Adding COVID to cancer: does cancer status influence COVID-19 infection preventive behaviors?

Introduction: A better understanding of how to promote disease mitigation and prevention behaviors among vulnerable populations, such as cancer survivors, is needed. This study aimed to determine patterns of and factors associated with COVID-19-related preventive behaviors among cancer survivors and assess whether the COVID-19 preventive behaviors of cancer survivors differ from the general population. Methods: In June 2020, an online survey of adults (N = 897) assessed predictors of COVID-19-related preventive behaviors, including socio-demographics, COVID-19 beliefs and perceptions (Health Belief Model [HBM] variables), and cancer statuses (cancer survivors currently in treatment, cancer survivors not currently in treatment, and individuals with no history of cancer). An average score of respondent engagement in eight preventive behaviors was calculated. Differences in HBM variables and preventive behaviors by cancer status were assessed using ANCOVAs. Hierarchical multiple regression analyzed associations among socio-demographics, HBM constructs, cancer statuses, and engagement in COVID-19 preventive behaviors. Results: Participants reported engaging in 3.5 (SD = 0.6) preventive behaviors. Cancer survivors not in treatment engaged in preventive behaviors significantly less than the comparison group. In the final adjusted model, after adding COVID-19 beliefs and perceptions, cancer status was no longer significant. All HBM constructs except perceived susceptibility were significant predictors of preventive behaviors. Conclusions: COVID-19 beliefs and perceptions were more robust predictors preventive behaviors than cancer status. Nonetheless, public health organizations and practitioners should communicate the risk and severity of infection among cancer survivors and emphasize the need to engage in protective behaviors for COVID-19 and other infectious diseases with this vulnerable population.

Barriers and Facilitators of Colorectal Cancer Screening During the COVID-19 Pandemic.

BACKGROUND: COVID-19 introduced new barriers to health care including cancer screenings. This study evaluated the role of pandemic- and copay-related barriers to colonoscopy and the extent to which home-based testing methods were utilized. METHODS: A cross-sectional survey assessed colorectal cancer (CRC) attitudes and screening early in the COVID-19 pandemic. RESULTS: Respondents (342; 50.37% female) were 62.32 (SD = 6.87) years old. Roughly half were White/Caucasian (329; 48.45%); 29.75% were Black/African American (202); and 21.80% were another race (148). Roughly two-thirds were up-to-date with CRC screening (459; 67.59%). In an adjusted model, those with a higher agreement that concerns about COVID-19 delayed scheduling their colonoscopy (OR = .79; 95% CI: .08, .63; P = .045) and concerns about copays delayed scheduling their colonoscopy (OR = .73; 95% CI: .73, .57; P = .02) were less likely to be up-to-date on screening. In another adjusted model, those screened during the pandemic were significantly more likely to be screened via an at-home test (OR = 10.93; 95% CI: 5.95, 20.27; P < .001). DISCUSSION: During the COVID-19 pandemic, screening copay-related concerns persisted and were significantly higher among those not up-to-date with CRC screening. Increased at-home testing and addressing copay barriers may increase CRC screening adherence now and in future infectious disease outbreaks.

#EndtheSTIgma: An Exploratory Analysis of the 2019 HPV Awareness Day Conversation on Twitter & Instagram.

The current study explores the risk communication conversations on Twitter and Instagram in the context of the 2019 HPV Awareness Day, through the theoretical lenses of the stigma associated with HPV, HPV-related cancer, and the HPV vaccine. Our findings reveal that: 1) self and enacted stigma are present in these social media conversations, via nonprofits and official ambassadors, and via regular people; 2) other categories related to stigma, which can be seen as reactions to stigma and appeals to better individuals and society (i.e. stopping stereotypes) also emerged in these conversations, via official and not official sources, pro and against vaccine discourses; and 3) the same categories emerged from the data via both platforms, but differences exist in terms of narratives and messaging. Practical implications are discussed.

Pandemic coping and COVID-19 preventive behaviors among cancer survivors.

BACKGROUND: Cancer survivors are at greater risk for COVID-19 complications, emphasizing the importance of adherence to COVID-19 prevention. Active coping mechanisms can help manage pandemic stress but disengaged coping practices can have adverse effects. OBJECTIVES: 1) Identify differences in COVID-19 coping styles and COVID-19 preventive behaviors among cancer survivors in active treatment, survivors not in treatment, and a comparison group without a cancer history. 2) Exploring variables that may predict adherence to COVID-19 preventative behaviors. PATIENT INVOLVEMENT & METHODS: This study used an online survey among two categories of cancer survivors - one group in active treatment and one group no longer in treatment - and one group without a cancer history (N = 897 total). RESULTS AND DISCUSSION: Cancer survivors in treatment were more likely to utilize both active and disengaged coping (p < .001). This could indicate that the additional COVID-19 strain is making survivors more likely to engage in coping in any way possible. Cancer survivors not in treatment were less likely to report intent to carry out COVID- 19 preventative behaviors compared to the comparison group (p = .009). Providers should understand how survivors may use both coping mechanism types because these coping strategies predict both depression and adherence to COVID-19 preventive behaviors.

Pinning Pink: Messages About Hereditary Breast Cancer Risk on Pinterest.

Social media messages and conversations provide an opportunity to study what users post about cancer risk and preventive behaviors. Personal stories of early detection, treatment, and survivorship are often shared. The purpose of this study was to examine the hereditary breast cancer-focused posts on the understudied visual social media platform Pinterest. Using systematic random sampling, n = 500 Pinterest posts (referred to as "pins") were collected using the keywords "breast cancer" and "genetic testing" in the late 2017. Using a quantitative content analysis, pins were coded for a variety of categories including poster identity, pin characteristics and content, the presence of Health Belief Model constructs, and engagement variables (i.e., repins/saves and comments). The primary findings of this study reveal that most pins were published by individuals and relatively few messages contained specific information about genetic testing. Study results also describe how Pinterest users interact with the content, including higher engagement with information-rich visuals and traditional breast cancer awareness symbols. The information gained from this study may serve as the foundation for better understanding how social media can be used to communicate with women about heritable breast health-related cancers, risks, and protective behaviors. Study results prompt practical recommendations for public health organizations interested in reaching women seeking information about heritable breast cancer on Pinterest.

Endorsement of COVID-19 related misinformation among cancer survivors.

OBJECTIVES: To determine whether cancer survivors currently in treatment are more or less likely to endorse COVID-19 related misinformation compared to their counterparts no longer in treatment and those without a cancer history. METHODS: We conducted a Qualtrics survey among 897 adults to determine differences in endorsement of COVID-19 misinformation among cancer survivors in active treatment, cancer survivors no longer in treatment, and a control group with no cancer history. RESULTS: Cancer survivors currently undergoing treatment were more likely to believe misinformation related to COVID-19 than those without a cancer history. Least likely to endorse COVID-19 misinformation were cancer survivor no longer in treatment. CONCLUSION: These results alert healthcare professionals to overall high levels of endorsement of COVID-19 misinformation among cancer survivors on active treatment. Oncologists and other providers working with patients undergoing treatment for cancer should be particularly mindful of the potential elevated beliefs in misinformation among this group. PRACTICAL IMPLICATIONS: Since patients undergoing cancer treatment seem to be particularly vulnerable to COVID-19 misinformation, oncologists and other healthcare providers working with this patient population should help address patients' concerns about the pandemic and how it relates to their course of treatment.

COVID-19-Related Misinformation among Parents of Patients with Pediatric Cancer.

We conducted a survey among 735 parents to determine differences in endorsement of misinformation related to the coronavirus disease pandemic between parents of children in cancer treatment and those with children who had no cancer history. Parents of children with cancer were more likely to believe misinformation than parents of children without cancer.

#TripleNegativeBreastCancer on Instagram.

Little is known about how triple negative breast cancer (TNBC) is discussed on the visual social media platform, Instagram. A greater understanding of the experiences of TNBC survivors that are documented on this platform may inform us of how this group of survivors cope with this rare, but aggressive form of breast cancer. This study analyzed a random sample (N = 501) of Instagram posts using the hashtag #triplenegativebreastcancer. Using a quantitative content analysis, posts were coded for the presence of health belief model constructs as well as the presence of treatment-related experiences, social support, and hereditary breast cancer genetic mutations (BRCA 1/2). Our findings suggest that health organizations and agencies are not utilizing Instagram as a conduit of health communications about TNBC to reach individuals worldwide. This article provides insights into potential strategies that can be used by these entities to promote user engagement with posts about TNBC, such as utilizing health messaging that is episodic in nature, uses supportive and encouraging words, and provides information about chemotherapy.

#BeTheMatch: Assessing How Testimonials on Reddit Promote the Importance of Donating Bone Marrow.

This study explores how sharing testimonials on the social media network Reddit may encourage individuals to donate bone marrow. The theory of planned behavior guided a quantitative content analysis of 1,015 Reddit comments about donation. Research questions asked how individuals post about donation and how Redditors engage with this content. Overall, comments addressed more positive than negative outcome, efficacy, and normative beliefs. Comments that discussed beliefs related to registering to donate and the process of donating received significantly higher engagement than other comments. Additionally, comments that included positive outcome beliefs related to registering, positive efficacy beliefs related to registering and donating, and positive normative beliefs related to donating received higher engagement than other comments. Results suggest testimonials may be most effective if they focus on behavior facilitators and if they present donation as a positive norm deviant behavior. Finally, the Reddit forums functioned as places for individuals to seek out and share information. Comments included calls to action and hyperlinks for health resources. This research reveals how organic conversations on Reddit may promote health information seeking and advocacy behavior adoption. Implications for the theory of planned behavior and the use of Reddit as a platform for health promotion are discussed.

HPV Vaccine Searches on Pinterest: Before and After Pinterest's Actions to Moderate Content.

Objectives. To compare how human papillomavirus (HPV) vaccination was portrayed on Pinterest before and after the platform acted to moderate vaccine-related search results to understand (1) what the information environment looked like previously and (2) whether Pinterest's policy decisions improved this environment in terms of sources and content.Methods. In this quantitative content analysis, we compared 2 samples of 500 HPV vaccine-focused Pinterest posts ("pins") collected before and after Pinterest's actions to provide more reliable vaccine-related information. Pins were based on search results and were analyzed using the Health Belief Model.Results. The majority of preaction search results leaned toward vaccine skepticism, specifically focused on perceived vaccine barriers. Few pins were published by public health-related Pinterest accounts. Postaction search results showed a significant shift to HPV vaccination benefits, and the number of pins by government or medical accounts increased. However, the proportion of pins in search results containing HPV content of any type was significantly lower.Conclusions. Pinterest's efforts to moderate vaccination discussions were largely successful. However, the ban also appeared to limit HPV vaccination search results overall, which may contribute to confusion or an information vacuum.

A Tale of Two Diverse Qualtrics Samples: Information for Online Survey Researchers.

BACKGROUND: There is often a lack of transparency in research using online panels related to recruitment methods and sample derivation. The purpose of this study was to describe the recruitment and participation of respondents from two disparate surveys derived from the same online research panel using quota sampling. METHODS: A commercial survey sampling and administration company, Qualtrics, was contracted to recruit participants and implement two Internet-based surveys. The first survey targeted adults aged 50 to 75 years and used sampling quotas to obtain diversity with respect to household income and race/ethnicity. The second focused on women aged 18 to 49 years and utilized quota sampling to achieve a geographically balanced sample. RESULTS: A racially and economically diverse sample of older adults (n = 419) and a geographically diverse sample of younger women (n = 530) were acquired relatively quickly (within 12 and 4 days, respectively). With exception of the highest income level, quotas were implemented as requested. Recruitment of older adults took longer (vs. younger female adults). Although survey completion rates were reasonable in both studies, there were inconsistencies in the proportion of incomplete survey responses and quality fails. CONCLUSIONS: Cancer researchers, and researchers in general, should consider ways to leverage the use of online panels for future studies. To optimize novel and innovative strategies, researchers should proactively ask questions about panels and carefully consider the strengths and drawbacks of online survey features including quota sampling and forced response. IMPACT: Results provide practical insights for cancer researchers developing future online surveys and recruitment protocols.See all articles in this CEBP Focus section, "Modernizing Population Science."

Breast Cancer Voices on Pinterest: Raising Awareness or Just an Inspirational Image?

The public increasingly searches for and discusses health information online, but few studies have examined breast cancer-related posts on visual social media platforms. To shed light on cancer-focused posts on the visual social media platform Pinterest, this study analyzed a random sample of 476 breast cancer-related posts (also referred to as "pins"). Using a quantitative content analysis, pins were coded for type of visual and textual information included and user engagement with pins (i.e., frequency of repins and comments). This novel research supports the current use and potential future utility of Pinterest as a venue for health communication related to breast cancer. Study results have important implications for the development of future health promotion programs on Pinterest aimed at reducing breast cancer risk among women.