Wayne State University

WSU researchers find negatives in colorectal cancer screening promotion dissuade African-Americans

DETROIT – A team of researchers spearheaded by a Wayne State University School of Medicine behavioral scientist has found that uniform messaging that incorporates the negative consequences of avoiding colorectal cancer screening may actually dissuade some audiences from seeking such evaluations.

In “Gain versus loss-framed messaging and colorectal cancer screening among African Americans: A preliminary examination of perceived racism and culturally targeted dual messaging,” published in the British Journal of Health Psychology, Todd Lucas, Ph.D., and colleagues found that African-Americans reacted negatively to “loss-framed” messaging about colorectal cancer screening. Caucasians reacted positively to such messaging.

The study sought to examine the potential for cultural differences in the effects of gain-framed and loss-framed messaging in the promotion of colorectal cancer screening. Gain-framed messaging emphasizes the positives of taking action, while loss-framed messaging emphasizes the negative that can occur from inaction.

The study found, in effect, that messaging about the negative effects of not seeking colorectal cancer screening is unlikely to be an effective tool with African-Americans, said Dr. Lucas, associate professor of Family Medicine and Public Health Sciences, Division of Population Health Sciences, and also the Department of Psychology.

Prospect theory holds that loss-framed messages make people more willing to take risks, Dr. Lucas said. Health detection behaviors like cancer screening are psychologically “risky” because they may reveal an illness. Consistent with the theory, Caucasians are more acceptable to taking that risk when potential losses are emphasized. The study suggests that African-Americans, however, are more receptive to gain-framed messaging. There may be a number of explanations for the difference between the two groups, but Dr. Lucas said the study indicates that with African-Americans loss-framed messaging may produce an inadvertent activation of negative emotion, possibly including perceived racism, that can impinge on how the message is received.

The study results, he said, suggest two things: first, that broadly construed messaging strategies should be “carefully vetted” before they are targeted across cultures. Secondly, the study indicates that emphasizing the positives of cancer screening may be a more successful messaging tactic with African-Americans.

“The message framing literature has suggested for years that loss-frames are generally better at compelling cancer screening behavior, but loss-framed messages may be having the exact opposite effect on African Americans, who thus far haven't been well attended to in the message framing literature,” Dr. Lucas said. “Emphasizing bad things that could result from not being screened may not be an effective messaging strategy, unless perhaps it is done in a way that seems culturally targeted to African-Americans,” for example a loss-framed message combined with a culturally-targeted self-control message.

Worldwide, colorectal cancer is the third most common cancer in men and second most common in women, with more than 1 million cases diagnosed annually. African-Americans have the highest rates of the disease and the highest death rate from colorectal cancer of any ethnic group in the United States. Improved screening and screening rates could mitigate those rates, but effective communication strategies are critical to boost screening numbers.

The study’s coauthors include Lenwood Hayman (Family Medicine and Public Health Sciences and also the Department of Psychology), James Blessman, M.D., M.P.H. (Family Medicine and Public Health Sciences) Julie Novak, Ph.D., (Wayne State University Department of Communication), and Kanzoni Asabigi (the city of Detroit’s Department of Health and Wellness Promotion).

The study was funded by a competitively-awarded Research Enhancement pilot grant from Wayne State University’s Office of the Vice President of Research, and has led to Dr. Lucas securing a $1.5 million R01 grant from the National Cancer Institute (CA175088). With that grant, he and his collaborators will attempt to further examine the findings in a sample of African-Americans in the Detroit community who are noncompliant with recommended colorectal cancer screening. He will test the efficacy of professionally developed gain- and loss-framed video messaging to alter receptivity to fecal immunochemical, or FIT Kit, testing, an in-home cancer screening tool that may appeal to those reluctant to undergo more invasive screening, like colonoscopy. Partners in the extended study include Trail Productions Inc., Metronet (a consortium of primary care practice-based research network helping to identify participants), the Population Studies and Disparities Research Program of the Barbara Ann Karmanos Cancer Institute and Quest Diagnostics.

The British Journal of Health Psychology publishes original research on all aspects of psychology related to health, health-related behavior and illness across the lifespan. Visit wileyonlinelibrary.com/journal/bjhp for more information.


Wayne State University is one of the nation’s pre-eminent public research universities in an urban setting. Through its multidisciplinary approach to research and education, and its ongoing collaboration with government, industry and other institutions, the university seeks to enhance economic growth and improve the quality of life in the city of Detroit, state of Michigan and throughout the world. For more information about research at Wayne State University, visit http://research.wayne.edu.