Listening Sessions to Shape the Innovative NIH ComPASS Common Fund Program to Advance Health Equity.

The National Institutes of Health (NIH) recognized the need for a research program to address the underlying structural factors that impact health. To inform the development of the NIH Common Fund Community Partnerships to Advance Science for Society (ComPASS) Program, NIH obtained input through community listening sessions. Through its design, ComPASS recognizes the essential role of community organizations as the lead in addressing persistent structural and social challenges to accelerate progress toward advancing health equity. (Am J Public Health. 2024;114(7):685-689. https://doi.org/10.2105/AJPH.2024.307656).

HPV-Related Cancer Prevention and Control Programs at Community-Based HIV/AIDS Service Organizations: Implications for Future Engagement.

Background: People living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and, men who have sex with men (MSM) are disproportionately affected by genital warts and cancers caused by human papillomavirus (HPV). We assessed community-based HIV/AIDS service organizations' (ASOs) staff awareness, knowledge, attitudes, and beliefs about HPV and effective cancer prevention tools, namely HPV vaccination, Pap, and HPV tests. The potential engagement of ASO staff in future efforts to reduce the disproportionate burden of genital warts and HPV-related cancers among HIV-positive women and MSM was explored. Methods: In May-June 2016, staff were recruited from three ASOs located in the South United States Census region-a geographical area disproportionately affected by HIV/AIDS. Participants completed a 30-min self-administered, 118-item paper and pencil survey about HPV and cancer. Data analysis was conducted using Stata/SE 14.2. Results: ASO staff (n = 30) were 83% non-Hispanic Black, 40% lesbian/gay, and worked with people living with HIV for an average of 11.4 ± 7.7 years. All reported hearing of HPV and 77% had heard of the HPV vaccine (n = 23). While all knew HPV can cause cervical cancer, only 67% knew HPV can cause anal cancer. Most (61%) thought the HPV vaccine could prevent cervical cancer. Fewer (39-48%) thought the HPV vaccine could prevent anal, oral, penile, vaginal, and vulvar cancers. All were willing to encourage MSM and female clients to talk to a healthcare provider about HPV vaccination. Almost all were willing to promote HPV vaccination to clients (91-95%) and navigate clients to adult safety net HPV vaccine providers (86-95%). More than half (59-67%) thought they could positively influence their MSM and female clients' HPV vaccine decision-making. Conclusion: HPV vaccination and the Pap and HPV tests are effective cancer prevention tools that can reduce the disproportionate burden of genital warts and HPV-related cancers among HIV-positive women and MSM. Engaging ASO staff in cancer prevention efforts may increase HPV vaccination rates and early detection of HPV-related cancers among HIV-positive women and MSM. Exploring ASOs as community-based settings for promoting effective cancer prevention tools may foster opportunities to reduce the disproportionate burden of genital warts and HPV-related cancers among HIV-positive women and MSM.

Patient-provider communication with HIV-positive women about abnormal Pap test results.

In this article, the authors examine communication between women living with human immunodeficiency virus (WLH) and health care providers (HCPs) regarding abnormal Pap tests. During the period of March 2011 through April 2012, 145 WLH were recruited from Ryan White funded clinics and community-based AIDS service organizations located in the southeastern United States. WLH who had an abnormal Pap test (69%, n = 100/145) were asked if their HCP shared and explained information about abnormal Pap tests. The authors performed chi-square tests and multivariable logistic regression analyses using Stata I/C 13. HCPs shared information about abnormal Pap tests with 60% of participants, and explained the information they shared to 78% of those. Health literate participants were more than three times as likely to have read the information received about abnormal Pap tests (adjusted odds ratio [aOR] = 3.49, 95% confidence interval [CI] 1.19-10.23), and almost five times as likely to have understood the cancer information they read (aOR = 4.70, 95% CI 1.55-14.24). Knowing other women who had had an abnormal Pap test was not significantly associated with cancer information seeking or processing after controlling for confounding factors. The present findings underscore the need to increase WLH's health literacy as an intermediate step to improving patient-provider communication among WLH. Lay sources of cancer information for WLH warrant further study.

Social and Structural Determinants of Cervical Health among Women Engaged in HIV Care.

Cervical cancer prevention/control efforts among women living with HIV/AIDS (WLH) are socially and structurally challenging. Healthcare access and perceived HIV stigma and discrimination are factors that may challenge risk reduction efforts. This study examined socio-structural determinants of cervical cancer screening among women engaged in HIV care. One hundred forty-five WLH seeking health/social services from AIDS Service Organizations in the southeastern US completed a questionnaire assessing factors related to cervical cancer prevention/control. Ninety percent were African American, mean age 46.15 ± 10.65 years. Eighty-one percent had a Pap test <1 year ago. Low healthcare access was positively associated with having a Pap test <1 year ago, (Odds ratio [OR] 3.80; 95 % Confidence interval [CI] 1.34-10.78). About 36 % reported ≥2 Pap tests during the first year after HIV diagnosis. Lower educational attainment was positively associated with having ≥2 Pap tests, OR 3.22; CI 1.08-9.62. Thirty-five percent reported more frequent Pap tests after diagnosis. Lower income was moderately associated with more frequent Pap tests post-diagnosis, OR 2.47; CI .98-6.23. Findings highlight the successes of HIV initiatives targeting socio-economically disadvantaged women and provide evidence that health policy aimed at providing and expanding healthcare access for vulnerable WLH has beneficial health implications.

Cervical Cancer Prevention Knowledge and Abnormal Pap Test Experiences Among Women Living with HIV/AIDS.

Cervical cancer prevention knowledge deficits persist among women living with HIV/AIDS (WLHA) despite increased risk of developing cervical dysplasia/cancer. We examined associations between WLHA's cervical cancer prevention knowledge and abnormal Pap test history. We recruited 145 urban and rural WLHA from Ryan White-funded clinics and AIDS service organizations located in the southeastern USA between March 2011 and April 2012. For this analysis, women who reported a history of cervical cancer (n = 3) or had a complete hysterectomy (n = 14) and observations with missing data (n = 22) were excluded. Stata/IC 13 was used to perform cross-tabulations and chi-squared tests. Our sample included 106 predominantly non-Hispanic Black (92%) WLHA. Mean age was 46.3 ± 10.9 years. Half (50%) had ≤ high school education. One third (37%) had low health literacy. The majority (83 %) had a Pap test <1 year ago, and 84 % knew that WLHA should have a Pap test every year, once two tests are normal. Many (68%) have had an abnormal Pap test. Abnormal Pap test follow-up care knowledge varied. While 86% knew follow-up care could include a repeat Pap test, only 56% knew this could also include an HPV test. Significantly, more women who had an abnormal Pap test knew follow-up care could include a biopsy (p = 0.001). For WLHA to make informed/shared decisions about their cervical health, they need to be knowledgeable about cervical cancer care options across the cancer control continuum. Providing WLHA with prevention knowledge beyond screening recommendations seems warranted given their increased risk of developing cervical dysplasia/neoplasia.

Does knowledge influence pap test screening among young African-American women?

Pap test screening among African-American women has substantially increased. However, African-American women continue to bear the burden of cervical cancer as compared to White women. The objective of this study was to assess the influence of Pap test knowledge on cervical screening history among young African-American women. Between January and April 2009, 320 women from historically black colleges and universities located in the southeastern United States who met study inclusion criteria completed an anonymous self-report questionnaire to assess their awareness, knowledge, and behaviors related to human papillomavirus and cervical cancer prevention and control. Seventy-six percent of women reported ever having a Pap test, 54 % reported having a Pap test less than 1 year ago, and 25 % reported ever having an abnormal Pap test result. The overall mean score on the six-point Pap test knowledge scale was 4.46 ± 1.02. Women who reported having an abnormal Pap test (4.96 ± 0.82) had significantly higher Pap test knowledge compared to those never having an abnormal result (4.49 ± 1.04), p < 0.01. No other differences were found. Efforts to improve Pap test knowledge among all women, including those with no prior abnormal Pap test history, are critical to cervical cancer prevention and control over the life course. Such efforts should include creating information that is relevant to the population and enables informed decision making about cervical health.

Factors associated With Medicaid providers' recommendation of the HPV vaccine to low-income adolescent girls.

PURPOSE: Human papillomavirus (HPV) vaccination in the United States remains a public health challenge with vaccine rates of 50%. Although health care providers can facilitate HPV vaccination, several factors may impede their ability to universally recommend the vaccine. To maximize the potential of HPV vaccines, it is important to understand challenges providers face in the clinical environment. The study sought to identify factors associated with recommendation of the HPV vaccine for low-income adolescents in the early (9-10), target (11-12), early adolescent catch-up (13-14), and late adolescent catch-up (15-17) vaccination groups. METHODS: Surveys were mailed between October 2009 and April 2010 to a random sample of Florida-based physicians serving Medicaid-enrolled adolescents. Data were analyzed in 2013. RESULTS: Among early adolescents, discomfort discussing sexually transmitted infections (STIs) with teens (odds ratio [OR] = 1.75), difficulty ensuring vaccine completion (OR = .73), and discomfort discussing STIs with parents (OR = .44) were associated with recommendation. For target adolescents, discomfort discussing STIs with teens (OR = 2.45), time constraints (OR = .70), vaccine efficacy concerns (OR = .65), discomfort discussing STIs with parents (OR = .33), obstetrics/gynecology (OR = .25) and family medicine (OR = .24) specialty, and non-Hispanic black patient (OR = .15) were associated with recommendation. In early catch-up adolescents, concerns that teens will practice riskier behaviors (OR = .57), discomfort discussing STIs with parents (OR = .47), and family medicine specialty (OR = .20) were associated with recommendation. For late catch-up adolescents, family medicine specialty (OR = .13) was associated with recommendation. CONCLUSIONS: Modifiable factors that impede or influence provider recommendations of HPV vaccines can be addressed through intervention. Overall, findings suggest that efforts should focus on sexuality communication and family medicine specialty.

Human papillomavirus vaccine administration among Medicaid providers who consistently recommended vaccination.

We examined factors potentially related to providers' self-reported human papillomavirus vaccine administration to female Medicaid enrollees among providers who consistently recommended vaccination. Some pronounced variability was observed in characteristics among providers who consistently administered vaccination, including provider age, race, and Vaccines for Children enrollment; patient/parent vaccine refusal; patient race/ethnicity; and patient volume.

Changes in Body Mass Index Following HAART Initiation among HIV-Infected Women in the Women's Interagency HIV Study.

OBJECTIVE: Examine changes in, and factors associated with changing body mass index (BMI) in women following highly active antiretroviral therapy (HAART) initiation. METHODS: 1177 HIV-infected Women's Interagency HIV Study participants who contributed 10,754 years of follow-up following HAART initiation were studied. Changes in median BMI up to 15 years following HAART initiation, and the highest and lowest BMI reached following HAART initiation were summarized by pre-HAART BMI category (<18.5 [underweight], 18.5-<25.0 [normal weight], 25.0-<30.0 [overweight], 30.0-<40.0 [obese], and ≥ 40.0 [morbidly obese]). Multivariate mixed effects ordinal logistic regression estimated the degree of association of each exposure of interest with post-HAART BMI. RESULTS: Before HAART, 39% percent of women had normal BMI, 31% were overweight, 23% were obese, and 5% were morbidly obese. Following HAART initiation, median BMI change (per 5 years) was 0.21 kg/m2 (90% confidence interval [CI]: -1.33, 0.42) for those with normal pre-HAART BMI, 0.39 kg/m2 (90% CI: 0.15,0.66) for overweight, 0.31 kg/m2 (90% CI: -1.18,0.67) for obese, and -0.36kg/m2 for morbidly obese women. After initiating HAART, 40% with normal pre-HAART BMI became overweight at some point; of those overweight, 46% remained overweight and 47% became obese; 71% of obese women remained obese and 27% became morbidly obese. Each year of nucleoside analog reverse transcriptase inhibitor use was associated with a 3% decreased odds of reaching a higher BMI category (OR 0.97, 95% CI: 0.95, 0.99), while each year of protease inhibitor or non-nucleoside analog reverse transcriptase inhibitor use were associated with a 6% (OR 1.06, 95% CI: 1.04, 1.08) and 5%(OR 1.05, 95% CI: 1.01, 1.08) increased odds of having a higher BMI category, respectively. CONCLUSIONS: Although overweight and obesity are highly prevalent in this large cohort of HIV-infected, minority women, HAART use was associated with only a modest increase in BMI over time.

The role of family history of cancer on cervical cancer screening behavior in a population-based survey of women in the Southeastern United States.

BACKGROUND: Our objective was to determine the association of self-reported family history of cancer (FHC) on cervical cancer screening to inform a potential link with cancer preventive behaviors in a region with persistent cancer disparities. METHODS: Self-reported FHC, Pap test behavior, and access to care were measured in a statewide population-based survey of human papillomavirus and cervical cancer (n = 918). Random-digit dial, computer-assisted telephone interviews were used to contact eligible respondents (adult [ages 18-70] women in South Carolina with landline telephones]. Logistic regression models were estimated using STATA 12. FINDINGS: Although FHC+ was not predictive (odds ratio [OR], 1.17; 95% confidence interval [CI], 0.55-2.51), private health insurance (OR, 2.35; 95% confidence interval [CI], 1.15-4.81) and younger age (18-30 years: OR, 7.76; 95% CI, 1.91, 3.16) were associated with recent Pap test behavior. FHC and cervical cancer screening associations were not detected in the sample. CONCLUSIONS: Findings suggest targeting older women with screening recommendations and providing available screening resources for underserved women.

Assessing the influence of health literacy on HIV-positive women's cervical cancer prevention knowledge and behaviors.

Women living with HIV (WLH) bear a disproportionate burden of cervical cancer and may face challenges understanding health information. The purpose of this study was to assess the influence of health literacy on WLH cervical cancer screening knowledge and behaviors. WLH were recruited from clinic- and community-based settings in the southeastern USA. The majority of women completing a questionnaire assessing factors related to cervical cancer were African American (90 %). About 38 % of women reported low health literacy. Compared to women with high health literacy, these women were more likely to report having had ≥ 2 Pap tests during the year after HIV diagnosis (p=0.02), and less likely to have had a Pap test <1 year previously (p=0.05). There was no difference in cervical cancer or human papillomavirus knowledge among those with low versus high health literacy. Results revealed mixed finding on the influence of health literacy on screening knowledge and behaviors.

Sociodemographic differences in fears and mistrust contributing to unwillingness to participate in cancer screenings.

Effective provider-patient relationships are vital for positive patient health outcomes. This analysis assessed sociodemographic differences in fears and mistrust related to the provider-patient relationship, which may contribute to unwillingness to participate in cancer screenings (CSs). The data are from a stratified, random-digit dial telephone questionnaire of non-institutionalized households in New York, Maryland, and Puerto Rico. Statistically significant results indicate that Hispanics, compared with Whites, were nearly two times more likely to report that fear of being a "guinea pig" and lacking trust in medical people would make them unwilling to participate in CSs. Additionally, those with less education were over two times more likely to indicate a fear of being embarrassed during the screening would make them unwilling to participate in CSs. These results highlight areas where health professionals can improve interactions with their patients and be attentive to their fears and/or mistrusts to promote CSs utilization.

Unwillingness to participate in colorectal cancer screening: examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older.

PURPOSE: Identify the influence of medical mistrust, fears, attitudes, and sociodemographic characteristics on unwillingness to participate in colorectal cancer (CRC) screening. DESIGN: Cross-sectional, disproportionally allocated, stratified, random-digit-dial telephone questionnaire of noninstitutionalized households. SETTING: New York City, New York; Baltimore, Maryland; San Juan, Puerto Rico. SUBJECTS: Ethnically diverse sample of 454 adults ≥50 years of age. MEASURES: Health status, cancer screening effectiveness, psychosocial factors (e.g., perceptions of pain, fear, trust), and CRC screening intentions using the Cancer Screening Questionnaire, which addresses a range of issues related to willingness of minorities to participate in cancer screening. ANALYSIS: Multivariate logistic regression was used to model the probability of reporting unwillingness to participate in CRC screening. RESULTS: Fear of embarrassment during screening (odds ratio [OR] = 10.72; 95% confidence interval [CI], 2.15-53.39), fear of getting AIDS (OR = 8.75; 95% CI, 2.48-30.86), fear that exam might be painful (OR = 3.43; 95% CI, 1.03-11.35), and older age (OR = 1.10; 95% CI, 1.04-1.17) were positively associated with unwillingness to participate in CRC screening. Fear of developing cancer (OR = .12; 95% CI, .03-.57) and medical mistrust (OR = .19; 95% CI, .06-.60) were negatively associated with unwillingness to screen. CONCLUSIONS: Findings suggest that CRC health initiatives should focus on increasing knowledge, addressing fears and mistrust, and normalizing CRC screening as a beneficial preventive practice, and should increase focus on older adults.

Formative research on perceptions of biobanking: what community members think.

Preparing healthy community members with timely communications prior to engaging them in a request to donate biospecimens promises to improve the experience of biobanking participation. To this end, a qualitative study was conducted to assess community member knowledge, attitudes, beliefs, and informational needs about cancer-related biospecimen collection in a large metropolitan area in southwest Florida. The study utilized purposive sampling techniques to recruit a total of 95 participants to participate in 12 focus groups, segmented by race/ethnicity and language preference (mixed race, African American only, and Spanish speaking) and age (18-29, 30-54, and 55 and older). Focus group interviews were analyzed using content analysis to identify emergent themes. Overall, participants in the 30 years and older groups were favorable toward participating in biobanking if their concerns were addressed, such as confidentiality and consent issues, in contrast to participants aged 18-29 who were more skeptical. For all participants, the desire to participate in research that seeks new cancer treatments outweighed mistrust. Moreover, many cited the potential scientific benefit for future generations as a primary motivator. Finally, in some groups a therapeutic misconception was expressed, where participants expressed a willingness to forego confidentiality of their health status in exchange for therapeutic benefit. This study contributes to the literature on community perceptions of the benefits and barriers of biobanking and adds to the development of meaningful education communication priming tools to advance understandings about biobanking.

Do health beliefs, health care system distrust, and racial pride influence HPV vaccine acceptability among African American college females?

The promise of human papillomavirus (HPV) vaccines rests with the ability to promote widespread uptake especially among populations at high risk of cervical cancer and other associated disease outcomes. The purpose of this study was to examine health beliefs and culturally specific influences of HPV vaccine acceptability among African American college females. Approximately 76 percent of participants reported HPV vaccine acceptability. Predictors of acceptability included: higher perceived benefit and lower racial pride. Findings can be used to inform development of campus-based HPV educational approaches to promote widespread HPV vaccine acceptability and safer sex practices among African American college females.

Creating a patient navigation model to address cervical cancer disparities in a rural Hispanic farmworker community.

This report describes the implementation of a pilot patient navigation (PN) program created to address cervical cancer disparities in a predominantly Hispanic agricultural community. Since November 2009, a patient navigator has provided services to patients of Catholic Mobile Medical Services (CMMS). The PN program has resulted in the need for additional clinic sessions to accommodate the demand for preventive care at CMMS.

HPV vaccine information-seeking behaviors among US physicians: government, media, or colleagues?

The multiple information sources available may pose a challenge to physicians in providing accurate human papillomavirus (HPV) vaccine information to patients. The purpose of this study was to describe physicians' HPV vaccine information-seeking behaviors and assess if these behaviors differ by physician specialty and sociodemographic characteristics. In 2009, 1008 Family Physicians (FPs), Pediatricians (Peds), and Obstetricians/Gynecologists (OBGYNs) completed a survey to assess their HPV vaccine information-seeking behaviors and vaccination practices. The largest proportion obtained HPV vaccine information from professional organizations (50.0%), followed by the Advisory Council on Immunization Practices (ACIP) (36.0%), and medical conferences (33.1%). Peds and FPs were more likely to obtain vaccine information from the ACIP (p-values<0.05). OBGYNs, non-White/Caucasian physicians, and those aged 40-49 were more likely to obtain vaccine information from internet websites (p-values<0.05). There is a need for targeted HPV vaccine communication approaches based on sociodemographic and physician specialty characteristics.

Working to close the gap: identifying predictors of HPV vaccine uptake among young African American women.

Factors associated with greater likelihood of human papillomavirus (HPV) vaccination among women who experience excess cervical cancer incidence and mortality requires further study. The purpose of this study was to assess factors associated with HPV vaccine uptake among young African American women. Three hundred sixty-three African American women aged 18-26 were recruited from Historically Black Colleges/Universities to complete a questionnaire to assess health beliefs associated with HPV vaccination. One quarter of participants reported uptake of the HPV vaccine. Women who reported uptake had significantly higher HPV knowledge, lower perceived barriers to vaccination, and were younger (all p<.05). Factors significantly associated with HPV vaccine uptake included HPV knowledge (OR=1.22), perceived severity of health outcomes (OR=0.48), perceived barriers to vaccination (OR=0.49), cues to action (OR=1.94), and age (OR=0.68). Findings can be used to inform the development of targeted HPV vaccine promotion programs for African American women to prevent continued cervical cancer disparities.

Knowledge, beliefs, and behaviors: examining human papillomavirus-related gender differences among African American college students.

OBJECTIVE: Given recent approval for administration of a human papillomavirus (HPV) vaccine to men, it is important to assess the HPV-related perspectives of men and women. The purpose of this study was to examine gender differences in HPV knowledge, beliefs, and vaccine acceptance among college students attending 3 historically black colleges/universities in the Southeast. PARTICIPANTS AND METHODS: A nonprobability sample of 575 students completed a self-report questionnaire. RESULTS: Males were significantly less likely to have heard of HPV, scored lower in HPV knowledge, were less likely to perceive HPV health outcomes as severe and that there was a benefit to vaccinate, reported fewer cues for vaccine acceptance, and perceived more barriers to vaccination compared to females (all p < .05). CONCLUSIONS: The gender disparities demonstrated in this study highlight the need to increase HPV-related communication/education to include men and to extend HPV research to a broader segment of the college population.

A SOCIAL NETWORK ANALYSIS APPROACH TO UNDERSTAND CHANGES IN A CANCER DISPARITIES COMMUNITY PARTNERSHIP NETWORK.

The Tampa Bay Community Cancer Network (TBCCN) is one of the Community Network Program sites funded (2005-10) by the National Cancer Institute's Center to Reduce Cancer Health Disparities. TBCCN was tasked to form a sustainable, community-based partnership network focused on the goal of reducing cancer health disparities among racial-ethnic minority and medically underserved populations. This article reports evaluation outcome results from a social network analysis and discusses the varying TBCCN partner roles-in education, training, and research-over a span of three years (2007-09). The network analysis included 20 local community partner organizations covering a tricounty area in Southwest Florida. In addition, multiple externally funded, community-based participatory research pilot projects with community-academic partners have either been completed or are currently in progress, covering research topics including culturally targeted colorectal and prostate cancer screening education, patient navigation focused on preventing cervical cancer in rural Latinas, and community perceptions of biobanking. The social network analysis identified a trend toward increased network decentralization based on betweenness centrality and overall increase in number of linkages, suggesting network sustainability. Degree centrality, trust, and multiplexity exhibited stability over the three-year time period. These results suggest increased interaction and interdependence among partner organizations and less dependence on the cancer center. Social network analysis enabled us to quantitatively evaluate partnership network functioning of TBCCN in terms of network structure and information and resources flows, which are integral to understanding effective coalition practice based on Community Coalition Action Theory ( Butterfoss and Kegler 2009). Sharing the results of the social network analysis with the partnership network is an important component of our coalition building efforts. A comprehensive baseline needs assessment for the next five-year funding phase (2010-15) of TBCCN Community Networks Program Centers (CNP Center) is under way to further evaluate the growth and sustainability of the partnership network, with an emphasis on community-based intervention research that takes into account culture and literacy. [social network, health care disparities, cancer screening].