The relationship between health literacy and indicators of informed decision making for colorectal cancer screening among African Americans

African Americans are disproportionately affected by colorectal cancer (CRC) incidence and mortality. CRC early detection leads to better treatment outcomes and, depending on the screening test, can prevent the development of CRC. African Americans, however, are screened less often than Whites. Aspects of decision making (e.g., decisional conflict, decision self-efficacy) can impact decision making outcomes and may be influenced by social determinants of health, including health literacy. However the relationship between social determinants of health and indicators of decision making in this population is not fully understood. Additionally, individuals have a choice between different CRC screening tests and an individual’s desire to use a particular screening test may be associated with social determinants of health such as health literacy. This study aimed to examine the relationship between social determinants of health and indicators of decision making for CRC screening among African Americans. A total of 111 participants completed a baseline and 14-month follow-up survey assessing decisional conflict, decision self-efficacy, decisional preference (shared versus informed decision making), and CRC test preference. Health literacy was negatively associated with decisional conflict and positively associated with decision self-efficacy (ps < .05). Individuals who were unemployed or working part-time had significantly greater decisional conflict than individuals working full-time (ps < .05). Individuals with a first-degree family history of CRC had significantly lower decision self-efficacy than individuals without a family history (p < .05). Women were significantly more likely to prefer making a shared decision rather than an informed decision compared to men (p < .05). Lastly, previous CRC screening behavior was significantly associated with CRC test preference (e.g., individuals previously screened using colonoscopy were significantly more likely to prefer colonoscopy for their next screening test; ps < .05). These findings begin to identify social determinants of health (e.g., health literacy, employment) that are related to indicators of decision making for CRC among African Americans. Furthermore, these findings suggest further research is needed to better understand these relationships to help with the future development and improvement of interventions targeting decision making outcomes for CRC screening in this population.

STRAINING ENGINEERING OF GRAPHENE AND GRAPHENE-BASED NANOSTRUCTURES

Graphene has emerged as an extraordinary material with its capability to accommodate an array of remarkable electronic, mechanical and chemical properties. Extra-large surface-to-volume ratio renders graphene a highly flexible morphology, giving rise to intriguing observations such as ripples, wrinkles and folds as well as the potential to transform into other novel carbon nanostructures. Ultra-thin, mechanically tough, electrically conductive graphene films promise to enable a wealth of possible applications ranging from hydrogen storage scaffolds, electronic transistors, to bottom-up material designs. Enthusiasm for graphene-based applications aside, there are still significant challenges to their realization, largely due to the difficulty of precisely controlling the graphene properties. Controlling the graphene morphology over large areas is crucial in enabling future graphene-based applications and material design. This dissertation aims to shed lights on potential mechanisms to actively manipulate the graphene morphology and properties and therefore enable the material design principle that delivers desirable mechanical and electronic functionalities of graphene and its derivatives.