Using Participatory Implementation Science to Advance Health Equity.

Participatory approaches to implementation science (IS) offer an inclusive, collaborative, and iterative perspective on implementing and sustaining evidence-based interventions (EBIs) to advance health equity. This review provides guidance on the principles and practice of participatory IS, which enables academic researchers, community members, implementers, and other actors to collaboratively integrate practice-, community-, and research-based evidence into public health and health care services. With a foundational focus on supporting academics in coproducing knowledge and action, participatory IS seeks to improve health, reduce inequity, and create transformational change. The three main sections of this review provide (a) a rationale for participatory approaches to research in implementation science, (b) a framework for integrating participatory approaches in research utilizing IS theory and methods, and (c) critical considerations for optimizing the practice and impact of participatory IS. Ultimately, participatory approaches can move IS activities beyond efforts to make EBIs work within harmful systems toward transformative solutions that reshape these systems to center equity.

Priority skills for equity-focused, evidence-based cancer control in community-based organizations: A group concept mapping analysis with academics and practitioners.

Introduction: Community-based organizations (CBOs) are important equity-promoting delivery channels for evidence-based interventions (EBIs). However, CBO practitioners often cannot access needed support to build EBI skills. Additionally, the capacity-building literature is hindered by inconsistent definitions, limited use of validated measures, and an emphasis on the perspectives of EBI developers versus implementers. To address these gaps, we explored commonalities and differences between CBO practitioners and academics in conceptualizing and prioritizing core EBI skills. Methods: We utilized Group Concept Mapping, a mixed-methods approach connecting qualitative data (e.g., regarding the range of critical EBI skills) and quantitative data (e.g., sorting and ranking data regarding unique skills) to create conceptual maps integrating perspectives from diverse participants. A total of 34 practitioners and 30 academics working with cancer inequities participated in the study. Results: Participants nominated 581 core skills for EBI use, and our team (including practitioners and academics) identified 98 unique skills from this list. Participants sorted them into conceptual groups, yielding five clusters: (1) using data and evaluation, (2) selecting and adapting EBIs, (3) connecting with community members, (4) building diverse and equitable partnerships, and (5) managing EBI implementation. The ordering of importance and presence of skill clusters were similar across groups. Overall, importance was rated higher than presence, suggesting capacity gaps. Conclusions: There are helpful commonalities between practitioners' and academics' views of core EBI skills in CBOs and apparent capacity gaps. However, underlying patterns suggest that differences between the groups' perceptions warrant further exploration.

Ea$ing into the USA: study protocol for adapting the Economic and Social Empowerment (EA$E) intervention for US-based, forcibly based populations.

INTRODUCTION: Immigrant and forcibly displaced women and girls are disproportionately impacted by the harmful health consequences of intimate partner violence (IPV) in the USA. Economic and Social Empowerment (EA$E), a women's protection and empowerment intervention, has shown promising reductions in IPV and gender inequities among forcibly displaced populations (FDPs) in low-income and middle-income countries. However, research on the integration of gender equity interventions into economic empowerment programming for FDPs within the USA is lacking. Additionally, there is growing interest in integrating gender equity programmes among US-based refugee resettlement organisations, including the International Rescue Committee (IRC). We describe our study protocol for examining the feasibility, acceptability and appropriateness of EA$E for use with US-based FDPs, and recommendations for adaptation. METHODS AND ANALYSIS: This is a convergent parallel study to guide the adaptation of EA$E for use with US-based FDPs. Mixed methods (quantitative and qualitative) will be used for the adaptation research. Quantitative data will consist of brief surveys, and qualitative data will consist of focus group discussions (FGDs). Our research will be guided by the 'administration' phase of the ADAPT-ITT framework, which entails pretesting the intervention with the new target audience and implementation context to examine acceptability, appropriateness and feasibility to receive feedback to inform modifications of the original intervention. This is done via theatre testing, an innovative approach to pretesting that allows the new target audience to experience the intervention and provide feedback. We will conduct FGDs with IRC staff (n=4, total of 24 participants) and refugee clients (n=8, total of 48 participants, women and men, French and English speaking). ETHICS AND DISSEMINATION: The study has received approval from the George Mason University Human Subjects Committee (#1686712-7) and IRC (via reliance agreement). Results will be made available to refugee resettlement organisations, policymakers, funders and other researchers. This study has been registered in Open Science Framework (https://doi.org/10.17605/OSF.IO/SZDVY).

Associations between sociodemographic factors and receiving "ask and advise" services from healthcare providers in India: analysis of the national GATS-2 dataset.

BACKGROUND: India is home to about 12% of the world's tobacco users, with about 1.35 million tobacco-related deaths each year. The morbidity and mortality rates are socially patterned based on gender, rural vs. urban residence, education, and other factors. Following the World Health Organization's guidance, it is critical to offer tobacco users support for cessation as a complement to policy and environmental changes. Such guidance is typically unavailable in low-resource systems, despite the potential for population-level impact. Additionally, service delivery for tobacco control tends to be patterned by sociodemographic factors. To understand current activity in this area, we assessed the percentage of daily tobacco users being asked about tobacco use and advised to quit by a healthcare provider. We also examined social patterning of receipt of services (related to by rural vs. urban residence, age, gender, education, caste, and wealth). METHODS: We analyzed cross-sectional data from India's 2016-2017 Global Adult Tobacco Survey (GATS-2), a nationally representative survey. Among 74,037 respondents, about 25% were daily users of smoked and/or smokeless tobacco. We examined rates of being asked and advised about tobacco use overall and based on rural vs. urban residence, age, gender, education, caste, and wealth. We also conducted multivariate logistic regression to assess the association of demographic and socioeconomic conditions with participants' receipt of "ask and advise" services. RESULTS: Nationally, among daily tobacco users, we found low rates of individuals reporting being asked about tobacco use or advised to quit by a healthcare provider (22% and 19%, respectively). Being asked and advised about tobacco use was patterned by age, gender, education, caste, and wealth in our final regression model. CONCLUSIONS: This study offers a helpful starting point in identifying opportunities to address a critical service delivery gap in India. Given the existing burden on the public health and health systems, scale-up will require innovative, resource-appropriate solutions. The findings also point to the need to center equity in the design and scale-up of tobacco cessation supports so that marginalized and underserved groups will have equitable access to these critical services.

Measuring capacity to use evidence-based interventions in community-based organizations: A comprehensive, scoping review.

Introduction: Community-based organizations (CBOs) are well-positioned to incorporate research evidence, local expertise, and contextual factors to address health inequities. However, insufficient capacity limits use of evidence-based interventions (EBIs) in these settings. Capacity-building implementation strategies are popular, but a lack of standard models and validated measures hinders progress in the field. To advance the literature, we conducted a comprehensive scoping review. Methods: With a reference librarian, we executed a comprehensive search strategy of PubMed/Medline, Web of Science Core Collection, and EBSCO Global Health. We included articles that addressed implementation science, capacity-building, and CBOs. Of 5527 articles, 99 met our inclusion criteria, and we extracted data using a double-coding process. Results: Of the 99 articles, 47% defined capacity explicitly, 31% defined it indirectly, and 21% did not define it. Common concepts in definitions were skills, knowledge/expertise, and resources. Of the 57 articles with quantitative analysis, 48 (82%) measured capacity, and 11 (23%) offered psychometric data for the capacity measures. Of the 99 studies, 40% focused exclusively on populations experiencing inequities and 22% included those populations to some extent. The bulk of the studies came from high-income countries. Conclusions: Implementation scientists should 1) be explicit about models and definitions of capacity and strategies for building capacity, 2) specify expected multi-level implementation outcomes, 3) develop and use validated measures for quantitative work, and 4) integrate equity considerations into the conceptualization and measurement of capacity-building efforts. With these refinements, we can ensure that the necessary supports reach CBO practitioners and critical partners for addressing health inequities.

Grounding implementation science in health equity for cancer prevention and control.

BACKGROUND: The past decade of research has seen theoretical and methodological advances in both implementation science and health equity research, opening a window of opportunity for facilitating and accelerating cross-disciplinary exchanges across these fields that have largely operated in siloes. In 2019 and 2020, the National Cancer Institute's Consortium for Cancer Implementation Science convened an action group focused on 'health equity and context' to identify opportunities to advance implementation science. In this paper, we present a narrative review and synthesis of the relevant literature at the intersection of health equity and implementation science, highlight identified opportunities (i.e., public goods) by the action group for advancing implementation science in cancer prevention and control, and integrate the two by providing key recommendations for future directions. DISCUSSION: In the review and synthesis of the literature, we highlight recent advances in implementation science, relevant to promoting health equity (e.g., theories/models/frameworks, adaptations, implementation strategies, study designs, implementation determinants, and outcomes). We acknowledge the contributions from the broader field of health equity research and discuss opportunities for integration and synergy with implementation science, which include (1) articulating an explicit focus on health equity for conducting and reviewing implementation science; (2) promoting an explicit focus on health equity in the theories, models, and frameworks guiding implementation science; and (3) identifying methods for understanding and documenting influences on the context of implementation that incorporate a focus on equity. To advance the science of implementation with a focus on health equity, we reflect on the essential groundwork needed to promote bi-directional learning between the fields of implementation science and health equity research and recommend (1) building capacity among researchers and research institutions for health equity-focused and community-engaged implementation science; (2) incorporating health equity considerations across all key implementation focus areas (e.g., adaptations, implementation strategies, study design, determinants, and outcomes); and (3) continuing a focus on transdisciplinary opportunities in health equity research and implementation science. We believe that these recommendations can help advance implementation science by incorporating an explicit focus on health equity in the context of cancer prevention and control and beyond.

Enabling community input to improve equity in and access to translational research: The Community Coalition for Equity in Research.

Background: The COVID vaccine trials illustrated the critical need for the development of mechanisms to serve as a bridge between least advantaged communities and researchers. Such mechanisms would increase the number of studies that are designed with community needs and interests in mind, in ways that will close gaps rather than widen them. This paper reports on the creation of the Community Coalition for Equity in Research, a community-driven resource designed to build community capacity to provide researchers with credible and actionable input on study design and implementation and increase researchers' understanding of factors that influence community support of research. Methods and Results: We provide a description of the Coalition's structure and process and an evaluation of its first year of operation. Researchers rated their experience very positively and reported that the Coalition's review will improve their research. Coalition members reported high levels of satisfaction with their participation and the processes set up for them to engage with researchers. Members also largely agreed that their participation has value for their community, and that it has increased their interest in research and the likelihood that they would recommend research participation to others. Conclusions: The Coalition represents a model for increasing two-way engagement between researchers and the larger community. We are optimistic that the Coalition will continue to develop and grow into a vibrant entity that will bring value to both investigators and our local communities and will increase the consideration of equity as a foundational principle in all translational research.

Overlooked Potential of Business-Inclusive Networks to Amplify Anchoring Activity Impact.

Mobilizing anchor institutions to promote community health and wellbeing is gaining prominence as an approach to systems change. Anchors are often conceptualized as large, locally rooted, nonprofits that leverage their resources for local benefit. However, existing literature underemphasizes 2 opportunities to enhance the systemic impact of anchoring activity: (1) coordinated action by anchoring networks that include diverse, multi-level stakeholders-a hallmark of health promotion and (2) the potential contributions of the business sector to anchoring networks. Our perspective describes the significance of both for amplifying anchoring impact and identifies critical questions for enabling action.

The Prevalence of Dissemination and Implementation Research and Training Grants at National Cancer Institute-Designated Cancer Centers.

Background: Dissemination and implementation (D&I) research is a key factor in the uptake and use of evidence-based cancer control interventions. National Cancer Institute (NCI)-designated cancer centers are ideal settings in which to further D&I knowledge. The purpose of this study was to summarize the characteristics of NCI-funded D&I science grants in the nation's cancer centers to understand the nature, extent, and opportunity for this key type of translational work. Methods: We used the National Institutes of Health Research Portfolio Online Reporting Tool to identify active NCI-funded grants in D&I science at NCI clinical cancer centers (n = 13) and comprehensive cancer centers (n = 51) as well as their academic affiliates. Active projects were eligible for inclusion if they 1) were awarded directly to an NCI cancer center or an academic or research affiliate, and 2) identified D&I content in the abstract. Portfolio data were collected in February 2021. Results: We identified 104 active NCI-funded D&I research or training grants across the 64 cancer centers; 57.8% of cancer centers had at least 1 NCI-funded D&I grant. Most awards (71.1%) were for research grants. Training grants constituted 29.1% of D&I-focused grants. Overall, 50.0% of grants (n = 52) concentrated on specific cancers. Almost two-thirds of grants (n = 68, 65.4%) had a stated health equity focus. Conclusions: More than one-half of NCI-designated cancer centers have active funding in D&I science, reflecting a substantial investment by NCI. There remains considerable room for further development, which would further support NCI's translational mission.

A model for sustainable, partnership-based telehealth services in rural India: An early process evaluation from Tuver village, Gujarat.

BACKGROUND: Telehealth can improve access to high-quality healthcare for rural populations in India. However, rural communities often have other needs, such as sanitation or employment, to benefit fully from telehealth offerings, highlighting a need for systems-level solutions. A Business of Humanity approach argues that innovative solutions to wicked problems like these require strategic decision-making that attends to a) humaneness, e.g., equity and safety and b) humankind, or the needs and potential of large and growing markets comprised of marginalized and low-income individuals. The approach is expected to improve economic performance and long-term value creation for partners, thus supporting sustainability. METHODS: A demonstration project was conducted in Tuver, a rural and tribal village in Gujarat, India. The project included seven components: a partnership that emphasized power-sharing and complementary contributions; telehealth services; health promotion; digital services; power infrastructure; water and sanitation; and agribusiness. Core partners included the academic partner, local village leadership, a local development foundation, a telehealth provider, and a design-build contractor. This early process evaluation relies on administrative data, field notes, and project documentation and was analyzed using a case study approach. RESULTS: Findings highlight the importance of taking a systems perspective and engaging inter-sectoral partners through alignment of values and goals. Additionally, the creation of a synergistic, health-promoting ecosystem offers potential to support telehealth services in the long-term. At the same time, engaging rural, tribal communities in the use of technological advances posed a challenge, though local staff and intermediaries were effective in bridging disconnects. CONCLUSION: Overall, this early process evaluation highlights the promise and challenges of using a Business of Humanity approach for coordinated, sustainable community-level action to improve the health and well-being of marginalized communities.

Qualitative Research Methods in Chronic Disease: Introduction and Opportunities to Promote Health Equity.

Public health research that addresses chronic disease has historically underutilized and undervalued qualitative methods. This has limited the field's ability to advance (a) a more in-depth understanding of the factors and processes that shape health behaviors, (b) contextualized explanations of interventions' impacts (e.g., why and how something did or did not work for recipients and systems), and (c) opportunities for building and testing theories. We introduce frameworks and methodological approaches common to qualitative research, discuss how and when to apply them in order to advance health equity, and highlight relevant strengths and challenges. We provide an overview of data collection, sampling, and analysis for qualitative research, and we describe research questions that can be addressed by applying qualitative methods across the continuum of chronic disease research. Finally, we offer recommendations to promote the strategic application of rigorous qualitative methods, with an emphasis on priority areas to enhance health equity across the evidence generation continuum.

Factors Influencing Implementation of a Workplace Tobacco Cessation Intervention in India: A Qualitative Exploration.

BACKGROUND: Tobacco use is projected to cause more than 8 million deaths annually worldwide by 2030 and is currently linked to 1 million annual deaths in India. Very few workplaces provide tobacco cessation as a part of occupational health in India. In this study, we examined promoters and barriers to implementing an evidence-based tobacco cessation program in a workplace setting in India. METHODS: In-depth interviews were conducted with all facilitators (two program coordinators and four counselors) of a workplace tobacco cessation intervention covering implementation efforts in five organizations, including three manufacturing units and two corporate settings. FINDINGS: The identified promoters for implementation of the program were as follows: (a) workplaces that provided access to many individuals, (b) high prevalence of tobacco use that made the intervention relevant, (c) core components (awareness sessions, face-to-face counseling and 6-months follow-up) that were adaptable, (d) engagement of the management in planning and execution of the intervention, (e) employees' support to each other to quit tobacco, (f) training the medical unit within the workplace to provide limited advice, and (g) efforts to advocate tobacco-free policies within the setting. Barriers centered around (a) lack of ownership from the workplace management, (b) schedules of counselors not matching with employees, (c) nonavailability of employees because of workload, and (d) lack of privacy for counseling. CONCLUSION/IMPLICATIONS FOR PRACTICE: This study provided practical insights into the aspects of planning, engaging, executing and the process of implementation of a tobacco cessation intervention in a workplace setting. It provided guidance for an intervention within occupational health units in similar settings.

Network-Based Delivery and Sustainment of Evidence-Based Prevention in Community-Clinical Partnerships Addressing Health Equity: A Qualitative Exploration.

Background: Increased delivery of evidence-based preventive services can improve population health and increase health equity. Community-clinical partnerships offer particular promise, but delivery and sustainment of preventive services through these systems face several challenges related to service integration and collaboration. We used a social network analysis perspective to explore (a) the range of contributions made by community-clinical partnership network members to support the delivery of evidence-based preventive services and (b) important influences on the ability of these partnerships to sustain service delivery. Methods: Data come from an implementation evaluation of the Prevention and Wellness Trust Fund initiative, which supported nine Massachusetts communities to coordinate delivery of evidence-based prevention and address inequities in hypertension, pediatric asthma, falls among older adults, or tobacco use. In 2016, we conducted semi-structured interviews with (a) leadership teams representing nine community-level partnerships and (b) practitioners from four high-implementation partnerships (n = 23). We managed data using NVivo11 and utilized a framework analysis approach. Results: Key network contributions for delivery of evidence-based preventive services included creating referrals, delivering services, providing links to community members, and administration and leadership. Less emphasized contributions included wraparound services, technical assistance, and venue provision. Implementers from high-implementation partnerships also highlighted contributions such as program adaptation, creating buy-in, and sharing information to improve service delivery. Expected drivers of program sustainability included the ability to develop a business case, ongoing network facilitation, technology support, continued integrated action, and sufficient staffing to maintain programming. Conclusion: The study highlights the need to take a long-term, infrastructure-focused approach when designing community-clinical partnerships. Strategic partnership composition, including identifying sources of necessary network contributions, in conjunction with efforts from the outset to link systems, align effort, and build a long-term funding structure can support the required coordinated action around preventive services needed to improve health equity.

Designing Capacity-Building Supports to Promote Evidence-Based Programs in Community-Based Organizations Working with Underserved Populations.

BACKGROUND: It is critical to build capacity to use evidence-based health promotion programs in community-based organizations (CBOs), particularly those working with underserved populations. Packages of ongoing capacity-building supports seem to be critical, but it is not clear how best to design and deploy them. OBJECTIVES: PLANET MassCONECT was a participatory research project to increase capacity for the use of evidence-based programs (EBPs) among CBO staff members in three Massachusetts communities experiencing health disparities. We assessed the impact of trainee engagement with capacity-building supports on the use of a systematic approach to program planning. METHODS: Trainees were enrolled from 2010 to 2012 and engaged until 2014. The intervention started with a workshop and included ongoing capacity-building supports (a customized web portal and resources, networking events, minigrants, and technical assistance). Logistic regression was used to examine the relationship between trainee engagement with capacity-building supports offered after the workshop and key outcomes at year 1. RESULTS: Of the capacity-building supports offered after the workshop, the web portal was the most popular. Higher use of systematic program planning approaches in the first year was predicted by web portal use (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.04-8.67; p = 0.04), and participation in the minigrant process (OR, 5.40; 95% CI, 1.09-28.69; p = 0.04). Separately, high intention to use systematic approaches for program planning was predicted by web portal use (OR, 3.47; 95% CI, 1.27-9.52; p = 0.02). CONCLUSIONS: Ongoing capacity-building supports may promote EBP planning in CBOs, but institutional constraints may limit practitioners' ability to engage with such supports.

Graphic and Arousing? Emotional and Cognitive Reactions to Tobacco Graphic Health Warnings and Associated Quit-Related Outcomes Among Low SEP Population Groups.

Research on graphic health warnings (GHWs) indicates that beyond changing cognitions about the health effects of smoking, GHWs evoke emotional reactions that can influence quit-related outcomes. Emotions can be classified based on valence (positive or negative) and arousal (calm or excited). However, although considerable research has examined the differential effectiveness of positive versus negative GHW-evoked emotions, research investigating the role of arousal activation in quit-related behaviors is scarce. This study examined associations between quit-related outcomes (intention and attempt to quit) and GHWs-evoked negative emotions classified as high and low in arousal activation as well as cognitive reactions among smokers of low socioeconomic position (SEP). It also examined whether perceived health risks of smoking moderate the relationship between emotional and cognitive reactions to GHWs and quit-related outcomes. Data were collected from low SEP smokers in three Massachusetts communities. Participants were screened and randomized to view one of the nine GHWs initially proposed for use by the U.S. Food and Drug Administration (FDA) and answered pre- and post-exposure questions. Results showed that GHW-evoked negative emotions high in arousal activation and cognitive reactions were both significantly associated with intention to quit during immediate post-test, controlling for age, warning label difference, and prior quit intention. However, these associations did not hold for quit attempts at follow-up. Perceived health risks of smoking moderated the association between cognitive reactions to GHWs and quit attempts at follow-up. The findings suggest that not all negative emotions evoked by GHWs are effective. Negative emotions high in arousal activation may be more effective in influencing quit-related behavioral intentions in low SEP groups. Additionally, unlike emotional reactions, cognitive reactions to GHWs may have effects that last relatively longer, but only among smokers who had low levels of perceived health risks of smoking at baseline.

Building practitioner networks to support dissemination and implementation of evidence-based programs in community settings.

Insufficient capacity to use evidence-based programs (EBPs) limits the impact of community-based organizations (CBOs) to improve population health and address health disparities. PLANET MassCONECT was a community-based participatory research (CBPR) project conducted in three Massachusetts communities. Researchers and practitioners co-created an intervention to build capacity among CBO staff members to systematically find, adapt, and evaluate EBPs. The project supported development of trainee social networks and this cross-sectional study examines the association between network engagement and EBP usage, an important goal of the capacity-building program. Trainee cohorts were enrolled from June 2010 to April 2012 and we collected community-specific network data in late 2013. The relationship of interest was communication among network members regarding the systematic approach to program planning presented in the intervention. For Communities A, B, and C, 39/59, 36/61, and 50/59 trainees responded to our survey, respectively. We conducted the full network analysis in Community C. The average degree, or number of connections with other trainees, is a useful marker of engagement; respondents averaged 6.6 reported connections. Degree was associated with recent use of EBPs, in a linear regression, adjusting for important covariates. The results call for further attention to practitioner networks that support the use of research evidence in community settings. Consideration of key contextual factors, including resource levels, turnover rates, and community complexity will be vital for success.

Graphic health warnings as activators of social networks: A field experiment among individuals of low socioeconomic position.

RATIONALE: Graphic health warnings (GHWs) on cigarette packages present an important tobacco control opportunity, particularly for vulnerable populations suffering a disproportionate tobacco burden. One mechanism by which GHWs may influence smoking outcomes is by prompting interpersonal discussions within health discussion networks (the set of personal contacts with whom an individual discusses health issues). OBJECTIVE: The study examined the association between GHW-prompted conversations within health discussion networks and key tobacco-related outcomes, with attention to valence and content of the discussions. METHOD: Between August 2013 and April 2014, we recruited 1200 individuals from three communities in Massachusetts, emphasizing recruitment of individuals of low socioeconomic position (SEP) and members of other selected vulnerable groups. Respondents were exposed to the nine GHWs proposed by the FDA in 2011, asked a series of questions, and assessed at follow-up a few weeks later. RESULTS: A total of 806 individuals were included in this analysis. About 51% of respondents reported having a health discussion network, with significantly lower reports among African-Americans and Hispanics compared to Whites. Around 70% of respondents (smokers and nonsmokers) with health discussion networks reported having one or more conversations about the GHWs with network members, the bulk of which were negative and focused on warning others about smoking. For smokers, we found a small but positive association between the percentage of network conversations that were negative and reports of quit attempts. CONCLUSION: The results point to a potential mechanism by which GHWs may impact tobacco-related outcomes, prompting further inquiry into the role of health discussion networks (and discussion networks, more broadly) in tobacco control among low SEP individuals.

Prevalence and Framing of Health Disparities in Local Print News: Implications for Multilevel Interventions to Address Cancer Inequalities.

BACKGROUND: Americans remain under-informed about cancer and other health disparities and the social determinants of health (SDH). The news media may be contributing to this knowledge deficit, whether by discussing these issues narrowly or ignoring them altogether. Because local media are particularly important in influencing public opinion and support for public policies, this study examines the prevalence and framing of disparities/SDH in local mainstream and ethnic print news. METHODS: We conducted a multi-method content analysis of local mainstream (English language) and ethnic (Spanish language) print news in two lower income cities in New England with substantial racial/ethnic minority populations. After establishing intercoder reliability (κ = 0.63-0.88), coders reviewed the primary English and Spanish language newspaper in each city, identifying both disparities and non-disparities health stories published between February 2010 and January 2011. RESULTS: Local print news coverage of cancer and other health disparities was rare. Of 650 health stories published across four newspapers during the one-year study period, only 21 (3.2%) discussed disparities/SDH. Although some stories identified causes of and solutions for disparities, these were often framed in individual (e.g., poor dietary habits) rather than social contextual terms (e.g., lack of food availability/affordability). Cancer and other health stories routinely missed opportunities to discuss disparities/SDH. CONCLUSION: Local mainstream and ethnic media may be ideal targets for multilevel interventions designed to address cancer and other health inequalities. IMPACT: By increasing media attention to and framing of health disparities, we may observe important downstream effects on public opinion and support for structural solutions to disparities, particularly at the local level. Cancer Epidemiol Biomarkers Prev; 25(4); 603-12. ©2016 AACR SEE ALL ARTICLES IN THIS CEBP FOCUS SECTION, "MULTILEVEL APPROACHES TO ADDRESSING CANCER HEALTH DISPARITIES".

Effect of information seeking and avoidance behavior on self-rated health status among cancer survivors.

OBJECTIVE: Social determinants, such as socioeconomic status (SES) and race/ethnicity are linked to striking health disparities across the cancer continuum. One important mechanism linking social determinants and health disparities may be communication inequalities that are caused by differences in accessing, processing and utilizing cancer information. In this context, we examined health information-seeking/avoidance as a potential mediator between social determinants and self-rated health (SRH) status among cancer survivors. METHODS: Data came from the 2008 well-informed, thriving and surviving (WITS) study of post-treatment cancer survivors (n=501). We examined the mediating effect of health communication-related behavior between SES and disparities in SRH. RESULTS: The likelihood of belonging to the Low SRH group was higher among patients who had avoided health information and whose family members had not sought health information on behalf of the survivor, those in the lowest household income bracket, and those who had high school or less education after adjusting for potential confounders. CONCLUSION: Differences in SRH among cancer survivors are associated with SES as well as communication inequalities. PRACTICE IMPLICATIONS: It is necessary to provide a supportive environment in which health information is made available if disparities in health-related quality of life among cancer survivors are to be reduced.

The communications revolution and health inequalities in the 21st century: implications for cancer control.

The radical and transformative developments in information and communication technologies (ICT) offer unprecedented opportunities to promote cancer control and enhance population and individual health. However, the current context in which these technologies are being deployed--where cancer incidence and mortality and communication are characterized by inequalities among different racial/ethnic and socioeconomic status groups--raises important questions for cancer communication research, policy, and practice. Drawing on illustrative data, this essay characterizes the communications revolution and elucidates its implications for cancer control, with a particular focus on communication inequalities and cancer disparities.