Cruciferous Vegetable Intervention to Prevent Cancer Recurrence in Non-Muscle Invasive Bladder Cancer Survivors: Development using a Systematic Process (Preprint)

Background

Bladder cancer is one of the top 10 most common cancers in the United States. Most bladder cancers (70%-80%) are diagnosed at early stages as non–muscle-invasive bladder cancer (NMIBC), which can be removed surgically. However, 50% to 80% of NMIBC cases recur within 5 years, and 15% to 30% progress with poor survival. Current treatments are limited and expensive. A wealth of preclinical and epidemiological evidence suggests that dietary isothiocyanates in cruciferous vegetables (Cruciferae) could be a novel, noninvasive, and cost-effective strategy to control NMIBC recurrence and progression.

Objective

The aim of this study is to develop a scalable dietary intervention that increases isothiocyanate exposure through Cruciferae intake in NMIBC survivors.

Methods

We worked with a community advisory board (N=8) to identify relevant factors, evidence-based behavior change techniques, and behavioral theory constructs used to increase Cruciferae intake in NMIBC survivors; use the PEN-3 Model focused on incorporating cultural factors salient to the group’s shared experiences to review the intervention components (eg, the saliency of behavioral messages); administer the revised intervention to community partners for their feedback; and refine the intervention.

Results

We developed a multicomponent intervention for NMIBC survivors consisting of a magazine, tracking book, live telephone call script, and interactive voice messages. Entitled POW-R Health: Power to Redefine Your Health, the intervention incorporated findings from our adaptation process to ensure saliency to NMIBC survivors.

Conclusions

This is the first evidence-based, theoretically grounded dietary intervention developed to reduce bladder cancer recurrence in NMIBC survivors using a systematic process for community adaptation. This study provides a model for others who aim to develop behavioral, community-relevant interventions for cancer prevention and control with the overall goal of wide-scale implementation and dissemination.

#BlackBreastsMatter: Process Evaluation of Recruitment and Engagement of Pregnant African American Women for a Social Media Intervention Study to Increase Breastfeeding

BACKGROUND

In the United States, there are lower rates of breastfeeding among African American mothers, particularly those who are younger women. Recent epidemiological studies have shown a strong association of more aggressive types of breast cancer (estrogen receptor negative) among African American women, with a higher risk in African American women who did not breastfeed their children.

OBJECTIVE

This study aims to describe the process evaluation of recruitment and educational strategies to engage pregnant African American participants for a pilot study designed to determine whether social media messaging about breast cancer risk reduction through breastfeeding may positively influence breastfeeding rates.

METHODS

This pilot study is conducted in collaboration with a local Women, Infants, and Children (WIC) organization and hospital and prenatal clinics of a local health care network. To engage African American women to enroll in the study, several methods and monitoring processes were explored, including WIC electronic text-based messages sent out to all phones of current WIC recipients (referred to as e-blasts); keyword responses to texts from flyers and posters in local community-based organizations, hospitals, and prenatal clinics; keyword responses using electronic links posted in established Facebook groups; and snowball recruitment of other pregnant women by current participants through Facebook. Once enrolled, participants were randomized to 2 study conditions: (1) an intervention group receiving messages about breast cancer risk reduction and breastfeeding or (2) a control group receiving breastfeeding-only messages. Data were obtained through electronic monitoring, SurveyMonkey, qualitative responses on Facebook, focus groups, and interviews.

RESULTS

More than 3000 text messages were sent and received through WIC e-blasts and keyword responses from flyers. A total of 472 women were recruited through WIC e-blast, and 161 responded to flyers and contacts through the local health care network, community-based organizations, Facebook, and friend referrals. A total of 633 women were assessed for eligibility to participate in the study. A total of 288 pregnant African American women were enrolled, consented, and completed presurvey assessments (102.8% of the goal), and 22 participants attended focus groups or interviews reporting on their experiences with Facebook and the educational messages.

CONCLUSIONS

This process evaluation suggests that using electronic, smartphone apps with social media holds promise for both recruitment and conduct of health education intervention studies for pregnant African American women. Providing messaging and resources through social media to reinforce and educate women about breastfeeding and potentially provide lactation support is intriguing. Convenience (for researchers and participants) is an attribute of social media for this demographic of women and worthy of further research as an educational tool.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03680235; https://clinicaltrials.gov/ct2/show/NCT03680235.

Abstract IA23: Engaging refugees and immigrants in breast health education

Refugees and immigrants often come from countries where preventative medicine and cancer screening opportunities are neither attainable nor a priority. Often, preventative services like mammography are new concepts for immigrant and refugee women. Language barriers can decrease patients' access to services, especially for screening tests. Barriers to health screenings include cultural belief factors along with limited knowledge, racial discrimination, embarrassment, fear of the test and/or diagnosis, and lack of culturally appropriate health resources. While barriers make it difficult for refugee and immigrant women to gain access to health services, the need to provide culturally sensitive health educational programs that address these issues in a culturally sensitive way is essential to ensure a healthy life style for this population. The International Institute has over 100 years of experience in serving refugees and immigrants in many capacities and is considered a reliable resource within the local immigrant and refugee community. The Institute worked closely with Roswell Park Comprehensive Cancer Center, local community health centers, and resettlement agencies to provide culturally tailored health education programming to over 1500 refugee and immigrant women and men, and screened approximately 400 women for mammography and clinical breast exams. Additionally, the institute has educated over 1,000 local health care providers working with the immigrant and refugee population on the importance of cultural competency in order to impact their cultural sensitivity in their current medical practices. Educational programs that train health care providers in cultural competency have been shown to improve patient-provider interaction. Successful methods used in working with the immigrant and refugee population include utilizing cultural and linguistic diverse staff, proficient interpreters and translators, and partnering with community-based agencies that also serve this population. Building trust and creating personal relationships with female attendees are crucial in working with the immigrant and refugee population. Fear of the cancer test and/or diagnosis is a major barrier for most immigrant/refugee women, and to freely discuss breast health and the importance of cancer screening is a novel concern, as the word “cancer” is taboo in most cultures and is not openly discussed. This presentation will discuss strategies used to engage this diverse population and discuss lessons learned from multiple community-based educational programs on breast health among immigrant and refugee females.

Citation Format: May Shogan, Frances Saad-Harfouche. Engaging refugees and immigrants in breast health education [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 IA23.

Clinician and Parent Perspectives on Educational Needs for Increasing Adolescent HPV Vaccination

Human papillomavirus (HPV)-related morbidity and mortality remain a significant public health burden despite the availability of HPV vaccines for cancer prevention. We engaged clinicians and parents to identify barriers and opportunities related to adolescent HPV vaccination within a focused geographic region. This mixed-method study design used an interviewer-administered semi-structured interview with clinicians (n = 52) and a written self-administered survey with similar items completed by parents (n = 54). Items focused on experiences, opinions, and ideas about HPV vaccine utilization in the clinical setting, family, and patient perceptions about HPV vaccination and potential future efforts to increase vaccine utilization. Quantitative items were analyzed using descriptive statistics, while qualitative content was analyzed thematically. Suggested solutions for achieving higher rates of HPV vaccination noted by clinicians included public health education, the removal of stigma associated with vaccines, media endorsements, and targeting parents as the primary focus of educational messages. Parents expressed the need for more information about HPV-related disease, HPV vaccines, vaccine safety, sexual concerns, and countering misinformation on social media. Results from this mixed-method study affirm that educational campaigns targeting both health care professionals and parents represent a key facilitator for promoting HPV vaccination; disease burden and cancer prevention emerged as key themes for this messaging.

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

OBJECTIVE

To 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.

METHODS

Witness 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.

RESULTS

A 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.

CONCLUSION

The 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.

Assessing the delivery of cessation services to smokers in urban, safety-net clinics

Inequities in smoking behaviors continue to exist with higher rates among persons with limited formal education and for those living below the poverty level. This report describes the scope of tobacco cessation services delivered to low socio-economic status (SES) patients in several primary care medical offices, considered as "safety-net" sources of health care. Using a cross-sectional design, a random sample of records were reviewed for 922 smokers from 4 medical offices. The primary outcome variable was the delivery of smoking cessation services as documented in medical records; information on patient demographics and number of visits during the past 12 months was also abstracted. Smoking status was assessed during the last office visit for 65 % of smokers, 59 % were advised to quit, readiness to quit was assessed for 24 %, 2 % indicated a willingness to quit within the next 30 days and a quit date was established for 1 %. Among smokers not yet ready to quit, few were counseled on the "5 R's" (Relevance, Risks, Rewards, Roadblocks, Repetition). These results expand our understanding of the unfortunately limited scope of cessation services delivered to persons seen in safety-net medical offices and call attention to the need to redouble efforts to more effectively address smoking cessation among diverse, low SES patients served by safety-net primary care clinics.