Annals of Behavioral Medicine

Sociocultural correlates of cervical cancer prevention behaviors among Hispanic/Latina women in the United States

Abstract Background Hispanic/Latina women in the United States have high rates of cervical cancer and little is known regarding how sociocultural factors might be related to their cervical cancer prevention behaviors. Purpose Two studies examined correlates of human papillomavirus (HPV) vaccine initiation, HPV vaccine completion, ever screening for cervical cancer, and being up to date with screening among screening- and vaccine-eligible Hispanic/Latina women. Methods Study 1 examined sociodemographic correlates of these behaviors using data from the Behavioral Risk Factor Surveillance System. Study 2 examined whether endorsement of simpatía (ie, expressing warmth to avoid conflict and promote harmony in interpersonal interactions) and familism (ie, supportive familial relationships that emphasize commitment to and prioritization of the family) explained unique variance in these behaviors while controlling for the sociodemographic variables from study 1. Results In study 1, women who were younger, insured, and who had higher income had greater odds of vaccine initiation. Heterosexual women and those with higher education had greater odds of vaccine completion. Women who were older, married, insured, heterosexual, and who had higher education and income had greater odds of ever screening. Women who were younger and heterosexual had greater odds of being up to date with screening. In study 2, endorsement of simpatía explained unique variance in vaccine initiation even while controlling for sociodemographic variables. Conclusions Age, income, sexual orientation, and insurance status were consistently related to cervical cancer prevention behaviors among Hispanic/Latina women. Future research should examine the mechanisms through which the association between simpatía and HPV vaccine initiation occurs.

Financial Anxiety is Associated With Cancer Screening Adherence in Women at High Risk of Breast Cancer

Abstract Background Previous studies have examined the impact of material financial hardship on cancer screening but without focusing on the psychological aspects of financial hardship. Purpose This study examined the effects of different types of financial anxiety on adherence to breast cancer screening in women at high risk of breast cancer. Adherence to cervical cancer screening was also examined to determine whether associations between financial anxiety and screening adherence were unique to breast cancer screening or more general. Methods Women (n = 324) aged 30–50 and at high risk for inherited breast cancer completed a survey on general financial anxiety, worry about affording healthcare, financial stigma due to cancer risk, and adherence to cancer screening. Multivariate analyses controlled for poverty, age, and race. Results More financial anxiety was associated with lower odds of mammogram adherence (odds ratio [OR] = 0.97, confidence interval [CI] = 0.94, 0.99), Pap smear adherence (OR = 0.98, CI = 0.96, 0.996), and clinical breast examination adherence (OR = 0.98, CI = 0.96, 0.995). More worry about affording healthcare was associated with lower odds of clinical breast examination adherence (OR = 0.95, CI = 0.91, 0.9992) but not mammogram or Pap smear adherence (p > .05). Financial stigma due to cancer risk was associated with lower odds of Pap smear adherence (OR = 0.87, CI = 0.77, 0.97) but no other cancer screenings (p > .07). Conclusions Financial anxiety may impede cancer screening, even for high-risk women aware of their risk status. Clinical interventions focused on social determinants of health may also need to address financial anxiety for women at high risk of breast cancer.

An Ecological Momentary Assessment Study Investigating Self-efficacy and Outcome Expectancy as Mediators of Affective and Physiological Responses and Exercise Among Endometrial Cancer Survivors

AbstractBackgroundPrevious studies have shown affective and physiological states in response to exercise as predictors of daily exercise, yet little is known about the mechanism underlying such effects.PurposeTo examine the mediating effects of self-efficacy and outcome expectancy on the relationships between affective and physiological responses to exercise and subsequent exercise levels in endometrial cancer survivors.MethodsEcological momentary assessment (EMA) surveys were delivered up to eight 5- to 7-day periods over 6 months. Participants (n = 100) rated their affective and physiological states before and after each exercise session (predictors) and recorded their self-efficacy and outcome expectancy each morning (mediators). Exercise (outcome) was based on self-reported EMA surveys and accelerometer measures. A 1-1-1 multilevel mediation model was used to disaggregate the within-subject (WS) and between-subject (BS) effects.ResultsAt the WS level, a more positive affective state after exercise was associated with higher self-efficacy and positive outcome expectation the next day, which in turn was associated with higher subsequent exercise levels (ps < .05). At the BS level, participants who typically had more positive affective and experienced less intense physiological sensation after exercise had higher average self-efficacy, which was associated with higher average exercise levels (ps < .05).ConclusionsIn endometrial cancer survivors, affective experience after exercise, daily self-efficacy and positive outcome expectation help explain the day-to-day differences in exercise levels within-person. Findings from this study highlight potentials for behavioral interventions that target affective experience after exercise and daily behavioral cognitions to promote physical activity in cancer survivors’ everyday lives.

Exploring quality of life impact on cancer screening in Black subgroups

Abstract Background Black individuals in United States have the poorest outcomes in cancer and receipt of cancer screening. Purposes This study seeks to describe cancer screening among Black subgroups, especially considering the influence on quality of life (QOL). Methods Data from the African Cancer Prevention Project of Philadelphia (CAP3) were analyzed to examine differences among Black subgroups for QOL variables and cancer screening. Descriptive analysis and Fisher’s exact test were conducted. Results The overall sample included 294 participants (177 African Americans, 34 US immigrants from Africa, and 83 US immigrants from Afro-Caribbean) ranging from 21 to 88 years old. Significant differences were found in various cancer screenings, such as Caribbean immigrant female participants receiving cervical cancer screening, African Americans receiving breast cancer screening, and US immigrants from Africa receiving colorectal cancer screening. Conclusions Quality-of-life factors varied across the 3 Black subgroups and varied by cancer screening site. QOL factors have a significant impact on cancer screening. More culturally tailored cancer prevention interventions should be developed for the self-reported Black population.

Identifying Mediators of Intervention Effects Within a Randomized Controlled Trial to Motivate Cancer Genetic Risk Assessment Among Breast and Ovarian Cancer Survivors

Abstract Background A theory-guided Tailored Counseling and Navigation (TCN) intervention successfully increased cancer genetic risk assessment (CGRA) uptake among cancer survivors at increased risk of hereditary breast and ovarian cancer (HBOC). Understanding the pathways by which interventions motivate behavior change is important for identifying the intervention’s active components. Purpose We examined whether the TCN intervention exerted effects on CGRA uptake through hypothesized theoretical mediators. Methods Cancer survivors at elevated risk for HBOC were recruited from three statewide cancer registries and were randomly assigned to three arms: TCN (n = 212), Targeted Print (TP, n = 216), and Usual Care (UC, n = 213). Theoretical mediators from the Extended Parallel Process Model, Health Action Planning Approach, and Ottawa Decision Support Framework were assessed at baseline and 1-month follow-up; CGRA uptake was assessed at 6 months. Generalized structural equation modeling was used for mediation analysis. Results The TCN effects were most strongly mediated by behavioral intention alone (β = 0.49 and 0.31) and by serial mediation through self-efficacy and intention (β = 0.041 and 0.10) when compared with UC and TP, respectively. In addition, compared with UC, the TCN also increased CGRA through increased perceived susceptibility, knowledge of HBOC, and response efficacy. Conclusions Risk communication and behavioral change interventions for hereditary cancer should stress a person’s increased genetic risk and the potential benefits of genetic counseling and testing, as well as bolster efficacy beliefs by helping remove barriers to CGRA. System-level and policy interventions are needed to further expand access.

Distinct Illness Representation Profiles Are Associated With Anxiety in Women Testing Positive for Human Papillomavirus

AbstractBackgroundTesting positive for human papillomavirus (HPV) at cervical cancer screening has been associated with heightened anxiety. To date, the cognitive determinants of heightened anxiety remain unclear, making it difficult to design effective interventions.PurposeThis study investigated latent illness representation profiles in women testing positive for HPV with no abnormal cells (normal cytology) and explored associations between these profiles and anxiety.MethodsWomen aged 24–66 (n = 646) who had tested HPV-positive with normal cytology at routine HPV primary screening in England completed a cross-sectional survey shortly after receiving their result.ResultsLatent profile analysis identified three distinct profiles of illness representations (termed “adaptive,” “negative,” and “negative somatic”), which differed significantly in their patterns of illness perceptions. Hierarchal linear regression revealed that these latent illness representation profiles accounted for 21.8% of the variance in anxiety, after adjusting for demographic and clinical characteristics. When compared with adaptive representations (Profile 1), women with negative representations (Profile 2) and negative somatic representations (Profile 3) had significantly higher anxiety, with clinically meaningful between-group differences (mean difference [MD] = 17.26, confidence interval [CI]: 14.29–20.22 and MD = 13.20, CI: 9.45–16.96 on the S-STAI-6, respectively).ConclusionThe latent illness representation profiles identified in this study provide support for the role of negative beliefs contributing to anxiety in women testing HPV-positive with normal cytology. Characteristics specific to subgroups of highly anxious women (Profiles 2 and 3) could be used by policymakers to target information in routine patient communications (e.g., test result letters) to reduce unnecessary burden. Future research should adopt longitudinal designs to understand the trajectory of illness representations from HPV diagnosis through to clearance versus persistence.