1
|
Beydoun HA, Tsai J. Lifetime prevalence and correlates of colorectal cancer screening among low-income U.S. Veterans. Cancer Causes Control 2024; 35:1215-1231. [PMID: 38714606 DOI: 10.1007/s10552-024-01881-5] [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] [Received: 10/25/2023] [Accepted: 04/10/2024] [Indexed: 05/10/2024]
Abstract
PURPOSE The Veterans Health Administration (VHA) is the largest integrated healthcare system in the U.S. While preventive healthcare services are high priority in the VHA, low-income U.S. Veterans experience adverse life circumstances that may negatively impact their access to these services. This study examined lifetime prevalence as well as demographic, socioeconomic, military-specific, and clinical correlates of colorectal cancer (CRC) screening among low-income U.S. Veterans ≥ 50 years of age. METHODS Cross-sectional data on 862 participants were analyzed from the 2021-2022 National Veteran Homeless and Other Poverty Experiences study. RESULTS Overall, 55.3% (95% confidence interval [CI] 51.3-59.3%) reported ever-receiving CRC-screening services. In a multivariable logistic regression model, never-receivers of CRC screening were twice as likely to reside outside of the Northeast, and more likely to be married (odds ratio [OR] = 1.86, 95% CI 1.02, 3.37), have BMI < 25 kg/m2 [vs. 25- < 30 kg/m2] (OR = 1.75, 95% CI 1.19, 2.58), or ≥ 1 chronic condition (OR = 1.46, 95% CI 1.06, 2.02). Never-receivers of CRC screening were less likely to be female (OR = 0.53, 95% CI 0.29, 0.96), aged 65-79y [vs. ≥ 80y] (OR = 0.61, 95% CI 0.40, 0.92), live in 5 + member households (OR = 0.33, 95% CI 0.13, 0.86), disabled (OR = 0.45, 0.22, 0.92), with purchased health insurance (OR = 0.56, 95% CI 0.33, 0.98), or report alcohol-use disorder (OR = 0.10, 95% CI 0.02, 0.49) and/or HIV/AIDS (OR = 0.28, 95% CI 0.12, 0.68). CONCLUSION Nearly 55% of low-income U.S. Veterans reported ever screening for CRC. Variations in CRC-screening behaviors according to veteran characteristics highlight potential disparities as well as opportunities for targeted behavioral interventions.
Collapse
Affiliation(s)
- Hind A Beydoun
- National Center on Homelessness Among Veterans (NCHAV), Veterans Health Administration, 810 Vermont Avenue, NW, Washington, DC, 20420, USA.
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Jack Tsai
- National Center on Homelessness Among Veterans (NCHAV), Veterans Health Administration, 810 Vermont Avenue, NW, Washington, DC, 20420, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
2
|
Cataneo JL, Kim TD, Park JJ, Marecik S, Kochar K. Disparities in Screening for Colorectal Cancer Based on Limited Language Proficiency. Am Surg 2022; 88:2737-2744. [PMID: 35642266 DOI: 10.1177/00031348221105596] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study analyzes the association between limited language proficiency and screening for colorectal cancer. METHODS This is a retrospective cohort study from the 2015 sample of the National Health Interview Survey database utilizing univariate and multivariate regression analysis. The study population includes subjects between 50 and 75 years of age. The main outcome analyzed was rates of screening colonoscopies between limited English-language proficiency (LEP) subjects and those fluent in English. Secondary outcomes included analysis of baseline, socioeconomic, access to health care variables, and other modalities for colorectal cancer screening between the groups. RESULTS Incidence of limited language proficiency was 4.8% (n = 1978, count = 4 453 599). They reported lower rates of screening colonoscopies (61% vs 34%, P < .001), less physician recommendation for a colonoscopy (87 vs 60%, P < .001), fewer polyps removed in the previous 3 years (24% vs 9.1%; P < .001), and fewer fecal occult blood samples overall (P < .001). Additionally, Hispanic non-LEP subjects have higher rates of colonoscopies compared to those with language barriers (50% vs 33%, P < .001). On multivariate analysis, LEP was associated with a lower likelihood to have a screening colonoscopy (OR .67 95% CI .49-.91). A second regression model with "Spanish language" and "other language" variables included, associated Spanish speakers with a lower likelihood for a screening colonoscopy (OR .71 95% CI .52-.97) when controlling for baseline, socioeconomic, and access to health care covariates. DISCUSSION Patients with limited English-language proficiency are associated with lower rates of screening for colorectal cancer, in particular the Spanish speaking subgroup.
Collapse
Affiliation(s)
- Jose L Cataneo
- 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Tae David Kim
- 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - John J Park
- 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | | | - Kunal Kochar
- 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| |
Collapse
|
3
|
Correlates of influenza vaccination among underserved Latinx middle-aged and older adults: a cross-sectional survey. BMC Public Health 2022; 22:907. [PMID: 35524229 PMCID: PMC9077953 DOI: 10.1186/s12889-022-13121-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Vaccination is a powerful tool in the fight against seasonal influenza, among underserved, middle-age and older, Latinx adults. Yet, vaccine hesitancy and inconsistent uptake in this population continues to represent a substantial challenge to public health. A better understanding of factors impacting influenza vaccination behaviors in this group could result in more effective messaging and initiatives promoting universal vaccination among Latinx. Methods In this cross-sectional survey, we explore correlates of influenza vaccination uptake among underserved, Latinx, older adults. Our focus was on the role of socio-demographics, living arrangements, financial strain, access and satisfaction with medical care, and the presence of major chronic conditions in terms of vaccine uptake. Middle-aged and older Latinx residents diagnosed with diabetes and/or hypertension (n=165), were recruited from the South Los Angeles Service Plan Area (SPA), a historically under-resourced community. Bi-variate and multi-variate logistical regression were performed on survey data to explore independent correlates of influenza vaccination. Results Almost half of underserved Latinx older adults in our study (45%) reported influenza vaccination within the 12 months prior to the study. The majority (~85%) reported receiving this recommendation from their primary care provider. However, thirty percent (30%) of those receiving this advice did not get the vaccine. A decreased likelihood of vaccination was significantly associated with living alone (p-value=0.026), lacking Medicare coverage (0.028), or higher levels of financial strain (0.020). Difficulty accessing medical care (p-value=0.008) or dissatisfaction with these experiences (p-value=0.001) were also strongly associated with decreased likelihood of vaccination. Participants diagnosed with COPD had 9.5 (CI: 1.76 – 51.3) higher odds of being vaccinated compared to those without; no correlation was detected for other chronic conditions. Conclusion The high number of unvaccinated Latinx participants receiving a vaccine recommendation from a provider is consistent with studies among other ethnic/racial minority older adults and highlights the pivotal role of the provider in influenza vaccine adoption. Additional findings reflect negative impact of Social Determinates of Health on preventive care efforts in this group. Further efforts to quantify these associations are needed to explore structural and human factors impacting influenza vaccine uptake.
Collapse
|
4
|
Bergmark RW, Burks CA, Schnipper JL, Weissman JS. Understanding and Investigating Access to Surgical Care. Ann Surg 2022; 275:492-495. [PMID: 35120062 DOI: 10.1097/sla.0000000000005212] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - Ciersten A Burks
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Jeffrey L Schnipper
- Hospital Medicine Unit and Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Joel S Weissman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
| |
Collapse
|
5
|
de Dios MA, Cano MÁ, Vaughan EL, Childress SD, McNeel MM, Harvey LM, Niaura RS. A pilot randomized trial examining the feasibility and acceptability of a culturally tailored and adherence-enhancing intervention for Latino smokers in the U.S. PLoS One 2019; 14:e0210323. [PMID: 30633744 PMCID: PMC6329496 DOI: 10.1371/journal.pone.0210323] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 12/19/2018] [Indexed: 11/24/2022] Open
Abstract
Latino smokers in the United States (US) are known to experience smoking cessation treatment disparities due to their under-utilization of services, limited access to health care, and poor smoking cessation treatment outcomes. A limited number of studies have focused on developing and testing smoking cessation treatments for Latino smokers in the US. The objectives of this study were to conduct a feasibility pilot randomized trial testing three smoking cessation interventions for Latinos. Twenty-five adult Latino smokers were randomized to one of three groups: Culturally-Tailored Smoking Cessation plus Adherence Enhancement (CT+AE), Culturally-Tailored Smoking Cessation (CTSC), and a Health Education (HE) control group. All participants received three counseling sessions along with nicotine replacement therapy (NRT). Data relating to intervention acceptability and NRT adherence were collected. Self-reported 7-day point prevalence smoking was collected at 3 and 6 month follow-up and biochemically verified with expired carbon monoxide testing. Overall, the interventions demonstrated high levels of feasibility and acceptability. Days of nicotine patch use were found to be higher in the CT+AE group (mean (M) = 81.3;standard deviation (SD) = 3.32) than the CTSC (M = 68.6;SD = 13.66) and HE (M = 64;SD = 17.70) groups. At 3-month follow-up, approximately 50% of the CT+AE group were smoking abstinent, 25% of the CTSC group, and 44% of the HE group. At 6-month follow-up, 37.5% of the CT+AE group were abstinent, 25% of the CTSC group, and 44.4% of the HE group. This study is the first to target Latino smokers in the US with a culturally-tailored intervention that addresses treatment adherence. Results support the preliminary feasibility and acceptability of the CT+AE intervention. Trial Registration: ClinicalTrials.gov NCT02596711.
Collapse
Affiliation(s)
- Marcel A. de Dios
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, Texas, United States of America
- Health Research Institute, University of Houston, Houston, Texas, United States of America
| | - Miguel Ángel Cano
- Department of Epidemiology, College of Public Health and Social Work, Florida International University, Miami, Florida, United States of America
| | - Ellen L. Vaughan
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, Indiana, United States of America
| | - Sarah D. Childress
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, Texas, United States of America
- Health Research Institute, University of Houston, Houston, Texas, United States of America
| | - Morgan M. McNeel
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, Texas, United States of America
| | - Laura M. Harvey
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, Texas, United States of America
| | - Raymond S. Niaura
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, New York, United States of America
| |
Collapse
|
6
|
Agirdas C, Holding JG. Effects of the ACA on Preventive Care Disparities. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:859-869. [PMID: 30143994 DOI: 10.1007/s40258-018-0423-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The Affordable Care Act (ACA) requires non-grandfathered private insurance plans, starting with plan years on or after September 23rd, 2010, to provide certain preventive care services without any cost sharing in the form of deductibles, copayments or co-insurance. This requirement may affect racial and ethnic disparities in preventive care as it provides the largest copay reduction in preventive care. OBJECTIVES We ask whether the ACA's free preventive care benefits are associated with a reduction in racial and ethnic disparities in the utilization of four preventive services: cholesterol screenings, colonoscopies, mammograms, and Pap smears. METHODS We use a data set of over 6000 individuals from the 2009, 2010, and 2013 Medical Expenditure Panel Surveys (MEPS). We restrict our data set only to individuals who are old enough to be eligible for each preventive service. Our difference-in-differences logistic regression model classifies privately insured Hispanics, African Americans, and Asians as the treatment groups and 2013 as the after-policy year. Our control group consists of non-Hispanic whites on Medicaid as this program already covered preventive care services for free or at a low cost before the ACA. RESULTS After controlling for income, education, marital status, preferred interview language, self-reported health status, employment, having a usual source of care, age and gender, we find that the ACA is associated with increases in the probability of the median, privately insured Hispanic person to get a colonoscopy by 3.6% and a mammogram by 3.1%, compared to a non-Hispanic white person on Medicaid. Similarly, we find that the median, privately insured African American person's probability of receiving these two preventive services improved by 2.3 and 2.4% compared to a non-Hispanic white person on Medicaid. We do not find any significant improvements for any racial or ethnic group for cholesterol screenings or Pap smears. Furthermore, our results do not indicate any significant changes for Asians compared to non-Hispanic whites in utilizing the four preventive services. These reductions in racial/ethnic disparities are robust to reconfigurations of time periods, previous diagnosis, and residential status. CONCLUSIONS Early effects of the ACA's provision of free preventive care are significant for Hispanics and African Americans. Further research is needed for the later years as more individuals became aware of these benefits.
Collapse
Affiliation(s)
- Cagdas Agirdas
- Sykes College of Business, University of Tampa, Box O, 401 W. Kennedy Blvd., Tampa, FL, 33606, USA.
| | - Jordan G Holding
- Mezrah Consulting, 5350 West Kennedy Boulevard, Suite Two, Tampa, FL, 33609, USA
| |
Collapse
|
7
|
The Effects of State Medicaid Expansion on Low-Income Individuals' Access to Health Care: Multilevel Modeling. Popul Health Manag 2018; 21:235-244. [DOI: 10.1089/pop.2017.0104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
8
|
Cole MB, Wilson IB, Trivedi AN. State Variation in Quality Outcomes and Disparities in Outcomes in Community Health Centers. Med Care 2017; 55:1001-1007. [PMID: 29016396 PMCID: PMC5688017 DOI: 10.1097/mlr.0000000000000818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prior studies have reported that community health centers perform as well as other sites of care, despite serving more vulnerable patient populations. However, there is little prior study of geographic variation in quality outcomes and disparities in outcomes in this setting. Quantifying geographic variation is important so as to target quality improvement efforts and funding and to learn from states where total quality is highest and racial/ethnic disparities are lowest. OBJECTIVES To estimate between-state variation in hypertension, diabetes, and pregnancy outcomes and racial/ethnic disparities in these outcomes for health center patients. METHODS Using data on all US health centers from 2010 to 2014 (N=1047 health centers/year, or 21.2 million patients in 2014), we used linear regression models to estimate adjusted quality outcomes and racial/ethnic disparities in quality outcomes by state for hypertension control, diabetes control, and normal birthweight. RESULTS We found wide variation in both outcomes and racial/ethnic disparities in outcomes between states for patients seen at health centers. For instance, between states, the mean proportion of patients with hypertension control ranged from 58% to 70% for white patients, from 49% to 64% for black patients, and from 53% to 74% for Hispanic patients (P<0.001). Racial/ethnic disparities in outcomes ranged from negative or nonsignificant in some states to positive in others. CONCLUSIONS Wide variation in health center patient outcomes and disparities in outcomes is observed between states. This variation suggests that policymakers should target funding and interventions to underperforming states, and identify determinants of high quality in higher performing states.
Collapse
Affiliation(s)
- Megan B Cole
- *Department of Health Law, Policy, & Management, Boston University School of Public Health, Boston, MA†Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI
| | | | | |
Collapse
|
9
|
Haas JS, Hill DA, Wellman RD, Hubbard RA, Lee CI, Wernli KJ, Stout NK, Tosteson ANA, Henderson LM, Alford-Teaster JA, Onega TL. Disparities in the use of screening magnetic resonance imaging of the breast in community practice by race, ethnicity, and socioeconomic status. Cancer 2016; 122:611-7. [PMID: 26709819 PMCID: PMC4742376 DOI: 10.1002/cncr.29805] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/09/2015] [Accepted: 10/29/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Uptake of breast magnetic resonance imaging (MRI) coupled with breast cancer risk assessment offers the opportunity to tailor the benefits and harms of screening strategies for women with differing cancer risks. Despite the potential benefits, there is also concern for worsening population-based health disparities. METHODS Among 316,172 women aged 35 to 69 years from 5 Breast Cancer Surveillance Consortium registries (2007-2012), the authors examined 617,723 negative screening mammograms and 1047 screening MRIs. They examined the relative risks (RRs) of MRI use by women with a <20% lifetime breast cancer risk and RR in the absence of MRI use by women with a ≥20% lifetime risk. RESULTS Among women with a <20% lifetime risk of breast cancer, non-Hispanic white women were found to be 62% more likely than nonwhite women to undergo an MRI (95% confidence interval, 1.32-1.98). Of these women, those with an educational level of some college or technical school were 43% more likely and those who had at least a college degree were 132% more likely to receive an MRI compared with those with a high school education or less. Among women with a ≥20% lifetime risk, there was no statistically significant difference noted with regard to the use of screening MRI by race or ethnicity, but high-risk women with a high school education or less were less likely to undergo screening MRI than women who had graduated from college (RR, 0.40; 95% confidence interval, 0.25-0.63). CONCLUSIONS Uptake of screening MRI of the breast into clinical practice has the potential to worsen population-based health disparities. Policies beyond health insurance coverage should ensure that the use of this screening modality reflects evidence-based guidelines.
Collapse
Affiliation(s)
- Jennifer S Haas
- Division of General Internal Medicine and Primary Care, Department of Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Deirdre A Hill
- Department of Internal Medicine and Cancer Research Center and School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | | | - Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | | | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Anna N A Tosteson
- Department of Medicine, Department of Community and Family Medicine, The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Louise M Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer A Alford-Teaster
- Department of Medicine, Department of Community and Family Medicine, The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Tracy L Onega
- Department of Biomedical Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| |
Collapse
|
10
|
Strom MA, Silverberg JI. Utilization of Preventive Health Care in Adults and Children With Eczema. Am J Prev Med 2016; 50:e33-44. [PMID: 26547540 PMCID: PMC5237391 DOI: 10.1016/j.amepre.2015.07.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 07/13/2015] [Accepted: 07/17/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Chronic disease is a barrier to delivery of preventive health care and health maintenance. However, health behaviors of adults and children with eczema, a chronic skin disorder, have not been examined. This study examined associations of eczema with vaccination, disease screening, health maintenance, and healthcare utilization. METHODS This study investigated 34,613 adults and 13,298 children from the 2012 National Health Interview Survey, a prospective questionnaire-based study. Data were analyzed between August 2014 and January 2015. RESULTS Adult eczema was associated with higher odds of vaccination for tetanus (OR [95% CI]=1.37 [1.22, 1.54]); influenza (1.23 [1.10, 1.37]); hepatitis A (1.21 [1.04, 1.41]) and B (1.21 [1.07, 1.35]); human papilloma virus (1.66 [1.32, 2.08]); and pneumonia (1.35 [1.19, 1.54]), but not herpes zoster virus (1.07 [0.87, 1.31]). Adult eczema was associated with increased measurement of blood glucose (1.29 [1.16, 1.44]); cholesterol (1.19 [1.06, 1.34]); blood pressure (1.84 [1.56, 2.08]); and HIV infection (1.50 [1.34, 1.70]), but not Pap smears (1.11 [0.95, 1.30]); colon cancer screening (p=0.17); or mammograms (p=0.63). Adults with eczema were more likely to interact with general doctors, mid-level providers, mental health professionals, eye doctors, podiatrists, chiropractors, therapists, obstetrician/gynecologists, and other specialists (p≤0.01). Childhood eczema was associated with higher rates of vaccination for influenza (p<0.0002); well child checkups (p=0.002); and interaction with most types of healthcare providers (p≤0.01). Many associations remained significant in multivariate models controlling for sociodemographics and healthcare interaction frequency. CONCLUSIONS Eczema in adults and children is associated with greater utilization of preventive health care and health maintenance, but not cancer screening.
Collapse
Affiliation(s)
- Mark A Strom
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, Illinois; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois.
| |
Collapse
|
11
|
Intrinsic Factors of Non-adherence to Breast and Cervical Cancer Screenings Among Latinas. J Racial Ethn Health Disparities 2015; 3:658-666. [DOI: 10.1007/s40615-015-0184-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/17/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
|
12
|
Rodriguez CJ, Cai J, Swett K, González HM, Talavera GA, Wruck LM, Wassertheil-Smoller S, Lloyd-Jones D, Kaplan R, Daviglus ML. High Cholesterol Awareness, Treatment, and Control Among Hispanic/Latinos: Results From the Hispanic Community Health Study/Study of Latinos. J Am Heart Assoc 2015; 4:JAHA.115.001867. [PMID: 26109505 PMCID: PMC4608071 DOI: 10.1161/jaha.115.001867] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We assessed high cholesterol (HC) awareness, treatment, and control rates among US Hispanic/Latino adults and describe factors associated with HC awareness and management. METHODS AND RESULTS Baseline data (collected 2008-2011) from a multisite probability sample of Hispanic/Latino adults in the Hispanic Community Health Study/Study of Latinos (18 to 74 years old; N=16 207) were analyzed. HC was defined as low-density lipoprotein-cholesterol ≥130 mg/dL and/or total cholesterol ≥240 mg/dL or use of cholesterol-lowering medication. Among Hispanic/Latino adults with HC, almost half (49.3%) were not aware of their condition and only 29.5% were receiving treatment. Men had a higher HC prevalence than women (44.0% versus 40.5%) but a lower rate of treatment (28.1% versus 30.6%). Younger adults were significantly less likely to be HC aware compared to those who were older. Those with hypertension, diabetes, and high socioeconomic position were more likely to be HC aware. US-born Hispanic/Latino were more likely to be HC unaware than foreign-born Hispanics/Latinos, but longer US residency was significantly associated with being HC aware, treated, and controlled. Cholesterol control was achieved among 64.3% of those who were HC treated. However, younger adults, women, those with lower income, those uninsured, and more recent immigrants were less likely to be HC controlled. Individuals of Puerto Rican or Dominican background were most likely to be HC aware and treated, whereas those of Mexican or Central American background were least likely to be HC treated. Individuals of Cuban and South American background had the lowest rates of HC control, whereas Puerto Ricans had the highest. CONCLUSIONS Understanding gaps in HC awareness, treatment, and control among US Hispanic/Latino adults can help inform physicians and policymakers to improve disease management and patient education programs.
Collapse
Affiliation(s)
- Carlos J Rodriguez
- Department of Medicine and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.J.R., K.S.)
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC (J.C.)
| | - Katrina Swett
- Department of Medicine and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.J.R., K.S.)
| | - Hector M González
- Department of Neurology, Michigan State University, East Lansing, Michigan (H.M.G., L.M.W.)
| | | | - Lisa M Wruck
- Department of Neurology, Michigan State University, East Lansing, Michigan (H.M.G., L.M.W.)
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Community Health, Albert Einstein School of Medicine, Bronx, NY (S.W.S., R.K.)
| | | | - Robert Kaplan
- Department of Epidemiology and Community Health, Albert Einstein School of Medicine, Bronx, NY (S.W.S., R.K.)
| | - Martha L Daviglus
- Department of Medicine, Institute for Minority Health Research, University of Illinois at Chicago, IL (M.L.D.)
| |
Collapse
|
13
|
Ortega AN, Rodriguez HP, Vargas Bustamante A. Policy dilemmas in Latino health care and implementation of the Affordable Care Act. Annu Rev Public Health 2015; 36:525-44. [PMID: 25581154 DOI: 10.1146/annurev-publhealth-031914-122421] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The changing Latino demographic in the United States presents a number of challenges to health care policy makers, clinicians, organizations, and other stakeholders. Studies have demonstrated that Latinos tend to have worse patterns of access to, and utilization of, health care than other ethnic and racial groups. The implementation of the Affordable Care Act (ACA) of 2010 may ameliorate some of these disparities. However, even with the ACA, it is expected that Latinos will continue to have problems accessing and using high-quality health care, especially in states that are not expanding Medicaid eligibility as provided by the ACA. We identify four current policy dilemmas relevant to Latinos' health and ACA implementation: (a) the need to extend coverage to the undocumented; (b) the growth of Latino populations in states with limited insurance expansion;
Collapse
Affiliation(s)
- Alexander N Ortega
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California 90095-1772; ,
| | | | | |
Collapse
|
14
|
Salinas JJ. Preventive health screening utilization in older Mexicans before and after healthcare reform. SALUD PUBLICA DE MEXICO 2015; 57 Suppl 1:S70-8. [PMID: 26172237 PMCID: PMC4720260 DOI: 10.21149/spm.v57s1.7592] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 05/27/2014] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To assess changes in preventive screening utilization in older Mexicans, pre- and post-Seguro Popular. MATERIALS AND METHODS Data from the Mexican Health and Aging Study (MHAS/Enasem) 2001 and 2012 were used. Logistic and ordinary least squares regression adjusted models were used to predict preventive care in 2012 by insurance status categories in 2001-2012, as the focus explanatory variable. RESULTS Participants who were uninsured in 2001 and had Seguro Popular in 2012 were significantly more likely to be tested for diabetes, high blood pressure and receive a tetanus shot than the continually uninsured. CONCLUSIONS While disparities in preventive screening between the insured and uninsured continue to exist in Mexico, Seguro Popular seems to have provided better access to health services to prevent chronic and infectious diseases for the otherwise uninsured population.
Collapse
Affiliation(s)
- Jennifer J Salinas
- School of Public Health, University of Texas, Houston, Texas, Estados Unidos de América
| |
Collapse
|
15
|
Bergmans R, Soliman AS, Ruterbusch J, Meza R, Hirko K, Graff J, Schwartz K. Cancer incidence among Arab Americans in California, Detroit, and New Jersey SEER registries. Am J Public Health 2014; 104:e83-91. [PMID: 24825237 DOI: 10.2105/ajph.2014.301954] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We calculated cancer incidence for Arab Americans in California; Detroit, Michigan; and New Jersey, and compared rates with non-Hispanic, non-Arab Whites (NHNAWs); Blacks; and Hispanics. METHODS We conducted a study using population-based data. We linked new cancers diagnosed in 2000 from the Surveillance, Epidemiology, and End Results Program (SEER) to an Arab surname database. We used standard SEER definitions and methodology for calculating rates. Population estimates were extracted from the 2000 US Census. We calculated incidence and rate ratios. RESULTS Arab American men and women had similar incidence rates across the 3 geographic regions, and the rates were comparable to NHNAWs. However, the thyroid cancer rate was elevated among Arab American women compared with NHNAWs, Hispanics, and Blacks. For all sites combined, for prostate and lung cancer, Arab American men had a lower incidence than Blacks and higher incidence than Hispanics in all 3 geographic regions. Arab American male bladder cancer incidence was higher than that in Hispanics and Blacks in these regions. CONCLUSIONS Our results suggested that further research would benefit from the federal recognition of Arab Americans as a specified ethnicity to estimate and address the cancer burden in this growing segment of the population.
Collapse
Affiliation(s)
- Rachel Bergmans
- Rachel Bergmans is with the Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor. Amr S. Soliman is with the Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha. Julie Ruterbusch is with the Department of Oncology, Wayne State School of Medicine, Detroit, MI. Rafael Meza and Kelly Hirko are with the Department of Epidemiology, University of Michigan School of Public Health. John Graff is with the New Jersey Registry, SEER Registry, Trenton. Kendra Schwartz is with Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| | | | | | | | | | | | | |
Collapse
|
16
|
Gawron AJ, Yadlapati R. Disparities in endoscopy use for colorectal cancer screening in the United States. Dig Dis Sci 2014; 59:530-7. [PMID: 24248417 DOI: 10.1007/s10620-013-2937-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 10/28/2013] [Indexed: 01/10/2023]
Abstract
It is well established that disparities exist for colorectal cancer (CRC) incidence rates and death. With screening, death from CRC may be considered a preventable occurrence. Endoscopy (flexible sigmoidoscopy and colonoscopy) is the only modality with therapeutic benefit of removal of pre-cancerous polyps. The Patient Protection and Affordable Care Act mandated that preventive screening services be covered, which includes endoscopy for colon cancer screening. Recent federal rules have eliminated cost sharing for polyp removal during screening colonoscopy in privately insured patients; however, this has not been mandated for Medicare patients. Understanding the current state of disparities in endoscopy use is important, as these policy changes will affect millions of patients. The purpose of this literature review was to summarize the known research on disparities in endoscopy use for colon cancer screening in the United States and highlight areas for future research.
Collapse
Affiliation(s)
- Andrew J Gawron
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, USA,
| | | |
Collapse
|
17
|
Murray K, Liang A, Barnack-Tavlaris J, Navarro AM. The reach and rationale for community health fairs. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:19-24. [PMID: 23907787 PMCID: PMC3909725 DOI: 10.1007/s13187-013-0528-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Latinos living in the USA account for one third of the uninsured population and face numerous cultural, linguistic, and financial barriers to accessing healthcare services. Community health fairs have developed to address the unmet need for no- and low-cost services that target prevention and education among underserved communities. The current research describes an ongoing effort in a community in Southern California and examines the barriers to health care among participants registering to receive free breast health screenings, one of the major services offered at a 2010 health fair. A total of 186 adult Latina women completed a brief questionnaire assessing their healthcare utilization and self-reported barriers to engaging in preventive and screening services. Approximately two thirds of the participants reported never receiving or having more than 2 years passing since receiving a preventive health check-up. Participants identified cost (64.5%) and knowledge of locations for services (52.3%) as the primary barriers to engaging in routine healthcare services. Engaging with health professionals represents a leading way in which adults obtain health information; health fairs offering cancer health screenings represent a culturally appropriate venue for increased cancer health equity. Implications of the current research for future health fairs and their role in community cancer education are discussed.
Collapse
Affiliation(s)
- Kate Murray
- University of California San Diego, 9500 Gilman Drive, 0725, La Jolla, CA, 92093-0725, USA,
| | | | | | | |
Collapse
|
18
|
Wang TF, Shi L, Nie X, Zhu J. Race/ethnicity, insurance, income and access to care: the influence of health status. Int J Equity Health 2013; 12:29. [PMID: 23663514 PMCID: PMC3654947 DOI: 10.1186/1475-9276-12-29] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 04/17/2013] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To examine health care access disparities with regard to health status and presence of functional limitations, a common measure of disability and multimorbidity, after controlling for individual's race/ethnicity, insurance status and income in the U.S. using the latest survey data. METHODS Using data from the 2009 Family Core component of the National Health Interview Survey (NHIS), we examined six measures of access to care in the twelve months prior to the interview. Covariates included self-perceived health status and the presence of functional limitations, race/ethnicity, insurance status, income, and other socioeconomic characteristics. Multiple logistic regressions were used to examine the associations. RESULTS People with functional limitations or worse health status experience greater barriers to access. Insurance status was the single factor that was associated with all six measures of access. Disparities among racial/ethnic groups in most access indicators as well as income levels were insignificant after taking into account individuals' health status measures. CONCLUSIONS Interventions to expand insurance coverage and the Patient Protection and Affordable Care Act are expected to contribute to reducing disparities in access to care. However, to further improve access to care, emphasis must be placed on those with poorer health status and functional limitations.
Collapse
Affiliation(s)
- Tze-Fang Wang
- School of Nursing, National Yang Ming University, Taipei 112, Taiwan
| | - Leiyu Shi
- Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore MD 21205, USA
| | - Xiaoyu Nie
- Primary Care Policy Center, Johns Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Jinsheng Zhu
- Primary Care Policy Center, Johns Hopkins University, 624 N. Broadway, Baltimore, MD 21205, USA
| |
Collapse
|
19
|
Surveillance of colorectal cancer screening in new Mexico hispanics and non-Hispanic whites. J Community Health 2013; 37:1279-88. [PMID: 22544418 DOI: 10.1007/s10900-012-9568-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The incidence of colorectal cancer (CRC) among Hispanics in the state of New Mexico has increased in the past decade while that among whites has declined significantly. Using the 2006 New Mexico Behavioral Risk Factor Surveillance System (BRFSS) survey, we compared CRC screening among Hispanics and whites by gender to examine the influence of demographic, socioeconomic, preventive health, and clinical measures on the utilization of CRC screening. Although we found no ethnic differences in the prevalence of current breast, cervical and cancer screening, Hispanics were less likely to be current with CRC screening than whites. These differences were observed across a range of socioeconomic and other explanatory measures and in both genders. Hispanics also had a higher prevalence of CRC-related risk factors than whites, including inactivity, obesity, and diabetes, and ranked lower for most socioeconomic measures. Adjusting for healthcare coverage, education, and income in logistic regression models eliminated the Hispanic-white differences in CRC screening among men, and substantially reduced but did not eliminate screening differences among women. Innovative methods are needed to reach Hispanics to raise awareness of and participation in CRC screening. Because many CRC risk factors are potentially modifiable, appropriate cultural and linguistic interventions tailored to specific Hispanic subgroups and aimed at promoting CRC screening and reducing CRC risk factors may decrease ethnic disparities in CRC incidence.
Collapse
|
20
|
Tapp H, Smith HA, Dixon JT, Ludden T, Dulin M. Evaluating primary care delivery systems for an uninsured Hispanic immigrant population. FAMILY & COMMUNITY HEALTH 2013; 36:19-33. [PMID: 23168343 DOI: 10.1097/fch.0b013e31826d7562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Hispanic populations experience disparities in health outcomes and health care. Using participatory methods, we evaluated 4 systems of primary care delivery for an uninsured Hispanic population. Best practices were determined that could be translated back to the partner clinics and the community. The assessment included patient service areas, provider discussion groups, patient surveys, calculation of travel distances, and costs. The following best practices were identified: improved proximity to services, enhanced bilingual services, affordable services, and integrated services. Researchers and providers not only identified translatable service delivery practices but also laid the foundation for ongoing research partnerships.
Collapse
Affiliation(s)
- Hazel Tapp
- Department of Family Medicine, Carolinas Medical Center, Charlotte, North Carolina 28207, USA.
| | | | | | | | | |
Collapse
|
21
|
de Dios MA, Anderson BJ, Stanton C, Audet DA, Stein M. Project Impact: a pharmacotherapy pilot trial investigating the abstinence and treatment adherence of Latino light smokers. J Subst Abuse Treat 2012; 43:322-30. [PMID: 22377389 PMCID: PMC3762477 DOI: 10.1016/j.jsat.2012.01.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 01/16/2012] [Accepted: 01/16/2012] [Indexed: 10/28/2022]
Abstract
Light smoking is particularly prevalent among Latino smokers. Nicotine replacement (NRT) and varenicline are effective medications for smoking cessation for moderate-heavy smokers but have not been tested in light smokers, and thus, there are no treatment guidelines for use with light smokers. This pilot trial tested the efficacy of NRT and varenicline in increasing smoking abstinence among Latino light smokers. A 3-group (NRT, varenicline, and varenicline-placebo) randomized design was used, and Latino light smokers (≤10 cigarettes per day) received 12 weeks of treatment, which included a culturally informed behavioral health session and ongoing medication management visits. At follow-up, there were no abstinent participants in the placebo and NRT groups. However, 30% of participants in the varenicline group were abstinent at the 3-, 4-, and 6-month follow-up. This study represents the only investigation that specifically targets Latino light smokers using these treatments and characterizing their treatment adherence.
Collapse
Affiliation(s)
- Marcel A de Dios
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02912, USA.
| | | | | | | | | |
Collapse
|
22
|
Jonnalagadda S, Bergamo C, Lin JJ, Lurslurchachai L, Diefenbach M, Smith C, Nelson JE, Wisnivesky JP. Beliefs and attitudes about lung cancer screening among smokers. Lung Cancer 2012; 77:526-31. [PMID: 22681870 DOI: 10.1016/j.lungcan.2012.05.095] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 05/01/2012] [Accepted: 05/09/2012] [Indexed: 12/23/2022]
Abstract
The National Lung Screening Trial (NLST) recently reported that annual computed tomography (CT) screening is associated with decreased lung cancer mortality in high-risk smokers. Beliefs about lung cancer and screening, particularly across race and ethnicity, and their influence on CT screening utilization are largely unexamined. Our study recruited asymptomatic, high-risk smokers, 55-74 years of age from primary care clinics in an academic urban hospital. Guided by the self-regulation theory, we evaluated cognitive and affective beliefs about lung cancer. Intention to screen for lung cancer with a CT scan was assessed by self-report. We used univariate and logistic regression analyses to compare beliefs about screening and intention to screen among minority (Blacks and Hispanics) and non-minority participants. Overall, we enrolled 108 participants, of which 40% were Black and 34% were Hispanic; the mean age was 62.3 years, and median pack-years of smoking was 26. We found that intention to screen was similar among minorities and non-minorities (p=0.19); however, Hispanics were less likely to report intention to screen if they had to pay for the test (p=0.02). Fatalistic beliefs, fear of radiation exposure, and anxiety related to CT scans were significantly associated with decreased intention to screen (p<0.05). Several differences were observed in minority versus non-minority participants' beliefs toward lung cancer and screening. In conclusion, we found that concerns about cost, which were particularly prominent among Hispanics, as well as fatalism and radiation exposure fears may constitute barriers to lung cancer screening. Lung cancer screening programs should address these factors to ensure broad participation, particularly among minorities.
Collapse
Affiliation(s)
- Sirisha Jonnalagadda
- Doris Duke Clinical Research Fellows, UMDNJ-Robert Wood Johnson Medical School, New York, NY 10029, USA
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Caviness CM, Anderson BJ, Stein MD. Prevalence and predictors of sexually transmitted infections in hazardously-drinking incarcerated women. Women Health 2012; 52:119-34. [PMID: 22458289 DOI: 10.1080/03630242.2011.649396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Incarcerated women are at high risk for sexually transmitted infections. Left untreated, these infections can have severe adverse health effects. In this study the authors present prevalence rates of trichomonas, chlamydia, and gonorrhea, and factors related to having a sexually transmitted infection in a sample of 245 hazardously-drinking incarcerated women who reported heterosexual intercourse in the previous 3 months. Vaginal swabs were collected following the self-report baseline assessment. Participants averaged 34.0 (±8.8) years of age; 174 (71.3%) were non-Hispanic Caucasian, 47 (19.3%) were African-American, 17 (7.0%) were Hispanic, and 6 (2.5%) were of other racial or ethnic origins. Twenty-three percent of participants tested positive for chlamydia, trichomonas, or gonorrhea. Being African-American, more frequent sex with a casual partner, and reporting more than one male partner were significantly positively related to sexually transmitted infection, while more frequent sex with a main partner was inversely related. Due to the high rates of infection in this population, jail admission provides a public health opportunity to access a concentrated group of sexually transmitted infectious women. Sexually transmitted infection testing targeted at specific demographic factors, for instance younger age, will miss infected women. Risky sexual partnerships, as well as the benefit of maintaining stable main partnerships may be important topics during sexually transmitted infection prevention interventions.
Collapse
|
24
|
|
25
|
Larkey LK, Herman PM, Roe DJ, Garcia F, Lopez A, Gonzalez J, Perera PN, Saboda K. A Cancer Screening Intervention for Underserved Latina Women by Lay Educators. J Womens Health (Larchmt) 2012; 21:557-66. [DOI: 10.1089/jwh.2011.3087] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Linda K. Larkey
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
- Arizona Cancer Center, University of Arizona, Tucson, Arizona
| | | | - Denise J. Roe
- Arizona Cancer Center, University of Arizona, Tucson, Arizona
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | | | - A.M. Lopez
- Arizona Cancer Center, University of Arizona, Tucson, Arizona
| | - J. Gonzalez
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | | | | |
Collapse
|
26
|
Ayala C, Fang J, Escobedo L, Pan S, Balcazar HG, Wang G, Merritt R. Actions to control high blood pressure among hypertensive adults in Texas counties along the Mexico border: Texas BRFSS, 2007. Public Health Rep 2012; 127:173-185. [PMID: 22379217 PMCID: PMC3268802 DOI: 10.1177/003335491212700206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES We examined the prevalence of actions taken to control blood pressure as measured by taking antihypertensive medication or making lifestyle modifications among hypertensive adults residing along the Texas/Mexico border. METHODS We used self-reported data from the 2007 Texas Behavioral Risk Factor Surveillance System, with oversampling of border counties. We calculated the age-standardized prevalence of actions taken to control hypertension by selected characteristics. RESULTS In analyses that combined ethnicity with predominant language spoken, those least likely to take any action to control their blood pressure--either by taking an antihypertensive medication or by making any of four lifestyle modifications--were Spanish-speaking Hispanic people (83.2% ± 2.7% standard error [SE]), with English-speaking non-Hispanic people (88.9% ± 0.8% SE) having the highest prevalence of taking action to control blood pressure. When analyzed by type of medical category, uninsured Hispanic people (63.8% ± 4.8% SE) had the lowest prevalence of taking action to control their blood pressure compared with uninsured non-Hispanic people (75.4% ± 4.7% SE). Nonborder Texas residents with hypertension were more likely to take antihypertensive medications (78.4% ± 1.0% SE) than border county residents with hypertension (70.7% ± 2.0% SE). CONCLUSIONS Public health efforts must be undertaken to improve the control of hypertension among residents of Texas counties along the Mexico border, particularly for uninsured Hispanic people.
Collapse
Affiliation(s)
- Carma Ayala
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention, Atlanta, GA 30341, USA.
| | | | | | | | | | | | | |
Collapse
|
27
|
Riley JL, Dodd VJ, Muller KE, Guo Y, Logan HL. Psychosocial factors associated with mouth and throat cancer examinations in rural Florida. Am J Public Health 2011; 102:e7-14. [PMID: 22390460 DOI: 10.2105/ajph.2011.300504] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the knowledge and prevalence of mouth and throat cancer examinations in a sample drawn from rural populations in north Florida. METHODS Telephone interviews were conducted across rural census tracts throughout north Florida in 2009 and 2010, in a survey that had been adapted for cultural appropriateness using cognitive interviews. The sample consisted of 2526 respondents (1132 men and 1394 women; 1797 Whites and 729 African Americans). RESULTS Awareness of mouth and throat cancer examination (46%) and lifetime receipt (46%) were higher than reported in statewide studies performed over the past 15 years. Only 19% of the respondents were aware of their examination, whereas an additional 27% reported having the examination when a description was provided, suggesting a lack of communication between many caregivers and rural patients. Surprisingly, anticipated racial/ethnic differences were diminished when adjustments were made for health literacy and several measures of socioeconomic status. CONCLUSIONS These findings support the notion that health disparities are multifactorial and include characteristics such as low health literacy, lack of access to care, and poor communication between patient and provider.
Collapse
Affiliation(s)
- Joseph L Riley
- Department of Community Dentistry, University of Florida, Gainesville, FL 32610-3628, USA.
| | | | | | | | | |
Collapse
|
28
|
Disparities in Pregnancy Healthcare Utilization Between Hispanic and Non-Hispanic White Women in Rhode Island. Matern Child Health J 2011; 16:1576-82. [DOI: 10.1007/s10995-011-0850-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
29
|
Bennett KJ, Pumkam C, Bellinger JD, Probst JC. Cancer Screening Delivery in Persistent Poverty Rural Counties. J Prim Care Community Health 2011; 2:240-9. [DOI: 10.1177/2150131911406123] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Rural populations are diagnosed with cancer at different rate and stages than nonrural populations, and race/ethnicity as well as the area-level income exacerbates the differences. The purpose of this analysis was to explore cancer screening rates across persistent poverty rural counties, with emphasis on nonwhite populations. Methods: The 2008 Behavioral Risk Factor Surveillance System was used, combined with data from the Area Resource File (analytic n = 309 937 unweighted, 196 344 347 weighted). Unadjusted analysis estimated screening rates for breast, cervical, and colorectal cancer. Multivariate analysis estimated the odds of screening, controlling for individual and county-level effects.Results: Rural residents, particularly those in persistent poverty counties, were less likely to be screened than urban residents. More African Americans in persistent poverty rural counties reported not having mammography screening (18.3%) compared to 15.9% of urban African Americans. Hispanics had low screening rates across all service types. Multivariate analysis continued to find disparities in screening rates, after controlling for individual and county-level factors. African Americans in persistent poverty rural counties were more likely to be screened for both breast cancer (odds ratio, 1.44; 95% confidence interval, 1.12-1.85) and cervical cancer (1.46; 1.07-1.99) when compared with urban whites. Conclusions: Disparities in cancer screening rates exist across not only race/ethnicity but also county type. These disparities cannot be fully explained by either individual or county-level effects. Programs have been successful in improving screening rates for African American women and should be expanded to target other vulnerable women as well as other services such as colorectal cancer screening.
Collapse
Affiliation(s)
- Kevin J. Bennett
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Chaiporn Pumkam
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Jessica D. Bellinger
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Janice C. Probst
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
30
|
Bennett KJ, Probst JC, Bellinger JD. Receipt of cancer screening services: surprising results for some rural minorities. J Rural Health 2011; 28:63-72. [PMID: 22236316 DOI: 10.1111/j.1748-0361.2011.00365.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Evidence suggests that rural minority populations experience disparities in cancer screening, treatment, and outcomes. It is unknown how race/ethnicity and rurality intersect in these disparities. The purpose of this analysis is to examine the cancer screening rates among minorities in rural areas. METHODS We utilized the 2008 Behavioral Risk Factor Surveillance System (BRFSS) to examine rates of screening for breast, cervical, and colorectal cancer. Bivariate analysis estimated screening rates by rurality and sociodemographics. Multivariate analysis estimated the factors that contributed to the odds of screening. RESULTS Rural residents were less likely to obtain screenings than urban residents. African Americans were more likely to be screened than whites or Hispanics. Race/ethnicity and rurality interacted, showing that African American women continued to be more likely than whites to be screened for breast or cervical cancer, but the odds decreased with rurality. CONCLUSIONS This analysis confirmed previous research which found that rural residents were less likely to obtain cancer screenings than other residents. We further found that the pattern of disparity differed according to race/ethnicity, with African Americans having favorable odds of receipt of service regardless of rurality. These results have the potential to create better targeted interventions to those groups that continue to be underserved.
Collapse
Affiliation(s)
- Kevin J Bennett
- University of South Carolina School of Medicine, Department of Family & Preventive Medicine, Columbia, South Carolina, USA
| | | | | |
Collapse
|
31
|
Zhu J, Brawarsky P, Lipsitz S, Huskamp H, Haas JS. Massachusetts health reform and disparities in coverage, access and health status. J Gen Intern Med 2010; 25:1356-62. [PMID: 20730503 PMCID: PMC2988151 DOI: 10.1007/s11606-010-1482-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 05/25/2010] [Accepted: 07/13/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Massachusetts health reform has achieved near-universal insurance coverage, yet little is known about the effects of this legislation on disparities. OBJECTIVE Since racial/ethnic minorities and low-income individuals are over-represented among the uninsured, we assessed the effects of health reform on disparities. DESIGN Cross-sectional survey data from the Behavioral Risk Factor Surveillance Survey (BRFSS), 2006-2008. PARTICIPANTS Adults from Massachusetts (n = 36,505) and other New England states (n = 63,263). MAIN MEASURES Self-reported health coverage, inability to obtain care due to cost, access to a personal doctor, and health status. To control for trends unrelated to reform, we compared adults in Massachusetts to those in all other New England states using multivariate logistic regression models to calculate adjusted predicted probabilities. KEY RESULTS Overall, the adjusted predicted probability of health coverage in Massachusetts rose from 94.7% in 2006 to 97.7% in 2008, whereas coverage in New England remained around 92% (p < 0.001 for difference-in-difference). While cost-related barriers were reduced in Massachusetts, there were no improvements in access to a personal doctor or health status. Although there were improvements in coverage and cost-related barriers for some disadvantaged groups relative to trends in New England, there was no narrowing of disparities in large part because of comparable or larger improvements among whites and the non-poor. CONCLUSIONS Achieving equity in health and health care may require additional focused intervention beyond health reform.
Collapse
Affiliation(s)
- Jane Zhu
- Harvard Medical School, Boston, MA USA
| | - Phyllis Brawarsky
- Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA USA
| | - Stuart Lipsitz
- Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA USA
| | | | - Jennifer S. Haas
- Harvard Medical School, Boston, MA USA
- Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA USA
- Harvard School of Public Health, 1620 Tremont Street, Boston, MA 02120 USA
| |
Collapse
|
32
|
Vargas Bustamante A, Chen J, Rodriguez HP, Rizzo JA, Ortega AN. Use of preventive care services among Latino subgroups. Am J Prev Med 2010; 38:610-9. [PMID: 20494237 DOI: 10.1016/j.amepre.2010.01.029] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Revised: 12/01/2009] [Accepted: 01/11/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies demonstrate a clear gap in access and receipt of preventive care between Latinos and non-Latino whites. Most of this work, however, pools Latinos together when they compare different racial and ethnic groups. There is currently no information about the consistency of preventive care utilization across major Latino subgroups. PURPOSE This study tests for three bundles of preventive care services to analyze the main determinants of adult preventive care receipt among the largest subgroups of U.S. Latinos and non-Latino whites. It also examines the contribution of observed and unobserved factors in explaining differences in the provision of preventive care services. METHODS The Medical Expenditure Panel Survey and the National Health Interview Survey from 2000 to 2006 were merged in 2009. The sample consisted of 28,781 Latinos and 78,979 non-Latino whites. This study compared disparities in the receipt of adult preventive care services and separately examined differences in the provision of the most cost-effective preventive services. Multivariate models adjust for confounding factors. The decomposition technique was used to parse out differences into observed and unobserved components. RESULTS Latinos of Mexican and Central/South American origin are much less likely to receive guideline-recommended preventive care services than non-Latino whites and other Latino subgroups. Larger disparities were observed for the most cost-effective preventive care services: smoking-cessation advice, colorectal cancer screening, and influenza vaccination. Observed factors accounted for a larger share of disparities across measures (33%-100%), with lack of health insurance coverage and not having a usual source of care as the largest and most consistent factors explaining disparities. CONCLUSIONS Health insurance coverage expansion and more integration of Latinos into primary care practices can substantially reduce disparities in the receipt of preventive care services. Preventive care initiatives should prioritize the availability of cost-effective services among Latinos of Mexican and Central/South American heritage.
Collapse
|
33
|
Scarborough JE, Bennett KM, Pietrobon R, Kuo PC, Pappas TN. Trends in the Utilization of High-Volume Hospitals by Minority and Underinsured Surgical Patients. Am Surg 2010. [DOI: 10.1177/000313481007600524] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Race- and insurance-based disparities exist in the utilization of high-volume hospitals for complex surgery. Retrospective analysis of the Nationwide Inpatient Sample from 1988 through 2005 was performed to examine hospital volume trends for eight procedures. Ordered logistic regression analyses were performed to determine temporal trends in the utilization of high-volume hospitals by minority and Medicaid-insured patients compared with white patients and those with private insurance or Medicare. Black patients are increasing their utilization of higher-volume hospitals, but not at a rate sufficient to overcome existing disparities relative to the utilization of such hospitals by white patients. Meanwhile, disparities in the utilization of higher-volume hospitals are increasing for Hispanics and patients who are primarily insured through Medicaid. Existing racial and insurance-based disparities in the utilization of high-volume surgical care will persist or become even more pronounced without active intervention from health care policymakers.
Collapse
Affiliation(s)
- John E. Scarborough
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kyla M. Bennett
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ricardo Pietrobon
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Paul C. Kuo
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Theodore N. Pappas
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
34
|
Bili A, Schroeder LL, Ledwich LJ, Kirchner HL, Newman ED, Wasko MCM. Patterns of preventive health services in rheumatoid arthritis patients compared to a primary care patient population. Rheumatol Int 2010; 31:1159-65. [PMID: 20349066 DOI: 10.1007/s00296-010-1461-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2010] [Accepted: 03/12/2010] [Indexed: 11/24/2022]
Abstract
To determine the proportion of rheumatoid arthritis (RA) patients receiving preventive health care according to US Preventive Services Task Force recommendations compared with a community-based population sample, with emphasis on dyslipidemia testing, given the increased risk of cardiovascular disease (CVD) in RA patients. Patients with RA (ICD-9 code 714.0 at ≥2 office visits with a rheumatologist) and a primary care physician (PCP) at the Geisinger Health System (GHS) were identified through electronic health records. The records were searched back from 3/31/08 for the length of time required to satisfy each outcome measure. Percentages were compared with population testing rates using the Pearson Chi-square test. Eight hundred and thirty-one RA patients were compared to 169,476 subjects with a PCP at GHS, stratified by gender and age. Patients with RA were more likely to have had dyslipidemia and osteoporosis testing compared with the general population (86 vs. 75 and 75 vs. 55%, respectively, P < 0.0001 for both). The proportion of RA patients receiving breast and cervical cancer testing was similar to the general population. The majority (79%) of lipid testing was ordered by PCPs. Those RA patients with recommended lipid testing had more traditional CVD factors (hypertension, diabetes, coronary artery disease). RA patients are screened more than the general population for two RA-related co-morbidities, i.e. dyslipidemia and osteoporosis. The RA patients with traditional cardiovascular risk factors are more likely to be tested for dyslipidemia. Further work is warranted to improve testing for modifiable CVD risk factors in this group with multiple co-morbidities.
Collapse
|
35
|
Wallace LS, DeVoe JE, Rogers ES, Protheroe J, Rowlands G, Fryer GE. Digging deeper: quality of patient-provider communication across Hispanic subgroups. BMC Health Serv Res 2009; 9:240. [PMID: 20025725 PMCID: PMC2803181 DOI: 10.1186/1472-6963-9-240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 12/21/2009] [Indexed: 11/10/2022] Open
Abstract
Background Recent research suggests that ethnic subgroup designation plays an important role in health-related disparities among Hispanics. Our objective was to examine the influence of Hispanics' self-reported ethnic subgroup designation on perceptions of their health care providers' communication behaviors. Methods Cross-sectional analysis of the 2005 Medical Expenditure Panel Survey (MEPS). Participants included non-institutionalized Hispanics (n = 5197; US population estimate = 27,070,906), aged ≥18 years, reporting visiting a health care provider within the past 12 months. Six (n = 6) items were used to capture respondents' perceptions of their health care providers' communication behaviors. Results After controlling for socio-demographic covariates, compared to Other Hispanics (reference group), very few differences in perceptions of health care providers communication emerged across ethnic subgroups. Puerto Ricans were more likely to report that their health care provider "always" showed respect for what they had to say (OR = 2.16, 95% CI 1.16-4.03). Both Puerto Ricans (OR = 2.28, 95% CI 1.06-4.92) and Mexicans (OR = 1.88, 95% CI 1.02-3.46) were more likely to indicate that their health care provider "always" spent enough time with them as compared to Other Hispanics. Conclusions We observed very few differences among Hispanics respondents in their perceived quality of interactions with health care providers as a function of their ethnic subgroup designation. While our findings somewhat contradict previous research, they do suggest that other underlying factors may influence the quality of perceived interactions with health care providers.
Collapse
Affiliation(s)
- Lorraine S Wallace
- University of Tennessee Graduate School of Medicine, Department of Family Medicine, Knoxville, Tennessee, USA.
| | | | | | | | | | | |
Collapse
|
36
|
Rodríguez MA, Bustamante AV, Ang A. Perceived quality of care, receipt of preventive care, and usual source of health care among undocumented and other Latinos. J Gen Intern Med 2009; 24 Suppl 3:508-13. [PMID: 19841999 PMCID: PMC2764043 DOI: 10.1007/s11606-009-1098-2] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Latinos are the largest minority group in the United States and experience persistent disparities in access to and quality of health care. OBJECTIVES (1) To determine the relationship between nativity/immigration status and self-reported quality of care and preventive care. (2) To assess the impact of a usual source of health care on receipt of preventive care among Latinos. DESIGN Using cross-sectional data from the 2007 Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey, a nationally representative telephone survey of 4,013 Latino adults, we compared US-born Latinos with foreign-born Latino citizens, foreign-born Latino permanent residents and undocumented Latinos. We estimated odds ratios using separate multivariate ordered logistic models for five outcomes: blood pressure checked in the past 2 years, cholesterol checked in the past 5 years, perceived quality of medical care in the past year, perceived receipt of no health/health-care information from a doctor in the past year, and language concordance. RESULTS Undocumented Latinos had the lowest percentages of insurance coverage (37% vs 77% US-born, P < 0.001), usual source of care (58% vs 79% US-born, P < 0.001), blood pressure checked (67% vs 87% US-born, P < 0.001), cholesterol checked (56% vs 83% US-born, P < 0.001), and reported excellent/good care in the past year (76% vs 80% US-born, P < 0.05). Undocumented Latinos also reported the highest percentage receiving no health/health-care information from their doctor (40% vs 20% US-born, P < 0.001) in the past year. Adjusted results showed that undocumented status was associated with lower likelihood of blood pressure checked in the previous 2 years (OR = 0.60; 95% CI, 0.43-0.84), cholesterol checked in the past 5 years (OR = 0.62; 95% CI, 0.39-0.99), and perceived receipt of excellent/good care in the past year (OR = 0.56; 95% CI, 0.39-0.77). Having a usual source of care increased the likelihood of a blood pressure check in the past 2 years and a cholesterol check in the past 5 years. CONCLUSION In this national sample, undocumented Latinos were less likely to report receiving blood pressure and cholesterol level checks, less likely to report having received excellent/good quality of care, and more likely to receive no health/health-care information from doctors, even after adjusting for potential confounders. Our study shows that differences in nativity/immigration status should be taken into consideration when we discuss perceived quality of care among Latinos.
Collapse
Affiliation(s)
- Michael A Rodríguez
- UCLA Department of Family Medicine, 10880 Wilshire Blvd #1800, Los Angeles, CA, 90024, USA.
| | | | | |
Collapse
|
37
|
Abstract
In this review, the authors provide an approach to the study of health disparities in the US Latino population and evaluate the evidence, using mortality rates for discrete medical conditions and the total US population as a standard for comparison. They examine the demographic structure of the Latino population and how nativity, age, income, and education are related to observed patterns of health and mortality. A key issue discussed is how to interpret the superior mortality indices of Latino immigrants and the subsequent declining health status of later generations. Explanations for differences in mortality include selection, reverse selection, death record inconsistencies, inequalities in health status, transnational migration, social marginality, and adaptation to environmental conditions in the United States. The utility of the public health social inequality framework and the status syndrome for explaining Latino disparities is discussed. The authors examine excess mortality from 8 causes: diabetes, stomach cancer, liver cancer, cervical cancer, human immunodeficiency virus/acquired immunodeficiency syndrome, liver disease, homicide, and work-related injuries. The impact of intergenerational changes in health behavior within the Latino population and the contributory role of suboptimal health care are interpreted in the context of implications for future research, public health programs, and policies.
Collapse
Affiliation(s)
- William A Vega
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90024-4142, USA.
| | | | | |
Collapse
|
38
|
Bazargan M, Ani C, Bazargan-Hejazi S, Baker RS, Bastani R. Colorectal cancer screening among underserved minority population: discrepancy between physicians' recommended, scheduled, and completed tests. PATIENT EDUCATION AND COUNSELING 2009; 76:240-247. [PMID: 19150198 DOI: 10.1016/j.pec.2008.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 11/18/2008] [Accepted: 12/06/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE This study examines the correlates of: (1) health care provider recommendation of CRC testing; (2) provider scheduling for recommended CRC testing using sigmoidoscopy, colonoscopy, or double-contrast barium enema; and (3) adherence to CRC scheduling among underserved minority populations. METHODS Medical record and schedule logbook reviews and interviewer-administered surveys. SETTING Large urban safety-net, outpatient primary care setting in Los Angeles County. PARTICIPANTS 306 African-American and Latino patients aged 50 years and older. RESULTS A vast majority of minority patients do not receive standard CRC testing in urban safety-net primary care settings. Of those patients who were actually scheduled for sigmoidoscopy or colonoscopy, almost half completed the procedure. Completing CRC testing was associated with marital status, co-morbid chronic physical conditions, number of risk factors for colorectal cancer, and lower perceived barriers to CRC testing. CONCLUSION Effective interventions to reduce CRC mortality among underserved minority populations require an integrated approach that engages patients, providers, and health care systems. PRACTICE IMPLICATIONS Designing interventions that (1) increase physician-patient communications for removing patients' perceived barriers for CRC testing and (2) promote a non-physician-based navigator system that reinforces physicians' recommendation are strongly recommended.
Collapse
Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles Drew University of Medicine & Science, Los Angeles, CA 90059, USA.
| | | | | | | | | |
Collapse
|
39
|
Kent EE, Sender LS, Largent JA, Anton-Culver H. Leukemia survival in children, adolescents, and young adults: influence of socioeconomic status and other demographic factors. Cancer Causes Control 2009; 20:1409-20. [PMID: 19496000 PMCID: PMC2746889 DOI: 10.1007/s10552-009-9367-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Accepted: 05/11/2009] [Indexed: 12/31/2022]
Abstract
Objective In California, leukemia represents ~35, 5, and 2% of all cancers in children (aged 0–14), adolescents (15–29), and young adults (30–39), respectively. Poorer survival has been previously noted in individuals residing in lower socioeconomic status (SES) neighborhoods. We explored the relationship between SES and survival as modified by age and race/ethnicity using data from the California Cancer Registry. Methods A total of 7,688 incident cases of first primary leukemia diagnosed during 1996–2005 in individuals aged 0–39 at diagnosis were included in this study. Univariate analyses of overall survival were conducted using the Kaplan–Meier method and multivariate survival analyses were performed using Cox proportional hazard regression to estimate hazard ratios. Results Multivariate analyses showed that overall survival and lymphoid cancer–specific survival was reduced in those individuals aged 15–39 compared to children aged 0–14. Although shorter survival was observed in non-whites, an association between lower-SES neighborhood and shorter survival was significant only for non-Hispanic whites (NHWs) (p value for trend <0.05). Lack of insurance was significantly associated with shorter survival for all race/ethnicities examined except Asian/Pacific Islanders (p value < 0.05). Conclusion Lower survival in individuals diagnosed with leukemia was observed in adolescents and young adults compared to children and in non-whites compared to NHWs. Further, the independent effects on survival of both low SES and lack of insurance at diagnosis persisted after adjustment for demographic variables and varied across race/ethnicities.
Collapse
Affiliation(s)
- Erin E Kent
- Department of Epidemiology, University of California, Irvine, 224 Irvine Hall, Irvine, CA 92697-7555, USA.
| | | | | | | |
Collapse
|
40
|
Emmons KM, Lobb R, Puleo E, Bennett G, Stoffel E, Syngal S. Colorectal cancer screening: prevalence among low-income groups with health insurance. Health Aff (Millwood) 2009; 28:169-77. [PMID: 19124867 DOI: 10.1377/hlthaff.28.1.169] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We examined the prevalence of colorectal cancer (CRC) screening in a low-income, racial/ethnic minority sample, among whom 97 percent had health insurance that covered CRC screening. This is a model for examining the impact of health insurance on racial/ethnic disparities in screening. Screening rates (67 percent self-reported; 52 percent adjusted based on a validation substudy) were higher than among similar population-based samples who have lower levels of insurance coverage. There were no differences by race/ethnicity. This study suggests that insurance coverage for CRC screening should be considered as part of a comprehensive approach to address CRC disparities.
Collapse
Affiliation(s)
- Karen M Emmons
- Dana-Farber Cancer Institute/Harvard School of Public Health in Boston, Massachusetts, USA.
| | | | | | | | | | | |
Collapse
|
41
|
Maxwell AE, Crespi CM. Trends in colorectal cancer screening utilization among ethnic groups in California: are we closing the gap? Cancer Epidemiol Biomarkers Prev 2009; 18:752-9. [PMID: 19273482 DOI: 10.1158/1055-9965.epi-08-0608] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Given the low prevalence of and racial/ethnic disparities in colorectal cancer screening, it is important to monitor whether prevalence and disparities are increasing or decreasing over time. METHODS We estimated the prevalence of colorectal cancer screening by year (2001, 2003, and 2005), modality (endoscopy, fecal occult blood test, either), and recency (ever had, up-to-date) for the California population as a whole, major racial/ethnic groups (White, Black, Latino, Asian), and selected Asian subgroups (Chinese, Filipino, Japanese, Korean, Vietnamese) using data from the California Health Interview Survey. All prevalence estimates were age- and gender-standardized. RESULTS From 2001 to 2005, prevalence of up-to-date screening increased significantly among Whites and Latinos but not among Blacks and Asian Americans. Screening prevalence varied substantially among Asian subgroups, with Korean, Filipino, and Vietnamese Americans having the lowest prevalence. Korean Americans were the only group in the analysis with a significant decline in screening prevalence from 2001 to 2005. The gap between the highest and the lowest up-to-date screening prevalence using any screening modality, exhibited by Japanese and Korean Americans, increased from 18% in 2001 to 30% in 2005. CONCLUSIONS Findings suggest that we need to intensify efforts to increase colorectal cancer screening, especially among Korean Americans but also among Filipinos, Vietnamese, and Latinos.
Collapse
Affiliation(s)
- Annette E Maxwell
- Division of Cancer Prevention and Control Research, School of Public Health/Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Dr. South, Room A2-125, CHS, Los Angeles, CA 90095-6900, USA.
| | | |
Collapse
|
42
|
Wallace LS, DeVoe JE, Heintzman JD, Fryer GE. Language preference and perceptions of healthcare providers' communication and autonomy making behaviors among Hispanics. J Immigr Minor Health 2008; 11:453-9. [PMID: 18814028 DOI: 10.1007/s10903-008-9192-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 09/09/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND To examine influence of language preference-English versus Spanish-on Hispanics' perceptions of their healthcare providers' communication behaviors. METHODS Using the 2005 Medical Expenditure Panel Survey (MEPS), we observed non-institutionalized Hispanics (n = 5197; US population estimate = 27,070,906), aged >or=18 years, reporting visiting a healthcare provider within the past 12 months. RESULTS When compared to Spanish responders (reference group), English responders were more likely to report that their healthcare provider "always" listened to them carefully (adjusted odds ratio (OR) = 1.39, 95% confidence interval (CI) 1.09-1.78), "always" explained things so that they understood (adjusted OR 1.37, 95% CI 1.08-1.73), "always" spent enough time with them (adjusted OR = 1.62, 95% CI 1.24-2.11),"always" asked them to help make decisions (adjusted OR 1.37, 95% CI 1.03-1.82), and "always" showed respect for treatment decisions (adjusted OR = 1.66, 95% CI 1.27-2.19). DISCUSSION Healthcare providers should consider the complex needs of Hispanic patients whose language of choice is not English.
Collapse
Affiliation(s)
- Lorraine S Wallace
- Department of Family Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA.
| | | | | | | |
Collapse
|