The impact of HPV vaccine narratives on social media: Testing narrative engagement theory with a diverse sample of young adults

Rates of human papillomavirus (HPV) infection are highest in young adults, who can be vaccinated against HPV if they were not vaccinated as adolescents. Since young adults increasingly access health information on social media, we tested the impact of a social media campaign with narrative-based health information on intentions related to HPV vaccination. We also aimed to understand which ads resonated most with young adults and led to higher survey completion rates. We created social media posts featuring videos promoting HPV vaccination. We launched a sponsored ad campaign on Facebook to reach young women, ages 18–26, across the country. Participants were randomly assigned one of 6 videos and then completed a brief survey about video engagement and intentions to: talk with a health care professional, talk with friends or family, and vaccinate against HPV. A descriptive correlational design and a test for moderation were used to explore hypothesized relationships. Across all ads, 1332 link clicks led to 991 completed surveys that were reduced to 607 surveys (95 % ages 18–26, 63 % non-Caucasian; 58 % sexually active). Higher video engagement was associated with stronger intentions to talk with a health care professional (r = 0.44, p =.01), talk with friends/family (r = 0.52, p =.01), and vaccinate against HPV (r = 0.43, p =.01). Young adults were receptive to watching narrative-based health information videos on social media. When promoting HPV vaccination, more engaging information leads to greater intentions to talk about the vaccine and get vaccinated.

Hydrogeochemical characteristics of surface and groundwater: suitability for human consumption and irrigated agriculture purposes in Suruliyar sub basin, South India

The Suruliyar sub basin in Tamil Nadu, India, was monitored for the assessment of water and soil quality. Surface water, groundwater, and soil samples were collected during the pre-monsoon (June 2016) and post-monsoon (December 2016) seasons within the sub basin area and analyzed for various physical, chemical, and biological properties, namely, pH, electrical conductivity, total dissolved solids (TDS), calcium, magnesium, sodium, nitrate, sulfate, fluoride, chloride, biological oxygen demand, chemical oxygen demand, and total and fecal coliform. All the values were compared with Indian and global standards, and the values for each parameter were within the permissible limits. However, some samples were edging toward the upward limit. Fecal coliforms (14 to 36 counts per 100 ml) were present in the river water, thus indicating anthropogenic contamination. Correlation analysis confirmed that TDS was significantly positively correlated with most of the cations and anions. Groundwater was assessed using several indices, such as the Piper diagram, United States Salinity Laboratory diagram, sodium adsorption ratio, and sodium percentage. Results showed that all the groundwater samples could be used for irrigation purposes; however, the chloride contents exceeded the permissible limit. Soil analysis results showed that all nutrients were within the permissible limits. Drought assessment showed the existence of both dry and wet years occurring most frequently, which might have a strong influence on the quality of water and soil parameters. This study suggests that the monitoring of surface, groundwater, and soil parameters is essential to maintain the sub basin area for ensuring sustainable development in the future.

Prevalence and perceptions of cannabis use among racially diverse patients with cancer pain: Results from a multi-site survey

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Background: While access to cannabis is prevalent among cancer patients1, unknowns persist about real-time use, perceived effectiveness in cancer pain management and impact on other medication use, including opioids. Moreover, racial disparities in cancer pain management persist2-3 with Black patients more likely to have undiagnosed pain.4 Studies on the intersection of cannabis, opioids, race and cancer pain are needed. As part of an NCI-funded initiative, we assessed the perceived effectiveness of cannabis vs. opioids for pain control by race. Methods: A survey was created by three Mid-Atlantic, cancer centers to examine self-reported cannabis use and knowledge, barriers and perceptions about cannabis among cancer patients. All sites assessed common core questions and included additional questions assessing cannabis and opioid use. Patients were eligible to participate if they were treated for cancer within the prior year. Surveys were distributed both by mail and electronically via REDCap. Results are compared separately by site. Results: In all, 2,734 patients are included in this analysis. Rates of cannabis use since diagnosis ranged from 32-41% of respondents, with similar rates of use between gender and race. Patients under age 65 more frequently reported cannabis use. Across sites, only 7-8% of patients reported currently using opioids. A sizable number patients who use cannabis reported using cannabis instead of opioids to treat pain. Of those using cannabis, most felt that cannabis was better in managing their pain than opioids, with Black patients reporting this much more frequently than White patients across two sites (Site A 62.2% vs 43.2%, Site B 77.78 vs 48.96%, Site C 50.0% vs. 65.5%). The most common reasons patients reported using cannabis instead of opioids included the perception that: “cannabis is safer” (80-82%), “cannabis is less addictive” (70-73%), and “cannabis has fewer side effects” (68-74%). Conclusions: Cannabis is frequently used by cancer patients, with many reporting use instead of opioids for pain management. Of those using cannabis for pain management, a significant majority felt that it is more effective than opioids. Black patients report cannabis as more effective than opioids for pain control more frequently than other races. Given the ongoing under-treatment of cancer pain in Black patients, more data is needed to understand whether cannabis is an effective tool to reduce disparities in cancer pain management. [Table: see text]

An advanced electrical vehicle charging station using adaptive hybrid particle swarm optimization intended for renewable energy system for simultaneous distributions

A proposed hybrid approaches are incorporated in Electric Vehicle (EV) fast charging station (FCS) using (RES). Hybrid approach is improved by Adaptive Hybrid Particle Swarm Optimization (AHPSO) named as AHWPSO, moreover the proposed work Grey Wolf Optimization (GWO) is assist with adaptive hybridize PSO algorithm. Therefore, an overall pricing cost should be reduced maximum Electric Vehicle Charging Station (EVCS) with minimal installation. This simulation work is verified an adaptive time varying weightage parameters to increase the AHWPSO particle diversity factor. Proposed algorithm is incorporated with improve the novelty, and compared the results are recent version of PSO used for EVCS. Its increase the charging ability, energy loss minimization, voltage deviation reduction, and cost minimization. A distribution micro-grid capacity and demand are tested. Similarly, low to peak period energy variations are controlled by proposed algorithm with reduced capacitor bank. Overall control algorithm code is executed buy MATLAB/Simulink platform, the performance of this work listed, and compare to the existing approaches with achievement of maximum efficiency.

Gaps in Public Awareness About BRCA and Genetic Testing in Prostate Cancer: Social Media Landscape Analysis

BACKGROUND

Genetic testing, particularly for BRCA1/2, is increasingly important in prostate cancer (PCa) care, with impact on PCa management and hereditary cancer risk. However, the extent of public awareness and online discourse on social media is unknown, and presents opportunities to identify gaps and enhance population awareness and uptake of advances in PCa precision medicine.

OBJECTIVE

The objective of this study was to characterize activity and engagement across multiple social media platforms (Twitter, Facebook, and YouTube) regarding BRCA and genetic testing for PCa compared with breast cancer, which has a long history of public awareness, advocacy, and prominent social media presence.

METHODS

The Symplur Signals online analytics platform was used to obtain metrics for tweets about (1) #BRCA and #breastcancer, (2) #BRCA and #prostatecancer, (3) #genetictesting and #breastcancer, and (4) #genetictesting and #prostatecancer from 2016 to 2020. We examined the total number of tweets, users, and reach for each hashtag, and performed content analysis for a subset of tweets. Facebook and YouTube were queried using analogous search terms, and engagement metrics were calculated.

RESULTS

During a 5-year period, there were 10,005 tweets for #BRCA and #breastcancer, versus 1008 tweets about #BRCA and #prostatecancer. There were also more tweets about #genetictesting and #breastcancer (n=1748), compared with #genetic testing and #prostatecancer (n=328). Tweets about genetic testing (12,921,954) and BRCA (75,724,795) in breast cancer also had substantially greater reach than those about PCa (1,463,777 and 4,849,905, respectively). Facebook groups and pages regarding PCa and BRCA/genetic testing had fewer average members, new members, and new posts, as well as fewer likes and followers, compared with breast cancer. Facebook videos had more engagement than YouTube videos across both PCa and breast cancer content.

CONCLUSIONS

There is substantially less social media engagement about BRCA and genetic testing in PCa compared with breast cancer. This landscape analysis provides insights into strategies for leveraging social media platforms to increase public awareness about PCa germline testing, including use of Facebook to share video content and Twitter for discussions with health professionals.

Exploring Knowledge and Attitudes About Human Papillomavirus Vaccination Among School Nurses in an Urban School District

BACKGROUND

Nurses in an urban school district completed a brief survey about their knowledge, attitudes, and practices related to human papillomavirus (HPV) vaccination.

METHODS

Descriptive and bivariate analyses examined trends and differences.

RESULTS

Among 208 nurses, only 3% correctly answered all 5 knowledge questions. Nurses with greater than 10 years of experience were more confident about where to refer a student for vaccination (p < .01) and less likely to be interested in providing the vaccine at their school (p < .001) compared to those with less than 10 years of experience. Almost one third (32%) of nurses reported having access to educational material about the HPV vaccine at their schools.

CONCLUSIONS

Whereas most nurses had positive attitudes about the vaccine, fewer were interested in administering the HPV vaccine in school. Educational resources for school nurses could increase awareness of the vaccine and promote linkages to care outside of school.

Dimensions of Misinformation About the HPV Vaccine on Instagram: Content and Network Analysis of Social Media Characteristics

BACKGROUND

The human papillomavirus (HPV) vaccine is a major advancement in cancer prevention and this primary prevention tool has the potential to reduce and eliminate HPV-associated cancers; however, the safety and efficacy of vaccines in general and the HPV vaccine specifically have come under attack, particularly through the spread of misinformation on social media. The popular social media platform Instagram represents a significant source of exposure to health (mis)information; 1 in 3 US adults use Instagram.

OBJECTIVE

The objective of this analysis was to characterize pro- and anti-HPV vaccine networks on Instagram, and to describe misinformation within the anti-HPV vaccine network.

METHODS

From April 2018 to December 2018, we collected publicly available English-language Instagram posts containing hashtags #HPV, #HPVVaccine, or #Gardasil using Netlytic software (n=16,607). We randomly selected 10% of the sample and content analyzed relevant posts (n=580) for text, image, and social media features as well as holistic attributes (eg, sentiments, personal stories). Among antivaccine posts, we organized elements of misinformation within four broad dimensions: 1) misinformation theoretical domains, 2) vaccine debate topics, 3) evidence base, and 4) health beliefs. We conducted univariate, bivariate, and network analyses on the subsample of posts to quantify the role and position of individual posts in the network.

RESULTS

Compared to provaccine posts (324/580, 55.9%), antivaccine posts (256/580, 44.1%) were more likely to originate from individuals (64.1% antivaccine vs 25.0% provaccine; P<.001) and include personal narratives (37.1% vs 25.6%; P=.003). In the antivaccine network, core misinformation characteristics included mentioning #Gardasil, purporting to reveal a lie (ie, concealment), conspiracy theories, unsubstantiated claims, and risk of vaccine injury. Information/resource posts clustered around misinformation domains including falsification, nanopublications, and vaccine-preventable disease, whereas personal narrative posts clustered around different domains of misinformation, including concealment, injury, and conspiracy theories. The most liked post (6634 likes) in our full subsample was a positive personal narrative post, created by a non-health individual; the most liked post (5604 likes) in our antivaccine subsample was an informational post created by a health individual.

CONCLUSIONS

Identifying characteristics of misinformation related to HPV vaccine on social media will inform targeted interventions (eg, network opinion leaders) and help sow corrective information and stories tailored to different falsehoods.

Creation of a telehealth task force to improve successful use of telehealth to maintain patient access during the COVID-19 pandemic

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Background: In response to the COVID-19 National Emergency, the Sidney Kimmel Cancer Center (SKCC) medical oncology practice desired to greatly expand telehealth (TH) utilization to decrease patient risk while maintaining access to care. TH utilization requires resources (smart phones, internet) and there are disparities in digital media access in our patient population. A digital literacy survey performed at the SKCC in 2018 noted that 30% of patients used Android phones and > 60% of patients accessed the internet from a PC. Methods: In response to increased TH demand and need for support, the SKCC launched an oncology-dedicated Telehealth Task Force (TTF) to address barriers to TH access. The TTF team consisted of nine full-time individuals with digital and healthcare literacy to assist in telehealth and patient portal troubleshooting. Critical functions of TTF’s targeted patient solutions include; set-up and delivery of smartphones, creating email accounts, performing test visits, creating EHR patient portal accounts, real- time assistance during TH visits with implementation of this intervention beginning on April 3, 2020 with monitoring of patient interactions/touchpoints. Results: The SKCC medical oncology TTF noted increased interactions with patients immediately with a marked increase in the composite of medical oncology appointments completed by TH (51.0% in April 2020 compared to a prior level of 15.7% in March 2020). Additionally, there was a statistically significant increase in the proportion of patients have an active patient portal EHR account during this same period (14.6%; 95% CI, 12.3% to 16.9%; p < 0.0001). Oncology infusion treatment appointments remained relatively consistent over time. Conclusions: The SKCC medical oncology practice experienced an exponential rise in TH utilization during an uncertain public health crisis. Disparity in digital literacy and resources essential for successful TH use were quickly appreciated as potential barriers to access. The creation of a dedicated Telehealth Task Force was critical in maintain access to care for oncology patients given their vulnerability to infection. Further investigation of TH supports to improve TH use are warranted. [Table: see text]

Abstract S11-01: Assessing the impact of the COVID-19 pandemic on cancer patients, survivors, and caregivers

Background: The COVID-19 global pandemic created significant and unprecedented disruptions in in medical care and social services. Cancer patients are at increased risk of COVID-19 infection due to their immunosuppressive state and may fare worse than others who are COVID-19 positive because of their aggressive underlying disease. While presumed to be substantial, the extent of the impact of the pandemic on cancer patients, survivors, and caregivers was unknown.

Methods: Between April 23, 2020 and May 19, 2020, our urban, NCI-designated cancer center launched a “COVID and Cancer” survey for cancer patients, survivors, and caregivers. The purpose of the survey was to assess disruptions to cancer care, use and perceptions of telemedicine, access to social services and cancer support programs, and psychosocial well-being. The online survey was distributed through our cancer center’s email list for patient and survivor programming, via the electronic patient portal to patients in active treatment, and across our cancer center’s social media platforms. Descriptive statistics reported mean scores and frequencies while bivariate statistics reported differences in outcomes by respondent characteristics. The protocol and survey were approved by our Institutional Review Board.

Results: In less than one month and in the height of the pandemic, 1,107 people completed the survey. After removing duplicate and incomplete responses, the final sample of 985 respondents included 377 (38%) patients in active treatment, 576 (56%) survivors, and 18 (2%) caregivers. Fifty-six percent (n=555) were female; the mean age of respondents was 63 years old (SD= 11.9). Seventy-two percent (n=705) of respondents had solid tumor cancers while some had either a heme malignancy (22%) or both (4%). Among the 688 respondents who needed cancer care during the pandemic, 294 (43%) reported disruptions in appointments, labs, or scans. Fewer (&lt;5%) reported disruptions in surgery, chemotherapy, or radiation. Almost half (n=335, 49%) reported a telehealth visit during this time. Most respondents (n=612, 62%) were worried about contracting COVID-19. Cancer patients who were in active treatment were significantly more likely to be worried about contracting COVID-19, as well as accessing medication, transportation, or caregiver support, than those who were not in active treatment.

Conclusions: Disruptions in cancer care were observed during the pandemic. Cancer patients in active treatment were more worried that resources needed for their care such as medication, transportation, and caregiver support would be impacted by the pandemic. At our cancer center, we tried to mitigate some of the survey observations by developing COVID-specific patient and caregiver support programs, partnering with local agencies to provide groceries and transportation to patients, and enhancing infrastructure to assist with telehealth appointments. Cancer center support services can overcome these barriers and ensure patient care, even in a pandemic.

Citation Format: Amy Leader, Preethi Selvan, Lisa Capparella, Rebecca Cammy, Janene Palidora, Ayako Shimada, Benjamin Leiby, Gregory Garber, Brooke Worster. Assessing the impact of the COVID-19 pandemic on cancer patients, survivors, and caregivers [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S11-01.

Abstract PR10: Examining the #HPV vaccine on Instagram: An analysis of post context, imagery, and sentiment

Introduction: We aimed to characterize publicly available Instagram posts about the human papillomavirus (HPV) vaccine and the impact of sentiment and context on post popularity via likes.

Methods: Using Netlytic, 3,378 publicly available English-language posts were collected using the search terms “HPV,” “HPVVaccine,” and “Gardasil.” A sub-sample of posts were randomly selected (n=288) and qualitatively coded to categorize aspects of a relevant post’s image, caption text, user, sentiment, and vaccine information. Coding and assessment of inter-rater reliability were facilitated by NVivo 12 (QSR Software), and discrepancies were resolved through group consensus. Descriptive and bivariate statistical analyses were conducted using StataIC 15.

Results: Four out of ten posts (n=114; 39.7%) depicted age-eligible individuals for the HPV vaccine. Girls were shown more than boys (26.6% versus 8.7%). One in four posts depicted the HPV vaccine (e.g., needle injection; n=70; 24.4%). Few posts included parents/caregiver figures (n=13; 4.6%) or health care professionals (n=41; 14.4%). User type was split evenly between individual and nonindividual users (51.2% individual versus 48.8% nonindividual). A majority of posts contained actionable information/resources (63.4%), compared to featuring personal narrative elements (36.62%). Posts were equally likely to be positive (50.9%) versus negative (46.0 %). Images showing males or females separately were more negative than positive, but males and females shown together were overwhelming positive (p = .0017). Nonindividual users posted positively significantly more than individual users (p &lt; .001). Personal narratives were significantly more negative than informational posts (p &lt; .001). The prototypic “most popular” post would have been antivaccine, shown a vaccine and a vaccine-eligible male, featured a combination of text and imagery, and included personal narrative elements. The average number of likes was 54 (SD = 143). Provaccination posts were liked significantly less than antivaccination posts (21 versus 93 likes; p = .0419).

Conclusion: In the era of “fake news,” HPV vaccination on Instagram is a topic characterized by emotionally charged expressions of personal beliefs, personal narratives, information, and misinformation. Personal narratives about HPV vaccination skewed towards antivaccine sentiment and were produced more often by individual users. Provaccine narratives tended to show individuals who had recently received the vaccine, but rarely provided long-term details about their experience with vaccination, starkly contrasting with the depth and scope of details included in antivaccine personal narrative posts. Unlike other social media, Instagram posts were more evenly divided between pro- and antivaccine expressions, creating an opportunity for provaccine individuals and organizations to promote HPV vaccination through the use of effective content, such as narrative-style posts.

Citation Format: Matthew Kearney, Preethi Selvan, Michael Hauer, Amy Leader, Philip Massey. Examining the #HPV vaccine on Instagram: An analysis of post context, imagery, and sentiment [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr PR10.

Abstract 2354: Multilevel analysis of colorectal cancer screening in southeastern Pennsylvania

Background: Colorectal cancer (CRC) is a leading cause of mortality in the US. There are racial and socioeconomic disparities in CRC incidence and mortality, in part due to underuse of CRC screening. The goal of this cross-sectional study was to examine multilevel factors associated with CRC screening in Southeastern PA.

Methods: We conducted a cross-sectional study using the Public Health Management Corporation's Community Health Database household survey (2010-2015) and American Community Survey data (2010-2014) to examine multilevel factors related to CRC screening via sigmoidoscopy and colonoscopy. We compared adults age 50+ that received CRC screening within 10 years (N=12963) to non-compliant individuals (N=4585), according to American Cancer Society guidelines. We conducted descriptive analyses to compare individual and residential census tract characteristics of the compliant and non-compliant groups. Multilevel regression models including random intercepts for census tracts (CTs) and CT-level socioeconomic status (SES) were used to examine independent associations with CRC screening compliance. P-values &lt;0.05 were considered statistically significant.

Results: In bivariate analysis, we observed that individuals that did not comply with CRC screening recommendations were more likely to be younger, male, non-black, unmarried, less educated, uninsured, and current smokers than those in compliance. Non-compliant individuals were also more likely to live in areas with lower SES, shorter distance to public transportation, lower educational attainment, lower median income, and higher percentages of uninsured, unemployed, poverty and households on public assistance compared to those in compliance. In multilevel regression analysis, being unmarried (OR=1.49, 95% CI=1.34-1.65), uninsured (OR=1.65, 95% CI=1.30-2.10), or living in lower SES census tracts (below the first SES quartile: OR=1.48, 95% CI=1.30-1.69 and between the 2nd and 3rd quartile: OR=1.51, 95% CI=1.29-1.75 vs. above the highest quartile) were associated with non-compliance in CRC screening recommendations. There were no interactions detected between race and census tract SES in these models.

Conclusions: We identified multilevel factors (marital status, health insurance status, and residential SES) significantly associated with non-compliance to CRC screening recommendations. Individuals and CTs with low levels of compliance can be identified and targeted for tailored interventions, such as peer support and community education about CRC in future studies. Future studies might examine how the availability and location of screening facilities may relate to CRC screening recommendation compliance rates in different neighborhoods.

Citation Format: Charnita M. Zeigler-Johnson, Scott Keith, Kari Moore, Russell McIntire, Preethi Selvan, Steven Melly, Ana Diez-Roux. Multilevel analysis of colorectal cancer screening in southeastern Pennsylvania [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2354.

Characterizing HPV Vaccine Sentiments and Content on Instagram

Background. With its growing popularity, inclusion of image and text, and user-friendly interface, Instagram is uniquely positioned for exploring health behaviors and sources and types of informational exposure related to the human papillomavirus (HPV) vaccine. Aims. To characterize public Instagram posts about the HPV vaccine and quantify the impact of sentiment and context on engagement via likes. Method. Using Netlytic, 3,378 publicly available English-language posts were collected using the search terms "#HPV," "#HPVVaccine," and "#Gardasil." We randomly selected 1,200 posts to content analyze. Our final analytic sample included 360 posts after excluding posts whose links were no longer active (n = 221) or that were not relevant (n = 619). Results. A higher proportion of posts were pro-vaccine (55.8%) than anti-vaccine (42.2%). Pro-HPV vaccination posts were liked significantly less than anti-vaccination posts (24 vs. 86 likes; p < .001). More posts contained actionable information/resources (63.9%) than personal narrative elements (36.1%). Less than one in three posts (30.0%) came from health-related sources. Discussion. Pro-vaccine posts were more prevalent on Instagram, and anti-vaccine posts had higher engagement and typically included misleading information about the HPV vaccine. Personal narratives skewed toward anti-vaccine sentiments and most were produced by individual users. Pro-vaccine narratives portrayed individuals who received the vaccine, but provided limited details on vaccine experiences, starkly contrasting with the depth of details in anti-vaccine personal narrative posts. Conclusion. On Instagram, individuals and organizations have an opportunity to promote HPV vaccination by continuing to provide informational resources in addition to creating more narrative-style posts.

Abstract A028: Exploring Asian Indian and Pakistani views about cancer and participation in research: An evaluation of a culturally tailored educational intervention

Background: Asian Indians and Pakistanis (AIP) are a growing population in the United States (US), and cancer is a leading cause of mortality in this population. Cancer screening rates among AIP populations in the US remain low compared to other racial and ethnic groups. In addition, AIP adults have been historically under-represented in clinical research and reasons are largely unexplored.

Methods: We delivered a culturally tailored educational intervention to improve knowledge, attitudes, and perceptions about cancer risk and preventive screening measures to AIP adults in the Philadelphia area. Participants of AIP descent, ages 18 and older, were recruited during an evening celebration at a local community center. The intervention, an oral presentation, was delivered by a physician of AIP descent with expertise in clinical cancer genetics. The presentation focused on screening measures and applicable genetic tests for breast, prostate, and colon cancers based on family history and individualized risk factors. Participants were assessed before (pre), immediately after (post), and 1 month following the presentation (follow-up) for changes in knowledge, attitudes, and perceptions of cancer risk and risk assessments. Data were analyzed for means, frequencies, and differences in means from baseline to endpoint and baseline to follow-up using SPSS. Only those who completed all three assessments were included in analysis.

Results: Twenty-three participants, 12 female and 10 male participants (1 not reported) of AIP descent, averaging 46 years of age, completed the study. All participants were born in India and had been living in the US for an average of 20 years. Most (n=13) preferred the English language when discussing medical material, while a few (n=3) preferred another language. While there was no significant improvement in overall knowledge or knowledge of screening timelines for prostate and colon cancers, participants showed a significant change in understanding of when screening for breast cancer should begin (p&lt;0.05). Pre- to post-intervention knowledge regarding genetic mutations (p&lt;0.05) and genetic testing (p&lt;0.05) was also improved. Lastly, participants were more willing to talk to their family members about cancer (p&lt;0.05), participate in a medical research study (p&lt;0.01), and undergo genetic testing for cancer risk assessment (p&lt;0.001) after exposure to the intervention.

Discussion: The intervention increased specific aspects of knowledge, willingness to participate in cancer research and risk assessments, and willingness to talk about cancer among AIP adults. This suggests that culturally tailored educational interventions, delivered in community settings, can be influential for this population. The efficacy of this research could be tested in a future randomized controlled trial with longer-term follow-up for sustained impact along with the collection of data regarding the uptake of cancer screening services post-intervention.

Citation Format: Veda N. Giri, Preethi Selvan, Salini Mohanty, Ray Lum, Samantha Serrao, Amy E. Leader. Exploring Asian Indian and Pakistani views about cancer and participation in research: An evaluation of a culturally tailored educational intervention [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 A028.

Recruiting patients with advanced cancer to participate in a non-opioid intervention for chronic pain management

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Background: Chronic pain related to advanced cancer is difficult to treat. In addition to traditional analgesics, non-pharmacological interventions, such as music therapy, may help alleviate pain in this population. Research studies to test the efficacy of these non-pharmacological interventions are necessary and important. However, recruiting patients with advanced cancer to participate in such interventions can be challenging. Identifying effective sources of referrals and barriers to participation may help increase recruitment rates in the future. Methods: We recruited patients with advanced cancer (stage III or IV) with chronic pain from two major hospital systems to participate in a pain management interventional study. The experimental group received individualized music therapy, while the control group received talk therapy. Participants attended six weekly sessions at the hospital and were compensated for time and travel. Recruitment methods included referrals from care teams, advertisement through flyers and posters, EMR chart reviews, and in-person recruitment at multiple infusion centers. Missing data was excluded from analyses. Chi-square tests assessed significant differences between groups. Results: Of 594 patients that were referred to the study, 7% enrolled (n = 40), 35% declined (n = 208), and 58% were ineligible (n = 346). Forty-seven percent (n = 19) of enrolled participants were female; race/ethnic distributions were the following: African American/Black (55%; n = 22), Caucasian/White (28%; n = 11), or other (17%; n = 7). The most effective recruitment method was through self-referral; of the 40 patients enrolled in the study, 9 (23%) were enrolled through this method. There were no statistically significant differences between referral source and enrollment. The top three reasons patients declined to participate included lack of interest (32%; n = 67), lack of time and/or energy (28%; n = 59), and lack of transportation (16%, n = 34). Conclusions: Although there were no differences in referral sources, more patients were enrolled through self-referral or in-person recruitment, showing the power of personal motivation and personal touch. While lack of participation due to interest, time, or energy are hard to overcome, future research should consider campaigns to reach patients who are motivated to participate. In addition to referrals, resources for in-person recruitment and transportation to help alleviate barriers to research participation should be considered.

Exploring Asian Indian views about cancer and participation in cancer research: an evaluation of a culturally tailored educational intervention

Asian Indians (AIs) are a growing population in the United States (US) with increased cancer incidence and mortality. However, screening rates among this population are low, and the population has been underrepresented in clinical research. This pilot study aims to address gaps in the literature in order to understand if a culturally tailored educational intervention will improve knowledge, risk perceptions, and awareness of cancer risk assessments among AIs. We delivered an educational intervention comprised of culturally tailored case studies describing risk factors for developing cancer in both males and females. We assessed knowledge gaps about cancer risk and genetic testing, cancer risk perceptions, and willingness to participate in medical research studies, pre- and post-intervention. Among 23 participants, knowledge of genetic testing use and screening recommendations significantly improved post-intervention, with increased willingness to discuss cancer with family members, participate in medical research, and undergo genetic testing for cancer risk assessment. However, findings at the 1-month follow-up time did not show significant changes, except for one knowledge item. Culturally tailored educational interventions, delivered in a community setting, can influence knowledge and risk perceptions about cancer risk and genetics among AIs. Our findings lay the groundwork to continue educational efforts in the area of cancer risk and genetic testing in the AI population, a growing population that has been understudied in the US.

Recruiting for an Online Survey through Social Media: Testing Variations in Messaging, Compensation, and Platform

To test three recruitment strategies for parents on social media (Facebook and Twitter) to complete a brief survey about the human papillomavirus (HPV) vaccine. Methods: We created three campaigns with ads on Facebook and promoted tweets on Twitter that invited parents of children ages 9–15 to complete a brief survey about the HPV vaccine. Iterative, yet varied, campaigns were conducted to determine the ideal social media platform, compensation amount, and messaging. Ads depicted vaccine-eligible children (11–12 years of age) of various ethnicities. Ad messaging was adapted from social media toolkits at the CDC and the HPV Roundtable. Parents who clicked on our ad were first screened for eligibility. Those who were eligible then completed a 20-item survey via Qualtrics that included questions about HPV, the vaccine, and social media use. Survey compensation was either $5 or $10. At the end of the survey, we provided information about HPV and the vaccine. The campaign was available in English and Spanish. Results: The first campaign was launched on both Facebook and Twitter and offered $5 compensation. The Facebook component yielded 18,527 impressions; two adults were confirmed eligible by the screener and both completed the survey (100% screener to completion rate). Cost per survey was $349.45. The Twitter component received 143,661 impressions and yielded 18 completed surveys, with a screener to completion rate of 26% and a cost of $42.99 per survey. For the second campaign, we dropped Facebook and focused solely on Twitter, offering $10 compensation. We received 50,475 impressions that yielded 55 completed surveys (screener to completion rate = 71%) costing $4.78 each. The final campaign tested simpler messaging on Twitter with $10 compensation, and received 8,897 impressions, 38 survey completions (screener to completion rate = 88%), and cost $1.19 per survey. Conclusions: While Facebook is widely used among Americans, our findings may suggest that Twitter is more engaging and cost-effective. Recent Facebook policy changes may explain the differences seen in cost and survey completion. Understanding the reach and effectiveness of the different platforms will help ensure the success of an intervention using social media.

Exploring Asian Indian and Pakistani views about cancer and participation in cancer genetics research: toward the development of a community genetics intervention

Cancer is a leading cause of mortality among the three million Asian Indian/Pakistanis (AIPs) in the USA. AIPs have traditionally been underrepresented in cancer-related research, although reasons remain largely unexplored. We sought to understand AIP's awareness and perceptions of cancer to improve their participation in risk assessment and cancer genetics research. Four focus groups, stratified by gender and birthplace (US-born vs. foreign-born), were held at an AIP cultural center. Discussions focused on knowledge and awareness of cancer risk; how AIP culture influences cancer perceptions; access to health care services for cancer screening, diagnosis, or treatment; and willingness to or experiences with participating in cancer genetics research. Sessions were audio-recorded, transcribed verbatim, and content analyzed using NVivo^®11 for dominant themes. Thirty-two AIP adults participated in a focus group. Information on family cancer history is challenging to obtain due to the desire for privacy, cancer stigma, and loss of medical records. Interest in genetic testing for cancer risk was mixed: some were in favor of knowing their personal risk, yet many noted that future generations in their family would benefit more by knowing their risk. Participants felt that the AIP community has largely been overlooked in recruitment efforts for research studies. Recommendations for improving recruitment efforts included partnering with community events and festivities, posting culturally and linguistically relevant recruitment materials, and focusing on population-wide health improvement. Understanding the culture and perceptions of AIPs, separate from Asian Americans at large, will allow for more tailored approaches for including this population in cancer genetics research.