Exploring HIV risks, testing and prevention among sub-Saharan African community members in Australia

Article


Mullens, Amy B., Kelly, Jennifer, Debattista, Joseph, Phillips, Tania M., Gu, Zhihong and Siggins, Fungisai. 2018. "Exploring HIV risks, testing and prevention among sub-Saharan African community members in Australia." International Journal for Equity in Health. 17. https://doi.org/10.1186/s12939-018-0772-6
Article Title

Exploring HIV risks, testing and prevention among sub-Saharan African community members in Australia

ERA Journal ID13583
Article CategoryArticle
AuthorsMullens, Amy B. (Author), Kelly, Jennifer (Author), Debattista, Joseph (Author), Phillips, Tania M. (Author), Gu, Zhihong (Author) and Siggins, Fungisai (Author)
Journal TitleInternational Journal for Equity in Health
Journal Citation17
Number of Pages12
Year2018
PublisherBioMed Central Ltd.
Place of PublicationUnited Kingdom
ISSN1475-9276
Digital Object Identifier (DOI)https://doi.org/10.1186/s12939-018-0772-6
Web Address (URL)https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-018-0772-6
Abstract

Background: Significant health disparities persist regarding new and late Human Immunodeficiency Virus (HIV) diagnoses among sub-Saharan African (SSA) communities in Australia. Personal/cultural beliefs and practices influence HIV (risk, prevention, testing) within Australia and during visits to home countries.

Method: A community forum was conducted involving 23 male and female adult African community workers, members and leaders, and health workers; facilitated by cultural workers and an experienced clinician/researcher. The forum comprised small/large group discussions regarding HIV risk/prevention (responses transcribed verbatim; utilizing thematic analysis).

Results: Stigma, denial, social norms, tradition and culture permeated perceptions/beliefs regarding HIV testing, prevention and transmission among African Australians, particularly regarding return travel to home countries.

Conclusions: International travel as a risk factor for HIV acquisition requires further examination, as does the role of the doctor in HIV testing and Pre-exposure Prophylaxis (PrEP). Further assessment of PrEP as an appropriate/feasible intervention is needed, with careful attention regarding negative community perceptions and potential impacts.

KeywordsCALD, PREP, HIV screening, African community members, HIV risks
Contains Sensitive ContentDoes not contain sensitive content
ANZSRC Field of Research 2020420603. Health promotion
320211. Infectious diseases
520399. Clinical and health psychology not elsewhere classified
Byline AffiliationsSchool of Psychology and Counselling
School of Health and Wellbeing
Department of Health, Queensland
Ethnic Communities Council of Queensland, Australia
Anyinginyi Health Aboriginal Corporation, Australia
Institution of OriginUniversity of Southern Queensland
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Fein, Erich C., Cassimatis, Mandy, Jakovickis, Dharmashakti and Mullens, Amy B.. 2019. "Strengths of the Health Action Process Approach: a Structured Review." 2019 Australian Psychological Society College of Health Psychologists Conference. Adelaide, Australia 25 - 27 Apr 2019 Melbourne, Australia.
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Fein, Erich C., Tyquin, Dana, Mullens, Amy, Goldwater, Aaron and Gilmour, John. 2019. "Sailing for Resilience: a Pilot Evaluation of Nature Therapy Program for Stress and Anxiety." 2019 Australian Psychological Society College of Health Psychologists Conference. Adelaide, Australia 25 - 27 Apr 2019 Melbourne, Australia.
Through Benevolent Eyes: the Differential Efficacy of Perspective Taking and Cognitive Reappraisalon the Regulation of Shame
Krishnamoorthy, Govind, Davis, Penelope, O'Donovan, Analise, McDermott, Brett and Mullens, Amy. 2021. "Through Benevolent Eyes: the Differential Efficacy of Perspective Taking and Cognitive Reappraisalon the Regulation of Shame." International Journal of Cognitive Therapy. 14 (2), pp. 263-288. https://doi.org/10.1007/s41811-020-00085-4
Effectiveness of Interventions for Hepatitis B and C: A Systematic Review of Vaccination, Screening, Health Promotion and Linkage to Care Within Higher Income Countries
Ortiz, Elizabeth, Scanlon, Brighid, Mullens, Amy and Durham, Jo. 2019. "Effectiveness of Interventions for Hepatitis B and C: A Systematic Review of Vaccination, Screening, Health Promotion and Linkage to Care Within Higher Income Countries." Journal of Community Health. 45, pp. 201 -218. https://doi.org/10.1007/s10900-019-00699-6
Stimulant expectancy questionnaire for men who have sex with men: a measure of substance‐related beliefs
Mullens, Amy B., Fein, Erich C., Young, Ross, Dunne, Michael P., Norton, Graham and Daken, Kirstie. 2020. "Stimulant expectancy questionnaire for men who have sex with men: a measure of substance‐related beliefs." Health Promotion Journal of Australia. 31 (2), pp. 309-319. https://doi.org/10.1002/hpja.271
Mentoring matters: findings from the APS College of Health Psychologists Survey
Mullens, Amy, Stapleton, Peta, Clarke, Allison and Strodl, Esben. 2019. "Mentoring matters: findings from the APS College of Health Psychologists Survey." In-Psych.
The OnTrack Diabetes Group Therapy Project: Feasibility Trial of a Web-based CBT Program with Conjunctive Group Therapy
Cassimatis, Mandy, Kavanagh, David, Kazantzis, Nikolaos and Mullens, Amy B.. 2019. "The OnTrack Diabetes Group Therapy Project: Feasibility Trial of a Web-based CBT Program with Conjunctive Group Therapy." International Society for Research on Internet Interventions - ISRII: The Next Generation (2019). Auckland, New Zealand 13 - 15 Feb 2019
HIV Point of Care Testing (PoCT) at late-night sex on premises venues (SOPV) for gay and bisexual men and other men who have sex with men (GBMSM): a mixed methods analysis
Mullens, Amy B., Daken, Kirstie, Lemoire, Jime, Brownlow, Charlotte, Driver, Glen and Gow, Jeff. 2020. "HIV Point of Care Testing (PoCT) at late-night sex on premises venues (SOPV) for gay and bisexual men and other men who have sex with men (GBMSM): a mixed methods analysis." AIDS and Behavior. 24 (2), pp. 450-466. https://doi.org/10.1007/s10461-019-02500-0
Whole-incarceration-setting approaches to supporting and upholding the rights and health of incarcerated transgender people
Bromdal, Annette, Clark, Kirsty A., Hughto, Jaclyn M. W., Debattista, Joseph, Phillips, Tania M., Mullens, Amy B., Gow, Jeff and Daken, Kirstie. 2019. "Whole-incarceration-setting approaches to supporting and upholding the rights and health of incarcerated transgender people." International Journal of Transgenderism. 20 (4), pp. 341-350. https://doi.org/10.1080/15532739.2019.1651684
Point-of-care testing (POCT) for HIV/STI targeting MSM in regional Australia at community ‘beat’ locations
Mullens, Amy, Duyker, Josh, Brownlow, Charlotte, Lemoire, Jime, Daken, Kirstie and Gow, Jeff. 2019. "Point-of-care testing (POCT) for HIV/STI targeting MSM in regional Australia at community ‘beat’ locations." BMC Health Services Research. 19 (93), pp. 1-10. https://doi.org/10.1186/s12913-019-3899-2
Recommendations and practices for holistic chronic obstructive pulmonary disease (COPD) assessment and optimal referral patterns in emergency department presentations: a scoping review protocol
Moloney, Clint, Beccaria, Gavin, Mullens, Amy, Issac, Hancy and Phillips, Tania. 2019. "Recommendations and practices for holistic chronic obstructive pulmonary disease (COPD) assessment and optimal referral patterns in emergency department presentations: a scoping review protocol ." BMJ Open. 9 (8), pp. 1-5. https://doi.org/10.1136/bmjopen-2019-030358
Substance-related expectancies mediate relationships between substance use (stimulants, alcohol) and condomless anal sex among men
Mullens, Amy, Fein, Erich, Ray, Madeleine and Young, Ross. 2018. "Substance-related expectancies mediate relationships between substance use (stimulants, alcohol) and condomless anal sex among men." International Journal of Behavioral Medicine. 25 (1 (Supplement)), p. S172.
Experiences of transgender prisoners and their knowledge, attitudes and practices regarding sexual behaviours and HIV/STIs: a systematic review
Mullens, Amy, Bromdal, Annette, Phillips, Tania and Gow, Jeff. 2018. "Experiences of transgender prisoners and their knowledge, attitudes and practices regarding sexual behaviours and HIV/STIs: a systematic review." International Journal of Behavioral Medicine. 25, p. S42.
The experience of psychological distress, symptoms of trauma, coping and post-traumatic growth in parents of children with congenital heart disease: a systematic review of the literature
Mullens, Amy and Brown, Jodie. 2018. "The experience of psychological distress, symptoms of trauma, coping and post-traumatic growth in parents of children with congenital heart disease: a systematic review of the literature." International Journal of Behavioral Medicine. 25 (1 (Supplement)), p. S14.
Experiences of transgender prisoners and their knowledge, attitudes, and practices regarding sexual behaviors and HIV/STIs: a systematic review
Bromdal, Annette, Mullens, Amy B., Phillips, Tania M. and Gow, Jeff. 2019. "Experiences of transgender prisoners and their knowledge, attitudes, and practices regarding sexual behaviors and HIV/STIs: a systematic review." International Journal of Transgenderism. 20 (1), pp. 4-20. https://doi.org/10.1080/15532739.2018.1538838
Characteristics Of Early Adopters Of Hiv Point Of Care Testing (Poct) At Late-Night Sex On Premises Venue (Sopv) Theme Parties
Mullens, Amy, Daken, Kirstie, Lemoire, Jime, Brownlow, Charlotte and Gow, Jeff. 2018. "Characteristics Of Early Adopters Of Hiv Point Of Care Testing (Poct) At Late-Night Sex On Premises Venue (Sopv) Theme Parties." 15th International Congress of Behavioral Medicine. Santiago, Chile 14 - 17 Nov 2018 United States. Springer.
Integrating theories of alcohol consumption: how do drinking motives influence self-efficacy?
Girdlestone, D., Fein, E. and Mullens, A.. 2017. "Integrating theories of alcohol consumption: how do drinking motives influence self-efficacy?" 38th National Conference of the Australian Association for Cognitive and Behaviour Therapy (AACBT 2017):Innovations in Cognitive and Behavioural Therapies across the Lifespan. Sydney, Australia 26 - 28 Oct 2017 Australia.
HIV risks and prevention: themes from a community forum among African community members in Queensland
Mullens, Amy, Debattista, Joseph, Gu, Zhihong, Siggins, Fungisai, Phillips, Tania and Kelly, Jennifer. 2017. "HIV risks and prevention: themes from a community forum among African community members in Queensland." ASBHM - CHP Conference 2017. Gold Coast, Australia 13 - 15 Jul 2017 Gold Coast, Australia.
Novel HIV testing during health promotion outreach: a qualitative analysis of field notes by peer-testers
Mullens, Amy, Duyker, Josh, Lemoire, Jime and Brownlow, Charlotte. 2017. "Novel HIV testing during health promotion outreach: a qualitative analysis of field notes by peer-testers." ASBHM - CHP Conference 2017. Gold Coast, Australia 13 - 15 Jul 2017 Gold Coast, Australia.
Health behaviours and health literacy: Hepatitis B regarding Sub-Saharan African migrants living in Queensland
Majerovic, A., Mullens, A., Debattista, J., Fein, E., Gu, Z. and Siggins, F.. 2017. "Health behaviours and health literacy: Hepatitis B regarding Sub-Saharan African migrants living in Queensland." ASBHM - CHP Conference 2017. Gold Coast, Australia 13 - 15 Jul 2017 Gold Coast, Australia.
Mentoring: results from the Australian Psychological Society College of Health Psychologists professional mentoring survey
Stapleton, P., Clarke, A., Strodl, E. and Mullens, A.. 2017. "Mentoring: results from the Australian Psychological Society College of Health Psychologists professional mentoring survey." ASBHM - CHP Conference 2017. Gold Coast, Australia 13 - 15 Jul 2017 Gold Coast, Australia.
Integrating theories of alcohol consumption: how do drinking motives influence HAPA self-efficacy?
Girdlestone, Denise, Fein, Erich and Mullens, Amy. 2017. "Integrating theories of alcohol consumption: how do drinking motives influence HAPA self-efficacy?" ASBHM - CHP Conference 2017. Gold Coast, Australia 13 - 15 Jul 2017 Gold Coast, Australia.
A research method to explore midwives’ views of national maternity service reforms
Roache, Bridget and Kelly, Jennifer. 2018. "A research method to explore midwives’ views of national maternity service reforms." Women and Birth. 31 (3), pp. 216-221. https://doi.org/10.1016/j.wombi.2017.09.014
Lived experiences among transgender and gender diverse offenders and their knowledge, attitudes and practices regarding sexual behaviours and HIV/STIs, and knowledge and attitudes among prison officers towards transgender and gender diverse prisoners, sexuality and HIV/STIs: protocol for a systematic review
Bromdal, Annette, Mullens, Amy, Phillips, Tania and Gow, Jeff. 2017. "Lived experiences among transgender and gender diverse offenders and their knowledge, attitudes and practices regarding sexual behaviours and HIV/STIs, and knowledge and attitudes among prison officers towards transgender and gender diverse prisoners, sexuality and HIV/STIs: protocol for a systematic review." PROSPERO: International Prospective Register of Systematic Reviews. 18 Sept 2017.
Predictors of breastfeeding exclusivity and duration in a hospital without Baby Friendly Hospital Initiative accreditation: a prospective cohort study
O'Connor, Michelle, Allen, Jyai, Kelly, Jennifer, Gao, Yu and Kildea, Sue. 2018. "Predictors of breastfeeding exclusivity and duration in a hospital without Baby Friendly Hospital Initiative accreditation: a prospective cohort study." Women and Birth. 31 (4), pp. 319-324. https://doi.org/10.1016/j.wombi.2017.10.013
Metacognitions mediate HIV stigma and depression/anxiety in men who have sex with men living with HIV
Strodl, Esben, Stewart, Lauren, Mullens, Amy B. and Deb, Sibnath. 2015. "Metacognitions mediate HIV stigma and depression/anxiety in men who have sex with men living with HIV." Health Psychology Open. 2 (1), pp. 1-11. https://doi.org/10.1177/2055102915581562
The essence of internationalisation
Kelly, Jennifer. 2011. "The essence of internationalisation ." Australian Nursing Journal. 19 (3), pp. 29-29.
Student nurses' attitudes toward nursing research
Owens, Pamela L. and Kelly, Jennifer. 1998. "Student nurses' attitudes toward nursing research." Nurse Educator. 23 (5).
Guidelines for Peer Supervision
Mullens, Amy. 2016. "Guidelines for Peer Supervision." Drug Arm Clinical Worker State-wide professional development forum (2016). Annerley, Australia
Substance use among LGQBTIQ
Mullens, Amy. 2016. "Substance use among LGQBTIQ." College of Community Services (Drug Arm, Healthy Options) LGBT Symposium (2016). Brisbane, Australia 11 Feb 2016
Queensland Chemsex Study
Ray, Madeleine, Garvey, Shane, Mullens, Amy and Fein, Erich. 2017. "Queensland Chemsex Study." The 2017 Australian Winter School Conference. Brisbane, Australia 27 - 28 Jul 2017
PoCT (point of care) HIV/STI testing at after-hours SOPV (sex on premises venues) theme parties
Mullens, Amy, Driver, Glen, Lemoire, Jime and Daken, Kirstie. 2017. "PoCT (point of care) HIV/STI testing at after-hours SOPV (sex on premises venues) theme parties." 9th IAS conference on HIV science (IAS 2017). Paris, France 23 - 26 Jul 2017
Comparison of government and non-government alcohol and other drug (AOD) treatment service delivery for the lesbian, gay, bisexual, and transgender (LGBT) community
Mullens, Amy B., Fischer, Jane, Stewart, Mary, Kenny, Kathryn, Garvey, Shane and Debattista, Joseph. 2017. "Comparison of government and non-government alcohol and other drug (AOD) treatment service delivery for the lesbian, gay, bisexual, and transgender (LGBT) community." Substance Use and Misuse. 52 (8), pp. 1027-1038. https://doi.org/10.1080/10826084.2016.1271430
Preparing nurses for practice: a phenomenological study of the new graduate in Australia
Kelly, Jennifer and Ahern, Kathy. 2008. "Preparing nurses for practice: a phenomenological study of the new graduate in Australia." Journal of Clinical Nursing. 18 (6), pp. 910-918. https://doi.org/10.1111/j.1365-2702.2008.02308.x
Partnerships and innovative models for the recruitment and retention of nurses
Kelly, Jennifer. 2009. "Partnerships and innovative models for the recruitment and retention of nurses." Australian Nursing Journal. 16 (4), pp. 26-26.
Predicating HIV risk behaviour secondary to substance use
Mullens, Amy, Young, Ross McD, Dunne, Michael P., Debattista, Joe and Norton, Graham. 2011. "Predicating HIV risk behaviour secondary to substance use." Australasian Professional Society on Alcohol and Other Drugs Conference 2011. Hobart, Tasmania 13 - 16 Nov 2011 United Kingdom. John Wiley & Sons.
Metacognitions mediate HIV stigma & depression/anxiety in men who have sex with men living with HIV
Mullens, Amy B., Strodl, Esben, Stewart, Lauren and Deb, Sibnath. 2016. "Metacognitions mediate HIV stigma & depression/anxiety in men who have sex with men living with HIV." 14th International Congress of Behavioral Medicine: Behavioral Medicine: Making an Impact in the Modern World (ICBM 2016). Melbourne, Australia 07 - 10 Dec 2016
Innovative methods to increase HIV testing among MSM in regional Queensland
Mullens, Amy, Duyker, Josh and Lemoire, Jime. 2016. "Innovative methods to increase HIV testing among MSM in regional Queensland." 14th International Congress of Behavioral Medicine: Behavioral Medicine: Making an Impact in the Modern World (ICBM 2016). Melbourne, Australia 07 - 10 Dec 2016
Depression mediates HIV stigma and medication adherence in men who have sex with men (living with HIV)
Mullens, Amy B., Strodl, Esben, Fein, Erich, Stewart, Lauren and Daken, Kirstie. 2016. "Depression mediates HIV stigma and medication adherence in men who have sex with men (living with HIV)." 14th International Congress of Behavioral Medicine: Behavioral Medicine: Making an Impact in the Modern World (ICBM 2016). Melbourne, Australia 07 - 10 Dec 2016
Utilisation of novel methodologies to engage 'hard to reach' clients in health promotion and screening, in rural and regional areas
Mullens, Amy B., Duyker, Josh and Lemoire, Jime. 2016. "Utilisation of novel methodologies to engage 'hard to reach' clients in health promotion and screening, in rural and regional areas." 8th Australian Rural and Remote Mental Health Symposium. Kingscliffe, Australia 02 - 04 Nov 2016 Nerang, Qld, Australia.
Maternal perceptions of breastfeeding difficulty after caesarean section with regional anaesthesia: a qualitative study
Chaplin, Jacqueline, Kelly, Jennifer and Kildea, Sue. 2016. "Maternal perceptions of breastfeeding difficulty after caesarean section with regional anaesthesia: a qualitative study." Women and Birth. 29 (2), pp. 144-152. https://doi.org/10.1016/j.wombi.2015.09.005
Supervision: considerations and self-reflective practice
Mullens, Amy. 2015. "Supervision: considerations and self-reflective practice." 2015 Queensland Clinical Training Network Research Symposium. Brisbane, Australia 12 - 13 Nov 2015 Australia.
A&D staff attitudes regarding LGBT clients
Mullens, Amy. 2016. "A&D staff attitudes regarding LGBT clients." 3rd International Conference on Social Identity and Health. Brisbane, Australia 16 - 18 Jun 2016 St Lucia, Australia.
Substance-related expectancies among men who have sex with men: development of psychometric tools to predict unprotected sexual activity
Boedicker Mullens, Amy. 2011. Substance-related expectancies among men who have sex with men: development of psychometric tools to predict unprotected sexual activity. PhD Thesis Doctor of Philosophy. Queensland University of Technology.
Confidant and breast cancer patient reports of quality of life
Sandgren, Ann K., Mullens, Amy B., Erickson, Shannon C., Romanek, Kathleen M. and McCaul, Kevin D.. 2004. "Confidant and breast cancer patient reports of quality of life." Quality of Life Research. 13 (1), pp. 155-160. https://doi.org/10.1023/B:QURE.0000015287.90952.95
The amyl nitrite expectancy questionnaire for men who have sex with men (AEQ-MSM): a measure of substance related beliefs
Mullens, Amy B., Young, Ross, Dunne, Michael P. and Norton, Graham. 2011. "The amyl nitrite expectancy questionnaire for men who have sex with men (AEQ-MSM): a measure of substance related beliefs." Substance Use and Misuse. 46 (13), pp. 1642-1650. https://doi.org/10.3109/10826084.2011.599096
The drinking expectancy questionnaire for men who have sex with men (DEQ-MSM): a measure of substance-related beliefs
Mullens, Amy B., Young, Ross McD., Dunne, Michael P. and Norton, Graham. 2011. "The drinking expectancy questionnaire for men who have sex with men (DEQ-MSM): a measure of substance-related beliefs." Drug and Alcohol Review. 30 (4), pp. 372-380. https://doi.org/10.1111/j.1465-3362.2010.00225.x
The cannabis expectancy questionnaire for men who have sex with men (CEQ-MSM): a measure of substance-related beliefs
Mullens, A. B., Young, R. McD., Dunne, M. and Norton, G.. 2010. "The cannabis expectancy questionnaire for men who have sex with men (CEQ-MSM): a measure of substance-related beliefs." Addictive Behaviors. 35, pp. 616-619. https://doi.org/10.1016/j.addbeh.2010.01.006
The consequences of substance use among gay and bisexual men: a consensual qualitative research analysis
Mullens, Amy B., Young, Ross McD., Hamernik, Elisabeth and Dunne, Michael. 2009. "The consequences of substance use among gay and bisexual men: a consensual qualitative research analysis." Sexual Health. 6 (2), pp. 139-152. https://doi.org/10.1071/SH08061
Sex on premises venue (SOPV) health promotion project in response to sustained increases in new HIV notifications
Mullens, Amy B., Staunton, Shaun, Debattista, Joseph, Hamernik, Elisabeth and Gill, Darren. 2009. "Sex on premises venue (SOPV) health promotion project in response to sustained increases in new HIV notifications." Sexual Health. 6 (1), pp. 41-44. https://doi.org/10.1071/SH07087
The motivational effects of thinking and worrying about the effects of smoking cigarettes
McCaul, Kevin D., Mullens, Amy, Romanek, Kathleen M., Erickson, Shannon C. and Gatheridge, Brian J.. 2007. "The motivational effects of thinking and worrying about the effects of smoking cigarettes." Cognition and Emotion. 21 (8), pp. 1780-1798. https://doi.org/10.1080/02699930701442840
Pressure injury prevention success in a regional hospital
Hunter, Michelle, Kelly, Jennifer, Stanley, Norma, Stilley, Amy and Anderson, Lynn. 2014. "Pressure injury prevention success in a regional hospital." Contemporary Nurse. 49 (1), pp. 75-82. https://doi.org/10.1080/10376178.2014.11081956
Lessons students and new graduates could teach: a phenomenological study that reveals insights on the essence of building a supportive learning culture through preceptorship
Kelly, Jennifer and McAllister, Margaret. 2013. "Lessons students and new graduates could teach: a phenomenological study that reveals insights on the essence of building a supportive learning culture through preceptorship." Contemporary Nurse. 44 (2), pp. 170-177. https://doi.org/10.5172/conu.2013.44.2.170
The future nursing workforce in Australia: baseline data for a prospective study of the profile, attrition rates and graduate outcomes in a contemporary cohort of undergraduates
Gaynor, Lynda, Gallasch, Tamara, Yorkston, Emily, Stewart, Simon, Bogossian, Fiona, Fairweather, Carrie, Foley, David, Nutter, Helen, Thompson, Jan, Stewart, Lee, Anastasi, Jenny, Kelly, Jenny, Barnes, Lynne, Glover, Pauline and Turner, Catherine. 2007. "The future nursing workforce in Australia: baseline data for a prospective study of the profile, attrition rates and graduate outcomes in a contemporary cohort of undergraduates." Australian Journal of Advanced Nursing. 25 (2), pp. 11-20.
Coping after cancer: risk perceptions, worry and health behaviors among colorectal cancer survivors
Mullens, Amy B., McCaul, Kevin D., Erickson, Shannon C. and Sandgren, Ann K.. 2004. "Coping after cancer: risk perceptions, worry and health behaviors among colorectal cancer survivors." Psycho-Oncology: journal of the psychological, social and behavioral dimensions of cancer. 13 (6), pp. 367-376. https://doi.org/10.1002/pon.751