Mira L Katz’s research while affiliated with The Ohio State University and other places

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

Some genetic counselors (GCs) may find theories, models, and frameworks (TMFs) useful in clinical skills selection and when reflecting on or evaluating genetic counseling practice. This paper aims to demonstrate how TMFs can be used to postulate how different skills may impact patients'/clients' decisions, behaviors, and outcomes and consider how multiple TMFs can inform the use of various skills or strategies to achieve different goals. Additionally, we provide examples of TMFs that may help GCs in nonclinical aspects of their work, such as implementing and evaluating new interventions or service delivery models. To guide the selection of appropriate TMFs, we provide a set of questions to consider and include examples of skills and approaches that align with different TMFs. While TMFs provide a structured approach and valuable guidance that may help advance genetic counseling practice, they have certain limitations. Additional research is necessary to determine the effectiveness of using TMFs to guide clinical practice and improve patient/client outcomes.

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

Background Up to 50% of people scheduled for screening colonoscopy do not complete this test and no studies have focused on minority and low-income populations. Interventions are needed to improve colorectal cancer (CRC) screening knowledge, reduce barriers, and provide alternative screening options. Patient navigation (PN) and tailored interventions increase CRC screening uptake, however there is limited information comparing their effectiveness or the effect of combining them. Purpose Compare the effectiveness of two interventions to increase CRC screening among minority and low-income individuals who did not attend their screening colonoscopy appointment—a mailed tailored digital video disc (DVD) alone versus the mailed DVD plus telephone-based PN compared to usual care. Methods Patients (n = 371) aged 45–75 years at average risk for CRC who did not attend a screening colonoscopy appointment were enrolled and were randomized to: (i) a mailed tailored DVD; (ii) the mailed DVD plus phone-based PN; or (iii) usual care. CRC screening outcomes were from electronic medical records at 12 months. Multivariable logistic regression analyses were used to study intervention effects. Results Participants randomized to tailored DVD plus PN were four times more likely to complete CRC screening compared to usual care and almost two and a half times more likely than those who were sent the DVD alone. Conclusions Combining telephone-based PN with a mailed, tailored DVD increased CRC screening among low-income and minority patients who did not attend their screening colonoscopy appointments and has potential for wide dissemination.

Purpose To assess the comparative effectiveness of a tailored, interactive digital video disc (DVD) intervention versus DVD plus patient navigation (PN) intervention versus usual care (UC) on the uptake of colorectal cancer (CRC) screening among females living in Midwest rural areas. Methods As part of a larger study, 663 females (ages 50–74) living in rural Indiana and Ohio and not up‐to‐date (UTD) with CRC screening at baseline were randomized to one of three study groups. Demographics , health status/history, and beliefs and attitudes about CRC screening were measured at baseline. CRC screening was assessed at baseline and 12 months from medical records and self‐report. Multivariable logistic regression was used to determine whether females in each group were UTD for screening and which test they completed. Results Adjusted for covariates, females in the DVD plus PN group were 3.5× more likely to complete CRC screening than those in the UC group (odds ratio [OR] 3.62; 95% confidence interval [CI]: 2.09, 6.47) and baseline intention to receive CRC screening (OR 3.45, CI: 2.21,5.42) at baseline. Adjusting for covariates, there was no difference by study arm whether females who became UTD for CRC screening chose to complete a colonoscopy or fecal occult blood test/fecal immunochemical test. Conclusions Many females living in the rural Midwest are not UTD for CRC screening. A tailored intervention that included an educational DVD and PN improved knowledge, addressed screening barriers, provided information about screening test options, and provided support was more effective than UC and DVD‐only to increase adherence to recommended CRC screening.

Objective To review mindfulness-based interventions (MBIs) tested in randomized controlled trials (RCT) across the cancer continuum. Data Source Articles identified in PubMed, CINAHL, Web of Science, PsycINFO, and Embase. Study Inclusion and Exclusion Criteria Two independent reviewers screened articles for: (1) topic relevance; (2) RCT study design; (3) mindfulness activity; (4) text availability; (5) country (United States); and (6) mindfulness as the primary intervention component. Data Extraction Twenty-eight RCTs met the inclusion criteria. Data was extracted on the following variables: publication year, population, study arms, cancer site, stage of cancer continuum, participant demographic characteristics, mindfulness definition, mindfulness measures, mindfulness delivery, and behavioral theory. Data Synthesis We used descriptive statistics and preliminary content analysis to characterize the data and identify emerging themes. Results A definition of mindfulness was reported in 46% of studies and 43% measured mindfulness. Almost all MBIs were tested in survivorship (50%) or treatment (46%) stages of the cancer continuum. Breast cancer was the focus of 73% of cancer-site specific studies, and most participants were non-Hispanic white females. Conclusion The scoping review identified 5 themes: (1) inconsistency in defining mindfulness; (2) differences in measuring mindfulness; (3) underrepresentation of racial/ethnic minorities; (4) underrepresentation of males and cancer sites other than breast; and (5) the lack of behavioral theory in the design, implementation, and evaluation of the MBI.

Purpose To determine the prevalence of food insecurity (FI) among females with a history of breast cancer compared to females without cancer in the USA and the sociodemographic characteristics that may explain their FI. Methods Using the 2019 National Health Interview (NHIS) survey that included the US Department of Agriculture’s (USDA’s) 10-item Household Food Security Survey Module, participants with high/moderate food security were considered food secure and low/very low food security were considered food insecure. Analyses accounted for complex survey design and included descriptive statistics, bivariate analyses, and multivariate regression analyses. Results Eligible females (40+ years old) included 557 with a history of breast cancer and 9678 without a cancer history. FI was experienced by an estimated 4.4% of females with breast cancer, compared to 9.3% of females without cancer. Controlling for age, race/ethnicity, education level, general health status, and body mass index, the prevalence ratio between the two study groups was 0.50 (95% CI 0.33–0.78). Conclusions In this national sample, the prevalence of FI among females with a history breast cancer was lower than females without a history of cancer. Implications for Cancer Survivors FI is low among breast cancer survivors, and routine FI screening among breast cancer survivors may not be warranted for all patients. Healthcare providers, however, should be aware of FI as a social determinant of health and consider it when there are known financial issues among cancer survivors.

Process evaluation is essential to understanding and interpreting the results of randomized trials testing the effects of behavioral interventions. A process evaluation was conducted as part of a comparative effectiveness trial testing a mailed, tailored interactive digital video disc (DVD) with and without telephone-based patient navigation (PN) to promote breast, cervical and colorectal cancer screening among rural women who were not up-to-date (UTD) for at least one screening test. Data on receipt, uptake, and satisfaction with the interventions were collected via telephone interviews from 542 participants who received the tailored interactive DVD (n = 266) or the DVD plus telephone-based PN (n = 276). All participants reported receiving the DVD and 93.0% viewed it. The most viewed sections of the DVD were about colorectal, followed by breast, then cervical cancer screening. Most participants agreed the DVD was easy to understand, helpful, provided trustworthy information, and gave information needed to make a decision about screening. Most women in the DVD+PN group, 98.2% (n = 268), reported talking with the navigator. The most frequently discussed cancer screenings were colorectal (86.8%) and breast (71.3%); 57.5% discussed cervical cancer screening. The average combined length of PN encounters was 22.2 minutes with 21.7 additional minutes spent on coordinating activities. Barriers were similar across screening tests with the common ones related to the provider/health care system, lack of knowledge, forgetfulness/too much bother, and personal issues. This evaluation provided information about the implementation and delivery of behavioral interventions as well as challenges encountered that may impact trial results.

Background: Genetic counseling and testing have an important role in the care of patients at elevated risk for breast cancer. However, conventional pre- and post-test genetic counseling is labor and time intensive, less accessible for patients living outside major urban centers, and impractical on a large scale. A patient-driven approach to genetic counseling and testing may increase access, improve patients' experiences, affect efficiency of clinical practice, and help meet workforce demand. The objective of this 2-arm randomized controlled trial is to determine the efficacy of Know Your Risk (KYR), a genetic counseling patient preference intervention. Methods: Females (n = 1000) at elevated risk (>20% lifetime) for breast cancer will be randomized to the KYR intervention or conventional genetic counseling. The study will provide comprehensive assessment of breast cancer risk by multigene panel testing and validated polygenic risk score. Primary outcome is adherence to National Comprehensive Cancer Network guidelines for a clinical encounter every 6-12 months and an annual mammogram (breast MRI if recommended) determined by medical record review. Secondary outcomes include adherence to other recommended cancer screening tests determined by medical record review and changes in breast cancer knowledge, perception of risk, post-test/counseling distress, and satisfaction with counseling by completion of three surveys during the study. Study aims will be evaluated for non-inferiority of the KYR intervention compared to conventional genetic counseling. Conclusion: If efficacious, the KYR intervention has the potential to improve patients' experience and may change how genetic counseling is delivered, inform best practices, and reduce workforce burden. Trial registration: ClinicalTrials.govNCT05325151.