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BACKGROUND Colorectal cancer (CRC) rates are increasing in individuals below the age of 50 and this trend has been projected to continue for the foreseeable future. Health officials are calling for increased awareness of rising rates in affected populations to promote discussion and early detection. METHODS In May 2018, we surveyed an online purposive sample of adults below the age of 50 (N = 624). We conducted an exploratory analysis examining knowledge of current CRC screening guidelines, knowledge of available CRC screening methods, perceived risk of CRC, and perceived importance of screening for CRC by gender, race, and previous CRC screening activity. RESULTS The sample was 56% female, averaged 36 years of age, largely identified as Caucasian (84%), married (48%), and well educated (70% with some college or a college degree). 36% correctly identified the current age of recommended CRC screening initiation. Few (8%) correctly identified all CRC screening options presented. Genetics was thought to be the most relevant determinant of CRC. African American or black participants perceived themselves to be at lower risk of CRC, while women rated the importance of screening significantly lower than men. CONCLUSION We identified a lack of CRC knowledge in individuals below the age of 50. Interventions should correct perceptions of risk of CRC and highlight the importance of screening. Complete knowledge of the range of screening options may reduce barriers to screening while a greater knowledge of modifiable risk factors of CRC can promote healthy behaviors.

The technology-facilitated behaviors that are considered intimate partner cyberstalking (IPC) remain unclear due to inconsistencies in the literature, and there is a lack of research examining IPC severity. This study aimed to (1) understand young adults’ perceptions of IPC behaviors and severity, and (2) assess associations among IPC perceived severity, victimization frequency, depressive symptoms, and social isolation. Two phases were conducted. During Phase 1, 104 university students (ages 18–25) rated the inclusion and perceived severity of a list of potential IPC behaviors via an online survey. Qualitative responses supported their severity ratings. During Phase 2, 181 Amazon Mechanical Turk (MTurk) workers (ages 18–25) who were victims of IPC completed a second online survey. The perceived severity ratings from Phase 1 were used to operationalize the victims’ severity experienced in Phase 2. Most students in Phase 1 believed multiple technology-facilitated behaviors were IPC. The most severe behavior was monitoring a partner’s activities using a hidden camera. From students’ qualitative responses, seven themes emerged that described the mildest behaviors, which were considered harmless and consensual. Seven themes emerged for the most severe behaviors, which were considered harmful and not consensual. As students’ perceived severity of behaviors increased (Phase 1), reported victimization frequency among MTurk workers decreased (Phase 2). Phase 2 participants were more likely to experience depressive symptoms and greater social isolation when the perceived severity of IPC victimization increased. Findings provide insight into young adults’ perceptions of IPC behaviors and severity. Additional research about IPC severity is encouraged to develop effective prevention strategies.

We explore challenges for implementing new recommendations to begin screening for colorectal cancer in people ages 45–49. Challenges include the costs, limited evidence, and ensuring health equity. We also offer solutions and recommendations for researchers and practitioners to include this new age group into screening programs. Finally, we conclude with suggesting areas for future work to address colorectal cancer in people under the age of 50.

Background In 2021, the United States Preventive Services Task Force updated their recommendation, stating that individuals ages 45-49 should initiate screening for colorectal cancer. Since several screening strategies are recommended, making a shared decision involves including an individual’s preferences. Few studies have included individuals under age 50. In this study, we use a multicriteria decision analysis technique called the Analytic Hierarchy Process to explore preferences for screening strategies and evaluate whether preferences vary by age. Methods Participants evaluated a hierarchy with 3 decision alternatives (colonoscopy, fecal immunochemical test, and computed tomography colonography), 3 criteria (test effectiveness, the screening plan, and features of the test) and 7 sub-criteria. We used the linear fit method to calculate consistency ratios and the eigenvector method for group preferences. We conducted sensitivity analysis to assess whether results are robust to change and tested differences in preferences by participant variables using chi-square and analysis of variance. Results Of the 579 individuals surveyed, 556 (96%) provided complete responses to the AHP portion of the survey. Of these, 247 participants gave responses consistent enough (CR p = 0.002). These results were consistent when we restricted analysis to individuals ages 45-55 (p = 0.011). Participants rated test effectiveness as the most important criteria for making their decision (weight = 0.555). Sensitivity analysis showed our results were robust to shifts in criteria and sub-criteria weights. Conclusions We reveal potential differences in preferences for screening strategies by age that could influence the adoption of screening programs to include individuals under age 50. Researchers and practitioners should consider at-home interventions using the Analytic Hierarchy Process to assist with the formulation of preferences that are key to shared decision-making. The costs associated with different preferences for screening strategies should be explored further if limited resources must be allocated to screen individuals ages 45-49.

The role of social influences on rural women's food choice is not well understood. Rural adults experience high rates of obesity and poor diet quality prompting exploration of how social factors influence food choice in this population. Semi-structured qualitative interviews were conducted with 20 women in rural North Central Florida. Women were purposively sampled and stratified by race and income. Lower income was defined as household income at or below 185% of the federal poverty level (FPL). Women at or below 185% poverty level (BPL) experienced direct social control of their eating behaviors, which occurred when social network members explicitly regulated or otherwise sanctioned eating behaviors or food choices. Women above 185% of the federal poverty level (APL) internalized social norms and self-regulated their eating behaviors to maintain healthy habits. APL women described choosing foods for health reasons whereas BPL women offered a variety of reasons including taste, convenience, family history, price, health, and routine. Findings suggest that women in different income groups have different social influences working to help them regulate eating behaviors as well as diverse priorities influencing their food choices. Future interventions to promote healthy eating may be more effective by incorporating social network members and framing intervention messages so they are consistent with priorities.

In recent years, a greater emphasis has been placed on shared decision-making (SDM) techniques between providers and patients with the goal of helping patients make informed decisions about their care and subsequently to improve patient health outcomes. Previous research has shown variability in treatment decision-making among patients with colorectal cancer (CRC), and there is little comprehensive information available to help explain this variability. Thus, the purpose of this study was to evaluate the current state of the literature on factors that are influential in treatment decision-making among patients with CRC. A priori search terms using Boolean connectors were used to examine PubMed, PsycINFO, Web of Science, CINAHL, and MEDLINE for relevant studies. Eligibility criteria for inclusion in the study included patients with CRC and examination of influences on CRC treatment decision-making. All relevant data were extracted including, author, title and year, study methodology, and study results. Findings (n = 13) yielded influences in four areas: informational, patient treatment goals, patient role preferences, and relationship with provider. Quality of life and trust in physician were rated a high priority among patients when making decisions between different therapeutic options. Several studies found that patients wanted to be informed and involved but did not necessarily want to make autonomous treatment choices, with many preferring a more passive role. Providers who initiate a dialog to better understand their patients’ treatment goals can establish rapport, increase patient understanding of treatment options, and help patients assume their desired role in their decision-making. Overall, there were a small number of studies that met all inclusion criteria with most used a cross-sectional design.

Purpose: Head and neck cancer (HNC) patients suffer from significant morbidity, which may introduce challenging care demands and subsequent stress-induced mind–body interactions for informal caregivers. This prospective study evaluated patient and caregiver predictors of diurnal cortisol rhythm among HNC caregivers during radiation treatment. Method: Patient–caregiver dyads completed measures at radiation treatment start (T1; n = 32) and 5 weeks into treatment (T2; n = 29). Measures included the Functional Assessment of Cancer Therapy–Head and Neck, the Caregiver Quality of Life (QOL) Index–Cancer, the Caregiver Reaction Assessment, the Medical Outcomes Social Support Survey, and the Eating Assessment tool. Patients also received a clinical swallowing evaluation using the Functional Assessment of Oral Intake Scale. Caregiver cortisol concentrations were assessed from salivary samples at T1 and T2. Results: Caregiver cortisol slope became significantly flatter during radiation treatment. Greater caregiver schedule burden was associated with a flatter cortisol slope (β = .35, p = .05) in caregivers at T1. Lower patient functional QOL (β = −.41, p = .05) and lower overall caregiver QOL at T1 (β = −.39, p = .04) were each separately associated with a flatter cortisol slope in caregivers over treatment. Conclusions: Results suggest the presence of a mind–body interaction in HNC caregivers. Dysregulation in diurnal cortisol rhythm in caregivers was significantly associated with increased caregiver schedule burden and lower patient and caregiver QOL. Targeted interventions developed for HNC caregivers may help to prevent negative health outcomes associated with dysregulated cortisol.

Objective The purpose of this pilot study was to (1) obtain preliminary data on changes in burden and quality of life in head and neck cancer caregivers during and shortly following patient radiotherapy, (2) assess the relationship between perceived social support and burden as well as perceived social support and quality of life in caregivers during radiotherapy, and (3) identify preferences for sources of support among caregivers during radiotherapy. Methods Caregivers completed burden and quality of life instruments at the start of patient radiotherapy (T1), 5 weeks into radiotherapy (T2), and 1 month post-radiotherapy (T3) and instruments for perceived social support and support preferences at T2 only. Results Caregivers showed a trend toward increased burden and worsened quality of life for the majority of subscales at T2 or T3 than at T1. Caregivers reported significantly lower esteem and significantly greater disruption at T2 than at T1 and significantly worse health at T3 than at T2. Higher perceived social support was typically associated with lower burden and higher quality of life at T2. Spouses/partners were the most commonly preferred source of support. Discussion These pilot findings suggest that caregivers experience psychosocial impairments during and shortly after patient radiotherapy, but more research using larger samples is warranted.

Purpose: The occurrence of late effects, combined with traditional growth and developmental issues, can significantly affect the health-related quality of life (HRQOL) of young adult survivors of childhood cancer (YASCC). Limited HRQOL measurement tools have been developed or validated for YASCC. The purpose of this study was to identify the domains of HRQOL that are unique to YASCC by conducting a systematic review of qualitative studies. Specifically, we compared the findings to the classical framework of HRQOL that was developed for survivors of adult-onset cancer and identified specific domains not being assessed in existing HRQOL instruments for YASCC. Methods: We searched qualitative studies published in peer-reviewed journals from 2000 to 2010 in the PsychINFO, PubMed, and EBSCOhost databases. A set of keywords and inclusion/exclusion criteria were utilized to identify eligible studies with a focus on survivorship and HRQOL issues of YASCC. Results: Sixteen studies met the inclusion/exclusion criteria and were investigated in this study. Six important domains of HRQOL were identified (physical, social, psychological, spiritual, fertility/sexual, resilience, and body appearance) with several sub-domains. Conclusion: Use of the classical HRQOL framework and existing instruments is not comprehensive enough for YASCC. Adding unique domains to the classical framework and existing instruments will make them valuable tools for measuring the HRQOL of YASCC and increase health professionals' ability to identify if and when psychosocial services are needed for this unique population.

Within the workplace, there is less reliance on engineering controls for dermal exposure protection and more reliance on the worker's motivation and training in use of personal protective equipment. Behavior thus becomes a significant determinant of dermal exposure, and its assessment paramount in examining and understanding factors influencing exposure. The main objectives of this study were to: (i) assess worker knowledge, attitudes, and perceptions (KAP) of workplace dermal hazards using a self-complete questionnaire and to examine KAP associations with behavior and exposure; (ii) compare worker and manager scores to identify potential gaps in KAP between the two groups; (iii) utilize a semiquantitative observational DeRmal Exposure Assessment Methodology (DREAM) to evaluate worker dermal exposure; and (iv) identify potential behavioral factors underlying exposure using DREAM and KAP. Nineteen industries across the Baltimore, Md. and Lancaster, Pa., regions participated in the study including a total of 89 workers and 17 managers. The scales within the KAP questionnaire that served as the outcome measure included knowledge, training, behavior, behavior beliefs, information beliefs, self-efficacy, and overall beliefs. DREAM scores ranged from 0.15 to 545 with a median of 8 and a mean (SD) of 22 (62.5). Whereas worker self-efficacy with respect to PPE use, and the group "workers with 10-20 years of experience" were marginally positively associated with protective behavior (p0.08 and p0.06, respectively), a question related to barriers to PPE use was negatively associated with precautionary behavior (p0.01). Dermal exposure was positively associated with workers in the age group 40-49 years as compared with those less than 40 years of age (OR = 4.86, 95% CI = 0.93, 25.62). There were no statistically significant associations between KAP and DREAM. This is one of the first studies to begin to elucidate worker knowledge, attitudes, and perceptions that underlie behaviors that lead to occupational dermal exposures. Results of the KAP questionnaire can inform strategies to improve awareness and protective practices in the workplace through factors such as increased worker dermal hazard knowledge, well-informed company PPE selection and availability, and improved worker training.

Four major California utility companies have active energy conservation programs mandated by the State's Public Utilities Commission (CPUC). These companies evaluate their programs and send reports of the evaluations to the CPUC. A review of 213 of these reports revealed a marketing research approach toward promoting conservation. Advertising and informational campaigns characterize most programs, and attitudes and self-reported behavior were the major outcome measures. This approach is shown to be ineffective. Suggestions for improvement include: 1. (1) the use of actual energy consumption as the primary outcome measure in evaluating conservation programs; 2. (2) the abandonment of conventional advertising, and the use of it only for the promotion of “hard” interventions; 3. (3) increased use of social diffusion methods to disseminate information; 4. (4) the design of more effective educational material by incorporating cognitive social psychological principles; and 5. (5) the utilization of “hard” interventions that have a direct, verifiable link to conservation.