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Tricco AC, Ng CH, Gilca V, Anonychuk A, Pham B, Berliner S. Canadian oncogenic human papillomavirus cervical infection prevalence: systematic review and meta-analysis. BMC Infect Dis 2011; 11:235. [PMID: 21892939 PMCID: PMC3185279 DOI: 10.1186/1471-2334-11-235] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 09/05/2011] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Oncogenic human papillomavirus (HPV) infection prevalence is required to determine optimal vaccination strategies. We systematically reviewed the prevalence of oncogenic cervical HPV infection among Canadian females prior to immunization. METHODS We included studies reporting DNA-confirmed oncogenic HPV prevalence estimates among Canadian females identified through searching electronic databases (e.g., MEDLINE) and public health websites. Two independent reviewers screened literature results, abstracted data and appraised study quality. Prevalence estimates were meta-analyzed among routine screening populations, HPV-positive, and by cytology/histology results. RESULTS Thirty studies plus 21 companion reports were included after screening 837 citations and 120 full-text articles. Many of the studies did not address non-response bias (74%) or use a representative sampling strategy (53%). Age-specific prevalence was highest among females aged < 20 years and slowly declined with increasing age. Across all populations, the highest prevalence estimates from the meta-analyses were observed for HPV types 16 (routine screening populations, 8 studies: 8.6% [95% confidence interval 6.5-10.7%]; HPV-infected, 9 studies: 43.5% [28.7-58.2%]; confirmed cervical cancer, 3 studies: 48.8% [34.0-63.6%]) and 18 (routine screening populations, 8 studies: 3.3% [1.5-5.1%]; HPV-infected, 9 studies: 13.6% [6.1-21.1%], confirmed cervical cancer, 4 studies: 17.1% [6.4-27.9%]. CONCLUSION Our results support vaccinating females < 20 years of age, along with targeted vaccination of some groups (e.g., under-screened populations). The highest prevalence occurred among HPV types 16 and 18, contributing a combined cervical cancer prevalence of 65.9%. Further cancer protection is expected from cross-protection of non-vaccine HPV types. Poor study quality and heterogeneity suggests that high-quality studies are needed.
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute, St Michael's Hospital, (38 Shuter Street), Toronto, Ontario, (M5B 1T8), Canada
| | - Carmen H Ng
- School of Population and Public Health, University of British Columbia, (2206 East Mall), Vancouver, British Columbia, (V6T 1Z3), Canada
| | - Vladimir Gilca
- Centre de Recherche du CHUL (CHUQ), l'Université Laval, (2705 boulevard Laurier), Québec, Québec, (G1V 4G2), Canada
| | - Andrea Anonychuk
- GlaxoSmithKline Biologicals, (Avenue Fleming 20), Wavre (1300), Belgium
| | - Ba' Pham
- Health Policy Management and Evaluation, University of Toronto, (155 College Street), Toronto, Ontario, (M5T 3MT), Canada
- Toronto Health Economics and Technology Assessment, University of Toronto, (144 College Street), Toronto, Ontario, (M5S 3M2), Canada
| | - Shirra Berliner
- Department of Epidemiology, University of Western Ontario, (Kresge Building), London, Ontario, (N6A 5C1), Canada
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Redwood-Campbell L, Fowler N, Laryea S, Howard M, Kaczorowski J. 'Before you teach me, I cannot know': immigrant women's barriers and enablers with regard to cervical cancer screening among different ethnolinguistic groups in Canada. Canadian Journal of Public Health 2011. [PMID: 21714325 DOI: 10.1007/bf03404903] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the similarities and differences among multiple groups of immigrant women and Canadian-born women of low socio-economic status regarding barriers and enablers associated with cervical cancer screening, in order to inform core elements of a strategy that would be acceptable across multiple underscreened groups. METHOD Within a health behaviour framework, we used a qualitative explanatory multiple-case study approach consisting of focus group interviews (n = 11) in Hamilton, Canada. Participants were newly immigrated (1-5 years) women and a group of Canadian-born women of low socio-economic status; all participants were in the age range 35-69 years and married. Language groups were Arabic, Cantonese, Somali, Dari (Afghanistan) and Spanish (Latin America). Two separate focus groups for each ethnolinguistic group were conducted; one in English and one in the native language. A template approach to analysis was used. RESULTS All groups indicated a strong need for information on necessity of screening and on how the procedure is done. Use of a video and a group discussion format were desired strategies. Women had positive feelings about being proactive for their health even if prevention had not been the norm in their home countries. There were differences between groups with respect to preferring a female clinician, which was a higher priority than language congruence with the provider. Only Chinese and Arabic groups discussed embarrassment and modesty as barriers. CONCLUSION Addressing key knowledge gaps around cervical cancer screening through personal approaches, educational videos and invitations may be useful core strategies to remove stigma and fear around screening and improve uptake across multiple ethnic groups and in women of lower socioeconomic status.
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Affiliation(s)
- Lynda Redwood-Campbell
- Department of Family Medicine, McMaster University, 175 Longwood Rd S, Ste 201A, Hamilton, ON L8P 0A1.
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Graham JE, Mishra A. Global challenges of implementing human papillomavirus vaccines. Int J Equity Health 2011; 10:27. [PMID: 21718495 PMCID: PMC3143925 DOI: 10.1186/1475-9276-10-27] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 06/30/2011] [Indexed: 12/02/2022] Open
Abstract
Human Papillomavirus vaccines are widely hailed as a sweeping pharmaceutical innovation for the universal benefit of all women. The implementation of the vaccines, however, is far from universal or equitable. Socio-economically marginalized women in emerging and developing, and many advanced economies alike, suffer a disproportionately large burden of cervical cancer. Despite the marketing of Human Papillomavirus vaccines as the solution to cervical cancer, the market authorization (licensing) of the vaccines has not translated into universal equitable access. Vaccine implementation for vulnerable girls and women faces multiple barriers that include high vaccine costs, inadequate delivery infrastructure, and lack of community engagement to generate awareness about cervical cancer and early screening tools. For Human Papillomavirus vaccines to work as a public health solution, the quality-assured delivery of cheaper vaccines must be integrated with strengthened capacity for community-based health education and screening.
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Affiliation(s)
- Janice E Graham
- Department of Bioethics, Dalhousie University, Faculty of Medicine, 1459 Oxford Street, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Amrita Mishra
- Technoscience and Regulation Research Unit, 1459 Oxford Street, Halifax, Nova Scotia, B3H 4R2, Canada
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Azerkan F, Sparén P, Sandin S, Tillgren P, Faxelid E, Zendehdel K. Cervical screening participation and risk among Swedish-born and immigrant women in Sweden. Int J Cancer 2011; 130:937-47. [PMID: 21437898 DOI: 10.1002/ijc.26084] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 02/23/2011] [Indexed: 11/10/2022]
Abstract
Cervical cancer is one of the most common cancers among women worldwide, although cervical screening has reduced the incidence in many high-income countries. Low screening uptake among immigrant women may reflect differences in risk of cervical cancer. We investigated the degree of participation in cervical screening among immigrant and Swedish-born women and their concurrent risk of cervical cancer based on individual information on Pap smears taken both from organized and opportunistic screening. Mean degree of participation in cervical screening was estimated for women between 23 and 60 years from 1993 to 2005, stratified by birth region and age at migration. In Poisson regression models, we estimated relative risks (RRs), incidence rates and incidence rate ratios of cervical cancer for women adhering or not to the cervical screening program. We also assessed effect of adherence to screening on the risk of cervical cancer among immigrant groups compared to Swedish-born women. The degree of participation was 62% and 49% among Swedish-born and immigrant women, respectively, with large variations between immigrant groups. Participation was lowest among those immigrating at older ages. Swedish-born and immigrant women who where nonadherent to the cervical screening program had a fivefold excess risk of cervical cancer compared to adherent women. After adjustment for screening adherence, excess RRs of cervical cancer were statistically significant only for women from Norway and the Baltic States. Participation to screening is lower among immigrant than Swedish-born women, and adherence to the recommended screening intervals strongly prevents cervical cancer.
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Affiliation(s)
- Fatima Azerkan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Chinese-Australian Women’s Knowledge, Facilitators and Barriers Related to Cervical Cancer Screening: A Qualitative Study. J Immigr Minor Health 2011; 13:1076-83. [DOI: 10.1007/s10903-011-9491-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lofters AK, Moineddin R, Hwang SW, Glazier RH. Predictors of low cervical cancer screening among immigrant women in Ontario, Canada. BMC WOMENS HEALTH 2011; 11:20. [PMID: 21619609 PMCID: PMC3121675 DOI: 10.1186/1472-6874-11-20] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/27/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Disparities in cervical cancer screening are known to exist in Ontario, Canada for foreign-born women. The relative importance of various barriers to screening may vary across ethnic groups. This study aimed to determine how predictors of low cervical cancer screening, reflective of sociodemographics, the health care system, and migration, varied by region of origin for Ontario's immigrant women. METHODS Using a validated billing code algorithm, we determined the proportion of women who were not screened during the three-year period of 2006-2008 among 455,864 identified immigrant women living in Ontario's urban centres. We created eight identical multivariate Poisson models, stratified by eight regions of origin for immigrant women. In these models, we adjusted for various sociodemographic, health care-related and migration-related variables. We then used the resulting adjusted relative risks to calculate population-attributable fractions for each variable by region of origin. RESULTS Region of origin was not a significant source of effect modification for lack of recent cervical cancer screening. Certain variables were significantly associated with lack of screening across all or nearly all world regions. These consisted of not being in the 35-49 year age group, residence in the lowest-income neighbourhoods, not being in a primary care patient enrolment model, a provider from the same region, and not having a female provider. For all women, the highest population-attributable risk was seen for not having a female provider, with values ranging from 16.8% [95% CI 14.6-19.1%] among women from the Middle East and North Africa to 27.4% [95% CI 26.2-28.6%] for women from East Asia and the Pacific. CONCLUSIONS To increase screening rates across immigrant groups, efforts should be made to ensure that women have access to a regular source of primary care, and ideally access to a female health professional. Efforts should also be made to increase the enrolment of immigrant women in new primary care patient enrolment models.
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Affiliation(s)
- Aisha K Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.
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McDermott S, Desmeules M, Lewis R, Gold J, Payne J, Lafrance B, Vissandjée B, Kliewer E, Mao Y. Cancer incidence among Canadian immigrants, 1980-1998: results from a national cohort study. J Immigr Minor Health 2011; 13:15-26. [PMID: 20490685 DOI: 10.1007/s10903-010-9347-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Canadian immigrants have lower overall cancer risk than the Canadian-born population. Less is known about risks for immigrant subgroups and site-specific cancers. Linked administrative data sets were used to compare cancer incidence between subgroups of immigrants to Canada and the general Canadian population. The study involved 128,962 refugees and 241,010 non-refugees. Standardized incidence ratios (SIRs) were calculated for all-site and site-specific cancers by immigration categories and regions of birth. Relative to the general Canadian population, incidence of all-site cancer was lower among immigrants overall, by sex and refugee status (non-refugee SIRs 0.25: men, 0.24: women; refugee SIRs 0.31: both). Significantly higher SIRs resulted for liver, nasopharyngeal and cervical cancers, including liver cancer among South-East Asian and North-East Asian immigrants, and nasopharyngeal cancer among North-East Asian non-refugees. Hypothesized explanations for variation in cancer incidence include earlier viral infection in the country of origin.
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Affiliation(s)
- Sarah McDermott
- Strategic Initiatives and Innovations Directorate, Public Health Agency of Canada, A.L. 6809B, Ottawa, ON, K1A 0K9, Canada.
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McDonald JT, Neily J. Race, immigrant status, and cancer among women in the United States. J Immigr Minor Health 2011; 13:27-35. [PMID: 19521768 DOI: 10.1007/s10903-009-9268-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Research on the incidence of cancer among the immigrant population has tended to be of quite a limited scope. We investigate whether immigrant women in the US are less likely to have been recently diagnosed with cancer, and what factors might help to explain any differences identified. We estimate multivariate Logistic regression models to identify the determinants of a diagnosis within the last 3 years of any cancer, of breast cancer and of cervical cancer as well as the use of cancer screening by US women, using self-reported information on cancer diagnosis from consecutive waves of the US National Health Interview Survey over the years 1998-2007. Immigrant women of different ethnic groups are less likely to have been diagnosed with cancer, breast cancer and cervical cancer compared to US-born women. The use of basic health services, including cancer screening, is also lower for immigrant women for each main ethnic group. More research is required to determine whether immigrants may face delays in timely diagnosis of cancer by health care professionals.
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Affiliation(s)
- James Ted McDonald
- Department of Economics, University of New Brunswick, Fredericton, NB, E3B5A3, Canada.
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Thomson MD, Hoffman-Goetz L. Application of the health literacy framework to diet-related cancer prevention conversations of older immigrant women to Canada. Health Promot Int 2011; 27:33-44. [PMID: 21421578 DOI: 10.1093/heapro/dar019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Health literacy, conceptualized as a framework involving basic (functional), interactive and critical skill sets, is a key determinant of health. Application of the health literacy framework (HLF) to immigrant populations has been limited. Our objective was to apply the HLF to discourses about diet-related colon cancer prevention among English-as-a-Second-Language (ESL) immigrant women. We also explored whether these discussions could inform the development of culturally appropriate information and potentially increase health literacy. Interviews were conducted with 64 older Spanish-speaking ESL immigrant women. Directed content analysis guided by the HLF was used to identify themes. Diet-related conversations were initiated by 43 (67%) participants. Four themes were identified: general information requests-low functional health literacy (FHL) (n = 23/43), specific nutrition inquiries-high FHL (n = 17/43), actions for healthy eating-low interactive health literacy (IHL) (n = 8/43) and community communication issues-high IHL (n = 3/43). No conversations representing critical health literacy were identified. Five women discussed both FHL and IHL themes. Women's diet-related conversations followed a continuum of increasing information needs supporting the HLF.
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Affiliation(s)
- M D Thomson
- Department of Social and Behavioral Health, Faculty of Medicine, Virginia Commonwealth University,1112 E. Clay Street, Richmond, VA 23298, USA.
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Cultural views, English proficiency and regular cervical cancer screening among older Chinese American women. Womens Health Issues 2011; 20:272-8. [PMID: 20620915 DOI: 10.1016/j.whi.2010.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 02/19/2010] [Accepted: 03/23/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the association between cultural views, English proficiency, and regular cervical cancer screening among older Chinese women. METHODS The study sample consisted of 473 asymptomatic Chinese participants aged 50 and older recruited from community organizations. The study outcome was regular receipt of Pap tests, defined as having a recent test in the past 3 years and another within 3 years before the present test. Eastern cultural views were measured by a 30-item scale that assessed beliefs about illness and cancer. Sociodemographics, cancer worry, physician recommendation, health insurance, and access barriers were included as covariates in multiple logistic regression models. RESULTS A total of 239 (50.5%) Chinese American women had regular Pap tests. Findings indicate that 1) women who held more traditional Chinese cultural views were less likely to be a regular screener (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.94-0.99); 2) women with higher English proficiency were 1.39 times more likely to have received regular Pap tests than women with lower proficiency (OR, 1.39; 95% CI, 1.13-1.72). CONCLUSION Cultural views and English proficiency were significant predictors of older Chinese American women regular receipt of Pap tests. Future research is needed to identify and design culturally and linguistically competent programs to promote cervical cancer screening.
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Thomson MD, Hoffman-Goetz L. Cancer information comprehension by English-as-a-second-language immigrant women. JOURNAL OF HEALTH COMMUNICATION 2011; 16:17-33. [PMID: 21120740 DOI: 10.1080/10810730.2010.529496] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Limited acculturation and socioeconomic factors have been associated with lower participation in cancer screening. Limited comprehension of cancer prevention information may contribute to this association. The authors used a stepwise linear regression to model acculturation and socioeconomic factors as predictors of comprehension (colon cancer and general health information) and screening intention in a sample of 78 Spanish-speaking immigrant women in Canada. The authors used the McNemar test to look for changes in women's screening intention. They used the Bidimensional Acculturation Scale, a language-based scale, to assess acculturation. Among English-as-a-second-language immigrant women, acculturation, television and Internet use, age, and Spanish-language education predicted comprehension of cancer prevention information, F(3, 69) = 6.76, p < .001, R(2) = .23. These variables also predicted comprehension of general health information, via the short form of the Test of Functional Health Literacy in Adults, F(4, 68) = 12.13, p < .001, R(2) = .42; and the Rapid Estimate of Adult Literacy in Medicine, F(2, 70) = 7.54, p = .001, R(2) = .17. However, the variables did not predict screening intention. More women expressed intention to be screened after reading the cancer prevention information than expected by chance alone, p = .002. Acculturation is an important influence on the comprehension of health information by older English-as-a-second-language immigrant women. However, other culture-related factors not measured by the Bidimensional Acculturation Scale likely influence their exposure to and understanding of health and cancer prevention information.
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Affiliation(s)
- M D Thomson
- Department of Health Studies and Gerontology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Lofters AK, Hwang SW, Moineddin R, Glazier RH. Cervical cancer screening among urban immigrants by region of origin: a population-based cohort study. Prev Med 2010; 51:509-16. [PMID: 20932995 DOI: 10.1016/j.ypmed.2010.09.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 09/23/2010] [Accepted: 09/27/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We compared the prevalence of appropriate cervical cancer screening among screening-eligible immigrant women from major geographic regions of the world and native-born women. METHODS We determined the proportion of women who were screened during the three-year period of 2006-2008 among 2.9 million screening-eligible women living in urban centres in Ontario, Canada. In multivariate analyses, we adjusted for numerous variables including age, neighbourhood-level income, and prenatal visits during the study period. RESULTS 61.3% of women were up-to-date on cervical cancer screening. Screening rates were lowest among women from South Asia when compared to the referent group (Canadian-born women and immigrants who arrived before 1985) (adjusted rate ratio 0.81, 95% CI [0.80-0.82] among women aged 18-49 years, adjusted rate ratio 0.67 [0.65-0.69] among women aged 50-66 years). Of the older South Asian women living in the lowest-income neighbourhoods and not in a primary care enrollment model, 21.9% had been appropriately screened. In contrast, among Canadian-born women living in the highest-income neighbourhoods and in a primary care enrollment model, 79.0% had been appropriately screened. CONCLUSION Efforts to reduce cervical cancer screening disparities should focus on women living in the lowest-income neighbourhoods and women from South Asia.
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Affiliation(s)
- Aisha K Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.
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Crocetti E, Manneschi G, Visioli CB, Zappa M. Risk of invasive cervical cancer and cervical intraepithelial neoplasia grade III in central Italy by area of birth. J Med Screen 2010; 17:87-90. [PMID: 20660437 DOI: 10.1258/jms.2010.009100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate cervical cancer incidence among women born in different countries but residing in Italy. SETTING Women aged 25-59 from a central Italian population-based cancer registry. METHODS Invasive and in situ cervical cancer incidence rates from 2000-2004 were calculated. Standardized incidence rates were based on the European standard population. Places of birth were categorized by nine different areas. RESULTS Within the resident population aged 25-59, there were 148 invasive cervical cancers (17.6% in women born outside Italy) and 501 (14.2% in women born outside Italy) cervical intraepithelial neoplasia grade III (CIN III) diagnoses. The incidence of invasive cervical cancer for women born in 'Central & South America and the Caribbean' was 60.5 per 100,000 and in 'Central and Eastern Europe' it was 38.3, statistically significantly higher than for women born in Italy (9.5 per 100,000). The CIN III rate was 35.0 per 100,000 for women born in Italy. The ratio between standardized rates for CIN III and invasive cancers was around 4 for women born in Italy and the 'extended European Union', and around 6 for those born in 'Asia'. It was 1.64 for women born in 'Africa', 1.31 in 'Central & South America and the Caribbean' and 0.69 for those born in 'Eastern Europe'. CONCLUSIONS Women who reside in Italy but were born in 'Central & South America and the Caribbean' or in 'Central and Eastern Europe' are at high risk for invasive cervical cancer. These groups are less inclined to participate in screening, and appropriate preventive strategies should be planned accordingly.
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Affiliation(s)
- Emanuele Crocetti
- Clinical and Descriptive Epidemiology Unit, Institute for cancer study and prevention ISPO, Florence, Italy.
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Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med 2010; 25:1186-92. [PMID: 20607434 PMCID: PMC2947642 DOI: 10.1007/s11606-010-1434-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 05/11/2010] [Accepted: 06/01/2010] [Indexed: 12/23/2022]
Abstract
INTRODUCTION U.S. Hispanic women suffer a disproportionate burden of cervical cancer, with incidence and mortality rates almost twice that of whites. Community health workers, or promotoras, are considered a potential strategy for eliminating such racial and ethnic health disparities. The current study is a randomized trial of a promotora-led educational intervention focused on cervical cancer in a local Hispanic community. METHODS Four promotoras led a series of two workshops with community members covering content related to cervical cancer. Sociodemographic characteristics, cervical cancer risk, previous screening history, cervical cancer knowledge, and self-efficacy were measured by a pre-intervention questionnaire. The post-intervention questionnaire measured the following outcomes: cervical cancer knowledge (on a 0-6 scale), self-efficacy (on a 0-5 scale), and receipt of Pap smear screening during the previous 6 months (dichotomous). Univariate analyses were performed using chi square, t-test, and the Mann-Whitney test. Multivariate logistic regression was used to model the association between explanatory variables and receipt of Pap smear screening. RESULTS There were no statistically significant differences between the two experimental groups at baseline. Follow-up data revealed significant improvements in all outcome measures: Pap smear screening (65% vs. 36%, p-value 0.02), cervical cancer knowledge (5.4 vs. 3.5, p-value<0.001), and self-efficacy (4.7 vs. 4.0, p-value 0.002). In multivariate analysis, cervical cancer knowledge (OR 1.68, 95% CI 1.10-2.81) and intervention group assignment (OR 6.74, 95% CI 1.77-25.66) were associated with receiving a Pap smear during the follow-up period. DISCUSSION Our randomized trial of a promotora-led educational intervention demonstrated improved Pap screening rates, in addition to increased knowledge about cervical cancer and self-efficacy. The observed association between cervical cancer knowledge and Pap smear receipt underscores the importance of educating vulnerable populations about the diseases that disproportionately affect them. Future research should evaluate such programs on a larger scale, and identify novel targets for intervention.
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Howlett RI, Larsh S, Dobi L, Mai V. Promoting cancer screening among Ontario Chinese women. Canadian Journal of Public Health 2010. [PMID: 19722348 DOI: 10.1007/bf03403954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Cancer screening participation is typically low among newcomers to Canada. Consequently, mortality and morbidity rates are higher in ethno/cultural populations. There are inherent challenges in reaching these population groups to increase awareness and participation in cancer screening. Many reports have cited the need for culturally appropriate materials and multi-pronged strategies for effective outreach in the Chinese community. This paper outlines the consultation/development process and evaluation strategy for promoting cancer screening among Chinese women with limited English language skills. PARTICIPANTS As Chinese is the third most commonly spoken language in Canada, this community education project focused on health promoters providing services to Chinese women 50 years and older. SETTING Ontario communities. INTERVENTION Partners and stakeholders were consulted and engaged to define the best approach to develop and distribute culturally sensitive public education resources to assist communities in realizing greater awareness of and participation in cancer screening. OUTCOMES Customized resource kits were developed and distributed to the target population over the course of two phases of this project. An evaluation strategy was designed and implemented to assess the impact of the project. CONCLUSION The process to develop culturally sensitive and evidence-based materials for Chinese is detailed in this article. This multi-year project designed and distributed customized resource kits, through consultation with partners and stakeholders. Project outcomes will be further assessed one year after distribution of the kits. This project template may be useful for adaptation and use in other ethnocultural groups within and outside Ontario.
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Lebrun LA, Dubay LC. Access to primary and preventive care among foreign-born adults in Canada and the United States. Health Serv Res 2010; 45:1693-719. [PMID: 20819107 DOI: 10.1111/j.1475-6773.2010.01163.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To conduct cross-country comparisons and assess the effect of foreign birth on access to primary and preventive care in Canada and the United States. DATA SOURCES Secondary data from the 2002 to 2003 Joint Canada-United States Survey of Health. STUDY DESIGN Descriptive and comparative analyses were conducted, and logistic regression models were used to assess the effect of immigrant status and country of residence on access to care. Outcomes included measures of health care systems and processes, utilization, and patient perceptions. PRINCIPAL FINDINGS In adjusted analyses, immigrants in Canada fared worse than nonimmigrants regarding having timely Pap tests; in the United States, immigrants fared worse for having a regular doctor and an annual consultation with a health professional. Immigrants in Canada had better access to care than immigrants in the United States; most of these differences were explained by differences in socioeconomic status and insurance coverage across the two countries. However, U.S. immigrants were more likely to have timely Pap tests than Canadian immigrants, even after adjusting for potential confounders. CONCLUSIONS In both countries, foreign-born populations had worse access to care than their native-born counterparts for some indicators but not others. However, few differences in access to care were found when direct cross-country comparisons were made between immigrants in Canada versus the United States, after accounting for sociodemographic differences.
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Affiliation(s)
- Lydie A Lebrun
- Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, 624 North Broadway, Room 447, Baltimore, MD 21205, USA.
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Low rates of cervical cancer screening among urban immigrants: a population-based study in Ontario, Canada. Med Care 2010; 48:611-8. [PMID: 20548258 DOI: 10.1097/mlr.0b013e3181d6886f] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Women who are immigrants or socioeconomically disadvantaged have been found to have significantly lower cervical cancer screening rates than their peers in Toronto, Ontario, Canada. The objective of this study was to examine rates of appropriate cervical cancer screening among women living in Ontario, Canada, using recent registration with Ontario's universal health insurance plan as an indicator of immigrant status. METHODS This retrospective cohort study included 2,273,995 screening-eligible women aged 25 to 69 years, who resided in Ontario's metropolitan areas during the calendar years 2003, 2004, and 2005. A validated algorithm was applied to the Ontario-wide physicians' claims database to determine which women had undergone cervical cancer screening with a Pap test during the 3-year period. RESULTS Appropriate cervical cancer screening occurred for 61.1% of women. Despite adjustment for physician contact and pregnancy rates, cervical cancer screening rates were especially low among: women aged 50 to 69 years; women living in low-income areas; and women who had registered with Ontario's universal health insurance plan within the preceding 10 years, a group consisting largely of recent immigrants. Women with all 3 of these characteristics had a screening rate of 31.0% compared with 70.5% among women with none of these characteristics. CONCLUSION Within a system of universal health insurance, appropriate cervical cancer screening is significantly lower among women who are older, living in low-income areas, or recent immigrants. Efforts to reduce disparities in cervical cancer screening should focus on women with these characteristics.
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Gushulak BD, Pottie K, Hatcher Roberts J, Torres S, DesMeules M. Migration and health in Canada: health in the global village. CMAJ 2010; 183:E952-8. [PMID: 20584934 DOI: 10.1503/cmaj.090287] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Immigration has been and remains an important force shaping Canadian demography and identity. Health characteristics associated with the movement of large numbers of people have current and future implications for migrants, health practitioners and health systems. We aimed to identify demographics and health status data for migrant populations in Canada. METHODS We systematically searched Ovid MEDLINE (1996-2009) and other relevant web-based databases to examine immigrant selection processes, demographic statistics, health status from population studies and health service implications associated with migration to Canada. Studies and data were selected based on relevance, use of recent data and quality. RESULTS Currently, immigration represents two-thirds of Canada's population growth, and immigrants make up more than 20% of the nation's population. Both of these metrics are expected to increase. In general, newly arriving immigrants are healthier than the Canadian population, but over time there is a decline in this healthy immigrant effect. Immigrants and children born to new immigrants represent growing cohorts; in some metropolitan regions of Canada, they represent the majority of the patient population. Access to health services and health conditions of some migrant populations differ from patterns among Canadian-born patients, and these disparities have implications for preventive care and provision of health services. INTERPRETATION Because the health characteristics of some migrant populations vary according to their origin and experience, improved understanding of the scope and nature of the immigration process will help practitioners who will be increasingly involved in the care of immigrant populations, including prevention, early detection of disease and treatment.
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Thomson MD, Hoffman-Goetz L. Colon cancer information preferences of English-as-a-second-language immigrant women: does language of interview matter? JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2010; 25:229-235. [PMID: 20151244 DOI: 10.1007/s13187-010-0041-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 01/08/2010] [Indexed: 05/28/2023]
Abstract
Language of interview, an acculturation proxy measure, may differentiate between cancer information preferences of English-as-a-second-language (ESL) immigrant women in Canada. Using directed content analysis, we compared 28 interviews conducted in Spanish or English. Demographic comparisons were completed using paired t tests and McNemar related samples. Themes identified were: (1) using English language information and (2) improving information for ESL speakers. No differences were found in women's conversations about colon cancer by age, income, education, or employment. However, English interviewees resided in Canada longer and watched less television. Language skill and contextual factors influence women's confidence using English cancer information.
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Affiliation(s)
- Maria D Thomson
- Department of Health Studies and Gerontology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Thomson MD, Hoffman-Goetz L. Acculturation and cancer information preferences of Spanish-speaking immigrant women to Canada: a qualitative study. Health Care Women Int 2010; 30:1131-51. [PMID: 19894155 DOI: 10.1080/07399330903200819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To explore the cancer information preferences of immigrant women by their level of acculturation we conducted interviews with 34 Spanish-speaking English-as-a-second-language (ESL) women. Chi-square and Fisher's exact tests were used to look for differences by acculturation. Four themes were identified: What is prevention? What should I do; sources of my cancer information, strategies I use to better understand, and identifying and closing my health knowledge gaps. Acculturation did not differentiate immigrant women's cancer information sources, preferences, or strategies used to address language barriers. We suggest the effect of acculturation is neither direct nor simple and may reflect other factors including self-efficacy.
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Affiliation(s)
- Maria D Thomson
- Faculty of Applied Health Sciences, Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada
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Shaw SJ, Huebner C, Armin J, Orzech K, Orzech K, Vivian J. The role of culture in health literacy and chronic disease screening and management. J Immigr Minor Health 2010; 11:460-7. [PMID: 18379877 DOI: 10.1007/s10903-008-9135-5] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cultural and language differences and socioeconomic status interact with and contribute to low health literacy, defined as the inability to understand or act on medical/therapeutic instructions. Health literacy is increasingly recognized as an important factor in patient compliance, cancer screening utilization, and chronic disease outcomes. Commendable efforts have been initiated by the American Medical Association and other organizations to address low health literacy among patients. Less work has been done, however, to place health literacy in the broader context of socioeconomic and cultural differences among patients and providers that hinder communication and compliance. This review examines cultural influences on health literacy, cancer screening and chronic disease outcomes. We argue that cultural beliefs around health and illness contribute to an individual's ability to understand and act on a health care provider's instructions. This paper proposes key aspects of the intersection between health literacy and culturally varying beliefs about health which merit further exploration.
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Affiliation(s)
- Susan J Shaw
- Department of Anthropology, University of Arizona, Tucson, AZ 85721-0030, USA.
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Kwan TTC, Chan KKL, Yip AMW, Tam KF, Cheung ANY, Lo SST, Lee PWH, Ngan HYS. Acceptability of human papillomavirus vaccination among Chinese women: concerns and implications. BJOG 2009; 116:501-10. [DOI: 10.1111/j.1471-0528.2008.01988.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Emmanuela Gakidou and colleagues find that coverage of cervical cancer screening in developing countries is on average 19% compared to 63% in developed countries.
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