Association of Preventive Care Attitudes and Beliefs with Colorectal Cancer Screening History among African American Patients of Community Health Centers.

Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer-related death among African Americans in the United States. However, when detected early, CRC is treatable and survival rates are high. CRC health disparities for African Americans compared with other groups may be due in part to lower screening adherence and later stage diagnosis. The objective of this research phase was to test predictors of ever having received CRC screening (i.e., self-report of lifetime receipt of CRC screening) using survey measures in the domains of healthcare communication, trust in doctors, CRC perceived susceptibility, CRC worry, negative cancer beliefs, CRC screening self-efficacy, and cultural constructs for CRC screening in a sample of African American community health center patients. The study recruited 115 African American patients between the ages of 45 to 64 years old from community health centers in north Florida to complete the baseline survey. Our results show significant differences in CRC screening history by age, marital status, level of mistrust of healthcare providers, and level of empowerment toward cancer screening. To increase CRC screening in this population, the study findings suggest development of intervention programs that focus on priority populations of younger, unmarried African Americans, especially given the current trend of early onset CRC. Moreover, survival rates are lower for unmarried and younger African Americans relative to older and married individuals. Such interventions should also aim to increase trust in healthcare providers and increase empowerment for CRC screening decision making to increase screening participation.

Associations of Content and Context of Communication with Prostate-Specific Antigen Testing.

There is limited research about the content and context of communication on prostate-specific antigen (PSA) testing among men in the state of Florida. The purpose of this study is to understand how the content communication (discussion of advantages and disadvantages of PSA testing between provider and patient; provider recommendations of PSA testing) and the context of communication (continuity of care denoted by the presence of a personal doctor) influence PSA testing. Data were drawn from the Florida Behavioral Risk Factor Surveillance System. Receipt of PSA testing was the primary outcome. Multiple logistic regression analyses were used to adjust for sociodemographic, clinical, healthcare access, and lifestyle characteristics when associating the content and context of communication with PSA testing. Discussions were classified into four mutually exclusive categories: discussions of advantages and disadvantages, only advantages, only disadvantages, and no discussion. The most significant predictors for PSA testing included physician recommendation, discussions including advantages, older age, non-smoking, and having a personal doctor. Individualized PSA screening may be a pathway to reducing racial disparities in screening for prostate cancer (PCa) and, by extension, lower incidence and mortality rates. Developing a bill to create an Office of Men's Health at Health & Human Services is recommended.

Assessing the effectiveness of a community health advisor plus screen to save educational intervention on stool-based testing adherence in an African American safety net clinic population: study protocol for a randomized pragmatic trial.

BACKGROUND: Colorectal cancer (CRC) is the second most deadly cancer affecting US adults and is also one of the most treatable cancers when detected at an earlier clinical stage of disease through screening. CRC health disparities experienced by African Americans are due in part to the later stage of diagnosis, suggesting the importance of improving African Americans' CRC screening participation. The national Screen to Save (S2S) initiative employs a community health educator to deliver CRC screening education which can be tailored for specific populations, and such approaches have increased CRC screening rates in disadvantaged and racial/ethnic minority populations. METHODS/DESIGN: In this trial emphasizing stool-based CRC screening, focus groups informed the development of an adapted S2S video and brochure tailored for African Americans and identified preferred motivational text messages for a multicomponent community health advisor (CHA) intervention. A CHA hired from the community was trained to deliver a 6-week CRC educational intervention consisting of an initial face-to-face meeting followed by 5 weeks of calls and texts. Interested eligible persons are enrolled primarily through recruitment by two partnering community health centers (CHCs) and secondarily through various outreach channels and, after consenting and completing a baseline survey, are randomly assigned to one of two study arms. The CHCs are blinded to study arm assignment. Intervention arm participants receive the brochure and CHA intervention while participants assigned to the control group receive only the brochure. All participants receive a stool-based CRC screening test from their health center, and the primary outcome is the completion of the screening test at 12 months. Secondary objectives are to estimate the effect of the intervention on mediating factors, explore the effect of moderating factors, and perform a cost-effectiveness analysis of the CHA intervention. DISCUSSION: The TUNE-UP study will enhance understanding about CRC screening in African Americans obtaining primary health care through CHCs and is one of the very few studies to examine a CHA intervention in this context. A better understanding of the mechanisms by which the intervention affects patient beliefs and behaviors will help focus future research while the exploratory cost-effectiveness analysis will inform CHCs' decision-making about implementing a CHA program to increase screening and reduce cancer health disparities. TRIAL REGISTRATION: ClinicalTrials.gov NCT04304001 . Registered on March 11, 2020.

Engaging the Community on Colorectal Cancer Screening Education: Focus Group Discussions Among African Americans.

Colorectal cancer (CRC) is the third most diagnosed cancer in the USA, and African Americans experience disproportionate CRC diagnosis and mortality. Early detection could reduce CRC incidence and mortality, and reduce CRC health disparities, which may be due in part to lower screening adherence and later stage diagnosis among African Americans compared to whites. Culturally tailored interventions to increase access to and uptake of CRC stool-based tests are one effective strategy to increase benefits of screening among African Americans. The objectives of this study were to obtain feedback from African Americans on CRC educational materials being developed for a subsequent behavioral clinical trial and explore participants' knowledge, attitudes, and beliefs about CRC and CRC screening. Seven focus groups were conducted between February and November 2020. Participants were African Americans recruited through community contacts. Four focus groups were held in-person and three were conducted virtually due to Covid-19 restrictions. Participants ranked CRC educational text messages and provided feedback on a culturally tailored educational brochure. A focus group guide with scripted probes was used to elicit discussion and transcripts were analyzed using traditional content analysis. Forty-two African Americans participated. Four themes were identified from focus group discussions: (1) knowledge, attitudes, and beliefs on CRC and CRC screening; (2) reliable sources of cancer education information; (3) cultural factors affecting perspectives on health; and (4) community insights into cancer education. Participant input on the brochure was incorporated in content creation. Engaging African American community members to qualitatively examine cancer prevention has value in improving implementation strategy and planning for behavioral clinical trials.

A Health Survey of African American Men Seen at an Academic Medical Center in the Southern United States.

BACKGROUND: African Americans have poorer cardiovascular health and higher chronic disease mortality than non-Hispanic whites. The high burden of chronic diseases among African Americans is a primary cause of disparities in life expectancy between African Americans and whites. METHODS: We conducted a cross-sectional study via a postal survey among a sample of 65 male, African American patients aged ≥ 40 years. The overall objective was to examine the frequency of high blood pressure, high cholesterol, diabetes, myocardial infarction, congestive heart failure, stroke, asthma, emphysema, and cancer among patients treated at Augusta University Health. RESULTS: A high percentage of study participants (81.5 %) reported a history of high blood pressure; 50.8% had high cholesterol; 44.3% were overweight, 44.3% were obese, and 13.9% were current cigarette smokers. About 36.9% of the men had a reported history of diabetes; 10.8% of the men had a history of heart attack, 13.9% had a history of congestive heart failure, 9.2% had a history of stroke, and 15.4% had a history of prostate cancer. Men who reported a personal history of prostate cancer were significantly more likely to have a history of heart attack and stroke and to be overweight (p < 0.05 in each instance). DISCUSSION: Additional studies are needed of cardiovascular risk factors and adverse cardiovascular events among African American men, and interventional research aimed at controlling hypertension. Of particular concern is prostate cancer, and whether patients with hypertension, hypercholesterolemia, and diabetes are receiving appropriate therapy to reduce their cardiovascular risk and prevent morbidity and mortality from adverse cardiovascular events.

Predictors of prostate cancer screening among African American men treated at an Academic Medical Center in the Southern United States.

BACKGROUND: The controversy surrounding prostate cancer screening, coupled with the high rates of incidence and mortality among African American men, increase the importance of African American men engaging in an informed decision-making process around prostate cancer screening. PURPOSE: To examine predictors of prostate cancer screening via the prostate-specific antigen (PSA) test. Secondary objectives were to examine whether African American men have been screened for prostate cancer; their confidence in making an informed choice about whether PSA testing is right for them; and whether they have talked with their provider about PSA testing and engaged in an informed decision-making process around prostate cancer screening. METHODS: We conducted a study among a sample of African American men patients ages ≥ 40 years. RESULTS: A total of 65 men completed the questionnaire (response rate = 6.5%). The mean age of the men was 64.4 years. Most of the participants (90.8%) reported a regular healthcare provider and that their provider had discussed the PSA test with them (81.3%). About 84.1% of the men ever had a PSA test, but only 38.0% had one in the past year. Most of the men reported that they make the final decision about whether to have a PSA test on their own (36.5%) or after seriously considering their doctor's opinion (28.6%). About 31.8% of the men reported that they share responsibility about whether to have a PSA test with their doctor. About half of the participants (49.2%) reported that they have made a decision about whether to have a PSA test and they are not likely to change their mind. The majority of the men (75%) perceived their risk of prostate cancer to be about the same level of risk as other men who were their age. The men's knowledge of prostate cancer was fair to good (mean prostate cancer knowledge scale = 10.37, SD 1.87). Knowledge of prostate cancer was positively associated with receipt of a PSA test (p < 0.0206). DISCUSSION: The modest overall prostate cancer knowledge among these participants, including their risk for prostate cancer, indicates a need for prostate cancer educational interventions in this patient population.

Systematic Review of Interventions to Increase Stool Blood Colorectal Cancer Screening in African Americans.

African Americans experience colorectal cancer (CRC) related disparities compared to other racial groups in the United States. African Americans are frequently diagnosed with CRC at a later stage, screening is underutilized, and mortality rates are highest in this group. This systematic review focused on intervention studies using stool blood CRC screening among African Americans in primary care and community settings. Given wide accessibility, low cost, and ease of dissemination of stool-based CRC screening tests, this review aims to determine effective interventions to improve participation rates. This systematic review included intervention studies published between January 1, 2000 and March 16, 2019. After reviewing an initial search of 650 studies, 11 studies were eventually included in this review. The included studies were studies conducted in community and clinical settings, using both inreach and outreach strategies to increase CRC screening. For each study, an unadjusted odds ratio (OR) for the CRC screening intervention compared to the control arm was calculated based on the data in each study to report effectiveness. The eleven studies together recruited a total of 3334 participants. The five studies using two-arm experimental designs ranged in effectiveness with ORs ranging from 1.1 to 13.0 using interventions such as mailed reminders, patient navigation, and tailored educational materials. Effective strategies to increase stool blood testing included mailed stool blood tests augmented by patient navigation, tailored educational materials, and follow-up calls or mailings to increase trust in the patient-provider relationship. More studies are needed on stool blood testing interventions to determine effectiveness in this population.

Adaptation of a Community Health Advisor Intervention to Increase Colorectal Cancer Screening Among African Americans in the Southern United States.

Community health advisor (CHA) interventions increase colorectal cancer (CRC) screening rates. African Americans experience CRC disparities in incidence and mortality rates compared to whites in the US. Focus groups and learner verification were used to adapt National Cancer Institute CRC screening educational materials for delivery by a CHA to African American community health center patients. Such academic-community collaboration improves adoption of evidence-based interventions. This short article describes the adaptation of an evidence-based cancer education intervention for implementation in an African American community.

Assessing an intervention to increase knowledge related to cervical cancer and the HPV vaccine.

Human papillomavirus (HPV) infection is the primary risk factor for cervical cancer. While the HPV vaccine significantly reduces the risk of HPV infection and subsequent cervical cancer diagnosis, underuse is linked to lack of knowledge of its effectiveness in preventing cervical cancer. The purpose of this study was to evaluate a cancer educational intervention (titled "MOVENUP") to improve knowledge of cervical cancer, HPV, and the HPV vaccine among predominantly African American communities in South Carolina. The MOVENUP cancer educational intervention was conducted among participants residing in nine South Carolina counties who were recruited by community partners. The 4.5-h MOVENUP cancer educational intervention included a 30-min module on cervical cancer, HPV, and HPV vaccination. A six-item investigator-developed instrument was used to evaluate pre- and post-intervention changes in knowledge related to these content areas. Ninety-three percent of the 276 participants were African American. Most participants reporting age and gender were 50+ years (73%) and female (91%). Nearly half of participants (46%) reported an annual household income <$40,000 and 49% had not graduated from college. Statistically significant changes were observed at post-test for four of six items on the knowledge scale (P<0.05), as compared to pre-test scores. For the two items on the scale in which statistically significant changes were not observed, this was due primarily due to a baseline ceiling effect.

A reproductive justice approach to understanding women's experiences with HPV and cervical cancer prevention.

Cervical cancer is a preventable disease. HPV infection has been linked to more than 90% of cervical cancers. A vaccine to prevent the acquisition of HPV has been available since 2006. The purpose of this study was to investigate women's perceptions of cervical cancer prevention, including HPV vaccination. A reproductive justice framework guided data collection and analysis. In 2016, researchers conducted 70 in-depth, semi-structured qualitative interviews with women aged 19-78 years in South Carolina. A purposive sampling approach was employed to maximize requisite variety based on social, economic, and environmental axes of inequality. Participants self-identified as white (53%), African American (33%), and Hispanic (9%). Data analysis included an inductive constant comparative method to identify patterns and themes across the interviews. Misinformation about the prevalence and risk of HPV and cervical cancer led to "othering" of women with HPV-related diagnoses based on the flawed assumption of not being at risk. Participants described a lack of knowledge about the effectiveness and safety of the HPV vaccine. Social norms influenced participants' perceptions of HPV vaccination and cervical cancer, including concerns about sexual activity and intergenerational communication. Participants' social construction of identity, including race/ethnicity, socioeconomic position, ability, age, gender, sexual orientation, and immigration status, impacted their perceptions of cervical cancer screening and the HPV vaccine. In particular, participants believed that the HPV vaccine was "only for girls" and identified gender norms that limited uptake. Participants described barriers to accessing health care and cervical cancer screening, including cost, health insurance, and life changes (e.g., pregnancy, relocating). Many participants experienced an abnormal Papanicolaou test and described follow-up care, including biopsies and treatment for cervical dysplasia. Findings from this study offer insight into women's identity and perceptions of cervical cancer prevention. Results provide practical recommendations to increase women's agency in the development of successful public health interventions.

Systematic Review of Mammography Screening Educational Interventions for Hispanic Women in the United States.

In the United States (U.S.), Hispanics experience breast cancer disparities. Breast cancer is the leading cause of cancer-related death among Hispanic women, and Hispanic women receive mammography screening at lower rates than some other ethnic groups. This low rate of screening mammography is associated with increased risk for possible late-stage diagnosis and lower survival rates. Educational interventions could play a role in increasing screening mammography rates among Hispanic women. This systematic review synthesized the current literature on educational interventions to increase mammography screening among Hispanic women. The review included studies published between May 2003 and September 2017 with experimental and quasi-experimental interventions to increase mammography screening among Hispanics in the U.S. Five studies out of an initial 269 studies met inclusion criteria for the review. All studies employed an interpersonal intervention strategy with community health workers, or promotoras, to deliver the mammography screening intervention. For each study, odds ratios (OR) were calculated to estimate intervention effectiveness based on similar follow-up time periods. The study ORs resulted in a narrow range between 1.02 and 2.18, indicating a low to moderate intervention effect for these types of interpersonal cancer education interventions. The summary OR for the random effects model was 1.67 (CI 1.24-2.26). Hispanics exhibit lower levels of adherence to screening mammography than non-Hispanic whites. Interpersonal cancer education interventions such as the use of promotoras may help to mediate the impact of barriers to receiving a mammogram such as low health literacy, deficits in knowledge about the benefits of screening, and low awareness of the availability of screening services.

Comparative study of HPV and Cervical Cancer Knowledge and Beliefs between Mexican Immigrant Women in the US and Peruvian Women.

Cervical cancer remains one of the major cancers affecting women from developing countries, especially those from socioeconomically disadvantage backgrounds. In the US, Hispanic immigrant women experience restricted access to health care and higher incidence rates of cervical cancer compared to the non-Hispanic white population. Knowledge of cervical cancer risk factors and symptoms is associated with greater interest in participating in regular cervical cancer screening. To explore knowledge and beliefs about cervical cancer, survey questionnaires were administered to Mexican immigrant women in southeast Georgia, US and to mestizo women - primarily Quechua language dominant speakers - in Cusco, Peru. As part of these survey studies, there was a list of 32 items asking participants to agree or disagree with whether certain symptoms or risk factors could cause cervical cancer and a pile sort of 15 of the most salient items. Cultural consensus analysis was used to calculate overall agreement with a cultural model of cervical cancer risk factor knowledge in each sample independently. For the Georgia sample, there was marginal consensus, but for the Peru sample, there was no consensus. Analysis of cultural competence values and residual agreement show significant differences across education in the Georgia study, with a positive correlation between education and cultural competence (r=0.50, p=0.001), but not in the Peru study. Likewise, the results of the pile sort data exhibited consensus for the Georgia sample for the cervical cancer risk factors, but not for the Peru sample. The lack of consensus among the Peru sample on either task suggests little widespread knowledge on risk factors of cervical cancer. Additional analyses related to factors associated with screening behaviors from the cultural cancer screening scale indicated more pronounced fatalistic beliefs and catastrophic disease expectations about cervical cancer among the Peruvian women compared to the Mexican immigrant women.

HPV Vaccination Communication Messages, Messengers, and Messaging Strategies.

Human papillomavirus (HPV) causes over 39,000 cancers annually in the US. The HPV vaccine is safe and effective but underutilized to prevent cancer. In the US, only 37% of adolescents ages 13-17 have received the full vaccine series. Ineffective messages and misinformation about the vaccine have negatively impacted its uptake in the US. It was initially only approved for girls and early marketing focused on cervical cancer prevention and prevention of HPV as a sexually transmitted infection. Understanding effective messages and methods of dissemination is critical to address suboptimal vaccine uptake. Qualitative interviews were conducted with 34 participants to identify best practices for HPV vaccination messaging in SC. Participants included state leaders representing public health, medical associations, K-12 public schools, universities, insurers, and cancer advocacy organizations. Recommended HPV vaccine messages included focusing on cancer prevention rather than sexual transmission, routinizing the vaccine, and highlighting risks/costs of HPV. Targeting messages to specific demographics and utilizing multiple media platforms to disseminate consistent, scientifically accurate messages were recommended. Strategies such as appealing to parents' moral responsibility to protect their children against cancer and addressing the ubiquity of HPV and sharing growing evidence that HPV may be transmitted independent of sexual activity were also recommended. Suggested HPV vaccine messengers included trusted peers, medical professionals, and health associations. Culture-centered narratives to raise the voices of cancer survivors and parents were also recommended. This study provides an array of HPV vaccination messages and dissemination strategies for optimizing HPV vaccination rates.

Validation of the Farsi version of the medical outcomes study-social support survey for mammography.

BACKGROUND: Social support can provide psychosocial benefits to promote positive health behaviors such as mammography screening. The purpose of this study was to assess the psychometric properties of the Mammography Social Support (MSS) scale among Iranian woman. METHODS: Participants were selected from women referring to healthcare centers in Sanandaj, Iran. A total of 434 questionnaires were completed (response rate 91%). The study sample for study 1 included 204 participants for the Exploratory Factor Analysis (EFA). Construct validity was determined by confirmatory factor analysis (CFA) using a study sample of 230 women in study 2. The reliability coefficient for each scale was calculated using Cronbach's alpha, corrected item-total correlations and test-retest respectively. RESULTS: CFA affirmed the three-factor structure of the MSS in measuring the functional dimensions of social support for mammography behavior consisting of 19 items. Initial results of the CFA did not fully support the proposed three-factor model. After the model was modified, the fit indices indicated, x2 was 2.3, Comparative Fit Index (CFI) = 0.96, Tucker- Lewis Index (TLI) = 0.95 providing a strong fit to the data. Cronbach's alphas for the subscales ranged from 0.82 and 0.90, whereas the alpha for the overall scale was 0.91. The 2-week test-retest reliability of MSS was 0.95. CONCLUSION: This study provides evidence for the psychometric properties to support the Farsi version of the MSS when applied to Iranian women. Exploring the three-factor model in relation to related concepts is suggested for future studies.

Educating Hispanic Women about Cervical Cancer Prevention: Feasibility of a Promotora-Led Charla Intervention in a Farmworker Community.

Hispanic women suffer disproportionately from cervical cancer incidence and mortality compared with non-Hispanic Whites in the United States. Peer-led health education and coaching via charlas (talking circles) may improve cervical cancer screening and early detection rates among specific sub-groups such as farmworker communities. This pilot study sought to collect preliminary evaluation data about the feasibility of implementing a promotora-led cervical cancer education intervention among women from a farmworker community. The study took place between April 2014 and November 2014. Created based on an established network (Tampa Bay Community Cancer Network, TBCCN), in partnership with a local farmworker organization (Farmworkers Self-Help, Inc.), the project entailed refinement of a curriculum guide including Spanish-language educational resources (teaching cards). Social Cognitive Theory and the Health Belief Model provided the conceptual framework for the study. Six women from the farmworker community helped to refine the intervention and were trained as promotoras. They successfully delivered the program via charlas to a total of 60 participants who completed baseline and post-intervention measures on knowledge (cervical cancer/HPV), beliefs, self-efficacy, and intentions. Findings demonstrated gains in knowledge and self-efficacy among charla participants (P<.0001), and support the promise of a community-driven intervention that is delivered by promotoras who use their cultural knowledge and trustworthiness to educate women about cancer screening practices. Results also add to the literature on the use of a charla approach for cancer prevention education within a farmworker community to prompt discussions about health. Future research should evaluate peer-led programs on a larger scale and among other at-risk groups in other community settings.

Correction to: Formative Research on Knowledge and Preferences for Stool-based Tests compared to Colonoscopy: What Patients and Providers Think.

The original version of this article unfortunately contained a mistake. There is a typo in the coauthor name, it should be Franklin G. Berger.

Correlates of Cervical Cancer Screening Adherence Among Women in the U.S.: Findings from HINTS 2013-2014.

Following the latest update of cervical cancer screening guidelines in 2012, we estimate the prevalence of guideline adherent cervical cancer screening and examine its associated factors among a nationally representative sample of US women aged 21-65 years. Our study was based on cross-sectional data from Cycles 3 (2013) and 4 (2014) of the Health Information National Trends Survey. The final analytic sample consisted of 2822 women. Guideline adherent cervical cancer screening was defined as having a Pap test within the last 3 years. Correlates of guideline adherent cervical cancer screening included socio-demographic and health-related characteristics and HPV/cervical cancer-related beliefs and knowledge items. Multivariable logistic regression analyses were used to estimate prevalence of guideline adherent screening. An estimated 81.3% of women aged 21-65 years reported being screened for cervical cancer within the last 3 years. Controlling for sociodemographic and health-related characteristics and survey year, women aged 46-65 years were less likely to be guideline adherent than those aged 21-30 years (aPR = 0.89; 95% CI 0.82-0.97). The adjusted prevalence of adherence was significantly higher among married/partnered than among not married women (aPR = 1.13; 95% CI 1.05-1.22), and those with one to three medical visits (aPR = 1.30; 95% CI 1.14-1.48), and four or more visits in the past year (aPR = 1.26; 95% CI 1.09-1.45) compared to those with no medical visits. Differences in unadjusted prevalence of guideline adherent screening depending on women's beliefs and knowledge about HPV and cervical cancer were not significant in adjusted analyses. Lack of interaction with a healthcare provider, being not married/partnered and increasing age continue to be risk factors of foregoing guideline adherent cervical cancer screening.

Formative Research on Knowledge and Preferences for Stool-based Tests compared to Colonoscopy: What Patients and Providers Think.

The rates of colorectal cancer (CRC) screening in the U.S. remain below national targets, so many people at risk are not being screened. The objective of this qualitative research project was to assess patient and provider knowledge and preferences about CRC screening modalities and specifically the use of the fecal immunochemical test (FIT) as a first line screening choice. Nine focus groups were conducted with a medically underserved patient population and qualitative interviews were administered to their medical providers. Thematic analysis was used to synthesize key findings. Both providers and patients thought that the FIT would be a good option for CRC screening both as an individual choice and for an overall program approach. The test is less expensive and therefore more readily available for patients compared to colonoscopy. Overall, there was consensus that the FIT offers a reasonably priced, simple approach to CRC screening which has broad appeal to both providers and patients. Concerns identified by patients and providers included the possibility of false positives with the FIT which could be caused by test contamination or failing to perform the test properly. Patients also described feelings of disgust toward performing the FIT and difficulties in following the instructions. Study findings indicate provider and patient support for using the FIT for CRC screening at both the individual and system-wide levels of implementation. While barriers to the use of the FIT were listed, benefits of using the FIT were perceived as positive motivators to engage previously unscreened and uninsured or under-insured individuals in CRC screening.