Higher-than-average cervical cancer incidence and mortality rates occur in Ohio Appalachia. Little is known, however, about societal norms and social determinants that affect these rates. To examine county-level sociocultural environments to plan a cervical cancer prevention program, the authors interviewed key informants from 17 of 29 Ohio Appalachia counties. Findings include the perceived offensiveness of the term Appalachia, the importance of long-standing family ties, urban and rural areas within counties, use and acceptability of tobacco, the view that cancer is a death sentence, and the stigmatization of people with cancer. Barriers to screening included cost, lack of insurance, transportation problems, fear, embarrassment, and privacy issues. These findings highlight the important role of geography, social environment, and culture on health behaviors and health outcomes. The interviews provided information about the unique characteristics of this population that are important when developing effective strategies to address cancer-related health behaviors in this medically underserved population.

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The purpose of this study was to examine barriers family physicians face when providing hospice care. A questionnaire was developed by the authors, and was mailed to 1,013 randomly selected AAFP members. The questionnaire addressed the various hospice care barriers. The respondents felt comfortable with hospice care, but felt that they did not receive adequate education in this area. They stated that they do have access to hospice programs. There is a general belief on the part of the respondents that their education in death and dying issues, and in hospice care was inadequate. The respondents, however, did feel comfortable in providing hospice care.

A campaign to educate key stakeholders in the clinical trials accrual process was successful in its goal of increasing accrual to therapeutic trials.

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