Subjective Risk and Health Protective Behavior:
Cancer Screening and Cancer Prevention
Leona S. Aiken
Mary A. Gerend
Arizona State University
Kristina M. Jackson
University of Missouri
This chapter explores the role of perceived risk in health protective behavior. Cancer serves as the context of the presentation; the discussion employs the literature on cancer screening and prevention to highlight theory and findings on the perception of risk in relation to health behavior. The origins of perceived risk, its role in health behavior models, and the linkages between perceived risk and behavior are explored. In models of health behavior, perceived risk for disease is the motivational engine for health protective action. This chapter is intended to serve two purposes: to provide both a broad picture of the literature on risk perception in health psychology and to characterize research on perceived risk for cancer as a putative determinant of cancer screening and preventive behavior.
The chapter first addresses the role of perceived susceptibility in models of health behavior. It then turns to perceived risk as a construct, its measurement, its observed relation to objective risk for cancer, and its determinants. It next explores the relation of perceived susceptibility and cancer distress to cancer screening and cancer preventive behavior. Here it considers not only the susceptibility-behavior link, but also explores other variables that may moderate or even mitigate the impact of perceived susceptibility on specific cancer protective behaviors. The chapter then considers interventions to increase screening and preventive behavior that involve the perceived susceptibility construct. The emphasis is on the use of mediational analysis to assess the direct and indirect impact of perceived susceptibility on screening and preventive behavior. Finally, it explores a number of issues that arise in consideration of how perceived susceptibility impacts health protective behavior.
Cancer is a feared disease of high prevalence. By age 59, over 8% of men and 9% of women will have developed an invasive cancer; from birth to death, these percentages rise to 47% of men and 38% of women (Landis, Murray, Bolden, & Wingo, 1998). Cancer is the second leading cause of death (23% of all deaths) behind heart disease (32%) among adults in the United States. In all, 1.23 million new cases of cancer and over 564,800 cancer deaths are expected in the United States in 1998 (Landis et al., 1998).
The public is inundated with information about cancer and with recommendations for cancer screening and prevention.