Julie Williams Merten

Barriers to cancer screening for people with disabilities: A literature review

BACKGROUND Over 50 million Americans are currently living with some form of disability. Studies have shown that people with disabilities are underinsured, have less access to health care, and are more likely to engage in risky health behavior. Routine preventive screenings for breast, cervical and colorectal cancer are recommended for all adults to improve early detection and treatment of cancer. Although early detection of cancer offers the best chances for treatment and survival, cancer screening has been limited for many people with disabilities. OBJECTIVE To present results of a scoping review of studies focused on barriers to cancer screening for people with disabilities. METHODS Online databases were searched for research articles on barriers to cancer screening (breast, cervical, prostate, and colorectal) in people with disabilities. RESULTS Thirty-five peer-reviewed articles met inclusion criteria. Existing research on cancer screenings, particularly prostate cancer, among people with disabilities is limited. Current studies suggest that those with advanced disabilities are not being screened for cancer as often as the able-bodied population with the exception of military veterans. Education, income, age, employment, screening history, tobacco use, activity level, disability level, and geography affected screening rates. CONCLUSIONS Barriers include cost, access, health care provider discomfort, and physical and cognitive restraints. Future interventions to improve routine preventive cancer screenings rates could include specialized health care provider training, community interventions, emphasis on the value of health promotion and the specific health care needs of people with disabilities.

Sun Safety Knowledge, Attitudes, and Behaviors among Beachgoing Adolescents.

Background Skin cancer rates are rising and could be reduced with better sun protection behaviors. Adolescent exposure to ultraviolet (UV) radiation is damaging because it can lead to skin cancer. This descriptive study extends understanding of adolescent sun exposure attitudes, knowledge, and behaviors. Methods A sample of 423 beachgoing adolescents in Florida were interviewed over 4 days. Results Adolescents did not know (63%) the peak hours of strongest UV exposure and nearly half planned to spend over 3 hours in the sun. Females were 2 times more likely to report wearing sunscreen less than SPF 15. Females were also 5 times as likely to intentionally tan and use tan enhancers. Respondents likely to sunburn reported better sunscreen usage and viewed a suntan less favorably. Of those surveyed, most believed that a suntan looked healthy (80%). Despite the reported risky sun behaviors, 67% thought that they were at risk of developing skin cancer. Discussion and Translation to Health Education Practice Insufficient sun protection behaviors and sun safety knowledge were apparent. Appearance motivations trumped sun-safe behaviors and the threat of skin cancer. Interventions should include sun safety education as well as sociocultural strategies to reduce the societal valuation of suntans.

Nature contact at school: The impact of an outdoor classroom on children’s well-being

ABSTRACT Nature contact facilitates healthy child development and a disconnect with nature presents potential health risks. This study was designed to test a nature intervention at an elementary school among children. An experimental crossover design was implemented over six weeks; two teachers taught their respective kindergarten classes the daily language arts lesson in either the control (indoor classroom) or nature treatment (outdoor classroom) conditions. Child well-being measures were compared in the two conditions. Teachers’ redirections of child behavior were significantly fewer in the nature condition (t = 2.49, p < 0.05) compared to the control. Also, fewer children were off task in the nature condition on average. There were mixed well-being results; children reported no significance difference in happiness in the two conditions, but teachers reported modest benefit in child well-being in the nature condition. The outdoor classroom is a promising method for increasing nature contact and promoting student well-being.

Applying a Social-Ecological Framework to Factors Related to Nicotine Replacement Therapy for Adolescent Smoking Cessation.

Objective: This systematic review synthesizes factors related to nicotine replacement therapy (NRT) use among adolescents seeking to quit smoking, using the social–ecological model as a guiding framework. Data Source: Searches of PubMED, ProQuest, EBSCOhost, and ERIC were conducted in July 2016. Study Inclusion and Exclusion Criteria: Original studies of cigarette smokers younger than 18 years that discussed NRT were included. Data Extraction: Two reviewers individually extracted study purpose, sample, design, and results. Data Synthesis: Factors were categorized by social–ecological model level and summarized. Results: A total of 103 907 articles were identified during initial search. After narrowing to peer-reviewed articles in English and eliminating reviews and adult-only studies, we reviewed 51 articles. These 51 articles identified factors from studies at each level of the social–ecological model: intrapersonal (k = 20), interpersonal (k = 2), organizational (k = 7), community (k = 11), and public policy (k = 14). Conclusion: Findings provide insight into the applicability of NRT for adolescent smoking cessation, and factors by social–ecological model level highlight areas for additional research. Future adolescent NRT studies should assess factors at the interpersonal, organizational, and community levels, as well as the interactions between levels.

Evaluation of a newly developed tobacco cessation program for people with disabilities

BACKGROUND Tobacco use is the single most preventable cause of morbidity and mortality, accounting for at least 480,000 deaths in the United States annually. People with disabilities smoke at a rate 1.5 times greater than the able-bodied population. Higher incidence of tobacco use among people with disabilities has been directly related to both unique and universal cessation barriers. Despite increased prevalence of tobacco use and cessation obstacles, evidence is lacking on the development of successful interventions targeting people with disabilities. OBJECTIVE We aimed to assess the feasibility, acceptability, and potential effectiveness of a cessation intervention tailored to people with disabilities. METHODS Eighteen tobacco users with disabilities (56% African American, 64% male) participated in a 4-week, 8-session tobacco cessation program consisting of group sessions on managing addiction, relapse, and lifestyle changes specific to people with disabilities. Semi-structured interviews were conducted at the conclusion of the program. A follow-up measure of smoking status, triggers, and nicotine replacement therapy usage was completed at 4 weeks and 6 months. RESULTS Sixteen participants completed the intervention (89%), with participants on average attending 86% of sessions. Most participants rated the program as excellent (83%) or good (8%). Qualitative interviews revealed participants value social support, accessibility, and a tailored program. Four participants (22%) reported abstinence at six months, which is greater than the standard quit rate. CONCLUSION This study suggests tailoring a cessation program to the characteristics unique to people with disabilities may be critical in delivering meaningful and effective cessation interventions among this population.

Rural Breast Cancer Patients and Survivors Perspectives using Online Health Resources

Rural Breast Cancer Patients and Survivor’s Perspectives using Online Health Resources Breast cancer is the second most common cancer in women, with over 2.5 million breast cancer survivors in the United States. These patients, survivors and their loved ones use the Internet to find information about breast cancer, search for treatment options and connect with support groups. For women in medically underserved areas, especially rural areas, the Internet could be one of their only sources of information.

The built environment, transportation policy, and population health: a comparison of two cities

This preliminary study assesses the relationship between active transportation, the built environment, and population perceived health in two comparable cities in the Southeastern United States at different stages of improving infrastructure for active commuting. Behavioral Risk Factor Surveillance Survey data from 2006 to 2012 were analyzed for Charlotte, NC, and Jacksonville, FL. The annual difference between the percentage of Charlotte respondents rating physical health as good compared to Jacksonville’s increased at a rate of 13% based on an exponential growth regression model (p = 0.02). Supportive urban and transportation policies aimed at facilitating healthy behaviors are associated with healthier communities.

Lifestyle Factors Associated With Sunscreen Use Among Young Adults

Background. Skin cancer is the most common cancer in the United States with melanoma rates increasing. Sunscreen use is an effective way to protect the skin and reduce skin cancer risk. Limited research has been conducted examining the relationship between sunscreen use and other lifestyle factors. Interventions aimed at multiple lifestyle factors have shown promise for prevention and reduced health care costs. Objective. This study explores the relationship between sunscreen use and lifestyle factors associated with mortality and morbidity among young adults. Lifestyle factors examined included physical activity, substance abuse, smoking, sexual behavior, unintentional injury, and mental well-being. Methods. A convenience sample of 747 college students was surveyed about sunscreen use and other health risks. Data were analyzed using SPSS 19. Results. White, female students older than 21 years were more likely to use sunscreen. Texting while driving, low life satisfaction, and binge drinking were associated with inadequate sunscreen use. Limitations. Convenience sampling limits generalizability and surveys are subject to recall, self-report, and self-selection bias. Conclusions. The findings provide the framework to develop multiple risk factor interventions.

Effectiveness and feasibility of a 10-minute employee stress intervention: Outdoor Booster Break

ABSTRACT There is a growing recognition that workplace environments affect employee health. Nature contact exposures in the workplace have been shown to be healthful for employees. This pilot study was designed to test the feasibility and efficacy of a daily outdoor work break (Outdoor Booster Break) compared to a daily indoor break. A census of university office staff was invited to participate (N = 244). Phase 1 focused on feasibility—participants (n = 119) reported that the Outdoor Booster Break was feasible (74%), practical (80%), and worthwhile (83%). During Phase II we used a single-site randomized controlled trial (RCT) to examine the effects of an Outdoor Booster Break—compared with a control indoor work break group—for 4 weeks on employee stress. Perceived stress was measured at pretest and posttest for both conditions. Mean posttest stress scores were lower for both the control group (n = 19) and the treatment group (n = 18). A main effects ANCOVA model controlling for baseline stress revealed posttest stress was lower for the treatment group compared to controls (p = .041). Taking a work break appears to have stress-reducing benefits, but the Outdoor Booster Break reduced stress significantly more than an indoor break. Implications for employers, worksite health promoters, and future research are discussed.

Skin Cancer Risk and Other Health Risk Behaviors A Scoping Review

Purpose. To present results of a scoping review focused on skin cancer risk behaviors and other related health risk behaviors. Skin cancer is highly preventable, yet it is the most common form of cancer in the United States with melanoma rates increasing. Limited research has been conducted examining the relationship between skin cancer prevention behaviors and other health risks, yet multiple behavioral health risk interventions have shown great promise for health promotion and reduced health care costs. Methods. Online databases were searched for research articles on skin cancer risk behaviors and related health risk behaviors. Results. Thirty-seven articles met inclusion criteria examining skin cancer behaviors including risk, sun protection behaviors, sunburn, and indoor tanning. The majority of existing studies focused on the relationship between skin cancer prevention behaviors and physical activity, body mass index, smoking, and alcohol abuse. Adults were the primary population of interest with some studies of adolescents. Conclusions. Poor skin cancer prevention behaviors were associated with alcohol use, marijuana use, and smoking among adolescents and adults. Studies on body mass index and physical activity had mixed relationships with skin cancer prevention behaviors and warrant further investigation. Indoor tanning was associated with other risky behaviors but other skin cancer prevention behaviors were not studied.