Prevalence and Potential Consequences of Exposure to Conflicting Information about Mammography: Results from Nationally-Representative Survey of U.S. Adults

ABSTRACT

As scientific evidence evolves and clinical guidelines change, a certain amount of conflicting health information in the news media is to be expected. However, research is needed to better understand the public’s level of exposure to conflicting health information and the possible consequences of such exposure. This study quantifies levels of public exposure to one paradigmatic case: conflicting information about breast cancer screening for women in their 40s. Using a nationally-representative survey of U.S. adults aged 18–59 in 2016, we implemented four distinct types of measures of exposure to conflicting mammography information: an ecological measure based on keyword counts of local news closed-captioning, an inferred exposure measure based on a series of knowledge questions, a thought-listing exercise where respondents described their perceptions of mammography without prompting, and an explicit measure of self-assessed exposure to conflict. We examined the relationship between these exposure measures and four outcomes: confusion about mammography, backlash toward mammography recommendations, and confusion and backlash about health information more generally. We found moderate amounts of exposure to conflicting information about mammography, more among women than men. Exposure to conflicting information – across multiple measures – was associated with more confusion about mammography, more mammography-related backlash, and general health information backlash, but not general confusion about health information. These observational findings corroborate experimental-based findings that suggest potentially undesirable effects of exposure to conflicting health information. More research is needed to better understand how to mitigate these possible outcomes, in the context of a media landscape that proliferates exposure to multiple scientific perspectives.

Author note

We thank Kari Mentzer for her work coding responses to the thought-listing exercise, Laura Baum for project support, and Jiani Yu on data management support during the early phase of this project. We also thank Karla Kerlikowske, Skip Lupia, Gary Schwitzer, Jonathan Slater, and Beth Virnig for their contributions to survey design. This work was supported by a Research Scholar Grant, RSG-14-166-01- CPPB, from the American Cancer Society (PI: SEG). Additional support was provided by a grant from the National Cancer Institute (5R21CA218054-02; PI: RHN). This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the American Cancer Society. We have no conflicts of interest to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1. In other work both by this team (R.H. Nagler et al., 2017) and others (Abelson et al., 2018), mammogram history has emerged as an important factor predicting attitudes about mammograms. As an exploratory analysis and to be consistent with this other work, we estimated models restricting to women in which we added mammogram history as a covariate and an interaction term with exposure. We report on these exploratory findings as a note in Results.

2. We also estimated models restricted to women only within the age group for whom we asked about their own mammogram status (women aged 30–59, n = 554). These models allowed us to ascertain whether women who routinely get mammograms (64.9% in this subsample) have a different response to exposure to conflict than those who do not, by estimating interaction terms between each of the exposure measures and mammogram screening status. The results are suggestive that exposure to conflict may have a different association with backlash for women who get an annual mammogram, with statistically significant interaction terms for two of the measures of conflict on the “scientists don’t know how you should avoid breast cancer” and “scientists keep changing their minds about what people should do to keep healthy” items. However, these are exploratory analyses, and we were not powered to assess interaction terms by screening behavior for women only. Future research should explore whether mammogram-related conflicting information differs in its effects on women based on their screening behaviors.

Additional information

Funding

This work was supported by the American Cancer Society [RSG-14-166-01- CPPB]; National Cancer Institute [5R21CA218054-02].