1. The BCERC: Communicating to Lay Audiences about Breast Cancer Risk Reduction Kami J. Silk, PhD Department of Communication Michigan State University

2. Project Funding This research was made possible by the Breast Cancer and the Environment Research Centers grant number 1-U01-ES12800 from the National Institute of Environmental Health Sciences (NIEHS), and the National Cancer Institute (NCI), NIH, DHHS. The contents of this presentation are solely the responsibility of the presenter and do not necessarily represent the official views of the NIEHS or NCI, NIH.

3. Investigators Michigan State University –Sandi Smith –Charles Atkin –Pamela Whitten –Kami Silk –Maria Lapinski –Lauren Hamel –Rose Clark-Hitt –Lindsay Neuberger –Nick Bowman –Samantha Nazione –Carolyn LaPlante –Courtney McFeters –Venessa Ferguson –Doshik Yun –Elizabeth Bigsby –Cathrine Kingsley –Leigh-Anne Goins University of Tennessee, Knoxville –Michael Kotowski College of Charleston –Merrissa Ferrara University of Maryland –Christine Skubisz University of California, Santa Barbara –Cynthia Stohl Pennsylvania State University –Julie Volkman

4. Overview Introduce BCERC Define transdisciplinary research Present the precautionary principle Identify environmental risk factors associated with breast cancer Focus on communicating to the lay public –Some translational research findings –Lessons learned & recommended message strategies

5. The Breast Cancer and Environment Research Centers (BCERC)

6. BCERC The National Institute of Environmental Health Sciences (NIEHS) and the National Cancer Institute (NCI) established the BCERC Network in 2003 Four BCERC centers across the United States –Michigan State University –Fox Chase Cancer Center –University of Cincinnati –University of California, San Francisco

7. BCERC Each Center has three cores –Epidemiology* –Biology –Communication Outreach and Translation Core MSU’s Communication Department is part of the COTC *MSU does not have an epidemiology core

8. BCERC Organizational Model UC MSU UCSF UP COTC BIO EPI Steering Committee Working Group BIO EPI COTC EPI BIO COTC BIOCOTC

9. BCERC COTC The overall goal for the COTC is to develop public health messages for: young girls and women who are at high risk for breast cancer about the role(s) of specific environmental stressors in breast cancer and how to reduce exposures to these stressors

10. “Transdisciplinary” Defined Involves broadly constituted teams of researchers that work across disciplines (and community members) in the development of the research questions to be addressed. By definition, the research problem is beyond the scope of any individual discipline. Prominent interest in translating scientific knowledge into practical applications to benefit the public (Source: Institute of Medicine)

11. Trans-Challenges and Solutions Challenges Integration Time Advocates and researchers have different goals Advocates as Volunteers Evaluation Funding (Source: BCERC members) Solutions Conference calls/meetings Funding grants longer than 5 years Input sought across projects Committee structure Shared authorship and collaboration on writing projects An assumption of “synergy”

12. Lessons Learned NIEHS & NCI strong support of model Evidence of “synergy” in types of RQs being asked Evaluation of the model is indeed difficult Great productivity in terms of papers and publications Technology can not replace face-to-face interactions Researchers and advocates bring specific “ways of knowing” to the table, all are valid

13. Environmental Risk Factors Any non-inherited factor that may increase or decrease an individual’s risk of breast cancer This includes lifestyle factors as well as environmental exposures –Cornell University’s program on Breast Cancer and Environmental Risk Factors These issues may be especially important for pre-pubertal females

14. BCERC Environmental Risk Factors Perfluorooctanoic acid (PFOA) –Yang C, Tan YS, Harkema JR, Haslam SZ. Effect of peripubertal PFOA exposure on mouse mammary gland development. Reprod Toxicol. 2009 June;27(3-4):299-306 Progesterone –Santos SJ, Aupperlee MD, Xie J, Durairaj S, Miksicek R, Conrad SE, Leipprandt JR Tan YS, Schwartz RC, Haslam SZ. Progesterone receptor A-regulated gene expression in mammary organoid cultures. J.Steroid Biochem Mol Biol. 2009 July;115(3-5):161-72 Radiation –Barcellos-Hoff MH and Nguyen DH. (2009) Radiation Carcinogenesis in Context: How Do Irradiated Tissues Become Tumors? Health Physics 97:446-457 Diet –Medvedovic M, Gear R, Freudenberg J, Schneider J, Bornschein R, Yan M, Mistry M,, Hendrix H, Karyala S, Halbleib D, Heffelfinger S, Clegg D. (2009) Influence of fatty acid diets on gene expression in rat mammary epithelial cells. Physiol. Genomics 38:80-88 Bisphenol A (BPA) –Jenkins S, Raghuraman N, Eltoum I, Carpenter D, Russo J, Lamartiniere C. (2009) Oral exposure to bisphenol A increases dimethylbenzanthracene-induced mammary cancer in rats. Env Hlth Perspective 117:910-915

15. …“when an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established by science Wingspread Statement on the Precautionary Principle, 1998 Advocates strongly adhere to it Potential conflict between researchers and advocates Precautionary Principle

16. MSU Communication Research

17. Range of Studies Memorable messages Health literacy/readability focus Media & website content analyses Focus Group research with moms and daughters Qualitative and quantitative testing of risk messages for mothers

18. Memorable Message Research Smith et al., JCancEd, JOHC, HC 359 women completed an online survey Asked to report characteristics of a memorable message about breast cancer if they had one 62% (208) had a memorable message

19. Memorable Message Research Individuals who had personal and friend or relative experience were significantly more likely to recall memorable messages than other respondents

21. Memorable Message Research

22. News Coverage in Media Outlets on Environmental Risks and Prevention Atkin, et al., JOHC Content analysis of 231 stories appearing in leading newspapers, news magazines, and television networks (2003 & 2004) 1/4 featured risk 1/3 featured prevention 1/4 featured detection 2/5 featured treatment 2/3 cited medical experts, researchers or breast cancer organizations Twice as many stories featured narrative evidence in comparison to statistical evidence Little emphasis was placed on behavioral prevention actions

23. Website Analyses Whitten, et al., JCMC Evaluation of design and theoretical criteria of websites Content analysis of 157 websites Overall, good use of design tenets However, most websites did not –Include a site map –Include a date of last revision –Inform users of environmental risk factors

24. Website Analyses Low use of theoretical variables EPPM, TPB and TM used Most websites –Created awareness –Provided negative consequences –Provided threats Most websites did not –Promote self-efficacy –Provide role models –Provide alternatives

25. Website Analyses Evidence use –85% of websites used statistics –36% used 1 st person, 23% 3 rd person storytelling Diversity use –30% had multiple languages –14% has sections for specific ethnic groups –17% had sections for specific age groups –23% had material readable at a 9 th grade level or under Environmental focus –420 pages of the 10 most popular websites were coded –About half of the pages provided at least some information regarding environmental risks and risk reduction behaviors

27. Literacy Research Exposing women to lay and scientific messages on the same topic (Genetics, PFOA, or progesterone) Preliminary findings: –Those in the lay conditions rated their messages as easier to read –Those in the lay conditions had a greater increase in knowledge –Those in the scientific conditions reported greater negative attitudes –Scientific literacy was positively associated with knowledge gain

28. Formative Research Focus group research with mothers indicated concern for daughters’ breast health; thus, a potential key audience (SSM) Communication research –source credibility is important, but findings do not distinguish between expert sources –personalized language may yield more influence than less personal language –behavioral intentions are a strong predictor of behavioral responses

29. Research Questions & Hypotheses RQ1: What messages (lifestyle, chemical, or development) are related to women’s behavioral intentions to engage in recommended actions? RQ2: Which message source is perceived as having the highest credibility across message types? H1:Women will rate high involvement messages with personal language more positively than low involvement messages with impersonal language.

30. Messages Message Content –Manipulates source (researcher vs. physician) –Personal or impersonal language –Presents research –Acknowledges inconclusive nature of evidence –Invokes precautionary principle –Provides behavioral recommendations for mothers eat healthy & keep active (lifestyle) read labels (chemical) be aware of daughters’ development (development)

31. RQ1: Effect of Message Topic on Intention Intention to Engage in Message Recommendation Lifestyle Message (n=196) 3.46 (.91) Chemical (n=193) 3.46 (.98) Development (N=201) 3.22 (.98)* p <.05*

32. RQ2: Source Credibility Results Physician SourceResearcher Source Overall (N=590) 2.38 (1.09)**2.15 (1.04)** Advocates (n=136) 2.17 (.98)2.01(.99) Lay Audience (n=454) 2.44 (1.11)*2.19 (1.05)* P <.05*,.01**

33. H1: Personal vs. Impersonal Language –Not supported. –Personalized language (you, your daughter) did not make a difference in level of behavioral intention to engage in message recommendations.

34. Message Study Implications Both sources highly credible, researchers slightly more credible overall for lay audience Personalization of message did not impact outcomes, perhaps indicating that women & mothers personalize all breast cancer related messages Women and mothers require specific message recommendations to increase likelihood of actual behavior

35. Mother’s intentions to teach daughters about risk (CRR) Examined the role of self-efficacy, response efficacy and personal responsibility among mothers (N=139) SE and RE were related to mothers’ intentions to teach their daughters how to maintain a healthy diet, engage in regular exercise behavior, and avoid chemical exposure PR was not related to behavioral intention

36. Mothers’ Concerns (JOHC) Examined mothers’ (N=386) concern about their daughters’ breast cancer risk influenced intentions to engage in preventive behaviors. Low concern –No family history, healthy lifestyle Moderate concern –No family history, healthy lifestyle, everyone at risk, can’t worry about everything High Concern –Family history, environmental exposures, concerned about lots of health issues

37. Current Message Development & Testing

38. Some Recommendations Need for more prevention messages –Precautionary principle Use of family and friends as sources –Especially mothers to daughters Improvement of television, newspaper, and website content about breast cancer is necessary –Increased talk of prevention –Increased discussion of environmental factors –Use clear and understandable language

39. Some Recommendations Mothers Clarify risk factors and provide information on how to accurately assess relative risks Encourage discussion with daughters, especially because they perceive schools are not informing girls on the issue Need an efficacy component to messages Incorporate their specific concerns Daughters Increase salience and self-efficacy Fear appeals inappropriate Link healthy lifestyle factors to other positive health outcomes

40. Some Recommendations Use both physicians and researchers as credible sources in messages Test messages for readability levels Include website links in messages for further information seeking People see science as “truth”; communicate that science is uncertain and emerging Collaborate with a range of people to create and disseminate messages

41. Health Care Providers Provider messages are memorable –Discuss prevention and environmental risk factors Sensitive to literacy issues –Make sure messages are understood –Provide credible information sources for further investigation by patients Motivational techniques –Increase self-efficacy –Share alternatives for how to live a healthy lifestyle

42. Future Directions Complete analyses and research for publication Recent funding to continue with MSU biologists Development & testing of a PFOA web page featuring video clips

43. BCERC Information www.bcerc.org MSU Research & References www.bcerc.msu.edu www.bcerc.org www.bcerc.msu.edu Thank You