William MP Klein

National Cancer Institute

Individuals with inherited cancer syndromes, such as Li-Fraumeni syndrome (LFS), may be motivated to adopt health-protective behaviors, such as eating more fruits and vegetables and increasing physical activity. Examining these health behaviors among young people with high lifetime genetic cancer risk may provide important insights to guide future...

This Viewpoint discusses the impact of the COVID-19 public health emergency on the trajectory of cancer deaths.

This Viewpoint describes how health communication science can be used to improve response to health challenges by providing credible health information to the public.

Introduction: Early adopters play a critical role in the diffusion of medical innovations by spreading awareness, increasing acceptability, and driving demand. Understanding the role of race in the context of other characteristics of potential early adopters can shed light on disparities seen in the early implementation of genomic medicine. We aim...

Whether to undergo genome sequencing in a clinical or research context is generally a voluntary choice. Individuals are often motivated to learn genomic information even when clinical utility—the possibility that the test could inform medical recommendations or health outcomes—is low or absent. Motivations to seek one's genomic information can be c...

e24076 Background: Nearly 20% of U.S. cancer survivors develop late cardiovascular disease (CVD) as a result of cardiotoxic cancer treatments. Patients and providers may consider alternative treatment options to lower cardiotoxicity risk, which may present a trade-off between reducing relatively near-term relapse/recurrence vs. preventing long-term...

Health behaviors are critical determinants of the well-being of individuals and populations, and understanding the determinants of these behaviors has been a major focus of research. One important determinant that has received little direct attention in past health research is uncertainty: a complex phenomenon that pertains not only to scientific i...

Background/purpose: We address four questions about interventions to promote physical activity in cancer survivors: (a) How often is both the adoption and maintenance of behavior change tested in trials? (b) How often do interventions generate adoption-plus-maintenance of behavior change? (c) Are intervention strategies specifically geared at prom...

Background: Alcohol is a leading risk factor for cancer, yet awareness of the alcohol-cancer link is low. Awareness may be influenced by perceptions of potential health benefits of alcohol consumption or certain alcoholic beverage types. The purpose of this study was to estimate awareness of the alcohol-cancer link by beverage type and to examine...

Background Future-oriented emotions are associated with consequential health decision-making, including genomic testing decisions. However, little is known about the relative role of various future-oriented emotions in such decisions. Moreover, most research on predictors of decision making regarding genomic testing is conducted with white particip...

In 1986, California enacted Proposition 65 (P65), requiring businesses to display warning signs informing consumers that specific chemicals and alcohol exposure increase the risk of cancer and reproductive harm. In 2018, the P65 alcohol warning signs were updated to include an informational P65 website link, and the update was associated with media...

Purpose As the cancer survivor population increases, diminished health care provider capacity will place more responsibility on survivors to obtain health information. Many survivors search for cancer information online, yet there is a dearth of research on how survivors obtain and engage with this information. This study examined cancer survivors’...

Background Individuals are regularly exposed to conflicting information about health; however, understanding of how individuals respond to different types of conflicting information is limited. Methods In total, 1027 US adults were randomly assigned to 1 of 8 conflicting information messages about nutrition and cancer risk, depicting 1/4 conflicti...

Objective: To test whether 2 conceptually overlapping constructs, dispositional optimism (generalized positive expectations) and optimistic bias (inaccurately low risk perceptions), may have different implications for smoking treatment engagement. Method: Predominantly Black, low-income Southern Community Cohort study smokers (n = 880) self-repo...

Background and Purpose Interventions are effective in promoting health behavior change to the extent that (a) intervention strategies modify targets (i.e., mechanisms of action), and (b) modifying targets leads to changes in behavior. To complement taxonomies that characterize the variety of strategies used in behavioral interventions, we outline a...

The COVID-19 crisis has exposed the public to considerable scientific uncertainty, which may promote vaccine hesitancy among individuals with lower tolerance of uncertainty. In a national sample of US adults in May–June 2020, we examined how both perceptions of uncertainty about COVID-19 and trait-level differences in tolerance of uncertainty arisi...

There remains an urgent need for effective communication about the importance of widespread adherence to behavioral recommendations to control the COVID-19 pandemic that will also reduce resistance to such guidance. We examined two strategies for COVID-19 communication- (1) self-affirmation (reflecting on a personal value in order to boost self-int...

Decisions about one’s health are often accompanied by uncertain outcomes, which may be either positively or negatively valenced. The presence of this uncertainty, which can range along a continuum from risk to ambiguity (i.e., decisions in which the outcome probabilities are known or unknown), can be perceived as threatening, and individuals tend t...

Future-oriented emotions such as anticipatory affect (i.e., current affect experienced regarding a potential future outcome) and anticipated affect (i.e., expectations about potential future affect), are uniquely associated with health decision-making (e.g., electing to receive results of genomic testing). This study investigated the degree to whic...

Risk perception refers to how individuals interpret their susceptibility to threats, and has been hypothesised as an important predictor of intentions and behaviour in many theories of health behaviour change. However, its components, optimal measurement, and effects are not yet fully understood. The TRIRISK model, developed in the US, conceptualis...

Purpose Women with Li–Fraumeni Syndrome (LFS) often consider risk-reducing mastectomy (RRM) due to extremely high risk of breast cancer at early ages. Data on uptake of RRM in LFS are scarce, and are inferred from experience in women with pathogenic variants (PVs) in BRCA1/2, despite differences in cancer risks. This study evaluated RRM uptake in a...

The disruption of routine cancer screening during the COVID-19 pandemic is a public health priority given documented delays in the diagnosis and treatment of screening-eligible cancers, and future impacts on cancer mortality. Furthermore, COVID-19 has disproportionately affected historically underrepresented populations such as the Hispanic communi...

Cancer prevention and control has benefited substantially from behavioral medicine research over the last several decades. The National Cancer Institute’s (NCI) Division of Cancer Control and Population Sciences, ably led by Barbara Rimer and then Bob Croyle since being established in 1997, has been a primary supporter of this research. NCI has mad...

Individuals often turn to others for decision‐making advice, which has the potential to improve decision‐making outcomes when advice is drawn from a reliable source. Because seeking advice is a kind of information seeking, it is likelier to occur when decisions involve ambiguity or when full information about outcomes is unavailable. We examined wh...

We investigated the effectiveness of inoculation and self-affirmation interventions in neutralizing effects of health misinformation. Women ( N=854) recruited via Prolific were randomly assigned to self-affirm (or not) and read an inoculation (versus control) message detailing five common attributes of misinformation. All participants read an artic...

Objective: Despite abundant observational and experimental tests, it is not yet clear whether enhancing autonomous motivation or perceived competence leads to health behavior change. We identified interventions that aimed to change these constructs and quantified the magnitude of changes in behavior observed when interventions generated increases...

Introduction Alcohol use increases cancer risk, yet awareness of this association is low. Alcohol control policies have the potential to reduce alcohol-caused cancer morbidity and mortality. Research outside the U.S. has found awareness of the alcohol–cancer link to be associated with support for alcohol control policies. The purpose of this study...

Introduction Electronic cigarette (e-cigarette) harm perceptions and information seeking behaviours are both important antecedents of e-cigarette use, yet the relationship between them has been rarely studied. We assessed how absolute (e-cigarettes are harmful to my health) and relative harm perceptions (e-cigarettes are more/less harmful than ciga...

Objective Self-affirmation reduces defensiveness toward threatening health messages. In this study, we compared several possible self-affirmation inductions in order to identify the most effective strategy. Design Women at increased risk for breast cancer (i.e. who drink 7+ drinks per week) were recruited through Amazon Mechanical Turk (N = 1,056)...

It is estimated that behaviors such as poor diet, alcohol consumption, tobacco use, sedentary behavior, and excessive ultraviolet exposure account for nearly half of all cancer morbidity and mortality. Accordingly, the behavioral, social, and communication sciences have been important contributors to cancer prevention and control research, with met...

Background Information avoidance tendencies have been found to be associated with lower intentions to pursue medically actionable genomic sequencing results, but less so among individuals who engage more in spontaneous self-affirmation. Yet these results were obtained with a largely non-Hispanic White, high-SES cohort. Purpose To assess these vari...

This study examined temporal and social comparisons of physical health status. Participants in two waves of the MIDUS cohort ranging in age from young adult to young-old (N = 2,408) rated current, past, and future physical health, as well as peer health. Past health was generally rated as better than current health (particularly among young adults)...

Background Effective communication of cancer-related genetic and genomic testing (CGT) with patients and the public is paramount to transforming and managing cancer prevention, detection, and care. Behavioral and social science theories could improve communication effectiveness and, in turn, health outcomes. Methods In this study, we characterized...

Although romantic couple concordance has been demonstrated across a wide array of health behaviors , little research has examined dyadic concordance in health beliefs . This study examined the extent to which cohabitating romantic dyads’ attitudes and beliefs coincide (i.e., dyadic concordance) in addition to how well they predict intentions to lea...

This study examines oncologist-reported reasons for not using multimarker tumor panel testing and the association between these reasons and oncologist-level, facility-level, and patient-mix characteristics. Methods: We used data collected from a nationally representative sample (N = 1,281) of medical oncologists participating in the National Canc...

Objective Smoking stigmatization has been shown to hinder cigarette smoking cessation, especially among individuals with a strong smoker identity. Self-affirmation, a psychological threat-management coping strategy, can promote smoking cessation, and may mitigate the adverse consequences of stigmatization. Design Data from an online sample of 1,02...

Researchers at the NCI have developed the Risk-Based NLST Outcomes Tool (RNOT), an online tool that calculates risk of lung cancer diagnosis and death with and without lung cancer screening, and false-positive risk estimates. This tool has the potential to facilitate shared decision making for screening. The objective of this study was to examine h...

Many US federal agencies apply principles from risk communication science across a wide variety of hazards. In so doing, they identify key research and practice gaps that, if addressed, could help better serve the nation’s communities and greatly enhance practice, research, and policy development.

Objective: Opportunities for patients to enroll in clinical trials for neurodevelopmental conditions are increasing. We studied what factors are associated with parents' decisional process to enroll their child in a clinical trial for a genetic neurodevelopmental condition (Fragile X syndrome). Method: Parents (n = 354; mostly biological mothers...

The current study tested whether self-affirmation or self-compassion exercises, shown to increase message acceptance, could maximize the benefit of a UV photo intervention on skin protection cognitions. College women (N = 167) were randomly assigned to: (1) view a UV photo or Black and White (no-UV) photo of their face and (2) write a self-affirmat...

Objective To investigate the effect of a genetic report format using risk communication "best-practices" on risk perceptions, in part to reduce risk overestimates. Methods Adults (N = 470) from the Coriell Personalized Medicine Collaborative (CPMC) were randomized to a 2 × 2 experimental design to receive a hypothetical "personalized" genetic risk...

Objective: Appetitive risk behaviors (ARB), including tobacco use, alcohol consumption, consumption of calorie dense/nutrient-poor foods, and sexual risk behavior contribute substantially to morbidity and mortality. Affective states that arise from a wide array of unrelated circumstances (i.e., incidental affect) may carry over to influence ARB. A...

Objective To determine how the method of presenting testing options and a provider recommendation can influence a decision about genetic testing for inherited cancer predispositions. Methods An online hypothetical vignette study was completed by 454 healthy volunteers. Participants were randomized to receive one of two survey versions which differ...

p> Introduction: Li-Fraumeni Syndrome (LFS) is a cancer predisposition syndrome, primarily caused by germline pathogenic variants (PV) in the tumor suppressor gene TP53 . Women with these PVs have an 85% lifetime risk of developing breast cancer (BC) and early onset BC, with a 50% risk by age 30. NCCN guidelines recommend risk-reducing mastectomy (...

Objective Individuals are often defensive toward health messages that suggest they are putting their health at risk because such messages threaten their self-competence and integrity. Although self-affirmation can facilitate prevention behaviors in response to health messages, effects are variable. We examined whether disease prevention focus might...

Many cigarette smokers make multiple attempts to quit before they are successful. Implicit theories of smoking (ITS)–beliefs about whether smoking behavior is something that is changeable (incremental belief) or fixed (entity belief)–may play a role in quitting. Four iterations of the cross-sectional, nationally-representative Health Information Na...

Objective To assess the extent to which spiritual well‐being moderates the relationship between anxiety and physical well‐being in a diverse, community‐based cohort of newly diagnosed cancer survivors. Methods Data originated from the Measuring Your Health (MY‐Health) study cohort (n=5506), comprised of people assessed within 6‐13 months of cancer...

Rationale: Individuals who choose to obtain genetic information may learn that their genetic profile confers health risks to themselves or offspring. Individuals may react more negatively to this information when personal attitudes, perceived norms, and/or the decision to receive results conflict with one another. Objective: We predicted that ho...

Objective: We conducted a meta-analysis of randomized controlled trials (RCTs) to promote health behavior change based on self-determination theory (SDT). The review aimed to (a) quantify the impact of SDT interventions on health behaviors, (b) test mediation by theoretically specified variables (autonomous motivation and perceived competence), an...

Much of clinical oncology hinges on the assessment, management, and communication of risk. Screening and genetic testing help identify future cancer risk; treatment decisions involve weighing competing risks; and early-phase clinical trials help determine acceptable risk of new therapies. Of course, in the current COVID-19 pandemic, oncologists hav...

Few trial data are available concerning the impact of personalised cancer risk information on behaviour. This study assessed the short-term effects of providing personalised cancer risk information on cancer risk beliefs and self-reported behaviour. We randomised 1018 participants, recruited through the online platform Prolific, to either a control...

Self-affirmation can buffer stress responses across different contexts, yet the neural mechanisms for these effects are unknown. Self-affirmation has been shown to increase activity in reward-related neural regions, including the ventral striatum and ventromedial prefrontal cortex (VMPFC). Given that reward-related prefrontal cortical regions such...

Objective: This experiment examined whether people respond differently to information about where they stand relative to peer behaviour or to expert behavioural recommendations, and whether responses depend on the attainability of these standards. Design: University students (N = 345) were randomly assigned to receive information about their exerci...

Objective Next generation sequencing (NGS) may aid in tumor classification and treatment. Barriers to shared decision-making may influence use of NGS. We examined, from oncologists’ perspectives, whether barriers to involving patients/families in decision-making were associated with NGS use. Methods Using data from the first national survey of med...

Background Most smokers attempt to stop using cigarettes numerous times before successfully quitting. Cigarette cravings may undermine perceived competence to quit and thus constitute psychological threats to the individual’s self-concept. Self-affirmation may promote smoking cessation by offsetting these threats. Objective This study examines whet...

BACKGROUND Most smokers attempt to stop using cigarettes numerous times before successfully quitting. Cigarette cravings may undermine perceived competence to quit and thus constitute psychological threats to the individual’s self-concept. Self-affirmation may promote smoking cessation by offsetting these threats. OBJECTIVE This study examines whe...

Background Medical information is often conflicting and consequently perceived as ambiguous. There are individual differences both in how much people perceive ambiguity and in their tolerance for such ambiguity. Little is known about how these constructs are related to each other and with other beliefs. Objective To examine the association between...

Human behavior plays a central role in cancer morbidity and mortality. Much behavior is, in turn, attributable to several core biological, cognitive, emotional, motivational, and interpersonal processes. Understanding the systematic and interactive impact of these processes can inform efforts to address cancer-relevant outcomes such as tobacco use,...

Social comparison processes exert a ubiquitous influence on people’s thoughts, decisions, and behaviors related to their health. Moreover, many comparative perceptions (e.g., perceived personal risk, estimation of social norms) are miscalibrated with reality. The way in which people compare themselves with others on a wide variety of dimensions can...

Risk perception is an important construct in many health behavior theories. Smoking risk perceptions are thoughts and feelings about the harms associated with cigarette smoking. Wide variation in the terminology, definition, and assessment of this construct makes it difficult to draw conclusions about the associations of risk perceptions with smoki...

Ample evidence has been available for some time indicating that alcohol use is a preventable risk factor for cancer, and the World Health Organization deemed alcohol a carcinogen more than 30 years ago. In the United States, it is estimated that 5.6% of incident cancer cases (approximately 87 000 each year) are associated with alcohol, including ca...

Objective: Parents often report guilt about what they feed their child, but no studies have examined how this guilt might affect their child-feeding or own eating behavior. Some studies suggest that guilt motivates healthy behaviors, yet others show that guilt impairs the self-control needed to abstain from unhealthy behaviors. Method: One hundr...

Purpose: Familial hypercholesterolemia (FH) is a common Mendelian disorder characterized by elevated LDL cholesterol levels, which if untreated can cause premature heart disease. Less than 10% of cases in the United States are diagnosed. This study investigates decision-making factors associated with intentions to have FH genetic testing among pat...

When one thinks about a conventional cross-disciplinary scientific team, the image that might come to mind is a group of seasoned researchers with disparate backgrounds, perhaps with one or more junior faculty members in the mix. Indeed, that is often the constitution of a scientific team, and such teams can produce stellar research ideas and outco...

With support from federal agency members of the United States National Science and Technology Council’s Social and Behavioral Science subcommittee (SBS), the National Academies of Sciences, Engineering and Medicine (NASEM) held a workshop in June, 2017 (NASEM, 2017) on Graduate Training in the Social and Behavioral Sciences to identify how SBS grad...

The study objective was to examine bivariate and multivariate associations among worry, perceptions, attitudes, sociodemographics, and uptake of cancer-related germline genetic testing. We used data from the Health Information National Trends Survey (cycle 5.1), administered (January–May 2017) to a nationally representative sample of non-institutio...

This paper examines three distinct examples of interventions in nonclinical settings selected to highlight the challenges and opportunities for evaluating cost-effectiveness in the field of health psychology and behavioral medicine. Nonclinical settings are defined as those involving systems outside of traditional medical/clinical settings, and inc...

Objective: To synthesize the literature on the effect of provision of personalised cancer risk information to individuals at population level risk on accuracy of risk perception and psychological responses. Methods: A systematic review and random effects meta-analysis of articles published from 01/01/2000 to 01/07/2017. Results: We included 23...

Background Prevention offers an effective public health strategy for cancer control. One approach that could be incorporated within general practice is the provision of personalised risk information. Few trial data are available concerning the impact of cancer risk information on behaviour. Aim To assess the short-term effects on computed cancer r...

Background: Awareness that alcohol consumption is associated with cancer is low in the United States, and predictors of awareness are not well understood. Methods: Data from the 2017 Health Information National Trends Survey (HINTS 5 Cycle 1) were used to describe knowledge of the association between drinking too much alcohol and cancer ("Yes,"...

Clinical and public health translation of genomics could be facilitated by expertise from behavioral medicine, yet genomics has not been a significant focus of the Society of Behavioral Medicine (SBM). SBM convened a working group (WG) to lead a systematic exploration of members’ views on: (a) whether SBM should give a higher priority to genomic tr...

Purpose Familial Hypercholesterolemia (FH) is a common Mendelian disorder characterized by elevated LDL cholesterol levels, which if untreated can cause premature heart disease. Less than 10% of cases in the US are diagnosed, and uptake of genetic testing is suboptimal. This study investigates decisionmaking factors associated with intentions to ha...

Objective: Prior research has documented the influence of social norms on health-related behaviors, though social norms may affect behaviors in more complex ways than have conventionally been modeled. The present research evaluates parent norms and teens' own attitudes as moderators of associations between perceived peer norms and diet and physica...

Clinical genetics and genomics will exert their greatest population impact by leveraging the rich knowledge of human behavior that is central to the discipline of behavioral medicine. We contend that more concerted efforts are needed to integrate these fields synergistically, and accordingly, we consider barriers and potential actions to hasten suc...

Purpose To evaluate factors associated with compliance to the National Comprehensive Cancer Network (NCCN) guidelines for BRCA1/2 testing and identify groups who are at risk of under- and over-use of BRCA1/2 testing. Methods Data included 20,758 women from Dr. Susan Love Research Foundation’s The Health of Women (HOW) Study®. Multinomial logistic...

We examined what proportion of the U.S. population with no personal cancer history reported receiving either genetic counseling or genetic testing for cancer risk, and also the association of these behaviors with cancer risk perceptions. We used data from the 2015 National Health Interview Survey. Objective relative risk scores for breast (women) a...

The National Institutes of Health (NIH) has played a major role in promoting behavioral medicine research over the past 40 years through funding, review, and priority-setting activities and programs including scientific conferences, meetings, workgroups, intramural research, and training opportunities. In this review of NIH activities in support of...

Effective use of genetic and genomic data in cancer prevention and treatment depends on adequate communication with patients and the public. Although relevant empirical work has emerged, the scope and outcomes of this communication research have not been characterized. We conducted a comprehensive scoping review of recent published research (2010–2...

Purpose: We examined the role of ethnic identity (which measures the degree to which individuals identify with their ethnic group) in beliefs about, and intentions to learn, genomic results. Methods: A longitudinal cohort was recruited to implement genome sequencing among healthy participants self-identifying as African, African American, or Afr...

Accurately assessing the public’s knowledge about the human papilloma virus (HPV) and the HPV vaccine remains critical for informing health education interventions aimed at increasing vaccine uptake. Responding “don’t know” (DK) to survey questions that assess knowledge is common and DK responders are often systematically different from other respo...

The ubiquitous social media landscape has created an information ecosystem populated by a cacophony of opinion, true and false information, and an unprecedented quantity of data on many topics. Policy makers and the social media industry grapple with the challenge of curbing fake news, disinformation, and hate speech; and the field of medicine is s...