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Racial disparities in breast cancer screening, morbidity, and mortality persist for Black women. This study examines Black women’s mammography beliefs and experiences with specific focus on barriers to mammography access in an urban city in the South East, United States. This retrospective, qualitative study used Penchansky and Thomas’ conceptualization of health care access as the framework for the data analysis. In-depth, semistructured interviews were conducted with 39 Black women. Structural and personal factors continue to create barriers to mammography among Black women. Barriers to mammography were identified for each of the Penchansky and Thomas five dimensions of access to care: accessibility, affordability, availability, accommodation, and acceptability. Clinical practice strategies to increase mammography screening in Black women must be multifactorial, patient-centered, and culturally congruent. Policy development must address the structural barriers to mammography screening through expansion of health insurance coverage and increased accessibility to health care.

Objectives: In this study, we pilot-tested #CRCFree, a Facebook-based intervention aimed at reducing colorectal cancer (CRC) risk in rural Appalachian adults at risk for CRC. Methods: Participants were 56 rural Appalachian adults aged > 50 years. Daily #CRCFree Facebook posts addressed diet, physical activity, and CRC screening. Participants' sociodemographics, diet, body mass index, physical activity, and CRC screening status were measured pre- and post-intervention. The Healthy Eating Index (HEI) and the Dietary Inflammatory Index (DII) assessed dietary patterns. Facebook engagement was measured throughout the intervention. A post-intervention focus group evaluated intervention acceptability. Results: Participants were Caucasian, aged 58 ± 6 years, and predominantly female (66%). Post-intervention, HEI scores increased (49.9 ± 9.9 vs 58.6 ± 12.1, p = Conclusions: These results provide preliminary evidence to support using Facebook to address CRC risk in this population. Participants were responsive to this intervention, and Facebook is a novel and accessible modality for health promotion.

Background: The University of Arizona Cancer Center (UACC) is the only NCI-designated Comprehensive Cancer Center in Arizona, serving a 5-county catchment area that is approximately 40% Hispanic/Latinx. To ensure that UACC is conducting culturally relevant and meaningful research that is aligned with community priorities, we established the Research Outreach for Southern Arizona (ROSA) program. The ROSA program aims to facilitate bidirectional learning opportunities between scientists and the community, focusing on cancer biology and basic science. Multiple approaches were taken to engage cancer biology researchers with the communities in the catchment area with an ultimate aim of developing Basic science Community based participatory research projects. Method: Through a partnership between the UACC’s Office of Community Outreach and Engagement and the Cancer Biology Program, the ROSA program employed multiple strategies to educate and engage basic scientists on best practices to effectively engage community members, which included: collaborative working groups, meet the scientist learning opportunities, student and community ambassadors, and creation of the ROSA Café Series (community conversations with UACC basic scientist). These strategies facilitated avenues for scientists to educate, learn from, and engage with the community. Results: The working group consisted of UACC basic scientists and community members that helped develop a ROSA survey that will be used to gain community input and learn more about community research priorities, knowledge base and culturally appropriate research. Additionally, ROSA community and student ambassadors were enrolled into a curriculum where they learned fundamentals of cancer biology via conversations with the basic scientists and provided opportunities for scientists to practice using lay language to express scientific ideas. Bidirectional learning opportunities were also presented within the structure of the ROSA Café’s with the ultimate goal of having community members learn directly from the researchers about current and potential projects. These strategies have ultimately led to interactions between the basic science and lay community that serve as a basis for future basic science projects that are community inspired and have potential for high community input and impact. Discussion: Helping basic scientists integrate their science more fully into communities has the potential for advancing science and promoting health equity in minoritized communities. This partnership is predicated on preparing basic scientists to interact comfortably and effectively with community members, necessitating common language and fuller understanding of community ways of knowing. The strategies employed and explicated here provide a model for cancer centers to develop culturally and community relevant basic science programs. Citation Format: Namoonga M. Mantina, Juan Contreras, Monica Yellowhair, Cynthia Miranti, Jennifer Hatcher. Multifaceted approach to engaging basic cancer scientists in community-based research. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4188.

Background American Indians (AI) experience major colorectal cancer (CRC) screening disparities with commensurate inequity in CRC mortality and other outcomes. The purpose of this report is to describe the methods and early results of adapting a previously successful intervention for the AI community. Methods The educational content and delivery strategy of the parent intervention were adapted for AIs guided by an adaptation framework and cultural consultations with the community and clinicians. As part of the environmental scanning, we identified the need to substantively revise our data entry, collection, and tracking system and develop a REDCap database for this purpose. In this study, we staggered the implementation of the intervention in each facility to inform the process from one clinic to the next, and assess both the clinical outcomes of the tailored intervention and the implementation processes across two clinic settings, Facilities A and B. Results The REDCap database is an indispensable asset, and without it we would not have been able to obtain reliable aggregate screening data while improvements to facility electronic health records are in progress. Approximately 8% (n = 678) of screening-eligible patients have been exposed to the navigator intervention. Of those exposed to the navigator intervention, 37% completed screening. Conclusions With the small numbers of patients exposed so far to the intervention, it would be premature to draw any broad conclusions yet about intervention effects. However, early screening completion rates are substantial advances on existing rates, and we have demonstrated that a tailored navigator intervention for facilitating CRC screening was readily adapted with provider and community input for application to AIs. A REDCap database for tracking of CRC screening by navigators using tablets or laptops on- or offline is easy to use and allows for generation of aggregate, anonymized screening data. Trial registration. There was no health intervention meeting the criteria of a clinical trial. The University of Arizona Institutional Review Board granted exemption from obtaining informed consent from patients undergoing CRC screening after administration of the tailored navigation intervention as usual care.

Background: The COVID-19 pandemic has forced many individuals to continue virtually via Zoom. To accommodate this change and remain accessible, the University of Arizona Cancer Center’s Office of Community Outreach and Engagement (COE) transitioned cancer education efforts to virtual webinars and social media. These multilingual and multicultural efforts were targeted toward residents of Arizona, as well as a broader network of participants. Objective: To develop accessible, virtual programming to engage communities across Arizona during the COVID-19 pandemic to continue cancer education and health promotion efforts in bilingual (English and Spanish) webinars where possible. Methods: Utilizing a vibrant social media presence, the COE team developed a weekly webinar series, entitled Let’s Taco ‘Bout Cancer!, a monthly Morning Cat Chat webinar, and an annual “Col-Chella” festival that focuses on cancer education. These series are based on informal interviews and conversations with cancer researchers, community health partners, cancer survivors/caretakers, and community advisory board members. All presentations were streamed via Zoom, social media accounts, and YouTube to be accessible for later use. Lastly, demonstration webinars (e.g. food preparation) for healthy behaviors were also implemented. Results: Since March 2020, more than 22,000 viewers have been recorded over 122 virtual cancer-related presentations that were given. Sixty-one percent of the presentations were in English and 39% were in Spanish. Collected surveys indicate the median age of the audience is 55 years old, 77% females, and 43% community members. Twenty-nine (29) percent identify as Hispanic, 48% as non-Hispanic white, and 17% as American Indian/Alaska Native. Evaluations reported that 86% of the audience were engaged, 94% that their knowledge was increased, and 69% indicated that their knowledge is applicable. Eighty-seven (87) percent thought the research topics discussed benefits their community and 83% preferred to receive cancer education materials via email. The collected evaluations indicate the audience’s top three priorities from the cancer center include: cancer prevention, education, and patient care. Discussion: Based on collected data, offering multicultural and multilingual outreach efforts virtually has allowed the COE team to continuously operate as an educational resource serving our diverse communities. Interacting and inviting members from Arizona’s Hispanic and American Indian communities, along with health professionals, has made the Cancer Center more relative to the population it serves as well as allowing Arizona residents to hear from their own community. Overtime, in-person efforts will resume with the inclusion of virtual engagement to have a well-rounded approach. Citation Format: Monica Yellowhair, Desiree Jones, Gabriela Ruiz, Octavio Castanos, Rene D. Herrera, Juan Contreras, David O. Garcia, Jennifer Hatcher. Development of virtual outreach strategies to supply cancer education and prevention information during the COVID-19 pandemic [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 434.

BACKGROUND: Appalachian Kentuckians suffer a disproportionate incidence and mortality from colorectal cancer (CRC) and are screened at lower rates (35%) compared with 47% of Kentuckians. OBJECTIVE: The aim of this study was to evaluate the efficacy of a motivational interviewing intervention delivered by trained Lay Health Advisors on CRC screening. METHOD: Eligible participants recruited from an emergency department (ED) completed a baseline survey and were randomized to either the control or the motivational interviewing intervention provided by Lay Health Advisors. Follow-up surveys were administered 3 and 6 months after baseline. To evaluate potential differences in treatment and control groups, t tests, X(2), and Mann-Whitney U tests were used. RESULTS: At either the 3- or 6 month assessment, there was no difference in the CRC screening by group (X(2) = 0.13, P = .72). There was a significant main effect for the study group in the susceptibility to CRC model; regardless of time, those in the intervention group reported approximately 1-point higher perceived susceptibility to CRC, compared with controls (est. b = 0.68, P = .038). Age and financial adequacy had a significant effect related to CRC screening. Older participants (est. b = 0.09, P = .014) and those who reported financial inadequacy (est. b = 2.34, P = .002) reported more screening barriers. CONCLUSION: This pilot study elucidated important factors influencing the uptake of CRC for an ED transient population and this may be useful in the design of future interventions using motivational interviewing in EDs. IMPLICATIONS FOR PRACTICE: Nurses can provide information about CRC screening guidelines and provide referrals to appropriate screening resources in the community.

Objective: The purpose of this paper is to elucidate factors impacting the health, development and management of chronic illnesses, particularly type 2 diabetes of rural grandparent-headed households (GHH). Research Design and Methods: Prospective data were collected from rural-dwelling members of GHHs living in Appalachia Kentucky with no known diagnosis of T2D. Data collected on family characteristics, T2D clinical risk factors, and social support were assessed using the Medical Outcomes Survey (MOS) Social Support and the Child and Adolescent Social Support Scale (CASSS). Results: Sixty-six grandparents and 72 grandchildren participated in the study. The average age and HbA1Cs were 59.4 years and 6.2% ± 1.4 for grandparents and 11.8 years and 4.9% ± 0.6 for grandchildren. The majority of grandparents were found to have prediabetes (31%) or undiagnosed diabetes (28%). The number of people living in GHHs were associated with grandparents’ triglycerides, HDL, and BMI whereas custody status was associated with BMI. Average social support scores among grandparents suggested moderately high perceived social support (79 ± 3.4). For grandchildren, social support provided by grandparents had no association with T2D risk factors, whereas support from teachers, classmates, and close friends was associated with HbA1C, BMI, and blood pressure in grandchildren. Conclusion: This study shows that rural-dwelling grandparent caregivers are at an increased risk for T2D. In addition, increased responsibility may provide a determinant of health due to the potential stress of caregiving for grandchildren. Social support between grandparents and grandchildren has no effect on T2D risk factors. However, social support provided by peers, teachers, and close friends were associated with T2D risk factors in grandchildren. These findings support the use of peer support and school settings as mechanisms for interventions to reduce T2D in adolescents, particularly those of GHHs. Disclosure B.L. Smalls: None. K.N. Palmer: None. O.A. Contreras: None. J. Hatcher: None. Funding National Institute for Diabetes and Digestive and Kidney Diseases (R03DK101705 to J.H.)

Objective: The purpose of this study is to assess type 2 diabetes mellitus (T2DM) risk factors in grandparent caregivers living in a rural environment. Methods: Clinical measures (hemoglobin A1c [HbA1c], blood pressure, and lipids) and self-reported data on social environment factors were attained. Data were analyzed via Pearson’s correlation and regression models. Results: By clinical definition of diabetes (HbA1c ≥ 6.5%), 21% were prediabetic and 28% had undiagnosed T2DM. There was an association between the number of individuals in the home and triglycerides ( r = −.25), high-density lipoproteins (HDL; r = .43), and body mass index (BMI; r = .39). Guardianship status had a significant association with BMI ( r = −.38). There was a significant association between low-density lipoprotein (LDL; r = −.32) and access to community shared resources. In the adjusted linear model, the number of grandchildren in the home had a significant relationship with HDL (β = .012, p = .021) whereas the number of individuals living in the home had a statistically significant relationship with HDL (β = .026, p < .000) and BMI (β = .046, p = .02). In addition, 15% of participants reported being food insecure. Discussion: Efforts are needed to identify and screen at-risk populations living in geographically isolated areas. Considerations should be given to leveraging existing community resources for grandparent caregivers via schools, health systems, and government agencies to optimize health and well-being.

PURPOSE: Women in the Appalachian region have a high mortality rate attributable to cancer in spite of lower incidence of cancer compared with the general US population. Empirical evidence suggests that social support influences cancer outcomes, including adherence to screening guidelines and treatment recommendations. The purpose of this study is to examine the impact of social support on breast cancer screening patterns in a sample of rural Appalachian women. METHODS: This paper reports the results of analyses of baseline cross-sectional data on breast cancer screening collected during a community-based group-randomized trial. We used the 2010 National Health Institute Survey questionnaires and the Medical Outcomes Study Social Support Survey to assess screening behavior and perceived social support, respectively. Data were analyzed using ANCOVA and ANOVA to assess the mean social support on breast cancer screening patterns (frequently, irregularly, and rarely/never) and relevant sociodemographic variables. FINDINGS: Of the eligible participant records analyzed (N = 289), 50% were married, 36% were employed, 20% attended college, 40% had no mammogram in 6 years, and 20% never had mammograms. Overall social support score was high at 73.1 (SD = 18.2). Association between breast cancer screening patterns and social support scores was not statistically significant at α < 0.05 (P value = 0.09). CONCLUSIONS: Although social support as it measured in this study does not show significant associations with screening patterns, it is important to understand how social network structures may influence screening patterns. Familial and social roles/responsibilities that result in reported social support may also be the barrier to cancer screening and other prevention health behaviors.

The purpose of this article is to review the current literature describing primary care providers’ (PCPs) attitudes related to lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) people. LGBTQ individuals experience significant health disparities, and these inequities may be better understood via an ecological systems framework. PCPs’ actual or perceived discriminatory attitudes can lead to suboptimal treatment or health outcomes for LGBTQ people. A review of the literature from 2005 through January 2017 was completed using the Cumulative Index for Nursing and Allied Health Literature and PubMed (Medline) databases. The purpose, sample, measure(s), design, findings, strengths, and weaknesses of each study were examined; and findings were synthesized, summarized, and critically appraised. Eight articles were eligible for review. There was significant heterogeneity in the studies’ purposes, research questions, LGBTQ population(s) of focus, and findings. Many PCPs’ attitudes toward LGBTQ people were positive, but a minority of each studies’ participants had negative attitudes toward LGBTQ people. Stigma and health care barriers negatively affect LGBTQ health. Interventions must address LGBTQ health disparities at the individual, mesosytem, exosystem, and macrosystem levels. Research, education, and practice strategies all must be integrated across socioecological levels as components of a population-based approach to eliminate health disparities for LGBTQ persons.

Health disparities researchers attempting to engage and effectively deliver interventions to underserved populations often encounter a number of challenges ranging from geographical considerations to more complex issues of medical mistrust. While there are a number of strategies researchers may employ to address these challenges, one of the most successful of these has been the use of community health workers (CHWs). Despite the documented success of CHWs, little information exists on the use of theory-driven intervention strategies with these community partners. Researchers who have partnered with CHWs tend to provide brief descriptions of training strategies and provide little discussion of the challenges and barriers to training a lay population in the delivery of technical interventions, including ensuring fidelity to the intervention protocol. The purpose of this article is to describe the feasibility of training CHWs to deliver a motivational interviewing intervention to promote cancer screening in underserved populations. With this article we present an innovative way to use motivational interviewing delivered by CHWs. Specifically, we will detail the development of the training protocol, the implementation of that training in a variety of research settings, and the development and implementation of fidelity protocols. We will use examples from two research studies where CHWs were successfully trained to use MI to promote cancer screening in underserved communities to highlight the challenges and barriers faced in developing and implementing the training and strategies used to overcome these challenges during the refinement of the intervention.

Purpose: To explore, from an emic perspective, the unique socio ecological context in which rural grandparent headed households (GHH) exist, and therefore provide a foundation for the development of culturally-appropriate interventions that might impact their health. Methods: This qualitative descriptive study was based on the conduct of in-depth, semi-structured interviews with fifteen grandparents, residing in rural Appalachian Kentucky, who were the primary caretakers for their grandchildren. The interviews were conducted using an interview guide that was based on the premises of the Social Ecological Model (SEM). A basic assumption of this model is that intrapersonal, social-cultural, organizational, and policy factors influence individual health and health behaviors, and that these influences are interrelated and reciprocal. Data was analyzed by the research team using line by line coding of the audio recorded transcriptions of the interviews. Findings: GHH experience both barriers and facilitators to maintaining the health of GHH. Many grandparents viewed the experience of belonging to a GHH as a positive one, believing that having their grandchildren in their home improved their health. They relied on formal and informal networks such as extended family and churches to help with caretaking responsibilities. Grandparents experienced notable barriers to health related to having the primary responsibility of their grandchildren, including lack of resources and family tension related to incarceration and/or opioid drug use by biological parents. Conclusions: GHH, one of the fastest growing family constellations in rural Appalachia and the US, may be particularly vulnerable to health threats elevating their risk for many chronic diseases. Effective health related interventions to address this risk should be based on the socio-ecological context in which these families exist. Keywords : Rural, Grandparent headed households, Qualitative, Socio-ecological model DOI: http://dx.doi.org/10.14574/ojrnhc.v18i1.486

Utilizing data from 40 in-depth interviews, this article identifies both barriers and facilitators to colorectal screening guideline adherence among Appalachian Kentucky adults recruited through a community-based research network. Key findings identify (a) varying levels of knowledge about screening guidelines, (b) reticence to engage in screening processes, and (c) nuanced communication with healthcare providers and family members regarding screening adherence. What participants knew about the screening process was often derived from personal stories or recalled stories from family members about their screening experiences. Reticence to engage in screening processes reflected reports of cumbersome preparation, privacy issues, embarrassment, medical mistrust, fear of receiving a cancer diagnosis, and lack of symptoms. Participants cited many ways to enhance patient-centered communication, and the findings from this study have implications for health communication message design and communication strategies for healthcare practices in Appalachian Kentucky clinics.

Sub-Saharan African immigrant (SSAI) men have significant influence on the health-seeking behavior including cervical cancer screening uptake by their female partners/wives. We conducted a qualitative descriptive study with 21 SSAI men to explore knowledge, perceptions, and support related to cervical screening. Participants were aged 36 ± 9 years, college educated (88%), and 53% have lived in the U.S.5 years. Three themes emerged; inadequate cervical cancer knowledge, willingness and strategies for support, and shared versus autonomous decision making for screening. Social structure with emphasis on male leadership could be leveraged in cervical cancer screening promotion for SSAI women.

African-Americans are vulnerable to both cancer and cardiovascular disease (CVD) due to intricately connected risk factors. Use of text messages is an innovative method to provide health information to reduce these risks. The aim of this study was to test the feasibility and acceptability of a text messaging intervention to reduce CVD and cancer risk factors in African-Americans.We developed an intervention using text messages culturally tailored for African-Americans over age 50 who were at risk (one or more modifiable risk factors) for CVD and/or cancer. Sociodemographic data, biologic measures, cancer screening practices, and general health status were assessed. Group interviews were conducted to assess feasibility and acceptability.Participants were primarily female (69%), aged 58 ± 5 years, who were married (59%) and worked full time (56%). In terms of feasibility and acceptability, themes of encouragement through text messages received and a desire for a longer study period emerged from group interviews with participants. Participants experienced significant decreases in waist circumference (41 ± 5 vs 40 ± 5, p = .002), systolic blood pressure (147 ± 25 mmHg vs 138 ± 20 mmHg, p = .009), diastolic blood pressure (87 ± 16 mmHg vs 82 ± 10 mmHg, p = .02), total cholesterol (194 ± 35 mg/dL vs 173 ± 32 mg/dL, p .001), and low-density lipoprotein levels (100 ± 32 mg/dL vs 86 ± 29 mg/dL, p = .015). Five participants had colorectal cancer screening, two had prostate cancer screening, and four had mammograms.Use of text messages was widely accepted among participants. Significant CVD risk reductions and increased cancer screenings were noted. Future studies should incorporate innovative strategies such as text messaging in promoting health in vulnerable populations.

Background: Rural Appalachian Kentucky has much higher colorectal cancer (CRC) morbidity (50.6 per 100,00) and mortality (19.8 per 100,000) than the U.S. Appalachian Kentucky CRC screening rates are 36% compared with 27% statewide and 53% nationally. This study assessed factors affecting Appalachian Kentuckians’ beliefs related to CRC and CRC screening. Methods: Appalachian Kentuckians 50 years of age and older who were not up-to-date on CRC screening (N = 190) completed a survey including subscales measuring perceived CRC susceptibility and perceived benefits of CRC screening. Mann-Whitney U and Kruskal-Wallis tests compared differences in beliefs and Spearman’s Rho examined the correlation between variables. Results: Sixty-two percent were concerned about developing CRC, and 94.7% had completed CRC screening previously. Participants felt more susceptible to CRC if they had a family history of CRC (p < .01) and if their healthcare provider recommended CRC screening (13.03 versus 12.19, p < .01). Perceived benefits of CRC screening were not significantly associated with demographic or healthcare access variables. Conclusions: Although many participants were concerned about developing CRC, very few had completed CRC screening. These findings and those of previous research provide information to guide tailored interventions to promote CRC screening in Appalachian Kentuckians. Individuals with a family history of cancer may perceive a higher CRC susceptibility and be more likely to complete CRC screening. Healthcare providers’ recommendations for CRC screening can influence perceived CRC susceptibility and potentially influence completion of CRC screening in this population. Citation Format: Mollie E. Aleshire, Adebola Adegboyega, Shuying Sha, Jennifer Hatcher. Factors affecting Appalachian Kentuckians' beliefs related to colorectal cancer and colorectal cancer screening [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-266.

Background: Appalachian Kentucky residents suffer significant colorectal cancer (CRC) disparity, in part related to low utilization of CRC screening. Reducing or removing potential barriers to CRC screening uptake may increase utilization of CRC screening in this population. The purpose of this study was to identify barriers to CRC screening in adults aged 50 years and older in rural Appalachian Kentucky. Methods: This study reports the analysis of baseline data from a randomized controlled trial designed to promote CRC screening in rural Appalachian Kentucky among individuals who have not been screened for CRC recruited from two Emergency Departments at St. Claire Regional Medical Center in Morehead, Kentucky, and Appalachian Regional Healthcare in Hazard, Kentucky. The survey used for this study assessed CRC screening status, barriers, susceptibility, and benefits related to CRC screening, sociodemographic characteristics, and other health-related information such as health care utilization including the reason for ED visit, insurance coverage, and health care access. Descriptive and bivariate analyses are reported. Results: Questionnaires were completed by 191 adults aged 50 and over, waiting for nonurgent care or with a family member in the ED of rural Appalachian hospitals. Participants were mostly Caucasian (98%), female (57%), aged 58 ± 8 years, who had household income < $20,000 (56%), and 95% had never undergone CRC screening. Fear of CRC result (51%), perceived pain (50%), and cost (49%) were the most salient barriers to CRC screening test. The following four demographic variables were significantly associated with barriers to CRC screening; education, marital status, income, and age. Conclusions: Rural Appalachian Kentucky residents do not screen for CRC according to guidelines, partly due to perceived barriers to CRC screening. Education and income level were associated with the perception of painful and costly CRC screening in this population, suggesting that they do not have adequate knowledge or access to CRC screening resources available in the communities. Considering the cultural norms peculiar to Appalachian Kentucky, this population will benefit from a community health worker-led educational intervention to promote CRC screening through short video messages about the CRC screening process, other less invasive screening options, and benefits of CRC screening. This intervention may be able to address the barriers identified in this group, including the perception of painful screening procedure and the fear of screening result. Additionally, appropriate navigation program to affordable and accessible CRC screening resources within the local community would be beneficial to addressing the dismal use of screening resources among individuals in this population. Citation Format: Adaeze Aroh, Adebola Adegboyega, Jennifer Hatcher. Reported barriers to colorectal cancer screening in Appalachian Kentucky [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B100.

Background: Globally, cervical cancer is one of the most common cancers among women. The risk of invasive cervical cancer remains high among sub-Saharan African immigrant (SSAI) women in the US despite being a preventable cancer. Women's knowledge about cervical cancer risk factors and preventive behaviors has been found to be related to the uptake of Pap screening and engagement in other healthy behaviors. Given the high prevalence of human papillomavirus (HPV) infection and other cervical cancer risks among SSAI women, it is critical that SSAI women be well informed and knowledgeable regarding their cervical cancer risk and prevention. The purpose of this study is to assess SSAI women's knowledge of cervical cancer risk factors, HPV, and cervical cancer screening. Methods: This study was a quantitative analysis of cross-sectional survey of 108 English-speaking SSAI women aged 21 and above recruited from Lexington and Frankfort, Kentucky, between October and December 2016. Information on demographics, screening behavior, and cervical cancer knowledge was collected. A knowledge scale including 14 questions about facts and common myths related to cervical cancer and HPV was used. Total knowledge scores were calculated for participants. Analysis was conducted to identify factors associated with knowledge scores. Results: Participants' mean age was 34 ± 9 years, 56% had a college degree, 65% reported that their income was adequate, and 54% had lived in the U.S for more than 5 years. The composite knowledge score was 7.8 ±3.6 with a maximum score of 14. In bivariate analysis, length of residence in the U.S (P= 0 .001), ever had Pap screening (P < 0.001), health insurance (P < 0.001), having primary provider (P = 0.020), and health provider recommendation for cervical cancer screening (P = 0.006) were associated with knowledge. In multiple regression analysis, longer length of residence in the U.S (P = 0.044) and ever having a Pap screening (P = 0.007) remained significantly associated with cervical cancer knowledge. Conclusions: Findings show a limited knowledge of cervical cancer risk factors and the role of HPV in cervical cancer. Future research should further explore and understand how length of residence in the US and having had a Pap screening are related to cervical cancer risks knowledge. The gaps in women's knowledge points to the need for targeted educational interventions to address knowledge needs of SSAI women to encourage cervical cancer screening prevention and timely detection. Citation Format: Adebola Adegboyega, Adaeze Aroh, Jennifer Hatcher. Knowledge of cervical cancer risk factors and screening among sub-Saharan African immigrant women [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B097.

Despite the proven effectiveness of colorectal cancer (CRC) screening, American Indians (AIs) have some of the lowest CRC screening rates. Nearly two-thirds of US adults are current with US Preventive Services Task Force guidelines for CRC screening. In contrast, based on Indian Health Service (IHS) Government Performance and Results Act (GPRA) data, AI screening rates range from a low of 28% in the Phoenix Area, to 30% in the Albuquerque Area and a high of only 51% in the Oklahoma Area. The AI CRC Screening Consortium was formed by the National Cancer Institute-Designated Cancer Centers at the Universities of Arizona, New Mexico, and Oklahoma to address the major regional CRC screening disparities. The Consortium’s overall objective is to increase CRC screening delivery and uptake in AIs aged 50 to 75 years at average risk for CRC through the implementation of cost-effective multilevel, multicomponent evidence-based interventions (EBIs) across AI populations (on and off tribal lands) in the tri-state region. As part of the planning phase of the project (Year 1), we completed mixed-methods environmental scans (focus group and interviews, and readiness to change surveys) among tribal members and multisector healthcare providers practicing at Indian Health Service (IHS, I), Tribal (T), and Urban Indian (U) (I/T/U) healthcare facilities across the three states. In all, we conducted seven focus groups, 71 interviews, and three surveys at nine I/T/U healthcare facilities. We organized the focus group and interview data according to The Guide to Community Preventive Services (The Community Guide) recommendations for strategies to increase: community demand, community access, and provider delivery of CRC screening. We will provide quotes and summaries underscoring the EBIs and strategies recommended by the multisector healthcare action teams for implementation at their healthcare facilities. We will also describe the establishment of the Consortium and challenges experienced in conducting research with multiple tribal and federal entities and regulatory authorities. The use of community-academic participatory approaches has facilitated bidirectional and mutually beneficial knowledge integration, collaborative inter-dependent partnerships, equity in data ownership, and capacity enhancement. The scope of this project presents an opportunity to reduce CRC incidence and mortality affecting thousands of AIs. Our collaborative work will create opportunities for future research addressing the spectrum of CRC prevention, detection, and treatment in AI populations across the US. Citation Format: Shiraz I Mishra, Mark P Doescher, Jennifer Hatcher, Kevin English, Dorothy Rhoades, Peter Lance, Shane Pankratz, Jessica Blanchard, Nicholas Edwardson, Michelle Hopkins, Andrew Sussman, Zsolt Nagykaldi, Cheyenne Jim. Evidence-based strategies to enhance colorectal cancer screening in American Indian communities [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C120.

The objective of this study was to test the efficacy of a pilot intervention to increase mammography utilization among African-American women recruited from those waiting in the emergency department (ED)for non-urgent complaints. In a 3-armed pilot of a randomized controlled trial we compared the effects of a brief motivational interview delivered by a lay health worker with those of a culturally targeted brochure and a usual care control group. The results showed that one quarter (23%) of the sample reported having never had a mammogram prior to the study. There was no group difference by mammography status at the 3-month interview. More than one quarter of those retained in the study indicated they had received a mammogram during the study (27.4%). The conclusions from the study were that lay health workers are a valuable asset and may be used in innovative settings such as the ED to increase screening among vulnerable populations.

Little is known about the factors that influence health behavior decision-making among people with schizophrenia. The purpose of this qualitative study was to describe the processes used by 10 African-American adults with schizophrenia when making health behavior decisions and identification of perceived barriers and facilitators to health. Three phases of health behavior decision-making were identified: Recognizing Complex Components of Health, Personalizing Components of Health, and Tracking Health Status. Findings may guide clinicians' efforts to improve the health status of patients, as well as influence future research in understanding health behavior decision-making among vulnerable populations.

Purpose: Papanicolau (Pap) screenings disparities exist for immigrant women in the United States. This study sought to have an understanding of factors influencing Pap screening among sub-Saharan African immigrant women. Method: This is a qualitative descriptive study. Women were recruited from the community and by word of mouth following institutional review board approval. Data were gathered through in-depth focus group and demographic questionnaires. Interview sessions were digitally recorded and transcribed verbatim. Transcripts were analyzed for themes. Findings: Twenty-two women aged 24 to 65 years were interviewed. Barriers to screening included low knowledge of screening, cost, cultural beliefs, fear and communication issues. Motivators to improve Pap use include provider’s recommendations, enlightenment, and family support. Discussion: Interventions addressing the barriers peculiar to this population may alleviate these barriers and improve Pap screening use in this population. Providers have the opportunity to influence screening attitudes of African-born women by providing awareness and patient-targeted interventions.

Background: Cervical cancer screening disparity puts sub-Saharan African immigrant women at an increased risk for development of invasive cervical cancer. Several studies have identified various factors influencing cervical cancer screening use among sub-Saharan African immigrants in the United States. One of such factors is the role of spousal support; African men are often the gatekeepers of health for their families and have significant influence on the health-seeking behavior of their wives/female partners. However, limited research exists on men's knowledge and support related to Pap screening. Thus, we conducted a qualitative descriptive study to assess knowledge and support related to Pap screening among sub-Saharan African immigrant men in Lexington, Kentucky. Method: In-depth individual interviews using semistructured guide were conducted with 21 sub-Saharan African immigrant men who were married or in committed relationships. Data were audio recorded, transcribed verbatim, and analyzed using content analysis. Results: The average age of the study participants was 36 ± 9; 53% have lived in the US for more than 5 years; 88% were college educated; 43% make more than $50,000 annually; and 62% were married. General knowledge of Pap screening, cervical cancer, and HPV's role in the etiology of cervical cancer was minimal. Men showed the desire to support their wives/female partners to have a Pap screening. All participants preferred to be carried along and informed about their wives' decision to have a Pap screening in order to provide any support that might be needed. The narratives related to health care providers' gender preference varied among men; several men showed preference for a female health care provider for Pap screening services for their wives/female partners while others showed no preference. Conclusions: These findings underscore the importance of men's support in promoting Pap screening among sub-Saharan African immigrant women. Men should be included in cervical cancer prevention efforts to leverage their support. Thorough understanding of African family dynamics, cultural norms, and values related to preventive health care seeking is essential to the design and implementation of interventions for improving Pap screening among sub-Saharan African immigrant women. Citation Format: Adebola Adegboyega, Jennifer Hatcher. Sub-Saharan African immigrant men's knowledge and support related to cervical cancer screening: A qualitative descriptive study [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C62.

Purpose: To examine the efficacy, acceptability, feasibility, and applicability of a Facebook (FB) intervention designed to reduce multiple colorectal cancer (CRC) risk factors in older adults residing in rural Appalachian Kentucky. Methods: We piloted a 12 week FB intervention culturally tailored for older adults residing in rural Eastern Kentucky to impact CRC risk factors, including: nutrition, physical activity, and screening. Participants were aged 50+, had internet access, and were at risk for CRC. During the 12 week study, the participants received three daily posts via secret FB group regarding CRC risk factors. Demographics, dietary measures, body mass index (BMI), and CRC screening were assessed at baseline and post intervention. FB engagement and physical activity were tracked throughout the intervention. Dietary measures included the Healthy Eating Index (HEI) and Dietary Inflammatory Index (DII). Physical activity was tracked using Fitbits. Post-intervention focus group interviews were conducted to assess feasibility and acceptability. Results: Participants (n = 57) were Caucasian, aged 58 ± 6 years, predominately female (67%), and the majority reported at least a high school education (77%). Post intervention, participants experienced significant increase in HEI scores (49.94 ± 9.84 vs. 58.60 ± 12.06, P = < 0.01). DII scores significantly decreased (2.44 ±1.12 vs. 1.60 ± 1.63, P = 0.003). There was no significant change in physical activity, BMI, or screening status. Participants, on average, viewed more than half of the posts. Focus group participants found FB posts to be useful and motivating. They reported that FB posts were educational and motivational. Conclusion: This pilot study shows promising preliminary data to support using a FB intervention in rural Appalachian older adults to decrease CRC risks. Participants were receptive to FB intervention, and FB provides a unique and accessible method for health promotion in hard to reach populations.

Context:Decades of behavioral research suggest that awareness of health threats is a necessary precursor to engage in health promotion and disease prevention, findings that can be extended to the community level. Purpose: We sought to better understand local perspectives on the main health concerns of rural Appalachian communities in order to identify the key health priorities. While Kentucky Appalachian communities are often described as suffering from substandard health, resource, and socioeconomic indicators, strong traditions of community mobilization make possible positive, home-grown change. Methods: To assess what women, the key health gatekeepers, perceive as the most significant health threats to their rural communities, 10 focus groups were held with 52 Appalachian women from diverse socioeconomic backgrounds. Tape-recorded narratives were content analyzed and a codebook was developed. Measures designed to increase data trustworthiness included member checks, negative case evidence, and multiple coding. Findings: The following rank-ordered conditions emerged as posing the greatest threat to the health of rural Appalachian communities: (1) drug abuse/medication dependence; (2) cancer; (3) heart disease and diabetes (tied); (4) smoking; (5) poor diet/overweight; (6) lack of exercise; and (7) communicable diseases. These health threats were described as specific to the local environment, deriving from broad ecological problems and were connected to one another. Conclusion: Drawing on participants' community-relevant suggestions, we suggest ways in which rural communities may begin to confront these health concerns. These suggestions range from modest, individual-level changes to broader structural-level recommendations.

This article critically reviews the state of measurement of self-esteem in African American women. The Rosenberg Self-Esteem Scale, the Tennessee Self-Concept Scale, and the Coopersmith Self-Esteem Inventory are three commonly used measures. However, their validity for African American women has not been adequately tested. Given the unique nature of the self-esteem of this group, related to experiences of racism and sexism, the accurate measurement of this construct is important. This review provided support for the internal consistency of each measure with alpha coefficients ranging from .74 to .87. However, the validity of the measures was not fully supported. Suggestions for further research specific to the unique needs of this population are discussed.

Backgrounds: African American women have a higher mortality rate from breast cancer than any other ethnic group in the country, with an estimated 30,700 new cases of invasive breast cancer and 6,310 deaths expected to occur in 2016. In part the disparate breast cancer mortality rate suffered by African American women can be attributed to irregular mammography screening patterns, which contribute to later stages of diagnosis as compared with other racial ethnic groups. Regular mammography screening may significantly reduce breast cancer mortality and narrow this disparity; however, African American women underutilize mammography screening according to goals set by Healthy People 2020. The purpose of this paper is to identify factors influencing regular breast cancer screening among African American women. Method: In-depth individual interviews were conducted with 39 African-American women, ranging in age from 42 to 79, who visited the ED of a public hospital with non-urgent complaints and those who were seated in the waiting area. Using qualitative analysis we identified Perceptions (individually held knowledge, attitudes, values or beliefs), Enablers (societal, systematic or structural influences) and Nurturers (supportive or discouraging influences from significant others) that influenced screening decisions. The sample included women who had been screened in the past two years and those who had not. Using the PEN-3 as a theoretical guide we explored, from the perception of the women, the factors that influence screening behaviors. Findings: The themes that emerged were placed within the appropriate cells (perceptions, enablers or nurturers) in the PEN-3 framework. The findings indicated that women's perceptions included fear of pain associated with mammography, fear of results, and fear of the unknown, fatalistic beliefs, and limited knowledge of personal risk for breast cancer. The only difference between the perceptions of women who had screened in the past two years and never screened women was knowledge. Women who had been screened in the past two years had more knowledge of mammography procedure and endorsed perceptions such as screening provides reassurance and maintenance of good health. Enablers identified included cost, access, gender and attitudes of the mammography provider, socioeconomic and race related discrimination, and previous experiences within the healthcare system. Previously screened women were more likely to have a source of insurance but both screened and unscreened women discussed financial burden associated with screening. Participants in both screened and unscreened groups emphasized the fact that their previous experiences within the healthcare influenced screening decisions. Nurturers identified included observations of family member's experiences with cancer, lack of health-related social support and shared mammography experiences within participants' social network. Women who receive encouraging feedback about mammography from their social network are more likely to have been screened. Conclusion: African American women suffer a significant disparity of breast cancer mortality as compared to other women in the U.S. Despite improvements in access, related to the enactment of the Affordable Care Act, this disparity persists. This study explores the influences on the decisions related to regular mammography screening from the perspective of African American women. The findings from this study underscore the critical need for development of culturally tailored interventions that address the issues salient to this population as well as interventions that leverage the powerful social networks that influence health care decisions in this population. Citation Format: Adebola Adegboyega, Arica Brandford, Jennifer Hatcher. Repeat mammography screening among African American women: Qualitative application of the PEN-3 framework. [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 C57.

Objective: To provide a conceptual description of an Emergency Department (ED) placed randomized controlled trial designed to reduce the disproportionate burden of colorectal cancer (CRC) among rural Appalachian residents. Background: Residents of rural Appalachia have a higher incidence and mortality rate from CRC than residents of any other region of the country. The Centers for Disease estimate that as many as 60% of CRC deaths could be prevented if everyone aged 50 and up were screened regularly. One of the primary barriers to CRC screening for rural Appalachian residents is limited access to the health care system resulting in infrequent recommendations for screening and inadequate screening education. Given the propensity of rural Appalachians to accept health related information from trusted community members we designed an intervention to be delivered by local community health workers in the ED while individuals waited for non urgent care or waited with a family member. The ED provides services to a segment of the population that is traditionally hard to reach and at high risk for underutilization of preventive services. ED visits may be the sole point of contact with the health care system for these vulnerable individuals and provides a venue and opportunity for CRC screening promotion and education. Methods: This ED-placed RCT, designed and implemented in collaboration with community members and health care providers in rural Eastern Kentucky, is one of the first to use the ED as a site to promote colorectal cancer screening using a community health worker trained to deliver a motivational interviewing intervention to persons waiting for non urgent care or with a family member, in the ED of rural Appalachian hospitals. Results: We provide a conceptual overview to key elements of the intervention, including intervention development and refinement, theoretical foundations, intervention approach and implementation and evaluation procedures. Conclusion: This RCT has recruited more than 150 persons from rural Appalachian EDs who have not been screened for CRC in accordance with guidelines. It provides promise that CRC screening promotion activities are appropriately placed in rural EDs and provides a solid platform from which researchers and providers may launch efforts to develop targeted preventative health interventions in innovative public health settings. Citation Format: Jennifer Hatcher, Arica Brandford, Adaeze Aroh, Adebola Adegboyega, Brenda Combs, Nancy Schoenberg. Promoting colorectal cancer screening in rural Appalachian emergency department. [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 C65.

Introduction One in 8 US women will develop invasive breast cancer in their lifetime. Despite evidence that mammography is an effective method of early detection, certain vulnerable groups, such as those using the emergency department as a medical home, do not adhere to mammography screening guidelines, and suffer disparate mortality from breast cancer. The purpose of this study was to investigate differences in beliefs regarding mammography screening among women attending the emergency department for nonurgent care and ultimately to develop interventions that promote mammography for this vulnerable population. Methods We explored the relationship between stage of readiness to adopt mammography behavior and barriers, benefits, and perceived susceptibility by administering scales for risk, benefits, and barriers to a sample of 110 women who had presented to the emergency department of a public hospital for nonurgent complaints or were seated in the ED waiting room. We also collected sociodemographic information and stage of readiness. Results Mammography adherence was about 60%. Most women who were not compliant with current guidelines were contemplators. Those who were not contemplating being screened were significantly less likely to perceive themselves to be at risk of getting breast cancer. Women who had more barriers to mammography perceived less benefit from having a mammogram. African American women perceived less benefit from having a mammogram. Discussion Mammography promotion is appropriately placed in the ED waiting room given the suboptimal rate at which this population is being screened. Beliefs regarding mammography differ for women in various stages of mammography adoption and for minority women. Understanding these differences will allow intervention in this setting to be tailored to the population. ED nurses are an important and sometimes sole point of health care contact for patients who routinely visit the emergency department. As such, they have a valuable opportunity to provide cancer screening promotion messages. It is critical that nurses in this setting understand the complexities of delivering this information and the need to do so.

Faith Moves Mountains assessed the effectiveness of a faith-placed lay health advisor (LHA) intervention to increase Papanicolaou (Pap) test use among middle-aged and older women in a region disproportionately affected by cervical cancer and low screening rates (regionally, only 68% screened in prior 3 years).This community-based RCT was conducted in four Appalachian Kentucky counties (December 2005-June 2008). Women aged 40-64 and overdue for screening were recruited from churches and individually randomized to treatment (n=176) or wait-list control (n=169). The intervention provided LHA home visits and newsletters addressing barriers to screening. Self-reported Pap test receipt was the primary outcome.Intention-to-treat analyses revealed that treatment group participants (17.6% screened) had over twice the odds of wait-list controls (11.2% screened) of reporting Pap test receipt post-intervention, OR=2.56, 95% CI: 1.03-6.38, p=0.04. Independent of group, recently screened participants (last Pap1 but5 years ago) had significantly higher odds of obtaining screening during the study than rarely or never screened participants (last Pap ≥5 years ago), OR=2.50, 95% CI: 1.48-4.25, p=0.001.The intervention was associated with increased cervical cancer screening. The faith-placed LHA addressing barriers comprises a novel approach to reducing cervical cancer disparities among Appalachian women.

Colorectal cancer (CRC) is 1 of the leading causes of cancer-related deaths among residents of rural Appalachia. Rates of guideline-consistent CRC screening in Appalachian Kentucky are suboptimal.This study sought to determine the relationship between CRC screening knowledge, specifically regarding recommended screening intervals, and receipt of screening among residents of rural Appalachian Kentucky.Residents of Appalachian Kentucky (n = 1096) between the ages of 50 and 76 years completed a telephone survey including questions on demographics, health history, and knowledge about CRC screening between November 20, 2009, and April 22, 2010.Although 67% of respondents indicated receiving screenings according to guidelines, respondents also demonstrated significant knowledge deficiencies about screening recommendations. Nearly half of respondents were unable to identify the recommended screening frequency for any of the CRC screening modalities. Accuracy about the recommended frequency of screening was positively associated with screening adherence.Enhanced educational approaches have the potential to increase CRC screening adherence in this population and reduce cancer mortality in this underserved region.Nurses play a critical role in patient education, which ultimately may increase screening rates. To fulfill this role, nurses should incorporate current recommendation about CRC screening into educational sessions. Advanced practices nurses in rural settings should also be aware of the increased vulnerability of their patient population and develop strategies to enhance awareness about CRC and the accompanying screening tests.

This paper reports findings from a qualitative study that explored the attitudes and beliefs concerning colorectal cancer screening (CRC) among patients and health care providers in Appalachian Kentucky. We report results from five focus groups; three with primary care providers and two with patients. Providers discussed patient characteristics, financial issues and health care delivery system factors as challenges to screening. Participants reported fear, embarrassment, financial issues, lack of perceived need, qualities of the test, lack of provider recommendation, and health care delivery barriers. Although there were some areas of agreement, there are marked differences between the perceptions of Appalachian health care providers and participants regarding colorectal cancer screening. This paper compares and contrasts those perceptions and provides suggestions for culturally competent practice and culturally relevant research to improve CRC screening in this vulnerable population.

Rural Appalachian women bear a disproportionate burden from many types of cancer yet often are underrepresented in cancer research. This article uses 2 case studies to illustrate barriers faced and strategies used when recruiting hard-to-reach rural participants. Recruitment barriers include the population's competing demands and lack of trust of outsiders. Strategies employed include involving insider advocates, highlighting the positive experiences of early participants, spending extensive time in the community, and emphasizing potential community benefits of the study. We suggest recruitment strategies to better involve rural women and others who, by virtue of being "hard-to-reach," often are overlooked.

Women who have not had a Papanicolaou (Pap) test in five years or more are at increased risk for developing invasive cervical cancer (ICC), 1 as one of the most common risk factors for this type of cancer is a deficient screening history.2 Pap smear screening can detect precancerous lesions which may be treated effectively and can result in the prevention of cancer development. The American Cancer Society1 reports that 60–80% of women newly diagnosed with ICC had not received a Pap test in the previous five years. Indeed, ICC is nearly completely preventable if screenings are consistent with established recommendations. Despite these encouraging facts, cervical cancer screening rates remain at less than optimal levels. Studies have shown that certain women, including minorities and low-income women, are less likely than other groups to be screened for cervical cancer and less likely to be diagnosed at early and more treatable stages of cancer.3–6 Lack of a regular care provider, absence of provider’s recommendation, high cost of health care/insurance, inconvenience, inadequate English proficiency, and lack of social support have been identified as barriers to timely screening among many of these women.4, 7–9 Although cervical cancer mortality has decreased over recent decades, certain groups continue to experience a greater burden from ICC. Like other groups of historically underserved women, Appalachian women have a lower prevalence of Pap testing and a higher rate of ICC than women in other parts of the United States.5, 10 Appalachian Kentucky has an ICC incidence rate (15.0/100,000) approximately 67% above the national average (9.0/100,000).11,12 At particularly elevated risk are those who are rarely- or never-screened, operationalized as those who have not had a Pap test in the previous five years or more, or ever, in their lifetimes. Since these rarely- or never-screened women are at the highest risk for developing ICC, they constitute an important target for screening interventions to reduce the incidence of ICC in Appalachian Kentucky. Several studies have examined the determinants of cervical cancer screening among Appalachian women. These studies have elucidated screening barriers that include the health care system (i.e., availability of services, cost of care), the environmental or community context, and individuals’ characteristics.13 For example, the Appalachian region struggles to maintain an adequate supply of health care professionals. 14 This endemic shortage makes access to preventive health care a challenge for Appalachian women, directly contributing to lower screening rates than are reported nationally.15 Environmental and community factors thwarting screening include poverty, lack of transportation, and low rates of adequate health insurance.16 Finally, individual characteristics, including culturally-based beliefs and inadequate knowledge, may exert a strong influence on the receipt of Pap tests. For example, some researchers have posited that culturally-based beliefs like fatalism undermine Pap tests and other cancer screening 17, Schoenberg and colleagues18 found that middle-aged and older Appalachian women may not receive Pap tests due to a constellation of these factors, including lack of regular reproductive health care, competing demands, and uncertainty about screening recommendations, given the change from one to two year screening interval recommendations and ambiguity about the ages at which to start and stop screening. Although these insights are essential to stem elevated rates of ICC, one limitation of most existing research is a nearly exclusive focus on women who have not been screened within the previous five years. Since the risk of ICC becomes much higher for women unscreened for five or more years, critical information is lacking on a most susceptible subgroup: Appalachian women who have not been screened in five years or more, or ever in their lifetimes.1 The purpose of this paper is to address this gap in knowledge regarding cervical screening behaviors by conducting an analysis of baseline data from a community-based intervention trial, Faith Moves Mountains, which aimed to increase Pap test use among Appalachian women who were out of compliance with screening recommendations. 19 The current analysis examined the unique sociodemographic and personal characteristics that predicted belonging to the group of rarely- or never-screened Appalachian women (i.e., last Pap test five or more years ago, or never), compared with the group of more recently-screened women (i.e., last Pap test more than 12 months but less than five years ago). Rarely- or never-screened women often are considered “hard to reach” and therefore have not been included in studies of barriers to cervical cancer screening. This study compares the characteristics of the more recently-screened women typically examined in the literature with those who are much more vulnerable to developing cervical cancer: rarely- or never-screened women. Identification of predictors of belonging to the rarely- or never-screened group may guide the development of intervention and policy strategies targeted toward this high-need population.

The Rosenberg Self-Esteem (RSE) Scale is a commonly used measure of global self-esteem, an important element of mental health. The purpose of this cross sectional secondary analysis was to examine the psychometric properties of the scale in a sample of 98 African American single mothers. The RSE Scale showed adequate internal consistency with an alpha coefficient of .83. Two factors that accounted for a total of 54.7% of the variance were extracted. Self-esteem showed a strong negative relationship with both depressive symptoms and negative thinking. This study provides support for the internal consistency of the RSE Scale and partial support for its construct validity in this population. The RSE appears to represent a bidimensional construct of self-esteem for African American women, with the cultural influences of racial esteem and the rejection of negative stereotypes forming a separate and distinct aspect of this concept. The RSE Scale should be used and interpreted with caution in this population given these findings.

OBJECTIVE To provide a conceptual description of Faith Moves Mountains (FMM), an intervention designed to reduce the disproportionate burden of cervical cancer among Appalachian women. METHODS FMM, a community-based participatory research program designed and implemented in collaboration with churches in rural, southeastern Kentucky, aims to increase cervical cancer screening (Pap tests) through a multiphase process of educational programming and lay health counseling. RESULTS We provide a conceptual overview to key elements of the intervention, including programmatic development, theoretical basis, intervention approach and implementation, and evaluation procedures. CONCLUSIONS After numerous modifications, FMM has recruited and retained over 400 women, 30 churches, and has become a change agent in the community.

Screening mammography is the single most effective method of early detection of breast cancer however mammography rates in America remain suboptimal among certain groups of women. African American women are one of those groups, experiencing high mortality rates and low rates of screening as compared to other ethnic groups. One of the factors related to inadequate screening is fear. Fear has been associated with participation in screening, however it is a concept that has been poorly explored within the context of culture. This report examined how African American women, who had been seen in the emergency department for non urgent complaints, describe their fear and its impact on their breast cancer screening patterns. Semi-structured interviews were used to gather data from 35 African American women, both screened and unscreened, between 2008 and 2010. Interview transcripts were analyzed and recurrent themes and patterns were identified. Most women expressed fear regarding cancer screening in some way, either fear of pain, fear of the unknown, or fear of finding out that something is wrong. This fear could be either a motivator or a barrier to mammography. This report illuminates that fear in the context of the other barriers and benefits to mammography experienced by these women. These findings will be important in the design of culturally relevant interventions that address the ongoing issue of inadequate screening mammography among African American women. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B46.