Levi Ross

Perceived Cancer Risk: Why Is It Lower Among Nonwhites than Whites?

Background: We explored racial/ethnic differences in perceived cancer risk and determinants of these differences in a nationally representative sample of whites, blacks, Hispanics, and Asians. Methods: Multiple regression techniques, including mediational analyses, were used to identify determinants and quantify racial/ethnic differences in the perception of the risk of developing cancer among 5,581 adult respondents to the 2007 Health Information Trends Survey (HINTS). Results: Blacks, Hispanics, and Asians reported lower perceived cancer risk than whites [Bs = −0.40, −0.34, and −0.69, respectively; (Ps < 0.001)]. Contributing factors included relatively lower likelihood of reporting a family history of cancer, lower likelihood of having smoked, and a less strong belief that everything causes cancer among nonwhites than among whites. Racial/ethnic differences in perceived risk were attenuated in older respondents because perceived cancer risk was negatively associated with age for whites but not for nonwhites. Conclusions: Nonwhites had lower perceptions of cancer risk than whites. Some of the racial/ethnic variability in perceived risk may be due to racial and ethnic differences in awareness of ones family history of cancer and its relevance for cancer risk, experiences with behavioral risk factors, and salience of cancer risk information. Cancer Epidemiol Biomarkers Prev; 19(3); 746–54

Qualitative Systematic Review of Barber-Administered Health Education, Promotion, Screening and Outreach Programs in African-American Communities

The barbershop has been portrayed as a culturally appropriate venue for reaching Black men with health information and preventive health screenings to overcome institutional and socio-cultural barriers. The purpose of this review is to synthesize the peer-reviewed literature on barbershop-based health programs to provide lessons learned for researchers and practitioners. A literature search was conducted to identify articles for the review. Inclusion criteria specified that studies had to be based in the United States and reported about research where barbers were either being assessed for the feasibility of their participation or recruited to administer health education/screening outreach or research activities. The literature search produced 901 unique bibliographic records from peer-reviewed publications. After eliminating articles not meeting the inclusion criteria, 35 articles remained for full-text review. The final article sample consisted of 16 articles for complete abstraction to assess characteristics of studies, role and training of barbers, outcomes targeted, effectiveness, and key findings. All barbershop-based studies reviewed targeted Black men in urban settings. Common study designs were cross-sectional studies, feasibility studies, needs assessments, and one-shot case studies. Barber administered interventions addressed primarily prostate cancer and hypertension, and barbers provided health education, screening, and referrals to health care. Nonintervention studies focused mostly on surveying or interviewing barbers for assessing the feasibility of future interventions. Barbershops are a culturally appropriate venue for disseminating health education materials in both print and media formats. Barbershops are also acceptable venues for training barbers to conduct education and screening. In studies where barbers received training, their knowledge of various health conditions increased significantly and knowledge gains were sustained over time. They were also able to increase knowledge and promote positive health behaviors among their customers, but these outcomes were variable and not consistently documented.

On Some Practical Considerations Regarding Community-Based Participatory Research for Addressing Cancer Health Disparities

There is a consensus about the benefits of community-based participatory research and the important role it can play in reducing cancer health disparities. Although every community-based participatory research project is unique in many ways, several fundamental issues deserve consideration. We discuss issues concerning community representation, possible tensions within community-based participatory research (CBPR) projects, and staffing CBPR projects. Flexibility, open-mindedness, transparency, and above all, caring, are characteristics that best ensure successful and rewarding outcomes.

Prostate Cancer Education in African American Barbershops Baseline Client Survey Results and Differences in Decisional Conflict and Stage of Decision Making

There have been very few studies to rigorously evaluate the potential of African American barbers to educate men about prostate cancer in the barbershop setting. This research brief presents baseline data from a cross-sectional survey identifying differences in decisional conflict and stage of decision making by screening status from an efficacy trial to educate African American men about informed decision making for prostate cancer screening. Those men who had already received the prostate-specific antigen (PSA) test were more advanced in their stage of decision making and had less decisional conflict about the PSA test than those men who had never received a PSA test. Educational interventions to increase informed decision making with prostate cancer screening must consider previous PSA test history as a mediating variable affecting decision self-efficacy.

Abstract A54: Examining sociodemographic differences in unmet treatment information needs among localized prostate cancer survivors

Background: Prostate cancer is the most commonly diagnosed cancer among men living in the United States. All men diagnosed with prostate cancer must undergo the complex process of treatment decision-making. Men have to be exposed to a range of issues related to treatment care planning and aftercare before they can make an informed treatment choice. The literature suggests that many men make prostate cancer treatment decisions before having all of their information needs satisfied. Patients who do not satisfy all of their information needs before undergoing treatment will have unmet needs. Men with unmet needs are more susceptible to making ill-informed choices and selecting treatment options that are poorly aligned with their preferences. Objectives: To quantify levels of unmet treatment information needs and to explore sociodemographic correlates of unmet needs among a sample of localized prostate cancer survivors. Methodology: From 2013 to 2014, sixty-three prostate cancer survivors completed self-administered surveys on a touch-screen computer. All participants were 40 years or older, self-identified as African American or White, was treated for or actively monitoring localized prostate cancer (Stage T1 or T2), and lived or worked in Western New York or Georgia. The survey collected information on sociodemographic variables, information seeking behavior, and treatment information needs. Unmet treatment information needs were classified as details or issues that survivors deemed important to know but did not explore before making their treatment decision. Each of the 20 treatment information need items was rated as “0 = unimportant” or “1= important”. An unmet needs composite scale was created which ranged from 0 - 20 (α = 0.895). Univariate statistics (frequencies, means and standard deviations) were computed to describe the study sample. Bivariate (T-test, ANOVA and Chi-square) and multivariate statistics were computed to examine associations between study variables. Significance levels for all statistical procedures was set at p ≤ 0.05. Results: Most participants were White (58.7%), college graduates (54.0%), not working (58.7%), married (78.4%) and had annual household incomes of

Using CBPR to Extend Prostate Cancer Education, Counseling, and Screening Opportunities to Urban-Dwelling African Americans

45,000+ (49.2%). A majority of participants (57.0%) reported at least one unmet information need (range = 0 – 19 unmet needs, mean = 2.83). African Americans reported more unmet needs than Whites (3.64African American vs. 2.50Whites). Results from multiple linear regression analysis indicated that race (β = -2.14, p = 0.05), income (β = -4.60, p = 0.01), and insurance status (β = 6.73, p = 0.01) were significant predictors of unmet information need (F(9,41) = 2.34; p = 0.03). African Americans were less likely to get information they wanted about “How different treatment options work (χ2 = 0.02)” and “How much time is required to complete treatment (χ2 = 0.04).”Conclusions: These results suggest that many prostate cancer patients do not receive all of the information they deem important for treatment decision-making. Treatment information seeking behavior appears to be an emerging area of disparity for African Americans and men with lower income. Patient centered interventions need to be developed and implemented to reduce unmet treatment information needs within these medically underserved populations. Citation Format: Jarrett Johnson, Sarbesh Pandeya, Ahmed Kabore, Stuart H. Tedders, Levi Ross. Examining sociodemographic differences in unmet treatment information needs among localized prostate cancer survivors. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A54.

Overview of Cancer Prevention and Control and African-Americans

Community-based participatory research (CBPR) is becoming one of the dominant approaches for bringing evidence- and consensus-based cancer prevention and control practices to medically underserved communities. There are many examples of how CBPR has been useful for generating culturally specific solutions for different health issues that affect African-Americans. However, few examples exist in the literature on how the CBPR approach can be applied to address prostate cancer. This paper describes a collaborative process for linking inner-city, African-American men to free prostate cancer education, physician counseling, and screening opportunities (prostate-specific antigen (PSA) testing and digital rectal examination (DRE)). The site of this community-based participatory project was the city of Buffalo, located in Erie County, New York. The collaborative, community-academic process that is described includes the following: (1) planning and conducting a community needs assessment to contextualize local prostate cancer issues, (2) organizing town and gown event planning, and (3) manipulating aspects of the built environment to build an infrastructure within the community to address disparities in screening opportunities. This paper concludes with a description of lessons learned that can help others develop and implement similar activities in other communities.

Abstract A45: Racial Differences in Psychosocial Barriers to Initiate Prostate Cancer Treatment Information Seeking

Achieving health equity, eliminating disparities, and improving the health of all groups is one of the goals of Healthy People 2020 [1]. One subpopulation that can greatly benefit from the achievement of this goal is African-Americans. Life expectancy for African-Americans (74.3 years) is nearly 4 years less than that of whites (78.1 years). When gaps in life expectancy are examined by race and gender, differences are still apparent. Life expectancy for African-American women (77.4 years) is 3.4 years less than that of their white counterparts (80.8 years), while life expectancy for African-American men (70.9 years) is 5 years less than that of white men (75.9 years) [2]. Cancer has a significant impact on the life expectancy of all Americans, and it is a major contributor of the life expectancy differences between African-Americans and whites. Cancer disparities occur when there are differences in the incidence, prevalence, mortality, and burden of disease among specific subpopulations [3]. The cancer incidence and mortality rates for all sites combined are higher for African-American men than for white men. Although the cancer incidence rate for African-American women is lower than that for white women, African-American females die from cancer at much higher rates.When 5-year cancer survival rates are examined by race, similar trends are found. Approximately 60 % of AfricanAmericans diagnosed with cancer live 5 years or longer compared to 69% of whites. Racial differences in cancer mortality for African-Americans are largely in breast and colorectal cancers in women, and prostate, lung, and colorectal cancers in men [4]. Thus, African-Americans experience disparate cancer outcomes across the continuum of care. The literature indicates that several factors interact at multiple ecological levels to influence the disparate cancer outcomes that are found among AfricanAmericans. At the individual level, factors such as knowledge, attitudes, and risk perceptions have been shown to shape outcomes. At the interpersonal level, social networks, provider recommendations to engage in risk reduction activities, and social support impact disparities. At the community level, the distribution of physicians, availability of specialized care, and social norms contribute to inequalities. There is a large body of research which shows that disparate cancer outcomes are exacerbated when contextualized factors such as SES, geographic environment (e.g., urban, rural), and insurance status are considered. Given that many of the accepted determinants of disparities are modifiable, cancer prevention and control researchers have numerous opportunities to promote equity in cancer outcomes for African-Americans. This special issue of the Journal of Cancer Education highlights the scholarly efforts that nationally recognized research teams have undertaken to improve cancer outcomes across the continuum of care for African-American men and women. These papers are organized into five overarching themes: (1) community organizing and communitybased participatory research (CBPR), (2) screening, (3) survivorship, (4) faith and faith-based organizations, and (5) emerging issues and innovative approaches. * John S. Luque luquej@musc.edu

Population-Based Analysis of Hematologic Malignancy Referrals to a Comprehensive Cancer Center, Referrals for Blood and Marrow Transplantation, and Participation in Clinical Trial, Survey, and Biospecimen Research by Race

Purpose: All men diagnosed with prostate cancer must undergo the complex process of treatment decision-making. Research indicates that most men are not prepared to fully interact with the information environment when they are initially diagnosed. The reasons behind this lack of preparedness are not fully understood. More information is needed about psychosocial facilitators and barriers to information gathering before appropriate interventions can be developed. The purpose of this research was to explore the different types of psychosocial assistance that men might need to help them begin gathering treatment information. Methods: A purposive sample of 63 African-American and Caucasian men treated for or actively monitoring localized prostate cancer (Stage T1 or T2) was recruited to participate. All recruitment was completed via cancer registries, newspaper ads, and word-of-mouth. All participants completed a 30-45 minute self-administered survey on a laptop or touchscreen computer. Data collected included: (1) demographic information and (2) information about their self-reported levels of (a) confidence, (b) confusion, (c) worry, (d) comfort, (e) ease, and (f) organization during their initial searches for treatment information. All men received a

The Feasibility of Using Social Networks to Understand the Causal Pathways of Cancer Disparities

25.00 honorarium for participating. Results: The mean age of participants was 64.17 years. Participants were between six months to 10 years post prostate cancer diagnosis (mean = 5.21 years, SD= 3.23). At the initial search for treatment information, the majority of men (82.5%) were not confident they knew all of the right information to look for and were not confident they could find answers for all of their questions (79.3%). When psychosocial barriers were compared by race, one significant relationship was found. A greater proportion of African Americans (19.2%) found the initial information gathering process more difficult than their Caucasian counterparts (13.5%) (p Citation Format: Heather Guerreso, Jarrett Johnson, Levi Ross. Racial differences in psychosocial barriers to initiate prostate cancer treatment information seeking. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A45.