1
|
Semprini J, Gadag K, Williams G, Muldrow A, Zahnd WE. Rural-Urban Cancer Incidence and Trends in the United States, 2000 to 2019. Cancer Epidemiol Biomarkers Prev 2024; 33:1012-1022. [PMID: 38801414 DOI: 10.1158/1055-9965.epi-24-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/18/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Despite consistent improvements in cancer prevention and care, rural and urban disparities in cancer incidence persist in the United States. Our objective was to further examine rural-urban differences in cancer incidence and trends. METHODS We used the North American Association of Central Cancer Registries dataset to investigate rural-urban differences in 5-year age-adjusted cancer incidence (2015-2019) and trends (2000-2019), also examining differences by region, sex, race/ethnicity, and tumor site. Age-adjusted rates were calculated using SEER∗Stat 8.4.1, and trend analysis was done using Joinpoint, reporting annual percent changes (APC). RESULTS We observed higher all cancer combined 5-year incidence rates in rural areas (457.6 per 100,000) compared with urban areas (447.9), with the largest rural-urban difference in the South (464.4 vs. 449.3). Rural populations also exhibited higher rates of tobacco-associated, human papillomavirus-associated, and colorectal cancers, including early-onset cancers. Tobacco-associated cancer incidence trends widened between rural and urban from 2000 to 2019, with significant, but varying, decreases in urban areas throughout the study period, whereas significant rural decreases only occurred between 2016 and 2019 (APC = -0.96). Human papillomavirus-associated cancer rates increased in both populations until recently with urban rates plateauing whereas rural rates continued to increase (e.g., APC = 1.56, 2002-2019). CONCLUSIONS Rural populations had higher overall cancer incidence rates and higher rates of cancers with preventive opportunities compared with urban populations. Improvements in these rates were typically slower in rural populations. IMPACT Our findings underscore the complex nature of rural-urban disparities, emphasizing the need for targeted interventions and policies to reduce disparities and achieve equitable health outcomes.
Collapse
Affiliation(s)
- Jason Semprini
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Khyathi Gadag
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Gawain Williams
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Aniyah Muldrow
- Department of Sociology, School of Arts and Sciences, Rutgers University, New Brunswick, New Jersey
| | - Whitney E Zahnd
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| |
Collapse
|
2
|
Vink E, Antaya G, Hamula C, Holinaty C, Minion J, Pond GR, McCrea S, Dwernychuk L, Graham H, Broderick G, Kinloch M, Brown Broderick J. HPV Self-Sampling for Cervical Cancer Screening in Under-Screened Saskatchewan Populations: A Pilot Study. Curr Oncol 2024; 31:4261-4269. [PMID: 39195300 DOI: 10.3390/curroncol31080317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024] Open
Abstract
Of all cancers in female Canadians, the most rapidly increasing incidence is that of cervical cancer. The objective of this pilot study was to assess how HPV self-sampling might improve cervical cancer screening participation in both urban and rural settings in Saskatchewan, one of the most sparsely populated provinces in Canada. Study groups consisted of n = 250 participants to whom self-swabbing kits were mailed with instructions and n = 250 participants to whom kits were handed out in 6 urban and rural clinics. The inclusion criteria selected subjects aged 30-69 years who were Saskatchewan residents for at least 5 years with valid health coverage, had a cervix, and had no record of cervical cancer screening in 4 years. The returned samples were analyzed for specific HPV strains using the Roche Molecular Diagnostics Cobas 4800® System. The overall response rate was ~16%, with the response to the handout distribution being roughly double that of the mailout. While HPV positivity did not differ across the distribution groups, participants at a specific inner-city clinic reported significantly higher positivity to at least one HPV strain as compared to any other clinic and all mailouts combined. For this high-risk population, in-person handout of self-sampling kits may be the most effective means of improving screening.
Collapse
Affiliation(s)
- Erin Vink
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5A2, Canada
| | - Gabriella Antaya
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5A2, Canada
| | - Camille Hamula
- Department of Laboratory Medicine and Pathology, College of Medicine University of Saskatchewan, Saskatoon, SK S7N 0W8, Canada
| | - Carla Holinaty
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, SK S7N 3Y5, Canada
| | - Jessica Minion
- Department of Laboratory Medicine and Pathology, College of Medicine University of Saskatchewan, Saskatoon, SK S7N 0W8, Canada
| | - Gregory R Pond
- Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Sabryna McCrea
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5A2, Canada
| | | | - Holly Graham
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, SK S7K 2Z4, Canada
| | - Gordon Broderick
- Vaccine and Infectious Disease Organization (VIDO), Saskatoon, SK S7N 5E3, Canada
| | - Mary Kinloch
- Department of Laboratory Medicine and Pathology, College of Medicine University of Saskatchewan, Saskatoon, SK S7N 0W8, Canada
| | - Jennifer Brown Broderick
- Department of Oncology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 4H4, Canada
| |
Collapse
|
3
|
Windon M, Haring C. Human papillomavirus circulating tumor DNA assays as a mechanism for head and neck cancer equity in rural regions of the United States. Front Oncol 2024; 14:1373905. [PMID: 38779091 PMCID: PMC11109404 DOI: 10.3389/fonc.2024.1373905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
The rates of human papillomavirus-positive oropharyngeal cancer (HPV-OPC) are rising worldwide and in the United States, particularly in rural regions including Appalachia. Rural areas face unique health challenges resulting in higher cancer incidence and mortality rates, and this includes HPV-OPC. The recent advent of highly sensitive liquid biopsies for the non-invasive detection of HPV-OPC recurrence (circulating tumor HPV DNA, HPV ctDNA) has been swiftly adopted as part of surveillance paradigms. Though knowledge gaps persist regarding its use and clinical trials are ongoing, the ease of collection and cost-effectiveness of HPV ctDNA make it more accessible for HPV-OPC survivors than usual surveillance methods of frequent exams and imaging. Herein, we discuss how implementing HPV ctDNA assays in rural regions of the United States provide one poignant example of how liquid biopsies can improve cancer care equity.
Collapse
Affiliation(s)
- Melina Windon
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky and Markey Cancer Center, Lexington, KY, United States
| | - Catherine Haring
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University and the James Comprehensive Cancer Center, Columbus, OH, United States
| |
Collapse
|
4
|
Ring KL, Duska LR. How far is too far? Cancer prevention and clinical trial enrollment in geographically underserved patient populations. Gynecol Oncol 2024; 184:8-15. [PMID: 38271774 DOI: 10.1016/j.ygyno.2024.01.008] [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: 10/31/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/27/2024]
Abstract
Despite dedicated efforts to improve equitable access to cancer care in the United States, disparities in cancer outcomes persist, and geographically underserved patients remain at an increased risk of cancer with lower rates of survival. The critical evaluation of cancer prevention inequities and clinical trial access presents the opportunity to outline novel strategies to incrementally improve bookended access to gynecologic cancer care for geographically underserved patients. Cancer prevention strategies that can be addressed in the rural patient population mirror priorities in the Healthy People 2030 objectives and include increased identification of high risk individuals who may benefit from increased cancer screening and risk reduction, increasing the proportion of people who discuss interventions to prevent cancer, such as HPV vaccination, with their provider, and increasing the proportion of adults who complete evidence based cancer screening. Barriers to accrual to clinical trials for rural patients overlap significantly with the same barriers to obtaining health care in general. These barriers include: lack of facilities and specialized providers; lack of robust health infrastructure; inability to travel; and financial barriers. In this review, we will discuss current knowledge and opportunities to improve cancer prevention initiatives and clinical trial enrollment in geographically underserved populations with a focus on rurality.
Collapse
Affiliation(s)
- Kari L Ring
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908, United States of America.
| | - Linda R Duska
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908, United States of America
| |
Collapse
|
5
|
Trott S, Lei F, Jay Christian W, Mao X, Lehmkuhl B, Kejner A. Geographic variation of HPV-associated cancer incidence in Kentucky using spatial scan statistics. Cancer Causes Control 2024; 35:817-824. [PMID: 38212533 PMCID: PMC11346267 DOI: 10.1007/s10552-023-01835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE Populations with high cancer risk that are targeted for screening, education, and vaccination have been shown to increase rates of screening, which ultimately may improve timing of diagnosis and overall outcome for certain cancers. Spatial scan analysis provides a visual representation of areas with higher rates of disease. Limited research has used this methodology to assess HPV-associated cancers. Using, spatial scan statistics, our goal was to identify regions within Kentucky having significantly higher rates of HPV-associated tumors. These regions can be targeted for public health efforts in the form of education, vaccination, screening, and physician recruitment. METHODS The Kentucky Cancer Registry data from 1995 to 2016 and spatial scan statistics were used to identify county-level clusters with high-incidence of HPV-associated cancers after adjustment for age and sex. Anatomic sites included in this analysis were oropharynx, cervix, anus, penis, and vulva. RESULTS There was one high-rate cluster of oropharyngeal cancer, which was observed in the Louisville metropolitan region (Relative Risk [RR] = 1.24, p < 0.001). One high-rate cluster of anal and penile cancer incidence in men was identified that partially overlapped with the oropharyngeal cluster. There were five clusters of higher cervical, vulvar, and anal cancer incidence in females, one of which overlapped with the oropharyngeal cluster. CONCLUSION Overlapping clusters of HPV-associated cancers were identified at the county-level and included both urban and rural counties of Kentucky. Findings can assist in the design of public health interventions to increase screenings, promote vaccination, and recruit physicians in these regions to improve prevention, diagnosis, and early treatment of HPV-associated cancers.
Collapse
Affiliation(s)
- Skylar Trott
- Department of Otolaryngology, University of Kentucky, Lexington, KY, USA
| | - Feitong Lei
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - W Jay Christian
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA
| | - Xihua Mao
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA
| | - Ben Lehmkuhl
- Department of Otolaryngology, University of Kentucky, Lexington, KY, USA
| | - Alexandra Kejner
- Department of Otolaryngology, Medical University of South Carolina, Charleston, SC, USA.
| |
Collapse
|
6
|
Loper OR, Schultz JM, Kintigh BF, Callaghan DJ. Missed opportunities for human papillomavirus vaccination using Iowa's Immunization Registry Information System. J Rural Health 2024. [PMID: 38683043 DOI: 10.1111/jrh.12839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/08/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Adolescent human papillomavirus (HPV) vaccination rates continue to remain lower than other adolescent vaccines, both nationwide and in Iowa. This study examined predictors of missed opportunities for first-dose HPV vaccine administrations in Iowa in order to conduct more targeted outreach and improve adolescent HPV vaccine uptake. METHODS A retrospective study was conducted to identify predictors of missed opportunities for first-dose HPV vaccination in Iowa adolescents using Iowa's Immunization Registry Information System. The study population included 154,905 adolescents aged 11-15 years between 2019 and 2022. Missed opportunity for first-dose HPV vaccination was defined as a vaccination encounter where an adolescent received a Tdap and/or MenACWY vaccine but did not receive the first-dose HPV vaccine during the same encounter. FINDINGS Over a third of the study population experienced a missed opportunity for HPV vaccination between 2019 and 2022. Missed opportunity for vaccination was most common among individuals living in a rural county (aOR = 1.36), underinsured adolescents (aOR = 1.74), males (aOR = 1.12), teens 13-15 years of age (aOR = 1.76), and White race and non-Hispanic ethnicity. CONCLUSION This study builds on previously reported predictors of missed opportunity for HPV vaccination in adolescents. Increased understanding of provider needs and barriers to administering HPV vaccination and further analysis of how the Vaccines for Children Program can play a role in HPV vaccination uptake is necessary to improve HPV vaccination rates among adolescents in Iowa and more specifically in rural communities.
Collapse
Affiliation(s)
- Ona R Loper
- Iowa Department of Health and Human Services, Des Moines, Iowa, USA
| | | | | | | |
Collapse
|
7
|
Gopalani SV, Senkomago V, Rim SH, Saraiya M. Human papillomavirus-associated anal squamous cell carcinoma: sociodemographic, geographic, and county-level economic trends in incidence rates-United States, 2001-2019. J Natl Cancer Inst 2024; 116:275-282. [PMID: 37851397 DOI: 10.1093/jnci/djad214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/25/2023] [Accepted: 10/11/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Incidence of anal squamous cell carcinoma is increasing, but vaccination against human papillomavirus (HPV) and removal of precancerous anal lesions could prevent new cases. The overall HPV-associated cancer incidence is reported to be higher in rural populations and in counties with lower economic status. We assessed these differences specifically for HPV-associated anal squamous cell carcinoma and described the geographic, county-level economic, and sociodemographic variations in incidence rates and trends. METHODS We analyzed data from the US Cancer Statistics to assess age-standardized incidence rates of HPV-associated squamous cell carcinomas among adults aged 18 years and older from 2001 to 2019. We calculated rate ratios and 95% confidence intervals to examine differences in incidence rates. We also quantified changes in incidence rates over time using joinpoint regression. RESULTS From 2001 to 2019, 72 421 new cases of HPV-associated anal squamous cell carcinoma were diagnosed among women (2.8 per 100 000) and 37 147 among men (1.7 per 100 000). Age-standardized incidence rates were higher in the South compared with other census regions and in counties ranked in the bottom 25% and 25%-75% economically than in the top 25%. The overall incidence rate increased in women but remained stable in men during 2009-2019. Incidence rates increased in adults aged 50 years and older but decreased among those aged 40-44 years from 2001 to 2019 in women and from 2007 to 2019 in men. CONCLUSIONS There were inequities in HPV-associated anal squamous cell carcinoma incidence by geographic and county-level economic characteristics. Failure to improve vaccine and treatment equity may widen existing disparities.
Collapse
Affiliation(s)
- Sameer Vali Gopalani
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Virginia Senkomago
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sun Hee Rim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
8
|
Dugan M, Stein GS, Carney JK, Clifford-Bova S. Evidence-Based Storytelling for a Strategic Roadmap to Promote Cancer Prevention via Adolescent HPV Vaccination in Northern New England. Crit Rev Eukaryot Gene Expr 2024; 34:69-102. [PMID: 38505874 DOI: 10.1615/critreveukaryotgeneexpr.2024052382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Vaccination rates for the human papillomavirus (HPV) among rural youth in northern New England lag those of more urbanized areas. Reasons include a lack of available medical offices, time constraints, perceptions of vaccines and HPV, and, to a smaller degree, delays caused by the COVID-19 pandemic. We have a responsibility to increase vaccinations in these communities. To do so, vaccination experts recommend addressing the three C's of vaccination hesitation: confidence, complacency, and convenience. With this framework as our foundation, in this article we detail a plan to address these important elements, and we add several more C's: clinics, communication, collaboration, community, capacity, and commitment to the list as we discuss the essential pieces-human, infrastructural, and perceptual-needed to create and promote successful, community-supported, school-based HPV vaccination clinics to serve youths aged nine to 18. We then integrate research and storytelling science into an innovative Persuasion Playbook, a guide for local opinion leaders to use in creating evidence-based, pro-vaccine messages on the community level to promote the clinics via evidence-based, pro-vaccination messages.
Collapse
Affiliation(s)
- Matthew Dugan
- Department of Biochemistry, University of Vermont, Burlington, VT 05405, USA
| | - Gary S Stein
- Department of Biochemistry, University of Vermont Larner College of Medicine, Burlington, VT 05405; University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT 05405
| | - Jan Kirk Carney
- Department of Biochemistry, University of Vermont, Burlington, VT 05405, USA
| | | |
Collapse
|
9
|
Falk GE, Okut H, Lightner JS, Farrokhian N, LaCrete F, Chiu A, Shnayder Y, Bond J, Sykes KJ. Forecasting Rural and Urban Otolaryngologists, Radiation Oncologists, and Oropharyngeal Carcinoma. Laryngoscope 2024; 134:136-142. [PMID: 37395265 DOI: 10.1002/lary.30809] [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: 11/23/2022] [Revised: 03/04/2023] [Accepted: 05/24/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To forecast oropharyngeal carcinoma (OPC) incidence with otolaryngologist and radiation oncologist numbers per population by rural and urban counties through 2030. METHODS Incident OPC cases were abstracted from the Surveillance, Epidemiology, and End Results 19 database, and otolaryngologists and radiation oncologists from the Area Health Resources File by county from 2000 to 2018. Variables were analyzed by metropolitan counties with over 1,000,000 people (large metros), rural counties adjacent to a metro (rural adjacent), and rural counties not adjacent to a metro (rural not adjacent). Data were forecasted via an unobserved components model with regression slope comparisons. RESULTS Per 100,000 population, forecasted OPC incidence increased from 2000 to 2030 (large metro: 3.6 to 10.6 cases; rural adjacent: 4.2 to 11.9; rural not adjacent: 4.3 to 10.1). Otolaryngologists remained stable for large metros (2.9 to 2.9) but declined in rural adjacent (0.7 to 0.2) and rural not adjacent (0.8 to 0.7). Radiation oncologists increased from 1.0 to 1.3 in large metros, while rural adjacent remained similar (0.2 to 0.2) and rural not adjacent increased (0.2 to 0.6). Compared to large metros, regression slope comparisons indicated similar forecasted OPC incidence for rural not adjacent (p = 0.58), but greater for rural adjacent (p < 0.001, r = 0.96). Otolaryngologists declined for rural regions (p < 0.001 and p < 0.001, r = -0.56, and r = -0.58 for rural adjacent and not adjacent, respectively). Radiation oncologists declined in rural adjacent (p < 0.001, r = -0.61), while increasing at a lesser rate for rural not adjacent (p = 0.002, r = 0.96). CONCLUSIONS Rural OPC incidence disparities will grow while the relevant, rural health care workforce declines. LEVEL OF EVIDENCE NA Laryngoscope, 134:136-142, 2024.
Collapse
Affiliation(s)
- Grace E Falk
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Hayrettin Okut
- Office of Research and Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas, U.S.A
| | - Joseph S Lightner
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, U.S.A
| | - Nathan Farrokhian
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Frantzlee LaCrete
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Alexander Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Justin Bond
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, Kansas, U.S.A
| |
Collapse
|
10
|
Shi R, Qi W, Cai J, Zhao M, Wang Z. Independent risk factors for high-risk human papillomavirus infection among rural women in Shanxi Province, China: a population-based, case-control study. Arch Gynecol Obstet 2023; 308:551-559. [PMID: 36814027 DOI: 10.1007/s00404-023-06959-0] [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: 03/27/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Persistent high-risk human papillomavirus (hrHPV) infection is associated with most cervical cancers. This study aims to investigate the prevalence of and independent risk factors for hrHPV infection among women residing in rural areas of Shanxi Province, China. METHODS Data from the records of the cervical cancer screening programs for rural women in Shanxi Province were retrospectively collected. Women receiving primary HPV screening between January 2014 and December 2019 were included. The detection rate of hrHPV was calculated, and the independent risk factors for hrHPV infection were analyzed by multivariate logistic regression. RESULTS Among the women included, the overall infection rate of hrHPV was 14.01% (15,605/111,353), with the top five subtypes being HPV16 (24.79%), HPV52 (14.04%), HPV58 (10.26%), HPV18 (7.25%), and HPV53 (5.00%). The independent risk factors for hrHPV infection were specific geographical regions, testing years, older age, lower education level, inadequate previous screening, bacterial vaginosis, trichomonas vaginitis, and cervical polyps. CONCLUSION Rural women over 40 years of age, especially those who had never received screening, have a significantly increased risk for hrHPV infection and should be the target population with priority in cervical cancer screening.
Collapse
Affiliation(s)
- Ru Shi
- Department of Obstetrics and Gynecology, Children's Hospital, Affiliated to Shanxi Medical University, 13 Xinmin North Street, Taiyuan, 030001, Shanxi, China
| | - Wenjuan Qi
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jing Cai
- Department of Obstetrics and Gynecology, Children's Hospital, Affiliated to Shanxi Medical University, 13 Xinmin North Street, Taiyuan, 030001, Shanxi, China
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Min Zhao
- Department of Obstetrics and Gynecology, Children's Hospital, Affiliated to Shanxi Medical University, 13 Xinmin North Street, Taiyuan, 030001, Shanxi, China.
| | - Zehua Wang
- Department of Obstetrics and Gynecology, Children's Hospital, Affiliated to Shanxi Medical University, 13 Xinmin North Street, Taiyuan, 030001, Shanxi, China.
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| |
Collapse
|
11
|
Thaker J, Albers AN, Newcomer SR. Nurses' perceptions, experiences, and practices regarding human papillomavirus vaccination: results from a cross-sectional survey in Montana. BMC Nurs 2023; 22:211. [PMID: 37337180 PMCID: PMC10278302 DOI: 10.1186/s12912-023-01379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Nationally, much of the focus on improving human papillomavirus (HPV) vaccine uptake has been on effective strategies that physicians use to promote vaccination. However, in large, predominately rural states like Montana, nurses and medical assistants play critical roles in immunization services delivery, and their viewpoints are imperative in designing strategies to increase vaccination rates. We conducted a cross-sectional, descriptive study to determine nurses' perceptions, experiences, and practices regarding human papillomavirus vaccination in a rural and medically underserved region of the United States. METHODS We designed, pilot-tested, and disseminated an online survey instrument to nurses and medical assistants working in clinics participating in the Vaccines for Children program in Montana. The online surveys were administered from November 2020 to March 2021. Survey questions focused on clinic vaccination practices, respondents' perceptions of the HPV vaccine, perceived barriers to vaccine uptake, and general opinions on potential strategies to improve HPV vaccination rates. RESULTS We analyzed data from 227 respondents. Overall, 90% of nurses strongly agreed or agreed that the HPV vaccine is important and had confidence in the vaccine's safety. More nurses reported experiencing greater parental vaccine refusal or delay for male patients regardless of age. About 53.7% of nurses reported that their clinics had reminder/recall systems to encourage parents to bring their children for vaccination. Nurses identified misinformation from social media, infrequent wellness visits, and vaccine safety concerns as barriers to HPV vaccine uptake. CONCLUSIONS Study findings identified several promising initiatives to accelerate vaccination in primarily rural states like Montana, including promoting widespread adoption of reminder/recall systems, training nurses in evidence-based techniques to provide strong vaccine recommendations, and leveraging social media to disseminate consistent messages about the HPV vaccine recommendations for both sexes and its role in cancer prevention.
Collapse
Affiliation(s)
- Juthika Thaker
- School of Public and Community Health Sciences, The University of Montana, 32 Campus Drive, Skaggs 173, Missoula, MT, 59803, USA.
- Center for Population Health Research, The University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA.
| | - Alexandria N Albers
- School of Public and Community Health Sciences, The University of Montana, 32 Campus Drive, Skaggs 173, Missoula, MT, 59803, USA
- Center for Population Health Research, The University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Sophia R Newcomer
- School of Public and Community Health Sciences, The University of Montana, 32 Campus Drive, Skaggs 173, Missoula, MT, 59803, USA
- Center for Population Health Research, The University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| |
Collapse
|
12
|
Alsoof D, Kasthuri V, Homer A, Glueck J, McDonald CL, Kuris EO, Daniels AH. County Rurality is Associated with Increased Tumor Size and Decreased Survival in Patients with Ewing Sarcoma. Orthop Rev (Pavia) 2023; 15:74118. [PMID: 37064044 PMCID: PMC10097591 DOI: 10.52965/001c.74118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Background Ewing Sarcoma (ES) is an aggressive tumor affecting adolescents and young adults. Prior studies investigated the association between rurality and outcomes, although there is a paucity of literature focusing on ES. Objective This study aims to determine whether ES patients in rural areas are subject to adverse outcomes. Methods This study utilized the Surveillance, Epidemiology, and End Results (SEER) database. A Poisson regression model was used with controls for race, sex, median county income, and age to determine the association between rurality and tumor size. A multivariate Cox Proportional Hazard Model was utilized, controlling for age, race, gender, income, and tumor size. Results There were 868 patients eligible for analysis, with a mean age of 14.14 years. Of these patients, 97 lived in rural counties (11.18%). Metropolitan areas had a 9.50% smaller tumor size (p<0.0001), compared to non-metropolitan counties. Patients of Black race had a 14.32% larger tumor size (p<0.0001), and male sex was associated with a 15.34% larger tumor size (p<0.0001). The Cox Proportional Hazard model estimated that metropolitan areas had a 36% lower risk of death over time, compared to non-metropolitan areas (HR: 0.64, p ≤ 0.04). Conclusion Patients in metropolitan areas had a smaller tumor size at time of diagnosis and had a more favorable survival rate for cancer-specific mortality compared to patients residing in rural areas. Further work is needed to examine interventions to reduce this discrepancy and investigate the effect of extremely rural and urban settings and why racial disparities occur.
Collapse
|
13
|
Magana K, Strand L, Love M, Moore T, Peña A, Ito Ford A, Vassar M. Health inequities in human papillomavirus prevention, diagnostics and clinical care in the USA: a scoping review. Sex Transm Infect 2023; 99:128-136. [PMID: 36396174 DOI: 10.1136/sextrans-2022-055587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) represents the most common STI in the USA. HPV inequities in prevention, diagnostics and clinical care persist. We define inequities as systematic, avoidable and unfair differences in health outcomes. OBJECTIVES The objectives of this scoping review are to chart existing data on HPV-related inequities, identify gaps in existing literature and guide future research to reduce these inequities. METHODS We completed a scoping review following guidelines from the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping reviews extension. We performed a literature search on PubMed and Ovid Embase in July 2022 for articles pertaining to HPV and evaluating populations within the USA. We included English language publications from 2018 to 2022 evaluating at least one health inequity outlined by the National Institutes of Health. General publication characteristics and health inequity data were charted in a masked, duplicate fashion using a pilot-tested Google Form. We analysed frequencies of health inequities and summarised main findings from included studies. RESULTS Our final sample included 170 publications. The most common inequities examined were race/ethnicity (140 studies), sex or gender (97 studies), and income (69 studies). Many historically marginalised racial/ethnic groups had lower rates of HPV-related knowledge, vaccination and worse overall outcomes related to HPV. Compared with women, men had lower rates of HPV vaccination and provider recommendation, and higher rates of HPV-infection. Results regarding income were largely conflicting. CONCLUSION Findings from our review demonstrate clear gaps in HPV-related inequity research. Vaccine completion, provider recommendation and intersectionality should continue to be evaluated to implement targeted interventions.
Collapse
Affiliation(s)
- Kimberly Magana
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Laura Strand
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Mitchell Love
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Ty Moore
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Andriana Peña
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Alicia Ito Ford
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| |
Collapse
|
14
|
Xiao W, Deng X, He T, Guo J. Using POI and time series Landsat data to identify and rebuilt surface mining, vegetation disturbance and land reclamation process based on Google Earth Engine. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2023; 327:116920. [PMID: 36463846 DOI: 10.1016/j.jenvman.2022.116920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/14/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
The development of coal resources is necessary, but it has a huge negative impact on land, ecology, and the environment. With the increasing awareness of environmental protection and the requirements of related regulations, the design and practice of reclamation projects run through the mining life cycle and continue for a long time after the coal production. High-precision monitoring of mining disturbance and reclamation, quantifying the degree and time of vegetation disturbance and restoration, is of great significance to minimize the environmental effect of mining. Remote sensing, widely used as efficient monitoring tool, but there is not enough research on disturbance and reclamation monitoring taking into account large-scale areas and high temporal and spatial accuracy. Especially when mining sites remain unknown, how to distinguish the disturbance of coal mining and other human activities affecting the surface land cover has become a challenge. Therefore, this paper proposed a method to reconstruct the time series of mining disturbance and reclamation in a large area by using the POI (point of interest) and Landsat time series images using multiple buffer analysis methods. The process includes: (1) Retrieval of POI in the study area based on the public mining list using Python crawler, and buffering 100 km for preliminary extraction of potential mining areas; (2) Using spectral index mask and random forest algorithm to accurately extract the exposed coal on the Google Earth Engine (GEE) platform; (3) Buffering 10 km to identify the occurrence of disturbance and reclamation, using pixel-based temporal trajectory identification of LandTrendr algorithm under GEE. The method successful detect the change points of surface coal mining disturbance and reclamation in eastern Inner Mongolia of China. The results show that: (1) The method can effectively identify the extent of surface coal mining disturbance and reclamation, and the overall extraction accuracy is 81%. (2) Surface coal mining disturbance in eastern Inner Mongolia was concentrated in 2006-2011. By 2020, the total disturbed area is 627.8 km2, with an average annual disturbance of 18.5 km2, and the annual maximum disturbance to the ground reached 64.6 km2 in 2008. With the total reclaimed area being 236.3 km2, the reclamation rate is about 37.6%. This study provides a systematic solution and process for monitoring the disturbance and reclamation of surface coal mining in a large range with little known about the mines' location. It can effectively identify the mining disturbance and reclamation process which can also be extended to other areas, providing a quantitative assessment of mining disturbance and reclamation, which can support further ecological restoration decision-making.
Collapse
Affiliation(s)
- Wu Xiao
- Department of Land Management, Zhejiang University, Hangzhou, China; Institute of Land Reclamation and Ecological Restoration , China University of Mining and Technology-Beijing, Beijing, China
| | - Xinyu Deng
- Department of Land Management, Zhejiang University, Hangzhou, China
| | - Tingting He
- Department of Land Management, Zhejiang University, Hangzhou, China.
| | - Jiwang Guo
- Department of Land Management, Zhejiang University, Hangzhou, China
| |
Collapse
|
15
|
Totten AM, Womack DM, Griffin JC, McDonagh MS, Davis-O'Reilly C, Blazina I, Grusing S, Elder N. Telehealth-guided provider-to-provider communication to improve rural health: A systematic review. J Telemed Telecare 2022:1357633X221139892. [PMID: 36567431 DOI: 10.1177/1357633x221139892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Telehealth may address healthcare disparities for rural populations. This systematic review assesses the use, effectiveness, and implementation of telehealth-supported provider-to-provider collaboration to improve rural healthcare. METHODS We searched Ovid MEDLINE®, CINAHL®, EMBASE, and Cochrane CENTRAL from 1 January 2010 to 12 October 2021 for trials and observational studies of rural provider-to-provider telehealth. Abstracts and full text were dual-reviewed. We assessed the risk of bias for individual studies and strength of evidence for studies with similar outcomes. RESULTS Seven studies of rural uptake of provider-to-provider telehealth documented increases over time but variability across geographic regions. In 97 effectiveness studies, outcomes were similar with rural provider-to-provider telehealth versus without for inpatient consultations, neonatal care, outpatient depression and diabetes, and emergency care. Better or similar results were reported for changes in rural clinician behavior, knowledge, confidence, and self-efficacy. Evidence was insufficient for other clinical uses and outcomes. Sixty-seven (67) evaluation and qualitative studies identified barriers and facilitators to implementing rural provider-to-provider telehealth. Success was linked to well-functioning technology, sufficient resources, and adequate payment. Barriers included lack of understanding of rural context and resources. Methodologic weaknesses of studies included less rigorous study designs and small samples. DISCUSSION Rural provider-to-provider telehealth produces similar or better results versus care without telehealth. Barriers to rural provider-to-provider telehealth implementation are common to practice change but include some specific to rural adaptation and adoption. Evidence gaps are partially due to studies that do not address differences in the groups compared or do not include sufficient sample sizes.
Collapse
Affiliation(s)
| | - Dana M Womack
- Oregon Health & Science University, Portland, OR, USA
| | | | | | | | - Ian Blazina
- Oregon Health & Science University, Portland, OR, USA
| | - Sara Grusing
- Oregon Health & Science University, Portland, OR, USA
| | - Nancy Elder
- Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
16
|
Jordan KH, Fisher JL, Paskett ED. Distinct sociodemographic differences in incidence and survival rates for human papillomavirus (HPV)-like, non-HPV-like, and “other”-like oral cavity and pharynx cancers: An analysis of Surveillance, Epidemiology and End Results (SEER) Program data. Front Oncol 2022; 12:980900. [PMID: 36072808 PMCID: PMC9444004 DOI: 10.3389/fonc.2022.980900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/28/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Oral cavity and pharynx cancer (OCPC) cases are traditionally dichotomized into human papillomavirus (HPV) and non-HPV types. Using a proxy for HPV status, the objective was to evaluate differences in incidence and survival rates of OCPC anatomic sub-sites identified as: 1) HPV-like; 2) non-HPV-like (i.e., tobacco/alcohol-related); and 3) “other”-like (i.e., not predominantly HPV-like nor tobacco/alcohol-like) OCPCs. Methods Data from the Surveillance, Epidemiology and End Results Program were used to examine incidence and survival rates for OCPC categories over time and according to age, sex, race, ethnicity, stage at diagnosis, neighborhood socioeconomic status (i.e., nSES or Yost Index), and rurality/urbanity (i.e., Rural Urban Commuting Area (RUCA) codes). Although HPV status was unavailable in this dataset, OCPC anatomies and histologies were classified into three sub-categories, based on potential risk factors. Frequencies, average annual, age-adjusted incidence rates, five-year relative survival rates, and 95% confidence intervals were examined across and within OCPC categories. Results HPV-like OCPC incidence rates sharply increased from 1975 through 2015 while non-HPV-like and “other”-like OCPC rates decreased, all converging to similar rates from 2016 through 2018. Increasing over time for both categories, survival was highest for HPV-like and lowest for non-HPV-like OCPCs; survival for “other”-like OCPCs remained stable. Generally, across OCPC categories, incidence and survival rates were significantly higher among males vs. females, Whites vs. African Americans, and non-Hispanics vs. Hispanics. “Other”-like OCPC incidence decreased with increasing nSES tertiles, while no nSES differences were observed for HPV-like and non-HPV-like OCPCs. Incidence rates were significantly lower among urban (vs. rural) residents. For all OCPC categories, survival rates were significantly higher with increasing nSES and variable across RUCA categories. Conclusion/Impact HPV-like and non-HPV-like OCPC cases had distinct sociodemographic differences; “other”-like OCPC cases were a sociodemographic blend of HPV-like and non-HPV-like OCPC cases, resembling more of the sociodemographic makeup of non-HPV-like OCPC cases. To prevent new OCPCs, additional studies are needed to epidemiologically and clinically differentiate between OCPC categories so that high-risk groups can be better targeted in future public health interventions.
Collapse
Affiliation(s)
- Kelsey H. Jordan
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
- *Correspondence: Kelsey H. Jordan, ; James L. Fisher,
| | - James L. Fisher
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, United States
- *Correspondence: Kelsey H. Jordan, ; James L. Fisher,
| | - Electra D. Paskett
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, United States
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| |
Collapse
|
17
|
Geographical risk pattern and temporal trends in incidence of HPV-related cancers in northern Thailand: A population-based study. PLoS One 2022; 17:e0270670. [PMID: 35763509 PMCID: PMC9239466 DOI: 10.1371/journal.pone.0270670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background The burden of HPV-related cancers in different regions worldwide varies according to several factors. This study aims to measure inequality in the risk of incidence of HPV-related cancers in term of geographical risk patterns in northern Thailand using a population-based cancer registry data. Methods Trends in age-standardized HPV-related cancer incidence were calculated for the 2008–2017 time period. The Besag-York-Molli´e model was used to explore the spatial distribution of the relative risk (RR) of HPV-related cancers at the district level. A higher RR reflects a larger disparity. The geographical risk pattern of the diseases in two periods, 2008–2012 and 2013–2017 were described and compared. Results From 2008 to 2017, the incidence of oropharyngeal and anal cancers showed a slightly increased trend in males but remained stable in females, the incidence of vulvar, vaginal and penile cancers were stable while the incidence of cervical cancer decreased. The RR range was closer to 1 in the second period compared to the first period. This suggests a decrease in the disparities of incidence of cervical cancer. However, in some areas near the Thai-Myanmar border, the RR values remained high. Conclusion The incidence rate of most HPV-related cancers remained low and stable over the study period in northern Thailand. For the most common HPV-related malignancy, cervical cancer, the incidence rate steadily decreased but with marked geographic disparities, possibly reflecting health inequity especially in the border areas.
Collapse
|
18
|
HPV and COVID-19 vaccines: Social media use, confidence, and intentions among parents living in different community types in the United States. J Behav Med 2022; 46:212-228. [PMID: 35672631 PMCID: PMC9173839 DOI: 10.1007/s10865-022-00316-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/29/2022] [Indexed: 12/01/2022]
Abstract
Our study measured parental confidence and intention/uptake of two adolescent vaccines (HPV and COVID-19), focusing on differences among community types including urban, suburban, and rural. Although social media provides a way for misinformation to spread, it remains a viable forum for countering misinformation and engaging parents with positive vaccine information across community types. Yet, little is understood about differences in social media use and vaccine attitudes and behaviors for parents living in rural, suburban and urban areas. We sought to determine how to better reach parents living in different community types with targeted social media channels and messaging. In August 2021, we used a cross-sectional survey programmed in Qualtrics to collect data from 452 parents of children ages 9 to 14 living in different community types across the United States. Participants came from a survey panel maintained by CloudResearch. Survey questions asked about demographics, political affiliation, community type, social media use, health and vaccine information sources, and attitudes and behaviors regarding the HPV and COVID-19 vaccines. Our sample of parents (n = 452) most frequently used Facebook (76%), followed by YouTube (55%), and Instagram (43%). When comparing social media use by community type, parents used the top platforms at similar rates. Social media use was associated with vaccine confidence and intention/uptake in unadjusted models but not in adjusted models. Further, there were no significant differences in HPV vaccine confidence or intention/uptake by community type (i.e., rural, suburban, urban). For the COVID-19 vaccine, parents in rural communities were less likely to have vaccine confidence and intention/uptake in the unadjusted model. For both HPV and COVID-19 vaccines, political affiliation was the only common factor associated with both vaccine confidence and intention/uptake. Parents who identified as Democrat compared to Republican had greater confidence in the vaccines and had higher odds of vaccine intention/uptake for their children. Although rurality has been associated with vaccine confidence in the past we did not find that in our study. Instead, political affiliation appeared to explain most of the variation in vaccine confidence and intention/uptake, suggesting that more research is needed to identify best practices for using social media to reach parents with different political beliefs.
Collapse
|
19
|
Emerging Disparities in Prevention and Survival Outcomes for Patients with Head and Neck Cancer and Recommendations for Health Equity. Curr Oncol Rep 2022; 24:1153-1161. [PMID: 35420396 PMCID: PMC9008381 DOI: 10.1007/s11912-022-01273-5] [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] [Accepted: 01/30/2022] [Indexed: 11/05/2022]
Abstract
Purpose of Review The aim of this review is to describe less known and emerging disparities found in the prevention and survival outcomes for patients with head and neck cancer (HNC) that are likely to play an increasingly important role in HNC outcomes and health inequities. Recent Findings The following factors contribute to HNC incidence and outcomes: (1) the effect of rurality on prevention and treatment of HNC, (2) dietary behavior and nutritional factors influencing the development of and survival from HNC, and (3) barriers and benefits of telehealth for patients with HNC. Summary Rurality, nutrition and diet, and telehealth usage and access are significant contributors to the existing health disparities associated with HNC. Population and culturally specific interventions are urgently needed as well as more research to further define the issues and develop appropriate population and individual level solutions.
Collapse
|
20
|
Jenkins WD, Rose J, Molina Y, Lee M, Bolinski R, Luckey G, Van Ham B. Cancer Screening among Rural People Who Use Drugs: Colliding Risks and Barriers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084555. [PMID: 35457423 PMCID: PMC9026855 DOI: 10.3390/ijerph19084555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 01/27/2023]
Abstract
Rural cancer disparities are associated with lesser healthcare access and screening adherence. The opioid epidemic may increase disparities as people who use drugs (PWUD) frequently experience healthcare-associated stigmatizing experiences which discourage seeking routine care. Rural PWUD were recruited to complete surveys and interviews exploring cancer (cervical, breast, colorectal, lung) risk, screening history, and healthcare experiences. From July 2020–July 2021 we collected 37 surveys and 8 interviews. Participants were 24.3% male, 86.5% White race, and had a mean age of 44.8 years. Females were less likely to report seeing a primary care provider on a regular basis, and more likely to report stigmatizing healthcare experiences. A majority of females reporting receiving recommendations and screens for cervical and breast cancer, but only a minority were adherent. Similarly, only a minority of males and females reported receiving screening tests for colorectal and lung cancer. Screening rates for all cancers were substantially below those for the US generally and rural areas specifically. Interviews confirmed stigmatizing healthcare experiences and suggested screening barriers and possible solutions. The opioid epidemic involves millions of individuals and is disproportionately experienced in rural communities. To avoid exacerbating existing rural cancer disparities, methods to engage PWUD in cancer screening need to be developed.
Collapse
Affiliation(s)
- Wiley D. Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL 62794, USA;
- Correspondence:
| | - Jennifer Rose
- Department of Family and Community Medicine, Southern Illinois University School of Medicine, Carbondale, IL 62901, USA; (J.R.); (G.L.)
| | - Yamile Molina
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA;
| | - Minjee Lee
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL 62794, USA;
- Simons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL 62702, USA
| | - Rebecca Bolinski
- Department of Sociology, Southern Illinois University, Carbondale, IL 62901, USA;
| | - Georgia Luckey
- Department of Family and Community Medicine, Southern Illinois University School of Medicine, Carbondale, IL 62901, USA; (J.R.); (G.L.)
| | - Brent Van Ham
- Center for Rural Health and Social Services Development, Southern Illinois University, Carbondale, IL 62901, USA;
| |
Collapse
|
21
|
Pruitt SL, Tiro JA, Kepka D, Henry K. Missed Vaccination Opportunities Among U.S. Adolescents by Area Characteristics. Am J Prev Med 2022; 62:538-547. [PMID: 35125272 DOI: 10.1016/j.amepre.2021.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/16/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A total of 3 vaccines are recommended for U.S. adolescents: tetanus, diphtheria, and acellular pertussis; meningococcal conjugate; and human papillomavirus. To understand the disparities in vaccine availability and hesitancy, adolescent-, household-, and area-level characteristics associated with patterns of vaccine coverage are described. METHODS In 2020-2021, the authors generated national estimates among 8 possible combinations of vaccine coverage and identified the associated characteristics using 2015-2017 National Immunization Survey-Teen for male and female adolescents aged 13-17 years (N=63,299) linked to area (ZIP code) characteristics. Next, the factors associated with a missed opportunity for human papillomavirus vaccine (i.e., receipt of tetanus, diphtheria, and acellular pertussis and meningococcal conjugate only compared with coverage of all the 3 vaccines) were identified using logistic regression. RESULTS Most U.S. adolescents received all the 3 vaccines (42.9%) or tetanus, diphtheria, and acellular pertussis and meningococcal conjugate only (32.1%); fewer received no vaccines (7.7%) or tetanus, diphtheria, and acellular pertussis only (6.6%); and the remainder received some combination of 1-2 vaccines. Missed opportunities for human papillomavirus vaccination were more likely among adolescents who were male, were of White race, were uninsured, were in middle-income households, and were living in rural areas and were less likely among adolescents who were older, who were Medicaid insured, whose parents completed surveys in Spanish, who were in poverty-level households, and who were living in high-poverty areas. CONCLUSIONS A substantial number of U.S. adolescents are not fully vaccinated, and coverage varies by vaccine type, population, and place. Providers should routinely stock all the 3 vaccines and promote simultaneous, same-day vaccination to avoid missed vaccine opportunities. More research and interventions are needed to understand and modify patient, provider, payer, vaccine supply/storage, or other reasons for suboptimal coverage of all the recommended vaccines.
Collapse
Affiliation(s)
- Sandi L Pruitt
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Jasmin A Tiro
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Deanna Kepka
- College of Nursing, The University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kevin Henry
- Department of Geography and Urban Studies, Temple University, Philadelphia, Pennsylvania; Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| |
Collapse
|
22
|
McCormick JB, Hopkins M, Lehman EB, Green MJ. Mining the Data: Exploring Rural Patients' Attitudes about the Use of Their Personal Information in Research. AJOB Empir Bioeth 2022; 13:89-106. [PMID: 35271430 PMCID: PMC10038193 DOI: 10.1080/23294515.2022.2040644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study examines rural patients' perceived importance of knowing or being consulted about researchers' access and use of their personal data (identifiable and de-identified health information, and identifiable and de-identified non-health information) across five scenarios. This study also examines their views on stewardship or governance of their personal information by researchers in their healthcare systems. METHODS We conducted a survey by mail. Data were analyzed using descriptive statistics. Multivariable regression analyses were conducted across each scenario and type of personal data with the same variables included in each model. RESULTS The majority of participants said it was "very important/absolutely essential" to know the purpose of the study, to be asked every time, and to know the policies governing researcher access and use of their identifiable health information. Just over two-thirds of respondents thought it "very important/absolutely essential" to know who serves on the data governance committee and to have a community member serve. Distrust in healthcare organizations was positively correlated with the scenarios while willingness to give permission to donate leftover biological specimens was negatively correlated. CONCLUSION Our study findings indicate that the type of personal information being accessed and used generally matters to 1,407 patients living in rural Pennsylvania. We also demonstrate that knowing their healthcare organizations' governance policies and practices for managing their personal data is important to many rural Pennsylvania patients. Biomedical researchers need to recognize and attend to those differences as much as possible in order to expand opportunities for and participation in research by residents of these rural communities. Supplemental data for this article is available online at.
Collapse
Affiliation(s)
- Jennifer B McCormick
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Margaret Hopkins
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Erik B Lehman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Michael J Green
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| |
Collapse
|
23
|
Adam EE, White MC, Saraiya M. Higher prevalence of hysterectomy among rural women than urban women: Implications for measures of disparities in uterine and cervical cancers. J Rural Health 2022; 38:416-419. [PMID: 34081371 PMCID: PMC8639816 DOI: 10.1111/jrh.12595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Differences in hysterectomy prevalence by rural or urban residence could distort comparisons of rural-urban cervical and uterine cancer incidence. Using data from a large population-based survey, we sought to understand whether hysterectomy prevalence varies by rural or urban residence and whether the relationship between hysterectomy prevalence and rurality varies by race or ethnicity. METHODS Our analysis included 197,759 female respondents to the 2018 Behavioral Risk Factor Surveillance System, aged 20-79 years. We calculated population weighted proportions and 95% confidence intervals for hysterectomy prevalence, stratified by rural-urban residence and 5-year age groups. We also report estimates of hysterectomy prevalence by rural-urban residence for specific race and ethnic groups. FINDINGS Hysterectomy prevalence increased with age and was more common among rural women than urban women. The largest absolute difference occurred among women aged 45-49 years; 28.6% of rural women (95% CI: 25.1-32.2) and 16.6% of urban women (95% CI: 15.3-17.8) reported a hysterectomy. For hysterectomy prevalence by race and ethnicity, rural estimates were higher than urban estimates for the following groups of women: non-Hispanic Asian, non-Hispanic other race, non-Hispanic Black, and non-Hispanic White. Among Hispanic women and non-Hispanic American Indian/Alaska Native women, rural-urban differences in hysterectomy prevalence were not statistically different at the 95% confidence level. CONCLUSIONS Our results suggest that variation in hysterectomy prevalence, if not adjusted in the analysis, could produce distorted comparisons in measures of the relationship between rurality and uterine and cervical cancer rates. The magnitude of this confounding bias may vary by race and ethnicity.
Collapse
Affiliation(s)
- Emily E Adam
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control, Atlanta, Georgia, USA
| | - Mary C White
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control, Atlanta, Georgia, USA
| | - Mona Saraiya
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control, Atlanta, Georgia, USA
| |
Collapse
|
24
|
Maples JM, Zite NB, Oyedeji O, Chamberlin SM, Mastronardi AM, Gregory S, Gatwood JD, Hohmeier KC, Booker ME, Perry JD, Moss HK, Kilgore LC. Availability of the HPV Vaccine in Regional Pharmacies and Provider Perceptions Regarding HPV Vaccination in the Pharmacy Setting. Vaccines (Basel) 2022; 10:vaccines10030351. [PMID: 35334983 PMCID: PMC8949528 DOI: 10.3390/vaccines10030351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 02/04/2023] Open
Abstract
There is increasing support for HPV vaccination in the pharmacy setting, but the availability of the HPV vaccine is not well known. Additionally, little is known about perceptions of medical providers regarding referring patients to community pharmacies for HPV vaccination. The purpose of this study was to determine HPV vaccine availability in community pharmacies and to understand, among family medicine and obstetrics–gynecology providers, the willingness of and perceived barriers to referring patients for HPV vaccination in a pharmacy setting. HPV vaccine availability data were collected from pharmacies in a southern region of the United States. Family medicine and obstetrics–gynecology providers were surveyed regarding vaccine referral practices and perceived barriers to HPV vaccination in a community pharmacy. Results indicated the HPV vaccine was available in most pharmacies. Providers were willing to refer patients to a community pharmacy for HPV vaccination, despite this not being a common practice, likely due to numerous barriers reported. Pharmacist-administered HPV vaccination continues to be a commonly reported strategy for increasing HPV vaccination coverage. However, coordinated efforts to increase collaboration among vaccinators in different settings and to overcome systematic and legislative barriers to increasing HPV vaccination rates are still needed.
Collapse
Affiliation(s)
- Jill M. Maples
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tennessee, Knoxville, TN 37920, USA; (N.B.Z.); (A.M.M.); (S.G.); (M.E.B.); (J.D.P.); (H.K.M.); (L.C.K.)
- Correspondence:
| | - Nikki B. Zite
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tennessee, Knoxville, TN 37920, USA; (N.B.Z.); (A.M.M.); (S.G.); (M.E.B.); (J.D.P.); (H.K.M.); (L.C.K.)
| | | | - Shauntá M. Chamberlin
- Department of Family Medicine, Graduate School of Medicine, University of Tennessee, Knoxville, TN 37920, USA;
| | - Alicia M. Mastronardi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tennessee, Knoxville, TN 37920, USA; (N.B.Z.); (A.M.M.); (S.G.); (M.E.B.); (J.D.P.); (H.K.M.); (L.C.K.)
| | - Samantha Gregory
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tennessee, Knoxville, TN 37920, USA; (N.B.Z.); (A.M.M.); (S.G.); (M.E.B.); (J.D.P.); (H.K.M.); (L.C.K.)
| | - Justin D. Gatwood
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville, TN 37211, USA; (J.D.G.); (K.C.H.)
| | - Kenneth C. Hohmeier
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville, TN 37211, USA; (J.D.G.); (K.C.H.)
| | - Mary E. Booker
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tennessee, Knoxville, TN 37920, USA; (N.B.Z.); (A.M.M.); (S.G.); (M.E.B.); (J.D.P.); (H.K.M.); (L.C.K.)
| | - Jamie D. Perry
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tennessee, Knoxville, TN 37920, USA; (N.B.Z.); (A.M.M.); (S.G.); (M.E.B.); (J.D.P.); (H.K.M.); (L.C.K.)
| | - Heather K. Moss
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tennessee, Knoxville, TN 37920, USA; (N.B.Z.); (A.M.M.); (S.G.); (M.E.B.); (J.D.P.); (H.K.M.); (L.C.K.)
| | - Larry C. Kilgore
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tennessee, Knoxville, TN 37920, USA; (N.B.Z.); (A.M.M.); (S.G.); (M.E.B.); (J.D.P.); (H.K.M.); (L.C.K.)
| |
Collapse
|
25
|
Valentine JA, Delgado LF, Haderxhanaj LT, Hogben M. Improving Sexual Health in U.S. Rural Communities: Reducing the Impact of Stigma. AIDS Behav 2022; 26:90-99. [PMID: 34436713 PMCID: PMC8390058 DOI: 10.1007/s10461-021-03416-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Abstract
Sexually transmitted infections (STI), including HIV, are among the most reported diseases in the U.S. and represent some of America's most significant health disparities. The growing scarcity of health care services in rural settings limits STI prevention and treatment for rural Americans. Local health departments are the primary source for STI care in rural communities; however, these providers experience two main challenges, also known as a double disparity: (1) inadequate capacity and (2) poor health in rural populations. Moreover, in rural communities the interaction of rural status and key determinants of health increase STI disparities. These key determinants can include structural, behavioral, and interpersonal factors, one of which is stigma. Engaging the expertise and involvement of affected community members in decisions regarding the needs, barriers, and opportunities for better sexual health is an asset and offers a gateway to sustainable, successful, and non-stigmatizing STI prevention programs.
Collapse
Affiliation(s)
- Jo A Valentine
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA.
| | - Lyana F Delgado
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
| | - Laura T Haderxhanaj
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
| | - Matthew Hogben
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
| |
Collapse
|
26
|
Griffin M, Jaiswal J, Stults CB. Human Papillomavirus Vaccination Rates by Gender Identity and Sexual Orientation Among 18-44-Year-Olds in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3079-3092. [PMID: 33942195 DOI: 10.1007/s10508-020-01900-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 11/22/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
In the U.S., human papillomavirus (HPV) vaccination has been recommended for individuals up to age 26, although the vaccination is currently approved for all people up to the age of 45. This research sought to explore HPV vaccination disparities by age with subgroup analysis by gender identity and sexual orientation groups, as well as sociodemographic factors that may serve as barriers to or facilitators of vaccination. This study used data from the 2018 Behavioral Risk Factor Surveillance System. Only data for individuals who reported their gender identity, sexual orientation, and HPV vaccination status were included in the analytic sample (n = 7330). HPV vaccination rates for this sample were low, as only 18.2% (n = 1332) of the sample had received the HPV vaccination. These low rates of vaccination were similar across all subsamples: cisgender men (9.8%, n = 343), cisgender women (25.8%, n = 985), heterosexuals (17.5%, n = 1197), lesbian women or gay men (20.8%, n = 40), and bisexuals (30.8%, n = 95). In multivariable logistic regression models, younger participants (18-34) were more likely to report receiving the HPV vaccination across all subsamples. Further modeling indicated several common factors associated with higher odds of vaccination: living in a metropolitan area, having insurance coverage, and having at least one provider. Understanding vaccination disparities, as well as vaccination facilitators and barriers, is important to inform policy and program efforts. This is especially significant for adults between the ages of 35 and 44 who were excluded from the initial vaccination recommendations but are vulnerable due to changing cultural norms, including delayed marriage, nonmonogamous long-term relationships, and the ending of long-term partnerships.
Collapse
Affiliation(s)
- Marybec Griffin
- Rutgers University School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA.
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA.
| | - Jessica Jaiswal
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA
- Department of Health Science, University of Alabama, Tuscaloosa, AL, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Christopher B Stults
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA
- Department of Psychology, Baruch College, City University of New York, New York, NY, USA
| |
Collapse
|
27
|
Garcia L, Reis LO, García-Perdomo HA. Living in a rural area as a risk factor for worst outcomes in penile cancer. Int Braz J Urol 2021; 47:1259-1263. [PMID: 34115455 PMCID: PMC8486456 DOI: 10.1590/s1677-5538.ibju.2021.99.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/10/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Lina Garcia
- UROGIV Research Group, School of Medicine, Universidad del Valle, Cali, Colombia
| | - Leonardo O Reis
- UroScience, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil.,Departamento de Urologia, Pontifícia Universidade Católica de Campinas - PUC - Campinas, Campinas, SP, Brasil
| | - Herney Andrés García-Perdomo
- UROGIV Research Group, School of Medicine, Universidad del Valle, Cali, Colombia.,Division of Urology/Urooncology. Department of Surgery. School of Medicine. Universidad del Valle. Cali, Colombia
| |
Collapse
|
28
|
Brandt HM, Vanderpool RC, Pilar M, Zubizarreta M, Stradtman LR. A narrative review of HPV vaccination interventions in rural U.S. communities. Prev Med 2021; 145:106407. [PMID: 33388323 PMCID: PMC10064483 DOI: 10.1016/j.ypmed.2020.106407] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/20/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022]
Abstract
Uptake of human papillomavirus (HPV) vaccine in the United States (U.S.) is far below the Healthy People 2020 goal of 80% coverage among adolescents. In rural communities, HPV vaccination coverage is low, yet incidence and mortality rates of HPV-associated cancer are high. Much of the research focused on HPV vaccination in rural U.S. communities has involved qualitative investigations, observations, survey research, and secondary data analysis with limited implementation of interventional study designs. The purpose of this narrative review was to examine intervention studies to increase HPV vaccination in rural settings and to summarize study characteristics and associated outcomes. PubMed, PsycINFO, CINAHL, and Web of Science were searched utilizing systematic narrative review methodology for studies describing implementation of HPV vaccination interventions in rural U.S. settings from January 2006-December 2019. Using specific search criteria, 991 studies were identified. After abstract review, 30 full-text articles were assessed for eligibility, and 15 met the inclusion criteria. The 15 articles - published from 2011 to 2019 - described HPV vaccination interventions in rural settings of six states, including communities, health clinics, and schools. A range of primary and secondary outcomes were reported, including HPV vaccine receipt (series initiation, continuation, and/or completion); HPV vaccine knowledge; and/or cervical cancer knowledge. Across the studies, there was an absence of the description of rural context. As compared to the broader HPV vaccination intervention literature, interventions in rural settings were limited. More interventional research is needed in rural communities given the elevated rates of HPV-related cancer and low rates of HPV vaccine uptake.
Collapse
Affiliation(s)
- Heather M Brandt
- University of South Carolina Arnold School of Public Health, Department of Health Promotion, Education, Behavior, Rural and Minority Health Research Center, 915 Greene Street, Columbia, SC 29208, United States.
| | - Robin C Vanderpool
- National Cancer Institute, Division of Cancer Control and Population Sciences, Health Communication and Informatics Research Branch, 9609 Medical Center Drive, 3E610, Rockville, MD 20850, United States.
| | - Meagan Pilar
- Washington University in St. Louis, Brown School of Social Work, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, United States.
| | - Maria Zubizarreta
- University of South Carolina Arnold School of Public Health, Core for Applied Research and Evaluation, 915 Greene Street, Columbia, SC 29208, United States.
| | - Lindsay R Stradtman
- University of Kentucky College of Public Health, Department of Health, Behavior & Society, 113 Washington Avenue, Lexington, KY 40506, United States
| |
Collapse
|
29
|
Global incidence trends in head and neck cancer for HPV-related and -unrelated subsites: A systematic review of population-based studies. Oral Oncol 2021; 115:105177. [PMID: 33561611 DOI: 10.1016/j.oraloncology.2020.105177] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
In head and neck cancer (HNC), some subsites are associated with human papillomavirus (HPV) infection, whereas others are unrelated. Although studies have demonstrated the heterogeneity of HPV prevalence worldwide, its impacts on incidence trends in HNC are unknown. This systematic review examined the incidence trends for HPV-related HNC subsites, exploring patterns by geographic region, age group, sex, and race/ethnicity. We searched for publications on PubMed, Embase, and Scopus. Eligible articles included population-based studies that analyzed incidence trends for subsites classified as a proxy for HPV infection in HNC (hereafter referred to as HPV-related subsites). We retrieved 3,948 non-duplicate records, of which 31 were eligible articles, representing 18 countries and spanning almost fifty years. Overall, the incidence of HPV-related HNC subsites rose, while most of the HPV-unrelated subsites declined or remained stable. For HPV-related HNC subsites, incidence trends increased regardless of age group, highlighting a distinct global pattern between sexes. Also, similar peaks in increased risk were observed in recent cohorts from both Australia and the United States. There is a dramatic shift in the global trends of HNCs, characterized by the emerging burden in HNC for HPV-related subsites.
Collapse
|
30
|
Lee M, Jenkins WD, Adjei Boakye E. Cancer screening utilization by residence and sexual orientation. Cancer Causes Control 2020; 31:951-964. [PMID: 32833199 DOI: 10.1007/s10552-020-01339-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 08/13/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Although few studies have examined screening uptake among sexual minorities (lesbian, gay, bisexual, queer), almost none have examined it in the specific context of rural populations. Therefore, our objective was to assess how cancer screening utilization varies by residence and sexual orientation. METHODS Publicly available population-level data from the 2014 and 2016 Behavioral Risk Factor Surveillance System were utilized. Study outcomes included recommended recent receipt of breast, cervical, and colorectal cancer screening. Independent variables of interest were residence (rural/urban) and sexual orientation (heterosexual/gay or lesbian/bisexual). Weighted proportions and multivariable logistic regressions were used to assess the association between the independent variables and the outcomes, adjusting for demographic, socioeconomic, and healthcare utilization factors. RESULTS Rates for all three cancer screenings were lowest in rural areas and among sexual minority populations (cervical: rural lesbians at 64.8% vs. urban heterosexual at 84.6%; breast: rural lesbians at 66.8% vs. urban heterosexual at 80.0%; colorectal for males: rural bisexuals at 52.4% vs. urban bisexuals at 81.3%; and colorectal for females: rural heterosexuals at 67.2% vs. rural lesbians at 74.4%). In the multivariate analyses for colorectal screening, compared to urban heterosexual males, both rural gay and rural heterosexual males were less likely to receive screening (aOR = 0.45; 95% = 0.24-0.73 and aOR = 0.79; 95% = 0.72-0.87, respectively) as were rural heterosexual females (aOR = 0.87; 95% = 0.80-0.94) compared to urban heterosexual females. For cervical screening, lesbians were less likely to receive screening (aOR = 0.62; 95% = 0.41-0.94) than heterosexuals, and there were no differences for breast screening. CONCLUSION We found that rural sexual minorities may experience disparities in cancer screening utilization associated with the compounding barriers of rural residence and sexual minority status, after adjusting for demographic, socioeconomic, and healthcare utilization factors. Further work is needed to identify factors influencing these disparities and how they might be addressed.
Collapse
Affiliation(s)
- Minjee Lee
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA. .,Simons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA.
| | - Wiley D Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA.,Simons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA
| |
Collapse
|
31
|
Beachum N, Dehority W. Safety of Peripherally Inserted Central Catheter Use in Children From Rural Versus Urban Settings Receiving Long-term Parenteral Antimicrobial Therapy. Hosp Pediatr 2020; 9:51-54. [PMID: 30552090 DOI: 10.1542/hpeds.2018-0196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine the safety of peripherally inserted central catheter (PICC) use for delivery of outpatient parenteral antimicrobial therapy (PAT) in children discharged to rural or urban locales. We hypothesized that children from rural settings would experience higher complication rates. PATIENTS AND METHODS We conducted a retrospective cohort study of children admitted to an academic medical center in the Southwestern United States over 9 years who were discharged with a PICC to complete a course of PAT with follow-up at our institution. To classify rural versus urban residence, we used rural-urban continuum codes from the US Department of Agriculture, the driving time in hours to the nearest trauma center, and the discharging center using Google Maps. RESULTS In total, 221 children met inclusion criteria (mean age 9.8 years). Osteoarticular infections and cystic fibrosis exacerbations were the most common indications for PICC use (68.8%). The mean driving time to the discharging hospital was significantly longer for those children residing in the most rural regions of the state (3.6 vs 0.8 hours; P < .001) as well as to the nearest level 1, 2, or 3 trauma center (2.2 vs 0.4 hours; P < .001). PICC complications occurred in 47 children (21.3%). No association was found between rural-urban continuum codes, driving times to the discharging hospital, or nearest trauma center with any complication nor with complications overall. CONCLUSIONS In our study, we demonstrate an equivalent safety profile for children in rural and urban settings with PICCs for receipt of outpatient PAT.
Collapse
Affiliation(s)
- Natasha Beachum
- School of Medicine, The University of New Mexico, Albuquerque, New Mexico
| | - Walter Dehority
- Division of Infectious Diseases, Department of Pediatrics, and
| |
Collapse
|
32
|
Näsman A, Du J, Dalianis T. A global epidemic increase of an HPV-induced tonsil and tongue base cancer - potential benefit from a pan-gender use of HPV vaccine. J Intern Med 2020; 287:134-152. [PMID: 31733108 DOI: 10.1111/joim.13010] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 12/28/2022]
Abstract
In 2007, human papillomavirus (HPV) type 16 was finally recognized as a risk factor, besides smoking and alcohol, for oropharyngeal squamous cell carcinoma (OPSCC), including tonsillar squamous cell carcinoma (TSCC), by the International Agency for Research against Cancer. Just before, in 2006, the Food and Drug Administration had approved Gardasil, the first vaccine against HPV16, 18, 6 and 11, for preventive vaccination women against cervical cancer. Concurrently, some Western countries, where smoking was decreasing, disclosed an epidemic increase in the incidence of OPSCC, especially of TSCC and base of tongue cancer (BOTSCC), together accounting for 80-90% of all OPSCCs, and mainly affecting men. The epidemic was later revealed to be due to a rise in HPV-positive cases, and scientists in the field suggested HPV vaccination also of boys. Globally, there are roughly 96 000 incident OPSCC cases/year of which 20-24% are caused by HPV, thereby accounting for around 22 000 OPSCC cases annually. Of these cases, 80-90% are due to HPV16 infection and would be prevented with the presently registered HPV vaccines. In Western countries, such as Sweden (with almost 400 TSCC and BOTSCC cases per year) and the United States, HPV prevalence in OPSCC is higher and around 70%. HPV vaccination of girls has been initiated in many countries, and the vaccines have been efficient and their side effects limited. HPV vaccination of boys has, however, been the exception, but should definitely not be delayed any further. It would benefit both girls and boys directly, and result in better and more robust herd immunity. Today, we have the possibility to eliminate several high-risk HPV types in the younger generations and avoid more than 600 000 cancer cases annually worldwide, and this possibility should be embraced by offering global pan-gender HPV vaccination.
Collapse
Affiliation(s)
- A Näsman
- From the, Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - J Du
- Department of Microbiology, Tumor Biology and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden
| | - T Dalianis
- From the, Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
33
|
Janis JA, Ahrens KA, Ziller EC. Female Age at First Sexual Intercourse by Rural–Urban Residence and Birth Cohort. Womens Health Issues 2019; 29:489-498. [DOI: 10.1016/j.whi.2019.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 07/09/2019] [Accepted: 07/17/2019] [Indexed: 01/30/2023]
|
34
|
Oerther S, Shattell M. Depression in Parents Who Live in Rural Communities: What Do We Know? J Psychosoc Nurs Ment Health Serv 2019; 57:2-3. [DOI: 10.3928/02793695-20191016-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Sarah Oerther
- Jonas Policy Scholar, Psychiatric, Mental Health & Substance Abuse Expert Panel, 2017-2019 Saint Louis University School of Nursing St. Louis, Missouri
| | | |
Collapse
|
35
|
Incentivized Screening to Reduce Sexually Transmitted Infection Risk and Prevalence. Sex Transm Dis 2019; 46:654-656. [DOI: 10.1097/olq.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|