Willingness to participate in various nontherapeutic cancer research activities among urban and rural African American and Latinx healthy volunteers

PURPOSE

Inclusion of racial/ethnic minorities in cancer research can reduce disparities in health outcomes; however, data regarding barriers and motivators to participation are sparse. This study assessed African American (AA) and Latinx healthy volunteers' perspectives regarding willingness to participate in noninvasive and invasive research activities.

METHODS

Using a 38-item questionnaire adapted from the Tuskegee Legacy Project Questionnaire, we assessed willingness to participate in 12 research activities, offering 27 possible barriers and 14 motivators. The sample was segmented into four subgroups by AA/Latinx and rural/urban.

RESULTS

Across five states and Puerto Rico, 533 participants completed questionnaires. Overall, participants were more willing to participate in noninvasive versus invasive procedures, although, all subgroups were willing to participate in research if asked. Rural AA were most willing to complete a survey or saliva sample, while rural Latinx were least willing. Urban AA were least willing to provide cheek swab, while rural counterparts were most willing. Self-benefit and benefit to others were among the top three motivators for all subgroups. Curiosity was a primary motivator for urban AA while obtaining health information motivated rural Latinx. Primary barriers included fears of side effects and being experimented on, lack of information, and lack of confidentiality.

CONCLUSIONS

Latinx and AAs are willing to participate in the continuum of nontherapeutic research activities suggesting their lack of participation may be related to not being asked. Inclusive enrollment may be achieved by assessing needs of participants during the design phase of a study in order to reduce barriers to participation.

An open-source high-frequency lock-in amplifier

We present characterization of a lock-in amplifier based on a field programmable gate array capable of demodulation at up to 50 MHz. The system exhibits 90 nV/√Hz of input noise at an optimum demodulation frequency of 500 kHz. The passband has a full-width half-maximum of 2.6 kHz for modulation frequencies above 100 kHz. Our code is open source and operates on a commercially available platform.

Neutral Silicon-Vacancy Center in Diamond: Spin Polarization and Lifetimes

We demonstrate optical spin polarization of the neutrally charged silicon-vacancy defect in diamond (SiV^{0}), an S=1 defect which emits with a zero-phonon line at 946 nm. The spin polarization is found to be most efficient under resonant excitation, but nonzero at below-resonant energies. We measure an ensemble spin coherence time T_{2}>100  μs at low-temperature, and a spin relaxation limit of T_{1}>25  s. Optical spin-state initialization around 946 nm allows independent initialization of SiV^{0} and NV^{-} within the same optically addressed volume, and SiV^{0} emits within the telecoms down-conversion band to 1550 nm: when combined with its high Debye-Waller factor, our initial results suggest that SiV^{0} is a promising candidate for a long-range quantum communication technology.

Electron paramagnetic resonance and photochromism of N3V0 in diamond

The defect in diamond formed by a vacancy surrounded by three nearest-neighbor nitrogen atoms and one carbon atom, [Formula: see text], is found in the vast majority of natural diamonds. Despite [Formula: see text] being the earliest electron paramagnetic resonance spectrum observed in diamond, to date no satisfactory simulation of the spectrum for an arbitrary magnetic field direction has been produced due to its complexity. In this work, [Formula: see text] is identified in [Formula: see text]-doped synthetic diamond following irradiation and annealing. The [Formula: see text] spin Hamiltonian parameters are directly determined and used to refine the parameters for [Formula: see text], enabling the latter to be accurately simulated and fitted for an arbitrary magnetic field direction. Study of [Formula: see text] under excitation with green light indicates charge transfer between [Formula: see text] and [Formula: see text]. It is argued that this charge transfer is facilitated by direct ionization of [Formula: see text], an as-yet unobserved charge state of [Formula: see text].

Affecting African American men's prostate cancer screening decision-making through a mobile tablet-mediated intervention

African American men experience a 60% higher incidence of prostate cancer and are more than twice as likely to die from it than White men. Evidence is insufficient to conclude that definitively screening for prostate cancer reduces the likelihood of morbidity or death. Patients are encouraged to discuss screening alternatives with health care providers for informed decision-making (IDM). The extent of IDM in clinical or community setting is not known. This study uses data from a community-based, computer-mediated, IDM intervention that targeted 152 African American aged 40 to 70. Pretest-posttest differences in means for prostate cancer knowledge, screening decisional conflict, and screening decisional self-efficacy were examined by two-tailed t-tests. Overall, the intervention significantly improved respondents' prostate cancer knowledge (p<.0001), significantly improved decisional self-efficacy (p<.0001) and significantly reduced decisional conflict (p<.0001). Specifically, the intervention significantly promoted IDM among men who reported more education, being married, having financial resources, and younger age.

Predictors of Cancer Screening Among Culturally Diverse Men

Men have higher rates of all cancers and are more likely to die from cancer than women; however, men are less likely to utilize disease prevention services. African American/Black men and Hispanic men have lower cancer survival rates and are less likely to utilize health care services than non-Hispanic White men. The present study examined demographic variables (age, household income, education, marital status, race/ethnicity, health insurance status), motivators to engage in healthy eating, and motivators to engage in physical activity as predictors of culturally diverse, medically underserved men's likelihood of getting a cancer screening (a) at the present time, (b) if no cancer symptoms are present, and (c) if a doctor discovers some cancer symptoms. Analyses were conducted using data from 243 men (47.3% non-Hispanic Black, 29.5% Hispanic, 16.5% non-Hispanic White, and 6.8% "other") recruited at the Men's Health Forum in Tampa, Florida. Age, having a medical or health condition that benefits from eating healthy, and having a commitment to physical activity were significant positive predictors of the likelihood of receiving a cancer screening. Motivation to engage in physical activity because of a personal priority was a significant negative predictor of the likelihood of getting a cancer screening. The findings from this study suggest that interventions to increase cancer screenings among culturally diverse, medically underserved men should be informed at least in part by an assessment of participating men's motivators for engaging in health promoting lifestyle behaviors such as physical activity and healthy eating.

The Yo me cuido® Program: Addressing Breast Cancer Screening and Prevention Among Hispanic Women

Breast cancer is less likely to be diagnosed at the earliest stage in Hispanic/Latino (Hispanic) women compared to non-Hispanic White women, even after accounting for differences in age, socioeconomic status, and method of detection. Moffitt Cancer Center created a comprehensive health education program called Yo me cuido (®) (YMC) to address and reduce breast cancer disparities among Spanish- and English-speaking Hispanic women by providing breast cancer and healthy lifestyles awareness and education, and promoting breast cancer screenings, reminders, and referrals for women 40 years and older. The purpose of this paper is to showcase the innovative approaches and methods to cancer prevention and early detection of the YMC program, and to promote it as an effective tool for improving outcomes in community health education, outreach, and engagement activities with Hispanic populations. Key components of the program include educational workshops, mammogram referrals, and a multimedia campaign. The YMC program is unique because of its approaches in reaching the Hispanic population, such as delivering the program with compassionate services to empower participants to live a healthier lifestyle. Additionally, direct follow-up for mammography screenings is provided by program staff. From 2011 to 2013, YMC has educated 2,226 women and 165 men through 93 workshops. About 684 (52 %) women ages 40 and older have had a screening mammogram within their first year of participating in the program. The YMC program is an innovative cancer education and outreach program that has demonstrated a positive impact on the lives of the Hispanic community in the Tampa Bay region.

Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations

This article provides an overview of the current literature on seven cancer sites that may disproportionately affect lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. For each cancer site, the authors present and discuss the descriptive statistics, primary prevention, secondary prevention and preclinical disease, tertiary prevention and late-stage disease, and clinical implications. Finally, an overview of psychosocial factors related to cancer survivorship is offered as well as strategies for improving access to care.

Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ) Perceptions and Health Care Experiences

BACKGROUND

The goal study of this was to explore attitudes, health knowledge, and experiences with healthcare setting and providers among gay, lesbian, bisexual, transgender, queer/questioning (GLBTQ) individuals and to identify areas for improvement.

METHODS

Members of Equality Florida™ residing in the five counties of the Tampa Bay region were recruited through email invitation to complete a 60-item questionnaire assessing demographics, attitudes, and experiences with healthcare providers (HCPs). Additional open-ended questions focused on experiences with HCPs and suggestions for ways to improve HCPs' cultural competency.

RESULTS

632 respondents completed the survey of which 41% were gay men and 29% were lesbian. The majority of participants was White, non-Hispanic (93%), married/partnered (78%), and had health insurance (88%). The majority (67%) reported they always or often disclosed their sexual orientation/identity to an HCP and few had negative reactions in the healthcare setting (<10%). Healthcare settings with equality signs and gender-neutral language were perceived as safer. Participants' responses suggested need for policy changes and improved cultural competence among HCPs.

CONCLUSION

Results show high rates of sexual orientation disclosure, greater acceptance from providers of GLBTQ status, and the need for examination of hospital policies and improved cultural competency.

Disparities in survival by insurance status in patients with Hodgkin lymphoma

BACKGROUND

The association between insurance status and outcomes has not been well established for patients with Hodgkin lymphoma (HL). The purpose of this study was to examine the disparities in overall survival (OS) by insurance status in a large cohort of patients with HL.

METHODS

The National Cancer Data Base (NCDB) was used to evaluate patients with stage I to IV HL from 1998 to 2011. The association between insurance status, covariables, and outcomes was assessed in a multivariate Cox proportional hazards model. Survival was estimated with the Kaplan-Meier method.

RESULTS

Among the 76,681 patients within the NCDB, 45,777 patients with stage I to IV HL were eligible for this study (median follow-up, 6.0 years). The median age was 39 years (range, 18-90 years). The insurance status was as follows: 3247 (7.1%) were uninsured, 7962 (17.4%) had Medicaid, 30,334 (66.3%) had private insurance, 3746 (8.2%) had managed care, and 488 (1.1%) had Medicare. Patients with an unfavorable insurance status (Medicaid/uninsured) were at a more advanced stage, had higher comorbidity scores, had B symptoms, and were in a lower income/education quartile (all P < .01). These patients were less likely to receive radiotherapy and start chemotherapy promptly and were less commonly treated at academic/research centers (all P < .01). Patients with unfavorable insurance had a 5-year OS of 54% versus 87% for those favorably insured (P < .01). When adjustments were made for covariates, an unfavorable insurance status was associated with significantly decreased OS (hazard ratio, 1.60; 95% confidence interval, 1.34-1.91; P < .01). The unfavorable insurance status rate increased from 22.8% to 28.8% between 1998 and 2011.

CONCLUSIONS

This study reveals that HL patients with Medicaid and uninsured patients have outcomes inferior to those of patients with more favorable insurance. Targeting this subset of patients with limited access to care may help to improve outcomes. Cancer 2015;121:3435-43. © 2015 American Cancer Society.

The importance of disclosure: lesbian, gay, bisexual, transgender/transsexual, queer/questioning, and intersex individuals and the cancer continuum

The Lesbian, Gay, Bisexual, Transgender/Transsexual, Queer/Questioning, Intersex (LGBTQI) population experiences cancer health disparities due to lack of disclosure and knowledge about increased cancer risk. Oncology health care providers and institutions should create environments that encourage disclosure of sexual orientation and identity.

A Community-Level Assessment of Barriers to Preventive Health Behaviors Among Culturally Diverse Men

There are significant gender disparities in health outcomes and health care utilization in the United States, with men experiencing more of these disparities. It is critical to ascertain the interplay between societal conditions, health behaviors, and access to services and the impact of these factors on health outcomes and utilization of health care. The present study is part of a larger initiative titled, The Men's Health Study: Addressing Healthy Lifestyle Behaviors, which has two purposes-to annually assess the motivators of and barriers to health-promoting behaviors among culturally diverse men attending the Men's Health Forum (MHF) and to use this information to develop an intervention program that facilitates healthy lifestyle behaviors among men. The MHF is a community-driven initiative for medically underserved men in Tampa, Florida that offers free health screenings and wellness exhibitors in order to empower men to lead a healthy lifestyle. The purpose of this article is to identify barriers to engaging in health-smart behaviors (e.g., cancer screenings, physical activity) among culturally diverse men who participated in the MHF and to detect any demographic differences among these barriers. A total of 254 men participated in the study. Findings identify that age was the only demographic variable that had a statistically significant association with any of the cancer-screening barriers. Some cancer-screening barriers appear to exist among all demographic groups since no statistical demographic differences were discovered. Income and education were significantly associated with barriers to engaging in health-smart behaviors. This may give researchers, health educators, and providers information needed to customize interventions to promote health and preventive health care among culturally diverse men.

Establishing the infrastructure to comprehensively address cancer disparities: a model for transdisciplinary approaches

The Center for Equal Health (CEH), a transdisciplinary Center of Excellence, was established to investigate cancer disparities comprehensively and achieve health equity through research, education, training, and community outreach. This paper discusses challenges faced by CEH, strategies employed to foster collaborations, lessons learned, and future considerations for establishing similar initiatives.

Assessing needs and assets for building a regional network infrastructure to reduce cancer related health disparities

Significant cancer health disparities exist in the United States and Puerto Rico. While numerous initiatives have been implemented to reduce cancer disparities, regional coordination of these efforts between institutions is often limited. To address cancer health disparities nation-wide, a series of regional transdisciplinary networks through the Geographic Management Program (GMaP) and the Minority Biospecimen/Biobanking Geographic Management Program (BMaP) were established in six regions across the country. This paper describes the development of the Region 3 GMaP/BMaP network composed of over 100 investigators from nine institutions in five Southeastern states and Puerto Rico to develop a state-of-the-art network for cancer health disparities research and training. We describe a series of partnership activities that led to the formation of the infrastructure for this network, recount the participatory processes utilized to develop and implement a needs and assets assessment and implementation plan, and describe our approach to data collection. Completion, by all nine institutions, of the needs and assets assessment resulted in several beneficial outcomes for Region 3 GMaP/BMaP. This network entails ongoing commitment from the institutions and institutional leaders, continuous participatory and engagement activities, and effective coordination and communication centered on team science goals.

Designing a community-based lay health advisor training curriculum to address cancer health disparities

INTRODUCTION

Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. APPROACH AND STRATEGIES: Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic-community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program.

DISCUSSION AND CONCLUSIONS

Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research.

A systematic review of the factors influencing African Americans' participation in cancer clinical trials

OBJECTIVE

This systematic review was conducted to synthesize the existing evidence regarding key considerations influencing African Americans' participation in cancer clinical trials (CCTs).

METHODS

The PubMed and PsycINFO databases were searched to identify peer-reviewed publications during the last decade (2002-2011) that met our inclusionary criteria. Our search utilized Boolean combinations of the following terms: "clinical trial"; "cancer"; "neoplasm"; "African American"; "Black"; "caregiver"; "decision making"; "recruitment"; "companion"; "family"; "significant other"; and "social support".

RESULTS

A total of 267 articles were identified in the database searches. Of these articles, a total of 31 were determined to meet the inclusion criteria and were retained for review. Key issues that emerged as impediments to a successful recruitment of African Americans to CCTs included negative attitudes towards clinical trials, low levels of knowledge and awareness regarding CCTs, religious beliefs, and structural barriers, such as transportation, childcare, and access to health care. Recommendations from physicians, family members, and friends may promote CCT participation. Multimedia, and culturally-appropriate recruitment approaches may also be effective in soliciting participation among African Americans.

CONCLUSION

Existing research underscores the importance of social support from family and friends, cultural appropriateness and sensitivity from physicians and in the design of the CCT, and enhanced education among African Americans in decision-making processes. As African Americans are underrepresented in CCTs, targeted strategies to enhance recruitment efforts and improve cancer treatment outcomes are essential.

Establishing the infrastructure to conduct comparative effectiveness research toward the elimination of disparities: a community-based participatory research framework

In Tampa, Florida, researchers have partnered with community- and faith-based organizations to create the Comparative Effectiveness Research for Eliminating Disparities (CERED) infrastructure. Grounded in community-based participatory research, CERED acts on multiple levels of society to enhance informed decision making (IDM) of prostate cancer screening among Black men. CERED investigators combined both comparative effectiveness research and community-based participatory research to design a trial examining the effectiveness of community health workers and a digitally enhanced patient decision aid to support IDM in community settings as compared with "usual care" for prostate cancer screening. In addition, CERED researchers synthesized evidence through the development of systematic literature reviews analyzing the effectiveness of community health workers in changing knowledge, attitudes and behaviors of African American adults toward cancer prevention and education. An additional systematic review analyzed chemoprevention agents for prostate cancer as an emerging technique. Both of these reviews, and the comparative effectiveness trial supporting the IDM process, add to CERED's goal of providing evidence to eliminate cancer health disparities.

Racial/ethnic differences in cancer prevention beliefs: applying the health belief model framework

PURPOSE

An understanding of each racial/ethnic group's beliefs about cancer prevention is important for designing/implementing interventions to reduce cancer-health disparities. The Health Belief Model was used to examine racial/ethnic differences in beliefs about cancer and cancer prevention.

DESIGN

The data were from the 2007 Health Information National Trends Survey, a biennial, cross-sectional survey using a random-digit-dial telephone frame and a mailing address frame.

SETTING

A weighted, nationally representative sample of American adults.

SUBJECTS

The sample consisted of 7452 individuals.

MEASURES

Model construct variables (perceived susceptibility; perceived severity; perceived benefits; perceived barriers; cues to action; self-efficacy) and race/ethnicity were assessed.

ANALYSIS

The Rao-Scott χ(2) test and multivariate logistic regression assessed racial/ethnic differences.

RESULTS

The constructs self-efficacy, perceived benefits, and perceived susceptibility were significantly associated with race/ethnicity. The remaining three constructs were not statistically significant. Multivariate analysis revealed Hispanics were less likely to believe they could lower their chances of getting cancer than did African-Americans and whites. Hispanics, Asians, and African-Americans were more likely to believe they had a lower chance of getting cancer in the future than did whites.

CONCLUSION

Culturally relevant health education/promotion interventions need to be developed and tailored to (1) empower Hispanics regarding their ability to prevent cancer and (2) educate racial/ethnic minorities about their susceptibility and risk perception for cancer.

High grade prostate intraepithelial neoplasia (PIN) is a PSA-independent risk factor for prostate cancer in African American men: results from a pilot study

African American men (AAM) demonstrate increased prostate cancer incidence and mortality rates. We investigated known prostate cancer risk factors in AAM. Prostate specific antigen (PSA) and diagnosis of high grade prostatic intraepithelial neoplasia (PIN) were significant prostate cancer predictors. However, even including AAM with low PSA (<4ng/ml), those with PIN had significantly elevated risk, compared to men without PIN (83.3% vs. 6.9%, p<0.0001). In AAM diagnosed with PIN, PSA level was no longer significant (83.3% vs. 92.3%, p=0.593 respectively). Our results suggest that a history of PIN is highly predictive of prostate cancer in AAM, and help provide PSA-independent venues for screening.

Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer

BACKGROUND

Laparoscopic resection is used widely in the management of colorectal cancer; however, the data on long-term outcomes, particularly those related to rectal cancer, are limited. The results of long-term follow-up of the UK Medical Research Council trial of laparoscopically assisted versus open surgery for colorectal cancer are presented.

METHODS

A total of 794 patients from 27 UK centres were randomized to laparoscopic or open surgery in a 2:1 ratio between 1996 and 2002. Long-term follow-up data were analysed to determine differences in survival outcomes and recurrences for intention-to-treat and actual treatment groups.

RESULTS

Median follow-up of all patients was 62·9 (interquartile range 22·9 - 92·8) months. There were no statistically significant differences between open and laparoscopic groups in overall survival (78·3 (95 per cent confidence interval (c.i.) 65·8 to 106·6) versus 82·7 (69·1 to 94·8) months respectively; P = 0·780) and disease-free survival (DFS) (89·5 (67·1 to 121·7) versus 77·0 (63·3 to 94·0) months; P = 0·589). In colonic cancer intraoperative conversions to open surgery were associated with worse overall survival (hazard ratio (HR) 2·28, 95 per cent c.i. 1·47 to 3·53; P < 0·001) and DFS (HR 2·20, 1·31 to 3·67; P = 0·007). In terms of recurrence, no significant differences were observed by randomized procedure. However, at 10 years, right colonic cancers showed an increased propensity for local recurrence compared with left colonic cancers: 14·7 versus 5·2 per cent (difference 9·5 (95 per cent c.i. 2·3 to 16·6) per cent; P = 0·019).

CONCLUSION

Long-term results continue to support the use of laparoscopic surgery for both colonic and rectal cancer.

Sociodemographic differences in fears and mistrust contributing to unwillingness to participate in cancer screenings

Effective provider-patient relationships are vital for positive patient health outcomes. This analysis assessed sociodemographic differences in fears and mistrust related to the provider-patient relationship, which may contribute to unwillingness to participate in cancer screenings (CSs). The data are from a stratified, random-digit dial telephone questionnaire of non-institutionalized households in New York, Maryland, and Puerto Rico. Statistically significant results indicate that Hispanics, compared with Whites, were nearly two times more likely to report that fear of being a "guinea pig" and lacking trust in medical people would make them unwilling to participate in CSs. Additionally, those with less education were over two times more likely to indicate a fear of being embarrassed during the screening would make them unwilling to participate in CSs. These results highlight areas where health professionals can improve interactions with their patients and be attentive to their fears and/or mistrusts to promote CSs utilization.

The men's health forum: an initiative to address health disparities in the community

Racial/ethnic, socioeconomic, and gender disparities in health and access to and use of health care services currently exist. Health professionals are continually striving to reduce and eliminate health disparities within their own community. One such effort in the area of Tampa Bay, Florida was the creation of the African American Men's Health Forum, currently referred to as the Men's Health Forum. The African American Men's Health Forum was the result of the community's desire to reduce the gap in health outcomes for African American men. Later, it was recognized that the gap in health outcomes impacts other communities; therefore, it was broadened to include all men considered medically underserved (those who are uninsured, underinsured, or without a regular health care provider). The Men's Health Forum empowers men with the resources, knowledge, and information to effectively manage their health by providing health education and screenings to the community. This article provides an explanation of the key components that have contributed to the success of the Men's Health Forum, including challenges and lessons learned. It is intended that this information be replicated in other communities in an effort to eliminate health disparities.

Unwillingness to participate in colorectal cancer screening: examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older

PURPOSE

Identify the influence of medical mistrust, fears, attitudes, and sociodemographic characteristics on unwillingness to participate in colorectal cancer (CRC) screening.

DESIGN

Cross-sectional, disproportionally allocated, stratified, random-digit-dial telephone questionnaire of noninstitutionalized households.

SETTING

New York City, New York; Baltimore, Maryland; San Juan, Puerto Rico.

SUBJECTS

Ethnically diverse sample of 454 adults ≥50 years of age.

MEASURES

Health status, cancer screening effectiveness, psychosocial factors (e.g., perceptions of pain, fear, trust), and CRC screening intentions using the Cancer Screening Questionnaire, which addresses a range of issues related to willingness of minorities to participate in cancer screening.

ANALYSIS

Multivariate logistic regression was used to model the probability of reporting unwillingness to participate in CRC screening.

RESULTS

Fear of embarrassment during screening (odds ratio [OR] = 10.72; 95% confidence interval [CI], 2.15-53.39), fear of getting AIDS (OR = 8.75; 95% CI, 2.48-30.86), fear that exam might be painful (OR = 3.43; 95% CI, 1.03-11.35), and older age (OR = 1.10; 95% CI, 1.04-1.17) were positively associated with unwillingness to participate in CRC screening. Fear of developing cancer (OR = .12; 95% CI, .03-.57) and medical mistrust (OR = .19; 95% CI, .06-.60) were negatively associated with unwillingness to screen.

CONCLUSIONS

Findings suggest that CRC health initiatives should focus on increasing knowledge, addressing fears and mistrust, and normalizing CRC screening as a beneficial preventive practice, and should increase focus on older adults.

Understanding the psychosocial issues of African American couples surviving prostate cancer

African Americans are disproportionately affected by prostate cancer, yet less is known about the most salient psychosocial dimensions of quality of life. The purpose of this study was to explore the perceptions of African American prostate cancer survivors and their spouses of psychosocial issues related to quality of life. Twelve African American couples were recruited from a National Cancer Institute Comprehensive Cancer Center registry and a state-based non-profit organization to participate in individual interviews. The study was theoretically based on Ferrell's Quality of Life Conceptual Model. Common themes emerged regarding the psychosocial needs of African American couples. These themes were categorized into behavioral, social, psychological, and spiritual domains. Divergent perspectives were identified between male prostate cancer survivors and their female spouses. This study delineated unmet needs and areas for future in-depth investigations into psychosocial issues. The differing perspectives between patients and their spouses highlight the need for couple-centered interventions.

Influence of scary beliefs about the Tuskegee Syphilis Study on willingness to participate in research

OBJECTIVES

To assess whether scary/alarming beliefs about details on the Tuskegee Syphilis Study (TSS) are associated with willingness and/or fear to participate in biomedical research.

METHODS

Scary beliefs about TSS were examined for 565 Black and White adults who had heard of the TSS. Multivariate analyses by race were used to measure association.

RESULTS

No association between scary beliefs and willingness or fear to participate in research was found (P > 0.05).

CONCLUSIONS

These findings provide additional evidence that awareness or detailed knowledge about the TSS does not appear today to be a major factor influencing Blacks' willingness to participate in research.

An Innovative Approach for Community Engagement: Using an Audience Response System

Community-based participatory research methods allow for community engagement in the effort to reduce cancer health disparities. Community engagement involves health professionals becoming a part of the community in order to build trust, learn from the community and empower them to reduce disparities through their own initiatives and ideas. Audience Response Systems (ARS) are an innovative and engaging way to involve the community and obtain data for research purposes using keypads to report results via power point. The use of ARS within communities is very limited and serves to widen the disparity gap by not delivering new advances in medical knowledge and technology among all population groups. ARS was implemented at a community town hall event sponsored by a National Institute on Minority Health and Health Disparities Exploratory Center of Excellence, the Center for Equal Health. Participants appreciated being able to see how everyone else answered and felt included in the research process. ARS is beneficial because the community can answer truthfully and provides instant research results. Additionally, researchers can collect large amounts of data quickly, in a non-threatening way while tracking individual responses anonymously. Audience Response Systems proved to be an effective tool for successfully accomplishing community-based participatory research.

Gender differences in cancer screening beliefs, behaviors, and willingness to participate: implications for health promotion

Men have higher cancer mortality rates for all sites combined compared with women. Cancer screening (CS) participation is important for the early detection of cancer. This study explores gender differences in CS beliefs, behaviors, and willingness to participate. The data were collected from a stratified, random-digit dial survey of adults living in New York, Maryland, and Puerto Rico. Chi-square tests and logistic regressions were computed to analyze gender associations among CS beliefs, behaviors, and willingness variables. Men and women believed that CSs were effective, though a higher percentage of men had never had a past CS. Men were less willing to participate in a CS at the present time and in a skin cancer exam; however, when given descriptions of screening conditions, men indicated more willingness to participate. These gender differences highlight the need for health professionals to examine their efforts in providing enhanced CS promotion and education among men.

Abstract B2: Applying audience response systems in community-based research

Background: Community-based participatory research methods allow for community engagement in the effort to reduce cancer health disparities. Community engagement involves health professionals becoming a part of the community in order to build trust, share their expertise, learn from the community and empower them to reduce disparities through their own initiatives and ideas. Audience response systems (ARS) are an innovative and engaging way to involve the community and obtain data for research purposes. ARS is an interactive-polling device that uses keypads to report live results via power point. The use of ARS within communities, specifically with underserved populations, unfortunately is very limited. These limitations serve to widen the disparity gap by not delivering new advances in medical knowledge and technology among all population groups.

Applying ARS: ARS was proven successful at the Gathering of Neighborhood Voices Town Hall, sponsored by the Center for Equal Health (CEH). CEH, a National Institute on Minority Health and Health Disparities Exploratory Center of Excellence, is a collaborative approach between the University of South Florida and Moffitt Cancer Center to address and reduce cancer health disparities within minority and underserved populations. The Town Hall included a panel of experts and community members engaging in a dialogue about cancer health disparities. The purpose of the Town Hall was to increase community members’ knowledge and awareness of cancer health disparities; obtain feedback from the community about their needs and their views of cancer; and build a partnership and trust with the community.

Results: Participants responded favorably toward the ARS and enjoyed the added interactions that resulted from this approach. They appreciated being able to “see how everyone else answered” and felt the event was “very helpful and informative.” About 93% of the audience responded they either liked or loved using the system. Importantly, participants stated that they “felt included in the research process.” About 78% of participants agreed or strongly agreed that they felt comfortable sharing their thoughts and opinions during the event. About 63% of participants had never heard of or knew very little about health disparities at the beginning; however, after the discussion, 97% of the audience felt health disparities existed within their community.

Benefits: ARS lets the community answer truthfully, with anonymity, and without fear of repercussion. It allows audience members the ability to easily engage during an event. ARS also gives the community instant research results, which addresses the ethical concerns of returning data to community participants. Health researchers can collect large amounts of data quickly, in a non-threatening way while tracking individual responses anonymously. ARS creates a participatory learning environment by stimulating discussions with community members.

Lessons Learned: Some questions were unable to be captured due to technology challenges so it is important that researchers become familiar with the system before initial use. Implementing an ARS-training for the researchers prior to the event and to pilot-test at the actual event location is ideal.

Researchers should make sure to understand what an appropriate literacy level is for the specific questions they ask.

Conclusion: ARS is beneficial to get feedback from the community on cancer health disparities and issues that are important to them. The use of ARS solved the ethical dilemma that the researchers face when trying to ensure that community members see the results of the research in which they contribute. ARS proved to be an effective tool for successfully accomplishing community-based participatory research.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B2.

Abstract A3: P20 Center of Excellence – The Research Conglomerate: Using a business marketing approach in cancer health disparities research

Introduction: As the types of grant funded research mechanisms are becoming more elaborate, business acumen in research is becoming necessary. One mechanism in particular that essentially can almost be mirrored as a small corporation is the P20 – Centers of Excellence (COE). The composition of a Center of Excellence is similar to that of a corporation and because of this uncanny likeness, business insight can be used to help guide the leadership of a COE. Even though marketing is usually thought of primarily as a business idiom, using social marketing is very common in public health research. But for a COE, a better way to succeed in the planning, directing, and executing of this particular research project would be to cross-pollinate business and social marketing. To aid in the planning, directing, and execution of the USF/Moffitt Center of Excellence – Center for Equal Health (CEH) – an approach combining business marketing with research was used. CEH is a joint partnership between the University of South Florida and the H. Lee Moffitt Cancer Center and Research Institute that conducts studies and promotes activities to reduce cancer health disparities among minority and underserved communities in the state of Florida.

To ensure that the vision, mission, and purpose of CEH are aligned with the actual work that has been done and to stay on track for what is intended to be done for the remainder of the funding allotment, a comprehensive marketing plan is being created using business and social marketing concepts in tandem. From the vantage point of the CEH administration, a business approach for the marketing plan is ideal for the overall COE, while a social marketing approach would also be used to focus on the behavioral changes that are needed within CEH. The processes associated with business and social marketing are the same, but a few of the concepts are very different. Using the business approach, the plan will identify and analyze other Centers with a focus of health disparities, or other competitors in the running for P20 funds. The marketing plan also explores the 4 P's of marketing (product, placement, price, promotion) which is a concept used in business and social marketing.

Summary: The initial stages of the marketing plan formulation were the most helpful for the CEH administration. During the initial stages, situation analysis and formative research was done to identify information gaps to be addressed that could help CEH pursue continual success. Using a mixed methods approach gave the administration the opportunity to qualitatively examine CEH as well as gain quantitative information about CEH from the other members. And while it is very important to obtain quantitative information about CEH, the administration found that the exploration of qualitative information assisted with the identification of the gaps that needed to be addressed within CEH.

Conclusions: Although a bit uncanny to think of using business to do health disparities research, using a business approach is seen to be an effective way gather information regarding the monstrous P20 COE mechanism. A lot of times research projects do not factor in the need for strategic planning at the time of grant submission, but it is essentially a very important process that is needed to keep administration and staff on track with the aims and goals that are set at the time of submission. Ultimately, because the P20 can be thought of as a research conglomerate, the use business marketing in health disparities research is very beneficial.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A3.

Detailed knowledge of the Tuskegee syphilis study: who knows what? A framework for health promotion strategies

This report explores the level of detailed knowledge about the Tuskegee Syphilis Study (TSS) among 848 Blacks and Whites in three U.S. cities across an array of demographic variables. The Tuskegee Legacy Project (TLP) Questionnaire was used, which was designed to explore the willingness of minorities to participate in biomedical studies. A component of the TLP Questionnaire, the TSS Facts & Myths Quiz, consisting of seven yes/no factual questions, was used to establish respondents' level of detailed knowledge on the TSS. Both Blacks and Whites had similar very low mean quiz score on the 7-point scale, with Blacks' scores being slightly higher than Whites (1.2 vs. 0.9, p = .003). When analyzing the level of knowledge between racial groups by various demographic variables, several patterns emerged: (a) higher education levels were associated with higher levels of detailed knowledge and (b) for both Blacks and Whites, 30 to 59 years old knew the most about TSS compared with younger and older adult age groups. The findings show that much of the information that circulates in the Black and White communities about the TSS is false, often minimizing or understating the most egregious injustices that occurred. Health promotion and educational implications of these findings are offered and conclude that the findings should be used as a catalyst to explore local realities and sentiments regarding participation in biomedical research within the research philosophy and framework of community-based participatory research.

Belief in AIDS origin conspiracy theory and willingness to participate in biomedical research studies: findings in whites, blacks, and Hispanics in seven cities across two surveys

PURPOSE

The purpose of this study was to determine whether a belief in the AIDS origin conspiracy theory is related to likelihood or fear of participation in research studies.

METHODS

The Tuskegee Legacy Project Questionnaire was administered via random-digit-dialed telephone interview to black, white, and Hispanic participants in 4 cities in 1999 and 2000 (n = 1,133) and in 3 cities in 2003 (n = 1,162).

RESULTS

In 1999, 27.8% of blacks, 23.6% of Hispanics, and 8% of whites (P ≤ .001) reported that it was "very or somewhat likely" that AIDS is "the result of a government plan to intentionally kill a certain group of people by genocide." In 2003, 34.1% of blacks, 21.9% of Hispanics, and 8.4% of whites (P ≤ .001) reported the same.

CONCLUSIONS

Whereas blacks and Hispanics were more than 3 times more likely than whites to believe in this AIDS origin conspiracy theory, holding this belief was not associated with a decreased likelihood of participation in, or increased fear of participation in, biomedical research.

Applying interdisciplinary theory in the care of Aboriginal women's mental health

This paper describes theories from various disciplines that are useful in conceptualizing and reflecting on the mental health of Aboriginal women. Critical social theory (sociology), Parse's human becoming theory (nursing) and ecological systems theory (developmental psychology) are considered valuable theories that aid in nursing praxis. These papers discuss how these different theoretical approaches are beneficial for achieving different goals and therefore provide important foundational underpinnings to challenging traditional assumptions that effect human behaviour and practice.

Abstract B110: Gender differences in cancer screening beliefs and behaviors: Implications for health promotion

Introduction: This study analyzes differences in cancer screening beliefs and behaviors among men and women. Knowledge of these differences might help health professionals redirect their efforts in promotion of cancer screening participation.

Methods: The data was collected from a stratified, random-digit dial survey of non-institutionalized adults (N=1148) living in New York City, New York; Baltimore, Maryland; and San Juan, Puerto Rico. The research instrument used was the Cancer Screening Questionnaire, which addressed a range of issues related to the beliefs and willingness to participate in cancer screening examinations. The variables used to assess gender differences were attitudes about how effective cancer screening is in detecting cancer; if they ever had a cancer screening in the past; and willingness to participate in a regular cancer screening if you have no symptoms. Other variables assessed were willingness to participate in a screening dependent on who conducts the screening and willingness to participate in a screening dependent on what one is asked to do during the screening. Unadjusted chi-square tests were computed to analyze gender differences among these variables.

Results: Attitudes about cancer screening effectiveness was not statistically significant (p=0.91). About the same proportions of men (68%) and women (70%) believed cancer screenings detected cancer all/most of the time. However, chi-square tests resulted in significant associations (p&lt;0.05) between gender and if they ever had a cancer screening in the past and willingness to participate in a regular cancer screening if you have no symptoms. About 57% of men had never had a cancer screening in the past compared to only 32% of women who had never had a screening. Willingness to participate in a regular cancer screening when there are no symptoms was also significant with gender. More men (40%) said they would be unlikely to participate compared to only 26% of women who would be unlikely. Most of the variables depending on who conducts the screening and what one is asked to do during the screening were not statistically significant. Participating in a cancer screening that is given by a doctor, participating when being interviewed about their smoking or alcohol habits, participating when having mouth scraped to collect cells, and participating when having skin surgically removed were the only significant variables.

Conclusions: Even though nearly the same proportion of men believed cancer screenings detected cancer all/most of the time compared to women; a significant proportion of men had never had a cancer screening nor was willing to participate in a regular cancer screening if they had no symptoms compared to women. These differences really highlight the need for better cancer screening promotion among men. There are already several fundraisers, commercials, and community awareness about women's cancer issues but there is a lack of promotion about cancer for men. Health educators, physicians, and community-based organizations should make an effort to focus on specific ways to encourage men to participate in cancer screenings.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B110.

Barbershop communications on prostate cancer screening using barber health advisers

OBJECTIVE

The authors report the outcomes of a community-based, barber health adviser pilot intervention that aims to develop customized educational materials to promote knowledge and awareness of prostate cancer (CaP) and informed decision making about prostate cancer screening (PCS) among a predominantly African American clientele.

METHOD

First, the authors implemented a series of learner verification processes with barbershop clients (n=15) to adapt existing CaP health promotion materials. Following intervention implementation in the barbershop, they conducted structured surveys with barbershop clients (n=40) to evaluate the intervention.

RESULTS

Findings from the posttest showed both a significant increase in barbershop clients' self-reported knowledge of CaP and in the likelihood of discussing PCS with a health care provider (p<.001). The client's cultural model of CaP risk factors revealed cultural consensus (eigenratio=3.3) and mirrored the biomedical model. All clients surveyed reported positively on the contents of the educational materials, and more than half (53%) had discussed CaP at least twice with their barber in the last month.

CONCLUSION

Based on the pilot results, the barber-administered intervention was an appropriate and viable communication channel for promoting CaP knowledge and awareness in a priority population, African American men.

Self-reported willingness to have cancer screening and the effects of sociodemographic factors

BACKGROUND

The relative effects of race/ethnicity and other sociodemographic factors, compared to those of attitudes and beliefs on willingness to have cancer screening, are not well understood.

METHODS

We conducted telephone interviews with 1148 adults (22% Hispanic, 31% African American, and 46% white) [corrected] from 3 cities in mainland United States and Puerto Rico. Respondents reported their sociodemographic characteristics, attitudes about barriers and facilitators of cancer screening, and willingness to have cancer screening under 4 scenarios: when done in the community vs one's doctor's office, and whether or not one had symptoms.

RESULTS

Racial/ethnic minority status, age, and lower income were frequently associated with increased willingness to have cancer screening, even after including attitudes and beliefs about screening. Having screening nearby was important for community screening, and anticipation of embarrassment from screening for when there were no cancer symptoms. Associations varied across 4 screening scenarios, with the fewest predictors for screening by one's doctor when there were symptoms.

CONCLUSIONS

Sociodemographic characteristics not only were related to willingness to have cancer screenings in almost all cases, but were generally much stronger factors than attitudinal barriers and facilitators. Cancer screening campaigns should affect attitudinal change where possible, but should also recognize that targeting screening to specific population groups may be necessary.

Barbers against prostate cancer: a feasibility study for training barbers to deliver prostate cancer education in an urban African American community

The goal of this pilot study was to assess the feasibility of training barbers to deliver a brief culturally and literacy appropriate prostate cancer educational intervention to urban African American men. Eight barbers received training to deliver a 2-month educational intervention in the barbershop and completed pre- and posttest training assessments. The training workshops led to a significant increase in mean prostate cancer knowledge scores among the barbers (60% before vs. 79% after; P < 0.05). The barbers also reported positively on the intervention in terms of satisfaction and relative ease of engaging clients. Training barbers to deliver a prostate cancer educational intervention is a feasible strategy for raising prostate cancer awareness of the disease among a priority population.

Identifying the Tuskegee Syphilis Study: implications of results from recall and recognition questions

Background

This analysis assessed whether Blacks, Whites and Puerto-Rican (PR) Hispanics differed in their ability to identify the Tuskegee Syphilis Study (TSS) via open-ended questions following lead-in recognition and recall questions.

Methods

The Tuskegee Legacy Project (TLP) Questionnaire was administered via a Random-Digit Dial (RDD) telephone survey to a stratified random sample of Black, White and PR Hispanic adults in three U.S. cities.

Results

The TLP Questionnaire was administered to 1,162 adults (356 African-Americans, 313 PR Hispanics, and 493 non-Hispanic Whites) in San Juan, PR, Baltimore, MD and New York City, NY. Recall question data revealed: 1) that 89% or more of Blacks, Whites, and PR Hispanics were not able to name or definitely identify the Tuskegee Syphilis Study by giving study attributes; and, 2) that Blacks were the most likely to provide an open-ended answer that identified the Tuskegee Syphilis Study as compared to Whites and PR Hispanics (11.5% vs 6.3% vs 2.9%, respectively) (p ≤ 0.002). Even when probed by a recognition question, only a minority of each racial/ethnic group (37.1%, 26.9%, and 8.6%, for Blacks, Whites and PR Hispanics, respectively) was able to clearly identify the TSS (p < 0.001).

Conclusions

The two major implications of these findings for health disparity researchers are 1) that it is unlikely that detailed knowledge of the Tuskegee Syphilis Study has any current widespread influence on the willingness of minorities to participate in biomedical research, and 2) that caution should be applied before assuming that what community leaders 'know and are aware of' is equally 'well known' within their community constituencies.

Beliefs of women's risk as research subjects: a four-city study examining differences by sex and by race/ethnicity

BACKGROUND

Given the history of vulnerability of women of childbearing age to medical treatments that have caused injury, for example, diethylstilbestrol (DES) and thalidomide, it is surprising that, to date, little research has directly examined attitudes of the general public regarding the vulnerability of women when they participate in biomedical research studies.

METHODS

We asked three questions about beliefs of women as biomedical research subjects of 623 white, 353 black, and 157 Hispanic people in four U.S. cities: (1) Do you believe that women are more likely to be "taken advantage of" when they become subjects in a medical research project as compared to men? (2) Do you believe that women of childbearing age (15-45-year-olds) should become study participants in medical research projects? and, if the response was no or don't know/not sure, (3) Would you still say no or don't know/not sure to question 2 even if it meant that we would not know anything about the health and medical treatments for women aged 15-45 years?

RESULTS

Overall, women were 60% more likely than men to state that women were more likely than men to be "taken advantage of," even when controlling for potential confounders, and both black and Hispanic participants were much more likely than white participants to state that this was the case. The majority of respondents (57.4%) said that women of childbearing age should not be research subjects; among women, both black and Hispanic people were less likely than white people to change their minds when prompted that this might mean that "nothing would be known about the health and medical treatments for women aged 15-45 years."

CONCLUSIONS

A substantial proportion of the participants reported knowledge of historical events, and this knowledge was related, particularly in black participants, to attitudes toward vulnerability of women as biomedical research subjects.

Exploring the "legacy" of the Tuskegee Syphilis Study: a follow-up study from the Tuskegee Legacy Project

The purpose of this follow-up 2003 3-City Tuskegee Legacy Project (TLP) Study was to validate or refute our prior findings from the 1999-2000 4 City TLP Study, which found no evidence to support the widely acknowledged "legacy" of the Tuskegee Syphilis Study (TSS), ie, that blacks are reluctant to participate in biomedical studies due to their knowledge of the TSS. The TLP Questionnaire was administered in this random-digit-dial telephone survey to a stratified random sample of 1162 black, white, and Puerto Rican Hispanic adults in 3 different US cities. The findings from this current 3-City TLP Study fail to support the widely acknowledged "legacy" of the TSS, as awareness of the TSS was not statistically associated with the willingness to participate in biomedical studies. These findings, being in complete agreement with our previous findings from our 1999-2000 4-City TLP, validate those prior findings.