Mira L. Katz

Purpose: To determine if the developed Know Your Risk (KYR) intervention is similar to conventional genetic counseling; we evaluated participants’ knowledge of cancer genetics, breast cancer risk perception, attitudes about genetic counseling and testing, and satisfaction with genetic counseling. Methods: Women ( n = 866) who screened at elevated risk for breast cancer were randomized to the KYR intervention or conventional genetic counseling (2022–2024). The KYR intervention included a series of online pre-test educational videos, direct access to genetic testing, and patient preference for receiving post-test genetic counseling. Participants completed surveys at baseline and after genetic counseling and testing. Non-inferiority hypothesis testing compared the two participant groups. Results: The mean knowledge score (range 0–12) increased in both study groups from a baseline mean of 6.87 (standard deviation (SD) = 2.46) to 8.66 (SD = 2.16) for the KYR intervention and 8.56 (SD = 2.14) for conventional counseling. Additionally, statistical analyses suggest the non-inferiority of the KYR intervention for participants’ accuracy of their breast cancer risk, attitudes about genetic counseling and genetic testing, and satisfaction with genetic counseling compared to participants randomized to conventional genetic counseling. Conclusion: Findings support that the components included in the KYR intervention are non-inferior for cancer genetic knowledge, risk perception, genetic counseling and testing attitudes, and genetic counseling satisfaction among women who screen at elevated risk for breast cancer. By using the combination of components included in the KYR intervention, genetic counseling and genetic testing are more accessible, convenient, and patient-driven. Trial Registration : ClinicalTrials.gov Identifier: NCT05325151.

Supplementary Figure S1: A map of counties with the number of participants enrolled per county

Background:Lower cervical cancer screening rates are associated with higher cervical cancer mortality among women living in rural compared with urban areas (defined by rural–urban community codes). The study purpose was to examine the effectiveness of a mailed digital video disc (DVD) versus DVD plus patient navigation (PN) versus usual care (UC) on increasing the percentage of rural women up to date (UTD) with cervical cancer screening guidelines.Methods:Rural women (ages 50–74 years) who were not UTD for cervical cancer screening (n = 553) were consented and randomized 2:2:1 (DVD, DVD + PN, and UC, respectively). Baseline and 12-month surveys included sociodemographic characteristics, history of previous cervical cancer screening, and cervical cancer screening knowledge and beliefs. Screening status was assessed by medical record review at baseline and 12 months after randomization.Results:The mean age of participants was 59.8 years. After controlling for covariates, women randomized to the DVD + PN group had greater odds [OR = 5.01; 95% confidence interval (CI), 2.38–11.50] of being UTD with cervical cancer screening compared with UC at 12 months after randomization. Other significant covariates in the model included having a college versus high school or lower education (OR = 2.36; 95% CI, 1.08–5.63), private (OR = 4.16; 95% CI, 1.28–19.1) or no insurance (OR = 8.74; 95% CI, 1.77–51.9) versus public insurance, normal (OR = 3.25; 95% CI, 1.46–7.24) or overweight (OR = 2.15; 95% CI, 1.05–4.42) versus obese body mass index, and positive screening intention in the next six months (OR = 2.59; 95% CI, 1.48–4.52).Conclusions:A DVD + PN intervention increased the percentage of rural women UTD with cervical cancer screening compared with UC or DVD only.Impact:Women who have a high school or lower education, were on public insurance, obese, and not planning to be screened need increased attention to become UTD with cervical cancer screening.

To assess awareness and willingness of average-risk adults to complete a colorectal cancer (CRC) screening blood test and evaluate test preferences for future screening. Following approval by the United States Food and Drug Administration, a cross-sectional online survey was conducted in September 2024 of adults ages 45-75 in the United States (n = 633). An informative statement about the new test was followed by a series of questions. Logistic regression identified correlates of participants' willingness to complete a CRC screening blood test. Only 18.2% of participants were aware of a CRC screening blood test. Most (77.9%) were willing to get the test if free or covered by health insurance, while only 19.2% were willing if it cost $895 out of pocket. Participants were more willing to complete a free CRC screening blood test if they had a high household income (odds ratio [OR] = 5.12, 95% confidence interval [CI]: 1.63-16.13), had a routine medical check-up in the last year (OR = 2.87, CI:1.44-5.71), and were more wanting to talk to a doctor at their next medical appointment about the new test (OR = 2.55, CI: 1.92-3.37). Participants' preferred CRC screening approach for the future was the blood test every three years (53.0%), an annual stool test (31.1%), and a colonoscopy every 10 years (15.8%). The blood test has the potential to increase CRC screening, as most participants were willing to complete the test if it was free or covered by health insurance. Findings can guide the development of programs that include the CRC screening blood test as an option.

Background: Lower cervical cancer screening rates are associated with higher cervical cancer mortality among women living in rural compared with urban areas (defined by rural–urban community codes). The study purpose was to examine the effectiveness of a mailed digital video disc (DVD) versus DVD plus patient navigation (PN) versus usual care (UC) on increasing the percentage of rural women up to date (UTD) with cervical cancer screening guidelines. Methods: Rural women (ages 50–74 years) who were not UTD for cervical cancer screening (n = 553) were consented and randomized 2:2:1 (DVD, DVD + PN, and UC, respectively). Baseline and 12-month surveys included sociodemographic characteristics, history of previous cervical cancer screening, and cervical cancer screening knowledge and beliefs. Screening status was assessed by medical record review at baseline and 12 months after randomization. Results: The mean age of participants was 59.8 years. After controlling for covariates, women randomized to the DVD + PN group had greater odds [OR = 5.01; 95% confidence interval (CI), 2.38–11.50] of being UTD with cervical cancer screening compared with UC at 12 months after randomization. Other significant covariates in the model included having a college versus high school or lower education (OR = 2.36; 95% CI, 1.08–5.63), private (OR = 4.16; 95% CI, 1.28–19.1) or no insurance (OR = 8.74; 95% CI, 1.77–51.9) versus public insurance, normal (OR = 3.25; 95% CI, 1.46–7.24) or overweight (OR = 2.15; 95% CI, 1.05–4.42) versus obese body mass index, and positive screening intention in the next six months (OR = 2.59; 95% CI, 1.48–4.52). Conclusions: A DVD + PN intervention increased the percentage of rural women UTD with cervical cancer screening compared with UC or DVD only. Impact: Women who have a high school or lower education, were on public insurance, obese, and not planning to be screened need increased attention to become UTD with cervical cancer screening.

Objective: There is an increasing interest in human papillomavirus (HPV) self-collection as a strategy for women not up-to-date with cervical cancer screening. We report the findings of an HPV self-collection educational intervention for health care providers and staff. Materials and Methods: As part of the Health Outcomes through Motivation and Education ( HOME ) Initiative , health care providers from 10 health care systems in Appalachian regions of four states attended online sessions during 2021–2023. Participants ( n = 167) completed pre- and postintervention surveys focused on knowledge and attitudes about HPV self-collection and cervical cancer screening. The postintervention survey also addressed satisfaction with the educational intervention. Results: Participants correctly answered an average of 4.6 out of 7 knowledge items on preintervention surveys and an average of 6.0 items on postintervention surveys ( p < 0.001). Attitudes were more positive on postintervention surveys and included that participants reported that they were better informed about HPV self-collection and more confident they could talk to patients about HPV self-collection (both p < 0.05). Nearly all (>97%) participants reported being satisfied with the educational intervention and being pleased their health center was included in the HOME Initiative . Conclusions: An online educational intervention for health care providers and staff about HPV self-collection as a cervical cancer screening strategy was efficacious in improving knowledge and attitudes and was well-received by participants. Given its online delivery and that it can be completed individually or in a group setting, this educational intervention with minor adaptations has potential for wide dissemination to educate health care providers and staff about HPV self-collection.

Background: Young gay, bisexual, and other men who have sex with men have been referred to as a “hard-to-reach” or “hidden” community in terms of recruiting for research studies. With widespread internet use among this group and young adults in general, web-based avenues represent an important approach for reaching and recruiting members of this community. However, little is known about how participants recruited from various web-based sources may differ from one another. Objective: This study aimed to determine how young gay, bisexual, and other men who have sex with men recruited from various web-based sources differ from one another in terms of participant characteristics and study engagement. Methods: Data were collected as part of a randomized controlled trial of Outsmart HPV, a web-based human papillomavirus (HPV) vaccination intervention for young gay, bisexual, and other men who have sex with men. From 2019 to 2021, we recruited young gay, bisexual, and other men who have sex with men in the United States who were aged 18-25 years and not vaccinated against HPV (n=1227) through various web-based avenues. We classified each participant as being recruited from either (1) social media (eg, Facebook, Instagram, Snapchat), (2) a dating app (eg, Grindr, Scruff), or (3) some other digital recruitment source (eg, existing research panel, university-based organization). Analyses compared participants from these 3 groups on demographic and health-related characteristics and metrics involving study engagement. Results: Most demographic and health-related characteristics differed by web-based recruitment source, including race or ethnicity (P<.001), relationship status (P<.001), education level (P<.001), employment status (P<.001), sexual self-identity (P<.001), health insurance status (P<.001), disclosure of sexual orientation (P=.048), and connectedness to the LGBTQ (lesbian, gay, bisexual, transgender, queer) community (P<.001) The type of device used by participants during study enrollment also differed across groups, with smartphone use higher among participants recruited via dating apps (n=660, 96.6%) compared to those recruited via social media (n=318, 78.9%) or other digital sources (n=85, 60.3%; P<.001). Participants recruited via social media were more likely than those recruited via dating apps to complete follow-up surveys at 3 different timepoints (odds ratios 1.52-2.09, P=.001-.008). These participants also spent a longer amount of time viewing intervention content about HPV vaccination (3.14 minutes vs 2.67 minutes; P=.02). Conclusions: We were able to recruit a large national sample of young gay, bisexual, and other men who have sex with men for a web-based HPV vaccination intervention via multiple methodologies. Participants differed on a range of demographic and health-related characteristics, as well as metrics related to study engagement, based on whether they were recruited from social media, a dating app, or some other digital recruitment source. Findings highlight key issues and considerations that can help researchers better plan and customize future web-based recruitment efforts of young gay, bisexual, and other men who have sex with men. Trial Registration: ClinicalTrials.gov NCT04032106; https://clinicaltrials.gov/study/NCT04032106 International Registered Report Identifier (IRRID): RR2-10.2196/16294

Background: Despite the promise of mail-based human papillomavirus (HPV) self-collection programs for increasing cervical cancer screening, few have been evaluated in the United States. We report the results of a mail-based HPV self-collection program for underscreened women living in Appalachia. Methods: We conducted a group randomized trial from 2021 to 2022 in the Appalachian regions of Kentucky, Ohio, Virginia, and West Virgnia. Participants were women of ages 30 to 64 years who were underscreened for cervical cancer and from a participating health system. Participants in the intervention group (n = 464) were mailed an HPV self-collection kit followed by telephone-based patient navigation (if needed), and participants in the usual care group (n = 338) were mailed a reminder letter to get a clinic-based cervical cancer screening test. Generalized linear mixed models compared cervical cancer screening between the study groups. Results: Overall, 14.9% of participants in the intervention group and 5.0% of participants in the usual care group were screened for cervical cancer. The mail-based HPV self-collection intervention increased cervical cancer screening compared with the usual care group (OR, 3.30; 95% confidence interval, 1.90–5.72; P = 0.005). One or more high-risk HPV types were detected in 10.5% of the returned HPV self-collection kits. Among the participants in the intervention group whom patient navigators attempted to contact, 44.2% were successfully reached. Conclusions: HPV self-collection increased cervical cancer screening, and future efforts are needed to determine how to optimize such programs, including the delivery of patient navigation services. Impact: Mail-based HPV self-collection programs are a viable strategy for increasing cervical cancer screening among underscreened women living in Appalachia.

BACKGROUND Young gay, bisexual, and other men who have sex with men have been referred to as a “hard-to-reach” or “hidden” community in terms of recruiting for research studies. With widespread internet use among this group and young adults in general, web-based avenues represent an important approach for reaching and recruiting members of this community. However, little is known about how participants recruited from various web-based sources may differ from one another. OBJECTIVE This study aimed to determine how young gay, bisexual, and other men who have sex with men recruited from various web-based sources differ from one another in terms of participant characteristics and study engagement. METHODS Data were collected as part of a randomized controlled trial of Outsmart HPV, a web-based human papillomavirus (HPV) vaccination intervention for young gay, bisexual, and other men who have sex with men. From 2019 to 2021, we recruited young gay, bisexual, and other men who have sex with men in the United States who were aged 18-25 years and not vaccinated against HPV (n=1227) through various web-based avenues. We classified each participant as being recruited from either (1) social media (eg, Facebook, Instagram, Snapchat), (2) a dating app (eg, Grindr, Scruff), or (3) some other digital recruitment source (eg, existing research panel, university-based organization). Analyses compared participants from these 3 groups on demographic and health-related characteristics and metrics involving study engagement. RESULTS Most demographic and health-related characteristics differed by web-based recruitment source, including race or ethnicity (P<.001), relationship status (P<.001), education level (P<.001), employment status (P<.001), sexual self-identity (P<.001), health insurance status (P<.001), disclosure of sexual orientation (P=.048), and connectedness to the LGBTQ (lesbian, gay, bisexual, transgender, queer) community (P<.001) The type of device used by participants during study enrollment also differed across groups, with smartphone use higher among participants recruited via dating apps (n=660, 96.6%) compared to those recruited via social media (n=318, 78.9%) or other digital sources (n=85, 60.3%; P<.001). Participants recruited via social media were more likely than those recruited via dating apps to complete follow-up surveys at 3 different timepoints (odds ratios 1.52-2.09, P=.001-.008). These participants also spent a longer amount of time viewing intervention content about HPV vaccination (3.14 minutes vs 2.67 minutes; P=.02). CONCLUSIONS We were able to recruit a large national sample of young gay, bisexual, and other men who have sex with men for a web-based HPV vaccination intervention via multiple methodologies. Participants differed on a range of demographic and health-related characteristics, as well as metrics related to study engagement, based on whether they were recruited from social media, a dating app, or some other digital recruitment source. Findings highlight key issues and considerations that can help researchers better plan and customize future web-based recruitment efforts of young gay, bisexual, and other men who have sex with men. CLINICALTRIAL ClinicalTrials.gov NCT04032106; https://clinicaltrials.gov/study/NCT04032106 INTERNATIONAL REGISTERED REPORT RR2-10.2196/16294