Browsing by Author "Knettel, Brandon"

Background: Cancer stigma presents a critical barrier to care seeking, contributing to delayed presentation and poor cancer outcomes worldwide. The burden of cancer in Tanzania is on the rise, with cancer being the third-leading cause of death in the country. Despite rising incidence and poor outcomes of cancer, cancer-related stigma interventions have received low prioritization. There is a need for sound research that focuses on understanding attitudes driving stigma, its impact on care seeking and treatment adherence, and intervention models to reduce stigma. Methods: We administered three open-ended qualitative questions to 140 adults newly diagnosed with cancer in Moshi, Tanzania. The questions explored, (1) common attitudes toward people with cancer, (2) the perceived impact of cancer-related stigma, and (3) ideas for reducing stigma experienced by people with cancer. Patients were recruited during routine appointments at the Cancer Center at Kilimanjaro Christian Medical Center. Data were analyzed using a team-based, applied thematic approach and NVivo 12 software. Twenty percent of the responses were double coded to assess inter-coder agreement and exceeded a pre-established threshold of 80% agreement (84.9%). Results: Participants described stigma as a major challenge for treatment and for receiving support from their social networks. Perceptions of financial stress, misconceptions about cancer such as the belief that it is contagious, and fear of death were common attitudes driving cancer stigma. Participants feared that symptoms would prevent them from working and that the cost of cancer care would drive away loved ones. Stigma was not a ubiquitous response, as some participants reported increased care and social support from family members after a cancer diagnosis. Experiences of stigma contributed to feelings of shame, fear of burdening the family, reduced resources to access treatment, and disengagement from care. Common substitutes to medical therapies included religious interventions and traditional medicine, which were perceived as less expensive and less stigmatizing. Participants felt they would benefit from improved financial support and professional counseling, as well as education for families and communities to reduce stigmatizing attitudes and enhance social support. Conclusions: There is need for intervention studies focused on improving cancer literacy, community advocacy to reduce cancer stigma, and increasing support for people with cancer and their families. There is also a clear need for policy efforts to make cancer care more affordable and accessible to reduce the financial burden on patients and families.

Background: Alcohol use accounts for over 3 million deaths each year and causes negative mental and physical health outcomes. Both adolescent use and early use initiation are associated with future dependence and alcohol-related harm. Orphaned and separated children (OSC) in low- and middle-income countries (LMICs) are particularly vulnerable to alcohol use. Methods: A cross-sectional analysis was used to explore predictors of adolescent alcohol use and early alcohol initiation among a sample of OSC in 5 LMICs. Bivariable logistic regression models were used to evaluate associations between age, gender, education, care setting, OSC status (single orphan, double orphan, neither), behavior and emotional health, the experience of potentially traumatic events (PTEs), social support, and participation in chores or work and the outcomes of early initiation and recent alcohol use. Variables with p-value <0.15 were included in a multivariable model for that respective outcome and evaluated through multivariable logistic regressions. Results: In multivariable regressions, age [OR 1.28 (1.11-1.48)], community-based setting [OR 2.74 (1.57-5.02)], non-abuse trauma [OR 5.23 (2.51-12.10)], and physical or sexual abuse [OR 1.27 (0.75-2.11)] were associated with recent use. Non-abuse trauma [OR 12.86 (3.83-80.12)] and work [OR 1.72 (0.91-3.12)] were associated with early use. Conclusions: Interventions targeting alcohol use among OSC may be more effective if they target predictors identified in this study, such as a community care setting.