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Carbunaru S, Rich JM, Neshatvar Y, Murray K, Nayan M. Differences in the treatment patterns of small renal masses: A disaggregated analyses by race/ethnicity. Urol Oncol 2024:S1078-1439(24)00638-0. [PMID: 39368941 DOI: 10.1016/j.urolonc.2024.08.020] [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: 05/14/2024] [Revised: 06/27/2024] [Accepted: 08/27/2024] [Indexed: 10/07/2024]
Abstract
OBJECTIVE To characterize differences in the management of small renal masses among disaggregated race/ethnic subgroups. MATERIAL AND METHODS We used the National Cancer Database to identify patients diagnosed with clinically localized kidney cancer and tumor size ≤4cm. We studied 16 predefined racial/ethnic subgroups and compared 1) the use of surveillance for tumors <2cm and 2) the use of radical nephrectomy for tumors ≤4cm. We used multivariable logistic regression to evaluate the independent association of race/ethnicity with management, adjusting for baseline characteristics. We also compared our disaggregated analyses to the 6 National Institute of Health aggregate race categories. RESULTS We identified 286,063 patients that met inclusion criteria. For tumors <2cm, Black Non-Hispanic (aOR 1.43) and Mexican patients (aOR 1.29) were significantly more likely to undergo surveillance compared to White patients. For tumors ≤4cm, Black Non-Hispanic (aOR 1.43), Filipino (aOR 1.28), Japanese (aOR 1.28), Mexican (aOR 1.32), and Native Indian patients (aOR 1.15) were significantly more likely to undergo radical nephrectomy compared to White patients. When comparing our disaggregated analyses to the NIH categories, we found that many disaggregated race/ethnic subgroups had associations with management strategies that were not represented by their aggregated group. CONCLUSIONS In this study, we found that the use of surveillance for tumors <2cm and radical nephrectomy for tumors ≤4cm varied significantly among certain race/ethnic subgroups. Our disaggregated approach provides information on differences in treatment patterns in particular subgroups that warrant further study to optimize kidney cancer care for all patients.
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Affiliation(s)
- Samuel Carbunaru
- Department of Urology, New York University School of Medicine, New York, NY
| | - Jordan M Rich
- Department of Urology, New York University School of Medicine, New York, NY
| | - Yassamin Neshatvar
- Department of Urology, New York University School of Medicine, New York, NY
| | - Katie Murray
- Department of Urology, New York University School of Medicine, New York, NY
| | - Madhur Nayan
- Department of Urology, New York University School of Medicine, New York, NY; Department of Population Health, New York University School of Medicine, New York, NY.
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2
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Kim DK, Rohde CH. Disaggregation of Asian American, Native Hawaiian, and Pacific Islander populations in postmastectomy breast reconstruction. J Plast Reconstr Aesthet Surg 2024; 96:58-68. [PMID: 39059255 DOI: 10.1016/j.bjps.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/21/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE Asian American, Native Hawaiian, and Pacific Islander (AANHPI) patient populations are often defined as one monolithic group in medical research despite cultural, socioeconomic, and clinical heterogeneity. Although the general AANHPI population is underrepresented in reception of postmastectomy breast reconstruction, existing literature has not characterized the disaggregation of such rates for AANHPI ethnic subgroups. METHODS Patients who underwent mastectomy were identified in the 2007 to 2020 registries within the Surveillance, Epidemiology and End Results database. Patients were stratified by race and ethnicity, and additional demographic and oncologic variables were collected. Multivariate binary logistic regression was conducted to assess for reception of postmastectomy immediate breast reconstruction (p < 0.05). RESULTS Among 33,422 AANHPI patients who underwent mastectomy, South Asian patients were associated with the highest breast reconstruction rates (33%) and Melanesians with the lowest (15%). Overall, AANHPI patients were associated with a lower breast reconstruction rate than non-Hispanic Whites (27% vs. 35%; p < 0.001). This difference increased from 6.4% in 2007 to 10% in 2020. After controlling for demographic and oncologic covariates, all AANHPI ethnic subgroups predicted a lower likelihood of breast reconstruction than non-Hispanic Whites (p < 0.001). Odds ratios for reconstruction ranged from 0.17 [95% confidence interval (95% CI), 0.11-0.27] for Melanesian patients to 0.45 (95% CI, 0.42-0.48) for South Asian patients. CONCLUSIONS Disparities in the receipt of immediate breast reconstruction exist within the AANHPI patient population in the United States. This analysis supported the need for disaggregation in plastic surgery research for improved knowledge and targeted interventions.
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Affiliation(s)
- Dylan K Kim
- Division of Plastic and Reconstructive Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Christine H Rohde
- Division of Plastic and Reconstructive Surgery, Columbia University Irving Medical Center, New York, NY, USA.
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Taafaki MR, Taira D, Braun KL. Scoping Review of Interventional Studies in Chronic Disease for Native Hawaiian, Pacific Islander, and Filipino Populations in the United States. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:58-66. [PMID: 37901666 PMCID: PMC10612424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Native Hawaiians (NHs), Pacific Islanders (PIs), and Filipinos experience health disparities in the United States (US) and need interventions that work for them. The purpose of this paper is to present a review of interventions designed to address chronic disease in Native Hawaiian, Pacific Islander, and Filipino populations in the US that were tested for clinical impact through a randomized controlled trial (RCT). Articles were identified through a search of 4 databases, citation chasing, and colleagues. The 23 included articles reported on 21 interventions addressing 4 chronic conditions-cancer, obesity, cardiovascular disease, and diabetes. All projects were guided by advisory groups, and all interventions were theory-based and tailored to the population, with culturally- and language-appropriate educational materials delivered by same-race individuals in familiar church, club, or home settings. About half were tested through cluster RCT. The majority of the interventions were successful, confirming the value of developing and delivering interventions in partnership with community. Given the growing numbers of NHs, PIs, and Filipinos in the US, more investigational studies are needed to develop and test culturally tailored and grounded interventions that meet the health needs of these populations.
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Affiliation(s)
- Munirih R. Taafaki
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (MRT)
| | - Deborah Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai’i at Hilo, Hilo, HI (DT)
| | - Kathryn L. Braun
- Thompson School of Social Work & Public Health, University of Hawai’i at Mānoa, Honolulu, HI (KLB)
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Jain B, Bajaj SS, Patel TA, Vapiwala N, Lam MB, Mahal BA, Muralidhar V, Amen TB, Nguyen PL, Sanford NN, Dee EC. Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study with Disaggregated Ethnic Groups. Ann Surg Oncol 2023; 30:5495-5505. [PMID: 37017832 PMCID: PMC10075171 DOI: 10.1245/s10434-023-13339-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/19/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Vast differences in barriers to care exist among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups and may manifest as disparities in stage at presentation and access to treatment. Thus, we characterized AANHPI patients with stage 0-IV colon cancer and examined differences in (1) stage at presentation and (2) time to surgery relative to white patients. PATIENTS AND METHODS We assessed all patients in the National Cancer Database (NCDB) with stage 0-IV colon cancer from 2004 to 2016 who identified as white, Chinese, Japanese, Filipino, Native Hawaiian, Korean, Vietnamese, Laotian, Hmong, Kampuchean, Thai, Asian Indian or Pakistani, and Pacific Islander. Multivariable ordinal logistic regression defined adjusted odds ratios (AORs), with 95% confidence intervals (CI), of (1) patients presenting with advanced stage colon cancer and (2) patients with stage 0-III colon cancer receiving surgery at ≥ 60 days versus 30-59 days versus < 30 days postdiagnosis, adjusting for sociodemographic/clinical factors. RESULTS Among 694,876 patients, Japanese [AOR 1.08 (95% CI 1.01-1.15), p < 0.05], Filipino [AOR 1.17 (95% CI 1.09-1.25), p < 0.001], Korean [AOR 1.09 (95% CI 1.01-1.18), p < 0.05], Laotian [AOR 1.51 (95% CI 1.17-1.95), p < 0.01], Kampuchean [AOR 1.33 (95% CI 1.04-1.70), p < 0.01], Thai [AOR 1.60 (95% CI 1.22-2.10), p = 0.001], and Pacific Islander [AOR 1.41 (95% CI 1.20-1.67), p < 0.001] patients were more likely to present with more advanced colon cancer compared with white patients. Chinese [AOR 1.27 (95% CI 1.17-1.38), p < 0.001], Japanese [AOR 1.23 (95% CI 1.10-1.37], p < 0.001], Filipino [AOR 1.36 (95% CI 1.22-1.52), p < 0.001], Korean [AOR 1.16 (95% CI 1.02-1.32), p < 0.05], and Vietnamese [AOR 1.55 (95% CI 1.36-1.77), p < 0.001] patients were more likely to experience greater time to surgery than white patients. Disparities persisted when comparing among AANHPI subgroups. CONCLUSIONS Our findings reveal key disparities in stage at presentation and time to surgery by race/ethnicity among AANHPI subgroups. Heterogeneity upon disaggregation underscores the importance of examining and addressing access barriers and clinical disparities.
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Affiliation(s)
- Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Miranda B Lam
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Vinayak Muralidhar
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Kaiser Permanente Northwest, Portland, OR, USA
| | - Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA.
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Korn AR, Walsh-Bailey C, Correa-Mendez M, DelNero P, Pilar M, Sandler B, Brownson RC, Emmons KM, Oh AY. Social determinants of health and US cancer screening interventions: A systematic review. CA Cancer J Clin 2023; 73:461-479. [PMID: 37329257 PMCID: PMC10529377 DOI: 10.3322/caac.21801] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/05/2023] [Accepted: 05/08/2023] [Indexed: 06/19/2023] Open
Abstract
There remains a need to synthesize linkages between social determinants of health (SDOH) and cancer screening to reduce persistent inequities contributing to the US cancer burden. The authors conducted a systematic review of US-based breast, cervical, colorectal, and lung cancer screening intervention studies to summarize how SDOH have been considered in interventions and relationships between SDOH and screening. Five databases were searched for peer-reviewed research articles published in English between 2010 and 2021. The Covidence software platform was used to screen articles and extract data using a standardized template. Data items included study and intervention characteristics, SDOH intervention components and measures, and screening outcomes. The findings were summarized using descriptive statistics and narratives. The review included 144 studies among diverse population groups. SDOH interventions increased screening rates overall by a median of 8.4 percentage points (interquartile interval, 1.8-18.8 percentage points). The objective of most interventions was to increase community demand (90.3%) and access (84.0%) to screening. SDOH interventions related to health care access and quality were most prevalent (227 unique intervention components). Other SDOH, including educational, social/community, environmental, and economic factors, were less common (90, 52, 21, and zero intervention components, respectively). Studies that included analyses of health policy, access to care, and lower costs yielded the largest proportions of favorable associations with screening outcomes. SDOH were predominantly measured at the individual level. This review describes how SDOH have been considered in the design and evaluation of cancer screening interventions and effect sizes for SDOH interventions. Findings may guide future intervention and implementation research aiming to reduce US screening inequities.
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Affiliation(s)
- Ariella R. Korn
- Cancer Prevention Fellowship Program, Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
- Behavioral and Policy Sciences Department, RAND Corporation, Boston, MA
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
| | - Margarita Correa-Mendez
- Cancer Prevention Fellowship Program, Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Peter DelNero
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Meagan Pilar
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Brittney Sandler
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO
| | - Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - April Y. Oh
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Abdul Latip SNB, Chen SE, Im YR, Zielinska AP, Pawa N. Systematic review of randomised controlled trials on interventions aimed at promoting colorectal cancer screening amongst ethnic minorities. ETHNICITY & HEALTH 2023; 28:661-695. [PMID: 36352539 DOI: 10.1080/13557858.2022.2139815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 10/16/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Significant disparities exist between different ethnic groups when it comes to participation in colorectal cancer (CRC) screening programmes. A variety of interventions have been proposed to improve participation rates of ethnic minorities for CRC screening. This systematic review aims to appraise the evidence available from published randomised controlled trials (RCTs) and to identify effective interventions aimed at promoting CRC screening amongst underserved ethnic minorities. DESIGN We searched EmBASE, Medline, PsychInfo, Scopus and CINAHL for RCTs that analysed interventions to promote CRC screening in all ethnic minorities. CRC screening was measured as documented or self-reported screening rates. The protocol of this study was registered prospectively on PROSPERO with the registration number CRD42020216384. RESULTS We identified 42 relevant RCT articles, out of 1805 articles highlighted by the initial search. All except one were conducted in the US. The most frequently studied ethnic groups were African-Americans (33%), East Asians (30%), and Hispanics/Latinos (23%). In total, 7/42 (16%) RCTs had multiple arms. Interventions mainly intended to educate (52%), provide patient navigation services (21%), or provide a combination of these interventions (19%). We demonstrate that combination methods are most effective. CONCLUSION Many RCTs, mostly in the US, have trialed interventions aimed to increase CRC screening uptake amongst ethnic minorities to varying success. We conclude that using a combination of methods with patient navigation, education, and cultural tailoring is most effective at increasing CRC screening uptake amongst ethnic minorities. This highlights that multiple factors may hinder CRC screening and finding a one-size-fits-all solution that can be reliably implemented among different cultures and countries may be complex.
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Affiliation(s)
- Siti Nadiah Binte Abdul Latip
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
| | | | - Yu Ri Im
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Agata P Zielinska
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Nikhil Pawa
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
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Wang CP, Vang SS, Cheung AJ, Lin JJ, Jandorf LH. A Community-Based Survey of Colorectal Cancer Screening Behaviors in Chinese Immigrants Residing in a Major Metropolitan Area. JOURNAL OF COMMUNITY MEDICINE & PUBLIC HEALTH 2023; 7:336. [PMID: 38765318 PMCID: PMC11101160 DOI: 10.29011/2577-2228.100336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Colorectal cancer is a common cause of screening preventable death in Chinese immigrants, but colorectal cancer screening rates remain low in this population. This study evaluated factors associated with colorectal cancer screening behaviors in Chinese Americans living in New York City. Methods Participants were foreign-born Chinese Americans, aged 50 years or older, who completed internet surveys between November 2020 and May 2021 regarding their colorectal cancer screening behaviors. Data were collected on demographics, health care utilization, participants' levels of health literacy, English proficiency, colorectal cancer perceptions and current colorectal cancer screening behaviors. Bivariate analyses using chi-square or t-tests were performed to examine associations between colorectal cancer screening behaviors and participant characteristics. Results 103 participants were surveyed with a mean age of 71.3 years. Most participants experienced high rates of socioeconomic disadvantage (i.e., less than a high school education, annual household income <$20,000, limited health literacy, and poor English proficiency). 92% were ever screened, 81% were up-to-date on screening, and 85% expressed intention to screen in the future. Almost all participants had a primary care provider and a language concordant provider. Individuals who intended to screen were more fearful of developing colorectal cancer (3.2 vs 2.8, p=0.02) and perceived a colorectal cancer diagnosis with greater severity (3.0 vs 2.7, p=0.07) than those without intention to screen. Conclusions In our sample, Chinese immigrants were adversely impacted by multiple social determinants of health but reported high colorectal cancer screening rates. Community-based outreach is critical to ensuring cancer-screening engagement in medically vulnerable populations.
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Affiliation(s)
- Christina P Wang
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Suzanne S Vang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Aaron J Cheung
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- BS program, School of Industrial and Labor Relations, Cornell University, Ithaca, NY, USA
| | - Jenny J Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lina H Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Garcia GM, Mapaye JC, Hedwig T, Petalio J, Aquino SR, Lasquete P, Tungul C. Feasibility of implementing project Buhay: the first colorectal cancer screening promotion programme for Filipinos in Alaska. Int J Circumpolar Health 2022; 81:2059173. [PMID: 35356871 PMCID: PMC8979537 DOI: 10.1080/22423982.2022.2059173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study assessed the feasibility of implementing Project Buhay (PB), the first colorectal cancer (CRC) screening promotion programme for Filipinos in Alaska and developed through university-community partnership. PB involved piloting two interventions: a group health education intervention and (GHEI) a video-based intervention (VBI) showing a mini-documentary of a Filipina from Alaska with CRC. Participants included self-identified Filipinos, aged 50 to 75 years who were not current in CRC screening. Data collected include recruitment, reach, implementation process, short-term outcomes, and implementation barriers. Results show that PB reached a total of three Alaskan communities and exposed almost 50 participants. GHEI and VBI participants were followed-up at three-month post-intervention, with 80% reporting their intention to get CRC screening within a year. The main barrier in implementing PB was its lack of funding and time, which lessened effectiveness and reduced community and participant reach. However, PB team's ability to make adjustments in implementation and leverage existing university and community assets led to the successful implementation of theinterventions. At the project's conclusion, there were positive implications for both the Filipino community in Alaska and project team, affirming the importance of university-community partnership.
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Affiliation(s)
- Gabriel M Garcia
- Division of Population Health Sciences, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Joy Chavez Mapaye
- Department of Journalism and Public Communications, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Travis Hedwig
- Division of Population Health Sciences, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Jessica Petalio
- Department of Psychology, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Suzanna Rosie Aquino
- Division of Population Health Sciences, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Pauline Lasquete
- Division of Health Promotion and Behavioral Sciences, San Diego State University, San Diego, Alaska, USA
| | - Claudine Tungul
- Department of Psychology, University of Alaska Anchorage, Anchorage, Alaska, USA
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Derrick T, Mack W, Palinkas L, Kipke M, Javier JR. Evaluating an Evidence-Based Parenting Intervention Among Filipino Parents: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e21867. [PMID: 35175200 PMCID: PMC8895283 DOI: 10.2196/21867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Filipino Americans underuse mental health and preventive care services even though studies have indicated that Filipino youth experience high rates of suicidal ideation, substance abuse, and teen pregnancies, whereas adults experience immigration stress, discrimination, and depression. Evidence-based parenting interventions provided in early childhood have proven to be effective in preventing the onset and escalation of child mental health disorders. In a pilot randomized controlled trial, we found that participation in the Incredible Years Basic Parent Training Program (IY) improved parenting stress and positive parenting practices and decreased child internalizing and externalizing symptoms among Filipino families. A fully powered trial is needed to determine the efficacy of IY as a prevention program among Filipino families. OBJECTIVE The aims of this study are to describe the design and rationale of a randomized controlled trial evaluating the effects of the web-based IY program among parents recruited from multiple community-based settings and its impact on parenting practices, parenting stress, and child problem behavior among Filipino Americans and describe the impact of COVID-19 on our study protocols. METHODS This study uses a randomized controlled 2-arm individually randomized group treatment pretest-posttest design for 180 parent-child dyads. Individuals are eligible if they are ≥18 years, live in California, and have at least one Filipino child aged 8-12 years. Consenting participants are randomly allocated to receive either the 12-week IY parenting intervention (intervention arm) or American Academy of Pediatrics' Bright Future handouts and placed on a waitlist to receive IY posttrial (waitlist control arm). Primary outcomes include the Parent Practices Interview and the Parenting Stress Index. Secondary outcomes will be measured using the Child Behavior Checklist (completed by parent) and will include child internalizing and externalizing behaviors and total problems. Data are collected at baseline and 3- and 6-month follow-ups. RESULTS Changes made to the protocol owing to COVID-19 include administration of surveys remotely and implementation of the intervention on the web. The pandemic has provided an opportunity to evaluate the effectiveness of a web-based version of IY that may improve access and increase use of the intervention. Recruitment and data collection procedures are still ongoing and are expected to be completed by December 2022. CONCLUSIONS Our research will determine whether IY promotes positive parenting practices and prevents child internalizing and externalizing behaviors in healthy but high-risk populations such as Filipino families. It will also uplift cultural narratives and add to the evidence base for web-based parenting programs and their implementation in real-world settings. If found efficacious, IY has the potential to prevent behavioral health disparities in this understudied and high-risk Filipino population and can be scaled, adapted, and implemented in other at-risk racial and ethnic minority communities. TRIAL REGISTRATION ClinicalTrials.gov NCT04031170; https://clinicaltrials.gov/ct2/show/NCT04031170. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21867.
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Affiliation(s)
| | - Wendy Mack
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Lawrence Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Michele Kipke
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Division of Research on Child, Youth, and Families, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Joyce Rivera Javier
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
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10
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Kim SB, Kang M. What are the effects of colorectal cancer screening interventions among Asian Americans? A meta-analysis. ETHNICITY & HEALTH 2022; 27:297-315. [PMID: 31906697 DOI: 10.1080/13557858.2019.1711024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 12/11/2019] [Indexed: 06/10/2023]
Abstract
Objective: Great strides have been made to conduct intervention studies aimed at increasing colorectal cancer (CRC) screening rates that are informed by sound theoretical frameworks and conducted using rigorous methodologies; however, efforts are still gaining wave to understand the efficacy of theory-based interventions among Asian American (AA) population. The purpose of this study was to report the results of a meta-analysis conducted on the effects of CRC screening interventions.Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to evaluate the CRC screening interventions. Literature search was performed on October 2018, and studies published in English and conducted in the United States were eligible for inclusion if they (1) conducted interventions with aims to increase CRC screening rates among AA and (2) utilized a randomized control trial or quasi-experimental study design, (3) reported quantitative screening rates following the intervention, and (4) included a comparison or control group for comparison. No publication year restriction was applied.Result: In total, 14 Odds Ratio (OR) from 16 studies were included in the meta-analysis. Overall, results indicated that AA participants who received the screening interventions aimed at improving screening were 1.78 times more likely to obtain a CRC screening at post-intervention compared to those in the control or comparison group, OR = 1.78 (1.44, 2.11).Conclusion: Understanding the efficacy of interventions designed to promote CRC screening among AA population is imperative to decrease CRC burden and mortality. Although research in this area is limited, this review sheds light on important socio-cultural strategies to developing a CRC screening intervention aimed at increasing screening rates among AA. Findings in this review demonstrate that improvement in screening can be achieved through a variety of ways, but the common feature across all the studies was the culturally responsive foundation of their respective interventions.
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Affiliation(s)
- Sophia B Kim
- Myron B. Thompson School of Social Work, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Minji Kang
- Center for Gendered Innovations in Science and Technology Researches (GISTeR), Korea Federation of Women's Science & Technology Associations, Seoul, Republic of Korea
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11
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Mohammed Nawi A. Public Health: Prevention. COLORECTAL CANCER 2021. [DOI: 10.5772/intechopen.94396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nowadays, colorectal cancer prevention strategies play an essential role in reducing the incidence and mortality of the cases. A well-designed and establishment of the clinical pathway of screening programme needed in all country. Types of screening tools used may vary between the country with the use of FOBT and colonoscopy. The standard guideline related to screening programme such as for high-risk group should be emphasized more as compared to the low-risk group. The uptake of screening for CRC should be highlighted more as the program have showed a significantly reduction of the cases and mortality. The barrier of CRC screening uptake mainly due to poor awareness, discomfort, low physician recommendation, low socioeconomic and improper screening programme. Therefore others prevention strategies beside screening program such as health education and interactive intervention strategies need to be empower.
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Leach KM, Granzow ME, Popalis ML, Stoltzfus KC, Moss JL. Promoting colorectal cancer screening: A scoping review of screening interventions and resources. Prev Med 2021; 147:106517. [PMID: 33711351 PMCID: PMC8096709 DOI: 10.1016/j.ypmed.2021.106517] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/22/2021] [Accepted: 03/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Early detection through screening can reduce colorectal cancer (CRC) mortality, but approximately 33% of adults aged 50-75 are not getting screened as recommended. Many interventions to increase CRC screening have been tested, but clinical and community organizations may be challenged in identifying the optimum programs and program materials to increase screening and ultimately reduce CRC mortality. METHODS We conducted a scoping review to characterize existing, US-based interventions to improve CRC screening and to identify gaps in the literature. We used t-tests and correlations to analyze the relationship between project features and intervention effect sizes. RESULTS The overall effect sizes were + 16% for changes in screening by any modality. The average effect sizes were greater for projects with more components, used patient navigation, and provided free/low-cost testing. CONCLUSION Interventions varied greatly in terms of follow-up time, test modality, and data sources. Organizations seeking to implement a program aimed at increasing CRC screening should consider both intervention components and relevant program materials.
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Affiliation(s)
- Kelsey M Leach
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States of America
| | - Marni E Granzow
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States of America
| | - Madyson L Popalis
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States of America
| | - Kelsey C Stoltzfus
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States of America
| | - Jennifer L Moss
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States of America.
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13
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Manne SL, Islam N, Frederick S, Khan U, Gaur S, Khan A. Culturally-adapted behavioral intervention to improve colorectal cancer screening uptake among foreign-born South Asians in New Jersey: the Desi Sehat trial. ETHNICITY & HEALTH 2021; 26:554-570. [PMID: 30394106 PMCID: PMC6500482 DOI: 10.1080/13557858.2018.1539219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
Objectives: Colorectal cancer (CRC) is the third most common cancer among Americans of South Asian (SA) descent and is a significant public health concern in SA communities. Rates of screening compliance among foreign-born SAs are very low. The goal of this study was to report on the development, acceptability, and preliminary impact of a culturally-targeted 1:1 intervention delivered in English, Hindi, and Urdu, called Desi-Sehat.Design: Ninety-three foreign-born SAs between the ages of 50 and 75 were recruited using community-based organization methods. Participants completed a baseline survey, participated in a 1:1 session with a community health educator, and a follow-up survey was administered four months after the baseline.Results: The acceptance rate was moderate (52.8%). Attendance at the intervention session was high. More than half of the population did not complete the follow-up survey (58.7%). Participant evaluations of the intervention were high. Intent-to-treat analyses indicate a 30% four month follow-up CRC screening uptake. There were significant increases in knowledge and significant reductions in perceived barriers to screening, worry about CRC screening tests, and worry about CRC. Effect sizes for significant changes were in the medium to large range.Conclusions: Desi Sehat was a well-evaluated and participation in the session was high, participant knowledge significantly increased, and screening barriers, worry about CRC, and worry about CRC screening tests declined significantly. Future studies should focus on enhancing recruitment and retention and include a randomized control design.
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Affiliation(s)
| | - Nadia Islam
- New York University School of Medicine, New York, NY,
| | - Sara Frederick
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,
| | - Usman Khan
- Rutgers Robert Wood Johnson Medical School,
| | | | - Anam Khan
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,
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14
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Ma GX, Zhu L, Lin TR, Tan Y, Do P. Multilevel Pathways of Colorectal Cancer Screening Among Low-Income Vietnamese Americans: A Structural Equation Modeling Analysis. Cancer Control 2021; 28:10732748211011077. [PMID: 33896230 PMCID: PMC8204627 DOI: 10.1177/10732748211011077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Colorectal cancer (CRC) disproportionately affects Vietnamese Americans, especially those with low income and were born outside of the United States. CRC screening tests are crucial for prevention and early detection. Despite the availability of noninvasive, simple-to-conduct tests, CRC screening rates in Asian Americans, particularly Vietnamese Americans, remain suboptimal. The purpose of this study was to evaluate the interplay of multilevel factors – individual, interpersonal, and community – on CRC screening behaviors among low-income Vietnamese Americans with limited English proficiency. Methods: This study is based on the Sociocultural Health Behavior Model, a research-based model that incorporates 6 factors associated with decision-making and health-seeking behaviors that result in health care utilization. Using a community-based participatory research approach, we recruited 801 Vietnamese Americans from community-based organizations. We administered a survey to collect information on sociodemographic characteristics, health-related factors, and CRC screening-related factors. We used structural equation modeling (SEM) to identify direct and indirect predictors of lifetime CRC screening. Results: Bivariate analysis revealed that a greater number of respondents who never screened for CRC reported limited English proficiency, fewer years of US residency, and lower self-efficacy related to CRC screening. The SEM model identified self-efficacy (coefficient = 0.092, P < .01) as the only direct predictor of lifetime CRC screening. Educational attainment (coefficient = 0.13, P < .01) and health beliefs (coefficient = 0.040, P < .001) had a modest significant positive relationship with self-efficacy. Health beliefs (coefficient = 0.13, P < .001) and educational attainment (coefficient = 0.16, P < .01) had significant positive relationships with CRC knowledge. Conclusions: To increase CRC screening uptake in medically underserved Vietnamese American populations, public health interventions should aim to increase community members’ confidence in their abilities to screen for CRC and to navigate associated processes, including screening preparation, discussions with doctors, and emotional complications.
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Affiliation(s)
- Grace X Ma
- Center for Asian Health, 12314Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.,Department of Clinical Sciences, 12314Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Lin Zhu
- Center for Asian Health, 12314Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Timmy R Lin
- Center for Asian Health, 12314Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Yin Tan
- Center for Asian Health, 12314Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Phuong Do
- Center for Asian Health, 12314Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
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15
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Inadomi JM, Issaka RB, Green BB. What Multilevel Interventions Do We Need to Increase the Colorectal Cancer Screening Rate to 80%? Clin Gastroenterol Hepatol 2021; 19:633-645. [PMID: 31887438 PMCID: PMC8288035 DOI: 10.1016/j.cgh.2019.12.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/05/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023]
Abstract
Screening reduces colorectal cancer mortality; however, this remains the second leading cause of cancer deaths in the United States and adherence to colorectal cancer screening falls far short of the National Colorectal Cancer Roundtable goal of 80%. Numerous studies have examined the effectiveness of interventions to increase colorectal cancer screening uptake. Outreach is the active dissemination of screening outside of the primary care setting, such as mailing fecal blood tests to individuals' homes. Navigation uses trained personnel to assist individuals through the screening process. Patient education may take the form of brochures, videos, or websites. Provider education can include feedback about screening rates of patient panels. Reminders to healthcare providers can be provided by dashboards of patients due for screening. Financial incentives provide monetary compensation to individuals when they complete screening tests, either as fixed payments or via a lottery. Individual preference for specific screening strategies has also been examined in several trials, with a choice of screening strategies yielding higher adherence than recommendation of a single strategy.
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Affiliation(s)
- John M. Inadomi
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, WA,Divisions of Clinical Research and Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA,Department of Health Services, University of Washington School of Public Health, Seattle, WA
| | - Rachel B. Issaka
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, WA,Divisions of Clinical Research and Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
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16
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Maxwell AE, Lucas-Wright A, Chang LC, Santifer RE, Crespi CM. Factors associated with colorectal cancer screening in a peer-counseling intervention study in partnership with African American churches. Prev Med Rep 2020; 20:101280. [PMID: 33344150 PMCID: PMC7736973 DOI: 10.1016/j.pmedr.2020.101280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 12/23/2022] Open
Abstract
Colorectal cancer (CRC) mortality is 47% higher in African American men and 34% higher in African American women compared to non-Hispanic white men and women. This analysis assessed factors associated with CRC screening among 163 African American participants of a peer-counseling intervention study (2016-2018). In a one-group pre/post-test pilot study, trained Community Health Advisors (CHAs) at 9 African American churches in Los Angeles (LA) promoted CRC screening via one-on-one counseling, print materials and telephone reminder calls. Participants completed telephone surveys 3-6 months after the intervention. We fit bivariate and multivariate mixed effects logistic regression models to assess correlates, including participants' demographic characteristics, access to care, cancer-related knowledge and attitudes and receipt of CHA counseling of (1) discussion of CRC screening with provider and (2) receipt of CRC screening during follow-up. After controlling for gender and education, receipt of CHA counseling (OR 3.77) was significantly associated with discussing CRC screening with a provider during follow-up but not with CRC screening. Instead, a routine check-up in the past 12 months (OR 4.47) and discussion of CRC screening with a provider (OR 3.07) were significantly associated with CRC screening during follow-up. Residence in South LA (OR 0.38) was significantly associated with lack of CRC screening. Findings confirm the important role of health care providers and suggest that residence in South LA constitutes an additional barrier to CRC screening. Further research and additional resources are needed to address disparities in the uptake of CRC screening among African Americans, especially in South LA.
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Affiliation(s)
- Annette E. Maxwell
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, 650 Charles Young Drive South, Box 956900, Los Angeles, CA 90095-6900, USA
| | - Aziza Lucas-Wright
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, 1721 East 120th Street, Los Angeles, CA 90059, USA
| | - L. Cindy Chang
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, 650 Charles Young Drive South, Box 956900, Los Angeles, CA 90095-6900, USA
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, 1721 East 120th Street, Los Angeles, CA 90059, USA
| | - Rhonda E. Santifer
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, 1721 East 120th Street, Los Angeles, CA 90059, USA
| | - Catherine M. Crespi
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, 650 Charles Young Drive South, Box 956900, Los Angeles, CA 90095-6900, USA
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17
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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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18
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Whitaker DE, Snyder FR, San Miguel-Majors SL, Bailey LO, Springfield SA. Screen to Save: Results from NCI's Colorectal Cancer Outreach and Screening Initiative to Promote Awareness and Knowledge of Colorectal Cancer in Racial/Ethnic and Rural Populations. Cancer Epidemiol Biomarkers Prev 2020; 29:910-917. [DOI: 10.1158/1055-9965.epi-19-0972] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/20/2019] [Accepted: 02/14/2020] [Indexed: 11/16/2022] Open
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19
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Javier JR, Reyes A, Coffey DM, Schrager SM, Samson A, Palinkas L, Kipke MD, Miranda J. Recruiting Filipino Immigrants in a Randomized Controlled Trial Promoting Enrollment in an Evidence-Based Parenting Intervention. J Immigr Minor Health 2019; 21:324-331. [PMID: 29774510 DOI: 10.1007/s10903-018-0755-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Filipinos, the second largest Asian subgroup in the U.S., experience significant youth behavioral health disparities but remain under-represented in health research. We describe lessons learned from using the Matching Model of Recruitment to recruit 215 Filipinos to participate in a large, randomized controlled trial of a culturally tailored video aimed at increasing enrollment in the Incredible Years® Parent Program. We recruited participants from schools, churches, clinics, community events, and other community-based locations. Facilitators of participation included: partnership with local community groups, conducting research in familiar settings, building on existing social networks, and matching perspectives of community members and researchers. Findings suggest recruitment success occurs when there is a match between goals of Filipino parents, grandparents and the research community. Understanding the perspectives of ethnic minority communities and effectively communicating goals of research studies are critical to successful recruitment of hard-to-reach immigrant populations in randomized controlled trials.
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Affiliation(s)
- Joyce R Javier
- Children's Hospital Los Angeles, 4650 Sunset Blvd. MS#76, Los Angeles, CA, 90027, USA. .,University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - Angela Reyes
- Children's Hospital Los Angeles, 4650 Sunset Blvd. MS#76, Los Angeles, CA, 90027, USA
| | - Dean M Coffey
- Children's Hospital Los Angeles, 4650 Sunset Blvd. MS#76, Los Angeles, CA, 90027, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Sheree M Schrager
- California State University, Northridge, Northridge, CA, USA.,University of Southern California School of Social Work, Los Angeles, CA, USA
| | - Allan Samson
- Children's Hospital Los Angeles, 4650 Sunset Blvd. MS#76, Los Angeles, CA, 90027, USA
| | - Lawrence Palinkas
- University of Southern California School of Social Work, Los Angeles, CA, USA
| | - Michele D Kipke
- Children's Hospital Los Angeles, 4650 Sunset Blvd. MS#76, Los Angeles, CA, 90027, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Jeanne Miranda
- University of California, Los Angeles, Los Angeles, CA, USA
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20
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Cuaresma CF, Sy AU, Nguyen TT, Ho RCS, Gildengorin GL, Tsoh JY, Jo AM, Tong EK, Kagawa-Singer M, Stewart SL. Results of a lay health education intervention to increase colorectal cancer screening among Filipino Americans: A cluster randomized controlled trial. Cancer 2019; 124 Suppl 7:1535-1542. [PMID: 29578603 DOI: 10.1002/cncr.31116] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/10/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Filipino colorectal cancer (CRC) screening rates fall below Healthy People 2020 goals. In this study, the authors explore whether a lay health educator (LHE) approach can increase CRC screening among Filipino Americans ages 50 to 75 years in Hawai'i. METHODS A cluster randomized controlled trial from 2012 through 2015 compared an intervention, which consisted of LHEs delivering 2 education sessions and 2 telephone follow-up calls on CRC screening plus a CRC brochure versus an attention control, in which 2 lectures and 2 follow-up calls on nutrition and physical activity plus a CRC brochure were provided. The primary outcome was change in self-reported ever receipt of CRC screening at 6 months. RESULTS Among 304 participants (77% women, 86% had > 10 years of residence in the United States), the proportion of participants who reported ever having received CRC screening increased significantly in the intervention group (from 80% to 89%; P = .0003), but not in the control group (from 73% to 74%; P = .60). After covariate adjustment, there was a significant intervention effect (odds ratio, 1.9; 95% confidence interval, 1.0-3.5). There was no intervention effect on up-to-date screening. CONCLUSIONS This first randomized controlled trial for CRC screening among Hawai'i's Filipinos used an LHE intervention with mixed, but promising, results. Cancer 2018;124:1535-42. © 2018 American Cancer Society.
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Affiliation(s)
- Charlene F Cuaresma
- Student Equity, Excellence and Diversity, University of Hawai'i-Mãnoa, Honolulu, Hawai'i
| | - Angela U Sy
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i
| | - Tung T Nguyen
- Department of Medicine, University of California-San Francisco, San Franciso, California
| | - Reginald C S Ho
- Department of Hematology-Oncology, Straub Clinic and Hospital, Honolulu, Hawai'i
| | - Ginny L Gildengorin
- Division of General Internal Medicine, University of California-San Francisco, San Franciso, California
| | - Janice Y Tsoh
- Department of Psychiatry, University of California-San Francisco, San Franciso, California
| | - Angela M Jo
- Department of Family Medicine, University of California-Los Angeles, Los Angeles, California
| | - Elisa K Tong
- Department of Internal Medicine, University of California-Davis, Davis, California
| | - Marjorie Kagawa-Singer
- Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California
| | - Susan L Stewart
- Division of Public Health Sciences, University of California-Davis, Davis, California
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Zabih V, Kahane A, O'Neill NE, Ivers N, Nathan PC. Interventions to improve adherence to surveillance guidelines in survivors of childhood cancer: a systematic review. J Cancer Surviv 2019; 13:713-729. [PMID: 31338733 DOI: 10.1007/s11764-019-00790-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Many survivors of childhood cancer are at high risk of late effects of their cancer therapy, including cardiac toxicity and subsequent malignant neoplasms (SMN). Current North American guidelines recommend periodic surveillance for these late effects. We conducted a systematic review of the literature to estimate rates of adherence to recommended surveillance and summarize studies evaluating interventions intended to increase adherence. METHODS We searched MEDLINE, Embase, Web of Science, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) for articles published between January 2000 and September 2018 that reported adherence to surveillance for cardiac toxicity and SMN (breast and colorectal cancer) and interventions implemented to improve completion of recommended testing. Risk of bias was assessed using relevant Cochrane checklists. Due to heterogeneity and overlapping study populations, we used narrative synthesis to summarize the findings. This review was registered in PROSPERO: CRD42018098878. RESULTS Thirteen studies met our inclusion criteria for assessing adherence to surveillance, while five assessed interventions to improve rates of surveillance. No studies met criteria for low risk of bias. Completion of recommended surveillance was lowest for colorectal cancer screening (11.5-30.0%) followed by cardiomyopathy (22.3-48.1%) and breast cancer (37.0-56.5%). Factors such as patient-provider communication, engagement with the health care system, and receipt of information were consistently reported to be associated with higher rates of surveillance. Of five randomized controlled trials aimed at improving surveillance, only two significantly increase completion of recommended testing-one for echocardiography and one for mammography. Both involved telephone outreach to encourage and facilitate these tests. CONCLUSION The majority of childhood cancer survivors at high risk of cardiac toxicity or SMN do not receive evidence-based surveillance. There is paucity of rigorous studies evaluating interventions to increase surveillance in this population. IMPLICATIONS FOR CANCER SURVIVORS Robust trials are needed to assess whether tailored interventions, designed based on unique characteristics and needs of each survivor population, could improve adherence.
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Affiliation(s)
- Veda Zabih
- Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | | | | | - Noah Ivers
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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22
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Lucas-Wright A, Duran P, Bazargan M, Vargas C, Maxwell AE. Cancer-related Knowledge, Attitudes and Behaviors within the Latino Faith Community in South Los Angeles. Ethn Dis 2019; 29:239-246. [PMID: 31057308 DOI: 10.18865/ed.29.2.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives The goal of this study was to establish relationships with Latino churches in South Los Angeles and to collect data from parishioners regarding their access to care, cancer risk factors, and cancer-related knowledge, attitudes and screening. Methods In 2014, we approached five Latino churches. All allowed us to describe the study and to consent potential respondents at a designated time during the church service. Results 398 Latino respondents (75% female) completed the survey in English (15%) or Spanish (85%). Most respondents were born in Mexico (63%). Only 56% had health insurance and 51% had a regular doctor. Based on self-reported height and weight, 33% were overweight and 51% were obese. However, only 42% of obese respondents had been told by their doctor that they were obese. Although it is well-established that obesity is a major cancer risk factor, respondents lacked knowledge about the important role of nutrition and exercise in cancer prevention. Among women, adherence to national screening guidelines was 88% for cervical cancer, 72% for breast cancer and 58% for colorectal cancer. However, they were quite willing to undergo cancer screening if recommended by a physician and reported few barriers to colorectal cancer screening. Conclusions Our data suggest a need to focus on both primary and secondary cancer prevention by promoting healthy lifestyles to curb the obesity epidemic and by promoting colorectal cancer screening. These data will inform future interventions to promote wellness in South Los Angeles in collaboration with the Latino faith community.
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Affiliation(s)
- Aziza Lucas-Wright
- Charles R. Drew University of Medicine and Science, Division of Cancer Research and Training, Los Angeles, CA
| | - Petra Duran
- Charles R. Drew University of Medicine and Science, Division of Cancer Research and Training, Los Angeles, CA
| | - Mohsen Bazargan
- Charles R. Drew University of Medicine and Science, Division of Cancer Research and Training, Los Angeles, CA
| | - Claudia Vargas
- Charles R. Drew University of Medicine and Science, Division of Cancer Research and Training, Los Angeles, CA
| | - Annette E Maxwell
- University of California Los Angeles Fielding School of Public Health & Jonsson Comprehensive Cancer Center; UCLA Kaiser Permanente Center for Health Equity
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23
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Domingo JLB, Chen JJ, Braun KL. Colorectal Cancer Screening Compliance among Asian and Pacific Islander Americans. J Immigr Minor Health 2019; 20:584-593. [PMID: 28378254 DOI: 10.1007/s10903-017-0576-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Colorectal cancer (CRC) screening prevalence remains low among Asians and Pacific Islanders. This study examined disparities and predictors of CRC screening compliance in adults age 50-75 years in Asians and Pacific Islanders in Hawai'i. Hawai'i Behavioral Risk Factor Surveillance System (BRFSS) data for 2011-2014 were analyzed. CRC screening status was dichotomized. Logistic regression was used to examine ethnic differences in and predictors of CRC screening status. Filipinos (OR 0.56), Chinese (OR 0.70), and Hawaiians (OR 0.75) were significantly less likely than whites to be CRC compliant. Higher education and income, employment, regular health provider, and routine checkups were important predictors of CRC compliance. Findings confirm lower CRC screening compliance in three of the four largest Asian and Pacific Islander groups in Hawai'i and that CRC screening compliance is influenced by several factors. Culturally tailored education and navigation services may be effective in reducing these disparities.
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Affiliation(s)
- Jermy-Leigh B Domingo
- University of Hawai'i at Mānoa, Office of Public Health Studies, 1960 East-West Road, Biomed, D-204, 96822, Honolulu, Hawai'i, USA.
| | - John J Chen
- University of Hawai'i John A. Burns School of Medicine, Office of Biostatistics & Quantitative Health Sciences, Honolulu, Hawai'i, USA
| | - Kathryn L Braun
- University of Hawai'i at Mānoa, Office of Public Health Studies, 1960 East-West Road, Biomed, D-204, 96822, Honolulu, Hawai'i, USA
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Tan N, Cho H. Cultural Appropriateness in Health Communication: A Review and A Revised Framework. JOURNAL OF HEALTH COMMUNICATION 2019; 24:492-502. [PMID: 31132946 PMCID: PMC7101074 DOI: 10.1080/10810730.2019.1620382] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A revised framework for cultural appropriateness is offered on the basis of a systematic review of operationalizations in 44 cancer screening interventions for Asian Americans. Studies commonly conveyed the epidemiological bases of the intervention (97.7%) and used the language of the population (95.5%). Less commonly reported were strategies central to health communication: cultural features of the intervention messages (77.3%) and the cultural beliefs and values that the intervention focused on (43.2%). Few used cultural tailoring (4.5%) and none aimed to address acculturation or cultural identity. The theoretical framework most frequently used was the health belief model (27.3%) which does not explain the role of culture. More studies focused on cultural barriers (20.5%) than cultural strengths (9.1%). Our revised framework comprises six cultural appropriateness strategies of cultural identity, linguistic, perceptual features, content, constituent-involving, and socioeconomic context-adaptive. It prioritizes cultural identity to recognize the dynamics within racial ethnic groups and to inform adaptive efforts for cultural appropriateness. It emphasizes examining cultural strengths that can facilitate change, as well as reducing cultural barriers. Future research and action should address the disparities in extant health disparities research in which theory and methods are underdeveloped and underutilized for Asian Americans.
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Gholampour Y, Jaderipour A, Khani Jeihooni A, Kashfi SM, Afzali Harsini P. The Effect of Educational Intervention Based on Health Belief Model and Social Support on the Rate of Participation of Individuals in Performing Fecal Occult Blood Test for Colorectal Cancer Screening. ASIAN PACIFIC JOURNAL OF CANCER PREVENTION : APJCP 2018; 19:2777-2787. [PMID: 30360606 PMCID: PMC6291048 DOI: 10.22034/apjcp.2018.19.10.2777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background and Aim: Among the screening tests for colorectal cancer, fecal occult blood test (FOBT) is important in comparison other methods due to its ease of use and low cost.The aim of this study is to survey the effect of educational intervention based on health belief model and social support on the rate of participation of individuals in performing fecal occult blood test for colorectal cancer screening among men who referred to the health centers in FasaCity, Fars province, Iran. Materials and Methods: In this quasi-experimental study, 200 men (100 in experimental group and 100 in control group) in FasaCity, Fars province, Iranwere selected in 2017. A questionnaire consisting of demographic information, knowledge, HBM constructs (perceived susceptibility, severity, benefits, barriers, self- efficacy and cues to action) and social support was used to measure the rate of participation of individuals in performing Fecal Occult Blood Test for colorectal cancer screening before and three months after the intervention. Data were analyzed using SPSS22 viadescriptive and inferential statistics, paired t-test, Mann-Whitney, Chi-square, and independent t-test at a significance level of 0.5. Results: The mean age of the men was 63.18 ± 8.25 years in the experimental group and 65.11 ± 7.66 years in the control group. Three months after the intervention, the experimental group showed a significant increase in the knowledge, perceived susceptibility, perceived severity, perceived benefits, Self-efficacy, cues to action, social support and the level of referrals (participation) of subjects for FOBTcompared to the control group. Conclusion: This study showed the effectiveness of HBM constructs and social support in adoption of the level of participation of subjects for FOBTin men. Hence, these models can act as a framework for designing and implementing educational interventions for undergoing FOBT.
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Affiliation(s)
- Yousef Gholampour
- Department of Internal Medicine, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran.
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Glenn BA, Hamilton AS, Nonzee NJ, Maxwell AE, Crespi CM, Ryerson AB, Chang LC, Deapen D, Bastani R. Obesity, physical activity, and dietary behaviors in an ethnically-diverse sample of cancer survivors with early onset disease. J Psychosoc Oncol 2018; 36:418-436. [PMID: 29764334 PMCID: PMC6209096 DOI: 10.1080/07347332.2018.1448031] [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: 01/07/2023]
Abstract
PURPOSE To assess weight status, physical activity, and dietary behaviors in an ethnically-diverse sample of breast and colorectal cancer survivors with early onset disease (≤ 50 years). METHODS Breast and colorectal cancer survivors, diagnosed between 1999 and 2009 with early-stage cancer diagnosed by 50 years of age, were identified through a population-based cancer registry and surveyed. Descriptive and regression analyses were conducted to characterize the sample and identify correlates of lifestyle behaviors. FINDINGS The majority of participants (n = 156) were female (83%), insured (84%), and racial/ethnic minorities (29% Asian, 24% Latino, 15% African American). Participants' mean age at response was 50 years and mean time since diagnosis was 9 years. Over half of survivors were overweight or obese. Few participants reported engaging in regular physical activity (31%) and adhering to minimum guidelines for fruit and vegetable consumption (32%). A substantial proportion of survivors consumed fast food in the past week (75%) and nearly half (48%) reported daily consumption of sugar-sweetened beverages. Lower income was associated with inadequate fruit and vegetable intake. Fast food and sugar-sweetened beverage consumption was significantly higher among racial/ethnic minority survivors compared to non-Latino whites. CONCLUSIONS High prevalence of overweight and suboptimal adherence to recommended nutrition and physical activity behaviors were observed among cancer survivors with early onset disease. Cancer survivors diagnosed at a young age may benefit from targeted interventions to address overweight and suboptimal nutrition and physical activity.
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Affiliation(s)
- Beth A Glenn
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - Ann S Hamilton
- b Department of Preventive Medicine, Los Angeles County Cancer Surveillance Program and Keck School of Medicine , University of Southern California , Los Angeles , California , USA
| | - Narissa J Nonzee
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - Annette E Maxwell
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - Catherine M Crespi
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - A Blythe Ryerson
- c Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta , Georgia , USA
| | - L Cindy Chang
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - Dennis Deapen
- b Department of Preventive Medicine, Los Angeles County Cancer Surveillance Program and Keck School of Medicine , University of Southern California , Los Angeles , California , USA
| | - Roshan Bastani
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
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Kelly C, Pericleous M, Hendy J, de Lusignan S, Ahmed A, Vandrevala T, Ala A. Interventions to improve the uptake of screening across a range of conditions in Ethnic Minority Groups: a systematic review. Int J Clin Pract 2018; 72:e13202. [PMID: 29920875 DOI: 10.1111/ijcp.13202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/15/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Screening programmes are well established in cancer, and are now being implemented in other conditions. An effective screening programme leads to early disease detection and improved outcomes but its impact is dependent on the quality of the test and the proportion of the target population participating. A further consideration is that uptake of screening by minority groups is low. PURPOSE To determine which interventions have successfully increased screening uptake amongst minorities. DATA SOURCES Medline, Cochrane database and the grey literature were searched from 1990 to 1st March 2016. STUDY SELECTION Fifty-five English language studies that assessed uptake of screening in any minority population in the country of study aged over 18 years and that included a comparison arm. DATA EXTRACTION Independent data extraction was undertaken by two researchers (CK and MP), using a predesigned data extraction form (DEF) which assisted retrieval of the core contents of each study and the organisation of material. DATA SYNTHESIS Evidence was organised by screening test and type of intervention. Two authors (CK and MP) extracted data into evidence tables to enable comparison of study characteristics and findings. The heterogeneity of methods precluded a meta-analysis thus results are descriptive. Evidence was also assessed, using the Cochrane Collaboration risk of bias tables. RESULTS This systematic review appraises data from international studies on a variety of minority groups, interventions and screening programmes providing a narrative review of their success and limitations.
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Affiliation(s)
- Claire Kelly
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, Surrey, UK
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
| | - Marinos Pericleous
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, Surrey, UK
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
| | - Jane Hendy
- Brunel Business School, Brunel University, London, UK
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
| | - Ayesha Ahmed
- Brunel Business School, Brunel University, London, UK
| | | | - Aftab Ala
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, Surrey, UK
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
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Huerta EE, Weeks-Coulthurst P, Williams C, Swain SM. Take care of your neighborhood. Breast Cancer Res Treat 2017; 167:225-234. [PMID: 28900788 DOI: 10.1007/s10549-017-4492-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 08/30/2017] [Indexed: 09/29/2022]
Abstract
PURPOSE Urban women in certain Washington, DC neighborhoods present with advanced breast cancer at high rates despite access to health insurance and health care. METHODS Through a two-phase intervention, community health workers (CHWs) educated and surveyed individuals regarding healthcare utilization and breast health and cancer awareness. In phase I, CHWs educated and administered a survey to 1092 women, of whom 95.1% had health insurance, in an attempt to explain the high rate of advanced breast cancer despite having health insurance. In phase II, a targeted CHW-administered intervention was designed based on data collected from the phase I survey, and provided to 658 women. Preintervention and postintervention surveys were administered to assess its impact on knowledge and beliefs about breast health and cancer screening. RESULTS During phase I, respondents most often identified personal factors (28.7%) and fear (27.7%) to explain the high rate of advanced breast cancer despite health insurance status. In phase II, the intervention improved perceptions of the safety and efficacy of mammograms with an absolute 15.4% increase in the respondents who believed that "A mammogram is the safest and most effective test available for finding early breast cancer." Perceived barriers discouraging mammograms were access (17.0%), pain (13.2%), and education (13.1%). CONCLUSIONS Among an urban population of predominantly insured women with high rates of advanced breast cancer at diagnosis, personal factors and fear were cited as the greatest barriers to breast cancer screening. Educational intervention by CHWs showed a positive impact on respondents' perceptions regarding mammogram safety and efficacy.
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Affiliation(s)
- Elmer E Huerta
- Washington Cancer Institute, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA.
| | - Patricia Weeks-Coulthurst
- Washington Cancer Institute, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA
| | - Courtney Williams
- Washington Cancer Institute, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA
| | - Sandra M Swain
- Washington Cancer Institute, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA.,Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3800 Reservoir Road NW, Washington, DC, 20057, USA
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Maxwell AE, Crespi CM, Arce AA, Bastani R. Exploring the effects of longstanding academic-community partnerships on study outcomes: A case study. Prev Med Rep 2017; 8:101-107. [PMID: 28948137 PMCID: PMC5601301 DOI: 10.1016/j.pmedr.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 11/13/2022] Open
Abstract
While sustained academic and community partnerships can improve relationships between research partners, they could also influence study outcomes. Research on this issue is limited. We conducted a trial (2010–15) to test two implementation strategies for an evidence-based intervention to promote colorectal cancer (CRC) screening at community organizations in Los Angeles (N = 17). For both strategies, trained community health advisors (CHAs) recruited Filipino Americans (N = 673) who were non-adherent to CRC screening guidelines. The main study outcome was CRC screening status of participants at 6-month follow-up. This case study compares outcomes among organizations that had participated in our prior effectiveness trial and new organizations with which we had no prior relationship. Using multilevel logistic regression with multiple imputation for missing outcomes, we compared CRC screening rates among previous versus new partners controlling for study condition and organizational, CHA and participant characteristics. Screening rates were substantially higher among participants of previous versus new partner organizations in unadjusted analysis (77% versus 55%, OR 2.8, p = 0.12), after adjusting for organization-level variables (81% versus 42%, OR 7.5, 95% CI [2.0–28.7], p = 0.003) and after additionally adding CHA and participant level factors to the model (79% versus 47%, OR 5.9, CI [1.3–27.3], p = 0.02). Analyses using complete cases and assuming not-screened for missing outcomes indicated similar differences in screening rates (30 and 33 percentage points, respectively). Study outcomes that are achieved with long-term community partners may not be generalizable to new partners. However, inclusion of new community partners is important for external validity of dissemination efforts in community settings. NCT01351220 (ClinicalTrials.gov) Long-term partnerships between academia and community can affect study outcomes. Study outcomes achieved with long-term community partners may not be generalizable. Inclusion of new partners may improve external validity of dissemination efforts. We recommend further examination of this issue in future studies. Inclusion of this construct in theoretical formulations should be considered.
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Affiliation(s)
- Annette E Maxwell
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, UCLA Kaiser Permanente Center for Health Equity, Los Angeles, United States
| | - Catherine M Crespi
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, UCLA Kaiser Permanente Center for Health Equity, Los Angeles, United States
| | - Anthony A Arce
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, UCLA Kaiser Permanente Center for Health Equity, Los Angeles, United States
| | - Roshan Bastani
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, UCLA Kaiser Permanente Center for Health Equity, Los Angeles, United States
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Rapkin BD, Weiss E, Lounsbury D, Michel T, Gordon A, Erb-Downward J, Sabino-Laughlin E, Carpenter A, Schwartz CE, Bulone L, Kemeny M. Reducing Disparities in Cancer Screening and Prevention through Community-Based Participatory Research Partnerships with Local Libraries: A Comprehensive Dynamic Trial. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2017; 60:145-159. [PMID: 28913882 PMCID: PMC5658033 DOI: 10.1002/ajcp.12161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Reduction of cancer-related disparities requires strategies that link medically underserved communities to preventive care. In this community-based participatory research project, a public library system brought together stakeholders to plan and undertake programs to address cancer screening and risk behavior. This study was implemented over 48 months in 20 large urban neighborhoods, selected to reach diverse communities disconnected from care. In each neighborhood, Cancer Action Councils were organized to conduct a comprehensive dynamic trial, an iterative process of program planning, implementation and evaluation. This process was phased into neighborhoods in random, stepped-wedge sequence. Population-level outcomes included self-reported screening adherence and smoking cessation, based on street intercept interviews. Event-history regressions (n = 9374) demonstrated that adherence outcomes were associated with program implementation, as were mediators such as awareness of screening programs and cancer information seeking. Findings varied by ethnicity, and were strongest among respondents born outside the U.S. or least engaged in care. This intervention impacted health behavior in diverse, underserved and vulnerable neighborhoods. It has been sustained as a routine library system program for several years after conclusion of grant support. In sum, participatory research with the public library system offers a flexible, scalable approach to reduce cancer health disparities.
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Affiliation(s)
- Bruce D. Rapkin
- Department of Epidemiology and Population Health, Division of Community Collaboration & Implementation Science, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elisa Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY, USA
| | - David Lounsbury
- Department of Epidemiology and Population Health, Division of Community Collaboration & Implementation Science, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Alexis Gordon
- Department of Epidemiology and Population Health, Division of Community Collaboration & Implementation Science, Albert Einstein College of Medicine, Bronx, NY, USA
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Jennifer Erb-Downward
- Department of Epidemiology and Population Health, Division of Community Collaboration & Implementation Science, Albert Einstein College of Medicine, Bronx, NY, USA
- Institute for Children Poverty and Homelessness, New York, NY, USA
| | | | - Alison Carpenter
- Department of Epidemiology and Population Health, Division of Community Collaboration & Implementation Science, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carolyn E. Schwartz
- DeltaQuest Foundation, Inc., Concord, MA, USA
- Departments of Medicine & Orthopaedic Surgery, Tufts Univ. Medical School, Boston, MA, USA
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Besharati F, Karimi-Shahanjarini A, Hazavehei SMM, Bashirian S, Bagheri F, Faradmal J. Development of a Colorectal Cancer Screening Intervention for Iranian Adults: Appling Intervention Mapping. Asian Pac J Cancer Prev 2017; 18:2193-2199. [PMID: 28843255 PMCID: PMC5697480 DOI: 10.22034/apjcp.2017.18.8.2193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: While the incidence rate of the colorectal cancer (CRC) has been increasing over the last three
decades in Iran, very limited interventions to increase CRC screening have been developed for Iranian population.
The purpose of this study was to describe the use of Intervention Mapping (IM) for applying theory and evidence and
considering local contexts to develop a CRC screening program among adults in Iran. Materials and Methods: From
April 2014 to July 2016 following the IM process, six steps were formulated and implemented. First a need assessment
was conducted involving relevant stakeholders and using focus groups discussions (n=10), individual interviews
(n=20), and a household survey (n= 480). Then a matrix of change objectives was developed for each behavioral
outcome and theoretical methods and their practical applications were identified to guide intervention development and
implementation. A multi-component intervention was developed and piloted. Decision on suitable parts of intervention
was made based on feedback of pilot study. Finally, evaluation plan including process and outcome evaluation was
generated and conducted to inform future scale up. Results: The needs assessment highlighted factors affecting CRC
screening including knowledge, self efficacy, social support and perceived benefit and barriers (financial problems,
fear of detection of cancer and etc). Results of needs assessment were used to develop next steps IM. The program
utilized methods like information delivery, modeling, and persuasion. Practical applications included video presentation,
group discussion, role playing and postcards.This program was assessed through a cluster-randomized controlled
trial. Results showed that there were significant differences in CRC screening uptake between intervention groups and
control (P<0.001). Conclusions: IM is a useful process in the design of a theory-based intervention addressing CRC
screening among Iranian population.
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Affiliation(s)
- Fereshteh Besharati
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
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Nguyen TT, Tsoh JY, Woo K, Stewart SL, Le GM, Burke A, Gildengorin G, Pasick RJ, Wang J, Chan E, Fung LC, Jih J, McPhee SJ. Colorectal Cancer Screening and Chinese Americans: Efficacy of Lay Health Worker Outreach and Print Materials. Am J Prev Med 2017; 52:e67-e76. [PMID: 27986352 PMCID: PMC5318244 DOI: 10.1016/j.amepre.2016.10.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/14/2016] [Accepted: 10/03/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Chinese Americans have low colorectal cancer (CRC) screening rates. Evidence-based interventions to increase CRC screening in this population are lacking. This study aims to compare the efficacy of two interventions in increasing CRC screening among Chinese Americans. DESIGN Cluster randomized comparative trial. SETTING/PARTICIPANTS From 2010 to 2014, a community-academic team conducted this study in San Francisco, CA with Chinese Americans aged 50-75 years who spoke English, Cantonese, or Mandarin. INTERVENTION Lay health worker (LHW) intervention plus in-language brochure (LHW+Print) versus brochure (Print). LHWs in the LHW+Print arm were trained to teach participants about CRC in two small group sessions and two telephone calls. MAIN OUTCOME MEASURES Change in self-reports of ever having had CRC screening and being up to date for CRC screening from baseline to 6 months post-intervention. Statistical analysis was performed from 2014 to 2015. RESULTS This study recruited 58 LHWs, who in turn recruited 725 participants. The average age of the participants was 62.2 years, with 81.1% women and 99.4% foreign born. Knowledge increase was significant (p<0.002) for nine measures in the LHW+Print group and six in the Print group. Both groups had increases in having ever been screened for CRC (LHW+Print, 73.9%-88.3%, p<0.0001; Print, 72.3%-79.5%, p=0.0003) and being up to date for CRC screening (LHW+Print, 60.0%-78.1%, p<0.0001; Print, 58.1%-64.1%, p=0.0003). In multivariable analyses, the intervention OR for LHW+Print versus Print was 1.94 (95% CI=1.34, 2.79) for ever screening and 2.02 (95% CI=1.40, 2.90) for being up to date. CONCLUSIONS Both in-language print materials and LHW outreach plus print materials increased CRC screening among Chinese Americans. The combination of LHW+Print was more effective than Print alone. These findings can guide clinicians and policymakers in choosing appropriate interventions to increase CRC screening among Chinese American immigrants. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT00947206.
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Affiliation(s)
- Tung T Nguyen
- Asian American Research Center on Health, San Francisco, California; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California.
| | - Janice Y Tsoh
- Asian American Research Center on Health, San Francisco, California; Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Kent Woo
- Asian American Research Center on Health, San Francisco, California; NICOS Chinese Health Coalition, San Francisco, California
| | - Susan L Stewart
- Department of Public Health Sciences, University of California, Davis, Davis, California
| | - Gem M Le
- Asian American Research Center on Health, San Francisco, California; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Adam Burke
- Asian American Research Center on Health, San Francisco, California; Department of Health Education, San Francisco State University, San Francisco, California
| | - Ginny Gildengorin
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Rena J Pasick
- Asian American Research Center on Health, San Francisco, California; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Jun Wang
- Asian American Research Center on Health, San Francisco, California; The American College of Traditional Chinese Medicine, San Francisco, California
| | - Elaine Chan
- Department of Psychiatry, University of California, San Francisco, San Francisco, California; NICOS Chinese Health Coalition, San Francisco, California
| | - Lei-Chun Fung
- Asian American Research Center on Health, San Francisco, California; Chinatown Public Health Center, Department of Public Health, San Francisco, California
| | - Jane Jih
- Asian American Research Center on Health, San Francisco, California; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Stephen J McPhee
- Asian American Research Center on Health, San Francisco, California; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
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Larkey L, Szalacha L, Herman P, Gonzalez J, Menon U. Randomized controlled dissemination study of community-to-clinic navigation to promote CRC screening: Study design and implications. Contemp Clin Trials 2017; 53:106-114. [PMID: 27940183 PMCID: PMC6386159 DOI: 10.1016/j.cct.2016.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/30/2016] [Accepted: 12/03/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Regular screening facilitates early diagnosis of colorectal cancer (CRC) and reduction of CRC morbidity and mortality. Screening rates for minorities and low-income populations remain suboptimal. Provider referral for CRC screening is one of the strongest predictors of adherence, but referrals are unlikely among those who have no clinic home (common among poor and minority populations). METHODS/STUDY DESIGN This group randomized controlled study will test the effectiveness of an evidence based tailored messaging intervention in a community-to-clinic navigation context compared to no navigation. Multicultural, underinsured individuals from community sites will be randomized (by site) to receive CRC screening education only, or education plus navigation. In Phase I, those randomized to education plus navigation will be guided to make a clinic appointment to receive a provider referral for CRC screening. Patients attending clinic appointments will continue to receive navigation until screened (Phase II) regardless of initial arm assignment. We hypothesize that those receiving education plus navigation will be more likely to attend clinic appointments (H1) and show higher rates of screening (H2) compared to those receiving education only. Phase I group assignment will be used as a control variable in analysis of screening follow-through in Phase II. Costs per screening achieved will be evaluated for each condition and the RE-AIM framework will be used to examine dissemination results. CONCLUSION The novelty of our study design is the translational dissemination model that will allow us to assess the real-world application of an efficacious intervention previously tested in a randomized controlled trial.
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Affiliation(s)
- Linda Larkey
- Arizona State University, College of Nursing and Health Innovation, 550 N 3rd Street, Phoenix, AZ 85004, United States.
| | - Laura Szalacha
- The University of Arizona, College of Nursing, 1305 N. Martin, Tucson, AZ 85721, United States
| | - Patricia Herman
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, United States
| | - Julie Gonzalez
- Arizona State University, College of Nursing and Health Innovation, 550 N 3rd Street, Phoenix, AZ 85004, United States
| | - Usha Menon
- The University of Arizona, College of Nursing, 1305 N. Martin, Tucson, AZ 85721, United States
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Effectiveness of patient-targeted interventions to promote cancer screening among ethnic minorities: A systematic review. Cancer Epidemiol 2016; 44:22-39. [DOI: 10.1016/j.canep.2016.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/13/2016] [Accepted: 07/15/2016] [Indexed: 11/23/2022]
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Maxwell AE, Danao LL, Cayetano RT, Crespi CM, Bastani R. Implementation of an evidence-based intervention to promote colorectal cancer screening in community organizations: a cluster randomized trial. Transl Behav Med 2016; 6:295-305. [PMID: 27282431 PMCID: PMC4927441 DOI: 10.1007/s13142-015-0349-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
UNLABELLED The implementation of evidence-based strategies to promote colorectal cancer (CRC) screening remains challenging. The aim of this study is to evaluate two strategies to implement an evidence-based intervention to promote CRC screening in Filipino American community organizations. Twenty-two community organizations were randomized to either a basic or enhanced implementation strategy. In both arms, community health advisors recruited participants non-adherent to CRC screening guidelines, conducted educational sessions, distributed print materials and free fecal occult blood test kits, reminded participants to get screened, and mailed letters to participants' providers. In the enhanced arm, leaders of the organizations participated in implementation efforts. While the effectiveness was similar in both arms of the study (screening rate at 6-month follow-up was 53 % in the enhanced arm, 49 % in the basic arm), 223 participants were screened in the enhanced arm versus 122 in the basic arm. The enhanced implementation strategy reached 83 % more participants and achieved a higher public health impact. TRIAL REGISTRATION NCT01351220 (ClinicalTrials.gov).
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Affiliation(s)
- Annette E Maxwell
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, CA, USA.
- , 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.
| | - Leda L Danao
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, CA, USA
| | - Reggie T Cayetano
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, CA, USA
| | - Catherine M Crespi
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, CA, USA
| | - Roshan Bastani
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, CA, USA
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Bastani R, Glenn BA, Maxwell AE, Jo AM, Herrmann AK, Crespi CM, Wong WK, Chang LC, Stewart SL, Nguyen TT, Chen MS, Taylor VM. Cluster-Randomized Trial to Increase Hepatitis B Testing among Koreans in Los Angeles. Cancer Epidemiol Biomarkers Prev 2015; 24:1341-9. [PMID: 26104909 PMCID: PMC4560609 DOI: 10.1158/1055-9965.epi-14-1396] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 06/02/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the United States, Korean immigrants experience a disproportionately high burden of chronic hepatitis B (HBV) viral infection and associated liver cancer compared with the general population. However, despite clear clinical guidelines, HBV serologic testing among Koreans remains persistently suboptimal. METHODS We conducted a cluster-randomized trial to evaluate a church-based small group intervention to improve HBV testing among Koreans in Los Angeles. Fifty-two Korean churches, stratified by size (small, medium, large) and location (Koreatown versus other), were randomized to intervention or control conditions. Intervention church participants attended a single-session small-group discussion on liver cancer and HBV testing, and control church participants attended a similar session on physical activity and nutrition. Outcome data consisted of self-reported HBV testing obtained via 6-month telephone follow-up interviews. RESULTS We recruited 1,123 individuals, 18 to 64 years of age, across the 52 churches. Ninety-two percent of the sample attended the assigned intervention session and 86% completed the 6-month follow-up. Sample characteristics included were as follows: mean age 46 years, 65% female, 97% born in Korea, 69% completed some college, and 43% insured. In an intent-to-treat analysis, the intervention produced a statistically significant effect (OR = 4.9, P < 0.001), with 19% of intervention and 6% of control group participants reporting a HBV test. CONCLUSION Our intervention was successful in achieving a large and robust effect in a population at high risk of HBV infection and sequelae. IMPACT The intervention was fairly resource efficient and thus has high potential for replication in other high-risk Asian groups.
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Affiliation(s)
- Roshan Bastani
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California.
| | - Beth A Glenn
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - Annette E Maxwell
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - Angela M Jo
- Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Alison K Herrmann
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - Catherine M Crespi
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - Weng K Wong
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - L Cindy Chang
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - Susan L Stewart
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, California
| | - Tung T Nguyen
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Moon S Chen
- Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis, Davis, California
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Nguyen BH, Stewart SL, Nguyen TT, Bui-Tong N, McPhee SJ. Effectiveness of Lay Health Worker Outreach in Reducing Disparities in Colorectal Cancer Screening in Vietnamese Americans. Am J Public Health 2015; 105:2083-9. [PMID: 26270306 DOI: 10.2105/ajph.2015.302713] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We conducted a cluster randomized controlled study of a lay health worker (LHW) intervention to increase colorectal cancer (CRC) screening rates among Vietnamese Americans, who typically have lower rates than do non-Hispanic Whites. METHODS We randomized 64 LHWs to 2 arms. Each LHW recruited 10 male or female participants who had never had CRC screening (fecal occult blood test, sigmoidoscopy, or colonoscopy). Intervention LHWs led 2 educational sessions on CRC screening. Control LHWs led 2 sessions on healthy eating and physical activity. The main outcome was self-reported receipt of any CRC screening at 6 months after the intervention. We conducted the study from 2008 to 2013 in Santa Clara County, California. RESULTS A greater proportion of intervention participants (56%) than control participants (19%) reported receiving CRC screening (P < .001). When controlling for demographic characteristics, the intervention odds ratio was 5.45 (95% confidence interval = 3.02, 9.82). There was no difference in intervention effect by participant gender. CONCLUSIONS LHW outreach was effective in increasing CRC screening in Vietnamese Americans. Randomized controlled trials are needed to test the effectiveness of LHW outreach for other populations and other health outcomes.
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Affiliation(s)
- Bang H Nguyen
- Bang H. Nguyen is with the Cancer Prevention Institute of California, Fremont and the Department of Health Research & Policy, Stanford University School of Medicine, Stanford, CA. Susan L. Stewart is with the Department of Public Health Sciences, University of California School of Medicine, Davis. Tung T. Nguyen and Stephen J. McPhee are with the Department of Medicine, University of California, San Francisco. Ngoc Bui-Tong is with the Vietnamese Reach for Health Coalition, Fremont, CA
| | - Susan L Stewart
- Bang H. Nguyen is with the Cancer Prevention Institute of California, Fremont and the Department of Health Research & Policy, Stanford University School of Medicine, Stanford, CA. Susan L. Stewart is with the Department of Public Health Sciences, University of California School of Medicine, Davis. Tung T. Nguyen and Stephen J. McPhee are with the Department of Medicine, University of California, San Francisco. Ngoc Bui-Tong is with the Vietnamese Reach for Health Coalition, Fremont, CA
| | - Tung T Nguyen
- Bang H. Nguyen is with the Cancer Prevention Institute of California, Fremont and the Department of Health Research & Policy, Stanford University School of Medicine, Stanford, CA. Susan L. Stewart is with the Department of Public Health Sciences, University of California School of Medicine, Davis. Tung T. Nguyen and Stephen J. McPhee are with the Department of Medicine, University of California, San Francisco. Ngoc Bui-Tong is with the Vietnamese Reach for Health Coalition, Fremont, CA
| | - Ngoc Bui-Tong
- Bang H. Nguyen is with the Cancer Prevention Institute of California, Fremont and the Department of Health Research & Policy, Stanford University School of Medicine, Stanford, CA. Susan L. Stewart is with the Department of Public Health Sciences, University of California School of Medicine, Davis. Tung T. Nguyen and Stephen J. McPhee are with the Department of Medicine, University of California, San Francisco. Ngoc Bui-Tong is with the Vietnamese Reach for Health Coalition, Fremont, CA
| | - Stephen J McPhee
- Bang H. Nguyen is with the Cancer Prevention Institute of California, Fremont and the Department of Health Research & Policy, Stanford University School of Medicine, Stanford, CA. Susan L. Stewart is with the Department of Public Health Sciences, University of California School of Medicine, Davis. Tung T. Nguyen and Stephen J. McPhee are with the Department of Medicine, University of California, San Francisco. Ngoc Bui-Tong is with the Vietnamese Reach for Health Coalition, Fremont, CA
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Larkey LK, McClain D, Roe DJ, Hector RD, Lopez AM, Sillanpaa B, Gonzalez J. Randomized controlled trial of storytelling compared to a personal risk tool intervention on colorectal cancer screening in low-income patients. Am J Health Promot 2015; 30:e59-70. [PMID: 25615708 DOI: 10.4278/ajhp.131111-quan-572] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Screening rates for colorectal cancer (CRC) lag for low-income, minority populations, contributing to poorer survival rates. A model of storytelling as culture-centric health promotion was tested for promoting CRC screening. DESIGN A two-group parallel randomized controlled trial. SETTING Primary care, safety-net clinics. SUBJECTS Low-income patients due for CRC screening, ages 50 to 75 years, speaking English or Spanish. INTERVENTION Patients were exposed to either a video created from personal stories composited into a drama about "Papa" receiving CRC screening, or an instrument estimating level of personal cancer risk. Patients received a health care provider referral for CRC screening and were followed up for 3 months to document adherence. MEASURES Behavioral factors related to the narrative model (identification and engagement) and theory of planned behavior. ANALYSIS Main effects of the interventions on screening were tested, controlling for attrition factors, and demographic factor associations were assessed. Path analysis with model variables was used to test the direct effects and multiple mediator models. RESULTS Main effects on CRC screening (roughly half stool-based tests, half colonoscopy) did not indicate significant differences (37% and 42% screened for storytelling and risk-based messages, respectively; n = 539; 33.6% male; 62% Hispanic). Factors positively associated with CRC screening included being female, Hispanic, married or living with a partner, speaking Spanish, having a primary care provider, lower income, and no health insurance. Engagement, working through positive attitudes toward the behavior, predicted CRC screening. CONCLUSION A storytelling and a personalized risk-tool intervention achieved similar levels of screening among unscreened/underscreened, low-income patients. Factors usually associated with lower rates of screening (e.g., no insurance, being Hispanic) were related to more adherence. Both interventions' engagement factor facilitated positive attitudes about CRC screening associated with behavior change.
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Tanjasiri SP, Weiss JW, Santos L, Flores P, Flores P, Lacsamana JD, Paige C, Mouttapa M, Quitugua L, Taito P, May VT, Tupua M, Vaikona E, Vaivao D, Vunileva I. CBPR-Informed Recruitment and Retention Adaptations in a Randomized Study of Pap Testing Among Pacific Islanders in Southern California. Prog Community Health Partnersh 2015; 9:389-96. [PMID: 26548790 PMCID: PMC5142847 DOI: 10.1353/cpr.2015.0067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pacific Islanders (PIs) experience high cervical cancer rates in the United States. Stage of diagnosis is also later for PIs than non-Hispanic Whites. The Pap test is severely underutilized among PIs: only 71% of Asian American and Pacific Islander women age 25 years or older received a Pap test within the last 3 years (U.S. average, 82%). Community-based participatory research (CBPR) is increasingly seen as an essential approach in designing and conducting culturally relevant and appropriate studies that reduce cancer incidence and other health disparities among minority and other medically underserved populations. PURPOSE The purpose of this article is to describe the lessons learned thus far regarding the identification, recruitment, and retention of PI community organizations and members into a CBPR-informed, randomized, community trial promoting Pap testing. METHODS This 5-year study used CBPR to develop and test the efficacy of a social support intervention for Chamorro, Samoan, and Tongan women to increase Pap testing in southern California. Eligible women were between the ages of 21 and 65, and married or in a long-term relationship with a man for at least 5 years. Women and their husbands or significant others received a 2-hour, culturally tailored workshop that include a group activity, information on Pap testing, a video, and corresponding materials. Comparison participants received a brochure about Pap testing. Three waves of data are collected from all participants: pretest (before workshop or brochure), posttest 1 (immediately after workshop or brochure), and posttest 2 (6 months follow-up). RESULTS Of the 76 organizations approached to participate in the study, 67 (88.2%) eventually agreed to participate. Thus far, 473 women and 419 men completed the study pretest, post-test, education, and 6-month follow-up. Only 242 women and 204 men of the eligible participants have completed the follow-up survey (63.5% of women and 60.5% of men retained after 6 months). LESSONS LEARNED The main strategy to overcome initial recruitment challenges was study staff persistence, because they averaged five contacts with each church or clan leader before receiving confirmation that an educational session can be scheduled. Personal connections provided an introduction to the most appropriate church or clan leader. Other efforts for retention include creation of an online version of the survey, re-attending church services, and creating special events organized around clan activities. CONCLUSIONS Although CBPR improves the cultural competence and relevance of study activities for ethnically diverse populations, selected past research shows that it does not ensure that such designs overcome all of the unique challenges in ethnically diverse communities. PI-specific organizational recruitment and individual retention is influenced by study issues and cultural factors in each community.
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A randomized controlled trial of two interventions to increase colorectal cancer screening among Hispanics on the Texas-Mexico border. Cancer Causes Control 2014; 26:1-10. [PMID: 25466604 DOI: 10.1007/s10552-014-0472-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 09/30/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second and third leading cause of cancer death for Hispanic men and women, respectively. CRC can be prevented if precursors are detected early and removed and can be successfully treated if discovered early. While one-on-one interventions for increasing CRC screening (CRCS) are recommended, few studies specifically assess the effectiveness of lay health worker (LHW) approaches using different educational materials. PURPOSE To develop and evaluate the effectiveness of two LHW-delivered CRCS interventions known as Vale la Pena (VLP; "It's Worth It!") on increasing CRCS among Hispanics. DESIGN The study design was a cluster randomized controlled trial with two treatment arms. SETTING/PARTICIPANTS Six hundred and sixty five Hispanics 50 years and older were recruited from 24 colonias (neighborhoods) in the Lower Rio Grande Valley of the Texas-Mexico border. INTERVENTION The interventions were a small media print intervention (SMPI) (including DVD and flipchart), and a tailored interactive multimedia intervention (TIMI) delivered on tablet computers. A no intervention group served as the comparison group. Data were collected between 2007 and 2009 and analyzed between 2009 and 2013. MAIN OUTCOME MEASURES Measures assessed CRCS behavior, self-efficacy, knowledge, and other psychosocial constructs related to CRCS and targeted through VLP. RESULTS Among participants reached for follow-up, 18.9 % in the SMPI group, 13.3 % in the TIMI group, and 11.9 % in the comparison group completed CRCS. Intent-to-treat analysis showed that 13.6 % in the SMPI group, 10.2 % in the TIMI group, and 10.8 % in the comparison group completed CRCS. These differences were not statistically significant. CONCLUSION Results indicated that there are no significant differences in CRCS uptake between groups.
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Maxwell AE, Bastani R, Glenn BA, Taylor VM, Nguyen TT, Stewart SL, Burke NJ, Chen MS. Developing theoretically based and culturally appropriate interventions to promote hepatitis B testing in 4 Asian American populations, 2006-2011. Prev Chronic Dis 2014; 11:E72. [PMID: 24784908 PMCID: PMC4008952 DOI: 10.5888/pcd11.130245] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Introduction Hepatitis B infection is 5 to 12 times more common among Asian Americans than in the general US population and is the leading cause of liver disease and liver cancer among Asians. The purpose of this article is to describe the step-by-step approach that we followed in community-based participatory research projects in 4 Asian American groups, conducted from 2006 through 2011 in California and Washington state to develop theoretically based and culturally appropriate interventions to promote hepatitis B testing. We provide examples to illustrate how intervention messages addressing identical theoretical constructs of the Health Behavior Framework were modified to be culturally appropriate for each community. Methods Intervention approaches included mass media in the Vietnamese community, small-group educational sessions at churches in the Korean community, and home visits by lay health workers in the Hmong and Cambodian communities. Results Use of the Health Behavior Framework allowed a systematic approach to intervention development across populations, resulting in 4 different culturally appropriate interventions that addressed the same set of theoretical constructs. Conclusions The development of theory-based health promotion interventions for different populations will advance our understanding of which constructs are critical to modify specific health behaviors.
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Affiliation(s)
- Annette E Maxwell
- University of California, Los Angeles, 650 Charles Young Drive South, Los Angeles, CA 90095-6900. E-mail:
| | | | - Beth A Glenn
- University of California, Los Angeles, California
| | | | | | | | | | - Moon S Chen
- University of California, Davis, Sacramento, California
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Abstract
OBJECTIVES Colorectal cancer (CRC) is the most commonly diagnosed cancer for all US populations including Asian Americans. CRC screening has considerable benefits to prevent CRC and reduce mortality. The purpose of this article was to review the published literature on rates of colorectal cancer screening and factors associated with colorectal cancer screening practice among Asian Americans. METHODS Through searching electronic reference databases from 2000 to 2013, 30 articles were found on Chinese, Filipino, Japanese, Korean, and Vietnamese Americans. FINDINGS Asian Americans had significantly low rates for CRC screening; Korean Americans reported the lowest rates, while higher screening rates were found among Japanese Americans. Older age, longer length of stay in the US, and having a physician's recommendation were the most common facilitators to receiving screening. The common inhibiting factors were financial issues, employment status, and worries/fears about the procedure. CONCLUSIONS Despite a number of Asian Americans being vulnerable to CRC, individual Asian subgroups were underserved with CRC screening and intervention. Further studies should focus on each individual Asian subgroup and culturally proficient CRC screening intervention programs should be developed for each.
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Affiliation(s)
- Hyenam Hwang
- School of Nursing, University of Texas at Austin, Texas, USA.
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Maxwell AE, Danao LL, Cayetano RT, Crespi CM, Bastani R. Adoption of an evidence-based colorectal cancer screening promotion program by community organizations serving Filipino Americans. BMC Public Health 2014; 14:246. [PMID: 24618267 PMCID: PMC3995646 DOI: 10.1186/1471-2458-14-246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 03/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Filipino Americans have low rates of colorectal cancer (CRC) screening and high CRC mortality. To reduce this disparity, we conducted a dissemination trial in which we offered two levels of technical assistance to community organizations to disseminate an evidence-based CRC screening promotion program among their Filipino American members. This report describes the recruitment of organizations and adoption - the proportion and representativeness of organizations that decided to implement the program. METHODS During the recruitment phase, we completed organizational assessments with 44 community-based organizations (previous partners in research, organizations that were referred to us, or new organizations) to assess their eligibility to participate (having≥150 Filipino American members age 50+). We compared organizational characteristics of organizations that did and did not adopt our CRC screening promotion program. RESULTS Twenty two of the 44 community organizations that completed the assessment adopted the CRC screening promotion program (50%). Adoption was highest among organizations that had previously partnered with us (11/14=79%) and among organizations that were referred to us by community partners (5/10=50%) and lowest among new organizations (6/20=30%). Few organizational differences were found between adopters and non-adopters. CONCLUSIONS The high rate of adoption among organizations that were referred by community partners or had partnered with us in the past underscores the importance of community resources, community-academic relationships, and partnership in the dissemination process. However, the moderate rate of adoption among new organizations and the demands of completing documentation and assessments in our trial to advance dissemination research raise questions regarding the generalizability of study findings.
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Affiliation(s)
- Annette E Maxwell
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles Young Dr, South A2-125 CHS, Box 956900, Los Angeles, CA 90095-6900, USA.
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Gimeno Garcia AZ, Hernandez Alvarez Buylla N, Nicolas-Perez D, Quintero E. Public awareness of colorectal cancer screening: knowledge, attitudes, and interventions for increasing screening uptake. ISRN ONCOLOGY 2014; 2014:425787. [PMID: 24729896 PMCID: PMC3963118 DOI: 10.1155/2014/425787] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 12/31/2013] [Indexed: 02/06/2023]
Abstract
Colorectal cancer ranks as one of the most incidental and death malignancies worldwide. Colorectal cancer screening has proven its benefit in terms of incidence and mortality reduction in randomized controlled trials. In fact, it has been recommended by medical organizations either in average-risk or family-risk populations. Success of a screening campaign highly depends on how compliant the target population is. Several factors influence colorectal cancer screening uptake including sociodemographics, provider and healthcare system factors, and psychosocial factors. Awareness of the target population of colorectal cancer and screening is crucial in order to increase screening participation rates. Knowledge about this disease and its prevention has been used across studies as a measurement of public awareness. Some studies found a positive relationship between knowledge about colorectal cancer, risk perception, and attitudes (perceived benefits and barriers against screening) and willingness to participate in a colorectal cancer screening campaign. The mentioned factors are modifiable and therefore susceptible of intervention. In fact, interventional studies focused on average-risk population have tried to increase colorectal cancer screening uptake by improving public knowledge and modifying attitudes. In the present paper, we reviewed the factors impacting adherence to colorectal cancer screening and interventions targeting participants for increasing screening uptake.
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Affiliation(s)
- Antonio Z Gimeno Garcia
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Unidad de Endoscopia, La Laguna, 38320 Tenerife, Spain ; Departamento de Gastroenterología, Hospital Universitario de Canarias, Unidad de Endoscopia, Ofra s/n, La Laguna, 38320 Tenerife, Spain
| | - Noemi Hernandez Alvarez Buylla
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Unidad de Endoscopia, La Laguna, 38320 Tenerife, Spain
| | - David Nicolas-Perez
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Unidad de Endoscopia, La Laguna, 38320 Tenerife, Spain
| | - Enrique Quintero
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Unidad de Endoscopia, La Laguna, 38320 Tenerife, Spain
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Adherence to Colorectal Cancer and Polyps Screening Recommendations Among Filipino-Americans. Gastroenterol Nurs 2014; 37:384-90. [DOI: 10.1097/sga.0000000000000071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Salimzadeh H, Eftekhar H, Majdzadeh R, Montazeri A, Delavari A. Effectiveness of a theory-based intervention to increase colorectal cancer screening among Iranian health club members: a randomized trial. J Behav Med 2013; 37:1019-29. [PMID: 24027014 DOI: 10.1007/s10865-013-9533-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 08/22/2013] [Indexed: 02/04/2023]
Abstract
Colorectal cancer is the third most commonly diagnosed cancer and the fourth leading cause of death in the world. There are few published studies that have used theory-based interventions designed to increase colorectal cancer screening in community lay health organizations. The present study was guided by the theoretical concepts of the preventive health model. Twelve health clubs of a municipal district in Tehran were randomized to two study groups with equal ratio. The control group received usual services throughout the study while the intervention group also received a theory-based educational program on colorectal cancer screening plus a reminder call. Screening behavior, the main outcome, was assessed 4 months after randomization. A total of 360 members aged 50 and older from 12 health clubs completed a baseline survey. Participants in the intervention group reported increased knowledge of colorectal cancer and screening tests at 4 months follow-up (p's < .001). Moreover, exposure to the theory-based intervention significantly improved self-efficacy, perceived susceptibility, efficacy of screening, social support, and intention to be screened for colorectal cancer, from baseline to 4 months follow-up (p's < .001). The screening rate for colorectal cancer was significantly higher in the intervention group compared to the control group (odds ratio = 15.93, 95% CI = 5.57, 45.53). Our theory-based intervention was found to have a significant effect on colorectal cancer screening use as measured by self-report. The findings could have implications for colorectal cancer screening program development and implementation in primary health care settings and through other community organizations.
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Affiliation(s)
- Hamideh Salimzadeh
- Digestive Diseases Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Maxwell AE, Stewart SL, Glenn BA, Wong WK, Yasui Y, Chang LC, Taylor VM, Nguyen TT, Chen MS, Bastani R. Theoretically informed correlates of hepatitis B knowledge among four Asian groups: the health behavior framework. Asian Pac J Cancer Prev 2013; 13:1687-92. [PMID: 22799389 DOI: 10.7314/apjcp.2012.13.4.1687] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Few studies have examined theoretically informed constructs related to hepatitis B (HBV) testing, and comparisons across studies are challenging due to lack of uniformity in constructs assessed. The present analysis examined relationships among Health Behavior Framework factors across four Asian American groups to advance the development of theory-based interventions for HBV testing in at-risk populations. METHODS Data were collected from 2007-2010 as part of baseline surveys during four intervention trials promoting HBV testing among Vietnamese-, Hmong-, Korean- and Cambodian-Americans (n = 1,735). Health Behavior Framework constructs assessed included: awareness of HBV, knowledge of transmission routes, perceived susceptibility, perceived severity, doctor recommendation, stigma of HBV infection, and perceived efficacy of testing. Within each group we assessed associations between our intermediate outcome of knowledge of HBV transmission and other constructs, to assess the concurrent validity of our model and instruments. RESULTS While the absolute levels for Health Behavior Framework factors varied across groups, relationships between knowledge and other factors were generally consistent. This suggests similarities rather than differences with respect to posited drivers of HBV-related behavior. DISCUSSION Our findings indicate that Health Behavior Framework constructs are applicable to diverse ethnic groups and provide preliminary evidence for the construct validity of the Health Behavior Framework.
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Affiliation(s)
- Annette E Maxwell
- School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, USA.
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Maxwell AE, Danao LL, Cayetano RT, Crespi CM, Bastani R. Evaluating the training of Filipino American community health advisors to disseminate colorectal cancer screening. J Community Health 2013; 37:1218-25. [PMID: 22430865 DOI: 10.1007/s10900-012-9557-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Community health advisor-led interventions are associated with improved health promotion behaviors, such as cancer screening, but the process of training community health advisors is rarely described and evaluated. We trained 91 Filipino Americans from 19 organizations to conduct small-group sessions with members of their organizations to promote colorectal cancer screening. Community health advisors completed brief pre- and post-training surveys that included knowledge of colorectal cancer screening guidelines (four items), perceived self-efficacy of performing specific tasks (15-item scale, Cronbach's alpha > 0.90) and satisfaction with the training itself (five items). Community health advisors had high levels of knowledge and self-efficacy at pre-training, but levels increased significantly immediately after the 6-h training (percent of knowledge items answered correctly: 63-94 %; self-efficacy: 8.2-8.9 on a 10 point scale, both p < 0.001). Correlates of self-efficacy at pre- and post-test were high educational attainment, health care background, high level of participation in the organization, being perceived by others as a leader, and frequent participation in research activities in the past. Consistent evaluation measuring similar constructs across studies may help to standardize the quality of the training, and may improve the implementation of community health advisor-led programs.
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Affiliation(s)
- Annette E Maxwell
- School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA.
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Maxwell AE, Danao LL, Bastani R. Dissemination of colorectal cancer screening by Filipino American community health advisors: a feasibility study. Health Promot Pract 2012; 14:498-505. [PMID: 22982706 DOI: 10.1177/1524839912458108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Filipino Americans underutilize life-saving screening tests for colorectal cancer, resulting in late stage of diagnosis and poor survival relative to other racial/ethnic groups. Education regarding colorectal cancer screening and distribution of free fecal occult blood test (FOBT) kits are evidence-based interventions that can significantly increase screening. However, this community will only benefit if the intervention is broadly disseminated. METHODS We assessed the feasibility of promoting colorectal cancer screening in Filipino American community settings working with community health advisors, and the practicality of conducting one-on-one or small group education, in addition to passing out free FOBT kits. RESULTS Twenty community health advisors from 4 organizations engaged in recruitment and education activities with 132 participants. Community health advisors consistently completed screening questionnaires to establish eligibility and kept logs of FOBT distribution. However, they did not consistently record eligible participants who did not consent to participate. Process checklists that indicated what information was covered in each educational session and postsession follow-up logs were partially completed. Almost all participants reported receipt of intervention components and receipt of screening at 4-month follow-up and reported high acceptability of the program. DISCUSSION The pilot study established the feasibility of working with community health advisors to promote colorectal cancer screening in Filipino American community settings. Findings informed the design of a dissemination trial that is currently ongoing with regards to monitoring recruitment, intervention implementation and follow-up and allowing flexibility regarding one-on-one or small group education.
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Affiliation(s)
- Annette E Maxwell
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA 90095-6900, USA.
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Jean-Jacques M, Kaleba EO, Gatta JL, Gracia G, Ryan ER, Choucair BN. Program to improve colorectal cancer screening in a low-income, racially diverse population: a randomized controlled trial. Ann Fam Med 2012; 10:412-7. [PMID: 22966104 PMCID: PMC3438208 DOI: 10.1370/afm.1381] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE More effective strategies are needed to improve rates of colorectal cancer screening, particularly among the poor, racial and ethnic minorities, and individuals with limited English proficiency. We examined whether the direct mailing of fecal occult blood testing (FOBT) kits to patients overdue for such screening is an effective way to improve screening in this population. METHODS All adults aged 50 to 80 years who did not have documentation of being up to date with colorectal cancer screening as of December 31, 2009, and who had had at least 2 visits to the community health center in the prior 18 months were randomized to the outreach intervention or usual care. Patients in the outreach group were mailed a colorectal cancer fact sheet and FOBT kit. Patients in the usual care group could be referred for screening during usual clinician visits. The primary outcome was completion of colorectal cancer screening (by FOBT, sigmoidoscopy, or colonoscopy) 4 months after initiation of the outreach protocol. Outcome measures were compared using the Fisher exact test. RESULTS Analyses were based on 104 patients assigned to the outreach intervention and 98 patients assigned to usual care. In all, 30% of patients in the outreach group completed colorectal cancer screening during the study period, compared with 5% of patients in the usual care group (P <.001). Nearly all of the screenings were by FOBT. The groups did not differ significantly with respect to the percentage of patients making a clinician visit or the percentage for whom a clinician placed an order for a screening test. CONCLUSIONS The mailing of FOBT kits directly to patients was efficacious for promoting colorectal cancer screening among a population with high levels of poverty, limited English proficiency, and racial and ethnic diversity. Non-visit-based outreach to patients may be an important strategy to address suboptimal rates of colorectal cancer screening among populations most at risk for not being screened.
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Affiliation(s)
- Muriel Jean-Jacques
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
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