Shiraz I. Mishra

Background. We tested the effectiveness of a theory-guided, culturally tailored cervical cancer education program designed to increase Pap smear use among Samoan women residing in the U.S. Territory of American Samoa. Methods. We used a two-group, pretest-posttest design. The sample comprised 398 Samoan women age 20 and older recruited from Samoan churches. Women in the intervention group received a culturally tailored cervical cancer education program in three weekly sessions. The primary outcome was self-reported receipt of a Pap smear. Results. Overall, there was a significant intervention effect, with intervention compared with control group women twice (adjusted odds ratio = 2.0, 95% confidence interval = 1.3–3.2, p<.01) as likely to self-report Pap smear use at the posttest. Conclusions. The findings support the efficacy of the multifaceted, theory-guided, culturally tailored community-based participatory cervical cancer education program for Samoan women in effecting positive changes in Pap smear use and cervical cancer related knowledge and attitudes.

The purpose of this study is to better understand the mental health/illness information and service delivery preferences among African American residents of Baltimore. We conducted four focus groups (n = 42) among African American adults currently unconnected with the mental health system. Participants expressed fear of stigma and perceptions of racism as major barriers to seeking information and/or services and discussed some normalizing strategies to address these barriers. African Americans harbor cultural and traditional beliefs regarding mental illness which could also act as barriers. Findings have implications for imparting acceptable and culturally sensitive mental health education and service delivery programs in community settings.

Background: There are no effective breast cancer education programs targeting Samoan women. We tested the effectiveness of a theory-guided, culturally appropriate breast cancer education program (the intervention) designed to increase mammography use among Samoan women. Methods: This community-based participatory cluster-randomized controlled intervention trial used a parallel two-group design. The sample consisted of 776 women aged 42 and older who had not had a mammogram in the preceding 2 years. The primary outcome was self-reported mammogram use between pretest and posttest. Results: Overall, there was no statistically significant intervention effect, although the odds of self-reported mammogram use were higher in the intervention than the control group (odds ratio (OR), 1.26; 95% confidence interval (95% CI), 0.74, 2.14; P = 0.39). Exploratory subgroup analyses found that the intervention was effective only among women who were aware of mammograms but had never previously obtained one (OR, 1.99; 95% CI, 1.03, 3.85; P = 0.04). Low need for social support and lack of endorsement of culture-specific beliefs about breast cancer were associated with mammogram use in this group. In women unaware of mammography at pretest, high perceived susceptibility to breast cancer and endorsement of culture-specific beliefs were associated with mammogram use. For women who had previously obtained a mammogram, lower self-efficacy was associated with mammogram use. Intervention compared with control group women had significantly higher levels of knowledge of risk factors and lower endorsement of culture-specific beliefs at posttest. Conclusions: Results suggest that a multifaceted education intervention may improve mammogram usage for certain subgroups of Samoan women. (Cancer Epidemiol Biomarkers Prev 2007;16(12):2594–604)

Background. There is little information on the associations between cultural and psychosocial factors and not receiving a mammogram by Samoan women.Methods. Survey of 809 Samoan women aged 42 years and older.Results. The likelihood of nonreceipt waslower for women who had higher perceptions of severity, agreement with a mammogram’s efficacy, higher group norms, higher self-efficacy, and those who placed greater importance on the breast. The likelihood of nonreceipt washigher for women who harbored misconceptions and endorsed culture-specific beliefs.Conclusions. Samoan women need specifically tailored breast cancer education which incorporates cultural and psychosocial factors important for behavior change.

Cancer in Maryland is a serious health concern for minority and underserved populations in rural and urban areas. This report describes the National Cancer Institute (NCI) supported Maryland Special Populations Cancer Network (MSPN), a community–academic partnership. The MSPN's priority populations include African Americans, Native Americans, and other medically underserved residents of rural and urban areas. The MSPN has established a community infrastructure through formal collaborations with several community partners located in Baltimore City, the rural Eastern Shore, and Southern and Western Maryland, and among the Piscataway Conoy Tribe and the other 27 Native American Tribes in Maryland. Key partners also include the University of Maryland Eastern Shore and the University of Maryland Statewide Health Network. The MSPN has implemented innovative and successful programs in cancer health disparities research, outreach, and training; clinical trials education, health disparities policy, and resource leveraging. The MSPN addresses the goal of the NCI and the Department of Health and Human Services (DHHS) to reduce and eventually eliminate cancer health disparities. Community–academic partnerships are the foundation of this successful network.

Provide comprehensive data on smoking behavior among Samoans. Cross-sectional, using systematic random sampling procedures, and in-person interviews. US Territory of American Samoa, Hawaii, and Los Angeles, California. 1834 adult, non-institutionalized Samoans. None. Prevalence and independent predictors of smoking. Approximately one fourth (26.6%) of Samoans were current smokers, with 31.4% of men and 22.5% of women currently smoking. More current smokers were found in American Samoa (28.9%), followed by Hawaii (26.9%) and Los Angeles (24.1%, P<.001). At each site, Samoan men compared with the women were significantly more likely to smoke (P<.001), initiate smoking earlier (P<.05), and smoke more cigarettes (P<.05). Cessation rates for the sample were very low. Predictors of smoking included being younger, male, married, less educated, with lower income, and more acculturated. The high smoking and low cessation rates indicate that smoking-related diseases will be significant causes of morbidity and mortality for Samoans for many years. The findings further underscore the importance of documenting smoking patterns and their determinants for subgroups rather than aggregates such as Asian American and Pacific Islanders. If Samoans are to meet the Healthy People 2010 tobacco goals, there is a need to: 1) develop tailored tobacco awareness and cessation programs based on the recommendations made by the Taskforce on Community Preventive Services; 2) understand the complex interactions between social, cultural, and psychological determinants of smoking and cessation behaviors; and 3) develop policies to limit availability of tobacco, environmental exposure from tobacco, and increase cessation efforts.

The Pacific Islander Cancer Control Network (PICCN) is one of the 18 Special Populations Networks recently established by the National Cancer Institute (NCI) to address the cancer control needs of America's medically under-served populations. The PICCN focuses on three Pacific Islander groups: Samoans, Guamanians/Chamorros, and Tongan Americans. The program provides an infrastructure for collaboration between an academic institution, the University of California, Irvine; an NCI designated cancer center, the Chao Family Comprehensive Cancer Center; community-based organizations; and other agencies concerned with the health of Pacific Islanders. The PICCN's objectives include improving cancer awareness, enhancing recruitment to clinical trials, increasing the number of cancer control investigators, and encouraging more research among these Pacific Islanders. The activities that increase cancer awareness include assessing existing cancer education materials aimed at Pacific Islanders, working with the NCI's Cancer Information Service to modify existing materials, developing new culturally-sensitive materials, and distributing the materials in a culturally-sensitive manner. The PICCN enhances recruitment of Pacific Islanders to clinical trials by establishing relationships with cancer centers, making them aware of existing cancer center studies, and developing culturally appropriate recruitment materials when necessary. The network plans to increase the number of Pacific Islander investigators and encourage more research among Pacific Islanders by identifying potential investigators, informing them about existing cancer control training opportunities, developing a new training opportunity, and providing mentors to help with the development of pilot projects and RO1 applications. Through these efforts, the PICCN is addressing the goal of eliminating health disparities among ethnic and racial minorities in this country.