Deborah Helitzer - Academia.edu (original) (raw)
Papers by Deborah Helitzer
BMC Medical Research Methodology, Sep 29, 2020
Background: A very large body of research documents relationships between self-reported Adverse C... more Background: A very large body of research documents relationships between self-reported Adverse Childhood Experiences (srACEs) and adult health outcomes. Despite multiple assessment tools that use the same or similar questions, there is a great deal of inconsistency in the operationalization of self-reported childhood adversity for use as a predictor variable. Alternative conceptual models are rarely used and very limited evidence directly contrasts conceptual models to each other. Also, while a cumulative numeric 'ACE Score' is normative, there are differences in the way it is calculated and used in statistical models. We investigated differences in model fit and performance between the cumulative ACE Score and a 'multiple individual risk' (MIR) model that enters individual ACE events together into prediction models. We also investigated differences that arise from the use of different strategies for coding and calculating the ACE Score. Methods: We merged the 2011-2012 BRFSS data (N = 56,640) and analyzed 3 outcomes. We compared descriptive model fit metrics and used Vuong's test for model selection to arrive at best fit models using the cumulative ACE Score (as both a continuous or categorical variable) and the MIR model, and then statistically compared the best fit models to each other. Results: The multiple individual risk model was a better fit than the categorical ACE Score for the 'lifetime history of depression' outcome. For the outcomes of obesity and cardiac disease, the cumulative risk and multiple individual risks models were of comparable fit, but yield different and complementary inferences. Conclusions: Additional information-rich inferences about ACE-health relationships can be obtained from including a multiple individual risk modeling strategy. Results suggest that investigators working with large srACEs data sources could empirically derive the number of items, as well as the exposure coding strategy, that are a best fit for the outcome under study. A multiple individual risk model could also be considered in addition to the cumulative risk model, potentially in place of estimation of unadjusted ACE-outcome relationships.
Cancer Epidemiology, Biomarkers & Prevention, 2020
Elimination of colorectal cancer disparities is a national priority. Despite the effectiveness of... more Elimination of colorectal cancer disparities is a national priority. Despite the effectiveness of colorectal cancer (CRC) screening tests for average risk adults, these tests are underutilized by American Indians/Alaska Natives. Subsequently, these populations have experienced either no change or an increase in CRC incidence. Prior to conducting a trial to determine the efficacy of interventions of graded intensity on screening behavior among six tribal communities in the Southwest United States, we set out to develop a culturally appropriate and theoretically grounded brochure to increase community demand for CRC screening. In order to ensure the brochure's health literacy to diverse tribal participants, we utilized the Suitability Assessment of Materials and Comprehensibility of Materials (SAM+CAM) instrument as a basis for structuring this process. Using an iterative process, we conducted two focus groups and made modifications to the brochure. We then implemented the SAM+CAM...
PubMed, Dec 1, 2022
Organizational culture is the shared, often unspoken, basic values, beliefs, and assumptions. Und... more Organizational culture is the shared, often unspoken, basic values, beliefs, and assumptions. Underlying culture influences organizational climate, the observable policies, practices, and procedures that faculty experience. Yet little is known about mentoring culture and climate in higher education. The purpose of this study was to a) conduct a psychometric evaluation of the 4-item Organizational Culture Mentoring Values (OCuM-V) scale and b) determine if organizational culture, operationalized as values related to mentoring, is associated with organizational mentoring climate (OMC) and involvement with mentoring. 298 [55 under-represented minority (URM)] faculty from University of New Mexico and Arizona State University completed a cross-sectional survey, including the OCuM-V scale and the 15-item OMC Availability (OMCA) scale. Items for both scales were rated No (1), Don't know (0), or Yes (1). Faculty reported if they were being mentored or providing mentoring. Exploratory factor analysis (EFA) and Cronbach's alpha were used for scale evaluation. Spearman correlation and logistic regression were used to assess OCuM-V association with climate and mentoring involvement, respectively. Overall, 24% of faculty were being mentored (27% for URM), and 43% were mentoring (38% for URM). OCuM-V items loaded on a single factor in EFA (Cronbach's alpha=0.84 for all; 0.88 for URM). OCuM-V was positively correlated with OMCA (including institutional expectations, mentor-mentee relationships, and resources subscales) for both all and URM faculty (r>0.4 p<.001 for all). Greater OCuM-V was associated with an increased odds of being mentored (OR=1.75±1.19-2.61) and providing mentoring (OR=1.83±1.30-2.58). Mentoring culture is associated with mentoring climate. Faculty who perceive stronger OCuM-V report a stronger OMC (available structure, programs/activities, policies/guidelines) and are being mentored or providing mentoring more often. Limitations include a small sample size for the URM group and cross-sectional data collection. Organizational leaders should explicitly promote values related to mentoring to strengthen both mentoring culture and climate at their institutions.
Journal of community medicine & health education, 2017
Introduction-Large programmatic grants advance the missions of funding agencies or organizations.... more Introduction-Large programmatic grants advance the missions of funding agencies or organizations. This article describes the programmatic impact of using "hierarchical" logic models in two Centers funded by the National Institute of Occupational Safety and Health (NIOSH) that were designed to achieve NIOSH goals. Such models are supportive of priority setting, policy implementation, and effective evaluation. Methods-Two NIOSH Centers, an Agricultural Center and an Occupational Safety and Health Education and Research Center, used the same hierarchical logic model process to support the NIOSH programmatic goal of improving worker health and safety in their respective occupational categories. The logic model development processes were led by the same evaluator. Results-Case studies describe the utilization of "hierarchical" logic models: in each case, NIOSH was the "grandparent", the Center was its descendant (parent) and the cores were the children. This lineage was articulated through the Center-wide logic model and through the logic model of each of its core programmatic areas (core). The Center-wide logic model ensured that the Center's goals, and the intended outcomes and impact of its work were linked to the mission and goals of NIOSH. Each core's logic model articulated how its goals, activities, and outcomes were specifically linked to the Center-wide model. Discussion-A hierarchical logic model process ensures that the objectives of the funding agency or organization are addressed, and enables stakeholders to articulate the linkages between each layer. This facilitates the process of developing, implementing and evaluating programmatic elements within the framework of strategic planning. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PubMed, Dec 1, 2021
Organizational climate is the shared perception of and the meaning attached to the policies, prac... more Organizational climate is the shared perception of and the meaning attached to the policies, practices, and procedures employees experience. University faculty can assess their organizational mentoring climate (OMC) using recently published, reliable, and valid OMC importance (OMCI) and availability (OMCA) scales. Factors affecting the OMC's importance and availability are, however, not known. By studying these factors, organizational leaders can determine whether and how to change the OMC to improve faculty mentoring outcomes. In this cross-sectional study, 300 faculty from the University of New Mexico (Main, Health Sciences Center [HSC] and branch campuses) and Arizona State University (a non-HSC campus) completed the online OMCI and OMCA scales, each with three subscales: Organizational Expectations, Mentor-Mentee Relationships, and Resources. OMCI scale items were rated from very unimportant (1) to very important (5); and, for OMCA, -1 (no), 0 (don't know), 1 (yes). The study used linear regression analysis after normalizing the scales to M=0 and SD=1. Although not explicitly targeted for recruitment, the respondents were predominantly women, non-Hispanic White, senior, tenure-track faculty members who were neither providing mentoring nor receiving mentoring. In the multivariable models, women faculty attached greater importance to mentoring climate components than men. HSC faculty and those receiving mentoring reported greater availability of mentoring climate components than their respective counterparts. Underrepresented minority (URM) faculty did not rate OMCI or OMCA differently than non-URM faculty. Faculty subgroups in this study attached varying levels of importance to the OMC and rated the availability of climate components differently. Factors impacting the importance of the OMC differed from those affecting the perceived availability of the climate components. Based on their relative importance and lack of availability, organizational leaders should create, modify and implement structures, programs, and policies to improve organizational mentoring expectations, mentor-mentee relationships, and mentoring resources, thereby strengthening their OMC.
PubMed, Dec 1, 2022
Many mentor training interventions in higher education focus on improving interactions between me... more Many mentor training interventions in higher education focus on improving interactions between mentors and mentees. Existing measures of interactions are based on reported perceptions of the mentor or mentee. However, there are currently no objective assessments of the mentor's behavioral skill. The purpose of this study was to develop a Mentor Behavioral Interaction (MBI) Rubric as a measure of a mentor's behavioral skill during single-episode interactions with a mentee. Subsequently, the content validity was assessed. The six items (Part 1), evaluated by five mentoring experts as quantifiable behaviors in any mentor-mentee interaction, were based on the Mentoring Competency Assessment (Fleming et al., 2013). The experts developed scoring criteria (highest, middle, and lowest performance) for each item, and created another eleven items (Part 2) to characterize the content (yes/no) of the interaction. Seven content experts rated the items and scoring criteria using a scale ranging from very (4) to not relevant (1) (Lynn, 1986). Five of the six Part 1 items and scoring criteria, and nine of the eleven Part 2 items had item content validity indices (I-CVI) ≥ 0.86. The Part 1 "motivates" item and scoring, and the Part 2 "personal/professional preferences" item were revised based on expert recommendations. One Part 2 item was deleted. Average scale content validity indices (S-CVI/Ave) were ≥ 0.90. The MBI Rubric is the first measure developed to assess single episodes of videoed mentor-mentee interactions. The Rubric may be used with other measures to assess the effectiveness of mentor training. Limitations include: evaluation of the mentor's behavior without accounting for the mentee's behavior; inability to infer cognitive processes; and focus on the quality of one interaction, rather than the effectiveness of the relationship over time. Future work will assess inter-rater reliability, sensitivity to change, and construct validity for the Rubric.
World Journal of Cardiovascular Diseases, 2017
Cardiovascular disease is the leading cause of death in the Westernized world. The costs in produ... more Cardiovascular disease is the leading cause of death in the Westernized world. The costs in productive lives lost to individuals, families, and society are staggering. The epidemiology, pathogenesis, and preventative treatment are all clearly described. Why then, has this epidemic not been eradicated? One reason is the uncertainty about the primary cause of atherosclerotic cardiovascular disease. Low density lipoprotein (LDL) is a circulating lipid particle that deposits cholesterol into the arterial wall which subsequently evolves into an atherosclerotic plaque and a life-threatening arterial thrombosis. The reason that LDL is not universally accepted as the cause of atherosclerosis is that there are no randomized controlled trials (RCT's) providing this evidence. For ethical, financial, and scientific reasons, an RCT of sufficient duration to prove or disprove this hypothesis may never be initiated. We propose a unique approach to support the critical role of LDL in the pathogenesis of cardiovascular disease. Employing criteria based on those proposed by Sir Austin Bradford Hill, we describe the large body of scientific evidence supporting LDL as the primary cause of atherosclerosis. Sir Austin Bradford Hill was a British epidemiologist/statistician who lived in the 20 th century. He acknowledged that the cause of a disease could not always be established by a randomized clinical trial. Therefore, he outlined nine criteria (now known as the Bradford-Hill criteria) that should be met if an etiological factor was likely the cause of a disease. The data in this manuscript are organized according to these nine criteria. These data strongly suggest that LDL is the primary cause of atherosclerotic cardiovascular disease and that sufficient LDL reduction (i.e., to <70 mg/dl) (<1.
Journal of clinical and translational science, Sep 22, 2020
Introduction: Although organizational climate may affect faculty's mentoring behaviors, there has... more Introduction: Although organizational climate may affect faculty's mentoring behaviors, there has not been any way to measure that climate. The purpose of this study was to test the reliability and validity of two novel scales to measure organizational mentoring climate importance and availability at two public research universities. Methods: We developed 36 content-valid mentoring climate items in four dimensions: Structure, Programs/Activities, Policies/Guidelines, and Values. In total, 355 faculty completed an anonymous, structured, online survey asking about the importance (very important to very unimportant) and availability (no, don't know, yes) of each of the items. We conducted reliability analyses and construct validity testing using exploratory common factor analysis, principal axis factoring, and oblique rotation. Results: The majority of the predominantly female, White non-Hispanic, senior, tenure-track faculty were not currently mentoring another faculty or being mentored. Analyses demonstrated a 15-item solution for both the Organizational Mentoring Climate Importance (OMCI) and the Availability (OMCA) Scales, with three factors each: Organizational Expectations, Mentor-Mentee Relationships, and Resources. Standardized Cronbach alphas ranged from 0.74 to 0.90 for the subscales, and 0.94 (OMCI) and 0.87 (OMCA) for the full scales. Faculty rated all items as somewhat to very important; however, perceived availability was very low ranging from mentor training programs (40%) to guidelines for evaluating mentoring success or managing conflict (2.5%). Conclusions: The scales will allow studying of how organizational climate may affect mentoring behavior and whether climate can be changed to improve faculty mentoring outcomes. We provide recommendations for furthering the science of organizational mentoring climate and culture.
Otjr-occupation Participation and Health, 2002
Changes in the perceived self-images and coping strategies of mothers of children with special ne... more Changes in the perceived self-images and coping strategies of mothers of children with special needs after they participated in a short-term occupational therapy intervention (Project Bien Estar) are discussed. We conducted focus groups to ascertain whether women's coping strategies and views of themselves had changed as a result of participation in the program. The results of this study found that participating in Project Bien Estar enabled participants to share their perceptions of their self-image such as feeling overwhelmed with their daily care routine, being socially isolated, losing their identity, and expecting less from their careers. Participants expressed that participating in the program helped them to feel strong, attractive, resilient, respected, and accepted. After participating in the program, they expressed they had gained coping skills such as increased ability to advocate for themselves and their child, more relaxed expectations about their responsibilities and what is needed to care well for their child, and increased self-care practices.
BMC Medical Ethics, Oct 11, 2016
Background: Returning neuroimaging incidental findings (IF) may create a challenge to research pa... more Background: Returning neuroimaging incidental findings (IF) may create a challenge to research participants' health literacy skills as they must interpret and make appropriate healthcare decisions based on complex radiology jargon. Disclosing IF can therefore present difficulties for participants, research institutions and the healthcare system. The purpose of this study was to identify the extent of the health literacy challenges encountered when returning neuroimaging IF. We report on findings from a retrospective survey and focus group sessions with major stakeholders involved in disclosing IF. Methods: We surveyed participants who had received a radiology report from a research study and conducted focus groups with participants, parents of child participants, Institutional Review Board (IRB) members, investigators and physicians. Qualitative thematic analyses were conducted using standard group-coding procedures and descriptive summaries of health literacy scores and radiology report outcomes are examined. Results: Although participants reported high health literacy skills (m = 87.3 on a scale of 1-100), 67 % did not seek medical care when recommended to do so; and many participants in the focus groups disclosed they could not understand the findings described in their report. Despite their lack of understanding, participants desire to have information about their radiology results, and the investigators feel ethically inclined to return findings. Conclusions: The language in clinically useful radiology reports can create a challenge for participants' health literacy skills and has the potential to negatively impact the healthcare system and investigators conducting imaging research. Radiology reports need accompanying resources that explain findings in lay language, which can help reduce the challenge caused by the need to communicate incidental findings.
Research Square (Research Square), Sep 3, 2020
Background: A very large body of research documents relationships between self-reported Adverse C... more Background: A very large body of research documents relationships between self-reported Adverse Childhood Experiences (srACEs) and adult health outcomes. Despite multiple assessment tools that use the same or similar questions, there is a great deal of inconsistency in the operationalization of selfreported childhood adversity for use as a predictor variable. Alternative conceptual models are rarely used and very limited evidence directly contrasts conceptual models to each other. Also, while a cumulative numeric 'ACE Score' is normative, there are differences in the way it is calculated and used in statistical models. We investigated differences in model t and performance between the cumulative ACE Score and a 'multiple individual risk' (MIR) model that enters individual ACE events together into prediction models. We also investigated differences that arise from the use of different strategies for coding and calculating the ACE Score. Methods: We merged the 2011-2012 BRFSS data (N = 56,640) and analyzed 3 outcomes. We compared descriptive model t metrics and used Vuong's test for model selection to arrive at best t models using the cumulative ACE Score (as both a continuous or categorical variable) and the MIR model, and then statistically compared the best t models to each other. Results: The multiple individual risk model was a better t than the categorical ACE Score for the 'lifetime history of depression' outcome. For the outcomes of obesity and cardiac disease, the cumulative risk and multiple individual risks models were of comparable t, but yield different and complementary inferences. Conclusions: Additional information-rich inferences about ACE-health relationships can be obtained from including a multiple individual risk modeling strategy. Results suggest that investigators working with
Journal of Investigative Medicine, 2006
Background Resilience is a set of coping skills people employ in times of stress. These skills ca... more Background Resilience is a set of coping skills people employ in times of stress. These skills can be acquired or modified through various interventions. Resilience may be a protective factor that mitigates the effects of adverse childhood events (ACE), which are risk factors for adult morbidity and mortality. We developed novel screening tools to elicit resiliency factors, the Comprehensive Resiliency Questionnaire (CRQ) and ACE (ACE Short-Form, ACE-SF). With this study, we will examine differences between and relationships of resiliency factors and ACE in two populations and validate the CRQ and the ACE-SF. Methods We delivered the CRQ and ACE-SF to 167 subjects. The CRQ covers 3 constructs: external support systems during childhood, current external support systems and attitudes and personal strengths. The ACE-SF has questions about the occurrence of environmental stressors and abuse during childhood. We recruited subjects from two populations: (1) students and health care professionals at the University of New Mexico School of Medicine and (2) adults seen at clinics for families with environmental risk factors through the Pediatrics Department of UNM Hospital. We performed qualitative interviews with a subset of 22 of these subjects employing the cognitive technique to check the face validity of the CRQ and ACE-SF. Results Population 1 (n = 103) had significantly greater childhood resilience factors than did the clinic patients (n = 43) (means = 46.3 vs 37.9; p < .0001). Similarly, Population 1 showed greater adulthood resilience factors than did Population 2 (means = 114.0 vs 89.5; p < .0001). Population 1 also reported significantly fewer adverse childhood adverse events than did clinic patients (means = 5.4 vs 10.0; p < .0001). The qualitative analysis supported face validity of both questionnaires. Conclusions The CRQ and the ACE-SF have face validity and can discriminate between groups that theoretically are expected to have differential levels of resilience and ACE. Reported resilience factors are negatively related to reported ACE, consistent with the proposition that resilient individuals may interpret adverse events less adversely than nonresilient people do. Our instruments may be employed to guide interventions to increase resiliency factors and therefore reduce risk factors for morbidity and mortality.
Community Mental Health Journal, Feb 17, 2020
Journal of American College Health
Research in Social and Administrative Pharmacy
OBJECTIVE Immunizing pharmacists can administer vaccines; however, they are less likely to admini... more OBJECTIVE Immunizing pharmacists can administer vaccines; however, they are less likely to administer adolescent vaccines such as vaccines that protect against human papillomavirus (HPV). Although past research has recommended incorporating pharmacists to increase adolescent vaccination, few intervention studies have tested healthcare delivery models that incorporate pharmacists to aid in vaccine series completion. This research explored the feasibility and acceptability of an intervention in which pharmacists administered booster doses of the HPV vaccine series. METHODS Between April 2019 and February 2020, the research team recruited participants for a pilot randomized controlled trial hosted in one federally qualified health center (FQHC) clinic. Researchers asked intervention group participants to complete the HPV vaccine series with their community pharmacists and control group participants to complete the series at their FQHC. We conducted a pre- and post-intervention surveys and in-depth interviews with both intervention and control group participants. RESULTS A total of 33 parents of children who received the first dose of the HPV vaccine enrolled in the study of whom 8 intervention and 11 control group participants completed post-intervention data collection. Although there were no statistically significant changes in vaccine completion and in psychometric variables, we did find that pharmacist-delivered HPV vaccination was acceptable, due, primarily, to convenience. Barriers to receiving pharmacist-administered vaccines included pharmacies' lack of stocking the vaccine and insurance-related barriers to care. CONCLUSION Although a promising and acceptable healthcare delivery approach, there are still barriers for caregivers to have their children vaccinated against HPV at their community pharmacies.
abstract: Aims: The aim of this research is to identify factors that would lead to increased util... more abstract: Aims: The aim of this research is to identify factors that would lead to increased utilization of the HPV vaccine among college students. Methods: We conducted 11 focus groups with a total of 28 students, averaging 3 per group. Using an inductive approach, we hand-coded focus group transcripts, developed a coding structure, and discussed themes as they emerged from the data. Results: Although more than half of the students had never heard of the HPV vaccine, students generally held positive views about vaccines. Barriers to receiving the HPV vaccine included lack of awareness and knowledge about the HPV vaccine, as well as lack of perceived need for the vaccine. When asked about the most important information that they needed in order to make an informed decision about whether or not to get the vaccine, participants mentioned the following: 1) prevalence of HPV, 2) HPV-related diseases, 3) what the HPV vaccine protects against, 4) HPV vaccine safety, 5) HPV vaccine efficacy, and 6) how they can access the vaccine. Participants differed in their preferences for types of health education, from an in-person informative lecture, to YouTube videos, to posters placed in dorms or in bathrooms. They preferred the conveyor of this information to be a trustworthy source; they identified healthcare providers, professors/researchers, and other students who have received the vaccine as credible sources. In terms of message appeal, many students described wanting the facts, statistics about HPV prevalence and the vaccine as well as narratives from students who have been diagnosed with HPV and those who have experience receiving the vaccine. Conclusions: Although this cancer prevention resource has been commercially available since 2006, college students still a lack of awareness and perceived need for the HPV vaccine. Future health education efforts should utilize participants’ recommendations to increase students’ understanding of HPV and the HPV vaccine and, therefore, impact their perceived susceptibility to HPV, the benefits of the vaccine to their health, and therefore increase utilization of this resource. Strategies to increase vaccination should include health education and vaccine implementation strategies, as well as strategies to reduce the cost of the vaccine for college students, thereby increasing the accessibility of the vaccine for this population
Journal of Cancer Education, 2019
Human papillomavirus (HPV) vaccination uptake varies by geographic regions with rural, often medi... more Human papillomavirus (HPV) vaccination uptake varies by geographic regions with rural, often medically underserved areas, lagging behind more urban regions in terms of vaccine initiation and completion. In these regions, pharmacies may serve as an additional location for HPV vaccine administration. Little is known about rural caregivers' willingness to have their HPV vaccine age-eligible children obtain this vaccine from their local pharmacist. First and second authors conducted 26 in-depth interviews with caregivers of HPV vaccine age-eligible children living in rural regions of a southwestern state to explore their perceptions of the HPV vaccine and their willingness for pharmacist-administered HPV vaccination. They analyzed interview data using an inductive qualitative content analyses approach. The majority of caregivers were unaware that pharmacists could offer adolescent vaccines. However, most were willing to allow their children to receive the vaccine from this non-traditional source. Comments related to obtaining vaccinations from pharmacists related mostly to concerns about proper training and their certification to vaccinate against HPV. Caregivers believed that having a pharmacist administer the HPV vaccine would not affect their relationship with their primary care provider. Caregivers preferred print health education resources and were interested in also receiving health information via social media to learn more about the HPV vaccine and pharmacists' role in HPV vaccine administration. Pharmacies may serve as an additional site to increase HPV vaccine initiation and completion. Rural regions need additional health information about the HPV vaccine and pharmacists' abilities to administer this cancer prevention resource.
Cancer Causes & Control, 2019
Purpose Immunocompromised populations including people living with HIV (PLWH) suffer disproportio... more Purpose Immunocompromised populations including people living with HIV (PLWH) suffer disproportionate burden from anal cancer, a rare cancer caused by persistent infection of the anal canal with oncogenic strains of human papillomavirus. In the US, there are no nationally adopted screening guidelines for anal cancer. In the absence of such guidelines, this study explores healthcare practitioners' screening practices for early signs of anal cancer among PLWH. Methods Between November 2017 and June 2018, the research team completed 25 interviews among a diverse sample of healthcare practitioners who provide care for PLWH. Results Providers expressed frustration that screening and treatment guidelines for anal cancer were scant, and they varied in their screening practices. The majority of providers screened PLWH for anal dysplasia via the anal Pap smear; few providers were trained and had the medical equipment to conduct high-resolution anoscopy-guided biopsies, a more sensitive and specific screening method. Others screened through digital ano-rectal examinations (DARE) and both visually and with a DARE. Participants discussed how providers may be over-treating their patients who have high-grade anal intraepithelial neoplasia (AIN) and the role of biomarkers to determine whether the lesion is carcinogenic. Conclusions Practitioners who provide care for PLWH are proactive in screening to help prevent and control anal cancer, a rare and slow-growing disease. Continuing to regularly surveil high-risk populations, particularly PLWH previously diagnosed with high-grade lesions, is critical to prevent and control anal cancer. Keywords Anal cancer • Anal intraepithelial neoplasia • Human papillomavirus • Human immunodeficiency virus Anal cancer is rare in the general population. In the United States (US), it is a cancer disparity among people who are immunosuppressed, including people living with HIV (PLWH) [1, 2]. In an analysis of 13 US cohort studies of PLWH, incidence of anal cancer was highest among HIVinfected men who have sex with men (131 per 100,000), followed by HIV-infected heterosexual men (46 per 100,000) and HIV-infected women (30 per 100,000) [2]. Also between the years 1999 and 2005, the incidence of anal cancer has continued increasing, irrespective of HIV status, by 2.1%
BMC Medical Research Methodology, Sep 29, 2020
Background: A very large body of research documents relationships between self-reported Adverse C... more Background: A very large body of research documents relationships between self-reported Adverse Childhood Experiences (srACEs) and adult health outcomes. Despite multiple assessment tools that use the same or similar questions, there is a great deal of inconsistency in the operationalization of self-reported childhood adversity for use as a predictor variable. Alternative conceptual models are rarely used and very limited evidence directly contrasts conceptual models to each other. Also, while a cumulative numeric 'ACE Score' is normative, there are differences in the way it is calculated and used in statistical models. We investigated differences in model fit and performance between the cumulative ACE Score and a 'multiple individual risk' (MIR) model that enters individual ACE events together into prediction models. We also investigated differences that arise from the use of different strategies for coding and calculating the ACE Score. Methods: We merged the 2011-2012 BRFSS data (N = 56,640) and analyzed 3 outcomes. We compared descriptive model fit metrics and used Vuong's test for model selection to arrive at best fit models using the cumulative ACE Score (as both a continuous or categorical variable) and the MIR model, and then statistically compared the best fit models to each other. Results: The multiple individual risk model was a better fit than the categorical ACE Score for the 'lifetime history of depression' outcome. For the outcomes of obesity and cardiac disease, the cumulative risk and multiple individual risks models were of comparable fit, but yield different and complementary inferences. Conclusions: Additional information-rich inferences about ACE-health relationships can be obtained from including a multiple individual risk modeling strategy. Results suggest that investigators working with large srACEs data sources could empirically derive the number of items, as well as the exposure coding strategy, that are a best fit for the outcome under study. A multiple individual risk model could also be considered in addition to the cumulative risk model, potentially in place of estimation of unadjusted ACE-outcome relationships.
Cancer Epidemiology, Biomarkers & Prevention, 2020
Elimination of colorectal cancer disparities is a national priority. Despite the effectiveness of... more Elimination of colorectal cancer disparities is a national priority. Despite the effectiveness of colorectal cancer (CRC) screening tests for average risk adults, these tests are underutilized by American Indians/Alaska Natives. Subsequently, these populations have experienced either no change or an increase in CRC incidence. Prior to conducting a trial to determine the efficacy of interventions of graded intensity on screening behavior among six tribal communities in the Southwest United States, we set out to develop a culturally appropriate and theoretically grounded brochure to increase community demand for CRC screening. In order to ensure the brochure's health literacy to diverse tribal participants, we utilized the Suitability Assessment of Materials and Comprehensibility of Materials (SAM+CAM) instrument as a basis for structuring this process. Using an iterative process, we conducted two focus groups and made modifications to the brochure. We then implemented the SAM+CAM...
PubMed, Dec 1, 2022
Organizational culture is the shared, often unspoken, basic values, beliefs, and assumptions. Und... more Organizational culture is the shared, often unspoken, basic values, beliefs, and assumptions. Underlying culture influences organizational climate, the observable policies, practices, and procedures that faculty experience. Yet little is known about mentoring culture and climate in higher education. The purpose of this study was to a) conduct a psychometric evaluation of the 4-item Organizational Culture Mentoring Values (OCuM-V) scale and b) determine if organizational culture, operationalized as values related to mentoring, is associated with organizational mentoring climate (OMC) and involvement with mentoring. 298 [55 under-represented minority (URM)] faculty from University of New Mexico and Arizona State University completed a cross-sectional survey, including the OCuM-V scale and the 15-item OMC Availability (OMCA) scale. Items for both scales were rated No (1), Don't know (0), or Yes (1). Faculty reported if they were being mentored or providing mentoring. Exploratory factor analysis (EFA) and Cronbach's alpha were used for scale evaluation. Spearman correlation and logistic regression were used to assess OCuM-V association with climate and mentoring involvement, respectively. Overall, 24% of faculty were being mentored (27% for URM), and 43% were mentoring (38% for URM). OCuM-V items loaded on a single factor in EFA (Cronbach's alpha=0.84 for all; 0.88 for URM). OCuM-V was positively correlated with OMCA (including institutional expectations, mentor-mentee relationships, and resources subscales) for both all and URM faculty (r>0.4 p<.001 for all). Greater OCuM-V was associated with an increased odds of being mentored (OR=1.75±1.19-2.61) and providing mentoring (OR=1.83±1.30-2.58). Mentoring culture is associated with mentoring climate. Faculty who perceive stronger OCuM-V report a stronger OMC (available structure, programs/activities, policies/guidelines) and are being mentored or providing mentoring more often. Limitations include a small sample size for the URM group and cross-sectional data collection. Organizational leaders should explicitly promote values related to mentoring to strengthen both mentoring culture and climate at their institutions.
Journal of community medicine & health education, 2017
Introduction-Large programmatic grants advance the missions of funding agencies or organizations.... more Introduction-Large programmatic grants advance the missions of funding agencies or organizations. This article describes the programmatic impact of using "hierarchical" logic models in two Centers funded by the National Institute of Occupational Safety and Health (NIOSH) that were designed to achieve NIOSH goals. Such models are supportive of priority setting, policy implementation, and effective evaluation. Methods-Two NIOSH Centers, an Agricultural Center and an Occupational Safety and Health Education and Research Center, used the same hierarchical logic model process to support the NIOSH programmatic goal of improving worker health and safety in their respective occupational categories. The logic model development processes were led by the same evaluator. Results-Case studies describe the utilization of "hierarchical" logic models: in each case, NIOSH was the "grandparent", the Center was its descendant (parent) and the cores were the children. This lineage was articulated through the Center-wide logic model and through the logic model of each of its core programmatic areas (core). The Center-wide logic model ensured that the Center's goals, and the intended outcomes and impact of its work were linked to the mission and goals of NIOSH. Each core's logic model articulated how its goals, activities, and outcomes were specifically linked to the Center-wide model. Discussion-A hierarchical logic model process ensures that the objectives of the funding agency or organization are addressed, and enables stakeholders to articulate the linkages between each layer. This facilitates the process of developing, implementing and evaluating programmatic elements within the framework of strategic planning. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PubMed, Dec 1, 2021
Organizational climate is the shared perception of and the meaning attached to the policies, prac... more Organizational climate is the shared perception of and the meaning attached to the policies, practices, and procedures employees experience. University faculty can assess their organizational mentoring climate (OMC) using recently published, reliable, and valid OMC importance (OMCI) and availability (OMCA) scales. Factors affecting the OMC's importance and availability are, however, not known. By studying these factors, organizational leaders can determine whether and how to change the OMC to improve faculty mentoring outcomes. In this cross-sectional study, 300 faculty from the University of New Mexico (Main, Health Sciences Center [HSC] and branch campuses) and Arizona State University (a non-HSC campus) completed the online OMCI and OMCA scales, each with three subscales: Organizational Expectations, Mentor-Mentee Relationships, and Resources. OMCI scale items were rated from very unimportant (1) to very important (5); and, for OMCA, -1 (no), 0 (don't know), 1 (yes). The study used linear regression analysis after normalizing the scales to M=0 and SD=1. Although not explicitly targeted for recruitment, the respondents were predominantly women, non-Hispanic White, senior, tenure-track faculty members who were neither providing mentoring nor receiving mentoring. In the multivariable models, women faculty attached greater importance to mentoring climate components than men. HSC faculty and those receiving mentoring reported greater availability of mentoring climate components than their respective counterparts. Underrepresented minority (URM) faculty did not rate OMCI or OMCA differently than non-URM faculty. Faculty subgroups in this study attached varying levels of importance to the OMC and rated the availability of climate components differently. Factors impacting the importance of the OMC differed from those affecting the perceived availability of the climate components. Based on their relative importance and lack of availability, organizational leaders should create, modify and implement structures, programs, and policies to improve organizational mentoring expectations, mentor-mentee relationships, and mentoring resources, thereby strengthening their OMC.
PubMed, Dec 1, 2022
Many mentor training interventions in higher education focus on improving interactions between me... more Many mentor training interventions in higher education focus on improving interactions between mentors and mentees. Existing measures of interactions are based on reported perceptions of the mentor or mentee. However, there are currently no objective assessments of the mentor's behavioral skill. The purpose of this study was to develop a Mentor Behavioral Interaction (MBI) Rubric as a measure of a mentor's behavioral skill during single-episode interactions with a mentee. Subsequently, the content validity was assessed. The six items (Part 1), evaluated by five mentoring experts as quantifiable behaviors in any mentor-mentee interaction, were based on the Mentoring Competency Assessment (Fleming et al., 2013). The experts developed scoring criteria (highest, middle, and lowest performance) for each item, and created another eleven items (Part 2) to characterize the content (yes/no) of the interaction. Seven content experts rated the items and scoring criteria using a scale ranging from very (4) to not relevant (1) (Lynn, 1986). Five of the six Part 1 items and scoring criteria, and nine of the eleven Part 2 items had item content validity indices (I-CVI) ≥ 0.86. The Part 1 "motivates" item and scoring, and the Part 2 "personal/professional preferences" item were revised based on expert recommendations. One Part 2 item was deleted. Average scale content validity indices (S-CVI/Ave) were ≥ 0.90. The MBI Rubric is the first measure developed to assess single episodes of videoed mentor-mentee interactions. The Rubric may be used with other measures to assess the effectiveness of mentor training. Limitations include: evaluation of the mentor's behavior without accounting for the mentee's behavior; inability to infer cognitive processes; and focus on the quality of one interaction, rather than the effectiveness of the relationship over time. Future work will assess inter-rater reliability, sensitivity to change, and construct validity for the Rubric.
World Journal of Cardiovascular Diseases, 2017
Cardiovascular disease is the leading cause of death in the Westernized world. The costs in produ... more Cardiovascular disease is the leading cause of death in the Westernized world. The costs in productive lives lost to individuals, families, and society are staggering. The epidemiology, pathogenesis, and preventative treatment are all clearly described. Why then, has this epidemic not been eradicated? One reason is the uncertainty about the primary cause of atherosclerotic cardiovascular disease. Low density lipoprotein (LDL) is a circulating lipid particle that deposits cholesterol into the arterial wall which subsequently evolves into an atherosclerotic plaque and a life-threatening arterial thrombosis. The reason that LDL is not universally accepted as the cause of atherosclerosis is that there are no randomized controlled trials (RCT's) providing this evidence. For ethical, financial, and scientific reasons, an RCT of sufficient duration to prove or disprove this hypothesis may never be initiated. We propose a unique approach to support the critical role of LDL in the pathogenesis of cardiovascular disease. Employing criteria based on those proposed by Sir Austin Bradford Hill, we describe the large body of scientific evidence supporting LDL as the primary cause of atherosclerosis. Sir Austin Bradford Hill was a British epidemiologist/statistician who lived in the 20 th century. He acknowledged that the cause of a disease could not always be established by a randomized clinical trial. Therefore, he outlined nine criteria (now known as the Bradford-Hill criteria) that should be met if an etiological factor was likely the cause of a disease. The data in this manuscript are organized according to these nine criteria. These data strongly suggest that LDL is the primary cause of atherosclerotic cardiovascular disease and that sufficient LDL reduction (i.e., to <70 mg/dl) (<1.
Journal of clinical and translational science, Sep 22, 2020
Introduction: Although organizational climate may affect faculty's mentoring behaviors, there has... more Introduction: Although organizational climate may affect faculty's mentoring behaviors, there has not been any way to measure that climate. The purpose of this study was to test the reliability and validity of two novel scales to measure organizational mentoring climate importance and availability at two public research universities. Methods: We developed 36 content-valid mentoring climate items in four dimensions: Structure, Programs/Activities, Policies/Guidelines, and Values. In total, 355 faculty completed an anonymous, structured, online survey asking about the importance (very important to very unimportant) and availability (no, don't know, yes) of each of the items. We conducted reliability analyses and construct validity testing using exploratory common factor analysis, principal axis factoring, and oblique rotation. Results: The majority of the predominantly female, White non-Hispanic, senior, tenure-track faculty were not currently mentoring another faculty or being mentored. Analyses demonstrated a 15-item solution for both the Organizational Mentoring Climate Importance (OMCI) and the Availability (OMCA) Scales, with three factors each: Organizational Expectations, Mentor-Mentee Relationships, and Resources. Standardized Cronbach alphas ranged from 0.74 to 0.90 for the subscales, and 0.94 (OMCI) and 0.87 (OMCA) for the full scales. Faculty rated all items as somewhat to very important; however, perceived availability was very low ranging from mentor training programs (40%) to guidelines for evaluating mentoring success or managing conflict (2.5%). Conclusions: The scales will allow studying of how organizational climate may affect mentoring behavior and whether climate can be changed to improve faculty mentoring outcomes. We provide recommendations for furthering the science of organizational mentoring climate and culture.
Otjr-occupation Participation and Health, 2002
Changes in the perceived self-images and coping strategies of mothers of children with special ne... more Changes in the perceived self-images and coping strategies of mothers of children with special needs after they participated in a short-term occupational therapy intervention (Project Bien Estar) are discussed. We conducted focus groups to ascertain whether women's coping strategies and views of themselves had changed as a result of participation in the program. The results of this study found that participating in Project Bien Estar enabled participants to share their perceptions of their self-image such as feeling overwhelmed with their daily care routine, being socially isolated, losing their identity, and expecting less from their careers. Participants expressed that participating in the program helped them to feel strong, attractive, resilient, respected, and accepted. After participating in the program, they expressed they had gained coping skills such as increased ability to advocate for themselves and their child, more relaxed expectations about their responsibilities and what is needed to care well for their child, and increased self-care practices.
BMC Medical Ethics, Oct 11, 2016
Background: Returning neuroimaging incidental findings (IF) may create a challenge to research pa... more Background: Returning neuroimaging incidental findings (IF) may create a challenge to research participants' health literacy skills as they must interpret and make appropriate healthcare decisions based on complex radiology jargon. Disclosing IF can therefore present difficulties for participants, research institutions and the healthcare system. The purpose of this study was to identify the extent of the health literacy challenges encountered when returning neuroimaging IF. We report on findings from a retrospective survey and focus group sessions with major stakeholders involved in disclosing IF. Methods: We surveyed participants who had received a radiology report from a research study and conducted focus groups with participants, parents of child participants, Institutional Review Board (IRB) members, investigators and physicians. Qualitative thematic analyses were conducted using standard group-coding procedures and descriptive summaries of health literacy scores and radiology report outcomes are examined. Results: Although participants reported high health literacy skills (m = 87.3 on a scale of 1-100), 67 % did not seek medical care when recommended to do so; and many participants in the focus groups disclosed they could not understand the findings described in their report. Despite their lack of understanding, participants desire to have information about their radiology results, and the investigators feel ethically inclined to return findings. Conclusions: The language in clinically useful radiology reports can create a challenge for participants' health literacy skills and has the potential to negatively impact the healthcare system and investigators conducting imaging research. Radiology reports need accompanying resources that explain findings in lay language, which can help reduce the challenge caused by the need to communicate incidental findings.
Research Square (Research Square), Sep 3, 2020
Background: A very large body of research documents relationships between self-reported Adverse C... more Background: A very large body of research documents relationships between self-reported Adverse Childhood Experiences (srACEs) and adult health outcomes. Despite multiple assessment tools that use the same or similar questions, there is a great deal of inconsistency in the operationalization of selfreported childhood adversity for use as a predictor variable. Alternative conceptual models are rarely used and very limited evidence directly contrasts conceptual models to each other. Also, while a cumulative numeric 'ACE Score' is normative, there are differences in the way it is calculated and used in statistical models. We investigated differences in model t and performance between the cumulative ACE Score and a 'multiple individual risk' (MIR) model that enters individual ACE events together into prediction models. We also investigated differences that arise from the use of different strategies for coding and calculating the ACE Score. Methods: We merged the 2011-2012 BRFSS data (N = 56,640) and analyzed 3 outcomes. We compared descriptive model t metrics and used Vuong's test for model selection to arrive at best t models using the cumulative ACE Score (as both a continuous or categorical variable) and the MIR model, and then statistically compared the best t models to each other. Results: The multiple individual risk model was a better t than the categorical ACE Score for the 'lifetime history of depression' outcome. For the outcomes of obesity and cardiac disease, the cumulative risk and multiple individual risks models were of comparable t, but yield different and complementary inferences. Conclusions: Additional information-rich inferences about ACE-health relationships can be obtained from including a multiple individual risk modeling strategy. Results suggest that investigators working with
Journal of Investigative Medicine, 2006
Background Resilience is a set of coping skills people employ in times of stress. These skills ca... more Background Resilience is a set of coping skills people employ in times of stress. These skills can be acquired or modified through various interventions. Resilience may be a protective factor that mitigates the effects of adverse childhood events (ACE), which are risk factors for adult morbidity and mortality. We developed novel screening tools to elicit resiliency factors, the Comprehensive Resiliency Questionnaire (CRQ) and ACE (ACE Short-Form, ACE-SF). With this study, we will examine differences between and relationships of resiliency factors and ACE in two populations and validate the CRQ and the ACE-SF. Methods We delivered the CRQ and ACE-SF to 167 subjects. The CRQ covers 3 constructs: external support systems during childhood, current external support systems and attitudes and personal strengths. The ACE-SF has questions about the occurrence of environmental stressors and abuse during childhood. We recruited subjects from two populations: (1) students and health care professionals at the University of New Mexico School of Medicine and (2) adults seen at clinics for families with environmental risk factors through the Pediatrics Department of UNM Hospital. We performed qualitative interviews with a subset of 22 of these subjects employing the cognitive technique to check the face validity of the CRQ and ACE-SF. Results Population 1 (n = 103) had significantly greater childhood resilience factors than did the clinic patients (n = 43) (means = 46.3 vs 37.9; p < .0001). Similarly, Population 1 showed greater adulthood resilience factors than did Population 2 (means = 114.0 vs 89.5; p < .0001). Population 1 also reported significantly fewer adverse childhood adverse events than did clinic patients (means = 5.4 vs 10.0; p < .0001). The qualitative analysis supported face validity of both questionnaires. Conclusions The CRQ and the ACE-SF have face validity and can discriminate between groups that theoretically are expected to have differential levels of resilience and ACE. Reported resilience factors are negatively related to reported ACE, consistent with the proposition that resilient individuals may interpret adverse events less adversely than nonresilient people do. Our instruments may be employed to guide interventions to increase resiliency factors and therefore reduce risk factors for morbidity and mortality.
Community Mental Health Journal, Feb 17, 2020
Journal of American College Health
Research in Social and Administrative Pharmacy
OBJECTIVE Immunizing pharmacists can administer vaccines; however, they are less likely to admini... more OBJECTIVE Immunizing pharmacists can administer vaccines; however, they are less likely to administer adolescent vaccines such as vaccines that protect against human papillomavirus (HPV). Although past research has recommended incorporating pharmacists to increase adolescent vaccination, few intervention studies have tested healthcare delivery models that incorporate pharmacists to aid in vaccine series completion. This research explored the feasibility and acceptability of an intervention in which pharmacists administered booster doses of the HPV vaccine series. METHODS Between April 2019 and February 2020, the research team recruited participants for a pilot randomized controlled trial hosted in one federally qualified health center (FQHC) clinic. Researchers asked intervention group participants to complete the HPV vaccine series with their community pharmacists and control group participants to complete the series at their FQHC. We conducted a pre- and post-intervention surveys and in-depth interviews with both intervention and control group participants. RESULTS A total of 33 parents of children who received the first dose of the HPV vaccine enrolled in the study of whom 8 intervention and 11 control group participants completed post-intervention data collection. Although there were no statistically significant changes in vaccine completion and in psychometric variables, we did find that pharmacist-delivered HPV vaccination was acceptable, due, primarily, to convenience. Barriers to receiving pharmacist-administered vaccines included pharmacies' lack of stocking the vaccine and insurance-related barriers to care. CONCLUSION Although a promising and acceptable healthcare delivery approach, there are still barriers for caregivers to have their children vaccinated against HPV at their community pharmacies.
abstract: Aims: The aim of this research is to identify factors that would lead to increased util... more abstract: Aims: The aim of this research is to identify factors that would lead to increased utilization of the HPV vaccine among college students. Methods: We conducted 11 focus groups with a total of 28 students, averaging 3 per group. Using an inductive approach, we hand-coded focus group transcripts, developed a coding structure, and discussed themes as they emerged from the data. Results: Although more than half of the students had never heard of the HPV vaccine, students generally held positive views about vaccines. Barriers to receiving the HPV vaccine included lack of awareness and knowledge about the HPV vaccine, as well as lack of perceived need for the vaccine. When asked about the most important information that they needed in order to make an informed decision about whether or not to get the vaccine, participants mentioned the following: 1) prevalence of HPV, 2) HPV-related diseases, 3) what the HPV vaccine protects against, 4) HPV vaccine safety, 5) HPV vaccine efficacy, and 6) how they can access the vaccine. Participants differed in their preferences for types of health education, from an in-person informative lecture, to YouTube videos, to posters placed in dorms or in bathrooms. They preferred the conveyor of this information to be a trustworthy source; they identified healthcare providers, professors/researchers, and other students who have received the vaccine as credible sources. In terms of message appeal, many students described wanting the facts, statistics about HPV prevalence and the vaccine as well as narratives from students who have been diagnosed with HPV and those who have experience receiving the vaccine. Conclusions: Although this cancer prevention resource has been commercially available since 2006, college students still a lack of awareness and perceived need for the HPV vaccine. Future health education efforts should utilize participants’ recommendations to increase students’ understanding of HPV and the HPV vaccine and, therefore, impact their perceived susceptibility to HPV, the benefits of the vaccine to their health, and therefore increase utilization of this resource. Strategies to increase vaccination should include health education and vaccine implementation strategies, as well as strategies to reduce the cost of the vaccine for college students, thereby increasing the accessibility of the vaccine for this population
Journal of Cancer Education, 2019
Human papillomavirus (HPV) vaccination uptake varies by geographic regions with rural, often medi... more Human papillomavirus (HPV) vaccination uptake varies by geographic regions with rural, often medically underserved areas, lagging behind more urban regions in terms of vaccine initiation and completion. In these regions, pharmacies may serve as an additional location for HPV vaccine administration. Little is known about rural caregivers' willingness to have their HPV vaccine age-eligible children obtain this vaccine from their local pharmacist. First and second authors conducted 26 in-depth interviews with caregivers of HPV vaccine age-eligible children living in rural regions of a southwestern state to explore their perceptions of the HPV vaccine and their willingness for pharmacist-administered HPV vaccination. They analyzed interview data using an inductive qualitative content analyses approach. The majority of caregivers were unaware that pharmacists could offer adolescent vaccines. However, most were willing to allow their children to receive the vaccine from this non-traditional source. Comments related to obtaining vaccinations from pharmacists related mostly to concerns about proper training and their certification to vaccinate against HPV. Caregivers believed that having a pharmacist administer the HPV vaccine would not affect their relationship with their primary care provider. Caregivers preferred print health education resources and were interested in also receiving health information via social media to learn more about the HPV vaccine and pharmacists' role in HPV vaccine administration. Pharmacies may serve as an additional site to increase HPV vaccine initiation and completion. Rural regions need additional health information about the HPV vaccine and pharmacists' abilities to administer this cancer prevention resource.
Cancer Causes & Control, 2019
Purpose Immunocompromised populations including people living with HIV (PLWH) suffer disproportio... more Purpose Immunocompromised populations including people living with HIV (PLWH) suffer disproportionate burden from anal cancer, a rare cancer caused by persistent infection of the anal canal with oncogenic strains of human papillomavirus. In the US, there are no nationally adopted screening guidelines for anal cancer. In the absence of such guidelines, this study explores healthcare practitioners' screening practices for early signs of anal cancer among PLWH. Methods Between November 2017 and June 2018, the research team completed 25 interviews among a diverse sample of healthcare practitioners who provide care for PLWH. Results Providers expressed frustration that screening and treatment guidelines for anal cancer were scant, and they varied in their screening practices. The majority of providers screened PLWH for anal dysplasia via the anal Pap smear; few providers were trained and had the medical equipment to conduct high-resolution anoscopy-guided biopsies, a more sensitive and specific screening method. Others screened through digital ano-rectal examinations (DARE) and both visually and with a DARE. Participants discussed how providers may be over-treating their patients who have high-grade anal intraepithelial neoplasia (AIN) and the role of biomarkers to determine whether the lesion is carcinogenic. Conclusions Practitioners who provide care for PLWH are proactive in screening to help prevent and control anal cancer, a rare and slow-growing disease. Continuing to regularly surveil high-risk populations, particularly PLWH previously diagnosed with high-grade lesions, is critical to prevent and control anal cancer. Keywords Anal cancer • Anal intraepithelial neoplasia • Human papillomavirus • Human immunodeficiency virus Anal cancer is rare in the general population. In the United States (US), it is a cancer disparity among people who are immunosuppressed, including people living with HIV (PLWH) [1, 2]. In an analysis of 13 US cohort studies of PLWH, incidence of anal cancer was highest among HIVinfected men who have sex with men (131 per 100,000), followed by HIV-infected heterosexual men (46 per 100,000) and HIV-infected women (30 per 100,000) [2]. Also between the years 1999 and 2005, the incidence of anal cancer has continued increasing, irrespective of HIV status, by 2.1%