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To test the efficacy of a community-based intervention, Empowering Communities for Life (EC4L), designed to increase colorectal cancer (CRC) screening through fecal occult blood test (FOBT) in rural underserved communities in a randomized controlled trial. Participants were randomized into 3 groups (2 interventions and 1 control). Interventions were delivered by community lay health workers or by academic health professionals. The main outcome of interest was return rate of FOBT screening kit within 60 days. Participants included 330 screening-eligible adults. The overall return rate of FOBT kits within 60 days was 32%. The professional group (Arm 2) had the highest proportion of returned FOBTs within 60 days at 42% (n = 46/110), a significantly higher return rate than the lay group (Arm 1) [28%(n = 29/103);P = 0.0422] or control group (Arm 3) [25%(n = 29/117);P = 0.0099]. Thus, one arm (Arm 2) of our intervention produced significantly higher CRC screening through FOBT. Community-based participation partnered with academic health professionals enhanced CRC screening among rural and poor-resourced communities.

There is a paucity of studies examining the beneficial effects of fish consumption on cardiovascular diseases (CVDs) among adults with diabetes, who experience a substantially high risk of CVDs.We analyzed the data of 1136 adults with diabetes mellitus aged 18 years and older who participated in the National Health and Nutrition Examination Survey, 1988-1994, and were followed up through December 31, 2010. We used Cox regression to estimate the adjusted hazard ratios (HRs) for the relative risk across the levels of fish consumption. A total of 698 deaths were recorded at the end of 11,465 person-years follow-up with a mortality rate of 60.88 per 1000 person-years. CVDs were listed as a contributing cause for 326 deaths, thus accounting for 46.4% of total deaths. Stroke-specific mortality rate among patients who ate fish less than once a week was more than twice as high as that among patients who ate fish more than twice a week, 6.23 vs. 2.36 per 1000 person-years, respectively. The corresponding CVD-specific rate was 34.38 vs. 22.99 per 1000 person-years, respectively. The adjusted HRs of death due to stroke were 1.00 (reference), 0.55 (95% confidence interval = 0.28-1.07), and 0.30 (0.11-0.80) among patients who ate fish1, 1-2, and 2 + times a week, and the corresponding HRs of death due to CVDs were 1.00 (reference), 0.78 (0.60-1.02), and 0.69 (0.50-0.96), respectively.A high consumption of fish was associated with a low risk of death due to CVDs, especially stroke, among adults with diabetes.

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.

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.

A major challenge facing contemporary cancer educators is how to optimize the dissemination of breast cancer prevention and control information to African American women in the Deep South who are believed to be cancer free. The purpose of this research was to provide insight into the breast cancer information-acquisition experiences of African American women in Alabama and Mississippi and to make recommendations on ways to better reach members of this high-risk, underserved population.Focus group methodology was used in a repeated, cross-sectional research design with 64 African American women, 35 years old or older who lived in one of four urban or rural counties in Alabama and Mississippi.Axial-coded themes emerged around sources of cancer information, patterns of information acquisition, characteristics of preferred sources, and characteristics of least-preferred sources.It is important to invest in lay health educators to optimize the dissemination of breast cancer information to African American women who are believed to be cancer free in the Deep South.

The purposes of this study are to explore cancer information acquisition patterns among African-American men and to evaluate relationships between information acquisition patterns and prostate cancer prevention and control knowledge. A random sample of 268 men participated in a statewide interviewer-administered, telephone survey. Men classified as non-seekers, non-medical source seekers, and medical source seekers of prostate cancer information differed on household income, level of education, and beliefs about personal risk for developing prostate cancer. Results from multiple regression analysis indicated that age, education, and information-seeking status were associated with overall levels of prostate cancer knowledge. Results from logistic regression analyses indicated that men who included physicians as one of many information resources (medical source seekers) had superior knowledge over non-seekers and non-medical source seekers on 33% of individual knowledge details. The findings emphasize the need to connect lower-income and lower-educated African-American men to physicians as a source of prostate cancer control information.

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 one's 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

Longitudinal studies have been conducted to evaluate correlates of stage of change movement among adult smokers but no studies were found to be conducted among adolescent smokers. This study used longitudinal data to examine adolescents' abstinence self-efficacy over 10-week and six-month periods and determined whether stage transitions were associated with concomitant changes or baseline values in perceived abstinence self-efficacy, nicotine dependence and motivation to quit. From baseline to 10-weeks results showed a change in motivation to quit and baseline stage were significantly associated with stage progression and regression. Additionally, intervention school status was significantly associated with stage progression. On the other hand, baseline score for nicotine dependence predicted stage regression not progression. Adolescents' becoming more or less 'ready' to quit smoking are influenced by their nicotine dependence and motivation to quit.

Cocaine use, marijuana use, alcohol use, and polysubstance use (e.g., alcohol and cocaine, alcohol and marifuana) are associated with high-risk sexual behavior and higher rates of sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). The purpose of this study was to examine readiness for using condoms among three groups (cocaine users, noncocaine drug users, and non-drug users) of African Americans living in low-income urban settings. African Americans in this sample differed in sex risk behaviors according to their drug use status. Noncocaine drug users reported higher levels of sex risk behaviors than non-drug users, and cocaine users reported the highest levels of risk. Cocaine users also reported lower levels of condom use with their main and nonmain sexual partners than both other groups. Results of multivariate analyses indicate that, compared to the other two groups, cocaine users are at earlier stages of readiness for condom use with main partners. Cocaine users have accurate perceptions of their HIV risk, but are more likely to factor into their decisions for using condoms cost and the trouble that it takes to get condoms. Different approaches to sexually transmitted disease and human immunodeficiency virus prevention will be necessary to meet the needs of these three different subgroups.

Education is a critical component of the National Blueprint to eliminate racial disparities in diabetes. Research indicates that traditional methods of diabetes education has had limited effectiveness with minority populations and suggests that different educational approaches be explored. The purpose of the research was to explore the effectiveness of an emergent technology (podcast) for use in educating inner-city, African American men about diabetes prevention. Thirty African American men participated in self-administered, pretest–posttest surveys in August 2009. Surveys collected information on demographic characteristics, perceptions of diabetes, and diabetes knowledge. Paired samples t test was computed to evaluate pretest–posttest changes in overall knowledge. McNemar or binomial tests were computed to evaluate pretest–posttest knowledge changes on each of the 15 individual knowledge items. Diabetes knowledge scores for the sample increased from 8.27 at pretest to 10.47 at posttest ( p = .001). Posttest knowledge scores increased for 77% of men, stayed the same for 13%, and decreased for 10%. Men who listened to the podcast correctly answered 40% more knowledge questions on their posttest assessments. Results from this exploratory study suggest that podcasts are useful for helping inner-city, African American men recall diabetes prevention information. Additional research is recommended with larger randomly selected samples using more rigorous research designs.

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 $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.

The barbershop is a promising setting where African-American men might receive information and education about prostate cancer. In this study, we assessed the feasibility of engaging rural barbershops as venues for barbers to deliver a prostate cancer education intervention to increase informed decision-making for prostate cancer screening among customers. Twelve barbershops were recruited from two separate micropolitan areas in Georgia as intervention and control sites. Structured interviews were conducted with 11 barbers in both sites about customer characteristics as well as their willingness to participate in the study. The interviews were audio recorded and transcribed for analysis. In the intervention site, six barbers completed a survey and a pre-/posttest prostate cancer knowledge instrument following training classes. Barbers reported a wide average range of customers served per week (50 to 300). African-American men made up an average of 87% of customers. Barbers thought prostate cancer was an important discussion topic, felt they would be comfortable discussing it, and supported the participation of their barbershop in the study. For intervention group barbers, there was a statistically significant difference between the average pretest knowledge score of 72% (mean 12.2, SD=3.2) and the posttest knowledge score of 89% (mean 15.2, SD=1.1) (P=0.03) on the 17-item prostate cancer knowledge instrument. Based on the multiple interactions with the barbers, there was high receptivity to the topic and consensus about the importance of addressing prostate cancer with their customers. Rural barbershops represent feasible venues for delivering a prostate cancer education intervention.

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 $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 < .05). Conclusions: Knowing what to look for and where to find answers is a common problem for both African American and Caucasian prostate cancer patients. Interventions need to be developed that make initial searches for information easier for African-American men. 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.

Racial and ethnic disparities have been reported in clinical trial/research participation, utilization of autologous and allogeneic blood and marrow transplantation (BMT), and availability of allogeneic donors. We performed a population-based cohort study to investigate adult hematologic malignancy referrals to a US tertiary cancer center, utilization of BMT, and participation in clinical trial, survey, and biospecimen research by race. US Census Data and the New York State Public Access Cancer Epidemiology Database identified the racial distribution of the general population and new hematologic malignancy cases in the primary catchment area. From 2005 to 2011, 1106 patients aged 18 to 75 years were referred for BMT consultation; although the rate of BMT among hematologic malignancy referrals did not differ by race, the reasons for not receiving a BMT did. Participation in biospecimen research did not vary by race; however, African Americans and other minorities were significantly less likely to participate in survey research than European Americans. Although rates of hematologic malignancy referrals and use of BMT for minorities appear to be low (