1
|
Garg A, Galvin AM, Griner SB, Rosberger Z, Daley EM, Thompson EL. HPV self-sampling among women in the United States: preferences for implementation. Cancer Causes Control 2024; 35:167-176. [PMID: 37633857 DOI: 10.1007/s10552-023-01778-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/09/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE With the inclusion of primary HPV testing in 2018 U.S. Preventive Services Taskforce guidelines, at-home HPV self-sampling may provide a future option for cervical cancer screening, especially among hard-to-reach populations in the U.S. This study evaluated the association of implementation preferences with the willingness of at-home HPV self-sampling. METHODS We conducted a cross-sectional study in 2018 among U.S. women ages 30-65 years, without a hysterectomy (n = 812). The outcome was willingness to have at-home HPV self-sampling (yes/no). Primary predictor variables (i.e., information source, methods of payment, methods of sending or receiving self-sampling kits) measured self-sampling implementation preferences. Adjusted logistic regression identified associations with willingness to have at-home HPV self-sampling. RESULTS Participants who preferred receiving information from healthcare providers (OR = 2.64; 95% CI 1.54,4.52) or from media or other sources (OR = 2.30; 95% CI 1.51,3.48) had higher HPV self-sampling willingness than participants who did not prefer those sources. Participants who did not want to pay for self-sampling (OR = 0.21; 95% CI 0.14,0.32) or did not know if they would pay for self-sampling (OR = 0.35; 95% CI 0.22,0.54) had lower odds of HPV self-sampling willingness compared to participants willing to pay. Participants who did not know which method they preferred for receiving a self-sampling kit (OR = 0.15, 95% CI 0.07,0.31) or preferred delivering the sample to the lab themselves (OR = 0.59; 95% CI 0.36,0.96) had lower odds for self-sampling willingness compared to participants who preferred the mail. CONCLUSION Understanding the preferences of women regarding the implementation of HPV self-sampling can improve uptake in cervical cancer screening, especially among hard-to-reach populations.
Collapse
Affiliation(s)
- Ashvita Garg
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Annalynn M Galvin
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stacey B Griner
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Zeev Rosberger
- Department of Oncology, Psychiatry and Psychology, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Ellen M Daley
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Erika L Thompson
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| |
Collapse
|
2
|
Kim MH, Jung HJ, Park SI, Kim BJ. Self-obtained vaginal samples for HPV DNA testing to detect HPV-related cervical disease. Int J Gynaecol Obstet 2021; 154:127-132. [PMID: 33368281 DOI: 10.1002/ijgo.13574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/06/2020] [Accepted: 12/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate if a self-obtained vaginal sample (SOVAS) contains sufficient DNA for a human papillomavirus (HPV) test and if the results are comparable to those obtained via cervical samples (CS) collected by a physician. METHODS One hundred and fifty-one women who had abnormal cervical smears or who were HPV-positive were enrolled. Self-sampling was done after reading instructions and watching a 2-min-long video, whereas CS was obtained with a cervical cytobrush during a gynecologic examination. RESULTS A multiplex real-time polymerase chain reaction-based assay detected the prevalence of any type of HPV to be 67.5% in the SOVAS and 57.4% in the CS, and that of high-risk (HR-) HPV to be 58.7% in the SOVAS and 48.6% in the CS. The sensitivity of detection of HR-HPV in the SOVAS was 100% (95% confidence interval [CI] -0.09 to 0.32) for high-grade squamous intraepithelial lesion, 78% (95% CI -0.09 to 0.13) for atypical squamous cells of undetermined significance or worse, and 95% (95% CI -0.01 to 0.25) for low-grade squamous intraepithelial lesion or worse, which was statistically within the non-inferiority margin compared with that of CS. CONCLUSION Our study shows that the collection of a SOVAS is feasible and it is comparable to a CS for HPV DNA testing. Future studies are required to investigate the feasibility and cost-effectiveness of a mail-delivered SOVAS for cervical cancer screening.
Collapse
Affiliation(s)
- Moon-Hong Kim
- Department of Obstetrics and Gynecology, Korea Institute of Radiological & Medical Sciences, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Hee-Jung Jung
- Department of Obstetrics and Gynecology, Korea Institute of Radiological & Medical Sciences, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Sang-Il Park
- Department of Obstetrics and Gynecology, Dongnam Institute of Radiological & Medical Sciences, Busan, Republic of Korea
| | - Beob-Jong Kim
- Department of Obstetrics and Gynecology, Korea Institute of Radiological & Medical Sciences, Korea Cancer Center Hospital, Seoul, Republic of Korea
| |
Collapse
|
3
|
Vielot NA, Islam JY, Sanusi B, Myers J, Smith S, Meadows B, Brewer NT, Smith JS. Overcoming barriers to adolescent vaccination: perspectives from vaccine providers in North Carolina. Women Health 2020; 60:1129-1140. [PMID: 32772834 DOI: 10.1080/03630242.2020.1802639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To capture strategies for achieving high adolescent coverage of tetanus-diphtheria-acellular pertussis (Tdap), meningococcal conjugate (MenACWY), and human papillomavirus (HPV) vaccination, we surveyed employees of 20 North Carolina (N.C.) clinics that achieved adolescent vaccination coverage higher than the state average. One employee per clinic completed a surveysummarizing clinic practices regarding adolescent vaccination; perceived barriers and facilitators to Tdap/MenACWY/HPV vaccination; and the role of "champions" who made special efforts to promote adolescent vaccination. Common perceived barriers for all vaccinations were parental opposition and logistical barriers to receiving vaccination. For HPV vaccination, employees cited parental concerns about sexual behavior and injection site pain; no school vaccination requirement; and low-perceived benefit in boys. Most clinics (80%) implemented successful changes to increase adolescent vaccination: consistently offering vaccination, tracking vaccination status using existing data, providing appointment reminders, updating providers on vaccination recommendations, and expanding vaccination hours. Strategies to improve HPV vaccination included co-administration with Tdap and MenACWY, and providing reminders to complete the vaccination series. Vaccine champions strongly recommended vaccination to parents (55%) and educated parents on vaccination recommendations (36%). Clinics in N.C.and similar settings can implement these and other low-resource strategies to overcome adolescent vaccination barriers. ABBREVIATIONS CDC=Centers for Disease Control and Prevention; EHR=Electronic health record; HPV=Human papillomavirus; Tdap=Tetanus-diphtheria-acellular pertussis vaccine; MenACWY=Meningococcal Conjugate Vaccine; NCIB=North Carolina Immunization Branch; NCIR=North Carolina Immunization Registry; ACIP=Advisory Committee on Immunization Practices.
Collapse
Affiliation(s)
- Nadja A Vielot
- Department of Family Medicine, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA
| | - Jessica Yasmine Islam
- Department of Epidemiology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA
| | - Busola Sanusi
- Department of Biostatistics, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA
| | - Jenny Myers
- Division of Public Health, Immunization Branch, North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
| | - Sara Smith
- Department of Epidemiology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA
| | - Beth Meadows
- Division of Public Health, Immunization Branch, North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
| | - Noel T Brewer
- Department of Health Behavior, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA
| | - Jennifer S Smith
- Department of Epidemiology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina , Chapel Hill, North Carolina, USA
| |
Collapse
|
4
|
Ford ME, Cannady K, Nahhas GJ, Knight KD, Chavis C, Crawford B, Malek AM, Martino E, Frazier S, Gathers A, Lawton C, Cartmell KB, Luque JS. Assessing an intervention to increase knowledge related to cervical cancer and the HPV vaccine. Adv Cancer Res 2020; 146:115-137. [PMID: 32241386 DOI: 10.1016/bs.acr.2020.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Human papillomavirus (HPV) infection is the primary risk factor for cervical cancer. While the HPV vaccine significantly reduces the risk of HPV infection and subsequent cervical cancer diagnosis, underuse is linked to lack of knowledge of its effectiveness in preventing cervical cancer. The purpose of this study was to evaluate a cancer educational intervention (titled "MOVENUP") to improve knowledge of cervical cancer, HPV, and the HPV vaccine among predominantly African American communities in South Carolina. The MOVENUP cancer educational intervention was conducted among participants residing in nine South Carolina counties who were recruited by community partners. The 4.5-h MOVENUP cancer educational intervention included a 30-min module on cervical cancer, HPV, and HPV vaccination. A six-item investigator-developed instrument was used to evaluate pre- and post-intervention changes in knowledge related to these content areas. Ninety-three percent of the 276 participants were African American. Most participants reporting age and gender were 50+ years (73%) and female (91%). Nearly half of participants (46%) reported an annual household income <$40,000 and 49% had not graduated from college. Statistically significant changes were observed at post-test for four of six items on the knowledge scale (P<0.05), as compared to pre-test scores. For the two items on the scale in which statistically significant changes were not observed, this was due primarily due to a baseline ceiling effect.
Collapse
Affiliation(s)
- Marvella E Ford
- Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States; Associate Director, Population Sciences and Cancer Disparities, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC United States; SmartState Endowed Chair in Cancer Disparities Research, South Carolina State University, Orangeburg, SC, United States.
| | - Kimberly Cannady
- Academic Affairs Faculty, Medical University of South Carolina, Charleston, SC, United States
| | - Georges J Nahhas
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States; Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, United States
| | - Kendrea D Knight
- Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Courtney Chavis
- Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Brittney Crawford
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Angela M Malek
- Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Erica Martino
- Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Starr Frazier
- Department of Biological and Physical Sciences, South Carolina State University, Orangeburg, SC, United States
| | - Antiqua Gathers
- Department of Biological and Physical Sciences, South Carolina State University, Orangeburg, SC, United States
| | - Claudia Lawton
- Institute of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Kathleen B Cartmell
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - John S Luque
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL, United States
| |
Collapse
|
5
|
Burger EA, Smith MA, Killen J, Sy S, Simms KT, Canfell K, Kim JJ. Projected time to elimination of cervical cancer in the USA: a comparative modelling study. LANCET PUBLIC HEALTH 2020; 5:e213-e222. [DOI: 10.1016/s2468-2667(20)30006-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/20/2019] [Accepted: 01/13/2020] [Indexed: 12/27/2022]
|
6
|
Tsui J, Llanos AA, Doose M, Rotter D, Stroup A. Determinants of Abnormal Cervical Cancer Screening Follow-Up And Invasive Cervical Cancer Among Uninsured and Underinsured Women in New Jersey. J Health Care Poor Underserved 2020; 30:680-701. [PMID: 31130545 DOI: 10.1353/hpu.2019.0050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To identify determinants of follow-up care and diagnosis of invasive cervical cancer among uninsured/underinsured women screened for cervical cancer. METHODS We examined the associations between health care facility, area-level, and individual-level factors on the outcomes of interest in retrospective cohort of women from the New Jersey Cancer Education and Early Detection Program (2000-2015). RESULTS Women screened at department of health clinics (aOR:3.11, 95% CI: 2.30-4.20) and health care system-affiliated clinics (aOR:1.71, 95% CI: 1.11-2.64) had higher odds of lacking follow-up care compared with women in private physician practices. Similarly, women residing in areas with the highest unemployment had higher odds of lacking follow-up (aOR:1.48, 95% CI: 1.07-2.06). Delays in follow-up care were higher for women born in Central/South American countries compared with U.S.-born women (aOR: 1.46, 95% CI: 1.12-1.92). CONCLUSIONS Improved outreach efforts and multilevel strategies are needed to address the persistent barriers to appropriate follow-up care for underserved women.
Collapse
|
7
|
Luque JS, Maupin J, Ferris DG. Comparative study of HPV and Cervical Cancer Knowledge and Beliefs between Mexican Immigrant Women in the US and Peruvian Women. CANCER HEALTH DISPARITIES 2019; 3:e1-e16. [PMID: 32280937 PMCID: PMC7147510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cervical cancer remains one of the major cancers affecting women from developing countries, especially those from socioeconomically disadvantage backgrounds. In the US, Hispanic immigrant women experience restricted access to health care and higher incidence rates of cervical cancer compared to the non-Hispanic white population. Knowledge of cervical cancer risk factors and symptoms is associated with greater interest in participating in regular cervical cancer screening. To explore knowledge and beliefs about cervical cancer, survey questionnaires were administered to Mexican immigrant women in southeast Georgia, US and to mestizo women - primarily Quechua language dominant speakers - in Cusco, Peru. As part of these survey studies, there was a list of 32 items asking participants to agree or disagree with whether certain symptoms or risk factors could cause cervical cancer and a pile sort of 15 of the most salient items. Cultural consensus analysis was used to calculate overall agreement with a cultural model of cervical cancer risk factor knowledge in each sample independently. For the Georgia sample, there was marginal consensus, but for the Peru sample, there was no consensus. Analysis of cultural competence values and residual agreement show significant differences across education in the Georgia study, with a positive correlation between education and cultural competence (r=0.50, p=0.001), but not in the Peru study. Likewise, the results of the pile sort data exhibited consensus for the Georgia sample for the cervical cancer risk factors, but not for the Peru sample. The lack of consensus among the Peru sample on either task suggests little widespread knowledge on risk factors of cervical cancer. Additional analyses related to factors associated with screening behaviors from the cultural cancer screening scale indicated more pronounced fatalistic beliefs and catastrophic disease expectations about cervical cancer among the Peruvian women compared to the Mexican immigrant women.
Collapse
Affiliation(s)
- John S. Luque
- Institute of Public Health, Florida A&M University, Tallahassee, FL, USA
| | - Jonathan Maupin
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
| | - Daron G. Ferris
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, USA
- CerviCusco, Cusco, Peru
| |
Collapse
|
8
|
The Next Generation of Cervical Cancer Screening: Should Guidelines Focus on Best Practices for the Future or Current Screening Capacity? J Low Genit Tract Dis 2019; 22:91-96. [PMID: 29570563 PMCID: PMC5895142 DOI: 10.1097/lgt.0000000000000378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
9
|
Des Marais AC, Zhao Y, Hobbs MM, Barclay L, Brewer NT, Smith JS. Home Self-Collection by Mail to Test for Human Papillomavirus and Sexually Transmitted Infections. Obstet Gynecol 2018; 132:1412-1420. [PMID: 30399091 PMCID: PMC6249061 DOI: 10.1097/aog.0000000000002964] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate the validity and acceptability of at-home self-collection to test for high-risk human papillomavirus (HPV) and sexually transmitted infections among women overdue for cervical cancer screening by national guidelines. METHODS Low-income, infrequently screened women were recruited from the general population in North Carolina to participate in an observational study. Participants provided two self-collected cervicovaginal samples (one at home and one in the clinic) and a clinician-collected cervical sample. Samples were tested for high-risk HPV, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium. Cervical samples were also tested by liquid-based cytology. RESULTS Overall, 193 women had conclusive high-risk HPV results for all three samples and cytology results. Prevalence of high-risk HPV within self-home samples (12.4%) was not different from that within clinician samples (11.4%; P=.79) and from that within self clinic samples (15.5%; P=.21). Positivity for high-risk HPV in all sample types increased with increasing grades of cervical abnormality (P<.001). Self-home samples detected high-risk HPV in all identified cases of high-grade squamous intraepithelial lesions and of cervical intraepithelial neoplasia 2 or worse. Detection was comparable across sample types for T vaginalis (range 10.2-10.8%), M genitalium (3.3-5.5%), C trachomatis (1.1-2.1%), and N gonorrhoeae (0-0.5%). Kappa values between sample types ranged from 0.56 to 0.66 for high-risk HPV, 0.86-0.91 for T vaginalis, and 0.65-0.83 for M genitalium. Most participants reported no difficulty understanding self-collection instructions (93.6%) and were willing to use self-collection in the future (96.3%). CONCLUSION Mail-based, at-home self-collection for high-risk HPV and sexually transmitted infection detection was valid and well accepted among infrequently screened women in our study. These findings support the future use of high-risk HPV self-collection to increase cervical cancer screening rates among higher risk women in the United States.
Collapse
Affiliation(s)
- Andrea C. Des Marais
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Yuqian Zhao
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), National Cancer Centre, Beijing, China
| | - Marcia M. Hobbs
- School of Medicine, University of North Carolina, Chapel Hill, NC
| | | | - Noel T. Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Jennifer S. Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
10
|
Luque JS, Tarasenko YN, Chen C. Correlates of Cervical Cancer Screening Adherence Among Women in the U.S.: Findings from HINTS 2013-2014. J Prim Prev 2018; 39:329-344. [PMID: 29876723 PMCID: PMC10878428 DOI: 10.1007/s10935-018-0513-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Following the latest update of cervical cancer screening guidelines in 2012, we estimate the prevalence of guideline adherent cervical cancer screening and examine its associated factors among a nationally representative sample of US women aged 21-65 years. Our study was based on cross-sectional data from Cycles 3 (2013) and 4 (2014) of the Health Information National Trends Survey. The final analytic sample consisted of 2822 women. Guideline adherent cervical cancer screening was defined as having a Pap test within the last 3 years. Correlates of guideline adherent cervical cancer screening included socio-demographic and health-related characteristics and HPV/cervical cancer-related beliefs and knowledge items. Multivariable logistic regression analyses were used to estimate prevalence of guideline adherent screening. An estimated 81.3% of women aged 21-65 years reported being screened for cervical cancer within the last 3 years. Controlling for sociodemographic and health-related characteristics and survey year, women aged 46-65 years were less likely to be guideline adherent than those aged 21-30 years (aPR = 0.89; 95% CI 0.82-0.97). The adjusted prevalence of adherence was significantly higher among married/partnered than among not married women (aPR = 1.13; 95% CI 1.05-1.22), and those with one to three medical visits (aPR = 1.30; 95% CI 1.14-1.48), and four or more visits in the past year (aPR = 1.26; 95% CI 1.09-1.45) compared to those with no medical visits. Differences in unadjusted prevalence of guideline adherent screening depending on women's beliefs and knowledge about HPV and cervical cancer were not significant in adjusted analyses. Lack of interaction with a healthcare provider, being not married/partnered and increasing age continue to be risk factors of foregoing guideline adherent cervical cancer screening.
Collapse
Affiliation(s)
- John S Luque
- Institute of Public Health, Florida A&M University, 1515 South MLK Blvd., Ste. 207B, Tallahassee, FL, 32307, USA.
| | - Yelena N Tarasenko
- Department of Health Policy and Management, Georgia Southern University, Statesboro, GA, USA
- Department of Epidemiology, Georgia Southern University, Statesboro, GA, USA
| | - Chen Chen
- College of Nursing and Health Professions, University of Southern Indiana, Evansville, IN, USA
| |
Collapse
|
11
|
Zhang Y, Ornelas IJ, Do HH, Magarati M, Jackson JC, Taylor VM. Provider Perspectives on Promoting Cervical Cancer Screening Among Refugee Women. J Community Health 2018; 42:583-590. [PMID: 27838808 DOI: 10.1007/s10900-016-0292-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Many refugees in the United States emigrated from countries where the incidence of cervical cancer is high. Refugee women are unlikely to have been screened for cervical cancer prior to resettlement in the U.S. National organizations recommend cervical cancer screening for refugee women soon after resettlement. We sought to identify health and social service providers' perspectives on promoting cervical cancer screening in order to inform the development of effective programs to increase screening among recently resettled refugees. This study consisted of 21 in-depth key informant interviews with staff from voluntary refugee resettlement agencies, community based organizations, and healthcare clinics serving refugees in King County, Washington. Interview transcripts were analyzed to identify themes. We identified the following themes: (1) refugee women are unfamiliar with preventive care and cancer screening; (2) providers have concerns about the timing of cervical cancer education and screening; (3) linguistic and cultural barriers impact screening uptake; (4) provider factors and clinic systems facilitate promotion of screening; and (5) strategies for educating refugee women about screening. Our findings suggest that refugee women are in need of health education on cervical cancer screening during early resettlement. Frequent messaging about screening could help ensure that women receive screening within the early resettlement period. Health education videos may be effective for providing simple, low literacy messages in women's native languages. Appointments with female clinicians and interpreters, as well as clinic systems that remind clinicians to offer screening at each appointment could increase screening among refugee women.
Collapse
Affiliation(s)
- Ying Zhang
- Family Medicine, University of Washington, UW Box 359846, 325 Ninth Ave, Seattle, WA, 98104, USA.
| | - India J Ornelas
- Health Services, University of Washington, UW Box 359455, Seattle, WA, 98105, USA
| | - H Hoai Do
- Cancer Prevention, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Maya Magarati
- School of Social Work, University of Washington, UW Box 354900, Seattle, WA, 98105, USA
| | - J Carey Jackson
- General Internal Medicine, University of Washington, UW Box 359959, Seattle, WA, 98104, USA
| | - Victoria M Taylor
- Cancer Prevention, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| |
Collapse
|
12
|
Zhao Y, Lai Y, Ge H, Guo Y, Feng X, Song J, Wang Q, Fan L, Peng Y, Cao M, Harris AL, Wang X, Tao L. Non-junctional Cx32 mediates anti-apoptotic and pro-tumor effects via epidermal growth factor receptor in human cervical cancer cells. Cell Death Dis 2017; 8:e2773. [PMID: 28492539 PMCID: PMC5520707 DOI: 10.1038/cddis.2017.183] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 12/13/2022]
Abstract
The role of connexin proteins (Cx), which form gap junctions (GJ), in progression and chemotherapeutic sensitivity of cervical cancer (CaCx), is unclear. Using cervix specimens (313 CaCx, 78 controls) and CaCx cell lines, we explored relationships among Cx expression, prognostic variables and mechanisms that may link them. In CaCx specimens, Cx32 was upregulated and cytoplasmically localized, and three other Cx downregulated, relative to controls. Cx32 expression correlated with advanced FIGO staging, differentiation and increased tumor size. In CaCx cell lines, Cx32 expression suppressed streptonigrin/cisplatin-induced apoptosis in the absence of functional GJ. In CaCx specimens and cell lines, expression of Cx32 upregulated epidermal growth factor receptor (EGFR) expression. Inhibition of EGFR signaling abrogated the anti-apoptotic effect of Cx32 expression. In conclusion, upregulated Cx32 in CaCx cells produces anti-apoptotic, pro-tumorigenic effects in vivo and vitro. Abnormal Cx32 expression/localization in CaCx appears to be both a mechanism and biomarker of chemotherapeutic resistance.
Collapse
Affiliation(s)
- Yifan Zhao
- Department of Pharmacology, Zhongshan
School of Medicine, Sun Yat-Sen University, Guangzhou
510080, China
- Department of Anesthesiology, Sun Yat-Sen
Memorial Hospital, Sun Yat-Sen University, Guangzhou
510120, China
| | - Yongchang Lai
- Department of Pharmacology, Zhongshan
School of Medicine, Sun Yat-Sen University, Guangzhou
510080, China
| | - Hui Ge
- Tumor Research Institute, Xinjiang
Medical University Affiliated Tumor Hospital, Urumqi,
Xinjiang
830000, China
| | - Yunquan Guo
- Department of Pathology, Xinjiang Medical
University Affiliated Tumor Hospital, Urumqi,
Xinjiang
830000, China
| | - Xue Feng
- Tumor Research Institute, Xinjiang
Medical University Affiliated Tumor Hospital, Urumqi,
Xinjiang
830000, China
| | - Jia Song
- Tumor Research Institute, Xinjiang
Medical University Affiliated Tumor Hospital, Urumqi,
Xinjiang
830000, China
| | - Qin Wang
- Department of Pharmacology, Zhongshan
School of Medicine, Sun Yat-Sen University, Guangzhou
510080, China
| | - Lixia Fan
- Department of Pharmacology, Zhongshan
School of Medicine, Sun Yat-Sen University, Guangzhou
510080, China
| | - Yuexia Peng
- Department of Pharmacology, Zhongshan
School of Medicine, Sun Yat-Sen University, Guangzhou
510080, China
| | - Minghui Cao
- Department of Anesthesiology, Sun Yat-Sen
Memorial Hospital, Sun Yat-Sen University, Guangzhou
510120, China
| | - Andrew L Harris
- Department of Pharmacology, Physiology
and Neuroscience, New Jersey Medical School - Rutgers University,
Newark, NJ
07103, USA
| | - Xiyan Wang
- Tumor Research Institute, Xinjiang
Medical University Affiliated Tumor Hospital, Urumqi,
Xinjiang
830000, China
| | - Liang Tao
- Department of Pharmacology, Zhongshan
School of Medicine, Sun Yat-Sen University, Guangzhou
510080, China
| |
Collapse
|
13
|
Islam JY, Gruber JF, Lockhart A, Kunwar M, Wilson S, Smith SB, Brewer NT, Smith JS. Opportunities and Challenges of Adolescent and Adult Vaccination Administration Within Pharmacies in the United States. BIOMEDICAL INFORMATICS INSIGHTS 2017; 9:1178222617692538. [PMID: 28469431 PMCID: PMC5345946 DOI: 10.1177/1178222617692538] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/04/2017] [Indexed: 11/16/2022]
Abstract
Pharmacies have been endorsed as alternative vaccine delivery sites to improve vaccination rates through increased access to services. Our objective was to identify challenges and facilitators to adolescent and adult vaccination provision in pharmacy settings in the United States. We recruited 40 licensed pharmacists in states with different pharmacy vaccination laws. Eligible pharmacists previously administered or were currently administering human papillomavirus (HPV); tetanus, diphtheria, and pertussis (TDAP); or meningitis (meningococcal conjugate vaccine [MCV4]) vaccines to adolescents aged 9 to 17 years. Pharmacists participated in a semistructured survey on in-pharmacy vaccine provision. Pharmacists commonly administered vaccinations to age-eligible adolescents and adults: influenza (100%, 100%), pneumococcal (35%, 98%), TDAP (80%, 98%), MCV4 (60%, 78%), and HPV (45%, 53%). Common challenges included reimbursement/insurance coverage (28%, 78%), education of patients/parents (30%, 40%), and pharmacists' time constraints (28%, 35%). Three-quarters of pharmacists reported that vaccination rates could be increased. National efforts should expand insurance coverage for vaccine administration reimbursement and improve data information systems to optimize provision within pharmacies.
Collapse
Affiliation(s)
- Jessica Y Islam
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joann F Gruber
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexandre Lockhart
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Manju Kunwar
- Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Spencer Wilson
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sara B Smith
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
14
|
Mapping new territory: Emerging challenges in cervical cancer prevention. Gynecol Oncol 2014; 132 Suppl 1:S1-2. [DOI: 10.1016/j.ygyno.2014.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
15
|
Cervical cancer prevention. Curr Opin Obstet Gynecol 2014; 26:1-2. [DOI: 10.1097/gco.0000000000000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Exploration of New England Native American Women’s Views on Human Papillomavirus (HPV), Testing, and Vaccination. J Racial Ethn Health Disparities 2014. [DOI: 10.1007/s40615-014-0009-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
17
|
Application of the Carolina Framework for Cervical Cancer Prevention. Gynecol Oncol 2013; 132 Suppl 1:S33-40. [PMID: 24333357 DOI: 10.1016/j.ygyno.2013.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/22/2013] [Accepted: 12/02/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The Carolina Framework for Cervical Cancer Prevention describes 4 main causes of cervical cancer incidence: human papillomavirus (HPV) infection, lack of screening, screening errors, and not receiving follow-up care. We present 2 applications of the Carolina Framework in which we identify high-need counties in North Carolina and generate recommendations for improving prevention efforts. METHODS We created a cervical cancer prevention need index (CCPNI) that ranked counties on cervical cancer mortality, HPV vaccine initiation and completion, Pap smear screening, and provision of Pap tests to rarely- or never-screened women. In addition, we conducted in-depth interviews with 19 key informants from programs and agencies involved in cervical cancer prevention in North Carolina. RESULTS North Carolina's 100 counties varied widely on individual CCPNI components, including annual cervical cancer mortality (median 2.7/100,000 women; range 0.0-8.0), adolescent girls' HPV vaccine initiation (median 42%; range 15%-62%), and Pap testing in the previous 3 years among Medicaid-insured adult women (median 59%; range 40%-83%). Counties with the greatest prevention needs formed 2 distinct clusters in the northeast and south-central regions of the state. Interviews generated 9 recommendations to improve cervical cancer prevention in North Carolina, identifying applications to specific programs and policies in the state. CONCLUSIONS This study found striking geographic disparities in cervical cancer prevention need in North Carolina. Future prevention efforts in the state should prioritize high-need regions as well as recommended strategies and applications in existing programs. Other states can use the Carolina Framework to increase the impact of their cervical cancer prevention efforts.
Collapse
|