B. Lee Green

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

This article provides an overview of the current literature on seven cancer sites that may disproportionately affect lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. For each cancer site, the authors present and discuss the descriptive statistics, primary prevention, secondary prevention and preclinical disease, tertiary prevention and late‐stage disease, and clinical implications. Finally, an overview of psychosocial factors related to cancer survivorship is offered as well as strategies for improving access to care. CA Cancer J Clin 2015;65:384–400.

A primer on quality indicators of distance education

In the past decade, there has been an enormous growth of distance education courses and programs in higher education. The growth of distance education is particularly evident in the field of health education. However, the enormous potential of distance education is tempered by one overriding question: How does one ensure that distance education coursework and degrees are of high quality? To this end, the purpose of this study is twofold: to identify quality indicators of distance education and to provide implications of the identified quality indicators for health education researchers and practitioners. The results of the study reveal common benchmarks and quality indicators that all parties deem important in designing, implementing, and evaluating distance education courses and programs.

Barbershop Communications on Prostate Cancer Screening Using Barber Health Advisers

Objective: The authors report the outcomes of a community-based, barber health adviser pilot intervention that aims to develop customized educational materials to promote knowledge and awareness of prostate cancer (CaP) and informed decision making about prostate cancer screening (PCS) among a predominantly African American clientele. Method: First, the authors implemented a series of learner verification processes with barbershop clients (n = 15) to adapt existing CaP health promotion materials. Following intervention implementation in the barbershop, they conducted structured surveys with barbershop clients (n = 40) to evaluate the intervention. Results: Findings from the posttest showed both a significant increase in barbershop clients’ self-reported knowledge of CaP and in the likelihood of discussing PCS with a health care provider (p < .001). The client’s cultural model of CaP risk factors revealed cultural consensus (eigenratio = 3.3) and mirrored the biomedical model. All clients surveyed reported positively on the contents of the educational materials, and more than half (53%) had discussed CaP at least twice with their barber in the last month. Conclusion: Based on the pilot results, the barber-administered intervention was an appropriate and viable communication channel for promoting CaP knowledge and awareness in a priority population, African American men.

Unwillingness to Participate in Colorectal Cancer Screening: Examining Fears, Attitudes, and Medical Mistrust in an Ethnically Diverse Sample of Adults 50 Years and Older:

Purpose. Identify the influence of medical mistrust, fears, attitudes, and sociodemographic characteristics on unwillingness to participate in colorectal cancer (CRC) screening. Design. Cross-sectional, disproportionally allocated, stratified, random-digit-dial telephone questionnaire of noninstitutionalized households. Setting. New York City, New York; Baltimore, Maryland; San Juan, Puerto Rico. Subjects. Ethnically diverse sample of 454 adults ≥50 years of age. Measures. Health status, cancer screening effectiveness, psychosocial factors (e.g., perceptions of pain, fear, trust), and CRC screening intentions using the Cancer Screening Questionnaire, which addresses a range of issues related to willingness of minorities to participate in cancer screening. Analysis. Multivariate logistic regression was used to model the probability of reporting unwillingness to participate in CRC screening. Results. Fear of embarrassment during screening (odds ratio [OR] = 10.72; 95% confidence interval [CI], 2.15–53.39), fear of getting AIDS (OR = 8.75; 95% CI, 2.48–30.86), fear that exam might be painful (OR = 3.43; 95% CI, 1.03–11.35), and older age (OR = 1.10; 95% CI, 1.04–1.17) were positively associated with unwillingness to participate in CRC screening. Fear of developing cancer (OR = .12; 95% CI, .03–.57) and medical mistrust (OR = .19; 95% CI, .06–.60) were negatively associated with unwillingness to screen. Conclusions. Findings suggest that CRC health initiatives should focus on increasing knowledge, addressing fears and mistrust, and normalizing CRC screening as a beneficial preventive practice, and should increase focus on older adults.

Cancer Health Disparities

There have been great improvements in the health and health outcomes of the United States population. Unfortunately, there are segments of the population that do not experience these same improvements and thus have disproportionate health outcomes compared to other groups, known as health disparities. Disparities in cancer and cancer-related outcomes are also experienced by these groups. This chapter discusses the disparities among five specific cancer sites (female breast, cervical, colorectal, prostate, and lung cancers), outlines potential causes of these cancer health disparities, and highlights effective strategies for reducing and eliminating them.

The Legacy of the Tuskegee Syphilis Study: Assessing its Impact on Willingness to Participate in Biomedical Studies

The phrase, legacy of the Tuskegee Syphilis Study, is sometimes used to denote the belief that Blacks are more reluctant than Whites to participate in biomedical research studies because of the infamous study of syphilis in men run by the U.S. Public Health Service from 1932–72. This paper is the first to attempt to assess directly the accuracy of this belief within a multi-city, multi-racial, large-scale, detailed random survey. We administered the Tuskegee Legacy Project (TLP) Questionnaire to 826 Blacks and non-Hispanic White adults in three U.S. cities. While Blacks had higher levels of general awareness of the Tuskegee Syphilis Study, there was no association between either awareness or detailed knowledge of the Tuskegee Syphilis Study and willingness to participate in biomedical research, either for Blacks or Whites observed in our survey. While this study refutes the notion that there is a direct connection between detailed knowledge of the Tuskegee Syphilis Study and willingness to participate in biomedical research, it does not assess the broader question of whether and how historical events influence people’s willingness to participate in research. Future studies should explore this.

Community health advisors as research partners: an evaluation of the training and activities.

The feasibility of training large numbers of community health advisors as research partners (CHARPs) was evaluated using talking circles data and cancer activity questionnaires and logs. The talking circles data indicated that the CHARPs (n = 108) valued their training and believed they learned necessary research partner skills. A review of contacts (n = 7,956) provided evidence that CHARPs (n = 883) could work as a team to deliver a variety of services over time to the community. The findings suggested that implementing a large scale intervention with CHARPs has the potential to increase the dissemination of cancer information and to reduce cancer disparities.

Toward a Model of Prostate Cancer Information Seeking Identifying Salient Behavioral and Normative Beliefs Among African American Men

Public health actions to improve African American mens ability to make informed decisions about participation in prostate cancer control activities have a greater likelihood of success when they are theory driven and informed by members of the target population. This article reports on formative research to evaluate the usefulness of the theory of reasoned action as a model to explain and predict prostate cancer information-seeking behavior by African American men. Fifty-two men participated in eight focus group interviews. Positive behavioral beliefs for obtaining prostate cancer information from physicians included increasing awareness of and obtaining accurate information about the disease, early detection and screening, and treatment. Negative beliefs included fear, distrust, and inconvenience. Significant others, peers, siblings, and religious leaders were identified as individuals who could influence this behavior. These findings provide additional insight into ways to reach and intervene with African American men to influence this important cancer control activity.

Sociodemographic Differences in Fears and Mistrust Contributing to Unwillingness to Participate in Cancer Screenings

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

Development of an Instrument to Assess Student Opinions of the Quality of Distance Education Courses

The purpose of this study was to develop a culturally sensitive instrument to assess the quality of distance education courses offered at a university in the southern United States through evaluation of student attitudes, opinions, and perceptions of distance education. Quality indicators, identified in a systematic literature review, coupled with an ecological framework served as the theoretical foundation for the instrument development process. The process of test development, outlined in the Standards for Educational and Psychological Testing (1999), was used and combined with Dillmans (2000) four stages of pretesting to construct the instrument. Results indicated that the model constructed from the quality indicators and ecological framework provided valid and reliable measures of student attitudes, opinions, and perceptions of quality of the distance education courses.