Beliefs in COVID-19 Vaccine Misinformation Among Unvaccinated Black Americans: Prevalence, Socio-Psychological Predictors, and Consequences.

Health-related misinformation is a major threat to public health and particularly worrisome for populations experiencing health disparities. This study sets out to examine the prevalence, socio-psychological predictors, and consequences of beliefs in COVID-19 vaccine misinformation among unvaccinated Black Americans. We conducted an online national survey with Black Americans who had not been vaccinated against COVID-19 (N = 800) between February and March 2021. Results showed that beliefs in COVID-19 vaccine misinformation were prevalent among unvaccinated Black Americans with 13-19% of participants agreeing or strongly agreeing with various false claims about COVID-19 vaccines and 35-55% unsure about the veracity of these claims. Conservative ideology, conspiracy thinking mind-set, religiosity, and racial consciousness in health care settings predicted greater beliefs in COVID-19 vaccine misinformation, which were associated with lower vaccine confidence and acceptance. Theoretical and practical implications of the findings are discussed.

Moral Foundations Predict COVID-19 Vaccine Hesitancy: Evidence from a National Survey of Black Americans.

In this study we examine the role of moral values in predicting COVID-19 vaccine hesitancy among Black Americans. Guided by moral foundations theory, we assess the associations between six moral foundations (care, fairness, loyalty, authority, purity, liberty) and attitudes and intentions toward COVID-19 vaccination. Results of a national survey of Black Americans (N = 1,497) indicate that the care and loyalty moral foundations consistently predicted less vaccine hesitancy with overall more favorable attitudes and intentions toward COVID-19 vaccination, whereas the purity and liberty moral foundations were consistently associated with greater vaccine hesitancy. Relationships between the foundations and vaccine hesitancy were mediated by perceived vaccine effectiveness and safety. Implications of the findings for COVID-19 vaccine communication are discussed.

Human Papillomavirus Vaccine Acceptability and Campaign Message Preferences Among African American Parents: a Qualitative Study.

Human papillomavirus (HPV) vaccination can prevent numerous cancers, yet uptake remains low for adolescents. Given disproportionate burden of cancers among African Americans, it is important to identify factors that influence HPV vaccination decisions among African American parents, specifically the role and preferences of vaccine campaign messages. The objectives of this study were to (1) identify the predictors of parents' decisions to get their children vaccinated against HPV, (2) assess parents' evaluation of current HPV vaccination campaign messages, and (3) uncover message strategies or themes parents consider to be effective and motivating to vaccinate their children against HPV. Focus groups were conducted with African American mothers and fathers (n = 18) in person. Several themes emerged regarding HPV vaccine acceptability including the desire to be informed, the unfamiliarity of vaccination, and mistrust toward government, pharmaceutical companies, and healthcare providers. Parental review of existing campaign messages highlighted the importance of clarifying risks and benefits of vaccination, including cancer prevention, and the preference for straightforward language. When brainstorming strategies to craft effective messages, parents highlighted need for the inclusion of diverse groups across race, gender, and age. Additionally, parents recommended clear language on side effects, eligibility, and additional resources for further information. Our findings highlight concerns and potential strategies to promote HPV vaccination tailored to African American parents and their children. Targeted interventions to increase vaccination need to consider the importance of building trust and representation in health promotional materials. Considerations for how messages were shared were also discussed such as physical locations, word of mouth, and social media.

Text Messaging as a Communication Modality to Promote Screening Mammography in Low-income African American Women.

INTRODUCTION: Though text messages are increasingly used in health promotion, the current understanding of text message-based interventions to increase screening mammography in low-income African American women is limited. This study aimed to assess the feasibility and acceptability of a text message-based intervention to increase screening mammography in low-income African American women. MATERIALS AND METHODS: A 15-item, self-administered, paper-based survey on cell phone ownership, text messaging practices and preferences for future breast health information was administered to 120 female patients at an urban family medicine office. Descriptive analyses and demographic correlates of text messaging practices and preferences were examined. RESULTS AND DISCUSSION: The majority of respondents (95%) were cell phone owners of whom 81% reported texting. Prior receipt of a text message from a doctor's office was reported by 51% of cell phone owners. Mammography appointment reminders were the most desired content for future breast health text messages. Age (≥ 70 years old) was found to have a significant negative relationship with text messaging practices and perceptions. IMPLICATIONS: The use of text messages to promote mammography was found to be acceptable in this patient population. In addition to age, variables such as the frequency, timing and subject content of text messages also influence their acceptability.

Understanding the psychological antecedents of COVID-19 vaccine acceptance among Black Americans: implications for vaccine communication.

BACKGROUND: Guided by the 5C (confidence, complacency, constraints, calculation, and collective responsibility) model of vaccination behavior, we examine the psychological antecedents of COVID-19 vaccine acceptance (i.e. attitudes and intentions toward COVID-19 vaccination) among Black Americans, a group disproportionately affected by the coronavirus pandemic. METHOD: We conducted a national survey of Black Americans (N = 1,497) in February/March 2021. RESULTS: We found that, among the five psychological antecedents, three (confidence, calculation - or extensive information searching, and collective responsibility) significantly predicted attitudes toward COVID-19 vaccination and had indirect effects on vaccination intentions through vaccination attitudes. Two antecedents (confidence and collective responsibility) also directly predicted vaccination intentions. Our analysis suggests that a partially mediated model produced better fit than a fully mediated model. CONCLUSIONS: Developing culturally tailored interventions for Black Americans that build confidence in COVID-19 vaccines, highlight collective responsibility, and attend to Black Americans' information sources is key to boosting Black Americans' COVID-19 vaccine acceptance. Future research is needed to understand how historical and ongoing racism affects the psychological antecedents of COVID-19 vaccine acceptance among Black Americans.

Intersectionality Impacts Survivorship: Identity-Informed Recommendations to Improve the Quality of Life of African American Breast Cancer Survivors in Health Promotion Programming.

(1) Background: African American women breast cancer survivors face unique experiences that impact their quality of life as they transition beyond treatments. Experiences may be complicated by living at the intersection of systemically oppressed identities, including gender, race, social class, and cancer-related disability. Using the Black Feminist Thought (BFT) framework and the PEN-3 cultural model, this qualitative study sought to: (a) understand African American women breast cancer survivors' lived experiences; (b) examine how the multiple intersecting factors of race, gender, social class/socioeconomic status, and cancer-related disability impact their quality of life; and (c) inform future health promotion programming that is culturally relevant to AAWBCS to improve their quality of life. (2) Methods: Seven focus groups were conducted with 30 African American breast cancer survivors in a Midwestern metropolitan region. Focus groups were audiotaped and transcribed verbatim. Framework analyses were conducted to identify themes with NVivo qualitative analysis software. (3) Results: Four themes emerged: (a) caregiving roles provide both support and challenges for survivors, (b) the "strong Black woman" is inherent in survivor experiences, (c) intersectionality impacts survivorship, and (d) African American women resist oppression through culturally specific supports and advocacy. (4) Conclusions: The intervention point of entry should be at the peer support group level and centered on family and provide community-based support and services. Future research should move upstream to address social determinants of health, including racism, sexism, and ableism; there is a critical need to discuss how structural racism affects health care and develop interventions to address racial discrimination and racial bias in health care.

The impact of socioeconomic status on survival in stage III colon cancer patients: A retrospective cohort study using the SEER census-tract dataset.

BACKGROUND: The impact of socioeconomic status (SES) has been described for screening and accessing treatment for colon cancer. However, little is known about the "downstream" effect in patients who receive guideline-concordant treatment. This study assessed the impact of SES on cancer-specific survival (CSS) and overall survival (OS) for stage III colon cancer patients. METHODS: The SEER Census Tract-Level SES Dataset from 2004 to 2015 was used to identify stage III colon adenocarcinoma patients who received curative-intent surgery and adjuvant chemotherapy. The predictor variable was census tract SES. SES was analyzed as quintiles. The outcome variables were OR and CSS. Statistical analysis included chi square tests for association, Kaplan-Meier, Cox, Fine and Gray regression for survival analysis. RESULTS: In total, 27,222 patients met inclusion criteria. Lower SES was associated with younger age, Black or Hispanic race/ethnicity, Medicaid/uninsured, higher T stage, and lower grade tumors. CSS at the 25th percentile was 54 months for the lowest SES quintile and 80 for the highest. Median OS was 113 months for the lowest SES quintile and not reached for highest. The 5-year CSS rate was 72.4% for the lowest SES quintile compared to 78.9% in the highest (p < 0.001). The 5-year OS rate was 66.5% for the lowest SES quintile and 74.6% in the highest (p < 0.001). CONCLUSION: This is the first study to evaluate CSS and OS in an incidence-based cohort of stage III colon cancer patients using a granular, standardized measure of SES. Despite receipt of guideline-based treatment, SES was associated with disparities in CSS and OS.

Breast Health: Breast Cancer.

Breast cancer is a leading cause of cancer mortality among women in the United States. Screening has been shown to increase early detection rates and decrease mortality rates. Evidence-based guidelines have been updated as knowledge has advanced. Screening recommendations from various organizations vary significantly. These variations-from screening modality, age to initiate and discontinue screening, and screening intervals-have led to confusion among patients and clinicians alike. Clinicians should be aware of the current screening recommendations so they can address questions patients may have about recommendation differences and to optimize early detection. Management of breast cancer is highly individualized and dependent on the subtype of cancer, the stage at diagnosis, patient preferences, and physician recommendations. Management may involve surgery, chemotherapy, radiation, and/or hormone therapy. Family physicians can help facilitate patient care throughout the screening, diagnosis, and treatment processes. Multiple factors contribute to disparities in breast cancer screening, management, and outcomes. Clinician knowledge of these factors can help reduce disparities in care and patient outcomes.

An Online, Self-Directed Curriculum of Core Research Concepts and Skills.

Introduction: Existing scholarly curricula often underemphasize basic research skills and do not address the individual learning needs of residents, whose level of prior exposure to research concepts varies widely. A supplemental educational experience was developed to address educational gaps in a family medicine residency curriculum, including systematic exploration and interpretation of the medical literature, development and exploration of clinically pertinent questions, and development of residents' written communication skills. Methods: A 2-week, online, self-directed research curriculum was developed. The five-module curriculum included (I) Research Methods and Data Analysis, (II) Article Review, (III) Board Review, (IV) Literature Search, and (V) Literature Review and Proposal. Two years after implementation, residents who completed the curriculum were surveyed to assess the overall rotation and its success in meeting learning objectives. Results: Eighteen residents completed the new rotation and demonstrated objectives through assignment completion and review. Additionally, residents reported improved skills on all objectives and were satisfied with the new curriculum and its self-led, online format. Those planning to do research after graduation were more likely to report several benefits from the rotation, including learning more about data analyses and being more likely to complete a future scholarly project. Discussion: An online, self-directed curriculum can provide a feasible and effective educational approach to efficient use of faculty and resident time, allowing time to be focused on resident-specific knowledge gaps and learning needs, rather than presenting all learning material uniformly. The online, accessible format aligned with residents' existing reliance on the internet as a primary information source.

Outcomes of a Community-based Breast Cancer Screening Program in Baltimore City.

INTRODUCTION: African American women have disproportionately high breast cancer (BC) mortality in comparison with White women. Early BC detection rates are lower in African American women than White women, reflecting sub-optimal use of screening mammography particularly among women who are uninsured. METHODS: A descriptive analysis of a community-based, cancer control program targeted at uninsured African Americans is presented. Program outcomes and correlates of program retention and BC detection are summarized. RESULTS: Data for 5,669 enrollees and 10,357 mammograms were analyzed. Breast cancer was diagnosed in 113 women, 69% at an early stage. The majority (72%) of BC cases were diagnosed during the initial program cycle. The strongest correlates of program retention were non-Hispanic ethnicity and prior mammography (p<.0001). DISCUSSION: This community-based cancer control program provided an early BC detection benefit to enrollees regardless of whether program services were conducted for only one cycle or were continued at regular intervals.

Psychosocial profiles of older adolescent MDMA users.

PURPOSE: Using a case-control design, patterns of drug use, psychological symptoms, and behavioral characteristics associated with 3,4-methylenedioxymethamphetamine (MDMA ) use were surveyed in a sample of older adolescents (median age 20). METHODS: One hundred (42 MDMA users; 58 non-MDMA users) older adolescents were recruited using the "snowball" technique and interviewed regarding their use of MDMA and other drugs. The Brief Symptom Inventory (BSI), the Problem Oriented Screening Instrument for Teenagers (POSIT), the HIV/sexually transmitted diseases (STD) risk scale, and the Childhood Trauma Questionnaire (CTQ) were also administered. RESULTS: MDMA users were more likely to use other substances, endorse more symptoms of psychological distress, and had more problems in functional lifestyle areas. They also reported more childhood experiences of physical abuse, emotional neglect, and physical neglect than non-MDMA users. MDMA users also reported more sexually risky behaviors. CONCLUSIONS: Occasional MDMA use among older adolescents was associated with polydrug use, multiple social difficulties, psychological symptoms, and health risk behaviors. Further research is warranted to understand the long term psychosocial consequences of chronic MDMA and polydrug usage.

Social determinants of breast cancer screening in urban primary care practices: a community-engaged formative study.

BACKGROUND: The recent decline in the breast cancer mortality rate can be attributed to intensive screening and early detection efforts. However, studies have documented a decline in self-reported recent mammography use and interventions to enhance mammography utilization have yielded modest improvements. To address the root causes of breast cancer disparities and improve mammography use, interventions need to address multiple layers of patient, provider, and health system factors. OBJECTIVE: Using community-based participatory research principles, we sought to learn from women receiving care through urban primary care practices about issues surrounding mammography screening and strategies to increase screening. METHODS: We conducted five focus groups among 41 eligible women who were predominantly African American, recruited using nonprobability purposive sampling methods from urban community health centers in Baltimore, Maryland. Data are reported from three focus groups (n = 28) that provided usable data. We used the social determinants of health perspective to conduct a qualitative content analysis and interpretation of the data. RESULTS: Major obstacles to obtaining a screening mammogram were individual-level (i.e., pain from the procedure) and structural-level factors (i.e., cost, geography, convenience). Strategies to overcome obstacles could include the creation of structural mechanisms whereby women can receive a host of services during one visit to a healthcare professional's office. Important promoters of screening behavior included social-level factors such as social support, hope, and positive treatment outcomes. CONCLUSION: The social determinants of health perspective provided a unique perspective to frame barriers and promoters of mammography utilization and insights to develop interventions aimed at improving cancer control among women receiving care at urban primary care health centers.