The cores include: Administration which will provide oversight, undertake dissemination; Training which will supervise a program of post-doctoral fellowships; and Theory and Methods which will assist projects in the development of common conceptual and methodological approaches, as well as a developmental program to support pilot projects. Investigators assure interdisciplinary collaboration by requiring all projects and cores to have communication and cancer control co-PIs, by establishing cross-Center educational programs, and shared reviews of ongoing and proposed research.

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Project 1
The new emphasis on patients as active consumers of health care and the rapid growth in the availability of health information lend urgent significance to the question of how people make sense of public health information to make decisions about their health. Although the new information paradigm has the potential to greatly improve health and health care in the U.S., the reality of what information searching and scanning actually occurs and the impact of this searching and scanning on health behavior and health status is what actually matters. Investigators propose to develop a descriptive model and specific measures of cancer-related information searching and scanning behavior in the general population and to determine whether this behavior is associated with post-diagnosis treatment choices as well as with changes in cancer screening and prevention behavior. The proposed research program includes three studies each of which focuses on colon, breast, and prostate cancer. Study 1 will improve the understanding of the relevant dimensions of searching/scanning behavior (SSB) in the context of the target cancer-related behaviors using in-depth interviews with samples drawn from both a general population and from among people recently diagnosed with each of the three cancers. The knowledge gained from Study 1 will inform and expand the conceptual model of searching and scanning behavior in the particular context of cancer and will guide development of a survey instrument for use in Study 2 and Study 3. Study 2 will use large, population based cross-sectional surveys (N=1800 general population, N=300 cancer patients) to refine and validate the descriptive model and measures of SSB developed in Study 1 to measure the distribution and correlates of SSB in the general population. Building on the identification of a representative cohort of individuals in Study 2, Study 3 will use a prospective cohort design (N=900) to examine the association of information searching and scanning behaviors with the evolution of attitudes, subjective norms, self-efficacy, intentions, and subsequent decisions about the target cancer- related behaviors. The results of these studies will provide both empirical evidence about the prevalence, determinants, and outcomes of cancer information searching and scanning in the general population and critically needed tools for furthering the study of this important area.

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Project 2
Cigarette smoking among young adults (ages 18-25) is an important cancer control problem. Despite increasing trends in smoking behavior, this group has been understudied with respect to anti-smoking campaigns. Although much attention has been directed to anti-smoking media campaigns for adolescents, on balance, these efforts have produced modest results. Some have argued that the theoretical underpinnings of such media-based anti-smoking prevention campaigns need to be refined ff their efficacy is to be improved. Toward this end, Penn will conduct experimental research to develop and test theory-based anti-smoking video segmen (referred to as PSAs) that are targeted to high and low sensation-seeking young adults. The specific aims are to:

1. evaluate the effects of the sensation value of the content of the PSAs in high and low sensation-seekers
2. evaluate the effects of the sensation value of the format of the PSAs in high and low sensations-seekers
3. explore the cognitive, affective, and arousal mechanisms by which the different PSAs exert an impact on behavioral intentions in these two groups.

The hypotheses, experimental design, and measures are guided by the modes of Communication and Health Behavior Change. Using a laboratory-based experimental design, PSAs will be developed and targeted to high sensation-seekers (HSS) and low sensation-seekers (LSS). Two aspects of the PSAs to be manipulated are sensation value, of the content (the theme of the anti-smoking appeal; e.g., tobacco industry manipulation vs. second-hand smoke) and sensation value of the format (the formal features; e.g., high vs. low intensity of visual and auditory effects). Study participants will be 800 males and females ages 18-25 from the Philadelphia area who have smoked at least 1 whole cigarette in the past 6 months. A factorial design will be used to test hypotheses about the impact of 8 different PSAs: (2 per condition):

1. high sensation value (HSV)-content and format
2. HSV-content, (LSV)-format
3. LSV-content, HSV-format
4. LSV-content and format.

The analyses will focus on the following mediating mechanisms in the communication and behavior change process: (a) arousal; (b) cognitive processing and affective evaluation; (c) comprehension (free and forced recall of content); (d) changes in smoking-related beliefs, attitudes about smoking, beliefs about the consequences, prototype images and social norms; and (e) behavioral intentions and willingness. Those PSAs found to be most effective in the research will be exported to the American Legacy Foundation for dissemination and large-scale evaluation.

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Project 3
New knowledge in the field of molecular genetics has raised the possibility of understanding the role of genetic factors in disease and of tailoring more effective prevention efforts. Genetic information can affect an individual's judgment of risk for smoking-related diseases and susceptibility to smoking addiction. Information about genetic vulnerability can elevate perceived risk and lead to healthier lifestyles or instill a sense of fatalism, undermining personal efficacy. One source of exposure to genetic risk information is through coverage in news and other public media. This research tests how information about genetic risk to nicotine addiction can be framed to make it more effective. This research describes the kinds of frames used among mainstream news outlets in discussing genetic susceptibility to cancer and conducts experimental research on effective frames for communicating genetic risk information about susceptibility to smoking addiction to young adult (18 - 25) smokers with a family history of smoking. The target population was chosen because trends in smoking behavior in this age group have been on the rise and because this is a period of transition to regular smoking and nicotine dependence. Three theories inform this work: Media Priming, the Integrative Theory of Behavior Change, and Exemplification Theory. When information is personal (i.e. uses exemplars) rather than general and abstract, perceived risk is biased in the direction of the exemplars. Exemplars can modify the negative effects of genetic risk. Those receiving personal stories of similar others engaged in efficacious action despite genetic vulnerability will have higher levels of personal efficacy and decreased levels of behavioral intention to smoke regularly. A complete content analysis of print and televised news will describe the frames employed in public discussion of genetic susceptibility to various cancers. A laboratory-based experiment will test the effect of exemplars in news. The factorial design presents stories with two levels of risk (general and genetic) and three levels of exemplification (efficacious, inefficacious, and none) to daily and non-daily smokers. The key outcome measures include personal efficacy and behavioral intention to quit. Both immediate and long-term consequences will be tested. Mechanisms mediating the effect of exemplars include availability of information in memory and emotional tone. Results will contribute to the understanding of the impact of genetic risk information on personal efficacy and to its effective communication in the public and clinical arenas. Dissemination of findings can affect news norms about reporting genetic information.

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