One Year Out: Experiences of Prisoners Returning to Cleveland

Presents findings from a longitudinal study of prisoner reentry, documenting the lives of nearly three hundred former prisoners and their ability to find stable housing, reunite with family, secure employment, and avoid substance use and recidivism

RELATIONSHIPS BETWEEN MASCULINITY BELIEFS AND COLORECTAL CANCER SCREENING IN MALE VETERANS

Colorectal cancer (CRC) is the third most common cancer diagnosed and the third most common cause of cancer deaths among men in the United States. Although CRC screening tests can reduce CRC incidence and mortality, men’s current rates of CRC screening fall below screening objectives. Results from qualitative studies have suggested masculinity to be a potential barrier to CRC screening as some men may find endoscopic screening procedures to breach masculinity norms. In prior studies, masculinity beliefs have been associated with preventive health behaviors as well as risk behaviors among men. However, to the author’s knowledge, no other quantitative studies have examined the relationship between masculinity and CRC screening adherence. The current study aimed to understand the relationship between three aspects of masculinity (i.e., self-reliance, risk-taking, and heterosexual self-presentation), health beliefs, participant characteristics, and CRC screening adherence. It was hypothesized that the three aspects of masculinity would be inversely associated with CRC screening adherence. Data were collected from 350 men aged 51-75 at average risk for CRC who were accessing primary care services at a Veterans Affairs Medical Center. Of the 350 consenting individuals, data from 327 participants were included in study analyses. Of those 327 participants, 213 individuals were adherent to CRC screening guidelines and the remaining 114 were non-adherent. Correlational and logistic regression analyses were utilized to examine associations between aspects of masculinity and CRC screening adherence. Conditional process analyses were used to examine whether health belief variables (i.e., trust in physician and cancer fear) mediated the relationships between certain aspects of masculinity and CRC screening adherence. Next, participant characteristics (i.e., race, age, and length of relationship between the patient and his primary care provider) were examined as potential moderators of certain relationships in the models utilizing conditional process analyses. In addition, a hierarchical logistic regression analysis was utilized to examine whether the three aspects of masculinity predicted CRC screening adherence above and beyond the predictive value of variables that have predicted CRC screening adherence in prior studies (i.e., race, age, education, physician recommending CRC screening, and family/friend recommending CRC screening). Furthermore, logistic regression analyses were used to examine the extent to which the three aspects of masculinity predicted the receipt of stool blood testing and endoscopic screening. Results suggested that none of the three masculinity variables were significantly associated with CRC screening adherence. In addition, health beliefs did not mediate the proposed relationships between aspects of masculinity and CRC screening adherence, and participant characteristics did not moderate relations between certain mediators and outcome variables. Potential explanations for study results and future directions are discussed. Prospective and longitudinal research studies that recruit participants from diverse backgrounds are required to better understand relationships among study variables

African American Patients’ Intent to Screen for Colorectal Cancer: Do Cultural Factors, Health Literacy, Knowledge, Age and Gender Matter?

African Americans have higher colorectal cancer (CRC) mortality rates compared with all racial/ethnic groups. Research suggests that CRC screening interventions for African Americans target cultural variables. Secondary analysis of data from 817 African-Americans who had not been screened for CRC was conducted to examine: 1) relationships among cultural variables (provider trust, cancer fatalism, health temporal orientation [HTO]), health literacy, and CRC knowledge; 2) age and gender differences; and 3) relationships among cultural variables, health literacy, CRC knowledge, and CRC screening intention. Provider trust, fatalism, HTO, health literacy, and CRC knowledge demonstrated significant relationships among study variables. Stool blood test intention model explained 43% of the variance, with age and gender being significant predictors. Colonoscopy intention model explained 41% of the variance with gender a significant predictor. Results suggest when developing CRC interventions for African Americans, addressing cultural variables is important, but particular attention should be given to age and gender

Integrating men's health and masculinity theories to explain colorectal cancer screening behavior

Colorectal cancer (CRC) is the third most common cause of cancer deaths among men in the United States. Although CRC screening has been found to reduce CRC incidence and mortality, current screening rates among men are suboptimal due to various practical and psychosocial barriers. One potential barrier to CRC screening identified in qualitative studies with men is the threat to masculinity that endoscopic screening methods pose. Indeed, beliefs about masculinity have been predictive of other preventive health behaviors among men. In this review article, we propose a novel conceptual framework to explain men's CRC screening behavior that integrates masculinity norms, gender role conflict, men's health care experiences, behaviors, and beliefs, and social and background variables. This framework has the potential to guide future research on men's CRC screening behaviors and other health behaviors and may inform gender-sensitive interventions that target masculinity beliefs to increase preventive health behaviors

Associations of health behaviors with human papillomavirus vaccine uptake, completion, and intentions among female undergraduate students

This study explored associations between health behaviors and human papillomavirus vaccine receipt/intentions among female undergraduates. Participants (N = 286) completed a survey assessing human papillomavirus vaccine uptake (receiving 1–3 shots vs no shots), completion (receiving 3 shots vs 1–2 shots), and intentions as well as various health behaviors. Human papillomavirus vaccine uptake and completion were associated with receipt of other preventive medical care; completion was associated with having a regular healthcare provider. Among unvaccinated students (n = 115), increased human papillomavirus vaccine intentions were associated with flu shot and human immunodeficiency virus test receipt. Findings suggest promoting human papillomavirus vaccination with other preventive medical care might improve vaccine receipt

Masculinity Beliefs and Colorectal Cancer Screening in Male Veterans

As the third most common cause of cancer death among United States men, colorectal cancer (CRC) represents a significant threat to men's health. Although adherence to CRC screening has the potential to reduce CRC mortality by approximately half, men's current rates of adherence fall below national screening objectives. In qualitative studies, men have reported forgoing screenings involving the rectum (e.g., colonoscopy) due to concern about breaching masculinity norms. However, the extent to which masculinity beliefs predict men's CRC screening adherence has yet to be examined. The current study tested the hypothesis that greater endorsement of masculinity beliefs (i.e., self-reliance, risk-taking, heterosexual self-presentation, and primacy of work) would be associated with a lower likelihood of adherence to CRC screening with any test and with colonoscopy specifically. Participants were 327 men aged 51-75 at average risk for CRC who were accessing primary care services at a Midwestern Veterans Affairs Medical Center. Contrary to hypotheses, masculinity beliefs did not predict CRC screening outcomes in hierarchical regression analyses that controlled for demographic predictors of screening. Although results are largely inconsistent with masculinity theory and prior qualitative findings, further research is needed to determine the degree to which findings generalize to other populations and settings

Self-efficacy mediates the relationship between social norms and HPV vaccine intentions in undergraduate students

poster abstractHuman papillomavirus (HPV) is the most common sexually transmitted infection in the United States. The HPV vaccine reduces incidences of genital warts and certain cancers among both men and women. Unfortunately, many undergraduate students have not been vaccinated. Previous research suggests students are more likely to report greater intentions to get vaccinated when others (e.g., friends, physicians) believe they should receive the vaccine; that is, greater social norms are associated with greater vaccine intentions. However, few studies have examined potential mediators of this association. Drawing from the Theory of Planned Behavior and the Health Belief Model, we hypothesized that social norms would be related to vaccine intentions through self-efficacy. Undergraduate students (N=210) who had not received the HPV vaccine completed an online survey. Participants were predominately White (72%), female (67%), heterosexual (92%), and on average 19.9 years of age (SD=3.2). Forty-nine percent were in a romantic relationship, and 55% were sexually active within the past three months. Participants completed HPV vaccine specific measures, including social norms regarding vaccination, self-efficacy for vaccination, and vaccine intentions. Two mediation analyses (one per gender) were conducted to examine whether self-efficacy mediated the relationship between social norms and vaccine intentions. For women and men, greater social norms were related to greater self-efficacy, and greater selfefficacy was related to greater vaccine intentions (ps<0.05); additionally, social norms were indirectly related to vaccine intentions through self-efficacy (p<0.05). For women, after accounting for self-efficacy, social norms were still significantly related to intentions (p<0.05). For men, however, after accounting for self-efficacy, social norms were not significantly related to intentions (p=0.75). Consistent with previous findings, social norms were positively related to vaccine intentions; however, we found that this association was mediated by self-efficacy. Future intervention studies should consider targeting social norms and improving students’ confidence in their ability to obtain the vaccine

Relationships between Health Behaviors and HPV Vaccine Receipt and Intentions among Undergraduate Women

poster abstractThe human papillomavirus (HPV) vaccine represents an important step in reducing cervical cancer incidence and mortality. In recent years, this vaccine has been routinely recommended for females under the age of 26; however, only one-third of adolescent females have initiated the 3-shot HPV vaccine series. Although a number of studies have identified predictors of HPV vaccination, few have examined its correlations with other health behaviors. Evidence suggests that health-enhancing behaviors (e.g., healthy diet, physical activity) tend to cluster together. In this study, we examined the relationships between health behaviors and HPV vaccine receipt and intentions among undergraduate women at IUPUI. Participants (N=286) completed an internet-based survey that included measures of health behaviors (e.g., diet and exercise, vaccination history, recent physical examination) as well as questions regarding HPV vaccine receipt and intentions (i.e., likelihood of being vaccinated). Participants were, on average, 19 years old (SD=1.9). The majority were Caucasian (75%), single (90%), sexually active (65%), and recipients of the HPV vaccine (58%). Results showed significant relationships between HPV vaccine receipt and the receipt of other medical care, including a flu shot in the past year (χ2(1, N=260)=3.88, p<.05), a Pap smear in the past three years (χ2(1, N=263)=6.49, p<.05), and a recent dental visit (r=.15, p<.05). Among those who had not received the HPV vaccine, increased HPV vaccine intentions were associated with the receipt of the flu shot in the past year (r=.19, p<.05) and the receipt of HIV testing (r=.19, p<.05). However, HPV vaccine receipt and intentions were not significantly related to engagement in any of the other health behaviors (e.g., diet and exercise). Findings suggest that HPV vaccine uptake and intentions to receive the vaccine are associated with the receipt of other preventative medical care among female undergraduates

Impact of Tailored Interventions on Receipt of a Preference-Concordant Colorectal Cancer Screening Test

Background. Individuals at average risk for colorectal cancer (CRC) have multiple test options. Preference for a specific test modality may affect decision making about CRC screening. The current study examined 1) the sociodemographic and health belief characteristics of average-risk participants with a test preference for stool blood test (SBT) versus those with a preference of colonoscopy, and following receipt of a tailored CRC screening intervention, 2) the percentage of participants who completed a preference-concordant CRC screening test, and 3) the sociodemographic, health care experience, and health belief characteristics and intervention group(s) associated with completion of a preference-concordant screening test. Methods. Participants (N = 603) were female, aged 50 to 75 years, at average CRC risk, not currently up-to-date with CRC screening recommendations, had Internet access, and were randomized to receive 1 of 3 tailored CRC screening promotion interventions. Multivariable logistic regression analyses were conducted. Results. Most women (64%) preferred SBT, whereas 36% preferred colonoscopy. There were significant differences in test preference by age, stage of change for the specific tests, perceived benefits of CRC screening, perceived barriers to both tests, and self-efficacy for colonoscopy. Two hundred thirty participants completed CRC screening at 6 months post-intervention. Of those, most (84%) completed a test concordant with their preference. Multivariable analyses revealed that compared with participants completing a preference-discordant test, those completing a preference-concordant test were older (P = 0.01), had health insurance (P < 0.05), and were in the phone counseling-only group (P < 0.01). Conclusions. High levels of completion of preference-concordant CRC screening can be achieved by educating average-risk patients about the multiple screening test options, soliciting their preferences, and offering testing that is concordant with their preference

Predictors of Colorectal Cancer Screening Adherence among Male Veterans

poster abstractColorectal cancer (CRC) is the second leading cause of cancer mortality. However, CRC risk can be decreased through regular CRC screening and removal of precancerous polyps during endoscopic screening tests. Indeed, it has been estimated that 75%-90% of CRC cases could be prevented through adherence to CRC screening guidelines. The CDC recommends CRC screening for average risk adults starting at age 50 with five test options including: (1) annual fecal occult blood test fecal (FOBT) or fecal immunochemical test (FIT); (2) flexible sigmoidoscopy every 5 years; (3) virtual colonoscopy every 5 years; (4) double-contrast barium enema every 5 years; or (5) colonoscopy every 10 years. In the U.S. population, demographic factors predict adherence to CRC screening guidelines such as completing high school, having a partner, and older age. Other predictors of CRC screening adherence in the general population include urban residency, White race, and having health insurance. However, few studies have examined predictors of CRC screening adherence among veterans. The present study focused on male veterans, as its primary aim was to examine masculinity beliefs as predictors of CRC screening. The proposed secondary analyses examine potential demographic and health correlates of adherence to CRC screening guidelines. In one prior study, increasing age was associated with decreased likelihood that male veterans were adherent to CRC screening guidelines. In the current study, 250 male veterans aged 51-75 at the Roudebush VA primary care clinic complete a survey on one occasion. Currently, 175 participants who are adherent to CRC screening and 64 non-adherent participants are enrolled. Participants’ CRC screening behaviors are collected via self-report and medical records. Correlations will be computed between demographic factors (e.g., age, race, education), BMI, and CRC screening guideline adherence. Findings will enhance our understanding of factors associated with veterans’ CRC screening behaviors