African American Women Breast Cancer Survivors: Coping with the COVID-19 Pandemic.

African American women breast cancer survivors are among those with the greater burden of cancer. Breast cancer is the second leading cause of death among black women, and this death rate is 40% higher than that of white women. The COVID-19 pandemic increased the burden of morbidity and mortality among this population of cancer survivors. In this report, we explore the ways in which the COVID-19 pandemic was a source of stress for African American women breast cancer survivors and their subsequent responses to these stressors. This is a qualitative descriptive study with content analysis of data from the narratives of 18 African American breast cancer survivors. Participants were interviewed via phone and video conferencing platform and asked questions related to their experiences with the COVID-19 pandemic. The findings suggest stressors associated with (1) potential COVID-19 spreaders in their immediate environments; (2) closures and restricted access to social- and faith-based activities; (3) televised news broadcasts of COVID-19; and (4) disruptions to planned cancer prevention and control healthcare. Three categories emerged that captured the ways in which these women responded to stressors during the early phase of this pandemic: (1) seeking control in their social environments; (2) following the rules; and (3) seeking support from God, family, and friends. These findings can be used to better support breast cancer patients during the early phases of a pandemic.

Disparities in HPV knowledge by race/ethnicity and socioeconomic position: Trusted sources for the dissemination of HPV information.

PURPOSE: To examine the differences in HPV and HPV vaccine awareness, knowledge, and beliefs by race/ethnicity and socioeconomic position (SEP) among a national sample of non-Hispanic whites (NH-Whites), non-Hispanic Blacks (NH-Blacks), and Hispanics in the United States. We also examine differences in trusted health information sources by race/ethnicity and SEP. METHODS: Data were obtained from the Health Information National Trends Survey, Cycle 1, conducted from January to April 2017. Descriptive statistics, bivariate analyses, multivariate logistic regression, and listwise deletion were used to examine HPV and HPV vaccine awareness and knowledge-related items, and trust in health information sources among NH-Whites, NH-Blacks, and Hispanics 18-49 years old. RESULTS: HPV vaccine awareness was moderate with no significant differences across racial/ethnic groups. NH-Whites had significantly higher knowledge that HPV causes cervical cancer than NH-Blacks and Hispanics (p < 0.001). High SEP NH-Blacks (OR = 0.42, 95% CI = [0.24-0.73], p = 0.002]) and Hispanics (OR = 0.49, 95% CI = [0.31-0.79, p = 0.003]) had lower odds of knowing HPV causes a sexually transmitted disease than their white counterparts. Low SEP NH-Blacks (OR = 11.03, 95% CI = [3.05-39.86, p < 0.001]) had 11 times the odds of ever hearing about the HPV vaccine than low SEP NH-Whites. NH-Blacks had twice the odds of trusting health information from television (OR = 2.39, 95% CI = [1.52-3.78]. p < 0.001), and almost six times the odds of trusting health information from religious organizations than low SEP NH-Whites (OR = 5.76, 95% CI = [2.02-16.44, p < 0.001]). CONCLUSION: Tailored communication strategies may address the low HPV knowledge among NH-Blacks and Hispanics from high and low SEP.

Key considerations for designing capacity-building interventions to support evidence-based programming in underserved communities: a qualitative exploration.

Increasing the use of evidence-based programs (EBPs) in community settings is critical for improving health and reducing disparities. Community-based organizations (CBOs) and faith-based organizations (FBOs) have tremendous reach and trust within underserved communities, but their impact is constrained by limited staff capacity to use EBPs. This exploratory study sought to identify design and delivery considerations that could increase the impact of capacity-building interventions for CBOs and FBOs working with underserved communities. Data come from a community-based participatory research project addressing cancer disparities in Black, Latino, and Brazilian communities from Greater Boston and Greater Lawrence, Massachusetts. We conducted four focus group discussions with program coordinators in CBOs and FBOs (n = 27) and key informant interviews with CBO and FBO leaders (n = 15). Three researchers analyzed the data using a multi-stage coding process that included both prefigured and emergent codes. Key design considerations included embedding customized capacity-building interventions into community networks with local experts, supporting ongoing engagement with the intervention via a range of resources and communication channels, and addressing resource constraints. Regarding the contextual factors that should influence capacity-building intervention content, participants highlighted resource constraints, environments in which EBP use is not the norm, and challenges linking available programs with the multi-level barriers to good health faced by community members. Overall, the study highlights the need for integrated, long-term capacity-building efforts developed in partnership with, and ultimately sustained by, local organizations.

Community Stakeholders' Perspectives on Introducing Human Papillomavirus Vaccination and Biobanking Evidence-Based Programs Within Medically Underserved Communities: A Community-Engaged Approach.

PURPOSE: We explored the perspectives of program coordinators and community leaders from Community-based-organizations (CBOs) and Faith-based-organizations (FBOs) to determine how information on human papillomavirus (HPV) vaccination and biobanking is understood and supported within medically underserved communities, and identified strategies for introducing evidence-based programs (EBP) on HPV vaccination and biobanking within underserved communities. METHODS: The EPIS framework guided discussions in four focus groups with program coordinators (n = 27) and one-on-one interviews with community leaders (n = 15) from CBOs and FBOs. RESULTS: Participants reported that community members were aware of HPV vaccination but did not know of the link between HPV infection and cancers. Awareness for biobanking was low. HPV vaccination and biobanking were not priority health concerns among community members due to other health issues. However, HPV vaccination and biobanking were considered sensitive health topics. For HPV vaccination, sensitivity was due to concerns that HPV vaccination promoted sex among adolescents, while for biobanking, sensitivity was due to historical abuses of people of color by the medical community. Participants reported that program coordinators' awareness of HPV vaccination and biobanking depended on their organizations' mission. Neither were considered a priority health concern due to lack of funding. Few EBP were available on HPV vaccination and biobanking. Recommendations on culturally-appropriate strategies for engaging community members on HPV vaccination and biobanking EBP are discussed. CONCLUSION: Given the promise of HPV vaccination and the Precision Medicine Initiative to reduce cancer disparities, findings elucidate factors to be considered when implementing EBP on HPV vaccination and biobanking into medically underserved communities.

Black Caribbean Emerging Adults: A Systematic Review of Religion and Health.

Religion, a prominent factor among Black diasporic communities, influences their health outcomes. Given the increase in Black Caribbeans living in the United States, it is important to understand how religion's function among different ethnic groups of Black Americans. We systematically reviewed four databases and included articles of any study design if they (a) focused on the religious experiences of emerging adults (18-29 years) identifying as Black Caribbean in the United States, in light of medical, public health, or mental health outcomes, and (b) were published before November 30, 2018. Study results contribute to future studies' conceptualization and measurement of religion among Black Caribbean emerging adults.

HPV vaccine acceptance among African-American mothers and their daughters: an inquiry grounded in culture.

BACKGROUND: Much of the research on African-Americans' HPV vaccine acceptance has largely focused on racial/ethnic differences related to cognitive, socio-economical, and structural factors that contribute to differences in HPV vaccine acceptance and completion. A growing body of literature suggest that cultural factors, such as mistrust of healthcare providers (HCPs) and the healthcare system, religion, and social norms related to appropriate sexual behaviors, also plays a prominent role in their HPV vaccine acceptance. However, these studies were limited in their use of theoretical approaches necessary to conceptualize and operationalize culture. OBJECTIVE: To explore the influence of culture on African-American mothers' and daughters' HPV vaccine acceptance using the PEN-3, a culturally-centered conceptual framework. METHODS: Grounded theory techniques were used to explore cultural factors that influenced the acceptance of the HPV vaccine among African-American mothers (n = 28) and their daughters (n = 34). RESULTS: Positive attitudes towards vaccination stemmed from beliefs that the HPV vaccine has cancer prevention benefits and that vaccinations in general protected against infectious diseases. Negative attitudes stemmed from beliefs that the HPV vaccine was too new, not effective, daughters were too young, and that vaccines were not a one-size-fits-all intervention. Majority of mothers and daughters indicated that their religious doctrine did not impede their HPV vaccination decisions. For a few mothers, religious beliefs could not be separated from their HPV vaccination decisions and ultimately deterred HPV vaccine acceptance. HCP recommendations were valued however mothers were often dissatisfied with the detail of information communicated. Support networks provided both positive and negative types of social support to mothers and daughters. The media highlighted the cancer prevention benefits of the HPV vaccine and unintentionally communicated negative information of the HPV vaccine, which deterred HPV vaccine acceptance. CONCLUSION: Study findings can inform the development of culturally appropriate interventions that advances the evidence on cervical cancer prevention.

African-American parents' and daughters' beliefs about HPV infection and the HPV vaccine.

OBJECTIVE: To increase our understanding about the health beliefs of African-American parents and their daughters toward HPV infection and HPV vaccine acceptance. METHODS: The Health Belief Model was used as a guiding framework. Principles of grounded theory, theoretical sampling, and constant comparison analysis were used to qualitatively analyze data generated from personal interviews of African-American parents (n = 30) and their 12- to 17-year-old daughters (n = 34). RESULTS: Mothers and daughters perceived low susceptibility to HPV infection and perceived the HPV vaccine as beneficial in protecting against genital warts and cervical cancer. Compared to daughters, parents placed particular emphasis on the vaccine's protection against genital warts. A major HPV vaccine acceptance barrier among parents and daughters was the politicization of the HPV vaccine by government figures. In addition, concerns about unknown side effects, safety, and effectiveness of HPV vaccination emerged. Cues to action varied among parents and daughters, and self-efficacy was higher among parents than daughters. CONCLUSION: Understanding the health beliefs that promote HPV vaccine acceptance, while identifying and addressing beliefs that are barriers among parents and daughters, will assist in the development of appropriate HPV vaccine promotion initiatives for African-American parents and daughters.