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A cancer diagnosis enlivens the question of what it means to live well with the Earth and its multidimensional beings, including the children I teach. A cancer diagnosis provides a necessary push to step out from the confines of a self and toward and into the wild fray of this life. I interpret my lived experiences through the practical philosophy of hermeneutics. Hermeneutics has helped me perform and write my lived experience, which I hope will draw in readers and listeners to a recognition of their inescapable ecological interdependence. Cultivating an ability to listen and interpret the world and the human and more-than-human kinships is important to me. Listening to words that children speak helps me learn to be open to the fullness of life, how life is lived, how life can be remembered and suffered and let go. I am gathering sense of being in the world and of understanding the offering that arrives when I nurture a commitment to care for the Earth.

The Accelerate Cancer Education (ACE) summer research program at The University of Kansas Cancer Center (KUCC) is a six-week, cancer-focused, summer research experience for high school students from historically marginalized populations in the Kansas City metropolitan area. Cancer affects all populations and continues to be the second leading cause of death in the United States, and a large number of disparities impact racial and ethnic minorities, including increased cancer incidence and mortality. Critically, strategies to bolster diversity, equity, inclusion, and accessibility are needed to address persistent cancer disparities. The ACE program offers an educational opportunity for a population of students who otherwise would not have easy access onto a medical center campus to make connections with cancer physicians and researchers and provides a vital response to the need for a more diverse and expansive oncology workforce. Students grow their technical, social, and professional skills and develop self-efficacy and long-lasting connections that help them matriculate and persist through post-secondary education. Developed in 2018, the ACE program has trained 37 high school junior and senior students. This article describes the need for and how we successfully developed and implemented the ACE program.

The Human Papillomavirus (HPV) vaccine can prevent 90% of cancers caused by HPV. Health care provider recommendations affect vaccine uptake, yet there are a lack of studies examining the impact of the school nurse (SN) in vaccine recommendations. The purpose of this study was to evaluate the impact of adding a SN HPV recommendation to the standard vaccination letter sent to parents/guardians. The rate of vaccination between the intervention and control schools was not statistically significant (Estimate (Std. Error) = -0.3066 (0.2151), p = 0.154). After controlling for age, sex, race, insurance type, and medical practice type, there was no significant difference in the likelihood to receive the HPV vaccine (OR = 1.53, 95% CI: 0.563-4.19 in 2018; OR = 1.34, 95% CI: 0.124-14.54 in 2019. Further work is needed to clarify how school nurses can better promote HPV vaccine, and which adolescent demographic groups (e.g., race, insurance type, provider type) face barriers to HPV vaccine uptake.

Background: Women with learning disabilities are less likely to access cervical and breast cancer screening when compared to the general population. The Social Ecological Model (SEM) was used to examine the inequalities faced by women with learning disabilities in accessing cervical and breast cancer screening in England, UK. Methods: The findings from a qualitative systematic review and a Q methodology study were triangulated. Framework analysis, in line with the SEM, was used to develop an integrated set of findings. Findings: Women with learning disabilities may lack knowledge of cancer symptoms, and cancer screening, as well as being scared about the process and getting the results. The attitudes of family and paid carers towards screening may influence women with learning disabilities' decisions as to whether screening is seen as favourable; support and training may ensure unbiased perspectives. Barriers were also associated with how cancer screening programmes are designed, such as postal invitations which assumes an ability to read. In addition, screening staff need to be aware of the general needs of people with learning disabilities, such as the benefits of easy-to-read documents. Lastly, multidisciplinary working is required so reasonable adjustments can be embedded into cancer screening pathways. Conclusion: This article highlights multiple methods to reduce the inequalities faced by women with learning disabilities, which can be achieved through reasonable adjustments. Embedding reasonable adjustments can support women with learning disabilities in making an informed decision and accessing screening if they choose to. This may result in women with learning disabilities getting a timely cancer diagnosis.

Background: Perceptual measures such as speech intelligibility are known to be biased, variant and subjective, to which an automatic approach has been seen as a more reliable alternative. On the other hand, automatic approaches tend to lack explainability, an aspect that can prevent the widespread usage of these technologies clinically. Aims: In the present work, we aim to study the relationship between four perceptual parameters and speech intelligibility by automatically modelling the behaviour of six perceptual judges, in the context of head and neck cancer. From this evaluation we want to assess the different levels of relevance of each parameter as well as the different judge profiles that arise, both perceptually and automatically. Methods and Procedures: Based on a passage reading task from the Carcinologic Speech Severity Index (C2SI) corpus, six expert listeners assessed the voice quality, resonance, prosody and phonemic distortions, as well as the speech intelligibility of patients treated for oral or oropharyngeal cancer. A statistical analysis and an ensemble of automatic systems, one per judge, were devised, where speech intelligibility is predicted as a function of the four aforementioned perceptual parameters of voice quality, resonance, prosody and phonemic distortions. Outcomes and Results: The results suggest that we can automatically predict speech intelligibility as a function of the four aforementioned perceptual parameters, achieving a high correlation of 0.775 (Spearman's [rho]). Furthermore, different judge profiles were found perceptually that were successfully modelled automatically. Conclusions and Implications: The four investigated perceptual parameters influence the global rating of speech intelligibility, showing that different judge profiles emerge. The proposed automatic approach displayed a more uniform profile across all judges, displaying a more reliable, unbiased and objective prediction. The system also adds an extra layer of interpretability, since speech intelligibility is regressed as a direct function of the individual prediction of the four perceptual parameters, an improvement over more black box approaches.

Globally, approximately 400,000 youth are diagnosed with pediatric cancer each year. Treatment-related side effects, psychosocial challenges, and frequent school absences may adversely impact learning and the education experience among these youth. Efforts to enhance interagency collaboration between health care settings and community schools are imperative to facilitate school reintegration. The "Standards for the Psychosocial Care of Children with Cancer and Their Families" outline specific guidelines related to the continuity of education for students impacted by pediatric cancer. In particular, the "Academic Continuity and School Reentry Support" and "Monitoring and Assessment of Neuropsychological Outcomes" standards of care highlighted within this article align with extant programmatic efforts for transitioning hospitalized school-aged children back into community schools. This article aims to describe systematic programmatic efforts within hospital-based psychosocial programs that are consistent with the "Standards for the Psychosocial Care of Children with Cancer and Their Families," as well as interagency collaboration with community schools to support student-centered education for youth impacted by pediatric cancer. Resources for school psychologists, teachers, hospital-based programs, and others involved in student-centered education for pediatric cancer patients and survivors are presented.

Recently, there has been an emphasis on keeping the study of anatomy using donor material confined to the domain of medical and allied healthcare professionals. Given the abundance of both accurate and inaccurate information online, coupled with a heightened focus on health following the COVID-19 pandemic, one may question whether it is time to review who can access learning anatomy using donors. In 2019, Brighton and Sussex Medical School (BSMS) obtained a Human Tissue Authority Public Display license with the aim of broadening the reach of who could be taught using donor material. In 2020, BSMS received its first full-body donor with consent for public display. Twelve workshops were delivered to student groups who do not normally have the opportunity to learn in the anatomy laboratory. Survey responses (10.9% response rate) highlighted that despite being anxious about seeing inside a deceased body, 95% felt more informed about the body. A documentary "My Dead Body" was filmed, focusing on the rare cancer of the donor Toni Crews. Viewing figures of 1.5 million, and a considerable number of social media comments highlighted the public's interest in the documentary. Thematic analysis of digital and social media content highlighted admiration and gratitude for Toni, the value of education, and that while the documentary was uncomfortable to watch, it had value in reminding viewers of life, their bodies, and their purpose. Fully consented public display can create opportunities to promote health-conscious life choices and improve understanding of the human body.

Black men have a greater risk of prostate cancer as well as worse quality of life and more decisional regret after prostate cancer treatment compared to non-Hispanic White men. Furthermore, patients with prostate cancer who primarily obtain information on the internet have significantly more decisional regret compared to other information sources. Our objective was to explore the perspectives of Black patients on the use and impact of the internet for their prostate cancer care. In 2022-2023, we conducted seven virtual focus groups with Black patients with prostate cancer (n = 22). Transcripts were independently analyzed by two experienced researchers using a constant comparative method. Online sources were commonly used by participants throughout their cancer journey, although informational needs varied over time. Patient factors affected use (e.g., physical health and experience with the internet), and family members played an active role in online information-seeking. The internet was used before and after visits to the doctor. Key topics that participants searched for online included nutrition and lifestyle, treatment options, and prostate cancer in Black men. Men reported many downstream benefits with internet use including feeling more empowered in decision-making, reducing anxiety about treatment and providing greater accountability for research. However, they also reported negative impacts such as feeling overwhelmed or discouraged sorting through the information to identify high-quality content that is personally relevant, as well as increased anxiety or loss of sleep from overuse. In summary, online sources have the potential to positively impact the cancer journey by reinforcing or supplementing information from health care providers, but can be harmful if the information is poor quality, not representative, or the internet is overused.

Healthy lifestyle behaviors can improve health-related quality of life (HRQOL) in cancer survivors; but the combination of behaviors most important for HRQOL is not known. This study investigated the patterns of lifestyle behaviors among cancer survivors and differences in HRQOL between behavioral classes. Cancer survivors (n = 2,463) were invited to participate in a cross-sectional survey. Participants (N= 591) were predominately female (63%) and non-Hispanic White (90%). Survey items included self-reported physical activity, diet, smoking, sleep, HRQOL, and demographics. Behavioral classes were estimated by latent class analysis. Differences between classes were assessed by latent class regression. Compared with the "healthy lifestyles" class (higher probabilities of meeting aerobic/strength-based activity guidelines, high fruit/vegetable intake, and no sleep problems; 11% of sample), the "sleep and diet problems with inconsistent physical activity" class (higher probabilities of not meeting strength-based guidelines, low fruit/vegetable intake, some sleep problems; marginally higher probability of meeting aerobic guidelines; 41%) had poorer general and physical HRQOL. The "poor physical activity and diet" class (higher probabilities of not meeting aerobic/strength-based guidelines, low fruit/vegetable intake, and some sleep problems; 48%) had poorer general, physical, and mental HRQOL. Few participants exhibited healthy lifestyle patterns associated with HRQOL. The findings provide opportunities to develop differentiated multiple behavior-change interventions, targeted to two common patterns of behavior. A large subgroup of cancer survivors was susceptible to suboptimal physical activity and diet, warranting interventions exclusively targeting these behaviors. Another subgroup was susceptible to suboptimal physical activity, diet, and sleep, indicating interventions for this group should include strategies targeting these three behaviors.

Community-engaged patient navigation safety net programs are established as an evidence-based approach to address cancer prevention and early detection efforts, but barriers to expand and sustain such programs persist. In addition, few studies describe how these programs impact buy-in among communities and policy change within health care systems and government. We describe how we used the Capacity for Sustainability Framework to guide efforts for program sustainability and community, institutional, and policy level change in a breast cancer screening and patient navigation safety net program. The nine domains of the Capacity for Sustainability Framework were used to develop program logic models, to inform program implementation and quality improvement agendas, and to guide multi-level partner and stakeholder engagement, outreach, and dissemination of outcomes. The program is currently in its seventh year and continues to be annually funded by a city public health department. In 2021, additional 5-year renewable funding from a state public health department was secured. In addition, institutional program support was expanded for patients diagnosed with breast cancer. Program leaders worked with policymakers to draft legislation to support training certification and third-payor reimbursement for patient navigators and community health workers. The program is well-known and trusted among community members, community-based organizations, and providers. Community, organizational, and policy-level outcomes demonstrate that community-engaged patient navigation safety net programs can influence more than individual and interpersonal outcomes and can be sustained over time.

Children with cancer experience recurring hospitalizations and isolation during treatment, which affect their school attendance. This study explores experiences of children with cancer, their classmates, and teachers with using the telepresence robot as a learning mediator in the hybrid classroom during treatment periods. 31 children with cancer (aged 7-17 years), 30 teachers, and 118 classmates participated in interviews and 19 h of participant observations were undertaken in nine classrooms. The Agential Realism Theory and Situational Analysis framed the data analysis. There was a single overarching theme, "Telepresence robot didactic," and five sub-themes (Telepresence mediated learning, school-home collaboration, hybrid robot teaching, intra-actions in class, and inclusive spatiality). This study advocates the complexity of telepresence robot didactics, emphasizing that numerous human and other factors must intra-act and work simultaneously to achieve optimal learning conditions for children during cancer treatment. This includes considerations such as modality availability for the remote child; the teacher's understanding of telepresence robot didactic and hybrid learning; the classmate's ability to involve the remote child in groupwork; the child's own treatment protocol, the robot's functionalities, and spatiality in the class. Strategies for use and the systematic surveillance of telepresence robots are needed to ensure that children during cancer treatment do not lag in academic achievement. This study proposes that children with cancer can continue participating in class while hospitalized or isolated and consequently reduce social and academic setbacks.

Background: The COVID-19 pandemic resulted in rapid changes to head and neck cancer (HNC) services. Multidisciplinary team (MDT) face-to-face appointments were converted to telehealth appointments (telephone and video-call) to reduce the risk of COVID-19 transmission. The literature exploring HNC patient experience of these appointment types is limited. Aims: To explore patient experience of telehealth appointments at one UK centre during the COVID-19 pandemic, as well as the variables that may influence patient preference for virtual or face-to-face appointments. Methods & Procedures: A survey-based study design was used, with closed questions and open text options to capture the views of the participants. Quantitative data were analysed using descriptive statistics. Open text data was used to add depth to the findings. Outcomes & Results: A total of 23 participant surveys were returned. Six categories were identified: Usability; Information receiving & giving; Satisfaction; Emotions and comfort; Rapport; and Travel time and cost. Overall, participants gave positive responses to each category and indicated that telehealth appointments met their needs. Areas for clinical consideration are highlighted. Variables such as age, travel distance from hospital site, fear of COVID-19 and information technology (IT) access did not appear to influence patient preference for appointment type. Conclusions & Implications: Going forward, telehealth may be considered for use in combination with face-to-face appointments in the HNC pathway. Areas for further development include a 'telehealth screening tool' that may help to identify those patients most appropriate for these appointment types, or who require support to access them.

Background: Individuals with severe motor and intellectual disabilities have become an aging population, and high cancer morbidity and mortality are critical issues affecting their survival. Cancer screening is a crucial method of resolving this issue; however, a suitable screening method for them has not been established. Methods: We used ultrasonography alone and performed breast cancer screening for women over 30 years old in our facility from 2016 to 2023. We observed the outcomes and calculated the recall/detection rate in this screening. Results: Three cases among 379 tested positive in this screening, all of which underwent radical surgery. They are alive and well without relapse present. We detected these breast cancer cases with a low recall rate. Conclusion: We were able to successfully detect breast cancer cases using ultrasonography alone. Ultrasonography is an effective and feasible tool for breast cancer screening in individuals with severe motor and intellectual disabilities.

It is important for high school female students, to be familiar with their own bodies and regularly examine their own breasts to check for any changes that could potentially be indicative of breast cancer. It is important to educate students about breast self-examination (BSE) as a means of detecting potential breast cancer early. A quasi-experimental pre and post-test design were implemented to evaluate the effectiveness of the educational program on high school female students by comparing the knowledge level obtained before and after the conduction of the educational program. The sociodemographic results of this study found that before conducting the educational program, a large number of participants (76.5%) had poor knowledge about BSE, but after the conduction of the educational program, there was a significant increase in knowledge, with 90.2% showing a positive effect of the program. The test of significance revealed that the increase in BSE knowledge score as a result of the educational program was highly significant (P < 0.000).

The Coronavirus Disease 2019 (COVID-19) pandemic has significantly affected the educational system. Historically, children with hematological and oncological conditions have experienced academic challenges. A retrospective chart review was conducted. Charts reviewed included children with oncology or hematology conditions, whose parents expressed educational concerns and were referred to an educational liaison in the Pediatric Hematology, Oncology, and Stem Cell Transplantation Division. The parental concerns for 102 children (M age = 10.03 ± 4.7; 59.8% male; 43.1% Latinx/ Hispanic) during the first half of the 2021 to 2022 academic year were extracted. Overall, all parents reported at least one concern with the average reporting 2.24 ± 1.34 (range of 1-6 concerns). The most common general concerns regarded: Individualized Education Programs (IEP) or special education evaluations; 504 accommodations; home instruction; school enrollment. Almost half of the parents had additional concerns they specifically attributed to COVID-19. Children with hematological and oncological conditions were experiencing various needs at this time, which likely have continued implications. It is important for educators, school psychologists, and health care providers to remain cognizant of the educational needs of medically vulnerable populations. Children with hematological and oncological conditions benefit from regular evaluation of their needs, as well as proactive forms of intervention.

Cutaneous malignancy is one of the leading causes of cancer-related morbidities and mortalities. Patient self-screening is helpful for early detection. Among educational pedagogies, game-based learning (GBL) has received increasing attention in recent years. We appraised the effectiveness of GBL, using Wordwall, to enhance cognitive performances pertaining to fundamental knowledge of cutaneous malignancies and perspectives on the intervention compared with a digital pamphlet. This multi-center study utilized a quasi-experimental research design and was conducted between February and April 2022. Participants were recruited and randomly assigned into a game group and a pamphlet group with a 1:1 ratio. Fundamental knowledge of cutaneous malignancies was assessed with pre- and post-intervention tests consisting of ten multiple choice questions with four alternative answers. These tests asked about prominent or pathognomonic features of cutaneous malignancies. During the five-day intervention period, recognition scores of participants in the game group were recorded. Perspectives on the interventions were also collected for analysis. A total of 94 participants were included, 60 (63.8%) were female. The mean age was 19.8 years (standard deviation [SD]=0.8). The increase in knowledge scores of the participants in the game group and pamphlet group was 2.57 (SD=1.30) and 2.36 (SD=1.52), respectively. In the game group, the mean best recognition score (13.89, SD=2.83) was significantly higher than the mean first recognition score (9.53, SD=2.48) with a pvalue <0.001. The overall satisfaction among the participants in the game group and pamphlet group was 4.41 (SD=0.57) and 4.23 (SD=0.59), respectively. This study suggests potentiality of GBL to enhance knowledge and recognition performances of common cutaneous malignancies with high satisfaction. Embedding this approach in the primary prevention of cutaneous malignancies might be a promising option to prevent cancer-related morbidities and mortalities.

Kentucky has the highest cancer incidence and mortality rates in the nation, with rates greatest in the Appalachian region due to poor health behaviors and inequities in social determinants of health. The Appalachian Career Training in Oncology (ACTION) Program at the University of Kentucky Markey Cancer Center engages 20 Appalachian-native high school students annually in cancer education, research, and outreach activities. During the COVID-19 pandemic, programming was disrupted, and alternative activities were implemented, including virtual research experiences. The program's goals were to improve students' biology and cancer content knowledge and research skills and help students make career decisions. Virtual laboratories were used to help accomplish these goals. This study aimed to evaluate the use of virtual laboratories embedded in the program and determine if such experiences helped reach the program's goals. A survey was used to measure students' perceptions of the virtual labs. Results indicated that students perceived they gained content knowledge, obtained research skills, and considered entering science and cancer-related careers. The decision to incorporate virtual laboratories into the ACTION programming during the COVID-19 pandemic was a sound instructional choice. Evidence provided herein gives researchers and program developers information necessary to consider using virtual labs in their programs.

Cancer research training programs build our future biomedical workforce. Training is often centered for students residing close to research institutions, making access more challenging for rural students. A cancer research training program was developed for high school students residing in five geographical regions across Oregon. Training was tiered in duration and intensity across the three years, including a one-week Introduction program and subsequent 10-week summer research training programs (Immersion and Intensive). A total of 60 students participated in in-person and/or virtual training, with Immersion students receiving mentored shadowing experiences in clinical care, public health, and outreach in their home communities. Laboratory rotations at a research-intensive institution enabled students to sample research environments before selecting an area of interest for Intensive training the following summer. Aligning with Self-Determination Theory, the Knight Scholars Program aims to build competence, relatedness, and autonomy of its trainees in biomedical sciences. The program exposed students to a wide range of interprofessional careers and collaborative teams, enabling scholars to envision themselves in various paths. Results show strong gains in interest and research self-efficacy for both Introduction and Immersion scholars, with findings highlighting the importance of representation within mentoring and training efforts.

The University of Pittsburgh Medical Center Hillman Cancer Center Academy (Hillman Academy) has the primary goal of reaching high school students from underrepresented and disadvantaged backgrounds and guiding them through a cutting-edge research and professional development experience that positions them for success in STEM. With this focus, the Hillman Academy has provided nearly 300 authentic mentored research internship opportunities to 239 students from diverse backgrounds over the past 13 years most of whom matriculated into STEM majors in higher education. These efforts have helped shape a more diverse generation of future scientists and clinicians, who will enrich these fields with their unique perspectives and lived experiences. In this paper, we describe our program and the strategies that led to its growth into a National Institutes of Health Youth Enjoy Science-funded program including our unique multi-site structure, tiered mentoring platform, multifaceted recruitment approach, professional and academic development activities, and a special highlight of a set of projects with Deaf and Hard of Hearing students. We also share student survey data from the past six years that indicate satisfaction with the program, self-perceived gains in key areas of scientific development, awareness of careers in STEM, and an increased desire to pursue advanced degrees in STEM.

The Youth Enjoy Science -Teach To Beat Cancer program funded by the National Cancer Institute utilizes the resources of the Case Western Reserve University School of Medicine and Case Comprehensive Cancer Center to provide experiences and training for grade 6-12 teachers so that they are expertly equipped to develop curricular approaches to take back to their classrooms to enhance science education, introduce concepts of cancer biology, encourage cancer risk reduction activities, foster disparity elimination and to motivate middle and high school students to pursue careers in biomedical sciences and cancer research. The program focuses on four aspects of teacher engagement and education: (1) Research Engagement, (2) Curriculum Development, (3) Risk Reduction and Disparity Elimination, and (4) Advocacy for Cancer Research and Cancer Research Careers. This program has been crucial to achieve the National Cancer Institute's goal of educating students from diverse backgrounds underrepresented in biomedical research in the Cleveland area as each teacher influences a significant number of students in their classrooms each year, and are introducing students to cancer biology, exciting them to consider careers in cancer prevention, diagnosis, control, treatment, and research. This article provides an overview of the program including its impact on the teachers and their students.

Computer Aided Detection (CAD) has been used to help readers find cancers in mammograms. Although these automated systems have been shown to help cancer detection when accurate, the presence of CAD also leads to an over-reliance effect where miss errors and false alarms increase when the CAD system fails. Previous research investigated CAD systems which overlayed salient exogenous cues onto the image to highlight suspicious areas. These salient cues capture attention which may exacerbate the over-reliance effect. Furthermore, overlaying CAD cues directly on the mammogram occludes sections of breast tissue which may disrupt global statistics useful for cancer detection. In this study we investigated whether an over-reliance effect occurred with a binary CAD system, which instead of overlaying a CAD cue onto the mammogram, reported a message alongside the mammogram indicating the possible presence of a cancer. We manipulated the certainty of the message and whether it was presented only to indicate the presence of a cancer, or whether a message was displayed on every mammogram to state whether a cancer was present or absent. The results showed that although an over-reliance effect still occurred with binary CAD systems miss errors were reduced when the CAD message was more definitive and only presented to alert readers of a possible cancer.

Background: Although there are a growing number of studies investigating the benefits of music therapy interventions with patients diagnosed with cancer, few studies have taken an approach that specifically examines indices of perceived well-being in women with breast cancer. Overcoming these challenges can be an important step in the recovery process. Purpose: The purpose of our study was to know the positive influence of responsive music therapy through gong sounds, emitted live, on different areas of well-being of women with breast cancer. Methods: Four individual sessions of responsive music therapy with live gong sounds were conducted in which three women (M = 54; SD = 5.57) participated both in the music therapy program and in the completion of the Functional Assessment of Cancer Therapy-Breast (FACT-B) and a semi-structured interview with ad hoc designed questions about perception of qualitative aspects. Results: The results showed that the music therapy sessions significantly improved, p = 0.043 < 0.05, various domains of perceived well-being in women with breast cancer. Discussion: This article highlights several key benefits associated with music therapy and various indices of well-being in women with breast cancer, identifies the limitations of the study, and discusses the findings. It is considered necessary to replicate this practice in future studies that include a larger sample and age range over longer follow-up periods. Translation for Health Education Practice: The text highlights the importance of considering music therapy as a complementary intervention in comprehensive cancer care programs, which may be relevant to health educators when considering intervention and support approaches for cancer patients. Health education interventions targeting the enhancement of cancer patients' well-being should incorporate music therapy techniques.

Background and objective: The aim of this study is to determine the knowledge, attitudes, and behaviors regarding testicular cancer and testicular self-examination (TSE) among medical faculty students in their last two semesters before beginning clinical practice. This study also investigates their beliefs about the importance and efficacy of these practices in early cancer detection. Materials and methods: This descriptive study was conducted between October 1, 2018, and July 31, 2019, involving both male and female students in the 5th and 6th grades of a medical faculty. A total of 278 students participated, providing insights into their level of awareness and engagement with TSE practices. Results: 52.2% of the students were aware of self-testicular examination, yet only 15.5% of male students reported performing TSE regularly. 13.3% of students reported receiving formal training on this topic during their medical education, and a mere 2.9% observed these examinations demonstrated in clinical settings. Champion's Health Belief Model Scale indicated average sensitivity scores of 11.01 ± 4.36, perceived severity of 20.58 ± 5.92, perceived benefits of 11.46 ± 2.99, perceived barriers at 10.14 ± 4.04, and self-efficacy scores at 18.64 ± 5.26. Conclusion and recommendations: The findings suggest that while medical students recognize the seriousness and benefits of TSE, there is a notable gap in regular practice and educational exposure. Increased educational efforts are recommended to enhance sensitivity and self-efficacy related to testicular cancer screening among future healthcare providers.

Cancer survivors experience both physical and cognitive changes after treatment that can impact their vocational well-being should they decide to return to work. In this article, we explore the ways in which career counselling interventions can address the challenges faced by cancer survivors as they re-enter the workforce. Four major career-related issues are outlined: physical functioning abilities, changes in cognitive functioning, changing perspectives and support. These issues are addressed using life-career transition and career counselling theories. Theory-informed helping strategies are considered for career counselling cancer survivors as they improve their vocational life and other aspects of personal well-being.

Cancer is an overwhelming and life-altering diagnosis. Receiving this type of diagnosis typically requires traditional medical therapeutics, but relaxation and healing techniques that reduce stress and calm fears are also beneficial. Artmaking and visual journaling are healing techniques used to improve emotional and psychological health among cancer patients (Barrett, 2011; Collie et al., 2006; Heiney et al., 2015; Predeger, 1996). A community setting can offer individuals creative and transformative visual arts experiences that promote healing and lifelong learning (Lawton & La Porte, 2013).

On March 7, 1962 the Royal College of Physicians published a report entitled "Smoking and Health" that made the causal link between smoking and lung cancer clear and explicit. Using a historical data set that contains information on smoking from 1958 to 1965, I find a decrease in smoking for those with more schooling after the report's publication. I do not find a difference in the effect for those with greater access to information (measured by TV ownership or newspaper readership). This suggests the education health gradient is more likely due to processing of information rather than access to information.

Physical activity (PA) is an important facet in survivorship care. Standardized curriculum which teaches undergraduate student exercise leaders how to implement PA programs for childhood cancer survivors have not been developed. Delivery of PA programs are limited by resources, so utilizing students to lead PA sessions is a potentially cost-effective approach. The purpose of this study was to learn how to optimize mentorship of student PA leaders in pediatric oncology. The aims were to report on the level of guidance provided to the student PA leaders, share student PA leaders' reflection of their mentorship and the challenges they faced. Student PA leaders designed and delivered a 31-week, virtual PA program to pediatric cancer survivors (5-18-year-olds). Mentors provided feedback on the recorded sessions. PA leaders were interviewed about their perceptions, their experiences and the type of feedback they valued the most. Student PA leaders received the most feedback during the first 2 weeks of the program, suggesting close oversight is needed during this time. Students valued the feedback on improving PA delivery/instruction the most. Students reported feeling anxious prior to sessions, especially when new content would be introduced because they were unsure how the patients would respond to the new activities. Reinforcing that the leaders have the ability to minimize PA barriers and provide support may help to resolve their anxiety of working with this population. Using a similar approach as presented in this paper may be advantageous in the development of high-performing PA leaders.

Objective: In contrast to previous research that has primarily focused on gender differences in health behaviour compliance, this study explored the association between gender consciousness and sun protection in China - a cultural setting in which there is a pronounced gender bias towards sun protection. These article is the first attempt to examine gender norms concerning sunscreen use among Chinese individuals, encompassing both young women and young men. Design and setting: Cross-sectional analysis conducted on one Chinese campus. Methods: Utilising data from the 2020 cohort of first-year students (549 male students and 1,489 female students) at a local university in Shanghai and employing OLS regression analysis, our analysis sheds light on gendered patterns of sun protection use among young individuals in China. Results: Findings reveal that gender attitudes affect women's sun protection frequency without influencing their choice of specific products. Conversely, men's gender consciousness shapes their sun protection methods but not their overall frequency of sun protection. In addition, despite lower aggregate levels of sun protection, young women exhibit higher heterogeneity in their responses than young men. Socioeconomic status, health awareness and gender consciousness are all significant factors influencing sun protection among female students; however, among men, only health awareness shows a positive correlation with the use of sun protection. Conclusion: The results of this study exhibit some differences from initial expectations, suggesting that the full adoption of sun protection measures is still a work in progress. However, despite the differences identified, findings provide valuable insights to inform future public health efforts to promote sun protection among youth.

Understanding the school nurse's experience in human papillomavirus (HPV) vaccine promotion can reduce vaccine disparities. HPV vaccination is critical to cancer prevention. Despite the importance of the school nurse in vaccine promotion, there is a lack of understanding. This article aims to examine the knowledge, attitude, experience, and role of school nurses related to HPV vaccination and promotion in school settings. A systematic search for school nurses and their experiences related to HPV vaccination was conducted. A thematic synthesis was undertaken using the socioecological model. This review highlights the complexity of HPV vaccine promotion in schools over time. Multilevel factors impact nursing practice. Nurses have good vaccine knowledge and positive attitudes. Poor workflow processes, competing demands, and vaccine communication challenge school nurses. The themes that were synthesized informed the LEADS model. With the support of school nurses, reaching the goal of eliminating cervical cancer as a public health problem is possible.

Background: Colorectal cancer (CRC) is the most common cancer diagnosed worldwide. CRC can be effectively prevented or treated if detected early, through screening. Purpose: This study aimed to determine the influencing factors of CRC screening participation in 50-70-year adults in Iran. Method: A total of 354 adults who never participated in the CRC screening from two health centers in Isfahan in September 2022 were selected randomly. A group of 329 sex and age-matched adults with a history of CRC screening was selected as a control group. Logistic regression analyses were applied to assess the cognitive differences between the two groups. Results: According to the results, Knowledge (OR = 1.61, 95% CI:1.36-1.9), perceived susceptibility (OR = 1.17, 95% CI:1.04-1.3), response efficacy (OR = 1.24, 95% CI:1.09-1.41), and self-efficacy (OR = 1.13, 95% CI:1.06-1.2) among the control group and perceived barriers (OR = 0.88, 95% CI:0.85-0.92) in the case group, were significant factors influencing participation in the CRC screening. Discussion Results of this study suggest that an HBM education model is an advantageous approach to increase CRC screening participation in adults. Translation to Health Education Practice: Certified Health Education Specialists are key personnel in using the HBM model of care and facilitators of behavioral change that will be resulted in improved participation in CRC screening.

When students think of evolution, they might imagine T. rex, or perhaps an abiotic scene of sizzling electrical storms and harsh reducing atmospheres, an Earth that looks like a lunar landscape. Natural selection automatically elicits responses that include "survival of the fittest," and "descent with modification," and with these historical biological catch phrases, one conjures up images of large animals battling it out on the Mesozoic plane. Rarely do teachers or students apply these same ideas to cancer and the evolution of somatic cells, which have accrued mutations and epigenetic imprinting and relentlessly survive and proliferate. Our questions in this paper include the following: Can cancer become an important teaching model for students to explore fundamental hypotheses about evolutionary process? Can the multi-step somatic cancer model encourage visualizations that enable students to revisit and reenter previous primary concepts in general biology such as the cell, mitosis, chromosomes, genetic diversity, ecological diversity, immune function, and of course evolution, continually integrating their biology knowledge into process and pattern knowledge? Can the somatic cancer model expose similar patterns and protagonists, linking Darwinian observations of the natural world to our body? And, can the cancer clone model excite critical thinking and student hypotheses about what cancer is as a biological process? Does this visually simple model assist students in recognizing patterns, connecting their biological curriculum dots into a more coherent learning experience? These biological dynamics and intercepting aptitudes of cells are amplified through the cancer model and can help shape the way biology students begin to appreciate the interrelatedness of all biological systems while they continue to explore pivotal points of biological fuzziness, such as the microbiome, limitations of models, and the complex coordination of genomic networks required for the function of even a single cell and the realization of phenotypes. In this paper we use clonal evolution of cancer as a model experience for students to recreate how a single, non-germline cell appears to shadow the classic pattern of natural selection in body cells that have gone awry. With authentic STEAM activities students can easily crossover and revisit previous biological topics and the ubiquitous nature of natural selection as seen in the example of somatic cells that result in a metastasizing tumor, giving students insight into natural selection's accommodating and tractable patterns throughout the planet.

Introduction: Cervical cancer is a preventable yet highly prevalent disease in Africa. Despite female adolescents and young women being a target group for cervical cancer prevention strategies, little research has examined their knowledge of how to prevent the disease. The study aimed to describe: (a) knowledge about cervical cancer prevention and (b) sociodemographic, social, and systemic factors associated with and interacting with knowledge among female senior high school students in Ghana. Methods: A cross-sectional survey assessed knowledge about (a) risk factors and (b) primary and secondary prevention of cervical cancer among 2,400 female students from 17 public senior high schools in the Ashanti region, Ghana. Descriptive statistics were used to describe knowledge. Linear mixed-effects regression models were used to examine factors associated with knowledge scores. Results: Knowledge gaps were observed for at least two-thirds (>65%) of students. Most students (mean age = 17) did not know that early sexual debut (before 18 years) is a risk factor for cervical cancer (72%) and that a blood test cannot detect cervical cancer (71%). Students in later stages of senior high school education and those who received sexual health education from teachers and parents had significantly greater cervical cancer knowledge scores than their counterparts. Interactive effects showed that school-based sexual health education was associated with higher knowledge scores than home-based education among students. Conclusions: Most female senior high school students had gaps in knowledge about cervical cancer prevention. Finding new ways to strengthen the capacity of schools and parents to deliver accurate cervical cancer prevention information is warranted.

The goal of the University of Southern California (USC) WonderKids Program is to expose students to numerous Science, Technology, Engineering, and Math (STEM) careers in an after-school setting. Elementary school students explore STEM fields with hands-on curricula and guest speakers from those fields. In partnership with the USC/Norris Comprehensive Cancer Center, a medical- and cancer-themed curriculum was developed for elementary students in the Los Angeles area. The curricula described in this article introduces first- and third-grade students to the main concepts of audiology, gastroenterology, and osteology/orthopedics fields and the way cancer can affect parts of the body that are covered in these fields. Pretests and posttests were designed to assess the impact of the educational intervention. Students demonstrated statistically significant improvements in their understanding of key objectives of all topics.

Background: It is widely accepted that family caregivers are central to the future of cancer care and the impetus is to understand how best to support and empower them. Aims: This study explored the role of the relationship between the caregiver and the child, the level of perceived support, and the self-compassion of the caregiver, on distress and wellbeing in mothers who were the primary caregiver for a child with cancer. Methods: A self-report questionnaire survey of 255 mothers assessed perceived support, attachment to the child, self-compassion and a range of demographic variables including age, education, employment and time since diagnosis. Results: A model was proposed and explored using Hierarchical Multiple Regression Analysis (HMRA) and tested more fully using Structural Equation Modelling. The results of both analyses support the model and show it to be an excellent fit for the data. Conclusions: The findings suggest that the quality of the attachment bond with the child along with mother's ability to be self-compassionate, combined with perceived social support may moderate the impact of care burden on perceived distress for mothers caring for a child with cancer.

Cervical cancer represents 7.5% of deaths caused by cancer in women. Prevention of cervical cancer can be done by cervical cancer screening. The purpose of the study was to determine the effect of video on knowledge level, attitude, and intention for cervical cancer screening in Yogyakarta. This study was a quantitative study with a quasi-experimental nonequivalent control group design. The study was carried out in April-October 2021. The population of the study was all women of childbearing age. The sample was 50 respondents for each group, experiment group and control group. The intervention was given through video education for the experiment group and pocketbooks for the control group. Data analysis used T-test, Wilcoxon test, and Mann-Whitney. There was a difference in the pre-test and post-test of knowledge level (p=0.002), attitude (p=0.023), intention (p=0.005) in the experiment group and knowledge level (p=0.001), attitude (p=0.000), intention (p=0.004) in the control group. There was a significant difference in women's intention (p=0.001) for cervical cancer screening with the video education method than pocketbooks. The method of providing educational videos and pocketbooks is effective for increasing the knowledge level, attitude, and intention for cervical cancer screening. Video has influence on intention to detection cervical cancer.

This study aimed to investigate senior high school students' computational thinking skills after implementing the Bioinformatics Module on molecular genetics concepts. The instructional approach used in the module is Computational Inquiry-based Teaching (CIbT). This study used a quasi-experiment method with a pretest-posttest control group design. The subjects in this study consist of 24 students in the control group and 38 students in the experimental group from a senior high school in Indonesia. The instrument used in this study is six items of computational thinking test. This module had four themes; Genetics Disease, Cancer, Forensic Science, and Evolution, conducted in 8 sessions. Each session lasted 90 minutes. The Bioinformatics Module consists of programming and databases, including unplugged computational activities and unplugged activities including coding using Python, searching in Uniprot, and using BLAST in NCBI. The CIbT has five steps: orientation, conceptualization, investigation, conclusion, and discussion. The Mann-Whitney test results showed that the p-value from N-Gain data is < 0.01. So, Bioinformatics Module on molecular genetics concepts using CIbT can improve computational thinking skills of senior high school students. For further implementation, biology teachers must prepare to use the Bioinformatics Module, including biology teachers' understanding of molecular genetics and bioinformatics practices to enrich the learning experience in the Bioinformatics Module.

Problem Addressed: To better understand the factors associated with family cancer history (FCH) information and cancer information seeking, we model the process an individual undergoes when assessing whether to gather FCH and seek cancer information and compare models by sociodemographics and family history of cancer. We used cross-sectional data from the Health Information National Trends Survey (HINTS 5, Cycle 2) and variables (e.g., emotion and self-efficacy) associated with the Theory of Motivated Information Management to assess the process of FCH gathering and information seeking. We completed path analysis to assess the process of FCH gathering and stratified path models. Results: Those who felt they could lower their chances of getting cancer (emotion) were more confident in their ability to complete FCH on a medical form (self-efficacy; B = 0.11, p < 0.0001) and more likely to have discussed FCH with family members (B = 0.07, p < 0.0001). Those who were more confident in their ability to complete a summary of their family history on a medical form were more likely to have discussed FCH with family members (B = 0.34, p < 0.0001) and seek other health information (B = 0.24, p < 0.0001). Stratified models showed differences in this process by age, race/ ethnicity, and family history of cancer. Implications for Public Health Research and Practice: Tailoring outreach and education strategies to address differences in perceived ability to lower chances of getting cancer (emotion) and confidence in the ability to complete FCH (self-efficacy) could help encourage less engaged individuals to learn about their FCH and gather cancer information.

Although human papillomavirus (HPV)-associated cancers are preventable and treatable at early stages, health disparities in HPV-associated cancer outcomes continue to exist among Hispanic populations. Hispanics residing along the U.S.-Mexico border face barriers distinct from other geographically dispersed populations within the United States. The current research aimed to explore perspectives and lived experiences of survivors and caregivers of HPV-associated cancers in El Paso, Texas, to inform intervention development and health practices to increase preventive services among populations residing on the U.S.-Mexico border region. A mixed-method approach was employed using a semi-structured interview guide with Quality of Life (QOL) scales with (N = 29) survivors and caregivers of HPV-associated cancers. Content analysis was used to extract themes and descriptive statistics were reported for quality of life. Five major themes were identified: (1) barriers to preventive services and treatment; (2) role of health care providers in diagnosis and care; (3) treatment challenges, support systems, and challenges associated with caregiving; and (4) HPV prevention and health recommendations from survivors and caregivers. Finally, given the context of the COVID-19 pandemic, an additional theme was explored on accessibility to health and human services. QOL scales suggested better overall physical health and spiritual well-being in survivors and fear of reoccurrence among caregivers and survivors. The current research highlights the role of health care providers and human service professionals in the promotion of health practices of at-risk populations by increasing health literacy among cancer patients and caregivers, and exploring experiences, challenges, and messages caregivers and survivors had regarding HPV prevention.

Introduction: Cervical cancer incidence and mortality is higher among Latinas compared with non-Hispanic White women and barriers to screening include lack of knowledge, lack of access to health care, and cultural factors. Both video and printed material have been found effective as health education tools in underserved populations. The purpose of this study was to show no difference between a flipchart presentation facilitated by a community health worker and a narrative video with limited in-person interaction in increasing cervical cancer screening rates among Latinas along the U.S.--Mexico border. Methods: Study design: Randomized controlled study. Participants: women in a community-based cervical cancer screening program. Outcomes: Primary outcome was screening completion and secondary outcomes were changes in psychosocial variables. Results: Total sample size was 500. Most participants were born in Mexico, had a low annual income, preferred Spanish, and did not have a regular doctor. Overall, 371 (74.2%) participants completed screening. There was no significant difference in screening completion between educational delivery modes. The only variable significantly associated with screening completion was age, with 51- to 65-year-olds being 44% more likely than 21- to 40-year-olds to have a Pap test. The only psychosocial variable that was significantly different by delivery mode was perceived susceptibility. The majority of all participants found both the video and flipchart presentation to be acceptable. Conclusion: A health promotion program delivered via self-administered video or PowerPoint slides showed no difference in increasing cervical cancer screening rates.

Alcohol is a known carcinogen. However, public awareness of cancer risk associated with alcohol use is low. A promising approach to raising awareness is to include cancer warning labels on alcohol-containing products, but there is limited knowledge of the design and effect of such warnings. The present study investigated the impact of visual elements on the effectiveness of cancer warning labels. In a randomized online experiment, alcohol consumers (N = 1,190) were randomly assigned to one of three conditions: exposure to (a) text-only warning labels, (b) pictorial warning labels showing graphic health effects (e.g., diseased organs), and (c) pictorial warning labels showing lived experience (e.g., cancer patients in a medical setting). The results showed that whereas the three warning types did not differ significantly in behavioral intentions, pictorial warnings featuring health effects led to greater disgust and anger than text-only warnings and pictorial warnings featuring lived experience. Moreover, anger predicted lower intentions to reduce alcohol use and was a significant mediator of the effects of warning type on behavioral intentions. The findings highlight the role of emotions in responses to health warning labels with different visual elements and suggest that text-only warnings and pictorial warnings with lived experience may be useful in preventing boomerang effects.

Pediatric cancer is the second leading cause of death among children ages 1-14 (Whitehead et al., 2016). Approximately 10,500 children ages 1-14 and 5090 adolescents ages 15-19 have been diagnosed with cancer in 2021 (American Cancer Society, 2021). An estimated 28% of childhood cases and 13% of adolescent patients will be diagnosed explicitly with Leukemia (American Cancer Society, 2021). Leukemia is a broad term that encompasses the malignant disease of bone marrow and other structures responsible for blood production (Olin et al., 2018). Children and adolescents experiencing pediatric leukemia often undergo treatment that produces biological, psychosocial, and cognitive impacts. Due to the occurrence of this disease in school-aged children and the wide-ranging consequences they face, school psychologists may be called upon to work with students and their families while they go through treatment during school-aged years. This article will discuss pediatric leukemia, treatment options, long-term impacts of treatment for patients, and considerations for working with children in the school system.

One of the ways to acquire scientific knowledge is by reading science comics. This study aims to investigate the attitudes (e.g., reading habits, interest, motivation) of university students toward reading science comics, and how they read science comics for acquiring scientific knowledge reflected by an eye tracker. Sixty-five undergraduates were invited to complete an attitudes and habits questionnaire of reading comics, after which they read a science comic where their reading processes were recorded by an eye tracker; finally, they completed a reading comprehension test. The results showed that most undergraduates had a positive attitude for reading comics, and were more likely to learn science by reading comics rather than texts. In addition, the analysis results of the linear mixed-effect models indicated that fixation with regard to re-reading durations could promote post-reading comprehension. The readers who particularly re-read the important information in relation to the boxed-in texts and graphics for a longer period scored higher in the post-test (e.g., the cause and variation processes of cancer). The analysis of variance also indicated that readers who exhibited a good test performance allocated more re-reading time on informational texts and diagrams. This meant they were more intentional and selective in re-reading the core and concept-intensive information; however, concerning the reader who performed poorly in their test, this reading pattern was unapparent. Therefore, those who exhibited a better grasp of the knowledge in the science comics were likely to fully process the areas that presented relevant information concerning important science concepts.

Objective: To examine the association between older adults' trust in cancer information and their preference for sources of this type of information. Design: Cross-sectional study. Setting: The USA. Method: The data were obtained from Health Information National Trends Survey 5 Cycle 4 (2020). The sample included older Internet users (N = 1,223). Results: Higher trust in cancer information from doctors and from religious organisations and leaders, as well as lower trust in cancer information from government health agencies and charitable organisations related to a greater preference for doctors. Greater preference for the Internet was a function of lower trust in cancer information from doctors and higher trust in cancer information from government health agencies. Finally, lower trust in cancer information from doctors and higher trust in cancer information from charitable organisations were associated with greater preference for cancer organisations as a primary source of cancer information. Conclusion: The results imply that doctors represent an source of cancer information, trust in which plays an important role with respect to preference for other sources. The results generally suggest that the trust older adults put in cancer information from different sources appears as a major predictor of their preference for the source of this information.

We describe an innovative, semester-long course in biology and communication skills for master's degree students in biostatistics. The primary goal of the course is to make the connection between biological science and statistics more explicit. The secondary goals are to teach oral and written communication skills in an appropriate context for applied biostatisticians, and to teach a structured approach to thinking that enables students to become lifelong learners in biology, study design, and the application of statistics to biomedical research. Critical evaluation of medical literature is the method used to teach biology and communication. Exercises are constructivist in nature, designed to be hands-on and encourage reflection through writing and oral communication. A single disease area (cancer) provides a motivating example to: (1) introduce students to the most commonly used study designs in medical and public health research, (2) illustrate how study design is used to address questions about human biology and disease, (3) teach basic biological concepts necessary for a successful career in biostatistics, and (4) train students to read and critically evaluate publications in peer-reviewed journals. We describe the design and features of the course, the intended audience, and provide detailed examples for instructors interested in designing similar courses.

It is essential that college students are knowledgeable about their family health history to make informed decisions about health behaviors and cancer screening. In the transitional phase from adolescence to adulthood, engaging in healthy behaviors and communication between family members can be challenging for college students. In this study, the Communication Privacy Management theory provided a framework to examine health and cancer communication among college students and their families. Methods: A cross-sectional online survey was conducted among college students aged 18 years and over (n = 106). Results: Knowledge of participants' family health history was significantly associated with family health and cancer communication, religious beliefs, and higher annual household income (> $75,000). Being young (< 22 years) and female was significantly associated with knowledge of family health history and family health and cancer communication. Conclusion: Demographic, socioeconomic, and sociocultural factors may influence college students' level of knowledge about their family health history and communication within their family about general health and cancer risk.

In response to the SARS-CoV-2 pandemic, a cancer research education program at the University of Nebraska Medical Center designed for Native American middle school, high school and undergraduate students adapted activities to be delivered online. There are considerable challenges to adapting in-person science programming to online delivery that can impact overall effectiveness. These challenges are further exacerbated when the cognate student population also faces significant disparities in health, wealth, and educational outcomes. We encountered both disadvantages and advantages in transitioning programming to online virtual formats. Challenges faced in delivering our programming during the pandemic included varied online accessibility, peripheral stressors, and disconnection to places and people. Despite these challenges, we found several benefits in remote delivery, some of which have alleviated barriers to program participation for Native American students. Some successes achieved by transitioning to fully remote programming included increased program reach, sustainability, and cultural relevancy. In this overview of the implementation of four online programs at the middle school, high school, and undergraduate levels, we highlight the challenges and successes experienced. Through this program description, we aim to provide insight into potential strategies to improve program delivery designed for Native American students during the SARS-CoV-2 pandemic and beyond.

Background: Early sexual reproductive health (SRH) education is linked to a reduction in risky sexual behaviors. Sexually transmitted infections (STIs) are rising at alarming rates. Risky sexual behaviors, including initiation of sex before age 13, having more than four sexual partners, and lack of use of condoms, increase the chance of infection and cancer. Informing students about the link between risky behaviors and cancer is vital to reduce morbidity and mortality. Methods: A trend analysis of the Youth Risk Behavior Surveillance System (YRBSS) data between 2001 and 2019 was conducted. Results from four survey responses related to sexual risk behaviors among 9th to 12th grade in Mississippi students are compared with their US peers. Results: Between 2001 and 2019, favorable declines in 3 out of 4 sexual risk behaviors were observed. Declining prevalence was reported for "ever had sexual intercourse," "age of sexual initiation at age 13 or younger," and "having 4 or more sexual partners in their lifetime" are promising. However, fewer students report using condoms. The adjusted prevalence rates for Mississippi students in all 4 measures were higher than the national responses. Conclusions: Our analysis supports the need for early skill-based sex education to promote health. States with increased behavioral risk among students should consider trends in data to improve education and policy.

People with intellectual disability receive breast, cervical, and colorectal cancer screening at lower rates relative to the general population, although the reasons for this disparity are largely unknown. Research, both with the general population and specific to people with intellectual disability, has revealed that a family physician's recommendation for cancer screening or continuity of primary care may increase screening rates. We interviewed family physicians and family medicine trainees regarding their experiences recommending cancer screening to patients with intellectual disability. We concluded that the decision to recommend cancer screening is complex, and includes physicians weighing their clinical judgement as to the best provision of care for patients with a patient's eligibility for screening, while continuing to respect patients' autonomy. This patient-physician interaction occurs within the larger medical environment. Further research with experienced family physicians is warranted to better understand this complex phenomenon.