Journal of Behavioral Medicine

, 29:449

Cognitive Mediators Linking Social Support Networks to Colorectal Cancer Screening Adherence

Article

This paper argues that normative considerations are more important than attitudinal factors in engaging colorectal cancer screening, and tests a model explaining how unique cultural expressions of social networks influence screening adherence. Structural equation modeling was used to understand colorectal cancer screening in a population-based sample of 341 Japanese Americans aged 50 and over. The model accounted for 25% of the variance in screening adherence. Adherence was most strongly associated with family/friend subjective norms about colorectal cancer screening use. Emotional family support, but not the size of the networks, was indirectly related to adherence via increased family/friend subjective norms, while emotional friend support was directly related to adherence. While usual source of care was directly associated with adherence, better provider-patient communication was directly and indirectly associated with adherence via increased perceived benefits. The findings of this study support strengthening informal support networks to enhance adherence among Japanese Americans at risk.

KEY WORDS:

cancer screening social support social linkage colorectal cancer. 

References

  1. Ajzen, A., and Fishbein, M. (1980). Understanding Attitudes and Predicting Social Behavior, Prentice-Hall, New Jersey.Google Scholar
  2. Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In Kuhl, J., and Beckman, J. (Eds.), Action Control: From Cognition to Behavior, Springer-Verlag, Berlin, pp.11–40.Google Scholar
  3. Ajzen, I. (1991). The theory of planned behavior. Organ. Behav. Hum. Decis. Process. 50: 179–211.CrossRefGoogle Scholar
  4. American Cancer Society (2005). Cancer Facts & Figures 2005, American Cancer Society, Atlanta, GA.Google Scholar
  5. Anderson, J. C., and Gerbing, D. W. (1988). Structural equation modeling in practice: A revew and recommended two-step approach. Psychol. Bull. 103: 411–423.CrossRefGoogle Scholar
  6. Arbuckle, J. L. (1995). AMOS 4.0 Programming Reference Guide, SmallWaters, Chicago.Google Scholar
  7. Arbuckle, J. L., and Wothke, W. (1999). AMOS 4.0 User's Guide, SmallWaters Corporation, Chicago.Google Scholar
  8. Asian American Federation of New York Census Information Center (2004). Census profile: New York City's Japanese American. Asian American Federation.Google Scholar
  9. Bandura, A. (1997). Self-Efficacy: The Exercise of Control, Freeman, New York.Google Scholar
  10. Baquest, C. R., and Commiskey, P. (1999). Colorectal cancer epidemiology in minorities: A review. J. Assoc. Acad. Minor. Physicians 10: 51–58.Google Scholar
  11. Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychol. Bull. 107: 238–246.PubMedCrossRefGoogle Scholar
  12. Bollen, K. A. (1989). Structural Equations with Latent Variables, Wiley, New York.Google Scholar
  13. Center for Disease Control and Prevention (July 23, 2004). Surveillance for certain health behaviors among selected local areas—United States, Behavioral Risk Factor Surveillance System, 2002. MMWR, 53, SS-05.Google Scholar
  14. Champion, V. L. (1993). Instrument refinement for breast cancer screening behaviors. Nurs. Res. 42: 139–143.PubMedCrossRefGoogle Scholar
  15. Champion, V. L. (1995). Development of a benefits and barriers scale for mammography utilization. Cancer Nurs. 18: 53–59.PubMedCrossRefGoogle Scholar
  16. Chen, J. Y., Diamant, A. L., Kagawa-Singer, M., Pourat, N., and Wold, C. (2004). Disaggregating data on Asian and Pacific Islander women to assess cancer screening. Am. J. Prev. Med. 27(2): 139–145.PubMedCrossRefGoogle Scholar
  17. Clipp, E. C., Carver, E. H., Pollak, K. I., Puleo, E., Emmons, K. M., Onken, J., Farraye, F. A., and McBride, C. M. (2004). Age-related vulnerabilities of older adults with colon adenomas: Evidence from Project Prevent. Cancer 100(5): 1085–1094.PubMedCrossRefGoogle Scholar
  18. Dawson, E. J., Crano, W. D., and Burgoon, M. (1996). Refining the meaning and measurement of acculturation: Revisiting a novel methodological approach. Int. J. Intercultural Relat. 20: 97–114.CrossRefGoogle Scholar
  19. DeCarlo, L. T. (1997). On the meaning and use of kurtosis. Psychol. Methods 2: 292–307.CrossRefGoogle Scholar
  20. Dillman, D. (1978). Mail and Telephone Surveys: The Total Design Method, Wiley, New York.Google Scholar
  21. DiMatteo, M. R. (2004). Social support and patient adherence to medical treatment: A meta-analysis. Health Psychol. 23(2): 207–218.PubMedCrossRefGoogle Scholar
  22. Doi, T. (1971). Amaeno Kouzoo (The structure of “Amae”), Koobundoo, Tokyo.Google Scholar
  23. Flood, D. M., Weiss, N. S., Cook, L. S., Emerson, J. C., Schwartz, S. M., and Potter, J. D. (2000). Colorectal cancer incidence in Asian migrants to the United States and their descendants. Cancer Causes Control 11: 403–411.PubMedCrossRefGoogle Scholar
  24. Freimuth, V. S., and Quinn, S. C. (2004). The contributions of health communication to eliminating health disparities. Am. J. Public Health 94: 2053–2055.PubMedGoogle Scholar
  25. Giuliano, A. R., Mokuau, N., Hughes, C., Tortolero-Luna, G., Risendal, B., Ho, R. C. S., Prewitt, T. E., and McCaskill-Stevens, W. J. (2000). Participation of minorities in cancer research: The influence of structural, cultural, and linguistic factors. Ann. Epidemiol. 10(8 Suppl): S22–34.PubMedCrossRefGoogle Scholar
  26. Green, P. M., and Kelly, B. A. (2004). Colorectal cancer knowledge, perceptions, and behaviors in African Americans. Cancer Nurs. 27(3): 206–215.PubMedCrossRefGoogle Scholar
  27. Greene, M. G., and Adelman, R. D. (2003). Physician-older patient communication about cancer. Patient Educ. Couns. 50(1): 55–60.PubMedGoogle Scholar
  28. Hawley, S. T., Levin, B., and Vernon, S. W. (2001). Colorectal cancer screening by primary care physicians in two medical care organizations. Cancer Detect. Prev. 25(3): 309–318.PubMedGoogle Scholar
  29. Heaney, C. A., and Israel, B. A. (1997). Social networks and social support. In Glanz, K., Lewis, F. M., and Rimer, B. (Eds.), Health Behavior and Health Education: Theory, Research, and Practice, Jossey-Bass Publications, San Francisco, pp.179–205.Google Scholar
  30. Honda, K. (2004). Factors associated with colorectal cancer screening among the US urban Japanese population. Am. J. Public Health 94(5): 815–822.PubMedGoogle Scholar
  31. Hu, L., and Bentler, P. M. (1999). Cutoff criteria for fir indices in covariance structure analysis: Conventional criteria versus new alternatives. Struct. Equation Model. 6: 1–55.CrossRefGoogle Scholar
  32. Hunt, L. M., Schneider, S., and Comer, B. (2004). Should “acculturation” be a variable in health research? A critical review of research on US Hispanics. Soc. Sci. Med. 59(5): 973–986.PubMedCrossRefGoogle Scholar
  33. Ino, S. M., and Glicken, M. D. (2002). Understanding and treating the ethnically Asian client: A collectivist approach. J. Health Soc. Policy 14(4): 37–48.PubMedCrossRefGoogle Scholar
  34. Joreskig, K. G. (1993). Testing structural equation models. In Bollen, K. A., and Long, J. S. (Eds.), Testing Structural Equation Models, Sage, Newbury Park, CA, pp. 294–316.Google Scholar
  35. Joreskog, K. G., and Sorbom, D. (1996). LISREL 8: User's Reference Guide, Scientific Software International, Chicago.Google Scholar
  36. Kagawa-Singer, M., and Kassim-Lakha, S. (2003). A strategy to reduce cross-cultural miscommunication and increase the likelihood of improving health outcomes. Acad. Med. 78: 577–587.PubMedCrossRefGoogle Scholar
  37. Kakai, H., Maskarinec, G., Shumay, D. M., Tatsumura, Y., and Tasaki, K. (2003). Ethnic differences in choices of health information by cancer patients using complementary and alternative medicine: An exploratory study with correspondence analysis. Soc. Sci. Med. 56(4): 851–862.Google Scholar
  38. Katz, M. L., James, A. S., Pignone, M. P., Hudson, M. A., Jackson, E., Oates, V., and Campbell, M. K. (2004). Colorectal cancer screening among African American church members: A qualitative and quantitative study of patient-provider communication. BMC Public Health 4: 62.PubMedCrossRefGoogle Scholar
  39. Kessler, R. C., DuPont, R. L., Berglund, P., and Wittchen, H. U. (1999). Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. Am. J. Psychiatry 156(12): 1915–1923.PubMedGoogle Scholar
  40. Kinney, A. Y., Bloor, L. E., Dudley, W. N., Millikan, R. C., Marshall, E., Martin, C., and Sandler, R. S. (2003). Roles of religious involvement and social support in the risk of colon cancer among Blacks and Whites. Am. J. Epidemiol. 158(11): 1097–1107.PubMedCrossRefGoogle Scholar
  41. Kline, R. B. (1998). Principles and Practice of Structural Equation Modeling, Guilford Press, New York.Google Scholar
  42. Kreps, G. L., O’Hair, D., and Clowers, M. (1995). Communication and health. In Kreps, G. L., and O'Hair, D. (Eds.), Communication and Health Outcomes, Hampton, Cresskill, NJ, pp. 5–18.Google Scholar
  43. Kreuter, M. W., Skinner, C. S., Steger-May, K., Holt, C. L., Bucholtz, D. C., Clark, E. M., and Haire-Joshu, D. (2004). Responses to behaviorally vs. culturally tailored cancer communication among African American women. Am. J. Health Behav. 28(3): 195–207.PubMedGoogle Scholar
  44. Lepore, S. J., Helgeson, V. S., Eton, D. T., and Schulz, R. (2003). Improving quality of life in men with prostate cancer: A randomized controlled trial of group education interventions. Health Psychol. 22(5): 443–452.PubMedCrossRefGoogle Scholar
  45. Marchand, L. L. (1999). Combined influence of genetic and dietary factors on colorectal cancer incidence in Japanese Americans. J. Natl. Cancer Inst. Monogr. 26: 101–105.PubMedGoogle Scholar
  46. McLaughlin, L. A., and Braun, K. L. (1998). Asian and Pacific Islander cultural values: Considerations for health care decision making. Health Soc. Work 23(2): 116–126.PubMedGoogle Scholar
  47. Messecar, D. (2000). Mammography screening for older women with and without cognitive impairment. J. Gerontol. Nurs. 26: 14–24.Google Scholar
  48. Miller, S. M., Shoda, Y., and Hurley, K. (1996). Applying cognitive-social theory to health-protective behavior: Breast self-examination in cancer screening. Psychol. Bull. 119(1): 70–94. Review.PubMedCrossRefGoogle Scholar
  49. Nelson, D. E., Kreps, G. L., Hesse, B. W., Croyle, R. T., Willis, G., Arora, N. K., Rimer, B. K., Viswanath, K. V., Weinstein, N., and Alden, S. (2004). The Health Information National Trends Survey (HINTS): Development, design, and dissemination. J. Health Commun. 9(5): 443–460, discussion 81–84.PubMedCrossRefGoogle Scholar
  50. O’Malley, A. S., Kerner, J., Johnson, A. E., and Mandelblatt, J. (1999). Acculturation and breast cancer screening among Hispanic women in New York. Am. J. Public Health 89: 210–227.Google Scholar
  51. Ries, L. A. G., Kosary, C. L., Hankey, B. F., Miller, B. A., Clegg, L. X., and Edwards, B. K. (Eds.) (1999). SEER Cancer Statistics Review, 1973—1996, National Cancer Institute, Bethesda, MD. NIH Publication 99-2789.Google Scholar
  52. Sorensen, G., Barbeau, E., Hunt, M. K., and Emmons, K. (2004). Reducing social disparities in tobacco use: A social-contextual model for reducing tobacco use among blue-collar workers. Am. J. Public Health 94(2): 230–239.PubMedCrossRefGoogle Scholar
  53. Steiger, J. H., and Lind, J. M. (1980). Statistically Based Tests for the Number of Common Factors, Iowa City, IA.Google Scholar
  54. Stein, J. A., and Fox, S. A. (1990). Brief communication: Language preference as an indication of mammography use among Hispanic women. J. Natl. Cancer Inst. 82: 1715–1716.PubMedCrossRefGoogle Scholar
  55. Taylor, M. L., and Anderson, R. (2002). Colorectal cancer screening: Physician attitudes and practices. WMJ 101(5): 39–43.PubMedGoogle Scholar
  56. Taylor, V., Lessler, D., Mertens, K., Tu, S. P., Hart, A., Chan, N., Shu, J., and Thompson, B. (2003). Colorectal cancer screening among African Americans: The importance of physician recommendation. J. Natl. Med. Assoc. 95(9): 806–812.PubMedGoogle Scholar
  57. U.S. Department of Health and Human Services (November 2000). Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. U. S. Government Printing Office, Washington, DC.Google Scholar
  58. Van Der Molen, B. (1999). Relating information needs to the cancer experience. Eur. J. Cancer 8: 238–244.CrossRefGoogle Scholar
  59. Vernon, S. W. (1997). Participation in colorectal cancer screening: A review. J. Natl. Cancer Inst. 89: 1406–1422.PubMedCrossRefGoogle Scholar
  60. Wellisch, D. W., Kagawa-Singer, M., Reid, S., et al. (1999). An exploratory study of social support: A cross-cultural comparison of Chinese-, Japanese, and Anglo-American breast cancer patients. Psycho-Oncology 8: 207–219.PubMedCrossRefGoogle Scholar
  61. Wong, S. T., and Gildengorin, G. (2004). Colorectal cancer screening among Asian Americans. Presented at 5th Asian American Cancer Control Academy. Available at http://www.aancart.org/academy/Presentations/FRI_Breakout/SWong_ColorectalScreening.ppt. Accessed November 29, 2004.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Columbia UniversityNew YorkUSA
  2. 2.Associate Research Scientist, Department of Epidemiology, Mailman School of Public HealthColumbia UniversityColumbiaUSA

Personalised recommendations