1
|
Richardson LC, King JB, Thomas CC, Richards TB, Dowling NF, Coleman King S. Adults Who Have Never Been Screened for Colorectal Cancer, Behavioral Risk Factor Surveillance System, 2012 and 2020. Prev Chronic Dis 2022; 19:E21. [PMID: 35446758 PMCID: PMC9044898 DOI: 10.5888/pcd19.220001] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Lisa C Richardson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F76, Atlanta, GA 30341.
| | - Jessica B King
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cheryll C Thomas
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas B Richards
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole F Dowling
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sallyann Coleman King
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
2
|
St John J, Reininger B, Balcazar H, Valerio-Shewmaker MA, Beaudoin CE. What About Promotores? Promotores' Psychosocial Determinants That Influenced the Delivery of a Cervical Cancer Education Intervention to Hispanics. Front Public Health 2021; 9:689616. [PMID: 34568252 PMCID: PMC8460865 DOI: 10.3389/fpubh.2021.689616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
This study tested whether a cancer education intervention affected promotores' self-efficacy to deliver an intervention to Hispanics and which psychosocial determinants of promotores influenced the number of Hispanic residents reached by promotores in the subsequent education intervention. A quasi-experimental, pre/post-design with a treatment group (no control) assessed differences for promotores (n = 136) before and after exposure to the cancer education intervention. The design also included a cross-sectional evaluation of the number of residents promotores reached with the educational intervention. After being trained, the promotores delivered the intervention to Hispanic residents (n = 1,469). Paired t-tests demonstrated increases in promotores' self-efficacy from pre- to post-intervention. Regression models assessed associations between the numbers of residents reached and select psychosocial determinants of promotores. Age and promotores' years of experience influenced their delivery of a cervical cancer education intervention to Hispanics, but not their delivery of breast or colorectal cancer education interventions. This is the first study to examine which psychosocial determinants influence promotores delivery of cancer education interventions. The outcomes potentially have implications for CHW interventions and training by examining this potential connection between CHWs' psychosocial determinants and intervention outcomes.
Collapse
Affiliation(s)
- Julie St John
- Department of Public Health, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Abilene, TX, United States
| | - Belinda Reininger
- University of Texas Health Science Center at Houston School of Public Health, Brownsville, TX, United States
| | - Hector Balcazar
- College of Science and Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
| | - Melissa A Valerio-Shewmaker
- College of Science and Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
| | | |
Collapse
|
3
|
Viramontes O, Bastani R, Yang L, Glenn BA, Herrmann AK, May FP. Colorectal cancer screening among Hispanics in the United States: Disparities, modalities, predictors, and regional variation. Prev Med 2020; 138:106146. [PMID: 32473957 DOI: 10.1016/j.ypmed.2020.106146] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/31/2020] [Accepted: 05/24/2020] [Indexed: 02/06/2023]
Abstract
Hispanics represent the largest and one of the fastest growing minority populations in the U.S. and have lower survival from colorectal cancer (CRC) than non-Hispanic Whites (NHW). We aimed to examine screening modalities, predictors, and regional disparities among Hispanics and NHW in the U.S. by conducting a cross-sectional analysis of Hispanic participants age 50 to 75 from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) survey. The primary outcome was self-reported CRC screening status. We used the Rao-Scott Chi-square test to compare screening rates and modalities in NHWs and Hispanics. We also used univariable and multivariable logistic regression to determine predictors of screening among Hispanics and calculated Hispanic-NHW screening rate differences for each U.S. state/territory as a measure of regional screening disparities. The screening rate was 53.4% for Hispanics (N = 12,395), compared to 70.4% for NHWs (N = 186,331) (p < 0.001). Among Hispanics, colonoscopy was most common (75.9%). Uninsured status (aOR = 0.51; 95% CI = 0.38-0.70) and limited access to medical care (aOR = 0.38; 95% CI = 0.29-0.49) predicted lack of screening. States/territories with the largest screening disparities were North Carolina (33.9%), Texas (28.3%), California (25.1%), and Nebraska (25.6%). Disparities were smallest in New York (2.6%), Indiana (3.1%), and Delaware (4.0%). In Ohio and Guam, Hispanics had higher screening rates than NHWs. In conclusion, Hispanics have lower CRC screening rates than NHWs across most U.S. states/territories; however, the disparity varies by region. Future efforts must address multi-level barriers to screening among Hispanics and target regions with low rates to improve CRC outcomes in this growing population.
Collapse
Affiliation(s)
- Omar Viramontes
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Medicine, UCSF, San Francisco, CA, United States of America
| | - Roshan Bastani
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States of America
| | - Liu Yang
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Beth A Glenn
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States of America
| | - Alison K Herrmann
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States of America
| | - Folasade P May
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States of America; Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Medicine, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America.
| |
Collapse
|
4
|
Grzywacz V, Hussain N, Ragina N. Racial Disparities and Factors Affecting Michigan Colorectal Cancer Screening. J Racial Ethn Health Disparities 2017; 5:901-906. [PMID: 29101688 DOI: 10.1007/s40615-017-0438-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 09/03/2017] [Accepted: 10/04/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The objective of this study was to investigate the various factors that influence colorectal cancer screening in Michigan using 6091 participants in the Michigan Behavioral Risk Factor Surveillance System representing adults ≥ 50 years old. METHODS Screening for colorectal cancer was assessed as fecal occult blood testing or colonoscopy/sigmoidoscopy. Full models simultaneously adjusted for alcohol use, angina/coronary heart disease, stroke, heart attack, gender, income, marital status, race, age, diabetes, disability, exercise, health care coverage, health care access, smoking, and mental health. Data analysis included cross-tabulation and logistic regression modeling. RESULTS Minorities were 1.3 (unadjusted odds ratio; 95% confidence interval = 1.03-1.57) times more likely to never have a colonoscopy/sigmoidoscopy than non-Hispanic whites. Race/ethnicity was not significant in the full model, but adults with the following characteristics were significantly (p < 0.05) more likely to never have a colonoscopy/sigmoidoscopy: no personal doctor/health care provider, no health care coverage, light alcohol consumption ≤ 25% of days, no alcohol consumption, low income < $15,000, 50-64 years old, no diabetes, no activity limitation, no exercise, smoked daily, and smoked some days. CONCLUSION The racial disparity in colorectal cancer screening in Michigan was explained by other characteristics. The healthcare community can work to eliminate racial disparities in colorectal cancer screening by increasing screening efforts for individuals with these characteristics.
Collapse
Affiliation(s)
- Vincent Grzywacz
- Central Michigan University College of Medicine, 1280 S. East Campus St, Mt. Pleasant, MI, 48859, USA.
| | - Nasir Hussain
- Central Michigan University College of Medicine, 1280 S. East Campus St, Mt. Pleasant, MI, 48859, USA
| | - Neli Ragina
- Central Michigan University College of Medicine, 1280 S. East Campus St, Mt. Pleasant, MI, 48859, USA
| |
Collapse
|
5
|
Kim SB. Unraveling the Determinants to Colorectal Cancer Screening Among Asian Americans: a Systematic Literature Review. J Racial Ethn Health Disparities 2017; 5:683-699. [PMID: 28779479 DOI: 10.1007/s40615-017-0413-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 11/26/2022]
Abstract
Colorectal cancer (CRC) is one of the top three cancers experienced among Asian American (AA) men and women. One effective way to decrease incidence and mortality from CRC is the adherence of regular CRC screening; however, AA continue to receive the lowest screening rates compared to other racial/ethnic groups. When disaggregating this heterogeneous population, further disparities exist between subgroups. Examination of facilitators and barriers to cancer screening among AA subgroups is fairly recent and the synthesis of this information is limited. As such, a systematic review was conducted examining the facilitators and the barriers among Chinese, Filipino, Korean, and Japanese Americans using a systematic literature review method. The Health Belief Model served as the primary theoretical framework for this study and used to organize and synthesize the facilitators and barriers to CRC screening. In total, 22 articles yielded 29 examinations of each of the AA subgroups. Different facilitators and barriers to screening uptake for each subgroup were revealed; however, consistent across all the subgroups was physician recommendation as a facilitator and participants' unawareness of screening tests and those stating having no problems/symptoms of CRC as a barrier across screening modalities. Tailored approach in outreach and intervention efforts are suggested when achieving to improve CRC screening in AA ethnic subgroups.
Collapse
Affiliation(s)
- Sophia B Kim
- University of Hawaii at Manoa, Myron B. Thompson School of Social Work, 2430 Campus Road, Gartley Hall, Honolulu, HI, 96822, USA.
| |
Collapse
|
6
|
Williams CD, Grady WM, Zullig LL. Use of NCCN Guidelines, Other Guidelines, and Biomarkers for Colorectal Cancer Screening. J Natl Compr Canc Netw 2016; 14:1479-1485. [PMID: 27799515 PMCID: PMC5117951 DOI: 10.6004/jnccn.2016.0154] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/31/2016] [Indexed: 12/24/2022]
Abstract
Colorectal cancer (CRC) remains a common cancer and significant public health burden. CRC-related mortality is declining, partly due to the early detection of CRC through robust screening. NCCN has established the NCCN Guidelines for CRC Screening to help healthcare providers make appropriate screening recommendations according to the patient's risk of developing CRC. This review describes the evolution of CRC screening guidelines for average-risk individuals, discusses the role of NCCN Guidelines for CRC Screening in cancer prevention, and comments on the current and emerging use of biomarkers for CRC screening.
Collapse
Affiliation(s)
- Christina D. Williams
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham, NC, USA
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
| | - William M. Grady
- Clinical Research Division, Fred Hutchison Cancer Research Center, University of Washington, Seattle, Washington, USA
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA
| | - Leah L. Zullig
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA
- Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
7
|
Vallet F, Guillaume E, Dejardin O, Guittet L, Bouvier V, Mignon A, Berchi C, Salinas A, Launoy G, Christophe V. Influence of a screening navigation program on social inequalities in health beliefs about colorectal cancer screening. J Health Psychol 2016; 21:1700-10. [DOI: 10.1177/1359105314564018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The aim of the study was to test whether a screening navigation program leads to more favorable health beliefs and decreases social inequalities in them. The selected 261 noncompliant participants in a screening navigation versus a usual screening program arm had to respond to health belief measures inspired by the Protection Motivation Theory. Regression analyses showed that social inequalities in perceived efficacy of screening, favorable attitude, and perceived facility were reduced in the screening navigation compared to the usual screening program. These results highlight the importance of health beliefs to understand the mechanism of screening navigation programs in reducing social inequalities.
Collapse
Affiliation(s)
- Fanny Vallet
- Unity of Cognitives and Affectives Sciences (URECA) Lille 3 University, France
| | - Elodie Guillaume
- U1086 INSERM UCBN “Cancers & Préventions”, University Hospital of Caen, France
| | - Olivier Dejardin
- U1086 INSERM UCBN “Cancers & Préventions”, University Hospital of Caen, France
| | - Lydia Guittet
- U1086 INSERM UCBN “Cancers & Préventions”, University Hospital of Caen, France
| | - Véronique Bouvier
- U1086 INSERM UCBN “Cancers & Préventions”, University Hospital of Caen, France
| | - Astrid Mignon
- Unity of Cognitives and Affectives Sciences (URECA) Lille 3 University, France
| | - Célia Berchi
- U1086 INSERM UCBN “Cancers & Préventions”, University Hospital of Caen, France
| | - Agnès Salinas
- EA 3918 CERReV (Centre d’Etude et de Recherche sur les Risques et les Vulnérabilités), University of Caen, France
| | - Guy Launoy
- U1086 INSERM UCBN “Cancers & Préventions”, University Hospital of Caen, France
| | - Véronique Christophe
- Unity of Cognitives and Affectives Sciences (URECA) Lille 3 University, France
- U1086 INSERM UCBN “Cancers & Préventions”, University Hospital of Caen, France
| |
Collapse
|
8
|
Dawson G, Crane M, Lyons C, Burnham A, Bowman T, Travaglia J. A qualitative investigation of factors influencing participation in bowel screening in New South Wales. Health Promot J Austr 2016; 27:48-53. [DOI: 10.1071/he15026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 11/04/2015] [Indexed: 01/30/2023] Open
|
9
|
Determinants of variations in self-reported barriers to colonoscopy among uninsured patients in a primary care setting. J Community Health 2015; 40:260-70. [PMID: 25096763 DOI: 10.1007/s10900-014-9925-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Colorectal cancer (CRC) is the third most common type of cancer among both males and females in the United States and the second leading cause of cancer-related deaths. Although largely preventable through screening, early detection and removal of polyps, screening rates are considered sub-optimal. Perceived barriers to screening have been reported to influence screening rates. This paper examines variations in the extent to which uninsured patients identified barriers to CRC screening using colonoscopy based on race/ethnicity, educational attainment, age, gender, marital status and prior colonoscopy. Multivariate analyses showed that compared to Caucasians, African Americans had an increased likelihood of identifying lack of transportation as a barrier [odds ratio (OR) 2.68; 95 % confidence interval (CI) 1.35-5.32] while Hispanics were more likely to identify fear of finding cancer as a barrier (OR 2.09; 95 % CI 1.19-3.66). Compared to those with more than a high school education, there was increased likelihood of identifying lack of knowledge as a barrier among individuals with high school education (OR 3.51; 95 % CI 1.94-6.36) or less than a high school education (OR 2.16; 95 % CI 1.04-4.50). Our findings suggest that strategies aimed at increasing colonoscopy screening rates among underserved populations should take into consideration race/ethnicity, educational attainment, age, and prior colonoscopy experience when developing education and outreach plans to reduce barriers to colonoscopy.
Collapse
|
10
|
Goldman SN, Liss DT, Brown T, Lee JY, Buchanan DR, Balsley K, Cesan A, Weil J, Garrity BH, Baker DW. Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial. J Gen Intern Med 2015; 30:1178-84. [PMID: 25814264 PMCID: PMC4510220 DOI: 10.1007/s11606-015-3234-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 01/14/2015] [Accepted: 02/02/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Colorectal cancer (CRC) screening rates are low among vulnerable populations. Fecal immunochemical tests (FITs) are one screening modality with few barriers. Studies have shown that outreach can improve CRC screening, but little is known about its effectiveness among individuals with no CRC screening history. We sought to determine whether outreach increases FIT uptake among patients with no CRC screening history compared to usual care. METHODS This study was a patient-level randomized controlled trial, including 420 patients who had never completed CRC screening and were eligible for FIT; 66% were female, 62.1% were Latino, and 70.7% were uninsured. The main outcome measure was FIT completion within 6 months of the randomization date. We assessed FIT completion at different time points corresponding to receipt of outreach components. All analyses were re-run with 12-month data. RESULTS Patients who received outreach were more likely to complete FIT than those in usual care (36.7% vs. 14.8%; p < 0.001). FIT completion was more common among patients with increased clinic visits. The difference in FIT completion between the outreach and usual care groups decreased over time. DISCUSSION The intervention improved FIT uptake among patients with no CRC screening history. However, the intervention was less effective than in a previous trial targeting patients due for repeat screening. Additional research is needed to determine the best methods for improving CRC screening among this hard-to-reach group.
Collapse
Affiliation(s)
- Shira N Goldman
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Knight JR, Kanotra S, Siameh S, Jones J, Thompson B, Thomas-Cox S. Understanding Barriers to Colorectal Cancer Screening in Kentucky. Prev Chronic Dis 2015; 12:E95. [PMID: 26086608 PMCID: PMC4473604 DOI: 10.5888/pcd12.140586] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Colorectal cancer screening rates have increased significantly in Kentucky, from 35% in 1999 to 66% in 2012. A continued improvement in screening requires identification of existing barriers and implementation of interventions to address barriers. Methods The state of Kentucky added a question to the 2012 Kentucky Behavioral Risk Factor Surveillance System survey for respondents aged 50 years or older who answered no to ever having been screened for colorectal cancer by colonoscopy or sigmoidoscopy to assess the reasons why respondents had not been screened. Combined responses constituted 4 categories: attitudes and beliefs, health care provider and health care systems barriers, cost, and other. Prevalence estimates for barriers were calculated by using raking weights and were stratified by race/ethnicity, sex, education, income, and health insurance coverage. Logistic regression estimated odds ratios for barriers to screening. Results The most common barriers in all areas were related to attitudes and beliefs, followed by health care provider and systems, and cost. Non-Hispanic whites and respondents with more than a high school education were more likely to choose attitudes and beliefs as a barrier than were non-Hispanic blacks and those with less than a high school education. Respondents with low incomes and with no insurance were significantly more likely to select cost as a barrier. No significant associations were observed between demographic variables and the selection of a health care provider and a health care system. Conclusion Barriers related to education, race/ethnicity, income, and insurance coverage should be considered when designing interventions. Expansion of Medicaid and implementation of the Affordable Care Act in Kentucky could have an impact on reducing these barriers.
Collapse
Affiliation(s)
| | | | - Seth Siameh
- Kentucky Department for Public Health, Frankfort, Kentucky
| | | | - Becki Thompson
- Kentucky Department for Public Health, Frankfort, Kentucky
| | - Sue Thomas-Cox
- Kentucky Department for Public Health, Frankfort, Kentucky
| |
Collapse
|
12
|
Pignone MP, Crutchfield TM, Brown PM, Hawley ST, Laping JL, Lewis CL, Lich KH, Richardson LC, Tangka FK, Wheeler SB. Using a discrete choice experiment to inform the design of programs to promote colon cancer screening for vulnerable populations in North Carolina. BMC Health Serv Res 2014; 14:611. [PMID: 25433801 PMCID: PMC4267137 DOI: 10.1186/s12913-014-0611-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 11/17/2014] [Indexed: 01/22/2023] Open
Abstract
Background Screening for colorectal cancer (CRC) is suboptimal, particularly for vulnerable populations. Effective intervention programs are needed to increase screening rates. We used a discrete choice experiment (DCE) to learn about how vulnerable individuals in North Carolina value different aspects of CRC screening programs. Methods We enrolled English-speaking adults ages 50–75 at average risk of CRC from rural North Carolina communities with low rates of CRC screening, targeting those with public or no insurance and low incomes. Participants received basic information about CRC screening and potential program features, then completed a 16 task DCE and survey questions that examined preferences for four attributes of screening programs: testing options available; travel time required; money paid for screening or rewards for completing screening; and the portion of the cost of follow-up care paid out of pocket. We used Hierarchical Bayesian methods to calculate individual-level utilities for the 4 attributes’ levels and individual-level attribute importance scores. For each individual, the attribute with the highest importance score was considered the most important attribute. Individual utilities were then aggregated to produce mean utilities for each attribute. We also compared DCE-based results with those from direct questions in a post-DCE survey. Results We enrolled 150 adults. Mean age was 57.8 (range 50–74); 55% were women; 76% White and 19% African-American; 87% annual household income under $30,000; and 51% were uninsured. Individuals preferred shorter travel; rewards or small copayments compared with large copayments; programs that included stool testing as an option; and greater coverage of follow-up costs. Follow-up cost coverage was most frequently found to be the most important attribute from the DCE (47%); followed by test reward/copayment (33%). From the survey, proportion of follow-up costs paid was most frequently cited as most important (42% of participants), followed by testing options (32%). There was moderate agreement (45%) in attribute importance between the DCE and the single question in the post-DCE survey. Conclusions Screening test copayments and follow-up care coverage costs are important program characteristics in this vulnerable, rural population. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0611-4) contains supplementary material, which is available to authorized users.
Collapse
|
13
|
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.
Collapse
|
14
|
Hoebel J, Starker A, Jordan S, Richter M, Lampert T. Determinants of health check attendance in adults: findings from the cross-sectional German Health Update (GEDA) study. BMC Public Health 2014; 14:913. [PMID: 25185681 PMCID: PMC4167266 DOI: 10.1186/1471-2458-14-913] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Germany, adult health checks are carried out in the primary care setting for early detection of chronic conditions, such as cardiovascular diseases, diabetes, and kidney disease. This study aims to examine the social, behavioural, and health-related determinants of health check attendance among eligible adults in Germany. METHODS Data were derived from the cross-sectional German Health Update (GEDA) study, a national health survey among adults in Germany carried out by the Robert Koch Institute. Analyses were restricted to respondents with statutory health insurance aged 35 years or older (n = 26,555). Logistic regression models were fitted to estimate associations between health check attendance and factors selected on the basis of Andersen's Behavioral Model of Health Services Use. RESULTS After mutual adjustment, higher health check attendance was associated with a higher age, higher socioeconomic status, being married, stronger social support, physical activity, non-smoking, greater fruit and vegetable consumption, and higher use of outpatient care in both sexes. In women, higher attendance was related to alcohol consumption and having company health insurance (BKK) after multiple adjustment. In men, higher attendance was associated with better self-rated health after adjusting for all other factors. CONCLUSIONS The findings of this study suggest that people with an unfavourable risk factor profile, such as socioeconomically disadvantaged groups, smokers, physically inactive people, and persons with a low fruit and vegetable intake, are less likely to have health checks than those with a more favourable risk profile. Health checks carried out in the primary care setting should be evaluated for their effects on population health and health inequality.
Collapse
Affiliation(s)
- Jens Hoebel
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101 Berlin, Germany.
| | | | | | | | | |
Collapse
|
15
|
Wheeler SB, Kuo TM, Goyal RK, Meyer AM, Hassmiller Lich K, Gillen EM, Tyree S, Lewis CL, Crutchfield TM, Martens CE, Tangka F, Richardson LC, Pignone MP. Regional variation in colorectal cancer testing and geographic availability of care in a publicly insured population. Health Place 2014; 29:114-23. [PMID: 25063908 DOI: 10.1016/j.healthplace.2014.07.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 06/25/2014] [Accepted: 07/01/2014] [Indexed: 12/15/2022]
Abstract
Despite its demonstrated effectiveness, colorectal cancer (CRC) testing is suboptimal, particularly in vulnerable populations such as those who are publicly insured. Prior studies provide an incomplete picture of the importance of the intersection of multilevel factors affecting CRC testing across heterogeneous geographic regions where vulnerable populations live. We examined CRC testing across regions of North Carolina by using population-based Medicare and Medicaid claims data from disabled individuals who turned 50 years of age during 2003-2008. We estimated multilevel models to examine predictors of CRC testing, including distance to the nearest endoscopy facility, county-level endoscopy procedural rates, and demographic and community contextual factors. Less than 50% of eligible individuals had evidence of CRC testing; men, African-Americans, Medicaid beneficiaries, and those living furthest away from endoscopy facilities had significantly lower odds of CRC testing, with significant regional variation. These results can help prioritize intervention strategies to improve CRC testing among publicly insured, disabled populations.
Collapse
Affiliation(s)
- Stephanie B Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7411, McGavran Greenberg Hall, Chapel Hill, NC 27599-7411, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, CB#7590, Chapel Hill, NC 27599-7590, USA; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB#7426, Chapel Hill, NC 27599-7426, USA.
| | - Tzy-Mey Kuo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, USA
| | - Ravi K Goyal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, USA
| | - Anne-Marie Meyer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7411, McGavran Greenberg Hall, Chapel Hill, NC 27599-7411, USA
| | - Emily M Gillen
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7411, McGavran Greenberg Hall, Chapel Hill, NC 27599-7411, USA
| | - Seth Tyree
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, USA
| | - Carmen L Lewis
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, CB#7590, Chapel Hill, NC 27599-7590, USA; Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, 5045 Old Clinic Building, CB#7110, Chapel Hill, NC 27599-5039, USA
| | - Trisha M Crutchfield
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, CB#7590, Chapel Hill, NC 27599-7590, USA; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB#7426, Chapel Hill, NC 27599-7426, USA
| | - Christa E Martens
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, USA
| | - Florence Tangka
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA
| | - Lisa C Richardson
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA
| | - Michael P Pignone
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, CB#7590, Chapel Hill, NC 27599-7590, USA; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB#7426, Chapel Hill, NC 27599-7426, USA; Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, 5045 Old Clinic Building, CB#7110, Chapel Hill, NC 27599-5039, USA
| |
Collapse
|
16
|
Guy GP, Richardson LC, Pignone MP, Plescia M. Costs and benefits of an organized fecal immunochemical test-based colorectal cancer screening program in the United States. Cancer 2014; 120:2308-15. [PMID: 24737634 DOI: 10.1002/cncr.28724] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/25/2014] [Accepted: 03/11/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite clear recommendations and evidence linking colorectal cancer screening to lower incidence and mortality, > 40% of adults are not up to date with screening. Existing domestic and international models of organized cancer screening programs have been effective in increasing screening rates. Implementing an organized, evidence-based, national screening program may be an effective approach to increasing screening rates. METHODS In the current study, the authors estimated the initial investment required and the cost per person screened of a nationwide fecal immunochemical test (FIT)-based colorectal cancer screening program among adults aged 50 years to 75 years. RESULTS The initial additional investment required was estimated at $277.9 to $318.2 million annually, with an estimated 8.7 to 9.4 million individuals screened at a cost of $32 to $39 per person screened. The program was estimated to prevent 2900 to 3100 deaths annually. CONCLUSIONS The results of the current study indicate that implementing a national screening program would make a substantial public health impact at a moderate cost per person screened. Results from this analysis may provide useful information for understanding the public health benefit of an organized screening delivery system and the potential resources required to implement a nationwide colorectal cancer screening program, and help guide decisions about program planning, design, and implementation.
Collapse
Affiliation(s)
- Gery P Guy
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | |
Collapse
|
17
|
Hoebel J, Richter M, Lampert T. Social status and participation in health checks in men and women in Germany: results from the German Health Update (GEDA), 2009 and 2010. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:679-85. [PMID: 24194789 DOI: 10.3238/arztebl.2013.0679] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 05/07/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Representative data for Germany were used to determine whether a person's social-status characteristics affect the likelihood of having a check-up for the early detection of disease. METHODS The analyses reported here were performed on data obtained in the Robert Koch Institute's German Health Update (GEDA) in 2009 and 2010. The survey responses of 26 555 people about whether they had had a check-up were evaluated. For inclusion, participants were required to be over age 35 and covered by statutory health insurance. To study the potential links between social status and check-up participation rates, a multidimensional social-status index was used in addition to three individual components of social status (highest educational level attained, occupational status, income). RESULTS 50.8% of the men and 49.8% of the women surveyed had had a check-up in the two years before the survey. Low social status was associated with a lower rate of check-ups for both sexes (for men, odds ratio [OR] 0.59, 95% confidence interval [CI] 0.50-0.70, p<0.001; for women, OR 0.63, 95% CI 0.55-0.72, p<0.001). For both men and women, occupational status and income each had independent effects on check-up participation, while educational level was not found to have any independent effect. CONCLUSION These findings indicate that socially disadvantaged persons are less likely to have check-ups than others. Efforts to increase check-up rates should take account of the demonstrated effects of income level and occupational status.
Collapse
Affiliation(s)
- Jens Hoebel
- Department of Epidemiology and Health Reporting, Robert Koch Institute Berlin
| | | | | |
Collapse
|