Objective: Cervical cancer survivors (CCS) tend to smoke cigarettes at rates much higher than other cancer survivors and women in the general population. However, few studies take a deep dive into ...the smoking behavior of cervical cancer survivors and none focus on the barriers they experience related to smoking cessation. This study aimed to describe CCS' tobacco use characteristics, quit attempts, and barriers to quit success. Method: In a concurrent mixed-method design, 50 CCS (94% White nonHispanic) who were diagnosed in the past 5 years and were current smokers at diagnosis provided data via standardized questionnaire and semi-structured interview. Results: More than three-quarters of participants were current smokers at the time of study participation, 25.6% of whom also reported noncigarette tobacco use (e.g., electronic cigarette, cigar, snus). Seventy percent of participants reported making at least one 24 hr quit attempt postdiagnosis, with 61.5% of current smokers preferring to quit without professional advice or counseling and 51.3% preferring to quit without medication assistance. Four themes emerged regarding barriers to smoking cessation: motivation and readiness; confidence and uncertainty; triggers; and social and environmental factors. Conclusions: The rate of smoking in CCS is remarkably high, which may partly be explained by negative attitudes toward and low use of evidence-based treatment as well as multi-level barriers to smoking cessation.
Public Health Significance Statement
This study highlights a very high smoking rate among CCS as well as a multitude of barriers to their smoking cessation. As CCS are a vulnerable, high-risk group for smoking persistence, they could benefit from tailored, high-intensity interventions.
For cancer survivors, social functioning greatly influences other quality of life dimensions. While there is potential for differences in social functioning to vary as a function of geographic ...residence, few studies examine the social functioning of rural cancer survivors specifically. This study aims to help fill this gap.
This was an embedded mixed-methods study where all participants completed a questionnaire, and some were purposively selected to complete an interview to gather more information about social functioning (ie, social roles, activities, network, support, and constraint). Participants (n = 93; 63% rural) were recruited through a state cancer registry and cancer care facility. Participants were predominately White, non-Hispanic (92.47%), roughly half female (54.84%), and on average, diagnosed in the past two years (SD = 1.68), and 61.45 (SD = 10.87) years old.
Few differences in the social functioning of rural and nonrural participants were found on questionnaires, though rural participants reported larger networks and more overall support. Across groups, common themes in the interview data were the experience of both social support (eg, instrumental support) and social constraint (eg, others minimizing participants' problems or sharing their own negative experiences).
This was the first cancer survivorship study to thoroughly examine social functioning by geographic residence. Rural cancer survivors described some unique strengths, but major group differences were not apparent. All participants highlighted situations when others, even with good intentions, were unhelpful to them. Future interventions to improve social functioning could work to dispel the belief that cancer survivors should handle their cancer on their own.
Quality of life is a multidimensional concept that includes perceptions of one's physical, psychological, social, and spiritual functioning, all of which are theorized to be interdependent. The focus ...of this study is social functioning, which itself is a multidimensional concept that includes social support and social constraint among other things. In cancer survivors, social support receives most of the research attention, but social constraint may have a stronger influence on quality of life.
This systematic literature review evaluates which aspect of social functioning-social support or social constraint-has a stronger relationship with the psychological functioning of cancer survivors.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in the identification and review of 32 independent records. Multiple measures of social support and social constraint were used across studies, with most having adequate psychometric properties. Psychological outcomes were divided into (a) general distress, (b) cancer-specific distress, (c) general well-being, and (d) cancer-specific well-being.
For general and cancer-specific distress, social constraint exhibited a larger association with distress than social support. Similarly, for general well-being, most studies reported a stronger association with social constraint than social support. For cancer-specific well-being, the opposite was true such that associations were stronger for social support than social constraint.
Results highlight the importance of considering social constraint when examining quality-of-life outcomes like psychological distress and well-being. Findings support social constraint as a target in interventions to reduce cancer survivors' distress, while social support could be considered in attempts to promote cancer-specific well-being.
This study evaluated one positive and one negative aspect of social functioning (social support and social constraint, respectively) to increase understanding of its relation to psychological ...functioning (distress and wellbeing) after cancer diagnosis. Participants in this longitudinal study were recently diagnosed, predominately late stage, first primary cancer survivors (
n
= 48). Data collection involved a 30-day period of daily assessment. Data were analyzed using multilevel linear models. As in prior studies, none of the variables changed significantly over time (
ps
= .07 to .99). Based on the intraclass correlation coefficient, 51 to 75% of the variance in the daily assessment data are attributable to between-person differences. There was a positive relationship between social constraint and both general and cancer-specific distress (
ps
< .05) and between social support and cancer-specific wellbeing (
ps
< .001). In prospective models, higher than average general distress predicted higher social support the next day (
p
= .004) and higher than average cancer-specific wellbeing predicted more social constraint the next day (
p
= .01). The findings lend some support to the interdependence of social functioning and psychological functioning after cancer diagnosis.
Objective
The prevalence of smoking among cervical cancer survivors typically exceeds what is found among women in the general population and other cancer survivors. Yet, there is a dearth of ...literature on risk and protective factors related to smoking among cervical cancer survivors, especially when it comes to identification of variables that are amendable to intervention. To help fill this gap in the literature, this qualitative study examines the nature of smoking‐related causal attributions and risk perceptions in cervical cancer survivors who smoked at cancer diagnosis.
Methods
Participants are 21 female cervical cancer survivors (M=45.7, SD=8.4 years old), all diagnosed in the past five years. Nearly three‐quarters of participants reported smoking in the past month. Results: Smoking was not uniformly recognized as a cause of cervical cancer (whether in general or participants' own cancer); the link between smoking and lung, head‐neck, and other cancers was more readily accepted. Despite generally weak endorsements of causal attributions, many participants reported smoking significantly increases risk for poor clinical (e.g., recurrence) and quality of life (e.g., pain) outcomes after cervical cancer diagnosis.
Conclusions
Findings suggest cervical cancer survivors may not fully understand or appreciate the role of smoking in cervical cancer risk whereas their beliefs about the role of smoking in cervical cancer prognosis are more well‐formed. This study highlights the potential role of causal attributions and risk perceptions in understanding and addressing the smoking‐related experience of cervical cancer survivors.
Objective: Bariatric surgery is an effective treatment for obesity, which has been increasing worldwide. However, bariatric surgery causes dramatic physical changes that can cause significant stress. ...Prior research has found that psychological variables such as personality traits and levels of psychopathology can influence success after bariatric surgery (in terms of body mass index BMI reduction and weight loss). However, most prior studies have been limited by small sample sizes, inconsistent follow up, and categorical assessment of psychopathology. Method: The present study examines the predictive utility of the Personality Assessment Inventory (PAI) scales for three bariatric surgery outcomes (BMI reduction, weight loss, and percent excess weight loss %EWL) across 10 follow-up points 5 years after surgery. It also examines the largest sample of bariatric surgery-completing patients (N = 2,267) on the PAI to date. Latent growth modeling was used to examine change in the outcome variables. Results: Results indicate that personality and psychopathology variables predicted less BMI reduction, weight loss, and %EWL 5 years after surgery and also affected the trajectories of change in the outcome variables across time. The PAI scales predicted more variance in the 5-year BMI outcomes than did age and gender. The most robust effects were for scales assessing phobias, traumatic stress, identity problems, and negative relationships. Conclusion: The PAI may be useful to clinical health psychologists who conduct recommended psychological evaluations with potential bariatric surgery candidates.
Abstract Background Black individuals in the United States (US) have a higher incidence of and mortality from colorectal cancer (CRC) compared to other racial groups, and CRC is the second leading ...cause of death among Hispanic/Latino populations in the US. Patient navigation is an evidence-based approach to narrow inequities in cancer screening among Black and Hispanic/Latino patients. Despite this, limited healthcare systems have implemented patient navigation for screening at scale. Methods We are conducting a stepped-wedge cluster randomized trial of 15 primary care clinics with six steps of six-month duration to scale a patient navigation program to improve screening rates among Black and Hispanic/Latino patients. After six months of baseline data collection with no intervention we will randomize clinics, whereby three clinics will join the intervention arm every six months until all clinics cross over to intervention. During the intervention roll out we will conduct training and education for clinics, change infrastructure in the electronic health record, create stakeholder relationships, assess readiness, and deliver iterative feedback. Framed by the Practical, Robust Implementation Sustainment Model (PRISM) we will focus on effectiveness, reach, provider adoption, and implementation. We will document adaptations to both the patient navigation intervention and to implementation strategies. To address health equity, we will engage multilevel stakeholder voices through interviews and a community advisory board to plan, deliver, adapt, measure, and disseminate study progress. Provider-level feedback will include updates on disparities in screening orders and completions. Discussion Primary care clinics are poised to close disparity gaps in CRC screening completion but may lack an understanding of the magnitude of these gaps and how to address them. We aim to understand how to tailor a patient navigation program for CRC screening to patients and providers across diverse clinics with wide variation in baseline screening rates, payor mix, proximity to specialty care, and patient volume. Findings from this study will inform other primary care practices and health systems on effective and sustainable strategies to deliver patient navigation for CRC screening among racial and ethnic minorities. Trial registration NCT06401174
Extremity injuries comprise the majority of battlefield injuries and contribute the most to long-term disability of servicemembers. The purpose of this study was to better define the contribution of ...muscle deficits and volumetric muscle loss (VML) to the designation of long-term disability in order to better understand their effect on outcomes for limb-salvage patients. Medically retired servicemembers who sustained a combat-related type III open tibia fracture (Orthopedic cohort) were reviewed for results of their medical evaluation leading to discharge from military service. A cohort of battlefield-injured servicemembers (including those with nonorthopedic injuries) who were medically retired because of various injuries (General cohort) was also examined. Muscle conditions accounted for 65% of the disability of patients in the Orthopedic cohort. Among the General cohort, 92% of the muscle conditions were identified as VML. VML is a condition that contributes significantly to long-term disability, and the development of therapies addressing VML has the potential to fill a significant void in orthopedic care.
Compared with non‐Hispanic White women, Latina women are less likely to receive genetic counseling (GC) and testing (GT) following BC diagnosis. This study used secondary data analysis to explore ...beliefs about GC among Latina BC survivors in and outside the US mainland. GC/GT‐naïve, high‐risk, Spanish‐preferring Latina BC survivors (n = 52) in FL and PR completed the Behavioral Beliefs about GC scale. Participants reported high positive beliefs about GC (M = 4.19, SD = 0.92); the majority agreed that GC was beneficial to understand cancer risk (90%) and promote discussion (87%) in their family. Participants reported low‐to‐moderate scores for barriers (Ms = 1.53–3.40; SDs = 0.59–0.90). The most frequently endorsed barriers were desire for additional GC information (M = 3.44; SD = 0.90), and GC logistic concerns (M = 2.71; SD = 0.80). No statistically significant differences for barriers and benefits scales were identified by place of residence (all ps ≥ 0.12). These findings highlight the importance of delivering culturally sensitive GC information to high‐risk Latina BC survivors.
Spanish‐preferring Latina breast cancer survivors had high positive beliefs about genetic counseling and their reported benefits and barriers for genetic counseling were similar for survivors residing in Florida and Puerto Rico. The study findings highlight the factors that should be considered when designing culturally sensitive interventions for Latina breast cancer survivors and suggest that similar intervention contents to promote uptake of genetic counseling could be implemented in Florida and Puerto Rico.
Prior to the COVID pandemic, Puerto Rico (PR) had one of the highest Human Papillomavirus (HPV) vaccine rates in the United States. The COVID pandemic and administration of COVID vaccines might have ...impacted attitudes toward HPV vaccination. This study compared attitudes toward HPV and COVID vaccines with respect to school-entry policies among adults living in PR. A convenience sample of 222 adults (≥21 years old) completed an online survey from November 2021 to January 2022. Participants answered questions about HPV and COVID vaccines, attitudes toward vaccination policies for school-entry, and perceptions of sources of information. We assessed the magnitude of association between the agreement of school-entry policies for COVID and HPV vaccination by estimating the prevalence ratio (PR
adjusted
) with 95% Confidence Intervals (95% CI). The most trusted source of information for HPV and COVID vaccines were healthcare providers (42% and 17%, respectively) and the CDC (35% and 55%, respectively), while the least trusted were social media (40% and 39%, respectively), and friends and family (23% n = 47, and 17% n = 33, respectively). Most participants agreed that HPV (76% n = 156) and COVID vaccines (69% n = 136) should be a school-entry requirement. Agreement with school policy requiring COVID vaccination was significantly associated with agreement of school policy requiring HPV vaccination (PR
adjusted
:1.96; 95% CI:1.48-2.61) after controlling for potential confounders. Adults living in PR have an overall positive attitude about mandatory HPV and COVID vaccination school-entry policies, which are interrelated. Further research should elucidate the implications of the COVID pandemic on HPV vaccine attitudes and adherence rates.
PDF
