The BCERC: Communicating to
Lay Audiences about Breast
Cancer Risk Reduction
Kami J. Silk, PhD
Department of Communication
Michigan State University
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.
Investigators
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Michigan State University
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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
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University of Tennessee, Knoxville
– Michael Kotowski
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College of Charleston
– Merrissa Ferrara
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University of Maryland
– Christine Skubisz
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University of California, Santa
Barbara
– Cynthia Stohl
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Pennsylvania State University
– Julie Volkman
Overview
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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
The Breast Cancer and
Environment Research Centers
(BCERC)
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
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Michigan State University
Fox Chase Cancer Center
University of Cincinnati
University of California, San Francisco
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
BCERC Organizational Model
BIO
COTC
Working
Group
MSU
EPI
BIO
EPI
Steering
Committee
UP
UC
COTC
BIO
COTC
UCSF
EPI
BIO
COTC
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
“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)
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”
Lessons Learned
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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
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
BCERC Environmental Risk Factors
• Perfluorooctanoic acid (PFOA)
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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
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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
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Barcellos-Hoff MH and Nguyen DH. (2009) Radiation Carcinogenesis in Context: How Do Irradiated Tissues Become
Tumors? Health Physics 97:446-457
• Diet
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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)
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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
Precautionary Principle
…“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
MSU Communication Research
Range of Studies
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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
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
Memorable Message Research
• Individuals who had
personal and friend or
relative experience
were significantly more
likely to recall
memorable messages
than other respondents
Memorable Message Research
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
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
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
Website Analyses
• Evidence use
– 85% of websites used statistics
– 36% used 1st person, 23% 3rd person storytelling
• Diversity use
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30% had multiple languages
14% has sections for specific ethnic groups
17% had sections for specific age groups
23% had material readable at a 9th 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
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
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
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.
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)
RQ1: Effect of Message Topic on Intention
Intention to Engage in
Message Recommendation
Lifestyle Message
(n=196)
Chemical
(n=193)
Development
(N=201)
3.46 (.91)
3.46 (.98)
3.22 (.98)*
p < .05*
RQ2: Source Credibility Results
Physician Source Researcher Source
Overall
(N=590)
Advocates
(n=136)
Lay Audience
(n=454)
2.38 (1.09)**
2.15 (1.04)**
2.17 (.98)
2.01(.99)
2.44 (1.11)*
2.19 (1.05)*
P < .05*, .01**
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.
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
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
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
Current Message Development & Testing
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
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
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
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
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
BCERC Information
www.bcerc.org
MSU Research & References
www.bcerc.msu.edu
Thank You