Outcome Expectancies, Health Information Seeking, and Cancer Beliefs Associated with Multivitamin/Mineral Use in a National Sample, HINTS-FDA 2015

Published:February 13, 2020DOI:



      Dietary supplements, including multivitamins/minerals, are commonly reported by adults, yet little is known about multivitamin/mineral use in relation to information seeking, cancer-specific outcome expectancies, and cancer beliefs.


      To examine the relationship of heath information seeking, beliefs about cancer, and outcome expectancies with multivitamin/mineral use within a national sample.


      A secondary analysis of data collected by The Health Information National Trends Survey (HINTS) and the US Food and Drug Administration (FDA) (HINTS-FDA 2015) was conducted. HINTS-FDA 2015 evaluated information seeking, beliefs about cancer, and health behaviors and was a self-administered, two-stage mail survey sent to a random sample of US postal addresses stratified by county smoking rates.


      Adult household residents were invited to participate, resulting in a 33% response rate (n=3,738).

      Main outcome measures

      Participants self-reported use of multivitamin/mineral products.

      Statistical analyses

      Adjusting for covariates (demographics, single-ingredient and herbal supplement use) weighted stepwise binary logistic regression was used to examine correlates of self-reported multivitamin/mineral use.


      Intake was associated with less than a high school education, having health insurance, and single-ingredient and herbal supplement use. Trust in health organizations (odds ratio [OR]=1.67, P<0.001) and the expectancy that cancer could be avoided with dietary supplements (OR=1.76, P<0.001) correlated with use. Agreement that supplements labeled as “anticarcinogenic” could treat (OR=3.07, P<0.001) or prevent cancer (OR=6.06, P<0.001) correlated with multivitamin/mineral use. Fatalistic beliefs (P<0.001) and negative information-seeking experiences (P<0.001) were associated with slightly lower odds of use.


      Despite leading health organizations’ discouragement of dietary supplements for cancer prevention, this study found that trust in health organizations and outcome expectancies were associated with multivitamin/mineral use. This divergence presents a need to explore how dietary supplement evidence based recommendations can be translated and disseminated for the public.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • National Institutes of Health
        Dietary Supplement Health and Education Act of 1994. Public Law 103-417. 103rd Congress.
        (Approved October 25, 1994. Accessed May 29, 2019)
        • Stohs S.J.
        • Preuss H.G.
        What health care professionals should know about the regulation and safety of dietary supplements.
        J Am Coll Nutr. 2017; 36: 306-309
        • US Food & Drug Administration (FDA)
        Structure/Function Claims.
        (Published December 14, 2017. Accessed February 19, 2019)
        • Bailey R.L.
        • Gahche J.J.
        • Miller P.E.
        • Thomas P.R.
        • Dwyer J.T.
        Why US adults use dietary supplements.
        JAMA. 2013; 173: 355
        • Dickinson A.
        • Blatman J.
        • El-Dash N.
        • Franco J.C.
        Consumer usage and reasons for using dietary supplements: Report of a series of surveys.
        J Am Coll Nutr. 2014; 33: 176-182
        • Council for Responsible Nutrition (CRN)
        2018 CRN consumer survey on dietary supplements: New data reaffirm trust and confidence in industry, reveal modern trends and habits of American consumers.
        (Accessed May 29, 2019)
        • Homer P.M.
        • Mukherjee S.
        The impact of dietary supplement form and dosage on perceived efficacy.
        J Consum Mark. 2018; 35: 228-238
        • Garcia-Cazarin M.L.
        • Wambogo E.A.
        • Regan K.S.
        • Davis C.D.
        Dietary supplement research portfolio at the NIH, 2009–2011.
        J Nutr. 2014; 144: 414-418
        • National Institutes of Health (NIH)
        National Center for Complementary and Integrative Health. Complementary, Alternative, or Integrative Health: What’s in a Name?.
        (Last modified April 2, 2019. Accessed May 29, 2019)
        • Kochanek K.D.
        • Murphy S.L.
        • Xu J.Q.
        • Arias E.
        Mortality in the United States, 2016. NCHS Data Brief, no 293.
        National Center for Health Statistics, Hyattsville, MD2017
      1. World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018. Accessed October 3, 2019.

        • The American Cancer Society (ACS)
        ACS Guidelines for Nutrition and Physical Activity.
        (Published January 11, 2012. Last modified April 13, 2017. Accessed October 3, 2019)
        • Bandura A.
        Self-efficacy: toward a unifying theory of behavioral change.
        Psychol Rev. 1977; 84: 191
        • Pawlak R.
        • Brown D.
        • Meyer M.K.
        • et al.
        Theory of planned behavior and multivitamin supplement use in Caucasian college females.
        J Prim Prev. 2008; 29: 57-71
        • Cotugna N.
        • Lee R.J.
        • Hopp J.
        Predictors of nutrition supplement use in the elderly. Part II: The role of beliefs, attitude, subjective norm and intention.
        J Nutr Eld. 1989; 8: 15-33
        • Ferrucci L.M.
        • McCorkle R.
        • Smith T.
        • Stein K.D.
        • Cartmel B.
        Factors related to the use of dietary supplements by cancer survivors.
        J Altern Complement Med. 2009; 15: 673-680
        • Söllner W.
        • Maislinger S.
        • DeVries A.
        • Steixner E.
        • Rumpold G.
        • Lukas P.
        Use of complementary and alternative medicine by cancer patients is not associated with perceived distress or poor compliance with standard treatment but with active coping behavior: A survey.
        Cancer. 2000; 89: 873-880
        • Walsh M.C.
        • Trentham-Dietz A.
        • Schroepfer T.A.
        • et al.
        Cancer information sources used by patients to inform and influence treatment decisions.
        J Health Commun. 2010; 15: 445-463
        • Brashers D.E.
        Communication and uncertainty management.
        J Commun. 2001; 51: 477-497
        • Emanuel A.S.
        • Godinho C.A.
        • Steinman C.
        • Updegraff J.A.
        Education differences in cancer fatalism: The role of information-seeking experiences.
        J Health Pyschol. 2018; 23: 1533-1544
        • Blake K.D.
        • Portnoy D.B.
        • Kaufman A.R.
        • et al.
        Rationale, procedures, and response rates for the 2015 administration of NCI’s Health Information National Trends Survey: HINTS-FDA 2015.
        J Health Commun. 2016; 21: 1269-1275
        • Peterson E.B.
        • Portnoy D.B.
        • Blake K.D.
        • et al.
        Item development and performance of tobacco product and regulation perception items for the Health Information National Trends Survey.
        Nicotine Tob Res. 2019; 21: 1565-1572
      2. Westat, 2015. Health Information National Trends Survey (HINTS 4): HINTS-FDA Methodology Report. Published December 2015. Accessed October 2018.

        • Befort C.A.
        • Nazir N.
        • Engelman K.
        • Choi W.
        Fatalistic cancer beliefs and information sources among rural and urban adults in the USA.
        J Cancer Educ. 2013; 28: 521-526
      3. IBM SPSS Statistics (for Windows) [computer program]. Version 21.0. Armonk, NY: IBM Corp; 2012.

        • Luo Q.
        • Asher G.N.
        Use of dietary supplements at a comprehensive cancer center.
        J Altern Complement Med. 2018; 24: 981-987
        • Knapik J.J.
        • Austin K.G.
        • Farina E.K.
        • Lieberman H.R.
        Dietary supplement use in a large, representative sample of the US Armed Forces.
        J Acad Nutr Diet. 2018; 118: 1370-1388
        • Rozga M.R.
        • Stern J.S.
        • Stanhope K.
        • Havel P.J.
        • Kazaks A.G.
        Dietary supplement users vary in attitudes and sources of dietary supplement information in East and West geographic regions: A cross-sectional study.
        BMC Complement Altern Med. 2013; 1: 200
        • Robinson A.
        • McGrail M.R.
        Disclosure of CAM use to medical practitioners: A review of qualitative and quantitative studies.
        Complement Ther Med. 2004; : 90-98
        • Pillitteri J.L.
        • Shiffman S.
        • Rohay J.M.
        • Harkins A.M.
        • Burton S.L.
        • Wadden T.A.
        Use of dietary supplements for weight loss in the United States: Results of a national survey.
        Obesity. 2008; 6: 790-796
        • Dodge T.
        • Kaufman A.
        What makes consumers think dietary supplements are safe and effective? The role of disclaimers and FDA approval.
        Health Psychol. 2007; 26: 513
        • Ashar B.H.
        • Rice T.N.
        • Sisson S.D.
        Physicians’ understanding of the regulation of dietary supplements.
        Arch Intern Med. 2007; 9: 966-969
        • Dodge T.
        • Litt D.
        • Kaufman A.
        Influence of the dietary supplement health and education act on consumer beliefs about the safety and effectiveness of dietary supplements.
        J Health Commun. 2011; 16: 230-244
        • Duberstein P.R.
        • Chen M.
        • Chapman B.P.
        • et al.
        Fatalism and educational disparities in beliefs about the curability of advanced cancer.
        Patient Educ Couns. 2018; 101: 113-118
        • Martínez M.E.
        • Jacobs E.T.
        • Baron J.A.
        • Marshall J.R.
        • Byers T.
        Dietary supplements and cancer prevention: balancing potential benefits against proven harms.
        J Natl Cancer Inst. 2012; 104: 732-739
        • Blumberg J.
        • Frei B.
        • Fulgoni V.
        • Weaver C.
        • Zeisel S.
        Impact of frequency of multi-vitamin/multi-mineral supplement intake on nutritional adequacy and nutrient deficiencies in US adults.
        Nutrients. 2017; 9: 849
        • Asher G.N.
        • Corbett A.H.
        • Hawke R.L.
        Common herbal dietary supplement-drug interactions.
        Am Fam Physician. 2017; 96: 101-107
        • Tsai H.H.
        • Lin H.W.
        • Simon Pickard A.
        • Tsai H.Y.
        • Mahady G.B.
        Evaluation of documented drug interactions and contraindications associated with herbs and dietary supplements: A systematic literature review.
        Int J Clin Pract. 2012; 66: 1056-1078
        • Andersen D.
        • Baird S.
        • Bates T.
        • et al.
        Academy of Nutrition and Dietetics: Revised 2017 scope of practice for the registered dietitian nutritionist.
        J Acad Nutr Diet. 2018; 118: 141-165
      4. Nathan JP, Kudadjie-Gyamfi E, Halberstam L, Wright JT. Consumers’ information-seeking behaviors on dietary supplements. Int Q Community Health Educ. Published online September 12, 2019.

        • Kramer A.A.
        • Zimmerman J.E.
        Assessing the calibration of mortality benchmarks in critical care: the Hosmer-Lemeshow test revisited.
        Crit Care Med. 2007; 35: 2052-2056


      K. L. Knippen is an assistant professor, Food & Nutrition, Bowling Green State University, Bowling Green, OH.


      R. Mahas is an assistant professor of nursing and public health, Madonna University, Livonia, MI.


      E. Van Wasshenova is an assistant professor, Interdisciplinary Health Sciences, Oakland University, Rochester, MI.