Increasing Lung Cancer Screening for High-Risk Smokers in a Frontier Population

Northern Plains American Indians (AIs) have some of the highest smoking and lung cancer mortality rates in the USA. They are a high-risk population in which many are eligible for low-dose computed tomography (LDCT) screening, but such screening is rarely used. This study investigated methods to increase LDCT utilization through both a provider and community intervention to lower lung cancer mortality rates. This study used the Precaution Adoption Model for provider and community interventions implemented in four study regions in western South Dakota. The goal was to increase LDCT screening for eligible participants. Intake surveys and LDCT screenings were compared at baseline and 6 months following the education programs for both interventions. A total of 131 providers participated in the provider intervention. At the 6-month follow-up survey, 31 (63%) referred at least one patient for LDCT (p < 0.05). Forty (32.3%) community participants reported their provider recommended an LDCT and of those, 30(75%) reported getting an LDCT (p < 0.05). A total of 2829 patient surveys were completed at the imaging sites and most (88%, n = 962) cited provider recommendation as their reason for obtaining an LDCT. Almost half (46%; n = 131) of the referring providers attended a provider education workshop, and 73% of the providers worked at a clinic that hosted at least one community education session. Over the study period, LDCT utilization increased from 640 to 1706, a 90.9% increase. The provider intervention had the strongest impact on LDCT utilization. This study demonstrated increased LDCT utilization through the provider intervention but increases also were documented for the other intervention combinations. The community-based education program increased both community and provider awareness on the value of LDCTs to lower lung cancer mortality rates.

Communication with physicians and family about breast Cancer recurrence

Objective

Adequate physician-patient communication about cancer recurrence is vital to quality of life and to informed decision-making related to survivorship care. The current study was guided by a cognitive-affective framework to examine communication with family and physicians about breast cancer recurrence risk.

Methods

A survey of recently-diagnosed, early-stage breast cancer patients in Appalachia investigated physician-patient and familial communication about breast cancer recurrence risk.

Results

Over 30% of participants reported not talking to family or physicians about breast cancer recurrence risk. Younger patients reported more conversations, and speaking with physicians was associated with greater perception risk factors associated with recurrence risk. Greater worry about recurrence was associated with more communication with family and plans to talk to family, physicians, and friends about recurrence risk in the future.

Conclusion

Additional supports for patients and physicians are needed to improve understanding of breast cancer recurrence risk and risk factors for recurrence.

Innovation

Family communication about breast cancer recurrence risk is understudied. The combination of physician and family communication adds novelty to our analysis.

Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) in Appalachia: protocol for a group randomized, delayed intervention trial

Appalachian regions of Kentucky and Ohio are hotspots for colorectal cancer (CRC) mortality in the USA. Screening reduces CRC incidence and mortality; however, screening uptake is needed, especially in these underserved geographic areas. Implementation science offers strategies to address this challenge. The aim of the current study was to conduct multi-site, transdisciplinary research to evaluate and improve CRC screening processes using implementation science strategies. The study consists of two phases (Planning and Implementation). In the Planning Phase, a multilevel assessment of 12 health centers (HC) (one HC from each of the 12 Appalachian counties) was conducted by interviewing key informants, creating community profiles, identifying HC and community champions, and performing HC data inventories. Two designated pilot HCs chose CRC evidence-based interventions to adapt and implement at each level (i.e., patient, provider, HC, and community) with evaluation relative to two matched control HCs. During the Implementation Phase, study staff will repeat the rollout process in HC and community settings in a randomized, staggered fashion in the remaining eight counties/HCs. Evaluation will include analyses of electronic health record data and provider and county surveys. Rural HCs have been reluctant to participate in research because of concerns about capacity; however, this project should demonstrate that research does not need to be burdensome and can adapt to local needs and HC abilities. If effective, this approach could be disseminated to HC and community partners throughout Appalachia to encourage the uptake of effective interventions to reduce the burden of CRC.

Development and Evaluation of Patient Navigation Training for Rural and Appalachian Populations

The Appalachian region of the USA includes 423 counties in 13 states positioned along the spine of the Appalachian Mountains stretching from New York to Mississippi. Approximately 42% of Appalachia is rural, and while the economy of Appalachia has diversified over the past two decades from reliance on agriculture and coal mining, 176 (41.6%) of the 423 counties are classified as economically distressed or at-risk. Patient navigation (PN) has been shown to be effective as an approach to address multiple barriers and enhance access to healthcare services, and yet there are no known PN programs focusing on the Appalachian population. This project was designed to develop, implement, and evaluate a curriculum and training program for PN for cancer prevention and control in Appalachia. The training program was developed through formative evaluation and offered daylong workshops that provided instruction in 60-90-min modules. Workshop topics included an introduction to PN, Appalachian culture, community needs assessment, communication, financial navigation, and navigation for screening and diagnostic follow-up for breast, cervical, and colorectal cancers. A total of 20 workshops were conducted with 334 attendees. The workshops were evaluated using a mixed-method approach using pre- and posttests and participant evaluations. The overall mean posttest scores increased by 4% from pretest (p < 0.05). Evaluation also showed that attendees valued the focus on Appalachian culture and judged the content relevant and useful. Attendees also expressed interest in additional opportunities for similar workshops that expanded upon current topics and allowed for exploration of Appalachian health-related issues.

Effectiveness and implementation of mPATH™-CRC: a mobile health system for colorectal cancer screening

BACKGROUND

Screening for colorectal cancer (CRC) is widely recommended but underused, even though CRC is the third most diagnosed cancer and the second leading cause of cancer death in the USA. The mPATH™ program is an iPad-based application designed to identify patients due for CRC screening, educate them on the commonly used screening tests, and help them select their best option, with the goal of increasing CRC screening rates.

METHODS

The mPATH™ program consists of questions asked of all adult patients at check-in (mPATH™-CheckIn), as well as a module specific for patients due for CRC screening (mPATH™-CRC). In this study, the mPATH™ program is evaluated through a Type III hybrid implementation-effectiveness design. Specifically, the study consists of three parts: (1) a cluster-randomized controlled trial of primary care clinics comparing a "high touch" evidence-based implementation strategy with a "low touch" implementation strategy; (2) a nested pragmatic study evaluating the effectiveness of mPATH-CRC™ on completion of CRC screening; and (3) a mixed-methods study evaluating factors that facilitate or impede the maintenance of interventions like mPATH-CRC™. The primary objective is to compare the proportion of patients aged 50-74 who are eligible for CRC screening who complete mPATH™-CRC in the 6th month following implementation between the "high touch" and "low touch" implementation strategies. Effectiveness of mPATH™-CRC is evaluated by comparing the proportion who complete CRC screening within 16 weeks of their visit to the clinic between a pre-implementation cohort (8 months before implementation) and a post-implementation cohort (8 months after implementation).

DISCUSSION

This study will provide data on both the implementation of the mPATH™ program and its effectiveness in improving screening rates for CRC. In addition, this work has the potential to have an even broader impact by identifying strategies to support the sustained use of other similar technology-based primary care interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03843957. Registered on 18 February 2019.

Beliefs and knowledge related to human papillomavirus (HPV) vaccine among African Americans and African immigrants young adults

BACKGROUND

Despite the disparate human papillomavirus (HPV) infection rates among sexually active Black young adults, HPV vaccine uptake remains low among this population. This study aimed to explore HPV beliefs, attitudes, and knowledge among Black young adults and provide recommendations on ways to improve vaccine uptake.

METHODS

We used a mixed-method, convergent design to conduct five focus groups and administered a 40-item electronic survey that was developed with health belief model (HBM) constructs. We assessed HPV and vaccine knowledge, barriers, and attitudes toward vaccination. We analyzed quantitative data using descriptive statistics and bivariate methods. Focus group transcripts were analyzed using content analysis. Results were integrated to obtain a better understanding of the topic.

RESULTS

Forty individuals participated in the study. The mean age was 22.2 ± 4.5 years and 55% identified as African immigrants. Integrated data revealed themes mapped to relevant HBM constructs. Almost one third (32.5%) of participants were unaware of their susceptibility to HPV infection and its severity. From focus group discussions, the majority (75%) believed that vaccines are beneficial. Major cues to action include promoting HPV vaccine uptake via community wide informational sessions, provider recommendation, and social and mass media campaigns.

CONCLUSION

Barriers to vaccine uptake, limited HPV knowledge, and lack of vaccine recommendation are important factors contributing to low vaccine uptake among Black young adults. Interventions to decrease barriers to HPV vaccination, increase HPV knowledge, address misconceptions, and unfavorable beliefs are needed to promote HPV vaccine uptake.

Beliefs associated with cancer screening behaviors among African Americans and Sub-Saharan African immigrant adults: a cross-sectional study

BACKGROUND

Beliefs influence cancer screening. However, there are conflicting findings about how belief influence cancer screening among Black adults. The aim of this study was to evaluate the relationships between beliefs (religiosity, fatalism, temporal orientation, and acculturation) and cervical, breast, and colorectal cancer screening behaviors among African Americans and sub-Saharan African immigrants.

METHODS

We conducted a cross-sectional survey of 73 African American and 59 English speaking Sub-Saharan immigrant adults recruited from Lexington and surrounding cities in Kentucky. Data collected included sociodemographic variables, cancer screening behaviors, and several instruments that characterize beliefs, including religiosity, fatalism, temporal orientation, and acculturation.

RESULTS

Participants' mean age was 43.73 years (SD = 14.0), 83% were females, and 45% self-identified as sub-Saharan immigrants. Based on eligibility for each screening modality, 64% reported having ever had a Pap test, 82% reported ever having mammogram, and 71% reported ever having a colonoscopy. Higher education (OR = 2.62, 95% CI = 1.43-4.80) and being insured (OR = 4.09, 95% CI = 1.10 - 15.18) were associated with increased odds of cervical cancer screening (pap test), while cancer fatalism (OR = 0.24, 95% CI = 0.07 - 0.88) was associated with decreased odds. Increased age (OR = 1.57, 95% CI = 1.06 - 2.32) and reduced present orientation (OR = 0.42, 95% CI = 0.22 - 0.80) were associated with receipt of a mammogram. Nativity was the only factor associated with colonoscopy screening. Compared to African Americans, sub-Saharan African immigrants were 90% less likely to have had a colonoscopy (OR = 0.10, 95% CI = 0.02 - 0.66).

CONCLUSION

This study contributes to the existing literature by confirming that beliefs are important in cancer screening behaviors among African American and sub-Saharan African immigrants. These findings should inform the development of cancer control and prevention programs for Black adults.

TRIAL REGISTRATION

US National Library of Science identifier NCT04927494. Registered June 16, 2021, www.

CLINICALTRIALS

gov.

Qualitative assessment of attitudes toward cervical cancer (CC) screening and HPV self-sampling among African American (AA) and Sub Saharan African Immigrant (SAI) women

OBJECTIVES

Despite the availability of preventive methods for cervical cancer (CC), uptake has been low among African American and Sub-Saharan Immigrant (AA/SAI) women. The purpose of this study was to understand AA/SAI women's values and beliefs of CC screening and explore willingness, acceptability, and concerns related to the HPV self-sampling method for CC.

DESIGN

Thirty AA/SAI women participated in one of six focus groups, each lasted 60-90 min, and were held over Zoom video conferencing. The sessions were audio-recorded, transcribed verbatim, and checked for accuracy by research staff prior to data analysis. Transcripts were content analyzed by two qualitatively trained research staff. NVivo software was used for data management and analysis.

RESULTS

The average age of participants was 33.67 ± 9.03, more than half were not married (53.3%), and less than half reported having health insurance coverage (46.7%). Participants included 16 AA and 14 SAI. Three main themes emerged from data analysis. (1) Beliefs and values related to CC Screening, (2) perceived barriers to attending CC screening, (3) recommendations to motivate regular CC screening. In addition, three factors emerged in the discussion on the HPV self-sampling method: confidence in ability to self-sample for CC, willingness to use HPV self-sampling kit, and result delivery.

CONCLUSIONS

This study identified a variety of reasons for the disproportionately low utilization of CC prevention services among AA/SAI women. Multidimensional approaches including educational and community engagement programs for this population could improve CC screening uptake and adoption of HPV self-sampling among AA/SAI women.

Building Cancer Prevention and Control Research Capacity in Rural Appalachian Kentucky Primary Care Clinics During COVID-19: Development and Adaptation of a Multilevel Colorectal Cancer Screening Project

This study describes the development of a colorectal cancer (CRC) screening multilevel intervention with four primary care clinics in rural Appalachian Kentucky. We also discuss barriers experienced by the clinics during COVID-19 and how clinic limitations and needs informed project modifications. Four primary care clinics were recruited, key informant interviews with clinic providers were conducted, electronic health record (EHR) capacity to collect data related to CRC screening and follow-up was assessed, and a series of meetings were held with clinic champions to discuss implementation of strategies to impact clinic CRC screening rates. Analysis of interviews revealed multilevel barriers to CRC screening. Patient-level barriers included fatalism, competing priorities, and financial and literacy concerns. The main provider- and clinic-level barriers were provider preference for colonoscopy over stool-based testing and EHR tracking concerns. Clinics selected strategies to address barriers, but the onset of COVID-19 necessitated modifications to these strategies. Due to COVID-19, changes in clinic staffing and workflow occurred, including provider furloughs, a state-mandated pause in elective procedures, and an increase in telehealth. Clinics adapted screening strategies to match changing needs, including shifting from paper to digital educational tools and using telehealth to increase annual wellness visits for screening promotion. While significant delays persist for scheduling colonoscopies, clinics were encouraged to promote stool-based tests as a primary screening modality for average-risk patients.

Universal Screening in Primary Care Practices by Self-administered Tablet vs Nursing Staff

This nonrandomized controlled trial investigates whether self-administered screening via an in-office tablet app was associated with improved detection of patients at risk for depression, injurious falls, or intimate partner violence compared with screening performed by clinicians.

A cluster randomized controlled trial for a multi-level, clinic-based smoking cessation program with women in Appalachian communities: study protocol for the "Break Free" program

BACKGROUND

The cervical cancer burden is high among women living in Appalachia. Cigarette smoking, a cervical cancer risk factor, is also highly prevalent in this population. This project aims to increase smoking cessation among women living in Appalachia by embedding a smoking cessation program within a larger, integrated cervical cancer prevention program.

METHODS

The broader program, the Take CARE study, is a multi-site research collaborative designed to address three risk factors for cervical cancer incidence and mortality: tobacco use, human papillomavirus (HPV) infection, and cervical cancer screening. Break Free is a primary care clinic-based implementation program that aims to promote smoking cessation among female smokers in Appalachia by standardizing clinical practice protocols. Break Free includes: (1) implementation of a tobacco user identification system in the Electronic Health Record, (2) clinic staff and provider training on the Ask, Advise and Refer (AAR) model, (3) provider implementation of AAR to identify and treat women who want to quit smoking within the next 6 months, (4) facilitated access to cessation phone counseling plus pharmacotherapy, and (5) the bundling of Break Free tobacco cessation with HPV vaccination and cervical cancer screening interventions in an integrated approach to cervical cancer prevention. The study spans 35 Appalachian health clinics across 10 healthcare systems. We aim to enroll 51 adult female smokers per health system (total N = 510). Baseline and follow-up data will be obtained from participant (provider and patient) surveys. The primary outcome is self-reported 12-month point prevalence abstinence among enrolled patients. All randomized patients are asked to complete follow-up surveys, regardless of whether they participated in tobacco treatment. Data analysis of the primary aims will follow intent-to-treat methodology. Secondary outcomes will assess program implementation and cost effectiveness.

DISCUSSION

Addressing high tobacco use rates is critical for reducing cervical cancer morbidity and mortality among women living in Appalachia. This study evaluates the implementation and effectiveness of a smoking cessation program in increasing smoking cessation among female smokers. If results demonstrate effectiveness and sustainability, implementation of this program into other health care clinics could reduce both rates of smoking and cervical cancer. Trial registration NCT04340531 (April 9, 2020).

Abstract PO-246: Correlates of HPV test history among African American and Sub-Saharan African immigrant women

Background: Human Papillomavirus (HPV) is the causative agent in nearly all cases of cervical cancer. Cervical cancer is preventable and treatable if detected early through regular screening. While Pap testing is a traditionally accepted screening option, HPV testing offers improved assurance of low cancer risk and reliable identification of cervical precancer and cancer. However, HPV testing is a relatively new testing option and remains underused. Black women, including Sub-Saharan African immigrants, have higher risk for cervical cancer incidence, mortality rates, and later stage of diagnosis for cervical cancer. The purpose of this study was to examine predictors of ever having had an HPV test among African American and Sub-Saharan African immigrant women. Methods: We conducted a cross-sectional 85-item survey with self-described African American or Sub-Saharan African immigrant women recruited from the community in a medium size city in the Southeastern US. Data included demographics, HPV and HPV testing knowledge, and HPV testing history. Logistic regression evaluated predictors of ever having had an HPV test. Results: The average age of the 91 women was 38.2 years (SD = 12.6) and almost two-thirds (65%) were African immigrants. The majority (84%) had ever had a Pap test and more than one-third (36%) had ever had a HPV test. Women were correct on less than half of the HPV knowledge 16-item scale (M = 7.1, SD = 4.7) and HPV testing knowledge was low, with women answering an average of less than two out of five items correctly (M = 1.8, SD = 1.5). Younger age (p=.004), higher education (p=.015), and higher HPV testing knowledge (p=.007) were significant predictors of having had an HPV test. Every one-year increase in age was associated with a 7% decrease in having had an HPV test (OR=.93, 95% CI = 0.88-0.98), while every one-level increase in education was associated with a 2-fold increase (OR=2.1, 95% CI=1.15-3.69). Every one-item increase in HPV testing knowledge was associated with an over two-fold increase in having had an HPV test (OR=2.1, 95% CI = 1.2-3.6). Conclusions: To ensure prompt diagnosis, follow up, and treatment, health care providers must stay abreast of updated screening guidelines and implement them. Future research should prioritize increasing knowledge and HPV testing among older women and those with lower educational attainment. c

Citation Format: Adebola Adegboyega, Amanda Wiggins, Lovoria B. Williams, Mark Dignan. Correlates of HPV test history among African American and Sub-Saharan African immigrant women [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-246.

Increasing Cervical Cancer Prevention Through HPV Testing: Challenges in Developing Persuasive Messages

Decades of promotion of the Pap test have fallen short in persuading vulnerable women to get screened for cervical cancer. Human papillomavirus (HPV) testing provides an additional screening tool, and the task for cancer control is to promote understanding of the test and encourage its use. Ogden and colleagues investigated the effect of message framing on increasing knowledge and intention to receive HPV testing. Although both messages increased knowledge and intention, no differences were found between gain- and loss-framed messages. We explore implications of this finding and discuss needed research to expand upon and contextualize this important formative research.See related article, p. 839.

Culturally Relevant Online Cancer Education Supports Tribal Primary Care Providers to Reduce Their Cancer Risk and Share Information About Cancer

BACKGROUND

Culturally relevant education is an opportunity to reduce health disparities, and online learning is an emerging avenue for health promotion. In 2014-2019, a team based at the Alaska Native Tribal Health Consortium developed, implemented, and evaluated culturally relevant online cancer education modules with, and for, Alaska's tribal primary care providers. The project was guided by Indigenous Ways of Knowing and the principles of community-based participatory action research and was evaluated in alignment with empowerment theory. About 265 unique learners completed 1,898 end-of-module evaluation surveys between March 2015 and August 2019, and 13 people completed a follow-up survey up to 28 months post module completion.

KEY FINDINGS

Learners described the modules as culturally respectful and informative and reported feeling more knowledgeable and comfortable talking about cancer as a result of the modules. About 98% of the learners planned to reduce their cancer risk because of the modules, and all follow-up survey respondents had reduced their risk, including by quitting smoking, getting screened for cancer, eating healthier, and exercising more. About 98% of the learners planned to share information with their patients, families, friends, and community members because of the modules, with all follow-up survey respondents indicating that they had shared information about cancer from the modules.

IMPLICATIONS FOR PRACTICE AND FURTHER RESEARCH

Culturally relevant online modules have the capacity for positive behavioral change and relatively high correlations between intent and behavior change. Future research could determine which aspects of the modules catalyzed reduced cancer risk and increased dissemination of cancer information.

Older and younger patients' perceptions, evaluations, and responses to worsening heart failure symptoms

BACKGROUND

Whether recognition and prompt response to worsening symptoms are worse in older compared with younger patients with heart failure (HF) is unclear.

OBJECTIVES

The aims of this study were to compare older and younger patients (1) perceptions, evaluations, and responses to worsening HF symptoms, and (2) responses once worsening symptoms were perceived.

METHODS

A mixed-methods study was conducted and to compare data between older (≥ 65) and younger (< 65) in 185 patients hospitalized with HF.

RESULTS

There were few differences attributed to age. In response to higher perceived symptom distress, patients in both groups did nothing and hoped their symptoms would go away (p = 0.004), ignored symptoms and continued doing what they were doing (p = 0.002), or laid down to relax (p < 0.001).

CONCLUSIONS

The majority of patients, regardless of age, did not recognize, interpret, and respond appropriately to HF symptoms. Interventions should be tested that target better symptom appraisal and promote appropriate symptom responses in patients with HF across all ages.

An Evaluation of Cancer Education Webinars in Alaska

Culturally relevant health promotion is an opportunity to reduce health inequities in the cancer burden, and online learning is an emerging avenue for health promotion. To address a desire for synchronous online cancer education, a project team offered ten 1-hr cancer education webinars for Alaska's rural tribal health workers. The project was guided by the framework of Community-Based Participatory Action Research, honored Indigenous Ways of Knowing, and was informed by Empowerment Theory. The evaluation of this community-based intervention included end-of-webinar surveys. Between February and April 2018, 41 surveys were completed by 11 unique participants. All participants reported that, as a result of the webinars, they planned both to change their own behavior to reduce cancer risk, and to talk with their patients more often about cancer prevention strategies such as screenings, physical activity, tobacco cessation, and eating healthy. While the webinars addressed desires for synchronous actions to support cancer learning, and led to intentions to positive change behaviors, the ten webinars engaged far fewer unique learners than the team's asynchronous cancer education modules. This experience may inform other cancer educators' efforts to develop, implement, and evaluate online learning opportunities. Despite the small numbers, these webinars resulted in increased learners' intent to reduce cancer risk behaviors, share cancer information, and improved learners' capacity to talk about cancer in their communities.

Development of a multilevel intervention to increase colorectal cancer screening in Appalachia

BACKGROUND

Colorectal cancer (CRC) screening rates are lower in Appalachian regions of the United States than in non-Appalachian regions. Given the availability of various screening modalities, there is critical need for culturally relevant interventions addressing multiple socioecological levels to reduce the regional CRC burden. In this report, we describe the development and baseline findings from year 1 of "Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) in Appalachia," a 5-year, National Cancer Institute Cancer MoonshotSM-funded multilevel intervention (MLI) project to increase screening in Appalachian Kentucky and Ohio primary care clinics.

METHODS

Project development was theory-driven and included the establishment of both an external Scientific Advisory Board and a Community Advisory Board to provide guidance in conducting formative activities in two Appalachian counties: one in Kentucky and one in Ohio. Activities included identifying and describing the study communities and primary care clinics, selecting appropriate evidence-based interventions (EBIs), and conducting a pilot test of MLI strategies addressing patient, provider, clinic, and community needs.

RESULTS

Key informant interviews identified multiple barriers to CRC screening, including fear of screening, test results, and financial concerns (patient level); lack of time and competing priorities (provider level); lack of reminder or tracking systems and staff burden (clinic level); and cultural issues, societal norms, and transportation (community level). With this information, investigators then offered clinics a menu of EBIs and strategies to address barriers at each level. Clinics selected individually tailored MLIs, including improvement of patient education materials, provision of provider education (resulting in increased knowledge, p = .003), enhancement of electronic health record (EHR) systems and development of clinic screening protocols, and implementation of community CRC awareness events, all of which promoted stool-based screening (i.e., FIT or FIT-DNA). Variability among clinics, including differences in EHR systems, was the most salient barrier to EBI implementation, particularly in terms of tracking follow-up of positive screening results, whereas the development of clinic-wide screening protocols was found to promote fidelity to EBI components.

CONCLUSIONS

Lessons learned from year 1 included increased recognition of variability among the clinics and how they function, appreciation for clinic staff and provider workload, and development of strategies to utilize EHR systems. These findings necessitated a modification of study design for subsequent years.

TRIAL REGISTRATION

Trial NCT04427527 is registered at https://clinicaltrials.gov and was registered on June 11, 2020.

Psychological factors among Appalachian women with abnormal Pap results

PURPOSE

Women who receive an abnormal Pap result may experience negative psychological factors. The purpose of this study is to assess the baseline occurrence of negative psychological factors and evaluate the relationships between psychological factors and demographic characteristics among Appalachian women who received abnormal Pap results.

METHODS

We conducted a secondary analysis of data collected from Appalachia Kentucky women (N = 521) ages ≥18 enrolled in an intervention. Data included sociodemographics, Beck depression and anxiety inventories, fatalism, and personal control measures. Multiple variable logistic regression was used to investigate the association between demographics and psychological factors.

FINDINGS

Participants were predominantly White (96.2%), with mean age 28.93 ± 11.03 years, and the majority (77%) had yearly income below $20,000. Depression was reported by 34.6% (n = 173); 10% (n = 50) experienced moderate or severe anxiety; 20.6% (n = 107) had fatalistic beliefs; and 55.1% (n = 289) believed they lacked personal control over cancer. Women with lower income had higher occurrence of depression (P = .003). Women with moderate to severe anxiety were significantly older than those with low to moderate depression (34.44 vs 28.34, P < .001). Controlling for other variables, as age increased, the odds of fatalistic beliefs increased, OR (95%) = 1.042 (1.022, 1.062). When education level increased, the odds of fatalistic beliefs decreased, OR (95%) = 0.873 (0.800, 0.952).

CONCLUSIONS

Given the high occurrence of depression, anxiety, and fatalistic beliefs among this population, health care providers should assess for underlying mental health diagnoses and psychological distress during each patient encounter and provide recommendations to address them.

Abstract P12: Colorectal cancer screening in Appalachian Kentucky primary care clinics during COVID-19

Background: Colorectal cancer (CRC) mortality is disproportionately higher in Appalachian counties of Kentucky than in non-Appalachian regions. Part of the mortality gap can be explained by lower screening rates in Appalachian counties. Researchers at Markey Cancer Center partnered with primary care clinics in eastern Kentucky to address this disparity by identifying strategies to implement evidence-based interventions (EBIs) to improve CRC screening and follow-up in Appalachian Kentucky. Methods: Members of the research team conducted formative research activities to identify multilevel barriers to CRC screening. A menu of EBIs was then created to address these barriers, and clinic champions selected EBIs that were feasible in their respective practices. However, because of restrictions during COVID-19, clinics experienced multiple changes to workflow and operations, necessitating modifications to program activities. Over a series of virtual meetings, clinic champions selected adaptations that could allow clinics to continue promoting CRC screening in their practices despite COVID-related limitations. Results: Changes in clinic staffing and workflow resulting from COVID-19 included provider furloughs, a state-mandated pause in elective procedures, mandatory parking lot visits for many in-person visits, and an increase in telehealth. Among our clinic partners, total in-person visits were reduced by nearly half from first to second quarter of 2020, whereas telehealth visits were 23 times higher, though telehealth visits were cut in half by third quarter. To match these changing modes of practice, clinics adapted creative strategies for communicating CRC screening recommendations to patients, including shifting from paper to digital educational tools, promoting screening via telehealth visits, and prioritizing recommendations for stool-based tests over colonoscopy for average-risk patients. As a result, orders for FIT and FIT-DNA were 2 and 3 times higher, respectively, from second to third quarter of 2020. Conclusion: Rural primary care clinics in Appalachia continue to promote CRC screening despite the multiple challenges related to COVID-19. One relevant reference for clinicians is the National Colorectal Cancer Roundtable’s playbook for reigniting CRC screening during COVID-19, a document that promotes stool-based screening for average-risk patients. While elective procedures remain backlogged in rural areas due to state regulations, research partners should emphasize the need to prioritize stool-based CRC screening for average-risk populations and reserve scheduling colonoscopies for high-risk individuals or those with abnormal stool-based test results. While our clinical partners had previously focused on a “colonoscopy first” approach to screening, our findings suggest that our clinic partners increased orders for stool-based CRC tests. Nevertheless, continued outreach is needed to ensure CRC screening rates remain optimal.

Citation Format: Aaron J. Kruse-Diehr, Mark Cromo, Melinda Rogers, Angela Carman, Bin Huang, David Gross, Sue Russell, Vickie Fairchild, Mark Dignan. Colorectal cancer screening in Appalachian Kentucky primary care clinics during COVID-19 [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr P12.

Abstract PO-254: The psychological impact of abnormal Pap smear results among Appalachian women

Background: Due to availability of Pap screening to detect precancerous cells the likelihood of dying from cervical cancer has declined. However, about 7% of the 66 million women screened each year have an abnormal Pap smear warranting further evaluation. Women with an abnormal Pap result may experience negative psychological factors that may deter them from obtaining follow up care. The aim of this study is to examine among women with abnormal Pap smear the relationship between psychological factors and demographic characteristics and determine predictors of negative psychological factors. Methods: We conducted a secondary analysis of data collected from Appalachian Kentucky women (N=521) ages ≥18 enrolled in an intervention to test the effectiveness of patient navigation to follow- up for abnormal Pap tests. Data included sociodemographics, Beck depression and anxiety inventories, fatalism, and personal control measures. Multiple logistic regressions was used to investigate the association between demographic variables and negative psychological factors. Results: Participants were predominantly white (96.2%), mean age 28.93±11.03 years, majority (77%) had yearly income below $20,000 and more than half (57%) were uninsured. Participants had a high prevalence of depression 34.6% (n=173), 10% (n=50) experienced moderate or severe anxiety, 20.6% (n=107) had fatalistic beliefs, and 55.1% (n=289) believed they lacked personal control over cancer. Women with lower income had higher prevalence of depression compared with those with higher income (p =.003).

Women with moderate to severe anxiety were significantly older than those with low to moderate depression (34.44 vs 28.34, p &lt; 0.001). In multiple logistic regression model, age and income were the two most important demographic variables related to the psychological factors of women with abnormal Pap smear. Specifically, as age increased, the odds of fatalistic beliefs increased when controlling for other variables in the model, (95%) =1.042 (1.022, 1.062). When education level increased, the odds of fatalistic beliefs decreased, OR (95%) =0.873 (0.800, 0.952).

Conclusion: Women who had abnormal Pap results had considerable negative psychological factors. Clinicians should address women’s questions and concerns about abnormal Pap and discuss the meaning of the result to mitigate associated negative psychological reactions that may deter them from obtaining timely follow up care. Researchers should develop educational interventions targeted at older and less educated women to address negative psychological factors related to abnormal Pap smear.

Citation Format: Adebola Adegboyega, Shuying Sha, Chigozie Nkwonta, Lovoria Williams, Mark Dignan. The psychological impact of abnormal Pap smear results among Appalachian women [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-254.

Abstract PO-253: Increasing colorectal cancer screening in rural underserved communities with multilevel interventions: Formative evaluation of accelerating colorectal cancer screening and follow-up through implementation science in Appalachia

Background: Colorectal cancer (CRC) screening is lower in Appalachian regions of Kentucky and Ohio than in their non-Appalachian counterparts, with lower screening contributing to increased CRC incidence and mortality. To address CRC disparities in these underserved regions, researchers from the University of Kentucky and The Ohio State University partnered with two federally qualified health centers (FQHCs) to develop and implement multilevel interventions (MLIs) during year one of a 5-year National Cancer Institute funded Cancer Moonshot project to increase CRC screening and follow-up in Appalachian Kentucky and Ohio. Methods: Drawing from the Model for the Analysis of Population Health and Health Disparities and using a social determinants of health framework, researchers selected and partnered with Community Advisory Boards (CAB) to guide project formation in two Appalachian counties, one in Kentucky and one in Ohio. These formative activities included creating community profiles, conducting key informant interviews with clinic and community champions, and completing data inventories to assess clinic capacity, ultimately resulting in two primary care clinics being selected for pilot year implementation activities. Results: Key informant interviews revealed barriers to CRC screening at multiple levels: patient (e.g., fear of screening results), provider (e.g., competing priorities), clinic (e.g., lack of reminder or tracking systems), and community (e.g., cultural norms). Clinic champions were provided with menus of evidence-based interventions (EBIs) to address barriers at each level and were encouraged to select locally relevant, implementable EBIs. Clinics chose to implement the following EBIs: improved patient education materials (patient-level), additional provider education (provider-level), improvement of electronic health record (EHR) reporting and creation of clinic-wide screening protocols (clinic-level), and provision of interactive screening education at community events (community- level). Conclusion: Results from pilot year activities were used to refine the project approach for years two through five. Project activities will be expanded to 10 more Appalachian counties in Kentucky and Ohio using a design wherein counties will be paired by participating clinic patient volume. As in pilot year activities, clinic/community champions will be encouraged to select EBIs appropriate to their patients, providers, clinics, and communities. To measure clinical outcomes, self- reported screening will be monitored using data from county-wide telephone surveys with additional data from clinic EHRs. Using an MLI approach may be well- received in underserved rural Appalachian communities and may ultimately be successful at reducing CRC screening disparities.

Citation Format: Aaron J. Kruse-Diehr, Jill M. Oliveri, Mira L. Katz, Mark Cromo, Robin C. Vanderpool, Michael L. Pennell, Darrell M. Gray II, Paul L. Reiter, Bin Huang, Gregory S. Young, Darla Fickle, Melinda Rogers, David Gross, Sue Russell, Electra D. Paskett, Mark Dignan. Increasing colorectal cancer screening in rural underserved communities with multilevel interventions: Formative evaluation of accelerating colorectal cancer screening and follow-up through implementation science in Appalachia [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-253.

Factors Contributing to Delay in Specialist Care After Colorectal Cancer Diagnosis in Kentucky

BACKGROUND

Abundant studies have associated colorectal cancer (CRC) treatment delay with advanced diagnosis and worse mortality. Delay in seeking specialist is a contributor to CRC treatment delay. The goal of this study is to investigate contributing factors to 14-d delay from diagnosis of CRC on colonoscopy to the first specialist visit in the state of Kentucky.

METHODS

The Kentucky Cancer Registry (KCR) database linked with health administrative claims data was queried to include adult patients diagnosed with stage I-IV CRC from January 2007 to December 2012. The dates of the last colonoscopy and the first specialist visit were identified through the claims. Bivariate and logistic regression analysis was performed to identify factors associated with delay to CRC specialist visit.

RESULTS

A total of 3927 patients from 100 hospitals in Kentucky were included. Approximately, 19% of patients with CRC visited a specialist more than 14 d after CRC detection on colonoscopy. Delay to specialist (DTS) was found more likely in patients with Medicaid insurance (OR 3.1, P < 0.0001), low and moderate education level (OR 1.4 and 1.3, respectively, P = 0.0127), and stage I CRC (OR 1.5, P < 0.0001). There was a higher percentage of delay to specialist among Medicaid patients (44.0%) than Medicare (18.0%) and privately insured patients (18.8%).

CONCLUSIONS

We identified Medicaid insurance, low education attainment, and early stage CRC diagnosis as independent risk factors associated with 14-d delay in seeking specialist care after CRC detection on colonoscopy.

Abstract A055: Pearls and pitfalls of implementing a patient navigation training workshop for Appalachia

The Appalachian region includes 13 states, ranging from southern New York to Mississippi. The region encompasses large areas experiencing high unemployment rates, poverty, and high rates of chronic disease, including cancer. Patient navigation (PN) is a patient-centered intervention designed to address barriers to timely cancer screening and treatment. Results of a prior project in the region indicated that existing PN training programs did not adequately address issues specific to working in Appalachia. To address this gap, we developed a culturally relevant PN training program to be delivered across the Appalachian region. We supported and delivered 20 trainings to over 300 participants from 2015 through the present, averaging 15 attendees per session. Participants included nurses, social workers, patient navigators, community health workers, and administrators living and working in Appalachia. The training's focus on integrating the unique aspects of Appalachian culture into patient navigation for cancer screening and care was rated high by participants. Additionally, participants appreciated the opportunity to network, since many participants work in isolation. Despite our model of providing multiple trainings in various locations throughout Appalachia, we noted there were still barriers to attendance. We conducted a formative evaluation to understand the challenges and identify solutions. We spent considerable time focusing on curricula development, but more attention was needed for detailed logistical considerations such as 1) earlier engagement of local community resources, including potential barriers to attending workshops and 2) local assistance in selecting training sites that would attract maximum attendance. Application of the guiding concepts in planning and data describing the workshop locations, participants, and evaluation results will be presented.

Citation Format: Mark Dignan, Sharon Dwyer, Elizabeth Rohan, Dana White, Georgina Castro, Reda Wilson, Eric Stockton. Pearls and pitfalls of implementing a patient navigation training workshop for Appalachia [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A055.

Abstract A068: Results to date: Efforts to increase cancer health disparities training in Geographic Management of Cancer Health Disparities Program Region 1 North

Introduction: The National Cancer Institute (NCI) Center to Reduce Center Health Disparities (CRCHD) Geographic Management of Cancer Health Disparities Program (GMaP) initiated in 2009 brings together investigators, trainees, students, and community health educators to network and share information, scientific resources, and tools to promote cancer and cancer health disparities research, as well as community education outreach within and across regions. To reach their goals, CRCHD initiated 7 GMaP regional “hubs” across the United States to enhance their capacity in areas of disparities research, contribute to the next generation of researchers, and achieve measurable reductions in cancer health disparities. Each hub is led by Regional Coordinating Directors (RCDs) who facilitate connections, provide funding and training resources and “leverage the strengths of its people, programs, and resources to provide greater access to cancer information.”

Methods: The GMaP Region 1 North (R1N) hub is based at the Markey Cancer Center in Lexington, Kentucky. R1N partners with Johns Hopkins University's Sidney Kimmel Comprehensive Cancer Center, the University of South Carolina, and the University of Virginia Cancer Center to serve Delaware, Kentucky, Maryland, Maine, New Hampshire, Vermont, Virginia, West Virginia, Washington, DC, and West Virginia. The overall goal of GMaP R1N is to enhance the capacity of regional cancer centers, associated academic partners, community partners, and early-stage investigators to contribute to the reduction of cancer health disparities in the region. As part of the Continuing Umbrella of Research Experiences (CURE) Program, GMaP R1N promotes the F31, K series, and Diversity Supplement funding opportunities to potential applicants. R1N implemented pilot awards and travel scholarships for CURE-eligible candidates; developed a listserv to communicate with researchers, trainees, and potential applicants; and maintains regular contact with trainees to answer questions and encourage applications for NCI CURE Program and other grant opportunities.

Results: R1N awarded 11 pilot projects, 22 travel scholarships, helped identify mentors and 146 potential applicants for NCI CURE Program grants, and collaborated with points of contact (POC) at colleges and universities, including Historically Black Colleges and Universities to identify potential applicants for NCI CURE and other funding.

Conclusions: Methods have been successful in increasing interest in NCI Cancer health disparities training opportunities. RCDs are critical in establishing and maintaining linkages to support mentor-mentee relationships supported by available funding mechanisms; to engage institutional support for pre- and post-award activities, especially for new investigators; and for shrinking delays in the IRB review and approval process. RCDs have identified process barriers and work with regional POCs to eliminate these barriers and increase efficiencies to further the GMaP mission.

Citation Format: Marcela Blinka, Mark Cromo, Julia F. Houston, Mark Dignan, Nathan Vanderford, B. Mark Evers, Janice Bowie, Adrian Dobs, James Hebert, Tisha Felder, Roger Anderson. Results to date: Efforts to increase cancer health disparities training in Geographic Management of Cancer Health Disparities Program Region 1 North [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A068.

Nonadherence to Standard of Care for Locally Advanced Colon Cancer as a Contributory Factor for High Mortality Rates in Kentucky

BACKGROUND

Kentucky has one of the highest mortality rates for colon cancer, despite dramatic improvements in screening. The National Comprehensive Cancer Network (NCCN) guidelines recommend operation and adjuvant chemotherapy for locally advanced (stage IIb/c and stage III) colon cancer (LACC). The purpose of this study was to determine the rate of nonadherence with current standard of care (SOC) and associated factors as possible contributors to mortality.

METHODS

The Kentucky Cancer Registry database linked with administrative health claims was queried for individuals (20 years and older) diagnosed with LACC from 2007 to 2012. Bivariate and logistic regression of nonadherence was performed. Survival analysis was performed with Cox regression and Kaplan-Meier plots.

RESULTS

A total of 1,404 patients with LACC were included. Approximately 42% of patients with LACC were noted to be nonadherent to SOC, with nearly all (95.7%) failing to receive adjuvant chemotherapy. After adjusting for all significant factors, we found the factors associated with nonadherence included the following: age older than 75 years, stage III colon cancer, high Charlson Comorbidity Index (3+), low poverty level, Medicaid coverage, and disability. Adherence to SOC is associated with a significant improvement in the 5-year survival rate compared with nonadherence (63.0% and 27.4%, respectively; p < 0.0001).

CONCLUSIONS

Our study identified multiple factors associated with the failure of patients with LACC to receive SOC, particularly adjuvant chemotherapy, suggesting the need to focus on improving adjuvant chemotherapy compliance in specific populations. Nonadherence to LACC SOC is likely a major contributor to the persistently high mortality rates in Kentucky.

A Framework for Culturally Relevant Online Learning: Lessons from Alaska's Tribal Health Workers

Culturally relevant health promotion is an opportunity to reduce health inequities in diseases with modifiable risks, such as cancer. Alaska Native people bear a disproportionate cancer burden, and Alaska's rural tribal health workers consequently requested cancer education accessible online. In response, the Alaska Native Tribal Health Consortium cancer education team sought to create a framework for culturally relevant online learning to inform the creation of distance-delivered cancer education. Guided by the principles of community-based participatory action research and grounded in empowerment theory, the project team conducted a focus group with 10 Alaska Native education experts, 12 culturally diverse key informant interviews, a key stakeholder survey of 62 Alaska Native tribal health workers and their instructors/supervisors, and a literature review on distance-delivered education with Alaska Native or American Indian people. Qualitative findings were analyzed in Atlas.ti, with common themes presented in this article as a framework for culturally relevant online education. This proposed framework includes four principles: collaborative development, interactive content delivery, contextualizing learning, and creating connection. As an Alaskan tribal health worker shared "we're all in this together. All about conversations, relationships. Always learn from you/with you, together what we know and understand from the center of our experience, our ways of knowing, being, caring." The proposed framework has been applied to support cancer education and promote cancer control with Alaska Native people and has motivated health behavior change to reduce cancer risk. This framework may be adaptable to other populations to guide effective and culturally relevant online interventions.

Spousal support and knowledge related to cervical cancer screening: Are Sub-Saharan African immigrant men interested?

Sub-Saharan African immigrant (SSAI) men have significant influence on the health-seeking behavior including cervical cancer screening uptake by their female partners/wives. We conducted a qualitative descriptive study with 21 SSAI men to explore knowledge, perceptions, and support related to cervical screening. Participants were aged 36 ± 9 years, college educated (88%), and 53% have lived in the U.S. > 5 years. Three themes emerged; inadequate cervical cancer knowledge, willingness and strategies for support, and shared versus autonomous decision making for screening. Social structure with emphasis on male leadership could be leveraged in cervical cancer screening promotion for SSAI women.

Online Health Promotion to Reduce Cancer Risk: Lessons From Learning With Alaska’s Tribal Primary Care Providers

Background: Alaska's tribal primary care providers in rural Alaska - community health aides and practitioners (CHA/Ps) - requested online education about cancer for themselves and their communities. Aim: A research team at the Alaska Native Tribal Health Consortium engaged in community-based participatory action research to develop culturally respectful online cancer education to support CHA/Ps to increase their knowledge, reduce their own cancer risk, and share cancer information. Methods: This project created ten online learning modules, a semester-long online course that combined the modules with synchronous conversations, and a supplemental webinar series. All modules were community-based and collaboratively developed with input from a community advisory group of CHA/Ps, content experts, and interested partners. Learners completed an evaluation survey at the end of each module and webinar. Course participants completed a precourse assessment, and evaluations at the end of each module, at the end of the course, two-months postcourse, and six-months postcourse. Results: While evaluation is ongoing, as of March 2018, 194 unique individuals, including 27 course participants, had completed 1,288 module evaluation surveys. Learners reported an increase in cancer knowledge, and intentions to reduce their personal cancer risk and share cancer information as a result of the online learning. On 98% of completed surveys, learners shared that they planned to change their interactions with patients as a result of the learning, including talking more about cancer screening, cutting down/quitting tobacco, being more physically active, and eating healthy. A total of 88% of unique learners planned to reduce their personal cancer risk as a result of the learning, including by quitting tobacco, having recommended cancer screenings, exercising, and eating healthier. Comparison of pre and postcourse survey responses showed CHA/Ps’ had changed to eat more fruits and vegetables and exercise more, as well as felt more knowledgeable about cancer, and more comfortable both with finding medically-accurate cancer information online and talking to their patients, families, and communities about cancer. Conclusion: This culturally respectful education strategy may be adaptable to other populations to support primary care providers and their communities to reduce cancer risk. This intervention may be of particular interest to health care providers, public health professionals, and those interested in health systems in rural and remote regions and in areas with limited medical infrastructure.

Culturally-Relevant Online Cancer Education Modules Empower Alaska's Community Health Aides/Practitioners to Disseminate Cancer Information and Reduce Cancer Risk

To address a desire for timely, medically accurate cancer education in rural Alaska, ten culturally relevant online learning modules were developed with, and for, Alaska's Community Health Aides/Practitioners (CHA/Ps). The project was guided by the framework of Community-Based Participatory Action Research, honored Indigenous Ways of Knowing, and was informed by Empowerment Theory. A total of 428 end-of-module evaluation surveys were completed by 89 unique Alaska CHA/Ps between January and December 2016. CHA/Ps shared that as a result of completing the modules, they were empowered to share cancer information with their patients, families, friends, and communities, as well as engage in cancer risk reduction behaviors such as eating healthier, getting cancer screenings, exercising more, and quitting tobacco. CHA/Ps also reported the modules were informative and respectful of their diverse cultures. These results from end-of-module evaluation surveys suggest that the collaboratively developed, culturally relevant, online cancer education modules have empowered CHA/Ps to reduce cancer risk and disseminate cancer information. "brought me to tears couple of times, and I think it will help in destroying the silence that surrounds cancer".

Abstract C12: Cancer navigation programs: Identifying barriers and addressing health disparities in Appalachia

The Appalachian region includes 13 states comprising 420 counties, beginning in the north in southern New York and following the Appalachian Mountains to Mississippi. The region has unique natural beauty and a heterogeneous population that shares distinct cultural characteristics but with high rates of unemployment, low income, and high rates of chronic disease, including cancer. Patient Navigation (PN) can address barriers and enhance access to cancer screening and care through the use of individual navigators who are sensitive to the needs, interests, and values of the community. Although there are numerous PN training programs available, there are no known programs specific to the Appalachian population. An electronic survey was distributed in 2011 and again in 2015/16 to better understand the cancer navigation programs in all 13 states of the Appalachian states and how they serve the regional population. In both waves of the survey over 150 responses were received from navigators, program directors, and supervisors. Survey results identify where cancer navigation programs take place (hospitals, health centers, and cancer centers), which health professionals fill the role of navigators (social workers, nurses, health educators), where navigation programs reside in health organizations (breast care centers, infusion centers, social services, and cancer centers), what aspects of the cancer continuum are addressed (prevention, screening, treatment to survivorship), and what range of services are provided by navigation programs (from education, referrals, to financial and spiritual support). A summary and comparison of quantitative data will be reported supplemented with qualitative findings and open-ended responses.

Citation Format: Sharon Dwyer, Elizabeth Rohan, Dana White, Eric Stockton, Georgina Castro, Reda Wilson, Carol White, Mark Dignan. Cancer navigation programs: Identifying barriers and addressing health disparities in Appalachia [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C12.

Co-Creating a Culturally Responsive Distance Education Cancer Course with, and for, Alaska's Community Health Workers: Motivations from a Survey of Key Stakeholders

To gain input on a proposed culturally responsive, distance-delivered cancer education course informed by empowerment theory and adult-learning principles, Alaska's Community Health Aides/Practitioners (CHA/Ps) and CHA/P leadership were invited to take an online survey in February 2015. The proposed course will be developed as part of the "Distance Education to Engage Alaskan Community Health Aides in Cancer Control" project. The results of the survey demonstrate that respondents are both interested in taking the proposed class and engaging in course development. The results also indicate that respondents have the technological comfort and capacity to be engaged in online learning and have primarily positive experiences and perceptions of distance education. This survey is the beginning of the interactive development of the online cancer education course and part of a continuing endeavor to promote wellness with, and for, Alaska's people by empowering Alaska's CHA/Ps and inspiring positive behavioral change to both prevent cancer and support those who feel its burdens.

Distributed Cognition in Cancer Treatment Decision Making: An Application of the DECIDE Decision-Making Styles Typology

Distributed cognition occurs when cognitive and affective schemas are shared between two or more people during interpersonal discussion. Although extant research focuses on distributed cognition in decision making between health care providers and patients, studies show that caregivers are also highly influential in the treatment decisions of patients. However, there are little empirical data describing how and when families exert influence. The current article addresses this gap by examining decisional support in the context of cancer randomized clinical trial (RCT) decision making. Data are drawn from in-depth interviews with rural, Appalachian cancer patients ( N = 46). Analysis of transcript data yielded empirical support for four distinct models of health decision making. The implications of these findings for developing interventions to improve the quality of treatment decision making and overall well-being are discussed.

Incidence and epigenetic factors associated with endometrial cancer in Appalachian Kentucky

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Background: Data from the US Cancer Statistics Working Group shows that the age-adjusted incidence of endometrial cancer was 25.6/100,000, 2009-2013 for the US and 24.9/100,000 for the Commonwealth of Kentucky. However, for the Kentucky River Area Development District (KR) in the Appalachian region, the rate was higher at 34.2/100,000. This investigation was designed to explore epigenetic factors related to the elevated incidence of endometrial cancer in the KR region of Kentucky. Methods: With IRB approval, retrospective data on women with endometrial cancer were abstracted from tumor registry records for the period 2005-2015. Data including age at diagnosis, family history of cancer, smoking, diabetes and demographic characteristics were analyzed using SPSS. Results: Data on 41 cases of endometrial cancer from 2005-2015 were included in the analyses. The age range was 37-87 with mean age 62. Of the 41 cases, 19.5% (8/41) were under age 50 at diagnosis. 2 out of 8 (25%) had family history of Lynch syndrome associated malignancies. 9 (22.0%) had family history of cancer. No significant associations between smoking, age at diagnosis and diabetes were noted. Conclusions: There is an increased incidence of endometrial carcinoma in Appalachian Kentucky in general, and elevated rates in women under age 50 compared to statewide and US rates. We have shown from our previous research that there is a higher incidence of lynch syndrome among young patients with colon cancer in Appalachian Kentucky. Similar findings were observed with endometrial cancer from this analysis. Further evaluation and genetic testing for any association with Lynch syndrome in this age group is needed.

The experience of treatment barriers and their influence on quality of life in American Indian/Alaska Native breast cancer survivors

BACKGROUND

American Indian and Alaska Native (AI/AN) breast cancer survivors experience disparities in breast cancer incidence and age-adjusted mortality compared with non-Hispanic white (NHW) breast cancer survivors. In addition, mortality-to-incidence rates indicate that AI/ANs continue to have the poorest survival from breast cancer compared with other racial groups. "Native American Cancer Education for Survivors" (NACES) is a cultural education and support intervention for AI/AN patients with cancer that collects data from voluntary participants through the NACES quality-of-life (QOL) survey regarding their cancer experience and survivor journey.

METHODS

Data from the NACES QOL survey were analyzed to determine whether barriers accessing and during initial cancer treatment impacted QOL domains for AI/AN cancer survivors. Exploratory analyses of selected variables were conducted and were followed by Kruskal-Wallis tests to determine whether these barriers influenced survivorship QOL for AI/AN breast cancer survivors.

RESULTS

AI/AN breast cancer survivors' social QOL was significantly affected by barriers to accessing cancer treatment. Many respondents experienced barriers, including a lack of cancer care at local clinics and the distance traveled to receive cancer care. During treatment, too much paperwork and having to wait too long in the clinic for cancer care were the most frequently reported barriers.

CONCLUSIONS

Treatment barriers influence AI/AN breast cancer survivors' social QOL. Mediating these barriers is crucial to ameliorating AI/AN survivors' disparities when accessing and completing cancer treatment and improving survivorship QOL. Cancer 2017;123:861-68. © 2016 American Cancer Society.

Abstract B27: A synergistic regional network's infrastructure to reduce cancer related health disparities

Cancer Health Disparities is defined by the National Cancer Institute (NCI) as “adverse differences in cancer incidence, prevalence, morbidity, mortality, survivorship, and burden of cancer or related health conditions that exist among specific population groups in the United States.” NCI recognizes the substantial progress in cancer treatment, screening, diagnosis, and prevention over the past several decades. However, addressing cancer-related health disparities in certain populations is an area in which progress has not kept pace. Therefore, NCI's Center to Reduce Center Health Disparities (CRCHD) created region-based “hubs” under the Geographic Management of Cancer Health Disparities Program (GMaP) to advance the science of cancer health disparities in the regions, contribute to the next generation of cancer health disparities researchers, and achieve measureable reductions in cancer health disparities in the United States.

GMaP Region 1 North (R1N) hub is based at the University of Kentucky Markey Cancer Center, with Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, University of South Carolina Cancer Prevention and Control Program, and the University of Virginia Cancer Center as lead institutions. The overall goal of GMaP R1N is to enhance the capacity of regional cancer centers, associated academic partners, community partners, and early-stage investigators to contribute to the reduction of cancer health disparities in the region covering Kentucky, West Virginia, Virginia, Delaware, Maryland, New Hampshire, Vermont, Maine, and Washington DC.

GMaP R1N is utilizing an infrastructure of investigators and partners throughout the region that serve on the Advisory Committee, Education and Outreach Subcommittee, Diversity Training Subcommittee, and/or Evaluation Subcommittee to: create opportunities for scientific exchange, cooperation, and collaboration among cancer and cancer-related health disparities researchers throughout the region; attract underrepresented students, trainees/scholars, and investigators to the biomedical cancer research enterprise; enhance access of underrepresented students, trainees, and scholars to career development and mentoring opportunities; and increase cancer information dissemination and sharing of best practices among researchers and trainees/ scholars.

Using this infrastructure, R1N anticipates enhanced collaboration between regional cancer centers and other academic partners, including regional minority serving institutions; increases in the number of competitive collaborative grant applications to NCI from regional cancer and academic centers; increases in the number of successful K- and R- award applications to NCI by underrepresented students, trainees/scholars, and investigators in the region; increased mentoring relationships developed, both within and across regional cancer and academic centers; and increased dissemination of research and career development opportunities across regional institutions.

Citation Format: Neha Jaggi, Julia Faith Houston, James R. Hebert, Mark Dignan, Nathan L. Vanderford, Mark Cromo, Mark Evers, Janice Bowie, Adrian Dobs, Olive Mbah, Ashleigh DeFries Gallagher, Roger Anderson. A synergistic regional network's infrastructure to reduce cancer related health disparities. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B27.

Recommendations for Cancer Epidemiologic Research in Understudied Populations and Implications for Future Needs

Medically underserved populations in the United States continue to experience higher cancer burdens of incidence, mortality, and other cancer-related outcomes. It is imperative to understand how health inequities experienced by diverse population groups may contribute to our increasing unequal cancer burdens and disparate outcomes. The National Cancer Institute convened a diverse group of scientists to discuss research challenges and opportunities for cancer epidemiology in medically underserved and understudied populations. This report summarizes salient issues and discusses five recommendations from the group, including the next steps required to better examine and address cancer burden in the United States among our rapidly increasing diverse and understudied populations. Cancer Epidemiol Biomarkers Prev; 25(4); 573-80. ©2016 AACR SEE ALL ARTICLES IN THIS CEBP FOCUS SECTION, "MULTILEVEL APPROACHES TO ADDRESSING CANCER HEALTH DISPARITIES".

Engaging Elements of Cancer-Related Digital Stories in Alaska

The tradition of storytelling is an integral part of Alaska Native cultures that continues to be a way of passing on knowledge. Using a story-based approach to share cancer education is grounded in Alaska Native traditions and people's experiences and has the potential to positively impact cancer knowledge, understandings, and wellness choices. Community health workers (CHWs) in Alaska created a personal digital story as part of a 5-day, in-person cancer education course. To identify engaging elements of digital stories among Alaska Native people, one focus group was held in each of three different Alaska communities with a total of 29 adult participants. After viewing CHWs' digital stories created during CHW cancer education courses, focus group participants commented verbally and in writing about cultural relevance, engaging elements, information learned, and intent to change health behavior. Digital stories were described by Alaska focus group participants as being culturally respectful, informational, inspiring, and motivational. Viewers shared that they liked digital stories because they were short (only 2-3 min); nondirective and not preachy; emotional, told as a personal story and not just facts and figures; and relevant, using photos that showed Alaskan places and people.

Promoting Mammography with African-American Women in the Emergency Department Using Lay Health Workers

The objective of this study was to test the efficacy of a pilot intervention to increase mammography utilization among African-American women recruited from those waiting in the emergency department (ED)for non-urgent complaints. In a 3-armed pilot of a randomized controlled trial we compared the effects of a brief motivational interview delivered by a lay health worker with those of a culturally targeted brochure and a usual care control group. The results showed that one quarter (23%) of the sample reported having never had a mammogram prior to the study. There was no group difference by mammography status at the 3-month interview. More than one quarter of those retained in the study indicated they had received a mammogram during the study (27.4%). The conclusions from the study were that lay health workers are a valuable asset and may be used in innovative settings such as the ED to increase screening among vulnerable populations.

Promoting Culturally Respectful Cancer Education Through Digital Storytelling

Cancer is the leading cause of mortality among Alaska Native people. Over half of Alaska Native people live in rural communities where specially trained community members called Community Health Aides/Practitioners (CHA/Ps) provide health care. In response to CHA/Ps' expressed desire to learn more about cancer, four 5-day cancer education and digital storytelling courses were provided in 2014. Throughout each course, participants explored cancer information, reflected on their personal experiences, and envisioned how they might apply their knowledge within their communities. Each course participant also created a personal and authentic digital story, a methodology increasingly embraced by Indigenous communities as a way to combine storytelling traditions with modern technology to promote both individual and community health. Opportunities to learn of CHA/Ps' experiences with cancer and digital storytelling included a 3-page end-of-course written evaluation, a weekly story-showing log kept for 4 weeks post-course, a group teleconference held 1-2 weeks post-course, and a survey administered 6 months post-course. Participants described digital storytelling as a culturally respectful way to support cancer awareness and education. Participants described the process of creating digital stories as supporting knowledge acquisition, encouraging personal reflection, and sparking a desire to engage in cancer risk reduction activities for themselves and with their families and patients. As a result of creating a personalized digital story, CHA/Ps reported feeling differently about cancer, noting an increase in cancer knowledge and comfort to talk about cancer with clients and family. Indigenous digital stories have potential for broad use as a culturally appropriate health messaging tool.

A randomized controlled trial of a faith-placed, lay health advisor delivered smoking cessation intervention for rural residents

INTRODUCTION

Rural US residents smoke at higher rates than urban or suburban residents. We report results from a community-based smoking cessation intervention in Appalachian Kentucky.

STUDY DESIGN

Single-blind, group-randomized trial with outcome measurements at baseline, 17 weeks and 43 weeks.

SETTING/PARTICIPANTS

This faith-placed CBPR project was located in six counties of rural Appalachian Kentucky. A total of 590 individual participants clustered in 28 churches were enrolled in the study.

INTERVENTION

Local lay health advisors delivered the 12-week Cooper/Clayton Method to Stop Smoking program, leveraging sociocultural factors to improve the cultural salience of the program for Appalachian smokers. Participants met with an interventionist for one 90 min group session once per week incorporating didactic information, group discussion, and nicotine replacement therapy.

MAIN OUTCOME MEASURES

The primary outcome was self-reported smoking status. Secondary outcomes included Fagerström nicotine dependence, self-efficacy, and decisional balance.

RESULTS

With post-intervention data from 92% of participants, those in intervention group churches (N = 383) had 13.6 times higher odds of reporting quitting smoking one month post-intervention than participants in attention control group churches (N = 154, p < 0.0001). In addition, although only 3.2% of attention control group participants reported quitting during the control period, 15.4% of attention control participants reported quitting smoking after receiving the intervention. A significant dose effect of the 12-session Cooper/Clayton Method was detected: for each additional session completed, the odds of quitting smoking increased by 26%.

CONCLUSIONS

The Cooper/Clayton Method, delivered in rural Appalachian churches by lay health advisors, has strong potential to reduce smoking rates and improve individuals' health.

Print Material in Cancer Prevention: an Evaluation of Three Booklets Designed with and for Alaska's Community Health Workers

With increased internet access in rural Alaska and subsequent shifts in access to health information, we sought to understand the current role of printed cancer education booklets focused on recommended cancer screening exams. This evaluation reviewed three cancer education booklets specifically created with and for Alaska's Community Health Workers (CHWs) and the people in their communities. The booklets were created in an adaptation of empowerment theory, focused on working within a community-based participatory framework, in a culturally respectful manner, to shift cancer prevention norms by empowering CHWs to catalyze health behavior change for both themselves and their communities. The booklets incorporated traditional Alaska Native values and were designed to connect with readers at an affective and informational place that emphasized relationships. Since 2010, over 20,000 booklets have been distributed. Between January 2013 and March 2014, CHWs from throughout Alaska were invited to complete a three-page anonymous written evaluation of the booklets during community health trainings in Anchorage, Alaska. A total of 102 CHWs completed evaluations, with the vast majority indicating that they liked (100 %), and learned (96 %) from, the booklets. The evaluation results suggest that printed booklets designed in a culturally responsive manner, which both communicate medically accurate information and reach readers at an affective place to inspire action through raising awareness in relationship with others, are a helpful way to receive, discuss, and disseminate cancer screening information among Alaska Native people.

Abstract A37: A group randomized trial to reduce obesity among Appalachian church members: The Walk by Faith study

Purpose: Appalachia is a rural, socioeconomically disadvantaged region with limited access to preventive health services. The Appalachia Community Cancer Network (ACCN) is an NCI-funded research initiative that collaborates with community-based cancer coalitions and other community groups to increase awareness, provide education, and promote cancer prevention. Using Community Based Participatory Research (CBPR) principles, ACCN tested a program to reduce overweight and obesity, a modifiable risk factor for cancer, by working with churches, an important institution in Appalachia. The primary outcome of this study was change in weight from baseline to twelve months. The goal of this report is to present trial results for weight reduction at 12 months.

Methods: The study was a group randomized trial where county or group of counties in five Appalachian states (Ohio, Pennsylvania, Kentucky, Virginia, and West Virginia) were randomly assigned to receive either an intervention program on diet and physical activity titled “Walk by Faith” (WbF) or an educational program focused on cancer screening titled “Ribbons of Faith” (RoF). Participants attended an information session, provided informed consent, were screened for eligibility, and completed biometric measurements including height, weight, blood pressure, and waist and hip circumference. Biometric measurements were also collected at 12 and 24 months. Participants reported on demographic, tobacco use, cancer and cancer screening history, healthcare access, Appalachian identity, physical activity and diet-related information at baseline and annually for two years. Church members were eligible if they were 18 years of age or older, overweight, willing to use a computer, and medically cleared to participate. Ohio and Pennsylvania sites enrolled participants from January through September in 2012, while the other three states enrolled participants from February to November 2013.

Participants in the WbF program received pedometers, monthly education sessions focused on healthy eating and exercise, healthy eating guide books, physical activity journals, and access to a website (Faithfully Living Well) customized for each church and designed to assist participants to overcome barriers to healthy eating and physical activity, track their weight and activities, and access health-related articles and healthy recipes. RoF participants were invited to attend monthly educational sessions about cancer and cancer screening.

Results: Of 866 interested parishioners at 28 churches, 159 (18%) were ineligible; of the 707 eligible individuals who completed screening, 663 (94%) were enrolled. Participants were predominantly female (71%) with average BMI of 33.2; 42% reported regular exercise, 25% had a high school education or lower, and 26% had household incomes &lt;$40,000. Although the difference in weight loss from baseline to 12 months for WbF compared to RoF was not statistically significant overall (1.1% decrease in weight for WbF vs. RoF, p=0.17), results varied by gender. Among men, those in the WbF arm experienced a 2.5% loss in weight compared to men in the RoF arm (p=0.03). Participants in the WbF group increased fruit and vegetable consumption by 26% at 12-months compared to the RoF group (p=0.03). Among WbF participants, greater participation in monthly educational sessions was associated with greater weight loss; for every two sessions attended, weight at 12-months reduced on average by 0.7% (p=0.002).

Conclusions: Overall, the WbF program facilitated weight loss in mainly male participants, and all participants improved fruit and vegetable intake. If participants were engaged in WbF activities, they lost more weight; thus, ways to improve participation should be explored. These results lend support to church-based intervention programs for underserved rural communities.

Citation Format: Ryan Baltic, Electra D. Paskett, Samuel Lesko, Stephenie Kennedy, Gene Lengerich, Karen A. Roberto, Nancy Schoenberg, Gregory Young, Mark Dignan. A group randomized trial to reduce obesity among Appalachian church members: The Walk by Faith study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A37.

Abstract PR01: Development and implementation of a church-based eHealth program to reduce obesity in Appalachian adults

Purpose: Significant disparities in incidence and mortality for cancers related to obesity have been identified in Appalachian adults compared to the entire US. The Appalachia Community Cancer Network (ACCN) partnered with churches in Kentucky, Ohio, Virginia, West Virginia, and Pennsylvania to conduct a community-based participatory research program with a goal of reducing obesity through environmental and individual change. The primary outcome is change in body mass index (BMI) from baseline to twelve months. Secondary outcomes include change in physical activity level, blood pressure and diet. The focus of this paper is on the development and implementation of the intervention program in thirteen churches across five states, maintenance of the program during the sustainability phase, and preliminary feedback on the intervention from participants.

Methods: The intervention program, Walk by Faith (WbF) was developed with input from focus groups and community advisory boards. The main component is the Faithfully Living Well (FLW) website that allows participants to upload steps from pedometers, track progress in walking and weight, health-related articles, recipes, forums, albums, and a rewards page – all tailored to each county. Comments from participants are recorded both on FLW and via email or paper. Comments were separated by phase and classified as either positive, neutral, requests for additional support, or reporting issues.

Ohio and Pennsylvania acted as a vanguard group, recruiting overweight adults one year prior to the other three states. Participants completed food frequency and physical activity questionnaires, biometric measurements (height, weight, blood pressure, resting heart rate, body image, waist and hip), and survey questions regarding their health behaviors, social support, and cancer history. Enrolled participants received Omron pedometers, string bags, CalorieKing pocket guides and food journals, and access to the FLW website. Monthly education sessions were held, as were church walks, physical activity and cooking classes, and a celebration event at the end of the 12-month intervention. Interventionists were employed to complete quarterly wellness plans with participants and assist with website use. Volunteer church navigators (CNs) within the churches coordinated monthly events with the help of staff. The sustainability phase started at the end of the 12-month period, when study staff distanced themselves from the program and CNs took over staff roles. Activities are suggested to CNs, CNs and participants decide type and frequency of activities, and CNs report on activities, attendance, and reception of events back to study staff.

Results: 429 intervention participants were enrolled from 13 churches. To date, 11 churches with 399 participants have moved to the sustainability phase. Participants have reported positive experiences and health benefits through voluntarily submitted success stories and comments on monthly process evaluations. Participants reported weight loss, increased fruit, vegetable and water intake, reduction in soda intake, and discontinuation of medications. Of the 194 comments received to date, 121 (62%) were positive comments about the program. The most common positive comments were about the quality of presentations (44%), materials and overall program (39%), and improved health status (7%). 15 comments (8%) requested additional support or communication from program leaders.

This abstract was also presented as Poster A14.

Citation Format: Ryan Baltic, Electra D. Paskett, Samuel Lesko, Stephenie Kennedy, Gene Lengerich, Karen Roberto, Nancy Schoenberg, Mark Dignan. Development and implementation of a church-based eHealth program to reduce obesity in Appalachian adults. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr PR01.

Abstract B14: Effectiveness of patient navigation for follow-up for abnormal pap tests in Appalachian Kentucky

Introduction. Residents of Appalachian Kentucky experiences significant cancer disparities. The population is characterized, in general, as largely rural with high poverty rates, high unemployment and limited access to health care. Lung and colorectal cancer incidence and mortality rates in this area are among the highest in the nation and although cervical cancer mortality has decreased over recent decades, data from the Surveillance, Epidemiology, and End Results (SEER) program reveals that mortality rates in Kentucky are substantially higher than the national average. In 2003, when this project began, the US cervical cancer mortality rate was 2.7 per 100,000 (95% confidence interval = 2.6-2.7). During the same period, the rate in Kentucky was 3.2 per 100,000 (2.9-3.6). In the 54 Appalachian counties in the state, the rate was even higher, 3.7 per 100,000 (3.5-4.0). Death from cervical cancer is preventable in nearly all cases with screening by the Pap test and adherence with recommendations to obtain follow-up care when abnormalities are detected.

Methods. To address the problem of elevated cervical cancer incidence and mortality experienced by rural Appalachian women, a patient navigation intervention program was developed with the goal of increasing adherence with recommendations for follow-up for women with abnormal Pap test results. The intervention was implemented in partnership with county health departments. Intervention effectiveness was evaluated in a quasi-experimental trial that included intervention county health departments (n=13) that provided patient navigation services and a comparison group of county health departments (n=13) that provided usual care. Women with abnormal Pap test results were enrolled in the intervention group county health departments and patient navigation was tailored to the type of follow-up care recommended. Study outcome data were collected from medical records. Participants were enrolled from September 2008 through July 2010. A total of 774 medical record reviews are included in the analysis (230 women in intervention and 544 women in comparison county health departments). Recommendations for follow-up, which were based on the type of abnormality and the age of the patient, included returning to the health department to obtain a repeat Pap test or making an appointment with a community gynecologist under contract with the health department.

Key Findings. The proportion of participants that received their recommended follow-up care was greater in the intervention group (91.6%) than in the comparison group (80.8%) (p=.01). The effect of the patient navigation intervention was strongest among women who received follow-up care from the health department as opposed to community gynecologists under contract with the health departments.

Conclusions. The results demonstrate the effectiveness of the patient navigation intervention and also provide evidence suggesting that development of policy to promote integration of navigation with rural health care delivery systems has great potential to improve patient outcomes.

Citation Format: Mark Dignan, Brent Shelton, Nancy E. Schoenberg, Carol R. White, Stacey A. Slone, Emily Van Meter, Frances J. Feltner, Gretchen Ely, Christopher DeSimone. Effectiveness of patient navigation for follow-up for abnormal pap tests in Appalachian Kentucky. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr B14.

Digital storytelling: a tool for health promotion and cancer awareness in rural Alaskan communities

Background

The purpose of this study was to learn community members’ perspectives about digital storytelling after viewing a digital story created by a Community Health Aide/Practitioner (CHA/P).

Methods

Using a qualitative research design, we explored digital storytelling likeability as a health-messaging tool, health information viewers reported learning and, if viewing, cancer-related digital stories facilitated increased comfort in talking about cancer. In addition, we enquired if the digital stories affected how viewers felt about cancer, as well as if viewing the digital stories resulted in health behaviour change or intent to change health behaviour.

Findings

A total of 15 adult community members participated in a 30–45 minute interview, 1–5 months post-viewing of a CHA/P digital story. The majority (13) of viewers interviewed were female, all were Alaska Native and they ranged in age from 25 to 54 years with the average age being 40 years. Due to the small size of communities, which ranged in population from 160 to 2,639 people, all viewers knew the story creator or knew of the story creator. Viewers reported digital stories as an acceptable, emotionally engaging way to increase their cancer awareness and begin conversations. These conversations often served as a springboard for reflection, insight, and cancer-prevention and risk-reduction activities.

Assessing and Adapting Patient Educational Materials: Addressing Low Health Literacy in an Inpatient Rehabilitation Setting

Date Presented 4/17/2015

Written patient education materials from an inpatient rehabilitation setting were assessed. The average reading level was 16th grade. Twenty documents were revised, and the average reading level was lowered to 5th grade. Focus groups with clinicians and clients were conducted to assess the materials.

Knowledge and perceptions of tobacco-related media in rural Appalachia

INTRODUCTION

A critical component of the US Food and Drug Administration's new authority to regulate tobacco products is understanding communications and marketing of tobacco products and their perceived risks in different geographic, age, race, ethnic and socioeconomic groups. Such information might be particularly useful in subgroups of the population or geographic areas that experience high tobacco use and suffer a disproportionate burden from tobacco-related diseases. For certain populations, there may be additional cultural factors unique to the geographical region which may promote smoking behavior. The purpose of the present study was to examine the perceptions of tobacco-related media messages among a sample of rural Appalachian natives, a population with smoking rates higher than the national average and who are disproportionately affected by tobacco-related and other cancers.

METHODS

A series of four focus group sessions were conducted in a north-central area of Pennsylvania, in one of 52 counties in Pennsylvania designated as within the Appalachian region. Participants were recruited via direct mail letters, advertisements in a local newspaper, and recruiting flyers posted at the local library. The focus groups were moderated by trained professional staff from The Pennsylvania State University's Center for Survey Research (CSR). Focus group sessions sought to examine perceptions of tobacco-related media in an Appalachian region of Pennsylvania. The sessions were audiotaped and transcribed, and the data was analyzed using qualitative approaches.

RESULTS

Participants reported that pro-tobacco ads and favorable messages were received through the internet, direct mail, convenience stores, billboards, movies, and other sources. Anti-tobacco messages were identified primarily from television and magazines. In general, participants concluded that quitting was a matter of choice and was not influenced by pro- or anti-tobacco media.

CONCLUSIONS

These results indicate that both pro- and anti-tobacco messages from a variety of sources are highly recognized and remembered in detail in Appalachia, but the effectiveness of anti-tobacco messages is questionable within this group. It was found that, without exception, group members reported that no media messages - either pro- or anti-tobacco - had any meaningful impact on their current behavior. Group members did, however, recognize that media messages influenced their behavior at the time they were first starting to smoke. The failure of these messages to connect with this population may reflect the lack of specific tailoring of messages to fit the distinct culture and values of this Appalachian population.