Guam Communications Network

Pap tests remain an essential cervical cancer detection method in the United States, yet they are underutilized among Pacific Islanders (PI) who experience elevated cervical cancer incidence and mortality. This study describes the design, methods, participants, and outcomes of a multiyear (2010-2016), community-based randomized intervention trial in southern California. Based upon strong collectivistic norms, the trial tested the efficacy of a unique social support intervention targeting Chamorro, Samoan, and Tongan women and their male husbands/partners. A single-session educational intervention was designed and tailored for ethnic- and gender-specific groups to increase men's social support for their female wives/partners to receive a Pap test, and for women to receive a Pap test. The comparison group received preexisting brochures on Pap testing (for women) or general men's health (for men). Pretest and 6-month follow-up data were analyzed. Intervention and comparison groups were mostly equivalent on pretest demographics and outcome variables. Intervention women who were not compliant with Pap screening recommendations at pretest were significantly more likely to have scheduled and received a Pap test at 6-month follow-up. However, 6-month follow-up results indicated no intervention effect on changes in women's Pap testing knowledge, fatalistic attitudes, or perceived social support from their male partner. Ethnic- and gender-tailored community interventions can successfully increase Pap test behaviors for PI women, although more research is needed on the specific pathways leading to behavior change. Collaborative community-based interventions lead to increases in women's cancer prevention and early detection for Pacific Islander and other collectivistic communities.

Pacific Islanders experience high rates of cervical cancer incidence and mortality. This cross-sectional study examined the extent to which Samoan, Chamorro, and Tongan women's perceived receipt of social support from their husbands or male partners was associated with rates of routine cancer screening- specifically Pap testing. A total of 585 Pacific Islander women who live in the United States completed a self-report survey. Women who reported having a Pap test within the past 3 years had significantly higher scores on support from their husbands/male partners. Furthermore, the relationship of emotional support and informational support with increased Pap testing was significantly stronger for Tongan women. The findings suggest that men play an important role in promoting women's cancer prevention behaviors in Pacific Islander and potentially other collectivistic populations. Incorporating social support messages into interventions may be a simple yet effective strategy to increase women's Pap testing.

Abstract Background: Pacific Islanders (PIs) experience high cancer health disparities, including later stage of cervical cancer diagnosis due in large part to more than 10% lower Pap screening rates compared to non-Hispanic Whites. The aim of this community-based participatory research (CBPR) randomized control intervention is to increase rates of Pap testing among PI women residing in Southern California. Baseline data examined whether a Multi-Attribute Utility (MAU) model (a descriptive behavioral decision-making model) and women's perceived receipt of social support from their husband/partner significantly predicted Pap testing within the past three years. We also examined whether social support mediated the relationship between utility and Pap testing. Procedures: PI couples were recruited from Samoan, Tongan, and Chamorro churches and cultural social networks, and were randomly assigned to one of two educational interventions regarding cervical cancer screening. Participating women had to be between 21 and 65 years old and married or in a long-term relationship. A baseline questionnaire assessed women's MAU decision-making parameters (subjective value, subjective likelihood, and momentary salience) for eight anticipated consequences of getting a Pap test. Items also assessed female participants' perceived social support (appraisal, emotional, instrumental, and informational) from their husband/partner, and Pap testing behaviors. Results: Only half of the participants (49.9%) had received a Pap test within the past three years. A logistic regression model indicated that the total MAU score (which is the sum of the products of perceived subjective value, perceived subjective likelihood, and momentary salience across the eight parameters) was associated with higher rates of Pap testing (AOR= 1.10, p< 0.01). Four additional logistic regression models were run, one for each of the four different social support subscales. Appraisal support (AOR= 1.21, p= 0.000), emotional support (AOR= 1.25, p= 0.000), informational support (AOR= 1.13, p< 0.000), and instrumental support (AOR= 1.19, p= 0.000) were all associated with higher rates of Pap testing. Next, four mediational models were run, one for each of the four social support subscales, with instrumental support significantly mediating the relationship between MAU total scores and Pap testing. Specifically, the mediational model indicated MAU total scores had both a direct relationship with increased Pap testing, as well as an indirect relationship with increased Pap testing through its relationship with increased instrumental support. Conclusions: Results indicate that PI women's Pap testing follows a personal decision, with husband/partner's instrumental support enhancing the decision to receive a Pap test. Provision of such social support is the basis for the present intervention that educates men about the importance of expressing their concern for, and intention to assist with, regular Pap testing among PI women. Citation Format: Sora Park Tanjasiri, Jie Wu Weiss, Michele Mouttapa, Lola Sablan Santos, Jasmine Lacsamana DeGuzman, Vanessa Tuione May, Lourdes Quitugua, Dorothy Vaivao. Role of social support in Pap test decision making among Pacific Islander women. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B67. doi:10.1158/1538-7755.DISP13-B67

We describe ethical issues that emerged during a one-year CBPR study of HIV and human papillomavirus (HPV) vulnerabilities and prevention in two Pacific Islander (PI) communities, and the collaborative solutions to these challenges reached by academic and community partners. In our project case study analysis, we found that ethical tensions were linked mainly to issues of mutual trust and credibility in PI communities; cultural taboos associated with the nexus of religiosity and traditional PI culture; fears of privacy breaches in small, interconnected PI communities; and competing priorities of scientific rigor versus direct community services. Mutual capacity building and linking CBPR practice to PI social protocols are required for effective solutions and progress toward social justice outcomes.