Despite over 15 years of human papillomavirus (HPV) vaccination implementation, uptake remains below national targets. Black/African American adolescents are less likely to complete the HPV vaccine series, due to a myriad of multilevel factors including vaccine hesitancy. The objective of this study was to develop a tailored mHealth intervention to promote vaccine confidence among Black families with adolescents. We generated a message bank from the literature, then prioritized and edited content according to needs identified in previous research with Black parents, community stakeholder input, and expert consensus. We conducted three rounds of prototype feedback sessions with 16 parents of adolescents aged 9-13 years from the Greater Newark Area. We recruited at family-friendly events, through community researchers, and with snow-ball sampling. We employed user-centered design techniques, elicited open-ended feedback, and collected relevance ratings for rapid qualitative analysis. Transcripts were thematically analyzed. Results indicated intervention content and features should be tailored by information source and channel. Fact-based messages with neutral framing balancing cancer prevention benefits and safety were highly rated. Including links to trustworthy sources was perceived as increasing credibility and helpful for family-centered decision-making. Parents also wanted age-appropriate information with graphics to explain the purpose and importance of HPV vaccination to their adolescents. Developing the intervention with families highlighted the need for multi-modalities, including informational short-message-service (SMS) and detailed emails with tailored information. Multi-modal interventions providing accurate information tailored to parents' questions and concerns, have potential to educate and empower parents to protect their children from HPV cancers.

Involving youth in chronic disease health promotion with adults can benefit both adults and youth. In this mixed-methods pilot study, we explored the effects of a youth-led digital hypertension education intervention on knowledge, self-efficacy, and behavior outcomes, as well as participant feedback, in parent-youth dyads. High school students (14+ years) paired themselves with an interested adult (18+ years) to create 19 adult-youth dyads. We implemented a 6-week youth-led digital hypertension education intervention to guide youth through learning and then teaching their adult about hypertension. We employed an explanatory sequential mixed-methods design. Hypertension knowledge, confidence in helping an adult manage hypertension (youth), blood pressure (BP) self-care activities (adults), and self-efficacy to manage hypertension (adults with hypertension) increased from pre- to post-intervention. Participants deemed the intervention acceptable and feasible. Pilot findings suggest that involving youth as learners, teachers, and supporters of health promotion can be a catalyst for adult change.

OBJECTIVE:Clinicians often suggest that breast cancer patients bring a companion with them to cancer-related appointments. However, a companion's presence shifts the interaction at a minimum from dyadic to triadic, with potential consequences for effective communication. It is not well documented how often breast cancer patients have time alone with their cancer team, how long any time alone lasts, and if patients are satisfied with the amount of time alone. METHODS:Current (undergoing treatment; n = 150) and former patients (treatment completed; n = 202) breast cancer patients who regularly bring a companion with them to their cancer care visits completed an online questionnaire about the time they spend alone with their oncology team. RESULTS:Current patients reported fewer instances of time alone with their care team than former patients. Overall, most patients reported that the frequency of time alone was about right and that they rarely brought up questions or topics that they would not want to raise with their companion present. Of the patients who reported having no time alone (n = 38), the primary reported reason was that they did not want time alone with their cancer care team. CONCLUSIONS:Approximately 1 in 3-4 patients reported that there were questions or topics that they feel more comfortable raising when they have time alone with their healthcare team, representing an important need for these patients. Most patients reported wanting time alone with their cancer care team and reported being satisfied with the amount they do have. PRACTICE IMPLICATIONS:Results are a positive reflection on the amount and frequency of time alone that breast cancer patients desire throughout the cancer care trajectory. To support patient communication needs, clinicians should provide at least some time alone with their patients, particularly when the patient regularly attends visits with a companion and may otherwise not have the opportunity to be alone with their cancer care team.

Support people are often both physically and emotionally involved in patients' cancer-care trajectories with first-hand knowledge of the patient's health; they also harbor their own fears and concerns. When present in the medical interaction, support people report hesitancy to share patient information and concerns with clinicians, although they deem this information is important for patient care. Framed in the disclosure decision-making model, this study examines how support people's perceptions of clinician empathic communication affect their disclosure efficacy, and how these concepts relate to outcomes of holding back information about patient health or their own fears and concerns. Participants included support people (N  = 129) recruited from the Love Research Army® who completed an online survey. Analyses investigated how disclosure efficacy influences the association between perceived clinician empathic communication and support person holding back patient health information (model 1) and support person holding back their own fears and concerns (model 2). Overall, results identify differences in support people's holding back when making disclosure decisions related to patients' physical health versus their own fears and concerns. Greater disclosure efficacy shaped the relationship between perceived clinician empathic communication and lower levels of holding back patient health information, bolstering the importance of clinician empathic communication with support people of cancer patients.

Media literacy interventions are promising approaches to mitigate the harmful impact of media on substance use behaviors, including smoking and vaping. Some media literacy interventions adopt an interactive format, involving adolescents in the creation of counter messages that challenge pro-substance media narratives. However, research has largely focused on the impact of media literacy interventions on behaviors, leaving a critical gap in understanding the actual content of messages that adolescents produce. Consequently, this study presents a content analysis of N = 256 anti-smoking/vaping messages created by Belgian adolescents during the #Smokefree intervention, which aimed to discourage smoking and vaping by involving adolescents in the planning/design of their own messages. Overall, adolescents mostly focused on vapes in their messages, which reflects a societal trend whereby vaping is becoming more prevalent while smoking is decreasing among adolescents. More importantly, adolescents relied on negative outcome expectations and descriptive norms to discourage smoking/vaping, and they were able to implement basic heuristic cues necessary to enhance message appeal in their messages. These findings suggest that adolescents can apply critical media literacy skills to their own anti-smoking/anti-vaping messages. It also sheds light on which elements of the media literacy intervention resonated with youth, thereby informing the development of future health campaigns and interventions.

This article reviews the development and testing of a youth substance prevention program, REAL media. The contributions of this body of research include theoretical development, measurement, and dissemination of an efficacious independently evaluated program. Special attention is given to the impact of the program through collaborations with multiple community groups and multiple phases of development and testing.

Objective: Caregivers often accompany patients to cancer-related medical appointments. Limited research exists on healthcare providers' (HCPs) evaluation of how caregiver communication influences interactions between healthcare providers and patients, particularly during gynecologic treatment visits. HCPs may perceive caregiver communication as helpful or challenging, and these triadic interactions may influence patient outcomes. Methods: Interviews with ten cancer specialist HCPs (medical assistants/technicians, nurse practitioners/registered nurses, oncologists) addressed experiences interacting with patients and caregivers. Results: Analyses revealed two themes concerning helpful communication: caregivers managing information and managing patient emotions. Three challenging themes include caregiver communication unsettling healthcare interactions, caregiver presence limiting patient communication, and caregiver engagement challenges. Conclusion: HCPs evaluate caregiver communication as helpful and challenging. Findings suggest benefits of communication training for gynecologic cancer patients such as requesting privacy when interacting with HCPs, for caregivers to promote awareness of effects of their behavior, and for HCPs to help manage triadic interactions while supporting patient needs. Innovation: HCP assessment of caregiver communication during gynecologic treatment visits offers unique insights regarding helpful and challenging behaviors contributing to implications for patient care and well-being. Applications may extend to other triadic interactions and cancer settings.

HPV-associated cancer disparities disproportionately affect Black/African American and Hispanic individuals in the U.S. HPV vaccination, which can prevent many HPV-associated cancers, should be clearly recommended by pediatricians to parents of adolescents aged 9-12, yet uptake and completion remain lower than other adolescent vaccinations. We used the Structural Influence Model of Health Communication to explore communication inequalities from interviews with 19 Black and Hispanic mothers of adolescents. We identified HPV vaccination information seeking behaviors, media use, and preferred channels to address information needs. This study provides insights into how mothers' nativity and ethno-racial identity influenced how they accessed and processed information from various sources. Preferences for digital and community-based strategies to address information gaps and hesitancy concerns are also presented. Findings suggest future prevention strategies must increase access to accurate information that resonates with NH-Black and Hispanic communities' needs and is disseminated via preferred communication channels to maximize the effects of multi-level interventions promoting HPV vaccination among communities experiencing disparities.

Cancer patients often attend medical interactions with at least one companion. The degree to which companions participate varies, ranging from passive observer to active advocate. However, the structure of the medical interaction often promotes dyadic rather than triadic communication, creating ambiguity about to the degree to which companions can and should participate. Participants (N = 34, 16 dyads) included gynecologic cancer patients who were undergoing chemotherapy treatment (n = 18) and their companions (n = 16); all participants were separately interviewed. Interviews included discussion of dyadic communication patterns within medical interactions. The normative rhetorical theory (Goldsmith, 2019) was applied as a guiding framework. Patients discussed the dilemma they experience when companions are expected but absent. Patients and companions provided positive reports of companion communication when behavior aligned with expectations. Alternatively, patients and companions experience dilemmas when companions participate more than or differently from how patients and/or companions had expected. Companions provided one strategy for managing the dilemma of how to participate in medical interactions. Implications and limitations are discussed.

Dyads can be challenging to recruit for research studies, but detailed reporting on strategies employed to recruit adult-adolescent dyads is rare. We describe experiences recruiting adult-youth dyads for a hypertension education intervention comparing recruitment in an emergency department (ED) setting with a school-based community setting. We found more success in recruiting dyads through a school-based model that started with adolescent youth (19 dyads in 7 weeks with < 1 hour recruitment) compared to an ED-based model that started with adults (2 dyads in 17 weeks with 350 hours of recruitment). These findings can benefit future adult-youth dyad recruitment for research studies.

Provider empathy is a crucial component in establishing therapeutic provider-patient relationships. The benefits of increased perceptions of empathy can support patient psychological adjustment to their cancer as well as patients' comfort and confidence in disclosing to providers, ultimately promoting patient engagement. Guided by the disclosure decision-making model, this manuscript explores how perceptions of empathy influence patient psychological adjustment and how those variables influence patient disclosure efficacy. The model ultimately predicts patient sharing and withholding of information during the medical interaction. This study tested a mediation model to investigate how current (n = 111) and former (n = 174) breast cancer patients' psychological adjustment mediates the relationship between patient perceptions of oncologist empathic communication and efficacy to disclose health information to their oncologist and their disclosure enactment in sharing and withholding. Overall, former patients compared to current patients had more positive perceptions of their oncologist's empathic communication, had better psychological adjustment, felt more self-efficacy to disclose to their oncologist, and shared more and withheld less information from their oncologist (p < .05 in all cases). Structural equation modeling revealed good fit to the data for both current and former patients such that more perceived empathic communication was associated with more efficacy for disclosure, which was associated with more sharing and less withholding. Additionally, there was an indirect relationship from perceptions of empathic communication to disclosure efficacy through patients' psychological adjustment to the diagnosis. Results reinforce the importance of providers' empathic communication for cancer patients' psychological adjustment because patient sharing and withholding of information remain crucially important to achieving holistic care across the cancer trajectory.

BackgroundHypertension affects one-third of adults in the United States and is the leading risk factor for death. Underserved populations are seen disproportionately in the emergency department (ED) and tend to have worse blood pressure (BP) control. For adults, a lack of hypertension knowledge is a common barrier to hypertension control, while social support is a strong facilitator, and providing information that is culturally sensitive and relevant is especially important in this context. The youth experience increased confidence when given the responsibility to provide health education and care navigation to others. As such, we planned a randomized controlled trial (RCT) for the effectiveness of a digital youth-led hypertension education intervention for adult patients in the ED with hypertension, focusing on change in BP and hypertension knowledge. ObjectiveIn preparation for an RCT, we conducted a formative study to determine acceptable and easily comprehensible ways to present hypertension information to adults with hypertension and optimal ways to engage youth to support adults on how to achieve better hypertension control. MethodsAfter creating an intervention prototype with 6 weekly self-guided hypertension online modules, we recruited 12 youth (adolescents, aged 15-18 years) for 3 focus groups and 10 adult ED patients with hypertension for individual online interviews to garner feedback on the prototype. After completing a brief questionnaire, participants were asked about experiences with hypertension, preferences for a hypertension education intervention, and acceptability, feasibility, obstacles, and solutions for intervention implementation with youth and adults. The moderator described and showed participants the prototyped intervention process and materials and asked for feedback. Questionnaire data were descriptively summarized, and qualitative data were analyzed using the template organizing style of analysis by 3 study team members. ResultsParticipants showed great interest in the intervention prototype, thought their peers would find it acceptable, and appreciated its involvement of youth. Youth with family members with hypertension reported that their family members need more support for their hypertension. Youth suggested adding more nutrition education activities to the intervention, such as a sodium tracker and examples of high-sodium foods. Adults discussed the need for a hypertension support intervention for themselves and the expected benefits to youth. They mentioned the overwhelming amount of hypertension information available and appreciated the intervention’s concise content presentation. They suggested adding more mental health and smoking cessation resources, information about specific hypertension medications, and adding active links for health care information. ConclusionsBased on focus groups and interviews with participants, a youth-led digital hypertension intervention is an acceptable strategy to engage both adults with hypertension and youth. Incorporating participant suggestions into the intervention may improve its clarity, engagement, and impact when used in a subsequent RCT.

BACKGROUND:Rates of melanoma have increased dramatically in the United States over the past 25 years, and it has become among the most prevalent cancers for young adult women. Intentional skin tanning leads to a pattern of intense and intermittent UV radiation exposure that is associated with increased risk of melanoma. Frequent tanning is most common among young women and is linked to a variety of sociocultural pressures that negatively impact body image and drive appearance control behaviors. Unfortunately, there are no established interventions designed for frequent tanners. This intervention addresses this gap with unique content informed by body image and acceptance-based interventions. The intervention is delivered using Facebook secret groups, an approach designed to support behavior change and ensure scalability.OBJECTIVE:This study aims to describe the rationale and methodology of a randomized controlled trial of a melanoma prevention program targeting young women engaged in frequent indoor or outdoor UV tanning.METHODS:Participants are women aged 18-25 years who report high-risk tanning (ie, at least 10 indoor tanning sessions in the past 12 months or 10 outdoor sessions in the previous summer). After recruitment and screening, participants completed a baseline survey and were randomly assigned to receive the intervention or an attention-matched control condition. Both conditions were 8-week-long Facebook groups (approximately 25 members each) with daily posting of content. Follow-up surveys are administered at 3, 8, and 18 months after baseline. The primary trial outcome is the combined number of indoor and outdoor tanning sessions reported at the 8-month follow-up. Hypothesized intervention mediators are assessed at the 3-month follow-up.RESULTS:This project was funded by a National Cancer Institute award (R01 CA218068), and the trial procedures were approved by the University of Kentucky Institutional Review Board in February 2020. Trial recruitment and enrollment occurred in 6 waves of data collection, which started in February 2022 and closed in May 2023. The study is closed to enrollment but remains open for follow-ups, and this protocol report was prepared before data analyses. As of February 2024, all participants have completed the 8-month follow-up assessment, and data collection is scheduled to close by the end of 2024 after the collection of the 18-month follow-up.CONCLUSIONS:This trial will contribute unique knowledge to the field of skin cancer prevention, as no fully powered trials have examined the efficacy of an intervention designed for frequent indoor or outdoor tanning. The trial may also contribute evidence of the value in translating principles of body image and acceptance-based interventions into the field of skin cancer prevention and beyond. If successful, the use of the Facebook platform is intended to aid in dissemination as it provides a way to embed the intervention into individuals' everyday routines.TRIAL REGISTRATION:ClinicalTrials.gov NCT03441321; https://clinicaltrials.gov/study/NCT03441321.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/56562.

OBJECTIVE:Support people of cancer patients are at significant risk for psychological distress. Additionally, cancer patients' well-being is reciprocally associated with support peoples' psychological well-being. Informed by Uncertainty in Illness Theory, this study tests whether support person psychological well-being is influenced by provider communication and uncertainty reduction. METHODS:We tested a multiple mediation model to investigate how empathic communication facilitates psychological adjustment in support people of cancer patients and how this process is mediated by support peoples' illness uncertainty and caregiver burden. Support people of cancer patients (N = 121; including spouses, adult children, etc.) completed an online questionnaire about their perceptions of oncologists' empathy, uncertainty about the cancer patients' illness, perceived caregiving burden, and their psychological adjustment to diagnoses. RESULTS:Path analysis revealed that (1) more perceived oncologist empathy was associated with less illness uncertainty, (2) more illness uncertainty was associated with worse psychological adjustment and more perceived caregiver burden, and (3) more burden was associated with worse adjustment (χ2 (2) = 1.19, p = 0.55; RMSEA < 0.01; CFI = 1.00; SRMR = 0.02). CONCLUSIONS:Given the reciprocal nature of well-being between cancer patients and their support people, it is critical to understand and bolster support people's psychological well-being. Results demonstrated how empathic provider communication can support psychological well-being for support people of cancer patients. Additionally, this study offers theoretical contributions to understandings of illness uncertainty in caregiver populations.

Objectives: This study examined the degree to which breast cancer patients' psychological well-being is facilitated through empathic provider communication. We explored symptom/prognostic uncertainty reduction as a mechanism through which provider communication influences patient psychological adjustment. Additionally, we tested if treatment status moderates this relationship.Methods: Informed by uncertainty in illness theory, current (n = 121) and former (n = 187) breast cancer patients completed questionnaires about perceptions of their oncologists' empathy and their symptom burden, uncer-tainty, and adjustment to their diagnosis. Structural equation modeling (SEM) was conducted to test hypothe-sized relationships between perceived provider empathic communication, uncertainty, symptom burden, and psychological adjustment.Results: SEM supported the following: (1) higher symptom burden was associated with increased uncertainty and reduced psychological adjustment, (2) lower uncertainty was associated with increased adjustment, and (3) increased empathic communication was associated with lower symptom burden and uncertainty for all patients (chi 2(139) = 307.33, p < .001; RMSEA = .063 (CI .053, .072); CFI = .966; SRMR = .057). Treatment status moderated these relationships (Delta chi 2 = 264.07, Delta df = 138, p < .001) such that the strength of the relationship between uncertainty and psychological adjustment was stronger for former patients than for current patients.Conclusions: Results of this study reinforce the importance of perceptions of provider empathic communication as well as the potential benefits of eliciting and addressing patient uncertainty about treatment and prognosis throughout the cancer care continuum.Practice Implications: Patient uncertainty should be a priority for cancer-care providers both throughout and post-treatment for breast cancer patients.

Background: In 2019, the World Health Organization identified vaccine hesitancy as a top ten global health threat, which has been exacerbated by the COVID-19 pandemic. Despite local and nationwide public health efforts, adolescent COVID-19 vaccination uptake in the US remains low. This study explored parents’ perceptions of the COVID-19 vaccine and factors influencing hesitancy to inform future outreach and education campaigns. Methods: We conducted two rounds of individual interviews via Zoom in May–September 2021 and January–February 2022, with parents of adolescents from the Greater Newark Area of New Jersey, a densely populated area with historically marginalized groups that had low COVID-19 vaccination uptake. Data collection and analysis was guided by the Increasing Vaccination Model and WHO Vaccine Hesitancy Matrix. Interview transcripts were double-coded and thematically analyzed in NVivo. Results: We interviewed 22 parents (17 in English, 5 in Spanish). Nearly half (45%) were Black and 41% were Hispanic. Over half (54%) were born outside of the US. Most of the parents described that their adolescents had received at least one dose of a COVID-19 vaccine. All but one parent had received the COVID-19 vaccine. Despite strong vaccination acceptance for themselves, parents remained hesitant about vaccinating their adolescents. They were mostly concerned about the safety and potential side effects due to the novelty of the vaccine. Parents sought information about the vaccines online, through healthcare providers and authorities, and at community spaces. Interpersonal communication exposed parents to misinformation, though some personal connections to severe COVID-19 illness motivated vaccination. Historical mistreatment by the healthcare system and politicization of the vaccine contributed to parents’ mixed feelings about the trustworthiness of those involved with developing, promoting, and distributing COVID-19 vaccines. Conclusions: We identified multilevel influences on COVID-19 vaccine-specific hesitancy among a racially/ethnically diverse sample of parents with adolescents that can inform future vaccination interventions. To increase vaccine confidence, future COVID booster campaigns and other vaccination efforts should disseminate information through trusted healthcare providers in clinical and also utilize community settings by addressing specific safety concerns and promoting vaccine effectiveness.