Civic Learning, Science, and Structural Racism.

Vaccine hesitancy is a major public health challenge, and racial disparities in the acceptance of vaccines is a particular concern. In this essay, we draw on interviews with mothers of Black male adolescents to offer insights into the reasons for the low rate of vaccination against the human papillomavirus among this group of adolescents. Based on these conversations, we argue that increasing the acceptance of HPV and other vaccines cannot be accomplished merely by providing people with more facts. Instead, we must address the pervasive racial discrimination in the United States that undermines trust in social institutions, including the health care system. In the short term, it may be helpful to increase the number of clinicians of color working in the health system, but more fundamental changes are required. The U.S. must adopt and implement policies that dismantle structural racism if it hopes to produce greater trust and community-oriented thinking on behalf of people who have been exploited for centuries.

In Their Own Words: Young Adults' Menthol Cigarette Initiation, Perceptions, Experiences and Regulation Perspectives.

Background: Menthol cigarettes are disproportionately used by young people and have been called smoking starter products. However, limited qualitative research exists on young adults' perceptions of and experiences with these products, with much of it based on document reviews of the tobacco industry's research. Methods: We conducted six focus groups with young adult (ages 18-24) menthol smokers in New Jersey (half with black smokers) between December 2014 and March 2015. Participants were asked open-ended questions about their menthol smoking initiation, preference reasons, substitution behaviors, and perceptions of menthol cigarette risks and regulation. Results: Participants' menthol cigarette initiation and preference were influenced by their perceived popularity, brand recognition, taste, smoothness, satisfaction and access (including as "loosies," typically available for Newport). Some believed menthol cigarettes were less harmful than non-menthol cigarettes when initiating smoking. Many currently believed menthol cigarettes were more harmful because they contained extra "additives," were stronger (ie, requiring fewer cigarettes to feel satisfied), and/or based on hearsay. Many had tried new brand Camel Crush, which was perceived to be especially minty, fun, and attractive for newer smokers. While some used non-menthol cigarettes when menthols were unavailable, many said they would never or almost never substitute. Many acknowledged a menthol cigarettes ban would likely help them quit smoking, even though they did not support the idea. Conclusions: Menthol cigarette initiation is influenced by an interplay of multiple factors including their sensory properties, marketing, perceived popularity and availability. The FDA should continue to pursue closing this flavored cigarette loophole. Implications: In this first qualitative study of menthol cigarette use among young adults, we found further evidence that menthol cigarettes can act as starter products because they are perceived as easier to smoke and taste and smell better than non-menthol cigarettes. We also add to the literature in finding that menthol cigarettes are perceived by young people who smoke menthol cigarettes as delivering satisfaction with fewer cigarettes, being accessible as "loosies", and being popular among their peers. Many did not understand the reasons behind a potential menthol ban. Any future regulation of menthol cigarettes should include a public educational campaign to support buy-in.

Engaging the community to improve nutrition and physical activity among houses of worship.

BACKGROUND: Obesity, physical inactivity, and poor nutrition have been linked to many chronic diseases. Research indicates that interventions in community-based settings such as houses of worship can build on attendees' trust to address health issues and help them make behavioral changes. COMMUNITY CONTEXT: New Brunswick, New Jersey, has low rates of physical activity and a high prevalence of obesity. An adapted community-based intervention was implemented there to improve nutrition and physical activity among people who attend houses of worship and expand and enhance the network of partners working with Rutgers Cancer Institute of New Jersey. METHODS: An adapted version of Body & Soul: A Celebration of Healthy Living and Eating was created using a 3-phase model to 1) educate lay members on nutrition and physical activity, 2) provide sustainable change through the development of physical activity programming, and 3) increase access to local produce through collaborations with community partners. OUTCOME: Nineteen houses of worship were selected for participation in this program. Houses of worship provided a questionnaire to a convenience sample of its congregation to assess congregants' physical activity levels and produce consumption behaviors at baseline using questions from the Health Information National Trends Survey instrument. This information was also used to inform future program activities. INTERPRETATION: Community-based health education can be a promising approach when appropriate partnerships are identified, funding is adequate, ongoing information is extracted to inform future action, and there is an expectation from all parties of long-term engagement and capacity building.

Research to reality (R2R) mentorship program: building partnership, capacity, and evidence.

Despite a wealth of intervention research in cancer control, full integration of evidence-based interventions into practice often fails, at least in part because of inadequate collaboration between practitioners and researchers. The National Cancer Institute piloted a mentorship program designed for practitioners to improve their ability to navigate evidence-based decision making within a context of inadequate resources, political barriers, and organizational constraints. The National Cancer Institute simultaneously sought to provide opportunities for practitioners and researchers to share and learn from each other. We identified four key successes and challenges related to translation as experienced by mentees: (a) establishing and maintaining partnerships, (b) data collection and analysis, (c) navigating context, and (d) program adaptation and evaluation. Mentorship programs have the potential to facilitate increased and more successful integration of evidence-based interventions into practice by promoting and building the capacity for collaborative decision making and generating in-depth understanding of the translation barriers and successes as well as strategies to address the complex contextual issues relative to implementation.

The role of health literacy on African American and Hispanic/Latino perspectives on cancer clinical trials.

Although cancer clinical trials are important for discovering lifesaving therapies, participation remains low among racial/ethnic minorities, and little research explores the role of health literacy in racial/ethnic minority perceptions of cancer clinical trials (CCTs). Five focus groups (n = 50) with African American and Hispanic participants explored CCT perceptions using a multidimensional health literacy framework. We found poor scientific literacy including misconceptions of scientific information, perceptions of clinical trials as uncertain and fear; limited civic literacy around topics of trust, perceptions of participants as guinea pigs, and concerns about of IRB protections; and cultural literacy challenges regarding the importance of home remedies for health, use of native language, and the importance of race/ethnicity matching to health care professionals. Results highlight the importance of attending to scientific literacy, cultural literacy, and civic literacy. Future educational interventions regarding cancer clinical trials should address the importance of health literacy in understanding cancer clinical trial decision making.

Ancillary services for individuals living with HIV/AIDS.

Providing comprehensive care to those living with HIV/AIDS remains a daunting task. Access to early HIV medical care helps to delay an AIDS diagnosis, and ancillary services can help meet the non-medical needs of HIV-positive individuals, which can ultimately impact their ability to access medical care. Some research has been done measuring ancillary service provision and primary care entry and retention; however, due to the lack of a comprehensive system of care, it has been difficult to determine the true impact of ancillary service usage and health outcomes. Additional qualitative research examining ancillary service usage, health outcomes, and quality of life needs to be done to develop a standard model of appropriate and comprehensive HIV care.