Cynthia A. Gelb

Physicians who use social media and other internet-based communication technologies

The demographic and practice-related characteristics of physicians who use social networking websites, portable devices to access the internet, email to communicate with patients, podcasts, widgets, RSS feeds, and blogging were investigated. Logistic regression was used to analyze a survey of US primary care physicians, pediatricians, obstetrician/gynecologists, and dermatologists (N=1750). Reported technology use during the last 6 months ranged from 80.6% using a portable device to access the internet to 12.9% writing a blog. The most consistent predictors of use were being male, being younger, and having teaching hospital privileges. Physician specialty, practice setting, years in practice, average number of patients treated per week, and number of physicians in practice were found to be inconsistently associated or unassociated with use of the technologies examined. Demographic characteristics, rather than practice-related characteristics, were more consistent predictors of physician use of seven internet-based communication technologies with varying levels of uptake.

Observations from the CDC: Using Health Communications for Primary Prevention of Skin Cancer: CDC's Choose Your Cover Campaign

SKIN CANCER IS THE MOST COMMON KIND of cancer in the United States, with approximately 1.3 million cases of highly curable basal cell or squamous cancers expected to occur this year. It is anticipated that 47,700 people will be diagnosed with melanoma, the most serious form of cancer, and over half of those diagnosed will be women.1 Current etiological evidence suggests a causal link between excessive and unprotected sun exposure and skin cancer, expecially sun exposure received early in life.2,3 According to experts, primary prevention of skin cancer involves one or more of the recommended sun protection behaviors: staying out of the sun between 10 AM and 4 PM , using protective clothing (hats, long sleeves, and long pants), seeking shade, and using sunscreen. Following these recommendations may prevent skin cancer or reduce the high incidence of skin cancer observed in the United States.4 Studies conducted in the United States indicate that most Americans, adults and children, do not follow recommended sun protection practices. When they do, however, sunscreen is clearly the method of choice. The reported use of sunscreen and other protection measures varies considerably depending on age, gender, setting, and how the behavior is measured. Protective clothing and sunglasses are rarely used or observed in children, hat use is more common, and reported sunscreen use ranges from 32% to 53%. Overall, women are far more likely than men to engage in prevention.5 The Centers for Disease Control and Prevention (CDC) took up the challenge of promoting sun protection practices in 1998, when they launched their 5-year skin cancer prevention campaign, called “Choose Your Cover” (CYC). The goals of the campaign include influencing social norms related to sun protection and tanned skin and increasing awareness, knowledge, and behaviors related to skin cancer.

Observations from the CDC: CDC's Screen for Life: a National Colorectal Cancer Action Campaign.

Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Despite the availability of several different screening tests for colorectal cancer, screening rates remain low. To raise awareness about colorectal cancer and encourage men and women aged 50 and older to speak with their physicians about being screened for colorectal cancer, the Centers for Disease Control and Prevention and the Health Care Financing Administration launched Screen for Life: A National Colorectal Cancer Action Campaign in 1999. The purpose of this paper is to outline the development of this multiyear, multimedia campaign, from conducting formative research to developing campaign messages and materials. Limited process evaluation results are presented.

Women's Knowledge and Awareness of Gynecologic Cancer: A Multisite Qualitative Study in the United States

BACKGROUND U.S. womens awareness and knowledge of gynecologic cancer have not been well studied, with the exception of cervical cancer screening and risk factors. METHODS Fifteen focus groups were conducted with women aged 40-60 years in Miami, New York City, Chicago, and Los Angeles. RESULTS Most participants said they had heard of cervical, ovarian, and uterine cancers but were unfamiliar with vaginal and vulvar cancers. The misconception that the Pap test screens for multiple gynecologic cancers was prevalent and engendered a false sense of security in some women. An annual Pap screening interval was most familiar to participants; some mentioned a shorter screening interval for high-risk women; few mentioned an extended screening interval. A few participants thought the pelvic examination could detect a variety of conditions, including ovarian cancer. Some knew that the human papillomavirus (HPV) could cause cervical cancer, but no other risk factors for specific cancers were mentioned with any consistency. Although some recognized unexplained vaginal bleeding as a symptom of cervical cancer, participants generally were unfamiliar with gynecologic cancer symptoms. Participants reported learning about the discussion topics from a variety of sources, including the mass media. CONCLUSIONS Participants lacked critical knowledge needed to understand their gynecologic cancer risk and seek appropriate care. Pap tests and routine examinations offer ideal opportunities to educate women about the purpose of the Pap test as well as risk factors and symptoms associated with various gynecologic cancers. The reported influence of the mass media also supports the viability of multimedia educational strategies.

Why the Pap Test? Awareness and Use of the Pap Test Among Women in the United States

OBJECTIVE To inform campaign development by assessing awareness, previous receipt, and knowledge of the purpose of Papanicolaou (Pap) testing among women aged ≥ 18 years and to identify differences in awareness, receipt, and knowledge by demographic characteristics. METHODS Data were analyzed from the 2008 HealthStyles survey, an annual mail survey conducted in the United States covering trends in health-related behavior. Women were asked questions on awareness, past use, and knowledge of the purpose of the Pap test and other gynecologic tests and procedures; 2991 women participated. RESULTS Although 96.7% of the women had heard of and 93.0% reported having received a Pap test, these proportions were lower among those who were 18-34 years old and among those who had lower levels of education and income. Over 80% knew the Pap test was used to screen for cervical cancer, but 63.3% believed it also was used to screen for vaginal cancer (44.9%), sexually transmitted diseases (STDs) other than human papillomavirus (HPV) (41.7%), ovarian cancer (40.6%), and other cancers and infections. CONCLUSIONS General familiarity and past receipt of the Pap test were high, but misconceptions about its purpose were prevalent. It is important that women understand what a routine Pap test is and is not capable of detecting so that signs and symptoms of gynecologic conditions other than cervical cancer may be recognized and addressed appropriately.

A national initiative for women and healthcare providers: CDC's Inside Knowledge: Get the Facts About Gynecologic Cancer campaign.

The Inside Knowledge: Get the Facts About Gynecologic Cancer campaign raises awareness of the five main types of gynecologic cancer: cervical, ovarian, uterine, vaginal, and vulvar. It encourages women to pay attention to their bodies and know what is normal for them so they can recognize the warning signs of gynecologic cancers and seek medical care. This report provides an overview of the development of this national campaign.

Gynaecologic cancer symptom awareness, concern and care seeking among US women: a multi-site qualitative study.

BACKGROUND With limited screening options, early detection of gynaecologic cancers can depend on women recognizing the potential significance of symptoms and seeking care. OBJECTIVE We investigated womens concern about symptoms that might be related to gynaecologic cancers, the underlying conditions they associated with symptoms and their actual and hypothetical response to symptoms. METHODS Fifteen focus groups with women aged 40-60 years were conducted in Chicago, Los Angeles, Miami and New York City. Participants were given an untitled list of symptoms that could indicate various gynaecologic cancers and asked if any would concern them, what could cause each and what they would do if they experienced any of them. RESULTS Overall, participants expressed greater concern about symptoms clearly gynaecologic in nature than other symptoms. Participants generally did not associate symptoms with any form of cancer. Some women who had experienced symptoms reported waiting an extended period before seeking care or not seeking care at all. The belief that a symptom indicated a benign condition was the most common reason given for delaying or foregoing care seeking. Strategies participants reported using to supplement or replace consultations with health care providers included Internet research and self-care. CONCLUSION Raising awareness of symptoms that can indicate gynaecologic cancers may lead to earlier detection and improved survival. In particular, women should be informed that gynaecologic cancers can cause symptoms that may not seem related to the reproductive organs (e.g. back pain) and that unusual vaginal bleeding should prompt them to seek care immediately.

Developing English and Spanish Television Public Service Announcements to Promote Colorectal Cancer Screening

Screen for Life: National Colorectal Cancer Action Campaign (SFL) is a federally funded campaign to promote understanding of colorectal cancer and the importance of regular screening for adults aged 50 years and older. SFL uses a variety of communication strategies, including television public service announcements (PSAs). SFL materials are developed using the Health Communication Process endorsed by the U.S. Department of Health and Human Services, which has four stages: (a) planning and strategy development; (b) developing and pretesting concepts, messages, and materials; (c) implementing the program; and (d) assessing effectiveness and making refinements. This article describes SFLs application of this process to develop television PSAs in English and Spanish.

How many “Get Screened” messages does it take? Evidence from colorectal cancer screening promotion in the United States, 2012 ☆

OBJECTIVE Colorectal cancer screening has been widely promoted in the United States. We investigated the association between reported exposure to screening information during the past year and screening participation and knowledge. METHOD Data from the 2012 HealthStyles Fall survey of U.S. adults were examined using adjusted logistic regression to examine the frequency of exposure to screening information as a predictor of screening participation and knowledge; analyses were limited to participants aged ≥50years with no history of colorectal cancer or polyps (N=1714). RESULTS Nearly half of the participants (44.9%) reported exposure to colorectal cancer screening information during the previous year. The most common sources of screening information were news reports, advertisements, and health care providers. Screening participation and knowledge consistently increased with the reported frequency of exposure to screening information, and these associations generally persisted when demographic variables were controlled. Compared with unexposed participants, significant gains in screening participation were associated with exposure to screening information 2-3 times (Adj. OR=1.84, p=0.001), 4-9 times (Adj. OR=2.00, p=0.001), and ≥10 times (Adj. OR=3.03, p<0.001) in the adjusted model. CONCLUSIONS Increasing public exposure to screening promotion messages may augment screening participation and knowledge.

Analysis of the Benefits and Costs of a National Campaign to Promote Colorectal Cancer Screening CDC’s Screen for Life—National Colorectal Cancer Action Campaign

The Centers for Disease Control and Prevention’s Screen for Life: National Colorectal Cancer Action Campaign (SFL) is one of the longest running national multimedia campaigns to promote colorectal cancer screening. Since its inception in 1999, no study has quantified the benefits and costs of SFL. We modeled the impact of SFL campaign on screening rates, assuming that the effect size would range from 0.5% to 10% of the unscreened population exposed to the campaign in the last 14 years. Given the estimated benefits of the campaign and costs, we calculated the cost per person screened (2012 dollars). We hypothesize that if 0.5% of the population exposed to campaign messages were screened for colorectal cancer, an additional 251,000 previously unscreened individuals would be screened. The average cost of SFL per person screened would be