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Cooper BR, Hill LG, Parker L, Jenkins GJ, Shrestha G, Funaiole A. Using qualitative comparative analysis to uncover multiple pathways to program sustainment: implications for community-based youth substance misuse prevention. Implement Sci Commun 2022; 3:55. [PMID: 35624521 PMCID: PMC9137145 DOI: 10.1186/s43058-022-00303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background In order to achieve wide-scale impact in community settings, programs must be sustained. Theory and empirical evidence suggest that intervention characteristics, organizational context, capacity for program implementation, and processes related to implementation are associated with continued program delivery. However, few studies examine how combinations of these factors work together in different settings to influence program sustainment. Methods Using scales specified in the Program Sustainability Assessment Tool (PSAT), the current cross-sectional study aims to identify the necessary and sufficient conditions for the sustainment of the Strengthening Families Program for Parents and Youth 10-14 (SFP 10-14). Staff (n = 59) at SFP 10-14 implementation sites across Washington State completed an online survey reporting on their current level of SFP 10-14 sustainment. They also completed PSAT, with eight scales designed to assess conditions that consistently produce sustainment. Data were analyzed using qualitative comparative analysis. Results Environmental support was the only necessary condition for sustainment success. Four solutions sufficient to achieve sustainment were also identified. These included the combined presence of (1) environmental support, organizational capacity, and funding stability; (2) environmental support, organizational capacity, communication, and program evaluation, in the absence of strategic planning; (3) environmental support, organizational capacity, program evaluation, and partnerships, in the absence of strategic planning; and (4) environmental support, communication, partnerships, and funding stability, in the absence of program evaluation. Conclusions Environmental support in combination with organizational capacity appeared to most consistently produce sustainment of SFP 10-14 programs in Washington State. Program providers will benefit from a focusing on enhancing those conditions to increase program sustainment.
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Affiliation(s)
- Brittany Rhoades Cooper
- Department of Human Development, Washington State University, Pullman, WA, USA. .,IMPACT Research Lab, Pullman, WA, USA.
| | - Laura G Hill
- Department of Human Development, Washington State University, Pullman, WA, USA.,IMPACT Research Lab, Pullman, WA, USA
| | - Louise Parker
- Department of Human Development, Washington State University, Pullman, WA, USA.,IMPACT Research Lab, Pullman, WA, USA
| | - Garrett J Jenkins
- Department of Human Development, Washington State University, Pullman, WA, USA
| | - Gitanjali Shrestha
- Department of Human Development, Washington State University, Pullman, WA, USA.,IMPACT Research Lab, Pullman, WA, USA
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Lui JHL, Brookman-Frazee L, Lind T, Le K, Roesch S, Aarons GA, Innes-Gomberg D, Pesanti K, Lau AS. Outer-context determinants in the sustainment phase of a reimbursement-driven implementation of evidence-based practices in children's mental health services. Implement Sci 2021; 16:82. [PMID: 34412666 PMCID: PMC8375074 DOI: 10.1186/s13012-021-01149-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there is increasing investment to implement evidence-based practices (EBPs) in public systems across the USA, continued or sustained use of EBPs after initial implementation remains a challenge. The low integration of EBPs in routine practice severely limits their public health impact, highlighting the need to understand factors that affect the return on costly investments in EBP implementation. This study aims to (1) characterize trajectories of EBP delivery volume through a reimbursement-driven implementation and (2) examine impacts of system-level policy regulatory activity and state-level mental health services funding on the implementation reimbursement strategy. METHODS This study involved secondary data analyses. Psychotherapy administrative claims and regulatory site visit data from the Los Angeles County Department of Mental Health and California state mental health expenditures were extracted from 2010 to 2017. Multilevel regression examined EBP claims volume over time with state expenditures and regulatory compliance as predictors. RESULTS EBP claims volume trajectories demonstrated a rapid initial increase, followed by a period of decrease, and a small increase in the final year. State mental health expenditures increased across time reflecting increased funding availability. State mental health expenditures and system regulatory compliance were inversely related to EBP claims volume. CONCLUSIONS The impact of reimbursement-driven EBP implementation strategy is sensitive to multiple outer-context determinants. At the system level, commitment to fidelity of implementation regulations resulted in reduced use of the reimbursement strategy. Alternative reimbursement streams not tied to EBPs coupled with an expanded array of reimbursable services also impacted the use of the reimbursement strategy to implement EBPs.
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Affiliation(s)
- Joyce H L Lui
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA.
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Teresa Lind
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Kenny Le
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Scott Roesch
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | | | - Keri Pesanti
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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3
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Leonard E, de Kock I, Bam W. Barriers and facilitators to implementing evidence-based health innovations in low- and middle-income countries: A systematic literature review. EVALUATION AND PROGRAM PLANNING 2020; 82:101832. [PMID: 32585317 DOI: 10.1016/j.evalprogplan.2020.101832] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/23/2020] [Accepted: 06/04/2020] [Indexed: 05/25/2023]
Abstract
The unsuccessful implementation of health innovations occurs frequently, leading to missed opportunities where improvements could have been made on various aspects of a health system. The purpose of this study is to identify, assess and synthesise the facilitators and barriers to sustainably implementing evidence-based health innovations in a low- and middle-income country (LMIC) context. To identify the LMIC specific facilitators and barriers, a systematic literature review was conducted. 79 studies were analysed, and the implementation barriers and facilitators identified in each study were extracted. The extracted barriers and facilitators were categorised and synthesized into one of seven concepts: context, innovation, relations and networks, institutions, knowledge, actors or resources. There were no substantial variations between the frequency that each concept was identified as a facilitator or barrier to implementation. However, resources, which includes time, human, financial and physical resources, was the most frequently mentioned concept; emphasising the need to focus on the resource situation in LMICs. This study contributes to the growing literature that aims to inform health system planners and evaluators in LMICs on effectively and sustainably implementing evidence-based health innovations.
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Affiliation(s)
- Elizabeth Leonard
- Department of Industrial Engineering, Stellenbosch University, Stellenbosch, Western Cape, South Africa.
| | - Imke de Kock
- Department of Industrial Engineering, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Wouter Bam
- Department of Industrial Engineering, Stellenbosch University, Stellenbosch, Western Cape, South Africa
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Katuramu R, Kamya MR, Sanyu N, Armstrong-Hough M, Semitala FC. Sustainability of the streamlined ART (START-ART) implementation intervention strategy among ART-eligible adult patients in HIV clinics in public health centers in Uganda: a mixed methods study. Implement Sci Commun 2020; 1:37. [PMID: 32885194 PMCID: PMC7427962 DOI: 10.1186/s43058-020-00025-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Despite increasing access to antiretroviral therapy (ART), the proportion of eligible patients initiated on treatment remains suboptimal. Only 64.6% of the people living with HIV (PLHIV) globally were initiated on ART by June 2019. The streamlined ART (START-ART) implementation study was based on the PRECEDE model, which suggests that "predisposing, enabling, and reinforcing" factors are needed to create behavior change. START-ART increased ART initiation within 2 weeks of eligibility by 42%. However, the gains from some implementation interventions erode over time. We evaluated facilitators and barriers to sustainability of this streamlined ART initiation in the year following the implementation period. Methods We designed a mixed-methods explanatory sequential study to examine the sustainability of START-ART implementation. Quantitative component consisted of cross-sectional patient chart reviews of routinely collected data; qualitative component consisted of key informant interviews of health workers in START-ART facilities 2 years after conclusion of the implementation period. We analyzed data from 15 public health centers of Mbarara district, where the START-ART implementation was carried out. We included PLHIV aged > 18 years who initiated ART from June 2013 to July 2016. The START-ART implementation took place from June 2013 to June 2015 while the sustainability period was from August 2015 to July 2016. Results A total of 863 ART-eligible patients were sampled. The median CD4 count was 348 cells/ml (IQR 215-450). During the intervention, 338 (77.4%) eligible patients initiated on ART within 2 weeks compared with 375 (88.2%) during the sustainability period (risk difference 10.8%; 95% CI 5.9-15.8%). In 14 of the 15 health centers, the intervention was sustained. During key informant interviews, rapid ART initiation sustainability was attributed to counseling skills that were obtained during intervention and availability of point-of-care (POC) CD4 PIMA machine. Failure to sustain the intervention was attributed to three specific barriers: lack of training after the intervention, transfer of trained staff to other health facilities, and shortage of supplies like cartridges for POC CD4 PIMA machine. Conclusion Rapid ART initiation was sustained in most health centers. Skills acquired during the intervention and functional POC CD4 machine facilitated while staff transfers and irregular laboratory supplies were barriers to sustainability of rapid ART initiation.
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Affiliation(s)
- Richard Katuramu
- Department of Internal Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.,Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Moses R Kamya
- Department of Internal Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.,Infectious Diseases Research Collaboration, Kampala, Uganda.,Makerere University Joint AIDS Program, Kampala, Uganda
| | - Naome Sanyu
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Fred C Semitala
- Department of Internal Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.,Infectious Diseases Research Collaboration, Kampala, Uganda.,Makerere University Joint AIDS Program, Kampala, Uganda
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Palinkas LA. Commentary: Equity and Exchange in Global Research-Practice Partnerships. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2019; 6:209-213. [PMID: 31828003 PMCID: PMC6905463 DOI: 10.1007/s40609-018-0118-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Lawrence A Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California
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Palinkas LA, Um MY, Aarons GA, Rafful C, Chavarin CV, Mendoza DV, Staines H, Patterson TL. Implementing Evidence-Based HIV Prevention for Female Sex Workers in Mexico: Provider Assessments of Feasibility and Acceptability. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2019; 6:57-68. [PMID: 31632894 PMCID: PMC6800729 DOI: 10.1007/s40609-018-0113-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study examined service provider perceptions of feasibility and acceptability of implementing evidence-based practices for preventing HIV/AIDS and STIs in female sex workers (FSWs) in Mexico. Semi-structured interviews were conducted with 124 directors, supervisors and counselors from 12 reproductive health clinics located throughout Mexico participating in a large randomized controlled trial to scale-up the use of a psychoeducational intervention designed to promote FSW condom use and enhance safer sex negotiation skills. Feasibility was based on assessment of personal, organizational and social costs, benefits, and capacity. Costs included anxiety over intervention competency, purchase of condoms and other supplies, expenses of laboratory tests for HIV/STIs, and stigma associated with FSWs. Benefits included increase in personal knowledge and experience, enhanced clinic reputation and service delivery capacity, and increased public health. Capacity was expressed in terms of provider skills to deliver the intervention and additional workload. Acceptability was expressed in terms of provider enthusiasm in delivering these services and FSWs willingness to receive the services. Service provider evaluations of feasibility and acceptability of implementing evidence-based prevention interventions are grounded in local contexts that define costs and benefits of and capacity for implementation and determine features of the intervention and its implementation that are acceptable.
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Affiliation(s)
- Lawrence A. Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Mee Young Um
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Gregory A. Aarons
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA USA
| | - Claudia Rafful
- Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA USA
- School of Public Health, San Diego State University, San Diego, CA USA
| | - Claudia V. Chavarin
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA USA
| | - Doroteo V. Mendoza
- Research and Evaluation Unit, Mexican Foundation for Family Planning (MexFam), Mexico City, Mexico
| | - Hugo Staines
- Faculty of Biomedical Sciences, Autonomous University of Ciudad Juarez, Ciudad Juárez, Chihuahua, Mexico
| | - Thomas L. Patterson
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA USA
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Pitpitan EV, Semple SJ, Aarons GA, Palinkas LA, Chavarin CV, Mendoza DV, Magis-Rodriguez C, Staines H, Patterson TL. Factors associated with program effectiveness in the implementation of a sexual risk reduction intervention for female sex workers across Mexico: Results from a randomized trial. PLoS One 2018; 13:e0201954. [PMID: 30204761 PMCID: PMC6133277 DOI: 10.1371/journal.pone.0201954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 07/18/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The overall aim of this paper is to examine effectiveness of an evidence-based intervention in community settings, and the factors associated with effectiveness. Limited research in the area of HIV prevention has focused on evaluating intervention program effectiveness in real-world settings. METHODS We implemented an efficacious theory-based sexual risk reduction intervention for female sex workers (FSW) called Mujer Segura across 13 different clinics in 13 sites across Mexico. The overall design was a cluster randomized Type I design simultaneously testing intervention program effectiveness with an observational study of implementation factors. We aimed to examine the effectiveness of Mujer Segura at reducing HIV/STI incidence among FSW participants at each site, and to examine the client-, provider-, organization-, and structure-related factors associated with program effectiveness. RESULTS We found lower HIV/STI incidence density in the intervention relative to the control group in 5 sites we labeled as "program effective sites," but not in 8 sites we labeled as "program ineffective sites." Using generalized estimating equations controlling for site and computed mean difference effect sizes, we examined statistically and practically significant differences, respectively, between the two groups of sites along various client-, provider-, organization-, and structure-related characteristics. Results indicated that client-level HIV/AIDS related knowledge, and proficiency and engagement in the organizational social context were associated with program effectiveness. CONCLUSIONS Enormous resources are required to systematically and adequately test the role of multilevel factors on program effectiveness. We successfully implemented Mujer Segura in 13 sites in Mexico. Results suggest that other measures may need to be included in future implementation studies than the ones included here. We were able to point to a few specific factors that should be targeted to increase effectiveness of similar evidence-based programs in low- and other middle-income countries like Mexico. TRIAL REGISTRATION ClinicalTrials.gov NCT01465607.
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Affiliation(s)
- Eileen V. Pitpitan
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Shirley J. Semple
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Gregory A. Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Lawrence A. Palinkas
- School of Social Work, University of Southern California, Los Angeles, California, United States of America
| | - Claudia V. Chavarin
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Doroteo V. Mendoza
- Evaluation and Research Department, Mexican Foundation for Family Planning (Mexfam), Mexico City, Mexico
| | - Carlos Magis-Rodriguez
- Centro Nacional para la Prevencíon y Control del VIH/SIDA (CENSIDA), Mexico City, Mexico
| | - Hugo Staines
- Universidad Autonoma de Ciudad Juarez, Ciudad Juarez, Chihuahua, Mexico
| | - Thomas L. Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
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Shelton RC, Cooper BR, Stirman SW. The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care. Annu Rev Public Health 2018; 39:55-76. [PMID: 29328872 DOI: 10.1146/annurev-publhealth-040617-014731] [Citation(s) in RCA: 335] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There is strong interest in implementation science to address the gap between research and practice in public health. Research on the sustainability of evidence-based interventions has been growing rapidly. Sustainability has been defined as the continued use of program components at sufficient intensity for the sustained achievement of desirable program goals and population outcomes. This understudied area has been identified as one of the most significant translational research problems. Adding to this challenge is uncertainty regarding the extent to which intervention adaptation and evolution are necessary to address the needs of populations that differ from those in which interventions were originally tested or implemented. This review critically examines and discusses conceptual and methodological issues in studying sustainability, summarizes the multilevel factors that have been found to influence the sustainability of interventions in a range of public health and health care settings, and highlights key areas for future research.
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Affiliation(s)
- Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA;
| | - Brittany Rhoades Cooper
- Department of Human Development, Washington State University, Pullman, Washington 99164, USA;
| | - Shannon Wiltsey Stirman
- Dissemination and Training Division, National Center for PTSD and Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California 94024, USA;
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Shelton RC, Charles TA, Dunston SK, Jandorf L, Erwin DO. Advancing understanding of the sustainability of lay health advisor (LHA) programs for African-American women in community settings. Transl Behav Med 2017; 7:415-426. [PMID: 28337722 PMCID: PMC5645282 DOI: 10.1007/s13142-017-0491-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Lay health advisor (LHA) programs have made strong contributions towards the elimination of health disparities and are increasingly being implemented to promote health and prevent disease. Developed in collaboration with African-American survivors, the National Witness Project (NWP) is an evidence-based, community-led LHA program that improves cancer screening among African-American women. NWP has been successfully disseminated, replicated, and implemented nationally in over 40 sites in 22 states in diverse community settings, reaching over 15,000 women annually. We sought to advance understanding of barriers and facilitators to the long-term implementation and sustainability of LHA programs in community settings from the viewpoint of the LHAs, as well as the broader impact of the program on African-American communities and LHAs. In the context of a mixed-methods study, in-depth telephone interviews were conducted among 76 African-American LHAs at eight NWP sites at baseline and 12-18 months later, between 2010 and 2013. Qualitative data provides insight into inner and outer contextual factors (e.g., community partnerships, site leadership, funding), implementation processes (e.g., training), as well as characteristics of the intervention (e.g., perceived need and fit in African-American community) and LHAs (e.g., motivations, burnout) that are perceived to impact the continued implementation and sustainability of NWP. Factors at the contextual levels and related to motivations of LHAs are critical to the sustainability of LHA programs. We discuss how findings are used to inform (1) the development of the LHA Sustainability Framework and (2) strategies to support the continued implementation and sustainability of evidence-based LHA interventions in community settings.
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Affiliation(s)
- Rachel C. Shelton
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, 722 168th Street, Room 941, New York, NY 10032 USA
| | - Thana-Ashley Charles
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, 722 168th Street, Room 941, New York, NY 10032 USA
| | - Sheba King Dunston
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, 722 168th Street, Room 941, New York, NY 10032 USA
- Present Address: Office of Research and Methodology, Question Design Research Laboratory, National Centers for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Hyattsville, MD 20782 USA
| | - Lina Jandorf
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1130, New York, NY 10029 USA
| | - Deborah O. Erwin
- Office of Cancer Health Disparities Research, Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263 USA
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