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Moran RJ, Waalen J, Murphy J, Nalawade V, Schiaffino M. Pneumococcal Vaccination Utilization Among Hispanic Long-Term Colorectal Cancer Survivors: Cross-Sectional Assessment of Claims. JMIR Public Health Surveill 2019; 5:e12603. [PMID: 31094341 PMCID: PMC6535973 DOI: 10.2196/12603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/29/2019] [Accepted: 03/30/2019] [Indexed: 01/27/2023] Open
Abstract
Background Colorectal cancer (CRC) is the second leading cancer-related cause of death in the United States. However, survivorship has been increasing. Both cancer survivors and underserved populations experience unique health-related challenges and disparities that may exist among long-term CRC survivors as it relates to routine preventive care, specifically pneumococcal (PNM) vaccination. Objective The aim of this study was to explore the relationship between long-term CRC survival and the receipt of PNM vaccine among Hispanic Medicare recipients compared with non-Hispanic populations. Methods This study is a cross-sectional analysis of the Surveillance, Epidemiology, and End Results (SEER)-Medicare claims data examining ethnic differences in the receipt of PNM vaccination among long-term CRC survivors. Multivariable logistic regression models considered Hispanic ethnicity while controlling for sociodemographic characteristics, comorbidity score, age, tumor stage, and SEER registry. Results Our sample revealed 32,501 long-term CRC survivors, and 1509 identified as Hispanic (4.64%) based on an established SEER algorithm. In total, 16,252 CRC survivors, or 50.00% of our sample, received a PNM vaccination. We found that Hispanic CRC survivors had 10% decreased odds of having received a PNM vaccine compared with non-Hispanic survivors (P=.03). Conclusions Disparities likely exist in the utilization of PNM vaccination among long-term CRC survivors. Among Medicare beneficiaries, the use of claims data regarding PNM vaccination highlights the relatively poor utilization of guideline-directed preventive care.
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Affiliation(s)
- Ryan J Moran
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States.,School of Public Health, San Diego State University, San Diego, CA, United States
| | - Jill Waalen
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States.,3Scripps Translational Research Institute, San Diego, CA, United States
| | - James Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, United States
| | - Vinit Nalawade
- School of Public Health, San Diego State University, San Diego, CA, United States.,Institute for Behavioral and Community Health, San Diego State University, San Diego, CA, United States
| | - Melody Schiaffino
- School of Public Health, San Diego State University, San Diego, CA, United States.,Institute for Behavioral and Community Health, San Diego State University, San Diego, CA, United States
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Watkins KL, Reitzel LR, Wetter DW, McNeill LH. HPV awareness, knowledge and attitudes among older African-American women. Am J Health Behav 2015; 39:205-11. [PMID: 25564833 PMCID: PMC5038912 DOI: 10.5993/ajhb.39.2.7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To assess correlates of human papillomavirus (HPV) awareness, knowledge, and attitudes among older, church-going African-American women. METHODS Participants (N = 759), aged 40-80, answered survey questions about HPV awareness, knowledge, and attitudes toward vaccination of adolescent daughters. Associations between participant characteristics and HPV items were assessed using chi-square tests and logistic regression analyses. RESULTS Younger age, higher education, a family history of cancer, and less spirituality were each associated with HPV awareness individually, and when considered jointly in a single model (p values <.038). Higher education was related to HPV knowledge (p = .006). CONCLUSIONS African-American women of older age, less education, no family history of cancer, and/or higher spirituality might benefit from targeted church-based HPV educational campaigns.
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Affiliation(s)
- Kellie L Watkins
- The University of Texas School of Public Health, Department of Epidemiology, Houston, TX, USA
| | - Lorraine R Reitzel
- The University of Houston, College of Education, Department of Educational Psychology, Houston, TX, USA.
| | - David W Wetter
- Department of Psychology, Rice University, Houston, TX, USA
| | - Lorna H McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Krist AH, Aycock RA, Etz RS, Devoe JE, Sabo RT, Williams R, Stein KL, Iwamoto G, Puro J, Deshazo J, Kashiri PL, Arkind J, Romney C, Kano M, Nelson C, Longo DR, Wolver S, Woolf SH. MyPreventiveCare: implementation and dissemination of an interactive preventive health record in three practice-based research networks serving disadvantaged patients--a randomized cluster trial. Implement Sci 2014; 9:181. [PMID: 25500097 PMCID: PMC4269965 DOI: 10.1186/s13012-014-0181-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 11/24/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Evidence-based preventive services for early detection of cancer and other health conditions offer profound health benefits, yet Americans receive only half of indicated services. Policy initiatives promote the adoption of information technologies to engage patients in care. We developed a theory-driven interactive preventive health record (IPHR) to engage patients in health promotion. The model defines five levels of functionality: (1) collecting patient information, (2) integrating with electronic health records (EHRs), (3) translating information into lay language, (4) providing individualized, guideline-based clinical recommendations, and (5) facilitating patient action. It is hypothesized that personal health records (PHRs) with these higher levels of functionality will inform and activate patients in ways that simpler PHRs cannot. However, realizing this vision requires both technological advances and effective implementation based upon clinician and practice engagement. METHODS/DESIGN We are starting a two-phase, mixed-method trial to evaluate whether the IPHR is scalable across a large number of practices and how its uptake differs for minority and disadvantaged patients. In phase 1, 40 practices from three practice-based research networks will be randomized to add IPHR functionality to their PHR versus continue to use their existing PHR. Throughout the study, we will engage intervention practices to locally tailor IPHR content and learn how to integrate new functions into their practice workflow. In phase 2, the IPHR to all nonintervention practices to observe whether the IPHR can be implemented more broadly (Scalability). Phase 1 will feature an implementation assessment in intervention practices, based on the RE-AIM model, to measure Reach (creation of IPHR accounts by patients), Adoption (practice decision to use the IPHR), Implementation (consistency, fidelity, barriers, and facilitators of use), and Maintenance (sustained use). The incremental effect of the IPHR on receipt of cancer screening tests and shared decision-making compared to traditional PHRs will assess Effectiveness. In phase 2, we will assess similar outcomes as phase 1 except for effectiveness. DISCUSSION This study will yield information about the effectiveness of new health information technologies designed to actively engage patients in their care as well as information about how to effectively implement and disseminate PHRs by engaging clinicians. TRIAL REGISTRATION ClinicalTrials.gov: NCT02138448.
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Affiliation(s)
- Alex H Krist
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
| | - Rebecca A Aycock
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
| | - Rebecca S Etz
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
| | - Jennifer E Devoe
- />OCHIN, Portland, OR, Oregon
- />Department of Family Medicine, Oregon Health & Science University, Portland, OR, Oregon
- />Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, Oregon
| | - Roy T Sabo
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
- />Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, Virginia
| | - Robert Williams
- />Department of Family Medicine, University of New Mexico, Albuquerque, NM Mexico
| | - Karen L Stein
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
| | - Gary Iwamoto
- />Department of Internal Medicine, University of New Mexico, Albuquerque, NM Mexico
| | | | - Jon Deshazo
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
| | - Paulette Lail Kashiri
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
| | | | - Crystal Romney
- />Department of Family Medicine, University of New Mexico, Albuquerque, NM Mexico
| | - Miria Kano
- />Department of Family Medicine, University of New Mexico, Albuquerque, NM Mexico
| | | | - Daniel R Longo
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
| | - Susan Wolver
- />Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, Virginia
| | - Steven H Woolf
- />Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, Virginia
- />Center on Society and Health, Virginia Commonwealth University, Richmond, VA, Virginia
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Branković I, Verdonk P, Klinge I. Applying a gender lens on human papillomavirus infection: cervical cancer screening, HPV DNA testing, and HPV vaccination. Int J Equity Health 2013. [PMID: 23394214 DOI: 10.1186/1475-9276-1214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Our aim is to provide a state-of-the-art overview of knowledge on sex (biological) and gender (sociocultural) aspects of Human papillomavirus (HPV) and cervical cancer for educational purposes. Considerable disparities exist in cervical cancer incidences between different subgroups of women. We provide an outline on the crucial issues and debates based on the recent literature published in leading gender medicine journals. Intersectionality was applied in order to help categorise the knowledge. METHODS Key terms (HPV, cervical cancer) were screened in Gender Medicine, Journal of Women's Health and Women & Health from January 2005-June 2012. Additional searches were conducted for topics insufficiently mentioned, such as HPV vaccination of boys. In total, 71 publications were included (56 original papers, four reviews, six reports, three commentaries, one editorial and one policy statement). RESULTS Research reveals complexity in the way various subgroups of women adhere to cervical screening. Less educated women, older women, uninsured women, homeless women, migrant women facing language barriers, women who have sex with women and obese women participate in Pap smears less frequently. A series of barriers can act to impede decisions to vaccinate against HPV. CONCLUSIONS Both male and female controlled preventive methods and treatment measures should be developed in order to tackle HPV infection and different strategies are needed for different subgroups. A substantial discussion and research on alternative methods of prevention was and is lacking. In future research, sex and gender aspects of HPV-related diseases of boys and men as well as subgroup differences in HPV risk need to be addressed.
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Affiliation(s)
- Ivan Branković
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, FHML, School CAPHRI, Maastricht University, PO Box 616, MD 6200, Maastricht, The Netherlands.
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Branković I, Verdonk P, Klinge I. Applying a gender lens on human papillomavirus infection: cervical cancer screening, HPV DNA testing, and HPV vaccination. Int J Equity Health 2013; 12:14. [PMID: 23394214 PMCID: PMC3598235 DOI: 10.1186/1475-9276-12-14] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 01/29/2013] [Indexed: 02/08/2023] Open
Abstract
Background Our aim is to provide a state-of-the-art overview of knowledge on sex (biological) and gender (sociocultural) aspects of Human papillomavirus (HPV) and cervical cancer for educational purposes. Considerable disparities exist in cervical cancer incidences between different subgroups of women. We provide an outline on the crucial issues and debates based on the recent literature published in leading gender medicine journals. Intersectionality was applied in order to help categorise the knowledge. Methods Key terms (HPV, cervical cancer) were screened in Gender Medicine, Journal of Women’s Health and Women & Health from January 2005-June 2012. Additional searches were conducted for topics insufficiently mentioned, such as HPV vaccination of boys. In total, 71 publications were included (56 original papers, four reviews, six reports, three commentaries, one editorial and one policy statement). Results Research reveals complexity in the way various subgroups of women adhere to cervical screening. Less educated women, older women, uninsured women, homeless women, migrant women facing language barriers, women who have sex with women and obese women participate in Pap smears less frequently. A series of barriers can act to impede decisions to vaccinate against HPV. Conclusions Both male and female controlled preventive methods and treatment measures should be developed in order to tackle HPV infection and different strategies are needed for different subgroups. A substantial discussion and research on alternative methods of prevention was and is lacking. In future research, sex and gender aspects of HPV-related diseases of boys and men as well as subgroup differences in HPV risk need to be addressed.
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Affiliation(s)
- Ivan Branković
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, FHML, School CAPHRI, Maastricht University, PO Box 616, MD 6200, Maastricht, The Netherlands.
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Miesfeldt S, Murray K, Lucas L, Chang CH, Goodman D, Morden NE. Association of age, gender, and race with intensity of end-of-life care for Medicare beneficiaries with cancer. J Palliat Med 2012; 15:548-54. [PMID: 22468739 DOI: 10.1089/jpm.2011.0310] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To measure intensity of end-of-life (EOL) care for Medicare cancer patients and variations in care by age, gender, and race. PATIENTS AND METHODS This retrospective cohort analysis of Medicare claims (20% sample) examined 235,821 Medicare Parts A and B fee-for-service patients dying with poor-prognosis cancers between 2003 and 2007. Logistic regression models quantified associations between care intensity and age, gender, and race. Measures included hospitalizations, emergency department (ED) visits, intensive care unit (ICU) admissions, in-hospital deaths, late-life chemotherapy administration, overall and late hospice enrollment within six months of death. RESULTS Within 30 days of death, 61.3% of patients were hospitalized, 10.2% were hospitalized more than once, 10.2% visited an ED more than once, 23.7% had ICU admissions, and 28.8% died in-hospital. Within two weeks of death, 6% received chemotherapy. In their final six months, 55.2% accessed hospice, 15.1% within three days of death. Older age (≥75 versus <75) was associated with lower odds ratios (ORs) of 0.49 to 0.89 for aggressive care, and an OR of 0.92 (95% CI 0.89-0.95) for late hospice enrollment. Female gender was associated with lower ORs (0.82 to 0.86) for aggressive care, and an OR of 0.84 (95% CI 0.81-0.86) for late hospice enrollment. Black (versus nonblack) race was associated with higher ORs (1.08 to 1.38) for aggressive acute care, lower ORs for late chemotherapy, OR 0.76 (95% CI 0.71-0.81), and late hospice enrollment, OR 0.81 (95% CI 0.76-0.86). CONCLUSIONS Seniors dying with poor-prognosis cancer experience high-intensity care with rates varying by age, gender, and race.
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Affiliation(s)
- Susan Miesfeldt
- Maine Medical Center Research Institute, Maine Medical Center, Portland, Maine, USA.
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Watson M, Saraiya M, Benard V, Coughlin SS, Flowers L, Cokkinides V, Schwenn M, Huang Y, Giuliano A. Burden of cervical cancer in the United States, 1998-2003. Cancer 2008; 113:2855-64. [PMID: 18980204 DOI: 10.1002/cncr.23756] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Recent interest in human papillomavirus (HPV)-associated cancers and the availability of several years of data covering 83% of the US population prompted this descriptive assessment of cervical cancer incidence and mortality in the US during the years 1998 through 2003. This article provides a baseline for monitoring the impact of the HPV vaccine on the burden of cervical cancer over time. METHODS Data from 2 federal cancer surveillance programs, the Centers for Disease Control and Prevention (CDC)'s National Program of Cancer Registries and the National Cancer Institiute's Surveillance, Epidemiology, and End Results Program, were used to examine cervical cancer incidence by race, Hispanic ethnicity, histology, stage, and US census region. Data from the CDC's National Center for Health Statistics were used to examine cervical cancer mortality by race, Hispanic ethnicity, and US census region. RESULTS The incidence rate of invasive cervical cancer was 8.9 per 100,000 women during 1998 through 2003. Greater than 70% of all cervical carcinomas were squamous cell type, and nearly 20% were adenocarcinomas. Cervical carcinoma incidence rates were increased for black women compared with white women and for Hispanic women compared with non-Hispanic women. Hispanic women had increased rates of adenocarcinomas compared with non-Hispanic women. The South had increased incidence and mortality rates compared with the Northeast. CONCLUSIONS Disparities by race/ethnicity and region persist in the burden of cervical cancer in the US. Comprehensive screening and vaccination programs, as well as improved surveillance, will be essential if this burden is to be reduced in the future.
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Affiliation(s)
- Meg Watson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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