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Inclusion of racial/ethnic minorities in cancer research can reduce disparities in health outcomes; however, data regarding barriers and motivators to participation are sparse. This study assessed African American (AA) and Latinx healthy volunteers' perspectives regarding willingness to participate in noninvasive and invasive research activities.Using a 38-item questionnaire adapted from the Tuskegee Legacy Project Questionnaire, we assessed willingness to participate in 12 research activities, offering 27 possible barriers and 14 motivators. The sample was segmented into four subgroups by AA/Latinx and rural/urban.Across five states and Puerto Rico, 533 participants completed questionnaires. Overall, participants were more willing to participate in noninvasive versus invasive procedures, although, all subgroups were willing to participate in research if asked. Rural AA were most willing to complete a survey or saliva sample, while rural Latinx were least willing. Urban AA were least willing to provide cheek swab, while rural counterparts were most willing. Self-benefit and benefit to others were among the top three motivators for all subgroups. Curiosity was a primary motivator for urban AA while obtaining health information motivated rural Latinx. Primary barriers included fears of side effects and being experimented on, lack of information, and lack of confidentiality.Latinx and AAs are willing to participate in the continuum of nontherapeutic research activities suggesting their lack of participation may be related to not being asked. Inclusive enrollment may be achieved by assessing needs of participants during the design phase of a study in order to reduce barriers to participation.

BackgroundWell-annotated, high-quality biorepositories provide a valuable platform to support translational research and discovery. However, most biorepositories have poor representation of minority groups, limiting the ability to address cancer health disparities and improve disease outcomes. This report describes the establishment of the Florida Pancreas Collaborative (FPC), the first state-wide prospective longitudinal cohort study and biorepository specifically designed to address the higher burden of pancreatic cancer (PaCa) in African Americans (AA) compared to Non-Hispanic Whites (NHW) and Hispanic/Latinx (H/L).MethodsWe describe rationale for establishing the FPC and provide an overview of key stakeholders; study eligibility and design; ascertainment and recruitment strategies; and standard operating procedures (SOPs) developed to collect, process, store, and transfer biospecimens, medical images, and data. We also describe the customized cloud-based, secure data management platform built to facilitate recruitment, track study-related workflow, house data, and perform queries. We also present progress to date regarding recruitment and biobanking.ResultsThe FPC consists of multidisciplinary teams from fifteen Florida medical institutions. From March 2019 through August 2020, 350 patients were assessed for study eligibility, 323 met inclusion/exclusion criteria, and 305 (94%) enrolled, including 228 NHW, 30 AA, and 47 H/L, with 94%, 100%, and 94% participation rates, respectively. A high percentage of participants have donated blood (87%), pancreatic tumor tissue (41%), computed tomography scans (76%), and baseline questionnaire data (62%).ConclusionsThis biorepository addresses a critical gap in PaCa research with the potential to advance basic, clinical, population-based, and translational studies intended to minimize disparities, increase quality of life, and reduce PaCa-related morbidity and mortality.ImpactThis multi-institutional infrastructure can serve as a prototype for development of similar resources across the country and disease sites.

Purpose The purpose of this paper is to provide a case study of a multifaceted institutional approach to minimizing cancer health disparities, presenting a novel organizational framework entitled, “A.C.C.E.S.S.” to guide those efforts. Design/methodology/approach This paper presents a case study of an organization that operates under the theory that cancer health disparities are a result of the cumulative incongruence of differences that exist between people in various contexts and interactions over time. Consequently, the A.C.C.E.S.S. framework is used to demonstrate the range of opportunities within an organization to intervene and mitigate gaps that result in inequality. Findings Addressing A.C.C.E.S.S. in various interactions and contexts over a sustained period of time results in a continuous improvement cycle that attenuates cancer health disparity. Originality/value The antecedents and impacts of cancer health disparities are well documented. However, there is a dearth of directionality for institutions and organizations in achieving equality in cancer treatment and care. This paper provides a framework to consider in organizing such endeavors.

BACKGROUND: The goal study of this was to explore attitudes, health knowledge, and experiences with healthcare setting and providers among gay, lesbian, bisexual, transgender, queer/questioning (GLBTQ) individuals and to identify areas for improvement. METHODS: Members of Equality Florida™ residing in the five counties of the Tampa Bay region were recruited through email invitation to complete a 60-item questionnaire assessing demographics, attitudes, and experiences with healthcare providers (HCPs). Additional open-ended questions focused on experiences with HCPs and suggestions for ways to improve HCPs’ cultural competency. RESULTS: 632 respondents completed the survey of which 41% were gay men and 29% were lesbian. The majority of participants was White, non-Hispanic (93%), married/partnered (78%), and had health insurance (88%). The majority (67%) reported they always or often disclosed their sexual orientation/identity to an HCP and few had negative reactions in the healthcare setting (

There have been great improvements in the health and health outcomes of the United States population. Unfortunately, there are segments of the population that do not experience these same improvements and thus have disproportionate health outcomes compared to other groups, known as health disparities. Disparities in cancer and cancer-related outcomes are also experienced by these groups. This chapter discusses the disparities among five specific cancer sites (female breast, cervical, colorectal, prostate, and lung cancers), outlines potential causes of these cancer health disparities, and highlights effective strategies for reducing and eliminating them.

Men have higher rates of all cancers and are more likely to die from cancer than women; however, men are less likely to utilize disease prevention services. African American/Black men and Hispanic men have lower cancer survival rates and are less likely to utilize health care services than non-Hispanic White men. The present study examined demographic variables (age, household income, education, marital status, race/ethnicity, health insurance status), motivators to engage in healthy eating, and motivators to engage in physical activity as predictors of culturally diverse, medically underserved men’s likelihood of getting a cancer screening (a) at the present time, (b) if no cancer symptoms are present, and (c) if a doctor discovers some cancer symptoms. Analyses were conducted using data from 243 men (47.3% non-Hispanic Black, 29.5% Hispanic, 16.5% non-Hispanic White, and 6.8% “other”) recruited at the Men’s Health Forum in Tampa, Florida. Age, having a medical or health condition that benefits from eating healthy, and having a commitment to physical activity were significant positive predictors of the likelihood of receiving a cancer screening. Motivation to engage in physical activity because of a personal priority was a significant negative predictor of the likelihood of getting a cancer screening. The findings from this study suggest that interventions to increase cancer screenings among culturally diverse, medically underserved men should be informed at least in part by an assessment of participating men’s motivators for engaging in health promoting lifestyle behaviors such as physical activity and healthy eating.

This article provides an overview of the current literature on seven cancer sites that may disproportionately affect lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. For each cancer site, the authors present and discuss the descriptive statistics, primary prevention, secondary prevention and preclinical disease, tertiary prevention and late-stage disease, and clinical implications. Finally, an overview of psychosocial factors related to cancer survivorship is offered as well as strategies for improving access to care.

BACKGROUND The association between insurance status and outcomes has not been well established for patients with Hodgkin lymphoma (HL). The purpose of this study was to examine the disparities in overall survival (OS) by insurance status in a large cohort of patients with HL. METHODS The National Cancer Data Base (NCDB) was used to evaluate patients with stage I to IV HL from 1998 to 2011. The association between insurance status, covariables, and outcomes was assessed in a multivariate Cox proportional hazards model. Survival was estimated with the Kaplan-Meier method. RESULTS Among the 76,681 patients within the NCDB, 45,777 patients with stage I to IV HL were eligible for this study (median follow-up, 6.0 years). The median age was 39 years (range, 18-90 years). The insurance status was as follows: 3247 (7.1%) were uninsured, 7962 (17.4%) had Medicaid, 30,334 (66.3%) had private insurance, 3746 (8.2%) had managed care, and 488 (1.1%) had Medicare. Patients with an unfavorable insurance status (Medicaid/uninsured) were at a more advanced stage, had higher comorbidity scores, had B symptoms, and were in a lower income/education quartile (all P

There is a need to implement evidence-based public health practice that integrates targeted and specific strategies and actions with community preferences to improve the health of populations. A community health needs assessment (CHNA) is vital to identifying the health concerns of communities, to learn about the factors that influence their health and the assets, resources, and challenges that impact those factors. It is required for tax-exempt entities to conduct a CHNA and adopt an implementation strategy to meet the identified community health needs. The goal of this article is to chart a pathway for health system leaders utilizing a CHNA process to address disparities in racial/ethnic groups and other medically underserved populations and to meet legal requirements. The efforts of the H. Lee Moffitt Cancer Center and Research Institute in developing its CHNA will be highlighted to provide clear evidence to health system leaders for why and how to conduct a thorough and compelling CHNA to meaningfully address health disparities locally and respond to longstanding historical health inequities at the health system level.

The Lesbian, Gay, Bisexual, Transgender/Transsexual, Queer/Questioning, Intersex (LGBTQI) population experiences cancer health disparities due to lack of disclosure and knowledge about increased cancer risk. Oncology health care providers and institutions should create environments that encourage disclosure of sexual orientation and identity.

Objective This systematic review was conducted to synthesize the existing evidence regarding key considerations influencing African Americans' participation in cancer clinical trials (CCTs). Methods The PubMed and PsycINFO databases were searched to identify peer-reviewed publications during the last decade (2002–2011) that met our inclusionary criteria. Our search utilized Boolean combinations of the following terms: “clinical trial”; “cancer”; “neoplasm”; “African American”; “Black”; “caregiver”; “decision making”; “recruitment”; “companion”; “family”; “significant other”; and “social support”. Results A total of 267 articles were identified in the database searches. Of these articles, a total of 31 were determined to meet the inclusion criteria and were retained for review. Key issues that emerged as impediments to a successful recruitment of African Americans to CCTs included negative attitudes towards clinical trials, low levels of knowledge and awareness regarding CCTs, religious beliefs, and structural barriers, such as transportation, childcare, and access to health care. Recommendations from physicians, family members, and friends may promote CCT participation. Multimedia, and culturally-appropriate recruitment approaches may also be effective in soliciting participation among African Americans. Conclusion Existing research underscores the importance of social support from family and friends, cultural appropriateness and sensitivity from physicians and in the design of the CCT, and enhanced education among African Americans in decision-making processes. As African Americans are underrepresented in CCTs, targeted strategies to enhance recruitment efforts and improve cancer treatment outcomes are essential.

It is well documented that cancer is disproportionately distributed in racial/ethnic minority groups and medically underserved communities. In addition, cancer prevention and early detection represent the key defenses to combat cancer. The purpose of this article is to showcase the comprehensive health education and community outreach activities at the H. Lee Moffitt Cancer Center and Research Institute (Moffitt) designed to promote and increase access to and utilization of prevention and early detection services among underserved populations. One of Moffitt's most important conduits for cancer prevention and early detection among underserved populations is through its community education and outreach initiatives, in particular, the Moffitt Program for Outreach Wellness Education and Resources (M-POWER). M-POWER works to empower underserved populations to make positive health choices and increase screening behaviors through strengthening collaboration and partnerships, providing community-based health education/promotion, and increasing access to care. Effective, empowering, and culturally and linguistically competent health education and community outreach, is key to opening the often impenetrable doors of cancer prevention and early detection to this society's most vulnerable populations.

African American men (AAM) demonstrate increased prostate cancer incidence and mortality rates. We investigated known prostate cancer risk factors in AAM. Prostate specific antigen (PSA) and diagnosis of high grade prostatic intraepithelial neoplasia (PIN) were significant prostate cancer predictors. However, even including AAM with low PSA (

In Tampa, Florida, researchers have partnered with community- and faith-based organizations to create the Comparative Effectiveness Research for Eliminating Disparities (CERED) infrastructure. Grounded in community-based participatory research, CERED acts on multiple levels of society to enhance informed decision making (IDM) of prostate cancer screening among Black men. CERED investigators combined both comparative effectiveness research and community-based participatory research to design a trial examining the effectiveness of community health workers and a digitally enhanced patient decision aid to support IDM in community settings as compared with “usual care” for prostate cancer screening. In addition, CERED researchers synthesized evidence through the development of systematic literature reviews analyzing the effectiveness of community health workers in changing knowledge, attitudes and behaviors of African American adults toward cancer prevention and education. An additional systematic review analyzed chemoprevention agents for prostate cancer as an emerging technique. Both of these reviews, and the comparative effectiveness trial supporting the IDM process, add to CERED’s goal of providing evidence to eliminate cancer health disparities.

There are significant gender disparities in health outcomes and health care utilization in the United States, with men experiencing more of these disparities. It is critical to ascertain the interplay between societal conditions, health behaviors, and access to services and the impact of these factors on health outcomes and utilization of health care. The present study is part of a larger initiative titled, The Men’s Health Study: Addressing Healthy Lifestyle Behaviors, which has two purposes—to annually assess the motivators of and barriers to health-promoting behaviors among culturally diverse men attending the Men’s Health Forum (MHF) and to use this information to develop an intervention program that facilitates healthy lifestyle behaviors among men. The MHF is a community-driven initiative for medically underserved men in Tampa, Florida that offers free health screenings and wellness exhibitors in order to empower men to lead a healthy lifestyle. The purpose of this article is to identify barriers to engaging in health-smart behaviors (e.g., cancer screenings, physical activity) among culturally diverse men who participated in the MHF and to detect any demographic differences among these barriers. A total of 254 men participated in the study. Findings identify that age was the only demographic variable that had a statistically significant association with any of the cancer-screening barriers. Some cancer-screening barriers appear to exist among all demographic groups since no statistical demographic differences were discovered. Income and education were significantly associated with barriers to engaging in health-smart behaviors. This may give researchers, health educators, and providers information needed to customize interventions to promote health and preventive health care among culturally diverse men.

Purpose Patient race has been shown to predict for differences in outcomes and has been attributed to socioeconomic factors such as social support and access to healthcare. In head and neck cancer (HNC), a disease without recommended screening, we sought to investigate the association between race, treatment delays and outcome. Methods Records of 1802 patients with non-metastatic squamous cell HNC treated between 1998 and 2013 were retrospectively assessed from an institutional database. Patient demographics, tumor and treatment characteristics, and patient outcomes were abstracted from the chart. Differences between groups were assessed via logistic regression multivariate analysis (MVA). Outcomes including locoregional control (LRC) and overall survival (OS) were then estimated via Kaplan-Meier and Cox-regression MVA. Results Median follow up was 34 months. Patient races included white (n = 1671, 93%), black (n = 80, 4%), Asian (n = 18, 1%), and other (n = 33, 2%). On logistic regression MVA, Black patients were less likely to be married (39% vs. 63%; OR 0.5 95%CI 0.30–0.83, p = 0.007) or be currently employed (43% vs. 61%; OR 0.44 95%CI 0.26–0.74, p = 0.002) when compared to non-blacks. Black patients were also younger (54 vs. 59 years, p = 0.001), more likely to present with advanced tumor stage (T4: 48% vs. 25%), and more often had >45 days elapsed from diagnosis to treatment initiation (DTI) (61% vs. 49%, p = 0.028). Delays in treatment, such as delayed diagnosis (advanced disease presentation) and delays in DTI > 45 days were also associated with marital and employment status. Black patients were associated with a lower 3-year LRC rate (65% vs. 81%, p 45 days DTI had a detriment in 3-year LRC (77% vs. 83%, p = 0.002) and OS (66% vs. 69%, p = 0.009). On Cox MVA, black race was independently prognostic for worse LRC (HR 1.62 95%CI 1.04–2.51, p = 0.033) and OS (HR 1.55 95%CI 1.15–2.08, p = 0.004) vs. non-blacks. Conclusion Black race is independently prognostic for LRC and OS. Delays in HNC treatment, such as more advanced tumor stage presentation and delays in treatment initiation, may be attributed to socioeconomic factors such as employment status and social support. Efforts to accommodate these factors may expedite treatment, in hopes of improving the race related outcome disparity in HNC.

Introduction. Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. Approach and Strategies. Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic–community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. Discussion and Conclusions. Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research.

Measuring health disparities is a challenging and at times a difficult proposition. It is generally accepted that at minimum, collecting, analyzing, reporting, and applying data through tailored and targeted interventions responsive to issues regarding race, ethnicity, and preferred language are essential for identifying, monitoring, and, ultimately, eliminating health disparities. Key to eliminating these disparities is determining whether the care and services being provided are resulting in vastly different experiences for some patients. Health care institutions and providers often convince themselves that collecting these data is a time-consuming, costly, and arduous endeavor. However, if patient information on Race, Ethnicity, Gender, Age, and preferred Language (REGAL) is currently being collected, one has the basic elements to effectively measure disparities across a host of clinical and nonclinical indicators. In formulating comparisons among targeted populations in areas such as access to health care, health care quality, health outcomes, prevention, early detection, treatment, and morbidity and mortality rates, it is critical to frame part of the discussion around collecting, analyzing, reporting, and applying REGAL data, including future expansion of measures and indicators. The Health Disparities REGAL Data Dashboard is a useful tool for health care institutions and providers and can provide an innovative approach to measuring health disparities.

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.

There are bioethical concerns related to prostate cancer screening. A new prostate cancer screening approach at a community health promotion event used vouchers to promote informed decision-making in order to reduce these concerns.

Racial/ethnic, socioeconomic, and gender disparities in health and access to and use of health care services currently exist. Health professionals are continually striving to reduce and eliminate health disparities within their own community. One such effort in the area of Tampa Bay, Florida was the creation of the African American Men's Health Forum, currently referred to as the Men's Health Forum. The African American Men's Health Forum was the result of the community's desire to reduce the gap in health outcomes for African American men. Later, it was recognized that the gap in health outcomes impacts other communities; therefore, it was broadened to include all men considered medically underserved (those who are uninsured, underinsured, or without a regular health care provider). The Men's Health Forum empowers men with the resources, knowledge, and information to effectively manage their health by providing health education and screenings to the community. This article provides an explanation of the key components that have contributed to the success of the Men's Health Forum, including challenges and lessons learned. It is intended that this information be replicated in other communities in an effort to eliminate health disparities.

Men have higher cancer mortality rates for all sites combined compared with women. Cancer screening (CS) participation is important for the early detection of cancer. This study explores gender differences in CS beliefs, behaviors, and willingness to participate. The data were collected from a stratified, random-digit dial survey of adults living in New York, Maryland, and Puerto Rico. Chi-square tests and logistic regressions were computed to analyze gender associations among CS beliefs, behaviors, and willingness variables. Men and women believed that CSs were effective, though a higher percentage of men had never had a past CS. Men were less willing to participate in a CS at the present time and in a skin cancer exam; however, when given descriptions of screening conditions, men indicated more willingness to participate. These gender differences highlight the need for health professionals to examine their efforts in providing enhanced CS promotion and education among men.

This report explores the level of detailed knowledge about the Tuskegee Syphilis Study (TSS) among 848 Blacks and Whites in three U.S. cities across an array of demographic variables. The Tuskegee Legacy Project (TLP) Questionnaire was used, which was designed to explore the willingness of minorities to participate in biomedical studies. A component of the TLP Questionnaire, the TSS Facts & Myths Quiz, consisting of seven yes/no factual questions, was used to establish respondents’ level of detailed knowledge on the TSS. Both Blacks and Whites had similar very low mean quiz score on the 7-point scale, with Blacks’ scores being slightly higher than Whites (1.2 vs. 0.9, p = .003). When analyzing the level of knowledge between racial groups by various demographic variables, several patterns emerged: (a) higher education levels were associated with higher levels of detailed knowledge and (b) for both Blacks and Whites, 30 to 59 years old knew the most about TSS compared with younger and older adult age groups. The findings show that much of the information that circulates in the Black and White communities about the TSS is false, often minimizing or understating the most egregious injustices that occurred. Health promotion and educational implications of these findings are offered and conclude that the findings should be used as a catalyst to explore local realities and sentiments regarding participation in biomedical research within the research philosophy and framework of community-based participatory research.

Purpose: The purpose of this study was to determine whether a belief in the AIDS origin conspiracy theory is related to likelihood or fear of participation in research studies. Methods: The Tuskegee Legacy Project Questionnaire was administered via random-digit-dialed telephone interview to black, white, and Hispanic participants in 4 cities in 1999 and 2000 (n = 1,133) and in 3 cities in 2003 (n = 1,162). Results: In 1999, 27.8% of blacks, 23.6% of Hispanics, and 8% of whites (P ≤ .001) reported that it was “very or somewhat likely” that AIDS is “the result of a government plan to intentionally kill a certain group of people by genocide.” In 2003, 34.1% of blacks, 21.9% of Hispanics, and 8.4% of whites (P ≤ .001) reported the same. Conclusions: Whereas blacks and Hispanics were more than 3 times more likely than whites to believe in this AIDS origin conspiracy theory, holding this belief was not associated with a decreased likelihood of participation in, or increased fear of participation in, bio...

Recent advances in mobile technologies have transformed the way we communicate and obtain information. Mobile technologies include mobile phones, smartphones, and tablet PCs. These devices have a range of functions from mobile cellular communication via telephone or text messages (SMS); ability to transmit photos and video; access to the internet; and software applications or ‘apps’. These technological advancements present a tremendous opportunity to impact cancer health disparities, which are differences in the incidence, prevalence, mortality, and burden of cancer and related adverse health conditions that exist among specific population groups in the United States (U.S.) (NCI, 2013). A commonly known cancer health disparity is the disproportionate impact of prostate cancer on African American (AA) men in the U.S. Whereas African Americans have the highest death rate and shortest survival of any racial and ethnic group in the U.S. for most cancers (ACS, 2013), this remains true in the context of prostate cancer. African American men have a 60% higher incidence rate and the death rate is 2.4 times higher than in white men (ACS, 2013). The causes of these inequalities are complex and are thought to reflect an unique interplay of biological differences and social and economic disparities. These social and economic disparities or social determinants of health include inequities in work, wealth, income, education, housing, and overall standard of living which often serve as barriers to high-quality cancer prevention, early detection, and treatment services These inequities are commonly paralleled by differences in access, use, and processing of cancer information or communication inequalities (Viswanath, 2006). Communication inequalities, a key predictor of health and healthcare disparities, has been defined as differences among social groups in the generation, manipulation, and distribution of information at the group level and differences in access to and ability to take advantage of information at the individual level (Viswanath, 2006). Communication inequalities have been documented along 5 broad dimensions: a) access to and use of communication technologies and media, b) attention to health information, c) active seeking of information, d) information processing, and e) communication effects on health outcomes. It has been hypothesized that inequalities in communication mediate the relationship between social determinants and outcomes along the cancer continuum, and thus serves as one explanation for cancer and other health disparities (Viswanath, 2006). As noted by the Institute of Medicine (IOM), to maximize the potential benefits of new communication technologies, “in many cases, new technology should be combined with established communication strategies,” (IOM, 2002). One established communication strategy among minority and medically underserved populations is the Community Health Worker (CHW) model. Historically, CHWs have been deemed an effective strategy traced back to the 1960's when it was created through the support of the federal government (Witmer, 1995) with the goal of reaching people in underserved communities and presenting health and screening information (Swider, 2002). The philosophy of CHW is to train selected community members in specific health topics so that they may then serve as an educational resource to other community members in making the appropriate health decisions. A common limitation to this community-based participatory strategy is the lack of evaluation of assessing the accuracy and comprehensiveness of the information and education provided. Utilization of mHealth interventions, such as apps delivered via mobile tablet technology provides, the ability to standardize the message delivered by CHW and received by community members. However, it remains unknown if African American men are receptive to utilizing mobile tablet technology to receive health education and health promotion messaging and secondarily if they would be amendable to messaging via an app. Given the increasing constraints of the patient/provider information exchange and the lack of conclusive evidence across the continuum of care for prostate cancer, in this study we sought to 1) examine the receptivity of African American men to receiving prostate cancer control messages via mobile tablet technology delivered by CHWs (Phase I) and 2) determine if African Americans would actually use an app to seek health information (Phase II). The findings presented in this paper are from two distinct phases of a larger community-based trial. In both phases, a convenience sampling strategy was administered for recruitment. Trained CHWs recruited African Americans from select community-based settings. In Phase I, data were obtained from 152 African American male respondents who were enabled by the CHWs to directly interface with the mobile tablet technology. Demographic data and responses to a 26-item participant acceptability survey were collected form participants. The collected information yielded measures of respondents' characteristic variables (i.e., educational level, income, marital status, and age) and their acceptability of the iPad delivered by a CHW. These findings will be presented in this session. The Usability Testing methodology, field testing, was implemented during Phase II. Data were obtained from 53 African American men and women who were enabled by CHWs to interface with the mobile tablet technology. Demographic and survey responses were obtained from participants. The survey used to gather this information from participants was divided into two sections. The first section had eleven (11) items that prompted a participant to rate their experience or position regarding the ease of use of the application via mobile tablet technology. The second section consisted of twenty three (23) items that required a participant to also rate their experience or position about specific ease of use with content and graphical display of the application. The response options were on a 5-point likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). These findings will also be presented in this session. Citation Format: Brian M. Rivers, Ben Osongo, Rodrigo Carvajal, Emerson Tillman, April Schenck, Richard Roetzheim, B. Lee Green. The acceptability and usability of an mHealth intervention to address prostate cancer disparities: A community-based participatory approach. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr ED01-03. doi:10.1158/1538-7755.DISP13-ED01-03

Objective: The authors report the outcomes of a community-based, barber health adviser pilot intervention that aims to develop customized educational materials to promote knowledge and awareness of prostate cancer (CaP) and informed decision making about prostate cancer screening (PCS) among a predominantly African American clientele. Method: First, the authors implemented a series of learner verification processes with barbershop clients ( n = 15) to adapt existing CaP health promotion materials. Following intervention implementation in the barbershop, they conducted structured surveys with barbershop clients ( n = 40) to evaluate the intervention. Results: Findings from the posttest showed both a significant increase in barbershop clients’ self-reported knowledge of CaP and in the likelihood of discussing PCS with a health care provider ( p < .001). The client’s cultural model of CaP risk factors revealed cultural consensus (eigenratio = 3.3) and mirrored the biomedical model. All clients surveyed reported positively on the contents of the educational materials, and more than half (53%) had discussed CaP at least twice with their barber in the last month. Conclusion: Based on the pilot results, the barber-administered intervention was an appropriate and viable communication channel for promoting CaP knowledge and awareness in a priority population, African American men.

The goal of this pilot study was to assess the feasibility of training barbers to deliver a brief culturally and literacy appropriate prostate cancer educational intervention to urban African American men. Eight barbers received training to deliver a 2-month educational intervention in the barbershop and completed pre- and posttest training assessments. The training workshops led to a significant increase in mean prostate cancer knowledge scores among the barbers (60% before vs. 79% after; P < 0.05). The barbers also reported positively on the intervention in terms of satisfaction and relative ease of engaging clients. Training barbers to deliver a prostate cancer educational intervention is a feasible strategy for raising prostate cancer awareness of the disease among a priority population.

Given the history of vulnerability of women of childbearing age to medical treatments that have caused injury, for example, diethylstilbestrol (DES) and thalidomide, it is surprising that, to date, little research has directly examined attitudes of the general public regarding the vulnerability of women when they participate in biomedical research studies.We asked three questions about beliefs of women as biomedical research subjects of 623 white, 353 black, and 157 Hispanic people in four U.S. cities: (1) Do you believe that women are more likely to be "taken advantage of" when they become subjects in a medical research project as compared to men? (2) Do you believe that women of childbearing age (15-45-year-olds) should become study participants in medical research projects? and, if the response was no or don't know/not sure, (3) Would you still say no or don't know/not sure to question 2 even if it meant that we would not know anything about the health and medical treatments for women aged 15-45 years?Overall, women were 60% more likely than men to state that women were more likely than men to be "taken advantage of," even when controlling for potential confounders, and both black and Hispanic participants were much more likely than white participants to state that this was the case. The majority of respondents (57.4%) said that women of childbearing age should not be research subjects; among women, both black and Hispanic people were less likely than white people to change their minds when prompted that this might mean that "nothing would be known about the health and medical treatments for women aged 15-45 years."A substantial proportion of the participants reported knowledge of historical events, and this knowledge was related, particularly in black participants, to attitudes toward vulnerability of women as biomedical research subjects.

Background: This analysis was conducted to determine whether there is a difference among blacks, Hispanics, and whites in their perception of risks associated with participating in either a biomedical study or a cancer screening. Methods: The Tuskegee Legacy Project Questionnaire, which focused on research subject participation, was administered in two different surveys (1999-2000 and 2003) in seven cities. The Cancer Screening Questionnaire was administered in 2003 in three cities. Results: The study sample across the three surveys consisted of 1,064 blacks, 781 Hispanics, and 1,598 non-Hispanic whites. Response rates ranged from 44% to 70% by city. Logistic regression analyses, adjusted for age, sex, education, income, and city, revealed that blacks and Hispanics each self-reported that minorities, compared with whites, are more likely to be "taken advantage of" in biomedical studies and much less likely to get a "thorough and careful examination" in a cancer screening (odds ratios ranged from 3.6 to 14.2). Conclusions: Blacks and Hispanics perceive equally high levels of risk for participating in cancer screening examinations and for volunteering to become research subjects in biomedical studies. This perception provides a strong message about the need to overtly address this critical health disparities issue.

Background: In the United States, blacks and Hispanics have lower cancer screening rates than whites have. Studies on the screening behaviors of minorities are increasing, but few focus on the factors that contribute to this discrepancy. This study presents the self-reported willingness by blacks, Puerto Rican Hispanics, and non-Hispanic whites to participate in cancer screenings in differing cancer screening situations. Methods: The Cancer Screening Questionnaire (CSQ), a 60-item questionnaire, was administered via random-digit-dial telephone interviews to adults in three cities: Baltimore, Maryland; New York, New York; and, San Juan, Puerto Rico. Results: The 1,148 participants in the CSQ study sample consisted of 355 blacks, 311 Puerto Rican Hispanics, and 482 non-Hispanic whites. Response rates ranged from 45% to 58% by city. Multivariable logistic regression analyses revealed that blacks and Puerto Ricans were often more likely (OR 2.0‐3.0) and never less likely than whites to self-report willingness to participate in cancer screenings regardless of who conducted the cancer screening, what one was asked to do in the cancer screening, or what type of cancer was involved (with the exception of skin cancer where blacks, compared with whites, had an OR of 0.5). Conclusions: The findings from this study provide evidence that blacks and Hispanics self-report that they are either as willing or more willing than whites to participate in cancer screening programs.

The phrase, 'legacy of the Tuskegee Syphilis Study', is sometimes used to denote the belief that Blacks are more reluctant than Whites to participate in biomedical research studies because of the infamous study of syphilis in men run by the U.S. Public Health Service from 1932-72. This paper is the first to attempt to assess directly the accuracy of this belief within a multi-city, multi-racial, large-scale, detailed random survey. We administered the Tuskegee Legacy Project (TLP) Questionnaire to 826 Blacks and non-Hispanic White adults in three U.S. cities. While Blacks had higher levels of general awareness of the Tuskegee Syphilis Study, there was no association between either awareness or detailed knowledge of the Tuskegee Syphilis Study and willingness to participate in biomedical research, either for Blacks or Whites observed in our survey. While this study refutes the notion that there is a direct connection between detailed knowledge of the Tuskegee Syphilis Study and willingness to participate in biomedical research, it does not assess the broader question of whether and how historical events influence people's willingness to participate in research. Future studies should explore this.

The purpose of this study was to develop a culturally sensitive instrument to assess the quality of distance education courses offered at a university in the southern United States through evaluation of student attitudes, opinions, and perceptions of distance education. Quality indicators, identified in a systematic literature review, coupled with an ecological framework served as the theoretical foundation for the instrument development process. The process of test development, outlined in the Standards for Educational and Psychological Testing (1999), was used and combined with Dillman’s (2000) four stages of pretesting to construct the instrument. Results indicated that the model constructed from the quality indicators and ecological framework provided valid and reliable measures of student attitudes, opinions, and perceptions of quality of the distance education courses.

Black students who attend predominately White institutions (PWI) face many obstacles. This study identified the stressful life events of Black college men via focus group discussions and examined how these events impact their mental health and health behaviors. Forty-six participants from a PWI and a historically Black college/university (HBCU) affirmed that they experience similar encounters with stressful life events, but partici-pants at the PWI reported that their major stressors were the result of “school-related” events, while participants at the HBCU reported stressors that were not school-related. Findings from this study present implications for future health promotion programs that target Black college men.

This article provides an overview of the current literature on seven cancer sites that may disproportionately affect lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. For each cancer site, the authors present and discuss the descriptive statistics, primary prevention, secondary prevention and preclinical disease, tertiary prevention and late-stage disease, and clinical implications. Finally, an overview of psychosocial factors related to cancer survivorship is offered as well as strategies for improving access to care.

The association between insurance status and outcomes has not been well established for patients with Hodgkin lymphoma (HL). The purpose of this study was to examine the disparities in overall survival (OS) by insurance status in a large cohort of patients with HL.The National Cancer Data Base (NCDB) was used to evaluate patients with stage I to IV HL from 1998 to 2011. The association between insurance status, covariables, and outcomes was assessed in a multivariate Cox proportional hazards model. Survival was estimated with the Kaplan-Meier method.Among the 76,681 patients within the NCDB, 45,777 patients with stage I to IV HL were eligible for this study (median follow-up, 6.0 years). The median age was 39 years (range, 18-90 years). The insurance status was as follows: 3247 (7.1%) were uninsured, 7962 (17.4%) had Medicaid, 30,334 (66.3%) had private insurance, 3746 (8.2%) had managed care, and 488 (1.1%) had Medicare. Patients with an unfavorable insurance status (Medicaid/uninsured) were at a more advanced stage, had higher comorbidity scores, had B symptoms, and were in a lower income/education quartile (all P .01). These patients were less likely to receive radiotherapy and start chemotherapy promptly and were less commonly treated at academic/research centers (all P .01). Patients with unfavorable insurance had a 5-year OS of 54% versus 87% for those favorably insured (P .01). When adjustments were made for covariates, an unfavorable insurance status was associated with significantly decreased OS (hazard ratio, 1.60; 95% confidence interval, 1.34-1.91; P .01). The unfavorable insurance status rate increased from 22.8% to 28.8% between 1998 and 2011.This study reveals that HL patients with Medicaid and uninsured patients have outcomes inferior to those of patients with more favorable insurance. Targeting this subset of patients with limited access to care may help to improve outcomes. Cancer 2015;121:3435-43. © 2015 American Cancer Society.

Recent studies indicate that the health gap between Black men and men of other racial/ethnic groups in the US is widening, with Black men experiencing poorer health. Because mental health is an indelible component of overall health, addressing the health issues of Black men requires a critical examination of factors that influence the mental health of this population. Prior research suggests that Black men have more adverse life experiences than men of other racial/ethnic groups and, consequently, experience more depressive symptoms. However, limited research exists regarding depression and Black men. Therefore, the purpose of this review is to organize available evidence systematically, while examining the factors that lead to depression in Black men. Results from over two decades of literature suggest that psychosocial coping, economic status/income, and racism/discrimination are the major factors that contribute to depression and depressive symptoms in Black men. Although the first two factors...

Health disparities have been conceptualized as being the result of a confluence of factors: environmental, social, biological, economic, and cultural to name a few. Given the increasingly deleterious impact of health disparities on the lives of all Americans, new research methodological research approaches are needed to adequately understand and address the component parts of health disparities. To effectively address health disparities, an increased focus is needed on implementing transdisciplinary approaches to health disparities research. One approach is to focus on mentoring young investigators and students. This article discusses the centrality of mentoring in developing young health disparities researchers. An overview of health disparities research and researchers, and a summary of the different aspects of mentoring are provided. In addition, a case study of the implementation of a transdisciplinary mentoring framework at a higher education institution is presented.

SOPHE leaders continue to challenge us to be true to the call for an “open society.” SOPHE has supported the Healthy People 2010 goal of eliminating health disparities through its Strategic Plan. SOPHE held an Inaugural Health Education Research Disparities Summit, Health Disparities and Social Inequities: Framing a Transdisciplinary Research Agenda in Health Education, August 8 and 9, 2005. This article explains the process used at the Summit where more than 80 researchers, academicians, practitioners, and students from across the country convened to ask fundamental questions about health disparity associated with race and ethnicity and how a health education research agenda could help in eliminating these disparities. From this Summit, about a dozen questions and/or recommendations have been developed to frame our future discussions about health disparities. Through its Research Agenda Committee, SOPHE has developed a process of translation and dissemination, including community participation, review, dialogue, and action

A number of academic disciplines are engaged in scholarly discussions regarding statistical practice reform, particularly the use of effect sizes. Health education must stimulate a similar conversation by adopting strategies for generating, reporting, and interpreting effect size estimates for various statistical analyses within journal articles. The purpose of this article is to demonstrate the practical applications of effect size reporting and interpretation in health education research. Congruent with previous recommendations in the American Journal of Health Education, this article will provide examples and techniques used for effect size reporting that educate the researcher and practitioner, thus improving the scholarship of health education publications. Effect size reporting should become the rule for health education and concerted efforts should be made to equip researchers and practitioners with the proficiency to perform this task effectively. Such skill building will increase the sch...

The broad goal of the Tuskegee Legacy Project (TLP) study was to address, and understand, a range of issues related to the recruitment and retention of Blacks and other minorities in biomedical research studies. The specific aim of this analysis was to compare the self-reported willingness of Blacks, Hispanics, and Whites to participate as research subjects in biomedical studies, as measured by the Likelihood of Participation (LOP) Scale and the Guinea Pig Fear Factor (GPFF) Scale. The Tuskegee Legacy Project Questionnaire, a 60 item instrument, was administered to 1,133 adult Blacks, Hispanics, and non-Hispanic Whites in 4 U.S. cities. The findings revealed no difference in self-reported willingness to participate in biomedical research, as measured by the LOP Scale, between Blacks, Hispanics, and Whites, despite Blacks being 1.8 times as likely as Whites to have a higher fear of participation in biomedical research on the GPFF Scale.