Background The introduction of HPV vaccines represents a breakthrough in the primary prevention of cervical cancer. However, little is known about vaccination uptake and correlates among U.S. low-income, ethnic minority and immigrant populations who may benefit most from the vaccine. Methods Telephone interviews (N=490) were conducted in six languages between January and November 2009 among mothers of vaccine-eligible girls (ages 9–18) using the Los Angeles County Department of Public Health, Office of Women’s Health service referral hotline. HPV and vaccine awareness, knowledge, beliefs, barriers, and daughter’s vaccine receipt were assessed. Results The sample consisted of low-income, uninsured, ethnic minority and immigrant women. Only 29% of daughters initiated the vaccine and 11% received all three doses. No ethnic differences were observed in initiation or completion rates. Ethnic differences were observed in HPV awareness, perceived risk, and other immunization related beliefs. The strongest predictor of initiation was vaccine awareness (OR=12.00). Daughter’s age and reporting a younger acceptable age for vaccination were positively associated with initiation. Mothers of unvaccinated girls reported lacking information about the vaccine to make a decision (66%) and not knowing where they could obtain the vaccine (74%). Conclusion Vaccination rates in this sample were lower than state and national estimates, and were associated with low levels of vaccine awareness. Interventions, including culturally targeted messaging, may be helpful for enhancing HPV vaccine knowledge, modifying vaccine-related beliefs and increasing uptake. Impact Our findings provide valuable guidance for developing interventions to address sub-optimal HPV vaccination in high risk groups.

Background We developed a new model of hypertension (HTN) care for non-Hispanic black men that links health promotion by barbers to medication management by specialty-trained pharmacists and demonstrated efficacy in a 6-month randomized trial (Victor et al., NEJM, 2018). The marked reduction in systolic blood pressure (BP) seen at 6 months warranted continuing the trial through 12 months to test sustainability, a necessary precondition for subsequent implementation research. Methods We enrolled a cohort of 319 black male patrons with systolic BP ≥ 140 mm Hg at baseline, in a cluster-randomized trial. Fifty-two Los Angeles County barbershops were assigned to either a pharmacist-led intervention or an active control group. In the intervention group, barbers promoted follow-up with pharmacists who prescribed BP medication under a collaborative practice agreement with patrons’ primary care providers (PCPs). In the control group, barbers promoted follow-up with PCPs and lifestyle modification. After BP assessment at 6 months, the intervention continued with fewer in-person pharmacist visits to test if the intervention effect could be sustained safely for one year while reducing pharmacist travel time to and from barbershops. Final BP and safety outcomes were assessed in both groups at 12 months. Results At baseline, mean systolic BP was 152.4 mm Hg in the intervention group and 154.6 mm Hg in the control group. At 12 months, mean systolic BP fell by −28.6 mm Hg (to 123.8 mm Hg) in the intervention group and by −7.2 mm Hg (to 147.4 mm Hg) in the control group. The mean reduction was 20.8 mm Hg greater with the intervention (95% confidence interval, 13.9 to 27.7; p < 0.0001). A goal BP < 130/80 was achieved by 68.0% of the intervention group versus 11.0% of the control group (p < 0.02). These new 12-month efficacy data are statistically indistinguishable from our previously reported 6-month data. No treatment-related serious adverse events occurred in either group over 12 months. Cohort retention at 12 months was 90% in both groups. Conclusion Among black male barbershop patrons with uncontrolled HTN, health promotion by barbers resulted in large and sustained BP reduction when coupled with medication management by specialty-trained pharmacists. Broad-scale implementation research is both justified and warranted. Clinical Trial Registration ClinicalTrials.gov,

Background First-degree relatives of melanoma survivors have a substantially higher lifetime risk for melanoma than individuals with no family history. Exposure to ultraviolet radiation is the primary modifiable risk factor for the disease. Reducing UV exposure through sun protection may be particularly important for children with a parental history of melanoma. Nonetheless, limited prior research has investigated sun protection practices and sun exposure among these children. Methods The California Cancer Registry was used to identify melanoma survivors eligible to participate in a survey to assess their children's sun protection practices and sun exposure. The survey was administered by mail, telephone, or web to Latino and non-Latino white melanoma survivors with at least one child (0–17 years; N = 324). Results Sun exposure was high and the rate of sunburn was equivalent to or higher than estimates from average risk populations. Use of sun protection was suboptimal. Latino children were less likely to wear sunscreen and hats and more likely to wear sunglasses, although these differences disappeared in adjusted analyses. Increasing age of the child was associated with lower sun protection and higher risk for sunburn whereas higher objective risk for melanoma predicted improved sun protection and a higher risk for sunburns. Perception of high barriers to sun protection was the strongest modifiable correlate of sun protection. Conclusions Interventions to improve sun protection and reduce sun exposure and sunburns in high risk children are needed. Impact Intervening in high risk populations may help reduce the burden of melanoma in the U.S.

BACKGROUND & AIMS: Over several decades, changes in health care have negatively impacted meaningful communication between the patient and provider and adversely affected their relationship. Under increasing time pressure, physicians rely more on technology than face-to-face time gathering data to make clinical decisions. As a result, they find it more challenging to understand the illness context and fully address patient needs. Patients experience dissatisfaction and a diminution of their role in the care process. For patients with disorders of gut-brain interaction, stigma leads to greater care dissatisfaction, as there is no apparent structural basis to legitimize the symptoms. Recent evidence suggests that practical communication skills can improve the patient-provider relationship (PPR) and clinical outcomes, but these data are limited. METHODS: The Rome Foundation convened a multidisciplinary working team to review the scientific evidence with the following aims: to study the effect of communication skills on patient satisfaction and outcomes by performing an evidence-based review; to characterize the influence of sociocultural factors, health care system constraints, patient perspective, and telehealth on the PPR; to review the measurement and impact of communication skills training on these outcomes; and to make recommendations to improve communication skills training and the PPR. RESULTS: Evidence supports the fact that interventions targeting patientprovider interactions improve population health, patient and provider experience, and costs. Communication skills training leads to improved patient satisfaction and outcomes. The following are relevant factors to consider in establishing an effective PPR: addressing health care system constraints; incorporating sociocultural factors and the role of gender, age, and chronic illness; and considering the changing role of telehealth on the PPR. CONCLUSIONS: We concluded that effective communication skills can improve the PPR and health outcomes. This is an achievable goal through training and system change. More research is needed to confirm these findings.

Background In the United States, Korean immigrants experience a disproportionately high burden of chronic hepatitis B (HBV) viral infection and associated liver cancer compared to the general population. However, despite clear clinical guidelines, HBV serologic testing among Koreans remains persistently sub-optimal. Methods We conducted a cluster-randomized trial to evaluate a church-based small group intervention to improve HBV testing among Koreans in Los Angeles. Fifty-two Korean churches, stratified by size (small, medium, large) and location (Koreatown versus other), were randomized to intervention or control conditions. Intervention church participants attended a single-session small-group discussion on liver cancer and HBV testing and control church participants attended a similar session on physical activity and nutrition. Outcome data consisted of self-reported HBV testing obtained via 6-month telephone follow-up interviews. Results We recruited 1123 individuals, 18-64 years of age, across the 52 churches. Ninety-two percent of the sample attended the assigned intervention session and 86% completed the 6-month follow-up. Sample characteristics included: mean age 46 years, 65% female, 97% born in Korea, 69% completed some college, and 43% insured. In an intent-to-treat analysis, the intervention produced a statistically significant effect (OR = 4.9, p < .001), with 19% of intervention and 6% of control group participants reporting a HBV test. Conclusion Our intervention was successful in achieving a large and robust effect in a population at high risk of HBV infection and sequelae. Impact The intervention was fairly resource efficient and thus has high potential for replication in other high-risk Asian groups.

In patients with mild to moderate gallstone pancreatitis without cholangitis, selective postoperative ERCP and CBD stone extraction is associated with a shorter hospital stay, less cost, no increase in combined treatment failure rate, and significant reduction in ERCP use compared with routine preoperative ERCP.

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 clusterrandomized 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

Background: Evidence about the accuracy of self-reports of colorectal cancer (CRC) screening is lacking. We conducted a validation protocol in a randomized trial to increase CRC screening among high-risk individuals. Methods: First-degree relatives (n = 1,280) of CRC cases who were due for CRC screening were included in the parent trial. All subjects who completed the follow-up interview (n = 948) were asked to participate in validation activities. Self-reports of receipt of CRC screening during the 12-month study period were verified via physicians. Results: Although 60% (n = 567) verbally agreed, only 171 subjects (18% of original sample) returned the signed validation form with the physician name and contact information and a medical information release statement. The signed forms were mailed to physicians with a $10 incentive and the request to list the dates of