1
|
Cervical Cancer Screening by Refugee Category in a Refugee Health Primary Care Clinic in Calgary, Canada, 2011-2016. J Immigr Minor Health 2022; 24:1534-1542. [PMID: 35233682 DOI: 10.1007/s10903-022-01345-5] [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: 02/07/2022] [Indexed: 10/19/2022]
Abstract
Newly arrived refugees and refugee claimants experience low cervical cancer screening (CCS) rates in Canada. We investigated CCS at a dedicated refugee clinic. We completed a retrospective cohort study among patients at the Mosaic Refugee Health Clinic in Calgary, Canada, between 2011 and 2016. We investigated CCS offers and completion by refugee category. We then used multivariable logistic regression to estimate the association of CCS screening and refugee category, accounting for sociodemographic and clinical factors. We included 812 refugees. Most were married (71%) and had limited English proficiency (57%). Overall, 88% and 77% of patients were offered and completed screening, respectively. Compared to government assisted refugees, privately sponsored refugees completed CCS more often (OR 1.60, 95% CI [1.02-2.49]). A dedicated refugee clinic may provide effective CCS to newly arrived refugees irrespective of refugee category, insurance status or other barriers.
Collapse
|
2
|
Machado S, Wiedmeyer ML, Watt S, Servin AE, Goldenberg S. Determinants and Inequities in Sexual and Reproductive Health (SRH) Care Access Among Im/Migrant Women in Canada: Findings of a Comprehensive Review (2008-2018). J Immigr Minor Health 2022; 24:256-299. [PMID: 33811583 PMCID: PMC8487436 DOI: 10.1007/s10903-021-01184-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 02/03/2023]
Abstract
Given growing concerns of im/migrant women's access to sexual and reproductive health (SRH) services, we aimed to (1) describe inequities and determinants of their engagement with SRH services in Canada; and (2) understand their lived experiences of barriers and facilitators to healthcare. Using a comprehensive review methodology, we searched the quantitative and qualitative peer-reviewed literature of im/migrant women's access to SRH care in Canada from 2008 to 2018. Of 782 studies, 38 met inclusion criteria. Ontario (n = 18), British Columbia (n = 6), and Alberta (n = 6) were primary settings represented. Studies focused primarily on maternity care (n = 20) and sexual health screenings (n = 12). Determinants included health system navigation and service information; experiences with health personnel; culturally safe and language-specific care; social isolation and support; immigration-specific factors; discrimination and racialization; and gender and power relations. There is a need for research that compares experiences across diverse groups of racialized im/migrants and a broader range of SRH services to inform responsive, equity-focused programs and policies.
Collapse
Affiliation(s)
- Stefanie Machado
- Centre for Gender and Sexual Health Equity, c/o St Paul's Hospital, 1081 Burrard, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Mei-Ling Wiedmeyer
- Centre for Gender and Sexual Health Equity, c/o St Paul's Hospital, 1081 Burrard, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Sarah Watt
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Argentina E Servin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Shira Goldenberg
- Centre for Gender and Sexual Health Equity, c/o St Paul's Hospital, 1081 Burrard, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.
| |
Collapse
|
3
|
Khalid A, Haque S, Alvi S, Ferdous M, Genereux O, Chowdhury N, Turin TC. Promoting Health Literacy About Cancer Screening Among Muslim Immigrants in Canada: Perspectives of Imams on the Role They Can Play in Community. J Prim Care Community Health 2022; 13:21501319211063051. [PMID: 35118911 PMCID: PMC8819818 DOI: 10.1177/21501319211063051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: Immigrants tend to have lower rates of cancer screening
than non-immigrants in Canada. Inequity in screening rates may stem from
religious factors, which religious leaders can influence. This study aimed to
explore the knowledge and attitudes held by Muslim religious leaders about
cancer screening, as well as the role religious leaders perceive they can play
in improving cancer screening health literacy among South Asian Muslim immigrant
women. Methods: We conducted interviews with 8 Muslim religious
leaders in Calgary, Canada. Participants’ knowledge and attitudes were
inductively summarized using descriptive analysis, while practices were
deductively thematically analyzed using the Socioecological Model and the
Communication for Development approaches. Results: We found
participants mostly had some knowledge of cancer, but lesser knowledge of
different screening tests and of low screening rates among immigrants.
Participants proposed that their role as a speaker, access to facilities and
community networks, and collaboration with universities and healthcare
professionals could help overcome religious misinterpretations and promote
cancer screening among South Asian Muslim immigrant women.
Conclusion: Religious leaders were highly supportive of
incorporating health messaging into faith-based messaging. Future work should
focus on implementing the practices recommended in this study with South Asian
Muslim immigrant women’s voices at their center.
Collapse
Affiliation(s)
- Ayisha Khalid
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sarika Haque
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Saad Alvi
- Department of Biological Sciences, University of Calgary, Calgary, AB, Canada
| | - Mahzabin Ferdous
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Olivia Genereux
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nashit Chowdhury
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,The O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
4
|
Immigration, screening, and cervical cancer incidence: an application of Age-Period-Cohort analysis. Eur J Cancer Prev 2020; 28:529-536. [PMID: 30431461 PMCID: PMC6784855 DOI: 10.1097/cej.0000000000000495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cervical cancer (CC) control is based on the implementation of effective screening programs. In the coming years, human papilloma virus vaccination coverage will contribute considerably toward cancer prevention. In Italy, where an organized screening program has been implemented, immigration from low/middle-income countries with a high prevalence of human papilloma virus infections has increased steadily over the last decades. To assess the impact of screening efforts in counteracting background changes, we analyzed the incidence trends of cervical intraepithelial neoplasia grade 3 carcinomas in situ (CIS) and invasive CC from 1994 to 2013 through an Age–Period–Cohort model using data of a regional population-based registry. Moreover, using Joinpoint regression, we compared the incidence of cervical lesions in native women with that observed in foreign-born women, highlighting the differences in age and screening status. The results indicate that the CC incidence trend decreased in Italian women (annual percent change = −2.7*%, 95% confidence interval = −4.3; −1.1), but increased (APC = 12.2*%, 95% confidence interval = 7.6; 17.0) in immigrants. For CIS, incidence rates show a growing trend in both groups, especially in women born abroad. For cancer, no marked changes in period-specific incidence rate ratios were detected until around 2000, when we found a slight decrease, followed by an increase. For CIS, we estimate an important upward trend in cohort-specific risks. The favorable effect of screening in preventing an increase in CC incidence has been counteracted by the progressive increase in immigrants from high-risk countries, where it is of increasing relevance to extend the use of vaccination.
Collapse
|
5
|
How does information on the harms and benefits of cervical cancer screening alter the intention to be screened?: a randomized survey of Norwegian women. Eur J Cancer Prev 2019; 28:87-95. [PMID: 29595751 DOI: 10.1097/cej.0000000000000436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cervical cancer (CC) is the 13th most frequent cancer among women in Norway, but the third most common among women aged 25-49 years. The national screening program sends information letters to promote screening participation. We aimed to evaluate how women's stated intention to participate in screening and pursue treatment changed with the provision of additional information on harms associated with screening, and to assess women's preferences on the timing and source of such information. We administered a web-based questionnaire to a panel of Norwegian women aged 25-69 years and randomized into three groups on the basis of when in the screening process additional information was introduced: (i) invited for routine screening, (ii) recommended an additional test following detection of cellular abnormalities, and (iii) recommended precancer treatment. A fourth (control) group did not receive any additional information. Results show that among 1060 respondents, additional information did not significantly alter women's stated intentions to screen. However, it created decision uncertainty on when treatment was recommended (8.76-9.09 vs. 9.40; 10-point Likert scale; P=0.004). Over 80% of women favored receiving information on harms and 59% preferred that information come from a qualified public health authority. Nearly 90% of women in all groups overestimated women's lifetime risk of CC. In conclusion, additional information on harms did not alter Norwegian women's stated intention to screen for CC; yet, it resulted in greater decision uncertainty to undergo precancer treatment. Incorporating information on harms into invitation letters is warranted as it would increase women's ability to make informed choices.
Collapse
|
6
|
Park J, Kim H, Yang W, Lee H, Park SM. Cervical Cancer Screening and Its Associated Factors Among North Korean Defectors Living in South Korea. J Immigr Minor Health 2019; 20:66-72. [PMID: 27738961 DOI: 10.1007/s10903-016-0510-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
North Korean defectors (NKD) have many health problems related to insufficient nutrition, trauma from escaping, and being exposed to infectious diseases, but little research exists on their cancer screening. A total of 638 NKD participated in this cross-sectional survey. South Korean natives (SKN) who participated in the Korean National Health and Nutrition Examination Survey V were selected using age matching to each NKD. Fisher's exact tests and logistic regression were used for data analysis. The cervical cancer screening rate of NKD was significantly lower than for SKN (42 and 70 %, respectively; P < .001). The adjusted proportions of cervical cancer screening for NKD in all age groups under 60 years (P < .01) and having education beyond high school (P < .001) were significantly lower than that of SKN. NKD who had education under a high school level were more likely to have cervical cancer screening compared to NKD with education beyond a high school level (OR 1.81, 95 % CI 1.12-2.93). NKD were less likely to receive appropriate cervical cancer screening compared to SKN, especially those aged 30-39 years or married. Tailored interventions for NKD are needed to improve cervical cancer screening compliance.
Collapse
Affiliation(s)
- Jeongok Park
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - HeesSook Kim
- Department of Nursing, Dongnam Health University, Suwon-si, Gyeonggi-do, South Korea
| | - Wonhee Yang
- University of North Carolina at Chapel Hill, Doctoral Student, Biostatistics, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - HaeWon Lee
- Institute for Health and Unification Studies, School of Medicine, Seoul National University, Seoul, South Korea
| | - Sang Min Park
- Department of Biomedical Sciences and Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
| |
Collapse
|
7
|
Leinonen MK, Campbell S, Ursin G, Tropé A, Nygård M. Barriers to cervical cancer screening faced by immigrants: a registry-based study of 1.4 million women in Norway. Eur J Public Health 2018; 27:873-879. [PMID: 28957477 PMCID: PMC5881680 DOI: 10.1093/eurpub/ckx093] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Immigrants from certain low- and middle-income countries are more prone to cancers attributed to viral infections in early life. Cervical cancer is caused by human papillomavirus but is highly preventable by regular screening. We assessed participation among immigrants in a population-based cervical screening programme and identified factors that predicted non-adherence within different immigrant groups. Methods We used data from several nationwide registries. The study population consisted of 208 626 (15%) immigrants and 1 157 223 (85%) native Norwegians. Non-adherence was defined as no eligible screening test in 2008–12. We estimated prevalence ratios with 95% confidence intervals (CIs) for factors associated with non-adherence by modified Poisson regression. Results In total, 52% of immigrants were not screened. All immigrants showed 1.72 times higher non-adherence rates (95% CI 1.71–1.73) compared with native Norwegian women when adjusted for age and parity. The proportion of non-adherent immigrants varied substantially by region of origin and country of origin. Being unemployed or not in the workforce, being unmarried, having low income and having a male general practitioner was associated with non-adherence regardless of region of origin. Living <10 years in Norway was an evident determinant of non-adherence among most but not all immigrant groups. Conclusions An increasing proportion of immigrants and low screening participation among them pose new public health challenges in Europe. Immigrants are diverse in terms of their sociodemographic attributes and screening participation. Tailored information and service delivery may be necessary to increase cancer screening among immigrants.
Collapse
Affiliation(s)
| | | | - Giske Ursin
- Department of Research, Cancer Registry of Norway, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ameli Tropé
- Department of Cervical Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| |
Collapse
|
8
|
Idehen EE, Koponen P, Härkänen T, Kangasniemi M, Pietilä AM, Korhonen T. Disparities in cervical screening participation: a comparison of Russian, Somali and Kurdish immigrants with the general Finnish population. Int J Equity Health 2018; 17:56. [PMID: 29728104 PMCID: PMC5935973 DOI: 10.1186/s12939-018-0768-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Cervical cancer is currently ranked as the fourth commonly diagnosed cancer in women globally. A higher incidence has been reported in low- and-middle-income countries, and the disease poses significant public health challenges. Evidence suggests that this disease is preventable by means of regular screening using the Papanicolaou (Pap) test. However, limited knowledge exists about disparities in cervical screening participation among immigrants compared with non-immigrants, in countries with universal cervical screening programmes. We aimed to examine disparities in cervical screening participation among women of Russian, Somali, and Kurdish, origin in Finland, comparing them with the general Finnish population (Finns). We controlled for differences in several socio-demographic and health-related variables as potential confounders. Methods We employed data from the Finnish Migrant Health and Well-being Study 2010–2012 and the National Health 2011 Survey. Data collection involved face-to-face interviews. Data on screening participation in the previous five years from women aged 29–60 were available from 537 immigrants (257 Russians, 113 Somalis, 167 Kurds) and from 436 Finns. For statistical analyses, we used multiple logistic regression. Results Age-adjusted screening participation rates were as follows: Russians 79% (95% CI 72.9–84.4), Somalis 41% (95% CI 31.4–50.1), and Kurds 64% (95% CI 57.2–70.8), compared with 94% (95% CI 91.4–95.9) among Finns. After additionally adjusting for socio-demographic and health-related confounders, all the immigrant groups showed a significantly lower likelihood of screening participation when compared with Finns. The Odds Ratios were as follows: Russians 0.32 (95% CI 0.18–0.58), Somalis 0.10 (95% CI 0.04–0.23), and Kurds 0.17 (95% CI 0.09–0.35). However, when additionally accounting for country of origin-confounder interactions, such differences were attenuated. Conclusions Our results indicate disparities in screening participation among these immigrants and a lower likelihood of screening participation compared with the general Finnish population. To improve equity in cervical cancer screening participation, appropriate culturally tailored intervention programmes for each immigrant group might be beneficial.
Collapse
Affiliation(s)
- Esther E Idehen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Yliopistoranta 1, P. O. Box 1627, 70211, Kuopio, Finland.
| | - Päivikki Koponen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tommi Härkänen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tellervo Korhonen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Yliopistoranta 1, P. O. Box 1627, 70211, Kuopio, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
9
|
Ghebre RG, Sewali B, Osman S, Adawe A, Nguyen HT, Okuyemi KS, Joseph A. Cervical cancer: barriers to screening in the Somali community in Minnesota. J Immigr Minor Health 2016; 17:722-8. [PMID: 25073605 DOI: 10.1007/s10903-014-0080-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examined barriers to and facilitators of cervical cancer screening among Somali immigrant women in Minnesota. We adopted the socioecological framework to illustrate screening barriers at multiple levels. We conducted 23 semi-structured key informant interviews and used a thematic exploratory approach to analyze the data. Barriers were classified into individual, community or health systems levels. Obstacles included lack of knowledge, religious beliefs, fatalism, fear, embarrassment, and lack of trust in the interpreters. Participants described a need for training of healthcare providers on issues surrounding Somali women's cultural practices and sexual health. Identifying individual, community, or health system barriers and addressing them concurrently may increase use of cancer screening services among Somali women. Future interventions need to address multilevel barriers with multilevel approaches to improve utilization of cervical cancer screening services in underserved immigrant populations in the United States.
Collapse
Affiliation(s)
- Rahel G Ghebre
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, MN, USA
| | | | | | | | | | | | | |
Collapse
|
10
|
Visioli CB, Crocetti E, Zappa M, Iossa A, Andersson KL, Bulgaresi P, Alfieri A, Amunni G. Participation and risk of high grade cytological lesions among immigrants and Italian-born women in an organized cervical cancer screening program in Central Italy. J Immigr Minor Health 2016; 17:670-8. [PMID: 24917238 DOI: 10.1007/s10903-014-0050-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Few studies analyzed the risk for high-grade squamous intraepithelial lesions or worse (HSIL+) among immigrants and natives attending organized cervical cancer (CC) screening programs (SP). We evaluated participation and diagnosis of HSIL+ by country of birth with logistic models. Overall 540,779 invitation letters were delivered to target women of Florence SP in three screening rounds (years 2000-2002, 2003-2005, 2006-2008). The probability of attending screening was lower for immigrants than natives, but the difference decreased from 35% (1st round) to 20% (2nd-3rd round) for women born in high migration pressure (HMP) countries. The risk of HSIL+ was double than natives for HMP-born women from countries with high prevalence of human papillomavirus, even adjusting for age and previous history of Pap test. This is an important public health problem due to an increasing proportion over time of immigrant women with a lower attendance and greater risk for CC.
Collapse
Affiliation(s)
- Carmen Beatriz Visioli
- Clinical and Descriptive Epidemiology Unit, ISPO - Istituto per lo Studio e la Prevenzione Oncologica, Via delle Oblate 2, 50144, Florence, Italy,
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Komparic A. An Ethical Justification for Expanding the Notion of Effectiveness in Vaccine Post-Market Monitoring: Insights from the HPV Vaccine in Canada. Public Health Ethics 2016; 9:78-91. [PMID: 26955399 PMCID: PMC4778494 DOI: 10.1093/phe/phu049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Health regulators must carefully monitor the real-world safety and effectiveness of marketed vaccines through post-market monitoring in order to protect the public's health and promote those vaccines that best achieve public health goals. Yet, despite the fact that vaccines used in collective immunization programmes should be assessed in the context of a public health response, post-market effectiveness monitoring is often limited to assessing immunogenicity or limited programmatic features, rather than assessing effectiveness across populations. We argue that post-market monitoring ought to be expanded in two ways to reflect a 'public health notion of post-market effectiveness', which incorporates normative public health considerations: (i) effectiveness monitoring should yield higher quality data and grant special attention to underrepresented and vulnerable populations; and (ii) the scope of effectiveness should be expanded to include a consideration of the various social factors that maximize (and minimize) a vaccine's effectiveness at the population level, paying particular attention to how immunization programmes impact related health gradients. We use the case of the human papillomavirus vaccine in Canada to elucidate how expanding post-market effectiveness monitoring is necessary to close the gap between clinical practice and public health, and to ensure that vaccines are effective in a morally relevant sense.
Collapse
|
12
|
Sewali B, Pratt R, Abdiwahab E, Fahia S, Call KT, Okuyemi KS. Understanding cancer screening service utilization by Somali men in Minnesota. J Immigr Minor Health 2015; 17:773-80. [PMID: 24817627 PMCID: PMC4227966 DOI: 10.1007/s10903-014-0032-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study examined factors that influence use of cancer screening by Somali men residing in Minnesota, USA. To better understand why recent immigrants are disproportionately less likely to use screening services, we used the health belief model to explore knowledge, beliefs, and attitudes surrounding cancer screening. We conducted a qualitative study comprised of 20 key informant interviews with Somali community leaders and 8 focus groups with Somali men (n = 44). Somali men commonly believe they are protected from cancer by religious beliefs. This belief, along with a lack of knowledge about screening, increased the likelihood to refrain from screening. Identifying the association between religion and health behaviors may lead to more targeted interventions to address existing disparities in cancer screening in the growing US immigrant population.
Collapse
Affiliation(s)
- Barrett Sewali
- Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | - Rebekah Pratt
- Corresponding author: Barrett Sewali, Department of Family Medicine and Community Health, 717 Delaware St. SE. Ste. 166, Minneapolis, MN 55414, Phone: 612-625-4912, Fax: 612-626-6782,
| | - Ekland Abdiwahab
- Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | - Saeed Fahia
- Confederation of Somali Community in Minnesota, Minneapolis, MN
| | - Kathleen Thiede Call
- Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
- Center for Health Equity, University of Minnesota, Minneapolis, MN
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Kolawole S. Okuyemi
- Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
- Center for Health Equity, University of Minnesota, Minneapolis, MN
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| |
Collapse
|
13
|
Myers RP, Crotty P, Town S, English J, Fonseca K, Tellier R, Swain MG, McGregor SE, Heitman SJ, Hilsden RJ. Acceptability and yield of birth-cohort screening for hepatitis C virus in a Canadian population being screened for colorectal cancer: a cross-sectional study. CMAJ Open 2015; 3:E62-7. [PMID: 25844371 PMCID: PMC4382029 DOI: 10.9778/cmajo.20140024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Screening for hepatitis C virus (HCV) is recommended in patients born between 1945 and 1965 ("baby boomers") in the United States. Because these patients are often screened for colorectal cancer, dual screening for HCV may enhance case identification. Our objectives were to assess the acceptability and yield of screening for HCV among patients undergoing screening for colorectal cancer. METHODS Patients referred for a colonoscopy to screen for colorectal cancer completed an anonymous survey regarding the acceptability of screening for HCV, risk factors and prior testing. The impacts of demographics and risk factors for HCV on willingness to be screened were determined using logistic regression, and the stored sera of 483 patients who had undergone screening for colorectal cancer between February 2011 and August 2012 were tested for HCV antibodies. RESULTS Among 1012 survey respondents (median age 56 yr; 911 [90.0%] were baby boomers, 880 [87.0%] were white and 223 [22.0%] were born outside Canada), 123 patients (12.2%) reported prior testing for HCV. HCV was previously diagnosed in 9 of these patients (0.9%, representing 1.0% of the patients who were baby boomers): 5 (55.6% of those diagnosed) reported risk factors. Excluding patients diagnosed with HCV, 903 (90.0%) respondents indicated that they would consent to testing of blood or saliva for HCV. After adjusting for age, sex and status of immigration, patients who were white (odds ratio [OR] 3.38, 95% confidence interval [CI] 1.81-6.32) and patients with risk factors (> 1 v. 0: OR 3.67, 95% CI 1.12-12.02) had a greater acceptance of screening. Among 483 patients screened for colorectal cancer, 3 were anti-HCV positive (0.6%, 95% CI 0.1%-1.8%), representing 0.8% (95% CI 0.2%-2.4%) of the patients who were baby boomers. INTERPRETATION Acceptance of screening for HCV is high among patients undergoing screening for colorectal cancer in the Calgary area. However, the low prevalence of HCV suggests that the cost-effectiveness of birth-cohort screening in this population warrants evaluation.
Collapse
Affiliation(s)
- Robert P Myers
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alta. ; Department of Community Health Sciences, University of Calgary, Calgary, Alta
| | - Pam Crotty
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alta
| | - Susanna Town
- Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alta
| | - Janine English
- Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alta
| | - Kevin Fonseca
- Provincial Laboratory for Public Health, Calgary, Alta
| | | | - Mark G Swain
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alta
| | - S Elizabeth McGregor
- Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alta
| | - Steven J Heitman
- Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alta
| | - Robert J Hilsden
- Department of Community Health Sciences, University of Calgary, Calgary, Alta. ; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alta
| |
Collapse
|
14
|
Spence AR, Alobaid A, Drouin P, Goggin P, Gilbert L, Provencher D, Tousignant P, Hanley JA, Franco EL. Screening histories and contact with physicians as determinants of cervical cancer risk in Montreal, Quebec. ACTA ACUST UNITED AC 2014; 21:294-304. [PMID: 25489256 DOI: 10.3747/co.21.2056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cervical cancer (cca) is largely a preventable disease if women receive regular screening, which allows for the detection and treatment of preinvasive lesions before they become invasive. Having been inadequately screened is a common finding among women who develop cca. Our primary objective was to determine the Pap screening histories of women diagnosed with cca in Montreal, Quebec. Secondary objectives were to determine the characteristics of women at greatest risk of cca and to characterize the level of physician contact those women had before developing cca. METHODS The Invasive Cervical Cancer Study, a population-based case-control study, consisted of Greater Montreal residents diagnosed with histologically confirmed cca between 1998 and 2004. Respondents to the 2003 Canadian Community Health Survey and a sample of women without cca obtained from Quebec medical billing records served as controls. RESULTS During the period of interest, 568 women were diagnosed with cca. Immigrants and women speaking neither French nor English were at greatest risk of cca. Most of the women in the case group had been screened at least once during their lifetime (84.8%-90.4%), but they were less likely to have been screened within 3 years of diagnosis. Having received care from a family physician or a medical specialist other than a gynecologist within the 5 years before diagnosis was associated with a greater risk of cca development. CONCLUSIONS Our findings provide evidence of the need for an organized population-based screening program. They also underscore the need for provider education to prevent missed opportunities for cca screening when at-risk women seek medical attention.
Collapse
Affiliation(s)
- A R Spence
- Division of Cancer Epidemiology, McGill University, Montreal, QC
| | - A Alobaid
- Department of Obstetrics and Gynecology, King Khaled University Hospital, Riyadh, Saudi Arabia
| | - P Drouin
- Division of Gynecologic Oncology, Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - P Goggin
- Institut national de santé publique du Québec, Montreal, QC
| | - L Gilbert
- Department of Obstetrics and Gynecology, Mc-Gill University Health Centre, Montreal, QC
| | - D Provencher
- Division of Gynecologic Oncology, Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - P Tousignant
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC. ; Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal, Montreal, QC
| | - J A Hanley
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC
| | - E L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, QC. ; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC
| |
Collapse
|
15
|
Omland G, Ruths S, Diaz E. Use of hormonal contraceptives among immigrant and native women in Norway: data from the Norwegian Prescription Database. BJOG 2014; 121:1221-8. [PMID: 24931487 PMCID: PMC4282112 DOI: 10.1111/1471-0528.12906] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2014] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To examine the use of hormonal contraceptives among immigrant and native women in Norway. DESIGN Nationwide registry-based study based on merged data from the Norwegian Prescription Database, the Norwegian Population Registry, the Regular General Practitioner Database and the Medical Birth Registry. SETTING Norway. SAMPLE All women born abroad to two foreign-born parents (immigrants), or born in Norway to two Norwegian-born parents (natives) aged 16-45 years, who lived in Norway in 2008. METHODS Data on all collected supplies of hormonal contraceptives in 2008 were merged with demographic, socio-economic and immigration data, information on any delivery and women's general practitioners. MAIN OUTCOME MEASURES User rates of hormonal contraception and predictors of contraceptive use. RESULTS A total of 893,073 women were included, of whom 130,080 were immigrants. More native women (38%) used hormonal contraceptives compared with all immigrant groups (15-24%). The odds ratios for any use of hormonal contraceptives for immigrants compared with Norwegian-born women were; Nordic countries 0.53, South and Central America 0.53, Western countries 0.39, Asia 0.30, Eastern Europe 0.29, Africa 0.29. Work, education, long stay in Norway and young age of immigration predicted the use of hormonal contraceptives among immigrants. CONCLUSIONS The use of hormonal contraceptives varies between natives and immigrant groups. Further work is needed to ascertain whether these differences can be explained by higher desires for fertility, preferential use of non-hormonal contraceptives or other reasons identified through qualitative research.
Collapse
Affiliation(s)
- G Omland
- Department of Global Public Health and Primary Care, University of BergenBergen, Norway
| | - S Ruths
- Department of Global Public Health and Primary Care, University of BergenBergen, Norway
- Research Unit for General Practice, Uni HealthBergen, Norway
| | - E Diaz
- Department of Global Public Health and Primary Care, University of BergenBergen, Norway
| |
Collapse
|
16
|
Carrière GM, Sanmartin C, Bryant H, Lockwood G. Rates of cancer incidence across terciles of the foreign-born population in Canada from 2001-2006. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2013; 104:e443-9. [PMID: 24495818 PMCID: PMC6973830 DOI: 10.17269/cjph.104.3884] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 10/25/2013] [Accepted: 10/29/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To address the issue of comparative risk of cancer in Canada's immigrant population, an area-based methodology was applied to examine whether or not estimated cancer incidence rates among individuals living in given areas vary systematically according to the concentration of foreign-born individuals living in the same area. This method provides an alternative, accessible surveillance method in the absence of linked individual-level information to extend the work of others by providing both national and subnational standardized, hence comparable, results to address this issue. METHODS Canadian Cancer Registry data (2001 to 2006) and 2006 Census data provided dissemination area information regarding the concentration of the foreign-born population and population estimates for rate denominators. Cancer (all cause and cause-specific) incidence rate ratios (age-standardized and by age/sex) were calculated by foreign-born concentration areas at both national and regional levels. RESULTS An inverse gradient was identified between cancer incidence rates and area concentration of foreign-born, with the all-sites cancer rate ranging from a low of 388 per 100,000 among individuals living in areas with a high concentration of foreign-born to a high of 493 per 100,000 among individuals living in areas with a low concentration of foreign-born. This pattern occurred nationally for lung, colorectal, prostate and female breast cancers. However, for liver, nasopharynx, and thyroid cancers, higher cancer rates were observed in areas with a higher versus lower concentration of foreign-born populations. CONCLUSION The study findings provide suggestive evidence of decreased cancer risk among foreign-born populations for most cancers except nasopharynx, liver and thyroid for which risks were higher. The results of this study demonstrate the value of ecological-based methods for disease surveillance in the absence of individual-level information on immigrant status in the national cancer registry.
Collapse
|