Barriers to the HPV Vaccination and Cervical Cancer Screening for BAME Women

Barriers to the HPV Vaccination and Cervical Cancer Screening for BAME Women What are the Barriers of Human Papillomavirus (HPV) Vaccination and Cervical Cancer Screening amongst Minority Women age 12-26? Abstract Background: Minority women systematically experience socio-economic disadvantages, which put them in the face of greater obstacles in attaining optimal health. Approximately 44 million women in the United States, nearly one third of all women in America, self-identify as women of a minority racial or ethnic group. Yet, minority women fare worse than non-Hispanic white women across a broad range of measures, with some of the largest disparities being that of HPV-related cervical cancer mortality. Objective: The objective is to emphasize the barriers of care in relation to cervical cancer screening and HPV vaccination, as well as examine patterns in barriers like demographic, cultural, and health belief factors amongst minority women.Methods: The data collection review and process was based on article review factors that were associated with HPV vaccine acceptability, initiation, and series completion among adolescent and young adult women of different racial, ethnic, and socioeconomic groups in the United States. Results: Selected characteristics of the included studies contended that an estimated 12,000 women are diagnosed with cervical cancer annually in the United States, and 4500,000 women worldwide develop cervical cancer each year. Higher rates of cervical cancer are found in US regions with large minority and impoverished populations. Conclusion: It is imperative for clinicians to progress minority women screening and early detection. Further intervention models need to reflect multifactorial determinants of screening utilization. Introduction Background While there have been strides in HPV and cervical cancer prevention efforts, many minority women across the board still experience significant barriers to care. For example, women from rural and poor communities tend to have health illiteracy in regard to their own self-care, which also includes their mistrust for the healthcare system. Additionally, many minority women simply lack financial access to care. Socio-economic disadvantages (i.e. race, class, gender, education, occupation, etc.) are the underlying issues. Though many health efforts are made by health professionals, and health ramifications like informative technologies and preventative care strategies have been achieved, there is a continual socio-economic and racial imbalance with both the diagnosis and treatment of cervical cancer, especially the strains directly influenced by HPV. Specific Aims Our specific aims are to first identify Health care barriers and challenges to cervical cancer screening and HPV vaccination within the population of minority women. We also want to uncover minority women, health care provider & health care system risk factors for cervical cancer screening & HPV vaccination, as well as, health care challenges and opportunities in improving cervical cancer screening rates amongst minority women. Lastly, we want to pinpoint the nurses’ roles in preventing cervical cancer in underserved racial and or ethnic populations. Methods Search Strategy In June 2017,we searched four electronic bibliographic databases (Google scholar, Medline, Pubmed and Cinahl) using the search terms ‘HPV’ ‘cervical cancer’ ‘pap smear’ ‘minority women’ ‘ethnic women’ and ‘health disparities’. All of the studies identified during the database search were assessed for relevance to the review based on the information provided in the title, abstract, and description of key words and terms. A full report was retrieved for all studies that met the inclusion criteria. Inclusion Criteria The data collection review and process was based on article review factors that were associated with HPV vaccine acceptability, initiation, and series completion among adolescent and young adult women of different racial, ethnic, and socioeconomic groups in the United States. We reviewed relevant peer-reviewed and evidence-based qualitative literature in order to identify current vaccination trends, rates and factors associated with HPV and cervical cancer. Study findings a related to race (black, Latina, Asian), and socio-economic disadvantages were summarized. Eligibility Criteria Understanding current vaccination trends and the barriers to series initiation and completion, the Centers for Disease Control and Prevention (CDC) recommends that 11 to 12 year old adolescents receive two doses of the HPV vaccine in order to protect against themselves against cancers that are caused by HPV. The HPV vaccine series can be given to girls beginning at age 9 years old, but many parents believe this age is too immature for a sexually transmitted disease vaccination. Additionally, it is recommended by the CDC that girls and women age 13 through 26 years of age who have not yet been vaccinated or completed the vaccine series to be given the HPV vaccination immediately to provide HPV-cancer related protection. In understanding HPV vaccination parameters, it is essential that we too recognize gaps in knowledge and all the misconceptions surrounding HPV vaccination and cervical cancer. When the vaccine is given prior to HPV exposure, it is highly effective in preventing infection from two high-risk genotypes (HPV-16/HPV-18) of HPV, which causes approximately 70 percent of cervical cancers, and two low-risk (HPV-6/HPV-11) genotypes that are responsible for over 90 percent of all genital warts. As we assessed the appropriateness of our criteria interests, we focused on Black/African-American, Latina and non-white adolescent women age 12-26, minority teen women reported having sexual intercourse, adolescent women who have completed puberty, and low income and health care illiterate young women, who are too uninsured or have limited access. Quality Assessment The methodological quality is significant to our study. It was organized and detailed oriented. It presented evidence that there is a need for increasing HPV vaccination among young minority women. The failure to achieve equitable vaccination has exacerbated health disparities in HPV and cervical cancer incidence and mortality. Research suggests that low- income and minority women are disadvantaged due to the difference in cervical cancer screening, practices and beliefs, as well as healthcare access barriers and systemic risk factors. We used the ‘Research and Quality Scoring Method’ by Sackett and Haynes, the Jadad scale, and the items published by Cho and Bero to rate the quality of each study (Table 1). The range of total quality scores was from 0 to 9. Studies that ranged from 0 to 5 were considered low quality, whereas studies that ranged from 6-9 were considered high quality. Two raters independently coded variables using Microsoft Excel. Discrepancies were identified and resolved amongst our team members. Table 1. Study quality ratings Statistical Analysis Race/ethnicity and low socio-economic status are known predictors of late-stage diagnosis of cervical cancer and are important predictors of cancer mortality. In the United States, approximately 12,000 women develop cervical cancer and 44000 die of the disease each year, with higher incidence and mortality rates reported in low-income minority populations. HPV vaccination has been shown to reduce the prevalence of high-risk HPV infection among teen women and thus, has the potential to decrease the risks of cervical cancer among vaccinated young women. According to preceding surveillance and qualitative studies, it is indicated that a decline in the annual rate of high-grade cervical cancer, from 834 per 100,000 in 2008 to 688 per 100,000 in 2014, among women aged 21 to 24 years, which reflects the impact of HPV vaccination. However, declines were not significant in areas with high proportions of minority women (i.e blacks, Latinas) and/or people living in low-income areas. Results Included Studies The search yielded nearly 500 potential article titles for review, yet less than 70 were relevant to our interests. And of that 70, about 20 were dated within the last 10 years. Accordingly, less than 20 seemed more characteristic of our research interests and provided adequate information to our research question. Description of Studies Selected characteristics of the included studies contended that an estimated 12,000 women are diagnosed with cervical cancer annually in the United States, and 4500,000 women worldwide develop cervical cancer each year. In the United States, cervical cancer incidence is nearly twice as high in counties with poverty levels > 20% compared with those with poverty levels

Same Sex Marriage Should be Legal Essay -- Homosexual Couples Should H

Marriage is the sacred bond between two people who love and cherish one another. Traditionally this bond has been held between man and woman. With so many changes in the world, there are more openly homosexual people in our society. Though people have become more accepting of the existence of homosexuality, gays and lesbians are still considered unequal when it comes to marriage. Homosexual couples should have the same rights to marry as heterosexual couples. Denying this right is unjust and is discrimination towards a group of people. Same-sex marriage has become more of a political issue when it really should be left up to one’s own personal and religious beliefs. Even though there are a few states that recognize legal same-sex marriage or domestic partnership, couples still have to face feeling inferior because of the little to no benefit they are given, while heterosexual marriages have an abundant of rights, privileges and benefits. If it is our constitutional right to get married to the person our choice then let it be. It should not matter what the next person feels because they have the right to feel the way they want to feel just as a person can fall in love and marry their significant other. Marriage is supposed to unite two people together for better and worse for the rest of their lives. Why would anyone want to deny another person the opportunity to commit their life to another person regardless of gender? According to a chart by Christine Vestal, a staff writer at Stateline.org, there is only six states that allow same-sex marriage: Massachusetts, Connecticut, Iowa, Vermont, Maine and New Hampshire. New Jersey and Connecticut are the only two states that recognize civil union for same-sex couples al... ...d religion. Many may feel that it is simply tradition for a man a woman to be married and homosexual marriage is just not the norm. On the other hand, what I just mention was also not normal and yet we as a nation have overcome them. It has taken time and great effort to win these rights and the privilege to make our own choices. Today many are more open-minded and tolerant of the existence of homosexuality and homosexual couples and there are a handful of states that are more accepting of the ideal of same-sex marriage. It is only a matter of time before the rest of the nation accepts this. Works Cited Oison, Theadore B. â€Å"The Conservative Case for Gay Marriage† Newsweek 09 Jan, 2010: Web. Saunders, Cat. â€Å"Gay Marriage? Absolutely!† The News Time July 2000: Web. Vestal, Christine â€Å"Gay marriage legal in six states† Stateline 04 Jun, 2009: Web.

Heritage Countee Cullen Essay

â€Å"What is Africa to me?† (Cullen, Line 10). Heritage is an African American poem by Countee Cullen that was written during the Harlem Renaissance. Cullen was born in a primarily white upbringing; therefore he had no experience in African culture or heritage and was confused. His African heritage concerns him; yet, because he must adapt to the orders of a mostly white culture that is not concerned with his cultural origins. This poem is primarily the internal conflict of Countee Cullen on the dilemma of a modern African American aware of his rich Native African heritage but stranded in a sterile conformist American culture that offer him only stereotypical insight into his heritage and no true unbiased perception of his own culture. In Heritage Cullen uses literary devices such as imagery, symbolism and irony to show that he is conflicted on his view of his African heritage. Cullen uses imagery as a literary device to show his confusion of African heritage. Thus Cullen begi ns with a question concerning the nature of an abstract and rather remote Africa. â€Å"What is Africa to me, copper sun or scarlet sea, jungle star or jungle track, strong bronzed men, or regal black, women from whose loins I sprang, when the birds of Eden sang† (Cullen, Lines 1-6). This quote shows how Cullen lists some concrete images which serve as specific emphases for his conflicting views of his native land. This shows an African Americans point of view of Africa. For example in the phrase â€Å"jungle star or jungle track†; the first part â€Å"jungle star† has a positive connotation and the second part â€Å"jungle track† has a negative connotation. In a way the positive connotations represent African perspective and the negative connotations represent African perspective. â€Å"Sung by wild barbaric birds, Goading massive jungle herds, Juggernauts of flesh that pass, Trampling tall defiant grass, Where young forest lovers lie, Plighting troth beneath the sky† (Cullen, Lines 13-17). In contrast to the first quotes the second imagery quote shows a purely American perspective of Africa. This quote shows the constant stereotypical view of Africa that Cullen was fed for his whole childhood.  This quote compared to the first show s that Africa was a wild barbaric place. These two perspectives really confused him. Not only does Cullen use imagery as a literary device to show his confusion on his heritage but he also uses symbolism as a literary device that show this too. Cullen furthermore uses a symbolism of the drum to show that even if he tries he cannot block out his heritage. â€Å"So I lie, who always hear, though I cram against my ear, both my thumbs, and keep them there, great drums throbbing through the air† (Cullen, Lines 19-22). This quote shows that he is trying to block out his heritage. Despite this effort he still hears the drum which symbolizes tribal beats from Africa. This shows that American culture has forced Cullen to deny the primitive African rhythms that pulses through his body. â€Å"Who find no peace, night or day, no slight release, from the unremittent beat, made by cruel padded feet, walking through my body’s street† (Cullen, Lines 64-68). In this quote reassures the point that he feels this tribal beat no matter what he does or what his condition he feels the beat within his blood and bones that he cannot get rid of. Not only does the author use symbolism as a literary device to illustrate his dilemma on his heritage but he also uses irony as another tool to show it. Finally Cullen uses irony to show that he still has not come to term about what his true heritage really is. â€Å"I belong to Jesus Christ†¦ although I speak with my mouth thus, in my heart, do I play a double part, ever at thy glowing altar, must my heart grow sick and falter, wishing he I served were black† (Cullen, Lines 96-101). This quote show irony because he states that he belongs to Christ, but later on he states that truly in his heart he wishes his god was black like him. This show that even if he thinks that he has decided which side to choose he still has not truly done so. â€Å"Nor yet has my heart or head, in the least way realized, they and I are civilized† (Cullen, Lines 126-128). This quote shows that he still has not decided yet; but he still ironically he still says â€Å"they and I are civilized†. This is ironic because the line before â€Å"Nor yet has my heart or head, in the least way realized† contradicts this statement. In this African American poem to show that he is conflicted on his view of his African heritage, Cullen uses literary devices such as imagery,  symbolism and irony. The circumstances he grew up with did not show him the perspective of his people; he was constantly give only the American point of view of Africa. This gave him a great internal dilemma of his own heritage because in his blood he had pride. At the end of this poem he is still conflicted about what his stance truly is. The lesson of this poem is that despite where you live and what biased information you are given you can never forget your roots. Work Cited Cullen, Countee. â€Å"Heritage.† The Poetry Foundation : Find Poems and Poets. Discover Poetry. The Poetry Foundation, n.d. Web. 4 Nov. 2014.

Children Working In The Factories during the British...

The British industrial revolution (1770 - 1850) had a super negative impact on the right of children. Since child labour was already a pervasive problem during the 17th century in Britain, the industrial revolution simply just made child labour even more overflowed. It was extremely unfair compare these thousands of children who worked non-stopping and suffered throughout their whole childhoods with the other normal kids who were at school and lived happily. However there had not been much things done to change this terrible fact. Therefore children working in factories during the industrial revolution was extraordinary normal. Before the industrial revolution started, Britain was poor, there wasn’t much factories and trading going on,†¦show more content†¦If the population of a country is heigh, hence the need of cloths, food and living essentials must increase as well. People can not live without the stuffs that were produced by the factories, in a positive perspec tive this was a very good sign for the growth of economy, nevertheless this also suggests that more manual power have to be put in, in order to overcome the huge shortage of labour. Unquestionably one of the most popular solution was to buy children from orphanages which most of the orphans’ owners and workhouses would love to do for the good profits. Further more according to a workhouse owner described, there is an additional issue that made owners of factories and workhouses to use child labour, and it is because many machines were powered by wheels which could get stuck or broke very often, hence the only option to get them fixed in the most efficient function is to let kids who mostly have small hands to reach in and repair them, and this could be very dangerous. There were tones of other factors that made people prefer to use child labour, for most of the children were forced to, yet they had no choice due to poverty and other issues. Technically children who were worki ng on workplaces were considered to be normal workers, therefore it was absolute legal to own these children to do physical works. However the conditions working on a factory can be horrible, most people back then had gotShow MoreRelatedIndustrial Revolution1573 Words   |  7 Pages Was the Industrial Revolution a Blessing or a Curse? The Industrial Revolution was a period of technological improvement that took place in Britain from about 1750 into the 1900’s. To many, the Industrial Revolution was the gateway into modern-day factories and machinery. The Industrial Revolution was spurred by the competition of Britain against India or China. 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Most of the stocks on the shelves of departmentRead MoreHistory Of Fabric And Textiles Textile Development During The Industrial Revolution839 Words   |  4 PagesThe history of fabric and textiles Textile development during the Industrial Revolution (1780-1850) In 1968, Eric Hobsbawm said: â€Å"Whoever says Industrial Revolution says cotton.† Among many historians the Industrial Revolution is considered as the process in which technological changes led by the mechanized factories of the cotton industry created large profits for innovators that continued in succeeding decades. It was the key event in the emergence of modern economic growth, which led to shifting

Essay on lost - 754 Words

Peer Pressure nbsp;nbsp;nbsp;nbsp;nbsp;The hard part of being a teenager is learning to make the right decisions. One of the things that affects decision making is pressure we encounter from friends. Peers influence life. At this stage in life, which is our teen years, we will always try to fit in. Everyone has or will face peer pressure sooner or later. Peer pressure can be broken down into two areas; good peer pressure and bad peer pressure. From being a teenager myself, I have been placed in situations where I was pressured into drugs and alcohol. It‘s hard to say no, but to avoid peer pressure, you just have to stand up for yourself and walk away from it. nbsp;nbsp;nbsp;nbsp;nbsp;Whether we know it or not, peers†¦show more content†¦Peer pressure can be extremely strong and hard to resist. nbsp;nbsp;nbsp;nbsp;nbsp;Bad peer pressure is being forced into doing something that you didnt want to do because your friends said that you should. Friends have a tendency to think that they know what is best for you, and if your friends are like some of mines, they always offer their opinion whether it is wanted or not. One of the major problems with peer pressure occurs when you get sucked into something that you really didnt want to do and subsequently, become addicted to it. Usually, people get backed into a situation to try illegal drugs, alcohol, and cigarettes and more then once, and these behaviors can become habit forming. nbsp;nbsp;nbsp;nbsp;nbsp; nbsp;nbsp;nbsp;nbsp;nbsp;Good peer pressure, on the other hand, is being pushed into something that you didnt have the courage to do or just didnt cross your mind to do. However, as you think about it, it seems like a good thing to do. Good peer pressure can also be a situation when your friends convince you not to do something you were going to do because it wasnt in your best interest. Some people say that good peer pressure is when you get pushed into something that you didnt want to do and it turned out well. nbsp;nbsp;nbsp;nbsp;nbsp;I being a teenager and all, have encountered peer pressure at the age of 13 years old. One of my so called friends, told me that smoking cigarettes isShow MoreRelatedHumanity and Its Way of Being Lost1052 Words   |  5 Pagesand all of the adults are dead. The boys take it upon themselves to survive, until they are rescued, but being upon that island for so long, the boys soon lose who they are. Some don’t want to be rescued, and some have just lost it completely. Lives and personalities are lost to the invading savagery of the island. Throughout the book, Golding shows how the boys upon the island slowly lose themselves. The island’s barbaric influence on the boys first takes place within their appearances. â€Å"His sandyRead MoreThe Reality Of The Television Series Lost1233 Words   |  5 Pages Although this more than likely will not happen to any given person, it is easy to envision how crucial and challenging it would be to collaborate with so many different personalities. However, this is the exact dilemma in the television series Lost. Lost demonstrates many concepts of communication, especially throughout the nineteenth episode. 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This rebelling hero always seeks for a chance to take his revenge on the unshakable authority. Based on consideration of the strength of his party, man, the newest creation of God, turned into the ideal target. In the end, Eve successfullyRead More TH E LOST SHEEP, LOST COIN AND LOST SON Essay2262 Words   |  10 Pagesthe â€Å"lost† people that were passing by and stopped to listen Jesus’ stories. He told so many of them, but I think that the most important parables are about The Lost Sheep, Lost Coin and Lost Son. Because, that are the parables where he shows that God Loves the Sinners. Those parables can be read only in Luke. The Lost Sheep and Lost Coin are almost certainly thematically related, along with the parable of The Lost Son, which follows them. Many people are thinking that The Lost Sheep and Lost Coin

The Action Of Leading A Group Or An Organization - 1143 Words

Leadership: the action of leading a group or an organization. Language: the method of human communication. Both qualities portray a very important role in human communication and leading qualities. A good leader is a person who has diligently worked hard for themselves, has good communication,confidence,commitment, and intuition. Brutus, a tragic hero in the play, Julius Caesar, is a great example who has some significant good and bad leadership and language qualities. He is one of the â€Å"conspirators† whose main intention of murdering Julius caesar was because of the well-being of Rome. He was brainwashed and manipulated by the cunning, Cassius. He was very shrewd and didn’t want Julius Caesar alive because he wanted to become powerful and†¦show more content†¦He speaks of them often to Cassius, and is greatly disturbed when events force him to act in a manner inconsistent with them. Ironically, his widely reputed honor is what causes Cassius to make an all -out effort to bring him into an enterprise of debatable moral respectability. Brutus reputation is so great that it will act to convince others who are as yet undecided to join.Brutus’ concentration on honorable and noble behavior also leads him into assuming a naive view of the world.He is unable to see through the roles being played by Cassius, Casca, and Antony. He does not recognize the bogus letters have been sent by Cassius,although they contain sentiments and diction that would warn a more prospective member. He underestimates Antony as an opponent and he loses control over the discussion at the capitol following the assassination.The events that occurred because of Brutus’ naiveness led to his downfall and death. His first mistake was in Act 2, Scene 1. This was when the fake letters are sent to him from the conspirators. This was all a lie, a trap, to get Brutus to join in on the conspirator for Cassius knew he could not do it without Brutus’ support. Brutus believes these letters are from the people of Rome and agrees to the death of Caesar. Another example of this naiveness is in Act 3, Scene 2. Brutus decides to allow Antony to speak to show honor to Caesar. In the end, this decision ruins him. Antony riles the crowd into believing that the conspiratorsShow MoreRelatedThe Action Of Leading A Group Of People Or An Organization1489 Words   |  6 Pages Leadership- the action of leading a group of people or an organization. The ever-changing world today is begging for leaders to stand up and come forth. As the world is looking for these confident leaders, it is important to know what makes up the psychological aspect of leaders. All successful leaders share similar basic characteristics. These characteristics make it so leaders are able to advocate their ideas, and lead a team into success. Also, for leaders to lead, there must be followers toRead MoreA Leader Is An Action Leading A Group Or Organization1749 Words   |  7 P ages What is leadership? It is defined as being an action leading a group or organization. It involves being able to take control of certain situations, and leading in the correct direction. Being a leader takes great knowledge and skill. It involves one being able to make smart decisions in order for his/her congregation to come out as successful. A leader must also know, that it is wise to have people in his/her corner to advise them of good or bad decisions. President Barack ObamaRead MoreBrief Historical Description Of The Tyco Company1221 Words   |  5 PagesWaltham, Massachusetts. In 1982, to fortify the organization, Tyco were partitioned into three business portions which are flame insurance, gadgets and bundling. 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Evaluation of Online and Physical Store-Free-Samples for Students

Question: Write an Internal Document Memo based on your findings. Answer: To: The CEO (Silk Road furnishing) From: (TO BE FILLED BY STUDENT) Date: 23/09/2017 Sub: Effectiveness of offline and online shop Dear Sir, In reference to your request of evaluating the effectiveness of the online and offline stores, I have conducted an observation survey in Coles. Coles is being selected due to the reason that they have the presence in both online and offline retailing and they are operating it effectively. The research was being designed in such a way that it has denoted the advantages being possessed from both the online and physical store. I have also shortlisted the activities that they have designed specifically for the online and physical stores. The research is been done by visiting the store of Coles and observing the trend in their online marketplace. In the initial stage of their operation in Melbourne and Sydney, Coles started with their physical store only. It helped them to cater to the customers effectively. It is been observed that, providing service from their physical store helped them in determining the requirement of the customers effectively. Providing of effective customer service through the salesperson is only being applicable in the case of physical stores. Thus, the customers tend to have favorable impression about the brand. This is not applicable in the case of online stores. Thus, Coles initiated their physical stores in the initial stage of their operation. It helped them in generating the initial brand equity from the market. Afterwards, they came up with the online store to extend their already established market. Thus, online store for them acted as complimentary to their physical stores. Another advantage being possessed by Coles from their physical store is the providence of touch and feel to the customers. This is more effective for Coles due to the reason that, they operate in the consumer goods category and thus, customers tend to have the access of touch and feel before taking their buying decisions. Thus, through their physical store, Coles is providing their customers the touch and feel of their products. This feature is also not being available in the online store. Moreover, the initiation of spot discounts and offers can be offered to the customers. Providing offers and discounts are one of the key marketing activities for the retail organizations such as Coles. Thus, through their physical store, they are effectively driving these marketing activities. However, from their presence in the online market also, they are gathering favorable outcomes from the market. As discussed earlier, the online store for Coles came after the establishment of their physical store. Thus, it helped them in extending their existing market in the Melbourne and Sydney. Moreover, the market reach of their physical store is limited to the area of the Sydney and Melbourne. However, with the initiation of the online store, their market reach covered the outskirts also. Customers having the knowledge of their physical store but cannot visit due to the distance factor, availed their online facility. The numbers of targeted audience also get increased. Online store of Coles also helps them in offering more diverse and large range of products to the customers. This is possible in the case of their physical store. This is due to the reason that, Coles is having huge product portfolio, which is not possible for them to display all in their store. However, on the other hand, the online store of them displays their entire product portfolio. It is being noticed that Coles has done an effective job in complying their Omni channel presence. Due to this reason, several customers visit their physical store in order to have the access of touch and feel and order the products afterwards according to their convenience and requirement. On the other hand, some other customers search and select their required items from the online store and visit the physical store to have that touch and feel of that particular product. Thus, the average time being consumed in the physical store for the customers is being reduced. Therefore, from the conducted research, it can be concluded that, Coles has effectively implemented the strategy for their physical and online store. In the case of the Silk Road Furnishing also, it is being recommended that, an effective Omni channel marketing policy should be initiated in order to manage both medium efficiently. It will help the organization in targeting the entire available market and providing the highest level of convenience to the customers. It is being expected that this survey research will help you in determining the effectiveness of both the medium. Accordingly you can decide your own strategy. Please feel free to contact me in case of any clarification. Thanks and Regards.