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Jolidon V, De Prez V, Bracke P, Cullati S, Burton-Jeangros C. Lack of social support, gender and colorectal cancer screening participation across Europe: How do screening programmes mitigate the effect of social support for men and women? SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:1212-1237. [PMID: 38761366 DOI: 10.1111/1467-9566.13791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/16/2024] [Indexed: 05/20/2024]
Abstract
This study investigates how a lack of social support differentially affects men and women's colorectal cancer (CRC) screening participation, considering different screening strategies implemented across European countries. Although health sociology has stressed gender differences in social support and its effects on health behaviours, this was overlooked by cancer screening research. Using a data set of 65,961 women and 55,602 men in 31 European countries, we analysed the effect of social support variables on CRC screening uptake. We found that living alone and lower perceived social support were associated with lower screening uptake for both men and women. These effects were, however, stronger among men. Population-based screening programmes mitigated these effects, particularly for women, but not for men living alone. In countries with opportunistic screening programmes, social support variables remained associated with screening uptake. We conclude that cancer screening interventions should pay attention to social support and its gender-differentiated effects.
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Affiliation(s)
- Vladimir Jolidon
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
| | - Vincent De Prez
- Department of Sociology, Ghent University, Ghent, Belgium
- Health Services Research, Sciensano, Brussels, Belgium
| | - Piet Bracke
- Department of Sociology, Ghent University, Ghent, Belgium
| | - Stéphane Cullati
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
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Watanabe T, Sugiyama T, Ito T, Kawamura C, Komiyama J, Tamiya N. Relationship between health checkups and cancer screenings of wives and health checkups of their husbands: A cross-sectional study in Japan. Prev Med Rep 2024; 41:102701. [PMID: 38571913 PMCID: PMC10987899 DOI: 10.1016/j.pmedr.2024.102701] [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: 10/21/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024] Open
Abstract
Objectives This study investigated the relationship between health checkups, cervical cancer screenings, and breast cancer screenings (collectively referred to as wellness examinations) of wives and health checkups of their husbands. We aimed to develop strategies to encourage wellness examinations among married individuals in Japan. Methods This study used the 2019 Comprehensive Survey of Living Conditions, focusing on married couples aged 40-64. We analyzed the percentage of wives undergoing wellness examinations, grouped based on whether their husbands had undergone health checkups. Subsequently, multivariable modified Poisson regression analysis was performed considering sociodemographic and health-related factors. All analyses considered medical insurance of wives because wellness examination methods varied depending on medical insurance type. Results The sample comprised 40,560 couples undergoing health checkups, 39,870 undergoing cervical cancer screening, and 39,895 undergoing breast cancer screening. Regardless of the medical insurance type of the wife, a significant positive association was observed between the wellness examination of wives and the health checkup of husbands across all age groups. After adjusting for covariates, prevalence ratios (95% confidence intervals) for wives whose husbands underwent health checkups were 2.24 (2.09-2.40) for national health insurance, 1.18 (1.16-1.21) for employee insurance (employee), and 1.53 (1.44-1.63) for employee insurance (family) for health checkups. Similar trends were observed in cervical and breast cancer screening. Conclusions Wellness examinations of wives were associated with those of their husbands, suggesting that couples often share similar health-seeking behaviors. Hence, targeted interventions are important for couples who do not undergo wellness examinations.
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Affiliation(s)
- Taeko Watanabe
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Takehiro Sugiyama
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, Japan
| | - Tomoko Ito
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Chitose Kawamura
- Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Jun Komiyama
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
- Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
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Heterogeneity in the Utilization of Fecal Occult Blood Testing and Colonoscopy among Migrants and Non-Migrants in Austria: Results of the Austrian Health Interview Survey. GASTROINTESTINAL DISORDERS 2023. [DOI: 10.3390/gidisord5010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Many European studies report lower participation in colorectal cancer screening among migrants than non-migrants. A major limitation of these studies is that usually, the heterogeneity of migrants cannot be accounted for. The aim of this investigation was to examine differences in the utilization of fecal occult blood testing and colonoscopy between non-migrants and the five largest migrant groups residing in Austria using data from the Austrian Health Interview Survey 2019. The two outcomes were compared between non-migrants and migrants using multivariable logistic regression adjusted for socioeconomic and health variables. Migrants from a Yugoslav successor state (OR = 0.61; 95%-CI: 0.44–0.83), Turkish (OR = 0.35; 95%-CI: 0.22–0.55), Hungarian (OR = 0.37; 95%-CI: 0.16–0.82) and German migrants (OR = 0.70; 95%-CI: 0.51–0.98) were less likely to have used a fecal occult blood test compared to non-migrants. Participation in colonoscopy was lower among Turkish migrants (OR = 0.42; 95%-CI: 0.27–0.67) and migrants from a Yugoslav successor state (OR = 0.56; 95%-CI: 0.42–0.75) than among non-migrants. The findings are consistent with studies from other countries and highlight barriers migrants face in accessing the health care system. To address these barriers, the heterogeneity of the population must be taken into account when developing educational materials in order to promote informed decisions about whether or not to participate in colorectal cancer screening.
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Chen YJ, Lin CF, Feng J, Chiu HL. Influencing factors of participation in and satisfaction with elderly health checkups: a cross-sectional study. Front Public Health 2023; 11:1104438. [PMID: 37188280 PMCID: PMC10177394 DOI: 10.3389/fpubh.2023.1104438] [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: 11/21/2022] [Accepted: 03/27/2023] [Indexed: 05/17/2023] Open
Abstract
Background Attending health checkups as a primary prevention strategy benefits older adults in facilitating the identification of health issues and risk factors for disease. Little is known about factors influencing participation in and satisfaction with a free annual elderly health checkup program (EHCP) in Taiwan. This study aimed to extend current knowledge related to the uptake of this service and individuals' views of the service. Methods This was a cross-sectional study using a telephone interview survey method to compare influencing factors and satisfaction between participants and non-participants of an EHCP. The individuals involved were older adults in Taipei, Taiwan. The random sampling method included 1,100 people, 550 older adults who had participated in the EHCP within the last 3 years, and 550 older adults who had not. A questionnaire containing personal characteristics and satisfaction with the EHCP was used. Independent t-test and Pearson's Chi-squared test were used to evaluate differences between the two groups. Associations between individual characteristics and health checkup attendance were estimated using log-binomial models. Results Results showed that 51.64% of participants reported being satisfied with the checkups; however, only 41.09% of non-participants were satisfied. In the association analysis, age, educational level, chronic diseases, and subjective satisfaction were related to older persons' participation. Furthermore, having a stroke was associated with a higher attendance rate [prevalence ratio: 1.49; 95% confidence interval: (1.13, 1.96)]. Conclusions The EHCP had a high proportion of satisfaction among participants, but the proportion was low among non-participants. Several factors were associated with participation and might lead to unequal healthcare service uptake. Health checkups need to increase among people at a young age, those with low educational backgrounds, and those without chronic diseases.
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Affiliation(s)
- Ying-Jen Chen
- Division of Geriatrics and General Internal Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiou-Fen Lin
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Jie Feng
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Huei-Ling Chiu
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Huei-Ling Chiu
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Vanaclocha-Espí M, Pinto-Carbó M, Martín-Pozuelo J, Romeo-Cervera P, Peiró-Pérez R, Barona C, Ortiz F, Nolasco A, Castán S, Salas D, Molina-Barceló A. Construction of an individual socioeconomic status index for analysing inequalities in colorectal cancer screening. PLoS One 2022; 17:e0278275. [PMID: 36454740 PMCID: PMC9714724 DOI: 10.1371/journal.pone.0278275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 11/12/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To construct an individual socioeconomic status index (ISESI) with information available in the Population Information System of the Region of Valencia, Spain, and use it to analyse inequalities in a colorectal cancer screening programme (CRCSP). METHODS Cross-sectional study of men and women aged between 50 and 75 at the time of the study (2020) that were selected from the target population of the Region of Valencia CRCSP. (study sample 1,150,684). First, a multiple correspondence analysis was performed to aggregate information from the Population Information System of the Region of Valencia into an ISESI. Second, data from the 2016 Region of Valencia Health Survey were used for validation, and finally the relationship between CRCSP participation and the ISESI was analysed by logistic regression models. RESULTS The variables included in the index were nationality, employment status, disability, healthcare coverage, risk of vulnerability and family size. The most important categories for determining the highest socioeconomic status were being employed and not being at risk of social vulnerability, and being unemployed and at risk of social vulnerability for determining the lowest socioeconomic status. Index validation demonstrated internal and external coherence for measuring socioeconomic status. The relationship between CRCSP participation and the ISESI categorised by quartile (Q) showed that Q4 (the lowest socioeconomic status) was less likely to participate OR = 0.769 (0.757-0.782) than Q1 (the highest socioeconomic status), and the opposite was found for Q2 OR = 1.368 (1.347-1.390) and Q3 OR = 1.156 (1.137-1.175). CONCLUSIONS An ISESI was constructed and validated using Population Information System data and made it possible to evaluate inequalities in colorectal cancer screening.
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Affiliation(s)
- Mercedes Vanaclocha-Espí
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
- * E-mail:
| | - Marina Pinto-Carbó
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
| | - Javier Martín-Pozuelo
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
| | - Paula Romeo-Cervera
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
| | - Rosana Peiró-Pérez
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
- General Directorate of Public Health, Valencian Community, Spain
| | - Carmen Barona
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
- General Directorate of Public Health, Valencian Community, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Ortiz
- Health Insurance Service and the SIP of the Conselleria de Sanitat, Valencian Community, Spain
| | | | - Susana Castán
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
- General Directorate of Public Health, Valencian Community, Spain
| | - Dolores Salas
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
- General Directorate of Public Health, Valencian Community, Spain
| | - Ana Molina-Barceló
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
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Gil N, Fisher A, Beeken RJ, Pini S, Miller N, Buck C, Lally P, Conway R. The role of partner support for health behaviours in people living with and beyond cancer: A qualitative study. Psychooncology 2022; 31:1997-2006. [PMID: 36097392 PMCID: PMC9828063 DOI: 10.1002/pon.6032] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/16/2022] [Accepted: 09/05/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study aimed to qualitatively explore how partner support for health behaviours is perceived, received, and utilised in people living with and beyond cancer (LWBC). METHODS Semi-structured audio interviews were conducted with 24 participants, 15 men and nine women, living with and beyond breast, prostate, and colorectal cancer. Inductive and deductive Thematic Analysis was used to analyse the data. RESULTS Three key themes with six subthemes were identified relating to partner support for health behaviours: (1) Interdependence (Reciprocity, Overt Control, Influence & Motivation) (2) Concordance (Shared Attitudes & Health Beliefs, Shared Health Behaviour) and (3) Communal Coping (Communal Orientation towards Health and Decision Making, Co-operative Action in Health Behaviour). CONCLUSIONS Partner support plays a unique and significant role in the health behaviours of people LWBC. Partners play a collaborative role in managing health and facilitating health behaviours, while the high level of concordance in couples may represent a potential barrier to change via the reinforcement of maladaptive health beliefs and behaviours. IMPLICATIONS FOR CANCER SURVIVORS Overall, findings demonstrate that partners should be considered and included where possible when designing future behaviour change interventions for people LWBC.
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Affiliation(s)
- Natalie Gil
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Abigail Fisher
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Rebecca J. Beeken
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Simon Pini
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Natalie Miller
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Caroline Buck
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Phillippa Lally
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Rana Conway
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
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The partner in the plate: the association between changes in partnership status and protein consumption among older people in Europe. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Experiencing a change in partnership status at older ages might have detrimental effects on an individual's habits, including eating behaviours. Prior studies presented evidence that widowhood is related to altered diets with a decrease in the amount of protein consumed, which is considered to be an important risk factor of frailty among older people. Using data from Waves 4–8 of the Survey of Health, Ageing and Retirement in Europe (N = 134,313), we investigate the association between stability and changes in partnership status and changes in the frequency of protein consumption at older ages. We also explore the potential moderating role played by changes in economic resources. Having never been married, being divorced and being widowed were significantly associated with a lower frequency of protein consumption among both men and women. The transition to widowhood was significantly associated with a reduction in the frequency of protein consumption, while this same association was not found in the transition to divorce. Subjective evaluation of economic resources did not moderate the relationship between changes in partnership status and frequency of protein consumption. In short, changes in eating behaviours after having experienced the loss of a partner due to widowhood might contribute to accounting for health differentials between those ageing alone and those with a partner.
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Herriges MJ, Shenhav-Goldberg R, Peck JI, Bhanvadia SK, Morgans A, Chino F, Chandrasekar T, Shapiro O, Jacob JM, Basnet A, Bratslavsky G, Goldberg H. Financial Toxicity and Its Association With Prostate and Colon Cancer Screening. J Natl Compr Canc Netw 2022; 20:981-988. [PMID: 36075394 DOI: 10.6004/jnccn.2022.7036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The term "financial toxicity" or "hardship" is a patient-reported outcome that results from the material costs of cancer care, the psychological impacts of these costs, and the coping strategies that patients use to deal with the strain that includes delaying or forgoing care. However, little is known about the impact of financial toxicity on cancer screening. We examined the effects of financial toxicity on the use of screening tests for prostate and colon cancer. We hypothesized that greater financial hardship would show an association with decreased prevalence of cancer screening. METHODS This cross-sectional survey-based US study included men and women aged ≥50 years from the National Health Interview Survey database from January through December 2018. A financial hardship score (FHS) between 0 and 10 was formulated by summarizing the responses from 10 financial toxicity dichotomic questions (yes or no), with a higher score associated with greater financial hardship. Primary outcomes were self-reported occurrence of prostate-specific antigen (PSA) blood testing and colonoscopy for prostate and colon cancer screening, respectively. RESULTS Overall, 13,439 individual responses were collected. A total of 9,277 (69.03%) people had undergone colonoscopies, and 3,455 (70.94%) men had a PSA test. White, married, working men were more likely to undergo PSA testing and colonoscopy. Individuals who had not had a PSA test or colonoscopy had higher mean FHSs than those who underwent these tests (0.70 and 0.79 vs 0.47 and 0.61, respectively; P≤.001 for both). Multivariable logistic regression models demonstrated that a higher FHS was associated with a decreased odds ratio for having a PSA test (0.916; 95% CI, 0.867-0.967; P=.002) and colonoscopy (0.969; 95% CI, 0.941-0.998; P=.039). CONCLUSIONS Greater financial hardship is suggested to be associated with a decreased probability of having prostate and colon cancer screening. Healthcare professionals should be aware that financial toxicity can impact not only cancer treatment but also cancer screening.
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Affiliation(s)
- Michael J Herriges
- Pediatrics Department, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | | | - Juliet I Peck
- Performing Arts Medicine Department, Shenandoah University, Winchester, Virginia
| | - Sumeet K Bhanvadia
- USC Norris Cancer Center, Keck Medical Center, University of Southern California, Los Angeles, California
| | - Alicia Morgans
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Fumiko Chino
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | | | | | - Alina Basnet
- Hematology/Oncology Department, State University of New York Upstate Medical University, Syracuse, New York
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Participation in Colorectal Cancer Screening among Migrants and Non-Migrants in Germany: Results of a Population Survey. GASTROINTESTINAL DISORDERS 2022. [DOI: 10.3390/gidisord4030011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Colorectal cancer screening can contribute to reducing colorectal cancer incidence and mortality. Findings on disparities in the utilization of colorectal cancer screening between migrants and non-migrants have been inconsistent, with some studies reporting lower, and some higher utilization among migrants. The aim of the present study was to examine potential disparities in fecal occult blood testing and colonoscopy among migrants in Germany. Data from a population survey on 11,757 men and women aged ≥50 years is used. Using multivariable logistic regression, the utilization of fecal occult blood testing and colonoscopy was compared between non-migrants, migrants from EU countries and migrants from non-EU countries, adjusting for socio-economic factors and also taking into account intersectional differences by sex and age. The study shows that migrants from the EU (adjusted OR = 0.73; 95%-CI: 0.57, 0.94) and from non-EU countries (adjusted OR = 0.39; 95%-CI: 0.31, 0.50) were less likely to utilize fecal occult blood testing than non-migrants. No disparities for the use of colonoscopy were observed. The findings are in line with studies from other countries and can be indicative of different barriers migrants encounter in the health system. Adequate strategies taking into account the diversity of migrants are needed to support informed decision-making among this population group.
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Adegboyega A, Aroh A, Williams LB, Mudd-Martin G. Social support and cervical cancer screening among sub-Saharan African immigrant (SAI) women. Cancer Causes Control 2022; 33:823-830. [PMID: 35426540 DOI: 10.1007/s10552-022-01577-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Low rates of Papanicolaou (Pap) screening among sub-Saharan African immigrant (SAI) women in the US contribute to cancer diagnoses at late stages and high mortality rates. This study was conducted to examine if social support, positively associated with preventive health practices, was predictive of Pap screening in a sample of SAI women. METHODS We conducted a cross-sectional study with SAI women who recently immigrated to the US. Participants completed a survey to assess ever having had Pap screening and social support using the Medical Outcomes Study Social Support Survey. RESULTS Among the 108 SAI women in our study, Pap screening uptake was 65.7%. Affectionate and positive social support were each associated with Pap screening [adjusted odds ratio (AOR) = 1.73 (1.05, 2.87) and 1.68 (1.01, 2.78), respectively]. DISCUSSION These findings suggest that consideration should be given to strengthening certain aspects of social support to increase uptake of Pap screening among SAI women.
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Affiliation(s)
- Adebola Adegboyega
- University of Kentucky, College of Nursing, Lexington, KY, 40536-0232, USA.
- University of Kentucky, 539 College of Nursing Building, Lexington, KY, 40536-0232, USA.
| | | | - Lovoria B Williams
- University of Kentucky, College of Nursing, Lexington, KY, 40536-0232, USA
| | - Gia Mudd-Martin
- University of Kentucky, College of Nursing, Lexington, KY, 40536-0232, USA
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Li JB, Ke KJ, Zhang WL, Wang LY, Wu YP, Weng F, Tian H, Qiu ZY, Li Y, Lin SY, Ye MX, Ou QJ, Gong CH, Lu ZH, Pan ZZ, Wan DS, Peng JH, Fang YJ. Factors associated with adherence to colonoscopy among individuals who were positive in the preliminary screening for colorectal neoplasms. Cancer Med 2022; 11:4321-4331. [PMID: 35441812 DOI: 10.1002/cam4.4730] [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: 08/04/2021] [Revised: 02/19/2022] [Accepted: 03/14/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the potential factors associated with adherence to colonoscopy among participants who were preliminarily screened positive in a community-based colorectal cancer screening program in China. METHODS This study analyzed data from 1219 out of 6971 community residents who were identified as positive cases by the well-validated high-risk factor questionnaire (HRFQ) or fecal immunochemical test (FIT) in the preliminary screening stage for colorectal neoplasms. Patients showing adherence to colonoscopy were defined as those who received positive results in a preliminary screening for colorectal neoplasms and later received a colonoscopy examination as required. The associations of social-demographic factors, lifestyle behaviors, history of diabetes, body mass index (BMI), and risk factors in the HRFQ with adherence to colonoscopy were evaluated using logistic regression models. RESULTS Among 1219 participants who preliminarily screened positive, the top five risk factors reported by the participants were chronic constipation (25.9%), hematochezia (23.5%), family history of CRC in first-degree relatives (22.1%), chronic diarrhea (21.8%), and history of polyps (16.6%). Around 14.2% of participants who preliminarily screened positive reported three or more risk factors, and the proportion was 26.2% among participants who were positive according to both HRFQ and FIT. Among all participants who were preliminarily screened positive, the multivariable results showed that those who were married (OR = 1.58, 95% CI: 1.12, 2.25, p = 0.01), had chronic diarrhea (OR = 1.34, 95% CI: 1.00, 1.78, p = 0.047), and had a positive FIT (OR = 1.60, 95% CI: 1.21, 2.10, p < 0.001 for patients who were negative according to HRFQ but positive according to FIT; OR = 2.12, 95% CI: 1.33, 2.78, p = 0.002 for patients who were positive for both HRFQ and FIT) were more likely to adhere to colonoscopy, while participants with a history of cancer (OR: 0.50, 95% CI: 0.31, 0.79, p = 0.003) were less likely to adhere to colonoscopy. The results among participants who were tested positive according to only HRFQ were similar to those among all participants who were tested positive according to HRFQ or FIT. However, among participants who were tested positive according to only FIT, we only found that those who were married (OR = 2.52, 95% CI: 1.08, 5.90, p = 0.033) had a higher odds of adhering to colonoscopy, while those with a history of diabetes (OR = 0.35, 95% CI: 0.13, 0.96, p = 0.042) were less likely to adhere to colonoscopy. CONCLUSION Our findings provide evidence supporting the development of tailored interventional strategies that aim to improve adherence to colonoscopy for individuals with a high risk of colorectal neoplasms. Both barriers and facilitators associated with adherence to colonoscopy should be considered in supportive systems and health policies. However, further well-designed prospective studies are warranted to confirm our findings.
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Affiliation(s)
- Ji-Bin Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Keng-Jian Ke
- Shenzhen Hospital, Southern Medical University, Shenzhen, P. R. China
| | - Wei-Li Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Ling-Yan Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Yan-Ping Wu
- Yuexiu District Center for Disease Control and Prevention, Guangzhou, P. R. China
| | - Fan Weng
- Yuexiu District Center for Disease Control and Prevention, Guangzhou, P. R. China
| | - Huan Tian
- Dadong Street Community Health Service Center, Guangzhou, P. R. China
| | - Zhi-Yu Qiu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Yin Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Shi-Yong Lin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Mei-Xian Ye
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Qing-Jian Ou
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Cheng-Hua Gong
- Yuexiu District Center for Disease Control and Prevention, Guangzhou, P. R. China
| | - Zhen-Hai Lu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Zhi-Zhong Pan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - De-Sen Wan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Jian-Hong Peng
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Yu-Jing Fang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
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12
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Shen C, Kwon M, Moss JL, Schaefer E, Zhou S, Dodge D, Ruffin MT. Utilization of Mammography During the Last Year of Life Among Older Breast Cancer Survivors. J Womens Health (Larchmt) 2022; 31:941-948. [PMID: 35394350 DOI: 10.1089/jwh.2021.0517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Mammography is generally recommended for breast cancer survivors. However, discussion is ongoing about stopping surveillance mammography when life expectancy is <5-10 years as the benefit of screening might be diminished toward the end of life. The utilization pattern of mammography in the last year of life among this population has not been well studied. Methods: We identified 58,736 females diagnosed with breast cancer between January 2002 and December 2015, who died at the age of at least 67, from the SEER-Medicare database. We examined the utilization patterns of mammography during their last year of life and investigated factors associated with the use of mammography at the end of life using a multivariable logistic regression model. Results: Overall, 28.5% of the patients received mammography during the last year of life. Multivariable logistic regression showed that older age (OR = 0.31, 95% CI = 0.29-0.34, p < 0.001 for 95 vs. 85 years old), more advanced cancer stage (OR = 0.22, 95% CI = 0.20-0.24 p < 0.001 for distant vs. localized disease), and higher comorbidity score (OR = 0.92, 95% CI = 0.91-0.93, p < 0.001 for every 1-point increase) were associated with less mammography use. Age was nonlinearly associated with mammography use, with a steady proportion of patients receiving a mammography until approximately age 80 and then a sharp decrease thereafter. Conclusion: This population-based study found that a sizable proportion of older breast cancer survivors received mammography during the last year of life.
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Affiliation(s)
- Chan Shen
- Department of Surgery and College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Michelle Kwon
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jennifer L Moss
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
- Department of Family and Community Medicine, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Eric Schaefer
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Shouhao Zhou
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Daleela Dodge
- Department of Surgery and College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Mack T Ruffin
- Department of Family and Community Medicine, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
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13
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The Significant Predictors for Breast, Cervical, Colorectal, or Oral Cancer Screening Intention and Behavior in Taiwan. Cancer Nurs 2022:00002820-990000000-00006. [PMID: 35349494 DOI: 10.1097/ncc.0000000000001107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cancer screening can improve outcomes in patients with cancer. Accordingly, under the direction of the National Health Insurance program, the Taiwan government conducts screenings for breast cancer, cervical cancer, oral cancer, and colorectal cancer. OBJECTIVE The aim of this study was to identify the primary predictors of cancer screening intention and behavior at 1 and 6 months after patients are provided information and an invitation by telephone to attend cancer screenings. METHODS In this prospective longitudinal study, 339 participants meeting the screening criteria were recruited. At baseline, telephone interviews were used to collect information on demographic characteristics, exercise and smoking habits, family cancer history, screening beliefs, and screening intention. Screening behavior was followed up at 1 and 6 months after the telephone interviews. RESULTS At baseline, 87.02% of the participants intended to undergo screening, and 31.86% and 63.42% had undergone screening after 1 and 6 months, respectively. The predictors of screening intention were awareness of the screening policy, willingness to learn about screening, and believing in the health benefits of screening. The predictor of screening behavior after 1 month was screening intention at baseline, and the predictors of behavior after 6 months were screening intention, marital status, and belief that cancer is a hereditary disease. CONCLUSION Adults with screening intention tended to undergo cancer screenings. IMPLICATIONS FOR PRACTICE The use of strategies based on screening intention, beliefs, and information can be used to improve participation in cancer screening in Taiwan.
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14
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Potter A, Chinegwundoh F, Vlaev I. Can targeting women with behavioural science 'nudges' help black men to find out more about their high risk of contracting prostate cancer? PATIENT EDUCATION AND COUNSELING 2021; 104:2531-2535. [PMID: 33863584 DOI: 10.1016/j.pec.2021.03.014] [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: 06/26/2020] [Revised: 02/07/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Prostate cancer is now deadlier than breast cancer in the UK, with more than 12,000 men dying from it in the country in 2018. Black men are nearly three times more likely to suffer prostate cancer, with one in four contracting the disease in their lifetime. Despite being a high risk group very few black men aged 45 and over visit their GP to discuss the pros and cons of screening. This is a problem as early onset of the disease presents no symptoms and when symptoms do appear, such as urinary problems, and men do visit a doctor it is often too late to reverse the cancer's spread. This study investigates using the strong social norm of wives and girlfriends being the guardian of black men's health as a way of influencing their behaviour. METHODS Using a historically controlled study via email we tested the social norm nudge in the field with 13 Afro-Caribbean organisations across the UK. RESULTS The trial found the social norm nudge produced a 15.5 per cent click-through rate, which was significantly higher than the historical controls. Meanwhile, the messenger effect saw a click-through rate of 38.5 per cent on men. CONCLUSION At a national level the social norm nudge would equate to 37,315 black women taking positive action to find out more information about their husband or boyfriend's high risk of contracting prostate cancer. PRACTICE IMPLICATIONS Use clinicians as messengers in correspondence to promote engagement with information about prostate cancer screening.
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Affiliation(s)
| | | | - Ivo Vlaev
- University of Warwick, United Kingdom.
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15
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Population-Based Data Reveal Factors Associated with Organised and Non-Organised Colorectal Cancer Screening: An Important Step towards Improving Coverage. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168373. [PMID: 34444122 PMCID: PMC8392464 DOI: 10.3390/ijerph18168373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023]
Abstract
We investigated factors associated with organised and non-organised colorectal cancer screening using faecal occult blood tests, based on data from 308 municipalities in Flanders (6.6 million residents, 57% of Belgium) during 2015-2017. Logistic regression with generalized estimating equations was used to assess the associations between municipal characteristics and organised and non-organised screening coverages. Factors associated negatively with both organised and non-organised screening: percentage of people aged 70-74 in the target population [OR (odds ratios) = 0.98, 95%CI (confidence interval): 0.97-0.99 and OR = 0.98, 95%CI: 0.96-0.999, respectively]; negatively with organised screening: average income [OR = 0.97, 95%CI: 0.96-0.98], percentage of people with a non-Belgian/Dutch nationality [OR = 0.962, 95%CI: 0.957-0.967]; positively with organised screening: percentages of men in the target population [OR = 1.13, 95%CI: 1.11-1.14], jobseekers [OR = 1.12, 95%CI: 1.09-1.15] and people with at least one general practitioner (GP) visit in the last year [OR = 1.04, 95%CI: 1.03-1.05]; positively with non-organised screening: number of patients per GP [OR = 1.021, 95%CI: 1.016-1.026], percentage of people with a global medical dossier handled by a preferred GP [OR = 1.025, 95%CI: 1.018-1.031]. This study helps to identify the hard-to-reach subpopulations in CRC screening, and highlights the important role of GPs in the process of promoting screening among non-participants and encouraging non-organised participants to switch to organised screening.
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16
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Sazali MF, Rahim SSSA, Hayati F, Mohd Daud MN, Avoi R, Omar A, Atil A, Abd Rahim MA, Madrim MF, Mokti K, Ramdzan AR, Sidek Ahmad ZN, Zakaria AD, Che Ani MF, Ibrahim AF, Azhar ZI, Jeffree MS, Hassan MR. Colorectal cancer and potential predictors of never screened for faecal occult blood test: a narrative review. J Public Health Res 2021; 11. [PMID: 34351098 PMCID: PMC8859728 DOI: 10.4081/jphr.2021.2377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022] Open
Abstract
Colorectal cancer (CRC) is a major public health threat. Therefore, CRC screening uptake has been a focus with the established precancerous lesion and the strong association of early detection with staging and survival of the disease. However, CRC screening is relatively low in many countries. This article briefly discussed the current situation of CRC, recommendations, and current uptake of CRC screening in various countries. Besides that, this article also highlights the potential factors that help to predict the CRC screening uptake worldwide. Identification of those factors could guide policymakers to develop an effective strategy to improve the CRC screening uptake and ultimately improve the health outcome of the population. Significance for public health This study highlights the public health challenge in early screening for colorectal cancer (CRC). The prevalence of never screened for faecal occult blood test is relatively high. This review dissects the issue and further discuss on the predictors, which could guide policymakers in developing strategy to improve CRC screening uptake.
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Affiliation(s)
- Mohd Fazeli Sazali
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Syed Sharizman Syed Abdul Rahim
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu.
| | - Mohd Nazri Mohd Daud
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Richard Avoi
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Azizan Omar
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Azman Atil
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Muhammad Aklil Abd Rahim
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Mohd Faizal Madrim
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Khalid Mokti
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Abdul Rahman Ramdzan
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Zulkhairul Naim Sidek Ahmad
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Andee Dzulkarnaen Zakaria
- Department of General Surgery, Hospital Universiti Sains Malaysia, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan.
| | - Mohd Firdaus Che Ani
- Department of Surgery, Faculty of Medicine, Universiti Teknologi MARA, Selangor.
| | - Aini Fahriza Ibrahim
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak.
| | - Zahir Izuan Azhar
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor.
| | - Mohammad Saffree Jeffree
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Mohd Rohaizat Hassan
- Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, Cheras, Kuala Lumpur.
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Gram MA, Therkildsen C, Clarke RB, Andersen KK, Mørch LS, Tybjerg AJ. The influence of marital status and partner concordance on participation in colorectal cancer screening. Eur J Public Health 2021; 31:340-346. [PMID: 33417705 DOI: 10.1093/eurpub/ckaa206] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Colorectal cancer screening program using a fecal immunochemical test aims to reduce morbidity and mortality through early detection. Although screening participation is free-of-charge, almost 40% of the invited individuals choose not to participate. To bring new insight into how non-participation can be identified and targeted, we examined the association between marital status and screening participation; with a focus on partner concordance in participation and sex differences. METHODS This nationwide cross-sectional study included all Danish citizens aged 50-74 years, who were invited to colorectal cancer screening between 2014 and 2017. Logistic regression analysis was used to estimate odds ratio (OR) of participation while adjusting for sociodemographic variables. RESULTS A total of 1 909 662 individuals were included in the analysis of which 62.7% participated in the screening program. Participation was highest among women. Stratified by marital status, screening participation was markedly lower in widowed (61.5%), divorced (54.8%) and single (47.3%), while participation reached 68.4% in married individuals. This corresponded to ORs of 0.59 (95% CI 0.58-0.59) for widowed, 0.56 (95% CI 0.55-0.56) for divorced and 0.47 (95% CI 0.47-0.48) for single, compared to married individuals. Individuals married to a participating partner were five times more likely to participate than married individuals with a non-participating partner, regardless of gender. CONCLUSIONS Marital status was strongly associated with participation in colorectal cancer screening, and participation was even higher in married individuals with a participating partner. Future efforts to increase participation in colorectal cancer screening could potentially benefit from considering the role of partner concordance.
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Affiliation(s)
- Mie Agermose Gram
- Cancer Surveillance and Pharmacoepidemiology, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christina Therkildsen
- The Danish HNPCC Register, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Rebecca B Clarke
- Cancer Surveillance and Pharmacoepidemiology, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Klaus K Andersen
- Cancer Surveillance and Pharmacoepidemiology, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Lina S Mørch
- Cancer Surveillance and Pharmacoepidemiology, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anne Julie Tybjerg
- Cancer Surveillance and Pharmacoepidemiology, The Danish Cancer Society Research Center, Copenhagen, Denmark
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Shimoda A, Saito Y, Ooe C, Kondo N. Income-based inequality in nationwide general health checkup participation in Japan. Public Health 2021; 195:112-117. [PMID: 34087670 DOI: 10.1016/j.puhe.2021.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/25/2020] [Accepted: 01/28/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE In Japan, it is mandatory for employers to provide general health checkup opportunities to employees. Although many companies have subsidized checkups for employees' dependent family members, their participation is low. We assessed income-based inequality in the participation of employees' dependents in the general health checkup. STUDY DESIGN This is a cross-sectional descriptive study. Annual participation rate in general health checkup and various factors including income, age, and sex were collected and analyzed to examine the income-based inequality of participation rate in general health checkup. METHODS The data for the present study were sourced from the Fukuoka Branch of the Japan Health Insurance Association, a large medical insurer in Japan. We extracted data of 196,057 dependents aged 40-74 years. We conducted a multiple logistic regression analysis using participation from April 2015 to March 2016 as dependent variable and income category ranging from 1 (lowest) to 4 (highest) between April and June 2015 as independent variable (adjusted for sex and age). We computed slope index of inequality (SII) and relative index of inequality (RII) based on income category. RESULTS Higher the income, the more likely were dependents to participate in the general health checkup. SII for the participation rate of general health checkup ranged between -0.02 (95% confidence interval [CI]: -0.07 to 0.03) and 0.06 (0.03-0.09) for men; 0.03 (0.01-0.06) and 0.10 (0.09-0.11) for women. RII for the participation rate of general health checkup ranged between -0.19 (95% CI: -0.66 to 0.29) and 0.88 (0.15-1.61) for men; 0.22 (0.05-0.39) and 0.68 (0.60-0.76) for women. The highest inequality existed for men in their 50s and 60s and women in their 50s; the lowest inequality was among men and women aged 70-74 years. CONCLUSION There was income-based inequality in participation in the general health checkup among dependents (family members) of the insured persons. The degree of inequality differed with age group. It cannot be explained solely by financial barrier among low-income group, rather it may reflect Japanese unique context in medical insurance system.
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Affiliation(s)
- A Shimoda
- Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Y Saito
- Department of Health Economics & Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - C Ooe
- Planning and Administration Group, Fukuoka Branch of Japan Health Insurance Association, Hakata Mitsui Building, Gofukucho 10-1, Hakata-ku, Fukuoka City, Fukuoka, Japan
| | - N Kondo
- Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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Comorbidity Profiles and Lung Cancer Screening among Older Adults: U.S. Behavioral Risk Factor Surveillance System 2017 to 2019. Ann Am Thorac Soc 2021; 18:1886-1893. [PMID: 33939595 DOI: 10.1513/annalsats.202010-1276oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Although lung cancer screening (LCS) with low-dose computed tomography (LDCT) is now recommended for those meeting standard risk factor-based eligibility criteria, the role of comorbidity in the uptake of LCS with LDCT in an older real-world U.S. population is not well established. OBJECTIVE To examine the relationships between comorbidity, functional status and LCS utilization in the United States. METHODS Using population-based data from the 2017-2019 Behavioral Risk Factor Surveillance System (BRFSS), we examined the association of comorbid conditions and functional limitations regarding activities of daily living with LCS utilization among participants that met the LCS criteria based on the US Preventive Service Taskforce guidelines. We employed multivariable weighted logistic regression models to evaluate these associations, both overall and within subgroups defined by age (<65 vs. ≥65 years), gender, and smoking history. RESULTS Of 11,214 participants that met the eligibility criteria for LCS, 1731 (16%) underwent LCS with LDCT. The majority were white (90%), male (55%), former smokers (52%) and living with at least one chronic comorbid condition (77%). Over 28% had 3 or more comorbid conditions and approximately 40% of participants reported having some form of functional limitations. In the multivariable models, the likelihood of undergoing LCS with LDCT within the past year was positively associated with higher levels of comorbidity (≥5 vs. 0: aOR=2.34, 95% CI=1.22,4.48) but not with functional limitations (≥3 vs. 0: aOR=1.00, 95% CI=0.66, 1.50). CONCLUSION The presence of comorbid conditions is associated with a higher likelihood of undergoing LCS with LDCT. Because poor health status may diminish the benefits of screening, future research is needed to precisely characterize the health status of LCS-eligible individuals.
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Clarke N, Kearney PM, Gallagher P, McNamara D, O'Morain CA, Sharp L. Negative emotions and cancer fatalism are independently associated with uptake of Faecal Immunochemical Test-based colorectal cancer screening: Results from a population-based study. Prev Med 2021; 145:106430. [PMID: 33482227 DOI: 10.1016/j.ypmed.2021.106430] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 12/24/2022]
Abstract
Although systematic colorectal cancer screening is efficacious, many programmes suffer from low uptake. Few behavioural or attitudinal factors have been identified as being associated with participation in colorectal cancer screening. We explored knowledge, beliefs about cancer, subjective health literacy, emotional attitudes to screening, and social influences among individuals invited to a population-based screening programme. Regression modelling of a cross-sectional survey of 2299 individuals (users and non-users) of a population-based Faecal Immunochemical Test (FIT) screening programme in Dublin was conducted. Questions were derived from previous theoretically-informed qualitative work and assessed using previously used and validated measures. The primary outcome variable was uptake status (User/Participation or Non-User/Non-participation); multivariable logistic regression was used to estimate the odds ratios (OR) for screening participation. Stronger fatalistic beliefs independently predicted lower uptake (OR = 0.94; 95% CI 0.90-0.98; P = 0.003). Those aged <65 who disagreed that "cancer can often be cured" also had lower uptake (OR = 0.43; 95% CI 0.22-0.82: P = 0.017). Agreement that the test was disgusting and tempting fate predicted lower uptake (OR = 0.16: 95% CI 0.10-0.27: p < 0.001), while the influence of a partner on decision to be screened was associated with higher uptake (OR = 1.32; 95% CI 1.15-1.50: P < 0.001). Negative cancer-related and screening-related beliefs and emotions are associated with non-participation in FIT (-based screening). Research is warranted to explore if these negative beliefs and emotions are modifiable and, if so, whether this would improve screening uptake. The association between the influence of a partner and screening participation present a challenge around improving uptake among those not in co-habiting relationships.
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Affiliation(s)
| | | | | | - Deirdre McNamara
- Department of Clinical Medicine, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin, Ireland.
| | - Colm A O'Morain
- Faculty of Health Science, Trinity College Dublin, Dublin, Ireland.
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, England, UK.
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Pallesen AVJ, Herrstedt J, Westendorp RGJ, Mortensen LH, Kristiansen M. Differential effects of colorectal cancer screening across sociodemographic groups in Denmark: a register-based study. Acta Oncol 2021; 60:323-332. [PMID: 33427545 DOI: 10.1080/0284186x.2020.1869829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) does not affect different sociodemographic groups uniformly. CRC screening programmes could seek to reduce this inequality; however, the screening programmes themselves might be subject to differential participation across sociodemographic groups. This study investigates the sociodemographic inequality at all steps in Denmark's nationwide CRC screening programme: screening participation, faecal immunochemical test (FIT) results, colonoscopy compliance, CRC diagnosis, and cancer stage. MATERIAL AND METHODS This cohort study includes all first-time invitees from the beginning of the Danish population-based CRC screening programme from 1 March 2014 to 31 December 2017. RESULTS Sixty-four percent of the invitees participated in the screening programme, and of those 7% were FIT-positive. After being invited to further diagnostic procedures, 90% responded to the invitation, and among those 5% were CRC-positive. Among those diagnosed with CRC, 9% were stage IV. Through multivariable analyses, we identified sociodemographic inequalities in all steps of the screening programme from returning a stool sample to being diagnosed with CRC. Specifically, we identified inequalities across sex, age, migration status, relationship status, the screening status of one's partner, education, income, and use of health services. Women were more likely to participate compared to men (RR = 1.13; 95% CI: 1.12-1.13), but had a lower risk of a positive FIT result (RR = 0.67; 95% CI: 0.66-0.68) and of a CRC diagnosis (RR = 0.88; 95% CI: 0.82-0.93) compared to men. The likelihood of participating as well as the risk of positive FIT results and CRC diagnosis increased with age. CONCLUSION All steps of the screening programme were subject to sociodemographic inequalities. Interventions are needed to target groups identified as having lower uptake as well as high-risk of being FIT- and/or CRC-positive. These groups include males, individuals aged 60+ years and individuals who do not visit their GP regularly.
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Affiliation(s)
- Anna Vera Jørring Pallesen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - Jørn Herrstedt
- Department of Clinical Oncology and Palliative Care Units, Zealand University Hospital, Roskilde and Naestved, Denmark
| | - Rudi G. J. Westendorp
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Laust Hvas Mortensen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Characterization of a Novel Entity of G3 (High-grade Well-differentiated) Colorectal Neuroendocrine Tumors (NET) in the SEER Database. Am J Clin Oncol 2021; 43:846-849. [PMID: 32910023 DOI: 10.1097/coc.0000000000000761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Small studies suggest that a new entity of high-grade (HG) (G3, by Ki-67 or mitotic index) well-differentiated (histologically) gastrointestinal neuroendocrine tumors (NETs) exists, but prognosis and characteristics are unknown. We further characterized demographics and prognosis of patients with colorectal G3 NETs. MATERIALS AND METHODS We used the Surveillance Epidemiology and End Results (SEER) database to study colorectal NETs diagnosed from 2000 to 2015. We evaluated demographic, clinical, and tumor characteristics. We compared overall survival (OS) for G1-2 NET, G3 NET, and NEC (neuroendocrine carcinoma). We used logistic regression to detect grade associations and Cox proportional hazards models to examine predictors of survival. RESULTS We identified 5894 cases with colorectal NET (5780 [98.1%] G1-2 and 114 [1.9%] G3); the cohort was 66% white, 47% male, and had a median age of 54. Patients with G3 NET were likely to be older (odds ratio [OR]: 2.23; 95% confidence interval [CI]: 1.19-4.19 for 60 to 69 vs. <50), unmarried (OR: 1.56; 95% CI: 1.02-2.38), and less likely to be diagnosed after 2010 (OR: 0.09; 95% CI: 0.06-0.15). OS for G3 NET (median, 36 mo; 95% CI: 13-92) fell between OS for NEC (median, 7 mo; 95% CI: 6-8), and G1-2 NET (median not reached, >120 mo). Among G1-3 NETs, black patients (hazard ratio [HR]: 1.30; 95% CI: 1.03-1.62), older patients (HR: 3.63; 95% CI: 2.63-5.01 for age 60 to 69 vs. <50), unmarried patients (HR: 1.40; 95% CI: 1.17-1.68), and those with HG features (HR: 3.97; 95% CI: 3.15-4.99) had worse survival. CONCLUSIONS We defined a subset of G3 NETs that are HG and well differentiated, more common in older, unmarried patients, with a prognosis between that of NEC and G1-2 NETs. Our analysis adds the first national registry study in support of a new classification of nonpancreatic HG and well-differentiated NETs.
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Clarke RB, Therkildsen C, Gram MA, Andersen KK, Mørch LS, Tybjerg AJ. Use of primary health care and participation in colorectal cancer screening - a Danish national register-based study. Acta Oncol 2020; 59:1002-1006. [PMID: 32286136 DOI: 10.1080/0284186x.2020.1750697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Christina Therkildsen
- The Danish HNPCC Register, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
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Zhang D, Advani S, Zhu Z, Dang L, Walter LC, Braithwaite D. Mammography use in relation to comorbidities and functional limitations among older breast cancer survivors. J Cancer Surviv 2020; 15:119-126. [PMID: 32720225 DOI: 10.1007/s11764-020-00917-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We sought to examine associations of mammography utilization with comorbidities and functional limitations in older breast cancer survivors. METHODS Female breast cancer survivors (N = 1064) identified in the 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) who were aged ≥ 65 years were included for this study. Mammography use, major comorbidities (diabetes mellitus, myocardial infarction, coronary heart disease, stroke, chronic obstructive pulmonary disease, arthritis, chronic kidney disease, depression, and malignancy other than breast cancer), functional limitations (impairment of vision, audition, cognition, and mobility), and other covariates were measured by self-report. We used multivariable logistic regression models to calculate adjusted odds ratios (aOR) of comorbidities and functional limitations. Subgroup analyses were conducted by age (65-74 vs. ≥ 75 years) and survival time (< 10 vs. ≥ 10 years), and interactions were examined by Wald tests. RESULTS Of the 1064 respondents, 841 (79.0%) had comorbidities, 418 (39.3%) had functional limitations, and 744 (69.9%) underwent mammography last year. Overall, the mean age was 73.8 years (SD = 5.1 years) and 91.4% were white. The multivariable model identified inverse associations with mammography use for functional limitations (≥ 2 vs. 0: aOR = 0.61, 95% CI = 0.39-0.95, p-trend = 0.09) but not comorbidities (≥ 2 vs. 0: aOR = 0.91, 95% CI = 0.61-1.35, p-trend = 0.62). The Wald test did not find any significant interaction. CONCLUSIONS A higher burden of functional limitations, not comorbidities, is associated with a lower rate of mammography use among older breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Interventions are needed to individualize surveillance mammography among older breast cancer survivors based on their health status.
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Affiliation(s)
- Dongyu Zhang
- Department of Oncology, Georgetown University School of Medicine, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Shailesh Advani
- Department of Oncology, Georgetown University School of Medicine, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.,Social Behavioral Research Branch, National Institute of Health, National Human Genome Research Institute, Bethesda, MD, USA
| | - Zhikai Zhu
- Department of Oncology, Georgetown University School of Medicine, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.,Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China
| | - Le Dang
- Department of Oncology, Georgetown University School of Medicine, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.,National Cancer Center/National Clinical Research Center for Cancer /Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China
| | - Louise C Walter
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA.,Department of Medicine, Division of Geriatrics, San Francisco VA Health Care System, San Francisco, CA, USA
| | - Dejana Braithwaite
- Department of Oncology, Georgetown University School of Medicine, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
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Gilfoyle M, Chaurasia A, Garcia J, Oremus M. Perceived susceptibility to developing cancer and screening for colorectal and prostate cancer: A longitudinal analysis of Alberta's Tomorrow Project. J Med Screen 2020; 28:148-157. [PMID: 32700624 DOI: 10.1177/0969141320941900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION To assess the association between perceived susceptibility of developing cancer and being screened via sigmoidoscopy/colonoscopy and prostate-specific antigen, respectively. METHODS Participants aged 35-69, who resided in Alberta, Canada, were enrolled into the study between 2000 and 2008. We used general linear mixed models, adjusted for age, marital status, work status, education, family history and place of residence, to explore the association. RESULTS Perceived susceptibility of developing cancer was associated with both screening tests at baseline and a maximum of 14-year follow-up: (i) colorectal cancer screening - adjusted odds ratios were 1.97 (95% CI = 1.52-2.55) per one-unit increase in participants' personal belief in susceptibility to cancer, and 1.03 (95% CI = 1.00-1.04) per one-percent increase in participants' estimate of their own chance of developing cancer; (ii) prostate cancer screening - adjusted odds ratios were 1.36 times greater (95% CI = 1.07-1.72), and 1.02 times higher (95% CI = 1.01-1.03), for each respective perceived susceptibility measure. CONCLUSION Health promotion can focus on targeting and heightening personal perceived susceptibility of developing cancer in jurisdictions with low screening rates for colorectal or prostate cancer.
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Affiliation(s)
- Meghan Gilfoyle
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Ashok Chaurasia
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - John Garcia
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Mark Oremus
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
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Travis E, Ashley L, Pownall M, O'Connor DB. Barriers to flexible sigmoidoscopy colorectal cancer screening in low uptake socio-demographic groups: A systematic review. Psychooncology 2020; 29:1237-1247. [PMID: 32539187 DOI: 10.1002/pon.5443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To synthesise qualitative evidence related to barriers and facilitators of flexible sigmoidoscopy screening (FSS) intention and uptake, particularly within low socio-demographic uptake groups. FSS uptake is lower amongst women, lower socio-economic status (SES), and Asian ethnic groups within the United Kingdom (UK) and United States of America. METHODS A total of 12 168 articles were identified from searches of four databases: EMBASE, MEDLINE, PsycINFO and Web of Science. Eligibility criteria included: individuals eligible to attend FSS and empirical peer-reviewed studies that analysed qualitative data. The Critical Appraisal Skills Program tool evaluated the methodological quality of included studies, and thematic synthesis was used to analyse the data. RESULTS Ten qualitative studies met the inclusion criteria. Key barriers to FSS intention and uptake centred upon procedural anxieties. Women, including UK Asian women, reported shame and embarrassment, anticipated pain, perforation risk, and test preparation difficulties to elevate anxiety levels. Religious and cultural-influenced health beliefs amongst UK Asian groups were reported to inhibit FSS intention and uptake. Competing priorities, such as caring commitments, particularly impeded women's ability to attend certain FSS appointments. The review identified a knowledge gap concerning factors especially associated with FSS participation amongst lower SES groups. CONCLUSIONS Studies mostly focussed on barriers and facilitators of intention to participate in FSS, particularly within UK Asian groups. To determine the barriers associated with FSS uptake, and further understand how screening intention translates to behaviour, it is important that future qualitative research is equally directed towards factors associated with screening behaviour.
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Affiliation(s)
| | - Laura Ashley
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
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Hepatitis B Virus Screening and Vaccination in First-generation African Immigrants: A Pilot Study. J Community Health 2020; 44:1037-1043. [PMID: 31123877 DOI: 10.1007/s10900-019-00668-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Foreign-born African immigrants bear a large burden of hepatitis B virus (HBV)-related liver disease in the U.S. However, HBV awareness and knowledge of HBV screening and vaccination among this population is limited. This study aimed to provide a better understanding of HBV burden in this vulnerable population and to identify risk factors for the implementation of more effective prevention and treatment programs. We conducted a cross-sectional survey among 71 first-generation African Americans in New York City. Participants' sociodemographic characteristics, HBV screening and vaccination history, knowledge of HBV transmission, and other related issues were asked. The study sample included 46 men and 23 women, with an average age of 32.75. Of the sample, 87.50% participants migrated from sub-Saharan Africa and 79.10% had lived in the U.S. for 10 or fewer years. Almost half of participants never underwent HBV screening (44.29%) or HBV vaccination (49.23%). About two-thirds (60.87%) of participants never received any HBV screening or vaccination recommendation from doctors. Multivariable analysis results showed that having a college degree and being currently married were significantly associated with HBV screening, while having health insurance was significantly associated with HBV vaccination. Survey data further indicated that first-generation African immigrants had very limited knowledge of HBV transmission, suggesting that this population would benefit from greater awareness of HBV risk factors and modes of transmission. The influence of education, marriage and spousal support, and access to health insurance on HBV screening and vaccination should be noted and further examined in future public health interventions and research.
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Antabe R, Kansanga M, Sano Y, Kyeremeh E, Galaa Y. Utilization of breast cancer screening in Kenya: what are the determinants? BMC Health Serv Res 2020; 20:228. [PMID: 32183801 PMCID: PMC7079358 DOI: 10.1186/s12913-020-5073-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 03/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer accounts for 23% of all cancer cases among women in Kenya. Although breast cancer screening is important, we know little about the factors associated with women's breast cancer screening utilization in Kenya. Using the Andersen's behavioural model of health care utilization, we aim to address this void in the literature. METHODS We draw data on the Kenya Demographic and Health Survey and employ univariate, bivariate, and multivariate analyses. RESULTS We find that women's geographic location, specifically, living in a rural area (OR = 0.89; p < 0.001) and the North Eastern Province is associated with lower odds of women being screened for breast cancer. Moreover, compared to the more educated, richer and insured, women who are less educated, poorer, and uninsured (OR = 0.74; p < 0.001) are less likely to have been screened for breast cancer. CONCLUSION Based on these findings, we recommend place and group-specific education and interventions on increasing breast cancer screening in Kenya.
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Affiliation(s)
- Roger Antabe
- Department of Geography, Western University, 1151 Richmond Street, Social Science Building, London, Ontario, N6A 3K7, Canada
| | - Moses Kansanga
- Department of Geography, Western University, 1151 Richmond Street, Social Science Building, London, Ontario, N6A 3K7, Canada
| | - Yujiro Sano
- Department of Sociology, Western University, 1151 Richmond Street, Social Science Building, London, Ontario, N6A 3K7, Canada
| | - Emmanuel Kyeremeh
- Department of Geography, Western University, 1151 Richmond Street, Social Science Building, London, Ontario, N6A 3K7, Canada
| | - Yvonne Galaa
- Department of Planning, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, KNUST, Kumasi, Ghana.
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Zhang D, Advani S, Huchko M, Braithwaite D. Impact of healthcare access and HIV testing on utilisation of cervical cancer screening among US women at high risk of HIV infection: cross-sectional analysis of 2016 BRFSS data. BMJ Open 2020; 10:e031823. [PMID: 31911515 PMCID: PMC6955489 DOI: 10.1136/bmjopen-2019-031823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Previous studies identified several factors associated with cervical cancer screening. However, many of them used samples from the general population and limited studies focused on women with high-risk health behaviours. We aimed to disentangle the association of cervical cancer screening with healthcare access and HIV testing among women at a high risk of HIV infection. DESIGN Nationwide cross-sectional survey in the USA. SETTING 2016 Behavioral Risk Factor Surveillance System. PARTICIPANTS 3448 women with a history of high-risk behaviours associated with HIV infection EXPOSURE AND OUTCOME: Clinical check-up, having personal healthcare provider, health coverage and HIV testing history were treated as exposures. Appropriate cervical cancer screening, which was defined according to 2016 US Preventive Services Task Force guideline, was treated as the outcome of interest. DATA ANALYSIS Multivariable logistic regression model was performed to evaluate associations of healthcare access and HIV testing with the uptake of cervical cancer screening; adjusted odds ratio (aOR) and 95% CI were reported. We further investigated if educational attainment modified associations identified in the primary multivariable model. RESULTS A total of 2911 (84.4%) high-risk women in our sample underwent cervical cancer screening. In the multivariable model, delayed clinical check-up (≥5 years ago vs within the past year: aOR: 0.19, 95% CI: 0.14 to 0.26), having no health insurance (aOR: 0.60, 95% CI: 0.46 to 0.79) and no history of HIV testing (no testing vs testing within the past year: aOR: 0.46, 95% CI: 0.35 to 0.61) were inversely associated with cervical cancer screening utilisation. CONCLUSION Factors reflecting healthcare access, specifically clinical check-up and health coverage, as well as history of HIV testing were associated with cervical cancer screening in this population-based study of high-risk women. Targeted interventions are warranted to further increase cervical cancer screening among women at high risk of HIV infection.
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Affiliation(s)
- Dongyu Zhang
- Department of Oncology, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Shailesh Advani
- Department of Oncology, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Social Behavioral Research Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Megan Huchko
- Department of Obstetrics and Gynecology, Duke Global Health Institute, Durham, North Carolina, USA
| | - Dejana Braithwaite
- Department of Oncology, Georgetown University School of Medicine, Washington, District of Columbia, USA
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Warner EL, Bodson J, Mooney R, Lai D, Samadder NJ, Kepka D. Latinas' Colorectal Cancer Screening Knowledge, Barriers to Receipt, and Feasibility of Home-Based Fecal Immunochemical Testing. J Immigr Minor Health 2019. [PMID: 28646404 DOI: 10.1007/s10903-017-0615-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Latinas' high colorectal cancer (CRC) mortality makes them a priority population for CRC screening. CRC screening knowledge, perceived barriers, and feasibility of using the Fecal Immunochemical Test (FIT) was assessed among Latinas in Utah. Participants aged ≥50 (n = 95) were surveyed about knowledge and barriers to CRC screening. 27 participants completed a FIT and evaluation survey. Fisher's exact tests assessed sociodemographic correlates of CRC screening outcomes. Most participants were overdue for CRC screening (n = 81, 85%). Age, acculturation, education, and employment were significantly associated with CRC screening status and/or reasons for being overdue (e.g., not knowing about the test, cost). All participants who received a FIT completed it, felt it was easy to use, and reported they would use it again. Latinas had limited awareness of CRC, CRC screenings, and experienced barriers to CRC screening (e.g., limited access, cost), but were willing to utilize a low-cost home-based FIT.
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Affiliation(s)
- Echo L Warner
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Rm 4125, Salt Lake City, UT, 84112, USA. .,College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT, 84112, USA.
| | - Julia Bodson
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Rm 4125, Salt Lake City, UT, 84112, USA
| | - Ryan Mooney
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Rm 4125, Salt Lake City, UT, 84112, USA
| | - Djin Lai
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Rm 4125, Salt Lake City, UT, 84112, USA.,College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT, 84112, USA
| | - N Jewel Samadder
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Rm 4125, Salt Lake City, UT, 84112, USA.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Deanna Kepka
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Rm 4125, Salt Lake City, UT, 84112, USA.,College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT, 84112, USA
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McDaniel JT, Albright D, Lee HY, Patrick S, McDermott RJ, Jenkins WD, Diehr AJ, Jurkowski E. Rural–urban disparities in colorectal cancer screening among military service members and Veterans. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2019. [DOI: 10.3138/jmvfh.2018-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction: Little is known about rural–urban disparities in colorectal cancer (CRC) screening rates among the military service member and Veteran (SMV) population in the United States. Given that health care access is a challenge in rural areas, we sought to determine whether rural-dwelling Veterans were less likely to be screened for CRC than urban-dwelling Veterans. Methods: Secondary data for this cross-sectional study were retrieved from the 2016 Behavioral Risk Factor Surveillance System for a national sample of non-institutionalized SMVs ( N = 63,919). The influence of rurality on CRC screening among SMVs was determined using maximum likelihood multiple logistic regression. Results: After controlling for relevant covariates, rurality was independently associated with decreased likelihood of meeting guidelines for CRC screening among SMVs (odds ratio = 0.83, 95% confidence interval, 0.76–0.90). Discussion: Innovative interventions for CRC screening should target SMVs in rural areas because doing so may lower mortality from CRC.
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Affiliation(s)
- Justin T. McDaniel
- Department of Public Health and Recreation Professions, Southern Illinois University, Carbondale, Illinois, USA
| | - David Albright
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
| | - Hee Yun Lee
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
| | - Sarah Patrick
- Jackson County Health Department, Murphysboro, Illinois, USA
| | - Robert J. McDermott
- Department of Public Health and Recreation Professions, Southern Illinois University, Carbondale, Illinois, USA
| | - Wiley D. Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Aaron J. Diehr
- Department of Public Health and Recreation Professions, Southern Illinois University, Carbondale, Illinois, USA
| | - Elaine Jurkowski
- School of Social Work, Southern Illinois University, Carbondale, Illinois, USA
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Zhang D, Zhang C, Sun X, Zhao Y, Tan Q, Zhou J, Huang H. BMI, Physical Inactivity, and Pap Test Use in Asian Women in the U.S. Am J Prev Med 2019; 56:e85-e94. [PMID: 30655085 DOI: 10.1016/j.amepre.2018.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION In the U.S., limited epidemiologic studies have investigated associations between BMI and physical inactivity and Pap test use among Asian women. The aim was to disentangle associations using data from the Behavioral Risk Factor Surveillance System between 2014 and 2016. METHODS In the Behavioral Risk Factor Surveillance System, BMI was categorized into four levels (<18.5, 18.5 to <25, 25 to <30, and ≥30) and inactivity was defined as having no physical activity in addition to the individual's regular job during the past month. Analyses were conducted in June 2018. Weighted percentages of covariates were used to descriptively summarize the data. Multivariable logistic regression corrected for sampling weight was used to estimate associations between BMI and inactivity and Pap test use. Subgroup analysis was conducted by income and education. RESULTS The analysis included 9,424 women and 59.6% of them had their last Pap test within 3 years. OR in the mutually adjusted model suggested underweight (BMI <18.5 compared with normal weight) was inversely associated with Pap test use within the last 3 years (OR=0.56, 95% CI=0.36, 0.88). Inactivity (compared with activity) was not associated with Pap test use within the last 3 years (OR=0.80, 95% CI=0.60, 1.06). Different association patterns of BMI and inactivity were observed by education. CONCLUSIONS This study suggests that being underweight, rather than overweight or obesity, is associated with a lower rate of Pap test use in U.S. Asian women. Health interventions to facilitate Pap test use in Asian women should explore other potential targets, not aiming to just prevent obesity or change physical inactivity.
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Affiliation(s)
- Dongyu Zhang
- Department of Oncology, Georgetown University School of Medicine, Washington, District of Columbia.
| | - Chengchen Zhang
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Xuezheng Sun
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yuan Zhao
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Qi Tan
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Junmin Zhou
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Hongtai Huang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, San Francisco, California
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Rapid review of factors associated with flexible sigmoidoscopy screening use. Prev Med 2019; 120:8-18. [PMID: 30597228 DOI: 10.1016/j.ypmed.2018.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/04/2018] [Accepted: 12/24/2018] [Indexed: 01/19/2023]
Abstract
Flexible sigmoidoscopy (FS) screening has been shown to reduce colorectal cancer (CRC) incidence and mortality among screened adults. The aim of this review was to identify patient-related factors associated with the screening test's use. We searched PubMed for studies that examined the association between FS screening use and one or more factors. To determine the eligibility of studies, we first reviewed titles, then abstracts, and finally the full paper. We started with a narrow search, which we expanded successively (by adding 'OR' terms) until the number of new publications eligible after abstract review was <1% of the total number of publications. We then abstracted factors from eligible papers and reported the number of times each was found to be positively or negatively associated with FS screening use. We identified 42 papers, most of which reported studies conducted in the United States of America (n = 21, 50%) and the United Kingdom (n = 13, 31%). Across studies, a wide range of factors were examined (n = 123), almost half of which were found to be associated with FS screening use at least once (n = 60). Sociodemographic and health and lifestyle factors that were frequently positively associated with FS screening use included: male gender, higher socioeconomic status and a family history of CRC. Frequently positively associated psychosocial factors included low perceived barriers and high perceived benefits. Findings suggest that future research should focus on developing a theoretical framework of cancer screening behaviour to allow a greater level of consistency and specificity in measuring key constructs.
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Khoja A, Aljawadi M, Al-Shammari SA, Bokhari NN, Aldarwish AA, Mardini WK, Khoja TA. Utilization of Colorectal Cancer Screening among Saudi Elderly Population: A Study from the Saudi National Survey for Elderly Health. Asian Pac J Cancer Prev 2018; 19:3401-3407. [PMID: 30583346 PMCID: PMC6428552 DOI: 10.31557/apjcp.2018.19.12.3401] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 11/05/2018] [Indexed: 02/07/2023] Open
Abstract
Objective: The goal of this study was to measure colorectal cancer screening (CRCS) utilization in Saudi Arabia ’s elderly population and to assess the factors associated with CRCS. Methods: The Saudi National Survey for Elderly Health was used to examine CRCS utilization. It is a nationally representative population-based cross-sectional survey that was conducted between 2006-2007. Utilization of CRCS was defined as any colonoscopy during the last five years or fecal occult blood test (FOBT) during the twelve months before the interview. Multivariable logistic regression was used to assess patients’ demographics, co-morbidities, number of visits to primary health clinics, and hospital availability and accessibility impact on CRCS. Results: The prevalence of CRCS utilization among Saudi elderly population was 5.64%. The fecal occult blood test was done in 4.4% of subjects while scope use was performed in 0.55%. In addition, 0.69% of patients have gone through both FOBT and scope use. Having blood in stools (OR=2.80; 95%CI: 1.3-6.00), Self-drivers (OR= 2.52) private driver (OR=2.1; 95%CI: 1.15-3.7) having 4 or more visits to primary care centers 1.81 (95%CI: 1.14-2.86) were positively associated with CRCS utilization. On the other hand, being single was negatively associated with CRCS utilization. Conclusion: In this nationally representative sample CRCS prevalence was very low. According to our findings and in the context of the burden of colorectal cancer on the population, we recommend developing national evidence-based policies and programs that take in consideration easiness of transportation and the availability of primary care centers near to Saudi elderly population.
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Affiliation(s)
- Abdullah Khoja
- Department of Public Health and Family Medicine, College of Medicine, Al Imam Mohammad ibn Saud Islamic University (IMSIU), Riyadh, Kingdom of Saudi Arabia.
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Learning to be More Positive About FIT. Am J Gastroenterol 2018; 113:1757-1759. [PMID: 30397307 PMCID: PMC6768597 DOI: 10.1038/s41395-018-0400-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/06/2018] [Indexed: 12/11/2022]
Abstract
Systematic application of the fecal immunochemical test (FIT) as a screen for colorectal cancer has been shown to meaningfully impact colorectal cancer incidence and mortality. However, there is room for improvement. FIT performance is impacted by a host of patient level factors such as sex and medication use. Meta-analysis has defined those factors most likely to result in a false positive or false negative test. Further work determining how best to gather information on important factors and incorporate them into the FIT result will further enhance the accuracy and outcomes accomplished with this valuable screening test.
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Goethe VE, Angerer H, Dinkel A, Arsov C, Hadaschik B, Imkamp F, Gschwend JE, Herkommer K. Concordance and Discordance of Sexual Identity, Sexual Experience, and Current Sexual Behavior in 45-Year-Old Men: Results From the German Male Sex-Study. Sex Med 2018; 6:282-290. [PMID: 30274908 PMCID: PMC6302220 DOI: 10.1016/j.esxm.2018.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 08/24/2018] [Accepted: 08/26/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Discordance of various aspects of sexual orientation has been mostly studied in young adults or in small samples of heterosexual men. Studies focusing on concordance and discordance of aspects of sexual orientation in representative samples of middle-aged men including homosexual men are scarce. AIM To investigate concordant and discordant sexual behavior in 45-year-old German men with a special focus on homosexual identified men. METHODS Data for this cross-sectional study were collected within the German Male Sex-Study. Participants were 45-year-old Caucasian males from the general population. Men self-reported on sexual identity, sexual experience, and current sexual behavior. Associations between sexual identity, experience, and behavior were analyzed using the chi-square test. MAIN OUTCOME MEASURE Associations of sexual identity with sexual experience and behavior in a community-based sample of men, and discordance of sexual identity and behavior especially in the subgroup of homosexual men. RESULTS 12,354 men were included in the study. 95.1% (n = 11.749) self-identified as heterosexual, 3.8% (n = 471) as homosexual, and 1.1% (n = 134) as bisexual. Sexual identity was significantly associated with sexual experience and behavior. 85.5% of all men had recently been sexually active, but prevalence of sexual practices varied. In hetero- and bisexuals, vaginal intercourse was the most common sexual practice, whereas oral sex was the most common in homosexuals. A discordance of sexual identity was especially found in homosexual men: 5.5% of homosexuals only had sexual experiences with women, and 10.3% of homosexuals recently had vaginal intercourse. In this latter subgroup, only one-quarter ever had sexual experience with a man, and three-quarters had only engaged in sexual activity with a woman. CONCLUSION Sexual identity is associated with differences in sexual experience and behavior in German middle-aged men. A considerable proportion of homosexual identified men live a heterosexual life. Goethe VE, Angerer H, Dinkel A, et al. Concordance and Discordance of Sexual Identity, Sexual Experience, and Current Sexual Behavior in 45-Year-Old-Men: Results From the German Male Sex-Study. Sex Med 201;6:282-290.
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Affiliation(s)
- Veronika E Goethe
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hannes Angerer
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas Dinkel
- Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Arsov
- Department of Urology, University Hospital Dusseldorf, Heinrich-Heine-University, Dusseldorf, Germany
| | - Boris Hadaschik
- Department of Urology, Heidelberg University Hospital, Ruprecht-Karls-University, Heidelberg, Germany; Department of Urology, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Florian Imkamp
- Clinic for Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany
| | - Jürgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kathleen Herkommer
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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Sun Safe Partners: A pilot and feasibility trial of a couple-focused intervention to improve sun protection practices. Prev Med Rep 2018; 12:220-226. [PMID: 30370209 PMCID: PMC6202659 DOI: 10.1016/j.pmedr.2018.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/04/2018] [Accepted: 10/14/2018] [Indexed: 11/23/2022] Open
Abstract
This single arm pilot intervention study evaluated the feasibility and preliminary impact of a Sun Safe Partners, which is a couple-focused intervention targeting improved sun protection behavior. Data were collected from New Jersey between August 2015 and March 2016. Participants were 61 couples reporting low levels of sun protection recruited from an online panel. After providing online consent, couples received mailed pamphlets and participated in a call where they discussed current levels of sun protection, made an Action Plan to improve sun protection, and discussed ways of assisting one another in improving sun protection. A call summary was mailed afterwards. Feasibility was assessed by study enrollment, call participation, follow-up survey completion, and intervention evaluation. Participants completed a baseline survey, and a one month and six month post-intervention survey assessing sun protection as well as individual and relationship-centered sun protection attitudes and practices. Results indicated that acceptance into the trial was 22.1%. Call participation was high (84%) and the intervention was well-evaluated. Among the 51 couples who completed the call and a follow-up, the intervention improved sun protection behaviors. Sun protection benefits, photo-aging risk, and relationship-centered attitudes and practices increased. A couple-focused intervention shows promise for improving sun protection. Future studies using a randomized clinical trial as well as strategies to improve study participation are recommended. Couples reported increases in their support for one another's sun protection. Couples understood how sun protection benefits their partners and the relationship. Couple-focused interventions can promote better sun protection behavior.
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Rotarou ES, Sakellariou D. Determinants of utilisation rates of preventive health services: evidence from Chile. BMC Public Health 2018; 18:839. [PMID: 29976166 PMCID: PMC6034328 DOI: 10.1186/s12889-018-5763-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preventive health services play a vital role in population health. However, access to such services is not always equitably distributed. In this article, we examine the barriers affecting utilisation rates of preventive health services, using Chile as a case study. METHODS We conducted a cross-sectional study analysing secondary data from 206,132 Chilean adults, taken from the 2015 National Socioeconomic Characterisation Survey of the Government of Chile. We carried out logistic regressions to explore the relationship between the dependent variable use of preventive services and various demographic and socioeconomic variables. RESULTS Categories more likely to use preventive services were women (OR=1.16; 95%CI: 1.11-1.21) and inactive people (OR=1.41; 95%CI: 1.33-1.48). By contrast, single individuals (OR= 0.85 ; 95%CI: 0.80-0.91) and those affiliated with the private healthcare provider (OR= 0.89; 95%CI: 0.81-0.96) had fewer odds of undertaking preventive exams. CONCLUSIONS The findings underline the necessity of better information campaigns on the availability and necessity of preventive health services, addressing health inequality in accessing health services, and tackling lifestyle-related health risks. This is particularly important in countries - such as Chile - characterised by high income inequality and low utilisation rates of preventive health services.
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Affiliation(s)
- Elena S. Rotarou
- Department of Economics, University of Chile, Diagonal Paraguay 257, Office 1506, 8330015 Santiago, Chile
| | - Dikaios Sakellariou
- Cardiff University, School of Healthcare Sciences, Eastgate House, Newport Road 35-43, Cardiff, CF24 0AB UK
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Leinonen MK, Campbell S, Ursin G, Tropé A, Nygård M. Barriers to cervical cancer screening faced by immigrants: a registry-based study of 1.4 million women in Norway. Eur J Public Health 2018; 27:873-879. [PMID: 28957477 PMCID: PMC5881680 DOI: 10.1093/eurpub/ckx093] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Immigrants from certain low- and middle-income countries are more prone to cancers attributed to viral infections in early life. Cervical cancer is caused by human papillomavirus but is highly preventable by regular screening. We assessed participation among immigrants in a population-based cervical screening programme and identified factors that predicted non-adherence within different immigrant groups. Methods We used data from several nationwide registries. The study population consisted of 208 626 (15%) immigrants and 1 157 223 (85%) native Norwegians. Non-adherence was defined as no eligible screening test in 2008–12. We estimated prevalence ratios with 95% confidence intervals (CIs) for factors associated with non-adherence by modified Poisson regression. Results In total, 52% of immigrants were not screened. All immigrants showed 1.72 times higher non-adherence rates (95% CI 1.71–1.73) compared with native Norwegian women when adjusted for age and parity. The proportion of non-adherent immigrants varied substantially by region of origin and country of origin. Being unemployed or not in the workforce, being unmarried, having low income and having a male general practitioner was associated with non-adherence regardless of region of origin. Living <10 years in Norway was an evident determinant of non-adherence among most but not all immigrant groups. Conclusions An increasing proportion of immigrants and low screening participation among them pose new public health challenges in Europe. Immigrants are diverse in terms of their sociodemographic attributes and screening participation. Tailored information and service delivery may be necessary to increase cancer screening among immigrants.
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Affiliation(s)
| | | | - Giske Ursin
- Department of Research, Cancer Registry of Norway, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ameli Tropé
- Department of Cervical Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
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Reblin M, Birmingham WC, Kohlmann W, Graff T. Support and negation of colorectal cancer risk prevention behaviors: analysis of spousal discussions. PSYCHOL HEALTH MED 2017; 23:548-554. [PMID: 28984149 DOI: 10.1080/13548506.2017.1381747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The shared social context created in a marriage may be important in motivating engagement in health behaviors, but spousal influence may not be uniformly applied. Our goal was to examine how spouses discuss health behaviors relevant for colorectal cancer (CRC) risk-reduction to better understand how spouses exert or fail to exert influence. In this pilot study, first degree relatives of CRC patients and their spouses completed demographic and self-reported health questionnaires. After a genetic counseling session regarding risk and risk reduction, couples engaged in a semi-structured discussion task to discuss lifestyle choices they currently undertake or could undertake to reduce risk. Demographic and health data was analyzed using descriptive statistics. Using a directed content analysis based on the transtheoretical model of behavior change, we coded discussion transcripts for depth and direction of talk for seven behavioral CRC risk factors. Spouses engaged in several strategies to reduce their risk for CRC, and problem-solved together to increase these preventative efforts. All couples mentioned diet and exercise as important factors in CRC risk; however, other risk factors received less attention. Despite evidence of support and encouragement, spouses ignored, minimized, or negated the importance of some health behaviors. Spousal influence could be an important tool to improve participation in health behaviors, but more guidance may be necessary to hold couples accountable to evidence-based guidelines to reduce risk. Health care providers should address couples as a unit to assess and address health behaviors.
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Affiliation(s)
- Maija Reblin
- a Department of Health Outcomes & Behavior , Moffitt Cancer Center , Tampa , FL , USA
| | | | - Wendy Kohlmann
- c Huntsman Cancer Institute, University of Utah , Salt Lake City, UT , USA
| | - Tyler Graff
- b Psychology Department , Brigham Young University , Provo , UT , USA
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Arden‐Close E, McGrath N. Health behaviour change interventions for couples: A systematic review. Br J Health Psychol 2017; 22:215-237. [PMID: 28150410 PMCID: PMC5408388 DOI: 10.1111/bjhp.12227] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/14/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Partners are a significant influence on individuals' health, and concordance in health behaviours increases over time in couples. Several theories suggest that couple-focused interventions for health behaviour change may therefore be more effective than individual interventions. DESIGN A systematic review of health behaviour change interventions for couples was conducted. METHODS Systematic search methods identified randomized controlled trials (RCTs) and non-randomized interventions of health behaviour change for couples with at least one member at risk of a chronic physical illness, published from 1990-2014. RESULTS We identified 14 studies, targeting the following health behaviours: cancer prevention (6), obesity (1), diet (2), smoking in pregnancy (2), physical activity (1) and multiple health behaviours (2). In four out of seven trials couple-focused interventions were more effective than usual care. Of four RCTs comparing a couple-focused intervention to an individual intervention, two found that the couple-focused intervention was more effective. CONCLUSIONS The studies were heterogeneous, and included participants at risk of a variety of illnesses. In many cases the intervention was compared to usual care for an individual or an individual-focused intervention, which meant the impact of the couplebased content could not be isolated. Three arm studies could determine whether any added benefits of couple-focused interventions are due to adding the partner or specific content of couple-focused interventions. Statement of contribution What is already known on this subject? Health behaviours and health behaviour change are more often concordant across couples than between individuals in the general population. Couple-focused interventions for chronic conditions are more effective than individual interventions or usual care (Martire, Schulz, Helgeson, Small, & Saghafi, ). What does this study add? Identified studies targeted a variety of health behaviours, with few studies in any one area. Further assessment of the effectiveness of couple-focused versus individual interventions for those at risk is needed. Three-arm study designs are needed to determine benefits of targeting couples versus couple-focused intervention content.
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Affiliation(s)
- Emily Arden‐Close
- Department of PsychologyFaculty of Science and TechnologyResearch Centre for Behaviour ChangeBournemouth UniversityPooleUK
| | - Nuala McGrath
- Department of Primary Care and Population SciencesUniversity of SouthamptonUK
- Department of Social Statistics and DemographyUniversity of SouthamptonUK
- Africa Centre for Health and Population StudiesUniversity of KwaZulu NatalDurbanSouth Africa
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Ghanouni A, Renzi C, Waller J. A cross-sectional survey assessing factors associated with reading cancer screening information: previous screening behaviour, demographics and decision-making style. BMC Public Health 2017; 17:327. [PMID: 28420378 PMCID: PMC5395826 DOI: 10.1186/s12889-017-4224-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 04/01/2017] [Indexed: 12/03/2022] Open
Abstract
Background There is broad agreement that cancer screening invitees should know the risks and benefits of testing before deciding whether to participate. In organised screening programmes, a primary method of relaying this information is via leaflets provided at the time of invitation. Little is known about why individuals do not engage with this information. This study assessed factors associated with reading information leaflets provided by the three cancer screening programmes in England. Methods A cross-sectional survey asked screening-eligible members of the general population in England about the following predictor variables: uptake of previous screening invitations, demographic characteristics, and ‘decision-making styles’ (i.e. the extent to which participants tended to make decisions in a way that was avoidant, rational, intuitive, spontaneous, or dependent). The primary outcome measures were the amount of the leaflet that participants reported having read at their most recent invitation, for any of the three programmes for which they were eligible. Associations between these outcomes and predictor variables were assessed using binary or ordinal logistic regression. Results After exclusions, data from 275, 309, and 556 participants were analysed in relation to the breast, cervical, and bowel screening programmes, respectively. Notable relationships included associations between regularity of screening uptake and reading (more of) the information leaflets for all programmes (e.g. odds ratio: 0.16 for participants who never/very rarely attended breast screening vs. those who always attended previously; p = .009). Higher rational decision-making scores were associated with reading more of the cervical and bowel screening leaflets (OR: 1.13, p < .0005 and OR: 1.11, p = .045, respectively). Information engagement was also higher for White British participants compared with other ethnic groups for breast (OR: 3.28, p = .008) and bowel (OR: 2.58, p = .015) information; an opposite relationship was observed for older participants (OR: 0.96, p = .048; OR: 0.92, p = .029). Conclusions Interventions that increase screening uptake may also increase subsequent engagement with information. Future research could investigate how to improve engagement at initial invitations. There may also be scope to reduce barriers to accessing non-English information and alternative communication strategies may benefit participants who are less inclined to weigh up advantages and disadvantages as part of their decision-making.
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Affiliation(s)
- Alex Ghanouni
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Cristina Renzi
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Jo Waller
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK.
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Galal YS, Amin TT, Alarfaj AK, Almulhim AA, Aljughaiman AA, Almulla AK, Abdelhai RA. Colon Cancer among Older Saudis: Awareness of Risk Factors and Early Signs, and Perceived Barriers to Screening. Asian Pac J Cancer Prev 2017; 17:1837-46. [PMID: 27221862 DOI: 10.7314/apjcp.2016.17.4.1837] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colon cancer screening (CRCS) uptake is markedly affected by public awareness of the disease. This study was conducted to assess levels of knowledge of CRC, to explore the pattern of CRCS uptake and identify possible barriers to screening among Saudis older than 50 years of age and primary care providers (PCPs) in Al Hassa region, Saudi Arabia. MATERIALS AND METHODS This cross-sectional study was conducted in randomly selected primary health care (PHC) centers, 884 Saudis and 39 PCPs being enrolled for data collection. Structured interviews were conducted to obtain information regarding socio-demographic characteristics, personal information relevant to CRC, awareness about early signs/symptoms and risk factors, and barriers to CRCS. Also, a self- administered data collection form was used to assess barriers to CRCS from the physicians' perspectives. RESULTS More than 66% of participants were lacking knowledge about CRC. Participants with higher educational levels, having ever heard about CRC, and having relatives with CRC had a significantly higher awareness of the disease. The rate of reported CRCS was low (8.6%). After conducting a logistic regression analysis, it was observed that female gender (OR=0.28; 95% CI=0.14-0.57; P=0.001), being unmarried (OR=0.11; 95% CI=0.10-0.23; P=0.001), lower levels of education (OR=0.36; 95% CI=0.16-0.82; P=0.015), and having no relatives with CRC (OR=0.30; 95% CI=0.17-0.56; P=0.001) were significantly associated with a lower CRCS uptake. There was a significant difference between most of the perceived barriers to CRCS and gender. Exploratory factor analysis showed that personal fear (especially fear of the screening results and shyness) was the major factor that hindered CRCS with high loading Eigen value of 2.951, explaining 34.8% of the barriers of the included sample toward utilization of CRCS, followed by lack of awareness of both person and providers (high Eigen value of 2.132, and explaining 23.7% of the barriers). The most frequently cited barriers to CRCS from the physicians' perspectives were lack of public awareness, lack of symptoms and signs, and fear of painful procedures. CONCLUSIONS Poor levels of knowledge about CRC were found among older Saudis attending PHC centers in Al Hassa, Saudi Arabia. It is crucial to implement an organized national screening program in Saudi Arabia to increase public awareness.
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Affiliation(s)
- Yasmine Samir Galal
- Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt E-mail :
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Park L, Mone A, Price JC, Tzimas D, Hirsh J, Poles MA, Malter L, Chen LA. Perceptions of fecal microbiota transplantation for Clostridium difficile infection: factors that predict acceptance. Ann Gastroenterol 2016; 30:83-88. [PMID: 28042242 PMCID: PMC5198252 DOI: 10.20524/aog.2016.0098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/16/2016] [Indexed: 12/21/2022] Open
Abstract
Background Despite the effectiveness of fecal microbiota transplantation (FMT) for treating recurrent Clostridium difficile (C. difficile) infection, some patients are reluctant to accept this therapy. Our study examined attitudes towards FMT and factors that contribute to patients’ acceptance of this treatment. Methods We distributed patient surveys at a Veterans Affairs hospital, a public hospital, and an academic faculty practice. Multivariable logistic regression was performed, adjusting for factors associated with FMT acceptance on univariate analysis and prior experience with C. difficile infection. Results Of 267 patients, only 12% knew of FMT prior to the survey, but 77% would undergo the procedure if medically indicated. On multivariable analysis, those with children and with college degrees or higher were more likely to agree to FMT (odds ratio [OR] 2.11, 95% confidence interval [CI] 1.02-4.35; OR 2.27, 95% CI 1.11-4.60 respectively). Sixty-five respondents (71%) chose colonoscopy as the preferred vehicle for FMT, while nasogastric tube was least preferred. Disease transmission was the most common concern (30%, n=242), and FMT success rate was the least selected concern (9.1%). Conclusions Most patients in a diverse sample of gastroenterology clinics had no prior knowledge of FMT, but were receptive to the procedure. Having children and higher education levels were predictors for FMT acceptance. Our findings suggest that barriers to FMT utilization may be overcome with counseling about safety concerns. More data on the risk of transmitting diseases or clinical characteristics, such as obesity, through FMT are needed and will be important for the acceptance of this procedure.
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Affiliation(s)
- Leslie Park
- Division of Gastroenterology, NYU Langone Medical Center, New York City, NY (Leslie Park, Anjali Mone, Demetrios Tzimas, Jacqueline Hirsh, Michael A. Poles, Lisa Malter, Lea Ann Chen)
| | - Anjali Mone
- Division of Gastroenterology, NYU Langone Medical Center, New York City, NY (Leslie Park, Anjali Mone, Demetrios Tzimas, Jacqueline Hirsh, Michael A. Poles, Lisa Malter, Lea Ann Chen)
| | - Jennifer C Price
- Division of Gastroenterology, University of California San Francisco, San Francisco, California (Jennifer C. Price), USA
| | - Demetrios Tzimas
- Division of Gastroenterology, NYU Langone Medical Center, New York City, NY (Leslie Park, Anjali Mone, Demetrios Tzimas, Jacqueline Hirsh, Michael A. Poles, Lisa Malter, Lea Ann Chen)
| | - Jacqueline Hirsh
- Division of Gastroenterology, NYU Langone Medical Center, New York City, NY (Leslie Park, Anjali Mone, Demetrios Tzimas, Jacqueline Hirsh, Michael A. Poles, Lisa Malter, Lea Ann Chen)
| | - Michael A Poles
- Division of Gastroenterology, NYU Langone Medical Center, New York City, NY (Leslie Park, Anjali Mone, Demetrios Tzimas, Jacqueline Hirsh, Michael A. Poles, Lisa Malter, Lea Ann Chen)
| | - Lisa Malter
- Division of Gastroenterology, NYU Langone Medical Center, New York City, NY (Leslie Park, Anjali Mone, Demetrios Tzimas, Jacqueline Hirsh, Michael A. Poles, Lisa Malter, Lea Ann Chen)
| | - Lea Ann Chen
- Division of Gastroenterology, NYU Langone Medical Center, New York City, NY (Leslie Park, Anjali Mone, Demetrios Tzimas, Jacqueline Hirsh, Michael A. Poles, Lisa Malter, Lea Ann Chen)
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Hanske J, Meyer CP, Sammon JD, Choueiri TK, Menon M, Lipsitz SR, Noldus J, Nguyen PL, Sun M, Trinh QD. The influence of marital status on the use of breast, cervical, and colorectal cancer screening. Prev Med 2016; 89:140-145. [PMID: 27215758 DOI: 10.1016/j.ypmed.2016.05.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 04/28/2016] [Accepted: 05/19/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE To examine the impact of marital status on the use of screening for breast, cervical, and colorectal cancer. METHODS We relied on 2012 Behavioral Risk Factor Surveillance System Survey age-appropriate screening cohorts. Appropriate screening for breast, cervical, and colorectal cancer was determined according to United States Preventive Services Task Force recommendations in effect at the time of the 2012 survey. Complex samples logistic regression models were performed to examine the effect of marital status on cancer screening. RESULTS Overall, 81.6, 83.9, and 68.9% of married participants underwent breast, cervical, and colorectal cancer, respectively, relative to 74.2, 75.1, and 60.9% for divorced/widowed/separated, individuals, and 74.7, 78.7, and 53.4% for never married individuals. Marital status (married vs. never married) was an independent predictor of screening for all cancers examined: breast cancer, odds ratio (OR): 1.42 (95% confidence interval [CI]: 1.25-1.61); cervical cancer, OR: 1.29 (95% CI: 1.16-1.43); colorectal cancer, OR: 1.63 (95% CI: 1.51-1.77). Gender-specific subgroup analyses for colorectal cancer suggests that marital status may exert a greater effect in men, relative to women (married men: OR 1.75, 95% CI: 1.56-1.96; married women: OR: 1.52, 95% CI: 1.35-1.70). CONCLUSION Being married is associated with increased utilization of breast, cervical, and colorectal cancer screening. The influence of marital status was greater in men relative to women eligible for colorectal cancer screening. Our results emphasize the importance of social determinants of health-seeking behaviors.
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Affiliation(s)
- Julian Hanske
- Center for Surgery and Public Health and Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Christian P Meyer
- Center for Surgery and Public Health and Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jesse D Sammon
- Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Mani Menon
- Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Stuart R Lipsitz
- Center for Surgery and Public Health and Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joachim Noldus
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Maxine Sun
- Center for Surgery and Public Health and Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health and Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Kotwal AA, Lauderdale DS, Waite LJ, Dale W. Differences between husbands and wives in colonoscopy use: Results from a national sample of married couples. Prev Med 2016; 88:46-52. [PMID: 27009632 PMCID: PMC5554589 DOI: 10.1016/j.ypmed.2016.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 03/07/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
Abstract
Marriage is linked to improved colorectal cancer-related health, likely in part through preventive health behaviors, but it is unclear what role spouses play in colorectal cancer screening. We therefore determine whether self-reported colonoscopy rates are correlated within married couples and the characteristics of spouses associated with colonoscopy use in each partner. We use US nationally-representative 2010 data which includes 804 male-female married couples drawn from a total sample of 3137 community-dwelling adults aged 55-90years old. Using a logistic regression model in the full sample (N=3137), we first find married men have higher adjusted colonoscopy rates than unmarried men (61% versus 52%, p=0.023), but women's rates do not differ by marital status. In the couples' sample (N=804 couples), we use a bivariate probit regression model to estimate multiple regression equations for the two spouses simultaneously as a function of individual and spousal covariates, as well as the adjusted correlation within couples. We find that individuals are nearly twice as likely to receive a colonoscopy if their spouse recently has had one (OR=1.94, 95% CI: 1.39, 2.67, p<0.001). Additionally, we find that husbands have higher adjusted colonoscopy rates whose wives are: 1) happier with the marital relationship (65% vs 51%, p=0.020); 2) more highly educated (72% vs 51%, p=0.020), and 3) viewed as more supportive (65% vs 52%, p=0.020). Recognizing the role of marital status, relationship quality, and spousal characteristics on colonoscopy uptake, particularly in men, could help physicians increase guideline adherence.
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Affiliation(s)
- Ashwin A Kotwal
- Brigham and Women's Hospital, Department of Medicine, 75 Francis St, Boston, MA 02115, USA
| | - Diane S Lauderdale
- University of Chicago, Department of Public Health Sciences, 5841 S. Maryland Ave, Chicago, IL 60637, USA
| | - Linda J Waite
- University of Chicago, Department of Sociology, 1159 E. 59(th) Street, Chicago, IL 60637, USA
| | - William Dale
- University of Chicago, Department of Medicine, Section of Geriatrics & Palliative Medicine and Hematology/Oncology, 5841 S. Maryland Ave, Chicago, IL 60637, USA.
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47
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Dyer G, Larsen SR, Gilroy N, Brice L, Greenwood M, Hertzberg M, Kabir M, Brown L, Hogg M, Huang G, Moore J, Gottlieb D, Kwan J, Tan J, Ward C, Kerridge I. Adherence to cancer screening guidelines in Australian survivors of allogeneic blood and marrow transplantation (BMT). Cancer Med 2016; 5:1702-16. [PMID: 27108674 PMCID: PMC4944898 DOI: 10.1002/cam4.729] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 11/07/2022] Open
Abstract
Allogeneic Blood and Marrow Transplant (BMT) survivors are at high risk of secondary cancers. Although current guidelines endorse survivors following Country-specific general population screening recommendations to mitigate this risk, little is known about cancer screening adherence in Australian BMT survivors. We conducted a cross-sectional survey of 441 BMT survivors who were >1 year post transplant, to explore rates of screening for secondary cancers and to identify barriers to cancer screening recommendations. Survey instruments included the Sydney Post-BMT Survey, FACT-BMT, DASS 21, The Chronic Graft versus Host Disease (GVHD) Activity Assessment-Patient Self-Report (Form B), the Lee Chronic GVHD Symptom Scale, Fear of Cancer Recurrence Scale, and The Post Traumatic Growth Inventory. Fifty-seven percent of respondents were male, median age 54 years, and 40% were >6 years post-BMT. Rates of cancer screening adherence were as follows: cervical 63.4%, breast 53.3%, skin 52.4%, and bowel 32.3%. Older BMT survivors and those >2 years post transplant were more likely to undergo cancer screening. Improved quality of life was associated with screening for skin, breast, and cervical cancer. Fear of cancer recurrence negatively impacted on cervical screening. For those who had not undergone screening, the majority reported not being advised to do so by their treatment team. This study is the largest and most comprehensive to date exploring cancer screening adherence in BMT survivors in Australia. These data provide the basis for health service reform to better meet the needs of BMT survivors and provide evidence to support counseling and education of both patients and professionals.
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Affiliation(s)
- Gemma Dyer
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Stephen R Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nicole Gilroy
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Lisa Brice
- Department of Haematology, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Matt Greenwood
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, St. Leonards, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Camperdown, NSW, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Westmead, NSW, Australia
| | - Louisa Brown
- Department of Haematology, Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - Megan Hogg
- Department of Haematoloy, Westmead Hospital, Sydney, NSW, Australia
| | - Gillian Huang
- Department of Haematoloy, Westmead Hospital, Sydney, NSW, Australia
| | - John Moore
- Department of Haematology, St Vincents Hospital, Sydney, NSW, Australia
| | - David Gottlieb
- Department of Haematoloy, Westmead Hospital, Sydney, NSW, Australia
| | - John Kwan
- Department of Haematoloy, Westmead Hospital, Sydney, NSW, Australia
| | - Jeff Tan
- Department of Haematology, St Vincents Hospital, Sydney, NSW, Australia
| | - Christopher Ward
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, St. Leonards, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Ian Kerridge
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, St. Leonards, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
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48
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Kirkøen B, Berstad P, Botteri E, Åvitsland TL, Ossum AM, de Lange T, Hoff G, Bernklev T. Do no harm: no psychological harm from colorectal cancer screening. Br J Cancer 2016; 114:497-504. [PMID: 26867161 PMCID: PMC4782205 DOI: 10.1038/bjc.2016.14] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/21/2015] [Accepted: 01/11/2016] [Indexed: 12/13/2022] Open
Abstract
Background: Participation in cancer screening programmes might cause worries in the population outweighting the benefits of reduced mortality. The present study aimed to investigate possible psychological harm of participation in a colorectal cancer (CRC) screening pilot in Norway. Methods: In a prospective, randomised trial participants (aged 50–74 years) were invited to either flexible sigmoidoscopy (FS) screening, faecal immunochemical test (FIT), or no screening (the control group; 1 : 1: 1). Three thousand two hundred and thirteen screening participants (42% of screened individuals) completed the Hospital Anxiety and Depression Scale questionnaire as well as the SF-12—a health-related quality of life (HRQOL) questionnaire when invited to screening and when receiving the screening result. A control group was invited to complete the questionnaires only. Two thousand six hundred and eighteen control participants (35% of invited individuals) completed the questionnaire. Results: A positive screening result did not increase participants' level of anxiety or depression, or decrease participants' level of HRQOL. Participants who received a negative result reported decreased anxiety and improvement on some HRQOL dimensions. However, no change was considered to be of clinical relevance. Conclusion: The current study showed no clinically relevant psychological harm of receiving a positive CRC screening result or of participating in FS or FIT screening, in a Norwegian population.
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Affiliation(s)
- Benedicte Kirkøen
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, P.O. box 5313 Majorstuen, 0304 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, P.O. box 1171 Blindern, 0318 Oslo, Norway
| | - Paula Berstad
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, P.O. box 5313 Majorstuen, 0304 Oslo, Norway.,Department of Research and Development, Telemark Hospital Trust, 3710 Skien, Norway
| | - Edoardo Botteri
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, P.O. box 5313 Majorstuen, 0304 Oslo, Norway.,Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Tone Lise Åvitsland
- Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, P.O. box 800, 3004 Drammen, Norway
| | - Alvilde Maria Ossum
- Department of Gastroenterology, Østfold Hospital Trust, P.O. box 300, 1714 Grålum, Norway
| | - Thomas de Lange
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, P.O. box 5313 Majorstuen, 0304 Oslo, Norway.,Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, P.O. box 800, 3004 Drammen, Norway
| | - Geir Hoff
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, P.O. box 5313 Majorstuen, 0304 Oslo, Norway.,Department of Research and Development, Telemark Hospital Trust, 3710 Skien, Norway.,Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. box 1089 Blindern, 0318 Oslo, Norway
| | - Tomm Bernklev
- Institute of Clinical Medicine, University of Oslo, P.O. box 1171 Blindern, 0318 Oslo, Norway.,Department of Research and Development, Telemark Hospital Trust, 3710 Skien, Norway
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Clarke N, Gallagher P, Kearney PM, McNamara D, Sharp L. Impact of gender on decisions to participate in faecal immunochemical test-based colorectal cancer screening: a qualitative study. Psychooncology 2016; 25:1456-1462. [PMID: 26864167 DOI: 10.1002/pon.4085] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Faecal immunochemical tests (FITs) are increasingly being used in population-based colorectal cancer-screening programmes. Uptake of FIT is lower in men than women; however, the reasons for this are not well understood. We aimed to explore gender differences in influences on decisions to participate in FIT screening. METHODS This is a qualitative study using in-depth face-to-face interviews of four groups of screening invitees (male and female screening users and male and female screening non-users), purposively sampled from the database of a population-based FIT screening programme. Recruitment continued until saturation was reached. Interviews were audio recorded and transcribed verbatim. Thematic analysis using the framework approach was employed with the theoretical domains framework guiding analysis. RESULTS Forty-seven screening invitees were interviewed. Six theoretical domains influenced screening uptake: 'environmental context and resources', 'beliefs about capabilities', 'beliefs about consequences', 'emotions', 'social influences' and 'knowledge'. Male non-users were often fatalistic, less knowledgeable and misinformed about cancer and FIT screening compared with other groups. Female non-users expressed negative attitudes, beliefs and emotions towards FIT screening, cancer, social influences and the medical profession and were over-confident about their health. CONCLUSIONS Negative attitudes and emotions to screening dominated non-user decision-making but differed by gender. Opportunities to improve uptake in men and women exist. Greater national discussions on the benefits of FIT screening, and development of screening materials tackling negative attitudes and beliefs while recognising male/female differences, may improve screening uptake. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Nicholas Clarke
- National Cancer Registry Ireland, Cork, Ireland.,Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Pamela Gallagher
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Deirdre McNamara
- Department of Clinical Medicine, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin, Ireland
| | - Linda Sharp
- National Cancer Registry Ireland, Cork, Ireland.,Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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50
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Liang PS, Wheat CL, Abhat A, Brenner AT, Fagerlin A, Hayward RA, Thomas JP, Vijan S, Inadomi JM. Adherence to Competing Strategies for Colorectal Cancer Screening Over 3 Years. Am J Gastroenterol 2016; 111:105-14. [PMID: 26526080 PMCID: PMC4887132 DOI: 10.1038/ajg.2015.367] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/03/2015] [Accepted: 10/01/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We have shown that, in a randomized trial comparing adherence to different colorectal cancer (CRC) screening strategies, participants assigned to either fecal occult blood testing (FOBT) or given a choice between FOBT and colonoscopy had significantly higher adherence than those assigned to colonoscopy during the first year. However, how adherence to screening changes over time is unknown. METHODS In this trial, 997 participants were cluster randomized to one of the three screening strategies: (i) FOBT, (ii) colonoscopy, or (iii) a choice between FOBT and colonoscopy. Research assistants helped participants to complete testing only in the first year. Adherence to screening was defined as completion of three FOBT cards in each of 3 years after enrollment or completion of colonoscopy within the first year of enrollment. The primary outcome was adherence to assigned strategy over 3 years. Additional outcomes included identification of sociodemographic factors associated with adherence. RESULTS Participants assigned to annual FOBT completed screening at a significantly lower rate over 3 years (14%) than those assigned to colonoscopy (38%, P<0.001) or choice (42%, P<0.001); however, completion of any screening test fell precipitously, indicating the strong effect of patient navigation. In multivariable logistic regression analysis, being randomized to the choice or colonoscopy group, Chinese language, homosexuality, being married/partnered, and having a non-nurse practitioner primary care provider were independently associated with greater adherence to screening (P<0.01). CONCLUSIONS In a 3-year follow-up of a randomized trial comparing competing CRC screening strategies, participants offered a choice between FOBT and colonoscopy continued to have relatively high adherence, whereas adherence in the FOBT group fell significantly below that of the choice and colonoscopy groups. Patient navigation is crucial to achieving adherence to CRC screening, and FOBT is especially vulnerable because of the need for annual testing.
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Affiliation(s)
- Peter S. Liang
- Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington, USA
| | - Chelle L. Wheat
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Anshu Abhat
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Alison T. Brenner
- Cecil Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Angela Fagerlin
- Veteran Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Rodney A. Hayward
- Veteran Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer P. Thomas
- Department of Medicine, University of California, San Francisco, California, USA
| | - Sandeep Vijan
- Veteran Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - John M. Inadomi
- Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington, USA
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