Journal of Behavioral Medicine

, Volume 38, Issue 4, pp 664–672 | Cite as

Affective associations and cognitive beliefs relate to individuals’ decisions to perform testicular or breast self-exams

  • Carolyn R. Brown-Kramer
  • Marc T. Kiviniemi


Affective associations with behavioral practices play an important role in individuals’ uptake of a variety of health behaviors. Most work has looked at individual behavioral practices with a direct impact on health; because screening behaviors are conceptually distinct from such behaviors, it is important to examine the interplay of affect and cognition in screening decision making. The current research explored affective and cognitive predictors of testicular and breast self-examination behavior. Young adult participants (N = 184) reported cognitive beliefs and affective associations with testicular self-exam behavior (male participants) and breast self-exam behavior (female participants) and reported their own current screening behavior. In univariable models, affective associations were related to screening behavior for both testicular self-exams and breast self-exams. When examining affective associations and cognitive beliefs as simultaneous predictors, affective associations (but not cognitive beliefs) predicted testicular self-exams, and neither affective associations nor cognitive beliefs were uniquely related to breast self-exams. Moreover, for testicular self-exams, affective associations mediated the relation between cognitive beliefs and screening behavior; no mediation was present for breast self-exam behavior. These findings suggest three potential outcomes: first, that greater consideration of affective associations in testicular self-exam screening decisions may be warranted; second, that breast and testicular self-exams may have different antecedents; and third, that incorporation of affective factors in intervention design might have merit for increasing engagement in some cancer screening behaviors.


Screening behavior Affect Cognition Cancer screening 


Conflict of interest

Carolyn R. Brown-Kramer and Marc T. Kiviniemi declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.


  1. Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.CrossRefGoogle Scholar
  2. Ajzen, I. (2002). Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior. Journal of Applied Social Psychology, 32, 665–683. doi: 10.1111/j.1559-1816.2002.tb00236.x CrossRefGoogle Scholar
  3. Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting behavior. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
  4. American Cancer Society (2014a). Breast cancer. Retrieved Oct. 17, 2014 from
  5. American Cancer Society (2014b). Testicular cancer. Retrieved Oct. 17, 2014 from
  6. Berry, D. A., Cronin, K. A., Plevritis, S. K., Fryback, D. G., Clarke, L., Zelen, M., et al. (2005). Effect of screening and adjuvant therapy on mortality from breast cancer. New England Journal of Medicine, 353, 1784–1792.PubMedCrossRefGoogle Scholar
  7. Cameron, L. D., & Leventhal, H. (2003). The self-regulation of health and illness behaviour. New York: Routledge.Google Scholar
  8. Centers for Disease Control and Prevention. (2013). Deaths: Final data for 2010. National Vital Statistics Reports, 61, 1–118.Google Scholar
  9. Champion, V. L. (1999). Revised susceptibility, benefits, and barriers scale for mammography screening. Research in Nursing & Health, 22, 341–348.CrossRefGoogle Scholar
  10. Consedine, N. S., Horton, D., Ungar, T., Joe, A. K., Ramirez, P., & Borrell, L. (2007). Fear, knowledge, and efficacy beliefs differentially predict the frequency of digital rectal examination versus prostate specific antigen screening in ethnically diverse samples of older men. American Journal of Men’s Health, 1, 29–43. doi: 10.1177/1557988306293495 PubMedCrossRefGoogle Scholar
  11. Crites, S. L., Fabrigar, L. R., & Petty, R. E. (1994). Measuring the affective and cognitive properties of attitudes: Conceptual and methodological issues. Personality and Social Psychology Bulletin, 20, 619–634.CrossRefGoogle Scholar
  12. Dillard, A. J., Ubel, P. A., Smith, D. M., Zikmund-Fisher, B. J., Nair, V., Derry, H. A., et al. (2011). The distinct role of comparative risk perceptions in a breast cancer prevention program. Annals of Behavioral Medicine, 42, 262–268. doi: 10.1007/s12160-011-9287-8 PubMedCentralPubMedCrossRefGoogle Scholar
  13. Ferrer, R. A., Fisher, J. D., Buck, R., & Amico, K. R. (2011). Pilot test of an emotional education intervention component for sexual risk reduction. Health Psychology, 30, 656–660. doi: 10.1037/a0023438 PubMedCrossRefGoogle Scholar
  14. Hay, J. L., McCaul, K. D., & Magnan, R. E. (2006). Does worry about breast cancer predict screening behaviors? A meta-analysis of the prospective evidence. Preventive Medicine, 42, 401–408. doi: 10.1016/j.ypmed.2006.03.002 PubMedCrossRefGoogle Scholar
  15. Hayes, A. (2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling [White paper].
  16. Janssen, E., Waters, E. A., van Osch, L., Lechner, L., & de Vries, H. (2014). The importance of affectively-laden beliefs about health risks: The case of tobacco use and sun protection. Journal of Behavioral Medicine, 37, 11–21. doi: 10.1007/s10865-012-9462-9 PubMedCentralPubMedCrossRefGoogle Scholar
  17. Keer, M., van den Putte, B., & Neijens, P. (2012). The interplay between affect and theory of planned behavior variables. American Journal of Health Behavior, 36, 107–115.PubMedCrossRefGoogle Scholar
  18. Kiviniemi, M. T., Bennett, A., Zaiter, M., & Marshall, J. R. (2011). Decision making for colorectal cancer screening: What do we know about theoretical models of decision making? Psycho-Oncology, 20, 1023–1033.PubMedCentralPubMedCrossRefGoogle Scholar
  19. Kiviniemi, M. T., & Bevins, R. (2007). Affect-behavior associations in motivated behavioral choice: Potential transdisciplinary links. In P. R. Zelick (Ed.), Issues in the Psychology of Motivation (pp. 65–80). Hauppage, NY: Nova.Google Scholar
  20. Kiviniemi, M. T., & Brown-Kramer, C. R. (in press). Planning versus action: Different decision-making processes predict plans to change one’s own diet versus actual dietary behavior. Journal of Health Psychology. Google Scholar
  21. Kiviniemi, M. T., & Duangdao, K. M. (2009). Affective associations mediate the influence of cost-benefit beliefs on fruit and vegetable consumption. Appetite, 52, 771–775.PubMedCentralPubMedCrossRefGoogle Scholar
  22. Kiviniemi, M. T., Hay, J. L., James, A. S., Lipkus, I. M., Meissner, H. I., Stefanek, M., et al. (2009). Decision making about cancer screening: An assessment of the state of the science and a suggested research agenda. Cancer Epidemiology, Biomarkers and Prevention, 18, 3133–3137.PubMedCentralPubMedCrossRefGoogle Scholar
  23. Kiviniemi, M. T., Jandorf, L., & Erwin, D. O. (2014). Disgusted, embarrassed, annoyed: Affective associations relate to uptake of colonoscopy screening. Annals of Behavioral Medicine, 48, 112–119. doi: 10.1007/s12160-013-9580-9 PubMedCrossRefGoogle Scholar
  24. Kiviniemi, M. T., Saad-Harfouche, F. G., Ciupak, G. L., Davis, W., Moysich, K., Hargrave, N. C., et al. (2013). Pilot intervention outcomes of an educational program for biospecimen research participation. Journal of Cancer Education, 28, 52–59. doi: 10.1007/s13187-012-0434-0 PubMedCentralPubMedCrossRefGoogle Scholar
  25. Kiviniemi, M. T., Voss-Humke, A. M., & Seifert, A. L. (2007). How do I feel about the behavior? The interplay of affective associations with behaviors and cognitive beliefs as influences on physical activity behavior. Health Psychology, 26, 152–158.PubMedCrossRefGoogle Scholar
  26. Lawton, R., Conner, M., & McEachan, R. (2009). Desire or reason: Predicting health behaviors from affective and cognitive attitudes. Health Psychology, 28, 56–65.PubMedCrossRefGoogle Scholar
  27. Ling, A. M. C., & Horwath, C. (2001). Perceived benefits and barriers of increased fruit and vegetable consumption: Validation of a decisional balance scale. Journal of Nutrition Education, 33, 257.CrossRefGoogle Scholar
  28. Liu, K., Daviglus, M. L., Loria, C. M., Colangelo, L. A., Spring, B., Moller, A. C., & Lloyd-Jones, D. M. (2012). Healthy lifestyle through young adulthood and the presence of low cardiovascular disease risk profile in middle age: The Coronary Artery Risk Development in (Young) Adults (CARDIA) study. Circulation, 125, 996–1004.PubMedCentralPubMedCrossRefGoogle Scholar
  29. MacKinnon, D. P. (2008). Introduction to statistical mediation analysis. New York: Lawrence Erlbaum Associates.Google Scholar
  30. McCaul, K. D., Branstetter, A. D., Schroeder, D. M., & Glasgow, R. E. (1996a). What is the relationship between breast cancer risk and mammography screening? A meta-analytic review. Health Psychology, 15, 423–429.PubMedCrossRefGoogle Scholar
  31. McCaul, K. D., Schroeder, D. M., & Reid, P. A. (1996b). Breast cancer worry and screening: Some prospective data. Health Psychology, 15, 430–433. doi: 10.1037/0278-6133.15.6.430 PubMedCrossRefGoogle Scholar
  32. McCaul, K. D., & Tulloch, H. E. (1999). Cancer screening decisions. Journal of the National Cancer Institute, 25, 52–58.PubMedCrossRefGoogle Scholar
  33. Miller, S. M., Shoda, Y., & Hurley, K. (1996). Applying cognitive-social theory to health-protective behavior: Breast self-examination in cancer screening. Psychological Bulletin, 119, 70–94.PubMedCrossRefGoogle Scholar
  34. Moser, R. P., McCaul, K., Peters, E., Nelson, W., & Marcus, S. E. (2007). Associations of perceived risk and worry with cancer health-protective actions. Journal of Health Psychology, 12, 53–65. doi: 10.1177/1359105307071735 PubMedCrossRefGoogle Scholar
  35. Rothman, A. J., & Salovey, P. (1997). Shaping perceptions to motivate healthy behavior: The role of message framing. Psychological Bulletin, 121, 3–19.PubMedCrossRefGoogle Scholar
  36. Schwartz, M. D., Lerman, C., Brogan, B., Peshkin, B. N., Isaacs, C., DeMarco, T., et al. (2005a). Utilization of BRCA1/BRCA2 mutation testing in newly diagnosed breast cancer patients. Cancer Epidemiology, Biomarkers and Prevention, 14, 1003–1007.PubMedCrossRefGoogle Scholar
  37. Schwartz, M. D., Peshkin, B. N., Tercyak, K. P., Taylor, K. L., & Valdimarsdittor, H. (2005b). Decision making and decision support for hereditary breast-ovarian cancer susceptibility. Health Psychology, 24, S78–S84. doi: 10.1037/0278-6133.24.4.S78 PubMedCrossRefGoogle Scholar
  38. Schwartz, M. D., Taylor, K. L., & Willard, K. S. (2003). Prospective association between distress and mammography utilization among women with a family history of breast cancer. Journal of Behavioral Medicine, 26, 105-117. doi:0160-7715/03/0400-0105/0Google Scholar
  39. Steinhardt, M. A., & Dishman, R. K. (1989). Reliability and validity of expected outcomes and barriers for habitual physical activity. Journal of Occupational Medicine, 31, 536–546.PubMedCrossRefGoogle Scholar
  40. Subramanian, S., Klosterman, M., Amonkar, M. M., & Hunt, T. L. (2004). Adherence with colorectal cancer screening guidelines: A review. Preventive Medicine, 38, 536–550.PubMedCrossRefGoogle Scholar
  41. Swan, J., Breen, N., Graubard, B. I., McNeel, T. S., Blackman, D., Tangka, F. K., & Ballard-Barbash, R. (2010). Data and trends in cancer screening in the United States: Results from the 2005 National Health Interview Survey. Cancer, 116, 4872–4881.PubMedCentralPubMedCrossRefGoogle Scholar
  42. van Dijk, S., Otten, W., Zoeteweij, M. W., Timmermans, D. R., van Asperen, C. J., Breuning, M. H., et al. (2003). Genetic counselling and the intention to undergo prophylactic mastectomy: Effects of a breast cancer risk assessment. British Journal of Cancer, 88, 1675–1681.PubMedCentralPubMedCrossRefGoogle Scholar
  43. Vernon, S. W. (1997). Participation in colorectal cancer screening: A review. Journal of the National Cancer Institute, 89, 1406–1422. doi: 10.1093/jnci/89.19.1406 PubMedCrossRefGoogle Scholar
  44. Walsh, E. M., & Kiviniemi, M. T. (2014). Changing how I feel about the food: experimentally manipulated affective associations with fruits change fruit choice behaviors. Journal of Behavioral Medicine, 37, 322–331.PubMedCentralPubMedCrossRefGoogle Scholar
  45. Walsh, J. M. E., & Terdiman, J. P. (2003). Colorectal cancer screening: Scientific review. Journal of the American Medical Association, 289, 1288–1296.PubMedCrossRefGoogle Scholar
  46. Webb, T. L., & Sheeran, P. (2006). Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychological Bulletin, 132, 249–268.PubMedCrossRefGoogle Scholar
  47. Weinstein, N. D. (1993). Testing four competing theories of health-protective behavior. Health Psychology, 12, 324–333.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of PsychologyNebraska Wesleyan UniversityLincolnUSA
  2. 2.Department of PsychologyUniversity of Nebraska – LincolnLincolnUSA
  3. 3.School of Public Health and Health ProfessionsUniversity at BuffaloBuffaloUSA

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