Classification tree analysis to examine influences on colorectal cancer screening.

PURPOSE: Identifying correlates of colorectal cancer screening (CRCS) is critical for cancer control and prevention. Classification tree analysis (CTA) is a potentially powerful analytic tool that can identify distinct population subgroups for which CRCS is influenced by any number of multivariable interactions. This study used CTA to identify correlates of CRCS for exclusive population subgroups. METHODS: Data were obtained from the 2007 Health Information National Trends Survey (HINTS) and analyzed in 2014. CTA was employed to determine the association between demographic (n = 11), psychosocial (n = 6), and numeracy (n = 3) variables and CRCS status of adults ≥50 years (n = 3,769). RESULTS: Overall CRCS rate was 66.9 %. Level of doctor avoidance (three categories) was the initial splitting variable, leading to a total of 21 terminal node subgroups of CRCS utilization: (1) avoid doctor, not for fear of illness/death [n = 625 (16.5 %), four subgroups]; (2) avoid doctor, fear illness/death [n = 366 (9.7 %), two subgroups]; (3) do not avoid doctor [n = 2,778 (73.7 %), 15 subgroups]. CONCLUSIONS: Doctor avoidance was an important behavioral influence on CRCS adherence. Use of CTA to identify unique characteristics within population subgroups has merit for tailoring future intervention strategies. Community-based approaches may be effective for reaching individuals who avoid routine doctor visits.

Understanding reversals of association between cancer screening and race/ethnicity.

BACKGROUND: We used a composite variable composed of insurance status, income, and race/ethnicity to investigate access-enhancing programs as a possible reason for "reversals of association" and large percent changes (LPC), between race/ethnicity and cancer screening, when comparing the unadjusted and adjusted ORs. METHODS: Data were from women aged 40-64 years, using the combined 2008 and 2010 Behavioral Risk Factor Surveillance System surveys. Recent mammography was within the past 2 years, and recent Pap testing was within the past 3 years. Initial analyses using all variables singly were followed by analyses that used the composite variable with the remaining covariates. RESULTS: Analyses with race/ethnicity singly indicated reversals of association for Hispanic women and higher estimated screening for black and Hispanic women than for white women. Analyses with the composite variable found no reversals of association, but there were several LPCs for Hispanic and black women, for lower income, and for uninsured women. White, uninsured, lower income women were among those with the lowest utilization. CONCLUSIONS: Results were consistent with the possibility that access-enhancing programs for lower income, uninsured and often non-white women can lead to overestimates of screening, reversals of association, and LPCs in multivariable analyses. Attention should be given to identifying LPCs to unadjusted ORs. Lower income, uninsured, white women are also a group at risk of extremely low mammography and Pap test utilization. IMPACT: Combining variables to create better-targeted population subgroups may help in the interpretation of analyses that produce reversals of association and LPCs for correlates of cancer screening utilization.

Using Cognitive Interviewing and Behavioral Coding to Determine Measurement Equivalence across Linguistic and Cultural Groups: An Example from the International Tobacco Control Policy Evaluation Project.

The present study aimed to examine and compare results from two questionnaire pretesting methods (i.e., behavioral coding and cognitive interviewing) in order to assess systematic measurement bias in survey questions for adult smokers across six countries (USA, Australia, Uruguay, Mexico, Malaysia and Thailand). Protocol development and translation involved multiple bilingual partners in each linguistic/cultural group. The study was conducted with convenience samples of 20 adult smokers in each country. Behavioral coding and cognitive interviewing methods produced similar conclusions regarding measurement bias for some questions; however, cognitive interviewing was more likely to identify potential response errors than behavioral coding. Coordinated survey qualitative pretesting (or post-survey evaluation) is feasible across cultural groups, and can provide important information on comprehension and comparability. Cognitive interviewing appears a more robust technique than behavioral coding, although combinations of the two might be even better.

Prostate cancer communication strategies recommended by older African-American men in South Carolina: a qualitative analysis.

BACKGROUND: Mortality from prostate cancer (PrCA) in African-American (AA) men is significantly higher than in European-American (EA) men. METHODS: Purposive sampling identified 25 AA men >or=45 years for interviews/focus groups. Participants were asked about cancer information-seeking behaviors, capacity to use information, and recommendations for messages and message delivery. Transcripts were analyzed for themes about PrCA communication. RESULTS: Barriers to information seeking were fear, poor resources, and limited family communication. Participants requested messages stressing men's "ownership" of PrCA delivered "word-of-mouth" by clergymen, AA women, and AA PrCA survivors. CONCLUSIONS: Direct and timely messages about PrCA should be developed for AA men.

African American men's understanding and perceptions about prostate cancer: why multiple dimensions of health literacy are important in cancer communication.

Prostate cancer (PrCA) is the most diagnosed cancer among men in the United States, especially among African American (AA) men. The purpose of this formative study was to explore the implications of applying Nutbeam's multidimensional health literacy framework to AA men's understanding of PrCA information. Participants were 25 AA men aged 45 and older in South Carolina. Their functional health literacy was assessed using two modified Cloze tests and the Shortened Test of Functional Health Literacy in Adults (S-TOFHLA). Men also participated in interviews or focus groups during which they were asked questions about PrCA risk, prevention, and screening. Transcripts were reviewed for recurrent themes and analyzed qualitatively using NVivo7. Mean S-TOFHLA was 28.28 (+/-1.98), implying "adequate" comprehension. Mean Cloze was .71 (+/-.05) for a Grade 8 document and .66 (+/-.04) for a Grade 13 document, also showing "adequate" comprehension. Cloze scores for the Grade 8 resource were lower for participants with less education (P = .047). Despite having satisfactory literacy test scores, results from interviews and focus groups revealed participants' limited understanding and misconceptions about PrCA risk. Many wanted information about screening and family history delivered word-of-mouth by AA women and church pastors as few of them had ever received or actively sought out PrCA resources. Using Nutbeam's framework, gaps in health literacy which were not adequately captured by the validated tools emerged during the interviews and focus groups. Study findings provide important implications for PrCA communication with AA men to correct misperceptions about cancer risk and motivate preventive behaviors.