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Liu T, Xiao X. A Framework of AI-Based Approaches to Improving eHealth Literacy and Combating Infodemic. Front Public Health 2021; 9:755808. [PMID: 34917575 PMCID: PMC8669242 DOI: 10.3389/fpubh.2021.755808] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
The global COVID-19 pandemic has put everyone in an urgent need of accessing and comprehending health information online. Meanwhile, there has been vast amount of information/misinformation/disinformation generated over the Internet, particularly social media platforms, resulting in an infodemic. This public health crisis of COVID-19 pandemic has put each individual and the entire society in a test: what is the level of eHealth literacy is needed to seek accurate health information from online resources and to combat infodemic during a pandemic? This article aims to summarize the significances and challenges of improving eHealth literacy in both communicable (e.g., COVID-19) and non-communicable diseases [e.g., cancer, Alzheimer's disease, and cardiovascular diseases (CVDs)]. Also, this article will make our recommendations of a general framework of AI-based approaches to improving eHealth literacy and combating infodemic, including AI-augmented lifelong learning, AI-assisted translation, simplification, and summarization, and AI-based content filtering. This general framework of AI-based approaches to improving eHealth literacy and combating infodemic has the general advantage of matching the right online health information to the right people.
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Affiliation(s)
- Tianming Liu
- Department of Computer Science, University of Georgia, Athens, GA, United States
| | - Xiang Xiao
- Department of Network and New Media, College of Humanities and Arts, Hunan International Economics University, Changsha, China
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Lee MH, Hong S, Merighi JR. The Association Between Fatalism and Mammography Use in Korean American Immigrant Women. HEALTH EDUCATION & BEHAVIOR 2021; 49:740-749. [PMID: 34396786 DOI: 10.1177/10901981211029253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fatalism is reported as a salient cultural belief that influences cancer screening disparities in racial and ethnic minority groups. Previous studies provide a range of measures and descriptions of cancer fatalism, but no studies to our knowledge have analyzed how fatalistic views cluster together within subgroups to form distinct profiles, and how these profiles can be predicted. This study identified subgroups of Korean American immigrants with similar fatalistic beliefs toward cancer and examined the influence of fatalism, health belief variables, and health literacy on mammography use. A cross-sectional survey design was used to obtain a convenience sample of 240 Korean American immigrant women in Los Angeles, California. Latent class analysis was used to identify unobserved subgroups of fatalism. Hierarchical logistic regression models were used to identify predisposing, enabling, and need factors associated with recent mammography use. The latent class analysis model identified three cancer fatalism subgroups: high fatalism (17.8%), moderate fatalism (36.7%), and low fatalism (45.5%). Women in the high fatalism subgroup were more likely to have had a mammogram within the past 2 years than women in the low fatalism subgroup. Regression analysis revealed three facilitators of recent mammogram use: level of fatalism, perceived barriers to mammogram, and family history of cancer. Although cultural beliefs can have a powerful influence on health-seeking behavior, it is important to weigh individual and contextual factors that may weaken or mediate the relationship between fatalism and engaging in preventive care such as having a mammogram.
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Affiliation(s)
- Mi Hwa Lee
- East Carolina University, Greenville, NC, USA
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Oliffe JL, Rossnagel E, Kelly MT, Bottorff JL, Seaton C, Darroch F. Men's health literacy: a review and recommendations. Health Promot Int 2021; 35:1037-1051. [PMID: 31557281 DOI: 10.1093/heapro/daz077] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although men's health promotion efforts have attracted programmatic and evaluative research, conspicuously absent are gendered insights to men's health literacy. The current scoping review article shares the findings drawn from 12 published articles addressing men's health literacy in a range of health and illness contexts. Evident was consensus that approaches tailored to men's everyday language and delivered in familiar community-based spaces were central to advancing men's health literacy, and, by extension, the effectiveness of men's health promotion programs. However, most men's health literacy studies focussed on medical knowledge of disease contexts including prostate and colon cancers, while diversity was evident regards conceptual frameworks and/or methods and measures for evaluating men's health literacy. Despite evidence that low levels of health literacy fuel stigma and men's reticence for health help-seeking, and that tailoring programs to health literacy levels is requisite to effective men's health promotion efforts, the field of men's health literacy remains underdeveloped. Based on the scoping review findings, recommendations for future research include integrating men's health literacy research as a needs analysis to more effectively design and evaluate targeted men's health promotion programs.
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Affiliation(s)
- John L Oliffe
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Emma Rossnagel
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary T Kelly
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Joan L Bottorff
- University of British Columbia, Okanagan, British Columbia, Canada
| | - Cherisse Seaton
- University of British Columbia, Okanagan, British Columbia, Canada
| | - Francine Darroch
- University of British Columbia, Vancouver, British Columbia, Canada
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The association between health literacy and theory of planned behavior with performance of cancer screening tests among rural patients: Cross- sectional study. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Keller KG, Toriola AT, Schneider JK. The relationship between cancer fatalism and education. Cancer Causes Control 2021; 32:109-118. [PMID: 33151430 PMCID: PMC8284073 DOI: 10.1007/s10552-020-01363-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 10/24/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Fatalism is defined by feelings of pessimism, hopelessness, and powerlessness regarding cancer outcomes. Early researchers reported associations between race and cancer fatalism. Yet current evidence suggests that social determinants of health are better predictors of cancer fatalism than race. Therefore, the aim of this study was to examine the association between age, race, education, and cancer fatalism. METHODS Three hundred ninety (n = 390) women who attended a screening mammogram at the Joanne Knight Breast Health Center at Siteman Cancer Center at Washington University School of Medicine (St. Louis, MO) completed the Powe Fatalism Inventory (PFI), a 15-item self-report instrument used to operationalize cancer fatalism. We used Pearson's correlation, independent samples t-tests, one-way ANOVA with post hoc tests, and linear regression to analyze the relationships between PFI total scores and age, race, and education. RESULTS There were no differences between the mean PFI scores for Non-Hispanic Whites (1.89, SD 0.55) and African Americans (2.02, SD 0.76, p = 0.092, 95% CI 0.27 to 0.02). We found significant differences between the mean PFI scores across levels of education. Women who attained a high school degree or less (n = 72) reported higher PFI scores (2.24, SD 0.77) than women who attended some college or post-high school vocational training (n = 111; 1.95, SD 0.61) and women with a college or postgraduate degree (n = 206; 1.83, SD 0.57). When PFI score was regressed onto age, race, and education, only education significantly explained fatalism (B = -0.19, p < 0.001). CONCLUSIONS In this study, cancer fatalism did not differ between Non-Hispanic White and African American women attending a screening mammogram. However, lower educational levels were associated with higher cancer fatalism. The previously observed associations between race and cancer fatalism may be explained by racial disparities in social determinants of health, such as education. Importantly, study findings indicate that the people with the greatest need for cancer fatalism interventions are those with lower educational levels.
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Maxwell AE, Lucas-Wright A, Chang LC, Santifer RE, Crespi CM. Factors associated with colorectal cancer screening in a peer-counseling intervention study in partnership with African American churches. Prev Med Rep 2020; 20:101280. [PMID: 33344150 PMCID: PMC7736973 DOI: 10.1016/j.pmedr.2020.101280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 12/23/2022] Open
Abstract
Colorectal cancer (CRC) mortality is 47% higher in African American men and 34% higher in African American women compared to non-Hispanic white men and women. This analysis assessed factors associated with CRC screening among 163 African American participants of a peer-counseling intervention study (2016-2018). In a one-group pre/post-test pilot study, trained Community Health Advisors (CHAs) at 9 African American churches in Los Angeles (LA) promoted CRC screening via one-on-one counseling, print materials and telephone reminder calls. Participants completed telephone surveys 3-6 months after the intervention. We fit bivariate and multivariate mixed effects logistic regression models to assess correlates, including participants' demographic characteristics, access to care, cancer-related knowledge and attitudes and receipt of CHA counseling of (1) discussion of CRC screening with provider and (2) receipt of CRC screening during follow-up. After controlling for gender and education, receipt of CHA counseling (OR 3.77) was significantly associated with discussing CRC screening with a provider during follow-up but not with CRC screening. Instead, a routine check-up in the past 12 months (OR 4.47) and discussion of CRC screening with a provider (OR 3.07) were significantly associated with CRC screening during follow-up. Residence in South LA (OR 0.38) was significantly associated with lack of CRC screening. Findings confirm the important role of health care providers and suggest that residence in South LA constitutes an additional barrier to CRC screening. Further research and additional resources are needed to address disparities in the uptake of CRC screening among African Americans, especially in South LA.
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Affiliation(s)
- Annette E. Maxwell
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, 650 Charles Young Drive South, Box 956900, Los Angeles, CA 90095-6900, USA
| | - Aziza Lucas-Wright
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, 1721 East 120th Street, Los Angeles, CA 90059, USA
| | - L. Cindy Chang
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, 650 Charles Young Drive South, Box 956900, Los Angeles, CA 90095-6900, USA
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, 1721 East 120th Street, Los Angeles, CA 90059, USA
| | - Rhonda E. Santifer
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, 1721 East 120th Street, Los Angeles, CA 90059, USA
| | - Catherine M. Crespi
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, 650 Charles Young Drive South, Box 956900, Los Angeles, CA 90095-6900, USA
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Klasko-Foster LB, Jandorf LM, Erwin DO, Kiviniemi MT. Predicting Colonoscopy Screening Behavior and Future Screening Intentions for African Americans Older than 50 Years. Behav Med 2019; 45:221-230. [PMID: 30427773 PMCID: PMC6517076 DOI: 10.1080/08964289.2018.1510365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
African Americans experience a disproportionate burden of morbidity and mortality from colorectal cancer, which may be due to low adherence to screening recommendations. Previous studies have found relationships between decision-making factors and screening behavior, but few have looked at both cognitive and affective factors or within a specifically African American sample. To better understand determinants that drive screening behavior, this study examines affective, cognitive, and social variables as predictors of colonoscopy in an age-eligible African American population. Participants completed surveys assessing affective associations with colonoscopy, perceived benefits and barriers, self-efficacy, knowledge, fear of colonoscopy, perceived risk, and colorectal cancer worry and fear. Regression analysis was used to model decision-making constructs as predictors of screening behavior/intentions. Affective, cognitive, and health care experience variables predicted colonoscopy completion and intentions. Provider-level factors and previous cancer screenings predicted prior screening only, but not intentions. Affective and cognitive components of perceived risk were associated with decreased likelihood of colonoscopy behavior, but increased likelihood of colonoscopy intentions. These findings suggest that colonoscopy decision making involves a complex array of both cognitive and affective determinants. This work extends our knowledge of colorectal cancer screening decision making by evaluating the effects of these multiple determinants on screening behavior in an African American sample. Future work exploring the interplay of affect and cognitions as influences on colonoscopy decision making and how health care experiences may moderate this effect is needed to develop effective intervention approaches and reduce screening disparities.
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Affiliation(s)
- Lynne B. Klasko-Foster
- University at Buffalo, SUNY, School of Public Health and Health Professions, Department of Community Health and Health Behavior, 3435 Main Street, 312 Kimball Tower, Buffalo, NY 14214
| | - Lina M. Jandorf
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1130, New York, NY, 10029,
| | - Deborah O. Erwin
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263,
| | - Marc T. Kiviniemi
- Department of Community Health and Health Behavior, University at Buffalo, SUNY, School of Public Health and Health Professions, 3435 Main Street, 314 Kimball Tower, Buffalo, NY 14214
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Knowledge, attitudes, and worries among different health literacy groups before receiving first invitation to colorectal cancer screening: Cross-sectional study. Prev Med Rep 2019; 14:100876. [PMID: 31080706 PMCID: PMC6506556 DOI: 10.1016/j.pmedr.2019.100876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/20/2019] [Accepted: 04/22/2019] [Indexed: 01/27/2023] Open
Abstract
Background Colorectal cancer screening uptake is associated with knowledge, attitudes and worries about screening. People with higher levels of health literacy usually have higher screening-related knowledge, but its association with attitudes and worries is sparsely described.The aim of this study was to describe knowledge, attitudes, and worries about colorectal cancer screening among unscreened citizens, and to estimate the association between these and health literacy. Methods In a cross-sectional study 10,030 53-74 year-old Central Denmark Region citizens received a questionnaire assessing knowledge, attitudes, worry and health literacy. Socioeconomic and -demographic data were linked from Statistics Denmark after data collection. Results In total, 7142 (71.2%) questionnaires were completed. A good general level of knowledge was observed (4.91 and 5.13 out of 7 for men and women, respectively). Citizens tended to be positive towards screening (21.4 and 21.3 on a 4-28 range scale for men and women respectively), and showed low levels of worries (8.8 and 9.09 on a 3-15 range scale for men and women respectively). Knowledge decreased and worries increased with lower levels of health literacy. Further, attitudes tended to be more positive with higher levels of health literacy. Conclusions In general, citizens tend to have good knowledge, positive attitudes and few worries about colorectal cancer screening. People with lower health literacy could benefit from targeted interventions that address knowledge and worries about screening to support informed decision making.
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Kawthaisong C, Promthet S, Kamsa-Ard S, Duangsong R. Questionnaire Validation of Colorectal Cancer Literacy Scale among Thai People in Northeastern Thailand. Asian Pac J Cancer Prev 2019; 20:645-651. [PMID: 30806072 PMCID: PMC6896999 DOI: 10.31557/apjcp.2019.20.2.645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Colorectal cancer is an important public health problem worldwide. Although progress in screening
and treatment has considerably improved the prognosis in the developed world, in developing countries colorectal cancer
mortality rate remains relatively high. Colorectal cancer screening literacy is an important initial step in overcoming this
problem. Development of a validated assessment instrument is therefore important for implementation of appropriate
health education programs to facilitate early detection. Objectives: This study focused on generation and validation of
a colorectal cancer screening literacy scale for Thai people in northeastern Thailand. Methods: This methodological
study was carried out in two phases: (1) literature reviews and semi-structured interviews were used to select items,
then the content and face validity were checked; and (2) a confirmatory factor analysis (CFA) was conducted to test
construct validity and reliability. A self-administered questionnaire was used to collect data from Thai people aged 50-
65 in June 2017. Results: For the total of 400 participants who responded (response rate 100 %), the age ranged from
50 to 65 years old (mean = 57.3, SD = 4.616). The colorectal cancer screening literacy scale was designed to include
6 domains and it was shown to have good internal consistency, and CFA demonstrated the model to fit data adequately
(Chi-squared/degree of freedom = 1.079, p = 0.061, CFI = 1.00, GFI = 0.93, AGFI = 0.91, RMSEA = 0.014 and SRMR
= 0.036). The final version of its, consisting of 57 items across the 6 domains covering key aspects of colorectal cancer
screening literacy, demonstrated good psychometric properties for this population. Conclusions: Use of the colorectal
cancer screening literacy scale in Thai people could lead to improved educational programs for optimizing colorectal
cancer screening.
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Affiliation(s)
| | - Supannee Promthet
- Department of Epidemiology and Biostatistics, ,Department of Public Health Administration Health Promotion Nutrition, Faculty of Public Health,
| | - Supot Kamsa-Ard
- Department of Epidemiology and Biostatistics, ,Department of Public Health Administration Health Promotion Nutrition, Faculty of Public Health, ,For Correspondence:
| | - Rujira Duangsong
- ASEAN Cancer Epidemiology and Prevention Research Group, Khon Kaen University, Thailand.
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Adams LB, Richmond J, Corbie-Smith G, Powell W. Medical Mistrust and Colorectal Cancer Screening Among African Americans. J Community Health 2018; 42:1044-1061. [PMID: 28439739 DOI: 10.1007/s10900-017-0339-2] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Despite well-documented benefits of colorectal cancer (CRC) screening, African Americans are less likely to be screened and have higher CRC incidence and mortality than Whites. Emerging evidence suggests medical mistrust may influence CRC screening disparities among African Americans. The goal of this systematic review was to summarize evidence investigating associations between medical mistrust and CRC screening among African Americans, and variations in these associations by gender, CRC screening type, and level of mistrust. MEDLINE, CINAHL, Web of Science, PsycINFO, Google Scholar, Cochrane Database, and EMBASE were searched for English-language articles published from January 2000 to November 2016. 27 articles were included for this review (15 quantitative, 11 qualitative and 1 mixed methods study). The majority of quantitative studies linked higher mistrust scores with lower rates of CRC screening among African Americans. Most studies examined mistrust at the physician level, but few quantitative studies analyzed mistrust at an organizational level (i.e. healthcare systems, insurance, etc.). Quantitative differences in mistrust and CRC screening by gender were mixed, but qualitative studies highlighted fear of experimentation and intrusiveness of screening methods as unique themes among African American men. Limitations include heterogeneity in mistrust and CRC measures, and possible publication bias. Future studies should address methodological challenges found in this review, such as limited use of validated and reliable mistrust measures, examination of CRC screening outcomes beyond beliefs and intent, and a more thorough analysis of gender roles in the cancer screening process.
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Affiliation(s)
- Leslie B Adams
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Jennifer Richmond
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Giselle Corbie-Smith
- Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Social Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wizdom Powell
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA. .,Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Hall MB, Vos P. Comparison of Cancer Fatalism Among Rural Smokers and Nonsmokers. J Community Health 2018; 44:215-221. [DOI: 10.1007/s10900-018-0576-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Christy SM, Gwede CK, Sutton SK, Chavarria E, Davis SN, Abdulla R, Ravindra C, Schultz I, Roetzheim R, Meade CD. Health Literacy among Medically Underserved: The Role of Demographic Factors, Social Influence, and Religious Beliefs. JOURNAL OF HEALTH COMMUNICATION 2017; 22:923-931. [PMID: 29125435 PMCID: PMC6278594 DOI: 10.1080/10810730.2017.1377322] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The current study examined the sociodemographic and psychosocial variables that predicted being at risk for low health literacy among a population of racially and ethnically diverse patients accessing primary care services at community-based clinics. Participants (N = 416) were aged 50-75 years, currently not up-to-date with colorectal cancer (CRC) screening, at average CRC risk, and enrolled in a randomized controlled trial (RCT) aimed at promoting CRC screening. Participants completed a baseline interview that assessed health literacy as measured by Rapid Estimate of Adult Literacy in Medicine-Revised, sociodemographic factors, and psychosocial variables (e.g., health beliefs) prior to randomization and receipt of an intervention. Thirty-six percent of the participants were found to be at risk for low health literacy. Sociodemographic and psychosocial variables were assessed as predictors of being at risk for low health literacy using logistic regression. In the final model, predictors were male gender, being from a racial/ethnic minority group, being unable to work, having higher social influence scores, and having higher religious belief scores. These findings suggest several patient characteristics that may be associated with low health literacy, and highlight the importance of supporting all patients through simplified and clear communications and information to improve understanding of CRC screening information.
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Affiliation(s)
- Shannon M. Christy
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Clement K. Gwede
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Steven K. Sutton
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Enmanuel Chavarria
- University of Texas Health Science Center at Houston, School of Public Health, Department of Health Promotion and Behavioral Sciences, Brownsville, Texas, USA
| | - Stacy N. Davis
- Health Education and Behavioral Science, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Rania Abdulla
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Chitra Ravindra
- Florida Department of Health Pinellas County, St. Petersburg, Florida, USA
| | - Ida Schultz
- Premier Community HealthCare Group, Inc., Dade City, Florida, USA
| | - Richard Roetzheim
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Cathy D. Meade
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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