Reactions to vaping cessation messaging and strategies among US young adults who use e-cigarettes

INTRODUCTION

Despite high rates of young adult e-cigarette use, research informing cessation interventions for this population, including those unready to quit, is limited.

METHODS

We analyzed 2022 cross-sectional survey data (from a larger longitudinal study) among 172 US young adult, past-month e-cigarette users (mean age=26.95 years; 57.6% female; 73.3% White). We examined: 1) perceived challenges to quitting e-cigarettes; 2) perceived impact of intervention messages targeting motivation and confidence, and their associations with quitting importance and confidence; and 3) poly-use with cigarettes and/or cannabis in relation to poly-product cessation preferences.

RESULTS

In all, 43.6% reported past-year e-cigarette quit attempts, and 55.3% reported quit readiness; 30.2% reported past-month poly-use with cigarettes, and 54.1% with cannabis. Frequently endorsed challenges to quitting/cutting down were related to stress/anxiety (41.9%), delaying cessation attempts (35.5%), and boredom (25.6%). Messages targeting motivation perceived as most impactful (scale: 1 = 'no impact at all' to 7 = 'a lot of impact') were related to saving money (mean score=4.78), improving health (mean score=4.15), and avoiding toxic chemicals (mean score=4.04), messages targeting confidence perceived as most impactful were related to patience (mean score=4.47), staying busy (mean score=4.27), and soliciting support (mean score=3.84). Perceiving greater impact of messages targeting motivation was associated with greater quitting importance (B=1.16; 95% CI: 0.71-1.60, p<0.001). Neither perceived impact of messages targeting motivation nor confidence were related to quitting confidence. E-cigarette-cannabis poly-users preferred to quit cigarettes first, e-cigarette-cigarette users preferred to quit cannabis first, and poly-users of all three products preferred to quit e-cigarettes first, followed by cigarettes, then cannabis.

CONCLUSIONS

E-cigarette cessation interventions must use relevant messages (e.g. target financial and health benefits of quitting) and consider poly-users' preferences for quitting.

Natural disasters: a comprehensive study using EMDAT database 1995-2022

INTRODUCTION

The frequency, intensity, and geographical reach of natural disasters, fueled in part by factors such as climate change, population growth, and urbanization, have undeniably been escalating concerns around the world.

DESIGN AND METHODS

This is a retrospective analysis of natural disasters recorded in the Emergency Events Database from 1995 to 2022.

RESULTS

Between 1995 and 2022, 11,360 natural disasters occurred, with a mean of 398 per year. Asia experienced the most disasters (4390) and the highest number of casualties (918,198). Hydrological disasters were the most common subgroup (4969), while geophysical disasters led in terms of deaths (770,644). Biological disasters caused the most injuries (2544), particularly in Africa.

CONCLUSION

Recognizing the historical impacts of the various subtypes of natural disasters may help different regions better risk analyze and mitigate the unique risks associated with such events.

Development of a cervical cancer prevention text-messaging program for women living with HIV

Cervical cancer screening and human papillomavirus (HPV) vaccination are critical for those immunocompromised due to human immunodeficiency virus (HIV). Health education programs, including text messaging, can effectively improve knowledge of cervical cancer and recommended screening. This paper describes the data-driven development of a 4-week text-messaging intervention to improve HPV and cervical cancer knowledge among women living with HIV (WLH). This study reports data from surveys (n = 81; January 2020 to September 2021) and focus group discussions (FGDs, n = 39; April-June 2020) conducted among WLH in the DC area. While most WLH revealed that their usual sources of health information were through in-person group sessions, they pointed out that these were impractical options due to the coronavirus 2019 pandemic. They noted that a text-messaging intervention was feasible and acceptable. FGD participants' responses structured around the Protection Motivation Theory constructs informed the text-messaging library, covering topics such as (I) understanding of cervical cancer and HPV, (II) cervical cancer prevention and (III) HPV self-sampling. The utilization of low-cost and easily accessible health education interventions, such as mobile-based text messaging, can effectively increase knowledge and awareness of cervical cancer in populations that have been historically difficult to access and during times when health services are disrupted such as during a global pandemic or public health emergency.

Gaps in Adhering to Pap Testing Recommendations and Related Barriers in a Sample of Young Adults in the US

Given ongoing gaps in adherence to Pap testing recommendations, this study examined: 1) adherence to Pap test screening recommendations; and 2) barriers to Pap test screening among those who were nonadherent, using constructs from the Andersen model. We analyzed Spring 2022 survey data among 541 US young adults who reported having a cervix (n = 541; mean age = 27.73, 42.1% heterosexual, 57.9% sexual minority, 86.0% woman, 3.7% transgender man, 68.2% White, 31.8% racial/ethnic minority). Multivariable logistic regression examined sociodemographic correlates of nonadherence to Pap testing recommendations (i.e., no Pap testing in the past 3 years). Among those who were nonadherent, barriers to Pap testing were assessed. 68.6% (n = 371) were defined as adherent and 31.4% (n = 170) nonadherent. Multivariable regression findings indicated significant differences by race/ethnicity such that Asians (vs. Whites) were more likely to be nonadherent (OR = 2.41, CI = 1.11, 3.70, p = .021); no other differences in relation to race/ethnicity or sexual/gender identity were found. The most commonly reported barriers were: "I have not gotten around to it" (42.9%), "getting a Pap test is just not a priority for me" (30.6%), "fear/worry" (28.2%), "dislike/don't like having procedures done" (27.1%), "my healthcare provider has never mentioned it" (21.2%), "haven't had sex so I don't consider myself at high risk" (20.6%), and "COVID-19 pandemic prevented me" (15.3%). Pap testing is underutilized among young adults in the US, particularly Asians. Multilevel interventions must address barriers within the healthcare system (e.g., provider recommendation), external environment (e.g., societal factors), and individual realm (e.g., perceptions).

E-cigarette cessation interest and quit attempts among young adults reporting exclusive e-cigarette use or dual use with other tobacco products: How can we reach them?

INTRODUCTION

There is limited evidence to inform e-cigarette quitting interventions. This mixed-methods study examined: 1) e-cigarette and other tobacco product perceptions and cessation-related factors; and 2) potential behavioral intervention strategies among young adults reporting exclusive e-cigarette use or dual use with other tobacco products.

METHODS

We analyzed Fall 2020 survey data from 726 participants reporting past 6-month e-cigarette use (mean age=24.15 years, 51.1% female, 38.5% racial/ethnic minority) from 6 US metropolitan areas and Spring 2021 qualitative interview data from a subset (n=40), comparing tobacco-related perceptions and cessation-related factors among those reporting exclusive use versus dual use.

RESULTS

Among survey participants (35.5% exclusive e-cigarette use, 64.5% dual use), those reporting dual use indicated greater importance of quitting all tobacco or nicotine products (mean=5.28, SD=3.44 vs mean=4.65, SD=3.75, p=0.033), whereas those reporting exclusive use expressed greater confidence in quitting e-cigarettes (mean=7.59, SD=3.06 vs mean=7.08, SD=3.01, p=0.029) and all tobacco and nicotine products (mean=7.00, SD=3.16 vs mean=6.31, SD=3.13, p=0.008), as well as less favorable perceptions (i.e. more harmful to health and addictive, less socially acceptable) of cigarettes, cigars, and smokeless tobacco (p<0.05). Interview participants (50.0% exclusive e-cigarette use; 50.0% dual use) attributed previous failed e-cigarette quit attempts to their inability to cope with social influences, stress, and withdrawal symptoms. Although most expressed disinterest in quitting due to belief of eventually outgrowing e-cigarettes (among those reporting exclusive use) or unreadiness to abstain from nicotine (among those reporting dual use), many acknowledged the need for quitting interventions.

CONCLUSIONS

Young adult e-cigarette cessation interventions should target risk perceptions, cessation barriers, and social influences/support.

Disparities in awareness of the HPV vaccine and HPV-associated cancers among racial/ethnic minority populations: 2018 HINTS

OBJECTIVES

Human papillomavirus (HPV) is a common virus that currently infects nearly 80 million people in the United States (U.S.) and can lead to cancer. HPV vaccination provides safe, effective, and lasting protection against HPV infections. Nevertheless, vaccination rates remain suboptimal. The purpose of this study was to examine the relationship between sociodemographic characteristics, HPV and HPV vaccine awareness, and knowledge of HPV-associated cancers among U.S. adults.

DESIGN

Using responses from 3504 U.S. adults (aged 18 years and older) from the Health Information National Trends Survey 5 Cycle 2 (January-May 2018), we performed descriptive analysis to assess the level of awareness of HPV and HPV vaccines and knowledge of HPV-associated cancer. Multivariable regression analysis (including race, gender, age, level of education, marital status, number of children younger than 18) was conducted with weighted analysis.

RESULTS

About 62% of respondents had heard of HPV and HPV vaccine. Asians had a lower level of awareness than non-Hispanic Whites of HPV (36.4% vs. 66.1%) and HPV vaccine (48.7% vs. 67.1%). Multivariable analysis showed that race/ethnicity was associated with outcomes, with Asians being less likely to have heard about HPV (aOR = 0.17, 95% CI: 0.07-0.38) and non-Hispanic Blacks (aOR = 0.57, 95% CI: 0.35-0.91) and Hispanics (aOR = 0.54, 95% CI: 0.36-0.80) being less likely to have heard of the HPV vaccine than non-Hispanic Whites. In addition, gender, age, marital status, and education were associated with awareness of HPV and the HPV vaccine; in particular, individuals who were female, younger (18-45), married, and more highly educated were more likely to have heard of HPV and HPV vaccine.

CONCLUSION

Results highlight disparities in HPV and HPV vaccine awareness among racial/ethnic minority populations. Future interventions and legislation should target racial/ethnic minority populations to foster improvements in HPV vaccine uptake and reduce disparities in HPV-associated cancers.

A pilot randomized controlled trial of automated and counselor-delivered text messages for e-cigarette cessation

INTRODUCTION

Automated text messaging programs show promise for e-cigarette cessation. Adding live text counseling could make them more engaging. We developed Quit the Vape (QTV), an automated e-cigarette cessation text messaging program, designed to be delivered as stand-alone or with counselor-delivered messages (QTV-C), and evaluated the acceptability and preliminary efficacy of QTV and QTV-C.

METHODS

Between May and August 2021, we recruited 58 e-cigarette users, aged 20-43 years, 53.5% male, 63.8% non-Hispanic White, from an ongoing cohort study in the United States. Inclusion criteria were: using nicotine-containing e-cigarettes on ≥4 days per month; smartphone ownership; and not receiving tobacco cessation treatment. Motivation to quit did not impact eligibility. Participants were randomized to QTV (n=20), QTV-C (n=19), or control (link to e-cigarette cessation website, n=19). At end-of-treatment, we assessed program engagement and satisfaction, and self-reported quitting behaviors (e.g. point prevalence abstinence, PPA).

RESULTS

At baseline, average past-month e-cigarette use was 26.8 days (SD=6.2). At follow-up at 4 weeks, among QTV and QTV-C participants, ≥85% replied to ≥1 message, ≥35% set a quit date, and ≤15% opted out. More QTV and QTV-C participants (55.6%) versus control (17.7%) reported program satisfaction (p=0.034). QTV-C participants (vs QTV and control) trended more favorably on 7-day e-cigarette PPA [27.8% (95% CI: 11.5-53.3) vs 11.1% (95% CI: 2.6-37.0) and 5.9% (95% CI: 0.7-34.5)] and quit attempts [66.7% (95% CI: 41.6-84.9) vs 50.0% (95% CI: 27.4-72.6) and 52.9% (95% CI: 29.2-75.5)].

CONCLUSIONS

Adding live text counseling to an automated text messaging program is acceptable and shows promise for e-cigarette cessation. A larger trial is warranted to assess its efficacy.

Prevalence of Food Insecurity Among Cancer Survivors in the United States: A Scoping Review

BACKGROUND

Medical financial hardship is an increasingly common consequence of cancer treatment and can lead to food insecurity. However, food security status is not routinely assessed in the health care setting, and the prevalence of food insecurity among cancer survivors is unknown.

OBJECTIVE

This scoping review aimed to identify the prevalence of food insecurity among cancer survivors in the United States before the COVID-19 pandemic.

METHODS

Five databases (PubMed, Scopus, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Web of Science, and ProQuest Dissertations and Theses) were systematically searched for articles that reported on food security status among US patients receiving active cancer treatment or longer-term cancer survivors and were published between January 2015 and December 2020.

RESULTS

Among the 15 articles meeting the inclusion criteria, overall food insecurity prevalence ranged from 4.0% among women presenting to a gynecologic oncology clinic to 83.6% among patients at Federally Qualified Health Centers. Excluding studies focused specifically on Federally Qualified Health Center patients, prevalence of food insecurity ranged from 4.0% to 26.2%, which overlaps the food insecurity prevalence in the general US population during the same time period (range, 10.5% to 14.9%). Women were more likely than men to report being food insecure, and the prevalence of food insecurity was higher among Hispanic and Black patients compared with non-Hispanic White patients.

CONCLUSIONS

Given significant heterogeneity in study populations and sample sizes, it was not possible to estimate an overall food insecurity prevalence among cancer survivors in the United States. Routine surveillance of food security status and other social determinants of health is needed to better detect and address these issues.

Hispanic caregivers' preferences for content, delivery methods, and sources of nutrition education from their child's preschool: Qualitative research findings

Background: With the obesity epidemic disproportionately affecting Hispanic children and preschool being a critical period when interventions may be effective to prevent it, nutrition education interventions in the preschool setting have the potential to stem obesity's spread. However, the nutrition education needs of low-income Hispanic populations and methods of delivery of that information require further exploration as culturally tailored approaches have seen limited reach to the target audience. Aim: To explore content, delivery methods, and sources of nutrition education that Hispanic caregivers prefer to receive from their child's preschool. Methods: Qualitative interviews with 25 self-identified Hispanic caregivers (≥18 years of age) of 3- to 5-year-old children at Head Start centers in the Washington, D.C., area. Caregivers were interviewed about preferred nutrition education topics, how nutrition education should be delivered, and by whom. Audio-recorded interviews were transcribed verbatim. Transcripts were analyzed using thematic analysis in NVivo v12. Results: Caregivers wanted to know about healthy foods and appropriate portion sizes to feed their children, fruit and vegetable feeding strategies, and how to incorporate Hispanic foods in healthy meals. Preferred delivery methods included receiving nutrition education and recipes in print and digital formats and in-person nutrition classes. Special Supplemental Nutrition Program for Women, Infants, and Children educators were regarded as trusted nutrition education sources. Conclusion: Tailored nutrition education messages combined with multiple delivery methods could be an effective way to reach Hispanic caregivers of preschoolers to increase their nutrition knowledge.

Exploring young adults' e-cigarette use behavior during COVID-19

INTRODUCTION

Changes in daily life related to COVID-19 have impacted e-cigarette use, particularly in young adults. This cross-sectional mixed-methods study explored young adults' perceptions regarding how COVID-19 influenced their e-cigarette use.

METHODS

We analyzed Fall 2020 survey data from 726 past 6-month e-cigarette users (mean age=24.15 years, 51.1% female, 35.5% sexual minority, 4.4% Black, 10.2% Asian, 12.1% Hispanic) and Spring 2021 semi-structured interview data among a subset of 40 participants (mean age=26.30 years, 35.0% female, 45.0% sexual minority, 5.0% Black, 22.5% Asian, 12.5% Hispanic). Participants were drawn from 6 metropolitan statistical areas with varied tobacco and cannabis legislative contexts.

RESULTS

Among survey participants, 44.4% also smoked cigarettes, 54.0% other tobacco products, and 60.1% used cannabis. They reported various changes in their daily lives, including changes in the nature and/or status of employment (e.g. 15.3% were laid off, 72.8% experienced household income loss). Regarding changes in e-cigarette use since COVID-19, 22.6% tried to cut down and 16.0% tried to quit. Interview participants commonly indicated that they increased their use due to stress, boredom, changes in accessibility, and/or changes to daily environment that made e-cigarette use more feasible.

CONCLUSIONS

Results highlight the importance of promoting opportunities for young adults to build relationships to decrease stress, foster a sense of belonging, and increase quality of life (e.g. increasing the accessibility to mental health and social support services, intentionally engaging young adults in pandemic-appropriate community-building and extracurricular activities). This research may help to inform future e-cigarette cessation interventions that consider the unique challenges of societal stressors, such as pandemics.

Young adults' knowledge, perceptions and use of cannabidiol products: a mixed-methods study

Cannabidiol (CBD) product regulatory efforts must be informed by research regarding consumer perceptions. This mixed-methods study examined CBD product information sources, knowledge, perceptions, use and use intentions among young adults. This study analyzed (i) Fall 2020 survey data from 2464 US young adults (Mage = 24.67, 51.4% ever users, 32.0% past 6-month users) and (ii) Spring 2021 qualitative interviews among 40 survey participants (27.5% past-month users). Overall, 97.9% of survey participants reported having heard of CBD, 51.4% ever/lifetime use and 32.0% past 6-month use. Survey participants learned about CBD from friends/family (58.9%), products/ads at retailers (36.4%), online content/ads (34.8%), CBD stores (27.5%) and social media (26.7%). One-fourth believed that CBD products were required to be US Food and Drug Administration-approved (24.9%), tested for safety (28.8%) and proven effective to be marketed for pain, anxiety, sleep, etc. (27.2%). Survey and interview participants perceived CBD as safe, socially acceptable and effective for addressing pain, anxiety and sleep. Interview findings expanded on prominent sources of marketing and product exposure, including online and specialty retailers (e.g. vape shops), and on participants' concerns regarding limited regulation and/or evidence regarding CBD's effectiveness/risks. Given young adults' misperceptions about CBD, surveillance of CBD knowledge, perceptions and use is critical as the CBD market expands.

'It's like if a vape pen and a cigarette had a baby': a mixed methods study of perceptions and use of IQOS among US young adults

Young adults' perceptions and use of heated tobacco products (HTPs) are understudied. This mixed methods study analyzed (i) Fall 2020 survey data from 2470 US young adults (meanage = 24.67; 19.5% and 25.2% past-month cigarette and e-cigarette use; 4.1% ever HTP use) assessing HTP use intentions and perceptions (1 = not at all to 7 = extremely) and (ii) Spring 2021 interview data regarding IQOS (most widely available HTP) in a subset of 40 e-cigarette users. Among survey participants, HTPs versus cigarettes and e-cigarettes showed lower use intentions (mean = 1.27 vs. mean = 1.73, mean = 2.16) but were perceived as less addictive (mean = 5.11 vs. mean = 6.28, mean = 5.82) and harmful (mean = 5.37 vs. mean = 6.65, mean = 5.62). HTPs were perceived more socially acceptable than cigarettes but less than e-cigarettes (mean = 3.39 vs. mean = 3.13, mean = 4.37). Among interviewees, most reported limited HTP knowledge. A few perceived IQOS as a hybrid of traditional cigarettes and e-cigarettes. Most perceived IQOS as harmful but less harmful than cigarettes and were uncertain in relation to e-cigarettes. Over half reported minimal interest in trying IQOS; common reasons included IQOS containing tobacco, limited flavors and use complexity. The varied perceptions of IQOS versus cigarettes and e-cigarettes underscore the need for continued surveillance of perceptions, use and marketing of IQOS to inform regulatory oversight and potential interventions.

Impact of existing and potential e-cigarette flavor restrictions on e-cigarette use among young adult e-cigarette users in 6 US metropolitan areas

Given the 2020 federal restrictions on flavored cartridge-based e-cigarettes and increasing state/local flavored e-cigarette sales restrictions, this mixed-methods study examined US young adult e-cigarette users' responses to flavored e-cigarette sales restrictions (e.g., changes in use, products used, access). We descriptively analyzed Fall 2020 survey data from 726 past 6-month e-cigarette users (Mage = 24.15, 51.1% female, 4.4% Black, 10.2% Asian, 12.1% Hispanic, 35.5% sexual minority), and qualitatively analyzed Spring 2021 semi-structured interview data among 40 participants (Mage = 26.30, 35.0% female, 5.0% Black, 22.5% Asian, 12.5% Hispanic, 45.0% sexual minority). Across all participants (i.e., survey and interview participants), ≥80% most commonly used non-tobacco flavors; ≥40% used tank-based devices. Survey participants most commonly reported that the federal restrictions did not impact their use: 35.8% used available flavors (i.e., tobacco, menthol), 30.4% continued to use tank-based e-cigarettes, and 10.1% switched to tank-based e-cigarettes. Only 8.4% reduced their e-cigarette use. Among interview participants, some indicated no impact on their e-cigarette use because they stocked up or obtained flavors from alternative sources (e.g., online). Some filled their own pods with e-liquids, switched to menthol/tobacco flavors, switched e-cigarette devices or brands, and/or reduced use. Regarding the anticipated impact of comprehensive flavor restrictions, some participants reported that they would: 1) quit vaping; 2) switch to cigarettes; or 3) not change their use (e.g., stock up on flavors). The potential unintended reactions to flavored e-cigarette sales restrictions (e.g., continued use of flavored cartridge-based e-cigarettes) underscore the need for ongoing surveillance of retail and consumer behavior to inform policy and compliance/enforcement efforts.

Perceptions and patient care needs among hepatitis B patients during COVID-19

Background

The novel coronavirus of 2019 (COVID-19) has been and continues to be a rapidly developing public health crisis, that has also disrupted routine and maintenance health care for people living with chronic conditions. Some of these chronic conditions also put individuals at increased risk of COVID-19 complications, particularly if the condition is not under control. For these reasons, the exploratory study reported here examined the needs and preparedness of patients at a community health organization that specifically provides hepatitis B virus (HBV) care for high-risk groups that had previously tested positive for HBV.

Methods

Current study utilized exploratory analysis of qualitative COVID-19-related statements collected during calls to a total of 44 patients reached during April and May, 2020 in the Washington D.C. area. Researchers worked with a community based non-profit organization to reach current HBV + and HCV + patients to provide retention in care and assess patient needs in maintaining management of their condition adapted to include offering medication refills, telehealth, and other resources. We gathered emergent themes, using socio-ecological framework, regarding capacity and needs for managing their chronic condition in a vulnerable population during the initial, most interrupted, time period of a global public health crisis.

Results

From the notes of the calls, five thematic categories emerged: COVID-19 prevention awareness, assistance program access, medical resource access, access to knowledge and awareness about assistance programs, and needs and barriers. From these five themes, providers can develop strategies to better prepare their patients and provide care to patients with chronic conditions during major disruptions.

Conclusions

Future recommendations include increasing hepatitis and COVID-19 vaccine efforts, collaborating with community partners, and screening and understanding social determinants of health that affect racial and ethnic minorities.

HPV knowledge, screening barriers and facilitators, and sources of health information among women living with HIV: perspectives from the DC community during the COVID-19 pandemic

Background

High-risk human papillomavirus (HPV) causes 99% of cervical cancer cases. Despite available prevention methods through the HPV vaccine and two screening modalities, women continue to die from cervical cancer worldwide. Cervical cancer is preventable, yet affects a great number of women living with HIV (WLH). Low screening rates among WLH further exacerbate their already high risk of developing cervical cancer due to immunosuppression. This study explores WLH’s current cervical cancer knowledge, screening barriers and facilitators, and sources of health information.

Methods

Focus group discussions were conducted with 39 WLH aged 21 years old or older, who resided in the Washington-Baltimore Metropolitan Area. Emergent themes were classified and organized into overarching domains and assembled with representative quotations.

Results

The women had limited knowledge of HPV and the cervical cancer screening guidelines for WLH. Coronavirus 2019 (COVID-19) pandemic has amplified screening barriers due to decreased accessibility to usual medical appointment and cervical cancer screenings. Screening facilitators included knowing someone diagnosed with cervical cancer and provider recommendations. WLH indicated that they obtained health information through in-person education (providers, peer groups) and written literature. Due to the pandemic, they also had to increasingly rely on remote and technology-based communication channels such as the internet, social media, television, radio, email, and short message service (SMS) text messaging.

Conclusions

Future health interventions need to explore the possibility of sharing messages and increasing cervical cancer and HPV knowledge of WLH through the use of SMS and other technology-based channels.

Linkage-to-Care Following Community-Based HBV and HCV Screening Among Immigrants from the Washington–Baltimore Metropolitan Area, 2016–2019

Understanding characteristics that impact linkage-to-care (LTC) among individuals living with HBV and/or HCV can enhance public health efforts to provide tailored care services to prevent and treat viral hepatitis among immigrants. Using HBV/HCV screening and LTC data from immigrants (2016–2019), descriptive and logistic regression analyses were conducted to assess (1) the relationship between LTC and sociodemographic factors and (2) factors associated with HBV/HCV LTC. About 87% of those positive HBsAg had LTC and 52% had LTC among those with HCVAB and confirmed PCR. Access to care was an important LTC predictor for HBV–LTC: those who had neither health insurance nor primary care provider (PCP) were more likely to have HBV–LTC than those who had either health insurance or PCP (aOR = 2.95, 95% CI = 1.32–6.59). It is essential to equally provide HBV/HCV LTC support to all immigrants from countries with high prevalence regardless of access to care.

Social media-based intervention to promote HBV screening and liver cancer prevention among Korean Americans: Results of a pilot study

Objective

In United States, Asian Americans are 10 times more likely to have hepatitis B virus (HBV) infection than Whites. Asian immigrants with limited English proficiency face extra barriers to HBV screening and many are unaware of the infectious status. This study aimed to evaluate a social media-based intervention to promote HBV screening and liver cancer prevention among Korean Americans (KA) with limited English proficiency.

Methods

Our community-academia partnership developed the “Lets talk about liver cancer” mHealth program by adapting a CDC media campaign. The program consisted of culturally tailored short video clips and pictorial messages and was delivered over 4 weeks to the participants via the popular Korean social media app, Kakao Talk. A total 100 KA living in greater Washington DC metropolitan were recruited via social media networks and completed this pre-post pilot study.

Results

Out of the 100 participants of KA, 56 were female, mean age was 60, and most have lived in the U.S. for more than 20 years, 84% had limited English proficiency, and 21% had a family history of HBV infection or liver cancer. After 4-week intervention, 95% completed the follow-up survey. Participants reported significant improvements in HBV-related knowledge, liver cancer prevention knowledge, perceived benefits of HBV testing, perceived risks of HBV infection, injunctive norms of HBV testing, and self-efficacy of HBV testing.

Conclusions

The Kakao Talk-based liver cancer prevention program for KAs was feasible and effective. We advocate for community-academia partnership to develop and implement culturally appropriate and social media-based interventions for underserved immigrants.

Assessment of Hepatitis B Virus Screening Behaviors among Asian-Americans through the Lens of Social Cognitive Theory

Background and Purpose

Asian-Americans suffer from significant liver cancer disparity caused by chronic hepatitis B virus (HBV) infection. Understanding psychosocial predictors of HBV screening is critical to designing effective interventions.

Methods

Chinese-, Korean-, and Vietnamese-Americans in the Baltimore-Washington metropolitan region (N=877) were recruited from community-based organizations. Applying the Social Cognitive Theory (SCT), three main theoretical constructs (knowledge, outcome expectancy, and self-efficacy) were tested. Descriptive analyses using Chi-square and ANOVA and multivariate logistic regression models were conducted.

Results

About 47% of participants reported ever having screening for HBV. Vietnamese-Americans had the lowest HBV screening rate (39%), followed by Korean-Americans (46%) and Chinese-Americans (55%). Multiple logistic regression analyses showed significant effects of HBV-related knowledge on screening in all three groups, whereas self-efficacy had significant effects in the Chinese and Korean subgroups, but not Vietnamese. HBV outcome expectancy had no effect on the screening outcome in any of the groups. Additionally, consistent in all three groups, those who had lived in the United States longer were less likely to have screening.

Conclusion

HBV screening rates in Asian Americans remain low; targeted interventions need to consider the differences across ethnic subgroups and address the psychosocial risk factors.

Young Adults' Vaping, Readiness to Quit, and Recent Quit Attempts: The Role of Co-use With Cigarettes and Marijuana

INTRODUCTION

E-cigarette cessation intervention research is limited. Young adult e-cigarette use and cessation is particularly nuanced, given various user profiles (ie, polytobacco use, co-use with marijuana) warranting different intervention approaches.

METHODS

The current study is an analysis of baseline survey data (collected September-December 2018) among 1133 young adult (aged 18-34) e-cigarette users in a 2-year longitudinal study. We examined (1) e-cigarette user profiles (ie, e-cigarette only; e-cigarette/other tobacco; e-cigarette/marijuana; e-cigarette/other tobacco/marijuana) and (2) correlates of readiness to quit e-cigarette use in the next 6 months and past-year e-cigarette quit attempts.

RESULTS

In this sample (Mage = 23.91, 47.3% male, 35.5% sexual minority, 75.2% White, 13.7% Hispanic), e-cigarette user profiles were as follows: 16.8% e-cigarettes-only, 23.4% e-cigarette/other tobacco, 18.0% e-cigarette/marijuana, and 41.8% e-cigarette/other tobacco/marijuana. Multinomial logistic regression (referent: e-cigarette-only use) indicated that all polyuse groups were more likely to use high-nicotine e-liquids (containing ≥9 mg of nicotine). Other predictors included e-cigarettes/other tobacco users being older and male; e-cigarettes/marijuana users using closed systems; and e-cigarettes/other tobacco/marijuana users being sexual minority (p's < .01). Readiness to quit e-cigarettes and past-year quit attempts were reported by 20.8% and 32.3%, respectively. Per multilevel regression, readiness to quit and quit attempts correlated with using fewer days, high-nicotine e-liquids, and closed systems, but not marijuana, as well as being heterosexual and Black (vs White); readiness to quit also correlated with being single; past-year quit attempts correlated with other tobacco use and being Hispanic.

CONCLUSIONS

Young adult e-cigarette users demonstrate distinct user profiles and cessation-related experiences that should be considered in developing cessation interventions.

IMPLICATIONS

The vast majority of young adult e-cigarette users use other tobacco products and marijuana. Unfortunately, few reported readiness to quit or attempting quit. Moreover, certain subgroups (eg, sexual/racial/ethnic minorities) are more likely to be ready or attempt to quit, but may not be successful. Vaping cessation interventions must attend to these nuances.

Treatment decision-making among patients with oropharyngeal squamous cell cancer: A qualitative study

Oropharyngeal squamous cell cancer (OPSCC) is now the most common site of head and neck squamous cell cancer. Despite the focus on treatment deintensification in clinical trials, little is known about the preferences, experiences and needs of patients with OPSCC when deciding between surgery and radiation therapy as primary treatment with curative intent. In this qualitative study, pre-treatment and post-treatment oropharyngeal cancer patients were recruited to take part in one-on-one interviews (n = 11 pre-treatment) and focus group discussions (n = 15 post-treatment) about treatment decision-making. Recordings were transcribed and assessed for emergent themes using framework analysis. From the one-on-one interviews and focus group discussions with OPSCC patients, fourteen themes were identified. Participants expressed alarm at diagnosis, decisional conflict, and a variety of roles in decision-making (physician-controlled, shared, and autonomous). Decisions were driven by the perceived recommendation of the treatment team, a desire for physical (surgical) tumor removal, fear of adverse effects of treatment, and patient-specific values. Although participants felt well-informed by their treating physicians, they identified a need for additional patient-centered information. Participants were critical of the poor quality of information available on the internet, and acknowledged the advantage of hearing the experiences of post-treatment patients. The experiences identified herein may be used to guide patient-centered communication during patient counseling and to inform interventions designed to support patients' needs at diagnosis, ultimately helping to implement high-quality, patient-centered care.

Cigar-Smoking Patterns by Race/Ethnicity and Cigar Type: A Nationally Representative Survey Among U.S. Adults

INTRODUCTION

Racial/ethnic minorities have a higher prevalence of past 30-day cigar smoking than White, non-Hispanics. Little is known, however, about racial/ethnic differences in advanced cigar-smoking patterns by cigar types. This research explores whether cigar-smoking patterns differ by race/ethnicity and cigar types.

METHODS

This study used a nationally representative sample of adults (aged ≥18 years; N=28,148) from the Wave 3 survey (2015-2016) of the Population Assessment of Tobacco and Health Study for analysis. Cigar-smoking patterns included past 30-day use, daily use, established use, past 12-month blunt use, use within 30 minutes of waking, and the number of cigars used per day. Weighted multivariable regressions were conducted in 2019 to examine the associations between race/ethnicity and cigar-smoking patterns by cigar types (traditional cigars, cigarillos, and filtered cigars), controlling for covariates.

RESULTS

Compared with White, non-Hispanics, Black, non-Hispanics were more likely to smoke cigars in the past 30 days (AOR=2.27, 95% CI=2.03, 2.54) and daily (AOR=2.65, 95% CI=1.89, 3.70), have established cigar smoking (AOR=1.95, 95% CI=1.66, 2.29), and smoke blunts in the past 12 months (AOR=2.30, 95% CI=1.84, 2.88). This pattern was generally consistent across cigar types and was especially pronounced for cigarillos. Compared with White, non-Hispanics, Hispanics were more likely to smoke cigars within 30 minutes of waking (AOR=1.50, 95% CI=1.10, 2.06).

CONCLUSIONS

This study finds that Black, non-Hispanics and Hispanics have more advanced patterns of cigar smoking than White, non-Hispanics. Interventions and policies for minimizing cigar smoking may differentially benefit these populations and reduce disparities.

Abstract PO-242: Viral hepatitis among foreign-born communities in the Washington- Baltimore metropolitan area: 5-year prevalence data and implications for linkage to care follow-up

Background: Viral hepatitis is a major public health problem around the world and in the United States, with significant morbidity and mortality. This research aimed to provide updated prevalence estimates and linkage-to-care rates for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among foreign-born immigrants in the Washington-Baltimore metropolitan area. Methods: This retrospective cohort study analyzed screening data obtained from over 275 community-based outreach events held from 2015 to 2019. Through strategic collaborations and culturally-appropriate programs, the Hepatitis B Initiative of Washington DC was able to provide no-cost HBV and HCV testing, vaccination, and treatment linkage-to-care services to 9,489 and 9,427 individuals, respectively. We examined the prevalence of positive HBV (HBsAg+) and HCV (HCVAb+) infections and linkage-to-care with associated sociodemographic characteristics. Results: Overall, prevalence amongst foreign-born clients screened over the 5-year period was 4.3% for HBV and 1.1% for HCV. The highest HBV prevalence was among participants born in Malaysia (8.5%), Cambodia (7.7%), and Vietnam (6.9%), whereas HCV prevalence was highest among participants born in Mongolia (5.0%), Cameroon (3.2%), and Burma (1.5%). Among the 378 HBV- and 102 HCV-infected individuals who were referred to care, linkage- to-care rates were 87.0% (2016-2019) and 47.1% (2017-2019) respectively. Among those linked to care, an overwhelming proportion reported not having health insurance (74.8%) and/or a usual source of care (75.3%); the majority were also female (52.8%), over 30 years of age (96.6%), and born in Asia (78.0%). Conclusions: Foreign-born individuals from Asia and Africa had the highest prevalence of viral hepatitis. These results underscore the need to disaggregate screening data by country of birth to inform prevention and linkage-to-care programs and their impact. Additionally, optimal HBV and HCV screening and linkage-to-care can be achieved among harder-to-reach at-risk populations through partnerships with community organizations, health centers, and public health departments.

Citation Format: Daisy Le, Annie Coriolan, Jane Pan, Carla Jean Berg, Y. Alicia Hong, Angeline Nguyen, Hai Chi Le, Lorien Cindy Abroms, Hee-Soon Juon, Y. Tony Yang. Viral hepatitis among foreign-born communities in the Washington- Baltimore metropolitan area: 5-year prevalence data and implications for linkage to care follow-up [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-242.

Does the time from diagnostic biopsy to neoadjuvant chemotherapy affect the rate of pathologic complete response in stages I-III breast cancer?

Background

Studies in the adjuvant setting suggest that the timing of breast cancer diagnosis, surgery, and chemotherapy might affect outcomes. In the neoadjuvant setting, data exploring whether expeditious neoadjuvant chemotherapy (nac) after diagnosis improves the rate of pathologic complete response (pcr) in breast cancer are limited.

Methods

Patients who received nac and completed treatment between May 2012 and December 2018 were identified from a prospectively collected database at BC Cancer. Time from diagnosis to start of nac was calculated. Patients were grouped into those who did and did not experience a pcr, and those who started nac within 28 days or after 28 days [time to nac (ttn)]. The association between pcr and ttn was tested using logistic regression.

Results

In the time period studied, 482 patients who received nac were identified. After exclusions, 421 patients met the eligibility criteria. Median time from biopsy to chemotherapy was 33 days (range: 7-140 days). In 149 patients (35.4%), nac was received within 28 days of diagnosis (range: 7-28 days); in 272 patients (64.6%), it was received after more than 28 days (range: 29-140 days). The overall pcr rate was 31.8%. A trend toward a higher pcr rate, although not statistically significant, was observed in the group that initiated chemotherapy within 28 days (34.2% vs. 30.5%, p = 0.43). In the logistic regression model, rates of pcr were associated with receptor status, but not age, stage, or ttn.

Conclusions

In the neoadjuvant setting, we observed no difference in the rate of pcr in patients who started nac within 28 days or after 28 days.

Abstract P4-08-27: The 21-gene Recurrence® (RS) Score assay in estrogen receptor positive node negative breast cancer: Real-world chemotherapy usage and patient characteristics within the intermediate and high-risk RS category

Background:

The Oncotype Dx, a 21-gene recurrence score (RS) assay, has been validated as a prognostic tool in early-stage, hormone receptor-positive, HER2-negative breast cancer. A RS of ≥ 31 is predictive for chemotherapy benefit. However, it has not been clearly established whether more intensive chemotherapy regimens for these patients provide further benefit and whether higher RS stratifications (≥41) influence treatment decisions.

Methods:

From the prospective British Columbia (BC) Breast Cancer Outcomes Unit database, we identified patients with N0 disease who received Oncotype Dx testing from May 2010 to December 2016. Patients with previous or synchronous breast cancer, and patients treated with neoadjuvant chemotherapy were excluded. Groups were defined that had an Oncotype Dx RS of 31-40 and ≥ 41. Demographic characteristics and type of chemotherapy received were collected. Additional subgroups were defined for patients who had a RS of 21-25 and who were ≤ 50 years old and &gt; 50 years old.

Results:

We identified 1,202 patients who received Oncotype Dx testing over the time period studied, with 14.8% (n=178) having a RS of ≥ 31. Among these high-risk patients, the median age was 58 (range 34-79), 90% received hormonal therapy and 85% received chemotherapy. In this cohort, 46% received docetaxel and cyclophosphamide for 4 cycles and 28% received 3rd generation chemotherapy. The use of 3rd generation chemotherapy in patients with a RS of ≥ 41 was significantly higher than in patients with RS between 31-40 (39% vs 22%, p = 0.006). Among patients who had a RS of 21-25 and who were ≤ 50 years old (n = 49), 53% received chemotherapy. Of patients who had a RS of 21-25 and who were &gt; 50 years old (n = 127), 16% received chemotherapy.

Conclusions:

Among patients with a RS ≥ 31, decisions regarding chemotherapy usage were heterogeneous with docetaxel and cyclophosphamide for 4 cycles being the most commonly used regimen. However, in those with a RS ≥ 41, 3rd generation chemotherapy was preferred. Patients with a RS between 21-25 and who were ≤ 50 years old received more chemotherapy than patients who were &gt; 50 years old.

 RS 31-40 (n=116)RS ≥ 41 (n=62)RS ≥ 31 (n=178)Median age58.0 (range, 36-79)57.5 (range 34-78)58.0 (range 34-79)Pre-menopausal28.4%29.0%28.7%Hormonal therapy93.1%83.9%89.9%Chemotherapy86.2%82.3%84.8%DCx4 (1)54.3% (n=63/116) Median age 59.0 (range, 36 – 78)30.6% (n=19/62) Median age 64.0 (range, 42 – 78)46.1% (n=82/178) Median age 59.5 (range, 36 – 78)3rd generation chemo (2)21.6% (n=25/116) Median age 56.0 (range, 39 – 79)38.7% (n=24/62) Median age 52.0 (range, 34 – 76)27.5% (n=49/178) Median age 54.0 (range, 34 – 79)Other chemo10.3% (n=12/116) Median age 57.5 (range, 52 – 78)12.9% (n=8/62) Median age 64.0 (range, 42 – 72)11.2% (n=20/178) Median age 58.5 (range, 42 – 78)(1) Docetaxel and cyclophosphamide, 4 cycles (2) Anthracycline and Taxane containing regimens, 6 cycles or 8 cycles

Citation Format: Le D, Chia S, Simmons C, Speers C, Gondara L, Nichol A, Lohrisch C, Gelmon KA. The 21-gene Recurrence® (RS) Score assay in estrogen receptor positive node negative breast cancer: Real-world chemotherapy usage and patient characteristics within the intermediate and high-risk RS category [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-08-27.

The Chinese and Korean American immigrant experience: a mixed-methods examination of facilitators and barriers of colorectal cancer screening

OBJECTIVE

Among Asian Americans, colorectal cancer (CRC) is the second leading cause of cancer deaths. Despite strong evidence that screening can reduce CRC-related mortality, fewer Chinese and Koreans receive screening as compared to non-Hispanic whites and blacks. The objective of this study was to examine facilitators and barriers as well as strategies to promote CRC screening in this population.

DESIGN

This study employed a mixed-methods design. We conducted 17 key informant interviews and 12 focus groups in the Washington, D.C. metropolitan area. 120 Chinese and Korean focus group participants, aged 50 to 85, also provided quantitative data through self-administered surveys. All participants were asked to discuss facilitators and barriers of CRC screening, including in relation to culture.

RESULTS

Participants who had a regular physician and doctor's recommendation for CRC screening were more likely to ever receive a colonoscopy (adjusted odds ratio (aOR) = 3.51; 95% confidence interval (CI): 1.26, 9.79 and aOR = 6.61; 95% CI: 2.63, 16.65, respectively). A doctor's recommendation was also significantly associated with receipt of a fecal occult blood test (FOBT) (aOR = 4.00; 95% CI: 1.43, 11.15). In terms of barriers, those who reported having no time and not having symptoms were less likely to have a colonoscopy (aOR = 0.15; 95% CI: 0.03, 0.82 and aOR = 0.02; 95% CI: 0.002, 0.23, respectively) than those who had time and symptoms. Preventive healthcare was often not viewed as a priority, particularly for those living the'immigrant life,' who gave precedence to work. Cultural barriers to CRC screening included language (e.g. limited English proficiency and low health literacy); fear of finding CRC and burdening the family especially children; fatalism; and stigma towards cancer.

CONCLUSIONS

Future interventions and programs aiming to increase CRC screening among Chinese and Korean Americans should address both cultural and non-cultural factors that influence CRC screening uptake.

Positive and Negative Religious Coping Styles as Prospective Predictors of Well-Being in African Americans

Research on religious coping has proliferated in recent years, but many key questions remain, including the independent effects of positive and negative religious coping styles on well-being over time. Further, little research on religious coping styles has been conducted with African Americans in spite of their documented importance in this population. The present study examined the independent prospective effects on well-being of positive and negative religious coping styles over the subsequent 2.5 years in a national sample of African American community-dwelling adults. Well-being indicators included depressive symptoms and positive and negative affect as well as self-esteem and meaning in life. Results indicated that when considering positive and negative religious coping styles together, baseline positive religious coping consistently and positively predicted the well-being indicators 2.5 years later, while negative religious coping consistently and negatively predicted the well-being indicators 2.5 years later. These effects remained when examining change in well-being levels over time, although they attenuated in magnitude. Finally, negative religious coping more strongly predicted the negative aspects of well-being (e.g., depressive symptoms, negative affect) 2.5 years later than did positive religious coping, an effect that also remained but was attenuated when controlling for baseline levels of well-being. These results highlight the nuanced relationships between both positive and negative religious coping styles and positive and negative aspects of well-being over time among African Americans. Future research might usefully examine how to minimize negative effects and capitalize on the salutary effects of positive religious coping.

"It Felt Like I Was Smoking Nothing:" Examining E-cigarette Perception and Discontinuation among Young Adults

OBJECTIVE

In this study, we sought to understand why young adults from urban low-income regions discontinue using e-cigarettes.

METHODS

We recruited 97 tobacco users aged 18-26 years from Baltimore, Maryland to participate in 17 focus groups. Qualitative data were analyzed using framework analysis.

RESULTS

Being less satisfying than combustible tobacco, perceived cumulating costs, and negative physical effects were expressed as top reasons for never using or discontinuing the use of e-cigarettes.

CONCLUSION

Understanding why young adults discontinue e-cigarette use is critical to inform e-cigarette intervention efforts and public policy. If e-cigarettes are to be promoted as harm reduction devices for combustible tobacco users, it will be important to ensure that they are affordable, satisfying, and formulated to minimize negative physical effects.

CervixCheck: A Spiritually-Based Text Messaging Intervention to Promote Cervical Cancer Awareness and Pap Test Screening Intention among African-American Women

BACKGROUND/PURPOSE

On a national level, African-American women have a 34% higher incidence of cervical cancer and are twice as likely to die of the disease when compared to White women. In response to the need to improve cervical cancer prevention and Pap test screening knowledge and utilization, we developed and pilot tested a 16-day SMS text message-based intervention. The CervixCheck study was designed to develop, pilot test, and evaluate the feasibility, acceptability, and initial efficacy of a spiritually-based SMS text messaging intervention aimed at increasing cervical cancer awareness and Pap test screening intention in church-attending African-American women ages 21-65. Methods/Approach: The Theory of Planned Behavior guided the development of the CervixCheck intervention. This intervention utilized a non-experimental one-group pretest-posttest design. In this article, we present findings from the pilot testing phase. Of the 52 participants at baseline, 46 completed the post-program survey.

RESULTS/FINDINGS

The current study provides evidence for the early feasibility, high acceptability, and some initial efficacy of the CervixCheck intervention. There was a significant pre-post increase observed for knowledge about cervical cancer and the Pap test (p = .001) and subjective norms (p = .006). Findings post-intervention also revealed that 83% of participants reported being either "satisfied" or "very satisfied" with the CervixCheck intervention and 85% found the SMS text messages either "useful" or "very useful".

CONCLUSIONS/SIGNIFICANCE

A spiritually-based SMS text messaging intervention could be a culturally-appropriate and cost-effective method of promoting cervical cancer early detection information to church-attending African-American women.

A Spiritually-Based Text Messaging Program to Increase Cervical Cancer Awareness Among African American Women: Design and Development of the CervixCheck Pilot Study

Background

Although Hispanic women have the highest cervical cancer incidence rate, African American women account for a disproportionate burden of cervical cancer incidence and mortality when compared with non-Hispanic white women. Given that religion occupies an essential place in African American lives, delivering health messages through a popular communication delivery channel and framing them with important spiritual themes may allow for a more accessible and culturally appropriate approach to promoting cervical cancer educational content to African American women.

Objective

The aim of this paper was to describe the design and development of the CervixCheck project, a spiritually based short message service (SMS) text messaging pilot intervention to increase cervical cancer awareness and Papanicolaou test screening intention among church-attending African American women aged 21 to 65 years.

Methods

Through focus group interviews (n=15), formative research was conducted to explore facilitators, motivators, and barriers to cervical cancer screening. The interviews were also used to identify logistical factors that should be considered when developing the CervixCheck intervention. Culturally appropriate and spiritually grounded SMS text messages were developed based on the analysis of focus group data and the review of previous studies that incorporated technology into health behavior change interventions. After the CervixCheck intervention was developed, cognitive response interviews (n=8) were used to review the content of the SMS text messaging library, to ensure that the content was acceptable and understandable, particularly for church-attending African American women aged 21 to 65 years.

Results

Design and development of the SMS text messages involved consideration of the content of the messages and technological specifications. Focus group participants overwhelmingly reported cell phone use and an interest in receiving spiritually based SMS text messages on cervical cancer prevention and early detection. Findings from the cognitive response interviews revealed that the content of the SMS text messaging library was acceptable and understandable with the target population. The revised SMS text messaging library currently includes 22 messages for delivery over 16 days, averaging 11 texts per week, with no more than two messages delivered per day. Initial usability testing also showed early feasibility.

Conclusions

The design and development of the CervixCheck intervention provides important insight into what may be considered an overlooked minority population and missed opportunity in health information technology research. With increased internet penetration through the use of mobile phones, it is appropriate to investigate the viability of technology as a means to reach minority communities and to reduce health disparities.

Endotoxin Removal from Whole Blood by a Novel Adsorption Resin: Efficiency and Hemocompatibility

The structural component of Gram- bacteria, endotoxin (ET), induces the release of endogenous mediators of sepsis. Attempts to remove these downstream molecules in vivo, have not improved survival. However, extracorporeal strategies such as continuous renal replacement therapy or therapeutic plasmapheresis have shown benefit. We are presenting an affinity-based extracorporeal technology for the removal of ET from whole blood. The small-scale device contains an adsorbent that removed 75% of ET present in whole blood. This affinity resin displayed good hemocompatibility regarding the coagulation pathway. Minimal platelet, neutrophil and complement activation were observed. There was also no evidence of consumption of coagulation factors or cell loss. In as much as ET participates in both the inflammatory and coagulation abnormalities in sepsis, this method represents an efficient and hemocompatible way to remove ET from whole blood, which, in an extracorporeal setting, may improve the outcome of sepsis.

Can Women Facilitate Men's Prostate Cancer Screening Informed Decision-Making? The M-PACT Trial

The M-PACT study compared an all-male with a mixed-sex intervention to increase informed decision-making for prostate cancer screening among African-American men in church settings. We recruited 262 men in 18 churches randomized to the two intervention approaches. Trained and certified lay peer community health advisors in each church led a series of four men's health workshops on informed decision-making for prostate cancer screening. African-American male workshop participants completed baseline, post-workshop, and 12-month follow-up surveys. Contrary to our expectations, including women in the workshops did not result in increased intervention efficacy for the informed decision-making outcomes as both groups showed significant improvement over time in several study outcomes including stage of decision-making for prostate cancer screening, preference for role in decision-making, prostate cancer knowledge, and self-reports of prostate specific antigen testing. Finally, men who attended multiple workshops had better informed decision-making outcomes on several indicators. The current findings suggest mixed results from including women in this men's health educational intervention. Future work should consider optimal ways of providing family support for African-American men's health promotion.

Is Colorectal Cancer A Western Disease? Role of Knowledge and Influence of Misconception on Colorectal Cancer Screening among Chinese and Korean Americans: A Mixed Methods Study

Background:

Chinese and Korean Americans have lower colorectal cancer (CRC) screening rates than other racial/ethnic groups, which may be explained by a low level of CRC knowledge and a high level of misconceptions. This study explores the role of knowledge in CRC screening among these groups.

Methods:

Chinese (N=59) and Korean (N=61) Americans older than 50 were recruited from the Washington D.C. Metropolitan area. They completed a detailed survey and participated in focus groups to discuss their knowledge on CRC and CRC screening. Seventeen physicians, community leaders, and patient navigators participated in key informant interviews. Using a mixed methods approach, data were analyzed quantitatively and qualitatively.

Results:

Participants lacked knowledge about CRC and CRC screening. More than half did not know that screening begins at age 50 and there are several types of tests available. More than 30% thought CRC screening was not necessary if there were no symptoms or there was nothing they could do to prevent CRC. Focus group findings suggested understanding about CRC was limited by an inadequate source of linguistically and culturally relevant health information. For example, many participants considered CRC a western condition mainly caused by unhealthy diet. This led to under-estimations about their susceptibility to CRC. Knowledge was positively associated with self-reported screening. Participants who had higher knowledge scores were more likely to report ever having had a colonoscopy and confidence in ability to have CRC screening.

Conclusions:

Mixed-methods analysis provides multi-faceted perspectives on CRC knowledge and its influence on screening. Study findings can help inform interventions to increase CRC screening among Chinese and Korean Americans.

[Relationship between crown form of upper central incisors and papilla filling in Chinese Han-nationality youth]

OBJECTIVE

To explore a crown form classification method for upper central incisor which is more objective and scientific than traditional classification method based on the standardized photography technique. To analyze the relationship between crown form of upper central incisors and papilla filling in periodontally healthy Chinese Han-nationality youth.

METHODS

In the study, 180 periodontally healthy Chinese youth ( 75 males, and 105 females ) aged 20-30 (24.3±4.5) years were included. With the standardized upper central incisor photography technique, pictures of 360 upper central incisors were obtained. Each tooth was classified as triangular, ovoid or square by 13 experienced specialist majors in prothodontics independently and the final classification result was decided by most evaluators in order to ensure objectivity. The standardized digital photo was also used to evaluate the gingival papilla filling situation. The papilla filling result was recorded as present or absent according to naked eye observation. The papilla filling rates of different crown forms were analyzed. Statistical analyses were performed with SPSS 19.0.

RESULTS

The proportions of triangle, ovoid and square forms of upper central incisor in Chinese Han-nationality youth were 31.4% (113/360), 37.2% (134/360) and 31.4% (113/360 ), respectively, and no statistical difference was found between the males and females. Average κ value between each two evaluators was 0.381. Average κ value was raised up to 0.563 when compared with the final classification result. In the study, 24 upper central incisors without contact were excluded, and the papilla filling rates of triangle, ovoid and square crown were 56.4% (62/110), 69.6% (87/125), 76.2% (77/101) separately. The papilla filling rate of square form was higher (P=0.007).

CONCLUSION

The proportion of clinical crown form of upper central incisor in Chinese Han-nationality youth is obtained. Compared with triangle form, square form is found to favor a gingival papilla that fills the interproximal embrasure space. The consistency of the present classification method for upper central incisor is not satisfying, which indicates that a new classification method, more scientific and objective than the present one, is to be found.

Religious Participation is Associated with Increases in Religious Social Support in a National Longitudinal Study of African Americans

This study reports on the association between religious beliefs and behaviors and the change in both general and religious social support using two waves of data from a national sample of African Americans. The Religion and Health in African Americans (RHIAA) study is a longitudinal telephone survey designed to examine relationships between various aspects of religious involvement and psychosocial factors over time. RHIAA participants were 3173 African American men (1281) and women (1892). A total of 1251 men (456) and women (795) participated in wave 2 of data collection. Baseline religious behaviors were associated with increased overall religious social support from baseline to wave 2 (p < .001) and with increased religious social support from baseline to wave 2 in each of the following religious social support subscales: emotional support received (p < .001), emotional support provided (p < .001), negative interaction (p < .001), and anticipated support (p < .001). Religious beliefs did not predict change in any type of support, and neither beliefs nor behaviors predicted change in general social support. African Americans who are active in faith communities showed increases in all types of religious social support, even the negative aspects, over a relatively modest longitudinal study period. This illustrates the strength of the church as a social network and the role that it plays in people's lives.

Abstract C67: Tell a Friend and Save a Life: Investigating the impact of knowledge on colorectal cancer screening behaviors and confidence among Chinese and Korean Americans using a mixed methods approach

Introduction: Colorectal cancer (CRC) screening rates for Chinese and Korean Americans are one of the lowest among all racial and ethnic groups. A lack of knowledge and misconceptions surrounding CRC may be contributing factors of this disparity. Hence in this study, we sought to assess the relationship between knowledge with CRC screening behaviors and confidence among Chinese and Korean Americans.

Methods: We recruited Chinese (n=59) and Korean Americans (n=61), 50 years and older, from the Washington, D.C. metropolitan area. CRC screening knowledge, behaviors, and confidence were assessed individually for participants through surveys and discussed in 12 focus group discussions (n=120). Mixed methods were employed to analyze the quantitative survey data and qualitative focus group data. For surveys, associations were analyzed using multivariate-adjusted logistic regression taking into account age, education, income, family history of CRC, having a regular physician, health insurance, and acculturation.

Results: Based on both quantitative and qualitative analyses, participants exhibited a general lack of knowledge about CRC and CRC screening. About 7 out of 10 participants believed that CRC is usually fatal, and 3 out of 10 participants believed that there is nothing they could do to prevent CRC. In addition, over 50% of participants did not know that CRC screening is recommended from age 50 and that there are different CRC screening tests. Participants alluded to the lack of culturally and linguistically tailored health information as being a probable cause of low levels of CRC knowledge in these populations. However, family and friends were found to play an important role in encouraging screening behaviors and providing CRC-related information. For instance, one focus group participant shared about an occasion where she insisted that a friend and her husband receive CRC screening. The participant stated, “Her husband still calls me a lifesaver” after several polyps were found and removed during his colonoscopy. Individuals having a family member or friend, who received CRC screening or had a history of CRC, tended to have greater CRC knowledge. Furthermore, quantitative data and focus group discussions revealed misconceptions regarding CRC as being a western disease, ensuing false beliefs of having less susceptibility. Moreover, increased knowledge was associated with having confidence in getting screening and receiving CRC screening. In particular, those who believed that CRC screening will decrease chances of dying from CRC were 10.2 times more likely to get a fecal occult blood test (95% confidence interval: 3.9-26.6) and 10.7 times more likely to have a colonoscopy (95% confidence interval: 2.8-40.9).

Conclusions: The combined use of surveys and focus groups provided a more in-depth examination and greater insight into how CRC knowledge impacts screening and confidence. Future efforts to increase CRC screening among Chinese and Korean Americans should (1) utilize family and friends as a channel to increase CRC knowledge and screening and (2) target the identified misconceptions held by these groups.

Citation Format: Mary Jung, Xiaoxiao Lu, Julia Cen Chen, Daisy Le, Jingjing Chen, Sunmin Lee. Tell a Friend and Save a Life: Investigating the impact of knowledge on colorectal cancer screening behaviors and confidence among Chinese and Korean Americans using a mixed methods approach. [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 C67.