Lifestyle risk factor related disparities in oral cancer examination in the U.S: a population-based cross-sectional study.

BACKGROUND: Oral cancers account for 3% of annual U.S. cancer diagnosis, 2 in 5 of which are diagnosed late when prognosis is poor. The purpose of this study was to report the population-level prevalence of oral cancer examination among adult smokers and alcohol drinkers and assess if these modifiable lifestyle factors are associated with receiving an oral cancer examination. METHODS: Adult participants ≥30 years (n = 9374) of the 2013-2016 cycles of the National Health and Nutrition Examination Survey were included. Oral cancer examination (yes/no), smoking (never, former, current) and alcohol use (abstainers, former, current) were self-reported. Survey-logistic regression estimated odds ratios (OR) and 95% confidence intervals (CIs) of ever and past year oral cancer examination adjusted for age, gender, race/ethnicity, education, income, and time since last dental visit. RESULTS: One third (33%) reported ever been examined for oral cancer, 66% of whom reported an examination in the past year. Adjusted OR (95% CI) of past year examination comparing current and former smokers to non-smokers were 0.51 (0.29, 0.88) and 0.74 (0.53, 1.04) respectively. Similarly, current and former alcohol drinkers relative to abstainers were less likely to report a past year oral cancer examination, OR (95% CI) = 0.84 (0.53, 1.30) and 0.50 (0.30, 0.83) respectively. CONCLUSION: This study showed that smokers and alcohol users were less likely than abstainers to self-report a past year oral cancer examination. Access to affordable and targeted oral cancer examination within the dental care setting might ensure that these high-risk individuals get timely examinations and earlier diagnosis that might improve prognosis and survival.

Communication strategies to reduce cancer disparities: Insights from African-American mother-daughter dyads.

INTRODUCTION: Mothers and daughters share a powerful and unique bond, which has potential for the dissemination of information on a variety of women's health issues, including the primary and secondary prevention of breast and cervical cancer. This study presents formative research from a long-term project examining the potential of mother-daughter communication in promoting cancer screening among African American women. METHOD: Thirty-two mother-daughter pairs (N = 64) completed orally administered surveys regarding their cancer knowledge, beliefs and attitudes, and barriers to care. This study compares the attitudes and beliefs of low-income, urban, African American mothers and their adolescent daughters regarding cervical and breast cancer screening. RESULTS: Both mothers and daughters had fairly high levels of knowledge about breast and cervical cancer. In addition, there was a high concordance rate between mothers' and daughters' responses, suggesting a potential sharing of health knowledge between mother and daughter. DISCUSSION: These results have implications for selecting communication strategies to reduce health disparities, and support that the mother-daughter dyad could be a viable unit to disseminate targeted screening information. (PsycINFO Database Record

Upward communication about cancer screening: adolescent daughter to mother.

Substantial breast and cervical cancer disparities exist in the United States, particularly among African American women with low socioeconomic status. There is considerable potential for discussions about cancer prevention between mothers and daughters. However, upward communication, from child to parent, remains a relatively novel research area, and it remains unclear how receptive mothers would be to messages from their daughter about cancer, a topic that may be considered culturally inappropriate for daughters to initiate. In this study, the authors simulated cancer message delivery to daughters and then conducted direct observation of daughters as they recalled and shared the message with their mother or female elder. The authors found that daughters were able to successfully recall and deliver a cancer appeal to their mother and mothers were generally receptive to this message. Not only did mothers listen to their daughters' appeals, but also daughters' knowledge of cancer was considerably improved by the opportunity to educate her female elder. Moreover, daughters' nonverbal communication suggested a surprisingly relaxed demeanor. The potential of young people to have an effect on the screening behavior of their female elders is very promising in terms of reducing cancer disparities.

Integrating cervical cancer prevention initiatives with HIV care in resource-constrained settings: A formative study in Durban, South Africa.

Cervical cancer screening rates remain suboptimal among women in South Africa (SA), where cervical cancer prevalence is high. The rollout of HIV-related services across SA may provide a means to deliver cervical cancer screening to populations with limited access to health care systems. In this mixed methods study, psychosocial factors influencing cervical cancer prevention and perceptions of the provision of Pap smears in HIV care settings were examined. Structured interviews were conducted with women (n = 67) from a municipal housing estate in Durban, SA. Key informants (n = 12) also participated in semi-structured interviews. Findings revealed that participants had low cervical cancer knowledge, but desired more information. Relevant themes included the normalisation of HIV and beliefs that cervical cancer might be worse than HIV. A comprehensive community clinic was desired by most, even if HIV-positive patients were treated there. This study provides important insight into integrating cervical cancer screening with HIV clinics, which may increase cancer screening among South African women.

Mother-Daughter Dyad Recruitment and Cancer Intervention Challenges in an African American Sample.

Developing an effective youth-based health messaging intervention for African American women, who remain disparately impacted by cancer, presents unique challenges. This paper reports on the challenges with recruiting familial dyads from predominantly low-income, African American neighborhoods, as well as the challenges associated with designing and implementing an upward-directed cancer screening intervention. We developed and pilot tested an educational workshop that provided adolescents with cancer screening information to share with their mother or female relative. Data from follow-up interviews and focus groups, as well as observation records regarding implementation obstacles highlight important lessons learned. The use of familial dyads as well as issues of access posed challenges for recruitment and follow-up. Workshop-related challenges stemmed from the approach, content and length. Finally, personal and environmental factors presented barriers to adolescent message delivery and adult follow-through. By identifying these challenges, we hope to influence and enable the future development of effective adolescent-initiated health messaging interventions.

Young Women's Sexual and Reproductive Health Post HPV Vaccination.

In the present study the authors sought to explore, in greater depth, the impact that HPV vaccination has on college-aged women's reproductive and sexual health. Qualitative interviews were conducted with 30 HPV-vaccinated, college women and analyzed for reoccurring themes. Although findings revealed that women's HPV-related knowledge was suboptimal, most women correctly believed that they were still at risk for HPV after having received the vaccination. Women indicated that having the HPV vaccine made them more aware of sexually transmitted infections and prompted them to continue to take care of their sexual health. Women reported that having the HPV vaccine did not influence their condom use or birth control choices, and they believed that obtaining Pap smears was still important. These results help us to understand the impact of HPV vaccination on women's reproductive and sexual health. These findings are promising and reinforce the importance of educating women about behaviors that will help them maintain reproductive and sexually healthy lives.

Community-engaged research: cancer survivors as community researchers.

The personal rewards and challenges experienced by community researchers are not well explored. Training laypersons to be engaged in some or all aspects of community-engaged research is becoming more common, highlighting the need to understand the challenges associated with this role. The complexities of this role are magnified when the layperson has multiple identities of overlap with the research participant. In this brief report, we explore the rewards and challenges reported by 8 cancer survivors and 2 cancer caregivers who conducted interviews with 32 other survivors, caregivers, and health care professionals. We report specifically on data from their exit interviews regarding the experience of being a community researcher conducting research on a subject matter that was very personal. Overall, being a community researcher was a rewarding experience that allowed them to reflect critically on their own personal path and cancer experiences. Importantly, this role provided them with insights into cancer and other disparities in their community beyond their own situation.

From adolescent daughter to mother: exploring message design strategies for breast and cervical cancer prevention and screening.

Early detection of breast and cervical cancers is one preventive behavior that may provide the adolescent daughter with a unique opportunity to provide encouragement to her mother or guardian to obtain screening. This study explored the design strategies necessary for developing an effective daughter-initiated message about screening for breast and cervical cancers. Thirty-two (N = 64) African-American mother-daughter dyads were interviewed about parenting style, goodwill, and daughters' credibility and risk behaviors that might influence receptivity toward a screening appeal. Mothers indicated that a tailored, emotional appeal combined with cancer facts delivered in a private setting would be most effective. Daughters were perceived as highly credible messengers and were perceived to have high levels of goodwill toward their mothers, regardless of risk behaviors.

Opportunities to reduce cancer barriers: community town halls and provider focus groups.

This paper presents the findings from town hall meetings held with community residents and focus groups with health care providers. A total of five town halls (N = 139) were conducted. Four were conducted in English and a fifth was conducted in Spanish to obtain the input of the local Hispanic community. Surveys were provided to town hall participants to assess their perceptions of cancer and screening as well as their cancer screening behaviors. Participants were asked questions designed to determine local gaps and needs in health and cancer care, and their attitudes regarding breast cancer resources, education, treatment, and clinical trials. Additionally, four focus groups (N = 45) were held with a wide range of providers to obtain their perspectives on barriers to breast cancer screening, local cancer prevention and care, and clinical trials. Results indicate gaps in local resources and support services, particularly in terms of education and integrated care.

Health promotion and cervical cancer in South Africa: why adolescent daughters can teach their mothers about early detection.

The notion that adolescent daughters can provide their mothers with health information that could actually impact the mothers' behavior is a novel area of health promotion research. The goal of this study is to explore the reasons why adolescent daughters would give their mothers cervical cancer information, and why mothers would have the intent to listen to advice to obtain a Pap smear. We randomly selected and interviewed 157 mother and daughter dyads in Cape Town, South Africa. Almost one-fourth of mothers (22%) indicated never having had a Pap smear, while 92% of their daughters said their mother has never talked to them about cervical cancer or a Pap smear. Willingness of daughters to ask their mothers to obtain a Pap smear was high (80%). Motivations included the important health benefit and the sense of responsibility to share life saving information. Most mothers said they would definitely obtain a Pap smear when advised by their daughter (74%), while 25% said they would have to think about it and 1% said they would not listen. Mothers' main motivations included the direct health benefit and a strong sense of duty and responsibility to listen to her daughter. This study provides important information about the reasons why an upward (child to parent) health intervention may be feasible. The values of duty and responsibility, especially as it manifests within the family, hold promise for informing health promotion interventions directed at multiple generations.

Needs of low-income african american cancer survivors: multifaceted and practical.

This study aimed to identify the needs of low-income, African American cancer survivors in an urban setting. Data were collected from semi-structured interviews conducted with cancer survivors (n = 12), caregivers (n = 10), professionals (n = 10), and surveys from town hall meetings (n = 80). The major needs identified, across all groups, included a diverse array of practical needs including transportation, financial and job assistance, childcare, self-care assistance, more education and lifestyle information when diagnosed as well as after diagnosis, better post treatment plan, and more need for social support. They identified the ideal resource center as being located within the survivor's neighborhood and would provide a range of medically specific support as well as recreational services. Being of limited economic means has a host of implications for those diagnosed with cancer and for their family members. Participants suggested that needs for cancer survivors have to take into account a complexity of factors including culture, family, and especially economic implications.

Community researchers conducting health disparities research: Ethical and other insights from fieldwork journaling.

Lay persons who are trained to conduct research in their own communities form an essential part of many research projects. However, the effects of conducting research in their own communities have not been adequately explored. This paper examines the experiences, perceptions, and challenges faced by a group of community researchers during their involvement in a research project that examined if, and how, the relationships between mothers and their adolescent daughters could be harnessed to develop a daughter-initiated cervical cancer intervention. Seven community researchers interviewed 157 mother-daughter pairs in Cape Town, South Africa. We examine the use of journaling as a tool to document the experiences of community researchers, and we consider how journaling may help the community-based researcher grapple with the research process, and, more broadly, what such journal content illustrates with respect to the nature and challenges of community-engaged health research. An analysis of the content of the journals provides a strong indication of how personal and intimate the research process can be for community researchers by virtue of the background that they bring into the process as well as the additional weight of the research process itself. The complexities of navigating dual and somewhat oppositional roles - the role of impartial scientist or researcher and the role of invested community person - has been both underestimated and insufficiently researched.

Photovoice: a needs assessment of African American cancer survivors.

The goal of this research was to understand the barriers and challenges that African American cancer survivors experience after being diagnosed with cancer. The authors provided 20 cancer survivors and caregivers with cameras to take pictures of their needs right after they were diagnosed with cancer. Most importantly, a major theme that arose from the participants' responses was the lack of culturally-specific support services located within their neighborhoods. Other needs included lack of social support, a lack of resources related to appearance, a lack of resources for continued care, and especially a lack of support services for children of survivors.

Cancer perceptions of South African mothers and daughters: implications for health promotion programs.

Cancer is one of the leading causes of death worldwide. A major reason why women do not obtain cancer screening procedures relates to the high levels of fear associated with cancer. In this study, we explored South African mothers' and daughters' reaction to the word "cancer" specifically. The study sample included 157 randomly selected mother and adolescent daughter pairs from an urban community in Cape Town, South Africa. Mothers and their adolescent daughters had very similar responses to the term "cancer." We found that most South African mothers and daughters had a fear-based attitude toward the illness. When we asked mothers what they immediately thought of upon hearing "cancer," a majority of women (69%) thought of death, and another 43% thought of suffering and the detrimental consequences of the illness. Similarly, 50% of the daughters also thought of death, and 42% thought of the detrimental aspects of cancer. Fatalistic attitudes and negative emotional reactions have important implications in cancer prevention and need to be addressed within a public health context.

The mother-daughter health collaborative: a partnership development to promote cancer education.

Creating meaningful partnerships with community partners to address cancer disparities remain challenging and a work in progress. This paper examines what started as the traditional formation of an academic-community partnership and evolved well beyond the initial research tasks. We evaluate the partnership process, which includes assessments by the members of the Mother-Daughter Health Collaborative, focusing on how partnership involvement in the data analysis process contributed to a sense of ownership and urgency about providing cancer education. The work of partnership is on-going, fluid, and challenging.

Cervical cancer attitudes and beliefs-a Cape Town community responds on World Cancer Day.

BACKGROUND: Attitudes and beliefs affect women's cervical cancer screening behavior. Methods. We surveyed 228 women in Cape Town, South Africa about their screening history, knowledge, beliefs, and access barriers regarding Papanicolaou (Pap) smears and cervical cancer. RESULTS: More than half of the participants had never had a Pap smear or had 1 more than 10 years ago. One third did not know what a Pap smear was. Lengthy wait times and fatalistic beliefs also affected screening behavior. Ethnicity was associated with differences in beliefs. CONCLUSIONS: Opportunistic cancer screening events are an effective way that women can obtain Pap smears and cancer education.

"I have never heard that one": young girls' knowledge and perception of cervical cancer.

With the advent of a vaccine for the human papillomavirus (HPV), many are claiming that cervical cancer may become a health worry of the past. While the vaccine certainly represents an important step forward in the fight against HPV and cervical cancer, it does not diminish the importance of health education or screening interventions particularly amongst adolescents. This study explores the existing state of cancer and cervical cancer knowledge of Latina and African American adolescent girls from low-income, urban neighborhoods. We found that the study participants expressed a range of attitudes toward cancer. Knowledge of cancer also was varied and somewhat anecdotal, showing no unified body of knowledge, but instead representing an assemblage of information culled from formal and informal sources. Participants were most familiar with breast and lung cancer and mentioned these types of cancer most frequently in the focus groups. Most participants had never heard of cervical cancer, while a few were familiar with several aspects of the disease. Cancer knowledge seemed to be gleaned mostly from personal stories, perhaps suggesting the pervasiveness of cancer incidence in their community. The predominant attitudes expressed toward cancer included fear, uncertainty, and anxiety. Our findings suggest that considerable continued health promotion efforts are needed to improve knowledge about cancer in general, and particularly about cervical cancer, to reduce fear and to highlight the effectiveness of prevention and screening.

Ethical challenges in the design and conduct of locally relevant international health research.

In this paper, we consider some of the challenges associated with the ethical need to conduct locally relevant international health research. We examine a cervical cancer research initiative in a resource-poor community in South Africa, and consider the extent to which this research was relevant to the expressed needs and concerns of community members. Results from informal discussions and a series of 27 focus groups conducted in the community provide insight into the community's needs and concerns, and its recommendations for how the research could be made more relevant to the community. We discuss these findings in the context of recent theory and literature on the role of community engagement in promoting local relevance and responsiveness in community-based health research. We anticipate that the paper's findings may help international health researchers better identify and assess the challenges of conducting locally relevant research across major global gaps in wealth and health.

Community-based participatory research (CBPR) in South Africa: engaging multiple constituents to shape the research question.

Community engagement is an on-going, arduous, and necessary process for developing effective health promotion programs. The challenges are amplified when the particular health issue or research question is not prominent in the consciousness of the targeted community. In this paper, we explore the community-based participatory research (CBPR) model as a means to negotiate a mutual agenda between communities and researchers. The paper is focused on the (perceived) need for cervical cancer screening in an under-resourced community in Cape Town, South Africa. Cervical cancer is a significant health problem in this community and elsewhere in South Africa. Unlike HIV-AIDS, however, many Black South Africans have not been educated about cervical cancer and the importance of obtaining screening. Many may not consider screening a priority in their lives. Our research included extensive consultations and informal interviews with diverse community and regional stakeholders. Following these, we conducted 27 focus groups and 106 demographic surveys with randomly selected youth, parents, local health care personnel, educators and school staff. Focus group data were summarized and analyzed cross-sectionally. Community stakeholders were involved throughout this research. Our consultations, interviews, and focus group data were key in identifying the concerns and priorities of the community. By engaging community stakeholders, we developed a research framework that incorporated the community's concerns and priorities, and stressed the intersecting roles of poverty, violence, and other cultural forces in shaping community members' health and wellbeing. Community members helped to refocus our research from cervical cancer to 'cervical health,' a concept that acknowledged the impact on women's bodies and lives of HIV-AIDS and STDs, sexual violence, poverty, and multiple social problems. We conclude that the research agenda and questions in community-based health research should not be considered immutable. They need to be open to negotiation, creativity, and constant reinvention.