***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We determined the barriers to and facilitators of  colorectal cancer ( CRC ) screening among two faith-based , inner city neighborhood health centers in Southwestern Pennsylvania . Data from a r and om sample of patients 50 years and older ( n=375 ) were used to estimate logistic regression equations to compare and contrast the predictors of four different CRC screening protocol s : ( 1 ) fecal occult blood test ( FOBT ) ≤ 2 years ago , ( 2 ) colonoscopy ≤ 10 years ago , ( 3 ) lower endoscopy ( colonoscopy or sigmoidoscopy ) ≤ 10 years ago , and ( 4 ) any of these screening measures . Racial differences ( between African Americans or Caucasians ) in type of colon cancer screening were not found . Controlling for covariates , logistic regression equations showed that a physician ’s support of colon cancer screening  was positively associated with the receipt of colonoscopy  ( OR : 19.47 , 95 CI : 5.45–69.54 ) , lower endoscopy ( OR : 10.96 , 95 CI : 3.77–31.88 ) and any colon cancer screening ( OR : 10.12 , 95 CI : 3.36–30.46 ) . Patients who see their physicians more frequently were also more likely to be screened for CRC . Unlike other studies , the faith-based environment in which these patients are treated may explain the lack of racial disparity specific to our measures of CRC screening Little is known about how minority groups react to public information that highlights racial disparities in cancer . This double-blind r and omized study compared emotional and behavioral reactions to four versions of the same colon cancer ( CRC ) information presented in mock news articles to a community sample of African-American adults ( n = 300 ) . Participants read one of four articles that varied in their framing and interpretation of race-specific CRC mortality data , emphasizing impact ( CRC is an important problem for African-Americans ) , two dimensions of disparity ( Blacks are doing worse than Whites and Blacks are improving , but less than Whites ) , or progress ( Blacks are improving over time ) . Participants exposed to disparity articles reported more negative emotional reactions to the information and were less likely to want to be screened for CRC than those in other groups ( both P < 0.001 ) . In contrast , progress articles elicited more positive emotional reactions and participants were more likely to want to be screened . Moreover , negative emotional reaction seemed to mediate the influence of message type on individuals wanting to be screened for CRC . Overall , these results suggest that the way in which disparity research is reported in the medium can influence public attitudes and intentions , with reports about progress yielding a more positive effect on intention . This seems especially important among those with high levels of medical mistrust who are least likely to use the health care system and are thus the primary target of health promotion advertising . ( Cancer Epidemiol Biomarkers Prev 2008;17(11):2946–53 Low-income minorities often face system-based and personal barriers to screening colonoscopy ( SC ) . Culturally targeted patient navigation ( CTPN ) programs employing professional navigators ( Pro-PNs ) or community-based peer navigators ( Peer-PNs ) can help overcome barriers but are not widely implemented . In East Harlem , NY , USA , where approximately half the residents participate in SC , 315 African American patients referred for SC at a primary care clinic with a Direct Endoscopic Referral System were recruited between May 2008 and May 2010 . After medical clearance , 240 were r and omized to receive CTPN  delivered by a Pro-PN ( n = 106 ) or Peer-PN ( n = 134 ) . Successful navigation was measured by SC adherence rate , patient satisfaction and navigator trust . Study enrollment was 91.4 % with no significant differences in SC adherence rates between Pro-PN ( 80.0 % ) and Peer-PN ( 71.3 % ) ( P = 0.178 ) . Participants in both groups reported high levels of satisfaction and trust . These findings suggest that CTPN Pro-PN and Peer-PN programs are effective in this urban primary care setting . We detail how we recruited and trained navigators , how CTPN was implemented and provide a preliminary answer to our questions of the study aims : can peer navigators be as effective as professionals and what is the potential impact of patient navigation on screening adherence Purpose . Identify the influence of medical mistrust , fears , attitudes , and sociodemographic characteristics on unwillingness to participate in colorectal cancer ( CRC ) screening .  Design . Cross-sectional , disproportionally allocated , stratified , r and  om-digit-dial telephone question naire of noninstitutionalized households . Setting . New York City , New York ; Baltimore , Maryl and ; San Juan , Puerto Rico . Subjects . Ethnically diverse sample of 454 adults ≥50 years of age . Measures . Health status , cancer screening effectiveness , psychosocial factors ( e.g. , perceptions of pain , fear , trust ) , and CRC screening intentions using the Cancer Screening Question naire , which addresses a range of issues related to willingness of minorities to participate in cancer screening . Analysis . Multivariate logistic regression was used to model the probability of reporting unwillingness to participate in CRC screening . Results . Fear of embarrassment during screening ( odds ratio [ OR ] = 10.72 ; 95 % confidence interval [ CI ] , 2.15–53.39 ) , fear of getting AIDS ( OR = 8.75 ; 95 % CI , 2.48–30.86 ) , fear that exam might be painful ( OR = 3.43 ; 95 % CI , 1.03–11.35 ) , and older age ( OR = 1.10 ; 95 % CI , 1.04–1.17 ) were positively associated with unwillingness to participate in CRC screening .  Fear of developing cancer ( OR = .12 ; 95 % CI , .03–.57 ) and medical mistrust ( OR = .19 ; 95 % CI , .06–.60 ) were negatively associated with unwillingness to screen . Conclusions . Findings suggest that CRC health initiatives should focus on increasing knowledge , addressing fears and mistrust , and normalizing CRC screening as a beneficial preventive practice , and should increase focus on older adults BACKGROUND Fecal occult blood testing ( FOBT ) can reduce colorectal cancer ( CRC ) mortality . Unfortunately , CRC screening is underutilized . Sociocultural mediators of FOBT adherence have not been extensively studied in lower income , minority population s. This study prospect ively studied FOBT return in a low-income , multiethnic population . METHODS Participants ( N = 298 ) , aged > or = 40 years , were surveyed and given FOBT kits with instructions . Those not returning kits within 30 days received a reminder telephone call . Bivariate and multivariate analyses assessed predictors of FOBT card return at 90 days . RESULTS Participants ( median age = 48 ) were predominately African American ( 69 % ) , without private insurance ( 88 % ) , and of low income . The largest group of participants preferred FOBT alone  ( 46 % ) , followed by whatever my doctor recommends ( 19 % ) , endoscopy + annual FOBT ( 16 % ) , endoscopy alone ( 14 % ) , and no screening ( 5 % ) . In multivariate analyses , FOBT return was predicted by age ( OR = 1.05 ) and lack of reported FOBT barriers ( OR = 3.81 ) . Among those > or = 50 and not up-to- date with screening ,  FOBT return  was predicted by cancer fatalism ( OR = 0.83 ) . FOBT barriers  were associated with age ( OR = 0.96 ) , less than high school education ( OR = 2.05 ) , and less physician trust ( OR = 2.12 ) . Endoscopy barriers were associated with age ( OR = 0.93 ) , less physician trust ( OR = 1.95 ) , and female gender ( OR = 3.45 ) . CONCLUSIONS Younger individuals and those with less education , less trust in health care providers , and more fatalistic beliefs are at risk for CRC screening non-adherence . Strategies addressing common misconceptions should improve CRC screening rates in low-income , multiethnic population OBJECTIVE This study examined the effects ( affective reactions , cognitive reactions and processing , perceived benefits and barriers and intent to screen ) of targeted peripheral+evidential ( PE ) and peripheral+evidential+socio-cultural ( PE+SC ) colorectal cancer communications . METHODS This study was a two-arm r and omized control study of cancer communication effects on affective , cognitive processing , and behavioral outcomes over a 22-week intervention . There were 771 African American participants , 45 - 75 years , participating in the baseline survey related to CRC screening . Three follow-up interviews that assessed intervention effects on affective response to the publications , cognitive processing , and intent to obtain CRC screening were completed . RESULTS There were no statistically significant differences between PE and PE+SC intervention groups for affect , cognitive processing or intent to screen . However , there were significant interactions effects on outcome variables . CONCLUSIONS The advantages and disadvantages of PE+SC targeted cancer communications and implication s of sex differences are considered . PRACTICE IMPLICATION S While there do not appear to be significant differences in behavioral outcomes when using PE and PE+SC strategies , there appear to be subtle differences in affective and cognitive processing outcomes related to medical suspicion and ethnic identity , particularly as it relates to gender PURPOSE We report the validation of an instrument to measure mistrust of health care organizations and examine the relationship between mistrust and health care service underutilization . METHODS We conducted a telephone survey of a r and om sample of households in Baltimore City , MD . We surveyed 401 persons and followed up with 327 persons ( 81.5 percent ) 3 weeks after the baseline interview . We conducted tests of the validity and reliability of the  Medical Mistrust Index ( MMI )  and then conducted multivariate modeling to examine the relationship between mistrust and five measures of underutilization of health services . RESULTS Using principle components analysis , we reduced the 17-item MMI to 7 items with a single dimension . Test-retest reliability was moderately strong , ranging from Pearson correlation of 0.346 - 0.697 . In multivariate modeling , the MMI was predictive of four of five measures of underutilization of health services : failure to take medical advice ( b=1.56 , p<.01 ) , failure to keep a follow-up appointment ( b=1.11 , p=.01 ) , postponing receiving needed care ( b=0.939 , p=.01 ) , and failure to fill a prescription ( b=1.48 , p=.002 ) . MMI was not significantly associated with failure to get needed medical care ( b=0.815 , p=.06 ) . CONCLUSIONS The MMI is a robust predictor of underutilization of health services . Greater attention should be devoted to building greater trust among patients BACKGROUND Colorectal cancer ( CRC ) screening is effective but underutilized . Although physician recommendation is an important predictor of screening , considerable variation in CRC screening completion remains . PURPOSE To characterize the influence of patient trust in care providers on CRC screening behavior . METHODS Data were collected as part of a cluster-r and omized CRC screening intervention trial performed in the San Francisco Community Health Network from March 2007 to January 2012 ( analysis , Spring 2012 ) . All study participants received a recommendation to complete CRC screening from their primary care provider ( PCP ) .  Included participants were aged 50 - 79 years , not current with screening , and completed the Wake Forest Trust Scale ( WFTS ) measuring trust in PCPs and doctors in general . Primary outcome was  CRC screening completion ( colonoscopy or fecal occult blood testing ) within 12 months following enrollment . Multivariable association adjusted for race/ethnicity , language , and other sociodemographics was estimated using generalized estimating equations with logit link and binomial distribution . RESULTS WFTS response was 70.3 % ( 701 ) . Most participants ( 83 % ) were Latino , Asian , or black . Most had income < $ 30,000 ( 96 % ) and public health insurance ( 86 % ) . Higher trust in PCP was associated with screening completion ( OR=1.11 , 95 % CI=1.03 , 1.17 ) , but trust in doctors was not ( OR=1.02 , 95 % CI=0.82 , 1.28 ) . Race , language , and other sociodemographic factors were not significant in multivariable analysis . CONCLUSIONS After controlling for traditional factors , trust in PCP remained the only significant driver of CRC  screening  completion in low-income patients . Interventions to promote CRC screening may be improved by including efforts to enhance patient trust in PCP 
    Output:
    
Quantitative differences in mistrust and CRC screening by gender were mixed , but qualitative studies highlighted fear of experimentation and intrusiveness of screening methods as unique themes among African American men .