Humor helps reduce avoidance of colorectal cancer information

Colorectal cancer (CRC) is no laughing matter. It's the second-leading cause of cancer deaths globally, according to the World Health Organization. But new research led by the University at Buffalo suggests that humor can be an effective mechanism for reaching people who otherwise avoid information about colorectal cancer screening or other health messaging.

The research, published online ahead of print in the British Journal of Health Psychology, found that in people who demonstrated a tendency to avoid information about colorectal cancer exposure to humorous comic strip cartoons made them more likely to agree to be directed to an online quiz to assess their personal risk for colorectal cancer. A second study found that similar exposure made them more likely to choose to watch a short video about colorectal cancer.

Health information avoidance is a defensive process people use to shield themselves from thinking about threatening ideas, such as the possibility of having cancer, or information that may require unwanted behavior changes, such as eating a healthier diet. It can take the form of avoiding seeking out health information altogether, avoiding exposure to information, or delaying obtaining information such as putting off scheduling a colonoscopy.

We were surprised to learn that simply exposing people to funny content, in this case having people rate comics, could reduce information avoidance."

Heather Orom, PhD, study's lead author, associate professor in the Department of Community Health and Health Behavior in UB's School of Public Health and Health Professions

"At this point we still don't know why humor is having this effect for people who avoid CRC information," Orom adds. "Our original hypothesis was that the comics would put people in a positive mood and that this would reduce their need to avoid threatening information by acting as a buffer against becoming too upset."

Orom and her colleagues' previous research found that about 20% of the population may avoid information about colorectal cancer and that the figure is similar for diabetes.

"We also know that people who avoid colorectal cancer information are less likely to be screened for the disease – close to half as likely," she says. "Getting screened is such an important thing we can do for ourselves because colorectal cancer is the third-most common cancer in men and women and one of the most preventable through regular screening, especially if you are screened with colonoscopy."

Routine screening for colorectal cancer should begin at age 45 for individuals at average risk, a newer guideline that may not be widely known.

"In 2021, the U.S. Preventive Services Task Force updated the screening recommendation from age 50 to 45 in response to increasing colorectal cancer rates among younger populations," explained co-author Natasha C. Allard, a PhD candidate in the Department of Community Health and Health Behavior who studies young adult cancer prevention.

The current, two-part study was an attempt to find ways to encourage people to get screened. So, Orom and her colleagues turned to humor in the form of comic strips, like TUNDRA's comic about Frosty the Snowman picking his nose.

In study 1, 288 individuals between the ages of 45 and 75 were asked to view one of four types of images: humorous comics, cute animals, coping messages, and streetscapes (the control group) and rate each one to indicate the extent to which they thought the comics were "funny," the animals were "cute," the coping images were "encouraging," and the streetscapes were "interesting."

Participants then rated their mood and were asked, "Would you like to receive a link at the end of this survey to take a quiz to learn more about your personal risk for colon cancer?" Those who reported avoidance tendencies were more likely to say yes.

Interestingly, viewing images of cute animals or coping messages did not increase engagement with colorectal cancer information.

In a second study, 505 individuals aged 45 to 75 were given the choice to watch either a video on expert advice on preventing colorectal cancer or a video on expert ways to take care of their feet.

Unlike in study 1, the humor and coping experimental groups reported being in a more positive mood after viewing the images than the control group, which saw streetscapes. As with the first study, being colorectal cancer screening adherent wasn't associated with which video they chose. Also similar to study 1, the effect of the humorous comics on choosing the CRC video were larger and more positive to the extent that participants tended to be more CRC avoidant.

Orom explains that the current study differed from previous research on humor and health messaging in that prior studies examined the impact of health messages that were designed to be humorous, rather than pre-exposing people to humor unrelated to the delivery of a subsequent, non-humorous health message.

"The reason we wanted to test whether humor might mitigate avoidance is that it's a strategy that can be incorporated into public health messaging," Orom says.

"Perhaps starting off with something humorous gets people who avoid health information to start to pay attention to the message. Then we will need to keep their attention, and that's what we're working on now."