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Damgacioglu H, Burus T, Sonawane K, Hill E, Lang Kuhs KA, Deshmukh AA. County-Level Trends in Cervical Cancer Incidence, Stage at Diagnosis, and Mortality in Kentucky. JAMA Netw Open 2023; 6:e2338333. [PMID: 37856127 PMCID: PMC10587791 DOI: 10.1001/jamanetworkopen.2023.38333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/29/2023] [Indexed: 10/20/2023] Open
Abstract
This cross-sectional study evaluates recent trends in rates of cervical cancer incidence and incidence-based mortality among women in Appalachian and non-Appalachian Kentucky counties.
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Affiliation(s)
- Haluk Damgacioglu
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
- Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Todd Burus
- Markey Cancer Center, University of Kentucky, Lexington
| | - Kalyani Sonawane
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
- Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Elizabeth Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
- Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Krystle A. Lang Kuhs
- Markey Cancer Center, University of Kentucky, Lexington
- Department of Epidemiology & Environmental Health, College of Public Health, University of Kentucky, Lexington
| | - Ashish A. Deshmukh
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
- Hollings Cancer Center, Medical University of South Carolina, Charleston
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Oshiro M, Kamizato M, Jahana S. Factors related to help-seeking for cancer medical care among people living in rural areas: a scoping review. BMC Health Serv Res 2022; 22:836. [PMID: 35765056 PMCID: PMC9241203 DOI: 10.1186/s12913-022-08205-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
Despite the importance of timely diagnosis and access to treatment, previous studies have not adequately explored help-seeking behavior in cancer treatment among rural and remote residents. The barriers preventing help-seeking behavior also remain unclear. To address this research gap, this study conducted a scoping review to suggest a framework for eliminating barriers and facilitating help-seeking for cancer treatment among rural and remote residents. To conduct the scoping review, three English medical databases (PubMed, MEDLINE, and CINAHL) were examined for the keywords "rural," "remote," "cancer," and "help-seeking." The research objectives and study designs, participants, and excerpts describing help-seeking of the selected papers were recorded in a data charting form. Descriptions of help-seeking behavior were organized and summarized according to their meaning and integrated into factors using thematic analysis. All extracted factors related to help-seeking were sorted into four main themes according to the Ecological Model of Health Behavior, the theoretical lens for this scoping review: (1) Intrapersonal; (2) Interpersonal; (3) Groups, culture, and organizations; and (4) Policy/environment. Factors were categorized as barriers and facilitators of help-seeking. A total of 13 papers were analyzed. Intrapersonal factors such as self-reliance, symptom appraisal, and fatalism, were identified as barriers to help-seeking, whereas presentation of abnormal and serious symptoms facilitated help-seeking. Interpersonal factors such as lack of understanding of family members, influence of surrounding people, role obligations, and lack of trust in experts hindered help-seeking, whereas understanding from surrounding people such as family and friends, promoted help-seeking. Groups, cultural, and organizational factors such as prejudice, social stigma, shame, lack of anonymity, and social norms acted as barriers to help-seeking. Policy-related barriers to help-seeking included lack of medical services and physical distance from medical institutions, leading to a time burden. The study discussed the identified factors from a rural context. Future studies should consider the identified barriers and facilitators according to the four main themes in rural areas when formulating interventions to promote help-seeking. Our findings can offer a theoretical foundation to develop actionable policies, preventive strategies, and relevant interventional tools that may facilitate oncological service utilization in rural areas.
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Affiliation(s)
- Mariko Oshiro
- Department of Nursing, Okinawa Prefectural College of Nursing, Yogi 1-24-1, Naha City, Okinawa, 902-8513, Japan.
| | - Midori Kamizato
- Department of Nursing, Okinawa Prefectural College of Nursing, Yogi 1-24-1, Naha City, Okinawa, 902-8513, Japan
| | - Sayuri Jahana
- Department of Nursing, Okinawa Prefectural College of Nursing, Yogi 1-24-1, Naha City, Okinawa, 902-8513, Japan
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Patterson JG, Borger TN, Burris JL, Conaway M, Klesges R, Ashcraft A, Hauser L, Clark C, Wright L, Cooper S, Smith MC, Dignan M, Kennedy-Rea S, Paskett ED, Anderson R, Ferketich AK. A cluster randomized controlled trial for a multi-level, clinic-based smoking cessation program with women in Appalachian communities: study protocol for the "Break Free" program. Addict Sci Clin Pract 2022; 17:11. [PMID: 35164857 PMCID: PMC8842942 DOI: 10.1186/s13722-022-00295-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/31/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The cervical cancer burden is high among women living in Appalachia. Cigarette smoking, a cervical cancer risk factor, is also highly prevalent in this population. This project aims to increase smoking cessation among women living in Appalachia by embedding a smoking cessation program within a larger, integrated cervical cancer prevention program. METHODS The broader program, the Take CARE study, is a multi-site research collaborative designed to address three risk factors for cervical cancer incidence and mortality: tobacco use, human papillomavirus (HPV) infection, and cervical cancer screening. Break Free is a primary care clinic-based implementation program that aims to promote smoking cessation among female smokers in Appalachia by standardizing clinical practice protocols. Break Free includes: (1) implementation of a tobacco user identification system in the Electronic Health Record, (2) clinic staff and provider training on the Ask, Advise and Refer (AAR) model, (3) provider implementation of AAR to identify and treat women who want to quit smoking within the next 6 months, (4) facilitated access to cessation phone counseling plus pharmacotherapy, and (5) the bundling of Break Free tobacco cessation with HPV vaccination and cervical cancer screening interventions in an integrated approach to cervical cancer prevention. The study spans 35 Appalachian health clinics across 10 healthcare systems. We aim to enroll 51 adult female smokers per health system (total N = 510). Baseline and follow-up data will be obtained from participant (provider and patient) surveys. The primary outcome is self-reported 12-month point prevalence abstinence among enrolled patients. All randomized patients are asked to complete follow-up surveys, regardless of whether they participated in tobacco treatment. Data analysis of the primary aims will follow intent-to-treat methodology. Secondary outcomes will assess program implementation and cost effectiveness. DISCUSSION Addressing high tobacco use rates is critical for reducing cervical cancer morbidity and mortality among women living in Appalachia. This study evaluates the implementation and effectiveness of a smoking cessation program in increasing smoking cessation among female smokers. If results demonstrate effectiveness and sustainability, implementation of this program into other health care clinics could reduce both rates of smoking and cervical cancer. Trial registration NCT04340531 (April 9, 2020).
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Affiliation(s)
- Joanne G Patterson
- Division of Epidemiology, College of Public Health, The Ohio State University, 354 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA.
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | - Tia N Borger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Jessica L Burris
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Mark Conaway
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Robert Klesges
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | | | - Lindsay Hauser
- UVA Cancer Center, University of Virginia, Charlottesville, VA, USA
| | - Connie Clark
- UVA Cancer Center, University of Virginia, Charlottesville, VA, USA
| | | | - Sarah Cooper
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Merry C Smith
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Mark Dignan
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Stephenie Kennedy-Rea
- West Virginia University Cancer Institute, Morgantown, WV, USA
- Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Electra D Paskett
- Division of Epidemiology, College of Public Health, The Ohio State University, 354 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Roger Anderson
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Amy K Ferketich
- Division of Epidemiology, College of Public Health, The Ohio State University, 354 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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4
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Szwarc L, Sánchez Antelo V, Paolino M, Arrossi S. "I'm neither here, which would be bad, nor there, which would be good": the information needs of HPV+ women. A qualitative study based on in-depth interviews and counselling sessions in Jujuy, Argentina. Sex Reprod Health Matters 2021; 29:1991101. [PMID: 34779742 PMCID: PMC8604540 DOI: 10.1080/26410397.2021.1991101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The objective of this qualitative study was to explore the information needs of HPV+ women. We conducted 38 in-depth interviews with HPV+ women in the province of Jujuy, Argentina. The interviews included a counselling session to respond to women’s concerns and questions. Women perceived the information provided as good, despite having several doubts and misconceptions after receiving results of an HPV+ test. They expressed difficulties in formulating questions during the consultation due to shame, excess of information provided or lack of familiarity with technical language. They valued emotional support and being treated kindly by professionals. The perceived information needs that emerged as most important were: (1) the meaning of an HPV+ result and its relationship with cervical cancer evolution and severity; (2) continuity and timing of the care process; (3) information on the sexual transmission of the virus; (4) explanation of the presence or absence of symptoms. Women’s primary unperceived information needs were: (1) detailed information about colposcopy, biopsy and treatments and their effects (including fertility consequences); and (2) deconstructing the association of sexual transmission with infidelity. Sources of information included: (1) the health care system; (2) the internet; and (3) social encounters (close friends and relatives). It is crucial to strengthen the processes for delivering results, with more thorough information, improved emotional support and active listening focused on the patient, as well as to conceive new formats to provide information in stages and/or gradually, in order to facilitate women’s access to the health care system and the information they need.
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Affiliation(s)
- Lucila Szwarc
- Research Fellow, Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina. Correspondence:
| | | | - Melisa Paolino
- Researcher, Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Silvina Arrossi
- Senior Researcher, Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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Thompson JR, Risser LR, Dunfee MN, Schoenberg NE, Burke JG. Place, Power, and Premature Mortality: A Rapid Scoping Review on the Health of Women in Appalachia. Am J Health Promot 2021; 35:1015-1027. [PMID: 33906415 DOI: 10.1177/08901171211011388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Appalachian women continue to die younger than in other US regions. We performed a rapid scoping review to summarize women's health research in Appalachia from 2000 to 2019, including health topics, study populations, theoretical frameworks, methods, and findings. DATA SOURCE We searched bibliographic databases (eg, PubMed, PsycINFO, Google Scholar) for literature focusing on women's health in Appalachia. STUDY INCLUSION AND EXCLUSION CRITERIA Included articles were: (1) on women's health in Appalachia; (2) published January 2000 to June 2019; (3) peer-reviewed; and (4) written in English. We excluded studies without reported data findings. DATA EXTRACTION Two coders reviewed articles for descriptive information to create summary tables comparing variables of interest. DATA SYNTHESIS Two coders co-reviewed a sub-sample to ensure consensus and refine data charting categories. We categorized major findings across the social-ecological framework. RESULTS A search of nearly 2 decades of literature revealed 81 articles, which primarily focused on cancer disparities (49.4%) and prenatal/pregnancy outcomes (23.5%). Many of these research studies took place in Central Appalachia (eg, 42.0% in Kentucky) with reproductive or middle-aged women (82.7%). Half of the studies employed quantitative methods, and half used qualitative methods, with few mixed method or community-engaged approaches (3.7%). Nearly half (40.7%) did not specify a theoretical framework. Findings included complex multi-level factors with few articles exploring the co-occurrence of factors across multiple levels. CONCLUSIONS Future studies should: 1) systematically include Appalachian women at various life stages from under-represented sub-regions; 2) expand the use of rigorous methods and specified theoretical frameworks to account for complex interactions of social-ecological factors; and 3) build upon existing community assets to improve health in this vulnerable population.
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Affiliation(s)
- Jessica R Thompson
- Department of Behavioral and Community Health Sciences, 51303University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
| | - Lauren R Risser
- Department of Behavioral and Community Health Sciences, 51303University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
| | | | | | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, 51303University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
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Arrossi S, Almonte M, Herrero R, Gago J, Sánchez Antelo V, Szwarc L, Thouyaret L, Paolino M, Wiesner C. Psycho-social impact of positive human papillomavirus testing in Jujuy, Argentina results from the Psycho-Estampa study. Prev Med Rep 2020; 18:101070. [PMID: 32257775 PMCID: PMC7113430 DOI: 10.1016/j.pmedr.2020.101070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 02/08/2023] Open
Abstract
Human papillomavirus (HPV) testing can have a negative impact on women's lives which might also result in abandoning the follow-up and treatment process. This study measured the psycho-social impact of HPV-positivity among HPV-tested women from Jujuy, Argentina, a middle-low income setting. In this cross-sectional study (2015-2016), the psycho-social impact of HPV-positivity was measured using the Psycho-Estampa Scale, specifically designed and validated to be used in screening contexts. We measured mean scores for each of the five scale domains, and the Overall Impact score (Values from 1: No impact to 4: Heavy impact). We compared scores according to cytology triage diagnosis using ordinal logistic regression. A total of 163 HPV-positive women were recruited at the Centro Carlos Alvarado hospital and included in the study sample; of these, 124 (76.1%) had normal triage cytologies. The overall Impact score was between low and moderate (mean:2.56, SD:0.65). The highest psycho-social impact was measured in the Worries about cancer and treatment domain (mean score:3.60, SD:0.60), followed by Sexuality domain (mean:2.50; SD:1.00). The Uncertainty about information provided by health providers domain had the lowest mean score (mean:2.14, SD:0.73). Compared to women with normal cytologies (n = 124), women with abnormal cytologies (n = 39) had a higher likelihood of greater overall Psycho-social Impact (OR: 2.91; p = 0.0036). No statistically significant differences were found in scores of specific domains according to cytology results. It is important to devise specific counseling interventions to reduce the psycho-social impact of HPV-Testing as primary screening and its potential effect on completion of the diagnosis/ treatment process.
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Affiliation(s)
- Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Maribel Almonte
- International Agency for Research on Cancer/World Health Organization (IARC-WHO), 150 Cours Albert Thomas, Lyon 69372, France
| | - Rolando Herrero
- International Agency for Research on Cancer/World Health Organization (IARC-WHO), 150 Cours Albert Thomas, Lyon 69372, France
| | - Juan Gago
- New York University-NYU, School of Medicine, USA
| | | | - Lucila Szwarc
- Centro de Estudios de Estado y Sociedad, Sánchez de Bustamante 27, Buenos Aires, Argentina
| | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino /Instituto Nacional del Cáncer (Argentina), Av. Julio A. Roca 781, Buenos Aires, Argentina
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Carolina Wiesner
- Instituto Nacional de Cancerología, Calle 1 No.9-85, Bogotá, Colombia
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Rodriguez SD, Vanderford NL, Huang B, Vanderpool RC. A Social-Ecological Review of Cancer Disparities in Kentucky. South Med J 2018; 111:213-219. [PMID: 29719033 DOI: 10.14423/smj.0000000000000794] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Cancer continuously ranks among the top 10 leading causes of death in the United States. The burden of cancer is particularly elevated in the Commonwealth of Kentucky and its 54-county Appalachian region, where cancer is the leading cause of death. Kentucky's high rates of cancer have been attributed to a wide range of socioeconomic, behavioral, environmental, and policy influences, resulting in numerous disparities. The present review specifically evaluates the burden of lung, colorectal, cervical, and head and neck cancers in Kentucky, along with resultant cancer control research and community outreach efforts conducted by the state's only National Cancer Institute-designated cancer center using an adapted version of McLeroy's Social-Ecological Model. Here, we categorize disparities and identify relevant intervention approaches based on their level of influence (ie, individual, community, and policy).
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Affiliation(s)
- Sharon D Rodriguez
- From the Colleges of Public Health and Medicine, University of Kentucky, Lexington
| | - Nathan L Vanderford
- From the Colleges of Public Health and Medicine, University of Kentucky, Lexington
| | - Bin Huang
- From the Colleges of Public Health and Medicine, University of Kentucky, Lexington
| | - Robin C Vanderpool
- From the Colleges of Public Health and Medicine, University of Kentucky, Lexington
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Kerr A, Ross E, Jacques G, Cunningham‐Burley S. The sociology of cancer: a decade of research. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:552-576. [PMID: 29446117 PMCID: PMC5901049 DOI: 10.1111/1467-9566.12662] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Biomedicine is often presented as the driving force behind improvements in cancer care, with genomics the latest innovation poised to change the meaning, diagnosis, treatment, prevention and lived experience of cancer. Reviewing sociological analyses of a diversity of patient and practitioner experiences and accounts of cancer during the last decade (2007-17), we explore the experiences of, approaches to and understandings of cancer in this period. We identify three key areas of focus: (i) cancer patient experiences and identities; (ii) cancer risk and responsibilities and (iii) bioclinical collectives. We explore these sociological studies of societal and biomedical developments and how sociologists have sought to influence developments in cancer identities, care and research. We end by suggesting that we extend our understanding of innovations in the fields of cancer research to take better account of these wider social and cultural innovations, together with patients, activists' and sociologists' contributions therein.
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Affiliation(s)
- Anne Kerr
- School of Sociology and Social PolicyUniversity of LeedsUK
| | - Emily Ross
- The Usher InstituteEdinburgh Medical SchoolUniversity of EdinburghUK
| | - Gwen Jacques
- School of Sociology and Social PolicyUniversity of LeedsUK
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Katz ML, Zimmermann BJ, Moore D, Paskett ED, Reiter PL. Perspectives from health-care providers and women about completing human papillomavirus (HPV) self-testing at home. Women Health 2016; 57:1161-1177. [PMID: 27700693 DOI: 10.1080/03630242.2016.1243608] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cervical cancer (CC) incidence and mortality rates are increased, and CC screening rates are low among Appalachian Ohio women. Mailing human papillomavirus (HPV) self-tests to women to complete at home is a potential new strategy to engage women in CC screening. The authors aimed to gain insights into the perceived acceptability of mailed HPV self-tests. Focus groups were conducted (August 2014-January 2015) among providers (physicians, nurse practitioners, nurses) and women in Appalachian Ohio. Providers (n = 28) and women (n = 15; age range: 32-62 years) reported general acceptance of HPV self-tests, however, for different reasons. Providers thought HPV self-testing would increase the proportion of under-screened women returning to the health-care system, while women thought self-testing would eliminate logistical and reduce psychological CC screening barriers. Findings provide insights into facilitators and barriers of completing an HPV self-test at home, returning it, reporting results, and providing needed follow-up care. To the authors' knowledge, no systematic research exists addressing providers' views regarding women's use of HPV self-tests and the relation of such use to fostering subsequent Pap testing. This information will be useful in developing CC screening programs that include mailed HPV self-tests, as well as encouragement of follow-up Pap testing to meet existing CC screening guidelines.
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Affiliation(s)
- Mira L Katz
- a Division of Health Behavior and Health Promotion, College of Public Health , The Ohio State University , Columbus , Ohio , USA.,b Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine , The Ohio State University , Columbus , Ohio , USA.,c Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA
| | - Barret J Zimmermann
- c Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA
| | - Deborah Moore
- d Valley View Health Centers , Waverlys , Ohio , USA
| | - Electra D Paskett
- b Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine , The Ohio State University , Columbus , Ohio , USA.,c Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA
| | - Paul L Reiter
- b Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine , The Ohio State University , Columbus , Ohio , USA.,c Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA
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Wigfall LT, Bynum SA, Friedman DB, Brandt HM, Richter DL, Glover SH, Hébert JR. Patient-provider communication with HIV-positive women about abnormal Pap test results. Women Health 2016; 57:19-39. [PMID: 26886433 DOI: 10.1080/03630242.2016.1150386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In this article, the authors examine communication between women living with human immunodeficiency virus (WLH) and health care providers (HCPs) regarding abnormal Pap tests. During the period of March 2011 through April 2012, 145 WLH were recruited from Ryan White funded clinics and community-based AIDS service organizations located in the southeastern United States. WLH who had an abnormal Pap test (69%, n = 100/145) were asked if their HCP shared and explained information about abnormal Pap tests. The authors performed chi-square tests and multivariable logistic regression analyses using Stata I/C 13. HCPs shared information about abnormal Pap tests with 60% of participants, and explained the information they shared to 78% of those. Health literate participants were more than three times as likely to have read the information received about abnormal Pap tests (adjusted odds ratio [aOR] = 3.49, 95% confidence interval [CI] 1.19-10.23), and almost five times as likely to have understood the cancer information they read (aOR = 4.70, 95% CI 1.55-14.24). Knowing other women who had had an abnormal Pap test was not significantly associated with cancer information seeking or processing after controlling for confounding factors. The present findings underscore the need to increase WLH's health literacy as an intermediate step to improving patient-provider communication among WLH. Lay sources of cancer information for WLH warrant further study.
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Affiliation(s)
- Lisa T Wigfall
- a Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA.,b Department of Health Services Policy and Management, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA
| | - Shalanda A Bynum
- c Department of Preventive Medicine and Biometrics, F. Edward Hébert School of Medicine , Uniformed Services University of the Health Sciences , Bethesda , Maryland , USA
| | - Daniela B Friedman
- d South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA.,e Department of Health Promotion, Education, and Behavior, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA
| | - Heather M Brandt
- d South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA.,e Department of Health Promotion, Education, and Behavior, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA
| | - Donna L Richter
- d South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA
| | - Saundra H Glover
- a Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA.,b Department of Health Services Policy and Management, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA
| | - James R Hébert
- d South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA.,f Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA
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11
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Wilson RJ, Ryerson AB, Singh SD, King JB. Cancer Incidence in Appalachia, 2004-2011. Cancer Epidemiol Biomarkers Prev 2016; 25:250-8. [PMID: 26819264 DOI: 10.1158/1055-9965.epi-15-0946] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/14/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Limited literature is available about cancer in the Appalachian Region. This is the only known analysis of all cancers for Appalachia and non-Appalachia covering 100% of the US population. Appalachian cancer incidence and trends were evaluated by state, sex, and race and compared with those found in non-Appalachian regions. METHODS US counties were identified as Appalachian or non-Appalachian. Age-adjusted cancer incidence rates, standard errors, and confidence intervals were calculated using the most recent data from the United States Cancer Statistics for 2004 to 2011. RESULTS Generally, Appalachia carries a higher cancer burden compared with non-Appalachia, particularly for tobacco-related cancers. For all cancer sites combined, Appalachia has higher rates regardless of sex, race, or region. The Appalachia and non-Appalachia cancer incidence gap has narrowed, with the exception of oral cavity and pharynx, larynx, lung and bronchus, and thyroid cancers. CONCLUSIONS Higher cancer incidence continues in Appalachia and appears at least in part to reflect high tobacco use and potential differences in socioeconomic status, other risk factors, patient health care utilization, or provider practices. It is important to continue to evaluate this population to monitor results from screening and early detection programs, understand behavioral risk factors related to cancer incidence, increase efforts to reduce tobacco use and increase cancer screening, and identify other areas where effective interventions may mediate disparities. IMPACT Surveillance and evaluation of special populations provide means to monitor screening and early detection programs, understand behavioral risk factors, and increase efforts to reduce tobacco use to mediate disparities.
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Affiliation(s)
- Reda J Wilson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - A Blythe Ryerson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Simple D Singh
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica B King
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Driscoll SD. Barriers and facilitators to cervical cancer screening in high incidence populations: A synthesis of qualitative evidence. Women Health 2015; 56:448-67. [DOI: 10.1080/03630242.2015.1101742] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rasul VH, Cheraghi MA, Behboodi Moqadam Z. Influencing factors on cervical cancer screening from the Kurdish women's perspective: A qualitative study. J Med Life 2015; 8:47-54. [PMID: 28255397 PMCID: PMC5327709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/27/2015] [Indexed: 11/18/2022] Open
Abstract
Aim:This study was aimed to explore and describe the Kurdish women's perception of cervical cancer screening. Methods: A qualitative design based on a conventional content analysis approach. Purposive sampling was applied to 19 women chosen, who had a Pap smear or refused to have one. The study was performed in the Kurdistan Region, Iraq. Semi-structure din-depth individual interviews were carried out to collect data. Results: Four main themes including conflict, belief, and awareness about cervical cancer screening and socio-cultural factors emerged during data analysis Conclusions: Cervical cancer has a high mortality rate in the developing countries. However, only a few Kurdish women participated in the cervical cancer screening in the Kurdistan Region, Iraq. Understanding the factors associated with the women's perception of cervical cancer could guide future educational planning and clinical interventions improve the cervical cancer screening.
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Affiliation(s)
- V H Rasul
- Faculty of Nursing and Midwifery, International Campus, Tehran University of Medical Sciences, Tehran, Iran; Shaqlawa Techniqueal Institute, Erbil Polytechnique University, Kurdistan Region, Iraq
| | - M A Cheraghi
- Faculty of Nursing and Midwifery, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Z Behboodi Moqadam
- Reproductive Health, Faculty of Nursing and Midwifery, International Campus, Tehran University of Medical Sciences, Tehran, Iran
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Zapka JM, Edwards HM, Chollette V, Taplin SH. Follow-up to abnormal cancer screening tests: considering the multilevel context of care. Cancer Epidemiol Biomarkers Prev 2014; 23:1965-73. [PMID: 25073625 PMCID: PMC4191903 DOI: 10.1158/1055-9965.epi-14-0454] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The call for multilevel interventions to improve the quality of follow-up to abnormal cancer screening has been out for a decade, but published work emphasizes individual approaches, and conceptualizations differ regarding the definition of levels. To investigate the scope and methods being undertaken in this focused area of follow-up to abnormal tests (breast, colon, cervical), we reviewed recent literature and grants (2007-2012) funded by the National Cancer Institute. A structured search yielded 16 grants with varying definitions of "follow-up" (e.g., completion of recommended tests, time to diagnosis); most included minority racial/ethnic group participants. Ten grants concentrated on measurement/intervention development and 13 piloted or tested interventions (categories not mutually exclusive). All studies considered patient-level factors and effects. Although some directed interventions at provider levels, few measured group characteristics and effects of interventions on the providers or levels other than the patient. Multilevel interventions are being proposed, but clarity about endpoints, definition of levels, and measures is needed. The differences in the conceptualization of levels and factors that affect practice need empirical exploration, and we need to measure their salient characteristics to advance our understanding of how context affects cancer care delivery in a changing practice and policy environment.
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Affiliation(s)
- Jane M Zapka
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
| | - Heather M Edwards
- Clinical Research Directorate/CMRP, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Veronica Chollette
- Process of Care Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Stephen H Taplin
- Process of Care Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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15
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Cervical Smears at Public Health Centres in Eastern Trinidad: Coverage and Follow-up, 2009-2010. W INDIAN MED J 2014; 63:575-81. [PMID: 25803370 DOI: 10.7727/wimj.2013.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 11/26/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The objective was to examine the cervical screening programme at selected health centres in the Eastern Regional Health Authority (ERHA), Trinidad and Tobago, specifically regarding Pap smear coverage, frequency distribution of abnormal smears and the adequacy of follow-up of abnormal smears, according to the Caribbean Frameworks for Developing National Screening and Clinical Guidelines for Cervical Cancer Prevention and Control. METHODS A retrospective analysis of secondary data from five health centres in the ERHA over the two-year period 2009-2010 was conducted. Data were entered into Microsoft Excel, cleaned and imported into SPSS (v 12) for analysis. Descriptive and Chi-squared analyses were carried out. RESULTS The cumulative cervical screening coverage for the years 2009 and 2010 was 2600 Pap smears for a population of 28 811 women (9% coverage). The proportion of cervical smears done per age group ranged from 1.6% to 8.6% in 2009 and from 1.9% to 12.9% in 2010. The proportion of Pap smears for the target population, 25-49 years, stood at 11% in 2009 and 13.2% in 2010. The distribution of abnormal Pap smears (n = 155) was: atypical squamous cell of undetermined significance (ASCUS), 68.4%; low-grade squamous intra-epithelial lesion (LSIL), 14.2%; atypical squamous cells - high-grade squamous intra-epithelial lesion cannot be excluded (ASC-H), 4.5%; atypical glandular cells of undetermined significance (AGUS), 1.3% and invasive squamous cervical carcinoma, 0.6%. Human papillomavirus was detected in 7.7% of the study population. More than half of the women with abnormal smears did not follow-up on recommendations for further care and there was a significant loss to follow-up especially among the women who were referred for repeat Pap smear. The significant predictor to whether follow-up care occurred or not was age (p < 0.05). CONCLUSION The cervical screening services in the ERHA in Trinidad did not provide adequate coverage to the target population or adequate follow-up care for women with abnormal smears in 2009 and 2010.
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Analysis of patterns of patient compliance after an abnormal Pap smear result: the influence of demographic characteristics on patient compliance. J Low Genit Tract Dis 2014; 17:298-302. [PMID: 23645065 DOI: 10.1097/lgt.0b013e31826b683e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to determine population characteristics that correlate to suboptimal follow-up after an abnormal cervical cytology result. MATERIALS AND METHODS Nonpregnant women, ages 21 to 65 years, with newly diagnosed abnormal cervical cytology result between January 2009 and January 2012 at an urban clinic were eligible for inclusion in this retrospective chart review. Cervical cytology data and demographic characteristics such as age, ethnicity, employment, marital and smoking status, health insurance and number of pregnancies were abstracted from electronic medical record. A log-linear model was used to determine which factors influenced patient compliance. RESULTS Of the total of 206 women, 78 (37.9%) had optimal follow-up and 128 (62.1%) had suboptimal follow-up. The 3 variables that were statistically significant in influencing patient follow-up after adjusted analyses included severity of cytology result (p = .0013), ethnicity (p = .02), and employment status (p = .0159). The risk ratio for optimal follow-up for those with severe cytology result was 1.81; for the non-whites, 1.77; and for the employed, 1.53. CONCLUSIONS Ethnicity, severity of cervical cytology result, and employment status play an important role in patient follow-up after an abnormal cervical cytology result. Detecting trends in our patient population that influence adherence to follow-up will help health care providers formulate strategies that target this problem.
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Miller SM, Hui SKA, Wen KY, Scarpato J, Zhu F, Buzaglo J, Hernandez EE. Tailored telephone counseling to improve adherence to follow-up regimens after an abnormal pap smear among minority, underserved women. PATIENT EDUCATION AND COUNSELING 2013; 93:488-95. [PMID: 24007767 PMCID: PMC3852173 DOI: 10.1016/j.pec.2013.08.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 07/25/2013] [Accepted: 08/11/2013] [Indexed: 05/03/2023]
Abstract
OBJECTIVE The present study explored the impact of a tailored telephone counseling intervention on increasing follow-up adherence after an abnormal Pap smear result among low-income, minority women, which may reduce cervical cancer disparity. METHODS Participants (N=211) were randomly assigned to receive: (1) a telephone reminder that included an assessment of barriers to adherence, as well as counseling tailored to the barriers elicited; (2) telephone reminder and barriers assessment, followed by a mailed home tailored barriers print brochure; or (3) enhanced standard care comprising telephone reminder and barriers assessment. Assessments were obtained at initial contact and 1-week later, as well as at 6- and 12-months after the initial colposcopy. RESULTS The telephone counseling group showed greater adherence to follow-up recommendations than did the combined other two groups (p<0.05). For the initial colposcopy, tailored telephone barriers counseling was more effective among women with a high school education or less. CONCLUSION Tailored telephone barriers counseling improves adherence to initial colposcopy, as well as to longer-term medical follow-up, among low-income, inner-city women. PRACTICE IMPLICATIONS Dissemination of barriers counseling into ongoing telephone reminder calls and contacts may decrease disparities in cancer outcomes, especially among women with less than post-secondary education.
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Affiliation(s)
- Suzanne M Miller
- Department of Psychosocial and Behavioral Medicine, Fox Chase Cancer Center/Temple University Health System, USA.
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Cohen EL, Scott AM, White CR, Dignan MB. Evaluation of Patient Needs and Patient Navigator Communication about Cervical Cancer Prevention in Appalachian Kentucky. THE JOURNAL OF COMMUNICATION 2013; 63:72-94. [PMID: 27030783 PMCID: PMC4809205 DOI: 10.1111/jcom.12002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Few studies describe the way patient navigation processes may address disparities in treatment and follow-up care for medically underserved populations. Using a social ecological framework, we analyzed survey assessments of 519 patients completing a randomized navigation trial in Appalachia Kentucky to examine patient-reported barriers to follow-up cervical cancer care. We also analyzed in-depth interview transcripts with four lay patient navigators in the trial to identify barriers to follow-up care and to learn what communication strategies navigators use to successfully (or unsuccessfully) help patients navigate around those barriers. Our analysis provides insight into how patient navigation may improve adherence to follow-up care through assisted uncertainty management. We also discuss opportunities for improving navigator training to address disparities in clinical outcomes.
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Paskett ED, Fisher JL, Lengerich EJ, Schoenberg NE, Kennedy SK, Conn ME, Roberto KA, Dwyer SK, Fickle D, Dignan M. Disparities in underserved white populations: the case of cancer-related disparities in Appalachia. Oncologist 2012; 16:1072-81. [PMID: 21873582 DOI: 10.1634/theoncologist.2011-0145] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
There are meaningful cancer-related disparities in the Appalachian region of the U.S. To address these disparities, the Appalachia Community Cancer Network (ACCN), a collaboration of investigators and community partners in five states (Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia), is involved in increasing cancer education and awareness, conducting community-based participatory research (CBPR), and creating mentorship and training opportunities. The primary objective of this paper is to describe cancer-related disparities in the Appalachian region of the U.S. as an example of the disparities experienced by underserved, predominantly white, rural populations, and to describe ACCN activities designed to intervene regarding these disparities. An ACCN overview/history and the diverse activities of ACCN-participating states are presented in an effort to suggest potential useful strategies for working to reduce health-related disparities in underserved white populations. Strengths that have emerged from the ACCN approach (e.g., innovative collaborations, long-standing established networks) and remaining challenges (e.g., difficulties with continually changing communities, scarce resources) are described. Important recommendations that have emerged from the ACCN are also presented, including the value of allowing communities to lead CBPR efforts. Characteristics of the community-based work of the ACCN provide a framework for reducing health-related disparities in Appalachia and in other underserved white and rural populations.
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Affiliation(s)
- Electra D Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Columbus, Ohio, USA
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