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Springer R, Erroba J, O'Malley JP, Huguet N. Differences in up-to-date colorectal and cervical cancer screening rates by ethnicity and preferred language: An analysis across patient-, clinic-, and area-level data sources. SSM Popul Health 2024; 25:101612. [PMID: 38322786 PMCID: PMC10844668 DOI: 10.1016/j.ssmph.2024.101612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/08/2024] Open
Abstract
Research objective There is interest in using clinic- and area-level data to inform cancer control, but it is unclear what value these sources may add in combination with patient-level data sources. This study aimed to investigate associations of up-to-date colorectal and cervical cancer screenings at community health centers (CHCs) with ethnicity and language variables at patient-, clinic-, and area-levels, while exploring whether patient-level associations differed based on clinic-level patient language and ethnicity distributions. Study design This was a cross-sectional study using data from multiple sources, including electronic health records, clinic patient panel data, and area-level demographic data. The study sample included English-preferring Hispanic, Spanish-preferring Hispanic, English-preferring non-Hispanic, and non-English-preferring non-Hispanic patients eligible for either colorectal cancer (N = 98,985) or cervical cancer (N = 129,611) screenings in 2019 from 130 CHCs in the OCHIN network in CA, OR, and WA. Population studied The study population consisted of adults aged 45+ eligible for colorectal cancer screening and adults with a cervix aged 25-65 eligible for cervical cancer screening. Principal findings Spanish-preferring Hispanic patients were significantly more likely to be up-to-date with colorectal and cervical cancer screenings than other groups. Patients seen at clinics with higher concentrations of Spanish-preferring Hispanics were significantly more likely to be up-to-date, as were individuals residing in areas with higher percentages of Spanish-speaking residents. Differential associations between patient ethnicity and language and up-to-date colorectal cancer screenings were greater among patients seen at clinics with higher concentrations of Spanish-preferring Hispanics. Conclusions The findings highlight that Spanish-speaking Hispanics seen in CHCs have higher rates of up-to-date cervical and colorectal cancer screenings than other groups and that this relationship is stronger at clinics with higher percentages of Spanish-preferring Hispanic patients. Our findings suggest area-level variables are not good substitutions for patient-level data, but variables at the clinic patient panel-level are more informative.
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Affiliation(s)
- Rachel Springer
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Jeremy Erroba
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Nathalie Huguet
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
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Seanez CM, Nuño T, Gachupin FC, Harris RB. Mammography Compliance for Arizona and New Mexico Hispanic and American Indian Women 2016-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:19. [PMID: 38248484 PMCID: PMC10815889 DOI: 10.3390/ijerph21010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/23/2024]
Abstract
Hispanic and American Indian (AI) women experience lower breast cancer incidence than non-Hispanic White (NHW) women, but later-stage diagnoses and lower survival rates, suggesting issues with screening and healthcare access. Between 1999-2015, NHW breast cancer incidence decreased by 10% but increased by 8% for AI women. This study used 2016 and 2018 Behavioral Risk Factor Surveillance System data for Arizona and New Mexico to explore mammography screening. Analyses included Hispanic, AI, and NHW women aged ≥40 years (n = 12,830) to calculate age-specific compliance by race/ethnicity, logistic regression, and adjusted and sample-weighted evaluated associations between compliance and socio-economic covariates. In total, 75.1% of Hispanic women aged 50-74 reported mammography in the past two years (United States Preventive Services Task Force compliant) compared to 73.9% of NHW and 71.0% of AI women. Women who reported doctor visits in the past 12 months were likelier to comply than those without (AOR = 4.2 for Hispanic, 2.9 for AI, and 3.2 for NHW women). Reporting access to a personal doctor was related to compliance, except for AI women. While screening compliance was over 74%, visiting a healthcare provider in the past 12 months was essential. AI women reported issues that suggest unique challenges when deciding on mammography.
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Affiliation(s)
- Carol M. Seanez
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave., Tucson, AZ 85724, USA; (T.N.); (R.B.H.)
| | - Tomas Nuño
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave., Tucson, AZ 85724, USA; (T.N.); (R.B.H.)
| | - Francine C. Gachupin
- Department of Family and Community Medicine, College of Medicine, University of Arizona, 1601 N Tucson Blvd., Ste 32, Tucson, AZ 85716, USA;
| | - Robin B. Harris
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave., Tucson, AZ 85724, USA; (T.N.); (R.B.H.)
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Melkonian SC, Chen L, Jim MA, Haverkamp D, King JB. Disparities in incidence and trends of colorectal, lung, female breast, and cervical cancers among non-Hispanic American Indian and Alaska Native people, 1999-2018. Cancer Causes Control 2023; 34:657-670. [PMID: 37126144 PMCID: PMC10951714 DOI: 10.1007/s10552-023-01705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE This study is the first to comprehensively describe incidence rates and trends of screening-amenable cancers (colorectal, lung, female breast, and cervical) among non-Hispanic AI/AN (NH-AI/AN) people. METHODS Using the United States Cancer Statistics AI/AN Incidence Analytic Database, we, calculated incidence rates for colorectal, lung, female breast, and cervical cancers for NH-AI/AN and non-Hispanic White (NHW) people for the years 2014-2018 combined. We calculated age-adjusted incidence rates (per 100,000), total percent change in incidence rates between 1999 and 2018, and trends over this time-period using Joinpoint analysis. Screening prevalence by region was calculated using Behavioral Risk Factor Surveillance System data. RESULTS Rates of screening-amenable cancers among NH-AI/AN people varied by geographic region and age at diagnosis. Over half of all lung and colorectal cancers in NH-AI/AN people were diagnosed at later stages. Rates of lung and colorectal cancers decreased significantly between 1999-2018 among NH-AI/AN men, but no significant changes were observed in rates of screening-amenable cancers among NH-AI/AN women. CONCLUSION This study highlights disparities in screening-amenable cancers between NH-AI/AN and NHW people. Culturally informed, community-based interventions that increase access to preventive health services could reduce cancer disparities among AI/AN people.
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Affiliation(s)
- Stephanie C Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 500 Gold Ave SW, 9th Floor, Suite 9222, Albuquerque, New Mexico 87102, USA.
| | | | - Melissa A Jim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 500 Gold Ave SW, 9th Floor, Suite 9222, Albuquerque, New Mexico 87102, USA
| | - Donald Haverkamp
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 500 Gold Ave SW, 9th Floor, Suite 9222, Albuquerque, New Mexico 87102, USA
| | - Jessica B King
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Moscovice IS, Parsons H, Bean N, Santana X, Weis K, Hui JYC, Lahr M. Availability of cancer care services and the organization of care delivery at critical access hospitals. Cancer Med 2023; 12:17322-17330. [PMID: 37439021 PMCID: PMC10501243 DOI: 10.1002/cam4.6337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/15/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Critical access hospitals (CAHs) provide an opportunity to meet the needs of individuals with cancer in rural areas. Two common innovative care delivery methods include the use of traveling oncologists and teleoncology. It is important to understand the availability and organization of cancer care services in CAHs due to the growing population with cancer and expected declines in oncology workforce in rural areas. METHODS Stratified random sampling was used to generate a sample of 50 CAHs from each of the four U.S. Census Bureau-designated regions resulting in a total sample of 200 facilities. Analyses were conducted from 135 CAH respondents to understand the availability of cancer care services and organization of cancer care across CAHs. RESULTS Almost all CAHs (95%) provided at least one cancer screening or diagnostic service. Forty-six percent of CAHs reported providing at least one component of cancer treatment (chemotherapy, radiation, or surgery) at their facility. CAHs that offered cancer treatment reported a wide range of health care staff involvement, including 34% of respondents reporting involvement of a local oncologist, 38% reporting involvement of a visiting oncologist, and 28% reporting involvement of a non-local oncologist using telemedicine. CONCLUSION Growing disparities within rural areas emphasize the importance of ensuring access to timely screening and guideline-recommended treatment for cancer in rural communities. These data demonstrated that CAHs are addressing the growing need through a variety of approaches including the use of innovative models that utilize non-local providers and telemedicine to expand access to crucial services for rural residents with cancer.
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Affiliation(s)
- Ira S. Moscovice
- Flex Monitoring Team, Division of Health Policy and ManagementUniversity of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Helen Parsons
- Division of Health Policy and ManagementUniversity of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Nathan Bean
- Hennepin County Department of Public HealthMinneapolisMinnesotaUSA
| | - Xiomara Santana
- Flex Monitoring Team, Division of Health Policy and ManagementUniversity of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Kate Weis
- University of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Jane Yuet Ching Hui
- Division of Surgical Oncology, Department of SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Megan Lahr
- Flex Monitoring Team, Division of Health Policy and ManagementUniversity of Minnesota School of Public HealthMinneapolisMinnesotaUSA
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Alkhaldi RO, Alzahrani HA, Metwally LA. Awareness Level About Cervical Cancer, Human Papillomavirus (HPV) and Corresponding Vaccine Among Women Living in the Western Region of Saudi Arabia. Cureus 2023; 15:e37512. [PMID: 37193479 PMCID: PMC10182381 DOI: 10.7759/cureus.37512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/18/2023] Open
Abstract
Background In this study, we aimed to evaluate the knowledge and awareness about cervical cancer, human papillomavirus (HPV) and its vaccine among women living in the western region of Saudi Arabia. Methodology Using a cross-sectional online survey, this study assesses the knowledge and awareness level of HPV and the risk factors of cervical cancer among women living in the western region of Saudi Arabia. The design of the questionnaire is based on several earlier studies in different populations. Results The total completed responses include a sample of 624 that was subjected to statistical analysis; the analysis showed that only 34.6% were aware of HPV. Participants who belonged to the 21-30 and 31-40-year-old groups had comparatively more awareness than other age groups (p<0.001). Most (83.8%) believed that it would cause cervical cancer. Less than half (45.8%) knew that there is a vaccine against HPV infection. When we assessed the willingness to receive the vaccine, it was found that 75.8% were willing to take it. Conclusions The study found that women in the western region of Saudi Arabia have limited knowledge of cervical cancer and HPV and its vaccine. There is a need to educate and promote awareness of HPV and its complications for women in the western region of Saudi Arabia.
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Chuck KW, Hong S, Lee Y. Underuse of Gastric Cancer Screening Services among Koreans with Type 2 Diabetes. Healthcare (Basel) 2023; 11:healthcare11070927. [PMID: 37046854 PMCID: PMC10093844 DOI: 10.3390/healthcare11070927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
We aimed to compare the gastric cancer screening rates between participants with diabetes and those without diabetes in the Korean population. The data of 4284 participants from the Korea National Health and Nutrition Examination Survey 2019 were used. Cancer-free people aged ≥40 years were included, and cancer screening rates in diabetes and non-diabetes participants were analyzed. Baseline characteristics and screening rates were calculated using weighted frequencies and multivariable regression at a 95% confidence interval in both groups. Screening for gastric cancer was significantly lower (odd ratio [OR]: 0.77, 95% CI: 0.64-0.95) in patients with diabetes than in those without diabetes. The odds of performing the recommended gastric cancer screening were also lower (OR: 0.72, 95% CI: 0.58-0.90) in participants with diabetes than in those without diabetes. After adjusting for socio-demographic factors, the multivariable logistics regression analysis also showed lower odds for gastric cancer screening participation in diabetic patients than in non-diabetes participants. Conclusively, people with diabetes were less likely to have ever had or been recommended screening compared with those without diabetes. Greater efforts need to be made by health specialists to increase the awareness and the need of long-term preventive care including gastric cancer screening in high-risk groups.
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Affiliation(s)
- Kumban Walter Chuck
- Department of Medical Sciences, Ajou University, 206 World cup-ro, Yeongtong-gu, Suwon-si 16499, Republic of Korea
| | - Seri Hong
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, 164-World cup-ro, Yeongtong-gu, Suwon-si 16499, Republic of Korea
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, 164-World cup-ro, Yeongtong-gu, Suwon-si 16499, Republic of Korea
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Hirko KA, Xu H, Rogers LQ, Martin MY, Roy S, Kelly KM, Christy SM, Ashing KT, Yi JC, Lewis-Thames MW, Meade CD, Lu Q, Gwede CK, Nemeth J, Ceballos RM, Menon U, Cueva K, Yeary K, Klesges LM, Baskin ML, Alcaraz KI, Ford S. Cancer disparities in the context of rurality: risk factors and screening across various U.S. rural classification codes. Cancer Causes Control 2022; 33:1095-1105. [PMID: 35773504 PMCID: PMC9811397 DOI: 10.1007/s10552-022-01599-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/15/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Prior cancer research is limited by inconsistencies in defining rurality. The purpose of this study was to describe the prevalence of cancer risk factors and cancer screening behaviors across various county-based rural classification codes, including measures reflecting a continuum, to inform our understanding of cancer disparities according to the extent of rurality. METHODS Using an ecological cross-sectional design, we examined differences in cancer risk factors and cancer screening behaviors from the Behavioral Risk Factor Surveillance System and National Health Interview Survey (2008-2013) across rural counties and between rural and urban counties using four rural-urban classification codes for counties and county-equivalents in 2013: U.S. Office of Management and Budget, National Center for Health Statistics, USDA Economic Research Service's rural-urban continuum codes, and Urban Influence Codes. RESULTS Although a rural-to-urban gradient was not consistently evident across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all ptrend < 0.03), while colorectal, cervical and breast cancer screening decreased (all ptrend < 0.001) with increasing rurality. Differences in the prevalence of risk factors and screening behaviors across rural areas were greater than differences between rural and urban counties for obesity (2.4% vs. 1.5%), physical activity (2.9% vs. 2.5%), binge alcohol use (3.4% vs. 0.4%), cervical cancer screening (6.8% vs. 4.0%), and colorectal cancer screening (4.4% vs. 3.8%). CONCLUSIONS Rural cancer disparities persist across multiple rural-urban classification codes, with marked variation in cancer risk factors and screening evident within rural regions. Focusing only on a rural-urban dichotomy may not sufficiently capture subpopulations of rural residents at greater risk for cancer and cancer-related mortality.
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Affiliation(s)
- Kelly A Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Fee Road, East Lansing, MI, 48824, USA.
| | - Huiwen Xu
- Department of Preventive Medicine and Population Health and Sealy Center On Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Laura Q Rogers
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle Y Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Siddhartha Roy
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Kimberly M Kelly
- Department of Pharmaceutical Systems & Policy, West Virginia University, Morgantown, WV, USA
| | - Shannon M Christy
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kimlin Tam Ashing
- Division of Health Equities, City of Hope Comprehensive Cancer Center and Beckman Institute, Duarte, CA, USA
| | - Jean C Yi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marquita W Lewis-Thames
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cathy D Meade
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Qian Lu
- Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clement K Gwede
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Julianna Nemeth
- Department of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Rachel M Ceballos
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Usha Menon
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Katie Cueva
- Institute of Social and Economic Research, University of Alaska, Anchorage, AK, USA
| | - Karen Yeary
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lisa M Klesges
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Monica L Baskin
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kassandra I Alcaraz
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sabrina Ford
- Department of Obstetrics, Gynecology & Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Bhatia S, Landier W, Paskett ED, Peters KB, Merrill JK, Phillips J, Osarogiagbon RU. Rural-Urban Disparities in Cancer Outcomes: Opportunities for Future Research. J Natl Cancer Inst 2022; 114:940-952. [PMID: 35148389 PMCID: PMC9275775 DOI: 10.1093/jnci/djac030] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/27/2021] [Accepted: 02/01/2022] [Indexed: 01/12/2023] Open
Abstract
Cancer care disparities among rural populations are increasingly documented and may be worsening, likely because of the impact of rurality on access to state-of-the-art cancer prevention, diagnosis, and treatment services, as well as higher rates of risk factors such as smoking and obesity. In 2018, the American Society of Clinical Oncology undertook an initiative to understand and address factors contributing to rural cancer care disparities. A key pillar of this initiative was to identify knowledge gaps and promote the research needed to understand the magnitude of difference in outcomes in rural vs nonrural settings, the drivers of those differences, and interventions to address them. The purpose of this review is to describe continued knowledge gaps and areas of priority research to address them. We conducted a comprehensive literature review by searching the PubMed (Medline), Embase, Web of Science, and Cochrane Library databases for studies published in English between 1971 and 2021 and restricted to primary reports from populations in the United States and abstracted data to synthesize current evidence and identify continued gaps in knowledge. Our review identified continuing gaps in the literature regarding the underlying causes of rural-urban disparities in cancer outcomes. Rapid advances in cancer care will worsen existing disparities in outcomes for rural patients without directed effort to understand and address barriers to high-quality care in these areas. Research should be prioritized to address ongoing knowledge gaps about the drivers of rurality-based disparities and preventative and corrective interventions.
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Affiliation(s)
- Smita Bhatia
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Wendy Landier
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Zhang M, Sit JWH, Chan DNS, Akingbade O, Chan CWH. Educational Interventions to Promote Cervical Cancer Screening among Rural Populations: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116874. [PMID: 35682457 PMCID: PMC9180749 DOI: 10.3390/ijerph19116874] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023]
Abstract
The urban-rural gap in cervical cancer screening uptake is a significant public health consideration. Educational interventions are commonly adopted to promote cervical cancer screening among females in rural areas; however, the characteristics and effectiveness of these educational interventions remain unclear. In this review, we aimed to identify the characteristics of educational interventions used in rural populations and to evaluate the effects of these interventions on cervical cancer screening-related outcomes. Seven English databases were searched in January 2022. Randomized controlled trials (RCTs) and quasi-experimental studies were included. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomized Controlled Trials and the JBI Critical Appraisal Checklist for Quasi-Experimental Studies were used for quality appraisal. RevMan 5.4 software was used for the meta-analysis. A narrative synthesis was conducted in instances where a meta-analysis was inappropriate. Three RCTs and seven quasi-experimental studies conducted in six countries were included. A social cognitive theory-based framework, the community setting, group sessions, healthcare professional-led approaches, and culture-tailored materials were implemented in the educational interventions for cervical cancer screening. The educational content mainly included basic information on cervical cancer screening, psychological issues, barriers and strategies to overcome them, and locally available resources. Educational interventions increased the knowledge and uptake of cervical cancer screening in the rural population. However, the studies only evaluated the short-term effects of these educational interventions, with the cervical screening behavior only being assessed in one instance for each participant. Educational interventions promote cervical cancer screening among females in rural areas. Theory-driven, community-involved, group-based, and healthcare professional-led approaches should be prioritized in the application of educational interventions in rural populations. Both the short- and long-term, influences of educational interventions on the cervical cancer screening behavior of females in rural areas need to be recognized.
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Affiliation(s)
- Mengyue Zhang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Janet W H Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Dorothy Ngo Sheung Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Oluwadamilare Akingbade
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
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Zhang Z, Curran G, Xu K, Lim JY, Farris PE, Shannon J. Identify factors for insufficient (> 2 yr) mammogram screening among Oregonian women. Cancer Causes Control 2022; 33:293-301. [PMID: 34993663 DOI: 10.1007/s10552-021-01529-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Women with breast cancer diagnosed from mammogram screenings have a lower mortality risk than women diagnosed from symptoms. Currently, the U.S Preventive Services Task Force recommends biannual screening for women aged 50-74 years old. In this study, we aimed to identify factors associated with inadequate screening defined as "no mammogram screening within past 2 years" to guide cancer prevention and early detection efforts. METHODS This study utilized area-based probabilistic sampling survey data, collected across Oregon in 2019. Dataset weights were calculated using a raking approach. Demographic and behavior information were collected with existing validated questionnaire items from national surveys. Weighted multivariable logistic regression analyses with missing-value imputations were conducted to identify factors associated with inadequate mammogram screening. RESULTS The study included 254 women 50-74 years old without previous breast or ovarian cancer history. 19.29% of the sample reported no mammogram within two years, including 1.57% with no previous mammograms. Following unadjusted analyses, the significant factors included education, occupation status, health insurance and smoking and were therefore included into the adjusted model. In the multivariate adjusted model education remained significant while occupation status, health insurance and smoking were no longer significant. Compared to women with a college graduate degree, women with less than college graduate degree were at higher risk of inadequate screening [OR (95% CI) = 3.23 (1.54, 6.74)]. CONCLUSIONS Lack of education was significantly associated with inadequate mammogram screening even after adjusting for occupation status, health insurance and smoking, which should prompt further outreach and education.
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Affiliation(s)
- Zhenzhen Zhang
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
| | - Grace Curran
- Cancer Early Detection Advanced Research, Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Kenneth Xu
- Department of Psychology, Tulane University, 6400 Freret St., 2007 Percival Stern Hall, New Orleans, LA, 70118, USA
| | - Jeong Youn Lim
- Biostatistics Shared Resources, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Paige E Farris
- OHSU-PSU School of Public Health, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Jackilen Shannon
- OHSU-PSU School of Public Health, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
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Pourat N, Lu C, Chen X, Zhou W, Hair B, Bolton J, Sripipatana A. Trends in access to care among rural patients served at HRSA-funded health centers. J Rural Health 2021; 38:970-979. [PMID: 34617337 DOI: 10.1111/jrh.12626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Nearly one-fifth of Americans live in rural areas and experience multiple socioeconomic and health disparities. Health Resources and Services Administration (HRSA)-funded health centers (HCs) provide comprehensive primary care in rural communities. However, no prior research has examined trends in access to care in rural HC patients. We examined the change in access to care among patients served at rural HRSA-funded HCs in the United States between 2009 and 2014. METHODS We compared patients by year to examine measures of access using multilevel generalized structural equation logistic regression models with random effects. We used the 2009 and 2014 cross-sectional Health Center Patient Surveys and identified 2,625 adult rural HC patients. Dependent variables were subjective (unmet need/delay in medical care, mental health, dental care, and prescription medications) and objective measures (preventive care and other health care utilization) in access to care. Our independent variable of interest was time, comparing access in 2009 and 2014. RESULTS Rural HC patients reported higher predicted probability of influenza vaccine receipt (37% vs 51%), and lower unmet (25% vs 14%) and delayed medical care (36% vs 18%) between 2009 and 2014. Any emergency department visits in the last year increased (32% vs 46%) and mammogram (70% vs 55%) and Pap test (83% vs 72%) screening rates decreased. CONCLUSIONS Observed increases in access to care among rural HC patients are positive developments but the challenges to access care still persist. Remote services, such as telehealth, could be cost-effective means of improving access to care among rural patients with limited provider supply.
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Affiliation(s)
- Nadereh Pourat
- Health Economics and Evaluation Research Program, UCLA Center for Health Policy Research, Los Angeles, California, USA.,UCLA Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, California, USA
| | - Connie Lu
- Health Economics and Evaluation Research Program, UCLA Center for Health Policy Research, Los Angeles, California, USA
| | - Xiao Chen
- Health Economics and Evaluation Research Program, UCLA Center for Health Policy Research, Los Angeles, California, USA
| | - Weihao Zhou
- Health Economics and Evaluation Research Program, UCLA Center for Health Policy Research, Los Angeles, California, USA
| | - Brionna Hair
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland, USA
| | - Joshua Bolton
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland, USA
| | - Alek Sripipatana
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland, USA
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12
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Fuzzell LN, Perkins RB, Christy SM, Lake PW, Vadaparampil ST. Cervical cancer screening in the United States: Challenges and potential solutions for underscreened groups. Prev Med 2021; 144:106400. [PMID: 33388330 DOI: 10.1016/j.ypmed.2020.106400] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/09/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022]
Abstract
Cervical cancer screening rates in the United States are generally high, yet certain groups demonstrate disparities in screening and surveillance. Individuals at greatest risk for cervical cancer are often from marginalized or underserved groups who do not participate in regular screening for a variety of reasons. Using the Population-based Research to Optimize the Screening Process (PROSPR) Trans-Organ Conceptual Model, including concepts of individual-, provider-, facility-, system-, or policy-level factors, we provide a commentary to highlight reasons for low screening participation among subgroups in the U.S. These include racial and ethnic minorities, rural residents, sexual and gender minorities, those with limited English proficiency, those with particular religious beliefs, and various health conditions. We describe barriers and offer potential solutions for each group. In addition, we discuss cross-cutting barriers to screening including difficulty interacting with the healthcare system (limited knowledge and health literacy, lack of provider recommendation/contact), financial (cost, lack of insurance), and logistical barriers (e.g., lack of usual source of care, competing demands, scheduling issues). Solutions to address these barriers are needed to improve screening rates across all underscreened groups. Changes at state and national policy levels are needed to address health insurance coverage. Mobile screening, ensuring that interpreters are available for all visits, and targeted in reach at non-gynecological visits can further overcome barriers. Employing community outreach workers can increase community demand for screening, and patient navigators can improve adherence to both screening and follow-up diagnostic evaluation. HPV self-sampling can address multiple barriers to cervical cancer screening.
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Affiliation(s)
- Lindsay N Fuzzell
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America.
| | - Rebecca B Perkins
- Boston University School of Medicine, 85 E. Concord St., Boston, MA 02118, United States of America
| | - Shannon M Christy
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; University of South Florida, College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States of America
| | - Paige W Lake
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America
| | - Susan T Vadaparampil
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; University of South Florida, College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States of America.
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13
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The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041384. [PMID: 33546168 PMCID: PMC7913122 DOI: 10.3390/ijerph18041384] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/15/2022]
Abstract
One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.
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14
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Roozbahani N, Izadi B, Aznab M, Naderi M, Khazaei S. Epidemiology and clinical investigation of all cancer types in Kermanshah, Iran (2010–2019). CLINICAL CANCER INVESTIGATION JOURNAL 2021. [DOI: 10.4103/ccij.ccij_170_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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15
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Gopalani SV, Janitz AE, Martinez SA, Gutman P, Khan S, Campbell JE. Trends in Cancer Incidence Among American Indians and Alaska Natives and Non-Hispanic Whites in the United States, 1999-2015. Epidemiology 2020; 31:205-213. [PMID: 31764279 PMCID: PMC7386857 DOI: 10.1097/ede.0000000000001140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Female breast, prostate, lung, and colorectal cancers are the leading incident cancers among American Indian and Alaska Native (AI/AN) and non-Hispanic White (NHW) persons in the United States. To understand racial differences, we assessed incidence rates, analyzed trends, and examined geographic variation in incidence by Indian Health Service regions. METHODS To assess differences in incidence, we used age-adjusted incidence rates to calculate rate ratios (RRs) and 95% confidence intervals (CIs). Using joinpoint regression, we analyzed incidence trends over time for the four leading cancers from 1999 to 2015. RESULTS For all four cancers, overall and age-specific incidence rates were lower among AI/ANs than NHWs. By Indian Health Service regions, incidence rates for lung cancer were higher among AI/ANs than NHWs in Alaska (RR: 1.46; 95% CI: 1.37, 1.56) and Northern (RR: 1.29; 95% CI: 1.25, 1.33) and Southern (RR: 1.06; 95% CI: 1.03, 1.09) Plains. Similarly, colorectal cancer incidence rates were higher in AI/ANs than NHWs in Alaska (RR: 2.29; 95% CI: 2.14, 2.45) and Northern (RR: 1.04; 95% CI: 1.00, 1.09) and Southern (RR: 1.11; 95% CI: 1.07, 1.15) Plains. Also, AI/AN women in Alaska had a higher incidence rate for breast cancer than NHW women (RR: 1.05; 95% CI: 1.05, 1.20). From 1999 to 2015, incidence rates for all four cancers decreased in NHWs, but only rates for prostate (average annual percent change: -4.70) and colorectal (average annual percent change: -1.80) cancers decreased considerably in AI/ANs. CONCLUSION Findings from this study highlight the racial and regional differences in cancer incidence.
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Affiliation(s)
- Sameer V. Gopalani
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Amanda E. Janitz
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Sydney A. Martinez
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Pamela Gutman
- Cherokee Nation Health Research, Cherokee Nation, Tahlequah, OK
| | - Sohail Khan
- Cherokee Nation Health Research, Cherokee Nation, Tahlequah, OK
| | - Janis E. Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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16
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Zahnd WE, Askelson N, Vanderpool RC, Stradtman L, Edward J, Farris PE, Petermann V, Eberth JM. Challenges of using nationally representative, population-based surveys to assess rural cancer disparities. Prev Med 2019; 129S:105812. [PMID: 31422226 PMCID: PMC7289622 DOI: 10.1016/j.ypmed.2019.105812] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/08/2019] [Accepted: 08/14/2019] [Indexed: 12/16/2022]
Abstract
Population-based surveys provide important information about cancer-related health behaviors across the cancer care continuum, from prevention to survivorship, to inform cancer control efforts. These surveys can illuminate cancer disparities among specific populations, including rural communities. However, due to small rural sample sizes, varying sampling methods, and/or other study design or analytical concerns, there are challenges in using population-based surveys for rural cancer control research and practice. Our objective is three-fold. First, we examined the characterization of "rural" in four, population-based surveys commonly referenced in the literature: 1) Health Information National Trends Survey (HINTS); 2) National Health Interview Survey (NHIS); 3) Behavioral Risk Factor Surveillance System (BRFSS); and 4) Medical Expenditures Panel Survey (MEPS). Second, we identified and described the challenges of using these surveys in rural cancer studies. Third, we proposed solutions to address these challenges. We found that these surveys varied in use of rural-urban classifications, sampling methodology, and available cancer-related variables. Further, we found that accessibility of these data to non-federal researchers has changed over time. Survey data have become restricted based on small numbers (i.e., BRFSS) and have made rural-urban measures only available for analysis at Research Data Centers (i.e., NHIS and MEPS). Additionally, studies that used these surveys reported varying proportions of rural participants with noted limitations in sufficient representation of rural minorities and/or cancer survivors. In order to mitigate these challenges, we propose two solutions: 1) make rural-urban measures more accessible to non-federal researchers and 2) implement sampling approaches to oversample rural populations.
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Affiliation(s)
- Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Dr. Suite 204, Columbia, SC 29210, United States of America.
| | - Natoshia Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, United States of America.
| | - Robin C Vanderpool
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY 40536, United States of America.
| | - Lindsay Stradtman
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY 40536, United States of America.
| | - Jean Edward
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, United States of America.
| | - Paige E Farris
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America.
| | - Victoria Petermann
- School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall Campus Box #7460, Chapel Hill, NC 27599-7460, United States of America.
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Dr. Suite 204, Columbia, SC 29210, United States of America; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America; Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America.
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17
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Tran L, Tran P. US urban-rural disparities in breast cancer-screening practices at the national, regional, and state level, 2012-2016. Cancer Causes Control 2019; 30:1045-1055. [PMID: 31428890 DOI: 10.1007/s10552-019-01217-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/09/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Previous studies suggesting that rural US women may be less likely to have a recent mammogram than urban women are limited in either scope or granularity. This study explored urban-rural disparities in US breast cancer-screening practices at the national, regional, and state levels. METHODS We used data from the 2012, 2014, and 2016 Behavioral Risk Factor Surveillance Systems surveys. Logistic models were utilized to examine the impact of living in an urban/rural area on mammogram screening at three geographic levels while adjusting for covariates. We then calculated average adjusted predictions (AAPs) and average marginal effects (AMEs) to isolate the association between breast cancer screening and the urban/rural factor. RESULTS At all geographic levels, AAPs of breast cancer screening were similar among urban, suburban, and rural residents. Regarding "ever having a mammogram" and "having a recent mammogram," urban women had small but significantly higher adjusted probabilities (AAP: 94.6%, 81.1%) compared to rural women (AAP: 93.5%, 80.2%). CONCLUSIONS While urban-rural differences in breast cancer screening are small, they can translate into tens of thousands of rural women not receiving mammograms. Hence, there is a need to continue screening initiatives in these areas to reduce the number of breast cancer deaths.
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Affiliation(s)
- Lam Tran
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Phoebe Tran
- Department of Chronic Disease Epidemiology, Yale University, New Haven, CT, USA
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18
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Yu L, Sabatino SA, White MC. Rural-Urban and Racial/Ethnic Disparities in Invasive Cervical Cancer Incidence in the United States, 2010-2014. Prev Chronic Dis 2019; 16:E70. [PMID: 31172917 PMCID: PMC6583816 DOI: 10.5888/pcd16.180447] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Racial and socioeconomic disparities exist in cervical cancer screening, incidence, and mortality. The purpose of this study was to investigate how cervical cancer stage at diagnosis is associated with rurality and race/ethnicity. Methods We analyzed 2010 through 2014 data from the Centers for Disease Control and Prevention’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. We compared cervical cancer frequency and age-adjusted incidence for each stage by county-level rurality and race/ethnicity. Results There were 59,432 incident cases of cervical cancer reported from 2010 through 2014. The most common stage at diagnosis was localized (urban, 43.3%; rural 41.3%). Rural counties had higher incidence than urban counties for localized (rate ratio [RR] = 1.11; 95% confidence interval [CI], 1.07–1.15), regional (RR = 1.14; 95% CI, 1.10–1.19), and distant (RR = 1.12; 95% CI, 1.05–1.19) stage cervical cancer. Hispanic and non-Hispanic black women had higher incidence of regional and distant cervical cancer than non-Hispanic white women. Non-Hispanic white women in rural counties had higher incidence than those in urban counties at every stage. However, incidence for non-Hispanic white women was lower than for non-Hispanic black or Hispanic women. Conclusion Rural counties had higher incidence of cervical cancer than urban counties at every stage. However, the association of rural residence with incidence varied by race/ethnicity.
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Affiliation(s)
- Lulu Yu
- Washington University School of Medicine, Saint Louis, Missouri
| | - Susan A Sabatino
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, Georgia.,Centers for Disease Control and Prevention, 4770 Buford Highway NE, F76, Atlanta, GA 30341.
| | - Mary C White
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, Georgia
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19
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Duggan C, Molina Y, Carosso E, Ibarra G, Thompson B. County of Residence and Screening Practices among Latinas and Non-Latina Whites in Two Rural Communities. Ethn Dis 2019; 29:31-38. [PMID: 30713414 DOI: 10.18865/ed.29.1.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objectives Latinas are less likely than non-Latina Whites (NLW) to utilize mammographic screening and are more likely to be diagnosed with late-stage breast cancer. Here, we examine the effects of county-level factors on guideline-concordant breast-cancer screening behaviors in Latinas and NLWs. Design Latinas (N=108) and NLW women (N=132) aged >40 years, residing in two adjacent rural, medically underserved counties in eastern Washington State, completed a baseline questionnaire on mammography utilization and demographics. Main Outcome Measures Differences in socioeconomic variables and knowledge of screening practices were examined by ethnicity and county of residence. Predictors of having had a mammogram within the past two years were analyzed using multivariate logistic regression. Results Ethnicity was not associated with having a guideline-concordant mammogram; however, age (odds ratio [OR]=1.04, 95%CI:1.01-1.08); having >12 years of education (OR=2.09, 95%CI:1.16-3.79); having a regular clinic for health care (OR=2.22, 95%CI:1.05-4.70); having had a prior clinical breast exam (OR=5.07, 95%CI:1.71-15.02), and county of residence (OR=2.27, 95%CI:1.18-4.37) were all associated with having had a guideline-concordant mammogram. Conclusions County of residence and having had a prior CBE were strong predictors of screening utilization. Community-level factors in medically underserved areas may influence screening patterns.
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Affiliation(s)
- Catherine Duggan
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Yamile Molina
- Community Health Sciences Division, University of Illinois-Chicago, Chicago, IL
| | - Elizabeth Carosso
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Genoveva Ibarra
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Beti Thompson
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
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20
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Jerome-D’Emilia B, Gachupin FC, Suplee PD. A Systematic Review of Barriers and Facilitators to Mammography in American Indian/Alaska Native Women. J Transcult Nurs 2018; 30:173-186. [DOI: 10.1177/1043659618793706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The purpose of this systematic review was to synthesize the current knowledge of factors that enable or impede American Indian and Alaska Native (AI/AN) women from accessing breast cancer screening. Methodology: A systematic search of MEDLINE and CINAHL databases identified relevant research studies published from 2007 to 2017. Results: Consistent with other low-income populations, socioeconomic factors were related to lower rates of screening in AI/AN women. However, some factors, such as reliance on the Indian Health Service, cultural issues, and traditionality were unique to this population. Discussion: AI/AN women appear to face many of the difficulties that other low-income minority women face in accessing preventive care; however, they may face unique challenges and circumstances in accessing care. Efforts to work with tribes in the development of interventions framed by community-based participatory research are needed to tackle the disparities in the AI/AN community.
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21
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Mohammed KA, Subramaniam DS, Geneus CJ, Henderson ER, Dean CA, Subramaniam DP, Burroughs TE. Rural-urban differences in human papillomavirus knowledge and awareness among US adults. Prev Med 2018; 109:39-43. [PMID: 29378268 DOI: 10.1016/j.ypmed.2018.01.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/14/2018] [Accepted: 01/21/2018] [Indexed: 12/23/2022]
Abstract
Rural residents of the United States have higher HPV-associated cancer incidence and mortality, and suboptimal HPV vaccine uptake compared to urban residents. This study aimed to assess differences in knowledge and awareness of HPV, the HPV vaccine, and HPV-associated cancers among rural and urban residents. We analyzed data from the Health Information National Trends Survey 2013-2017 on 10,147 respondents ages ≥18 years. Multivariable logistic regression analyses compared urban/rural differences in knowledge and awareness of HPV, associated cancers, and HPV vaccine. Models were adjusted for sex, age, race/ethnicity, education, household income, census region, health insurance, regular provider, internet use, and personal history of cancer. Overall, 67.2% and 65.8% of urban residents were aware of HPV and HPV vaccine, respectively, compared to only 55.8% and 58.6% of rural residents. Adjusted models illustrated that compared to urban residents, rural residents were less likely to be aware of HPV (OR = 0.68, 95% CI = 0.53-0.86) and HPV vaccine (OR = 0.78, 95% CI = 0.63-0.97). Among those who were aware of HPV, rural residents were less likely to know that HPV causes cervical cancer (OR = 0.62, 95% CI = 0.46-0.84) and that HPV can be transmitted through sexual contact (OR = 0.72, 95% CI = 0.56-0.94). No significant differences between rural and urban residents were noted for knowledge that HPV is transmitted sexually and that it causes oral, anal, and penile cancers. This study highlights significant rural health disparities in knowledge and awareness of HPV and the HPV vaccine compared to urban counterparts.
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Affiliation(s)
- Kahee A Mohammed
- Saint Louis University Center for Outcomes Research (SLUCOR), St. Louis, MO, USA; Department of Internal Medicine, School of Medicine, Saint Louis University, St. Louis, MO, USA.
| | - Divya S Subramaniam
- Saint Louis University Center for Outcomes Research (SLUCOR), St. Louis, MO, USA
| | - Christian J Geneus
- Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Emmett R Henderson
- Saint Louis University College of Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Caress A Dean
- Master of Public Health Program, School of Health Sciences, Oakland University, Rochester, MI, USA
| | - Dipti P Subramaniam
- Division of Health Services Research, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Thomas E Burroughs
- Saint Louis University Center for Outcomes Research (SLUCOR), St. Louis, MO, USA; Saint Louis University College of Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
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22
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Heintzman J, Hatch B, Coronado G, Ezekiel D, Cowburn S, Escamilla-Sanchez O, Marino M. Role of Race/Ethnicity, Language, and Insurance in Use of Cervical Cancer Prevention Services Among Low-Income Hispanic Women, 2009-2013. Prev Chronic Dis 2018; 15:E25. [PMID: 29470167 PMCID: PMC5833315 DOI: 10.5888/pcd15.170267] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Hispanic women in the United States have an elevated risk of cervical cancer, but the existing literature does not reveal why this disparity persists. Methods We performed a retrospective cohort analysis of 17,828 low-income women aged 21 to 64 years seeking care at Oregon community health centers served by a hosted, linked electronic health record during 2009 through 2013. We assessed the odds of having had Papanicolaou (Pap) tests and receiving human papillomavirus (HPV) vaccine, by race/ethnicity, insurance status, and language. Results Hispanic women, regardless of pregnancy status or insurance, had greater odds of having had Pap tests than non-Hispanic white women during the study period. English-preferring Hispanic women had higher odds of having had Pap tests than Spanish-preferring Hispanic women (OR, 2.08; 95% confidence interval [CI], 1.63–2.66) but lower odds of having received HPV vaccination (OR, 0.21; 95% CI, 0.12–0.38). Uninsured patients, regardless of race/ethnicity, had lower odds of HPV vaccine initiation than insured patients did. Once a single dose was received, there were no significant racial/ethnic differences in vaccine series completion. Conclusion In this sample of low-income women seeking care at Oregon community health centers, we found minimal racial/ethnic disparities in the receipt of cervical cancer prevention services. Inequities by insurance status, especially in the receipt of HPV vaccine, persist. Community health center–based care may be a useful model to address racial/ethnic disparities in prevention, but this model would need further population-wide study.
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Affiliation(s)
- John Heintzman
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239. .,OCHIN, Inc, Portland, Oregon
| | - Brigit Hatch
- Oregon Health and Science University, Portland, Oregon.,OCHIN, Inc, Portland, Oregon
| | - Gloria Coronado
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - David Ezekiel
- Oregon Health and Science University, Portland, Oregon
| | | | | | - Miguel Marino
- Oregon Health and Science University, Portland, Oregon
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Utilization of Cervical Cancer Screening Among Hispanic Immigrant Women in Coastal South Carolina. J Racial Ethn Health Disparities 2017; 5:588-597. [PMID: 28702925 DOI: 10.1007/s40615-017-0404-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aims to examine prevalence and correlates of cervical cancer screening utilization and adherence among a growing population of Hispanic immigrant women in coastal South Carolina. METHODS We conducted a cross-sectional survey of 196 women to assess recency of screening and hypothesized study predictors (health status, beliefs, self-efficacy, having a regular provider, barriers to screening, and trust in providers). Multiple ordinal logistic regressions identified final covariates which would predict recency of screening. RESULTS Approximately 84% of women were up-to-date with their Pap tests and 47% had received a Pap test in the previous year. In the adjusted analyses, having a regular provider and having a chronic medical condition were significantly associated with recency of Pap test. CONCLUSIONS Differences in cervical cancer screening for participants were partially explained by psychosocial factors, health status, and individual and structural barriers to healthcare.
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Musselwhite LW, Oliveira CM, Kwaramba T, de Paula Pantano N, Smith JS, Fregnani JH, Reis RM, Mauad E, Vazquez FDL, Longatto-Filho A. Racial/Ethnic Disparities in Cervical Cancer Screening and Outcomes. Acta Cytol 2016; 60:518-526. [PMID: 27825171 DOI: 10.1159/000452240] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/03/2016] [Indexed: 12/15/2022]
Abstract
Invasive cervical cancer disproportionately affects women without sufficient access to care, with higher rates among minority groups in higher-income countries and women in low-resource regions of the world. Many elements contribute to racial/ethnic disparities in the cervical cancer continuum - from screening and diagnosis to treatment and outcome. Sociodemographic factors, access to healthcare, income and education level, and disease stage at diagnosis are closely linked to such inequities. Despite the identification of such elements, racial/ethnic disparities persist, and are widening in several minority subgroups, particularly in older women, who are ineligible for human papillomavirus (HPV) vaccination and are underscreened. Recent studies suggest that racial/ethnic differences in HPV infection exist and may also have a role in observed differences in cervical cancer. In this review, we provide an overview of the current literature on racial disparities in cervical cancer screening, incidence, treatment and outcome to inform future strategies to reduce persistent inequities.
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Cancer screening barriers and facilitators for under and never screened populations: A mixed methods study. Cancer Epidemiol 2016; 45:126-134. [PMID: 27810484 DOI: 10.1016/j.canep.2016.10.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 07/21/2016] [Accepted: 10/23/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cancer screening is below targets in Ontario, Canada. Our objective was to identify and quantify the barriers and facilitators for breast, cervical and colorectal cancer screening for under and never screened (UNS) residents living in Ontario between 2011 and 2013. METHODS We used a multi-phased mixed methods study design. Results from thematic analysis of focus group discussions with health care providers and UNS community members were used to develop an on-line, province-wide, cross-sectional survey to estimate the prevalence of barriers and facilitators for the provincial population. Adjusted prevalence odds ratios and 95% confidence intervals were estimated for UNS compared to regularly screened participants using logistic regression. RESULTS Four focus groups were held with health service providers and sixteen with UNS community members. Top barriers and facilitators themed around provider-patient communication, fear and embarrassment, history of physical or sexual abuse, social determinants of health (including low literacy, lack of awareness, and health insurance), symptoms appearing, and family and friends. 3075 participants completed the online survey. Compared to regularly screened participants, UNS had significantly higher odds of reporting: no regular health care provider; not feeling comfortable talking about screening; or the Doctor or Nurse Practitioner not suggesting screening. UNS also had significantly higher odds of reporting the facilitators: the test being less scary/painful or uncomfortable; friend/family insisting on getting screened; starting to have symptoms; or an easier test that could be done at home. CONCLUSIONS Interventions addressing fear through individual, interpersonal and structural facilitators may increase cancer screening.
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Rust G, Zhang S, Malhotra K, Reese L, McRoy L, Baltrus P, Caplan L, Levine RS. Paths to health equity: Local area variation in progress toward eliminating breast cancer mortality disparities, 1990-2009. Cancer 2015; 121:2765-74. [PMID: 25906833 PMCID: PMC4540479 DOI: 10.1002/cncr.29405] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/06/2015] [Accepted: 03/10/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND US breast cancer deaths have been declining since 1989, but African American women are still more likely than white women to die of breast cancer. Black/white disparities in breast cancer mortality rate ratios have actually been increasing. METHODS Across 762 US counties with enough deaths to generate reliable rates, county-level, age-adjusted breast cancer mortality rates were examined for women who were 35 to 74 years old during the period of 1989-2010. Twenty-two years of mortality data generated twenty 3-year rolling average data points, each centered on a specific year from 1990 to 2009. Mixed linear models were used to group each county into 1 of 4 mutually exclusive trend patterns. The most recent 3-year average black breast cancer mortality rate for each county was also categorized as being worse or not worse than the breast cancer mortality rate for the total US population. RESULTS More than half of the counties (54%) showed persistent, unchanging disparities. Roughly 1 in 4 (24%) had a divergent pattern of worsening black/white disparities. However, 10.5% of the counties sustained racial equality over the 20-year period, and 11.7% of the counties actually showed a converging pattern from high disparities to greater equality. Twenty-three counties had 2008-2010 black mortality rates better than the US average mortality rate. CONCLUSIONS Disparities are not inevitable. Four US counties have sustained both optimal and equitable black outcomes as measured by both absolute (better than the US average) and relative benchmarks (equality in the local black/white rate ratio) for decades, and 6 counties have shown a path from disparities to health equity.
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Affiliation(s)
- George Rust
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
- Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Shun Zhang
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Khusdeep Malhotra
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Leroy Reese
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Luceta McRoy
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA
| | - Peter Baltrus
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Lee Caplan
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Robert S Levine
- Department of Family & Community Medicine, Meharry Medical College, Nashville, TN
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Abstract
Previous studies have shown an association between cervical cancer screening and racial/ethnic minority status, no usual source of care, and lower socioeconomic status. This study describes the demographics and health beliefs of women who report never being screened for cervical cancer by area of residence. Data from the 2010 Behavioral Risk Factor Surveillance System were used to study women aged 21-65 years who reported never being screened for cervical cancer. Multivariate logistic regression modeling was used to calculate predicted marginals to examine associations between never being screened and demographic characteristics and health belief model (HBM) constructs by metropolitan statistical area (MSA). After adjusting for all demographics and HBM constructs, prevalence of never being screened was higher for the following women: non-Hispanic Asians/Native Hawaiians/Pacific Islanders (16.5 %, 95 % CI = 13.7 %, 19.8 %) who live in MSAs; those with only a high school diploma who live in MSAs (5.5 %, 95 % CI = 4.7 %, 6.5 %); those living in non-MSAs who reported "fair or poor" general health (4.1 %, 95 % CI = 3.1 %, 5.4 %); and those living in either MSAs and non-MSAs unable to see a doctor within the past 12 months because of cost (MSA: 4.4 %, 95 % CI = 4.0 %, 4.8 %; non-MSA: 3.4 %, 95 % CI = 2.9 %, 3.9 %). The Affordable Care Act will expand access to insurance coverage for cervical cancer screening, without cost sharing for millions of women, essentially eliminating insurance costs as a barrier. Future interventions for women who have never been screened should focus on promoting the importance of screening and reaching non-Hispanic Asians/Native Hawaiians/Pacific Islanders who live in MSAs.
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28
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Hernández CM, Wallace D. A profile of Mexican-born women who adhere to national cervical cancer screening recommendations. J Community Health Nurs 2014; 31:157-66. [PMID: 25051321 DOI: 10.1080/07370016.2014.926678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to examine Mexican-born women's utilization and adherence to cervical cancer screening guidelines. Ninety-seven women in the southeastern United States participated. Data were collected in Spanish. The majority of women met adherence guidelines for the pap exam. Marital status, educational attainment, marianismo, blood pressure knowledge, fatalism, cultural cancer beliefs, trust in provider, and perceived provider communication abilities were not associated with utilization or adherence to screening guidelines. This study had higher than expected adherence to screening guidelines. Nearly all women received screenings through safety net services indicating the need to advocate for continued public health funding.
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Affiliation(s)
- Christina M Hernández
- a School of Nursing , The University of North Carolina at Greensboro , Greensboro , North Carolina
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Meilleur A, Subramanian SV, Plascak JJ, Fisher JL, Paskett ED, Lamont EB. Rural residence and cancer outcomes in the United States: issues and challenges. Cancer Epidemiol Biomarkers Prev 2014; 22:1657-67. [PMID: 24097195 DOI: 10.1158/1055-9965.epi-13-0404] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
"Neighborhoods and health" research has shown that area social factors are associated with the health outcomes that patients with cancer experience across the cancer control continuum. To date, most of this research has been focused on the attributes of urban areas that are associated with residents' poor cancer outcomes with less focused on attributes of rural areas that may be associated with the same. Perhaps because there is not yet a consensus in the United States regarding how to define "rural," there is not yet an accepted analytic convention for studying issues of how patients' cancer outcomes may vary according to "rural" as a contextual attribute. The research that exists reports disparate findings and generally treats rural residence as a patient attribute rather than a contextual factor, making it difficult to understand what factors (e.g., unmeasured individual poverty, area social deprivation, area health care scarcity) may be mediating the poor outcomes associated with rural (or non-rural) residence. Here, we review literature regarding the potential importance of rural residence on cancer patients' outcomes in the United States with an eye towards identifying research conventions (i.e., spatial and analytic) that may be useful for future research in this important area.
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Affiliation(s)
- Ashley Meilleur
- Authors' Affiliations: Departments of Health Care Policy and Medicine, Harvard Medical School, Department of Society, Human Development, and Health, Harvard School of Public Health, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; and Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Division of Epidemiology, College of Public Health, and Division of Cancer Control and Prevention, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
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Gesink D, Mihic A, Antal J, Filsinger B, Racey CS, Perez DF, Norwood T, Ahmad F, Kreiger N, Ritvo P. Who are the under- and never-screened for cancer in Ontario: a qualitative investigation. BMC Public Health 2014; 14:495. [PMID: 24885998 PMCID: PMC4229738 DOI: 10.1186/1471-2458-14-495] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/14/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Observed breast, cervical and colon cancer screening rates are below provincial targets for the province of Ontario, Canada. The populations who are under- or never-screened for these cancers have not been described at the Ontario provincial level. Our objective was to use qualitative methods of inquiry to explore who are the never- or under-screened populations of Ontario. METHODS Qualitative data were collected from two rounds of focus group discussions conducted in four communities selected using maps of screening rates by dissemination area. The communities selected were archetypical of the Ontario context: urban, suburban, small city and rural. The first phase of focus groups was with health service providers. The second phase of focus groups was with community members from the under- and never-screened population. Guided by a grounded theory methodology, data were collected and analyzed simultaneously to enable the core and related concepts about the under- and never-screened to emerge. RESULTS The core concept that emerged from the data is that the under- and never-screened populations of Ontario are characterized by diversity. Group level characteristics of the under- and never-screened included: 1) the uninsured (e.g., Old Order Mennonites and illegal immigrants); 2) sexual abuse survivors; 3) people in crisis; 4) immigrants; 5) men; and 6) individuals accessing traditional, alternative and complementary medicine for health and wellness. Under- and never-screened could have one or multiple group characteristics. CONCLUSION The under- and never-screened in Ontario comprise a diversity of groups. Heterogeneity within and intersectionality among under- and never-screened groups adds complexity to cancer screening participation and program planning.
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Affiliation(s)
- Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada.
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