authors: Waters E.A. , Taber J.M. , Ackermann N. , Maki J. , McQueen A.M. , Scherer L.D. .
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2023 May; 43(4), p. 430-444.
EPub date: 2023-04-02 00:00:00.0.
PMID: 37005827
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Dismissing "Don't Know" Responses to Perceived Risk Survey Items Threatens the Validity of Theoretical and Empirical Behavior-Change Research.
Authors: Waters E.A. , Kiviniemi M.T. , Hay J.L. , Orom H. .
Source: Perspectives On Psychological Science : A Journal Of The Association For Psychological Science, 2021-11-23 00:00:00.0; , p. 17456916211017860.
EPub date: 2021-11-23 00:00:00.0.
PMID: 34813719
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Mental imagery-based self-regulation: Effects on physical activity behaviour and its cognitive and affective precursors over time.
Authors: Ackermann N. , Cameron L.D. , Maki J. , Carter C.R. , Liu Y. , Dart H. , Bowen D.J. , Colditz G.A. , Waters E.A. .
Source: British Journal Of Health Psychology, 2021-09-14 00:00:00.0; , .
EPub date: 2021-09-14 00:00:00.0.
PMID: 34523193
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Essentialism and Exclusion: Racism in Cancer Risk Prediction Models.
Authors: Waters E.A. , Colditz G.A. , Davis K.L. .
Source: Journal Of The National Cancer Institute, 2021-04-26 00:00:00.0; , .
EPub date: 2021-04-26 00:00:00.0.
PMID: 33905490
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Adherence of Internet-Based Cancer Risk Assessment Tools to Best Practices in Risk Communication: Content Analysis.
Authors: Waters E.A. , Foust J.L. , Scherer L.D. , McQueen A. , Taber J.M. .
Source: Journal Of Medical Internet Research, 2021-01-25 00:00:00.0; 23(1), p. e23318.
EPub date: 2021-01-25 00:00:00.0.
PMID: 33492238
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Risk Ladder, Table, or Bulleted List? Identifying Formats That Effectively Communicate Personalized Risk and Risk Reduction Information for Multiple Diseases.
Authors: Waters E.A. , Maki J. , Liu Y. , Ackermann N. , Carter C.R. , Dart H. , Bowen D.J. , Cameron L.D. , Colditz G.A. .
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2021 Jan; 41(1), p. 74-88.
EPub date: 2020-10-26 00:00:00.0.
PMID: 33106087
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Translating Cancer Risk Prediction Models into Personalized Cancer Risk Assessment Tools: Stumbling Blocks and Strategies for Success.
Authors: Waters E.A. , Taber J.M. , McQueen A. , Housten A.J. , Studts J.L. , Scherer L.D. .
Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2020 Dec; 29(12), p. 2389-2394.
EPub date: 2020-10-12 00:00:00.0.
PMID: 33046450
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Participatory Design of a Personalized Genetic Risk Tool to Promote Behavioral Health.
Authors: Ramsey A.T. , Bray M. , Acayo Laker P. , Bourdon J.L. , Dorsey A. , Zalik M. , Pietka A. , Salyer P. , Waters E.A. , Chen L.S. , et al. .
Source: Cancer Prevention Research (philadelphia, Pa.), 2020 Jul; 13(7), p. 583-592.
EPub date: 2020-03-24 00:00:00.0.
PMID: 32209550
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Physical activity: the relative associations with cognitive and affective risk beliefs.
Authors: Janssen E. , Waters E.A. .
Source: Psychology & Health, 2019 Nov; 34(11), p. 1294-1313.
EPub date: 2019-04-23 00:00:00.0.
PMID: 31012749
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Using the Short Graph Literacy Scale to Predict Precursors of Health Behavior Change.
Authors: Okan Y. , Janssen E. , Galesic M. , Waters E.A. .
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2019 04; 39(3), p. 183-195.
EPub date: 2019-03-08 00:00:00.0.
PMID: 30845893
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Comparison of Performance Between a Short Categorized Lifestyle Exposure-based Colon Cancer Risk Prediction Tool and a Model Using Continuous Measures.
Authors: Liu Y. , Colditz G.A. , Rosner B.A. , Dart H. , Wei E. , Waters E.A. .
Source: Cancer Prevention Research (philadelphia, Pa.), 2018-11-16 00:00:00.0; , .
EPub date: 2018-11-16 00:00:00.0.
PMID: 30446519
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Awareness of Health Outcomes Associated with Insufficient Physical Activity and Associations with Physical Activity Intentions and Behavior.
Authors: Waters E.A. , Hawkins E. .
Source: Journal Of Health Communication, 2018-08-09 00:00:00.0; , p. 1-9.
EPub date: 2018-08-09 00:00:00.0.
PMID: 30089442
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Don't know responses to cognitive and affective risk perception measures: Exploring prevalence and socio-demographic moderators.
Authors: Janssen E. , Verduyn P. , Waters E.A. .
Source: British Journal Of Health Psychology, 2018-02-02 00:00:00.0; , .
EPub date: 2018-02-02 00:00:00.0.
PMID: 29393593
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Combining risk communication strategies to simultaneously convey the risks of four diseases associated with physical inactivity to socio-demographically diverse populations.
Authors: Janssen E. , Ruiter R.A.C. , Waters E.A. .
Source: Journal Of Behavioral Medicine, 2017-10-13 00:00:00.0; , .
EPub date: 2017-10-13 00:00:00.0.
PMID: 29027602
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Development of a Cancer Risk Prediction Tool for Use in the UK Primary Care and Community Settings.
Authors: Lophatananon A. , Usher-Smith J. , Campbell J. , Warcaba J. , Silarova B. , Waters E.A. , Colditz G.A. , Muir K.R. .
Source: Cancer Prevention Research (philadelphia, Pa.), 2017 Jul; 10(7), p. 421-430.
EPub date: 2017-05-30 00:00:00.0.
PMID: 28559460
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Using An Internet-based Breast Cancer Risk Assessment Tool To Improve Social-cognitive Precursors Of Physical Activity
Authors: Fowler S.L. , Klein W.M. , Ball L. , McGuire J. , Colditz G.A. , Waters E.A. .
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2017-03-01 00:00:00.0; , p. 272989X17699835.
PMID: 28363033
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