Addressing Barriers and Facilitators to African Americans' and Hispanics' Participation in Clinical and Genomic Research Through a Bioethical Sensitive Video.

Research advances on effective methods to prevent, diagnose, and treat cancer continue to emerge through clinical and genomic research. Most clinical trial and genomic research participants identify as White which limits the generalizability of research findings to non-White populations. With the development and access to technology, digital delivery of salient and tailored health education may provide innovative pathways to increase representation of African Americans (AA) and Hispanics in research. This project focused on the creation of a bioethical sensitive education video aimed at increasing participation in clinical trials and genomic research by bringing together experts from the community, healthcare, biomedical research, and public health. The goal was to utilize existing educational resources to create a tailored message to address AA/Hispanics' beliefs, values, and bioethical concerns related to participation in clinical and genomic research. Models of behavior change and communication theories were leveraged to frame key components of the message, which then informed the framework for the animated video. Development of the video consisted of six iterative phases: 1) writing sessions; 2) storyboarding; 3) animating; 4) screening/revisions; 5) acceptability testing; 6) finalization. The final animated video is approximately 5 min in length and covers several topics including the goal of clinical research, disparities in research participation, bioethical concerns, and genomic research regulations. Increasing AA and Hispanic participation in clinical and genomic research is imperative to achieving health equity. Tailored messages via short videos may assist in addressing the barriers and facilitators towards research participation and increase intentions to enroll in trials.

Enhancing the Awareness of Modifiable Risk Factors for Cancer Prevention in the Alabama Black Belt Region: A Follow-up Study.

We determined the profile of participants in the multi-level annual marathons held in Alabama Black Belt counties in terms of lifestyle characteristics and considered how these characteristics relate to a family history of cancer. Data on socioeconomic, health, and lifestyle characteristics of respondents were collected during the Annual Healthy Lifestyle Marathons of 2013-2019. These events were five miles in length and allowed participants to walk, bike, or run. Characteristics of respondents were compared using frequencies, percentages, and cross-tabulations. Most of the respondents with a family history of cancer were within the 18 to 24-year age category; had an annual income in the range of under U.S. $10,000; had received some college training; reported their overall health as good; and were African American. Although low consumption of fruits and vegetables has a demonstrated association with being diagnosed with cancer, in 2019 only 43% of respondents reported frequent intake of fruits and vegetables. Community-based health programs are critically needed to improve health in rural Black Belt communities.

Weight and blood pressure reduction among participants engaged in a cancer awareness and prevention program.

OBJECTIVES: African-Americans consume a diet high in fat, salt and sugar; such dietary habits increase the risks of cancer and other chronic diseases. The objective of this study was to engage rural communities in a nutrition and physical activity behavior modification program to promote cancer awareness and risk reduction. METHODS: Focus group discussions were conducted to generate information for the development of a nutrition and physical activity program. African Americans (N=62) from two rural counties (Bullock and Macon) in Alabama participated in a year-long intervention program in 2012 and 2013. Weight loss and blood pressure were evaluated to measure the impact of the intervention. RESULTS: Themes emerged for the focus group discussions were: nutrition, health, family, environment, and resource access. In Macon County participants lost weight irrespective of the exercise regimen, with those involved in floor exercise losing the most weight (-22.4 lbs, or-11.18 % change), while in Bullock county walking was most effective in weight loss (6.1 lbs or -3.40 % change) p<0.05. Systolic and diastolic pressure decreased from 5.3 to 10.5 mm Hg; -2.0 to -6.4 mmHg, respectively, for Bullock county, except for the walking group,). In Macon County, both systolic and diastolic pressure % change ranged from -8.94 to 12.66 and -5.34 to 12.66 mmHg respectively, irrespective of physical activity respectively. CONCLUSION: In this study, changes in weight lost and blood pressure were observed among individuals engaged in a nutrition education and physical activity program.

Healthy Lifestyle: a community-based cancer awareness and prevention intervention program.

Healthy Lifestyle engages the community in the development of a health behavior modification program to reduce cancer risk among African Americans. The objectives are 1) to assess knowledge, attitudes, and behaviors that affect cancer risk through focus group discussions; and 2) to identify community members to implement programs and practices that facilitate healthy behavior routines. Thirty-four African American focus group participants completed surveys regarding health knowledge and behavioral practices. Results from the focus groups identified three themes: 1) Health and Nutrition; 2) Environment; and 3) Family. The majority of focus group participants (94%) indicated that annual physical exams were important. However, of that group, 47% had not had a physical within the last 12 months and only 44% had scheduled appointments. Of the 79% who indicated they could commit to a two-year study, only 64% felt they could be leaders.

Increasing prostate cancer screening among African American men.

The study evaluates the impact of prostate cancer education on screening rates among African American men in rural Black Belt counties in Alabama. The goal of the study is to promote screening behavior in African American men. The objectives were: 1) to identify enablers and barriers to screening; 2) to develop and test the effectiveness of an education intervention; and 3) to determine the impact of the intervention on prostate cancer screening rates through follow-up survey. The study followed a quasi-experimental three-phase design: 1) focus group, 2) education intervention, and 3) follow-up. Focus groups (N = 76) indicate men are reluctant to talk about their health with anyone. Analysis of pre-test and post-test paired t-test indicate a significant increase in knowledge and awareness of prostate cancer (85%). Follow-up survey results indicate that 48% (N = 105) of the participants who had not been screened within the last 12 months were screened after attending the education session.

Barriers to early detection and treatment of head and neck squamous cell carcinoma in African American men.

BACKGROUND: African Amercians afflicted with head and neck squamous cell carcinoma (HNSCC) have a strikingly worse survival than do whites. One apparent cause is an advanced stage of presentation in African Americans. This study was designed to identify barriers to early treatment among African American men. METHODS: Twenty-four African American male HNSCC survivors completed structured interviews. Interviewers elicited the participants' experiences from symptom recognition to receiving definitive care. RESULTS: Most participants were seen with advanced-stage HNSCC. Overall, 10% experienced barriers to obtaining early medical care, though 30% were hesitant to seek care due to perceived barriers. Definitive treatment began for 81% within 3 months of initial care seeking. CONCLUSION: Once participants sought care, most of them received definitive treatment within a reasonable time frame. To explain the advanced stage at presentation, either tumor growth rate was extremely rapid or participants sought care when the tumor was quite advanced. The themes suggested by this elicitation study require further validation.