Amy Leader

Is the Promise of Cancer-Screening Programs Being Compromised? Quality of Follow-Up Care after Abnormal Screening Results

Cancer screening has increased dramatically in the United States, yet in some populations, particularly racial minorities or the poor, advanced disease at diagnosis remains high. One potential explanation is that follow-up of abnormal tests is suboptimal, and the benefits of screening are not being realized. The authors used a conceptual model of access to care and integrated constructs from models of provider and patient health behaviors to review published literature on follow-up care. Most studies reported that fewer than 75 percent of patients received some follow-up care, indicating that the promise of screening may be compromised. They identified pervasive barriers to follow-up at the provider, patient, and health care system levels. Interventions that address these barriers appear to be effective. Improvement of data infrastructure and reporting will be important objectives for policy makers, and further use of conceptual models by researchers may improve intervention development and, ultimately, cancer control.

The HPV vaccine and the media: How has the topic been covered and what are the effects on knowledge about the virus and cervical cancer?

OBJECTIVE In June 2006, the first vaccine for HPV was approved by the FDA and media coverage about the topic increased significantly. This study sought to explore the nature of the coverage and whether knowledge about HPV was affected by it. METHODS A content analysis, including 321 news stories from major newspapers, the AP wire and television news networks was conducted. A monthly RDD-recruited Internet survey with a national sample (n=3323) was used to assess changes in population knowledge. RESULTS Twenty-three percent of stories did not mention the sexually transmitted nature of the disease and 80% left out information about the need for continued cervical cancer screening after vaccination. Exposure to health-related media content was significantly associated with knowledge about HPV, even controlling for baseline knowledge (OR=1.62, 95% CI=1.12-2.35). CONCLUSIONS Changes in the volume of coverage over time were associated with knowledge about HPV, but the content analysis reveals that many of the stories were missing important information. PRACTICE IMPLICATIONS Clinicians must consider the potential media source patients are using for HPV-related information in order to correct inaccurate or incomplete information that could affect health behavior.

Acceptability of the Human Papillomavirus Vaccine Among Urban Adolescent Males

The human papillomavirus (HPV) vaccine was recently approved for use in males. Certain groups, such as men who have sex with men (MSM), are at increased risk of HPV infection. The purpose of the study was to understand perceptions of HPV and the vaccine among adolescent and young adult males, both heterosexual and MSM. Seventy-six males (45 heterosexual, 31 MSM) completed a questionnaire and participated in a focus group. Overall, 42% had heard of HPV and 39% had heard of the HPV vaccine. Males had moderate to favorable attitudes toward vaccination, although intentions to vaccinate were more neutral. MSM were more knowledgeable, aware, and in control of the decision to vaccinate than heterosexual males. Increasing awareness and knowledge about HPV and the vaccine may be necessary to encourage vaccination; certain subgroups of males may be more receptive to HPV vaccination than others.

Are Patterns of Health Behavior Associated with Cancer Screening

Purpose. This study investigates the relationship between patterns of health behaviors and the use of cancer-screening tests while controlling for sociodemographic and health system factors. Design. Cross-sectional analysis of the 2000 National Health Interview (NHIS). Setting. Nationally representative sample. Subjects. Adults 50 years and older. Measures. Use of cancer-screening tests, health behaviors, sociodemographic factors, and health system factors from self-reported responses from the NHIS. Sixteen health behavior patterns were identified based on lifestyle recommendations for physical activity, tobacco use, alcohol consumption, and fruit and vegetable consumption. Results. Health behavior patterns, age, educational attainment, usual source of care, and health insurance were significantly associated with the use of breast, cervical, and colorectal cancer screening (p < .05). Approximate B2 for the four models ranged from .067 for colorectal cancer screening in women to .122 for cervical cancer screening. Having a usual source of care was the strongest correlate of screening; the magnitude of associations for health behavior patterns and demographic variables and screening was similar and much smaller than those for usual source of care. Conclusion. These findings demonstrate relationships between patterns of multiple health behaviors and use of recommended cancer-screening tests, even when accounting for factors known to influence test use. This suggests potential for addressing cancer screening in the context of multiple behavior change interventions once barriers to health care access are removed.

The Development of a Culturally Relevant, Theoretically Driven HPV Prevention Intervention for Urban Adolescent Females and Their Parents/Guardians

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, accounting for the large majority of cervical cancer and anogenital warts cases. Two HPV vaccines are currently licensed and recommended for women and girls. However, vaccination rates have been suboptimal, with evidence of disparities influencing both uptake and series completion among African American and Hispanic adolescents. There has been a dearth of theory-based, behavioral interventions targeted to prevent HPV infection and increase HPV vaccine uptake among urban adolescents. This article describes the development of two skills-based intervention curricula aimed to increase HPV prevention and vaccination among low-income urban adolescent females 9 to 18 years old. Guided by the theory of planned behavior, elicitation research was conducted to elucidate the social psychological factors that underlie HPV vaccination intentions (N = 141). The findings were subsequently used to identify theoretical mediators of behavioral change to drive the intervention. Culturally relevant strategies to promote HPV vaccination were translated into the curricula content. Both curricula were designed to motivate and empower participants to reduce risk of being infected with HPV. Targeting theoretical mediators of behavioral change, derived from the voices of the community, may prove to be successful in increasing HPV vaccination and preventing HPV.

Measuring Informed Decision Making about Prostate Cancer Screening in Primary Care

Purpose. To measure the extent of informed decision making (IDM) about prostate cancer screening in physician-patient encounters, describe the coding process, and assess the reliability of the IDM measure. Methods. Audiorecoded encounters of 146 older adult men and their primary care physicians were obtained in a randomized controlled trial of mediated decision support related to prostate cancer screening. Each encounter was dual coded for the presence or absence of 9 elements that reflect several important dimensions of IDM, such as information sharing, patient empowerment, and engaging patients in preference clarification. An IDM-9 score (range = 0–9) was determined for each encounter by summing the number of elements that were coded as present. Estimates of coding reliability and internal consistency were calculated. Results. Male patients tended to be white (59%), married (70%), and between the ages of 50 and 59 (70%). Physicians tended to be white (90%), male (74%), and have more than 10 years of practice experience (74%). IDM-9 scores ranged from 0 to 7.5 (mean [SD], 2.7 [2.1]). Reliability (0.90) and internal consistency (0.81) of the IDM-9 were both high. The IDM dimension observed most frequently was information sharing (74%), whereas the dimension least frequently observed was engagement in preference clarification (3.4%). Conclusions. In physician-patient encounters, the level of IDM concerning prostate cancer screening was low. The use of a dual-coding approach with audiorecorded encounters produced a measure of IDM that was reliable and internally consistent.

The association between neighborhood social capital and cancer screening.

OBJECTIVES To examine the association between social capital and adherence to cancer screening exams. METHODS Data from a population-based survey assessed perceived neighborhood social capital as well as cancer screening behavior. We analyzed the influence of social capital on adherence to screening guidelines for cervical, breast, and colorectal cancer. RESULTS Data from 2668 adults documented that those with greater perceived neighborhood social capital were more likely to be screened for cancer. The effect was strongest for colorectal cancer and weakest for cervical cancer. CONCLUSIONS Research on understanding the effect of the neighborhood social environment on efforts related to cancer screening behavior may be helpful for increasing cancer screening rates.

Awareness of Anticancer Vaccines Among Asian American Women with Limited English Proficiency: An Opportunity for Improved Public Health Communication

Background. Asian Americans suffer from liver and cervical cancers, both vaccine preventable, yet vaccine awareness has not been described. Methods. Cross-sectional survey (6 languages, 380 adult women). Results. Those with limited English proficiency (LEP) were less likely to have accurate knowledge of cervical cancer vaccine (44% vs. 76%, among the 34% aware of any cancer-preventive vaccines) and were more likely to believe vaccines existed for nonvaccine-preventable cancers. Awareness of anti-liver cancer vaccine was low for both LEP and non-LEP women. Conclusion. There is a great need to educate Asian Americans about vaccinepreventable cancers, especially among LEP women.Background. Asian Americans suffer from liver and cervical cancers, both vaccine preventable, yet vaccine awareness has not been described. Methods. Cross-sectional survey (6 languages, 380 adult women). Results. Those with limited English proficiency (LEP) were less likely to have accurate knowledge of cervical cancer vaccine (44% vs. 76%, among the 34% aware of any cancer-preventive vaccines) and were more likely to believe vaccines existed for nonvaccine-preventable cancers. Awareness of anti-liver cancer vaccine was low for both LEP and non-LEP women. Conclusion. There is a great need to educate Asian Americans about vaccinepreventable cancers, especially among LEP women.

Acceptability of the human papillomavirus vaccine among diverse Hispanic mothers and grandmothers.

The human papillomavirus (HPV) vaccine has the potential to reduce rates of cervical cancer and other HPV-related morbidity among Hispanic women who are disproportionately affected by this disease. Understanding the barriers faced by this population is an important public health goal. In this qualitative pilot study, 17 mothers and grandmothers of adolescent girls from diverse Hispanic backgrounds in a large northeastern city in the United States were interviewed to examine attitudes regarding vaccine acceptability. The findings reveal that negative media, concerns about sexuality, side effects, and efficacy may impact vaccine uptake and completion. Of the 4 participants whose daughters had received the vaccine, only 1 had completed the full series, which may speak to the trend of lower series completion among Hispanics. This pilot data could inform important considerations when designing longitudinal research that may provide some necessary insights into the factors that facilitate or impede HPV vaccine completion among U.S. Hispanics.

Exploring Asian Indian and Pakistani views about cancer and participation in cancer genetics research: toward the development of a community genetics intervention

Cancer is a leading cause of mortality among the three million Asian Indian/Pakistanis (AIPs) in the USA. AIPs have traditionally been underrepresented in cancer-related research, although reasons remain largely unexplored. We sought to understand AIP’s awareness and perceptions of cancer to improve their participation in risk assessment and cancer genetics research. Four focus groups, stratified by gender and birthplace (US-born vs. foreign-born), were held at an AIP cultural center. Discussions focused on knowledge and awareness of cancer risk; how AIP culture influences cancer perceptions; access to health care services for cancer screening, diagnosis, or treatment; and willingness to or experiences with participating in cancer genetics research. Sessions were audio-recorded, transcribed verbatim, and content analyzed using NVivo®11 for dominant themes. Thirty-two AIP adults participated in a focus group. Information on family cancer history is challenging to obtain due to the desire for privacy, cancer stigma, and loss of medical records. Interest in genetic testing for cancer risk was mixed: some were in favor of knowing their personal risk, yet many noted that future generations in their family would benefit more by knowing their risk. Participants felt that the AIP community has largely been overlooked in recruitment efforts for research studies. Recommendations for improving recruitment efforts included partnering with community events and festivities, posting culturally and linguistically relevant recruitment materials, and focusing on population-wide health improvement. Understanding the culture and perceptions of AIPs, separate from Asian Americans at large, will allow for more tailored approaches for including this population in cancer genetics research.