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Closing the Gap: Cancer Information and Communication Inequalities

Closing the Gap: Cancer Information and Communication Inequalities. K. “Vish” Viswanath, Ph.D. Harvard School of Public Health Dana-Farber Cancer Institute. No Data <10% 10%–14%. Obesity Trends Among U.S. Adults*. (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person).

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Closing the Gap: Cancer Information and Communication Inequalities

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  1. Closing the Gap: Cancer Information and Communication Inequalities K. “Vish” Viswanath, Ph.D. Harvard School of Public Health Dana-Farber Cancer Institute

  2. No Data <10% 10%–14% Obesity Trends Among U.S. Adults* (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) *BRFSS, 1985

  3. No Data <10% 10%–14% Obesity Trends Among U.S. Adults (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) *BRFSS, 1990

  4. No Data <10% 10%–14% 15%–19% Obesity Trends Among U.S. Adults* (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) *BRFSS, 1995

  5. No Data <10% 10%–14% 15%–19% ≥20 Obesity Trends Among U.S. Adults* (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) *BRFSS,1997

  6. <10% 10%-14% No Data 15%-19% 20%-24% ≥25% Obesity Trends Among U.S. Adults* (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) *BRFSS, 2001

  7. Citations • Source: BRFSS, CDC. • Source: Mokdad A H, et al. JAMA 1999;282:16. • Source: Mokdad A H, et al. JAMA 2001;286:10. • Source: Mokdad A H, et al. JAMA 2003;289:1.

  8. Differential Disease Burden in the Population • Higher incidence rates: • Black males more likely to develop any type of cancer than White males • Higher death rates: • Black women are more likely to die from breast cancer than White women. • Cardiovascular disease • SES disparities in smoking

  9. Cigarette Smoking Among Adults by Education 1980-2004 Percent Year Source: National Health Interview Surveys: 1980, 1985, 1990, 1995, 2000, 2004.

  10. Estimated Prevalence of Diabetes in Adults (>20yrs.) by Race/Ethnicity2002 and 2005 Percent Year Source: American Diabetes Association available at http://www.diabetes.org/diabetes-statistics/prevalence.jsp

  11. Obesity Prevalence by Education Level 1991-2001 Percent Year Source: CDC, BRFSS, 1991-2001

  12. Why do these disparities exist? • Social determinants: • Social cohesion • Social stratification • Social Class • SES • SEP • Social networks • Neighborhood conditions • Social policies

  13. Multilevel approach to epidemiology Figure: Adopted from Kaplan (2004)

  14. What links social determinants with health outcomes? Communication one potential thread linking proximal to distant factors and their outcomes to health

  15. Multilevel approach to epidemiology Figure: Adopted from Kaplan (2004)

  16. Abundance of health information FIGURE: Print news coverage of health issues.

  17. Health-related newsstories increasing FIGURE: Ethnic print coverage of leading health issues.

  18. Coffee as a Health Drink? Studies Find Some Benefits Study links caffeine to higher blood pressure Coffee seen not to raise heart attack risk: study One cup of coffee a day 'risky‘ A cup of confusion: Is coffee healthy or not?

  19. Challenges in the Information Age Challenge #1 • More information does not necessarily mean more communication.

  20. 40% 31% 18% 11% Strongly Agree Somewhat Agree Somewhat Strongly Disagree Disagree Everything Causes Cancer

  21. 41% 36% 15% 9% Strongly Agree Somewhat Agree Somewhat Strongly Disagree Disagree Don’t Know Which Recommendations to Follow

  22. 36% 36% 22% 6% Strongly Agree Somewhat Agree Somewhat Strongly Disagree Disagree Not Much People Can Do

  23. Challenges in the Information Age Challenge #2 • Information, however, is always unequally distributed • There exists a Communication Inequality among individual and groups where some people have better access to information, pay more attention to it, learn more from it and have the capacity to act on it. Viswanath (2006). Public Health Communication and Health Disparities

  24. Functions of Communication in Health • Informational: acquire knowledge • Instrumental: enables action • Social control: defines social norms • Communal: access to social capital

  25. Dimensions of communication inequality • At the individual level Differences in: • Access to and use of information channels • Attention to health content • Seeking Information • Recall, knowledge and comprehension • Capacity to act on information

  26. Recent Work • SES, Race and Ethnicity are associated with • subscription to cable or satellite TV and the Internet • daily readership of newspapers • attention to health content in different media • differential time with different media • knowledge gaps in health

  27. Access to Information Services among Different SES and Racial Ethnic Groups Note: For all ethnicity assessments, multi-racial persons were excluded from the analysis. Data from HINTS.

  28. Major Media and their Audience Demographics in the United States* *United States Bureau of Census, Statistical Abstract of the United States, 2004-5, available at http://www.census.gov/prod/2004pubs/04statab/infocomm.pdf

  29. Communication Inequalities:Application to Risk Communication • Risk communication is unique • Confrontation between Theory & Application • Individual and macro levels of analyses intersect • A product of interaction among agencies, activist groups and individuals • Depending on how risk is framed and communicated, the consequences could be profound

  30. Communication Inequalities and Risk: Exemplar data on Environment and Health

  31. Salient Risks in MA % Respondents Saying ** is a Major Threat to the Health of Massachusetts’ Residents Unprotected Sex Mosquitoes Pesticide Exposure Poor Diet Lack of Exercise Contaminated Food Polluted Air/Water Bioterrorism Substance Abuse Smoking/SHS Source: MA Cancer Communications Survey (October 2006)

  32. Health Concerns of Low-SEP residents in MA • Low-SEP individuals in Massachusetts have a broad range of concerns about environmental hazards on health: • rodents • violence and drugs • chemical exposures • the air that we breathe • the water that we drink. • People in these communities have a strong sense of how environmental hazards may negatively affect health. • Participants living in Boston and Lawrence overwhelmingly cited asthma and cancer as major environmental health issues in their communities • Participants in Worcester were more concerned with HIV, TB, and Hepatitis C as health problems caused by their environments. Source: Viswanath & Taylor-Clark, (November 2006)

  33. Newspapers Magazines Radio Internet Television Doctors Family/Friends Scientific Expert Community Group Sources of Information % Saying ** is a Trusted Channel/Source of Information on Health and the Environment Env./Advocacy Group PH State Commissioner Local Health Dep’t. Rep. Source: MA Cancer Communications Survey (October 2006)

  34. Information Efficacy Felt frustrated Concerned about the quality of information Information was too hard to understand Felt frustrated *n= 306 Source: MA Cancer Communications Survey (October 2006)

  35. Inequality in access to and use of information channels: Language barriers: 3-40% non-English speakers in the United States

  36. Media exposure and language of interview, weighted

  37. Info sources credibility ratings and language of interview, weighted

  38. Inequality in comprehension and knowledge of health information • Confusion due to plethora of information at each stage • Prevention • Diagnosis • Treatment • Navigation of health system • Change over life course • 38% of HINTS respondents < high school education reported “too many recommendations” to follow for cancer prevention

  39. Inequality in comprehension and knowledge of health information • Issue of health literacy in the informed decision making environment • 47-51% of US adults lack basic literacy skills (1992 NALS) • The Knowledge gap hypothesis

  40. The Knowledge Gap Hypothesis • Increasing flow of information into a social system is more likely to benefit groups of higher socioeconomic status (SES) than those of lower SES groups, thus widening the already existing gaps in information rather than narrowing them (Tichenor, Donohue & Olien, 1980)

  41. Factors that influence knowledge gaps at the Individual level * • Prior Knowledge (Price & Zaller, 1993) • Motivation • Interest • Salience • Interaction between motivation & SES *Viswanath & Finnegan, 1996

  42. Percent saying that their chances of cancer increase by "a lot or some" with exposure by Income 90 80 70 60 50 <$24,999 Percent $25,000 - $49,999 40 $50,000+ 30 20 10 0 Smoking Exposure to Sun Income

  43. Inequality in capacity to act on health information • Action is subject to opportunity structure and built environment • Examples from Energy balance • Access to green space (Sallis et al., 2002) • Availability of grocery stores (Block et al., 2004, Moore et al., 2006) • Neighborhood disorder (King et al., 2002, Perkins et al., 1993)

  44. Trajectories of communication inequality • Will disparities disappear with technological advances? • Decrease in cost of technology will lead to saturation? • With improvement comes greater demand for more high-end equipment • Not a one time expenditure • Trend towards convergence of channels and content– what are the implications?

  45. Implications for inequality research • What does convergence of technologies mean to access to and use of different channels? Would it be cost efficient and more affordable if most information and entertainment be obtained from a small set of media delivery systems and services? • Is the constant change and improvement in technologies of information delivery systems likely to be a deterrent for those who cannot afford to update their technologies?

  46. Implications for inequality research • Does the increasing sophistication in using and operating the new technologies likely to leave certain groups at a disadvantage?

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