Alice R. Richman

Meta‐analyses of the effect of false‐positive mammograms on generic and specific psychosocial outcomes

Objectives: While a previous meta‐analysis found that false‐positive mammography results affect womens likelihood of returning for screening, effects on well being have yet to be meta‐analyzed. We investigated whether the effects of false‐positive mammograms on womens well‐being are limited to outcomes specific to breast cancer.

Women's experiences with genomic testing for breast cancer recurrence risk

Few studies have examined how patients understand and use genomic test results when deciding about treatment. This study examined how women receive and incorporate results of Oncotype DX, a genomic test that offers recurrence risk estimates, into decisions about adjuvant treatment for early stage breast cancer.

Engaging in health behaviors to lower risk for breast cancer recurrence.

Purpose While post-treatment breast cancer survivors face up to twice the cancer risk of the general population, modifiable health behaviors may somewhat reduce this risk. We sought to better understand health behaviors that early stage breast cancer survivors engage in to reduce recurrence risk. Methods Data came from a cross-sectional multi-site survey of 186 early-stage breast cancer survivors who received genomic testing for breast cancer recurrence risk (Oncotype DX) during their clinical care. Study outcomes were meeting health behavior recommendations (daily fruit and vegetable intake, regular physical activity, and having a healthy body mass index (BMI)). Results Approximately three-quarters of survivors we surveyed believed the 3 behaviors might reduce their cancer risk but many did not engage in these behaviors for this purpose: 62% for BMI, 36% for fruit and vegetable consumption, and 37% for physical activity. Survivors with higher recurrence risk, as indicated by their genomic test results, were no more likely to meet any of the three health behavior recommendations. Adherence to health behavior recommendations was higher for women who were white, college-educated, and had higher incomes. Conclusions Many nonadherent breast cancer survivors wish to use these behavioral strategies to reduce their risk for recurrence, suggesting an important opportunity for intervention. Improving BMI, which has the largest association with cancer risk, is an especially promising target.

Optimising human papillomavirus self-testing for high risk women

Objectives Human papillomavirus self-tests that can be used at home and returned by mail may increase cervical cancer screening rates. Growing evidence suggests that self-test methods could increase screening for high-risk and hard-to-reach populations. The purpose of this study was to identify which self-test device women prefer and why. Methods Four focus groups were conducted with 30 high-risk women in two rural and two urban counties in North Carolina. Women evaluated three self-test devices: the Pantarhei screener (a lavage that releases liquid into the vagina and re-collects fluid), the Qiagen cervical brush (a brush that women insert into the vagina and is turned around to collect cells) and the Fournier cervical self-sampling device (a tampon-like plastic wand). Results The majority of women reported that they would use the brush (70%), followed by the wand (67%) and the lavage (43%). Women from urban areas appeared to prefer the brush, whereas women from rural areas endorsed the wand. Women reported liking the lavage because it seemed easy to use; they liked the wand because of its inviting colour (green), and liked the brush because of its small size and familiarity. Women reported disliking the lavage because the liquid seemed messy and unsanitary, disliked the wand due to the 15–20 recommended turns, and disliked the brush because it was short and the tip seemed abrasive. Conclusions No one device was perfect, although suggestions for an optimal self-test most resembled the brush. These findings can be used to develop an optimal self-test collector for women.

Sexual behaviour and interest in using a sexual health mobile app to help improve and manage college students' sexual health

Many US college students are reported to engage in risky sexual behaviour. Smartphone applications are a popular way to provide users with information in real time. We explored the potential for mobile technology to be used in promoting the sexual health of college students. Using findings from an online survey among a random sample of 5000 college students (15% response), we examined sexual behaviours and interest in a sexual health application in January 2012. The majority of students were female (73%) and owned a smartphone (74%). Twenty-nine per cent currently used health-related applications on their phone and 67% reported interest in using a free application that could improve/manage their sexual health. Interest in use varied based on gender, race/ethnicity, sexual orientation, having an unintended pregnancy, sexually transmitted infection (STI) testing, smartphone ownership and past application use. The top most useful features for women included a period tracker (46%), birth control reminder (43%) and STI and pregnancy symptom checker (30%). Women were more likely to be interested in using the application compared with men and those engaging in more sexual activity were more likely to be interested as compared with those engaging in less sexual activity. The evaluation of mobile technology to promote healthy sexuality among college students is warranted.

Understanding the Breast Cancer Experience of Survivors: a Qualitative Study of African American Women in Rural Eastern North Carolina

The purpose of this study is to gain an in-depth understanding of African American breast cancer survivors’ experiences, barriers and facilitators in accessing breast cancer treatment, and challenges in adherence to follow-up care. We conducted seven focus groups with 32 African American women with breast cancer in three rural counties in eastern North Carolina during August–November 2013. Surveys were also utilized to gather basic demographic and breast health history information. Thematic analysis was performed using the immersion crystallization approach. Several common areas of life affected by breast cancer included faith and support networks, psychosocial well-being, and quality of care issues. Faith in God was an important coping mechanism essential to all women in the study and a critical facilitator in survivorship. Support networks consisted of family, church-family, friends, and co-workers. The concept of fear included the discovery of breast cancer and fear of death, negative side effects of treatment, and social stigma of having breast cancer. Factors that influenced provider-patient relationship were age of provider, perceived lack of empathy, and providers leaving during treatment. Participants also expressed their lack of knowledge regarding a number of the side effects they were experiencing during and after their treatment. Results of this study contribute to the assessment of potential coping mechanisms used by African American breast cancer survivors (i.e., spirituality, positive attitudes, and support networks) that can potentially be effective and have a positive impact on the adjustment of life for survivors.

A randomized intervention study to evaluate whether electronic messaging can increase human papillomavirus vaccine completion and knowledge among college students

ABSTRACT Objective: To evaluate an intervention aimed at increasing human papillomavirus (HPV) vaccine completion of the 3-dose series and knowledge. Participants: Two hundred sixty-four male and female US college students 18–26 years old who were receiving HPV vaccine dose 1. Methods: Students were randomly assigned to the intervention or control group. Intervention participants received the electronic intervention (text/e-mail appointment reminders and education messages) and controls received standard-of-care. Baseline/follow-up survey data were collected. Main outcome measures included vaccine completion and knowledge. Results: HPV vaccine completion across groups were not significantly different for HPV dose 2 (53% vs 52%) and dose 3 (34% vs 32%). Mean knowledge score at follow-up for intervention group was significantly higher (p = .01) than at baseline. No significant differences in knowledge were found for the control group. The biggest predictor of HPV vaccine completion was female gender. Conclusions: The intervention increased knowledge but not vaccine completion. More research with catch-up age populations is needed.

Cognitive testing of human papillomavirus vaccine survey items for parents of adolescent girls.

Objective Many studies have been conducted to understand what factors are associated with human papillomavirus (HPV) vaccine acceptability and completion of the 3-dose vaccination series, but few have examined whether people understand the survey items used to assess these relationships. Through a multisite collaborative effort, we developed and cognitively tested survey items that represent constructs known to affect vaccine acceptability and completion. Materials and Methods Investigators from 7 research centers in the United States used cognitive interviewing techniques and in-person and telephone interviews to test 21 items. Four rounds of testing, revising, and retesting were conducted among racially and ethnically diverse parents (n = 62) of girls between the ages of 9 and 17 years. Results The final survey contained 20 items on attitudes and beliefs relevant to HPV vaccine. Some parents misinterpreted statements about hypothetical vaccine harms as statements of fact. Others were unwilling to answer items about perceived disease likelihood and perceived vaccine effectiveness, because they said the items seemed to have a “right” answer that they did not know. On the basis of these and other findings from cognitive testing, we revised the wording of 14 questions to improve clarity and comprehension. We also revised instructions, response options, and item order. Conclusions Cognitive testing of HPV vaccine survey items revealed important differences between intended and ascribed item meaning by participants. Use of the tested survey questions presented here may increase measurement validity and researchers’ ability to compare findings across studies and populations. Additional testing using quantitative methods can help to further validate these items.

Exploring emergency contraception knowledge among Florida pharmacy school students: a preliminary assessment.

OBJECTIVES The United States leads all industrialized nations in unintended pregnancies. Many unintended pregnancies could be avoided through the use of emergency contraception (EC), a hormonal contraceptive that is highly effective if taken up to 5 days after unprotected intercourse. Pharmacists play a critical role in the ability of women to obtain EC, either over-the-counter or by prescription. This study assessed if U.S. pharmacy schools report teaching about EC in pharmacy school classes and how pharmacy students in Florida report learning about EC. METHODS This study employed a mixed methods study design: a questionnaire was sent to the 91 deans of accredited pharmacy schools in the United States and focus groups were conducted with Florida pharmacy school students at the four accredited schools of pharmacy in Florida. RESULTS Findings reported between the two phases of the study were discordant: All schools reported teaching EC content, whereas most students reported learning about EC outside of their classes. Knowledge that students have about EC does not seem to be adequate. Pharmacy students have preconceived biases or judgments about people who use EC and reported being hesitant about dispensing the medication. CONCLUSION This preliminary analysis revealed that pharmacy schools report to be teaching about EC in their pharmacy schools classes, but pharmacy school students may not feel well enough informed to dispense EC. Future research in understanding the complex process of how education can impact professional beliefs and practice is critical.

Feasibility of a Catch-up HPV Vaccination Program Among College Students Attending a Large Rural University in the South

Our study explored the eligibility and willingness of students to participate in a university-wide catch-up Human papillomavirus (HPV) vaccination program. A total of 1804 electronic surveys (82% response) assessing demographics, HPV knowledge, eligibility, and willingness were gathered. HPV knowledge was moderate, with just over a quarter (26%) answering all knowledge items correctly. Most understood that HPV is sexually transmitted (82%) while fewer knew HPV can cause cancer in men (40%) and that a vaccine is available for men (32%). Eligibility (71%) and willingness (71%) to receive school-based HPV vaccinations was high. These data support developing a college-wide catch-up HPV vaccination program.