Jenna L. Davis

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.

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.

Gender differences in cancer screening beliefs, behaviors, and willingness to participate: implications for health promotion.

Men have higher cancer mortality rates for all sites combined compared with women. Cancer screening (CS) participation is important for the early detection of cancer. This study explores gender differences in CS beliefs, behaviors, and willingness to participate. The data were collected from a stratified, random-digit dial survey of adults living in New York, Maryland, and Puerto Rico. Chi-square tests and logistic regressions were computed to analyze gender associations among CS beliefs, behaviors, and willingness variables. Men and women believed that CSs were effective, though a higher percentage of men had never had a past CS. Men were less willing to participate in a CS at the present time and in a skin cancer exam; however, when given descriptions of screening conditions, men indicated more willingness to participate. These gender differences highlight the need for health professionals to examine their efforts in providing enhanced CS promotion and education among men.

Racial/Ethnic Differences in Cancer Prevention Beliefs: Applying the Health Belief Model Framework

Purpose. An understanding of each racial/ethnic groups beliefs about cancer prevention is important for designing/implementing interventions to reduce cancer-health disparities. The Health Belief Model was used to examine racial/ethnic differences in beliefs about cancer and cancer prevention. Design. The data were from the 2007 Health Information National Trends Survey, a biennial, cross-sectional survey using a random-digit-dial telephone frame and a mailing address frame. Setting. A weighted, nationally representative sample of American adults. Subjects. The sample consisted of 7452 individuals. Measures. Model construct variables (perceived susceptibility; perceived severity; perceived benefits; perceived barriers; cues to action; self-efficacy) and race/ethnicity were assessed. Analysis. The Rao-Scott χ2 test and multivariate logistic regression assessed racial/ethnic differences. Results. The constructs self-efficacy, perceived benefits, and perceived susceptibility were significantly associated with race/ethnicity. The remaining three constructs were not statistically significant. Multivariate analysis revealed Hispanics were less likely to believe they could lower their chances of getting cancer than did African-Americans and whites. Hispanics, Asians, and African-Americans were more likely to believe they had a lower chance of getting cancer in the future than did whites. Conclusion. Culturally relevant health education/promotion interventions need to be developed and tailored to (1) empower Hispanics regarding their ability to prevent cancer and (2) educate racial/ethnic minorities about their susceptibility and risk perception for cancer.

Empowering underserved populations through cancer prevention and early detection.

Abstract It is well documented that cancer is disproportionately distributed in racial/ethnic minority groups and medically underserved communities. In addition, cancer prevention and early detection represent the key defenses to combat cancer. The purpose of this article is to showcase the comprehensive health education and community outreach activities at the H. Lee Moffitt Cancer Center and Research Institute (Moffitt) designed to promote and increase access to and utilization of prevention and early detection services among underserved populations. One of Moffitt’s most important conduits for cancer prevention and early detection among underserved populations is through its community education and outreach initiatives, in particular, the Moffitt Program for Outreach Wellness Education and Resources (M-POWER). M-POWER works to empower underserved populations to make positive health choices and increase screening behaviors through strengthening collaboration and partnerships, providing community-based health education/promotion, and increasing access to care. Effective, empowering, and culturally and linguistically competent health education and community outreach, is key to opening the often impenetrable doors of cancer prevention and early detection to this society’s most vulnerable populations.

Detailed Knowledge of the Tuskegee Syphilis Study: Who Knows What? A Framework for Health Promotion Strategies

This report explores the level of detailed knowledge about the Tuskegee Syphilis Study (TSS) among 848 Blacks and Whites in three U.S. cities across an array of demographic variables. The Tuskegee Legacy Project (TLP) Questionnaire was used, which was designed to explore the willingness of minorities to participate in biomedical studies. A component of the TLP Questionnaire, the TSS Facts & Myths Quiz, consisting of seven yes/no factual questions, was used to establish respondents’ level of detailed knowledge on the TSS. Both Blacks and Whites had similar very low mean quiz score on the 7-point scale, with Blacks’ scores being slightly higher than Whites (1.2 vs. 0.9, p = .003). When analyzing the level of knowledge between racial groups by various demographic variables, several patterns emerged: (a) higher education levels were associated with higher levels of detailed knowledge and (b) for both Blacks and Whites, 30 to 59 years old knew the most about TSS compared with younger and older adult age groups. The findings show that much of the information that circulates in the Black and White communities about the TSS is false, often minimizing or understating the most egregious injustices that occurred. Health promotion and educational implications of these findings are offered and conclude that the findings should be used as a catalyst to explore local realities and sentiments regarding participation in biomedical research within the research philosophy and framework of community-based participatory research.

The Men’s Health Forum: An Initiative to Address Health Disparities in the Community

Racial/ethnic, socioeconomic, and gender disparities in health and access to and use of health care services currently exist. Health professionals are continually striving to reduce and eliminate health disparities within their own community. One such effort in the area of Tampa Bay, Florida was the creation of the African American Men’s Health Forum, currently referred to as the Men’s Health Forum. The African American Men’s Health Forum was the result of the community’s desire to reduce the gap in health outcomes for African American men. Later, it was recognized that the gap in health outcomes impacts other communities; therefore, it was broadened to include all men considered medically underserved (those who are uninsured, underinsured, or without a regular health care provider). The Men’s Health Forum empowers men with the resources, knowledge, and information to effectively manage their health by providing health education and screenings to the community. This article provides an explanation of the key components that have contributed to the success of the Men’s Health Forum, including challenges and lessons learned. It is intended that this information be replicated in other communities in an effort to eliminate health disparities.

Increasing Physical Activity in Children 8 to 12 Years Old: Experiences with Verb™ Summer Scorecard:

Interventions which facilitate physical activity of youth are vital for promoting community health and reducing obesity. This study assessed the results of a community-driven program, VERB™ Summer Scorecard, as knowledge of exposure to and awareness of community-based interventions for physical activity among youth could inform design and implementation of such interventions. A total of 2,215 youth ages 8 to 12 years responded to a survey about physical activity. Ordinal logistic regression suggested that youth who participated in this program were 1.73 times (95%CI = 1.41, 2.11) more likely to report high physical activity than nonparticipating youth 9 mo. after the interventions first full-scale application. The program appeared to appeal more to girls than boys. Such results are encouraging for use in communities.

Establishing the Infrastructure to Comprehensively Address Cancer Disparities: A Model for Transdisciplinary Approaches

The Center for Equal Health (CEH), a transdisciplinary Center of Excellence, was established to investigate cancer disparities comprehensively and achieve health equity through research, education, training, and community outreach. This paper discusses challenges faced by CEH, strategies employed to foster collaborations, lessons learned, and future considerations for establishing similar initiatives.