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BackgroundCurrent clinical guidelines recommend that hormone receptor–positive breast cancer survivors take adjuvant hormonal therapy (AHT) for 5 to 10 years, following the end of definitive treatment. However, fewer than half of patients adhere to the guidelines, and suboptimal adherence to AHT is associated with an increased risk of breast cancer mortality. Research has extensively documented sociodemographic and disease-specific factors associated with adherence to AHT, but very little evidence exists on behavioral factors (eg, knowledge, patient-provider communication) that can be modified and targeted by interventions. ObjectiveThe goal of this study is to develop and test a theory-based, multilevel intervention to improve adherence to AHT among breast cancer survivors from racially and socioeconomically disadvantaged backgrounds (eg, Medicaid-insured). The specific aims are to (1) explore multilevel (eg, patient, health care system) factors that influence adherence to AHT; (2) develop a theory-based, multilevel intervention to improve adherence to AHT; and (3) pilot test and evaluate the intervention developed in Aim 2. MethodsFor Aim 1, we will recruit breast cancer survivors and health care professionals to participate in semistructured interviews to gain their perspectives about barriers and facilitators to AHT use. We will conduct a directed content analysis of the Aim 1 qualitative interview data. For Aim 2, we will integrate Aim 1 findings and current literature into the design of a multilevel intervention using an Intervention Mapping approach. For Aim 3, we will recruit Medicaid-insured breast cancer survivors to assess the feasibility of the pilot intervention. ResultsFrom May 2016 to July 2018, we completed interviews with 19 breast cancer survivors and 23 health care professionals in South Carolina. We will conduct a directed content analysis of the qualitative interview data. Results from this analysis will be used, in combination with current literature, to design (Aim 2) and pilot test a theory-based multilevel intervention (Aim 3) in Summer 2021. Results of the pilot are expected for Fall 2021. ConclusionsThis study will provide a deeper understanding of how to improve adherence to AHT, using a novel and multilevel approach, among socioeconomically disadvantaged breast cancer survivors who often experience disproportionate breast cancer mortality. International Registered Report Identifier (IRRID)DERR1-10.2196/17742

Diverse representation in higher education leadership is critical to the Academy's mission of teaching, research, and service. As academic leadership positions are rarely occupied by faculty from underrepresented gender and minoritized groups, inclusive mentorship practices are necessary to equip and support administrators of diverse backgrounds and identities. In this qualitative study, administrators from a school of public health in the southeastern United States present findings from an electronic survey exploring experiences with peer mentorship as it relates to leadership and training. Open-ended responses are compared with peer mentorship literature. Thematic analysis demonstrated peer mentorship is specifically beneficial for: (1) sharing knowledge and improving navigation; (2) cultivating change with respect and inclusivity; and (3) inspiring motivation and balance to prevent burnout. This study demonstrates the value of peer mentorship models for co-development of successful leadership qualities and for addressing administrative pressures through inclusive practices that promote diversity and improve equity.

We conducted an online survey to examine religiosity, sexual health knowledge, and behavior and sexual health information sources among undergraduate students affiliated with student religious organizations (n = 45) and unaffiliated students (n = 82). Analyses included Fisher's exact tests, t-tests, and exact regression models. Students reporting religious affiliation considered religious sources to be believable (p = 0.004 for sexual health; p < 0.0001 for romantic relationships) and identified these sources as their primary information sources for romantic relationships (p = 0.0042). Although religiously affiliated students reported fewer sexual partners in the past year (p = 0.020), their reported condom use was not significantly different from that of unaffiliated students. Future research should explore the focus and content of romantic relationship information provided by student religious organizations. Health practitioners and educators should consider strategies for collaborating with religious organizations to meet the information needs of these students.

Sex education takes place in a wide range of contexts including through the media. Media use among young men who have sex with men is high and gender identity and sexual orientation are topics often integrated into today's media. Little is known about young men who have sex with men's perceptions of how the media frames messages about gender identity and sexual orientation and the implications these messages have on HIV prevention. A greater understanding of young men who have sex with men's perceptions of media framing about gender identity and sexual orientation is needed to ensure prevention efforts reach those most impacted by HIV. Focus groups were conducted with forty-two African American men who have sex with men, aged 18-21, living in the Southeastern USA. Thematic analysis revealed that participants reported using the Internet and television to access gender identity and sexual orientation information. Participants felt that the media's framing of gender identity and sexual orientation only worsened HIV-related stigma and discrimination. Findings illustrate the important role that media can play in educating about gender identity and sexual orientation and the implications this framing has for HIV prevention.

Multiple evidence-based approaches (EBAs) exist to improve colorectal cancer screening in health clinics. The success of these approaches is tied to effective implementation. Therefore, the purpose of this study was to assess the implementation of EBAs for colorectal cancer screening and clinic-level correlates of implementation in federally qualified health centers (FQHCs). We conducted descriptive and cross-sectional analyses using data collected from FQHC clinics across seven states (n = 51). A clinic representative completed electronic surveys about clinic characteristics (e.g., size, patient characteristics, and medical record system characteristics) and the implementation of Community Guide recommended EBAs (e.g., client reminders, small media, and provider assessment and feedback). We used bivariate Spearman correlations to assess clinic-level correlates with implementation outcomes. Most clinics were planning to implement, in the early implementation stages, or inconsistently implementing EBAs. No EBA was fully implemented by more than nine (17.6%) clinics. Clinic size variables were inversely related to implementation levels of one-on-one education; medical record variables were directly related to implementation levels of client and provider reminders as well as provider assessment and feedback; and rapid and timely feedback from clinic leaders was directly associated with implementation levels of four out of six EBAs. Given the varying levels of implementation, clinics need to assess current use of implementation strategies and improve effective program delivery to increase colorectal cancer screening among their patients. In addition, clinics should also consider how their characteristics may support or serve as a barrier to implementation in their respective settings.

Background: Effective online communication about the environmental risk factors of breast cancer is essential because of the multitude of environmental exposures and debate regarding the conclusiveness of scientific evidence. Purpose: The aim of this study was "to assess the content, readability, and cultural sensitivity" of online resources focused on the environmental risks factors of breast cancer. Methods: A purposive sample of webpages focused on environmental risk factors of breast cancer was obtained through a Google search using 17 search terms. Using nonparametric statistics, we assessed the content, readability, and cultural appropriateness of 235 webpages. Results: Eighty-two percent of webpages referred to research studies in their content. For the majority of sites, readability was at a high school reading grade level. Webpages were not explicitly intended for specific racial/ethnic groups. Discussion: Technical language and non-culturally specific messages may hinder users' attention to and comprehension of online breast cancer information. Additional research is needed to examine in-depth the accuracy of this online content. Translation to Health Education Practice: Findings suggest that collaborations between scientists, Health Educators, website designers/media professionals, and the community will be critical to the delivery of accurate, up-to-date, plain-language, and culturally sensitive information about breast cancer and the environment.

For college students who are exposed to multimedia, the sources of COVID-19 vaccine information and their trust in these sources may play a role in shaping the vaccine acceptance spectrum (refusal, hesitancy, and acceptance). Based on an online survey among 1,062 college students in South Carolina, we investigated vaccine information sources among college students and examined how COVID-19 vaccine acceptance was associated with information source and trust level in each source. The top three sources of COVID-19 vaccine information were health agencies, mass media, and personal social networks. Trust in mass media, health agencies, scientists, and pharmaceutical companies was negatively associated with vaccine refusal. Trust in government and scientists was negatively associated with vaccine hesitancy. Our findings highlight the importance of restoring trust in government, healthcare system, scientists, and pharmaceutical industries in the COVID-19 era. [ABSTRACT FROM AUTHOR]

We are an interdisciplinary group of colleagues dedicated to partner engagement and team science. This influences our academic work, informs our research mentorship and capacity-building initiatives with junior scholars, conditions how we communicate with individuals outside of our disciplines, and makes lifelong learning a priority for ourselves and our trainees. Using the analogy of a seven-layer cake, this paper describes our capacity-building approach to develop, engage, and sustain research teams in a manner that aligns with health and risk communication principles. While preparing for a pandemic and engaging in team-based academic research may seem like apples and oranges, they both require the same key component throughout the process that we must encourage in our mentorship practices – effective communication. We provide concrete examples from our experiences on research teams that span decades and institutions. [ABSTRACT FROM AUTHOR]

Sexual and gender minority (SGM) youth are at disproportionate risk for HIV. Schools play an integral role in educating young people about sexual health in addition to providing sexual health services. This qualitative study examined SGM youths' perception of school sexual health education and services. A total of 42 self-identified African American SGM males participated in focus groups or in an in-depth interview. Qualitative findings revealed that schools are missing the opportunity to educate SGM youth about sexual health. Youth participants noted several barriers to accessing sexual health education and services at schools including limited, targeted health information and school nurses not being knowledgeable of health issues that impact SGM youth. Participants noted that school sexual health services are not adequately marketed to students and sometimes do not include testing for HIV and other sexually transmitted diseases. Suggestions for future research and implications for school nurses and sexual health services are discussed.

Little is known about university campus religious organisations' influence on students' sexuality-related attitudes and behaviours. This study sought to better understand sexuality-related communication within the context of campus ministries by exploring students' and campus ministry leaders' conversational experiences at a public university in the south-east USA. Data sources included an online survey of undergraduates participating in student religious organisations (n = 57), focus groups with campus ministry students (n = 36), and individual interviews with campus ministry leaders (n = 19). Findings indicated student satisfaction with the focus and frequency of conversations about romantic relationships and sexual health within the context of campus ministries. However, both campus ministry students and leaders indicated discomfort in discussions of sexuality. Leaders acknowledged their need for better strategies to engage students; students focused on how to integrate religious messages about sexuality with messages from other sources. These findings suggest campus ministry leaders may benefit from focused training and support to communicate more effectively with college students about sexuality.

Introduction: Cancer rates increase with age, and older cancer survivors have unique medical care needs, making assessment of health status and identification of appropriate supportive resources key to delivery of optimal cancer care. Comprehensive geriatric assessments (CGAs) help determine an older person's functional capabilities as cancer care providers plan treatment and follow-up care. Despite its proven utility, research on implementation of CGA is lacking. Methods: Guided by a qualitative description approach and through interviews with primary care providers and oncologists, our goal was to better understand barriers and facilitators of CGA use and identify training and support needs for implementation. Participants were identified through Cancer Prevention and Control Research Network partner listservs and a national cancer and aging organization. Potential interviewees, contacted via email, were provided with a description of the study purpose. Eight semi-structured interviews were conducted via Zoom, recorded, and transcribed verbatim by a professional transcription service. The interview guide explored providers' knowledge and use of CGAs. For codebook development, three representative transcripts were independently reviewed and coded by four team members. The interpretive process involved reflecting, transcribing, coding, and searching for and identifying themes. Results: Providers shared that, while it would be ideal to administer CGAs with all new patients, they were not always able to do this. Instead, they used brief screening tools or portions of CGAs, or both. There was variability in how CGA domains were assessed; however, all considered CGAs useful and they communicated with patients about their benefits. Identified facilitators of implementation included having clinic champions, an interdisciplinary care team to assist with implementation and referrals for intervention, and institutional resources and buy-in. Barriers noted included limited staff capacity and competing demands on time, provider inexperience, and misaligned institutional priorities. Discussion: Findings can guide solutions for improving the broader and more systematic use of CGAs in the care of older cancer patients. Uptake of processes like CGA to better identify those at risk of poor outcomes and intervening early to modify treatments are critical to maximize the health of the growing population of older cancer survivors living through and beyond their disease. [ABSTRACT FROM AUTHOR]

Purpose: To improve population health, community members need capacity (i.e., knowledge, skills, and tools) to select and implement evidence-based interventions (EBIs) to fit the needs of their local settings. Since 2002, the Centers for Disease Control and Prevention has funded the national Cancer Prevention and Control Research Network (CPCRN) to accelerate the implementation of cancer prevention and control EBIs in communities. The CPCRN has developed multiple strategies to build community members' capacity to implement EBIs. This paper describes the history of CPCRN's experience developing and lessons learned through the use of five capacity-building strategies: (1) mini-grant programs, (2) training, (3) online tools, (4) evidence academies, and (5) evaluation support for partners' capacity-building initiatives. Methods: We conducted a narrative review of peer-reviewed publications and grey literature reports on CPCRN capacity-building activities. Guided by the Interactive Systems Framework, we developed histories, case studies, and lessons learned for each strategy. Lessons were organized into themes. Results: Three themes emerged: the importance of (1) community-engagement prior to and during implementation of capacity-building strategies, (2) establishing and sustaining partnerships, and (3) co-learning at the levels of centers, networks, and beyond. Conclusion: CPCRN activities have increased the ability of community organizations to compete for external funds to support implementation, increased the use of evidence in real-world settings, and promoted the broad-scale implementation of cancer control interventions across more than eight states. Lessons from this narrative review highlight the value of long-term thematic networks and provide useful guidance to other research networks and future capacity-building efforts. [ABSTRACT FROM AUTHOR]

The current study used a qualitative, phenomenological approach to investigate the health information-seeking practices of African American young men who have sex with men (AAYMSM). Forty-two self-identified AAYMSM, aged 18 to 21, residing in a Southeastern U.S. city participated in a qualitative focus group or face-to-face interview to examine their access to health information, current and preferred sources and types of health information, and recommendations for improving the delivery of health information to AAYMSM. Participants reported accessing health information from a complex network of sources, including peers, health care professionals, parents, and the Internet. Most consulted these sources to access information about the prevention of sexually transmitted infections (STIs) and HIV/AIDS. In addition, participants provided recommendations to improve delivery of health information and identified parents and the Internet as preferred sources of health information. This research highlights the importance of developing health information, specifically for AAYMSM.

Background: By March 2014, all U.S. citizens were required to have health insurance according to the Affordable Care Act (ACA). Purpose: Study objectives were to explore individuals' opinions, perceptions, and communication sources and needs about the ACA and to assess differences by age group. Methods: In November 2013, 10 1-hour focus groups (5 with adults aged 40+; 5 with adults < age 40) were conducted with 102 individuals in one southeastern county. Audio files were transcribed and organized using NVivo 10. Recurring themes were examined by age group. Results: Younger participants had less awareness of the ACA. Both older and younger groups mentioned benefits of receiving preventive care and being covered for preexisting conditions. Confusion and lack of perceived understanding were evident across age groups. Participants heard about the ACA mainly through media and few interpersonal sources. They preferred to obtain in-person ACA information through state officials or trusted experts. Discussion: Varying knowledge levels, perceptions, and communication sources about the ACA impact use of health insurance and access to care. Translation to Health Education Practice: Clear information should be communicated to each age group using their preferred communication channels to increase understanding of the ACA and its importance to prevent chronic diseases.