Supporting ColoREctal Equitable Navigation (SCREEN): a protocol for a stepped-wedge cluster randomized trial for patient navigation in primary care.

BACKGROUND: Black individuals in the United States (US) have a higher incidence of and mortality from colorectal cancer (CRC) compared to other racial groups, and CRC is the second leading cause of death among Hispanic/Latino populations in the US. Patient navigation is an evidence-based approach to narrow inequities in cancer screening among Black and Hispanic/Latino patients. Despite this, limited healthcare systems have implemented patient navigation for screening at scale. METHODS: We are conducting a stepped-wedge cluster randomized trial of 15 primary care clinics with six steps of six-month duration to scale a patient navigation program to improve screening rates among Black and Hispanic/Latino patients. After six months of baseline data collection with no intervention we will randomize clinics, whereby three clinics will join the intervention arm every six months until all clinics cross over to intervention. During the intervention roll out we will conduct training and education for clinics, change infrastructure in the electronic health record, create stakeholder relationships, assess readiness, and deliver iterative feedback. Framed by the Practical, Robust Implementation Sustainment Model (PRISM) we will focus on effectiveness, reach, provider adoption, and implementation. We will document adaptations to both the patient navigation intervention and to implementation strategies. To address health equity, we will engage multilevel stakeholder voices through interviews and a community advisory board to plan, deliver, adapt, measure, and disseminate study progress. Provider-level feedback will include updates on disparities in screening orders and completions. DISCUSSION: Primary care clinics are poised to close disparity gaps in CRC screening completion but may lack an understanding of the magnitude of these gaps and how to address them. We aim to understand how to tailor a patient navigation program for CRC screening to patients and providers across diverse clinics with wide variation in baseline screening rates, payor mix, proximity to specialty care, and patient volume. Findings from this study will inform other primary care practices and health systems on effective and sustainable strategies to deliver patient navigation for CRC screening among racial and ethnic minorities. TRIAL REGISTRATION: NCT06401174.

Bystander Acknowledgment Mitigates the Psychological and Physiological Pain of Racial Discrimination for Black Young Adults: A Randomized Controlled Trial.

Racism increases pain sensitization and contributes to racialized pain inequities; however research has not tested interventions targeting racism to reduce pain. In this study we examined whether White bystanders can act to mitigate racism's pain sensitizing effects. To simulate racial exclusion in the laboratory, Black young adults (age 18-30; N = 92) were randomly assigned to be included or excluded by White players in a ball-tossing game (Cyberball). For half of excluded participants, White bystanders acknowledged and apologized for the racial exclusion. Participants completed a cold pressor task to assess pain threshold, tolerance, and unpleasantness; and completed a survey assessing psychological needs (i.e., belongingness, self-esteem, meaningful existence, and self-control). Participants who experienced racial exclusion reported significantly more threatened psychological needs and increased laboratory pain sensitization (i.e., lower pain threshold and tolerance) than those who were included. However, when a White bystander acknowledged the racism, excluded participants reported higher levels of self-control, self-esteem, and decreased pain sensitization (pain threshold and tolerance) relative to excluded participants whose experience was not acknowledged. Our findings support that racism increased Black people's pain sensitivity and provide initial evidence for White bystander acknowledgment as a health intervention. PERSPECTIVE: Continual exposure to racism likely contributes to inequities in pain sensitization. We demonstrate that acute exposure to mild racism increases acute pain sensitization. Results suggest that a bystander acknowledging witnessed racism can buffer the acute sensitizing effects of racism on pain, pointing to the potential of interpersonal interventions targeting racism.

Watching the fall of Roe v. Wade: Media exposure relates to U.S. women's alcohol use intentions.

OBJECTIVE: The Supreme Court of the United States' decision in Dobbs v. Jackson Women's Health Organization in June 2022 overturned Roe v. Wade and ended federal protection of abortion rights. Given the drastic policy changes as a result of the ruling and high exposure to media related to abortion, women opposed to the decision may have experienced distress, which could trigger maladaptive coping strategies, such as alcohol use. The present research examined how consuming abortion-related media in the weeks following the Dobbs decision impacted alcohol use intentions among women of reproductive age residing in the 13 "trigger law" states that immediately restricted abortion access. METHOD: A sample of 196 women (Mage = 30.52, SD = 6.9) residing in trigger law states answered questions about abortion-related media consumption, views toward the Dobbs ruling, negative affect, and alcohol use intentions. RESULTS: Consuming more abortion-related media predicted higher alcohol use intentions for women who opposed the ruling, but not those who were in favor of abortion restrictions. CONCLUSIONS: This timely study provides evidence of how the Dobbs ruling is associated with health ramifications beyond reproduction, yielding insights about how high media exposure to large-scale, distressing events may put those most affected-women of reproductive age in states that enacted new policies restricting abortion access-at risk for alcohol use. Findings highlight an imperative direction for future research as abortion restrictions continue to be spotlighted in U.S. media and state legislatures. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Intersectional discrimination from black women, white women, black men, or white men impacts young adult black women's affective states and risky health cognitions.

OBJECTIVE: Black women experience pronounced inequalities in alcohol use and sexual risk outcomes. Racial discrimination is a known contributor to health inequalities. However, Black women face unique and intersectional forms of discrimination beyond racial discrimination. The current study investigates how exclusion from four distinct social groups effects Black women's negative affect and risky health cognitions. DESIGN: Black women (N = 124; ages 18-29) were randomly assigned to be excluded in Cyberball by Black women, Black men, White women, or White men. MAIN OUTCOME MEASURES: Participants responded to measures of internalising (depressive, anxious) and externalising (anger) affect, heavy alcohol use willingness, and risky sex expectations. RESULTS: Participants primarily attributed exclusion from White women to racial discrimination, exclusion from Black men to gender discrimination, and exclusion from White men to both gender and racial discrimination. When excluded by White women, participants reported the highest levels of anger, depressive affect, and anxiety. Exclusion by White men predicted the greatest heavy drinking willingness, though exclusion by Black men predicted the greatest risky sex expectations. CONCLUSION: This study is the first to demonstrate that exclusion from different social groups leads to differing patterns of negative affect and risky health cognitions in young adult Black women.

Rare exemplars and missed opportunities: Intersectionality within current sexual and gender diversity research and scholarship in psychology.

Using intersectionality as our critical analytical framework, we examined 22 articles on sexual and gender diversity (SGD) published in peer-reviewed psychology journals between January and June 2022 to: (1) identify their engagement with intersectionality's core themes; and (2) highlight key findings and directions for future intersectional SGD research. Our review includes 12 theoretical and empirical articles that addressed a breadth of topics such as intersectional stigma/discrimination, gendered racism, minority stress, and intersectional ableism. This review highlights opportunities within intersectional SGD research in psychology to provide a needed corrective to the discipline's tradition of individualistic, single-axis research focused on predominantly White, cisgender and heterosexual people, and attend to intersectionality's focus on intersecting power relations and commitments to social justice.

The Influence of Descriptive and Injunctive Norms on U.S. Adolescent Marijuana Use: A Systematic Review of the Literature.

OBJECTIVE: Prior research among adolescents has identified injunctive and descriptive norms as predictors of marijuana use. Yet, there is no consensus on which norm (i.e., injunctive or descriptive) or referent group (e.g., parents, peers, closest friend) is most consistently related to adolescent marijuana use. The objective of this review is to synthesize literature on perceived social norms and adolescent marijuana use and to identify the referents most commonly studied in relation to adolescent marijuana use. METHOD: A systematic review, following PRISMA guidelines, assessed studies published from 1998 to 2018 that reported the impact of adolescents' perceived injunctive norms and descriptive norms on self-reported marijuana use. Seventeen peer-reviewed English-language studies met inclusion criteria. RESULTS: Across cross-sectional and longitudinal studies, injunctive norms and descriptive norms significantly predicted adolescent marijuana use. Peer norms were the most commonly measured descriptive norm and were found to be most positively related to marijuana use. Parental norms were the most measured injunctive norm and were also positively related to use. CONCLUSIONS: Injunctive norms and descriptive norms are key factors in considering adolescent marijuana use, although peer descriptive norms may be most influential. The lack of systematic definition and measurement of marijuana use, norms, and referents was apparent in the literature. Future research should systemize norm constructs and explore differences in the norm-marijuana use relationship among adolescents with intersecting identities (e.g., gender, race) and social network referents (e.g., family, peer groups).

Abstaining College Students' Motives to Use E-Cigarettes: A Brief Report.

OBJECTIVE: Although college students have higher rates of e-cigarette use compared with non-college-attending young adults, e-cigarette-abstaining college students are an understudied population. The present study was designed to create a scale assessing current e-cigarette abstainers' motives to abstain from or initiate e-cigarette use. METHOD: Participants from two universities who had never used e-cigarettes (n = 281) completed an online survey. Participants indicated their e-cigarette abstention and initiation motives, and their perceived vulnerability to, willingness to use, and intentions to use e-cigarettes. RESULTS: Analyses revealed three factors of abstention motives (avoiding health outcomes, low incentive to initiate, and concerns regarding social approval of use) and three factors of initiation motives (tobacco alternatives, social reasons, and coping with negative emotions). When demographics were controlled for, only coping motives significantly positively related to abstainers' willingness and intentions for future e-cigarette initiation. Furthermore, only the avoiding health outcomes abstention motive was positively related to participants' perceived vulnerability to the negative health effects of e-cigarettes. CONCLUSIONS: This study provides initial support for a scale to assess what motives abstainers may have to initiate e-cigarette use. Results indicated that coping motives may be indicators of readiness to initiate e-cigarettes.