1
|
Bhattacharya M, Cronin KA, Farrigan TL, Kennedy AE, Yu M, Srinivasan S. Description of census-tract-level social determinants of health in cancer surveillance data. J Natl Cancer Inst Monogr 2024; 2024:152-161. [PMID: 39102885 DOI: 10.1093/jncimonographs/lgae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/05/2024] [Accepted: 05/07/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Disparities in cancer incidence, stage at diagnosis, and mortality persist by race, ethnicity, and many other social determinants, such as census-tract-level socioeconomic status (SES), poverty, and rurality. Census-tract-level measures of these determinants are useful for analyzing trends in cancer disparities. METHODS The purpose of this paper was to demonstrate the availability of the Surveillance, Epidemiology, and End Results Program's specialized census-tract-level dataset and provide basic descriptive cancer incidence, stage at diagnosis, and survival for 8 cancer sites, which can be screened regularly or associated with infectious agents. We present these analyses according to several census-tract-level measures, including the newly available persistent poverty as well as SES quintile, rurality, and race and ethnicity. RESULTS Census tracts with persistent poverty and low SES had higher cancer incidence rates (except for breast and prostate cancer), higher percentages of cases diagnosed with regional or distant-stage disease, and lower survival than non-persistent-poverty and higher-SES tracts. Outcomes varied by cancer site when analyzing based on rurality as well as race and ethnicity. Analyses stratified by multiple determinants showed unique patterns of outcomes, which bear further investigation. CONCLUSIONS This article introduces the Surveillance, Epidemiology, and End Results specialized dataset, which contains census-tract-level social determinants measures, including persistent poverty, rurality, SES quintile, and race and ethnicity. We demonstrate the capacity of these variables for use in producing trends and analyses focusing on cancer health disparities. Analyses may inform interventions and policy changes that improve cancer outcomes among populations living in disadvantaged areas, such as persistent-poverty tracts.
Collapse
Affiliation(s)
- Manami Bhattacharya
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kathleen A Cronin
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Tracey L Farrigan
- Resource and Rural Economics Division, Economic Research Service, US Department of Agriculture, Washington, DC, USA
| | - Amy E Kennedy
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Mandi Yu
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Shobha Srinivasan
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| |
Collapse
|
2
|
Jewett PI, Gangnon RE, Hing AK, Henning-Smith C, Chantarat T, Areba EM, Borowsky IW. Racial Arrest Disparities in the USA by Rural-Urban Location and Region. J Racial Ethn Health Disparities 2024; 11:2355-2377. [PMID: 37525024 DOI: 10.1007/s40615-023-01703-5] [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: 03/01/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Urban racial arrest disparities are well known. Emerging evidence suggests that rural policing shares similar patterns as urban policing in the USA, but without receiving the same public scrutiny, raising the risk of biased rural policing going unnoticed. METHODS We estimated adult and adolescent arrest rates and rate ratios (RR) by race, rural-urban status, and US region based on 2016 Uniform Crime Reporting Program arrest and US Census population counts using general estimating equation Poisson regression models with a 4-way interaction between race, region, age group, and urbanicity. RESULTS With few exceptions, arrest rates were highest in small towns and rural areas, especially among Black and American Indian populations. Arrest rates differed between US regions with highest rates and racial disparities in the Midwest. For example, arrest rates among Black adults in the rural Midwest were 148.6 arrests [per 1000 population], 95% CI 131.4-168.0, versus 94.4 arrests, 95% CI 77.2-115.4 in the urban Midwest; and versus corresponding rural Midwest arrests among white adults, 32.7 arrests, 95% CI 30.8-34.8, Black versus white rural RR 4.54, 95% CI 4.09-5.04. Racial arrest disparities in the South were lower but still high, e.g., rural South, Black versus White adults, RR 1.86, 95% CI 1.71-2.03. CONCLUSIONS Rural areas and small towns are potential hotspots of racial arrest disparities across the USA, especially in the Midwest. Approaches to overcoming structural racism in policing must include strategies targeted at rural/small town communities. Our findings underscore the importance of dismantling racist policing in all US communities.
Collapse
Affiliation(s)
- Patricia I Jewett
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Ronald E Gangnon
- Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA
| | - Anna K Hing
- Center for Antiracism Research for Health Equity, School of Public Health, University of Minnesota, Minneapolis, MN, USA
- Minnesota Population Center, Institute for Social Research and Data Innovation, University of Minnesota, Minneapolis, MN, USA
| | - Carrie Henning-Smith
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Tongtan Chantarat
- Center for Antiracism Research for Health Equity, School of Public Health, University of Minnesota, Minneapolis, MN, USA
- Minnesota Population Center, Institute for Social Research and Data Innovation, University of Minnesota, Minneapolis, MN, USA
| | - Eunice M Areba
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Iris W Borowsky
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
3
|
McClellan CB. Health care Utilization and Expenditures in Health Professional Shortage Areas. Med Care Res Rev 2024; 81:335-345. [PMID: 38486440 DOI: 10.1177/10775587241235705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Healthcare provider shortages are associated with adverse health outcomes, presumably stemming from the lack of access to primary care. This study examines the impact of Health Professional Shortage Areas (HPSAs) on healthcare utilization and spending across different types of care. Using the Medical Expenditure Panel Survey from 2002 to 2019, this study estimates the difference in healthcare utilization in HPSAs compared with non-HPSAs using a generalized random forest, which allows for more complex modeling of the outcome and a principled examination of heterogenous treatment effects. The results indicate HPSAs are associated with a 5% reduction in medical office visits, but no reduction in hospital-based care. These effects are concentrated in older persons living in urban areas, Black persons, and Medicaid beneficiaries. No statistically significant effects on annual spending were observed. These results offer insight into potential areas for further policy efforts aimed at reducing provider shortages.
Collapse
|
4
|
Farr DE, Benefield T, Lee MH, Torres E, Henderson LM. Multilevel contributors to racial and ethnic inequities in the resolution of abnormal mammography results. Cancer Causes Control 2024; 35:995-1009. [PMID: 38478206 PMCID: PMC11216886 DOI: 10.1007/s10552-024-01851-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/08/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Multiple ecological levels influence racial inequities in the completion of diagnostic testing after receiving abnormal mammography results (diagnostic resolution). Yet, few studies examine more than two ecological levels. We investigated the contributions of county, imaging facility, and patient characteristics on our primary and secondary outcomes, the achievement of diagnostic resolution by (1)Black women and Latinas, and (2) the entire sample. We hypothesized that women of color would be less likely to achieve resolution than their White counterparts, and this relationship would be mediated by imaging facility features and moderated by county characteristics. METHODS Records for 25,144 women with abnormal mammograms between 2011 and 2019 from the Carolina Mammography Registry were merged with publicly available county data. Diagnostic resolution was operationalized as the percentage of women achieving resolution within 60 days of receiving abnormal results and overall time to resolution and examined using mixed effects logistic regression and Cox proportional hazard models, respectively. RESULTS Women of color with abnormal screening mammograms were less likely to achieve resolution within 60 days compared with White women (OR 0.83, CI 0.78-0.89; OR 0.74, CI.60-0.91, respectively) and displayed longer resolution times (HR 0.87, CI 0.84-0.91; HR 0.78, CI 0.68-0.89). Residential segregation had a moderating effect, with Black women in more segregated counties being less likely to achieve resolution by 60 days but lost statistical significance after adjustment. No mediators were discovered. CONCLUSION More work is needed to understand how imaging center and community characteristics impact racial inequities in resolution and resolution in general.
Collapse
Affiliation(s)
- Deeonna E Farr
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 2307 Carol G. Belk Building, Mail Stop 529, Greenville, NC, 27858, USA.
| | - Thad Benefield
- Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Mi Hwa Lee
- School of Social Work, College of Health and Human Performance, East Carolina University, Greenville, NC, 27858, USA
| | - Essie Torres
- Office of the Vice Chancellor for Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-4000, USA
| | - Louise M Henderson
- Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, USA
| |
Collapse
|
5
|
Zullig LL, Makarov D, Becker D, Dardashti N, Guzman I, Kelley MJ, Melnic I, Juarez Padilla J, Rojas S, Thomas J, Tumminello C, Sherman SE. Telehealth Research and Innovation for Veterans with Cancer: the THRIVE Center. J Natl Cancer Inst Monogr 2024; 2024:70-75. [PMID: 38924789 PMCID: PMC11207852 DOI: 10.1093/jncimonographs/lgae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/10/2024] [Accepted: 04/09/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND In recent years the US health-care system has witnessed a substantial increase in telehealth use. Telehealth enhances health-care access and quality and may reduce costs. However, there is a concern that the shift from in-person to telehealth care delivery may differentially improve cancer care access and quality in certain clinical settings and for specific patient populations while potentially exacerbating disparities in care for others. Our National Cancer Institute-funded center, called Telehealth Research and Innovation for Veterans with Cancer (THRIVE), is focused on health equity for telehealth-delivered cancer care. We seek to understand how social determinants of telehealth-particularly race and ethnicity, poverty, and rurality-affect the use of telehealth. METHODS THRIVE draws from the Health Disparities Research Framework and the Consolidated Framework for Implementation Research. THRIVE consists of multiple cores that work synergistically to assess and understand health equity for telehealth-delivered cancer care. These include the Administrative Core, Research and Methods Core, Clinical Practice Network, and Pragmatic Trial. RESULTS As of October 2023, we identified and trained 5 THRIVE scholars, who are junior faculty beginning a research career. We have reviewed 20 potential pilot studies, funding 6. Additionally, in communication with our funders and advisory boards, we have adjusted our study design and analytic approach, ensuring feasibility while addressing our operational partners' needs. CONCLUSIONS THRIVE has several key strengths. First, the Veterans Health Administration's health-care system is large and diverse regarding health-care setting type and patient population. Second, we have access to longitudinal data, predating the COVID-19 pandemic, about telehealth use. Finally, equitable access to high-quality care for all veterans is a major tenet of the Veterans Health Administration health-care mission. As a result of these advantages, THRIVE can focus on isolating and evaluating the impact of social determinants of telehealth on equity in cancer care.
Collapse
Affiliation(s)
- Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Danil Makarov
- VA New York Harbor Healthcare System, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Daniel Becker
- VA New York Harbor Healthcare System, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Navid Dardashti
- VA New York Harbor Healthcare System, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Ivonne Guzman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, NC, USA
| | - Michael J Kelley
- Department of Veterans Affairs, National Oncology Program, Washington, DC, USA
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
- Division of Hematology-Oncology, Durham Veterans Affairs Healthcare System, Durham, NC, USA
| | - Irina Melnic
- VA New York Harbor Healthcare System, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Janeth Juarez Padilla
- VA New York Harbor Healthcare System, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Sidney Rojas
- VA New York Harbor Healthcare System, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jerry Thomas
- VA New York Harbor Healthcare System, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Christa Tumminello
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, NC, USA
| | - Scott E Sherman
- VA New York Harbor Healthcare System, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
6
|
Zahnd WE, Hung P, Crouch EL, Ranganathan R, Eberth JM. Health care access barriers among metropolitan and nonmetropolitan populations of eight geographically diverse states, 2018. J Rural Health 2024. [PMID: 38877611 DOI: 10.1111/jrh.12855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 04/18/2024] [Accepted: 05/28/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Nonmetropolitan populations face frequent health care access barriers compared to their metropolitan counterparts, but differences in the number of these barriers across groups are not known. Our objective was to examine the differences in health care access barriers across metropolitan, micropolitan, and noncore populations. METHODS We used Behavioral Risk Factor Surveillance System data from the optional "Health Care Access" module to perform a cross-sectional analysis examining access barriers across levels of rurality using bivariate analyses and Poisson models. Access barriers were operationalized as a count ranging from 0 to 5, reflective of the number of financial barriers and nonfinancial barriers. RESULTS Micropolitan and noncore respondents had lower educational attainment, were older, and were less racially/ethnically diverse than metropolitan respondents. They also reported more barriers, including lacking health insurance, medical debt, and foregoing care or medication due to cost. These barriers were most pronounced in non-Hispanic Black, Hispanic, and American Indian/Alaska Native nonmetropolitan populations, compared to their White counterparts. In adjusted analysis, micropolitan respondents reported more barriers compared to metropolitan (prevalence rate ratio = 1.06; 95% confidence interval: 1.02-1.10) as did women, racial/ethnic minority populations, and those with less education. CONCLUSIONS Micropolitan populations experience more barriers to health care, and nonmetropolitan respondents report more cost-related barriers than their metropolitan counterparts, raising concerns on health care disparities and financial burdens for these underserved populations. This underscores the need to mitigate these barriers, particularly among those in micropolitan areas and minorized populations.
Collapse
Affiliation(s)
- Whitney E Zahnd
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa, USA
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Peiyin Hung
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Elizabeth L Crouch
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Radhika Ranganathan
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
7
|
Ratnapradipa KL, Napit K, King KM, Ramos AK, Luma LBL, Dinkel D, Robinson T, Rohde J, Schabloske L, Tchouankam T, Watanabe-Galloway S. African American and Hispanic Cancer Survivors' and Caregivers' Experiences in Nebraska. J Immigr Minor Health 2024; 26:554-568. [PMID: 38180583 DOI: 10.1007/s10903-023-01570-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/06/2024]
Abstract
Racial and ethnic minority populations experience poorer cancer outcomes compared to non-Hispanic White populations, but qualitative studies have typically focused on single subpopulations. We explored experiences, perceptions, and attitudes toward cancer care services across the care continuum from screening through treatment among African American and Hispanic residents of Nebraska to identify unique needs for education, community outreach, and quality improvement. We conducted four focus groups (N = 19), April-August 2021 with people who were aged 30 or older and who self-identified as African American or Hispanic and as cancer survivors or caregivers. Sessions followed a structured facilitation guide, were audio recorded and transcribed, and were analyzed with a directed content analysis approach. Historical, cultural, and socioeconomic factors often led to delayed cancer care, such as general disuse of healthcare until symptoms were severe due to mistrust and cost of missing work. Obstacles to care included financial barriers, transportation, lack of support groups, and language-appropriate services (for Hispanic groups). Knowledge of cancer and cancer prevention varied widely; we identified a need for better community education about cancer within the urban Hispanic community. Participants had positive experiences and a sense of hope from the cancer care team. African American and Hispanic participants shared many similar perspectives about cancer care. Our results are being used in collaboration with national and regional cancer support organizations to expand their reach in communities of color, but structural and cultural barriers still need to be addressed.
Collapse
Affiliation(s)
- Kendra L Ratnapradipa
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA.
| | - Krishtee Napit
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
| | - Keyonna M King
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Athena K Ramos
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lady Beverly L Luma
- Office of Community Outreach and Engagement, Fred and Pamela Buffett Cancer Center, Omaha, NE, USA
| | - Danae Dinkel
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | | | - Jolene Rohde
- Nebraska Comprehensive Cancer Control Program, Nebraska Department of Health and Human Services, Lincoln, NE, USA
| | | | - Tatiana Tchouankam
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
- Office of Community Outreach and Engagement, Fred and Pamela Buffett Cancer Center, Omaha, NE, USA
| |
Collapse
|
8
|
Lara-Morales A, Soto-Ruiz N, Agudelo-Suárez AA, García-Vivar C. Social determinants of health in post-treatment cancer survivors: Scoping review. Eur J Oncol Nurs 2024; 70:102614. [PMID: 38795448 DOI: 10.1016/j.ejon.2024.102614] [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: 11/29/2023] [Revised: 05/10/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE To identify, analyze and describe the available scientific evidence about the influence of social determinants of health on cancer survivors. METHODS A scoping review was outlined according to the steps described by the Joanna Brigs Institute Reviewer's Manual: selection of studies, data mapping, and results grouping, synthesis and report, was conducted. PubMed, CINAHL, Scopus and LILACS databases were searched from 2011 to 2023. RESULTS Out of a total of 1783 papers initially screened, only 19 studies met the inclusion criteria for the scoping review, focusing on the primary social determinants impacting the health of cancer survivors. These studies were categorized into six main themes: a) employment (challenges in work reintegration and work-place difficulties); b) variations among different ethnic groups; c) disparities based on sex; d) barriers and facilitators in accessing health and social security services; e) the role of support networks and social environments; and f) socioeconomic lever (influence of income and socioeconomic status). CONCLUSIONS Understanding the impact of social determinants on the post-treatment quality of life for cancer survivors is crucial. Comprehensive survivorship care should address not just medical needs but also holistic aspects like social support, education, overall well-being, and improvements in physical and social environments. This multifaceted approach ensures the well-rounded support needed for optimal survivorship outcomes.
Collapse
Affiliation(s)
- Alfredo Lara-Morales
- Department of Nursing and Obstetrics, Guanajuato University, C. Pedro Lascurain de Retana, Calzada de Guadalupe, 36700, Guanajuato, Gto, Mexico.
| | - Nelia Soto-Ruiz
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. Barañain S/n, 31008, Pamplona, Navarra, Spain; IdiSNA, Navarra Institute for Health Research, Irunlarrea, 3, 31008, Pamplona, Navarra, Spain.
| | - Andrés A Agudelo-Suárez
- Faculty of Dentistry, University of Antioquia, Calle 64 Nº 52-59, 050010, Medellin, Antioquia, Colombia.
| | - Cristina García-Vivar
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. Barañain S/n, 31008, Pamplona, Navarra, Spain; IdiSNA, Navarra Institute for Health Research, Irunlarrea, 3, 31008, Pamplona, Navarra, Spain.
| |
Collapse
|
9
|
Okon M, Williams J, Truong K, Yu Q, Griffin S, Zhang L. Characteristics of lung cancer screening eligible population in the US and prediction of the eligibility with simplified criteria. Transl Cancer Res 2024; 13:2155-2163. [PMID: 38881910 PMCID: PMC11170509 DOI: 10.21037/tcr-23-1942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/16/2024] [Indexed: 06/18/2024]
Abstract
Background In 2021, updates to the lung cancer screening (LCS) guidelines extended the eligibility to include younger individuals and those with lower lifetime smoking intensity. A significant challenge in the LCS implementation is identifying eligible individuals because lifetime smoking intensity, a key criterion of current guidelines, is typically unavailable in electronic health records and difficult to assess accurately. This study aimed to (I) examine the characteristics of the eligible population in the US based on current guidelines and (II) evaluate the performance of five simplified criteria as alternative tools for predicting LCS eligibility. Methods National Health and Nutrition Examination Survey (NHANES) 2013-2018 data were used. Five simplified criteria were: (I) ever smoker, defined as an individual with any positive smoking history; (II) current or former smoker, an individual with any positive smoking history or who quit smoking within 15 years; (III) current smoker, an individual currently smoking; (IV) current smoker, an individual currently smoking >0.5 packs per day (ppd); (V) current smoker, a person currently smoking >1 ppd. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. The complex survey design was considered. Results About 16.70 million individuals (representing 16.01% of population aged 50-80 years) were eligible for LCS in the US. The percentage of LCS eligibility was higher among people who were younger, male, non-Hispanic White, less educated, single, not insured, with poorer health status and lower socioeconomic status. Except for the criterion of current smoker with >1 ppd having low sensitivity (0.08), other criteria had sensitivity ranging between 0.45 and 1.00. The accuracy of the five criteria used ranged between 0.70 and 0.91. Conclusions Individuals with less favorable social and clinical characteristics have higher chances of being eligible for LCS, potentially amplifying disparities in LCS utilization. Simplified criteria can be used as prescreening tools to identify target populations, which could facilitate LCS implementation at the population level.
Collapse
Affiliation(s)
- Marvin Okon
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Joel Williams
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Khoa Truong
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Qingzhao Yu
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Sarah Griffin
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Lu Zhang
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| |
Collapse
|
10
|
Birken SA, Peluso AG, Shalowitz DI, Isom S, Wagi CR, Randazzo A, Falk D, Strom C, Bell R, Weaver KE. Primary Care Provider Visits Among Cancer Survivors 5-7 Years Postdiagnosis. JCO Oncol Pract 2024:OP2300699. [PMID: 38776486 DOI: 10.1200/op.23.00699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/11/2024] [Accepted: 04/10/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE Cancer survivors experience better outcomes when primary care providers (PCPs) are engaged in their care. Nearly all survivors have a PCP engaged in their care in the initial 5 years postdiagnosis, but little is known about sustained PCP engagement. We assessed PCP engagement in survivors' care 5-7 years postdiagnosis and characterized survivors most vulnerable to loss to PCP follow-up. METHODS We linked electronic health record ambulatory care and cancer registry data from an National Cancer Institute-Designated Comprehensive Cancer Center to identify eligible survivors (≥18 years; diagnosed with breast, colorectal, or uterine cancer; had an in-network PCP). We used multiple logistic regression to assess associations between survivor demographics, clinical factors, and health care utilization and odds of sustained PCP engagement. RESULTS In 5-7 years postdiagnosis, PCPs were engaged in care for 43% of survivors. Survivors with sustained PCP-engagement were on average 4.6 years older than those without (P < .0001); survivors had 1.36 greater odds of having regular PCP visits for each decade increase in age on cancer diagnosis (P = .0030). Survivors were less likely to be lost to PCP follow-up if diagnosed at an earlier stage with odds at 0.57 and 0.10 for stage I and stage IV, respectively (P = .0005), and had 2.70 greater odds of engagement in care with at least one oncology visit annually 5-7 years postdiagnosis (P < .0001). CONCLUSION Sustained PCP engagement is endorsed as critical by survivors, PCPs, and oncologists. We found most survivors were lost to PCP follow-up 5-7 years postdiagnosis. Our study is among the first to contribute empirical evidence of survivors being lost in transition. Findings from this study demonstrate the need to bridge gaps in long-term care for cancer survivors.
Collapse
Affiliation(s)
- Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Alexandra G Peluso
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - David I Shalowitz
- West Michigan Cancer Center, Kalamazoo, MI
- Collaborative on Equity in Rural Cancer Care, Kalamazoo, MI
| | - Scott Isom
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Cheyenne R Wagi
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Aliza Randazzo
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Derek Falk
- Department of Population and Quantitative Health Science, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Carla Strom
- Office of Cancer Health Equity, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Ronny Bell
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, UNC Chapel Hill, Chapel Hill, NC
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| |
Collapse
|
11
|
Graves JM, Beese SR, Abshire DA, Bennett KJ. How rural is All of Us? Comparing characteristics of rural participants in the National Institute of Health's All of Us Research Program to other national data sources. J Rural Health 2024. [PMID: 38683037 DOI: 10.1111/jrh.12840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/10/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE The National Institute of Health's All of Us Research Program represents a national effort to develop a database to advance health research, especially among individuals historically underrepresented in research, including rural populations. The purpose of this study was to describe the rural populations identified in the All of Us Research Program using the only proxy measure currently available in the dataset. METHODS Currently, the All of Us Research Program provides a proxy measure of rurality that identifies participants who self-reported delaying care due to far travel distances associated with living in rural areas. Using the All of Us Controlled Tier Dataset v6, we compared sociodemographic and health characteristics of All of Us rural participants identified via this proxy to rural US residents from nationally representative data sources using chi-squared tests. RESULTS 3.1% of 160,880 All of Us participants were rural, compared to 15%-20% of US residents based on commonly accepted rural definitions. Proportionally more rural All of Us participants reported fair or poor health status, history of cancer, and history of heart disease (P<.01). CONCLUSIONS The All of Us measure may capture a subset of underserved participants who live in rural areas and experience health care access barriers due to distance. Researchers who use this proxy measure to characterize rurality should interpret their findings with caution due to differences in population and health characteristics using this proxy measure rural compared to other commonly used rural definitions.
Collapse
Affiliation(s)
- Janessa M Graves
- WWAMI Rural Health Research Center, Department of Family Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Shawna R Beese
- College of Nursing, Washington State University, Spokane, Washington, USA
- College of Agricultural, Human, and Natural Resource Sciences, Extension, Washington State University, Pullman, Washington, USA
| | - Demetrius A Abshire
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Kevin J Bennett
- University of South Carolina School of Medicine-Columbia, Columbia, South Carolina, USA
| |
Collapse
|
12
|
Peng W, Huang Q, Mao B. Evaluating variations in the barriers to colorectal cancer screening associated with telehealth use in rural U.S. Pacific Northwest. Cancer Causes Control 2024; 35:635-645. [PMID: 38001334 DOI: 10.1007/s10552-023-01819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE The incidence and mortality rates of colorectal cancer (CRC) remain consistently high in rural populations. Telehealth can improve screening uptake by overcoming individual and environmental disadvantages in rural communities. The present study aimed to characterize varying barriers to CRC screening between rural individuals with and without experience in using telehealth. METHOD The cross-sectional study surveyed 250 adults aged 45-75 residing in rural U.S. states of Alaska, Idaho, Oregon, and Washington from June to September 2022. The associations between CRC screening and four sets of individual and environmental factors specific to rural populations (i.e., demographic characteristics, accessibility, patient-provider factors, and psychological factors) were assessed among respondents with and without past telehealth adoption. RESULT Respondents with past telehealth use were more likely to screen if they were married, had a better health status, had experienced discrimination in health care, and had perceived susceptibility, screening efficacy, and cancer fear, but less likely to screen when they worried about privacy or had feelings of embarrassment, pain, and discomfort. Among respondents without past telehealth use, the odds of CRC screening decreased with busy schedules, travel burden, discrimination in health care, and lower perceived needs. CONCLUSION Rural individuals with and without previous telehealth experience face different barriers to CRC screening. The finding suggests the potential efficacy of telehealth in mitigating critical barriers to CRC screening associated with social, health care, and built environments of rural communities.
Collapse
Affiliation(s)
- Wei Peng
- Edward R. Murrow College of Communication, Washington State University, Murrow Hall 211, Pullman, WA, 99164, USA.
| | - Qian Huang
- Department of Communication, University of North Dakota, Grand Forks, ND, USA
| | - Bingjing Mao
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
13
|
Simmonds KP, Atem FD, Welch BG, Ifejika NL. Racial and Ethnic Disparities in the Medical Management of Poststroke Complications Among Patients With Acute Stroke. J Am Heart Assoc 2024; 13:e030537. [PMID: 38390802 PMCID: PMC10944023 DOI: 10.1161/jaha.123.030537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 01/04/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND To inform clinical practice, we sought to identify racial and ethnic differences in the medical management of common poststroke complications. METHODS AND RESULTS A cohort of acutely hospitalized, first-time non-Hispanic White (NHW), non-Hispanic Black, and Hispanic patients with stroke was identified from electronic medical records of 51 large health care organizations (January 1, 2003 to December 5, 2022). Matched propensity scores were used to account for baseline differences. Primary outcomes included receipt of medication(s) associated with the management of the following poststroke complications: arousal/fatigue, spasticity, mood, sleep, neurogenic bladder, neurogenic bowel, and seizure. Differences were measured at 14, 90, and 365 days. Subgroup analyses included differences restricted to patients with ischemic stroke, younger age (<65 years), and stratified by decade (2003-2012 and 2013-2022). Before matching, the final cohort consisted of 348 286 patients with first-time stroke. Matching resulted in 63 722 non-Hispanic Black-NHW pairs and 24 009 Hispanic-NHW pairs. Non-Hispanic Black (versus NHW) patients were significantly less likely to be treated for all poststroke complications, with differences largest for arousal/fatigue (relative risk (RR), 0.58 [95% CI, 0.54-0.62]), spasticity (RR, 0.64 [95% CI, 0.0.62-0.67]), and mood disorders (RR, 0.72 [95% CI, 0.70-0.74]) at 14 days. Hispanic-NHW differences were similar, albeit with smaller magnitudes, with the largest differences present for spasticity (RR, 0.67 [95% CI, 0.63-0.72]), arousal/fatigue (RR, 0.77 [95% CI, 0.70-0.85]), and mood disorders (RR, 0.79 [95% CI, 0.77-0.82]). Subgroup analyses revealed similar patterns for ischemic stroke and patients aged <65 years. Disparities for the current decade remained significant but with smaller magnitudes compared with the prior decade. CONCLUSIONS There are significant racial and ethnic disparities in the treatment of poststroke complications. The differences were greatest at 14 days, outlining the importance of early identification and management.
Collapse
Affiliation(s)
- Kent P Simmonds
- Department of Physical Medicine and Rehabilitation UT Southwestern Medical Center Dallas TX USA
| | - Folefac D Atem
- Department of Physical Medicine and Rehabilitation UT Southwestern Medical Center Dallas TX USA
- Department of Biostatistics University of Texas Health Science Center at Houston School of Public Health Houston TX USA
| | - Babu G Welch
- Department of Neurological Surgery UT Southwestern Medical Center Dallas TX USA
| | - Nneka L Ifejika
- Department of Physical Medicine and Rehabilitation UT Southwestern Medical Center Dallas TX USA
- Department of Neurology UT Southwestern Medical Center Dallas TX USA
| |
Collapse
|
14
|
Welch AC, London SM, Wilshire CL, Gilbert CR, Buchwald D, Ferguson G, Allick C, Gorden JA. Access to Lung Cancer Screening Among American Indian and Alaska Native Adults: A Qualitative Study. Chest 2024; 165:716-724. [PMID: 37898186 DOI: 10.1016/j.chest.2023.10.025] [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: 04/04/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer mortality among American Indian and Alaska Native populations. American Indian and Alaska Native people use commercial tobacco products at higher rates compared with all other races and ethnicities. Moreover, they show lower adherence to cancer screening guidelines. RESEARCH QUESTION How do American Indian and Alaska Native adults perceive and use lung cancer screening? STUDY DESIGN AND METHODS We conducted a study in which we recorded and transcribed data from three focus groups consisting of American Indian and Alaska Native adults. Participants were recruited through convenience sampling at a national health conference. Transcripts were analyzed by inductive coding. RESULTS Participants (n = 58) of 28 tribes included tribal Elders, tribal leaders, and non-Native volunteers who worked with tribal communities. Limited community awareness of lung cancer screening, barriers to lung cancer screening at health care facilities, and health information-seeking behaviors emerged as key themes in discussions. Screening knowledge was limited except among people with direct experiences of lung cancer. Cancer risk factors such as multigenerational smoking were considered important priorities to address in communities. Limited educational and diagnostic resources are significant barriers to lung cancer screening uptake in addition to limited discussions with health care providers about cancer risk. INTERPRETATION Limited access to and awareness of lung cancer screening must be addressed. American Indian and Alaska Native adults use several health information sources unique to tribal communities, and these should be leveraged in designing screening programs. Equitable partnerships between clinicians and tribes are essential in improving knowledge and use of lung cancer screening.
Collapse
Affiliation(s)
- Allison C Welch
- Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA
| | - Sara M London
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Candice L Wilshire
- Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA
| | | | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Gary Ferguson
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Cole Allick
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Jed A Gorden
- Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA.
| |
Collapse
|
15
|
Nelson D, Selby P, Kane R, Harding-Bell A, Kenny A, McPeake K, Cooke S, Hogue T, Oliver K, Gussy M, Lawler M. Implementing the European code of cancer practice in rural settings. J Cancer Policy 2024; 39:100465. [PMID: 38184144 DOI: 10.1016/j.jcpo.2023.100465] [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: 04/12/2023] [Revised: 12/08/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
Existing evidence often indicates higher cancer incidence and mortality rates, later diagnosis, lower screening uptake and poorer long-term survival for people living in rural compared to more urbanised areas. Despite wide inequities and variation in cancer care and outcomes across Europe, much of the scientific literature explicitly exploring the impact of rurality on cancer continues to come from Australia and North America. The European Code of Cancer Practice or "The Code" is a citizen and patient-centred statement of the most salient requirements for good clinical cancer practice and has been extensively co-produced by cancer patients, cancer professionals and patient advocates. It contains 10 key overarching Rights that a cancer patient should expect from their healthcare system, regardless of where they live and has been strongly endorsed by professional and patient cancer organisations as well as the European Commission. In this article, we use these 10 fundamental Rights as a framework to argue that (i) the issues and needs identified in The Code are generally more profound for rural people with cancer; (ii) addressing these issues is also more challenging in rural contexts; (iii) interventions and support must explicitly account for the unique needs of rural residents living with and affected by cancer and (iv) new innovative approaches are urgently required to successfully overcome the challenges faced by rural people with cancer and their caregivers. Despite equitable healthcare being a key European policy focus, the needs of rural people living with cancer have largely been neglected.
Collapse
Affiliation(s)
- David Nelson
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK; Macmillan Cancer Support, London, UK.
| | - Peter Selby
- Faculty of Medicine and Health, University of Leeds, Leeds, UK; Lincoln Medical School, Universities of Nottingham and Lincoln, Lincoln, UK
| | - Ros Kane
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | | | - Amanda Kenny
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK; La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Kathie McPeake
- Macmillan Cancer Support, London, UK; NHS Lincolnshire Integrated Care Board, Sleaford, UK
| | - Samuel Cooke
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Todd Hogue
- School of Psychology, University of Lincoln, Lincoln, UK
| | | | - Mark Gussy
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK; La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Mark Lawler
- Patrick G Johnston Centre for Cancer Research, Faculty of Medicine, Health and Life Sciences, Queens University Belfast, Belfast, UK
| |
Collapse
|
16
|
Tsai M, Vernon M, Su S, Coughlin SS, Dong Y. Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia. Cancer Med 2024; 13:e6954. [PMID: 38348574 PMCID: PMC10904969 DOI: 10.1002/cam4.6954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/15/2023] [Accepted: 01/10/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION The study's purpose was to examine 5-year colorectal cancer (CRC) survival rates between White and Black patients. We also determined whether regional socioeconomic status (SES) is associated with CRC survival between White and Black patients in the Clayton, West Central, East Central, Southeast, and Northeast Georgia public health districts. METHODS We performed a retrospective cohort analysis using data from the 1975 to 2016 Surveillance, Epidemiology, and End Results program. The 2015 United States Department of Agriculture Economic Research Services county typology codes were used to identify region-level SES with persistent poverty, low employment, and low education. Kaplan-Meier method and Cox proportional hazard regression were performed. RESULTS Among 10,876 CRC patients (31.1% Black patients), 5-year CRC survival rates were lower among Black patients compared to White patients (65.4% vs. 69.9%; p < 0.001). In multivariable analysis, White patients living in regions with persistent poverty had a 1.1-fold increased risk of CRC death (HR, 1.12; 95% CI, 1.00-1.25) compared to those living in non-persistent poverty regions. Among Black patients, those living in regions with low education were at a 1.2-fold increased risk of CRC death (HR, 1.19; 95% CI, 1.01-1.40) compared to those living in non-low education regions. DISCUSSION AND CONCLUSIONS Black patients demonstrated lower CRC survival rates in Georgia compared to their White counterparts. White patients living in regions with persistent poverty, and Black patients living in regions with low education had an increased risk of CRC death. Our findings provide important evidence to all relevant stakeholders in allocating health resources aimed at CRC early detection and prevention and timely referral for CRC treatment by considering the patient's regional SES in Georgia.
Collapse
Affiliation(s)
- Meng‐Han Tsai
- Cancer Prevention, Control & Population Health Program, Georgia Cancer CenterAugusta UniversityAugustaGeorgiaUSA
- Georgia Prevention Institute, Augusta UniversityAugustaGeorgiaUSA
| | - Marlo Vernon
- Cancer Prevention, Control & Population Health Program, Georgia Cancer CenterAugusta UniversityAugustaGeorgiaUSA
- Georgia Prevention Institute, Augusta UniversityAugustaGeorgiaUSA
| | - Shaoyong Su
- Georgia Prevention Institute, Augusta UniversityAugustaGeorgiaUSA
| | - Steven S. Coughlin
- Department of Biostatistics, Data Science and EpidemiologyAugusta UniversityAugustaGeorgiaUSA
| | - Yanbin Dong
- Georgia Prevention Institute, Augusta UniversityAugustaGeorgiaUSA
| |
Collapse
|
17
|
Bonner SN, Curley R, Love K, Akande T, Akhtar A, Erhunmwunsee L. Structural Racism and Lung Cancer Risk: A Scoping Review. JAMA Oncol 2024; 10:122-128. [PMID: 38032677 DOI: 10.1001/jamaoncol.2023.4897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Importance Structural racism is associated with persistent inequities in health and health outcomes in the US for racial and ethnic minority groups. This review summarizes how structural racism contributes to differential population-level exposure to lung cancer risk factors and thus disparate lung cancer risk across different racial and ethnic groups. Observations A scoping review was conducted focusing on structural racism and lung cancer risk for racial and ethnic minority groups. The domains of structural racism evaluated included housing and built environment, occupation and employment, health care, economic and educational opportunity, private industry, perceived stress and discrimination, and criminal justice involvement. The PubMed, Embase, and MedNar databases were searched for English-language studies in the US from January 1, 2010, through June 30, 2022. The review demonstrated that racial and ethnic minority groups are more likely to have environmental exposures to air pollution and known carcinogens due to segregation of neighborhoods and poor housing quality. In addition, racial and ethnic minority groups were more likely to have exposures to pesticides, silica, and asbestos secondary to higher employment in manual labor occupations. Furthermore, targeted marketing and advertisement of tobacco products by private industry were more likely to occur in neighborhoods with more racial and ethnic minority groups. In addition, poor access to primary care services and inequities in insurance status were associated with elevated lung cancer risk among racial and ethnic minority groups. Lastly, inequities in tobacco use and cessation services among individuals with criminal justice involvement had important implications for tobacco use among Black and Hispanic populations. Conclusions and Relevance The findings suggest that structural racism must be considered as a fundamental contributor to the unequal distribution of lung cancer risk factors and thus disparate lung cancer risk across different racial and ethnic groups. Additional research is needed to better identify mechanisms contributing to inequitable lung cancer risk and tailor preventive interventions.
Collapse
Affiliation(s)
- Sidra N Bonner
- Department of Surgery, University of Michigan, Ann Arbor
- National Clinician Scholars Program, University of Michigan, Ann Arbor
| | - Richard Curley
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Kyra Love
- Library Services, City of Hope, Duarte, California
| | - Tola Akande
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Aamna Akhtar
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Loretta Erhunmwunsee
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
- Department of Populations Sciences, City of Hope National Medical Center, Duarte, California
| |
Collapse
|
18
|
Njoku A, Sawadogo W, Frimpong P. Racial and Ethnic Disparities in Cancer Occurrence and Outcomes in Rural United States: A Scoping Review. Cancer Control 2024; 31:10732748241261558. [PMID: 38857181 PMCID: PMC11165954 DOI: 10.1177/10732748241261558] [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: 01/07/2024] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Cancer is the second-leading cause of death in the United States. Most studies have reported rural versus urban and Black versus White cancer disparities. However, few studies have investigated racial disparities in rural areas. OBJECTIVE We conducted a literature review to explore the current state of knowledge on racial and ethnic disparities in cancer attitudes, knowledge, occurrence, and outcomes in rural United States. METHODS A systematic search of PubMed and Embase was performed. Peer-reviewed articles published in English from 2004-2023 were included. Three authors independently reviewed the articles and reached a consensus. RESULTS After reviewing 993 articles, a total of 30 articles met the inclusion criteria and were included in the present review. Studies revealed that underrepresented racial and ethnic groups in rural areas were more likely to have low cancer-related knowledge, low screening, high incidence, less access to treatment, and high mortality compared to their White counterparts. CONCLUSION Underrepresented racial and ethnic groups in rural areas experienced a high burden of cancer. Improving social determinants of health may help reduce cancer disparities and promote health.
Collapse
Affiliation(s)
- Anuli Njoku
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, CT, USA
| | - Wendemi Sawadogo
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, CT, USA
| | - Princess Frimpong
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, CT, USA
| |
Collapse
|
19
|
Vilaro MJ, Bryan E, Palani T, Cooks EJ, Mertens G, Zalake M, Lok BC, Krieger JL. Rural adults' perceptions of nutrition recommendations for cancer prevention: Contradictory and conflicting messages. PREVENTIVE ONCOLOGY & EPIDEMIOLOGY 2023; 1:2237680. [PMID: 38390218 PMCID: PMC10883477 DOI: 10.1080/28322134.2023.2237680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Despite robust evidence linking alcohol, processed meat, and red meat to colorectal cancer (CRC), public awareness of nutrition recommendations for CRC prevention is low. Marginalized populations, including those in rural areas, experience high CRC burden and may benefit from culturally tailored health information technologies. This study explored perceptions of web-based health messages iteratively in focus groups and interviews with 48 adults as part of a CRC prevention intervention. We analyzed transcripts for message perceptions and identified three main themes with subthemes: (1) Contradictory recommendations, between the intervention's nutrition risk messages and recommendations for other health conditions, from other sources, or based on cultural or personal diets; (2) reactions to nutrition risk messages, ranging from aversion (e.g., "avoid alcohol" considered "preachy") to appreciation, with suggestions for improving messages; and (3) information gaps. We discuss these themes, translational impact, and considerations for future research and communication strategies for delivering web-based cancer prevention messages.
Collapse
Affiliation(s)
| | - Emma Bryan
- STEM Translational Communication Center, University of Florida
| | - Te Palani
- STEM Translational Communication Center, University of Florida
| | - Eric J Cooks
- STEM Translational Communication Center, University of Florida
| | - Gillian Mertens
- STEM Translational Communication Center, University of Florida
- Literacy Department, SUNY Cortland
| | - Mohan Zalake
- Computer and Information Sciences and Engineering, University of Florida
| | - Benjamin C Lok
- Computer and Information Sciences and Engineering, University of Florida
| | | |
Collapse
|
20
|
Huang D, Chang CPE, Newman M, Deshmukh V, Snyder J, Date A, Galvao C, Lloyd S, Henry NL, O'Neil B, Hashibe M. Adverse health outcomes among rural prostate cancer survivors: A population-based study. Cancer Epidemiol 2023; 86:102430. [PMID: 37473579 PMCID: PMC11150278 DOI: 10.1016/j.canep.2023.102430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Rural cancer survivors experience considerable health disparities compared to urban cancer survivors for cancer treatment and survival. The objective of our study was to investigate the risk of developing diseases for rural compared to urban prostate cancer survivors in Utah. METHODS We identified a cohort of 3575 rural prostate cancer survivors and 17,778 urban prostate cancer survivors from the Utah Cancer Registry. The Fine-Gray subdistribution hazards model was used to estimate hazard ratios and 95 % confidence intervals for diseases in major body systems among rural compared to urban prostate cancer survivors at > 1-5 years and > 5 years after prostate cancer diagnosis. RESULTS Rural residence was associated with an increased risk of diseases of the respiratory system at > 5 years (HR: 1.16, 95 % CI: 1.01-1.32) after cancer diagnosis compared to urban residence among prostate cancer survivors in Utah. Decreased risks were observed in infectious and parasitic diseases, diseases of the blood and blood-forming organs, diseases of the nervous system and sense organs, and diseases of the skin and subcutaneous tissue for rural prostate cancer survivors between 1 and 5 years after cancer diagnosis. CONCLUSIONS Rural prostate cancer survivors in Utah were somewhat healthier compared to urban prostate cancer survivors. Further studies are needed to confirm whether these associations are also supported for rural prostate cancer survivors in other regions of the U.S.
Collapse
Affiliation(s)
- Daren Huang
- Huntsman Cancer Institute, Salt Lake City, UT, United States; Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Chun-Pin Esther Chang
- Huntsman Cancer Institute, Salt Lake City, UT, United States; Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States.
| | - Michael Newman
- Department of Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Vikrant Deshmukh
- Department of Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, UT, United States
| | - Ankita Date
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Carlos Galvao
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Shane Lloyd
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT, United States
| | - N Lynn Henry
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Brock O'Neil
- Division of Urology, University of Utah, Salt Lake City, UT, United States
| | - Mia Hashibe
- Huntsman Cancer Institute, Salt Lake City, UT, United States; Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| |
Collapse
|
21
|
Sokale IO, Raza SA, Thrift AP. Disparities in cancer mortality patterns: A comprehensive examination of U.S. rural and urban adults, 1999-2020. Cancer Med 2023; 12:18988-18998. [PMID: 37559501 PMCID: PMC10557857 DOI: 10.1002/cam4.6451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Cancer mortality rates overall in the U.S. have decreased significantly; however, the rate of decline has not been uniform across sociodemographic groups. We aimed to compare trends in cancer mortality rates from 1999 to 2020 between rural and urban individuals and to examine whether any rural-urban differences are uniform across racial and ethnic groups. METHODS We used U.S.-wide data from the National Center for Health Statistics, for all cancer deaths among individuals aged 25 years or older. We estimated average annual percentage change (AAPC) in age-standardized cancer mortality rates in the U.S. by cancer type, rural-urban status, sex, and race and ethnicity. RESULTS There was a larger reduction in cancer mortality rates among individuals from urban (males: AAPC, -1.96%; 95% CI, -2.03, -1.90; females: AAPC, -1.56%; 95% CI, -1.64, -1.48) than rural (males: AAPC, -1.43%; 95% CI, -1.47, -1.39; females: AAPC, -0.93; 95% CI, -1.03, -0.82) areas. AAPCs for cancer types were uniformly higher among urban areas compared with rural areas. Despite overall decreases, deaths rates for liver and pancreas cancers increased, including in the most recent period among males (2012-2020, APC, 1.34; 95% CI, 0.49, 2.20) and females (2013-2020, APC, 1.52; 95% CI, 0.03, 3.02) in rural areas. CONCLUSIONS Cancer death rates decreased in all racial and ethnic populations; however, the rural-urban differences varied by race/ethnicity. The rate of decline in mortality rates were lower in rural areas and death rates for liver and pancreas cancers increased, particularly for individuals living in rural America.
Collapse
Affiliation(s)
- Itunu O. Sokale
- Section of Epidemiology and Population Sciences, Department of MedicineBaylor College of MedicineHoustonTexasUSA
| | - Syed Ahsan Raza
- Section of Epidemiology and Population Sciences, Department of MedicineBaylor College of MedicineHoustonTexasUSA
| | - Aaron P. Thrift
- Section of Epidemiology and Population Sciences, Department of MedicineBaylor College of MedicineHoustonTexasUSA
- Dan L Duncan Comprehensive Cancer CenterBaylor College of MedicineHoustonTexasUSA
| |
Collapse
|
22
|
Yeary KHK, Willis DE, Yu H, Johnson B, McElfish PA. Self-reported Racial Discrimination and Healthy Behaviors in Black Adults Residing in Rural Persistent Poverty Areas. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01738-8. [PMID: 37555914 DOI: 10.1007/s40615-023-01738-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Racism is a social determinant of health inequities and associated with poorer health and health behaviors. As a domain of racism, self-reported racial discrimination affects health through unhealthy behaviors (e.g., smoking) but the understudied impact of self-reported racial discrimination's relationship with healthy behaviors (e.g., cancer screening) precludes a comprehensive understanding of racism's impact on health inequities. Understanding how self-reported racial discrimination impacts healthy behaviors is even more important for those living in rural persistent poverty areas (poverty rates of 20% or more of a population since 1980), who have a higher disease burden due to poverty's interaction with racism. The distinct sociocultural context of rural persistent poverty areas may result in differential responses to self-reported racial discrimination compared to those in non-persistent poverty areas. METHODS A community-engaged process was used to administer a survey to a convenience sample of 251 Black adults residing in 11 rural persistent poverty counties in the state of Arkansas. Self-reported racial discrimination, fruit and vegetable intake, colorectal cancer screening, cervical cancer screening, and screening mammography were assessed. Stress and religion/spirituality were also assessed as potential mediators or moderators in the relationship between self-reported racial discrimination and healthy behaviors. RESULTS In adjusted models, those reporting more self-reported racial discrimination had a higher probability of having had a test to check for cervical cancer (situation discrimination: OR = 1.23, 95% CI: 1.04-1.5; frequency discrimination: OR = 1.06, 95% CI: 1.02-1.12). Stress and religion/spirituality were not significant mediators/moderators. DISCUSSION Greater self-reported racial discrimination was associated with a higher odds of cervical cancer screening. Black adults residing in rural persistent poverty areas may have greater self-reported racial discrimination-specific coping and racial identity attitudes.
Collapse
Affiliation(s)
| | - Don E Willis
- University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Han Yu
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Beverly Johnson
- University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Pearl A McElfish
- University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| |
Collapse
|
23
|
Tobin EC, Nolan N, Thompson S, Elmore M, Richmond BK. The Intersection of Race and Rurality and its Effect on Colorectal Cancer Survival. Am Surg 2023; 89:3163-3170. [PMID: 36890731 DOI: 10.1177/00031348231160833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Outcomes in colorectal cancer treatment are historically worse in Black people and residents of rural areas. Purported reasons include factors such as systemic racism, poverty, lack of access to care, and social determinants of health. We sought to determine whether outcomes worsened when race and rural residence intersected. METHODS The National Cancer Database was queried for individuals with stage II-III colorectal cancer (2004-2018). To examine the intersectionality of race/rurality on outcomes, race (Black/White) and rurality (based on county) were combined into a single variable. Main outcome of interest was 5-year survival. Cox hazard regression analysis was performed to determine variables independently associating with survival. Control variables included age at diagnosis, sex, race, Charlson-Deyo score, insurance status, stage, and facility type. RESULTS Of 463 948 patients, 5717 were Black-Rural, 50 742 were Black-Urban, 72 241 were White-Rural, and 33 5271 were White-Urban. Five-year mortality rate was 31.6%. Univariate Kaplan-Meier survival analysis demonstrated race-rurality was associated with overall survival (P < .001), with White-Urban having the greatest mean survival length (47.9 months) and Black-Rural with the lowest (46.7 months). Multivariable analysis found that Black-Rural (1.26, 95% confidence interval [1.20-1.32]), Black-Urban (1.16, [1.16-1.18]), and White-Rural (HR: 1.05; (1.04-1.07) had increased mortality when compared to White-Urban individuals (P < .001). CONCLUSION Although White-Rural individuals fared worse than White-Urban, Black individuals fared worst of all, with the poorest outcomes observed in Black individuals in rural areas. This suggests that both Black race and rurality negatively affect survival, and act synergistically to further worsen outcomes.
Collapse
Affiliation(s)
- Edward Charles Tobin
- Department of Surgery, Charleston Area Medical Center Institute for Academic Medicine, Charleston, WV, USA
| | - Nicholas Nolan
- Department of Surgery, West Virginia University School of Medicine, Charleston, WV, USA
| | - Stephanie Thompson
- Department of Surgery, Charleston Area Medical Center Institute for Academic Medicine, Charleston, WV, USA
| | - Michael Elmore
- Department of Surgery, West Virginia University School of Medicine, Charleston, WV, USA
| | - Bryan Kelly Richmond
- Department of Surgery, West Virginia University School of Medicine, Charleston, WV, USA
| |
Collapse
|
24
|
Semprini J, Williams JC. Community socioeconomic status and rural/racial disparities in HPV-/+ head and neck cancer. Tech Innov Patient Support Radiat Oncol 2023; 26:100205. [PMID: 36974082 PMCID: PMC10038787 DOI: 10.1016/j.tipsro.2023.100205] [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] [Received: 10/20/2022] [Revised: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Background Head and Neck Cancer (HNC) is a major cause of cancer morbidity and mortality in the United States, but the burden is not evenly distributed. Rural and racial disparities are obvious across the HNC continuum. Most HNC disparities research have emphasized individual factors perpetuating rural and racial disparities, ignoring the role of community-level factors. Methods We analyzed data from the Surveillance Epidemiology and End Results (SEER) program's "Specialized HNC-Human Papillomavirus (HPV) Census-Tract SES" datafile (2010-2016). In addition to cancer patient characteristics, this data includes a socioeconomic status (SES) quintile based on the patient's census-tract. Our outcome variables included whether the HNC patient 1) was diagnosed at a distant stage, 2) received initial treatment two or more months after diagnosis, 3) received radiation therapy, 4) survived two years after diagnosis. We tested for differences across SES quintiles, in the full sample and then within rural/racial categories. We then tested for differences between each rural/racial category conditional on SES quintile. Results For both HPV(-) and HPV + HNCs, patients in higher SES census-tracts have 8-10% lower rates of distant stage diagnoses and delayed treatment initiation, and 12.0-14.5% higher survival rates than patients in lower SES census-tracts. Radiation treatment only varied across SES quintiles in HPV + HNC patients. We find little evidence of rural-urban differences within each socioeconomic quintile. However, within lower SES quintiles, we found significant racial disparities in delayed detection and treatment. These differences were largest in the lowest SES quintile, as non-Hispanic Black patients reported 10-11% higher rates of delayed detection and treatment initiation than non-Hispanic White patients. Conclusions Our research illustrates the value and constraints in leveraging community-level factors in health disparities research that can ultimately assist in designing effective policies that address and achieve rural and racial cancer equity.
Collapse
Affiliation(s)
- Jason Semprini
- University of Iowa College of Public Health, United States
- Corresponding author at: 145 N. Riverside Dr. N277, Iowa City, IA 52240, United States.
| | - Jessica C. Williams
- University of Boston School Henry M. Goldman School of Dental Medicine, United States
| |
Collapse
|
25
|
Miller MC, Bayakly R, Schreurs BG, Flicker KJ, Adams SA, Ingram LA, Hardin JW, Lohman M, Ford ME, McCollum Q, McCrary-Quarles A, Ariyo O, Levkoff SE, Friedman DB. Highlighting the value of Alzheimer's disease-focused registries: lessons learned from cancer surveillance. FRONTIERS IN AGING 2023; 4:1179275. [PMID: 37214775 PMCID: PMC10196140 DOI: 10.3389/fragi.2023.1179275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/26/2023] [Indexed: 05/24/2023]
Abstract
Like cancer, Alzheimer's disease and related dementias (ADRD) comprise a global health burden that can benefit tremendously from the power of disease registry data. With an aging population, the incidence, treatment, and mortality from ADRD is increasing and changing rapidly. In the same way that current cancer registries work toward prevention and control, so do ADRD registries. ADRD registries maintain a comprehensive and accurate registry of ADRD within their state, provide disease prevalence estimates to enable better planning for social and medical services, identify differences in disease prevalence among demographic groups, help those who care for individuals with ADRD, and foster research into risk factors for ADRD. ADRD registries offer a unique opportunity to conduct high-impact, scientifically rigorous research efficiently. As research on and development of ADRD treatments continue to be a priority, such registries can be powerful tools for conducting observational studies of the disease. This perspectives piece examines how established cancer registries can inform ADRD registries' impact on public health surveillance, research, and intervention, and inform and engage policymakers.
Collapse
Affiliation(s)
- Margaret C. Miller
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Office of the Study of Aging, University of South Carolina, Columbia, SC, United States
| | - Rana Bayakly
- Georgia Department of Public Health, Atlanta, GA, United States
| | - Bernard G. Schreurs
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Kimberly J. Flicker
- Office of the Study of Aging, University of South Carolina, Columbia, SC, United States
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Swann Arp Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Lucy A. Ingram
- Office of the Study of Aging, University of South Carolina, Columbia, SC, United States
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - James W. Hardin
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Matthew Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Office of the Study of Aging, University of South Carolina, Columbia, SC, United States
| | - Marvella E. Ford
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Quentin McCollum
- College of Social Work, University of South Carolina, Columbia, SC, United States
| | - Audrey McCrary-Quarles
- Department of Health Sciences, South Carolina State University, Orangeburg, SC, United States
| | - Oluwole Ariyo
- Department of Biology, Allen University, Columbia, SC, United States
| | - Sue E. Levkoff
- College of Social Work, University of South Carolina, Columbia, SC, United States
| | - Daniela B. Friedman
- Office of the Study of Aging, University of South Carolina, Columbia, SC, United States
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| |
Collapse
|
26
|
Nechuta S, Wallace H. Improving rural cancer prevention: targeted data and understanding rural-specific factors and lived experiences. J Natl Cancer Inst 2023; 115:345-348. [PMID: 36744916 PMCID: PMC10086619 DOI: 10.1093/jnci/djad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/07/2023] Open
Affiliation(s)
- Sarah Nechuta
- School of Interdisciplinary Health, Grand Valley State University, Grand Rapids, MI, USA
| | - Heather Wallace
- School of Interdisciplinary Health, Grand Valley State University, Grand Rapids, MI, USA
| |
Collapse
|
27
|
Oh DL, Schumacher K, Yang J, Wang K, Lin K, Gomez SL, Shariff-Marco S. Disparities in cancer incidence by rurality in California. J Natl Cancer Inst 2023; 115:385-393. [PMID: 36622036 PMCID: PMC10086626 DOI: 10.1093/jnci/djac238] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/14/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cancer rates in rural areas across the United States have different patterns than in urban areas. This study examines associations between rurality and incidence for the top 5 cancers in California and evaluates whether these associations vary jointly by sex, race, and ethnicity. METHODS We used 2015-2019 California Cancer Registry data to compare incidence rate ratios (IRRs) and trends for breast, prostate, lung, colorectal, and skin (melanoma) cancers. We leveraged census tract aggregation zones and 7 levels of percentage rural population (0%, >0% to <10%, 10% to <20%, 20% to <30%, 30% to <40%, 40% to <50%, and 50+%). RESULTS Zones with higher proportions of rural population were significantly associated with lower incidence of female breast cancer and prostate cancer, though the trends were not statistically significant overall. Zones with higher proportions of rural population were significantly associated with higher incidence of lung cancer and melanoma. There were no statistically significant trends for colorectal cancer overall. Comparing areas with 50% and over rural population with areas with 0% rural population, the IRR for lung cancer in Hispanic females was higher (IRR = 1.43, 95% confidence interval [CI] = 1.17 to 1.74) than in Hispanic males (IRR = 0.90, 95% CI = 0.72 to 1.11). Also, in areas with 50% or more rural population, the IRR for melanoma was higher in Hispanic females (IRR = 1.75, 95% CI = 1.23 to 2.45) than non-Hispanic White females (IRR = 0.87, 95% CI = 0.80 to 0.95). CONCLUSIONS Our findings show that rurality is associated with cancer incidence and underscore the importance of jointly examining rural disparities with sex, race, and ethnicity by cancer site.
Collapse
Affiliation(s)
- Debora L Oh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Greater Bay Area Cancer Registry, University of California, San Francisco, USA
| | - Karen Schumacher
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
| | - Juan Yang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Greater Bay Area Cancer Registry, University of California, San Francisco, USA
| | - Katarina Wang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Katherine Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Greater Bay Area Cancer Registry, University of California, San Francisco, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Greater Bay Area Cancer Registry, University of California, San Francisco, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Greater Bay Area Cancer Registry, University of California, San Francisco, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
| |
Collapse
|
28
|
Ratnapradipa KL, Napit K, Ranta J, Luma LB, Dinkel D, Robinson T, Schabloske L, Watanabe-Galloway S. Qualitative Analysis of Colorectal Cancer Screening in Rural Nebraska. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:652-663. [PMID: 35437633 PMCID: PMC9015281 DOI: 10.1007/s13187-022-02170-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 05/20/2023]
Abstract
Compared to urban residents, rural populations are less likely to engage in colorectal cancer (CRC) screening. As part of a statewide cancer needs assessment, we aimed to elicit rural perspectives about CRC screening and resources. We conducted three focus groups with rural Nebraska cancer survivors and caregivers (N = 20) in Spring 2021 using a collective case study design. Participant awareness of and knowledge about CRC screening methods varied across focus groups; overall, 95% of participants had heard of colonoscopy. Participants were less familiar with fecal tests and had confusion about them. Colonoscopy was associated with negative perceptions regarding the time, cost, and discomfort of the preparation and procedure, but some providers did not discuss alternative methods unless the patient resisted colonoscopy. Healthcare providers played a key role educating rural communities about CRC screening recommendations (age, risk) and testing options and being persistent in those recommendations. CRC awareness campaigns should include a variety of communication channels (TV, radio, billboards, health fairs, churches, healthcare settings). Promotion of CRC screening should include education about screening age guidelines, alternative test types, and informed decision-making between provider and patient regarding preferred screening methods based on the pros and cons of each test type. Individuals with a family history of colon issues (Crohn's disease, CRC) are considered high risk and need to be aware that screening should be discussed at earlier ages.
Collapse
Affiliation(s)
- Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center (UNMC), NSW, 68198-4395, Omaha, USA.
| | - Krishtee Napit
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center (UNMC), NSW, 68198-4395, Omaha, USA
| | - Jordan Ranta
- Sarpy/Cass Health Department, Papillion, NE, USA
| | - Lady Beverly Luma
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, UNMC, Omaha, NE, USA
| | - Danae Dinkel
- School of Health & Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | | | | | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center (UNMC), NSW, 68198-4395, Omaha, USA
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, UNMC, Omaha, NE, USA
| |
Collapse
|
29
|
Taylor L, Gangnon R, Powell WR, Kramer J, Kind AJH, Bartels CM, Brennan MB. Association of rurality and identifying as black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study. BMJ Open Diabetes Res Care 2023; 11:11/2/e003185. [PMID: 37072336 PMCID: PMC10124219 DOI: 10.1136/bmjdrc-2022-003185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/28/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Rural patients with diabetic foot ulcers, especially those identifying as black, face increased risk of major amputation. Specialty care can reduce this risk. However, care disparities might beget outcome disparities. We aimed to determine whether a smaller proportion of rural patients, particularly those identifying as black, receive specialty care compared with the national proportion. RESEARCH DESIGN AND METHODS This 100% national retrospective cohort examined Medicare beneficiaries hospitalized with diabetic foot ulcers (2013-2014). We report observed differences in specialty care, including: endocrinology, infectious disease, orthopedic surgery, plastic surgery, podiatry, or vascular surgery. We used logistic regression to examine possible intersectionality between rurality and race, controlling for sociodemographics, comorbidities, and ulcer severity and including an interaction term between rurality and identifying as black. RESULTS Overall, 32.15% (n=124 487) of patients hospitalized with a diabetic foot ulcer received specialty care. Among rural patients (n=13 100), the proportion decreased to 29.57%. For patients identifying as black (n=21 649), the proportion was 33.08%. Among rural patients identifying as black (n=1239), 26.23% received specialty care. This was >5 absolute percentage points less than the overall cohort. The adjusted OR for receiving specialty care among rural versus urban patients identifying as black was 0.61 (95% CI 0.53 to 0.71), which was lower than that for rural versus urban patients identifying as white (aOR 0.85, 95% CI 0.80 to 0.89). This metric supported a role for intersectionality between rurality and identifying as black. CONCLUSIONS A smaller proportion of rural patients, particularly those identifying as black, received specialty care when hospitalized with a diabetic foot ulcer compared with the overall cohort. This might contribute to known disparities in major amputations. Future studies are needed to determine causality.
Collapse
Affiliation(s)
- Lindsay Taylor
- Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ronald Gangnon
- Population Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - W Ryan Powell
- Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- University of Wisconsin Center for Health Disparities Research, Madison, Wisconsin, USA
| | - Joseph Kramer
- Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- University of Wisconsin Center for Health Disparities Research, Madison, Wisconsin, USA
| | - Amy J H Kind
- Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- University of Wisconsin Center for Health Disparities Research, Madison, Wisconsin, USA
| | | | - Meghan B Brennan
- Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
30
|
Morgan MB, Mates JL. Ethics of Artificial Intelligence in Breast Imaging. JOURNAL OF BREAST IMAGING 2023; 5:195-200. [PMID: 38416925 DOI: 10.1093/jbi/wbac076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Indexed: 03/01/2024]
Abstract
There is great interest in the development of artificial intelligence (AI) applications for medical imaging in general and specifically in breast imaging. Because of the scale of application and the potential for harm, there has been a parallel interest in assuring that these new technologies are scrutinized and applied in ethical ways. The four principles of autonomy, beneficence, non-maleficence, and justice are widely accepted as a framework for bioethical analysis. We incorporate a fifth principle of explicability (adapted from Floridi and Cowls) because of the unique considerations of AI. We review definitions of each of these principles and provide examples of their practical application to breast imaging.
Collapse
Affiliation(s)
- Matthew B Morgan
- University of Utah School of Medicine, Department of Radiology and Imaging Sciences, Salt Lake City, UT, USA
| | | |
Collapse
|
31
|
Honaker MD, Irish W, Parikh AA, Snyder RA. Association of Rural Residence and Receipt of Guideline-Concordant Care for Locoregional Colon Cancer. Ann Surg Oncol 2023; 30:3538-3546. [PMID: 36933082 DOI: 10.1245/s10434-023-13340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/19/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Incidence and mortality rates of colon cancer (CC) are higher in rural populations. This study aimed to determine whether rural residence is associated with differences in guideline-concordant care for patients with locoregional CC. METHODS Patients with stages I-III CC from 2006 to 2016 were identified in the National Cancer Database. Guideline-concordant care (GCC) was defined as resection with negative margins, adequate nodal harvest, and receipt of adjuvant chemotherapy for patients with high-risk stage II or III disease. Multivariable logistic regression (MVR) was performed to evaluate the association between rural residence and the odds of receiving GCC. Effect modification was evaluated using a two-way interaction for rurality by insurance status. RESULTS Of 320,719 identified patients, 6191 (2%) were rural. The rural patients had lower income and lower educational status than the urban patients and were more often Medicare-insured (p < 0.001). The rural patients traveled farther (44.5 vs. 7.5 miles; p < 0.001), although time to surgery was similar (8 vs. 9 days). The two cohorts had similar resection rates (98.8% vs. 98.0%), margin positivity (5.4% vs. 4.8%), adequate lymphadenectomy (80.9% vs. 83.0%), adjuvant chemotherapy (stage III: 69.2% vs. 68.7%), and receipt of GCC (66.5% vs. 68.3%). In the MVR, the odds of receiving GCC did not differ between the rural and urban patients (odds ratio, 0.99; 95% confidence interval, 0.94-1.05%). Insurance status did not differentially influence the receipt of GCC by the rural versus the urban patients (interaction: p = 0.83). CONCLUSIONS Rural and urban patients with locoregional CC are equally likely to receive GCC, suggesting that differences in cancer care delivery may not explain rural-urban disparities.
Collapse
Affiliation(s)
- Michael D Honaker
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - William Irish
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Alexander A Parikh
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA.,Department of Surgery, The University of Texas San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Rebecca A Snyder
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA. .,Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
32
|
Cénat JM, Dromer É, Darius WP, Dalexis RD, Furyk SE, Poisson H, Mansoub Bekarkhanechi F, Shah M, Diao DG, Gedeon AP, Lebel S, Labelle PR. Incidence, factors, and disparities related to cancer among Black individuals in Canada: A scoping review. Cancer 2023; 129:335-355. [PMID: 36436148 DOI: 10.1002/cncr.34551] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Canada, two of five individuals will be diagnosed with cancer in their lifetime and one in four will die from this disease. Given the disparities observed in health research among Black individuals, we conducted a scoping review to analyze the state of cancer research in Canadian Black communities regarding prevalence, incidence, screening, mortality, and related factors to observe advances and identify gaps and disparities. METHODS A comprehensive search strategy was developed and executed in December 2021 across 10 databases (e.g., Embase). Of 3451 studies generated by the search, 19 were retained for extraction and included in this study. RESULTS Studies were focused on a variety of cancer types among Black individuals including anal, breast, cervical, colorectal, gastric, lung, and prostate cancers. They included data on incidence, stage of cancer at diagnosis, type of care received, diagnostic interval length, and screening. A few studies also demonstrated racial disparities among Black individuals. This research reveals disparities in screening, incidence, and quality of care among Black individuals in Canada. CONCLUSIONS Given the gaps observed in cancer studies among Black individuals, federal and provincial governments and universities should consider creating special funds to generate research on this important health issue. PLAIN LANGUAGE SUMMARY Important gaps were observed on research on cancer among Black communities in Canada. Studies included in the scoping review highlights disparities in screening, incidence, and quality of care among Black individuals in Canada.
Collapse
Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.,Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada.,University of Ottawa Research Chair on Black Health, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Élisabeth Dromer
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Wina Paul Darius
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Hannah Poisson
- Faculty of Science, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Muhammad Shah
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Guangyu Diao
- Faculty of Arts and Science, McGill University, Montreal, Quebec, Canada
| | | | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | |
Collapse
|
33
|
Barberan Parraga C, Singh R, Lin R, Tamariz L, Palacio A. Colorectal Cancer Screening Disparities Among Race: A Zip Code Level Analysis. Clin Colorectal Cancer 2023; 22:183-189. [PMID: 36842869 DOI: 10.1016/j.clcc.2023.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) screening can prevent disease by early identification. Existing disparities in CRC screening have been associated with factors including race, socioeconomic status, insurance, and even geography. Our study takes a deeper look into how social determinants related to zip code tabulation areas affect CRC screenings. MATERIALS AND METHODS We conducted a retrospective cross-sectional study of CRC screenings by race at a zip code level, evaluating for impactful social determinant factors such as the social deprivation index (SDI). We used publicly available data from CDC 500 Cities Project (2016-2019), PLACES Project (2020), and the American Community Survey (2019). We conducted multivariate and confirmatory factor analyses among race, income, health insurance, check-up visits, and SDI. RESULTS Increasing the tertile of SDI was associated with a higher likelihood of being Black or Hispanic, as well as decreased median household income (P < .01). Lower rates of regular checkup visits were found in the third tertile of SDI (P < .01). The multivariate analysis showed that being Black, Hispanic, lower income, being uninsured, lack of regular check-ups, and increased SDI were related to decreased CRC screening. In the confirmatory factor analysis, we found that SDI and access to insurance were the variables most related to decreased CRC screening. CONCLUSION Our results reveal the top 2 factors that impact a locality's CRC screening rates are the social deprivation index and access to health care. This data may help implement interventions targeting social barriers to further promote CRC screenings within disadvantaged communities and decrease overall mortality via early screening.
Collapse
Affiliation(s)
- Carla Barberan Parraga
- Department of Medicine and Epidemiology Universidad Catolica Santiago de Guayaquil, Guayaquil, Ecuador.
| | - Roshni Singh
- Miller School of Medicine, University of Miami, Miami, FL
| | - Rachel Lin
- Miller School of Medicine, University of Miami, Miami, FL
| | | | - Ana Palacio
- Miami Veterans Affairs Medical Center, Miami, FL
| |
Collapse
|
34
|
Hao S, Meyer D, Klose C, Irish W, Honaker MD. Association of distance traveled on receipt of surgery in patients with locally advanced rectal cancer. Int J Colorectal Dis 2023; 38:8. [PMID: 36629973 DOI: 10.1007/s00384-022-04300-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Studies have shown patients residing in rural settings have worse cancer-related outcomes than those in urban settings. Specifically, rural patients with colorectal cancer have lower rates of screening and longer time to treatment. However, physical distance traveled has not been as well studied. This study sought to determine disparities in receipt of surgery in patients by distance traveled for care. METHODS A retrospective cohort study of patients with AJCC stage II/III rectal adenocarcinoma was identified within the National Cancer Database (2004-2017). Primary outcome was correlation of distance traveled to receipt of surgery. Multi-variable logistic regression was used to adjust for confounding factors. RESULTS 65,234 patients were included in the analysis. 94.6% resided in urban-metro areas while 2.2% resided in rural areas. Patients were predominantly non-Hispanic White (NHW) (75.2%) with an overall median age at diagnosis of 61 (IQR 52-71). Overall, 82.6% of patients received surgery. NHW patients were more likely to receive surgery than non-Hispanic Black patients (OR 0.67; 95% CI 0.61-0.73, p < 0.001), as were patients who were privately insured (OR 1.90, 95% CI 1.67-2.15, p < 0.001) or had Medicare (OR 1.68, 95% CI 1.47-1.92, p < 0.001) compared to uninsured patients. Patients traveling distances in the 4th quartile (median 47.9 miles) were more likely to receive surgery than those traveling the shortest distances (1st quartile: median 2.5 miles) (OR 1.37, 95% CI 1.24-1.50, p < 0.001). CONCLUSION Patients traveling farther distances were more likely to receive surgery than those traveling shorter distances. Shorter distance traveled does not appear to be associated with higher rates of surgical resection in patients with stage II/III rectal cancer.
Collapse
Affiliation(s)
- Scarlett Hao
- Division of Surgical Oncology, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - David Meyer
- East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Charles Klose
- East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - William Irish
- Division of Surgical Oncology, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA
- Division of Surgical Reseach, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Michael D Honaker
- Division of Surgical Oncology, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA.
| |
Collapse
|
35
|
Vilaro MJ, McAlindon K, Mertens G, Ashley T, Zalake M, Cooks EJ, Krieger JL. Information Architects: Using Community-Engaged and Qualitative Methods to Design a Technology-Based Nutrition and Cancer Risk Intervention for Rural Adults. Cancer Control 2023; 30:10732748221130162. [PMID: 36919704 PMCID: PMC10017944 DOI: 10.1177/10732748221130162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/25/2022] [Accepted: 09/15/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Nearly half of all cancer deaths are preventable through modification or avoidance of key risk factors. As such, there is a growing urgency to identify effective, low-resource, and scalable technologies that support clinical care and patient self-management of health behaviors. PURPOSE Informed by theories of cognitive load and user-centered design approaches, we develop a culturally tailored, multicomponent digital intervention to engage rural adults between 50-73 years old with their personalized nutrition risk factors for colorectal cancer (CRC) prevention. METHOD A total of 48 adults tested a Virtual Health Assistant (VHA) prototype during focus groups in individual think-aloud interviews to facilitate iterative adaptations to a web-based CRC prevention intervention. Qualitative data was analyzed to identify user needs and preferences related to information and with a focus on avoiding cognitive overload. RESULTS The VHA serves as a conceptual pre-training for users helping them understand CRC prevention key concepts and engendering motivation to act on the promoted behavior. A website was identified as a strategy to fill information gaps and present actionable information, after the VHA interaction. Cognitive load reducing strategies were used including segmenting where information is presented in learner-controlled segments rather than continuously. CONCLUSIONS Findings indicate potential benefits of designing CRC prevention information technologies with the rural older adults. Integrating patient-centered needs before launching health information web content will be important as the rapid growth of telemedicine aims to reach traditionally marginalized and underserved populations. Theoretically informed considerations for potential adverse outcomes (eg, information overload) are discussed.
Collapse
Affiliation(s)
- Melissa J. Vilaro
- Department of Family, Youth and Community Sciences, University of Florida, Gainesville, FL, USA
| | - Kathryn McAlindon
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Gillian Mertens
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Taylor Ashley
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Mohan Zalake
- Computer & Information Sciences & Engineering, University of Florida, Gainesville, FL, USA
| | - Eric J. Cooks
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Janice L. Krieger
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| |
Collapse
|
36
|
Moore JX, Andrzejak SE, Jones S, Han Y. Exploring the intersectionality of race/ethnicity with rurality on breast cancer outcomes: SEER analysis, 2000-2016. Breast Cancer Res Treat 2023; 197:633-645. [PMID: 36520228 PMCID: PMC9883364 DOI: 10.1007/s10549-022-06830-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/30/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE Disparities in breast cancer survival have been observed within marginalized racial/ethnic groups and within the rural-urban continuum for decades. We examined whether there were differences among the intersectionality of race/ethnicity and rural residence on breast cancer outcomes. METHODS We performed a retrospective analysis among 739,448 breast cancer patients using Surveillance Epidemiology and End Results (SEER) 18 registries years 2000 through 2016. We conducted multilevel logistic-regression and Cox proportional hazards models to estimate adjusted odds ratios (AORs) and hazard ratios (AHRs), respectively, for breast cancer outcomes including surgical treatment, radiation therapy, chemotherapy, late-stage disease, and risk of breast cancer death. Rural was defined as 2013 Rural-Urban Continuum Codes (RUCC) of 4 or greater. RESULTS Compared with non-Hispanic white-urban (NH-white-U) women, NH-black-U, NH-black-rural (R), Hispanic-U, and Hispanic-R women, respectively, were at increased odds of no receipt of surgical treatment (NH-black-U, AOR = 1.98, 95% CI 1.91-2.05; NH-black-R, AOR = 1.72, 95% CI 1.52-1.94; Hispanic-U, AOR = 1.58, 95% CI 1.52-1.65; and Hispanic-R, AOR = 1.40, 95% CI 1.18-1.67), late-stage diagnosis (NH-black-U, AOR = 1.32, 95% CI 1.29-1.34; NH-black-R, AOR = 1.29, 95% CI 1.22-1.36; Hispanic-U, AOR = 1.25, 95% CI 1.23-1.27; and Hispanic-R, AOR = 1.17, 95% CI 1.08-1.27), and increased risks for breast cancer death (NH-black-U, AHR = 1.46, 95% CI 1.43-1.50; NH-black-R, AHR = 1.42, 95% CI 1.32-1.53; and Hispanic-U, AHR = 1.10, 95% CI 1.07-1.13). CONCLUSION Regardless of rurality, NH-black and Hispanic women had significantly increased odds of late-stage diagnosis, no receipt of treatment, and risk of breast cancer death.
Collapse
Affiliation(s)
- Justin Xavier Moore
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA USA ,Institute of Preventive and Public Health, Medical College of Georgia, Augusta University, Augusta, GA USA ,Cancer Prevention, Control, & Population Health Program, Department of Medicine, Institute of Public and Preventive Health, Medical College of Georgia at Augusta University, 1410 Laney Walker Blvd. CN-2135, Augusta, GA 30912 USA
| | - Sydney Elizabeth Andrzejak
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA USA
| | - Samantha Jones
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA USA
| | - Yunan Han
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110 USA
| |
Collapse
|
37
|
Newman SD, Moss K, Pichon M, Scott D, Rogers K, Orr A, Bui C, Payne-Foster P. The health of rural Black communities during COVID: Some affirmations, some surprises. Front Public Health 2023; 11:932451. [PMID: 37124765 PMCID: PMC10133505 DOI: 10.3389/fpubh.2023.932451] [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: 04/29/2022] [Accepted: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
Background and objective There are overwhelming health disparities in the Deep South. It is important to include the voice of communities affected by these disparities when developing interventions. The goal of the current study was to develop an academic community engaged partnership to strengthen the ability to address priority health concerns of rural African American communities with a focus on health literacy and health advocacy. Methods A community-based participatory research approach was used to administer a 15-item community health survey in five rural communities led by African American mayors in Alabama (N = 752). The survey assessed the health concerns and the potential behaviors that may be associated with those health concerns. Results The five communities demonstrated similarities as well as differences in both the health concerns endorsed and the potential health behaviors that may contribute to those concerns. All five communities identified cardiovascular disease as a health concern with three endorsing mental health issues and 2 dental health. With respect to behaviors, all five communities identified either unhealthy eating/exercise and substance use as concerns with one community identifying racism as a risky behavior affecting health. Conclusion The results presented replicate CBPR studies demonstrating that communities are important sources of information about local health priorities and concerns.
Collapse
Affiliation(s)
- Sharlene D. Newman
- Alabama Life Research Institute, The University of Alabama, Tuscaloosa, AL, United States
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
- *Correspondence: Sharlene D. Newman,
| | - Kimberly Moss
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
| | - Melonie Pichon
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
| | - Deborah Scott
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
| | - Kileema Rogers
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
| | - Angela Orr
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
| | - Chuong Bui
- Alabama Life Research Institute, The University of Alabama, Tuscaloosa, AL, United States
| | - Pamela Payne-Foster
- Advancing Health Literacy in the Alabama Black Belt, HHS, Fort Deposit, AL, United States
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, AL, United States
| |
Collapse
|
38
|
Cooks EJ, Duke KA, Flood-Grady E, Vilaro MJ, Ghosh R, Parker N, Te P, George TJ, Lok BC, Williams M, Carek P, Krieger JL. Can virtual human clinicians help close the gap in colorectal cancer screening for rural adults in the United States? The influence of rural identity on perceptions of virtual human clinicians. Prev Med Rep 2022; 30:102034. [PMID: 36531088 PMCID: PMC9747643 DOI: 10.1016/j.pmedr.2022.102034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/05/2022] Open
Abstract
Rural adults experience disparities in colorectal cancer screening, a trend even more distinct among rural Black adults. Healthcare disruptions caused by COVID-19 exacerbated inequities, heightening attention on virtual communication strategies to increase screening. Yet little is known about how rural adults perceive virtual human clinicians (VHCs). Given that identifying as rural influences perceived source credibility often through appearance judgments, the goal of this pilot was to explore how to develop VHCs that individuals highly identified with rurality find attractive. Between November 2018 and April 2019, we tested a culturally tailored, VHC-led telehealth intervention delivering evidence-based colorectal cancer prevention education with White and Black adults (N = 2079) in the United States recruited through an online panel who were non-adherent to screening guidelines and between 50 and 73 years of age. Participants were randomized on three factors (VHC race-matching, VHC gender-matching, Intervention type). Ordinal logistic regression models examined VHC appearance ratings. Participants with a high rural identity (AOR = 1.12, CI = [1.02, 1.23], p =.02) rated the VHCs more attractive. High rural belonging influenced VHC attractiveness for Black participants (AOR = 1.22, CI = [1.03, 1.44], p =.02). Also, Black participants interacting with a Black VHC and reporting high rural self-concept rated the VHC as more attractive (AOR = 2.22, CI = [1.27, 3.91], p =.01). Findings suggest adults for whom rural identity is important have more positive impressions of VHC attractiveness. For patients with strong rural identities, enhancing VHC appearance is critical to tailoring colorectal cancer prevention interventions.
Collapse
Affiliation(s)
- Eric J. Cooks
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, USA
| | - Kyle A. Duke
- Department of Statistics, North Carolina State University, USA
| | - Elizabeth Flood-Grady
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, USA
| | - Melissa J. Vilaro
- Department of Family, Youth, and Community Sciences, University of Florida, USA
| | - Rashi Ghosh
- Department of Computer & Information Science & Engineering, College of Engineering. University of Florida, USA
| | - Naomi Parker
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, USA
| | - Palani Te
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, USA
| | - Thomas J. George
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, USA
| | - Benjamin C. Lok
- Department of Computer & Information Science & Engineering, College of Engineering. University of Florida, USA
| | - Maribeth Williams
- Department of Community Health and Family Medicine, University of Florida, USA
| | - Peter Carek
- Department of Community Health and Family Medicine, University of Florida, USA
| | - Janice L. Krieger
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, USA
| |
Collapse
|
39
|
Ponce SEB, Thomas CR, Diaz DA. Social determinants of health, workforce diversity, and financial toxicity: A review of disparities in cancer care. Curr Probl Cancer 2022; 46:100893. [DOI: 10.1016/j.currproblcancer.2022.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
|
40
|
Ramkumar N, Colla CH, Wang Q, O’Malley AJ, Wong SL, Brooks GA. Association of Rurality, Race and Ethnicity, and Socioeconomic Status With the Surgical Management of Colon Cancer and Postoperative Outcomes Among Medicare Beneficiaries. JAMA Netw Open 2022; 5:e2229247. [PMID: 36040737 PMCID: PMC9428741 DOI: 10.1001/jamanetworkopen.2022.29247] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/09/2022] [Indexed: 01/13/2023] Open
Abstract
Importance Rural patients with colon cancer experience worse outcomes than urban patients, but the extent to which disparities are explained by social determinants is not known. Objectives To evaluate the association of rurality with surgical treatment and outcomes of colon cancer and to investigate the intersection of rurality with race and ethnicity and socioeconomic status. Design, Settings, and Participants This cohort study included fee-for-service Medicare beneficiaries 65 years or older diagnosed with incident, nonmetastatic colon cancer between April 1, 2016, and September 30, 2018, with follow-up until December 31, 2018. Data were analyzed from August 3, 2020, to April 30, 2021. Exposures Rurality of patient's residence, categorized as metropolitan, micropolitan, or small town or rural, using Rural-Urban Commuting Area codes. Main Outcomes and Measures Receipt of surgery, emergent surgery, or minimally invasive surgery (MIS); 90-day surgical complications; and 90-day mortality. Results Among 57 710 Medicare beneficiaries with incident, nonmetastatic colon cancer, 46.6% were men, 53.4% were women, and the mean (SD) age was 76.6 (7.2) years. In terms of race and ethnicity, 3.7% were Hispanic, 6.4% were non-Hispanic Black (hereinafter Black), 86.1% were non-Hispanic White (hereinafter White), and 3.8% were American Indian or Alaska Native, Asian or Pacific Islander, or unknown race or ethnicity. Patients residing in nonmetropolitan areas were more likely to undergo surgical resection than those residing in metropolitan areas (69.2% vs 63.9%; P < .001). Black race was independently associated with lower hazard of surgical resection (hazard ratio, 0.92 [95% CI, 0.88-0.95]). Race and ethnicity and measures of socioeconomic status did not modify the association of rurality with surgery. Beneficiaries from small town and rural areas had higher odds of undergoing emergent surgery (adjusted odds ratio [OR], 1.32 [95% CI, 1.20-1.44]) but lower odds of undergoing MIS (adjusted OR, 0.75 [95% CI, 0.70-0.80]), with similar findings for patients residing in micropolitan areas. Members of racial and ethnic minority groups who resided in small town and rural settings experienced higher odds of postoperative surgical complications (P = .001 for interaction) and mortality (P = .001 for interaction). Notably, White patients who resided in small town and rural areas experienced lower odds of postoperative mortality than their White metropolitan counterparts (adjusted OR, 0.81 [95% CI, 0.71-0.92]), but Black patients who resided in small town and rural areas had significantly higher odds of postoperative mortality (adjusted OR, 1.86 [95% CI, 1.16-2.97]) than their Black metropolitan counterparts. Conclusions and Relevance These findings suggest that Medicare beneficiaries from small town and rural areas were more likely to undergo surgery for nonmetastatic colon cancer than metropolitan beneficiaries but also more likely to undergo emergent surgery and less likely to have MIS. The experiences of rural patients varied by race; rurality was associated with higher postoperative mortality for Black patients but not for other racial and ethnic groups.
Collapse
Affiliation(s)
- Niveditta Ramkumar
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Carrie H. Colla
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Congressional Budget Office, Washington, DC
| | - Qianfei Wang
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - A. James O’Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Department of Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Sandra L. Wong
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Congressional Budget Office, Washington, DC
- Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Gabriel A. Brooks
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| |
Collapse
|
41
|
Ulmer KK, Greteman B, McDonald M, Gonzalez Bosquet J, Charlton ME, Nash S. Association of Distance to Gynecologic Oncologist and Survival in a Rural Midwestern State. WOMEN'S HEALTH REPORTS 2022; 3:678-685. [PMID: 36147832 PMCID: PMC9436260 DOI: 10.1089/whr.2022.0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Keely K. Ulmer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Breanna Greteman
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Megan McDonald
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jesus Gonzalez Bosquet
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mary E. Charlton
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Sarah Nash
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| |
Collapse
|
42
|
Myers KJ, Jaffe T, Kanda DA, Pankratz VS, Tawfik B, Wu E, McClain ME, Mishra SI, Kano M, Madhivanan P, Adsul P. Reaching the "Hard-to-Reach" Sexual and Gender Diverse Communities for Population-Based Research in Cancer Prevention and Control: Methods for Online Survey Data Collection and Management. Front Oncol 2022. [PMID: 35756657 DOI: 10.3389/fonc.2022.841951:10.3389/fonc.2022.841951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
PURPOSE Around 5% of United States (U.S.) population identifies as Sexual and Gender Diverse (SGD), yet there is limited research around cancer prevention among these populations. We present multi-pronged, low-cost, and systematic recruitment strategies used to reach SGD communities in New Mexico (NM), a state that is both largely rural and racially/ethnically classified as a "majority-minority" state. METHODS Our recruitment focused on using: (1) Every Door Direct Mail (EDDM) program, by the United States Postal Services (USPS); (2) Google and Facebook advertisements; (3) Organizational outreach via emails to publicly available SGD-friendly business contacts; (4) Personal outreach via flyers at clinical and community settings across NM. Guided by previous research, we provide detailed descriptions on using strategies to check for fraudulent and suspicious online responses, that ensure data integrity. RESULTS A total of 27,369 flyers were distributed through the EDDM program and 436,177 impressions were made through the Google and Facebook ads. We received a total of 6,920 responses on the eligibility survey. For the 5,037 eligible respondents, we received 3,120 (61.9%) complete responses. Of these, 13% (406/3120) were fraudulent/suspicious based on research-informed criteria and were removed. Final analysis included 2,534 respondents, of which the majority (59.9%) reported hearing about the study from social media. Of the respondents, 49.5% were between 31-40 years, 39.5% were Black, Hispanic, or American Indian/Alaskan Native, and 45.9% had an annual household income below $50,000. Over half (55.3%) were assigned male, 40.4% were assigned female, and 4.3% were assigned intersex at birth. Transgender respondents made up 10.6% (n=267) of the respondents. In terms of sexual orientation, 54.1% (n=1371) reported being gay or lesbian, 30% (n=749) bisexual, and 15.8% (n=401) queer. A total of 756 (29.8%) respondents reported receiving a cancer diagnosis and among screen-eligible respondents, 66.2% reported ever having a Pap, 78.6% reported ever having a mammogram, and 84.1% reported ever having a colonoscopy. Over half of eligible respondents (58.7%) reported receiving Human Papillomavirus vaccinations. CONCLUSION Study findings showcase effective strategies to reach communities, maximize data quality, and prevent the misrepresentation of data critical to improve health in SGD communities.
Collapse
Affiliation(s)
- Katie J Myers
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Talya Jaffe
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Deborah A Kanda
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - V Shane Pankratz
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Bernard Tawfik
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Emily Wu
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Molly E McClain
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Shiraz I Mishra
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Miria Kano
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, Tucson, AZ, United States.,Comprehensive Cancer Center, University of Arizona, Tucson, AZ, United States.,Public Health Research Institute of India, Mysuru, India
| | - Prajakta Adsul
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| |
Collapse
|
43
|
Myers KJ, Jaffe T, Kanda DA, Pankratz VS, Tawfik B, Wu E, McClain ME, Mishra SI, Kano M, Madhivanan P, Adsul P. Reaching the "Hard-to-Reach" Sexual and Gender Diverse Communities for Population-Based Research in Cancer Prevention and Control: Methods for Online Survey Data Collection and Management. Front Oncol 2022; 12:841951. [PMID: 35756657 PMCID: PMC9213655 DOI: 10.3389/fonc.2022.841951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Around 5% of United States (U.S.) population identifies as Sexual and Gender Diverse (SGD), yet there is limited research around cancer prevention among these populations. We present multi-pronged, low-cost, and systematic recruitment strategies used to reach SGD communities in New Mexico (NM), a state that is both largely rural and racially/ethnically classified as a "majority-minority" state. Methods Our recruitment focused on using: (1) Every Door Direct Mail (EDDM) program, by the United States Postal Services (USPS); (2) Google and Facebook advertisements; (3) Organizational outreach via emails to publicly available SGD-friendly business contacts; (4) Personal outreach via flyers at clinical and community settings across NM. Guided by previous research, we provide detailed descriptions on using strategies to check for fraudulent and suspicious online responses, that ensure data integrity. Results A total of 27,369 flyers were distributed through the EDDM program and 436,177 impressions were made through the Google and Facebook ads. We received a total of 6,920 responses on the eligibility survey. For the 5,037 eligible respondents, we received 3,120 (61.9%) complete responses. Of these, 13% (406/3120) were fraudulent/suspicious based on research-informed criteria and were removed. Final analysis included 2,534 respondents, of which the majority (59.9%) reported hearing about the study from social media. Of the respondents, 49.5% were between 31-40 years, 39.5% were Black, Hispanic, or American Indian/Alaskan Native, and 45.9% had an annual household income below $50,000. Over half (55.3%) were assigned male, 40.4% were assigned female, and 4.3% were assigned intersex at birth. Transgender respondents made up 10.6% (n=267) of the respondents. In terms of sexual orientation, 54.1% (n=1371) reported being gay or lesbian, 30% (n=749) bisexual, and 15.8% (n=401) queer. A total of 756 (29.8%) respondents reported receiving a cancer diagnosis and among screen-eligible respondents, 66.2% reported ever having a Pap, 78.6% reported ever having a mammogram, and 84.1% reported ever having a colonoscopy. Over half of eligible respondents (58.7%) reported receiving Human Papillomavirus vaccinations. Conclusion Study findings showcase effective strategies to reach communities, maximize data quality, and prevent the misrepresentation of data critical to improve health in SGD communities.
Collapse
Affiliation(s)
- Katie J Myers
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Talya Jaffe
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Deborah A Kanda
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - V Shane Pankratz
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Bernard Tawfik
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Emily Wu
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Molly E McClain
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Shiraz I Mishra
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Miria Kano
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, Tucson, AZ, United States.,Comprehensive Cancer Center, University of Arizona, Tucson, AZ, United States.,Public Health Research Institute of India, Mysuru, India
| | - Prajakta Adsul
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| |
Collapse
|
44
|
Baumann AA, Woodward EN, Singh RS, Adsul P, Shelton RC. Assessing researchers' capabilities, opportunities, and motivation to conduct equity-oriented dissemination and implementation research, an exploratory cross-sectional study. BMC Health Serv Res 2022; 22:731. [PMID: 35650573 PMCID: PMC9161573 DOI: 10.1186/s12913-022-07882-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/30/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND A recent paradigm shift has led to an explicit focus on enhancing health equity through equity-oriented dissemination and implementation (D&I) research. However, the integration and bidirectional learning across these two fields is still in its infancy and siloed. This exploratory study aimed to examine participants' perceived capabilities, opportunities, and motivations to conduct equity-oriented D&I research. METHODS We conducted an exploratory cross-sectional survey distributed online from December 2020 to April 2021. Participants were recruited at either D&I or health disparities-oriented conferences, meetings, through social media, or personal outreach via emails. Informed by the Capability, Opportunity, and Motivation Model (COM-B), the survey queried respondents about different aspects of engaging in and conducting equity-oriented D&I research. All analyses were conducted in SPSS Version 27.0. RESULTS A total of 180 participants responded to the survey. Most participants were women (81.7%), white (66.1%), academics (78.9%), and faculty members (53.9%). Many reported they were advanced (36.7%) or advanced beginners (27.8%) in the D&I field, and a substantial proportion (37.8%) reported being novice in D&I research that focused on health equity. Participants reported high motivation (e.g., 62.8% were motivated to apply theories, models, frameworks for promoting health equity in D&I research), but low capability to conduct equity-oriented D&I research (e.g., 5% had the information needed for promoting health equity in D&I research). Most participants (62.2%) reported not having used measures to examine equity in their D&I projects, and for those who did use measures, they mainly used individual-level measures (vs. organizational- or structural-level measures). When asked about factors that could influence their ability to conduct equity-oriented D&I research, 44.4% reported not having the skills necessary, and 32.2% stated difficulties in receiving funding for equity-oriented D&I research. CONCLUSIONS Study findings provide empirical insight into the perspectives of researchers from different backgrounds on what is needed to conduct equity-oriented D&I research. These data suggest the need for a multi-pronged approach to enhance the capability and opportunities for conducting equity-oriented D&I work, such as: training specifically in equity-oriented D&I, collaboration between D&I researchers with individuals with expertise and lived experience with health equity research, funding for equity-oriented D&I research, and recognition of the value of community engaged research in promotion packages.
Collapse
Affiliation(s)
- Ana A. Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO USA
| | - Eva N. Woodward
- Center for Mental Healthcare and Outcomes Research, U.S. Department of Veterans Affairs, North Little Rock, AR USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Rajinder Sonia Singh
- South Central Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, North Little Rock, North Little Rock, AR USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY USA
| |
Collapse
|
45
|
Rock CL, Thomson CA, Sullivan KR, Howe CL, Kushi LH, Caan BJ, Neuhouser ML, Bandera EV, Wang Y, Robien K, Basen-Engquist KM, Brown JC, Courneya KS, Crane TE, Garcia DO, Grant BL, Hamilton KK, Hartman SJ, Kenfield SA, Martinez ME, Meyerhardt JA, Nekhlyudov L, Overholser L, Patel AV, Pinto BM, Platek ME, Rees-Punia E, Spees CK, Gapstur SM, McCullough ML. American Cancer Society nutrition and physical activity guideline for cancer survivors. CA Cancer J Clin 2022; 72:230-262. [PMID: 35294043 DOI: 10.3322/caac.21719] [Citation(s) in RCA: 230] [Impact Index Per Article: 115.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/22/2021] [Accepted: 12/15/2021] [Indexed: 12/13/2022] Open
Abstract
The overall 5-year relative survival rate for all cancers combined is now 68%, and there are over 16.9 million survivors in the United States. Evidence from laboratory and observational studies suggests that factors such as diet, physical activity, and obesity may affect risk for recurrence and overall survival after a cancer diagnosis. The purpose of this American Cancer Society guideline is to provide evidence-based, cancer-specific recommendations for anthropometric parameters, physical activity, diet, and alcohol intake for reducing recurrence and cancer-specific and overall mortality. The audiences for this guideline are health care providers caring for cancer survivors as well as cancer survivors and their families. The guideline is intended to serve as a resource for informing American Cancer Society programs, health policy, and the media. Sources of evidence that form the basis of this guideline are systematic literature reviews, meta-analyses, pooled analyses of cohort studies, and large randomized clinical trials published since 2012. Recommendations for nutrition and physical activity during cancer treatment, informed by current practice, large cancer care organizations, and reviews of other expert bodies, are also presented. To provide additional context for the guidelines, the authors also include information on the relationship between health-related behaviors and comorbidities, long-term sequelae and patient-reported outcomes, and health disparities, with attention to enabling survivors' ability to adhere to recommendations. Approaches to meet survivors' needs are addressed as well as clinical care coordination and resources for nutrition and physical activity counseling after a cancer diagnosis.
Collapse
Affiliation(s)
- Cheryl L Rock
- Department of Family Medicine, School of Medicine, University of California at San Diego, La Jolla, California
| | - Cynthia A Thomson
- Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Kristen R Sullivan
- Department of Population Sciences, American Cancer Society, Atlanta, Georgia
| | - Carol L Howe
- Department of Medicine, University of Arizona Health Sciences Library, Tucson, Arizona
- Department of Family and Community Medicine, University of Arizona Health Sciences Library, Tucson, Arizona
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Bette J Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Marian L Neuhouser
- Cancer Prevention Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ying Wang
- Department of Population Sciences, American Cancer Society, Atlanta, Georgia
| | - Kimberly Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Karen M Basen-Engquist
- Division of Cancer Prevention and Population Sciences, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Justin C Brown
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - Kerry S Courneya
- Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Tracy E Crane
- Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Coral Gables, Florida
| | - David O Garcia
- Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Barbara L Grant
- Cancer Care Center, St Alphonsus Regional Medical Center, Boise, Idaho
| | - Kathryn K Hamilton
- Carol G. Simon Cancer Center, Morristown Medical Center, Morristown, New Jersey
| | - Sheri J Hartman
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, La Jolla, California
| | - Stacey A Kenfield
- Department of Urology, University of California at San Francisco, San Francisco, California
| | - Maria Elena Martinez
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, La Jolla, California
- Moores Cancer Center, University of California at San Diego, La Jolla, California
| | | | - Larissa Nekhlyudov
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Alpa V Patel
- Department of Population Sciences, American Cancer Society, Atlanta, Georgia
| | - Bernardine M Pinto
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Mary E Platek
- School of Health Professions, D'Youville College, Buffalo, New York
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Erika Rees-Punia
- Department of Population Sciences, American Cancer Society, Atlanta, Georgia
| | - Colleen K Spees
- College of Medicine, The Ohio State University, Columbus, Ohio
| | | | | |
Collapse
|
46
|
Brennan MB, Powell WR, Kaiksow F, Kramer J, Liu Y, Kind AJH, Bartels CM. Association of Race, Ethnicity, and Rurality With Major Leg Amputation or Death Among Medicare Beneficiaries Hospitalized With Diabetic Foot Ulcers. JAMA Netw Open 2022; 5:e228399. [PMID: 35446395 PMCID: PMC9024392 DOI: 10.1001/jamanetworkopen.2022.8399] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Patients identifying as Black and those living in rural and disadvantaged neighborhoods are at increased risk of major (above-ankle) leg amputations owing to diabetic foot ulcers. Intersectionality emphasizes that the disparities faced by multiply marginalized people (eg, rural US individuals identifying as Black) are greater than the sum of each individual disparity. OBJECTIVE To assess whether intersecting identities of Black race, ethnicity, rural residence, or living in a disadvantaged neighborhood are associated with increased risk in major leg amputation or death among Medicare beneficiaries hospitalized with diabetic foot ulcers. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used 2013-2014 data from the US National Medicare Claims Data Database on all adult Medicare patients hospitalized with a diabetic foot ulcer. Statistical analysis was conducted from August 1 to October 27, 2021. EXPOSURES Race was categorized using Research Triangle Institute variables. Rurality was assigned using Rural-Urban Commuting Area codes. Residents of disadvantaged neighborhoods comprised those living in neighborhoods at or above the national 80th percentile Area Deprivation Index. MAIN OUTCOMES AND MEASURES Major leg amputation or death during hospitalization or within 30 days of hospital discharge. Logistic regression was used to explore interactions among race, ethnicity, rurality, and neighborhood disadvantage, controlling for sociodemographic characteristics, comorbidities, and ulcer severity. RESULTS The cohort included 124 487 patients, with a mean (SD) age of 71.5 (13.0) years, of whom 71 286 (57.3%) were men, 13 100 (10.5%) were rural, and 21 649 (17.4%) identified as Black. Overall, 17.6% of the cohort (n = 21 919), 18.3% of rural patients (2402 of 13 100), and 21.9% of patients identifying as Black (4732 of 21 649) underwent major leg amputation or died. Among 1239 rural patients identifying as Black, this proportion was 28.0% (n = 347). This proportion exceeded the expected excess for rural patients (18.3% - 17.6% = 0.7%) plus those identifying as Black (21.9% - 17.6% = 4.3%) by more than 2-fold (28.0% - 17.6% = 10.4% vs 0.7% + 4.3% = 5.0%). The adjusted predicted probability of major leg amputation or death remained high at 24.7% (95% CI, 22.4%-26.9%), with a significant interaction between race and rurality. CONCLUSIONS AND RELEVANCE Rural patients identifying as Black had a more than 10% absolute increased risk of major leg amputation or death compared with the overall cohort. This study suggests that racial and rural disparities interacted, amplifying risk. Findings support using an intersectionality lens to investigate and address disparities in major leg amputation and mortality for patients with diabetic foot ulcers.
Collapse
Affiliation(s)
| | - W. Ryan Powell
- Department of Medicine, University of Wisconsin, Madison
| | - Farah Kaiksow
- Department of Medicine, University of Wisconsin, Madison
| | - Joseph Kramer
- Department of Medicine, University of Wisconsin, Madison
| | - Yao Liu
- Department of Ophthalmology, University of Wisconsin, Madison
| | - Amy J. H. Kind
- Department of Medicine, University of Wisconsin, Madison
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison
- Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Hospital, Department of Veterans Affairs, Madison, Wisconsin
| | | |
Collapse
|
47
|
The Impact of a Grocery Store Closure in One Rural Highly Obese Appalachian Community on Shopping Behavior and Dietary Intake. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063506. [PMID: 35329193 PMCID: PMC8951354 DOI: 10.3390/ijerph19063506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022]
Abstract
Research has examined how the entry of grocery stores into neighborhoods influences dietary outcomes, yet limited evidence suggests a direct correlation between opening a store and changes in dietary intake. A factor that might influence individuals’ behavior more directly is the closing of a grocery store where residents shop. This study aims to examine how a grocery closure in a rural Appalachian high poverty county is associated with dietary intake. A cohort of n = 152 individuals were recruited to participate in a longitudinal study examining purchasing habits and dietary intake. At time point two, one year later, n = 74 individuals completed the survey via phone. Results indicate those that switched from shopping at a local grocery store to a supercenter significantly increased their dietary intake of fruit (0.2 ± 0.8), fruits and vegetables (1.4 ± 2.7), alcohol (grams) (17.3 ± 54.1), and tomato sauce (0.1 ± 0.3). A local grocery store closure was associated with a change in shopping behavior and dietary intake. Community-level interventions targeting dietary behaviors must account for neighborhood food environment influences, including grocery store availability. Policy aimed at improving food access in rural communities need to consider approaches to improving a variety of food venues with affordable healthy food, while addressing the evolving grocery shopping behaviors of consumers.
Collapse
|
48
|
Rodman J, Mishra SI, Adsul P. Improving Comprehensive Cancer Control State Plans for Colorectal Cancer Screening in the Four Corners Region of the United States. Health Promot Pract 2022:15248399211073803. [PMID: 35184614 DOI: 10.1177/15248399211073803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Colorectal cancer (CRC) disparities continue to persist in the four corners region (states of New Mexico, Arizona, Utah, and Colorado) of the United States. The Comprehensive Cancer Control (CCC) state plans provide a policy and practice snapshot on how a state identifies and addresses its cancer burden. This study critically examines the four state plans to identify gaps and opportunities for cancer prevention and control. Using a conventional content analysis approach, we reviewed the CCC plans for CRC screening-related information, culminating in a conceptual framework that highlights three themes. First, states reported their cancer burden using national data from American Cancer Society, Centers for Disease Control and Prevention, or the NCI's Surveillance, Epidemiology, and End Results. Although these data informed specific goals and objectives, not all plans reported state-level data on CRC differences by specific social determinants of health and other characteristics. Second, it was not clear whether the interventions chosen to address state plan objectives were evidence-based and whether or not clearly described criteria were used for the selection of the interventions. Third, very limited information was provided in terms of state-specific contextual challenges and practical implementation of interventions. Study findings highlight opportunities to improve state-level cancer prevention and control efforts: first, by promoting the selection and adaptation of contextually relevant evidence-based interventions for this unique region; and second, through multidirectional engagement with communities, researchers, and policy and practice stakeholders. Such synergies in research and policies are vital for a coordinated and integrated approach to cancer prevention and control.
Collapse
Affiliation(s)
- Joseph Rodman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Shiraz I Mishra
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, NM, USA.,Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Prajakta Adsul
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| |
Collapse
|
49
|
Butler EN, Umar A, Heckman-Stoddard BM, Kundrod KA, Signorello LB, Castle PE. Redefining precision cancer prevention to promote health equity. Trends Cancer 2022; 8:295-302. [PMID: 35181273 DOI: 10.1016/j.trecan.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 11/15/2022]
Abstract
Precision cancer prevention as it is currently envisioned is a targeted, molecular-based approach to intercept carcinogenesis before cancer develops or before it becomes untreatable. Unfortunately, due to systemic biases, current precision cancer prevention interventions might not be effective in all populations, especially in minoritized communities. In addition, not all cancer risk is attributable to genetic or even biological factors, but includes social determinants of health (SDH). Here, we propose a broader framework for precision cancer prevention, anchored in optimizing the benefits to harms for all people. We propose that precision cancer prevention considers not only what is being delivered, but also for whom, where, and how, with a goal of achieving cancer prevention health equity.
Collapse
Affiliation(s)
- Eboneé N Butler
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA; Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Asad Umar
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Brandy M Heckman-Stoddard
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Kathryn A Kundrod
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Lisa B Signorello
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA; Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
| |
Collapse
|
50
|
Cohen SA, Nash CC, Byrne EN, Mitchell LE, Greaney ML. Black/White Disparities in Obesity Widen with Increasing Rurality: Evidence from a National Survey. Health Equity 2022; 6:178-188. [PMID: 35402770 PMCID: PMC8985531 DOI: 10.1089/heq.2021.0149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Steven A. Cohen
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Caitlin C. Nash
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Erin N. Byrne
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Lauren E. Mitchell
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Mary L. Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| |
Collapse
|