Cancer Research Participation Beliefs and Behaviors of a Southern Black Population: A Quantitative Analysis of the Role of Structural Factors in Cancer Research Participation.

Increasing the participation of Blacks in cancer research is a vital component of a strategy to reduce racial inequities in cancer burden. Community-based participatory research (CBPR) is especially well-suited to advancing our knowledge of factors that influence research participation to ultimately address cancer-related health inequities. A paucity of literature focuses on the role of structural factors limiting participation in cancer research. As part of a larger CBPR project, we used survey data from a statewide cancer needs assessment of a Black faith community to examine the influence of structural factors on attitudes toward research and the contributions of both structural and attitudinal factors on whether individuals participate in research. Regression analyses and non-parametric statistics were conducted on data from 727 adult survey respondents. Structural factors, such as having health insurance coverage, experiencing discrimination during health care encounters, and locale, predicted belief in the benefits, but not the risks, of research participation. Positive attitudes toward research predicted intention to participate in cancer research. Significant differences in structural and attitudinal factors were found between cancer research participants and non-participants; however, directionality is confounded by the cross-sectional survey design and causality cannot be determined. This study points to complex interplay of structural and attitudinal factors on research participation as well as need for additional quantitative examinations of the various types of factors that influence research participation in Black communities.

The use of illustrated story mapping to enhance focus group discussion.

Key informant interviews and focus groups assist in eliciting qualitative data from the community in order to develop educational programs. This article describes how an additional methodology, illustrated story maps, are used to obtain context-specific information on what African American and Hispanic men need to know to make an informed decision about prostate cancer screening. These maps are created as a result of key informant interviews and implemented during focus groups. Twenty focus groups are conducted using the story maps, which depicts scenarios of how men make medical decisions, possible influences on medical decisions, and potential consequences of these decisions. The illustrated story maps prove to encourage directed discussion during the focus groups, while still allowing for open sharing of personal experiences. The authors recommend the use of maps when adapting and planning communication and educational programs, particularly where participant dialogue is central to success of the endeavor.

HBCUs inform students and the community about cervical cancer.

In summary, HBCUs can no longer remain reactive, but must spearhead efforts to increase both the health of the student body, as well as the community at large. HBCUs should collaboratively initiate a "Call to Action", whereby policies and programs could be created to aid in the prevention of HPV and other STIs. To support this action, HBCUs could more actively pursue funding sources that support both universities and the communities in which they exist. Student orientation could be redefined to include short courses in STI awareness and prevention, and be communicated in a manner that is professional, yet engaging to students. Moreover, university departments which have an interest in the health of communities should supervise these efforts. The knowledge of university faculty members within departments of Nursing, Social Work, Public Health, Rehabilitation Counseling and Physical Education should extend beyond the classroom and into the community. Clark commented, "Perhaps course content across departments could be revised to encompass an increased focus on practice skills which support awareness and prevention efforts". Through employment, volunteerism and student internships, each of these disciplines have established relationships with the surrounding community and understand the associated critical needs. Such relationships provide the best environment for both the creation and implementation of services, and provide students with a model of how to "give back" to the community by utilizing their education. Campus health centers should be more prevention-driven beyond the distribution of condoms and pamphlets, to collaborate with local area high schools and community-based organizations to create an information network accessible to students and community residents. Additionally, health centers should promote the availability of HPV vaccination, which depending on state of residence and age, may be free or available at a discounted cost. According to Bynum, some HBCUs have already begun to promote and provide the vaccination, "South Carolina State University is one of the HBCUs which provides the HPV vaccination and promotes HPV prevention. There has been a great initiative by their health center to focus prevention efforts on incoming freshman". HBCU administrations must bear in mind that beyond the campus, students will undoubtedly carry the information learned during college into the communities in which they live after graduation and moreover, utilize this information as a basis for educating their children and families. Community activist and Columbia resident Linda "T'Zima" Brown, whose 16 year-old son is considering application to Delaware State University, believes that HBCUs bear a great responsibility to the well-being of the community, "We as residents should be able to take part in the events that our black colleges have. Black colleges used to operate from a more inclusive, family approach, and we need to get back to that; plus, many HBCUs are supported with our state dollars, so the community should be able to look to them for information aside from what our children relay to us".

What is needed for informed decisions about prostate cancer screening: perspectives of African-American and Hispanic men.

Professional guidelines suggest that men should learn about risks and benefits of screening to make informed decisions consistent with their preferences. We used concept mapping to investigate views of informed decision making (IDM) of minority men. Statements about what men need for IDM about prostate cancer screening were sorted by similarity and rated for importance by 16 Hispanic and 15 African-American men. Multidimensional scaling and cluster analysis were used to develop a concept map for IDM. The 10-cluster solution was selected. The clusters rated most important were labeled Future Considerations, What to Know and Decision to Make. Clusters labeled Social Support and Sharing Perspectives depicted social aspects of the decision and were intermediate in importance. There was strong correlation in relative importance ratings of clusters by African-American and Hispanic men. However, African-American men gave higher importance ratings than Hispanic men. Concept mapping, a method with strong participatory elements, was useful in identifying conceptual frameworks for IDM of African-American and Hispanic men. Health education to support IDM requires some shifts in focus and strategy. It is important that interventions with minority men build upon a strong conceptual framework.

Racial disparities in colon cancer. Primary care endoscopy as a tool to increase screening rates among minority patients.

Colon cancer is a condition whose far-reaching effects have been well documented nationally and within the state of South Carolina. Fortunately, the disease is amenable to both primary and secondary prevention through screening colonoscopy. Despite the conceptual simplicity of recommending colonoscopy, barriers exist to universal (or even widespread) screening. Currently the infrastructure necessary to achieve screening goals set by the American Cancer Society (ACS), the American College of Gastroenterology (ACG), and the South Carolina Department of Health and Environmental Control (DHEC) has not been established. At current rates of training gastroenterologists, the medical community will not be able to come close to achieving widespread screening. Given the discrepancy between the public health benefit of achieving the goals and the deaths that have occurred because of the resource shortfall, we propose alternative measures to screen the at-risk population for consideration. This need is most acute in the black community, in which where screening rates tend to be lower and polyps have been found to progress more quickly than among white populations. In South Carolina, one model has used primary care physicians as the labor force to provide routine screening colonoscopy for their own patients. This model makes screening much more accessible to minority patients, as the wait is shorter and the cost typically lower. In combination with a faith-based partnership with minority religious organizations, this model has begun to make needed inroads toward addressing the disparities associated with colon cancer. Cancer 2007. (c) 2006 American Cancer Society.