BUFFALO, N.Y. – More African Americans get colorectal
cancer (CRC) and die from it than any other ethnic or racial
While screening for the disease, by colonoscopy in particular,
is the most effective way to detect colorectal cancer early and
thereby improve treatment outcomes, studies show that there are
substantial disparities for screening when comparing African
Americans to other groups.
Compared to white Americans, African Americans are 20 percent
more likely to get CRC and 18 percent more likely to die from
The University at Buffalo, Roswell Park Cancer Institute and
Icahn School of Medicine at Mount Sinai are collaborators on a
$2,658,940 grant from the National Cancer Institute to study what
influences African Americans to get screened for CRC and to develop
interventions based on those influences.
“There is a critical need to understand why so many
African Americans aren’t getting screened for CRC,”
says Marc Kiviniemi, PhD, assistant professor in the UB Department
of Community Health and Health Behaviors and one of several
principal investigators on the grant.
Kiviniemi says that while most behavioral research has linked
cognitive decision-making (perceived benefits and barriers) and
affective decision-making (fear and worry) to predicting whether
individuals will get CRC screening, little work has been done on
examining these dynamics among African Americans.
“This creates significant gaps in knowledge about the role
of feelings in predicting and potentially increasing CRC screening
for minorities,” he says.
Kiviniemi says most educational material about CRC involves
fact-based strategies for informing the public about the importance
of CRC screening, but this does not seem to be an effective
strategy for encouraging screening for African Americans.
The goal of this study, he says, is to use our understanding of
how and why African Americans are influenced to participate in CRC
screening and to develop narrative-based educational strategies to
encourage CRC screening in African American communities.
The study will examine the impact of two randomized community
interventions on cognitive and affective factors and their
resulting influence on health care seeking and CRC screening
behaviors for African Americans.
Kiviniemi is an expert on how individuals’ health decision
making is influenced by feelings. He began his research in
“At first I was just observing and listening to people
talk about their health behaviors and noticing that there were
situations where people knew that they ‘should’ do
something but didn’t really want to – like exercising
or getting a colonoscopy – or other situations where they
knew that they shouldn’t do something but liked doing it
– like eating junk food,” he says.
Most of the theories that existed to explain people's health
behaviors, Kiviniemi says, could explain the "should do" or
"shouldn't do" judgments people were making but couldn't account
for the more visceral, emotional reactions that lead people to do
things like eat junk food or to not get a screening test.
“For several years now, my lab’s work has focused on
understanding how individuals’ emotions affect their choices
about health,” says Kiviniemi.
“From a practical, health promotion perspective, we
address the question of how we can shift the emotional associations
people have with health behaviors to encourage them to make
healthier behavioral choices.”
Kiviniemi’s lab will figure prominently into the study. It
is set up for the work on study design and data analysis.
His fellow principal investigators on the grant are Deborah
Erwin, PhD, Roswell Park Cancer Institute, and Lina Jandorf, MA, of
Icahn School of Medicine at Mount Sinai. Gary Winkel, PhD,
also of Icahn School of Medicine at Mount Sinai, is a