Supplementary Table 3 shows the charting tool used for data extraction, outlining study, participant, and message characteristics collected across included studies, including design features, sample demographics, message content, exposure details, and outcome measures.

This study examined whether message reactance mediates the cognitive effects of messages about the causal relationship between alcohol and cancer. We randomly assigned US adults (N = 799) recruited from a commercial online research panel to receive one of two types of messages about the alcohol-cancer link: (1) high-certainty (e.g., “Drinking alcohol causes cancer”), and (2) low-certainty, employing the modal verb “may” (e.g., “Drinking alcohol may cause cancer”). We evaluated whether message reactance mediated the effects of message certainty vs. uncertainty on (1) perceived causal certainty about the alcohol-cancer link, and (2) perceived alcohol-related cancer risk. We also explored whether heavy vs. non-heavy alcohol consumption moderated these effects. Message reactance mediated the effects of high-certainty (vs. low) messages on perceived causal certainty (direct: b=0.54; indirect: b=-0.11; both ps<0.001) and alcohol-related cancer risk (direct: b=0.37; indirect: b=-0.13; both ps<0.001)—suppressing the positive effects of expressed certainty on both outcomes. The suppressive effects of message reactance on perceived causal certainty were stronger for participants reporting heavy (b=-0.50) vs. non-heavy alcohol consumption (b=-0.35; p=.034). Conditional indirect effects for the perceived causal certainty model only remained significant for participants with non-heavy alcohol consumption (b=-0.10; p=.004). Effects of high-certainty (vs. low) messages were negatively mediated by message reactance and moderated by alcohol consumption. Findings suggest that although high-certainty risk messages may increase cancer risk perceptions, their effect is attenuated by inciting negative reactance to the messages, particularly for those who consume a heavy amount of alcohol. These mixed effects should be considered in future messaging initiatives aimed at communicating the alcohol-cancer relationship to the public.

Background: Randomized controlled trials (RCTs) are needed to evaluate multicancer detection (MCD) tests. A novel “intended-effect” RCT design in which control group participants receive MCD testing but results remain undisclosed can increase statistical efficiency. Prospective participants may find this design unacceptable due to ambiguity aversion introduced by the existence of undisclosed but theoretically knowable test results. We evaluated this effect and tested if reducing ambiguity by ensuring the unknowability of test results mitigates this bias. Methods: US adults aged 45 to 70 y ( N = 1,576) were randomized to read about 1 of 4 RCT designs evaluating MCD testing: 1) RCT with a conventional control group (no testing), 2) RCT with a standard intended-effect control group (ie, control gets testing but not the results), 3) modified intended-effect RCT emphasizing disclosure safeguards to ensure the unknowability of control group test results to participants and researchers, and 4) modified intended-effect RCT with time-delayed testing on control group blood samples after trial completion. Outcomes were study interest (5-point scale, with higher values indicating more interest) and intention to participate (yes/no). Analyses of variance, chi-square tests, and regression-based analyses examined the main effects and potential mediating roles of the perceived net benefit of participating in the study and trust in study researchers. Results: Intention to participate was similar across all conditions (range: 14%–21%). Study interest was higher in the conventional control ( M = 3.73) vs the 3 intended-effect designs ( P < 0.05), which did not differ ( M s = 3.36–3.45). The negative influence of intended-effect designs on study interest was partially mediated by perceived net benefit. Conclusion: Intended-effect RCT designs lower interest in MCD trial participation, in part by reducing prospective participants’ perceptions of benefiting from the trial. Strategies to reduce ambiguity do not mitigate this effect.

Supplementary Table 1 shows the full PRISMA-ScR checklist detailing each reporting item, its description, and the corresponding manuscript page number where it is addressed.

Supplementary Table 2 shows the detailed search strategies used across all databases, including PubMed/MEDLINE, Cochrane Library, Embase, CINAHL Plus, Web of Science, Scopus, PsycInfo, ProQuest Dissertations & Theses, and Google Scholar, along with search dates, concepts, and full query strings for each platform.

Supplementary Table 4 shows the comprehensive evidence table summarizing all included studies, detailing authors, study characteristics, sample demographics, message types, control conditions, and whether drinking behavior was measured as an outcome.

Abstract Public health messaging is a key strategy for raising awareness of the alcohol–cancer link. This review summarizes research on messages communicating this link. Eligible studies were in English, involved human participants, and assessed messages about alcohol and cancer. A systematic search was conducted in July 2021 and updated in July 2023 across seven databases (PubMed/MEDLINE, Cochrane Library, Embase, Scopus, CINHAL, Web of Science, and PsycInfo) using keywords for alcohol, cancer, and messaging. Two coders independently screened and extracted data from eligible studies using Covidence. We identified 121 studies from 104 articles, yielding 236 alcohol–cancer messages. Most studies were published within the past decade (n = 80, 66%) and assessed alcohol beverage warning labels referencing cancer (n = 75, 62%). Most studies included adults who consumed alcohol (n = 85, 70%). Men comprised less than 50% of the sample in half of the studies. Breast cancer was the most mentioned cancer in messages (n = 85, 36%). Messages commonly used probabilistic causal language expressing uncertainty in the outcome [e.g., “alcohol increases cancer risk” (n = 149, 63%)]. Understanding public awareness of cancer-relevant health behaviors is critical to cancer prevention and control. Messages about the carcinogenic effects of alcohol can be an effective public health strategy if rigorously tested across broad populations.

Public health messaging is a key strategy for raising awareness of the alcohol-cancer link. This review summarizes research on messages communicating this link. Eligible studies were in English, involved human participants, and assessed messages about alcohol and cancer. A systematic search was conducted in July 2021 and updated in July 2023 across seven databases (PubMed/MEDLINE, Cochrane Library, Embase, Scopus, CINHAL, Web of Science, and PsycInfo) using keywords for alcohol, cancer, and messaging. Two coders independently screened and extracted data from eligible studies using Covidence. We identified 121 studies from 104 articles, yielding 236 alcohol-cancer messages. Most studies were published within the past decade (n = 80, 66%) and assessed alcohol beverage warning labels referencing cancer (n = 75, 62%). Most studies included adults who consumed alcohol (n = 85, 70%). Men comprised less than 50% of the sample in half of the studies. Breast cancer was the most mentioned cancer in messages (n = 85, 36%). Messages commonly used probabilistic causal language expressing uncertainty in the outcome [e.g., "alcohol increases cancer risk" (n = 149, 63%)]. Understanding public awareness of cancer-relevant health behaviors is critical to cancer prevention and control. Messages about the carcinogenic effects of alcohol can be an effective public health strategy if rigorously tested across broad populations.

Supplementary Table 5 shows the study outcomes recoding framework, detailing outcome categories, definitions, and example measures used to classify message evaluation, product perceptions, intermediate cognitive and affective responses, policy support, behavioral intentions, and other study outcomes.

Li-Fraumeni syndrome (LFS) is an inherited condition associated with high multi-organ cancer risks from birth. Young adults (YAs; 18–39 years) with LFS experience psychosocial challenges that may negatively affect health-related quality of life (HRQOL). This study aimed to describe a specific psychosocial challenge, concerns about the consequences of LFS (CC-LFS), and investigate relationships among CC-LFS and HRQOL among YAs. An online survey assessed CC-LFS and HRQOL among YAs with LFS enrolled in a National Cancer Institute study. Regression analyses examined relationships between CC-LFS and HRQOL scores, adjusted for age, cancer, and history of mental health challenges. Of 37 total respondents (78% female; Mage = 31 years), 51% had a cancer history. Many reported past mental health challenges, including emotional problems (70%), depression/anxiety disorders (68%), and suicidal ideation (43%). Mean scores for mental (M = 65.8), physical (M = 67.5), and general (M = 63.9) HRQOL were lower than in the general population. Higher CC-LFS scores (M = 31/50, SD = 7.2) were associated with lower scores for each HRQOL domain. Adjusting for covariates, higher CC-LFS scores were associated with lower physical HRQOL (β = −0.491, 95% CI −0.76, −0.22, p < 0.001) and general HRQOL (β = −0.466, 95% CI −0.77, −0.16, p = 0.004), but not mental HRQOL (p = 0.102). CC-LFS accounted for significant proportions of unique variance in general (R2adj = 17.7%, p = 0.004) and physical HRQOL (R2adj = 20.4%, p < 0.001). Findings suggest YAs with LFS may experience substantial concerns, mental health challenges, and diminished HRQOL. Concerns about LFS consequences appear to be a psychosocial risk factor that clinicians and researchers might address through targeted interventions to improve YAs’ psychosocial health.

This Viewpoint discusses how the integration of individual- and population-level strategies could help the scientific literature offer actionable guidance on cancer control, therefore improving public health.

OBJECTIVES:To investigate the effects of causal language in warning messages about alcohol and cancer risk. METHODS:In an online factorial experiment conducted in 2023, 799 US adults were randomly assigned to view one of eight messages employing different combinations of causal verbs (e.g., "causes") and modal verbs (e.g., "may") to describe the alcohol-cancer relationship. Analyses compared the effects of causal language on perceptions of causal certainty, alcohol-related cancer risk, message credibility, message reactance, and alcohol consumption intentions. RESULTS:Causal language did not affect perceived causal certainty, perceived cancer risk, or alcohol consumption intentions, but decreased perceived message credibility and increased reactance. Modal language decreased perceived causal certainty and cancer risk, increased perceived credibility of messages containing "causes," and decreased reactance to all messages. CONCLUSIONS:Causal language in alcohol warning messages has complex, countervailing effects: higher-certainty causal verbs do not increase risk perceptions but increase negative reactance, whereas higher-uncertainty modal verbs decrease risk perceptions but also reactance. These results suggest causal language may pose potential tradeoffs for risk communication efforts, raising the need for caution and more research to understand its effects.

Changes in the information landscape and increasing polarization in society over recent decades have made it more difficult to establish common ground, which poses a profound challenge to effective health communication and public health in general. We highlight the importance of assessing health communication approaches for their potential to bring people together and reduce polarization. We outline several communication approaches that use existing common ground (e.g., appeals to shared values, shared identity, common goals, social norms) or cultivate common ground (e.g., dialogue to bridge divides, trust-focused communication, efforts to humanize scientists), positing that by furthering common ground, these approaches can serve to increase a shared understanding of contentious health topics and foster greater trust in science and evidence-based health information. We end by cautioning against the use of approaches that may be shown to be effective on some measures but may also inadvertently create further polarization, such as the use of certain fear appeals, disparaging humor, or stigmatizing language. (Am J Public Health. 2025;115(4):511-518. https://doi.org/10.2105/AJPH.2024.308003).

ABSTRACTBackgroundNearly 20% of US cancer survivors develop cardiovascular disease (CVD) from cardiotoxic cancer treatments. Patients and providers may consider alternative treatments to lower cardiotoxicity risk, but these may be less effective at preventing relapse/recurrence, presenting a difficult tradeoff.AimsThis study explored survivors' cancer treatment decision‐making when weighing this tradeoff.MethodsUsing adjusted multivariable logistic regression, we examined 443 US survivors' risk perceptions (deliberative, affective, and intuitive) about cancer and CVD and associations of these with their selection between two hypothetical cancer treatments: Treatment A: 5% chance of cancer recurrence and 10% chance of CVD; Treatment B: 10% chance of recurrence and 5% chance of CVD. We explored the effects of delay discounting by randomizing to a condition describing cancer recurrence/CVD as either immediate or delayed.ResultsMore survivors (Mage = 48, range = 18–93; M = 10.8 years post‐diagnosis) selected Treatment A than Treatment B (72% v. 28%). Timing of onset was not associated with treatment selection. Greater affective risk perception (worry) about cancer was associated with increased odds of choosing Treatment A, whereas greater CVD worry was associated with decreased odds (OR‐cancer = 1.33, p = 0.006; OR‐CVD = 0.72, p = 0.007). Neither deliberative nor experiential risk perceptions were associated with treatment choice.ConclusionsSurvivors were more likely to select the treatment that minimized recurrence rather than CVD—regardless of the timing of onset. Treatment decision was linked to both cancer‐ and CVD‐related worry but not deliberative or experiential risk perceptions. During treatment discussions, clinicians should open conversations about the risks of treatment‐associated cardiotoxicity, the probabilities, and patients' relative worries about cancer and cardiotoxicity.

OBJECTIVE:Health information avoidance can prevent or delay the detection and diagnosis of a disease. One resource that could mitigate health information avoidance in individuals of African descent is engagement with ethnic identity. However, historical medical mistrust in these communities could make ethnic identity exacerbate information avoidance. The present study examines the association between ethnic identity and health information avoidance and the potential moderating effect of spontaneous self-affirmation (which has been shown to be protective against information avoidance) in an African descent cohort participating in an exome sequencing study (ClinSeq). METHOD:Participants were 407 individuals who self-identified as African, African American, or Afro-Caribbean (Mage = 57.52 years old, SDage = 6.22; 75.2% female). Prior to receiving their sequencing results, participants reported their engagement with their ethnic identity, tendency to self-affirm, and tendency to avoid health information in a baseline assessment. We used the Hayes PROCESS macro to test a moderation model with age, sex, education, and income as covariates. RESULTS:The model revealed a positive association between ethnic identity and health information avoidance only when self-affirmation was low, producing a significant interaction (b = -.25, SE = .11, p = .03, 95% confidence interval = [-.47, -.02]). No other associations were significant. CONCLUSIONS:Self-affirmation may be protective against health information avoidance among individuals of African descent who engage highly with their ethnic identity. Future research should consider ethnic identity and self-affirmation as factors in health information avoidance. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

BACKGROUND:Hispanic/Latina women in the United States have high rates of cervical cancer and little is known regarding how sociocultural factors might be related to their cervical cancer prevention behaviors. PURPOSE:Two studies examined correlates of human papillomavirus (HPV) vaccine initiation, HPV vaccine completion, ever screening for cervical cancer, and being up to date with screening among screening- and vaccine-eligible Hispanic/Latina women. METHODS:Study 1 examined sociodemographic correlates of these behaviors using data from the Behavioral Risk Factor Surveillance System. Study 2 examined whether endorsement of simpatía (ie, expressing warmth to avoid conflict and promote harmony in interpersonal interactions) and familism (ie, supportive familial relationships that emphasize commitment to and prioritization of the family) explained unique variance in these behaviors while controlling for the sociodemographic variables from study 1. RESULTS:In study 1, women who were younger, insured, and who had higher income had greater odds of vaccine initiation. Heterosexual women and those with higher education had greater odds of vaccine completion. Women who were older, married, insured, heterosexual, and who had higher education and income had greater odds of ever screening. Women who were younger and heterosexual had greater odds of being up to date with screening. In study 2, endorsement of simpatía explained unique variance in vaccine initiation even while controlling for sociodemographic variables. CONCLUSIONS:Age, income, sexual orientation, and insurance status were consistently related to cervical cancer prevention behaviors among Hispanic/Latina women. Future research should examine the mechanisms through which the association between simpatía and HPV vaccine initiation occurs.