Carolyn Beeker

Colorectal cancer screening in older men and women: Qualitative research findings and implications for intervention

As part of the formative research for developing interventions to increase colorectal cancer screening in men and women aged 50 and older, 14 focus groups were conducted to identify (1) knowledge, attitudes, and beliefs about colorectal cancer and colorectal cancer screening, (2) barriers to screening, and (3) strategies for motivating and supporting behavior change. Participants had either private insurance or Medicare and reported different levels of experience with colorectal cancer screening. Overall, they were poorly informed about colorectal cancer and the possible benefits of screening, reporting little or no information from physicians or mass media, negative attitudes toward screening procedures, and fear of cancer. Despite references to the subject matter as embarrassing or private, both men and women, African Americans and whites, appeared to talk candidly and comfortably in the permissive context of the focus group. This studys findings suggest that public education campaigns, decision aids, and targeted interventions are urgently needed to put colorectal cancer screening on the publics “radar screen,” to increase awareness of the prevention and early detection benefits of screening, and to encourage people 50 and older—and the health care providers who serve them—to make screening a high priority.

Community empowerment paradigm drift and the primary prevention of HIV/AIDS

Long discussed in the public health arena, the concept of empowerment has only recently entered the discourse on the primary prevention of HIV/AIDS in the United States. Despite its broad appeal, empowerment has not been systematically incorporated into theory-based interventions, which may reflect a lack of consensus on the meaning of empowerment, how to measure it, and the intervention strategies it implies. The purpose of this paper is to consider the relevance of empowerment to community interventions for persons at risk for HIV, particularly women. The origins of empowerment are reviewed; community empowerment as an intervention framework is described and its core assumptions defined. There is some evidence of the growing influence of empowerment and related concepts in recent HIV-related policy, research, and programs funded through the Centers for Disease Control and Prevention. However, adoption of an empowerment framework for HIV prevention will require further theory and measurement development, as well as changes in how public health researchers and practitioners work with the communities they serve.

Finding the “Community” in Community-Level HIV/AIDS Interventions: Formative Research with Young African American Men Who Have Sex with Men

Data from 76 qualitative interviews with 18- to 29-year-old African American men who have sex with men (MSM) in Chicago and Atlanta were examined to identify perceptions of “community” and components of a community-level HIV/AIDS intervention. Many men reported feeling marginal to African American and gay White communities because of perceived homophobia and racism. Those who reported feeling part of gay African American communities characterized communities in terms of settings, social structures, and functions, including social support, socialization, and mobility. Despite these positive functions, divisions among groups of MSM, lack of settings for nonsexual interaction with other MSM, lack of leadership, and negative attitudes toward homosexuality may make it difficult for men to participate in activities to alter community contexts that influence behavior. Rather, changing norms, increasing social support, and community building should be part of initial community-level interventions. Community building might identify leaders, cre ate new settings, and create opportunities for dialogue between MSM and African American community groups to address negative perceptions of homosexuality.

Perceived condom norms and HIV risks among social and sexual networks of young African American men who have sex with men

The association between condom norms and unprotected sexual intercourse was examined within social and sexual networks of young African American men who have sex with men (MSM) in an HIV epicenter of the southern United States. We used a chain-link design to recruit 158 young African American men: 95 initial participants, 56 contacts of participants (alters) and 7 contacts of alters. Men in the high-risk group, compared with those in the no-risk group, perceived significantly lower approval concerning condom use in their social and sexual networks. Also, 100 participants could be connected to each other in 86 dyads of social and sexual networks. Within these dyads, men perceived that their friends and acquaintances approved for them to use condoms but that their friends and acquaintances did not use condoms themselves. Low HIV risk behavior appears associated with perceived social norms that support ones use of condoms, even when perceived norms do not support condom use by network members themselves.

Review: Engaging Women's Interest in Colorectal Cancer Screening: A Public Health Strategy

Screening rates for colorectal cancer are unacceptably low. New guidelines, public education campaigns, and expanded coverage of screening costs by healthcare insurance are expected to increase screening rates, but interventions targeting women may accelerate this change. Most American women already participate in regular cancer screening, in the form of Papanicolaou (Pap) tests and mammography, so they may be receptive to tailored messages about the need to add regular colorectal cancer screening to their preventive health regimen. In addition, their role in promoting the health of family members may position women to influence screening behavior in family and friends. Women may be particularly valuable change agents in populations where screening rates are traditionally low, such as medically underserved populations, the elderly or low socioeconomic status groups with competing health priorities, and populations with cultural values or practices inconsistent with the adoption of a new screening behavior. To serve as agents of change in their family and social networks, women must understand that colorectal cancer is not solely a mans disease and that the benefits of colorectal screening are similar to those of Pap testing and mammography. Colorectal cancer screening should also be promoted within a framework of a lifelong strategy for health maintenance for both men and women. The message to women should emphasize the value of colorectal cancer screening rather than the disagreement among experts over preferred screening strategies and should emphasize the value of shared decision making between the patient and her healthcare provider.

Heterogeneity of risk among African-American men who have sex with men

The objective of this study was to examine the social mixing and sexual risk taking of African-American men who have sex with men (AAMSM). The design was a cross-sectional survey with targeted, ethnographically informed recruitment of respondents (n = 95), and subsequent recruitment of their network partners (n = 63). We ascertained current demographics, occupation, peer norms for sexual activity, community involvement, and information about members of their social and sexual network. Risk level was categorized by the frequency of anal sex and the consistency of condom use for anal sex. Twenty-nine of 158 (18.4%) persons were classified as being at high risk (any anal intercourse in the past three months with less than 100% condom use); 79 of 158 (50%) were at medium risk (any anal intercourse in the past three months with 100% condom use reported), and 50 (31.7%) were at low risk (no reported anal intercourse). The risk groups were similar with regard to perception of behavioural and community norms. White-collar workers associated predominantly with each other and other groups mixing preferentially with white-collar workers. Clustering within contact networks (the extent to which partners to a respondent know each other) was high for all risk groups (∼0.4–0.5), indicating dense, interactive networks. In conclusion, this study group demonstrates a greater degree of social mixing and heterogeneity than is commonly assumed for AAMSM. At least some portion of AAMSM has internalized public health messages about safer sexual activity. Intervention programmes should avoid the pitfalls of assumed homogeneity.