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Title:
Body image, attitudes, and self-efficacy as predictors of past behavior and future intention to perform breast and skin self-examinations
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Chait, Sari R
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University of South Florida
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Cancer
Self-screening
Body satisfaction
Health behaviors
Detection
Dissertations, Academic -- Psychology -- Masters -- USF   ( lcsh )
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bibliography   ( marcgt )
theses   ( marcgt )
non-fiction   ( marcgt )

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Abstract:
ABSTRACT: Breast self-examinations (BSE) and skin self-examinations (SSE) provide people with a cost-effective and time-efficient approach to the detection of cancer. Given the utility of these self-examination behaviors, it is important to determine who is likely to perform them regularly and why. Prior research has demonstrated a relationship of attitudes and self-efficacy with performance of and intention to practice the exams. Body image, although not previously studied, can be hypothesized to influence performance of these behaviors as well. To address these issues, the current study sought to determine if there are relationships between attitudes, self-efficacy, and body image and the practice of BSE and SSE. One hundred and six women completed measures assessing attitudes, self-efficacy, body image, past performance of BSE and SSE, and future intention to perform BSE and SSE. Results indicated that attitude was positively related to past performance of BSE and SSE and future intention to perform SSE. Self-efficacy was positively related to past performance and future intention to perform BSE and SSE. Body image was positively related only to past performance of SSE. Future research should further examine the relationship between body image and SSE utilizing longitudinal designs and a more diverse population.
Thesis:
Thesis (M.A.)--University of South Florida, 2007.
Bibliography:
Includes bibliographical references.
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by Sari R. Chait.
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Title from PDF of title page.
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Document formatted into pages; contains 49 pages.

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aleph - 001917768
oclc - 182555848
usfldc doi - E14-SFE0002064
usfldc handle - e14.2064
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Body Image, Attitudes, and Self-Efficacy as Pr edictors of Past Behavior and Future Intention to Perform Breast and Skin Self-Examinations by Sari R. Chait A thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts Department of Psychology College of Arts and Sciences University of South Florida Major Professor: Paul B. Jacobsen, Ph.D. Jamie Goldenberg, Ph.D. Kevin Thompson, Ph.D. Date of Approval: December 8, 2006 Keywords: cancer, self-screening, body satis faction, health behaviors, detection Copyright 2007, Sari R. Chait

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i Table of Contents List of Tables iii Abstract iv Introduction 1 Breast Self-Examinations 1 Skin Self-Examinations 3 Psychological Predictors of BSE 5 Psychological Predictors of SSE 6 Body Image 7 Aims 10 Hypotheses 11 Method 13 Participants 13 Procedure 13 Measures 14 Demographic Information 14 Body Image 14 Self-Exam Behaviors 15 Self-Exam Intentions 16 Self-Efficacy for Self-Exam Behaviors 16 Attitudes Toward Self-Exam Behaviors 16 Statistical Analyses 16 Results 18 Participants 18 Description of BSE and SSE Behaviors 18 Relationship of MBSRQ Subscales to Performance of BSE and SSE 19 Relationship of BASS Scale to Performance of BSE and SSE 20 Relationship of Attitudes Toward BSE and SSE and Performance of BSE and SSE 21 Relationship of Self-Efficacy for Performing BSE and SSE and Performance of BSE and SSE 21 Relationship of Demographic Variables to BSE, SSE and Body Image 22 Regression Analysis of SSE Behavior 23

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ii Discussion 25 References 43

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iii List of Tables Table 1 Demographic Characteristics of Sample (N = 106) 34 Table 2 Correlational Analyses of MBSRQ Subscales with Self-Screening Behaviors 35 Table 3 Correlational Analyses of BASS Measures with Self-Screening Behaviors 36 Table 4 Correlational Analyses of Attitudes Toward BSE and SSE with Self-Screening Behaviors 37 Table 5 Correlational Analyses of Se lf-Efficacy for Performing BSE and SSE with Self-Screening Behaviors 38 Table 6 Correlational Analyses of Demographic Variables with BSE and SSE Behaviors and Intentions 39 Table 7 Correlational Analyses of Demographic Variables with MBSRQ Subscales and BASS Scales 40 Table 8 Multiple Regression Anal yses of SSE Behavior with the Appearance Evaluation Subscale 41 Table 9 Multiple Regression Analyses of SSE Behavior with the BASS 42

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iv Body Image, Attitudes, and Self-Efficacy as Pr edictors of Past Behavior and Future Intention to Perform Breast and Skin Self-Examinations Sari R. Chait ABSTRACT Breast self-examinations (BSE) and skin self-examinations (SSE) provide people with a cost-effective and time-efficient approa ch to the detection of cancer. Given the utility of these self-examination behaviors, it is important to dete rmine who is likely to perform them regularly and w hy. Prior research has dem onstrated a relationship of attitudes and self-efficacy with performance of and intention to prac tice the exams. Body image, although not previously studied, can be hypothesized to influence performance of these behaviors as well. To address these i ssues, the current study s ought to determine if there are relationships between attitudes, self-efficacy, and body image and the practice of BSE and SSE. One hundred and six women completed m easures assessing attitudes, self-efficacy, body image, past performance of BSE and SSE, and future intention to perform BSE and SSE. Results indicated that attitude was positively related to past performance of BSE and SSE and future in tention to perform SSE. Self-efficacy was positively related to past performance and fu ture intention to perform BSE and SSE. Body image was positively related only to past performance of SSE. Future research should further examine the relationship between body image and SSE utilizing longitudinal designs and a more diverse population.

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1 Introduction It is estimated that 214,640 people will be diagnosed with breast cancer and 68,780 will be diagnosed with skin cancer (excluding basal and squamous cell cancer) in the United States in 2006 (American Cancer Society, 2006). While there is currently no definitive cure for either form of cancer, th e earlier it is detected, the greater the chances are of a full recovery. Detecti on of cancer in its earlier st ages translates to increased survival rates; as such, early detection is crucial. Public education resources have been employed to disseminate information regard ing such screening tools as mammography, colonoscopy, and prostate exams. In addi tion to screening measures performed by a medical professional, there have been efforts to encourage the public to engage in regular self-screening methods. Self-s creening measures provide pe ople with a cost-effective and time-efficient approach to the detection of cancer. Two self-examinations shown to be potentially effective in detecting cancer early are breast self-exams (BSE) for the detection of breast cancer and sk in self-exams (SSE) for the detection of skin cancers. Given the utility of these self-examination meas ures, it is important to determine who is likely to perform them regularly and why. To address this issue, the current study seeks to identify factors associated with performance of BSE and SSE. Breast Self-Examinations BSE is a relatively easy, noninvasive way for women to familiarize themselves with their own breasts, making the detecti on of abnormalities easier. As it is a free

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2 method of early detection, BSE is often an appealing option for those women looking for a cost-effective, time-efficient method when a clinical breast exam does not provide those benefits (Chouliara, Papadioti-Athanasi ou, Power, & Swanson, 2004). Additionally, research has shown that attendance to regular mammograms is associated with performance of BSE, suggesting further benefi ts of adhering to regular BSE (Rodriguez, Plasencia, & Schroeder, 1995). Despite this, recent findings indicate that only about one third of US women regularly perform BS E (Elmore, Armstrong, Lehman, & Fletcher, 2005). For example, Frank, Rimer, Brogan, and Elon (2000) found that only 21% of respondents in the Women Physicians’ H ealth Study reported performing BSE on a monthly basis. Although controversy exists regarding the benefits and consequences of performing BSE, there is evidence that engagi ng in regular BSE is effective in detecting early stage breast cancer. Newcomb et al. (1991) found that wo men who engaged in BSE with greater proficiency had a decreased risk of death from breast cancer. BSE may be particularly effective among women w ho are not obtaining regular mammograms, such as women below the age of 40 year s and those who cannot afford regular mammograms. Harvey, Miller, Baines, a nd Corey (1997) reported that among women 40 to 45 years of age, a population that is ge nerally not having routine mammograms, 65% of all breast cancers were detected by self-d etection; it is import ant to note that selfdetection included BSE and breast lumps found by women accidentally. Of over 3,000 cases of invasive breast cancer diagno sed in Wisconsin between 1988 and 1990, 55% were detected by the patient herself (R eeves, Newcomb, Remington, & Marcus, 1995). Given the evidence that BSE is a potentially efficient and eas y method of detecting breast

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3 cancer early, it is alarming that so few wome n in the United States report performing it regularly. Because of the existing controversies regarding the benefits and consequences of BSE, the American Cancer Society no longe r recommends that wo men perform monthly BSE; however, they do suggest it as an opti on for women starting in their 20’s (Smith et al., 2003). The organization desc ribes the self-screening measur e as a useful tool for the detection of any changes or abnormalities in the breast tissue; performing regular BSE is seen as allowing a woman to become familiar enough with her own breasts so as to detect such changes. Despite mixed findings, most organizations and health professionals agree that BSE is still an effective tool for the early detection of brea st cancer. Given the ongoing debate, a shift in emphasis has occurr ed highlighting the need for women to familiarize themselves with their own breast ti ssue through the use of BSE, rather than emphasizing the need for women to engage in routine, monthly BSE (Mayo Clinic, 2005). Consequently, while organizations st ill recommend BSE as an option for women, the emphasis has moved from the routine nature of the exam to the benefit of becoming familiar with one’s own breast tissue. Skin Self-Examinations Similar to BSE, the importance of perfor ming SSE is highlighted by the fact that the most common way in which skin cancer is currently detected is through selfexamination (Oliveria et al., 2004). Furt hermore, Berwick, Begg, Fine, Roush, and Barnhill (1996) demonstrated that SSE ha s the potential to reduce mortality from melanoma, a particularly deadly form of skin cancer, by 63%. Melanoma lesions detected early are generally th in and surgical removal of th ese lesions usually leads to a

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4 cure; by examining one’s skin regularly, it is possible to identify any abnormalities before they develop into later-stage melanoma, thus decreasing the risk of this potentially fatal skin cancer (Miller et al., 1996). Like ot her self-screening measures, SSE is a free, relatively easy method of detecting skin can cer. Despite the evidence emphasizing the benefits of practicing SSE, research shows that SSE is still not perf ormed as regularly or as thoroughly as possible (Koh et al., 1992; Miller et al., 1996 ; Weinstock et al., 1999). In a survey examining knowledge, awareness, and screening practices for melanoma, Miller et al. (1996) found that while 46% of respondents reported examining themselves for signs of skin cancer, only 26% of responde nts reported looking specifically at moles in order to detect either changes or ne w growths, indicating a lack of thoroughness among those that perform SSE. Weinstock et al (1999) conducted a su rvey in an attempt to determine the frequency and adequacy of skin examinations. The researchers distinguished between SSE and a thorough skin examination (TSE). They asked participants how frequently they examined each of eight body regions (arms and face, chest and front of legs, side of body, back of legs, upper-back and tops of shoulders, sides of legs and bottoms of feet, middle and lower pa rts of back, and back of thighs). A skinexamination was considered a TSE if the participant “always” or “almost always” examined at least seven of the listed regions and the eighth region wa s examined at least “sometimes.” The authors found that 59% of respondents performed SSE, defined as looking “at all the different areas of the skin deliberately and systematically at least sometimes” or having a partner do so. Ho wever, a much smaller proportion of the sample (9%) performed TSE at least once ever y few months, again indicating that people are generally not performing a thorough SSE. Gi ven the potential life -saving nature of

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5 SSE, it is alarming that so few people perform them regularly or thoroughly. As such, it is important to determine specific barriers to and predictors of performing the exam. The American Cancer Society recommends performing SSE regularly, preferably on a monthly basis, suggesting that each indi vidual should become familiar with any moles, freckles, or marks on her body in or der to detect changes (American Cancer Society, n.d.). An SSE performe d correctly requires an indivi dual to stand in front of a full-length mirror and carefully inspect all areas of the skin, paying pa rticular attention to all marks. In order to help examine hard -to-see regions of the body, such as the lower back, the American Cancer Society recomm ends using a hand-held mirror or having a friend or family member check one’s skin. Psychological Predictors of BSE Because of the utility of BSE and the large number of women who do not practice it regularly, numerous studies have sought to identify psycho logical predictors of who will perform BSE. As demonstrated by Lerm an, Rimer, Trock, Balshem, and Engstrom (1990), intention to practice th e behavior is one of the st rongest predicto rs of actual performance. Other variables consistently found to predict practice of BSE include positive attitude towards BSE and percei ved self-efficacy in performing BSE. Luszczynska and Schwarzer (2003) suggest th at BSE may be more influenced by selfefficacy than professionally administered screening measures, su ch as mammograms. Given that an effective BSE requires that the participant have the necessary knowledge and skills, it seems likely this would be more heavily influenced by one’s self-efficacy in performing the exam. In a study of 160 college students, it was found that attitude and confidence were predictors of BSE and that ou tcome expectancies, or participants’ beliefs

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6 about the costs and benefits of performing BSE, were pred ictors of attitude (Ronis & Kaiser, 1989). Egbert and Parrott (2001) found that, in a population of rural women, the greater their self-efficacy in performing BSE, th e more likely they were to engage in the behavior. Numerous other studies have demons trated similar findings in that the lower a woman’s confidence in her ability to perform BSE, the less likely she is to perform it regularly (Duke, Gordon-Sosby, Reynolds, & Gram, 1994; Fletcher, Morgan, O’Malley, & Earp, 1989; Katz, Meyers, & Wa lls, 1995; Ronis & Kaiser, 1989). Several studies have indicated that more positive attitudes to ward the exam and greater self-efficacy also predict stronger futu re intentions to practice BSE and not just past behavior (Calnan & Rutter, 1988 ; Moore, Barling, & Hood, 1998; McCaul, Sandgren, O’Neill, & Hinsz, 1993). For example, in a study aimed at determining if selfefficacy and perceived control should be adde d to the theory of reasoned action, male and female college students participated in an e xperiment in which they were taught how to properly perform either a testic ular self-exam or a BSE and were instructed to perform one such exam each month for three months. At the three-month follow-up, participants were assessed for how many times they had performed the self-exam behavior in the three-month interval. The researchers f ound that, among other variables, both attitudes and self-efficacy predicted intention to perform BSE (McCaul et al., 1993). Psychological Predictors of SSE Similar to BSE, there has been an intere st in identifying psyc hological predictors of who will perform SSE since this self-exam is a useful tool for the detection of skin cancer. There is growing evidence in the literature that positiv e attitude and self-efficacy both predict SSE behaviors and intentions. As part of the first phase of a randomized

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7 controlled trial of a community-based melanom a screening program, Janda et al. (2004) recruited a random sample of Australians ove r the age of 30. Those respondents who had a more positive attitude towards skin cancer sc reening were found to be more likely to examine their skin for abnormalities. These researchers also determined that those participants reporting a more pos itive attitude towards skin cancer screening were more likely to report stronger inten tions to perform SSE. In a study aimed at determining predictors of SSE performance among individual s at increased risk due to family history of skin cancer and/or the presence of sk in nevi, Robinson, Fisher, and Turrisi (2002) compared participants who had never perfor med SSE with those who examined only their face, and those who had examined their face and other body parts. The findings identified several predictors of conducting a more thorough SSE; these included greater confidence in one’s ability to perform SSE and a more positive attitude toward SSE. In a study of unaffected first-degr ee relatives of individuals diagnosed with malignant melanoma, Manne et al. (2004) assessed participants on num erous variables including perceived benefits and barriers to performing SSE and SSE behavior in the past year. It was found that those participants who had enga ged in at least one SSE in the past year were more likely to perceive greater benef its of practicing SSE and fewer barriers to performing SSE. Body Image Another factor that may affect whet her women perform BSE and SSE is body image. A standard definition of body imag e does not exist; researchers each formulate their own definition, including and excludi ng various aspects (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). Cash ( 2000), taking a multidimensional approach,

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8 describes body image as the “atti tudinal dispositions toward th e physical self” (p. 1). As it regards attitudes, this multidimensional ap proach takes into account not only evaluative aspects, but also cognitive a nd behavioral aspects. This approach to understanding body image includes the notion that one’s physical self is composed of one’s physical appearance as well as one’s physical health and fitness competence (Cash, 2000). This approach is well demonstrated by the Multidimensional Body-Self Relations Questionnaire (MBSRQ; Cash, 1990), a commonly used measure of body image. The measure assesses numerous aspects of body im age including one’s self-evaluation of appearance, fitness ability, and health, as well as beliefs about the importance of appearance, fitness, and health. A poor body image can be theorized to f unction as a barrier to women’s practice of BSE and SSE. Although the literature re garding the relationship between body image and self-screening behaviors is scarce, ther e is reason to believe that the two are positively related. Research has shown th at one method for coping with a poor body image is to engage in avoidance behavior. In a study aimed at validating the Body Image Coping Strategies Inventory (BICSI; Cash, Santos, & Williams, 2005), a measure of how people manage body image related stressors, Cash et al. (2005) assess ed college students on several aspects of body image as well as on the BICSI. Include d in the BICSI are items measuring avoidance, which refers to “an attempt to escape or avert stressful bodyimage situations” (Cash et al., 2005, p. 192); items on this subscale include “I avoid looking at myself in the mirror” and “I try to ignore the situation a nd my feelings.” It was found that, among women, avoidance wa s significantly related to greater body dissatisfaction and body image dysphoria. These results suggest that when faced with a

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9 threat to her body image, a woman may empl oy avoidance in an effort to minimize discomfort (Cash et al., 2005). Of the va rious aspects of body image, the dynamics related to appearance evaluation and satisfac tion seem most likely to affect a woman’s willingness to engage in self-screening behaviors. In the face of a self-exam that requires a woman to manually and visually scrutini ze her body and familiarize herself with any potential abnormalities, namely BSE or SSE, a woman with poorer body image, or, more specifically, a woman who evalua tes her appearance more negatively and is less satisfied with her physical appearance, may engage in avoidance and fail to practice the behavior, thus eliminating the threat to her body image. The factor structure of the MBSRQ further suggest s that body image may be correlated with self-examination behavior. Brown, Cash, and Mikul ka (1990) performed a factor analysis of the Body-Self Relations Questionnaire (BSRQ), an earlier version of the MBSRQ, in order to determine the validity of the conceptual basi s of this measure; the MBSRQ is comprised of the revised BSRQ subscales and two a dditional groups of subscales. This study demonstrated that s ubscales related to health and fitness, specifically Health Orientat ion, Health Evaluation, Fitne ss Orientation, and Illness Orientation, were positively co rrelated with the Appearance Evaluation subscale. The Appearance Evaluation subscale is a measur e of one’s feelings about level of attractiveness or unattractiveness and level of satisfaction with one’s looks. The direction of the correlations indicate that women who tend to value physical fitness, who feel their bodies are in good health, who try to maintain a healthy lifestyle, and who pay close attention to their physical symptoms are more likely to find their own body attractive and to be satisfied with their appearance. Fu rthermore, this study also found that Fitness

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10 Orientation, Health Orientati on, and Illness Orientation were positively correlated with Appearance Orientation. This indicates that women who value fitness, lead a healthy lifestyle, and pay close atte ntion to physical symptoms are likely to place more importance on their physical appearance a nd engage in more extensive grooming behaviors (Brown et al., 1990; Cash, 2000). It follows from these findings that women who have a poorer body image (i.e., those who score lower on the Appearance Evaluation and Appearance Orientation subscales of the MBSRQ) might be less likely to engage in health promotion behaviors such as BSE and SSE. In order to properly conduct a BSE or SSE, a woman must both feel her own body and examine it closely in a mirror; additionally, for a SSE, it is recommended that she consider having someone else examine hard -to-see regions of the body. It can be theorized that the dynamics of body image related to attitudes towards and satisfaction with one’s physical experience will be relate d to a woman’s willingness to engage in such self-examination behaviors. If a woman is di ssatisfied with her overall appearance, she is presumably less likely to want to examine it cl osely or to have someone else view it. Aims A primary goal of this study was to exam ine the relationship between body image, as measured by the Appearance Evaluation, Appearance Orientation, and the Body Areas Satisfaction Scale (BASS) subs cales of the MBSRQ, and the practice of engaging in selfexaminations for the detection of cancer, specifically BSE and SSE. This study also aimed to examine the relationship between one’s self-efficacy for performing BSE and SSE and frequency of doing so. Another goal of this study was to examine the relationship between one’s atti tude towards self-screening be haviors for the detection of

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11 cancer and one’s frequency of engaging in thos e activities. Finally, exploratory analyses were conducted in order to evaluate wh ether body image accounts for significant variability in BSE and SSE behavior above and beyond the relevant demographic and psychological variables. Hypotheses 1. There will be a positive relationship be tween body image, as measured by the Appearance Evaluation, Appearance Orient ation, and the BASS subscales of the MBSRQ, and the practice of BSE and SSE. a. A more positive body image will be related to having engaged in BSE and SSE more frequently in the past year. b. A more positive body image will be rela ted to intending to perform BSE and SSE more frequently in the coming year. c. Greater satisfaction with one’s breasts will be related to having engaged in BSE more frequently in the past year. d. Greater satisfaction with one’s breast s will be related to intending to perform BSE more frequen tly in the coming year. e. Greater overall satisfaction with one’s body parts will be related to having engaged in SSE more freque ntly in the past year. f. Greater overall satisfaction with one ’s body parts will be related to intending to perform SSE more fr equently in the coming year. 2. There will be a positive relationship between positive attitude toward selfscreening measures for cancer, namely BSE and SSE, and the practice of such activities.

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12 a. A more positive attitude toward these self-exams will be related to having engaged in BSE and SSE more fr equently in the past year. b. A more positive attitude toward these self-exams will be related to intending to perform BSE and SSE mo re frequently in the coming year. 3. There will be a positive relationship be tween self-efficacy about performing BSE and SSE and the practice those behaviors. a. Greater self-efficacy toward these self -exams will be related to having engaged in BSE and SSE more fr equently in the past year. b. Greater self-efficacy toward these self-e xams will be related to intending to perform BSE and SSE more fr equently in the coming year.

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13 Method Participants Participants in this study were wome n who were currently enrolled in a noncancer comparison group in a study titled “C ognitive Behavioral Aspects of CancerRelated Fatigue” at the Moffitt Cancer Center. Eligibility criteria for the aforementioned study were: 1) age greater than or equal to 18 years; 2) no presence of any discernable psychiatric or neurological di sorder that would interfere w ith study participation; 3) the ability to speak and read standa rd English; and 4) no history of cancer or other potentially life-threatening diseases; 5) no history of a chronic disease or disorder in which fatigue is a prominent symptom; and 6) no plans to move more than 50 miles within the next three years. Procedure In order to obtain a non-cancer compar ison sample for the ongoing fatigue study, the investigators purchased contact lists from Market ing Systems Group, Inc (Fort Washington, PA). These lists provide contac t information for randomly selected females who were of similar age (i.e., within five year s) and who resided in the same zip code as the patient to whom they were matched. Potential participants were mailed an introductory letter providing basi c information about the study; a member of the research team subsequently contacted them by tele phone approximately 10 days after the letter was mailed out. Eligibility was determined over the telephone and, if eligible and

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14 interested, the participant provi ded verbal consent. Once consented, an appointment was set up for the participant to come to Moffitt to complete the baseline assessment. Prior to the appointment, the participant was mailed a packet of questionnaires which she was asked to complete and bring to her in-person assessment. All participants completed neuropsychol ogical testing, psychosocial measures, and questions regarding current health behavi ors and beliefs at baseline and will complete those same measures again three years following their baseline assessment. For their participation in the aforementioned fatigue study, participants were paid $100 upon completion of each assessment. The present study used data from the baseline assessment to which additional measures were added. The next section describes those measures specific to the current study. Measures Demographic Information. Demographic information was obtained through use of a standard questionnaire. Variables assessed include: date of birt h, race, marital status, income, education, body mass index, and menopausal status. Body Image. The Multidimensional BodySelf Relations Questionnaire (MBSRQ; Cash, 1990) was used to assess body image. This is a 69-item self-report measure designed to assess the self-attitudinal aspects of body image. Participants rate on a five-point scale (1=Definitely Disagree to 5=Definitely Agree) the extent to which they agree or disagree that each statement a pplies to them. The survey, derived from a longer initial versi on (Winstead & Cash, 1984), was developed and normed using a national body image survey (Cash, Winstea d, & Janda, 1985; Cash, Winstead, & Janda, 1986). The measure consists of 10 subscales : 1) Appearance Evaluation; 2) Appearance

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15 Orientation; 3) Fitness Evaluati on; 4) Fitness Orientation; 5) Health Evaluation; 6) Health Orientation; 7) Illness Orientation; 8) Body Areas Satisfacti on Scale (BASS); 9) Overweight Preoccupation; and 10) Self-Classified Weight. Only the first eight subscales were administered. Given that this study was primarily interested in overall body image and site-specific satisfaction, analyses were conducted only on the Appearance Evaluation, Appearance Orientation, and BA SS subscales. Because it was hypothesized that satisfaction with one’s breasts would be related to BSE behavi or and intention, an additional item was added to the BASS assessi ng satisfaction with breast appearance. The BASS yields a total score and also includ es a single item assess ing satisfaction with overall appearance. As used in this st udy, the expanded BASS yi elded three outcome measures: an item assessing satisfaction with one’s overall appearance, an item assessing satisfaction with one’s breasts, and the overall scale score. The specific MBSRQ subscales of interest have demonstrated ad equate internal consistency reliability among females in a normative population, with al phas ranging from .75 to .90 (Cash, 2000). Cronbach alpha coefficients were calculated to evaluate internal consistency of the Appearance Evaluation subscale ( = .87), the Appearance Orientation subscale ( = .85), and the BASS ( = .85) in the current study. Self-Exam Behaviors. As part of a larger set of questions regarding current health behaviors, participants were asked how often they perfor med BSE and SSE in the past year, using separate four-point scales ranging from “never” to “more than once a month.” These items were adapted from other studies that have examined past performance of BSE and SSE (e.g., Berwick et al., 1996; Choul iara, et al., 2004; Erblich, Bovbjerg, & Valdimarsdottir, 2000).

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16 S elf-Exam Intentions. In order to determine future intentions, participants were asked to indicate how often they plan to perform BSE and SS E in the next year using a six-point scale ranging from “n ever” to “more than once a month.” These items were adapted from other studies that have examin ed future intention to perform BSE and SSE (e.g., Janda et al., 2004; Luszczynska & Schwarzer, 2003). Self-Efficacy for Self-Exam Behaviors. To determine participants’ self-efficacy in performing BSE and SSE, particip ants were asked how confident they feel in their ability to perform these exams using separate five -point scales rangi ng from “not at all confident” to “extremely confident.” These items were adapted from other studies that have examined confidence in personal abil ity to perform BSE a nd SSE (e.g., Erblich et al., 2000; Robinson et al., 2002). Attitudes Toward Self-Exam Behaviors. To assess attitudes towards BSE and SSE, participants were asked to rate on a 5point scale, ranging fr om “strongly disagree” to “strongly agree,” the extent to which they ag ree or disagree with a series of statements about the benefits of performing these behavior s. Examples of items include: “A woman would be less anxious if she did a monthly br east self-exam” and “I believe that checking one’s skin for growths or changes in spot s or moles would be beneficial.” These questions were adapted from previous studies that have examined attitudes towards BSE and SSE (e.g., Erblich et al., 2000; Ho et al., 2005; Manne et al., 2004). Cronbach alpha coefficients were calculated to evaluate internal consistency of the total score for the BSE attitude scale ( = .84) and SSE attitude scale ( = .75) in the current study. Statistical Analyses To test the study hypotheses, correlational analyses were conducted to determine:

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17 the relationship between body image and past performance and future intentions to perform BSE and SSE; the relationship between attitudes toward BSE and SSE and past performance and future intentions to perf orm BSE and SSE; and the relationship between self-efficacy regarding BSE and SSE and past performance and future intentions to perform BSE and SSE. In addition, multiple regression analyses were conducted to identify variability in BSE and SSE related to body image above and beyond other significant (< .05) correlates of BSE and SSE The general strategy was to enter the demographic and psychological variables found to be significantly related to BSE and SSE in univariate analyses before entering body image into the model. The projected sample size for the curr ent study was guided by consideration of statistical power, based on administering the first seven subscales of the MBSRQ, not the BASS. Based on previous research, there is reason to believe that the relationship of body image, attitudes, and self-efficacy to BS E and SSE will reflect a medium effect size (r=.30). Calculations indicated that 80 participants would be required in order to have adequate statistical power (0.80) to detect a medium effect size (r=.30) at alpha=.05 (twotailed). Therefore, we sought to obtain comp lete data on 80 individuals. However, after data collection began, we decided to admi nister the BASS in order to examine the relationship between site-specific satisfacti on and BSE and SSE behaviors; the committee agreed that the overall sample size should be increased such that there would be complete data on at least 60 participants. Thus, we have conducted analyses on a total of 106 participants, 60 of whom completed the BASS.

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18 Results Participants Eight hundred forty six letters were mailed out to potential participants; of these, 142 were ineligible, 291 refused to particip ate, and 240 could not be reached. Of the women who were eligible, 27% (n = 106) agreed to participate in th e study. A total of 106 women completed the measures of BSE and SSE behavior, BSE and SSE attitude and self-efficacy, and the MBSRQ. A subset of these participants (n = 60) also completed the BASS. Participants ranged in age from 28 to 77 years old (M = 56.59; SD = 9.09). The majority of the participants gr aduated high school or higher (97%), were married (74%), had a gross annual income greater than $40,000 (79%), and were Caucasian (98%). See Table 1 for co mplete demographic information. Description of BSE and SSE Behaviors Of the 106 participants, 18% reported not having performe d BSE at all in the past year, 40% reported performing BSE less than once a month in the past year, 39% reported performing BSE about once per mont h in the past year, and 3% reported performing BSE more than once per month in the past year. In regard s to intentions to perform BSE in the coming year, 10% reported no intention to perform BSE, 4% reported intending to perform it once, 15% reported an intent to perfor m BSE two to five times in the coming year, 16% reported an intent to perform the exam six to 11 times in the

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19 coming year, 52% reported intending to pe rform BSE about once per month, and 3% reported an intent to perform BSE more than once per month in the coming year. Of the 106 participants, 34% reported not having performe d SSE at all in the past year, 49% reported performing the exam less than once per month, 12% reported performing SSE about once per month in the past year, and 5% reported performing the exam more than once per month in the past ye ar. In regards to in tention to perform SSE in the coming year, 10% reported no intention to perform SSE in the coming year, 14% reported an intent to perform the exam once in the coming year, 27% reported intending to perform the exam two to five times, 12% re ported an intent to perform SSE six to 11 times in the coming year, 29% reported inte nding to perform the exam once per month, and 8% reported an intent to perform SSE more than once per month in the coming year. Relationship of MBSRQ Subscales to Performance of BSE and SSE Correlational analyses were conducted to test hypotheses that scores on the Appearance Evaluation and Appearance Orient ation subscales of the MBSRQ would be positively related to measures of past BSE and SSE behavior and future intentions regarding BSE and SSE (see Table 2). Inc onsistent with what was predicted, the Appearance Evaluation and Appearance Orient ation subscales of the MBSRQ were not significantly positively correlated with measur es of past BSE behavior or future intentions. Likewise, the same subscales did not demonstrate hypothesized relationships with SSE intentions. However, as hypot hesized, there was a significant relationship between the Appearance Evaluation subscale and past SSE behavior. Specifically, having a more positive body image was related to having performed SSE more frequently in the past year.

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20 Relationship of BASS Scale to Performance of BSE and SSE A second set of correlational analyses was conducted to test hypotheses that scores on the BASS total scale and the BA SS item assessing satisfaction with one’s breasts would be positively related to meas ures of past BSE behavior and future intentions regarding BSE (see Table 3). Co rrelational analyses were also conducted to test hypotheses that scores on the BASS to tal scale and BASS item assessing satisfaction with overall appearance would be positively rela ted to measures of past SSE behavior and future intentions regarding SSE. Incons istent with what was predicted, no significant relationships were found between the BASS total scale and the BASS item assessing breast satisfaction with the measures of pa st BSE behavior and future intentions regarding BSE. Also inconsistent with predictions, no significant relationships were found between the BASS tota l scale score and the BA SS item assessing overall appearance satisfaction with the measure of fu ture intention to practice SSE. However, as predicted, the BASS item assessing satisfac tion with one’s overall appearance and the average BASS score were significantly corre lated with the measures of past SSE behavior. Specifically, results indicated th at having a greater sa tisfaction with one’s overall appearance, as assesse d by the overall composite score and the single item, was related to having performed SSE more fr equently in the past year. In order to determine if satisfaction w ith specific body parts was responsible for the significant relationship between the BASS an d past performance of SSE, correlational analyses were conducted to an alyze the relationship between the individual items making up the BASS with SSE past behavior. Performance of SSE in the past year was significantly correlated with sati sfaction with one’s hair (p < .05), satisfaction with one’s

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21 breasts (p < .05), and satisfaction with one’s muscle tone (p < .005). In addition, the relationships between SSE past behavior a nd satisfaction with one ’s lower torso, upper torso, and weight were all approaching significance (p = .05). Relationship of Attitudes Toward BSE and SSE and Performance of BSE and SSE A third set of correlational analyses was conducted to test the hypotheses that scores on measures of attitudes would be posit ively related to measures of past BSE and SSE behavior and future intentions regardi ng BSE and SSE (see Table 4). Inconsistent with hypotheses, attitude towards BSE was not significantly related to future intention to perform the exam. However, as hypothesized, attitude toward BSE was significantly related to past performance of BSE. Specifically, results indicated that having a more positive attitude towards BSE was related to having performed BSE more frequently in the past year. With regard to SSE, results confirmed hypotheses that attitude toward SSE would be significantly correlated with past be havior of the exam and future intention to perform the exam. Specifically, results in dicated that having a more positive attitude toward SSE was related to having performed th e exam more frequently in the past year and to intending to perform the exam more frequently in the coming year. Relationship of Self-Efficacy for Perfor ming BSE and SSE and Performance of BSE and SSE A fourth set of correlatio nal analyses was conducted to test the hypotheses that self-efficacy for performing BSE and SSE would be positively related to measures of past BSE and SSE behavior and future intentions regarding BSE and SSE (see Table 5). As hypothesized, self-efficacy for performing BSE was significantly related to past performance of the exam and future intenti on to perform the exam. Specifically, results

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22 indicated that having more confidence in one ’s ability to perform BSE was related to having performed BSE more frequently in the past year and to intending to perform the exam more frequently in the coming year. Also consistent with hypotheses, results confirmed that self-efficacy for performing SSE was significantly related to past performance of the exam and future intenti on to perform the exam. Specifically, results indicated that having greater confidence in one’s ability to perform SSE was related to having performed SSE more frequently in the past year and to inte nding to perform the exam more frequently in the coming year. Relationship of Demographic Variables to BSE, SSE and Body Image Univariate analyses were conducted to examine the relationship between demographic variables and BSE and SSE beha viors and intentions. The demographic variables examined were age, education, ma rital status, menopausal status, and income (see Table 6). Education and income were both significantly negativ ely correlated with BSE past behavior; specifical ly, results indicated that gr eater education and greater income were associated with less frequent perf ormance of BSE in the past year. No other significant relationships were found between demographic variables and BSE and SSE past behavior or future inte ntions. Based on these findings education and income were identified as variables that were possibl e candidates for inclusion in the regression analyses described below. Exploratory univariate analyses were conducted to examine the relationship between the same demographic variables a nd the measures of body image, specifically the Appearance Evaluation and Appearance Orie ntation subscales of the MBSRQ and the three scores yielded from th e BASS (see Tables 7). Th e only significant relationship

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23 detected was between Appearance Orientat ion and age; specifi cally older age was associated with a more positive body image. Regression Analysis of SSE Behavior Based on findings that scores on the A ppearance Evaluation subscale, the selfefficacy measure, and attitudes scale were al l related to SSE behavior, a hierarchical regression analysis was conducted to dete rmine if body image, as measured by the Appearance Evaluation subscale of the MBSRQ, accounted for significant variability in SSE behavior above and beyond that accounted for by self-efficacy and attitudes towards SSE (see Table 8). No demographic variables were included in this analysis since none examined were significantly correlated with SSE behavior. Self-efficacy for performing SSE and attitude towards SSE were controlled fo r by being entered into the equation first. The Appearance Evaluation subscale was then entered into the equation on the second step. Self-efficacy and attitude accounted for 29% of the variance in SSE behavior (p < .0001). Body image, as measured by the Appearance Evaluation subscale of the MBSRQ, subsequently accounted for 32% of the remaining variance (p = .0194). Together, these variables account for 61% of the total variance in SSE behavior. Based on findings that scores on the BASS scale, the self-efficacy measure, and the attitudes scale were all related to SSE behavior, a s econd hierarchical regression analysis was conducted to determine if body image, as measured by the BASS scale, accounted for significant variability in SSE behavior above and beyond that accounted for by self-efficacy and attitudes towards SSE (see Table 9). No demographic variables were included in this analys is since none examined were significantly correlated with SSE behavior. Self-efficacy for performi ng SSE and attitude towards SSE were

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24 controlled for by being entered into the equatio n first. The BASS scale was then entered into the equation on the second step. Self-e fficacy and attitude accounted for 41% of the variance in SSE behavior (p < .0001). B ody satisfaction, as measured by the BASS, accounted for 43% of the remaining variance; th is result was not sta tistically significant (p = .2774). It is important to note that this regression an alysis was conducted with 60 participants, not the entire sample of 106 women.

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25 Discussion The primary aim of the current study wa s to examine the relationship between body image and women’s past practice of BSE and SSE and their intention to perform these self-exam behaviors in the future. This study also sought to examine the relationship between other psychological variab les, specifically self-efficacy and attitude, and their relationship with women’s practice of BSE and SSE and intention to perform these exams. It was hypothesized that body image would be positively related to the frequency with which women performed BSE and SSE in the past year. It was also hypothesized that body image would be positiv ely related to the frequency with which women intend to perform BSE and SSE in the coming year. Contrary to what was expected, body image was not significantly related to women’s pa st behavior of BSE nor was it significantly related to their intention to perform BSE in the future. Also contrary to expectations, body image was not significantl y related to women’s intention to perform SSE in the coming year. However, as hypothesized, body image was significantly related to women’s past performance of SSE. Specifical ly, the results of th is study indicate that women with a more positive body image performed SSE more frequently in the past year. It was hypothesized that attitude towa rds BSE and SSE would be positively related to the frequency with which women performed these exams in the past year. It was also hypothesized that attitude towards BSE and SSE would be positively related to

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26 the frequency with which women intend to perform these exams in the coming year. Consistent with what was predicted, attit ude towards BSE was significantly related to performance of BSE in the past year; specifica lly, the results indicated that having a more positive attitude towards the exam was rela ted to having performed the exam more frequently in the past year. The results did not confirm the hypothesi s that attitude would be significantly related to intention to perf orm BSE in the coming year. As expected, attitude towards SSE was significantly relate d to both past performance of the exam and future intention to perform the exam. Speci fically, the results i ndicated that having a more positive attitude towards SSE was re lated to having performed the exam more frequently in the past year and to intending to perform it more frequently in the coming year. Finally, it was hypothesized that self-effi cacy for performing BSE and SSE would be positively related to the frequency with which women performed these exams in the past year. It was also hypothesized that self-efficacy for performing BSE and SSE would be positively related to the frequency with which women intend to perform these exams in the coming year. As predicted, self-e fficacy for performing BSE was significantly related to both past performance of BSE a nd future intention to perform the exam; the results indicated that having a greater self -efficacy for performing BSE was related to having performed it more frequently in the pa st year and to intendi ng to perform it more frequently in the coming year. Also cons istent with hypotheses, self-efficacy for performing SSE was significantly related to both past performance of SSE and future intention to perform the exam. The results indicated that having a greater self-efficacy

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27 for performing SSE was related to having perfor med it more frequently in the past year and to intending to perform it more frequently in the coming year. Exploratory regression analys es revealed that body image, as measured by the Appearance Evaluation subscale of the MBSRQ, accounted fo r a significant amount of variance in past SSE behavior above and beyond that accounted for by both attitude and self-efficacy. However, hierarchical regres sion analyses conducted with body image as measured by the BASS total scale score and SSE behavior did not reveal the same finding; in this analysis, body image did not account for a significant amount of variability in SSE behavior above and beyond that which was accounted for by selfefficacy and attitude. It is important to note that the BASS scal e was only completed by 60 participants, while the MBSRQ subscales were completed by 106 participants. This likely affected the results of the hierarch ical regression analyses; specifically, the relatively small sample size of 60 reduced pow er in the analysis, making it difficult to detect any significant findings. Exploratory univariate anal yses examining the relationship between body image and demographic variables rev ealed only one significant rela tionship; as age increased, body image improved, as measured by the A ppearance Orientation subscale of the MBSRQ. While these analyses were for e xploratory purposes only and did not factor into the selection of variables to include in the regression analyses, it is important to note that the lack of relations hip between demographics a nd body image measures suggests that body image is not merely a correlate of these other variab les; SSE behavior is more likely to be affected by body image and not simply by demographic variables that are related to body image. While the current study did not dete ct relationships among most

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28 demographic variables with body image, some previous research has identified such relationships. Among studies examining th e relationship of various demographic variables and body image, findings indicate that culture has an influence; for example, it has been demonstrated that African American women experience less body dissatisfaction than Caucasian women (e .g., Abood & Chandler, 1997; Snooks & Hall, 2002; Stevens, Kumanyika, & Keil, 1994). Wh ile the literature regarding SES and body image is somewhat scarce, there is some evidence indicating that there exists a relationship; for example, some studies have found that higher SES is related to having a better body image among women (e.g., Stor y, French, Resnick, & Blum, 1995). A thorough review of the li terature revealed no prior studies examining the relationship between body image and BSE or SSE behavior and intentions; the current study appears to be the first to examine th is relationship. There does exist, however, literature regarding the relationship betw een body image and other health-related behaviors. For example, research has show n that women who exerci se often have lower body satisfaction than those w ho do not exercise (e.g., Davis & Cowles, 1991; Lowery et al., 2005). In addition, McDonald and Th ompson (1992) found that people who exercised for weight, tone, and physical a ttractiveness had lower body satisfaction than those who exercised for health and enjoyment. In addition to identifying a variable that may affect women’s willingness to perform SSE, this study also confirmed prior research regarding the relationship of selfefficacy to past performance of and future intentions to perform BSE and SSE. With regard to BSE, findings from this study ar e consistent with numerous studies showing that having greater self-efficacy for performi ng BSE is related to having performed the

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29 exam more frequently in the past (e.g., D uke, et al., 1994; Egbert and Parrott, 2001; Fletcher, et al., 1989; Katz, et al., 1995; Ronis & Kaiser 1989) and having greater intentions to perform it in the future (e.g., Luszczynska, 2004; Norman & Hoyle, 2004). The current study’s findings are al so consistent with prior stud ies that have demonstrated a positive relationship of self-efficacy to pa st performance of SSE (e.g., Robinson et al., 2002) and intentions to perform it in the future (e.g., Robinson et al., 2002). The results of this study ge nerally confirm previous findi ngs that attitude towards BSE and SSE is related to past performance of and future intention to perform BSE and SSE (e.g., Calnan & Rutter, 1988; Janda et al ., 2004; McCaul, et al ., 1993; Robinson et al., 2002; Ronis & Kaiser, 1989). For example, Janda et al. (2004) found that having a more positive attitude towards SSE was relate d to having a great intention to perform the exam. Although prior research has shown that having a more positive attitude towards BSE is related to having a gr eater intention to perform th e exam (e.g., Calnan & Rutter, 1988; McCaul, et al., 1993; Moor e, et al., 1998), th e results of the current study did not confirm those findings. However, it is impor tant to note that, in the current study, the correlation between attitude towards BSE a nd future intention to perform the exam approached significance (r = .17, p = .09). Prior studies have shown that attitude towards BSE and SSE is related to past performance of the exams, a finding replicated in the current study. For example, Ronis and Kais er (1989) demonstrated that attitude was positively related to college students’ past pe rformance of BSE. Similarly, Janda et al. (2004) found that having a more positive attitude towards SSE was related to having performed the exam more frequently in the past in adults.

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30 Several limitations of the cu rrent study should be noted. First, this study used a cross-sectional design that doe s not allow for examination of temporal relationships between the variables of interest, namely body image, self-efficacy, and attitude and the outcome variables, specifically BSE and SSE behavior and intentions. Given the study design, it is not possible to confidently model causal relati onships among the study variables. Furthermore, this design requi res retrospective reporting on past selfexamination behavior which may not be accurate as people are required to think back over a long period of time. Another limitation in the current study is the small sample size. Because the BASS was only administered to 60 women, it may have made it difficult to detect significant variability in the regression analyses. This study also utilized single-item measures to assess past behavior and future in tention to perform BSE and SSE. This does not allow for determination of statistical reliability of the measures and serves as a limitation to the study design. The use of a single-item measure may also explain why body image was signifi cantly related to past SSE behavior but not to future intentions to perform the exam; the single item may not have allowed for an accurate assessment of intention. A fi nal limitation of this study is th at it was only conducted with women, who were predominantly non-Hispan ic and Caucasian; this limits the generalizability of the findings to a more di verse group with regard to both gender and ethnicity. The results of the current study have im portant clinical implications. As awareness of the susceptibility to and potenti ally fatal threat of skin cancer increases, people are being encouraged to engage in behavi ors that will lead to earlier detection. Research has found that the most common way in which skin cancer is currently detected

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31 is through self-examination (Oliv eria et al., 2004). Given th is finding, it seems important to understand potential barriers to performan ce of SSE. This study helps identify several such barriers; these include self-efficacy fo r performing SSE, attitude towards performing SSE, and one’s body image. When barriers to performance of SSE are identified, it allows for discovery of ways to minimize ba rriers, thereby increasing performance of the exam. The findings suggest that women with a poorer body image may be less likely to perform SSE. As this same relationship was not detected with BSE, it seems likely that there is something unique about SSE that allows performance of the exam to be influenced by body image; this same characte ristic does not play a role in BSE. One plausible explanation for the discrepant fi nding is that SSE requires one to visually examine her entire body while standing in front of a full-length mirror. Additionally, it is recommended that a person have a partner or spouse inspect her ha rd-to-see regions of the body, such as the lower back (American Cancer Society, n.d.). A BSE requires examination of only a small region of the body and is conducted mostly through tactile examination, rather than visual inspection; it is also important to note that a BSE does not require someone else to examine one’s body. It makes sense, therefore, that someone with a poor body image may not be willing to engage in SSE as it requires visual examination of the entire body. Conversel y, a woman with poor body image may not be as inhibited in her performan ce of BSE as it does not require her to visually inspect her entire body so she is not forced to conf ront her own dissatisfaction with her body. Furthermore, a woman with a poor body image ma y be less likely to pe rform SSE as it is recommended that she have someone else inspect parts of her body for her; a woman

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32 with poor body image may be less likely to feel comfortable having someone else examine parts of her body that she cannot easily see. Based on findings that self-efficacy and attitude towards BSE and SSE were related to past behavior and future intenti on to perform these exams, it stands to reason that interventions aimed at improving attitude s toward these exams and self-efficacy for performing these exams should result in an incr ease in examination behavior. Consistent with this view, McCaul et al. (1993) found that following in struction in how to properly perform BSE or testicular se lf-examination, greater self-efficacy was related to having a greater intention to perform either BSE or testicular self-examination. The current study demonstrated that wo men with a more positive body image are more likely to perform SSE. These findings s uggest that an intervention to increase body satisfaction in women dissatisfied with th eir body image may succe ssfully increase the rates at which they perform SSE. Numerous studies have identified interventions that increase women’s body image and overall sa tisfaction. For example, research has demonstrated the successful implementa tion of a dissonance induction strategy in decreasing body dissatisfaction; this type of interventi on involves the use of psychoeducational components and a counterattitu dinal advocacy strategy in which the participant learns to argue ag ainst the thin-ideal attitude (Roehri g, Thompson, Brannick, & van den Berg, 2006; Stice, Chase, Stormer, & Appel, 2001). Future research should investigate the use of similar interven tions as a way of increasing women’s body satisfaction, thereby increasing thei r willingness to perform SSE. Since this is the first study identifi ed to study the relationship between body image and BSE and SSE, it is important that future research further examine this

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33 relationship. Based on findings that SSE, but not BSE, was re lated to body image, future research should seek to understand the difference between the two self-examination behaviors that appears to allow one and not the other to be influenced by body image. Furthermore, longitudinal designs should be employed in order to examine the temporal relationship between body image and self-examination behavior. To further shed light on the relationship, future research should in clude a more diverse population, including men, non-Caucasian people, and people from a variet y of SES and educational backgrounds. It is possible that a similar relationship exists with other self-examina tion behaviors, such as testicular self-exams; this potential relati onship should be explore d. Finally, the use of interventions to improve body image should be expl ored as it may lead to an increase in people’s willingness to perform self-exa mination behaviors such as SSE.

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34 Table 1 Demographic Characteristics of Sample (N = 106) ________________________________________________________________ Variable _____ Mean age (SD) 56.59 (9.09) Mean BMI (SD) 27.86 (6.21) Education Partial high school 3 (2.8%) High school graduate 18 (17.0%) Partial college/specia lized training 34 (32.1%) College/university graduate 29 (27.4%) Graduate degree 22 (20.8%) Race White/Caucasian 98 (92.5%) Black/African American 6 (5.7%) American Indian/Alaska Native 1 (1.0%) More than one race 1 (1.0%) Ethnicity Hispanic 4 (3.8%) Non-Hispanic 102 (96.2%) Marital Status Single 4 (3.8%) Married 74 (69.8%) Divorced 21 (19.8%) Widowed 5 (4.7%) Separated 2 (1.9%) Employment status Paid full-time employment 52 (49.1%) Paid part-time employment 15 (14.2%) Not employed – disabled 1 (1.0%) Not employed – retired 25 (23.6%) Not employed – Seeking work 3 (2.8%) Homemaker 9 (8.5%) Student 1 (1.0%) Total household income Less than $ 10,000 1 (1.0%) $10,000 $19,999 6 (5.7%) $20,000 $ 39,999 15 (14.2%) $40,000 $59,999 27 (25.5%) $60,000 $100,000 35 (33.0%) Greater than $100,000 22 (20.8%)

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35 Table 2 Correlational Analyses of MBSRQ Subs cales with Self-Screening Behaviors Appearance Evaluation Appearance orientation BSE in past year .05 .01 BSE intention -.10 .02 SSE in past year .28* .01 SSE intention .13 .12 n = 106 p < .01

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36 Table 3 Correlational Analyses of BASS Meas ures with Self-Screening Behaviors BASS: breasts Bass: Overall Appearance BASS average score BSE in past year .14 .19 .13 BSE intention .05 -.07 .03 SSE in past year N/A .27* .36** SSE intention N/A .14 .16 n = 60 p < .05 ** p < .01

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37 Table 4 Correlational Analyses of Attitudes Toward BSE and SSE with Self-Screening Behaviors Attitude BSE in past year .21* BSE intention .17 SSE in past year .28** SSE intention .35*** n = 106 p < .05 ** p < .01 ***p < .001

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38 Table 5 Correlational Analyses of Se lf-Efficacy for Performing BS E and SSE with Self-Screening Behaviors Self-efficacy BSE in past year .31** BSE intention .24* SSE in past year .51*** SSE intention .56*** n = 106 p < .05 ** p < .01 ***p < .0001

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39 Table 6 Correlational Analyses of Demographic Variables with BSE and SSE Behaviors and Intentions BSE past behavior BSE intentions SSE past behavior SSE intentions Age .04 -.01 .06 .13 Education -.22* -.15 .07 .13 Marital Status .09 .11 .03 -.05 Menopausal status .13 .07 -.08 .09 Income -.19* -.08 .02 -.11 *p < .05

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40 Table 7 Correlational Analyses of Demographic Variables with MBSRQ Subscales and BASS Scales Appearance Evaluation Appearance Orientation BASS total scale BASS: overall appearance BASS: breasts Age -.03 .29** -.13 .00 .02 Education .20* .02 .10 .03 .13 Marital Status -.03 .01 -.03 -.07 -.06 Menopausal Status -.05 .25* -.13 -.04 .12 Income .03 -.13 .04 -.08 .04 *p < .05 **P < .01

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41 Table 8 Multiple Regression Analyses of SSE Behav ior with the Appearance Evaluation Subscale Variable R2 Cumulative R2 p Step 1 Attitude .14 .10 Self-efficacy .44 .285 .285 <.001 Step 2 Appearance Evaluation subscale .20 .038 .323 .02 n = 106 Model F (3, 102) = 16.21, p < .0001

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42 Table 9 Multiple Regression Analyses of SSE Behavior with the BASS Variable R2 Cumulative R2 p Step 1 Attitude .18 .09 Self-efficacy .52 .413 .413 <.001 Step 2 BASS .12 .012 .425 .28 n = 60 Model F (3, 56) = 13.85, p < .0001

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43 References Abood, D.A. & Chandler, S.B. (1997). Race and the role of weight, weight change, and body dissatisfaction in eating disorders. American Journal of Health Behavior. 21, 21-25. American Cancer Society. (2006). Cancer Facts & Figures 2006. Atlanta, GA: American Cancer Society. American Cancer Society. (n.d.). Detailed guide: Can melanoma be found early? Retrieved December 15, 2005, from http: //www.cancer.org/docroot/CRI/content/ CRI_2_4_3X_Can_melanoma_be_found_ early_50.asp?sitearea= Berwick, M., Begg, C.B., Fine, J.A., Roush, G.C. & Barnhill, R.L. (1996). Screening for cutaneous melanoma by skin self-examination. Journal of the National Cancer Institute, 88, 17-23. Brown, T.A., Cash, T.F., & Mikulka, P.J. (1990). Attitudinal body-image assessment: Factor analysis of the Body-Se lf Relations Questionnaire. Journal of Personality Assessment, 55, 135-144. Calnan, M., & Rutter, D.R. (1988). Do hea lth beliefs predict health behaviour? A follow-up analysis of breast self-examination. Social Science and Medicine, 26, 463-465. Cash, T.F. (1990). The Multidimensional Body-Se lf Relations Questionnaire. Old Dominion University, Norfolk, VA.

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Body image, attitudes, and self-efficacy as predictors of past behavior and future intention to perform breast and skin self-examinations
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ABSTRACT: Breast self-examinations (BSE) and skin self-examinations (SSE) provide people with a cost-effective and time-efficient approach to the detection of cancer. Given the utility of these self-examination behaviors, it is important to determine who is likely to perform them regularly and why. Prior research has demonstrated a relationship of attitudes and self-efficacy with performance of and intention to practice the exams. Body image, although not previously studied, can be hypothesized to influence performance of these behaviors as well. To address these issues, the current study sought to determine if there are relationships between attitudes, self-efficacy, and body image and the practice of BSE and SSE. One hundred and six women completed measures assessing attitudes, self-efficacy, body image, past performance of BSE and SSE, and future intention to perform BSE and SSE. Results indicated that attitude was positively related to past performance of BSE and SSE and future intention to perform SSE. Self-efficacy was positively related to past performance and future intention to perform BSE and SSE. Body image was positively related only to past performance of SSE. Future research should further examine the relationship between body image and SSE utilizing longitudinal designs and a more diverse population.
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Cancer.
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