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Human papillomavirus (HPV)-related morbidity and mortality remain a significant public health burden despite the availability of HPV vaccines for cancer prevention. We engaged clinicians and parents to identify barriers and opportunities related to adolescent HPV vaccination within a focused geographic region. This mixed-method study design used an interviewer-administered semi-structured interview with clinicians (n = 52) and a written self-administered survey with similar items completed by parents (n = 54). Items focused on experiences, opinions, and ideas about HPV vaccine utilization in the clinical setting, family, and patient perceptions about HPV vaccination and potential future efforts to increase vaccine utilization. Quantitative items were analyzed using descriptive statistics, while qualitative content was analyzed thematically. Suggested solutions for achieving higher rates of HPV vaccination noted by clinicians included public health education, the removal of stigma associated with vaccines, media endorsements, and targeting parents as the primary focus of educational messages. Parents expressed the need for more information about HPV-related disease, HPV vaccines, vaccine safety, sexual concerns, and countering misinformation on social media. Results from this mixed-method study affirm that educational campaigns targeting both health care professionals and parents represent a key facilitator for promoting HPV vaccination; disease burden and cancer prevention emerged as key themes for this messaging.

This study applies qualitative research methods to explore perspectives on cessation among smokers/former smokers recruited from an area of Northern Appalachia. Six focus groups, stratified by age group (18-39 years old and 40 years and older), were conducted among participants (n = 54) recruited from community settings. Participants described varied interest in and challenges with quitting smoking. Smokers 40 years and older more readily endorsed the health risks of smoking and had greater interest in quitting assistance. Participants expressed frustration with the US government for allowing a harmful product (e.g., cigarettes) to be promoted with minimal regulation. Use of social media was robust among both age groups; participants expressed limited interest in various social media/technology platforms for promoting smoking cessation. Findings from this understudied area of northern Appalachia reflect the heterogeneity of this region and contribute novel information about the beliefs, attitudes, and experiences of current and formers smokers with regard to cessation.

This project assessed the impact of a community-based educational program on breast cancer knowledge and screening among Buffalo (NY) immigrant and refugee females. Program participants completed language-matched pre- and post-test assessments during a single session educational program; breast cancer screening information was obtained from the mobile mammography unit to which participants were referred. Pre- and post-test knowledge scores were compared to assess changes in responses to each of the six individual knowledge items, as well as overall. Mammogram records were reviewed to identify Breast Imaging Reporting and Data System (BI-RADS) scores. The proportion of correct responses to each of the six knowledge items increased significantly on the post-program assessments; 33 % of women >40 years old completed mammograms. The findings suggest that a health education program for immigrant and refugee women, delivered in community-based settings and involving interpreters, can enhance breast cancer knowledge and lead to improvements in mammography completion.

Objectives: To explore awareness of human papillomavirus (HPV) and use of HPV vaccines (Gardasil and Cervarix) by college students., Participants: The sample was composed of 817 undergraduates at 2 northeastern US universities; they participated between February and May 2010., Methods: Students were provided with a link to an anonymous, self-administered, Web-based survey comprised of 76 questions. The survey included questions about health behaviors, awareness, and knowledge of HPV and the 2 HPV vaccines, and vaccine uptake., Results: Results indicate high levels of awareness of HPV as well as marked sex differences related to vaccine awareness and uptake. Both sexes are largely unaware of Cervarix and the differences between Cervarix and Gardasil., Conclusion: The study affirms the importance of a clinician's recommendation for HPV vaccination. Public health messaging should become more inclusive of adolescent and young adult males. College students' awareness of HPV vaccine options mirrors Gardasil's market dominance in the United States.

Background: Smoking rates are higher among those living at or below poverty and among persons with lower levels of education. We report on a formative research project examining patient perceptions of tobacco cessation strategies among diverse, low socioeconomic, urban smokers cared for in community-based primary care medical offices., Method: We conducted 10 focus groups among low socioeconomic status participants recruited from urban primary care medical offices in Buffalo and Niagara Falls, New York. Participants included current or former smokers, who were stratified by age-group (18-39 years and 40+ years). The focus groups discussed perceptions of tobacco cessation strategies, previous quit attempts, and use/attitudes regarding technology and social media as potential platforms for cessation support., Results: Participants (n = 96) included predominantly African Americans (n = 62, 65%) and European Americans (n = 16, 16%); 56% were older than 40 years and 92% were low income. Most participants were supportive of cessation message delivery via phone; however, the age-groups varied in their attitudes on quitting smoking, desired frequency of phone contacts, and social media usage. Participants aged 18 to 39 years reported more Internet use, greater use of text messaging, and were more open to health information via social media., Conclusions: Based on significant variation between younger and older smokers' perceptions of tobacco addiction and use of communication technologies, it appears reasonable to stratify the content and platform of health messaging by the target age-group.

The aim of this study was to assess levels of knowledge regarding breast cancer screening among primary care physicians in rural areas of Crete. A cross-sectional survey of 106 general practitioners and internists and 83 trainee general practitioners (GPs) employed as of October 2004 and practicing at 14 primary health centers in Crete was performed. It was a self-administered survey with 27 items exploring knowledge, attitudes, and behaviors concerning delivery of general preventive and cancer screening services. The main outcome measures were responses to four items on approaches to breast cancer screening practices. Overall response rate was 55% (primary care physicians (PCPs) = 53%; trainee GPs = 60%). Respondents demonstrated a limited awareness of international recommendations for breast cancer screening and exhibited marked variation in their responses to survey items. Agreement with current international guidelines ranged from 31% to 58% for the individual survey items. This survey revealed limited knowledge among PCPs to well-publicized breast cancer screening guidelines and variations in approaches to breast cancer early detection.

Objective: This study characterized longitudinal changes in cigarette smoking and purchase and cessation patterns among low-income smokers in New York State., Design: Longitudinal tobacco use surveys were conducted in 2002 and 2005. Responses from the 2002 and 2005 surveys were compared among participants who completed both surveys., Setting: New York State., Participants: Adult low-income smokers (n = 274) were recruited from the Department of Social Services office in Erie County, New York, in 2002 and recontacted in 2005., Main Outcome Measures: These included cigarette smoking, cessation and purchase behaviors, awareness and use of the Quitline, and participation in tobacco industry promotions during the 3-year follow-up period., Results: During the 3-year follow-up period, 37 participants (13.5%) stopped smoking. Among smokers, the average number of daily cigarettes smoked decreased from 16.1 to 13.7 cigarettes (P < .01). There were significant increases in the proportion of smokers who reported that they had ever used a stop smoking medication (26.6% to 51.9%), had ever heard of the Quitline (32.5% to 73.0%), or had ever called the Quitline (4.2% to 11.0%). There was an increase in the use of tobacco industry coupons (41.1% to 59.3%)., Conclusions: Findings suggest that state and local tobacco control policies and programs are being increasingly utilized by this population; however, tobacco company price promotions are also being increasingly used, offsetting the public health benefit of the tobacco control policies and programs in this low-income population.

Background: Few studies have examined factors associated with the actual use of the human papillomavirus (HPV) vaccine since licensure in 2006. The aims of this study were to assess HPV vaccination rates and to examine whether knowledge and risk perceptions regarding HPV were associated with the reported use of the HPV vaccine among female college students., Methods: Using a cross-sectional design, 406 women aged 18-26 years were recruited at two public universities and completed a self-administered survey. Respondents who reported having received at least one dose of HPV vaccine were classified as 'vaccinated' (n=177, 43.6%). Responses, stratified by the receipt of HPV vaccine, were compared using descriptive statistics and multivariate models., Results: Based on multivariate logistic regression modelling, 18-year-old women were approximately four times more likely to report use of the HPV vaccine compared with respondents aged 19-26 years. Respondents who correctly indicated that HPV caused genital warts were 1.85 times more likely (adjusted odds ratio (OR) 1.85, 95% CI 1.20 to 2.93) to have received at least one HPV vaccine. African American and Asian women were each less likely to be vaccinated compared with white women. Risk perception was not significantly associated with vaccine uptake, however, the majority of respondents failed accurately to recognise their high risk of both acquiring and transmitting HPV., Conclusions: These findings suggest knowledge deficits and misperceptions about HPV risk as potential themes for educational campaigns encouraging the greater use of the preventive HPV vaccine among this subgroup.

Background: This study explores physicians' assistants' (PA) knowledge and practice regarding tobacco cessation counseling, approaches to lung cancer early detection and management of patients at high risk of developing lung cancer., Methods: A cross-sectional survey design was used to examine approaches to tobacco use prevention and the early detection of lung cancer among PAs from Western New York State., Results: PAs report promoting use of the nicotine patch, nicotine spray and bupropion when counseling smokers on cessation. Reported management strategies for a patient at high risk of developing lung cancer were not supported by current literature., Conclusion: These findings suggest the need for professional educational programs aimed not only at conveying the continued importance of tobacco cessation counseling, but also information on the appropriate management options for patients at increased risk of developing lung cancer.

Background: The prevalence of smoking remains higher among the Medicaid population compared with the general population. To reduce this disparity, the majority of state Medicaid programs now provide coverage for smoking cessation pharmacotherapy. The objectives of this study were to (1) assess awareness of this benefit among Medicaid smokers and (2) compare the use of pharmacotherapy among a sample of Medicaid smokers with smokers in the general population of western New York., Methods: This report summarizes findings from two cross-sectional studies conducted in western New York State during 2002 to 2003: (1) Medicaid smokers (n = 1,174) completed an interviewer-administered questionnaire in the Office of Medicaid Management and (2) smokers from the general population (n = 852) completed a telephone survey., Results: The majority of Medicaid smokers (54%) remain unaware of the program benefit providing coverage for smoking cessation pharmacotherapies. Medicaid smokers were much less likely (odds ratio = 0.33, 95% confidence interval = 0.25-0.44) than the general population to report having ever used pharmacotherapies., Conclusions: Highlighting the availability of the smoking cessation pharmacotherapy benefit to Medicaid program participants may be one strategy to enhance quit attempts among this population. Future research should identify other potential barriers to the use of effective pharmacotherapies among poorer smokers.

Purpose: To determine nurse practitioners' (NPs') knowledge and reported practices regarding breast cancer screening in a climate of conflicting guidelines., Data Source: A descriptive, cross-sectional survey design was used to examine approaches to cancer screening among NPs in western New York., Conclusions: Among the 175 NP respondents, agreement with the accepted answers for the individual breast cancer-screening items ranged from 51% to 80%; responses did not vary by age group or gender. Overall, 54% demonstrated agreement with three or more of four breast cancer-screening items., Implications for Practice: These findings suggest the need to implement educational interventions as one means of decreasing variation in breast cancer screening among NPs. Also, the development and endorsement of a single set of evidence-based breast cancer-screening guidelines would promote adoption of a single screening recommendation.

Purpose: To determine nurse practitioners' (NPs') knowledge, practice, and attitudes about tobacco cessation counseling and lung cancer early detection., Data Source: A descriptive, cross-sectional survey design was used to examine NPs' approaches to primary and secondary prevention of tobacco use among patients in western New York., Conclusions: Among the 175 respondents, NPs appropriately counseled tobacco users on tobacco cessation. However, there was limited understanding of first-line pharmacological agents used for tobacco cessation and of how to manage treatment for a patient at high risk for lung cancer., Implications for Practice: These findings suggest the need to implement professional educational programs aimed at conveying not only the importance of tobacco cessation counseling but also information on the most effective first-line pharmacological agents and appropriate management options for patients at increased risk of developing lung cancer.

Background: Guidelines for breast cancer screening often provide conflicting recommndations., Methods: A cross-sectional survey design was used to examine approaches to cancer screening among primary care physicians., Results: Among the 187 respondents, levels of agreement with the "correct" response ranged between 50% and 73% for each of the four items relating to breast cancer screening; only 42% of physicians demonstrated agreement with three or more of the four items. Physician gender, specialty group, and age category were significant predictors of responses., Conclusions: These findings suggest the need to implement educational interventions as one means of decreasing variation in breast cancer screening.

Background: Information on the effectiveness of elementary school level, tobacco-use prevention programs is generally limited. This study assessed the impact of a structured, one-time intervention that was designed to modify attitudes and knowledge about tobacco. Participants were fifth-grade students from schools in western New York State., Methods: Twenty-eight schools, which were in relatively close geographic proximity, were randomized into three groups; Group 1 was used to assess whether attitudes/knowledge were changed in the hypothesized direction by the intervention, and if those changes were retained four months later. Groups 2 and 3, were used as comparison groups to assess possible test-retest bias and historical effects. Groups 1 and 3 were pooled to assess whether attitudes/knowledge were changed by the intervention as measured by an immediate post-test. The non-parametric analytical techniques of Wilcoxon-Matched Pairs/Sign Ranks and the Mann-Whitney-Wilcoxon Rank Sums Tests were used to compare proportions of correct responses at each of the schools., Results: Pooled analyses showed that short-term retention on most items was achieved. It was also found that retention on two knowledge items 'recognition that smokers have yellow teeth and fingers' and 'smoking one pack of cigarettes a day costs several hundred dollars per year' was maintained for four months., Conclusions: The findings suggest that inexpensive, one-time interventions for tobacco-use prevention can be of value. Changes in attitudes and knowledge conducive to the goal of tobacco-use prevention can be achieved for short-term retention and some relevant knowledge items can be retained for several months.

Cancer has become a significant health problem in American Indian and Alaskan Native (AI/AN) communities. Despite the precipitous rise in cancer rates, limited data are available concerning cancer control services operative in these communities. To address this issue, a cross-sectional survey of all federally recognized tribes was undertaken to ascertain the breadth of cancer control activities offered and Tribal Health Directors perceptions of and priorities ascribed to cancer. This article presents responses given by AN Health Directors juxtaposed to those proffered by AI Health Directors. Nearly three-quarters (71%) of respondents perceived cancer rates to be increasing. Cancer was found to rank third, fifth among AI Health Directors, among seven health conditions when Directors were asked to rank their Tribe's commitment to confronting each one. Awareness of cancer as a public health concern coupled with competing health problems relegates cancer control activities to a lower priority. Findings underscore the need to elevate the issue of cancer in Indian Country as well as to educate investigators to become more sensitive and responsive to other Tribal health issues.