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Zanwar PP, Davis MM, Horner-Johnson W. Assessing Intersectional Disparities in Cervical Cancer Screening by Disability Status, Race, and Ethnicity. AJPM FOCUS 2022; 1:100019. [PMID: 37791247 PMCID: PMC10546533 DOI: 10.1016/j.focus.2022.100019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Separate bodies of research have studied disparities by disability status and by race or ethnicity in receipt of cervical cancer screening. Much less is known about how these disparities intersect. The purpose of this study was to evaluate disparities in compliance with the U.S. Preventive Services Task Force guidelines for Pap testing in age-eligible women at the intersection of disability and race or ethnicity. Methods We conducted cross-sectional analyses of the Medical Expenditure Panel Survey Household Component deidentified public data files pooled for years 2007-2016, using a modified Poisson regression analysis to compute prevalence ratios for being up to date with Pap testing by disability status and race or ethnicity. We also calculated predicted marginal proportions adjusting for demographic and socioeconomic covariates. Results The analytic sample included 68,507 women with nonmissing covariates; 15.6% had a disability. Overall, the proportion current with Pap testing was significantly lower among women with disabilities than among those without disabilities (82.1% vs 88.6%, p<0.0001). Furthermore, within each racial and ethnic group, women with disabilities were less likely than those without disabilities to be current with Pap testing. In adjusted analyses, prevalence ratios for White women with disabilities (adjusted prevalence ratio=0.94; 95% CI=0.92, 0.96) and other race women with and without disabilities (adjusted prevalence ratio=0.91; 95% CI=0.86, 0.95 and adjusted prevalence ratio=0.91; 95% CI=0.89, 0.95, respectively) were significantly below those for the reference group of White women without disabilities. Hispanic women with disabilities did not differ significantly from White women without disabilities, and Black women with disabilities had significantly higher adjusted prevalence ratios than White women without disabilities (adjusted prevalence ratio=1.07; 95% CI=1.05, 1.09). When taking covariates into account, the proportion of Black women with disabilities current with screening was only slightly lower than the estimated proportion for Black women without disabilities (92% vs 93%). The gap in screening between White women with and without disabilities narrowed somewhat (from 9 percentage points to 4 percentage points) but remained significant. Conclusions Our results extend previous research focused separately on disability or race and ethnicity. Women with disabilities in all racial and ethnic groups fell short of Healthy People 2020 goals for cervical cancer screening.
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Affiliation(s)
- Preeti Pushpalata Zanwar
- Applied Health Economics & Outcomes Research & Health Policy, Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania
- NIA Funded Network on Life Course Health Dynamics & Disparities, University of Southern California, Los Angeles, California
| | - Melinda M. Davis
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
- Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Willi Horner-Johnson
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
- Institute on Development and Disability, School of Medicine, Oregon Health & Science University, Portland, Oregon
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2
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Merrill RM, Williams EN, Fuhriman H. Risk Behaviors Correlate with Higher Prevalence of Papanicolaou, Human Papillomavirus, and Human Immunodeficiency Virus Screening Among Women in the United States. J Womens Health (Larchmt) 2021; 30:615-624. [PMID: 33085563 DOI: 10.1089/jwh.2020.8656] [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] [Indexed: 11/12/2022] Open
Abstract
Introduction: This study assesses whether women with human immunodeficiency virus (HIV) risk behavior have higher Papanicolaou (Pap), human papillomavirus (HPV), and HIV testing, and whether the level of selected variables associated with HIV risk behavior correlate with greater testing. Association between HIV risk situations and HPV vaccination is also evaluated. Methods: A cross-sectional assessment was performed in women at age 18 years and older completing the 2018 Behavioral Risk Factor Surveillance System (BRFSS) survey. Independent variables considered and adjusted for, included age, race/ethnicity, marital status, education, annual household income, smoking status, and health care status. Results: Prevalence of a Pap test in the past 3 years was 66.2%, of HPV test in the past 5 years was 40.2%, and of HIV test ever was 41.9%. HIV risk situations applied to 4.9% women (15.2% in ages 18-24, 7.2% in 25-44, 1.9% in 45-64, and 0.6% in 65 years and older). Adjusted odds (95% confidence interval) of a Pap, HPV, or HIV test according to HIV risk behavior status were 1.5 (1.3-1.8), 1.6 (1.4-1.8), and 2.6 (2.3-2.9), respectively. The positive association between HIV risk behavior and Pap testing depends on marital status. HIV risk behavior significantly correlates with several variables, which, in turn, correlate with testing. There was no association between HIV risk behavior and HPV vaccination. Conclusions: Women with HIV risk behavior are more likely to pursue Pap, HPV, and HIV testing. The significant positive associations are largest for HIV testing and smallest for Pap testing, after adjustment for the selected variables. HIV risk behavior is not associated with HPV vaccination.
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Affiliation(s)
- Ray M Merrill
- Department of Public Health, College of Life Sciences, Brigham Young University, Provo, Utah, USA
| | - Elizabeth N Williams
- Department of Public Health, College of Life Sciences, Brigham Young University, Provo, Utah, USA
| | - Heidi Fuhriman
- Department of Public Health, College of Life Sciences, Brigham Young University, Provo, Utah, USA
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Valvi N, Vin-Raviv N, Akinyemiju T. Medicaid Expansion and Breast Cancer Screening in Appalachia and Non-Appalachia, United States, BRFSS 2003 to 2015. Cancer Control 2019; 26:1073274819845874. [PMID: 31067985 PMCID: PMC6509986 DOI: 10.1177/1073274819845874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Prior data suggests that breast cancer screening rates are lower among women in the Appalachian region of the United States. This study examined the changes in breast cancer screening before and after the implementation of the Affordable Care Act Medicaid expansion, in Appalachia and non-Appalachia states. Methods: Data from the Behavioral Risk Factor Surveillance System between 2003 and 2015 were analyzed to evaluate changes in breast cancer screening in the past 2 years among US women aged 50-74 years. Multivariable adjusted logistic regression and generalized estimating equation models were utilized, adjusting for sociodemographic, socioeconomic, and health-care characteristics. Data were analyzed for 2 periods: 2003 to 2009 (pre-expansion) and 2011 to 2015 (post-expansion) comparing Appalachia and non-Appalachia states. Results: The prevalence for of self-reported breast cancer screening in Appalachia and non-Appalachia states were 83% and 82% (P < .001), respectively. In Appalachian states, breast cancer screening was marginally higher in non-expanded versus expanded states in both the pre-expansion (relative risk [RR]: 1.002, 95% confidence interval [CI]: 1.002-1.003) and post-expansion period (RR: 1.001, 95% CI: 1.001-1.002). In non-Appalachian states, screening was lower in non-expanded states versus expanded states in both the pre-expansion (RR: 0.98, 95% CI: 0.97-0.98) and post-expansion period (RR: 0.95, 95% CI: 0.95-0.96). There were modest 3% to 4% declines in breast cancer screening rates in the pos-texpansion period regardless of expansion and Appalachia status. Conclusions: Breast cancer screening rates were higher in Appalachia versus non-Appalachia US states and higher in expanded versus nonexpanded non-Appalachia states. There were modest declines in breast cancer screening rates in the post-expansion period regardless of expansion and Appalachia status, suggesting that more work may be needed to reduce administrative, logistical, and structural barriers to breast cancer screening services.
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Affiliation(s)
- Nimish Valvi
- 1 Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Neomi Vin-Raviv
- 2 School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA.,3 University of Northern Colorado Cancer Rehabilitation Institute, School of Sport and Exercise Science, University of Northern Colorado, Greeley, CO, USA
| | - Tomi Akinyemiju
- 1 Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA.,4 Markey Cancer Center, University of Kentucky, Lexington, KY, USA
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4
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Kushalnagar P, Engelman A, Simons AN. Deaf Women's Health: Adherence to Breast and Cervical Cancer Screening Recommendations. Am J Prev Med 2019; 57:346-354. [PMID: 31377087 PMCID: PMC6702039 DOI: 10.1016/j.amepre.2019.04.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION No prevalence studies on cancer screening adherence among Deaf women have been conducted in the past decade. Current data on breast and cervical cancer screening are needed from Deaf women who adhered or did not adhere to the U.S. Preventative Services Task Force screening guidelines. The objectives of this study were to assess whether disparities for cancer screening adherence persist for Deaf women compared with the general population and whether racial and ethnic disparities for adherence exist among Deaf women. METHODS Data for adherence to Pap (n=529, Deaf women; n=1,119, hearing women) and mammogram screening (n=324, Deaf women; n=1,086, hearing women) were drawn from the Health Information National Trends Survey in American Sign Language (Deaf women; February-August 2017 and October 2017-May 2018) and the Health Information National Trends Survey 5, Cycle 1, data set (hearing women; January-May 2017). Data were analyzed in 2018. Propensity score model of the weighed samples estimated the probability of adherence among the entire sample and within the sample of Deaf women for each screening test. RESULTS About 78% (n=415) of age-eligible Deaf women and 85% (n=956) of age-eligible hearing women adhered to Pap screening recommendations (p<0.001). For breast cancer screening, the adherence rates for 245 Deaf women and 891 hearing women were 76% and 82%, respectively (p<0.01). After adjusting for correlates, for Deaf women, disparities remained for cervical cancer screening but not breast cancer screening. Race and ethnicity were not associated with cancer screening adherence. CONCLUSIONS This is a call to action for targeted, accessible health promotion interventions for age-eligible Deaf women to increase adherence to cervical cancer screening.
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Affiliation(s)
- Poorna Kushalnagar
- Department of Psychology, Gallaudet University, Washington, District of Columbia.
| | - Alina Engelman
- Department of Health Sciences, California State University, East Bay, Hayward, California
| | - Abbi N Simons
- Department of Science, Technology, and Mathematics, Gallaudet University, Washington, District of Columbia
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Lea CS, Perez-Heydrich C, Des Marais AC, Richman AR, Barclay L, Brewer NT, Smith JS. Predictors of Cervical Cancer Screening Among Infrequently Screened Women Completing Human Papillomavirus Self-Collection: My Body My Test-1. J Womens Health (Larchmt) 2019; 28:1094-1104. [PMID: 30874477 PMCID: PMC6703237 DOI: 10.1089/jwh.2018.7141] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Approximately one-half of cervical cancer cases in the United States occur in underscreened or never-screened women. We examined predictors to completing Papanicolaou (Pap) testing and whether a positive human papillomavirus (HPV) self-collection result affects Pap testing adherence among underscreened women. Materials and Methods: Low-income women aged 30-65 years who reported no Pap testing in ≥4 years were recruited in North Carolina. Knowledge, attitudes, and barriers regarding cervical cancer and Pap testing were assessed by telephone questionnaires. We mailed self-collection kits for HPV testing and provided information regarding where to obtain affordable Pap testing. Participants received $45 for completing all activities. We used multivariable logistic regression to assess the predictors of longer reported time since last Pap (≥10 vs. 4-9 years) and of completion of Pap testing following study enrollment (follow-up Pap). Results: Participants (n = 230) were primarily black (55%), uninsured (64%), and with ≤high school education (59%). Cost and finding an affordable clinic were the most commonly reported barriers to screening. White women and those with ≤high school education reported longer intervals since last Pap test. Half of the participants reported completing a follow-up Pap test (55%). Women with a positive HPV self-collection were five times more likely to report completing a follow-up Pap test than those with negative self-collection (odds ratio = 5.1, 95% confidence interval 1.4-25.7). Conclusions: Improving awareness of resources for affordable screening could increase cervical cancer screening in underserved women. Home-based HPV self-collection represents an opportunity to re-engage infrequently screened women into preventive screening services.
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Affiliation(s)
- Cary Suzanne Lea
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Carolina Perez-Heydrich
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina
- Department of Biological Sciences, Meredith College, Raleigh, North Carolina
| | - Andrea C. Des Marais
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Alice R. Richman
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina
| | - Lynn Barclay
- American Sexual Health Association, Research Triangle Park, North Carolina
| | - Noel T. Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer S. Smith
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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Affiliation(s)
- Lee A Learman
- Division of Obstetrics and Gynecology, Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Francisco A R Garcia
- Pima County, Tucson, Arizona
- College of Public Health, University of Arizona, Tucson
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7
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Fujihara N, Lark ME, Fujihara Y, Chung KC. The effect of economic downturn on the volume of surgical procedures: A systematic review. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.06.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wyatt TE, Pernenkil V, Akinyemiju TF. Trends in breast and colorectal cancer screening among U.S. adults by race, healthcare coverage, and SES before, during, and after the great recession. Prev Med Rep 2017; 7:239-245. [PMID: 28879070 PMCID: PMC5575433 DOI: 10.1016/j.pmedr.2017.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/24/2017] [Accepted: 04/01/2017] [Indexed: 11/01/2022] Open
Abstract
The aim of this study is examine trends in breast and colorectal cancer screening in the U.S. by race, healthcare coverage, and socio-economic status (SES) before the Great Recession (2003-2005), during the recession (2007-2009), and post-recession/Affordable Care Act (ACA) period (2010 - 2012). Data on a representative sample of U.S. adults was obtained from the Behavioral Risk Factor Surveillance System (BRFSS). Breast and colorectal cancer screening were defined in line with U.S. Preventative Services Task Force guidelines, and survey weighted statistical methods were utilized to analyze trends in cancer screening among 1,858,572 BRFSS participants. Overall, 83% of women received mammograms in the past 2 years, while 95% of adults received colorectal cancer screening in the past 10 years. Compared with the pre-recession period, the odds of colorectal screening within 5 years were slightly higher during the recession (OR: 1.05, 95% CI: 1.03-1.08) but significantly lower in the post-recession/ACA period (OR: 0.73, 95% CI: 0.72-0.75). Odds of mammography screening were lower during (OR: 0.94,95% CI: 0.91-0.96) and post-recession/ACA period (OR: 0.80, 95% CI: 0.78-0.82). Breast cancer screening rates declined in the recession and post-recession, while colorectal cancer screening rates increased during the recession and decreased post-recession. Low SES adults and those without healthcare coverage were the least likely to receive screening.
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Affiliation(s)
- Taylor E Wyatt
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vikash Pernenkil
- University of South Alabama, College of Medicine, Mobile, AL, USA
| | - Tomi F Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
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9
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Gomez SL, Canchola AJ, Nelson DO, Keegan THM, Clarke CA, Cheng I, Shariff-Marco S, DeRouen M, Catalano R, Satariano WA, Davidson-Allen K, Glaser SL. Recent declines in cancer incidence: related to the Great Recession? Cancer Causes Control 2017; 28:145-154. [PMID: 28130633 DOI: 10.1007/s10552-016-0846-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 12/22/2016] [Indexed: 01/03/2023]
Abstract
PURPOSE In recent years, cancer case counts in the U.S. underwent a large, rapid decline-an unexpected change given population growth for older persons at highest cancer risk. As these declines coincided with the Great Recession, we examined whether they were related to economic conditions. METHODS Using California Cancer Registry data from California's 30 most populous counties, we analyzed trends in cancer incidence during pre-recession (1996-2007) and recession/recovery (2008-2012) periods for all cancers combined and the ten most common sites. We evaluated the recession's association with rates using a multifactorial index that measured recession impact, and modeled associations between case counts and county-level unemployment rates using Poisson regression. RESULTS Yearly cancer incidence rate declines were greater during the recession/recovery (3.3% among males, 1.4% among females) than before (0.7 and 0.5%, respectively), particularly for prostate, lung, and colorectal cancers. Lower case counts, especially for prostate and liver cancer among males and breast cancer, melanoma, and ovarian cancer among females, were associated with higher unemployment rates, irrespective of time period, but independent of secular effects. The associations for melanoma translated up to a 3.6% decrease in cases with each 1% increase in unemployment. Incidence declines were not greater in counties with higher recession impact index. CONCLUSIONS Although recent declines in incidence of certain cancers are not differentially impacted by economic conditions related to the Great Recession relative to pre-recession conditions, the large recent absolute declines in the case counts of some cancer may be attributable to the large declines in unemployment in the recessionary period. This may occur through decreased engagement in preventive health behaviors, particularly for clinically less urgent cancers. Continued monitoring of trends is important to detect any rises in incidence rates as deferred diagnoses come to clinical attention.
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Affiliation(s)
- Scarlett Lin Gomez
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA. .,Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA. .,Stanford Cancer Institute, Stanford, USA.
| | - Alison J Canchola
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA
| | - David O Nelson
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.,Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA.,Stanford Cancer Institute, Stanford, USA
| | - Theresa H M Keegan
- Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Christina A Clarke
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.,Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA.,Stanford Cancer Institute, Stanford, USA
| | - Iona Cheng
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.,Stanford Cancer Institute, Stanford, USA
| | - Salma Shariff-Marco
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.,Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA.,Stanford Cancer Institute, Stanford, USA
| | - Mindy DeRouen
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA
| | - Ralph Catalano
- School of Public Health, University of California, Berkeley, CA, USA
| | | | - Kathleen Davidson-Allen
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA
| | - Sally L Glaser
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.,Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA.,Stanford Cancer Institute, Stanford, USA
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10
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Lee JY, Malak SF, Klimberg VS, Henry-Tillman R, Kadlubar S. Change in Mammography Use Following the Revised Guidelines from the U.S. Preventive Services Task Force. Breast J 2016; 23:164-168. [PMID: 27797121 DOI: 10.1111/tbj.12703] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The U.S. Preventive Services Task Force (USPSTF) recommended screening mammography every 1-2 years for women 40 years and older in 2002, and changed its recommendations in 2009 to no routine screening for women between 40 and 49 years of age; and biennial screening for women between 50 and 74 years of age. This study evaluates the change in mammographic use after the issuance of the revised recommendations. Women who participated in a cross-sectional study of breast cancer risk factors from 2007 to 2013 were asked if they had received a mammogram in the preceding 2 years. All 3442 study participants who enrolled in the study after January 1, 2011 were matched by race, age, and educational level with women enrolled between 2007 and 2010. The proportions of women who stated they had received a mammogram in the past 2 years were compared between the two groups. One fourth of the participants were African American and 39% were 40-49 years of age. Among white women, significant decreases in recent mammogram use from 2007-2010 to 2011-2013 were detected for women 40-49 years of age (-10.3%, p < 0.001) and 50-74 years of age (-8.8%, p < 0.001). Among African-American women, the change in recent mammogram use was not statistically significant for women 40-49 years of age (-2.7%, p = 0.440) or 50-74 years of age (-2.2%, p = 0.398). Following the change in the USPSTF guidelines, mammography use among white women declined; however, no change was observed among African-American women.
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Affiliation(s)
- Jeannette Y Lee
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sharp F Malak
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Vicki Suzanne Klimberg
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ronda Henry-Tillman
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Susan Kadlubar
- Division of Medical Genetics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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11
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Johnson DC, Lhaki P, Bhatta MP, Kempf MC, Smith JS, Bhattarai P, Aryal S, Chamot E, Regmi K, Vermund SH, Shrestha S. Spousal migration and human papillomavirus infection among women in rural western Nepal. Int Health 2016; 8:261-8. [PMID: 27048288 DOI: 10.1093/inthealth/ihw015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 01/12/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In April 2014 we investigated the association of migration of a woman's husband with her high-risk human papillomavirus (HR-HPV) infection status and her abnormal cervical cytology status in the Achham district of rural Far-Western Nepal. METHODS Women were surveyed and screened for HR-HPV during a health camp conducted by the Nepal Fertility Care Center. Univariate and multivariable statistical tests were performed to determine the association of a husband's migration status with HR-HPV infection and cervical cytology status. RESULTS In 265 women, the prevalence of HR-HPV was 7.5% (20/265), while the prevalence of abnormal cervical cytology, defined using the Bethesda system as atypical glandular cells of undetermined significance or worse, was 7.6% (19/251). Half of the study participants (50.8%, 130/256) had husbands who had reported migrating for work at least once. Women aged ≤34 years were significantly less likely to test positive for HR-HPV than women aged >34 years (OR 0.22, 95% CI 0.07 to 0.71). HR-HPV infection and abnormal cervical cytology status were not directly associated with a husband's migration. CONCLUSION Older women were found to have a higher prevalence of HPV than younger women. It is possible that a husband's migration for work could be delaying HR-HPV infections in married women until an older age.
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Affiliation(s)
- Derek C Johnson
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pema Lhaki
- NFCC/NFCC International, Kathmandu, Nepal
| | - Madhav P Bhatta
- College of Public Health, Kent State University, Kent, OH, USA
| | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA Department of Health Behavior, University of Alabama at Birmingham, AL, USA
| | - Jennifer S Smith
- Department of Epidemiology, University of North Carolina, Chapel Hill, USA
| | | | - Shilu Aryal
- Nepal Family Health Division, Kathmandu, Nepal
| | - Eric Chamot
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kiran Regmi
- Nepal Family Health Division, Kathmandu, Nepal
| | - Sten H Vermund
- Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sadeep Shrestha
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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