Purpose of Review Despite cervical cancer (CC) being a cancer that can be eliminated, CC disparities persist such that minoritized populations shoulder a disproportionate mortality burden. This may reflect upstream, fundamental drivers of health that impede equitable access to prevention, screening, early detection, and treatment among some groups. This systematic review summarizes evidence on the relationships between structural racism and CC care across the continuum. Recent Findings Following PRISMA guidelines, we conducted a comprehensive search for peer-reviewed, English-language studies relevant to our research question that were published from 2012–2022 using PubMed, CINAHL, Web of Science, and Embase. Of 8,924 articles identified, 4,383 duplicates were removed, and 4,541 underwent screening, with 206 articles meeting eligibility criteria for inclusion in our data synthesis. Among reviewed studies, 60.2% (n = 124) compared CC outcomes by race and ethnicity, often as proxies for upstream racism. Key findings included evidence of lower CC screening rates among Asian American and Pacific Islander women and higher rates among Black and Hispanic/Latinx women. Barriers to healthcare access and socioeconomic status (SES) factors contributed to delayed follow-up, later-stage CC diagnoses, and poorer outcomes, particularly for Black and Hispanic/Latinx women and those residing in low-SES neighborhoods. Summary This review underscores associations between race, ethnicity, SES, and outcomes across the CC continuum. Most studies examined racial and ethnic disparities in the outcomes of interest rather than directly evaluating measures of structural racism. Future research should refine measures of structural racism to deepen our understanding of its impact on CC across the care continuum.

Background: Although melanoma survival rates have improved in recent years, survivors remain at risk of recurrence, second primary cancers, and keratinocyte carcinomas. The National Comprehensive Cancer Network recommends skin examinations by a physician every 3 to 12 months. Regular thorough skin self-examinations (SSEs) are recommended for survivors of melanoma to promote the detection of earlier-stage, thinner melanomas, which are associated with improved survival and lower treatment costs. Despite their importance, less than a quarter of survivors of melanoma engage in SSEs. Objective: Previously, our team developed and evaluated a web-based, fully automated intervention called mySmartSkin (MSS) that successfully improved SSE among survivors of melanoma. Enhancements were proposed to improve engagement with and outcomes of MSS. The purpose of this paper is to describe the rationale and methodology for a type-1 hybrid effectiveness-implementation randomized trial evaluating the enhanced MSS versus control and exploring implementation outcomes and contextual factors. Methods: This study will recruit from state cancer registries and social media 300 individuals diagnosed with cutaneous malignant melanoma between 3 months and 5 years after surgery who are currently cancer free. Participants will be randomly assigned to either enhanced MSS or a noninteractive educational web page. Surveys will be collected from both arms at baseline and at 3, 6, 12, and 18 months to assess measures of intervention engagement, barriers, self-efficacy, habit, and SSE. The primary outcome is thorough SSE. The secondary outcomes are the diagnosis of new or recurrent melanomas and sun protection practices. Results: Multilevel modeling will be used to examine whether there are significant differences in survivor outcomes between MSS and the noninteractive web page over time. Mixed methods will evaluate reach, adoption, implementation (including costs), and potential for maintenance of MSS, as well as contextual factors relevant to those outcomes and future scale-up. Conclusions: This trial has the potential to improve outcomes in survivors of melanoma. If MSS is effective, the results could guide its implementation in oncology care and nonprofit organizations focused on skin cancers. International Registered Report Identifier (IRRID): RR1-10.2196/52689

Despite widespread use of hair products globally, little is known about the prevalence and patterns of use in populations outside the United States. As some hair products contain endocrine-disrupting chemicals (EDCs) and EDCs have been linked to breast cancer, which is increasing globally, in this study, we addressed key knowledge gaps about hair product use and practices, and perceptions of use among women in two counties in Kenya. Using community-engaged approaches in Embu and Nakuru, Kenya, we recruited women aged 15–50 years to complete a questionnaire that ascertained hair product use in the last 7–14 days, ever using hair dyes and chemical relaxers, and participants’ perceptions or harm around hair product use. In multivariable-adjusted regression models, we evaluated associations between participants’ sociodemographic characteristics and perceptions of hair product use in relation to if they have ever used hair dyes and relaxers. In our sample of 746 women (mean age, 30.4 ± 8.1 years), approximately one-third of participants reported ever using permanent and/or semi-permanent hair dyes, with approximately one-fifth reporting current use. Almost 60% reported ever using chemical relaxers, with a little over one-third reporting current use. Increasing age and having an occupation in the sales and service industry were statistically significant predictors of hair dye use (OR 1.04, 95% CI: 1.02–1.06 and OR 2.05, 95% CI: 1.38–3.03, respectively) and relaxer use (OR 1.03, 95% CI: 1.01–1.06 and OR 1.93, 95% CI: 1.30–2.87). On average, participants reported moderate-to-high levels of concern about exposures and general health effects from using hair products, and relatively high levels of perceived risk of breast cancer related to hair product use. However, in contrast to our hypotheses, we observed mixed evidence regarding whether higher levels of perceived risk were associated with lower odds of ever using hair dyes and relaxers. These findings add new knowledge to the extant literature on hair product use among women in Kenya, where breast cancer incidence rates are increasing. Improving the understanding of patterns of use of specific products and their chemical ingredients—which may be hormone disruptors or carcinogens—and exploring the role of environmental health literacy are critical for developing interventions to reduce potentially harmful exposures found in these products.

Background: Middle childhood (ages 8-12 years) is a critical period for forming behavioral habits and reducing the risk for the development of skin cancer later in life. During this time, children develop more autonomy and spend more unsupervised time away from their parents. Professional agencies recommend that all children engage in regular sun protection behaviors and avoid the sun during peak daytime hours. Unfortunately, in middle childhood, child sun protection often declines and UV radiation exposure increases. Effective parenting involves balancing ways to encourage the child’s increasing independence while providing practical assistance to ensure sun protection is implemented. Objective: The goal was to evaluate the feasibility, acceptability, and preliminary effects of Sun Safe Families, a Facebook group intervention for parents of children between 8 and 12 years of age. Methods: The team developed Facebook messages targeting parent knowledge, normative influences, sun safety barriers, planning and goal setting, confidence in implementing sun safety, communication, forming habits, and managing sun safety in risky situations. A total of 92 parents were enrolled, and the groups ran for 6 weeks. Feasibility was measured by enrollment and retention rates. Acceptability was measured by engagement in the Facebook groups. Satisfaction was assessed by a treatment evaluation. At pre- and post-intervention, parents completed measures of child sun protection, UV radiation exposure, sunburn, sun safety knowledge, child risk, barriers, sun protection self-efficacy, planning, sun safe habits, norms for child sun safety, and communication about sun safety. Results: Enrollment (64.3%, 92/143) and retention (94.6%, 87/92) were good. On average, participants viewed 67.6% (56.8/84) of posts, “liked” 16.4% (13.77/84) of posts, commented on 14.8% (12.43/84) of posts, and voted on 46% (6.4/14) of polls. Satisfaction was excellent. From pre- to post-intervention, there were significant increases in child sun protection, sun exposure, and sunburn (P<.01; moderate effect sizes), as well as statistically significant increases in planning and self-efficacy (P<.05) and family norms and parent communication (P<.01). Conclusions: This study demonstrated high survey retention, acceptability, and satisfaction with the intervention. There were promising preliminary effects on child sun protection behaviors and parent sun protection attitudes and communication with their child. Replication with a larger sample size and a comparison condition is warranted.

Breast cancer (BC) is the leading cancer among women, with rising incidence in sub-Saharan Africa. Personal care products (PCPs), including hair products, contain endocrine-disrupting chemicals and carcinogens implicated in BC risk, yet evidence is largely from Western populations. We examined perceived BC risk and its association with hair product use among women in Embu and Nakuru Counties, Kenya. A cross-sectional survey of 744 women aged 15–50 years conducted in May–July 2023 assessed perceived BC risk related to hair product use. Latent class analysis (LCA) identified risk profiles, and multivariable logistic regression examined associations between risk class and PCP use in the prior 7–14 days. LCA identified three risk classes: no/low (11.0%), high (42.7%), and very high (46.2%). Classes differed in concern, behavioral intentions, and information-seeking about hair product ingredients, with the very high-risk class reporting the greatest concern and intention to change practices. However, perceived risk was not associated with lower hair product use after correction for multiple comparisons. Perceived BC risk was associated with greater concern and intention to change hair product practices, but not lower product use. Culturally responsive interventions are needed to translate risk awareness into behavior change and safer PCP use.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Middle childhood (ages 8-12 years) is a critical period for forming behavioral habits and reducing the risk for the development of skin cancer later in life. During this time, children develop more autonomy and spend more unsupervised time away from their parents. Professional agencies recommend that all children engage in regular sun protection behaviors and avoid the sun during peak daytime hours. Unfortunately, in middle childhood, child sun protection often declines and UV radiation exposure increases. Effective parenting involves balancing ways to encourage the child’s increasing independence while providing practical assistance to ensure sun protection is implemented. Objective: The goal was to evaluate the feasibility, acceptability, and preliminary effects of Sun Safe Families, a Facebook group intervention for parents of children between 8 and 12 years of age. Methods: The team developed Facebook messages targeting parent knowledge, normative influences, sun safety barriers, planning and goal setting, confidence in implementing sun safety, communication, forming habits, and managing sun safety in risky situations. A total of 92 parents were enrolled, and the groups ran for 6 weeks. Feasibility was measured by enrollment and retention rates. Acceptability was measured by engagement in the Facebook groups. Satisfaction was assessed by a treatment evaluation. At pre- and post-intervention, parents completed measures of child sun protection, UV radiation exposure, sunburn, sun safety knowledge, child risk, barriers, sun protection self-efficacy, planning, sun safe habits, norms for child sun safety, and communication about sun safety. Results: Enrollment (64.3%, 92/143) and retention (94.6%, 87/92) were good. On average, participants viewed 67.6% (56.8/84) of posts, “liked” 16.4% (13.77/84) of posts, commented on 14.8% (12.43/84) of posts, and voted on 46% (6.4/14) of polls. Satisfaction was excellent. From pre- to post-intervention, there were significant increases in child sun protection, sun exposure, and sunburn (P<.01; moderate effect sizes), as well as statistically significant increases in planning and self-efficacy (P<.05) and family norms and parent communication (P<.01). Conclusions: This study demonstrated high survey retention, acceptability, and satisfaction with the intervention. There were promising preliminary effects on child sun protection behaviors and parent sun protection attitudes and communication with their child. Replication with a larger sample size and a comparison condition is warranted.