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Cancer is one of the main causes of death in the US. Lung cancer remains the highest killing form of cancer. Lung screening rates are low amongst the general population and even lower in minority populations. It is not well known what the barriers are for lung cancer screening. In order to investigate barriers, I created questions to add onto an existing questionnaire survey for an ongoing lung cancer screening research project. These questions focused on social determinants of health and the survey was administered to patients who were non-adherent to lung cancer screening. Patients reported cost concerns for screening, potential medical care costs, and ability to attend medical appointments as barriers to lung cancer screening. Both non-white and female patients reported more difficulties attending appointments than their white and male counterparts. Patient physician relationship and perceived racial discrimination were not barriers to lung cancer screening in the patient population surveyed. Further research needs to investigate specific details on these barriers to create interventions to increase lung cancer screening rates. / Urban Bioethics

Cervical cancer remains the leading cause of cancer mortality among women worldwide, a burden in the developing countries and commonly detected through symptoms at later invasive stages. The study aimed at establishing knowledge and awareness of the importance of cervical cancer screening in the Makhuduthamaga Sub-district by exploring the perceptions of women and professional nurses and through the review of the National Cervical Cancer Screening Policy (2013). Recommendations to address the gap in knowledge and to inform the National Cervical Cancer Screening Policy were developed based on the study findings. A mixed-method approach was used in this study through a sequential explanatory design, which is quantitatively driven was used. Quantitative data were obtained by using a researcher developed checklist. The checklist was developed from variables stated in the National Cervical Cancer Screening Policy and was used to review its implementation. Qualitative data was obtained through in-depth interviews with individual women and focus group discussions with professional nurses. The study was conducted in ten randomly selected clinics of Makhuduthamaga Sub-district. Purposive sampling was done to obtain qualitative data. An average score of 9.7 was obtained for all ten clinics that participated in the study with regard to the evaluation of the implementation of the National Cervical Cancer Screening Policy. Only 6 (60%) clinics implemented the policy whereas 4 (40%) clinics did not implement the policy. Women and professional nurses perceived cervical cancer screening as important. Lack of knowledge among women regarding cervical cancer screening contributed to the majority of women not screening for cervical cancer. Lack of resources, the 10 year interval of normal cervical cancer screening, the use of disposable vaginal speculums and brushes, lack of standardized cervical cancer screening training, centralization of cytology laboratories came out as factors that negatively influence the uptake of cervical cancer screening. Cervical cancer screening awareness campaigns, availability of resources and standardized in-service trainings on cervical cancer screening were recommended to enhance the cervical cancer screening uptake. / Health Studies / D. Litt. et Phil. (Health Studies)

Abstract Title: The Relationship between Perceived Personal Risk of getting Prostate cancer and Prostate-Specific Antigen (PSA) Screening Yeatoe G. McIntosh, MPH Candidate Advisor: Emmanuel Anum, MBChB, MPH, PHD Preceptor: Emmanuel Anum, MBChB, MPH, PHD Background: Prostate cancer is one of the most common cancer diagnoses in the United States. The American Cancer Society estimates that in 2008 28,660 deaths would be attributed to prostate cancer, projecting it to be the leading cause of cancer deaths in U.S. men. Despite the potential threat this cancer presents to men and the potential for improved disease outcomes from early detection, guidelines for screening for prostate cancer are varied, and disparities in screening prevalence exist. In addition, disparities in knowledge about prostate cancer screening and misconceptions about the disease seem widespread. The main purpose of this study was to determine the relationship between perceived personal risk of getting prostate cancer and prostate cancer screening with the Prostate-specific antigen (PSA) test. Methods: Data were collected from the 2003 Health Information National Trends Survey (HINTS). Overall, 1,815 men ages 35 and above were included in the sample after exclusion of men ages 18-34. Logistic regression analyses were conducted to assess the association between perceived personal risk and prostate cancer screening with PSA test, while testing for interaction and further adjusting for possible confounders. A reduced model, in which variables with non-significant Wald chi-squared statistic had been excluded, was compared to the full model to access the change in parameter estimates. Using the model-based approach, we compared models with interaction terms to the one without interaction terms using the likelihood ratio test. Parameter estimates from the best fitting model were reported using the design-based method. SAS version 9.1 statistical software was used for analyses. Results: Among men ages 35-49, those who perceived their risk as high, were significantly less likely to screen than those who perceived their risk as low (OR: 0.20 95% CI: 0.05-0.78). Within ages 50-64 and 65 and above, there were no significant differences between perceived risk levels and PSA testing. Men, who did receive healthcare provider recommendation for screening, were more likely to obtain prostate cancer (PSA) screening than men who did not receive such recommendation (OR: 92.56 95% CI 36.56, 234.36). Conclusions: The relationship between perceived personal risk of getting prostate cancer and PSA screening is modified by age. As men aged, their odds of screening increased. The most significant predictor of PSA screening was health provider recommendation. PSA screening showed no association with either race or household income.

BACKGROUND: Colorectal cancer (CRC) is the fourth most common and second most deadly cancer in the United States. However, it is highly preventable and treatable if detected at the precancerous or local stage of development. There exists multiple screening methods each with varying sensitivity, required effort, and recommended frequency of use. Complete adherence to screening guidelines by the recommended, at-risk population would halve the current mortality rate. Unfortunately, screening adherence remains the lowest of all screened cancers with a median state screening adherence rate of about 65%. To understand what individual-level factors influence an individual’s decision to be screened, health behavior theory is used. However, few studies have evaluated the performance of entire behavioral theories in their ability to explain CRC screening intentions and behaviors. METHOD: Health Belief Model, Theory of Reasoned Action, Theory of Planned Behavior, and Attribution Theory were evaluated within the context of colorectal cancer screening using an online national sample (N=403) of at-risk individuals age 50 and older. Confirmatory factor analyses were performed for each evaluated construct of the theory. Structural equation models were created using the estimated constructs for each theory. Each theory was evaluated for the following screening use: colonoscopy, sigmoidoscopy, fecal occult blood test (FOBT), and general screening use. Fit statistics were estimated for each model. Models with acceptable fit were examined for significant pathways within the model as well as consistency of the model with the behavioral theory. RESULTS: All models displayed adequate fit statistics. While not all pathways were significant in each model, no estimate was the inverse in directionality to that hypothesized. This provides support that each theory lends some explanatory power and none of the theories evaluated detract from understanding CRC screening intentions and behaviors. Comparison of the models illustrates advantages to each theory and suggests potential integration of theories. CONCLUSION: The constructs of the Health Belief Model, Theory of Planned Behavior, and Attribution Theory all provide adequate explanations of individual-level CRC screening behavior influences. Although, further review and refinement of the theories is warranted and recommended.

Prostate cancer is the most commonly occurring cancer and the second leading cause of cancer death for men in the United States. Because early prostate cancer is frequently without symptoms and data on how to prevent prostate cancer is lacking, early detection has the greatest potential for decreasing mortality. Studies have shown Hispanics/Latinos to be less likely than whites or African-Americans to utilize prostate cancer screening exams. The purpose of this descriptive study was to design a social marketing plan which could be used as a model to promote Hispanic/Latino participation at prostate cancer screenings. Information obtained through medical and marketing literature review, the author's experiences serving on the promotion committee of a community-sponsored prostate cancer screening project, and interviews with 51 Hispanic/Latino prostate cancer screening participants is described and incorporated into a guide with recommendations for future program planners.

The national recommendations for use of the prostate specific antigen (PSA) test for prostate cancer screening have been modified over the years as scientific evidence emerged. Current screening recommendations discourage widespread PSA screening for men at low to average risk, but provide specific guidelines for shared-decision making between men and their health providers about the benefits and risks of PSA testing. This study was an examination of relationships between men’s assessment of the quality of their care and communication with their health providers, the extent to which providers engage men in recommended discussions about PSA testing, and factors associated with shared-decision making and PSA testing. Secondary data from the U.S. Health Information National Trends Survey 4, Cycle 2 that included men with no history of prostate cancer and in the recommended age ranges for prostate cancer screening were analyzed (N=777). Non-Hispanic white men rated their quality of care higher than men of other races (c2 (49, n=635) = 7.23, p = 0.0098), whereas Hispanic men gave the lowest ratings compared to other men (c2 (49, n=635) = 5.42, p = 0.024). Previous PSA testing was reported by 64% of the men, 56% of whom stated that they discussed screening with their provider and 80% reported that they were asked if they wanted to have the test done. However, only 21% - 39% reported having ever discussed the pros and cons of PSA testing. Discussing PSA testing with a provider was the strongest predictor of obtaining the test (OR=69.5, CI = 23.6 – 204.6) but the effect was significantly modified when providers and patients engaged in the shared-decision making process (OR = 47.42, CI = 14.91 – 150.74). Age, education level and perceived quality of care were consistent, positive predictors of PSA testing. These results indicate there is a gap in provider-patient discussions about PSA screening and suggest that health providers may not be following the recommended guidelines for the content of the discussions needed to facilitate shared-decision making. Effective provider-based interventions to increase shared-decision-making about PSA testing are needed if the national objectives for prostate cancer screening are to be met.

Lung cancer is the leading cause of cancer death in the United States. While low-dose computed tomography (CT) screening reduces lung cancer mortality by 20%, 97% of suspicious lesions are found to be benign upon further investigation. Computer-aided diagnosis (CAD) tools can improve the accuracy of CT screening, however, current CAD tools which focus on imaging characteristics of the nodule alone are challenged by the limited data captured in small, early identified nodules. We hypothesize a CAD tool that incorporates quantitative CT features from the surrounding lung parenchyma will improve the ability of a CAD tool to determine the malignancy of a pulmonary nodule over a CAD tool that relies solely on nodule features. Using a higher resolution research cohort and a retrospective clinical cohort, two CAD tools were developed with different intentions. The research-driven CAD tool incorporated nodule, surrounding parenchyma, and global lung measurements. Performance was improved with the inclusion of parenchyma and global features to 95.6%, compared to 90.2% when only nodule features were used. The clinically-oriented CAD tool incorporated nodule and parenchyma features and clinical risk factors and identified several features robust to CT variability, resulting in an accuracy of 71%. This study supports our hypothesis that the inclusion of parenchymal features in the developed CAD tools resulted in improved performance compared to the CAD tool constructed solely with nodule features. Additionally, we identified the optimal amount of lung parenchyma for feature extraction and explored the potential of the CAD tools in a clinical setting.

Despite the growing concerns about routine prostate-specific antigen (PSA) screening in men, little is known about the societal and economic impact of screening among the African American population. The purpose of this qualitative case study was to explore beliefs among African American men about PSA screening, funding for screening, and the role of the United States Preventive Service Task Force in addressing the problem. Guided by rational choice theory, data collection consisted of completion of a health beliefs survey, face-to-face interviews, field notes taken during interview, and interview audio recording. The population for the study included African American men residing in a large metropolitan Midwestern city, who are between the ages of 45 and 65, and who have not been diagnosed with prostate cancer disease. Data were analyzed using NVivo10-© to identify themes and patterns. Results from the study show that the decision to participate in prostate screening for African American men is hindered due to concerns about access, cost, and affordability. These three factors should be further evaluated in a larger setting for a greater understanding of their roles in more effective screening programs and policies. Insights gained from this study may positively impact future policy by providing a deeper understanding of the beliefs held by African American men on the issue of prostate cancer screening that may eventually lead to developing and successfully implementing policies that can be cost effective.