Cognitive-Affective-Behavioral Imbalance in Skin Cancer Prevention: A Magic-Square-Inspired Mathematical Model Using HINTS 2005 Data

A magic-square-inspired mathematical model was developed in this study to examine cognitive-affective-behavioral imbalance in skin cancer prevention among adults in the U.S. using data from the 2005 Health Information National Trends Survey (HINTS). After normalizing nine variables representing cognitive beliefs, affective responses, and protective behaviors and arranging them in a 3x3 structure, a magic-square imbalance score (MSIS) was calculated from variation among row, column, and diagonal means in a way that higher values represented greater imbalance. A total of 1,279 adults were included in the complete-case sample. The weighted mean MSIS reported 17.4, while the mean protection index reported 63.6. There was a decline in protection across increasing imbalance groups from 71.8 in the low-MSIS group to 62.7 in the middle group and 56.2 in the high group. Greater sunscreen non-use, shade non-use, and tanning exposure were associated with higher imbalance. In the adjusted analyses, cognitive-affective discordance alone was not significantly associated with protection. However, lower protection was associated with greater psychological adversity. For demographic profiles, women, older adults, and college graduates indicated stronger protective behavior. These findings suggest that an original quantitative approach may be provided by a magic-square-inspired framework to identify imbalance among beliefs, emotions, and behaviors related to skin cancer prevention.