Cancer Screening In African Americans Research Articles

Are Contemporary Interventions Effectively Lowering Barriers to Colorectal Cancer Screening in African Americans?

Are Contemporary Interventions Effectively Lowering Barriers to Colorectal Cancer Screening in African Americans?

Is there evidence to start colorectal cancer screening in African Americans before the standard guideline age?

Is there evidence to start colorectal cancer screening in African Americans before the standard guideline age?

Databases for Gastrointestinal Clinical and Public Health Research: Have Database, Will Research

Databases for Gastrointestinal Clinical and Public Health Research: Have Database, Will Research

Colorectal cancer screening in African Americans: are we following the guidelines?

The age at onset, incidence, and mortality rate of colorectal cancer varies among racial groups being highest in African Americans. This increased risk led to the recommendation to begin screening at the age of 45years. Whether the recommendation for screening of African Americans at an earlier age was implemented is unknown. We used data from the Cancer Control Supplement of National Health Interview Survey (NHIS) conducted in the years 2005, 2010, and 2015 to analyze demographic data and use of colorectal screening (colonoscopy, stool heme testing, sigmoidoscopy, computed tomographic colonography) among the US population between the ages of 45-49years. Data on colorectal screening was available from 6740 individuals; 16.5% were African Americans. Screening test use among African Americans in 2005, 2010, and 2015 was similar to use in Whites (i.e., 15.4% (95% CI 11.4-19.4), 28.4% (95% CI 19.3-30.4) and 20.2% (95% CI 14.8-25.5) vs. 16.9% (95% CI 15.1-18.6), 19.3% (95% CI 16.9-21.7), and 21.4% (95% CI 18.6-24.2) in 2005, 2010 and 2015, respectively. Observed screening test use rates may largely be accounted for by diagnostic exams. The recommendation for earlier colorectal screening of African Americans has not yet resulted in increased test utilization. These results emphasize the need for multidisciplinary actions to inform and implement public health policy.

Barriers Driving Racial Disparities in Colorectal Cancer Screening in African Americans.

Colorectal cancer screening has been shown to decrease mortality from colorectal cancer. Screening disparities continue to exist among ethnic minorities, particularly for African Americans. We herein review the barriers of colorectal cancer screening in this population. At its foundation are patient barriers, which are further compounded by physician-related barriers and the idiosyncrasies of the healthcare system. Interventions to address the barriers include patient outreach, provider education, and healthcare legislation addressing financial barriers. Recent research has focused on factors predicting intentions to undergo colorectal cancer screening. Underlying all of the barriers is the systemic racism that affects and influences the healthcare system as much as all other institutions and contributes to inequities in the delivery of effective cancer prevention efforts. Perpetual disparities in CRC screening within the African American community are due to multifactorial barriers from the individual patient to provider and healthcare system and societal influences. An awareness of the behavioral and systemic factors that affect African Americans must underpin efforts to reach full equity in delivering CRC screening to this often medically underserved segment of our society.

Systematic Review of Interventions to Increase Stool Blood Colorectal Cancer Screening in African Americans.

African Americans experience colorectal cancer (CRC) related disparities compared to other racial groups in the United States. African Americans are frequently diagnosed with CRC at a later stage, screening is underutilized, and mortality rates are highest in this group. This systematic review focused on intervention studies using stool blood CRC screening among African Americans in primary care and community settings. Given wide accessibility, low cost, and ease of dissemination of stool-based CRC screening tests, this review aims to determine effective interventions to improve participation rates. This systematic review included intervention studies published between January 1, 2000 and March 16, 2019. After reviewing an initial search of 650 studies, 11 studies were eventually included in this review. The included studies were studies conducted in community and clinical settings, using both inreach and outreach strategies to increase CRC screening. For each study, an unadjusted odds ratio (OR) for the CRC screening intervention compared to the control arm was calculated based on the data in each study to report effectiveness. The eleven studies together recruited a total of 3334 participants. The five studies using two-arm experimental designs ranged in effectiveness with ORs ranging from 1.1 to 13.0 using interventions such as mailed reminders, patient navigation, and tailored educational materials. Effective strategies to increase stool blood testing included mailed stool blood tests augmented by patient navigation, tailored educational materials, and follow-up calls or mailings to increase trust in the patient-provider relationship. More studies are needed on stool blood testing interventions to determine effectiveness in this population.

Abstract C68: Addressing negative cognitive and affective factors to increase colorectal cancer screening for African Americans

Abstract Introduction/Background: Given the lower colorectal cancer (CRC) screening rates and higher mortality for African Americans in the U.S., there is a critical need for effective interventions–especially at the community level (due to lower physician referrals)--to encourage appropriate CRC screening. Prior research on decision making for CRC screening has shown that both cognitive (e.g., expected utility beliefs) and affective factors (e.g., embarassment, fear, disgust about screening tests) influence screening behavior and intentions. The purpose of this study was to test the effectiveness of a community-based intervention to address cognitive and affective determinants of screening in order to positively influence behavior change and increase CRC screening. This presentation reports the contextual factors reported in interviews in response to the educational program and video that influenced the understanding and behavior change of participants to seek CRC screening. Methods: This study used a randomized experimental design with pre-post assessments of key dependent variables, plus qualitative interviews of a subsample of participants at one-week and six-months post intervention. African American male and female participants >50 years of age from Buffalo and New York, New York were randomized by program session to receive either a one-time, narrative communication or fact-based, didactic video and educational session about CRC and screening using colonoscopy. Qualitative findings were organized and analyzed using NVivo and the PEN-3 framework. Results: A total of 333 study eligible African Amercian men and women from the two sites were randomized, and 1-week (n=39) and 6-month (n=26) interviews were completed. There were no significant demographic or screening intention differences in this qualitative sample between attendees of the didactic (n=31) and narrative (n=34) programs at baseline. Reported changes in awareness and feelings about colonoscopy in response to the videos demonstrated positive influences on the “Perceptions,” affective associations, and cognitive factors related to colonoscopy with the highest number (30 v. 23 responses) and the most dramatic responses reported by participants in the Narrative Communication video sessions. Participant responses in the Narrative group included discussion of how the video and program increased comfort level with the test; reduced anxiety, fear, and stress related to the test; increased understanding of the test itself, why and how it is done; and provided a basis for understanding how colonoscopy actually prevents CRC. Presentation of response examples within the PEN-3 framework will elucidate how qualities in the videos may have served to change and influence participants' feelings and knowledge to positively impact CRC screening. Conclusion: Discourse analysis findings from this study suggest that this community-based intervention using culturally targeted, racially concordant videos is an effective tool to convert existing negative cognitive and affective factors that are recognized barriers to CRC screening. Pertinent to these findings, prior baseline analysis (manuscript under review) of the total study sample showed greater need to address knowledge, perceived benefits, and negative feelings about colonoscopy, particularly among African Americans with lower income and education. Therefore, these qualitative findings further support and explain how the video and educational intervention, especially the narrative video, may be especially impactful in addressing social determinants of screening disparities among less educated and lower income African Americans. Citation Format: Deborah O. Erwin, Marc Kiviniemi, Lynne Klasko, Elisa M. Rodriguez, Frances G. Saad-Harfouche, Erin Ellis, Lina Jandorf. Addressing negative cognitive and affective factors to increase colorectal cancer screening for African Americans [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 C68.

Abstract C15: Increasing cancer prevention education and cancer screening in African Americans through a cancer health ministry

Abstract Objectives: 1. To assess church's ability to increase screening and awareness for different cancers 2. To describe how one church was able to create cancer screening opportunities for their community Background: It has been documented that faith-based health programs are capable of producing positive results in health education and cancer prevention. With a little more than half of the African American population reporting church attendance at least once a week, church health ministries are capable of having a strong impact on cancer prevention. While many churches have wellness ministries, the presence of a cancer ministry is often overlooked. Having a cancer ministry can help increase participation in cancer prevention, cancer awareness, and screening in the African American community. Introduction: Fallbrook Church is a local African American church in the northern part of Houston, Texas. The church boast a membership of over 7,000 and holds two worships services every week. Although Fallbrook has an established wellness ministry, a motivated survivor wanted to start a cancer ministry based on her own experience with diagnosis and treatment. The member reached out to the Faith Health and Family Collaborative at MD Anderson Cancer Center for support in developing a cancer ministry. Methods: The National Outreach Network Community Health Educator met with the Combat Ready Cancer Ministry to plan events and identify community partners who could assist with screening and education. After meeting with the group and sharing different resources that were available from MD Anderson Cancer Center and other community partners, the ministry was able to not only focus on being a support group for members who were diagnosed with cancer, but also schedule four prevention and education events for the 2017 calendar year. Results: The first event focused on oral cancer. The event featured a local dentistry office that was able to perform oral exams and educate participants on oral cancer. The event was attended by 42 participants. The second event focused on colorectal cancer and featured the National Cancer Institute's Screen to Save initiative. This event featured a presentation from the NON CHE at MD Anderson Cancer Center, a walk-through adventure colon, and an opportunity to receive a free FOBT kit for early detection of colorectal cancer. The event had more than 200 attendees and 25 people participated in the City of Houston's Colorectal Cancer Awareness Program to receive free FOBT kits. Their third event focused on prostate cancer, a cancer that affects more African American men than any other ethnic group. This event featured education from a local urologist and an opportunity to get a free PSA test for prostate cancer detection. Seventy-two men attended the event and 86% of the men received free PSA screenings. The group's fourth event is scheduled for November and will focus on providing onsite mammograms for members of the church. The cancer ministry partnered with The Rose (local mammography and diagnostic imaging center). This partner will perform onsite mammograms, and for every two insured participants The Rose will provide one free mammogram. Discussion: Cancer health disparities continue to be an issue in the United States. The African American church has proven to be a great tool to help reach many of our underserved communities. Creating a ministry that focuses on cancer and connecting the ministry to resources provides the opportunity to increase education, awareness, and screening for many of the cancers that affect African Americans more than other ethnic groups. Citation Format: Terrence R. Adams. Increasing cancer prevention education and cancer screening in African Americans through a cancer health ministry [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 C15.

Designing a randomized controlled trial to evaluate a community-based narrative intervention for improving colorectal cancer screening for African Americans

ObjectiveTo describe the methodology of a 2-arm randomized controlled trial that compared the effects of a narrative and didactic version of the Witness CARES (Community Awareness, Reach, & Empowerment for Screening) intervention on colorectal cancer screening behavior among African Americans, as well as the cognitive and affective determinants of screening. MethodsWitness CARES targeted cognitive and affective predictors of screening using a culturally competent, community-based, narrative or didactic communication approach. New and existing community partners were recruited in two New York sites. Group randomization allocated programs to the narrative or didactic arm. Five phases of data collection were conducted: baseline, post-intervention, three-month, six-month, and qualitative interviews. The primary outcome was screening behavior; secondary outcomes included cognitive and affective determinants of screening. ResultsA total of 183 programs were conducted for 2655 attendees. Of these attendees, 19.4% (N=516) across 158 programs (50% narrative; 50% didactic) were study-eligible and consented to participate. Half (45.6%) of the programs were delivered to new community partners and 34.8% were delivered at faith-based organizations. Mean age of the total sample was 64.7years and 75.4% were female. ConclusionThe planned number of programs was delivered, but the proportion of study-eligible attendees was lower than predicted. This community-based participatory research approach was largely successful in involving the community served in the development and implementation of the intervention and study.

Early Experience in Lung Cancer Screening in African Americans

Early Experience in Lung Cancer Screening in African Americans

Social networks as predictors of colorectal cancer screening in African Americans.

BackgroundEarly detection can reduce colorectal cancer (CRC) mortality by 15%–33%, and screening is widely recommended for average-risk adults beginning at age 50 years. Colorectal cancer mortality rates are higher in African Americans than in whites, while screening rates are somewhat lower. Individual social networks can reduce emotional and/or logistical barriers to health-promoting but distasteful procedures such as CRC screening. The aim of this study was to examine social network interactions, and their impact on CRC screening among African Americans. We hypothesized a positive association between social network index (SNI) scores and CRC screening.MethodsIn a community intervention trial with four arms, we previously demonstrated the efficacy of a small group educational intervention to promote CRC screening among African Americans. This intervention outperformed a one-on-one educational intervention, a reduced out-of-pocket expense intervention, and a control condition. In the present analysis, we compared the SNI scores for participants in the small group intervention cohort with a comparison group comprised of the other three cohorts. Social networks were assessed using the Social Network Index developed by Cohen.ResultsSmall group participants had a significantly higher network diversity score (Mean difference 0.71; 95% CI, 0.12–1.31; p=0.0017) than the comparison group. In the second component of the SNI score – the number of people talked to over a two week period – the small group intervention cohort also scored significantly higher than the comparison group. (Mean difference, 9.29; 95% CI, 3.963–14.6266; p=0.0004).ConclusionsThe findings suggest that social interaction and support was at least partially responsible for the relatively high post-intervention screening rate in the small group intervention participants. Education in small groups could foster strong social networks. Strong and positive network diversity and a large number of people in social networks may enhance CRC screening rates among African Americans.

Colorectal cancer screening in African Americans: practice patterns in the United States. Are we doing enough?

Background: Colorectal cancer (CRC) is a common form of malignancy and a leading cause of death in the United States. Screening decreases CRC incidence and mortality. African Americans are at an increased risk of developing CRC, and recommendations are to initiate screening at the age of 45. This study aims to assess the rate of screening for colorectal cancer in African Americans between the ages of 45–49.Methods: African Americans between the ages of 45–49 were identified in the Explorys national database. Patients who completed a colonoscopy, sigmoidoscopy or fecal occult blood test were identified and stratified by sex and insurance status. A P value < 0.05 was considered significant.Results: A total of 181 200 African Americans were identified as eligible for screening. Only 31 480 patients (17.4%) received at least one screening procedure for CRC. The majority of patients (66.7%) were screened via colonoscopy. African American females were more likely to complete a screening test (17.8% vs 16.7%; P < 0.01). The majority of patients (66.0%) who completed a screening test had private insurance.Conclusion: Race, gender and barriers to medical care contribute to disparities in CRC screening rates. Among African Americans, CRC screening remains suboptimal. Tailored public health initiatives, medical record alerts and improved communication between providers and patients are fundamental to addressing issues that impact poor adherence to CRC screening in African Americans.

Abstract B94: Social networks as predictors of colorectal cancer screening in African Americans

Abstract Background: Early detection can reduce colorectal cancer (CRC) mortality by 15%–33%, and screening is widely recommended for average-risk adults beginning at age 50 years. However, African Americans have disproportionately low screening rates compared to whites. Factors that seem to facilitate CRC screening include higher income, higher education, older age, and male sex, strong social ties and supportive relationships. Individual social networks reduce emotional and/or logistical barriers to colorectal cancer screening participation. The aim of this study was to examine social network interactions, and its impact on colorectal cancer screening among African Americans. We hypothesized that a positive association is expected between social network index scores and colorectal cancer screening. Methods: Our preliminary published literature (Blumenthal Daniel S; Smith Selina A; Majett Charlye D; Alema-Mensah Ernest. A trial of 3 interventions to promote colorectal cancer screening in African Americans. Cancer, Feb2010;116(4): 922-9) showed that small groups (4-15 participants trained with CRC educational resources from the National Cancer Institute and the American Cancer Society) were significantly more likely to have CRC screening. Three hundred sixty-nine African-American men and women aged 50 years and above were enrolled in this randomized, controlled community intervention trial. Social networks were assessed using the Social Network Index (SNI) based on the index developed by Berkman (1979) [28]. The SNI consists of four domains: marriage or partnership, friends and relatives, religious activity, and voluntary associations. Categories were scored as follows: married (married = 1, widowed, divorced, separated, or never married = 0); contact with friends and relatives (≥156 contacts per year = 1, &amp;lt;156 contacts per year = 0); frequency of church or religious service attendance (attended four or more services per year = 1, attended less than four = 0); group (such as church groups, unions, fraternal or athletic groups, or school groups) participation (yes = 1, no = 0). Scores were summed for the four dichotomized variables with a range of 0 to 4. Scores of 0 and 1 indicate the fewest ties and a score of 4 the most ties. Cronbach's alpha for the SNI scale was 0.25 in this study. Descriptive statistics and bivariate analyses were run. T-test statistics was used to determine differences between the small group (intervention) and other groups (control, financial incentive and one on one). Results: There was a statistically significant difference in the network diversity among the groups. Small group participants had a higher network diversity score (Mean difference 0.71; 95% CI, 0.12-1.31; p=0.0017) compared to the other groups. Total number of people in social network score was significantly higher among the small group than the other groups (Mean difference, 9.29; 95% CI, 3.96-14.62; p=0.0004). Conclusions: Group education in small groups could foster strong social networks which may improve CRC screening rates among African Americans. Strong and positive network diversity and optimal number of people in social networks may enhance CRC screening rates. However, the screening rate of less than 35% in a group of individuals who participated in an educational program through multiple sessions over a period of several weeks indicated that there still are barriers to overcome. Citation Format: Ernest Alema-Mensah, Selina Smith, Mechelle Claridy, Victor Ede, Benjamin Ansa, Daniel Blumenthal. Social networks as predictors of colorectal cancer screening in African Americans. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B94.

Addressing Low Colorectal Cancer Screening in African Americans: Using Focus Groups to Inform the Development of Effective Interventions.

African Americans have the highest burden of colorectal cancer (CRC) in the United States of America (USA) yet lower CRC screening rates than whites. Although poor screening has prompted efforts to increase screening uptake, there is a persistent need to develop public health interventions in partnership with the African American community. The aim of this study was to conduct focus groups with African Americans to determine preferences for the content and mode of dissemination of culturally tailored CRC screening interventions. In June 2013, 45-75-year-old African Americans were recruited through online advertisements and from an urban Veterans Affairs system to create four focus groups. A semi-structured interview script employing open-ended elicitation was used, and transcripts were analyzed using ATLAS.ti software to code and group data into a concept network. A total of 38 participants (mean age = 54) were enrolled, and 59 ATLAS.ti codes were generated. Commonly reported barriers to screening included perceived invasiveness of colonoscopy, fear of pain, and financial concerns. Facilitators included poor diet/health and desire to prevent CRC. Common sources of health information included media and medical providers. CRC screening information was commonly obtained from medical personnel or media. Participants suggested dissemination of CRC screening education through commercials, billboards, influential African American public figures, Internet, and radio. Participants suggested future interventions include culturally specific information, including details about increased risk, accessing care, and dispelling of myths. Public health interventions to improve CRC screening among African Americans should employ media outlets, emphasize increased risk among African Americans, and address race-specific barriers. Specific recommendations are presented for developing future interventions.

Abstract PC01-01: Colorectal cancer screening for African Americans: Should we be screening at an earlier age? The Pro side

Abstract Colorectal cancer is the second leading cause of cancer mortality in the United States, and there are seven tests recommended for its screening to help detect cancer and/or its precursors at an early stage. Major risk factors for colorectal cancer are age, family history, and race. Surveillance, Epidemiology, and End Results (SEER) data consistently show that in the United States that Blacks have the highest incidence of and highest mortality from colorectal cancer, compared to Whites, Native Americans, Hispanic Americans, and Asian Americans. Blacks, when compared to Whites, tend to present at advance stages of colorectal cancer, and have poorer survival at all stages. There are a number of theories and potentially contributing factors to cause this disparity, including socio-economic, insurance, and education differences, access to medical care, the use of colorectal cancer screening methods, types of diet, obesity and physical activity, use of tobacco products, use of NSAIDs and hormone replacement therapy, but it is not clear if one or all factors are contributing and/or are relevant. Some studies point towards health care utilization as the major contributing factor for disparity. Additionally, there is strong evidence that Blacks have an anatomical shift of polyps and cancer to the right colon when compared to Whites. This is important as colonoscopic screening does not reduce mortality to the same degree when cancers are in the right side of the colon when compared to left-sided colon cancers. The proportion of Blacks presenting with colorectal cancer below the age of 50 when screening is recommended is 10.6%, compared to 5.5% for Whites. This rate approximates 5.5% for Blacks at age 45 years. The American College of Gastroenterology, the American College of Physicians, and the Institute for Clinical Systems Improvement have all recommended earlier ages (40 or 45 years) to begin screening Blacks for colorectal cancer in the United States, although other organizations have yet to make this recommendation. A general approach to any cancer screening involves (a) a sensitive and specific test, (b) acceptable to asymptomatic persons, (c) reduce morbidity and mortality, and (d) be cost-effective and affordable to society. Most of the seven tests recommended for colorectal cancer screening meet these general criteria. There are modifications to colorectal cancer screening based on higher risk populations, such as those with potential familial inheritance of cancer and those with a history of inflammatory bowel disease. The rationale is that these populations develop colorectal cancer earlier, and that by screening them earlier will find cancers or their precursors at early stages. Based on objective data, colonoscopic screening should be the preferred approach for Blacks due to the higher right-sided colon prevalence for polyps and cancers. And, as for inflammatory bowel disease and potential hereditary predisposition or based on family history, the time for screening Blacks should be at an earlier age due to higher prevalence and mortality from colorectal cancer. Indeed, the cost-effectiveness for screening Blacks with colonoscopy is much greater than Whites due to the higher rates of the disease. Citation Format: John M. Carethers. Colorectal cancer screening for African Americans: Should we be screening at an earlier age? The Pro side. [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 PC01-01. doi:10.1158/1538-7755.DISP13-PC01-01

Abstract PC01-02: Colorectal cancer screening for African Americans: Should we be screening at an earlier age? Con

Abstract African Americans have the highest colorectal cancer (CRC) incidence and mortality of any racial/ethnic group. Citing the higher age-specific rate of CRC compared to whites that begins after age 45, several medical societies have recommended early age of screening initiation for African Americans at age 40 or 45 years. However, there are several reasons why early screening initiation may be a suboptimal strategy for improving CRC outcomes among African Americans. First, evidence to support effectiveness of early screening initiation for improving CRC outcomes is limited. The highest excess rates of CRC among African Americans occur after age 60, and the most rigorous studies suggest that there are not substantial differences in rates of polyps between African Americans and other groups younger than age 50, making the effectiveness of early initiation uncertain. Second, there are substantial logistical challenges to implementing early age of screening initiation for African Americans, but not other groups. Third, many alternate strategies have been proven to improve CRC screening; if implemented widely these strategies might be more effective than lowering the age of screening initiation. In taking the “Con” position against lowering the screening age, the author will highlight these issues, and make the case that lowering the screening age may not be the optimal strategy for improving CRC outcomes among African Americans. Citation Format: Samir Gupta. Colorectal cancer screening for African Americans: Should we be screening at an earlier age? Con. [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 PC01-02. doi:10.1158/1538-7755.DISP13-PC01-02

Mo1069 Addressing Low Colorectal Cancer Screening in African Americans: Focus Groups Reveal Insights for Developing an Effective Intervention

Mo1069 Addressing Low Colorectal Cancer Screening in African Americans: Focus Groups Reveal Insights for Developing an Effective Intervention

Broadening the examination of sociocultural constructs relevant to African-American colorectal cancer screening

The importance of sociocultural constructs as influences on cancer attitudes and screening has been established in the literature. This paper reports on the efforts to explore alternatives to sociocultural constructs previously associated with African-American cancer screening, but with low acceptance among community members or incomplete measurement (empowerment and collectivism) and develop a measure for a recently identified construct of interest (privacy). We report preliminary psychometric data on these sociocultural scales and their associations with cancer attitudes. African-Americans (N = 1021), 50–75 years of age participated in this study. Participants were identified via a listed sample and completed a telephone survey administered via call center. Sociocultural attitudes were assessed using items identified through computerized database searches, reviewed by advisory panels, edited and tested using cognitive response strategies. Cancer screening pros and cons, cancer worry, perceived cancer risk, colorectal cancer (CRC) screening subjective norms, and perceived self-efficacy for colorectal cancer screening (CRCS) were also assessed. Confirmatory factor analyses and multivariate analyses were conducted to provide support for the validity of the constructs and to understand the associations among the selected sociocultural constructs (empowerment, collectivism, and privacy) and cancer beliefs and attitudes (CRC perceived benefits and barriers, perceived risks, subjective norms, and perceived behavioral control/self-efficacy). Consistent with the literature, the factor analytic model (RMSEA for the model was .062; 90% CI: .060–.065) provided support for the empowerment, collectivism, and privacy constructs. The modified collectivism and privacy scales had acceptable reliability. The privacy scale demonstrated the strongest associations with measures of cancer beliefs and attitudes. The implication of the findings and need for further scale development activities is discussed.

A Community-Driven Intervention for Prostate Cancer Screening in African Americans

The purpose of the study was to assess the impact of an educational intervention on prostate cancer screening behavior and knowledge. Participants were 104 African American men, 45 years and older, who had not been screened for prostate cancer with a prostate-specific antigen and/or digital rectal exam within the past year. All participants received an intervention delivered by trained lay community educators using a prostate cancer educational brochure developed in collaboration with the community, with structured interviews preintervention and 3 months postintervention. The main study outcomes included prostate-specific antigen screening rates during the 3-month interval and knowledge, barriers to screenings, and decisional conflict around screening. Compared with the 46 men who did not get screened, the 58 participants who got screened were more likely to have greater than a high school education, annual household incomes ≥$25,000, and a family history of non-prostate cancer (p < .05). Average knowledge scores increased, and barriers to screening scores decreased, from preintervention to postintervention only for participants who had been screened (p < .05). The results of this study demonstrate the feasibility and efficacy of an academic institution collaborating with the African American community to develop a successful prostate cancer educational intervention, an approach that can be expanded to other cancers and other chronic diseases.

Cervical Cancer Screening in African Americans With Inflammatory Bowel Disease

Introduction:Several studies have shown an increased risk for having abnormal Papanicolaou (Pap) smears in women with Inflammatory Bowel Disease(IBD). It is unknown if this is due to the disease itself or from receiving immunosuppressants.In addition, no studies to date have validated this in non-caucasian populations.Higher cervical cancer incidence has been described in healthy blacks in the face of lower screening rates.The aim of our study was to ascertain the rate of abnormal Pap smears in blacks with IBD and identify factors leading to less screening.Methods: Using ICD9 codes, a retrospective chart review was done on selected women seen in our institution for IBD management over the last 10 years.Data on age at disease onset/study entry,family history of IBD, disease pattern and distribution, extraintestinal manifestations, clinical status, frequency of follow up, and Pap smears were taken from clinicians' notes and endoscopic/radiologic reports.Exclusion criteria were male gender and age <18. Fisher's exact test was used to test association between groups who have and have not had Pap smears and dichotomous outcomes; t-test was used for continuous outcomes.The bootstrap method of inflating p-values to account for the multiple testing problem was used. All analysis was done through SAS (SAS Institute,Cary NC) Release 9.2 software. Results:150 black women with IBD were included in the study.96 (64%) of women had a Pap smear performed in our institution with 38/96 (40%) being abnormal (29 atypical squamous cells of undetermined significance, 7 low grade squamous intraepitheliel lesion, 1 high grade squamous intraepitheliel lesion, 1 cervical cancer).49/96 (51%) had been exposed to immunosuppressive therapy for IBD and 18/96 (19%) had been on estrogen containing contraception. The 96 women who had a Pap smear were then compared to 54 women who had not had a Pap smear (See Table 1).Women who had not had a Pap smear tended to have not been seen in the gastroenterology clinic within one year (6/54 vs. 41/ 96; p=0.0007) and noted to be less frequently in remission of IBD (12/54 vs. 51/96; p= 0.0033).Conclusions: There is an absence of data on predictors of cervical cancer screening among blacks with IBD. 36% of blacks seen in our institution had not had a Pap smear. Of those screened, 40% of women had an abnormal Pap smear. While older age, lower socioeconomic status, Crohn's disease, and exposure to immunosuppressants have been reported as independent predictors of lower use of cervical cancer screening, we instead found that less follow-up with a gastroenterologist and less disease remission were more common in those not screened. We encourage gastroenterologists,particularly those servicing nonwhite communities, to be mindful that women with IBD are at increased risk for cervical cancer and to take responsibility in having their patients screened. Comparison of IBD Black women with and without Pap Smears