Background
Anxiety, worry, and fear are among the most common emotional responses to the threat of disease and several studies have linked various fears to cancer preventive and detection behaviors. Cancer-related worry and fears about screening or its consequences are also characteristics that vary across ethnic groups and may be differentially linked to screening outcomes [1]. Limiting the utility of this growing literature are at least two key considerations.
First, little attention has been paid to documenting variation in cancer-related fears among subpopulations of persons of African descent, despite evidence that (a) rates of screening may vary among both male [2] and female [3] immigrants from islands in the Caribbean living in the United States and (b) incidence rates for cancers such as those of the prostate may be very high in men from Jamaica [4], Guadaloupe [5] and Trinidad and Tobago [6], as well as in immigrant groups in both the United Kingdom [7] and United States [8]. Second, findings regarding the relations anxiety, cancer worry, and screening fear hold with screening behavior seen thus far have been inconsistent, in our view because anxieties stemming from different sources have different relations with behavior. In the emotions theory view, understanding the role of fear in health behavior in diverse groups is predicated on understanding the object or source of the fear [9–11] for the simple reason that anxiety motivates avoidance of particular elicitors [10, 12].
Research conducted within the U54 Comprehensive Cancer Partnership between Long Island University and Columbia University has produced several studies documenting differences in breast and prostate cancer screening frequencies among Caribbean subpopulations living in Brooklyn, New York [1, 12, 13]. A major concentration in this program of behavioral research has investigated whether trait anxiety, cancer worry, and screening-related fears vary across Caribbean subpopulations and whether these highly differentiated emotional responses independently predict screening behavior in multivariate models [1, 2, 12–14]. Consistent with theory, we expected that fears pertaining to the screening context (e.g., fear of pain or the psychological implications of certain screens), would predict avoidance of the fear-inducing situation and thus be associated with less frequent screening. Conversely, where fears relate to the disease itself, greater fear should predict more frequent screening.