Perceived cancer risk and risk attributions among African-American residents of a low-income, predominantly African-American neighborhood

Abstract

Objective. In some national surveys, African-Americans have had lower scores on perceived cancer risk items than whites. Our goals were to confirm low perceptions of cancer risk in an African-American community sample and explore participants' attributions for their perceived cancer risk.

Design. Data were from three cross-sectional surveys. We report levels of perceived absolute and comparative cancer risk in a community sample of African-Americans (N = 88), and African-Americans (Ns = 655, 428) and whites (Ns = 5262, 1679) from two nationally representative Health Information National Trends Surveys (HINTS). We analyzed the content of spontaneously-provided explanations for perceived risk from the community sample.

Results. Perceived absolute and comparative cancer risk were lower in the community and national samples of African-Americans than in the national sample of whites. Participants' spontaneous attributions for low or lower than average risk included not having family history or behavioral risk factors, classes of attributions noted elsewhere in the literature. However, participants also explained that they wanted to avoid wishing cancer on themselves (positive affirmations) and hoped their risk was low (wishful thinking), responses rarely reported for majority-white samples.

Conclusions. Results provide further evidence that cancer risk perceptions are lower among African-Americans than whites. Some participant explanations for low perceived risk (wishful thinking, affirmations) are inconsistent with behavioral scientists' assumptions about perceived risk questions. Results reveal a need to expand cancer risk attribution typologies to increase applicability to diverse populations, and may indicate that perceived cancer risk questions have lower validity in African-American populations.

Keywords:

• cancer
• risk perception
• African-American
• risk attribution
• race

Acknowledgements

We would like to gratefully acknowledge the effort of several community members and students. We thank Rita Hubbard-Robinson, Victoria Hall, Teresa Semalulu, Alex Ruch, Merissa Slevar, Lauren Nitecki, Delores Wilkenson, Kelly Showard, Hiruy Berhane, and Celina Bryan for their invaluable help with data collection and dissemination of results to the community.

Key messages

1. This study replicates previous findings that perceived risk for cancer is rated relatively low among African Americans.

2. Eight and 16% of the sample also said that they did not know their perceived absolute and comparative cancer risk.

3. A relatively large number of participants appraised their risk as low or said that they did not know their risk for reasons rarely reported when perceived risk attributions have been studied in majority white samples.

4. Implications include the need to critically evaluate whether existing theories of risk appraisal ought to take into account a wider variety of factors that influence risk appraisal and whether the assumption that perceived risk questions always assess perceived susceptibility for illness is valid.