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Thompson HM, Yung J, Li J, Cone J. Colorectal cancer screening: results from the World Trade Center Health Registry cohort. Cancer Causes Control 2024:10.1007/s10552-024-01895-z. [PMID: 38907087 DOI: 10.1007/s10552-024-01895-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 06/03/2024] [Indexed: 06/23/2024]
Abstract
PURPOSE Little is known about colorectal cancer screening in 9/11 World Trade Center (WTC)-exposed populations. We utilized survey data from the WTC Health Registry (WTCHR) to examine associations between enrollees' characteristics and colorectal cancer (CRC) screening. METHODS We studied 22,061 enrollees aged 50-75 who completed the WTCHR follow-up survey in 2015-2016. Those with a history of CRC were excluded. Screening was defined as a self-reported, routine colonoscopy or sigmoidoscopy during the 12-month period prior to the survey. Multivariable log binomial regression identified factors associated with screening in the 12 months preceding the survey. We also stratified by age group. RESULTS Of 22,061 enrollees, 23% were screened, with largely similar rates across age groups. Higher screening percentages were seen in selected groups including non-Hispanic Black enrollees (26.4%), males (24.3%), those married/living with a partner (24.1%), those with a higher household income (≥ $150 k, 25.4%), those who received services from the WTC Health Program (25.6%), and those with greater perceived social support (24.4%). On multivariable analyses, non-Hispanic Black enrollees [adjusted relative risk (aRR) = 1.30, 95% confidence interval (CI) 1.19-1.42] were significantly more likely to report screening, even after stratifying by age group. Hispanic enrollees, those with a higher household income, those with increased perceived social support, and those with diagnosed medical conditions under 70 years old were also associated with screening. CONCLUSION We found that non-Hispanic Black compared with non-Hispanic White enrollees were more likely to obtain screening for CRC. Continued efforts to promote health and wellness of WTC-exposed population is essential.
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Affiliation(s)
- Hannah M Thompson
- Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - James Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA.
- World Trade Center Health Registry, 30-30 47th Avenue, Room 414, Long Island City, NY, 11101, USA.
- World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY, 11101, USA.
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Ansa BE, Datta B, Ibrahim S, Islam KMM, Saucier A, Coffin J. Role of Social Support in Screening Colonoscopy/Sigmoidoscopy Uptake among U.S. Adults. Healthcare (Basel) 2024; 12:344. [PMID: 38338228 PMCID: PMC10855932 DOI: 10.3390/healthcare12030344] [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: 11/30/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Colorectal cancer (CRC) is a major clinical and public health burden. Screening has been shown to be effective in preventing CRC. In 2021, less than 72% of adult Americans had received CRC screening based on the most recent guidelines. This study examined the relationship between social support and screening colonoscopy or sigmoidoscopy uptake among U.S. adults and the socioeconomic factors that impact the relationship. We conducted a cross-sectional study using the 2021 National Health Interview Survey (NHIS) data for 20,008 U.S. adults to assess the weighted rates of screening colonoscopy or sigmoidoscopy among individuals with strong, some, and weak social support. Adjusted binary logistic regression models were utilized to obtain the weighted odds of receiving a screening colonoscopy or sigmoidoscopy among adults with different levels of social support and socioeconomic status. About 58.0% of adults who reported having colonoscopy or sigmoidoscopy had strong social support, compared to 52.0% who had some or weak social support. In addition, compared to adults with weak social support, the weighted adjusted odds of having colonoscopy or sigmoidoscopy were 1.0 (95% C.I. = 0.994, 0.997; p < 0.001) and 1.3 (95% C.I. = 1.260, 1.263; p < 0.001) for adults with some and strong social support, respectively. Socioeconomic differences were observed in the odds of colonoscopy or sigmoidoscopy uptake based on having strong social support. Having strong social support is an important factor in increasing colonoscopy or sigmoidoscopy screening uptake. Policies and interventions that enhance social support among adults for screening colonoscopy or sigmoidoscopy are warranted.
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Affiliation(s)
- Benjamin E. Ansa
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA; (B.D.); (S.I.); (K.M.I.)
- Department of Health Management, Economics and Policy, Augusta University, Augusta, GA 30912, USA
| | - Biplab Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA; (B.D.); (S.I.); (K.M.I.)
- Department of Health Management, Economics and Policy, Augusta University, Augusta, GA 30912, USA
| | - Samah Ibrahim
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA; (B.D.); (S.I.); (K.M.I.)
- Department of Biostatistics, Data Science and Epidemiology, Augusta University, Augusta, GA 30912, USA
| | - KM Monirul Islam
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA; (B.D.); (S.I.); (K.M.I.)
- Department of Biostatistics, Data Science and Epidemiology, Augusta University, Augusta, GA 30912, USA
| | - Ashley Saucier
- Department of Family and Community Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.S.); (J.C.)
| | - Janis Coffin
- Department of Family and Community Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.S.); (J.C.)
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Rogers CR, Figueroa R, Brooks E, Petersen EM, Kennedy CD, Gray II DM, Sapienza M, Hung M. Factors associated with colorectal cancer screening intent and uptake among adult Non-Hispanic Black men. Am J Cancer Res 2021; 11:6200-6213. [PMID: 35018252 PMCID: PMC8727804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/24/2021] [Indexed: 06/14/2023] Open
Abstract
Non-Hispanic (NH) Black men in the United States have the lowest five-year colorectal cancer (CRC) survival rate across all racial/ethnic and sex subgroups and are less likely than their NH White counterparts to complete CRC screening. We hypothesized that greater masculinity barriers to medical care (MBMC) would be negatively associated with CRC screening uptake. Employing a survey design, we examined the MBMC scale and other psychosocial factors influencing CRC screening intent and uptake in a sample of 319 NH Black men aged 45 to 75 years residing in Minnesota, Ohio, and Utah. A series of ordinary least squares and logistic regression models were run with intention and uptake as the outcome variable while controlling for various demographic characteristics. Independent variables in all models included average score on the MBMC; CRC screening knowledge, beliefs and values; and barriers to and social support for CRC screening. Social support, marital status, and age were positively associated with CRC screening intention. Increased CRC screening knowledge and older age were associated with a greater likelihood of completing a stool-based screening test for CRC. Fewer masculinity-related and CRC screening barriers were associated with a greater likelihood of undergoing a sigmoidoscopy or colonoscopy. Contrary to our primary hypothesis, lesser MBMC-related perceptions were associated with increased CRC screening uptake among NH Black men. Our findings inform future CRC promotion programs and emphasize the need for multilevel interventions tailored toward this marginalized population to reduce disparities in screening and survival.
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Affiliation(s)
- Charles R Rogers
- University of Utah School of Medicine, Department of Family & Preventive Medicine375 Chipeta Way, Suite A, Salt Lake, UT 84108, USA
| | - Roger Figueroa
- Cornell University, College of Human Ecology, Division of Nutritional Sciences244 Garden Avenue, Ithaca, NY 14853, USA
| | - Ellen Brooks
- University of Utah School of Medicine, Department of Family & Preventive Medicine375 Chipeta Way, Suite A, Salt Lake, UT 84108, USA
| | - Ethan M Petersen
- University of Utah School of Medicine, Department of Family & Preventive Medicine375 Chipeta Way, Suite A, Salt Lake, UT 84108, USA
| | - Carson D Kennedy
- University of Utah School of Medicine, Department of Family & Preventive Medicine375 Chipeta Way, Suite A, Salt Lake, UT 84108, USA
| | - Darrell M Gray II
- The Ohio State University, College of Medicine1590 N High St. Suite 525, Columbus, OH 43201, USA
| | - Michael Sapienza
- Colorectal Cancer Alliance1025 Vermont Ave. NW, Suite 1066, Washington, DC 20005, USA
| | - Man Hung
- College of Dental Medicine, Roseman University of Health Sciences10894 South River Front Pkwy, South Jordan, UT 84095, USA
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Rogers CR, Brooks E, Petersen E, Campanelli P, Figueroa R, Kennedy C, Thorpe RJ, Levant RF. Psychometric Properties and Analysis of the Masculinity Barriers to Medical Care Scale Among Black, Indigenous, and White Men. Am J Mens Health 2021; 15:15579883211049033. [PMID: 34636686 PMCID: PMC8516392 DOI: 10.1177/15579883211049033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Non-Hispanic (NH) Black, American Indian/Alaska Native (Indigenous), and NH-White men have the highest colorectal cancer (CRC) mortality rates among all other racial/ethnic groups. Contributing factors are multifaceted, yet no studies have examined the psychometric properties of a comprehensive survey examining potential masculinity barriers to CRC screening behaviors among these populations. This study assessed the psychometric properties of our Masculinity Barriers to Medical Care (MBMC) Scale among NH-Black, Indigenous, and NH-White men who completed our web-based MBMC, Psychosocial Factors, and CRC Screening Uptake & Intention Survey. We conducted exploratory factor analysis on a sample of 254 men and multivariate analysis of variance (MANOVA) on a separate sample of 637 men nationally representative by age and state of residence. After psychometric assessment, the MBMC scale was reduced from 24 to 18 items and from six to four subscales. NH-Black men’s mean scores were lowest on three of four subscales (Being Strong, Negative and Positive Attitudes) and highest on the Acknowledging Emotions subscale. Compared with both Indigenous and NH-White men, NH-Black men had significantly lower Negative Attitudes subscale scores and significantly higher scores on the Acknowledging Emotions subscale. Compared with both Indigenous and NH-Black men, NH-White men had significantly higher Being Strong and Positive Attitudes subscales scores. This study expands on previous research indicating that, among racialized populations of men, endorsement of traditional masculine ideologies influences engagement in preventive health behaviors. Our scale can be tailored to assess attitudes to screening for other cancers and diseases that disproportionately burden medically underserved populations.
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Affiliation(s)
- Charles R Rogers
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ellen Brooks
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ethan Petersen
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Pamela Campanelli
- UK Survey Methods Consultant, Chartered Statistician, Colchester, UK
| | - Roger Figueroa
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Carson Kennedy
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Roland J Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ronald F Levant
- Department of Psychology (Professor Emeritus), The University of Akron, Akron, OH, USA
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Harper DM, Plegue M, Sen A, Gorin SS, Jimbo M, Patel MR, Resnicow K. Predictors of screening for cervical and colorectal cancer in women 50-65 years old in a multi-ethnic population. Prev Med Rep 2021; 22:101375. [PMID: 33996388 PMCID: PMC8086134 DOI: 10.1016/j.pmedr.2021.101375] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/21/2021] [Accepted: 04/08/2021] [Indexed: 01/05/2023] Open
Abstract
Middle Eastern/North Africa (MENA) women are often not identified in cancer screening studies. The aim of this study was to determine the rates and predictors of cervical and colorectal cancer (CRC) screening for women 50-65 years of three race/ethnicities. White, black and MENA women of Southeast Michigan were surveyed once in 2019 for demographics, health care barriers, chronic diseases, and cancer screening updates using in-person, telephone, and online methods. Descriptive statistics and multivariate multinomial logistic regression were used to predict up-to-date colorectal cancer and cervical cancer screening. All analyses were adjusted by local population weights for comparability and generalizability. 394 women participated with 54% up-to-date on both screenings, 21% for cervical cancer screening alone, and 12% for CRC alone. Women more likely to be up-to-date for only cervical cancer screening compared to both cancer screens are younger (aOR 0.83 (95% CI 0.76, 0.92), are of MENA descent (7.97 (2.46, 25.76) and have no insurance (9.41 (1.07, 82.92). There are no predictors for women being up-to-date for CRC screening alone compared to both screens. Among women 50-65 years old, being up-to-date in cervical cancer screening is unrelated to being up-to-date for CRC screening. Compared to Healthy People 2020, there are significant gaps in cervical and CRC screening among women 50-65 years old of all races, but particularly among women of MENA descent who are even less likely to have CRC screening than cervical cancer screening.
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Key Words
- 50–65 years old
- BMI, body mass index
- COVID-19, coronavirus -19 or SARS-CoV-2 – severe acute respiratory syndrome coronavirus 2
- CRC, colorectal cancer
- Cervical cancer screening
- Colorectal cancer screening
- FDA, Food and Drug Administration of the United States
- FIT DNA, multitarget stool DNA test
- FIT, fecal immunochemical test
- FOBT, fecal occult blood test
- Females
- MENA, Middle Eastern/North African
- MT, sDNA test – multitarget stool DNA test - Cologuard®
- Middle Eastern-North American (MENA) ethnicity
- OR, odds ratio
- SE, standard error
- USPSTF, United States Preventive Services Task Force
- aOR, adjusted odds ratio
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Affiliation(s)
- Diane M. Harper
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Women’s and Gender Studies, University of Michigan, Ann Arbor, MI, USA
| | - Melissa Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | | | - Mas Jimbo
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Minal R. Patel
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Ken Resnicow
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
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6
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Rogers CR, Matthews P, Xu L, Boucher K, Riley C, Huntington M, Le Duc N, Okuyemi KS, Foster MJ. Interventions for increasing colorectal cancer screening uptake among African-American men: A systematic review and meta-analysis. PLoS One 2020; 15:e0238354. [PMID: 32936812 PMCID: PMC7494124 DOI: 10.1371/journal.pone.0238354] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/07/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND African-American men have the lowest 5-year survival rate in the U.S. for colorectal cancer (CRC) of any racial group, which may partly stem from low screening adherence. It is imperative to synthesize the literature evaluating the effectiveness of interventions on CRC screening uptake in this population. MATERIALS AND METHODS In this systematic review and meta-analysis, Medline, CINAHL, Embase, and Cochrane CENTRAL were searched for U.S.-based interventions that: were published after 1998-January 2020; included African-American men; and evaluated CRC screening uptake explicitly. Checklist by Cochrane Collaboration and Joanna Brigg were utilized to assess risk of bias, and meta-regression and sensitivity analyses were employed to identify the most effective interventions. RESULTS Our final sample comprised 41 studies with 2 focused exclusively on African-American men. The most frequently adopted interventions were educational materials (39%), stool-based screening kits (14%), and patient navigation (11%). Most randomized controlled trials failed to provide details about the blinding of the participant recruitment method, allocation concealment method, and/or the outcome assessment. Due to high heterogeneity, meta-analysis was conducted among 17 eligible studies. Interventions utilizing stool-based kits or patient navigation were most effective at increasing CRC screening completion, with odds ratios of 9.60 (95% CI 2.89-31.82, p = 0.0002) and 2.84 (95% CI 1.23-6.49, p = 0.01). No evidence of publication bias was present for this study registered with the International Prospective Registry of Systematic Reviews (PROSPERO 2019 CRD42019119510). CONCLUSIONS Additional research is warranted to uncover effective, affordable interventions focused on increasing CRC screening completion among African-American men. When designing and implementing future multicomponent interventions, employing 4 or fewer interventions types may reduce bias risk. Since only 5% of the interventions solely focused on African-American men, future theory-driven interventions should consider recruiting samples comprised solely of this population.
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Affiliation(s)
- Charles R. Rogers
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Phung Matthews
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Lei Xu
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, United States of America
| | - Kenneth Boucher
- Cancer Biostatistics Shared Resource, Huntsman Cancer Institute, Salt Lake City, UT, United States of America
| | - Colin Riley
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Matthew Huntington
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Nathan Le Duc
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Kola S. Okuyemi
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Margaret J. Foster
- Medical Sciences Library, Texas A&M University, College Station, TX, United States of America
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Patel K, Gishe J, Liu J, Heaston A, Manis E, Moharreri B, Hargreaves M. Factors Influencing Recommended Cancer Screening in Low-Income African American Women in Tennessee. J Racial Ethn Health Disparities 2019; 7:129-136. [PMID: 31664677 DOI: 10.1007/s40615-019-00642-4] [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] [Received: 04/24/2019] [Revised: 09/11/2019] [Accepted: 09/20/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study examined the factors that predict recommended screening compliance to cervical, breast, and colorectal cancers in low-income African American women. It also examined obstacles to screenings by geographic region and screening status. METHODS As a part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African American women 40 years and older (n = 308) were selected from the Meharry CNP community survey database. RESULTS There were several predictors to recommended screening such as being employed and having health insurance (P < 0.05). Additionally, the obstacles to screening posed a similar level of difficulty for participants from different geographic areas. DISCUSSION Sociodemographic differences and obstacles of screening need to be addressed in educational interventions aimed at improving cancer screenings.
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Affiliation(s)
- Kushal Patel
- Department of Public Health, Health Administration and Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-411, Nashville, TN, 37203, USA.
| | - Jemal Gishe
- Department of Public Health, Health Administration and Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-410, Nashville, TN, 37203, USA
| | - Jianguo Liu
- Department of Internal Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN, 37208, USA
| | - Alexis Heaston
- Department of Public Health, Health Administration and Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-416, Nashville, TN, 37203, USA
| | - Elizabeth Manis
- Department of Public Health, Health Administration and Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-419, Nashville, TN, 37203, USA
| | - Bella Moharreri
- Department of Public Health, Health Administration and Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-419, Nashville, TN, 37203, USA
| | - Margaret Hargreaves
- Department of Internal Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN, 37208, USA
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Brittain K, Kamp K, Cassandras C, Salaysay Z, Gómez-Márquez J. Colorectal Cancer Awareness for Women via Facebook: A Pilot Study. Gastroenterol Nurs 2018; 41:14-18. [PMID: 29373351 PMCID: PMC6040828 DOI: 10.1097/sga.0000000000000294] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Colorectal cancer is the third leading cause of cancer death among U.S. women. Women report being screened for colorectal cancer less often than men, and if colorectal cancer screening guidelines were routinely followed, approximately 60% of colorectal cancer deaths could be prevented. Many colorectal cancer screening interventions have not used Facebook, which is the most popular social media site among women. Little is known about engaging women in colorectal cancer screening and risk reduction information using Facebook. The "Colorectal Cancer Screening Awareness for Women" Facebook page was created to promote colorectal cancer screening and risk reduction awareness among women. Facebook posts targeted women aged 45-64 years and highlighted colorectal cancer screening methods, guidelines, and colorectal cancer risk reduction strategies. Demographics and data about the women's interactions with the page were collected using Facebook analytics and analyzed. The majority of the 391 users of the Colorectal Cancer Screening Awareness for Women Facebook page were women aged 45-54 years (56.5%). The most "liked" posts were related to colorectal cancer risk reduction behaviors. In an effort to increase routine colorectal cancer screening and colorectal cancer risk reduction behaviors, gastroenterology nurses and practices should consider Facebook as a good method to regularly engage women in colorectal cancer screening and colorectal cancer risk reduction information.
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Affiliation(s)
- Kelly Brittain
- Assistant Professor, College of Nursing, Michigan State University
| | - Kendra Kamp
- Doctoral Student, College of Nursing, Michigan State University
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Woodward EN, Walsh JL, Senn TE, Carey MP. Positive social interaction offsets impact of low socioeconomic status on stress. J Natl Med Assoc 2018; 110:371-377. [PMID: 30126563 PMCID: PMC6639010 DOI: 10.1016/j.jnma.2017.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/28/2017] [Accepted: 07/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Stress is associated with unhealthy behaviors and premature morbidity and mortality, especially among those of low socioeconomic status (SES). Clarifying the roles of stress-related risk and protective factors can guide interventions designed to reduce stress and improve health among socioeconomically disadvantaged populations. PURPOSE (1) Replicate prior research showing that lower SES is associated with higher stress in a predominantly racial minority, socioeconomically disadvantaged sample, and (2) test the hypothesis that different types of social support (a protective factor) mitigate the deleterious effects of SES on self-reported perceived stress. METHODS Low-income patients (N = 508, 54% male, 68% African American, Mage = 28) from a publicly-funded clinic provided demographic information and then completed measures of perceived stress and social support. Four types of social support were assessed (viz., affectionate, emotional/informational, positive social interaction, and tangible). Structural equation modeling tested the hypothesized associations among SES, social support, and stress. RESULTS Individuals of lower SES, β = -0.27 (0.08), p < 0.01, and lower overall social support, β = -0.47 (0.05), p < 0.001, reported higher stress. Social support moderated associations between SES and stress, with participants with lower SES benefitting the most from social support. Of the four types of social support that were measured, positive social interaction was the strongest moderator, β = 0.20 (0.08), p = 0.01. CONCLUSIONS The associations among SES, stress, and social support corroborate prior research. Positive social interaction was particularly important for decreasing stress among socioeconomically disadvantaged persons.
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Affiliation(s)
- Eva N Woodward
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Brown University, Box G-BH, Providence, RI 02912, USA.
| | - Jennifer L Walsh
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Brown University, Box G-BH, Providence, RI 02912, USA; Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906, USA; Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Behavioral and Social Sciences, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA
| | - Theresa E Senn
- School of Nursing, University of Rochester, Box SON, Helen Wood Hall, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906, USA; Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Behavioral and Social Sciences, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA
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10
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Kegler MC, Beasley DD, Liang S, Cotter M, Phillips E, Hermstad A, Williams R, Martinez J, Riehman K. Using the consolidated framework for implementation research to understand safety net health system efforts to increase colorectal cancer screening rates. HEALTH EDUCATION RESEARCH 2018; 33:315-326. [PMID: 29982384 DOI: 10.1093/her/cyy019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 06/24/2018] [Indexed: 06/08/2023]
Abstract
Guided by the Consolidated Framework for Implementation Research (CFIR), this study aimed to identify factors that influence implementation of evidence-based provider and client-oriented strategies to promote colorectal cancer (CRC) screening in safety net health systems. Site visits and key informant interviews (n=33) were conducted with project leaders and staff in five health systems funded by an American Cancer Society grants program. Within- and cross-site analyses identified CFIR constructs that influenced implementation of provider and client-oriented strategies to promote CRC screening through colonoscopies and fecal immunochemical tests. Of the five CFIR domains, constructs within four CFIR domains (inner setting, outer setting, individual characteristics and process domains) were particularly salient in discussions of implementation while constructs within one CFIR domain (characteristics of the intervention) were not. This study provides a detailed description of how facilitating and inhibiting factors influenced the implementation of evidence-based practices related to CRC screening within safety net health systems. These findings can inform future efforts to promote evidence-based strategies to increase CRC screening rates in safety net health systems.
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Affiliation(s)
- Michelle C Kegler
- Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA
| | - Derrick D Beasley
- Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA
| | - Shuting Liang
- Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA
| | - Megan Cotter
- Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA
| | - Emily Phillips
- Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA
| | - April Hermstad
- Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA
| | - Rentonia Williams
- Statistics & Evaluation Center, Department of Intramural Research, American Cancer Society, Inc., Atlanta, GA, USA
| | - Jeremy Martinez
- Statistics & Evaluation Center, Department of Intramural Research, American Cancer Society, Inc., Atlanta, GA, USA
| | - Kara Riehman
- Statistics & Evaluation Center, Department of Intramural Research, American Cancer Society, Inc., Atlanta, GA, USA
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11
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Rogers CR, Goodson P, Dietz LR, Okuyemi KS. Predictors of Intention to Obtain Colorectal Cancer Screening Among African American Men in a State Fair Setting. Am J Mens Health 2018; 12:851-862. [PMID: 27161985 PMCID: PMC5101175 DOI: 10.1177/1557988316647942] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Racial disparities in health among African American men in the United States are appalling. African American men have the highest mortality and incidence rates from colorectal cancer compared with all other ethnic, racial, and gender groups. Juxtaposed to their white counterparts, African American men have colorectal cancer incidence and mortality rates 27% and 52% higher, respectively. Colorectal cancer is a treatable and preventable condition when detected early, yet the intricate factors influencing African American men's intention to screen remain understudied. Employing a nonexperimental, online survey research design at the Minnesota State Fair, the purpose of this study was to explore whether male role norms, knowledge, attitudes, and perceptions influence intention to screen for colorectal cancer among 297 African American men. As hypothesized, these Minnesota men (ages 18 to 65) lacked appropriate colorectal cancer knowledge: only 33% of the sample received a "passing" knowledge score (85% or better). In a logistic regression model, the three factors significantly associated with a higher probability of obtaining colorectal cancer screening were age, perceived barriers, and perceived subjective norms. Findings from this study provide a solid basis for informing health policy and designing health promotion and early-intervention colorectal cancer prevention programs that are responsive to the needs of African American men in Minnesota and beyond.
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Affiliation(s)
| | | | | | - Kola S. Okuyemi
- University of Minnesota Medical School,
Minneapolis, MN, USA
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12
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A Mobile App to Increase Informed Decisions About Colorectal Cancer Screening Among African American and Caucasian Women. Gastroenterol Nurs 2018; 41:297-303. [DOI: 10.1097/sga.0000000000000319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Rogers CR, Robinson CD, Arroyo C, Obidike OJ, Sewali B, Okuyemi KS. Colorectal Cancer Screening Uptake's Association With Psychosocial and Sociodemographic Factors Among Homeless Blacks and Whites. HEALTH EDUCATION & BEHAVIOR 2017; 44:928-936. [PMID: 28978252 DOI: 10.1177/1090198117734284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The homeless represent an extremely disadvantaged population that fare worse than minority groups in access to preventive services and health, and minority groups fare worse than Whites. Early detection screening for colorectal cancer (CRC) saves lives, but empirical data about CRC screening practices among homeless Blacks and Whites are limited. Psychosocial risk factors may serve as a barrier to CRC screening completion among homeless Black individuals. A secondary data analysis of a randomized clinical trial for smoking cessation among homeless smokers was conducted to determine whether psychosocial factors and sociodemographic factors were more highly associated with CRC screening uptake among homeless Blacks than among their White counterparts. Study participants ( N = 124) were surveyed on their CRC screening status, sociodemographic variables, and psychosocial correlate measures including anxiety, depression, hopelessness, depression severity, and perceived stress. Associations between these factors were examined with logistic regression. White participants who were currently disabled/unable to work were 6.2 times more likely to ever receive CRC screening than those who were employed. Black participants with public health insurance coverage were 90% less likely to ever obtain CRC screening than participants without health insurance. Black and White participants had similar levels of anxiety symptoms, depression, and hopelessness, yet depression was the only psychosocial variable negatively associated with CRC screening status. Black and White participants with symptoms of depression were 58% less likely to complete screening than those without depression. Mental health risk and sociodemographic factors may serve as barriers to CRC screening among homeless Blacks and Whites.
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Affiliation(s)
| | | | | | | | - Barrett Sewali
- 5 Uganda National Expanded Programme on Immunisation, Kampala, Uganda, Africa
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14
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Rogers CR, Mitchell JA, Franta GJ, Foster MJ, Shires D. Masculinity, Racism, Social Support, and Colorectal Cancer Screening Uptake Among African American Men: A Systematic Review. Am J Mens Health 2017; 11:1486-1500. [PMID: 26483293 PMCID: PMC4835264 DOI: 10.1177/1557988315611227] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Colorectal cancer (CRC) is highly preventable when CRC screening is utilized, yet CRC screening completion among African American men is relatively low and their mortality rates remain 50% higher juxtaposed to their White counterparts. Since a growing body of literature indicates masculinity, racism, and social support each have strong influences on CRC screening uptake, this systematic review examined the connections between these three sociocultural factors and CRC screening uptake among African American men. Potential studies were retrieved from MEDLINE, CINAHL, EMBASE, and PsycINFO. Cited reference searching for the final sample was employed to identify and assess additional studies for inclusion using Scopus. The methodological quality of the reviewed evidence was also evaluated. Nineteen studies met inclusion/exclusion criteria. Thirteen studies employed nonexperimental research designs; a quasi-experimental design was present in four, and two utilized experimental designs. Studies were published between 2000 and 2014; the majority between 2009 and 2013. Social support was most frequently addressed (84%) while masculinity and racism were equally studied with paucity (11%) for their influence on CRC screening. After evaluating conceptual and methodological characteristics of the studies, 42% fell below average in quality and rigor. The need for increased attention to the sociocultural correlates of CRC screening for African American men are highlighted in this systematic review, and important recommendations for research and practice are provided. Alongside a call for more rigorous research, further research examining the influence of masculinity and racism on CRC screening completion among African American men is warranted.
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15
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Alema-Mensah E, Smith SA, Claridy M, Ede V, Ansa B, Blumenthal DS. Social networks as predictors of colorectal cancer screening in African Americans. JOURNAL OF THE GEORGIA PUBLIC HEALTH ASSOCIATION 2017; 6:369-372. [PMID: 28730185 PMCID: PMC5515378 DOI: 10.21633/jgpha.6.306] [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] [Indexed: 11/21/2022] Open
Abstract
Background Early detection can reduce colorectal cancer (CRC) mortality by 15%–33%, and screening is widely recommended for average-risk adults beginning at age 50 years. Colorectal cancer mortality rates are higher in African Americans than in whites, while screening rates are somewhat lower. Individual social networks can reduce emotional and/or logistical barriers to health-promoting but distasteful procedures such as CRC screening. The aim of this study was to examine social network interactions, and their impact on CRC screening among African Americans. We hypothesized a positive association between social network index (SNI) scores and CRC screening. Methods In a community intervention trial with four arms, we previously demonstrated the efficacy of a small group educational intervention to promote CRC screening among African Americans. This intervention outperformed a one-on-one educational intervention, a reduced out-of-pocket expense intervention, and a control condition. In the present analysis, we compared the SNI scores for participants in the small group intervention cohort with a comparison group comprised of the other three cohorts. Social networks were assessed using the Social Network Index developed by Cohen. Results Small group participants had a significantly higher network diversity score (Mean difference 0.71; 95% CI, 0.12–1.31; p=0.0017) than the comparison group. In the second component of the SNI score – the number of people talked to over a two week period – the small group intervention cohort also scored significantly higher than the comparison group. (Mean difference, 9.29; 95% CI, 3.963–14.6266; p=0.0004). Conclusions The findings suggest that social interaction and support was at least partially responsible for the relatively high post-intervention screening rate in the small group intervention participants. Education in small groups could foster strong social networks. Strong and positive network diversity and a large number of people in social networks may enhance CRC screening rates among African Americans.
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Affiliation(s)
- Ernest Alema-Mensah
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA.,Cancer Research Program, Morehouse School of Medicine, Atlanta, GA
| | - Selina A Smith
- Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Mechelle Claridy
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA.,Cancer Research Program, Morehouse School of Medicine, Atlanta, GA
| | - Victor Ede
- Satcher Health Leadership Institute, Division of Behavioral Health, Morehouse School of Medicine, Atlanta, GA
| | - Benjamin Ansa
- Institute of Public and Preventive Health, Augusta University, Augusta, GA
| | - Daniel S Blumenthal
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
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16
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Sociocultural and health correlates related to colorectal cancer screening adherence among urban African Americans. Cancer Nurs 2016; 38:118-24. [PMID: 24836955 DOI: 10.1097/ncc.0000000000000157] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) incidence and mortality are highest among African Americans. African Americans lag behind whites in CRC screening rates. Research has examined the role of CRC screening knowledge and beliefs and their relationship to CRC screening adherence. However, studies have not examined the effect cultural identity, social support, CRC beliefs, an informed decision, and having a chronic disease has on CRC screening among African Americans. OBJECTIVES This study examined CRC screening adherence among African Americans within the context of sociocultural variables, an informed decision, and health factors. METHODS A secondary data analysis was performed on survey data collected from 129 African American men and women. RESULTS Social support and family influence were related to having a colonoscopy. Having diabetes was negatively related to having a colonoscopy. There was no relationship between having a primary care provider and making an informed decision about CRC screening. Religiosity and having a primary care provider predicted colonoscopy. CONCLUSIONS The results indicate that certain sociocultural variables are related to colonoscopy. However, those same variables may not be related to or predictive of fecal occult blood test adherence. The diagnosis of diabetes may present a challenge to CRC screening adherence. IMPLICATIONS FOR PRACTICE The results of the study suggest that social support and family influence concerning CRC screening be assessed to provide additional support to colonoscopy adherence. The results also suggest that diabetic patients may require additional intervention to increase colonoscopy adherence rates.
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17
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Brittain K, Christy SM, Rawl SM. African American patients' intent to screen for colorectal cancer: Do cultural factors, health literacy, knowledge, age and gender matter? J Health Care Poor Underserved 2016; 27:51-67. [PMID: 27182187 DOI: 10.1353/hpu.2016.0022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
African Americans have higher colorectal cancer (CRC) mortality rates. Research suggests that CRC screening interventions targeting African Americans be based upon cultural dimensions. Secondary analysis of data from African-Americans who were not up-to-date with CRC screening (n=817) was conducted to examine: 1) relationships among cultural factors (i.e., provider trust, cancer fatalism, health temporal orientation (HTO)), health literacy, and CRC knowledge; 2) age and gender differences; and 3) relationships among the variables and CRC screening intention. Provider trust, fatalism, HTO, health literacy and CRC knowledge had significant relationships among study variables. The FOBT intention model explained 43% of the variance with age and gender being significant predictors. The colonoscopy intention model explained 41% of the variance with gender being a significant predictor. Results suggest that when developing CRC interventions for African Americans, addressing cultural factors remain important, but particular attention should be given to the age and gender of the patient.
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Affiliation(s)
- Kelly Brittain
- College of Nursing, Michigan State University, East Lansing
| | - Shannon M Christy
- Department of Psychology, Purdue School of Science, Indiana University-Purdue University Indianapolis
| | - Susan M Rawl
- School of Nursing, Indiana University, Indianapolis
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18
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Predictors of stage of adoption for colorectal cancer screening among African American primary care patients. Cancer Nurs 2015; 37:241-51. [PMID: 24145250 DOI: 10.1097/ncc.0b013e3182a40d8d] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Compared with other racial groups, African Americans have the highest colorectal cancer (CRC) incidence and mortality rates coupled with lower screening rates. OBJECTIVE Our study examined the predictors of stage of adoption for fecal occult blood testing (FOBT) and colonoscopy among African American primary care patients who were nonadherent to published screening guidelines. METHODS Baseline data (N = 815) in a randomized clinical trial were analyzed. Participants were categorized into precontemplation, contemplation, and preparation stages for FOBT and colonoscopy. Predictor variables were demographics, clinical variables, CRC health beliefs and knowledge, and social support. Hierarchical modeling was to identify significant predictors of stage of adoption. RESULTS Older, male, Veterans Affairs participants and those with higher perceived self-efficacy, family/friend encouragement, and a provider recommendation had higher odds of being at a more advanced stage of adoption for FOBT. Patients with a history of cancer and higher perceived barriers had higher odds of being at an earlier stage of adoption for FOBT. Predictors of more advanced stage of adoption for colonoscopy included higher perceived benefits, higher perceived self-efficacy, family/friend encouragement, and a provider recommendation for colonoscopy. Higher income (>30 000 vs <15 000) was predictive of earlier stage of adoption for colonoscopy. CONCLUSIONS Enhancing self-efficacy, encouragement from family and friends, and provider recommendations are important components of interventions to promote CRC screening. IMPLICATIONS FOR PRACTICE Nurses can use knowledge of the characteristics associated with stage of adoption to educate and motivate their African American primary care patients to complete CRC screening tests.
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19
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Nfonsam VN, Vijayasekaran A, Pandit V, E V, Aziz H, Nzuonkwelle S, Ohlson E, DiGiovanni RM, Jandova J. Patients Diagnosed with Colorectal Cancer in Rural Areas in Arizona Typically Present with Higher Stage Disease. ACTA ACUST UNITED AC 2015; 5. [PMID: 27559492 DOI: 10.4172/2161-069x.1000346] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite the decreasing incidence of colorectal cancer (CRC) over the past three decades disparities remain in its incidence, stage at presentation, and efficiency of staging and treatment between different communities, particularly when comparing urban and rural areas. The aim of the study was to assess disparities that exist in CRC outcomes among urban, international border counties, and non-border counties in Arizona. METHODS A retrospective analysis of CRC data from the Arizona Cancer Registry was performed. Data obtained included age, sex, ethnicity, tumor grade, and tumor stage. The data was then categorized into three sections: international border counties, urban counties, and rural counties. The outcome measure was stage of CRC at diagnosis. RESULTS There were a total of 39, 958 reported incident cases of colorectal cancer from 1995-2010. Of the total incident cases, 53.1% were male and the average age at diagnosis was 69.5. 86.6% were white non-Hispanic, 8.37% Hispanic, 2.4% African American, 1.7% Native American and 1% Asian. There was a significant decrease in the incidence of CRC in all counties, 24.08% in border, 22.5% in urban, and 12.3% in rural. Rural counties showed a higher number of observed cases than expected cases of stage 4 CRC and more unknown diagnosis of grade, stage and lymph node assessment as determined by the adjusted residual. CONCLUSION Patients in rural counties are more likely to present with a higher stage of CRC and are less likely to have their cancer adequately staged. This is likely due to lack of better access to healthcare, lack of awareness and poor education and also inadequate specialists.
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Affiliation(s)
- Valentine N Nfonsam
- Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA
| | - Aparna Vijayasekaran
- Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA
| | - Viraj Pandit
- Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA
| | - Vera E
- Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA
| | - Hassan Aziz
- Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA
| | - Sumediah Nzuonkwelle
- Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA
| | - Eric Ohlson
- Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA
| | - Ryan M DiGiovanni
- Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA
| | - Jana Jandova
- Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA; Department of Pathology, University of Arizona, Tucson, Arizona, USA
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20
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Resnicow K, Zhou Y, Hawley S, Jimbo M, Ruffin MT, Davis RE, Shires D, Lafata JE. Communication preference moderates the effect of a tailored intervention to increase colorectal cancer screening among African Americans. PATIENT EDUCATION AND COUNSELING 2014; 97:370-5. [PMID: 25224317 PMCID: PMC6208142 DOI: 10.1016/j.pec.2014.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 07/04/2014] [Accepted: 08/18/2014] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Test the impact of tailoring CRC screening messages for African Americans (AAs) using novel theoretical variables and to examine moderating effect of communication preferences. METHODS Participants were randomized to receive two minimally tailored or two enhanced tailored print newsletters addressing CRC. The enhanced intervention was tailored on Self-Determination Theory and other novel psychological constructs. Minimal tailoring only used information available in the patient's EHR. The primary outcome was CRC screening based on EHR. Participants were AA members aged 50-74 of an integrated health care delivery system not up to date on CRC screening. RESULTS We enrolled 881 participants. CRC screening participation rates at 1-year follow up were 20.5% and 21.5% in the minimally and enhanced tailored groups, respectively. Communication preferences moderated the impact of the intervention. Specifically, among those with an autonomous communication preference, screening rates in the minimally and enhanced tailored groups were 17.1% and 25.9%, respectively, while no intervention effect was evident among those with a directive preference. CONCLUSION Future research is needed to explore the impact of communication preference tailoring for other health behaviors and among other populations. PRACTICE IMPLICATIONS Tailored communications should consider communication style preference to help guide the content and tone of messages.
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Affiliation(s)
- Ken Resnicow
- University of Michigan School of Public Health, Department of Health Behavior & Health Education, Ann Arbor, USA.
| | - Yan Zhou
- University of Michigan, Ann Arbor, USA
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21
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Rogers CR, Goodson P. Male Role Norms, Knowledge, Attitudes, and Perceptions of Colorectal Cancer Screening among Young Adult African American Men. Front Public Health 2014; 2:252. [PMID: 25506049 PMCID: PMC4245902 DOI: 10.3389/fpubh.2014.00252] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/09/2014] [Indexed: 11/23/2022] Open
Abstract
Racial disparities in health among African American men (AAM) in the United States are extensive. In contrast to their White counterparts, AAM have more illnesses and die younger. AAM have colorectal cancer (CRC) incidence and mortality rates 25% and 50% higher, respectively, than White men. Due to CRC's younger age at presentation and high incidence among AAM, CRC screening (CRCS) is warranted at the age of 45 rather than 50, but little is known about younger AAM's views of CRCS. Employing survey design, the purpose of the study was to describe the male role norms (MRN), knowledge, attitudes, perceived subjective norms, and perceived barriers associated with screening for CRC among a non-random sample of 157 young adult AAM (ages 19-45). Sixty-seven percent of the study sample received a passing knowledge score (85% or better), yet no significant differences were found among the three educational levels (i.e., low, medium, high). More negative attitudes toward CRCS correlated with the participants' strong perceptions of barriers, but no extremely negative or positive MRN and perceived subjective norms were found. The factors significantly associated with attitudes were family history of cancer (unsure), work status, and perceived barriers. Findings from this study provide a solid basis for developing structured health education interventions that address the salient factors shaping young adult AAM's view of CRC and early detection screening behaviors.
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Affiliation(s)
- Charles R. Rogers
- Program in Health Disparities Research, Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Patricia Goodson
- Health and Kinesiology, Texas A&M University, College Station, TX, USA
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22
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Thompson VLS, Harris J, Clark EM, Purnell J, Deshpande AD. Broadening the examination of sociocultural constructs relevant to African-American colorectal cancer screening. PSYCHOL HEALTH MED 2014; 20:47-58. [PMID: 24628025 PMCID: PMC3992476 DOI: 10.1080/13548506.2014.894639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The importance of sociocultural constructs as influences on cancer attitudes and screening has been established in the literature. This paper reports on the efforts to explore alternatives to sociocultural constructs previously associated with African-American cancer screening, but with low acceptance among community members or incomplete measurement (empowerment and collectivism) and develop a measure for a recently identified construct of interest (privacy). We report preliminary psychometric data on these sociocultural scales and their associations with cancer attitudes. African-Americans (N = 1021), 50-75 years of age participated in this study. Participants were identified via a listed sample and completed a telephone survey administered via call center. Sociocultural attitudes were assessed using items identified through computerized database searches, reviewed by advisory panels, edited and tested using cognitive response strategies. Cancer screening pros and cons, cancer worry, perceived cancer risk, colorectal cancer (CRC) screening subjective norms, and perceived self-efficacy for colorectal cancer screening (CRCS) were also assessed. Confirmatory factor analyses and multivariate analyses were conducted to provide support for the validity of the constructs and to understand the associations among the selected sociocultural constructs (empowerment, collectivism, and privacy) and cancer beliefs and attitudes (CRC perceived benefits and barriers, perceived risks, subjective norms, and perceived behavioral control/self-efficacy). Consistent with the literature, the factor analytic model (RMSEA for the model was .062; 90% CI: .060-.065) provided support for the empowerment, collectivism, and privacy constructs. The modified collectivism and privacy scales had acceptable reliability. The privacy scale demonstrated the strongest associations with measures of cancer beliefs and attitudes. The implication of the findings and need for further scale development activities is discussed.
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Affiliation(s)
- V L Sanders Thompson
- a Brown School, Public Health Program , Washington University in St. Louis , St. Louis , MO , USA
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23
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Martinez KA, Pollack CE, Phelan DF, Markakis D, Bone L, Shapiro G, Wenzel J, Howerton M, Johnson L, Garza MA, Ford JG. Gender differences in correlates of colorectal cancer screening among Black Medicare beneficiaries in Baltimore. Cancer Epidemiol Biomarkers Prev 2013; 22:1037-42. [PMID: 23629519 PMCID: PMC3681887 DOI: 10.1158/1055-9965.epi-12-1215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Previous research has shown colorectal cancer (CRC) screening disparities by gender. Little research has focused primarily on gender differences among older Black individuals, and reasons for existing gender differences remain poorly understood. METHODS We used baseline data from the Cancer Prevention and Treatment Demonstration Screening Trial. Participants were recruited from November 2006 to March 2010. In-person interviews were used to assess self-reported CRC screening behavior. Up-to-date CRC screening was defined as self-reported colonoscopy or sigmoidoscopy in the past 10 years or fecal occult blood testing in the past year. We used multivariable logistic regression to examine the association between gender and self-reported screening, adjusting for covariates. The final model was stratified by gender to examine factors differentially associated with screening outcomes for males and females. RESULTS The final sample consisted of 1,552 female and 586 male Black Medicare beneficiaries in Baltimore, Maryland. Males were significantly less likely than females to report being up-to-date with screening (77.5% vs. 81.6%, P = 0.030), and this difference was significant in the fully adjusted model (OR: 0.72; 95% confidence interval, 0.52-0.99). The association between having a usual source of care and receipt of cancer screening was stronger among males compared with females. CONCLUSIONS Although observed differences in CRC screening were small, several factors suggest that gender-specific approaches may be used to promote screening adherence among Black Medicare beneficiaries. IMPACT Given disproportionate CRC mortality between White and Black Medicare beneficiaries, gender-specific interventions aimed at increasing CRC screening may be warranted among older Black patients.
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Affiliation(s)
- Kathryn A Martinez
- North Campus Research Complex, 2800 Plymouth Road, Building 16, 4th Floor, Ann Arbor, MI 48109, USA.
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