IMPORTANCE COVID-19 has disproportionately affected Black individuals in the US; however, vaccination rates among Black individuals trail those among other racial groups. This disparity is often attributed to a high level of vaccine hesitancy among Black individuals, but few studies have examined changes in vaccine hesitancy over time. OBJECTIVES To compare changes in vaccine hesitancy between Black and White individuals in the US and to examine mechanisms that might help explain the observed differences. DESIGN, SETTING, AND PARTICIPANTS This survey study used 7 waves of data collected using a panel design. A total of 1200 English-speaking adults in the US were recruited from a nonprobability online panel to construct a census-matched sample. Participants were contacted monthly between

This study retested PRISM, a model of risk information seeking, and found that it is applicable to the context of cancer risk communication. The study, which used an online sample of 928 U.S. adults, also tested the effect of additional variables on that model and found that the original model better fit the data. Among the strongest predictors of cancer information seeking were seeking-related subjective norms, attitude toward seeking, perceived knowledge insufficiency, and affective risk response. Furthermore, risk perception was a strong predictor of an affective risk response. The authors suggest that, given the robustness across studies, the path between seeking-related subjective norms and seeking intention is ready to be implemented in communication practice.

Purpose Latino Medicare enrollees report suboptimal rates of colorectal cancer screening (CRCS) despite Medicare policies designed to improve CRCS access for older persons. Patient navigation (PN) may address many underlying barriers to CRCS, yet little is known about the effectiveness of PN to increase CRCS adherence among Latino Medicare enrollees. Methods Using a randomized controlled trial study design, we evaluated tailored PN delivered outside of primary care settings as an intervention to increase CRCS adherence in this population. Intervention participants (n=135) received tailored PN services which included education, counseling and logistical support administered in their language of choice. Comparison participants (n=168) received mailed cancer education materials. We compared CRCS rates between interventions and used multivariable logistic regression to assess the odds of CRCS adherence for PN versus comparison groups after adjusting for covariates of interest. Results More navigated than non-navigated participants became CRCS adherent during the study period (43.7% versus 32.1%, P=0.04). The odds of CRCS adherence were significantly higher for PN relative to comparison participants before and after adjusting for covariates (unadjusted OR: 1.64, P=0.04; adjusted OR: 1.82, P=0.02). Higher CRCS adherence rates were observed primarily in the uptake of endoscopic screening methods. Conclusions This study demonstrates that PN delivered outside of the primary care environment is modestly effective in increasing CRCS adherence among Latino Medicare enrollees. This intervention strategy should be further evaluated as a complement to primary care-based PN and other care coordination strategies to increase adherence with CRCS and other evidence-based screenings among older Latinos.

Background We assessed attitudes of breast cancer patients regarding molecular testing for personalized therapy and research. Methods A questionnaire was given to female breast cancer patients presenting to a cancer center. Associations between demographic, clinical variables and attitudes towards molecular testing were evaluated. Results 308 patients were approached and 100 completed the questionnaire (32% response rate). Most participants were willing to undergo molecular testing to assist in selection of approved drugs (81%) and experimental therapy (59%) if testing was covered by insurance. Most participants were white (71%). Even if testing was financially covered, non-white participants were less willing to undergo molecular testing for selection of approved drugs (nonwhites vs. whites, 54% vs. 90%, OR=0.13; p=0.0004) or experimental drugs (35% vs. 68%, OR=0.26; p=0.0072). Most participants (75%) were willing to undergo a biopsy to guide therapy, and 46% were willing to undergo research biopsies. Non-white participants were less willing to undergo research biopsies (17% vs. 55%, OR=0.17; p=0.0033). Most participants wanted to be informed when research results had implications for treatment (91%), new cancer risk (90%), and other preventable/treatable diseases (87%). Conclusions Most patients are willing to undergo molecular testing and minimally invasive procedures to guide approved or experimental therapy. There are significant differences in attitudes towards molecular testing between racial groups; non-whites are less willing to undergo testing even if the results would guide their own therapy. Novel approaches are needed to prevent disparities in delivery of genomically informed care and to increase minority participation in biomarker-driven trials.

We investigated the risk-information-processing behaviors of people living at or near the poverty line. Because significant gaps in health and communication exist among high- and low-income groups, increasing the information seeking and knowledge of poor individuals may help them better understand risks to their health and increase their engagement in health-protective behaviors. Most earlier studies assessed only a single health risk selected by the researcher, whereas we listed 10 health risks and allowed the respondents to identify the one that they worried about most but took little action to prevent. Using this risk, we tested one pathway inspired by the risk information seeking and processing model to examine predictors of information insufficiency and of systematic processing and extended this pathway to include health-protective action. A phone survey was conducted of African Americans and whites living in the southern United States with an annual income of ≤$35,000 (N= 431). The results supported the model pathway: worry partially mediated the relationship between perceived risk and information insufficiency, which, in turn, increased systematic processing. In addition, systematic processing increased health-protective action. Compared with whites and better educated respondents, African Americans and respondents with little education had significantly higher levels of information insufficiency but higher levels of systematic processing and health-protective action. That systematic processing and knowledge influenced health behavior suggests a potential strategy for reducing health disparities.