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Kolobova I, Nyaku MK, Karakusevic A, Bridge D, Fotheringham I, O'Brien M. Vaccine uptake and barriers to vaccination among at-risk adult populations in the US. Hum Vaccin Immunother 2022; 18:2055422. [PMID: 35536017 PMCID: PMC9248946 DOI: 10.1080/21645515.2022.2055422] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To reduce morbidity and mortality associated with vaccine-preventable diseases (VPD), it is imperative that vaccination programs are implemented and prioritized throughout all stages of life across all populations. This study aimed to determine vaccine uptake and barriers to vaccination against VPDs among at-risk adult populations in the United States. We conducted a systematic literature review for articles published between January 2010 and June 2020 and identified 153 publications. The review identified 17 at-risk populations. Vaccine uptake was suboptimal among many populations, with factors including age, gender, and disease severity, associated with uptake. This review identified several barriers that impact vaccine uptake among at-risk populations, with concerns over safety, vaccine costs, lack of insurance, and lack of provider recommendation commonly reported across populations. Embracing a national life-course immunization framework that integrates developing policies, guidelines, and education would be a step to addressing these barriers.
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Affiliation(s)
- Irina Kolobova
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Mawuli Kwame Nyaku
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | | | - Megan O'Brien
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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Paskett ED, Pennell ML, Ruffin MT, Weghorst CM, Lu B, Hade EM, Peng J, Bernardo BM, Wewers ME. A Multi-level Model to Understand Cervical Cancer Disparities in Appalachia. Cancer Prev Res (Phila) 2021; 13:223-228. [PMID: 32132116 DOI: 10.1158/1940-6207.capr-19-0239] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/15/2019] [Accepted: 09/13/2019] [Indexed: 02/06/2023]
Abstract
The Appalachian region experiences higher incidence and mortality due to cervical cancer compared with other regions of the United States. The goal of the Ohio State University Center for Population Health and Health Disparities (CPHHD), called the Community Awareness Resources and Education (CARE) project, was to understand reasons for this disparity. The first wave (2003-2008) of funding included three projects focusing on the known risk factors for cervical cancer, lack of screening, smoking, and infection with human papillomavirus (HPV). On the basis of the results of these projects, the second wave (2011-2017) included four projects, designed to address a multi-level model of factors contributing to cervical disparities in Appalachia. The results of these projects were then used to refine a multi-level model that explains cervical cancer disparities in Appalachia. Future funded projects will take these multi-level explanations for cervical disparities and focus on implementation science strategies to reduce the burden of cervical cancer morbidity and mortality in Appalachia.See all articles in this Special Collection Honoring Paul F. Engstrom, MD, Champion of Cancer Prevention.
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Affiliation(s)
- Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio. .,Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Michael L Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Mack T Ruffin
- Department of Family and Community Medicine, Penn State College of Medicine, Milton S. Hersey Medical Center, Hershey, Pennsylvania
| | - Christopher M Weghorst
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.,Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Bo Lu
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Erinn M Hade
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Juan Peng
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | | | - Mary Ellen Wewers
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio
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3
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Bertagnolli MM. Cancer Care in the Rural United States: A Visitor’s Perspective From Appalachian Ohio; Pine Ridge, South Dakota; and Sidney, Montana. JCO Oncol Pract 2020; 16:405-407. [DOI: 10.1200/op.20.00244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hewage SS, Griswold HR, Sergeev AV, Gerome JM, Hamilton A, Holben DH. Women in food insecure, rural Appalachian households participate in risky sexual behaviors: a pilot study. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2020. [DOI: 10.1080/19320248.2018.1491366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | | | - Jody M. Gerome
- Ohio University Heritage College of Osteopathic Medicine
| | | | - David H. Holben
- Department of Nutrition and Hospitality Management, University of Mississippi School of Applied Sciences
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Linn BK, Ely GE, Staton M. Latent Profiles of Health and Reproductive Risk and Protective Factors among Women in Appalachia. JOURNAL OF SOCIAL WORK PRACTICE IN THE ADDICTIONS 2020; 20:155-167. [PMID: 33209100 PMCID: PMC7668409 DOI: 10.1080/1533256x.2020.1748976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Women who use opiates and are involved in the criminal justice system in Appalachia may be prone to adverse health outcomes. In this study, we performed a latent class analysis of risk and protective factors on 400 drug-using women recruited from rural, Appalachian jails. A two-profile solution best fit the data. Both profiles evinced low levels of condom use, reproductive and physical health screens, and STD history. However, the primary substantive difference between the profiles was partner risk behavior: the higher risk class had main male partners with histories of injection drug use and incarceration. Results suggest that interventions need to be tailored to unique profiles of risk and protective factors, which should include taking partner risk into consideration.
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Affiliation(s)
- Braden K Linn
- Clinical and Research Institute on Addictions, University at Buffalo, The State University of New York, Buffalo, NY
| | - Gretchen E Ely
- School of Social Work, University at Buffalo, The State University of New York, Buffalo, NY
| | - Michele Staton
- University of Kentucky, College of Medicine, Medical Behavioral Science Building, Lexington, KY
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6
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Knobloch TJ, Peng J, Hade EM, Cohn DE, Ruffin MT, Schiano MA, Calhoun BC, McBee WC, Lesnock JL, Gallion HH, Pollock J, Lu B, Oghumu S, Zhang Z, Sears MT, Ogbemudia BE, Perrault JT, Weghorst LC, Strawser E, DeGraffinreid CR, Paskett ED, Weghorst CM. Inherited alterations of TGF beta signaling components in Appalachian cervical cancers. Cancer Causes Control 2019; 30:1087-1100. [PMID: 31435875 PMCID: PMC6768402 DOI: 10.1007/s10552-019-01221-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 08/15/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE This study examined targeted genomic variants of transforming growth factor beta (TGFB) signaling in Appalachian women. Appalachian women with cervical cancer were compared to healthy Appalachian counterparts to determine whether these polymorphic alleles were over-represented within this high-risk cancer population, and whether lifestyle or environmental factors modified the aggregate genetic risk in these Appalachian women. METHODS Appalachian women's survey data and blood samples from the Community Awareness, Resources, and Education (CARE) CARE I and CARE II studies (n = 163 invasive cervical cancer cases, 842 controls) were used to assess gene-environment interactions and cancer risk. Polymorphic allele frequencies and socio-behavioral demographic measurements were compared using t tests and χ2 tests. Multivariable logistic regression was used to evaluate interaction effects between genomic variance and demographic, behavioral, and environmental characteristics. RESULTS Several alleles demonstrated significant interaction with smoking (TP53 rs1042522, TGFB1 rs1800469), alcohol consumption (NQO1 rs1800566), and sexual intercourse before the age of 18 (TGFBR1 rs11466445, TGFBR1 rs7034462, TGFBR1 rs11568785). Interestingly, we noted a significant interaction between "Appalachian self-identity" variables and NQO1 rs1800566. Multivariable logistic regression of cancer status in an over-dominant TGFB1 rs1800469/TGFBR1 rs11568785 model demonstrated a 3.03-fold reduction in cervical cancer odds. Similar decreased odds (2.78-fold) were observed in an over-dominant TGFB1 rs1800469/TGFBR1 rs7034462 model in subjects who had no sexual intercourse before age 18. CONCLUSIONS This study reports novel associations between common low-penetrance alleles in the TGFB signaling cascade and modified risk of cervical cancer in Appalachian women. Furthermore, our unexpected findings associating Appalachian identity and NQO1 rs1800566 suggests that the complex environmental exposures that contribute to Appalachian self-identity in Appalachian cervical cancer patients represent an emerging avenue of scientific exploration.
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Affiliation(s)
- Thomas J Knobloch
- College of Public Health, The Ohio State University, Columbus, OH, 43210, USA.
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA.
| | - Juan Peng
- Department of Biomedical Informatics, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Erinn M Hade
- Department of Biomedical Informatics, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - David E Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wexner Medical Center, College of Medicine, The Ohio State University Columbus, Columbus, OH, 43210, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Mack T Ruffin
- Department of Family and Community Medicine, Milton S. Hershey Medical Center, Penn State University, Hersey, PA, 17033, USA
| | - Michael A Schiano
- Department of Obstetrics & Gynecology, West Virginia University, Charleston, WV, 26505, USA
- Charleston Area Medical Center Health System, Charleston, WV, 25302, USA
| | - Byron C Calhoun
- Department of Obstetrics & Gynecology, West Virginia University, Charleston, WV, 26505, USA
- Charleston Area Medical Center Health System, Charleston, WV, 25302, USA
| | | | | | | | - Jondavid Pollock
- Wheeling Hospital, Schiffler Cancer Center, Wheeling, WV, 26003, USA
| | - Bo Lu
- College of Public Health, The Ohio State University, Columbus, OH, 43210, USA
| | - Steve Oghumu
- College of Public Health, The Ohio State University, Columbus, OH, 43210, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Zhaoxia Zhang
- College of Public Health, The Ohio State University, Columbus, OH, 43210, USA
| | - Marta T Sears
- College of Public Health, The Ohio State University, Columbus, OH, 43210, USA
| | | | - Joseph T Perrault
- Division of Cancer Prevention and Control, Wexner Medical Center, College of Medicine, The Ohio State University Columbus, Columbus, OH, 43210, USA
| | - Logan C Weghorst
- College of Public Health, The Ohio State University, Columbus, OH, 43210, USA
| | - Erin Strawser
- College of Public Health, The Ohio State University, Columbus, OH, 43210, USA
| | - Cecilia R DeGraffinreid
- Division of Cancer Prevention and Control, Wexner Medical Center, College of Medicine, The Ohio State University Columbus, Columbus, OH, 43210, USA
| | - Electra D Paskett
- College of Public Health, The Ohio State University, Columbus, OH, 43210, USA
- Division of Cancer Prevention and Control, Wexner Medical Center, College of Medicine, The Ohio State University Columbus, Columbus, OH, 43210, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Christopher M Weghorst
- College of Public Health, The Ohio State University, Columbus, OH, 43210, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
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Presser BE, Katz ML, Shoben AB, Moore D, Ruffin MT, Paskett ED, Reiter PL. Effects of an Education Intervention about HPV Self-Testing for Healthcare Providers and Staff. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:954-959. [PMID: 28074444 PMCID: PMC5503812 DOI: 10.1007/s13187-017-1164-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Human papillomavirus (HPV) self-testing is an emerging cervical cancer screening strategy, yet efforts to educate healthcare providers and staff about HPV self-testing are lacking. We report the findings of a brief education intervention about HPV self-testing for healthcare providers and staff. We conducted education sessions during 2015 with healthcare providers and staff (n = 33) from five federally qualified health centers located in Appalachian Ohio. Participants attended a one-time session and completed pre- and post-intervention surveys. Analyses for paired data assessed changes in knowledge and beliefs about HPV, HPV-related disease, and HPV self-testing. The intervention increased participants' knowledge and affected many of the beliefs examined. Participants answered an average of 4.67 of six knowledge items correctly on pre-intervention surveys and 5.82 items correctly on post-intervention surveys (p < 0.001). The proportion of participants who answered all six knowledge items correctly increased substantially (pre-intervention =9% vs. post-intervention =82%, p < 0.001). Compared to pre-intervention surveys, participants more strongly believed on post-intervention surveys that it is important to examine HPV self-testing as a potential cervical cancer screening strategy, that their female patients would be willing to use an HPV self-test at home by themselves, and that they have the knowledge to talk with their patients about HPV self-testing (all p < 0.05). A brief education intervention can be a viable approach for increasing knowledge and affecting beliefs about HPV self-testing among healthcare providers and staff. Findings will be valuable for planning and developing future HPV self-test interventions that include an education component for healthcare providers and staff.
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Affiliation(s)
| | - Mira L Katz
- College of Public Health, The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, 1590 North High Street, Suite 525, Columbus, OH, 43201, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Abigail B Shoben
- College of Public Health, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | | | - Mack T Ruffin
- Department of Family and Community Medicine, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Electra D Paskett
- College of Public Health, The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, 1590 North High Street, Suite 525, Columbus, OH, 43201, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Paul L Reiter
- College of Public Health, The Ohio State University, Columbus, OH, USA.
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, 1590 North High Street, Suite 525, Columbus, OH, 43201, USA.
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
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Human Papillomavirus Prevalence Is Associated With Socioeconomic Gradients Within a Medically Underserved Appalachian Region. Sex Transm Dis 2017; 44:750-755. [PMID: 28876304 DOI: 10.1097/olq.0000000000000675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess type-specific prevalence of human papillomavirus (HPV) infection in a medically underserved Appalachian area and to determine whether gradients in poverty are associated with prevalence. METHODS Among 398 women, a validated assay tested self-collected cervicovaginal samples for 37 HPV types. Three economic strata were created based on household income: below the federal poverty level for 1 person, between the FPLs for families of 1 to 4 persons, and above the FPL for a family of 4. RESULTS Prevalence was 55.6%, with 33% having at least 1 high-risk infection. Prevalence was 27.8% for 9-valent HPV vaccine-preventable types and 39.2% for multiple types. Compared with FPL for a family of 4, women with federal poverty level for 1 person had 3 times greater prevalence, 2.3 times greater prevalence of high-risk types, and 2.5 times greater prevalence of multiple types. CONCLUSION Human papillomavirus prevalence was high, with one-third of the sample having at least 1 high-risk type and those in the lowest-income category being disproportionately infected.
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Karuri AR, Kashyap VK, Yallapu MM, Zafar N, Kedia SK, Jaggi M, Chauhan SC. Disparity in rates of HPV infection and cervical cancer in underserved US populations. Front Biosci (Schol Ed) 2017; 9:254-269. [PMID: 28410118 DOI: 10.2741/s486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
There is a higher rate of HPV infection and cervical cancer incidence and mortality in underserved US population who reside in Appalachian mountain region compared to Northern Plains. Social and behavioral factors such as smoking and alcohol consumption are for such a high incidence. However, by and large, the reasons for these discrepancies lie in the reluctance of the underserved population to adopt preventive measures such as prophylactic Human papilloma virus (HPV) vaccines and Pap smear screening that have significantly reduced the incidence and mortality rate of cervical cancer in Caucasian women. Thus, it is clear that drastic change in social behavior and implementation of preventive measures is required to effectively reduce the incidence and mortality from cervical cancer in this underserved population.
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Affiliation(s)
- Asok Ranjan Karuri
- Department of Pharmaceutical Sciences and Cancer Research Center, University of Tennessee Health Science Center, Memphis, Tennessee, USA, 38163
| | - Vivek Kumar Kashyap
- Department of Pharmaceutical Sciences and Cancer Research Center, University of Tennessee Health Science Center, Memphis, Tennessee, USA, 38163
| | - Murali Mohan Yallapu
- Department of Pharmaceutical Sciences and Cancer Research Center, University of Tennessee Health Science Center, Memphis, Tennessee, USA, 38163
| | - Nadeem Zafar
- Department of Pathology, University of Tennessee Health Science Center, Memphis, Tennessee, USA, 38163
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, 38152
| | - Meena Jaggi
- Department of Pharmaceutical Sciences and Cancer Research Center, University of Tennessee Health Science Center, Memphis, Tennessee, USA, 38163
| | - Subhash C Chauhan
- Department of Pharmaceutical Sciences and Cancer Research Center, University of Tennessee Health Science Center, Memphis, Tennessee, USA, 38163,
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Paskett ED, Krok-Schoen JL, Pennell ML, Tatum CM, Reiter PL, Peng J, Bernardo BM, Weier RC, Richardson MS, Katz ML. Results of a Multilevel Intervention Trial to Increase Human Papillomavirus (HPV) Vaccine Uptake among Adolescent Girls. Cancer Epidemiol Biomarkers Prev 2017; 25:593-602. [PMID: 27196093 DOI: 10.1158/1055-9965.epi-15-1243] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/12/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Uptake of the human papillomavirus (HPV) vaccine is low in Appalachian Ohio and areas with high cervical cancer rates. METHODS We conducted a group-randomized trial among 12 counties in Appalachian Ohio randomized to receive either an HPV vaccine (intervention counties) or influenza vaccine (comparison counties) multilevel intervention (MLI). Parents (n = 337) who had a daughter aged 9 to 17 years who had not received the HPV vaccine were recruited from commercial lists. Clinics (N = 24) and 119 providers from these clinics were also recruited. The primary outcome was medical record-confirmed receipt of the first shot of the HPV vaccine 3 months after receiving the intervention among daughters of parents enrolled in the study. Secondary outcomes included receipt of the first HPV vaccine shot by 6 months and changes in provider knowledge. RESULTS According to medical records, 10 (7.7%) daughters of intervention participants received the first shot of the HPV vaccine within 3 months of being sent the intervention materials compared with 4 (3.2%) daughters of comparison group participants (P = 0.061). By 6 months, 17 (13.1%) daughters of intervention participants received the first HPV vaccine shot compared with eight (6.5%) daughters of comparison group participants (P = 0.002). Provider knowledge about HPV increased (P < 0.001, from baseline to after education). CONCLUSIONS The MLI increased uptake of the HPV vaccine among girls aged 9 to 17 years; however, uptake was low. IMPACT To improve HPV vaccine uptake, attention to additional levels of influence (e.g., policy, community) and more elements within levels (e.g., reminders, automated prompts) may be needed. Cancer Epidemiol Biomarkers Prev; 25(4); 593-602. ©2016 AACR SEE ALL ARTICLES IN THIS CEBP FOCUS SECTION, "MULTILEVEL APPROACHES TO ADDRESSING CANCER HEALTH DISPARITIES".
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Affiliation(s)
- Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio. Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio.
| | | | - Michael L Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Cathy M Tatum
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Paul L Reiter
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio. Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Juan Peng
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | | | | | - Morgan S Richardson
- Department of Neurology, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Mira L Katz
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio. Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio
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Katz ML, Zimmermann BJ, Moore D, Paskett ED, Reiter PL. Perspectives from health-care providers and women about completing human papillomavirus (HPV) self-testing at home. Women Health 2016; 57:1161-1177. [PMID: 27700693 DOI: 10.1080/03630242.2016.1243608] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cervical cancer (CC) incidence and mortality rates are increased, and CC screening rates are low among Appalachian Ohio women. Mailing human papillomavirus (HPV) self-tests to women to complete at home is a potential new strategy to engage women in CC screening. The authors aimed to gain insights into the perceived acceptability of mailed HPV self-tests. Focus groups were conducted (August 2014-January 2015) among providers (physicians, nurse practitioners, nurses) and women in Appalachian Ohio. Providers (n = 28) and women (n = 15; age range: 32-62 years) reported general acceptance of HPV self-tests, however, for different reasons. Providers thought HPV self-testing would increase the proportion of under-screened women returning to the health-care system, while women thought self-testing would eliminate logistical and reduce psychological CC screening barriers. Findings provide insights into facilitators and barriers of completing an HPV self-test at home, returning it, reporting results, and providing needed follow-up care. To the authors' knowledge, no systematic research exists addressing providers' views regarding women's use of HPV self-tests and the relation of such use to fostering subsequent Pap testing. This information will be useful in developing CC screening programs that include mailed HPV self-tests, as well as encouragement of follow-up Pap testing to meet existing CC screening guidelines.
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Affiliation(s)
- Mira L Katz
- a Division of Health Behavior and Health Promotion, College of Public Health , The Ohio State University , Columbus , Ohio , USA.,b Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine , The Ohio State University , Columbus , Ohio , USA.,c Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA
| | - Barret J Zimmermann
- c Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA
| | - Deborah Moore
- d Valley View Health Centers , Waverlys , Ohio , USA
| | - Electra D Paskett
- b Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine , The Ohio State University , Columbus , Ohio , USA.,c Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA
| | - Paul L Reiter
- b Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine , The Ohio State University , Columbus , Ohio , USA.,c Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA
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Kish JK, Rolin AI, Zou Z, Cucinelli JE, Tatalovich Z, Saraiya M, Altekruse SF. Prioritizing US Cervical Cancer Prevention With Results From a Geospatial Model. J Glob Oncol 2016; 2:275-283. [PMID: 28413829 DOI: 10.1200/jgo.2015.001677] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine if differences in screening and vaccination patterns across the population may accentuate ethnic and geographic variation in future burden of disease. METHODS Using Cancer in North America data provided by the North American Association of Central Cancer Registries, county cervical cancer incidence trends from 1995 to 2009 were modeled for the entire United States using ecologic covariates. Rates for health service areas were also modeled by ethnicity. State-level incidence was mapped together with Papanicolaou (Pap) screening, past 3 years (women ≥ 18 years old), and three-dose human papillomavirus (HPV) vaccine coverage (girls 13 to 17 years old) to identify potential priority areas for preventive services. RESULTS US cervical cancer incidence decreased more during the periods 1995 to 1999 and 2000 to 2004 than during the period 2005 to 2009. During these 15 years, the most affected areas became increasingly confined to Appalachia, the lower Mississippi Valley, the Deep South, Texas, and Florida. Hispanic and black women experienced a higher incidence of cervical cancer than both white and Asian and Pacific Islander women during each period. Women in 10 of 17 states/districts with a high incidence (≥ 8.14/100,000) reported low Pap testing (< 78.5%), HPV vaccine coverage (< 33.9%), or both prevention technologies. CONCLUSION The decline in cervical cancer incidence has slowed in recent years. Access to HPV vaccination, targeted screening, and treatment in affected populations is needed to reduce cervical cancer disparities in the future.
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Affiliation(s)
| | | | - Zhaohui Zou
- Information Management Services, Silver Spring, MD
| | | | | | - Mona Saraiya
- Centers for Disease Control and Prevention, Atlanta, GA
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Nesbitt S, Palomarez RE. Review: Increasing Awareness and Education on Health Disparities for Health Care Providers. Ethn Dis 2016; 26:181-90. [PMID: 27103768 DOI: 10.18865/ed.26.2.181] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The focus of this review is to highlight health care disparities and trends in several common diseases in selected populations while offering evidence-based approaches to mitigating health care disparities. Health care disparities cross many barriers and affect multiple populations and diseases. Ethnic minorities, the elderly, and those of lower socioeconomic status (SES) are more at-risk than others. However, many low SES Whites and higher SES racial minorities have poorer health than their racial or SES peers. Also, recent immigrant groups and Hispanics, in particular, maintain high health ratings. The so-called Hispanic Paradox provides an example of how culture and social background can be used to improve health outcomes. These groups have unique determinants of disparity that are based on a wide range of cultural and societal factors. Providing improved access to care and reducing the social determinants of disparity is crucial to improving public health. At the same time, for providers, increasing an understanding of the social determinants promotes better models of individualized care to encourage more equitable care. These approaches include increasing provider education on disparities encountered by different populations, practicing active listening skills, and utilizing a patient's cultural background to promote healthy behaviors.
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Kelly KM, Schoenberg N, Wilson TD, Atkins E, Dickinson S, Paskett E. Cervical cancer worry and screening among appalachian women. J Prim Prev 2015; 36:79-92. [PMID: 25416153 DOI: 10.1007/s10935-014-0379-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although many have sought to understand cervical cancer screening (CCS) behavior, little research has examined worry about cervical cancer and its relationship to CCS, particularly in the underserved, predominantly rural Appalachian region. Our mixed method investigation aimed to obtain a more complete and theoretically-informed understanding of the role of cancer worry in CCS among Appalachian women, using the Self-Regulation Model (SRM). Our quantitative analysis indicated that the perception of being at higher risk of cervical cancer and having greater distress about cancer were both associated with greater worry about cancer. In our qualitative analysis, we found that, consistent with the SRM, negative affect had a largely concrete-experiential component, with many women having first-hand experience of the physical consequences of cervical cancer. Based on the results of this manuscript, we describe a number of approaches to lessen the fear associated with CCS. Intervention in this elevated risk community is merited and may focus on decreasing feelings of worry about cervical cancer and increasing communication of objective risk and need for screening. From a policy perspective, increasing the quantity and quality of care may also improve CCS rates and decrease the burden of cancer in Appalachia.
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Affiliation(s)
- Kimberly M Kelly
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, Mary Babb Randolph Cancer Center, Robert C. Byrd Health Sciences Center, West Virginia University, PO Box 9510, Morgantown, WV, 26506, USA,
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15
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Vanderpool RC, Dressler EVM, Stradtman LR, Crosby RA. Fatalistic beliefs and completion of the HPV vaccination series among a sample of young Appalachian Kentucky women. J Rural Health 2015; 31:199-205. [PMID: 25640763 DOI: 10.1111/jrh.12102] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Uptake and completion of the 3-dose human papillomavirus (HPV) vaccine is important for the primary prevention of cervical cancer. However, HPV vaccination rates among adolescent females and young women remain low in certain geographic areas of the United States, including Appalachia. Although greater fatalistic beliefs have been previously associated with lower rates of preventive cancer behaviors among adults, little research exists on the impact of fatalism on HPV vaccination behaviors, especially among younger individuals. Therefore, the purpose of this study was to examine the association between fatalistic beliefs and completion of the full HPV vaccine series among young women, ages 18-26, in Appalachian Kentucky. RESULTS Data from this study were from a baseline survey completed by 344 women randomized into a communication intervention trial focused on increasing adherence to the 3-dose HPV vaccine series. Principal components analysis was used to construct 2 fatalism-related subscales from 8 survey questions. FINDINGS In a controlled analysis, 1 subscale--"lack of control over cancer"--was significantly associated with not completing the full HPV vaccine series. In a rural area that experiences higher rates of cervical cancer, poverty, limited access to health care, and negative cancer-related attitudes and experiences, fatalism may be common, even among young people. CONCLUSION Future educational and interventional research addressing fatalistic beliefs in a culturally sensitive manner may be warranted to improve HPV vaccination behaviors and impact cancer disparities among Appalachian women.
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Wilson AR, Welch RJ, Hashibe M, Greenwood J, Jackson B, She RC. Surveillance of human papilloma virus using reference laboratory data for the purpose of evaluating vaccine impact. Online J Public Health Inform 2014; 6:e194. [PMID: 25598867 PMCID: PMC4292532 DOI: 10.5210/ojphi.v6i3.5593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Nationwide positivity rates of high-risk human papillomavirus for the United States before and since the introduction of a Human Papillomavirus (HPV) vaccine in 2006 would provide insight into the population impact of HPV vaccination. Data for high-risk HPV testing results from January 1, 2004 to June 1, 2013 at a national reference laboratory were retrospectively analyzed to produce 757,761 patient records of women between the ages of 14 and 59. Generalized linear models and finite mixture models were utilized to eliminate sources of bias and establish a population undergoing standard gynecological screening. Unadjusted positivity rates for high-risk HPV were 27.2% for all age groups combined. Highest rates occurred in women aged 14 to 19. While the positivity rates decreased for all age groups from 2004 to 2013, the higher age categories showed less downward trend following vaccine introduction, and the two age categories 20 to 24 and 25 to 29 showed a significantly different downward trend between pre- and post-vaccine time periods (-0.1% per year to -1.5% per year, and 0.4% per year to -1.5% per year, respectively). All other age groups had rates of change that became less negative, indicating a slower rate of decline.
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Affiliation(s)
- Andrew R Wilson
- University of Utah Department of Family and Preventive Medicine, Salt
Lake City, Utah
| | - Ryan J. Welch
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake
City, Utah
| | - Mia Hashibe
- University of Utah Department of Family and Preventive Medicine, Salt
Lake City, Utah
| | - Jessica Greenwood
- University of Utah Department of Family and Preventive Medicine, Salt
Lake City, Utah
| | - Brian Jackson
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake
City, Utah
| | - Rosemary C. She
- Keck School of Medicine of the University of Southern California, Los
Angeles, California
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