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Testicular self-examination (TSE) is an important behaviour to prevent the development of testicular cancer. This thesis examined the stages of decision making, emotions, perceived costs and benefits of screening, the self perceptions, social influences, and health routines in samples of adult males and adolescent school boys. A multi-method approach was adopted involving qualitative and quantitative methods of study. The qualitative part of the investigation comprised a series of studies including focus groups, in-depth interviews, programme evaluation and survey studies. The aim was to elucidate the meanings associated with health and illness and preventive cancer screening. Such information formed the bases for developing a survey measure and a health promotion programme to promote TSE. A comparative cross-sectional approach, including the components of three social cognition models was then carried out revealing a hybrid model (HSCM) to be most effective in explaining TSE. Acknowledging traditional social cognitions as predictors of TSE decision making, it also stresses the importance of emotional cognitions, self perceptions and routine behaviours. Using a five-stage model building approach, a longitudinal examination of stages of decision making was also carried out. Logistic analysis revealed that much of the variation in TSE practice was explained by a planning stage, implicating a two-stage motivation and volition stage rather than a five-stage model. In addition to explaining the characteristics associated with TSE practice and elucidating a stage approach to decision making, a draft health promotion programme was developed and evaluated. Two forms of the programme, a booklet and a seminar, were appraised and deemed effective as motivators of preventive action. Findings are discussed in terms of theory and practice of health education. The implications of the findings for health psychology are also discussed.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Background: One out of every three cancer diagnoses is a skin cancer, and the incidence of both melanoma and non‐melanoma type skin cancers is increasing. Skin cancers, including melanoma, are typically treatable if detected early. However, there is insufficient evidence to support recommendations to establish population based skin cancer screening programs. The specific aims of this study are 1) to evaluate characteristics of participants who attend a community skin cancer screening event and who are referred for follow up due to suspicious lesions, 2) to determine the proportion of participants with suspicious lesions identified at a community skin cancer screening event who complied with a request to visit a dermatologist or primary care physician, and 3) to evaluate attitudes toward sun protection practices, and perceived risk of developing skin cancer among participants who attend a community skin cancer screening and have a suspicious skin lesion. Methods: The Skin Cancer Institute sponsored a series of community skin cancer screening events in Tucson, Arizona from 2006 to 2013. Participants completed an American Academy of Dermatology screening form prior to a skin examination by a dermatologist. Participants with suspicious lesions identified at the examination who agreed to be contacted again received questionnaires 4 months after the initial screening to assess compliance with follow‐up recommendations, and their sun protection practices and risk perceptions. Results: 1979 community members attended the skin cancer screenings. The majority of the participants were Caucasian, females, had blue eyes and brown hair, were college educated, had no prior personal or family history of skin cancer, had health insurance but did not have a regular dermatologist, reported that they had never been to a skin cancer screening before, and stated that without this screening that they would not have their skin examined. 748 (37.8%) of community members were referred and instructed to see a dermatologist for further evaluation of a skin lesion. Of the 441 participants with a suspicious lesion who consented to participate in the follow‐up study, 120 returned a questionnaire; 90 (75%) reported that they followed up with a dermatologist or physician, and 30 (25%) did not. Of the 90 participants who followed up, 53% received a skin biopsy. The self reported diagnoses from the biopsies of the suspicious skin lesions were the following: 1% atypical or dysplastic nevus, 21% actinic keratosis, 16% basal cell carcinoma, 8% squamous cell carcinoma, 2% melanoma, and 38% did not have skin cancer. Conclusions/Impact: This study demonstrated that 38% of community skin cancer screening participants were referred for follow up due to a suspicious skin lesion being identified during a skin cancer screening event. It also appeared that 75% of those who responded to the follow‐up questionnaire complied with the request within four months, although the response rate for the follow‐up questionnaire was low. Therefore, implementing a formal reminder system following the skin cancer screenings may increase the percentage of participants who follow up with a primary care physician or dermatologist after the screening for further evaluation of their suspicious skin lesion.

Colorectal cancer (CRC) is a primary cause of cancer-related mortality in the United States. Asian Americans have the highest CRC mortality rates. CRC screening tests can reduce CRC incidence, yet Asian Americans, specifically the subgroup of Vietnamese Americans, underuse CRC screening. The purpose of this phenomenological study was to understand why Vietnamese Americans, ages 50 to 75, underuse CRC screening. The health belief model constructs of susceptibility, severity, benefits, barriers, and self-efficacy were the framework for understanding this population's health-related behaviors. Three research questions focused on how knowledge, language, and cultural beliefs and perceptions affect Vietnamese Americans' CRC screening decisions. Interviews were conducted with 11 participants, and transcribed interview responses were input into NVivo 11 software to maintain a reliable database and to identify emerging themes. Key study findings revealed knowledge and English language gaps as well as adverse cultural perceptions of fear and doubt that influenced CRC screening choices among these 11 Vietnamese Americans. Future researchers might focus on cultural-tailored strategies to minimize these barriers for Vietnamese Americans. An understanding of this study population's perspectives offers the promise of positive social change for health services and public health administrations to develop cultural-tailored interventions that promote healthy lifestyles, prevention, early CRC detection and, consequently, reduce mortality rates and associated health care costs.

Degree awarded (2003): EdDHRD, Counseling, Human and Organizational Studies, George Washington University / ABSTRACT OF DISSERTATION<p>The Effect of Patient Race upon Physicians Colorectal Cancer Screening: A Retrospective Medical Record Review and Physician Pattern Variable Analysis<p>There is a significant disparity in the health status of African-Americans and whites in the United States. Studies have revealed that African-Americans have higher mortality rates from colorectal cancer than whites. Differences in colorectal cancer screening of African-Americans compared to whites may account for a proportion of the excess mortality. This study evaluated internal medicine resident physicians colorectal cancer screening practices in African-American and white patients. Additionally, an analysis of physicians pattern variable orientation was performed to determine if there was a relationship between physicians orientation and adherence to colorectal cancer screening guidelines.<p>A retrospective review of medical records from January 2002 through March 2002 was conducted to assess internal medicine resident physicians performance of colorectal cancer screening. Univariate analysis revealed that there were statistically significant differences in the rate at which physicians performed rectal examinations (p=0.0039), fecal occult blood testing (p=0.0006) and colonic examinations (p<0.0001) in African-American compared to white patients. Multivariate analysis, evaluating patient race, patient gender, patient age and physician gender, demonstrated that patient race was the only factor significant for not performing colorectal cancer screening tests.<p>Physicians perspectives about the medical profession and the delivery of medical services were assessed by evaluating pattern variable orientations. Integrative, value and motivational orientations of the physicians were determined by using semi-structured interviews. All of the physicians had a self-orientation (integrative pattern variable), a universalistic-achievement orientation (value pattern variables) and a specificity orientation (motivational pattern variable). However, the physicians differed in their affectivity-affective neutrality orientation (motivational pattern variable). All of the physicians who had an affective orientation toward their patients adhered to colorectal cancer screening recommendations. The physicians who expressed affective neutrality toward their patients did not adhere to colorectal cancer screening recommendations.<p>This study revealed significant differences in the performance of colorectal cancer screening in African-American compared to white patients. Additionally, physicians pattern variable orientations correlated with adherence to practice guidelines. This study is important because it provides information about physician practice patterns. The results of this study can serve as the basis for the development of educational interventions for physicians that can improve health care delivery. / Advisory Committee: Dr. John Williams, Dr. David Schwandt (Chair), Dr. Andrea Casey, Dr. Jeffrey Lenn, Dr. Victor Scott

Colorectal cancer (CRC) is one of the most common causes of death from malignant disease. Nevertheless, no ideal screening method exists and there is a lack of prognostic and predictive factors to support clinical decisions and to aid the development of a more individualized treatment for patients with CRC. The aim of this thesis was to investigate early detection, prognostic and predictive factors of CRC. In the first paper, a novel method to collect cells for DNA quantification from the rectal mucosa was investigated. The sensitivity and specificity of this test to detect CRC or any pathology in colon and rectum were ultimately too low to be acceptable. In the second paper, the prognostic value of growth differentiation factor 15 (GDF 15) was evaluated in patients curatively operated for colorectal cancer. GDF 15 expression was demonstrated to be associated with a negative prognosis in patients with stages I-III and III disease. In the third paper, the prognostic value of BRAF, PIK3CA KRAS and MSI was evaluated in a cohort of patients with CRC stratified by disease and recurrence. The results indicated that patients with CRC stage III without recurrence have a higher frequency of BRAF mutation compared to stage III patients with recurrence. In the fourth paper, histopathological predictors of pathologic complete response (pCR) as well as the association between pre-treatment carcinoembryonic antigen (CEA) levels and pCR in non-smoking and smoking patients receiving preoperative chemo-radiotherapy for rectal cancer were evaluated. Only in non-smokers was a low CEA level significantly associated with pCR, suggesting that the predictive value of CEA for pCR in rectal cancer in smokers can be limited. In sum, this research has investigated a new method for CRC detection and further evaluated the clinical use of prognostic and predictive markers in CRC.

Background: Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer death in Arizona. Given that by the year 2030 Arizona is expected to be the second most populated state in the U.S., it is imperative to evaluate whether this state has the colorectal screening capacity to accommodate the growing population.Methods: 338 members of the American College of Gastroenterology were invited to participate. Information for the total number of colonoscopies and sigmoidoscopies performed during an average week was ascertained by analyzing 105 surveys. We estimated the current and potential volume of screening procedures.Results: Physicians reported performing 8,717 endoscopic procedures weekly (7,990 colonoscopies and 727 sigmoidoscopies). They reported being able to increase their capacity by an additional 3,183 (36.5%) procedures a week (2,347 colonoscopies and 836 flexible sigmoidoscopies).Conclusions: Our findings suggest that Arizona has the ability to significantly expand its endoscopic capacity.