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Herrmann AK, Ferullo SL, Hernandez M, Barriga VA, Leggis B, Ruiz J, Glenn BA, Bastani R. Adapting E-cigarette prevention programming to reach the latinx community. Cancer Causes Control 2024; 35:405-416. [PMID: 37812335 PMCID: PMC10838817 DOI: 10.1007/s10552-023-01796-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 09/06/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE E-cigarettes are the most commonly used tobacco product among youth in the United States. Yet evidence-based prevention programming is limited due to the rapid onset of this threat. Community-based efforts to address vaping largely target youth in school settings. Although parents can play an important role in youth tobacco control efforts, messages about the dangers of vaping, use among adolescents, and strategies for intervening have not reached many Spanish-speaking parents in low-income Latinx communities. Our community-academic team developed e-cigarette prevention programming for use by promotor/as de salud to address this unmet need. METHODS During the 1-year project, the team worked closely with a Project Advisory Committee to: review existing evidence-informed materials; conduct focus groups with parents, youth and promotor/as to guide program development; develop a curriculum to prepare promotor/as to educate low-literacy, Spanish-speaking parents about vaping; craft Spanish language resources for promotor/as to use in community education sessions; train 61 promotor/as to deliver the program; and support program delivery to 657 community members. RESULTS Focus groups with promotor/as and community members, key-informant interviews, and brief surveys informed program development and assessment. Community member feedback was essential to development of appropriate materials. Promotor/as demonstrated significant pre- to post- training increases in e-cigarette knowledge and confidence in delivering vaping prevention education. Community members demonstrated a mastery of basic e-cigarette concepts and expressed intention to discuss vaping with their children. CONCLUSIONS Promotor/a-led programming for parents represents a promising approach to vaping prevention and control in the Latinx community.
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Affiliation(s)
- Alison K Herrmann
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles E Young Dr. S, Los Angeles, CA, 90095-6900, USA.
| | - Sylvia Lopez Ferullo
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles E Young Dr. S, Los Angeles, CA, 90095-6900, USA
| | - Miriam Hernandez
- Visión y Compromiso, 1000 Alameda Street, Los Angeles, CA, 90012, USA
| | | | - Bernadett Leggis
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles E Young Dr. S, Los Angeles, CA, 90095-6900, USA
| | - Julissa Ruiz
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles E Young Dr. S, Los Angeles, CA, 90095-6900, USA
| | - Beth A Glenn
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles E Young Dr. S, Los Angeles, CA, 90095-6900, USA
| | - Roshan Bastani
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles E Young Dr. S, Los Angeles, CA, 90095-6900, USA
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2
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Velez MA, Glenn BA, Garcia-Jimenez M, Cummings AL, Lisberg A, Nañez A, Radwan Y, Lind-Lebuffe JP, Brodrick PM, Li DY, Fernandez-Turizo MJ, Gower A, Lindenbaum M, Hegde M, Brook J, Grogan T, Elashoff D, Teitell MA, Garon EB. Consent document translation expense hinders inclusive clinical trial enrolment. Nature 2023; 620:855-862. [PMID: 37532930 PMCID: PMC11046417 DOI: 10.1038/s41586-023-06382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/28/2023] [Indexed: 08/04/2023]
Abstract
Patients from historically under-represented racial and ethnic groups are enrolled in cancer clinical trials at disproportionately low rates in the USA1-3. As these patients often have limited English proficiency4-7, we hypothesized that one barrier to their inclusion is the cost to investigators of translating consent documents. To test this hypothesis, we evaluated more than 12,000 consent events at a large cancer centre and assessed whether patients requiring translated consent documents would sign consent documents less frequently in studies lacking industry sponsorship (for which the principal investigator pays the translation costs) than for industry-sponsored studies (for which the translation costs are covered by the sponsor). Here we show that the proportion of consent events for patients with limited English proficiency in studies not sponsored by industry was approximately half of that seen in industry-sponsored studies. We also show that among those signing consent documents, the proportion of consent documents translated into the patient's primary language in studies without industry sponsorship was approximately half of that seen in industry-sponsored studies. The results suggest that the cost of consent document translation in trials not sponsored by industry could be a potentially modifiable barrier to the inclusion of patients with limited English proficiency.
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Affiliation(s)
- Maria A Velez
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Beth A Glenn
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA, USA
- UCLA Center for Cancer Prevention and Control Research, University of California, Los Angeles, Los Angeles, CA, USA
- UCLA Kaiser Permanente Center for Health Equity, University of Califonia, Los Angeles, Los Angeles, CA, USA
| | - Maria Garcia-Jimenez
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Division of Hematology/Oncology, UCLA-Olive View Medical Center, Los Angeles, CA, USA
| | - Amy L Cummings
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Aaron Lisberg
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Andrea Nañez
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yazeed Radwan
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jackson P Lind-Lebuffe
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Paige M Brodrick
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Debory Y Li
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Arjan Gower
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Maggie Lindenbaum
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Manavi Hegde
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jenny Brook
- Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tristan Grogan
- Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, CA, USA
| | - David Elashoff
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, CA, USA
| | - Michael A Teitell
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Edward B Garon
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA.
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA.
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3
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Glenn BA, Crespi CM, Herrmann AK, Nonzee NJ, Rosen DL, Park CL, Johnson G, Chang LC, Singhal R, Taylor VM, Bastani R. Effectiveness and feasibility of three types of parent reminders to increase adolescent human papillomavirus (HPV) vaccination. Prev Med 2023; 169:107448. [PMID: 36773962 DOI: 10.1016/j.ypmed.2023.107448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/17/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
Parent reminders have produced modest improvements in human papillomavirus (HPV) vaccination among adolescents. However, little prior research has compared the effectiveness and feasibility of different HPV reminder types in resource-limited settings. We conducted a quasi-experimental study (2016-2017) to evaluate the effectiveness of three parent reminder types (mailed letters, robocalls, text messages) on next-dose HPV vaccine receipt among 12-year-olds in a large Federally Qualified Health Center in Los Angeles County. Six clinics were matched into three pairs: randomly assigning one clinic within each pair to intervention and control. Intervention clinics were randomly assigned to deliver one of the three parent reminder types. We calculated rates of next-dose vaccine receipt and assessed intervention effects using logistic regression models. We calculated the proportion of each type of reminder successfully delivered as a feasibility measure. The study sample comprised 877 12-year-olds due for an HPV vaccine dose (47% female, >85% Latino). At 4-month follow-up, 23% of intervention patients received an HPV vaccine dose compared to only 12% of control patients. Overall, receipt of any reminder increased rates of the next-needed HPV vaccine compared to usual care (p = 0.046). Significant improvements were observed for text reminders (p = 0.036) and boys (p = 0.006). Robocalls were the least feasible reminder type. Text message reminders are feasible and effective for promoting HPV vaccination. Future research is needed to assess the effectiveness and feasibility of reminders compared to other vaccine promotion strategies.
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Affiliation(s)
- Beth A Glenn
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles E Young Dr. S, Los Angeles, CA 90095-6900, USA.
| | - Catherine M Crespi
- UCLA Center for Cancer Prevention and Control Research, Department of Biostatistics, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Dr. South, Los Angeles, CA 90095-6900, USA.
| | - Alison K Herrmann
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles E Young Dr. S, Los Angeles, CA 90095-6900, USA.
| | - Narissa J Nonzee
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles E Young Dr. S, Los Angeles, CA 90095-6900, USA.
| | - Debra L Rosen
- Northeast Valley Health Corporation, San Fernando Health Center, 1600 San Fernando Rd, San Fernando, CA 91340, USA.
| | - Christine L Park
- Northeast Valley Health Corporation, San Fernando Health Center, 1600 San Fernando Rd, San Fernando, CA 91340, USA.
| | - Gina Johnson
- Northeast Valley Health Corporation, San Fernando Health Center, 1600 San Fernando Rd, San Fernando, CA 91340, USA.
| | - L Cindy Chang
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles E Young Dr. S, Los Angeles, CA 90095-6900, USA.
| | - Rita Singhal
- Disease Control Bureau, Los Angeles County Department of Public Health, 2615 S Grand Ave #500, Los Angeles, CA 90007, USA.
| | - Victoria M Taylor
- Department of Health Services, University of Washington School of Public Health and Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA..
| | - Roshan Bastani
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, 650 Charles E Young Dr. S, Los Angeles, CA 90095-6900, USA.
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Datta GD, Mayrand MH, Glenn BA. Correspondence on "The increasing incidence of stage IV cervical cancer in the USA: what factors are related?" by Francoeur et al. Int J Gynecol Cancer 2023; 33:136. [PMID: 36307146 DOI: 10.1136/ijgc-2022-004066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Geetanjali D Datta
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, California, USA .,Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Marie-Helene Mayrand
- Research Center of the Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Quebec, Canada
| | - Beth A Glenn
- Department of Health Policy and Management, UCLA Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA.,UCLA Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California, USA
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Mesia RJ, Espinosa PR, Hutchison H, Safaeinili N, Finster LJ, Muralidharan V, Glenn BA, Haile RW, Rosas LG, Swetter SM. Melanoma awareness and prevention among latinx and non-latinx white adults in urban and rural California: A qualitative exploration. Cancer Med 2022; 12:7438-7449. [PMID: 36433634 PMCID: PMC10067099 DOI: 10.1002/cam4.5457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 09/26/2022] [Accepted: 11/09/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Melanoma mortality rates in the US are highest among older men, individuals of lower socioeconomic status (SES), and people of color. To better understand these inequities, a qualitative exploratory study was conducted in Northern and Southern California to generate knowledge about barriers and facilitators of awareness, prevention, and early detection of melanoma in lower SES Latinx and non-Latinx White (NLW) individuals living in urban and semi-rural areas. METHODS Nineteen focus groups were conducted (N = 176 adult participants), stratified by race/ethnicity (Latinx, low-income NLW), geography (semi-rural, urban), and language (English and Spanish). Inductive and deductive thematic analysis was conducted, and the findings were organized using the socioecological model framework: individual, interpersonal, community, and health system/policy levels. RESULTS Four socioecological themes describe how key factors affect knowledge, perceived risk, preventive behaviors, and melanoma screening. Individual level findings revealed that many participants were not familiar with melanoma, yet were willing to learn through trusted sources. Having brown or darker skin tone was perceived as being associated with lower risk for skin cancer. Interpersonally, social relationships were important influences for skin cancer prevention practice. However, for several Latinx and semi-rural participants, conversations about melanoma prevention did not occur with family and peers. At the community level, semi-rural participants reported distance or lack of transportation to a clinic as challenges for accessing dermatology care. Healthcare systems barriers included burdens of additional healthcare costs for dermatology visits and obtaining referral. CONCLUSIONS Varying factors influence the awareness levels, beliefs, and behaviors associated with knowledge, prevention, and early detection of melanoma among low-income Latinx and NLW individuals and in semi-rural areas. Results have implications for health education interventions. Navigation strategies that target individuals, families, and health care settings can promote improved prevention and early detection of melanoma in these communities.
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Affiliation(s)
- Rachel J Mesia
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | | | - Hayden Hutchison
- Cancer Research Center for Health Equity, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Nadia Safaeinili
- Stanford University School of Medicine, Office of Community Engagement, Stanford, California, USA
| | - Laurel J Finster
- Cancer Research Center for Health Equity, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Vijaytha Muralidharan
- Department of Dermatology/Cutaneous Oncology, Stanford University Medical Center, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Dermatology Service, Palo Alto, California, USA
| | - Beth A Glenn
- UCLA Fielding School of Public Health, UCLA Kaiser Permanente Center for Health Equity, Los Angeles, California, USA
| | - Robert W Haile
- Cancer Research Center for Health Equity, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Lisa Goldman Rosas
- Stanford University School of Medicine, Office of Community Engagement, Stanford, California, USA
| | - Susan M Swetter
- Department of Dermatology/Cutaneous Oncology, Stanford University Medical Center, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Dermatology Service, Palo Alto, California, USA
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Glenn BA, Nonzee NJ, Herrmann AK, Crespi CM, Haroutunian GG, Sundin P, Chang LC, Singhal R, Taylor VM, Bastani R. Impact of a Multi-Level, Multi-Component, System Intervention on HPV Vaccination in a Federally Qualified Health Center. Cancer Epidemiol Biomarkers Prev 2022; 31:1952-1958. [PMID: 35914738 PMCID: PMC9581499 DOI: 10.1158/1055-9965.epi-22-0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/18/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccines can significantly reduce the burden of HPV-associated cancers, but remain underutilized. We evaluated a multi-component, system-level intervention to improve HPV vaccination in a large Federally Qualified Health Center (FQHC) that serves a primarily low income Latino population. METHODS From January 2015 through March 2017, we evaluated the effectiveness of a multi-component, system-level intervention to improve HPV vaccination rates in 8 clinics randomly assigned to study condition (4 intervention, 4 usual care). The intervention included parent reminders for HPV vaccine series completion, provider training, clinic-level audit and feedback, and workflow modifications to reduce missed opportunities for vaccination. Using a difference-in-differences approach, we compared HPV vaccination rates among patients ages 11-17 during a 12-month pre-intervention period and a 15-month intervention period. Linear mixed models were used to estimate intervention effects on vaccine initiation and completion. RESULTS The sample included approximately 15,000 adolescents each quarter (range 14,773-15,571; mean age 14 years, 51% female, 88% Latino). A significantly greater quarterly increase in HPV vaccine initiation was observed for intervention compared to usual care clinics (0.75 percentage point greater increase, p < 0.001), corresponding to 114 additional adolescents vaccinated per quarter. The intervention led to a greater increase in HPV vaccine completion rates among boys (0.65 percentage point greater increase, p<0.001), but not girls. CONCLUSIONS Our system-level intervention was associated with modest improvements in HPV vaccine initiation overall and completion among boys Impact: Study findings have implications for reducing HPV-related cancers in safety net populations.
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Affiliation(s)
- Beth A Glenn
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Narissa J Nonzee
- UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Alison K Herrmann
- UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | | | | | - Phillip Sundin
- UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - L Cindy Chang
- UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Rita Singhal
- Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | | | - Roshan Bastani
- UCLA Fielding School of Public Health, Los Angeles, CA, United States
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Swetter SM, Mesia RJ, Rodriguez Espinosa P, Hutchison H, Safaeinili N, Finster LJ, Muralidharan V, Glenn BA, Haile RW, G. Rosas L. A qualitative exploration of melanoma awareness and prevention among Latinx and non-Latinx White populations in urban and rural California. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9588 Background: Melanoma mortality rates remain high among individuals of lower socioeconomic (SES) status, and racial/ethnic minorities, despite rates declining in non-Latinx whites (NLW). To improve understanding about the factors contributing to inequities in melanoma prevention and care, a qualitative exploratory study was conducted in Northern and Southern California regarding awareness, prevention, and early detection of melanoma in lower SES NLW and Latinx populations living in urban and semi-rural areas. Methods: Nineteen focus group (n = 176 individuals: 77% female, 59% self-identified Latinx/Hispanic, and 40% Medi-Cal/state insurance recipients) were conducted with adult participants, stratified by race/ethnicity (Latinx, low-income NLW), geography (semi-rural, urban), and language (English and Spanish). The interview topics included: 1) awareness and views of melanoma risk, prevention, and early detection screening practices; 2) acceptability of primary and secondary prevention strategies in their respective community; and 3) barriers and facilitators of engagement in melanoma prevention and care. Using a hybrid inductive and deductive approach, thematic analysis was used for data analysis. Findings were organized within a socioecological model (individual, interpersonal, community and health system/policy level). Results: Individual level findings revealed that many participants were not familiar about melanoma yet were willing to learn through trusted sources. Brown or darker skin tones were perceived as having less risk for skin cancer. Interpersonally, social relationships were important influences for individuals practicing skin cancer prevention. However, for several Latinx and semi-rural participants, conversations about melanoma prevention did not occur with family and peers. At the community level, semi-rural participants reported distance or lack of transportation to a clinic as challenges for dermatology care access. Healthcare systems barriers included burdens of additional medical care costs and obtaining dermatology referral. Many participants were in support of health regulations and education that reduce skin cancer risks for outdoor workers and children. Conclusions: Varying and intersecting factors influence melanoma awareness, and behaviors associated with knowledge, prevention, and early detection of melanoma in low-income NLW and Latinx individuals and in those living in semi-rural areas. Our findings promote understanding of how barriers across the socioecological spectrum may affect melanoma prevention and early detection particularly among men, individuals of lower socioeconomic status, and Latinx individuals. The study results have implications for health education interventions, which can involve health navigation strategies for individuals and families.
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Affiliation(s)
- Susan M. Swetter
- Stanford University Medical Center and Cancer Institute, Stanford, CA
| | - Rachel J. Mesia
- Stanford University School of Medicine, Stanford Cancer Institute, Redwood City, CA
| | | | | | - Nadia Safaeinili
- University of California Berkeley, School of Public Health, Berkeley, CA
| | - Laurel J. Finster
- Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - Vijaytha Muralidharan
- Stanford University Medical Center, Department of Dermatology/Cutaneous Oncology, Stanford, CA
| | - Beth A Glenn
- University of California-Los Angeles, Los Angeles, CA
| | | | - Lisa G. Rosas
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
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Velez MA, Lindenbaum M, Hegde M, Brook J, Nañez A, Lind-Lebuffe JP, Brodrick PM, Radwan Y, Fernandez Turizo MJ, Yessuf NM, Tsai HHC, Cummings AL, Lisberg AE, Elashoff D, Teitell M, Glenn BA, Garon EB. Cost of consent document (CD) translation is a potential barrier to consenting limited English-proficient participants (LEPPs) in non-industry–sponsored studies (NISS). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6533 Background: Racial/ethnic minority patients (pts) are underrepresented in cancer clinical trials. Challenges specific to LEPPs include the need for translated CDs, which can cause research delays and add cost. While most enrollment barriers are similar between industry sponsored studies (ISS) and NISS, costs of CD translation are typically covered by the sponsor in ISS. NISS often have limited, or no funds allocated for CD translation. Although it is required that LEPPs sign translated CDs, we hypothesized that investigators on NISS would find ways to avoid incurring the cost of CD translation. Methods: All pts who consented to studies at the UCLA Jonsson Comprehensive Cancer Center from 2013-2018 were included. Electronic health record data was reviewed. Adult LEPPs had a primary language other than English and their chart either flagged them as needing an interpreter or the pt used an interpreter in their care 6 months before or after the consent date. For pediatric patients, regardless of the pts primary language, LEPPs had a guardian who needed an interpreter within 6 months of the consent date. CD language was documented when available by chart review, but when not, we evaluated all IRB-approved CDs for the corresponding study and assumed that the pt signed appropriately translated CDs if available at the time of consent or within the following month. Chi square tests were used to compare the proportion of LEPPs who consented to NISS vs ISS and the proportion of LEPPs who consented with CDs not in their primary language. All analyses were performed using JMP, Version 16. SAS Institute Inc., Cary, NC, 19892021. Results: Although we do not have access to data on to whom consents were offered, of the 12202 consenting events during the study period, the proportion of consenting events for LEPPs was 2.7% in NISS vs 5.4% for ISS (p < 0.01). This difference did not appear to be driven by study type, as results were similar when only consenting events for interventional studies (n = 9886) were considered, with LEPPs representing 2.4% in NISS vs 5.5% in ISS (p < 0.01). Among LEPPs, 67.2% of participants who consented to NISS consented with CDs in a language other than their primary language vs 32.2% in ISS (p < 0.01). LEPPs who consented with language appropriate CDs represented 0.9% of those consenting to NISS vs 3.7% for ISS (p < 0.01). Conclusions: LEPPs consented less frequently to NISS compared to ISS, and when they did consent to NISS, the CDs were usually not translated into the pts primary language. We posit that the cost of translating CD discourages investigators from consenting LEPPs to NISS. Approaches that reduce or eliminate translation costs should increase the availability of translated CDs, potentially increasing enrollment of LEPPs to NISS while ensuring that they are fully informed about the purpose, procedures, and risks involved in these trials.
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Affiliation(s)
- Maria A Velez
- Department of Medicine, Division of Hematology/Oncology, UCLA, Los Angeles, CA
| | | | - Manavi Hegde
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Jenny Brook
- University of California-Los Angeles, Los Angeles, CA
| | - Andrea Nañez
- University of California-Los Angeles, Los Angeles, CA
| | | | - Paige M Brodrick
- Department of Medicine, Division of Hematology/Oncology, UCLA, Los Angeles, CA
| | - Yazeed Radwan
- Department of Medicine, Division of Hematology/Oncology, UCLA, Los Angeles, CA
| | | | - Nawal M Yessuf
- Department of Medicine, Division of Hematology/Oncology, UCLA, Los Angeles, CA
| | | | - Amy Lauren Cummings
- Department of Medicine, Division of Hematology/Oncology, UCLA, Los Angeles, CA
| | - Aaron E. Lisberg
- Department of Medicine, Division of Hematology/Oncology, UCLA, Los Angeles, CA
| | | | | | - Beth A Glenn
- University of California-Los Angeles, Los Angeles, CA
| | - Edward B. Garon
- Department of Medicine, Division of Hematology/Oncology, UCLA, Los Angeles, CA
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Bastani R, Glenn BA, Singhal R, Crespi CM, Nonzee NJ, Tsui J, Chang LC, Herrmann AK, Taylor VM. Increasing HPV Vaccination among Low-Income, Ethnic Minority Adolescents: Effects of a Multicomponent System Intervention through a County Health Department Hotline. Cancer Epidemiol Biomarkers Prev 2021; 31:175-182. [PMID: 34649960 DOI: 10.1158/1055-9965.epi-20-1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/17/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Introduction of the human papillomavirus (HPV) vaccine in 2006 was a game-changing advance in cancer control. Despite the vaccine's potential cancer prevention benefits, uptake remains low. We utilized a randomized design to evaluate a multicomponent intervention to improve HPV vaccine uptake among low-income, ethnic minority adolescents seeking services through a county health department telephone hotline. METHODS Hotline callers who were caregivers of never-vaccinated adolescents (11-17 years) were randomized by call-week to intervention or control conditions. The intervention included brief telephone and print education, delivered in multiple languages, and personalized referral to a low-cost/free vaccine provider. Participants completed baseline (n = 238), 3-month (n = 215), and 9-month (n = 204) telephone follow-up surveys. RESULTS HPV vaccine initiation rates increased substantially by 9-month follow-up overall, although no differences were observed between intervention and control groups (45% vs. 42%, respectively, P > 0.05). We also observed significant improvements in perceived HPV risk, barriers to vaccination, and perceived knowledge in both study conditions (P < 0.05). CONCLUSIONS A low-intensity county hotline intervention did not produce a greater increase in HPV vaccination rates than routine practice. However, 44% of unvaccinated adolescents in both conditions received at least one dose of the vaccine, which can be viewed as a successful public health outcome. Future studies should evaluate more intensive interventions that address accessing and utilizing services in complex safety net settings. IMPACT Study results suggest the need for investigators to be aware of the potential priming effects of study participation, which may obscure the effect of low-intensity interventions.
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Affiliation(s)
- Roshan Bastani
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California.
| | - Beth A Glenn
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California
| | - Rita Singhal
- Health Promotion Bureau, Los Angeles County Department of Public Health, Los Angeles, California
| | - Catherine M Crespi
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Biostatistics, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California
| | - Narissa J Nonzee
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California
| | - Jennifer Tsui
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - L Cindy Chang
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California
| | - Alison K Herrmann
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California
| | - Victoria M Taylor
- Department of Health Services, University of Washington School of Public Health and Fred Hutchinson Cancer Research Center, Seattle, Washington
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10
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Flores YN, Amoon AT, Su B, Velazquez-Cruz R, Ramírez-Palacios P, Salmerón J, Rivera-Paredez B, Sinsheimer JS, Lusis AJ, Huertas-Vazquez A, Saab S, Glenn BA, May FP, Williams KJ, Bastani R, Bensinger SJ. Serum lipids are associated with nonalcoholic fatty liver disease: a pilot case-control study in Mexico. Lipids Health Dis 2021; 20:136. [PMID: 34629052 PMCID: PMC8504048 DOI: 10.1186/s12944-021-01526-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022] Open
Abstract
Background Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease and cirrhosis. NAFLD is mediated by changes in lipid metabolism and known risk factors include obesity, metabolic syndrome, and diabetes. The aim of this study was to better understand differences in the lipid composition of individuals with NAFLD compared to controls, by performing direct infusion lipidomics on serum biospecimens from a cohort study of adults in Mexico. Methods A nested case-control study was conducted with a sample of 98 NAFLD cases and 100 healthy controls who are participating in an on-going, longitudinal study in Mexico. NAFLD cases were clinically confirmed using elevated liver enzyme tests and liver ultrasound or liver ultrasound elastography, after excluding alcohol abuse, and 100 controls were identified as having at least two consecutive normal alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (< 40 U/L) results in a 6-month period, and a normal liver ultrasound elastography result in January 2018. Samples were analyzed on the Sciex Lipidyzer Platform and quantified with normalization to serum volume. As many as 1100 lipid species can be identified using the Lipidyzer targeted multiple-reaction monitoring list. The association between serum lipids and NAFLD was investigated using analysis of covariance, random forest analysis, and by generating receiver operator characteristic (ROC) curves. Results NAFLD cases had differences in total amounts of serum cholesterol esters, lysophosphatidylcholines, sphingomyelins, and triacylglycerols (TAGs), however, other lipid subclasses were similar to controls. Analysis of individual TAG species revealed increased incorporation of saturated fatty acyl tails in serum of NAFLD cases. After adjusting for age, sex, body mass index, and PNPLA3 genotype, a combined panel of ten lipids predicted case or control status better than an area under the ROC curve of 0.83. Conclusions These preliminary results indicate that the serum lipidome differs in patients with NAFLD, compared to healthy controls, and suggest that assessing the desaturation state of TAGs or a specific lipid panel may be useful clinical tools for the diagnosis of NAFLD. Supplementary Information The online version contains supplementary material available at 10.1186/s12944-021-01526-5.
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Affiliation(s)
- Yvonne N Flores
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA. .,UCLA Center for Cancer Prevention and Control and UCLA-Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA. .,Unidad de Investigación Epidemiológica y en Servicios de Salud, Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, Mexico.
| | - Aryana T Amoon
- UCLA Center for Cancer Prevention and Control and UCLA-Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Baolong Su
- UCLA Lipidomics Laboratory, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Rafael Velazquez-Cruz
- Laboratorio de Genómica del Metabolismo Óseo, Instituto Nacional de Medicina Genómica (INMEGEN), Ciudad de México, Mexico
| | - Paula Ramírez-Palacios
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, Mexico
| | - Jorge Salmerón
- Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Berenice Rivera-Paredez
- Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Janet S Sinsheimer
- UCLA Department of Human Genetics and Computational Medicine, Los Angeles, CA, USA.,Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Aldons J Lusis
- UCLA Department of Medicine, Division of Cardiology, David Geffen School of Medicine, Los Angeles, CA, USA.,UCLA Department of Microbiology, Immunology & Molecular Genetics, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Adriana Huertas-Vazquez
- UCLA Department of Medicine, Division of Cardiology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Sammy Saab
- UCLA Department of Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, Los Angeles, CA, USA.,Pfleger Liver Institute, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Beth A Glenn
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.,UCLA Center for Cancer Prevention and Control and UCLA-Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Folasade P May
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.,UCLA Center for Cancer Prevention and Control and UCLA-Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.,UCLA Department of Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, Los Angeles, CA, USA.,Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Kevin J Williams
- UCLA Lipidomics Laboratory, David Geffen School of Medicine, Los Angeles, CA, USA.,UCLA Department of Biological Chemistry, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Roshan Bastani
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.,UCLA Center for Cancer Prevention and Control and UCLA-Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Steven J Bensinger
- UCLA Lipidomics Laboratory, David Geffen School of Medicine, Los Angeles, CA, USA.,UCLA Department of Microbiology, Immunology & Molecular Genetics, David Geffen School of Medicine, Los Angeles, CA, USA
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11
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Olmos-Ochoa TT, Miake-Lye IM, Glenn BA, Chuang E, Duru OK, Ganz DA, Bastani R. Sustaining Successful Clinical-community Partnerships in Medically Underserved Urban Areas: A Qualitative Case Study. J Community Health Nurs 2021; 38:1-12. [PMID: 33682552 DOI: 10.1080/07370016.2021.1869423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Clinical-community partnerships can improve access and receipt of preventive health services in community settings. Understanding how to sustain their potential benefits is warranted. Qualitative case-study of the Faith Community Health Partnership (FCHP), a collaboration between faith-community nurses and community organizations sustained over 25 years. We used content analysis principles to report on partnership sustainability themes identified through semi-structured interviews with FCHP partners (n = 18). Factors supporting partnership sustainability: Maintaining partners' commitment over time; strategic resource-sharing; facilitating engagement; and preserving partnership flexibility. Sustaining clinical-community partnerships is a dynamic and continuous process requiring significant time, effort, and resources on behalf of partners.
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Affiliation(s)
- Tanya T Olmos-Ochoa
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, North Hills, California, USA
| | - Isomi M Miake-Lye
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, North Hills, California, USA
| | - Beth A Glenn
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA.,UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, Los Angeles, California, USA.,Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California, USA
| | - Emmeline Chuang
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA.,UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, Los Angeles, California, USA
| | - O Kenrik Duru
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - David A Ganz
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, North Hills, California, USA.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Roshan Bastani
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA.,UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, Los Angeles, California, USA
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12
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Glenn BA, Nonzee NJ, Tieu L, Pedone B, Cowgill BO, Bastani R. Human papillomavirus (HPV) vaccination in the transition between adolescence and adulthood. Vaccine 2021; 39:3435-3444. [PMID: 33992435 DOI: 10.1016/j.vaccine.2021.04.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/27/2021] [Accepted: 04/09/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Young adulthood is characterized by changes in health care decision-making, insurance coverage, and sexual risk. Although the human papillomavirus (HPV) vaccine is now approved for adults up to age 45, and catch-up vaccination is currently recommended up through age 26, vaccination rates remain low in young adults. This study explored perspectives on HPV vaccination among young adults receiving care at the student health center of a large public university. METHODS We conducted semi-structured interviews (n = 27) and four focus groups with female and male undergraduate and graduate students (n = 18) and semi-structured interviews with health care providers (n = 6). Interviews and focus groups explored perceived risk of HPV infection, benefits of the HPV vaccine, and motivations for and barriers to HPV vaccination. RESULTS Many young adults cited their parents' views and recommendations from medical providers as influential on their decision-making process. Students perceived that cervical cancer prevention was a main benefit of the HPV vaccine and sexual activity was a risk factor for HPV infection. Students often lacked knowledge about the vaccine's benefits for males and expressed some concerns about the safety and side effects of a vaccine perceived as new. Logistical barriers to vaccination included uncertainty over vaccination status and insurance coverage for the vaccine, and concerns about balancing the vaccine schedule with school obligations. Providers' vaccine recommendations were impacted by health system factors, including clinical infrastructure, processes for recommending and documenting vaccination, and office visit priorities. Suggested vaccination promotion strategies included improving the timing and messaging of outreach efforts on campus and bolstering clinical infrastructure. CONCLUSIONS Although college may be an opportune time to reach young adults for HPV vaccination, obstacles including navigating parental influence and independent decision-making, lack of awareness of vaccination status, and numerous logistical and system-level barriers may impede vaccination during this time.
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Affiliation(s)
- Beth A Glenn
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South Drive, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Narissa J Nonzee
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South Drive, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Lina Tieu
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South Drive, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Bettina Pedone
- UCLA Arthur Ashe Student Health & Wellness Center, University of California, Los Angeles, 221 Westwood Plaza, Los Angeles, CA 90095, USA.
| | - Burt O Cowgill
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South Drive, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Roshan Bastani
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, 650 Charles Young Drive South Drive, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
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13
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Flores YN, Datta GD, Yang L, Corona E, Devineni D, Glenn BA, Bastani R, May FP. Disparities in Hepatocellular Carcinoma Incidence, Stage, and Survival: A Large Population-Based Study. Cancer Epidemiol Biomarkers Prev 2021; 30:1193-1199. [PMID: 33737301 DOI: 10.1158/1055-9965.epi-20-1088] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/09/2020] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Liver cancer is one of the most rapidly increasing cancers in the United States, and hepatocellular carcinoma (HCC) is its most common form. Disease burden and risk factors differ by sex and race/ethnicity, but a comprehensive analysis of disparities by socioeconomic status (SES) is lacking. We examined the relative impact of race/ethnicity, sex, and SES on HCC incidence, stage, and survival. METHODS We used Surveillance, Epidemiology, and End Results (SEER) 18 data to identify histologically confirmed cases of HCC diagnosed between January 1, 2000 and December 31, 2015. We calculated age-adjusted HCC incidence, stage at diagnosis (local, regional, distant, unstaged), and 5-year survival, by race/ethnicity, SES and sex, using SEER*Stat version 8.3.5. RESULTS We identified 45,789 cases of HCC. Incidence was highest among low-SES Asian/Pacific Islanders (API; 12.1) and lowest in high-SES Whites (3.2). Incidence was significantly higher among those with low-SES compared with high-SES for each racial/ethnic group (P < 0.001), except American Indian/Alaska Natives (AI/AN). High-SES API had the highest percentage of HCC diagnosed at the local stage. Of all race/ethnicities, Blacks had the highest proportion of distant stage disease in the low- and high-SES groups. Survival was greater in all high-SES racial/ethnic groups compared with low-SES (P < 0.001), except among AI/ANs. Black, low-SES males had the lowest 5-year survival. CONCLUSIONS With few exceptions, HCC incidence, distant stage at diagnosis, and poor survival were highest among the low-SES groups for all race/ethnicities in this national sample. IMPACT HCC prevention and control efforts should target low SES populations, in addition to specific racial/ethnic groups.
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Affiliation(s)
- Yvonne N Flores
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), California. .,Center for Cancer Prevention and Control Research and UCLA-Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California.,Unidad de Investigación Epidemiológica y en Servicios de Salud, Delegación Morelos, Instituto Mexicano del Seguro Social, Blvd. Benito Juárez No. 31, Colonia Centro, Cuernavaca, México
| | - Geetanjali D Datta
- Center for Cancer Prevention and Control Research and UCLA-Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California.,Université de Montréal School of Public Health, Montreal, Canada.,Centre Hospitalier de l'Université de Montréal Research Centre, Montreal, Canada
| | - Liu Yang
- Department of Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Edgar Corona
- Department of Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Divya Devineni
- Department of Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Beth A Glenn
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), California.,Center for Cancer Prevention and Control Research and UCLA-Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California
| | - Roshan Bastani
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), California.,Center for Cancer Prevention and Control Research and UCLA-Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California
| | - Folasade P May
- Center for Cancer Prevention and Control Research and UCLA-Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California.,Department of Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, California.,Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
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14
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Shah MD, Glenn BA, Chang LC, Chung PJ, Valderrama R, Uyeda K, Szilagyi PG. Reducing Missed Opportunities for Human Papillomavirus Vaccination in School-Based Health Centers: Impact of an Intervention. Acad Pediatr 2020; 20:1124-1132. [PMID: 32294534 DOI: 10.1016/j.acap.2020.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Human papillomavirus (HPV) immunization rates among US adolescents are low. Missed opportunities (MOs) for HPV vaccination are common. School-based health centers (SBHCs) have potential to boost HPV vaccination, but their role in addressing MOs has not been examined. METHODS We implemented a multicomponent intervention, consisting of 3 immunization process workflow modifications combined with provider performance feedback, in 2 Los Angeles area SBHCs and conducted a pre/post evaluation of MOs. Our primary outcome was SBHC-based MOs for HPV vaccination during all visits, including visits for confidential reproductive health care (ie, confidential visits). Secondary outcomes were MOs for meningococcal (MenACWY) and influenza vaccination during visits for nonconfidential care. RESULTS MOs for HPV vaccination decreased during all visit types from the baseline to the intervention period (82.3% to 46.1%; adjusted risk ratio [RR] = 0.558, P < .0001). The rate decrease appeared to be greater during physical examination visits than confidential visits (83.4% to 31.6% vs 98.7% to 70.4%, respectively). MOs for MenACWY (74.5% to 35.0%; adjusted RR = 0.47, P < .0001) and influenza (86.7% to 69.3%; adjusted RR = 0.792, P < .0001) vaccination also decreased during nonconfidential visits. Vaccine refusal was the most frequently documented reason for HPV vaccine MOs during both physical examination and confidential visits. CONCLUSIONS A pragmatic, multicomponent SBHC intervention reduced MOs for HPV vaccination during all visit types. MOs for MenACWY and influenza vaccination also decreased during nonconfidential visits. Findings suggest that practice-level improvements in SBHCs can improve delivery of HPV and other adolescent vaccines.
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Affiliation(s)
- Megha D Shah
- Division of General Pediatrics, Department of Pediatrics, David Geffen School of Medicine and UCLA Mattel Children's Hospital (University of California, Los Angeles) (MD Shah, PJ Chung, R Valderrama, and PG Szilagyi), Los Angeles, Calif.
| | - Beth A Glenn
- UCLA Kaiser Permanente Center for Health Equity (BA Glenn and LC Chang), Los Angeles, Calif; Jonsson Comprehensive Cancer Center at UCLA (BA Glenn and LC Chang), Los Angeles, Calif; Department of Health Policy and Management, UCLA Fielding School of Public Health (BA Glenn), Los Angeles, Calif
| | - L Cindy Chang
- UCLA Kaiser Permanente Center for Health Equity (BA Glenn and LC Chang), Los Angeles, Calif; Jonsson Comprehensive Cancer Center at UCLA (BA Glenn and LC Chang), Los Angeles, Calif
| | - Paul J Chung
- Division of General Pediatrics, Department of Pediatrics, David Geffen School of Medicine and UCLA Mattel Children's Hospital (University of California, Los Angeles) (MD Shah, PJ Chung, R Valderrama, and PG Szilagyi), Los Angeles, Calif
| | - Rebecca Valderrama
- Division of General Pediatrics, Department of Pediatrics, David Geffen School of Medicine and UCLA Mattel Children's Hospital (University of California, Los Angeles) (MD Shah, PJ Chung, R Valderrama, and PG Szilagyi), Los Angeles, Calif
| | - Kimberly Uyeda
- Los Angeles Unified School District (K Uyeda), Los Angeles, Calif. Dr Shah is now with the Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Los Angeles, Calif. Dr Chung is now with the Department of Health Systems Science, Kaiser Permanente School of Medicine, Pasadena, Calif. Dr Uyeda is now with the California School-Based Health Alliance, Oakland, Calif
| | - Peter G Szilagyi
- Division of General Pediatrics, Department of Pediatrics, David Geffen School of Medicine and UCLA Mattel Children's Hospital (University of California, Los Angeles) (MD Shah, PJ Chung, R Valderrama, and PG Szilagyi), Los Angeles, Calif
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15
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Viramontes O, Bastani R, Yang L, Glenn BA, Herrmann AK, May FP. Colorectal cancer screening among Hispanics in the United States: Disparities, modalities, predictors, and regional variation. Prev Med 2020; 138:106146. [PMID: 32473957 DOI: 10.1016/j.ypmed.2020.106146] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/31/2020] [Accepted: 05/24/2020] [Indexed: 02/06/2023]
Abstract
Hispanics represent the largest and one of the fastest growing minority populations in the U.S. and have lower survival from colorectal cancer (CRC) than non-Hispanic Whites (NHW). We aimed to examine screening modalities, predictors, and regional disparities among Hispanics and NHW in the U.S. by conducting a cross-sectional analysis of Hispanic participants age 50 to 75 from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) survey. The primary outcome was self-reported CRC screening status. We used the Rao-Scott Chi-square test to compare screening rates and modalities in NHWs and Hispanics. We also used univariable and multivariable logistic regression to determine predictors of screening among Hispanics and calculated Hispanic-NHW screening rate differences for each U.S. state/territory as a measure of regional screening disparities. The screening rate was 53.4% for Hispanics (N = 12,395), compared to 70.4% for NHWs (N = 186,331) (p < 0.001). Among Hispanics, colonoscopy was most common (75.9%). Uninsured status (aOR = 0.51; 95% CI = 0.38-0.70) and limited access to medical care (aOR = 0.38; 95% CI = 0.29-0.49) predicted lack of screening. States/territories with the largest screening disparities were North Carolina (33.9%), Texas (28.3%), California (25.1%), and Nebraska (25.6%). Disparities were smallest in New York (2.6%), Indiana (3.1%), and Delaware (4.0%). In Ohio and Guam, Hispanics had higher screening rates than NHWs. In conclusion, Hispanics have lower CRC screening rates than NHWs across most U.S. states/territories; however, the disparity varies by region. Future efforts must address multi-level barriers to screening among Hispanics and target regions with low rates to improve CRC outcomes in this growing population.
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Affiliation(s)
- Omar Viramontes
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Medicine, UCSF, San Francisco, CA, United States of America
| | - Roshan Bastani
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States of America
| | - Liu Yang
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Beth A Glenn
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States of America
| | - Alison K Herrmann
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States of America
| | - Folasade P May
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States of America; Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Medicine, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America.
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Flores YN, Sanchez GJ, ten Hoeve J, Amoon AT, Graeber T, Glenn BA, May FP, Durazo F, Zhang ZF, Salmerón J, Pollock BH, Bastani R. Abstract 3122: Metabolic dysregulation and risk of non-alcoholic fatty liver disease in Mexican adults. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-3122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease and the fastest growing cause of cirrhosis in the United States (U.S.). This is very concerning because NAFLD-related cirrhosis is associated with hepatocellular carcinoma (HCC), the most common form of liver cancer. Latinos have the highest prevalence of NAFLD in the U.S., and the second highest incidence of and mortality from liver cancer, after American Indians. Known risk factors for NAFLD include obesity, metabolic syndrome, diabetes, and insulin resistance. Less is known about how specific metabolites may contribute to increased liver cancer susceptibility among Latinos despite the disproportionate burden of disease in this population.
Methods: Using existing clinical data and biospecimens obtained from a longitudinal study in Mexico, we examined the association between metabolic dysregulation and NAFLD in a sample of Mexican adults. A nested case-control analysis was conducted using 100 cases of NAFLD and 100 healthy controls. Risk of NAFLD was assessed using metabolic markers supplemented by clinical data. NAFLD cases were clinically confirmed by a hepatologist using elevated liver enzyme tests (ALT >40 UI/L or AST >40 UI/L) and ultrasound of the liver, after excluding heavy or binge drinking (>2 drinks per day for males, >1 drink per day for females). 159 targeted metabolites were detected with a Thermo Scientific Q Exactive mass spectrometer run with polarity switching on full scan mode with a 65-975 m/z range. TraceFinder Software 4.1 (Thermo Scientific) was used to quantify metabolites using retention time and accurate mass measurements (< 5 ppm). Data analysis was carried out using in-house R scripts. Principal component analysis was constructed from metabolites identified as significant (p<0.05) using a Multiple Analysis of Covariance comparing the healthiest controls in our cohort (without diabetes or metabolic syndrome, n=46) to the least healthy cases (with diabetes and metabolic syndrome, n=24).
Results: Out of 159 metabolites assessed, we found 25 metabolites to be significantly different between the groups after adjusting for age and sex. After further Bonferroni correction for multiple comparisons, eight were significantly increased in cases: Aconitate, Gluconic Acid, Glucose, Hexose Phosphate, Malate, and Phosphate; while two had significantly lower levels: Guanine and Inosine. Our findings indicate distinguishable changes in the serum metabolites of patients with NAFLD, which appear to be associated with more metabolic dysregulation.
Conclusions: Our results support the use of mass spectrometry-based metabolomics as an appropriate tool to identify serum metabolite signatures associated with NAFLD disease progression. This tool may be useful in developing targeted liver cancer prevention strategies. These findings should be validated in larger studies that examine the trafficking of these identified prognostic metabolites through the liver.
Citation Format: Yvonne N. Flores, Gerardo J. Sanchez, Johanna ten Hoeve, Aryana T. Amoon, Thomas Graeber, Beth A. Glenn, Folasade P. May, Francisco Durazo, Zuo-Feng Zhang, Jorge Salmerón, Brad H. Pollock, Roshan Bastani. Metabolic dysregulation and risk of non-alcoholic fatty liver disease in Mexican adults [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3122.
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Affiliation(s)
| | | | | | | | | | - Beth A. Glenn
- 1University of California, Los Angeles, Los Angeles, CA
| | | | | | | | - Jorge Salmerón
- 2Universidad Nacional Autónoma de México, Ciudad de México, Mexico
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May FP, Yang L, Corona E, Glenn BA, Bastani R. Disparities in Colorectal Cancer Screening in the United States Before and After Implementation of the Affordable Care Act. Clin Gastroenterol Hepatol 2020; 18:1796-1804.e2. [PMID: 31525514 DOI: 10.1016/j.cgh.2019.09.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Colorectal cancer (CRC) is major cause of cancer-related mortality in the United States. Screening, however, is suboptimal and there are disparities in outcomes. After health policy changes and national efforts to increase rates of screening and address inequities, we aimed to examine progress towards eliminating racial and ethnic disparities in CRC screening. METHODS We conducted a repeated cross-sectional analysis of average-risk adults (age 50-75 years) included in the behavioral risk factors surveillance system survey. The main outcome was CRC screening status. We determined screening rates overall and by race and ethnicity (1 variable) for each survey year from 2008 through 2016 and used Joinpoint analyses to determine significant trends in rates over time by race and ethnicity. We also examined screening modalities used overall and by race and ethnicity. RESULTS We analyzed data from 1,089,433 respondents. Screening uptake was 61.1% in 2008 and 67.6% in 2016 (P < .001); it was highest among whites and lowest among Hispanics. Only whites, Hispanics, and Asians had significantly higher screening rates in each study year (P < .001). Despite increasing rates among Hispanics, the screening rate disparity between whites and Hispanics was 17% at the end of the study period. Screening rates in blacks did not change with time and were 4.0% lower than the rate in whites in 2016. Other racial and ethnic groups had varying levels of improvement with time. Colonoscopy was the most common modality each year. CONCLUSIONS In a cross-sectional analysis of average-risk adults, we found that although rates of CRC screening have increased overall since 2008, they have increased disproportionately in each racial and ethnic group, and disparities in screening uptake persist.
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Affiliation(s)
- Folasade P May
- Tamar and Vatche Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Kaiser Permanente Center for Health Equity, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California.
| | - Liu Yang
- Tamar and Vatche Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Edgar Corona
- Tamar and Vatche Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Beth A Glenn
- Kaiser Permanente Center for Health Equity, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Roshan Bastani
- Kaiser Permanente Center for Health Equity, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
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Flores YN, Salmerón J, Glenn BA, Lang CM, Chang LC, Bastani R. Clinician offering is a key factor associated with HPV vaccine uptake among Mexican mothers in the USA and Mexico: a cross-sectional study. Int J Public Health 2018; 64:323-332. [PMID: 30506364 DOI: 10.1007/s00038-018-1176-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/01/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare the knowledge, beliefs, and practices regarding HPV vaccination among mothers of vaccine-eligible girls in Mexico and the USA. METHODS Similar samples of Mexican mothers with vaccine-eligible daughters were surveyed at two clinics in Cuernavaca, Morelos, from July to October 2012 (n = 200) and at two clinics in Oxnard, California, from August to November 2013 (n = 200). RESULTS Although mothers in the USA had less knowledge and more negative attitudes toward the vaccine than their counterparts in Mexico, vaccine uptake rates were higher in the USA (49% vs. 40%). US mothers were more likely to have discussed and been offered the HPV vaccine by a clinician than mothers in Mexico. In multivariate analyses, having been offered the HPV vaccine was the most important predictor of vaccine uptake. CONCLUSIONS Our results suggest that healthcare access or other system, clinic, or provider factors are the main drivers of vaccine receipt in this binational sample of Mexican mothers. Interventions and programs that encourage clinicians to offer the HPV vaccine should be developed to increase vaccine uptake in both countries.
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Affiliation(s)
- Yvonne N Flores
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, Mexico.
- UCLA Department of Health Policy and Management and Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Los Angeles, CA, USA.
- UCLA Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.
| | - Jorge Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, Mexico
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Beth A Glenn
- UCLA Department of Health Policy and Management and Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Los Angeles, CA, USA
- UCLA Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Cathy M Lang
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - L Cindy Chang
- UCLA Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Roshan Bastani
- UCLA Department of Health Policy and Management and Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Los Angeles, CA, USA
- UCLA Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
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Kegler MC, Liang S, Weiner BJ, Tu SP, Friedman DB, Glenn BA, Herrmann AK, Risendal B, Fernandez ME. Measuring Constructs of the Consolidated Framework for Implementation Research in the Context of Increasing Colorectal Cancer Screening in Federally Qualified Health Center. Health Serv Res 2018; 53:4178-4203. [PMID: 30260471 DOI: 10.1111/1475-6773.13035] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To operationalize constructs from each of the Consolidated Framework for Implementation Research domains and to present psychometric properties within the context of evidence-based approaches for promoting colorectal cancer screening in federally qualified health centers (FQHCs). METHODS Data were collected from FQHC clinics across seven states. A web-based Staff Survey and a Clinic Characteristics Survey were completed by staff and leaders (n = 277) from 59 FQHCs. RESULTS Internal reliability of scales was adequate ranging from 0.62 for compatibility to 0.88 for other personal attributes (openness). Intraclass correlations for the scales indicated that 2.4 percent to 20.9 percent of the variance in scale scores occurs within clinics. Discriminant validity was adequate at the clinic level, with all correlations less than 0.75. Convergent validity was more difficult to assess given lack of hypothesized associations between factors expected to predict implementation. CONCLUSIONS Our results move the field forward by describing initial psychometric properties of constructs across CFIR domains.
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Affiliation(s)
- Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Shuting Liang
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Bryan J Weiner
- Departments of Global Health and Health Services, University of Washington, Seattle, WA
| | - Shin Ping Tu
- General Internal Medicine, University of California Davis, Sacramento, CA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior and the Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Beth A Glenn
- UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health & Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA
| | - Alison K Herrmann
- UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health & Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA
| | - Betsy Risendal
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Comprehensive Cancer Center, Aurora, CO
| | - Maria E Fernandez
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
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Glenn BA, Hamilton AS, Nonzee NJ, Maxwell AE, Crespi CM, Ryerson AB, Chang LC, Deapen D, Bastani R. Obesity, physical activity, and dietary behaviors in an ethnically-diverse sample of cancer survivors with early onset disease. J Psychosoc Oncol 2018; 36:418-436. [PMID: 29764334 PMCID: PMC6209096 DOI: 10.1080/07347332.2018.1448031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess weight status, physical activity, and dietary behaviors in an ethnically-diverse sample of breast and colorectal cancer survivors with early onset disease (≤ 50 years). METHODS Breast and colorectal cancer survivors, diagnosed between 1999 and 2009 with early-stage cancer diagnosed by 50 years of age, were identified through a population-based cancer registry and surveyed. Descriptive and regression analyses were conducted to characterize the sample and identify correlates of lifestyle behaviors. FINDINGS The majority of participants (n = 156) were female (83%), insured (84%), and racial/ethnic minorities (29% Asian, 24% Latino, 15% African American). Participants' mean age at response was 50 years and mean time since diagnosis was 9 years. Over half of survivors were overweight or obese. Few participants reported engaging in regular physical activity (31%) and adhering to minimum guidelines for fruit and vegetable consumption (32%). A substantial proportion of survivors consumed fast food in the past week (75%) and nearly half (48%) reported daily consumption of sugar-sweetened beverages. Lower income was associated with inadequate fruit and vegetable intake. Fast food and sugar-sweetened beverage consumption was significantly higher among racial/ethnic minority survivors compared to non-Latino whites. CONCLUSIONS High prevalence of overweight and suboptimal adherence to recommended nutrition and physical activity behaviors were observed among cancer survivors with early onset disease. Cancer survivors diagnosed at a young age may benefit from targeted interventions to address overweight and suboptimal nutrition and physical activity.
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Affiliation(s)
- Beth A Glenn
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - Ann S Hamilton
- b Department of Preventive Medicine, Los Angeles County Cancer Surveillance Program and Keck School of Medicine , University of Southern California , Los Angeles , California , USA
| | - Narissa J Nonzee
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - Annette E Maxwell
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - Catherine M Crespi
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - A Blythe Ryerson
- c Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta , Georgia , USA
| | - L Cindy Chang
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - Dennis Deapen
- b Department of Preventive Medicine, Los Angeles County Cancer Surveillance Program and Keck School of Medicine , University of Southern California , Los Angeles , California , USA
| | - Roshan Bastani
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
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Glenn BA, Crespi CM, Rodriguez HP, Nonzee NJ, Phillips SM, Sheinfeld Gorin SN, Johnson SB, Fernandez ME, Estabrooks P, Kessler R, Roby DH, Heurtin-Roberts S, Rohweder CL, Ory MG, Krist AH. Behavioral and mental health risk factor profiles among diverse primary care patients. Prev Med 2018; 111:21-27. [PMID: 29277413 PMCID: PMC5930037 DOI: 10.1016/j.ypmed.2017.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/02/2017] [Accepted: 12/13/2017] [Indexed: 10/18/2022]
Abstract
Behavioral and mental health risk factors are prevalent among primary care patients and contribute substantially to premature morbidity and mortality and increased health care utilization and costs. Although prior studies have found most adults screen positive for multiple risk factors, limited research has attempted to identify factors that most commonly co-occur, which may guide future interventions. The purpose of this study was to identify subgroups of primary care patients with co-occurring risk factors and to examine sociodemographic characteristics associated with these subgroups. We assessed 12 behavioral health risk factors in a sample of adults (n=1628) receiving care from nine primary care practices across six U.S. states in 2013. Using latent class analysis, we identified four distinct patient subgroups: a 'Mental Health Risk' class (prevalence=14%; low physical activity, high stress, depressive symptoms, anxiety, and sleepiness), a 'Substance Use Risk' class (29%; highest tobacco, drug, alcohol use), a 'Dietary Risk' class (29%; high BMI, poor diet), and a 'Lower Risk' class (27%). Compared to the Lower Risk class, patients in the Mental Health Risk class were younger and less likely to be Latino/Hispanic, married, college educated, or employed. Patients in the Substance Use class tended to be younger, male, African American, unmarried, and less educated. African Americans were over 7 times more likely to be in the Dietary Risk versus Lower Risk class (OR 7.7, 95% CI 4.0-14.8). Given the heavy burden of behavioral health issues in primary care, efficiently addressing co-occurring risk factors in this setting is critical.
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Affiliation(s)
- Beth A Glenn
- Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, Los Angeles, CA 90095, USA.
| | - Catherine M Crespi
- Center for Cancer Prevention and Control Research, Department of Biostatistics, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, Los Angeles, CA 90095, USA
| | - Hector P Rodriguez
- Division of Health Policy and Management, University of California, Berkeley School of Public Health, 50 University Hall, Berkeley, CA 94720, USA
| | - Narissa J Nonzee
- Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, Los Angeles, CA 90095, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Chicago, IL 60611, USA
| | - Sherri N Sheinfeld Gorin
- New York Physicians against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, NY 10032, USA; Division of Cancer Control and Population Sciences (Leidos Biomedical Research, Inc.), National Cancer Institute, 6130 Executive Plaza, Bethesda, MD 20892, USA
| | - Sallie Beth Johnson
- Department of Health Sciences Administration, Jefferson College of Health Sciences at Carilion Clinic, 101 Elm Avenue, Roanoke, VA 24016, USA; Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA
| | - Maria E Fernandez
- University of Texas Health Science Center at Houston, School of Public Health, 7000 Fannin Street, Houston, TX 77030, USA
| | - Paul Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Rodger Kessler
- Doctor of Behavorial Health Program, College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ 85004, USA
| | - Dylan H Roby
- Department of Health Services Administration, University of Maryland School of Public Health, 4200 Valley Drive, College Park, MD 20742, USA
| | - Suzanne Heurtin-Roberts
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Boulevard, Rockville, MD 20852, USA
| | - Catherine L Rohweder
- UNC Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, NC 27599, USA
| | - Marcia G Ory
- Center for Population Health and Aging, Texas A&M Health Sciences Center, College Station, TX 77843, USA
| | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, PO Box 980251, Richmond, VA 23298, USA
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Krist AH, Glasgow RE, Heurtin-Roberts S, Sabo RT, Roby DH, Gorin SNS, Balasubramanian BA, Estabrooks PA, Ory MG, Glenn BA, Phillips SM, Kessler R, Johnson SB, Rohweder CL, Fernandez ME. The impact of behavioral and mental health risk assessments on goal setting in primary care. Transl Behav Med 2017; 6:212-9. [PMID: 27356991 DOI: 10.1007/s13142-015-0384-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patient-centered health risk assessments (HRAs) that screen for unhealthy behaviors, prioritize concerns, and provide feedback may improve counseling, goal setting, and health. To evaluate the effectiveness of routinely administering a patient-centered HRA, My Own Health Report, for diet, exercise, smoking, alcohol, drug use, stress, depression, anxiety, and sleep, 18 primary care practices were randomized to ask patients to complete My Own Health Report (MOHR) before an office visit (intervention) or continue usual care (control). Intervention practice patients were more likely than control practice patients to be asked about each of eight risks (range of differences 5.3-15.8 %, p < 0.001), set goals for six risks (range of differences 3.8-16.6 %, p < 0.01), and improve five risks (range of differences 5.4-13.6 %, p < 0.01). Compared to controls, intervention patients felt clinicians cared more for them and showed more interest in their concerns. Patient-centered health risk assessments improve screening and goal setting.Trial RegistrationClinicaltrials.gov identifier: NCT01825746.
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Affiliation(s)
- Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, PO Box 980101, Richmond, VA, 23298, USA.
| | - Russell E Glasgow
- Department of Family Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Suzanne Heurtin-Roberts
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Dylan H Roby
- School of Public Health, University of Maryland, College Park, MD, USA
| | - Sherri N Sheinfeld Gorin
- Division of Cancer Control and Population Sciences (Leidos Biomedical Research, Inc.), National Cancer Institute, Rockville, MD, USA
| | - Bijal A Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Science, University of Texas Health Science Center at Houston School of Public Health, Dallas, TX, USA
| | - Paul A Estabrooks
- Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA, USA
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Marcia G Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Sciences Center School of Public Health, College Station, TX, USA
| | - Beth A Glenn
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Rodger Kessler
- Department of Family Medicine, University of Vermont, Burlington, VT, USA
| | - Sallie Beth Johnson
- Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA, USA
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Catherine L Rohweder
- Consortium for Implementation Science, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Maria E Fernandez
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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Abstract
Many professional organizations recommend skin self-examination (SSE) as a tool for early detection of malignancy among melanoma survivors, a growing population that is at increased risk for new or recurrent melanoma. This study examined the frequency and correlates of SSE use among melanoma survivors. Additionally, we assessed skin exam use among children of survivors, who are at elevated lifetime risk for the disease. The California Cancer Registry was used to identify melanoma survivors, who were contacted, screened for eligibility, and invited to participate in a survey. The survey, administered by mail, web, or telephone, assessed a broad range of topics related to melanoma prevention in high-risk families. The present study focuses on skin examination practices of survivors and their children and potential correlates of these practices. Among a sample of 316 melanoma survivors, fewer than one in five participants performed monthly skin self-exams, a lower rate than that observed in previous studies. Although greater family history of melanoma, use of skin protection strategies, and the perceived severity of melanom were associated with more frequent use of skin self-exams, these relationships disappeared in adjusted analyses. Participants reported unexpectedly frequent use of skin examinations for their children despite the lack of professional guidelines for this practice. Interventions are needed to improve skin self-examination practices among melanoma survivors and to counsel parents about optimal melanoma prevention strategies for their children.
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Affiliation(s)
- Beth A Glenn
- Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Dr. South, Room A2-125, CHS, Los Angeles, CA, 90095-6900, USA.
| | - Katherine L Chen
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - L Cindy Chang
- Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Dr. South, Room A2-125, CHS, Los Angeles, CA, 90095-6900, USA
| | - Tiffany Lin
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Roshan Bastani
- Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Dr. South, Room A2-125, CHS, Los Angeles, CA, 90095-6900, USA
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Gase LN, Gomez LM, Kuo T, Glenn BA, Inkelas M, Ponce NA. Relationships Among Student, Staff, and Administrative Measures of School Climate and Student Health and Academic Outcomes. J Sch Health 2017; 87:319-328. [PMID: 28382671 PMCID: PMC5876042 DOI: 10.1111/josh.12501] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/16/2016] [Accepted: 11/02/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND School climate is an integral part of a comprehensive approach to improving the well-being of students; however, little is known about the relationships between its different domains and measures. We examined the relationships between student, staff, and administrative measures of school climate to understand the extent to which they were related to each other and student outcomes. METHODS The sample included 33,572 secondary school students from 121 schools in Los Angeles County during the 2014-2015 academic year. A multilevel regression model was constructed to examine the association between the domains and measures of school climate and 5 outcomes of student well-being: depressive symptoms or suicidal ideation, tobacco use, alcohol use, marijuana use, and grades. RESULTS Student, staff, and administrative measures of school climate were weakly correlated. Strong associations were found between student outcomes and student reports of engagement and safety, while school staff reports and administrative measures of school climate showed limited associations with student outcomes. CONCLUSIONS As schools seek to measure and implement interventions aimed at improving school climate, consideration should be given to grounding these efforts in a multidimensional conceptualization of climate that values student perspectives and includes elements of both engagement and safety.
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Affiliation(s)
- Lauren Nichol Gase
- TL1 Scholar, Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
| | - Louis M. Gomez
- Professor and Chair, Education Department, Graduate School of Education & Information Studies, University of California, Los Angeles, Box 951521, 1002 MH, Los Angeles, CA 90095-1521, Phone: (310) 825-0978, Fax: (310) 206-3076,
| | - Tony Kuo
- Acting Director, Division of Chronic Disease and Injury Prevention\Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8 Floor, Los Angeles, CA 90010, Phone: (213) 351-7341, Fax: (213) 351-2713,
| | - Beth A. Glenn
- Associate Professor, Department of Health Policy and Management, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Box 956900, A2-125 CHS, Los Angeles, CA 90095-6900, Phone: (310) 206-9715, Fax: (310) 206-3566,
| | - Moira Inkelas
- Associate Professor, Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 10990 Wilshire Blvd., Ste 900, Los Angeles, CA 90095-6939, Phone: (310) 312-9081, Fax: (310) 312-9210,
| | - Ninez A. Ponce
- Professor, Department of Health Policy and Management, Associate Director, Center for Health Policy Research, Fielding School of Public Health, University of California, Los Angeles, 10960 Wilshire Blvd., Ste 1550, Los Angeles, CA 90095-1772, Phone: (310) 794-2691, Fax: (310) 825-2594,
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May FP, Glenn BA, Crespi CM, Ponce N, Spiegel BMR, Bastani R. Decreasing Black-White Disparities in Colorectal Cancer Incidence and Stage at Presentation in the United States. Cancer Epidemiol Biomarkers Prev 2016; 26:762-768. [PMID: 28035021 DOI: 10.1158/1055-9965.epi-16-0834] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 12/18/2022] Open
Abstract
Background: There are long-standing black-white disparities in colorectal cancer incidence and outcomes in the United States. Incidence and stage at diagnosis reflect the impact of national efforts directed at colorectal cancer prevention and control. We aimed to evaluate trends in black-white disparities in both indicators over four decades to inform the future direction of prevention and control efforts.Methods: We used Surveillance, Epidemiology, & End Results (SEER) data to identify whites and blacks with histologically confirmed colorectal cancer from January 1, 1975 through December 31, 2012. We calculated the age-adjusted incidence and the proportion of cases presenting in late stage by race and year. We then calculated the annual percentage change (APC) and average APC for each indicator by race, examined changes in indicators over time, and calculated the incidence disparity for each year.Results: There were 440,144 colorectal cancer cases from 1975 to 2012. The overall incidence decreased by 1.35% and 0.46% per year for whites and blacks, respectively. Although the disparity in incidence declined from 2004 to 2012 (APC = -3.88%; P = 0.01), incidence remained higher in blacks in 2012. Late-stage disease declined by 0.27% and 0.45% per year in whites and blacks, respectively. The proportion of late-stage cases became statistically similar in whites and blacks in 2010 (56.60% vs. 56.96%; P = 0.17).Conclusions: Black-white disparities in colorectal cancer incidence and stage at presentation have decreased over time.Impact: Our findings reflect the positive impact of efforts to improve colorectal cancer disparities and emphasize the need for interventions to further reduce the incidence gap. Cancer Epidemiol Biomarkers Prev; 26(5); 762-8. ©2016 AACR.
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Affiliation(s)
- Folasade P May
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California. .,UCLA Kaiser Permanente Center for Health Equity, Los Angeles, California.,Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Beth A Glenn
- UCLA Kaiser Permanente Center for Health Equity, Los Angeles, California.,Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Catherine M Crespi
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Biostatistics at UCLA Fielding School of Public Health, Los Angeles, California
| | - Ninez Ponce
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Brennan M R Spiegel
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California
| | - Roshan Bastani
- UCLA Kaiser Permanente Center for Health Equity, Los Angeles, California.,Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
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26
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Gase LN, Glenn BA, Gomez LM, Kuo T, Inkelas M, Ponce NA. Understanding Racial and Ethnic Disparities in Arrest: The Role of Individual, Home, School, and Community Characteristics. Race Soc Probl 2016; 8:296-312. [PMID: 28713449 PMCID: PMC5509345 DOI: 10.1007/s12552-016-9183-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Contact with the justice system can lead to a range of poor health and social outcomes. While persons of color are disproportionately represented in both the juvenile and criminal justice systems, reasons for these patters remain unclear. This study sought to examine the extent and sources of differences in arrests during adolescence and young adulthood among blacks, whites, and Hispanics in the USA. Multilevel cross-sectional logistic regression analyses were conducted using data from waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (n = 12,752 respondents). Results showed significantly higher likelihood of having ever been arrested among blacks, when compared to whites, even after controlling for a range of delinquent behaviors (odds ratio = 1.58, 95 % confidence interval = 1.27, 1.95). These black-white disparities were no longer present after accounting for racial composition of the neighborhood, supporting the growing body of research demonstrating the importance of contextual variables in driving disproportionate minority contact with the justice system.
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Affiliation(s)
- Lauren Nichol Gase
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA 90010, USA
| | - Beth A. Glenn
- Department of Health Policy and Management, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Box 956900, A2-125 CHS, Los Angeles, CA 90095-6900, USA
| | - Louis M. Gomez
- Education Department, Graduate School of Education and Information Studies, University of California, Los Angeles, Box 951521, 1002 MH, Los Angeles, CA 90095-1521, USA
| | - Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA 90010, USA
| | - Moira Inkelas
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 10990 Wilshire Blvd., Ste 900, Los Angeles, CA 90095-6939, USA
| | - Ninez A. Ponce
- Department of Health Policy and Management, Center for Health Policy Research, Fielding School of Public Health, University of California, Los Angeles, 10960 Wilshire Blvd., Ste 1550, Los Angeles, CA 90095-1772, USA
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27
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Glenn BA, Tsui J, Coronado GD, Fernandez ME, Savas LS, Taylor VM, Bastani R. Understanding HPV vaccination among Latino adolescent girls in three U.S. regions. J Immigr Minor Health 2016; 17:96-103. [PMID: 24557745 DOI: 10.1007/s10903-014-9996-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A multi-site study was conducted to assess HPV vaccine initiation and correlates of initiation among Latina adolescents. The study was a collaboration of the CDC/NCI-funded Cancer Prevention and Control Research Network. Data were collected in 2009 from caregivers of Latina adolescents recruited from Los Angeles Country (n = 274), Washington State (Yakima Valley region; n = 90), and Texas (Houston, n = 38; Lower Rio Grande Valley, n = 42). A set of 24 survey items assessed use of the HPV vaccine and awareness, attitudes and barriers to vaccination. Moderate levels of vaccine awareness among caregivers and low uptake of the vaccine (26-37%) among girls were observed. Attitudinal barriers such as concerns about negative effects of the vaccine on daughter's sexual behavior, fertility, and future health were infrequently endorsed. Efforts to understand regional similarities and differences may help inform interventions.
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Affiliation(s)
- Beth A Glenn
- Center for Cancer Prevention and Control Research, UCLA Fielding School of Public Health, 650 Charles Young Drive South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA,
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28
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Hudson SM, Rondinelli J, Glenn BA, Preciado M, Chao C. Human papillomavirus vaccine series completion: Qualitative information from providers within an integrated healthcare organization. Vaccine 2016; 34:3515-21. [DOI: 10.1016/j.vaccine.2016.02.066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/19/2016] [Accepted: 02/23/2016] [Indexed: 01/18/2023]
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29
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Li J, Maxwell AE, Glenn BA, Herrmann AK, Chang LC, Crespi CM, Bastani R. Healthcare Access and Utilization among Korean Americans: The Mediating Role of English Use and Proficiency. Int J Soc Sci Res 2016; 4:83-97. [PMID: 29057278 PMCID: PMC5647155 DOI: 10.5296/ijssr.v4i1.8678] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The literature suggests that Korean Americans underutilize health services. Cultural factors and language barriers appear to influence this pattern of low utilization but studies on the relationships among length of stay in the US, English use and proficiency, and utilization of health services among Korean Americans have yielded inconsistent results. This study examines whether English language use and proficiency plays a mediating role in the relationships between length of stay in the US and health insurance coverage, access to and use of care. Structural equation modeling was used for mediation analysis with multiple dependent variables among Korean Americans (N = 555) using baseline data from a large trial designed to increase Hepatitis B testing. The results show 36% of the total effect of proportion of lifetime in the US on having health insurance was significantly mediated by English use and proficiency (indirect effect = 0.166, SE = 0.07, p<.05; direct effect = 0.296, SE = 0.13, p<.05). Proportion of lifetime in the US was not associated with usual source of care and health service utilization. Instead, health care utilization was primarily driven by having health insurance and a usual source of care, further underscoring the importance of these factors. A focus on increasing English use and proficiency and insurance coverage among older, female, less educated Korean Americans has the potential to mitigate health disparities associated with reduced access to health services in this population.
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Affiliation(s)
- Jiang Li
- Department of Health Policy and Management, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, and UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles E. Young Drive South, Room A2-125 CHS, Los Angeles, CA 90095, USA, Tel: 1-310-206-8954
| | - Annette E Maxwell
- Department of Health Policy and Management, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, and UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles E. Young Drive South, Room A2-125 CHS, Los Angeles, CA 90095, USA, Tel: 1-310-794-9282
| | - Beth A Glenn
- Department of Health Policy and Management, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, and UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles E. Young Drive South, Room A2-125 CHS, Los Angeles, CA 90095, USA, Tel: 1-310-206-9715
| | - Alison K Herrmann
- Department of Health Policy and Management, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, and UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles E. Young Drive South, Room A2-125 CHS, Los Angeles, CA 90095, USA, Tel: 1-310-206-8483
| | - L Cindy Chang
- Jonsson Comprehensive Cancer Center and UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles E. Young Drive South, Room A2-125 CHS, Los Angeles, CA 90095, USA, Tel: 1-310-204-9038
| | - Catherine M Crespi
- Department of Biostatistics, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, and UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles E. Young Drive South, Room A2-125 CHS, Los Angeles, CA 90095, USA, Tel: 1-310-206-9364
| | - Roshan Bastani
- Department of Health Policy and Management, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, and UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles E. Young Drive South, Room A2-125 CHS, Los Angeles, CA 90095, USA, Tel: 1-310-206-9266
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Garza JR, Glenn BA, Mistry RS, Ponce NA, Zimmerman FJ. Subjective Social Status and Self-Reported Health Among US-born and Immigrant Latinos. J Immigr Minor Health 2016; 19:108-119. [DOI: 10.1007/s10903-016-0346-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Glenn BA, Lin T, Chang LC, Okada A, Wong WK, Glanz K, Bastani R. Sun protection practices and sun exposure among children with a parental history of melanoma. Cancer Epidemiol Biomarkers Prev 2015; 24:169-77. [PMID: 25587110 DOI: 10.1158/1055-9965.epi-14-0650] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND First-degree relatives of melanoma survivors have a substantially higher lifetime risk for melanoma than individuals with no family history. Exposure to ultraviolet radiation (UVR) is the primary modifiable risk factor for the disease. Reducing UV exposure through sun protection may be particularly important for children with a parental history of melanoma. Nonetheless, limited prior research has investigated sun protection practices and sun exposure among these children. METHODS The California Cancer Registry was used to identify melanoma survivors eligible to participate in a survey to assess their children's sun protection practices and sun exposure. The survey was administered by mail, telephone, or web to Latino and non-Latino white melanoma survivors with at least one child (0-17 years; N = 324). RESULTS Sun exposure was high and the rate of sunburn was equivalent to or higher than estimates from average-risk populations. Use of sun protection was suboptimal. Latino children were less likely to wear sunscreen and hats and more likely to wear sunglasses, although these differences disappeared in adjusted analyses. Increasing age of the child was associated with lower sun protection and higher risk for sunburn, whereas higher objective risk for melanoma predicted improved sun protection and a higher risk for sunburns. Perception of high barriers to sun protection was the strongest modifiable correlate of sun protection. CONCLUSIONS Interventions to improve sun protection and reduce sun exposure and sunburns in high-risk children are needed. IMPACT Intervening in high-risk populations may help reduce the burden of melanoma in the United States.
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Affiliation(s)
- Beth A Glenn
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California.
| | - Tiffany Lin
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - L Cindy Chang
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Ashley Okada
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Weng Kee Wong
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Karen Glanz
- Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roshan Bastani
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
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Bastani R, Glenn BA, Maxwell AE, Jo AM, Herrmann AK, Crespi CM, Wong WK, Chang LC, Stewart SL, Nguyen TT, Chen MS, Taylor VM. Cluster-Randomized Trial to Increase Hepatitis B Testing among Koreans in Los Angeles. Cancer Epidemiol Biomarkers Prev 2015; 24:1341-9. [PMID: 26104909 PMCID: PMC4560609 DOI: 10.1158/1055-9965.epi-14-1396] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 06/02/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the United States, Korean immigrants experience a disproportionately high burden of chronic hepatitis B (HBV) viral infection and associated liver cancer compared with the general population. However, despite clear clinical guidelines, HBV serologic testing among Koreans remains persistently suboptimal. METHODS We conducted a cluster-randomized trial to evaluate a church-based small group intervention to improve HBV testing among Koreans in Los Angeles. Fifty-two Korean churches, stratified by size (small, medium, large) and location (Koreatown versus other), were randomized to intervention or control conditions. Intervention church participants attended a single-session small-group discussion on liver cancer and HBV testing, and control church participants attended a similar session on physical activity and nutrition. Outcome data consisted of self-reported HBV testing obtained via 6-month telephone follow-up interviews. RESULTS We recruited 1,123 individuals, 18 to 64 years of age, across the 52 churches. Ninety-two percent of the sample attended the assigned intervention session and 86% completed the 6-month follow-up. Sample characteristics included were as follows: mean age 46 years, 65% female, 97% born in Korea, 69% completed some college, and 43% insured. In an intent-to-treat analysis, the intervention produced a statistically significant effect (OR = 4.9, P < 0.001), with 19% of intervention and 6% of control group participants reporting a HBV test. CONCLUSION Our intervention was successful in achieving a large and robust effect in a population at high risk of HBV infection and sequelae. IMPACT The intervention was fairly resource efficient and thus has high potential for replication in other high-risk Asian groups.
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Affiliation(s)
- Roshan Bastani
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California.
| | - Beth A Glenn
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - Annette E Maxwell
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - Angela M Jo
- Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Alison K Herrmann
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - Catherine M Crespi
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - Weng K Wong
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - L Cindy Chang
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - Susan L Stewart
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, California
| | - Tung T Nguyen
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Moon S Chen
- Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis, Davis, California
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Bastani R, Glenn BA, Maxwell AE, Ganz PA, Mojica CM, Alber S, Crespi CM, Chang LC. Randomized trial to increase colorectal cancer screening in an ethnically diverse sample of first-degree relatives. Cancer 2015; 121:2951-9. [PMID: 25946376 PMCID: PMC4545725 DOI: 10.1002/cncr.29403] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/06/2015] [Accepted: 03/12/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Ethnic minorities, especially African Americans and Latinos, bear a disproportionate burden of colorectal cancer (CRC), as reflected in incidence, cancer stage, and mortality statistics. In all ethnic groups, first-degree relatives (FDRs) of CRC cases are at an elevated disease risk. However, underuse of CRC screening persists and is particularly evident among minority groups. The current study tested a stepped intervention to increase CRC screening among an ethnically diverse sample of FDRs of CRC cases. METHODS A statewide cancer registry was used to recruit CRC cases and through them their FDRs. Relatives who were not current on CRC screening were randomized to intervention or usual-care control arms. The stepped intervention consisted of ethnically targeted and individually tailored print materials followed by telephone counseling for those unscreened at 6 months. RESULTS The study sample of 1280 individuals consisted of 403 Latino, 284 African American, 242 Asian, and 351 white FDRs. Statistically significant effects were observed for the cumulative print plus telephone intervention at 12 months (26% in the intervention vs 18% in the control group) and the print intervention alone at 6 months (15% in the intervention vs 10% in the control group). The effect of the print intervention alone versus the cumulative interventions was not statistically significantly different. Stratified analyses indicated that the intervention was effective among white, Latino, and Asian individuals, but not among African-Americans. CONCLUSIONS Overall, the intervention was effective in increasing screening rates. Oversampling racial/ethnic minorities allowed for the examination of effects within subgroups, revealing no effect among African American individuals. This finding illustrates the importance of including sufficient numbers of participants from diverse ethnic subgroups in intervention research to enable such stratified analyses.
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Affiliation(s)
- Roshan Bastani
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, CA
| | - Beth A. Glenn
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, CA
| | - Annette E. Maxwell
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, CA
| | - Patricia A. Ganz
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, CA
| | - Cynthia M. Mojica
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Susan Alber
- Department of Statistics, Volgenau School of Engineering, George Mason University, Fairfax, VA
| | - Catherine M. Crespi
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, CA
| | - L. Cindy Chang
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, CA
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Maxwell AE, Young S, Rabelo Vega R, Herrmann AK, See C, Glenn BA, Mistry R, Bastani R. Training Mixtec promotores to assess health concerns in their community: a CBPR pilot study. J Immigr Minor Health 2015; 16:310-3. [PMID: 22940912 DOI: 10.1007/s10903-012-9709-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An academic institution and a community organization partnered for one of the first studies assessing health needs of Mixtecs, indigenous immigrants from Southern Mexico, residing in Ventura County, California. Ten bilingual Spanish- and Mixteco-speaking promotores received a 1-day focus group training, participated in a focus group themselves and conducted 5 focus groups with 42 Mixtec community members. The focus group training is described. Health concerns discussed in the focus groups include outdoor exercise among women viewed as flirtatious; reluctance to ask for governmental assistance due to fear that children will have to pay back later; soda consumption perceived as a symbol of socio-economic status; and unwillingness to obtain mammograms or pap smears because private body parts are to be touched by husbands only. Training promotores to conduct focus groups can increase organizational capacity to identify pressing health needs in under-represented and hard-to-reach population groups.
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Affiliation(s)
- Annette E Maxwell
- Center for Cancer Prevention and Control Research, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Box 956900, A2-125 CHS, Los Angeles, CA, 90095-6900, USA,
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Preciado M, Hudson SM, Rondinelli J, Glenn BA, Chao C. An In-Depth Interview Study of Immunization Providers to Understand Practice Patterns, Barriers and Facilitators for Administering the 3-Dose HPV Vaccine Series. J Patient Cent Res Rev 2015. [DOI: 10.17294/2330-0698.1084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tu SP, Young VM, Coombs LJ, Williams RS, Kegler MC, Kimura AT, Risendal BC, Friedman DB, Glenn BA, Pfeiffer DJ, Fernandez ME. Practice adaptive reserve and colorectal cancer screening best practices at community health center clinics in 7 states. Cancer 2014; 121:1241-8. [PMID: 25524651 DOI: 10.1002/cncr.29176] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/14/2014] [Accepted: 11/04/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Enhancing the capability of community health centers to implement best practices (BPs) may mitigate health disparities. This study investigated the association of practice adaptive reserve (PAR) with the implementation of patient-centered medical home (PCMH) colorectal cancer (CRC) screening BPs at community health center clinics in 7 states. METHODS A convenience sample of clinic staff participated in a self-administered, online survey. Eight PCMH CRC screening BPs were scored as a composite ranging from 0 to 32. The PAR composite score was scaled from 0 to 1 and then categorized into 3 levels. Multilevel analyses examined the relation between PAR and self-reported implementation of PCMH BPs. RESULTS There were 296 respondents, and 59% reported 6 or more PCMH BPs at their clinics. The mean PAR score was 0.66 (standard deviation, 0.18), and the PCMH BP mean scores were significantly higher for respondents who reported higher clinic PAR categories. In comparison with the lowest PAR level, adjusted PCMH BP means were 25.0% higher at the middle PAR level (difference, 3.2; standard error, 1.3; t = 2.44; P = .015) and 63.2% higher at the highest PAR level (difference, 8.0; standard error, 1.9; t = 4.86; P < .0001). CONCLUSIONS A higher adaptive reserve, as measured by the PAR score, was positively associated with self-reported implementation of PCMH CRC screening BPs by clinic staff. Future research is needed to determine the PAR levels most conducive to implementing CRC screening and to develop interventions that enhance PAR in primary care settings.
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Affiliation(s)
- Shin-Ping Tu
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia; Department of Health Services, University of Washington, Seattle, Washington
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Glenn BA, Tsui J, Singhal R, Sanchez L, Nonzee NJ, Chang LC, Taylor VM, Bastani R. Factors associated with HPV awareness among mothers of low-income ethnic minority adolescent girls in Los Angeles. Vaccine 2014; 33:289-93. [PMID: 25434792 DOI: 10.1016/j.vaccine.2014.11.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/29/2014] [Accepted: 11/18/2014] [Indexed: 11/26/2022]
Abstract
Among caregivers of adolescent girls, awareness of human papillomavirus (HPV) is strongly associated with vaccine uptake. Little is known, however, about the predictors of HPV awareness among low-income ethnic minority groups in the U.S. The purpose of this study is to understand demographic factors associated with HPV awareness among low-income, ethnic minority mothers in Los Angeles County. We conducted a cross-sectional study of caregivers of adolescent girls through the Los Angeles County Department of Public Health Office of Women's Health's hotline. The majority of the participants were foreign-born (88%), one quarter lacked a usual source of care, and one quarter lacked public or private health insurance for their daughter. We found that one in three participants had never heard of HPV or the vaccine. Mothers that were unaware of HPV were significantly more likely to conduct the interview in a language other than English and to lack health insurance for their daughters. HPV vaccine awareness was much lower in our caregiver sample (61%) than in a simultaneous national survey of caregivers (85%). The associations between lack of awareness and use of a language other than English, as well as lack of health insurance for their daughter indicate the need for HPV vaccine outreach efforts tailored to ethnic minority communities in the U.S.
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Affiliation(s)
- Beth A Glenn
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Jennifer Tsui
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Rita Singhal
- Office of Women's Health, Los Angeles County Department of Public Health, 3400 Aerojet, 3rd Floor, El Monte, CA 91731-2803, USA.
| | - Leah Sanchez
- Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Narissa J Nonzee
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - L Cindy Chang
- Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
| | - Victoria M Taylor
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, (M3-B232), Seattle, WA 98109-4433, USA.
| | - Roshan Bastani
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA; Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
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Phillips SM, Glasgow RE, Bello G, Ory MG, Glenn BA, Sheinfeld-Gorin SN, Sabo RT, Heurtin-Roberts S, Johnson SB, Krist AH. Frequency and prioritization of patient health risks from a structured health risk assessment. Ann Fam Med 2014; 12:505-13. [PMID: 25384812 PMCID: PMC4226771 DOI: 10.1370/afm.1717] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 09/15/2014] [Accepted: 09/17/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To describe the frequency and patient-reported readiness to change, desire to discuss, and perceived importance of 13 health risk factors in a diverse range of primary care practices. METHODS Patients (n = 1,707) in 9 primary care practices in the My Own Health Report (MOHR) trial reported general, behavioral, and psychosocial risk factors (body mass index [BMI], health status, diet, physical activity, sleep, drug use, stress, anxiety or worry, and depression). We classified responses as "at risk" or "healthy" for each factor, and patients indicated their readiness to change and/or desire to discuss identified risk factors with providers. Patients also selected 1 of the factors they were ready to change as most important. We then calculated frequencies within and across these factors and examined variation by patient characteristics and across practices. RESULTS On average, patients had 5.8 (SD = 2.12; range, 0-13) unhealthy behaviors and mental health risk factors. About 55% of patients had more than 6 risk factors. On average, patients wanted to change 1.2 and discuss 0.7 risks. The most common risks were inadequate fruit/vegetable consumption (84.5%) and overweight/obesity (79.6%). Patients were most ready to change BMI (33.3%) and depression (30.7%), and most wanted to discuss depression (41.9%) and anxiety or worry (35.2%). Overall, patients rated health status as most important. CONCLUSIONS Implementing routine comprehensive health risk assessments in primary care will likely identify a high number of behavioral and psychosocial health risks. By soliciting patient priorities, providers and patients can better manage counseling and behavior change.
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Affiliation(s)
- Siobhan M Phillips
- Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.).
| | - Russell E Glasgow
- Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.)
| | - Ghalib Bello
- Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.)
| | - Marcia G Ory
- Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.)
| | - Beth A Glenn
- Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.)
| | - Sherri N Sheinfeld-Gorin
- Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.)
| | - Roy T Sabo
- Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.)
| | - Suzanne Heurtin-Roberts
- Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.)
| | - Sallie Beth Johnson
- Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.)
| | - Alex H Krist
- Implementation Sciences Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland (S.M.P., R.E.G., S. H-R.); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (S.M.P.); Colorado Health Outcomes Program, University of Colorado; Aurora, Colorado (R.E.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia (G.B., R.T.S.); Health Promotion & Community Health Sciences, Health Science Center, Texas A&M University, Round Rock, Texas (M.G.O.); Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, California (B.A.G.); Leidos Biomedical Research, Inc, Division of Cancer Control and Population Sciences of the National Cancer Institute, New York Physicians Against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, New York (S.N.S-G.); Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia (S.B.J.); Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, Virginia (S.B.J.); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia (A.H.K.)
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Abstract
Many US parents are concerned that vaccinating daughters against human papillomavirus (HPV) will communicate implicit approval for sexual activity and be associated with early or risky sexual behavior (Scarinci et al. in J Womens Health 16(8):1224-1233, 2007; Schuler et al. in Sex Transm Infect 87:349-353, 2011). The aims of this study were to understand (a) whether the HPV vaccine was associated with risky sexual behavior among a diverse sample of female adolescents and young adults, and (b) to better understand the chronology of HPV vaccination and sexual behavior. An anonymous web-based survey was used to collect data from 114 female community college students. T test and Chi square analyses were used to compare vaccinated and unvaccinated groups on age at first intercourse and proportion who had ever had sexual intercourse. Linear multiple regression was used to predict frequency of condom use and number of sexual partners in the past year, using vaccination status and demographic factors as predictors. About 38% reported receiving at least one dose of the HPV vaccine. Many of those vaccinated (45%) received the vaccine after having initiated sexual activity. The proportion of women who were sexually experienced did not differ by HPV vaccine status, nor did age at first intercourse, number of partners in the past year, or frequency of condom use. Current findings suggest that HPV vaccination is not associated with riskier sexual activity for the young women in this sample. Adolescents and their parents may benefit from education about the need to receive the HPV vaccine before onset of sexual activity.
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Affiliation(s)
- Erica Marchand
- Center for Cancer Prevention and Control Research, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095, USA,
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Tsui J, Gee GC, Rodriguez HP, Kominski GF, Glenn BA, Singhal R, Bastani R. Exploring the role of neighborhood socio-demographic factors on HPV vaccine initiation among low-income, ethnic minority girls. J Immigr Minor Health 2014; 15:732-40. [PMID: 23081659 DOI: 10.1007/s10903-012-9736-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Little is known about whether neighborhood factors are associated with human papillomavirus (HPV) vaccine uptake, especially among disadvantaged groups that can benefit most from the vaccine. We used data collected from immigrant, low-income mothers of adolescent girls and data from the 2005-2009 American Community Survey to investigate the relationship between HPV vaccine initiation and neighborhood characteristics. We compared initiation rates across levels of neighborhood disadvantage and employed multilevel logistic regression models to examine contextual effects on uptake. Overall, 27 % of girls (n = 479) initiated the vaccine. Initiation rates were highest among girls from the most disadvantaged neighborhoods (30 %), however, neighborhood factors were not independently associated with vaccine initiation after adjusting for individual factors. Mother's awareness of HPV, age, and insurance status were strong predictors for initiation. Future interventions should focus on improving awareness among low-income mothers as well as targeting vulnerable families outside the catchment area of public programs.
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Affiliation(s)
- Jennifer Tsui
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St., New York, NY 10032, USA.
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Maxwell AE, Bastani R, Glenn BA, Taylor VM, Nguyen TT, Stewart SL, Burke NJ, Chen MS. Developing theoretically based and culturally appropriate interventions to promote hepatitis B testing in 4 Asian American populations, 2006-2011. Prev Chronic Dis 2014; 11:E72. [PMID: 24784908 PMCID: PMC4008952 DOI: 10.5888/pcd11.130245] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Introduction Hepatitis B infection is 5 to 12 times more common among Asian Americans than in the general US population and is the leading cause of liver disease and liver cancer among Asians. The purpose of this article is to describe the step-by-step approach that we followed in community-based participatory research projects in 4 Asian American groups, conducted from 2006 through 2011 in California and Washington state to develop theoretically based and culturally appropriate interventions to promote hepatitis B testing. We provide examples to illustrate how intervention messages addressing identical theoretical constructs of the Health Behavior Framework were modified to be culturally appropriate for each community. Methods Intervention approaches included mass media in the Vietnamese community, small-group educational sessions at churches in the Korean community, and home visits by lay health workers in the Hmong and Cambodian communities. Results Use of the Health Behavior Framework allowed a systematic approach to intervention development across populations, resulting in 4 different culturally appropriate interventions that addressed the same set of theoretical constructs. Conclusions The development of theory-based health promotion interventions for different populations will advance our understanding of which constructs are critical to modify specific health behaviors.
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Affiliation(s)
- Annette E Maxwell
- University of California, Los Angeles, 650 Charles Young Drive South, Los Angeles, CA 90095-6900. E-mail:
| | | | - Beth A Glenn
- University of California, Los Angeles, California
| | | | | | | | | | - Moon S Chen
- University of California, Davis, Sacramento, California
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Krist AH, Glenn BA, Glasgow RE, Balasubramanian BA, Chambers DA, Fernandez ME, Heurtin-Roberts S, Kessler R, Ory MG, Phillips SM, Ritzwoller DP, Roby DH, Rodriguez HP, Sabo RT, Sheinfeld Gorin SN, Stange KC. Designing a valid randomized pragmatic primary care implementation trial: the my own health report (MOHR) project. Implement Sci 2013; 8:73. [PMID: 23799943 PMCID: PMC3694031 DOI: 10.1186/1748-5908-8-73] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 06/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a pressing need for greater attention to patient-centered health behavior and psychosocial issues in primary care, and for practical tools, study designs and results of clinical and policy relevance. Our goal is to design a scientifically rigorous and valid pragmatic trial to test whether primary care practices can systematically implement the collection of patient-reported information and provide patients needed advice, goal setting, and counseling in response. METHODS This manuscript reports on the iterative design of the My Own Health Report (MOHR) study, a cluster randomized delayed intervention trial. Nine pairs of diverse primary care practices will be randomized to early or delayed intervention four months later. The intervention consists of fielding the MOHR assessment--addresses 10 domains of health behaviors and psychosocial issues--and subsequent provision of needed counseling and support for patients presenting for wellness or chronic care. As a pragmatic participatory trial, stakeholder groups including practice partners and patients have been engaged throughout the study design to account for local resources and characteristics. Participatory tasks include identifying MOHR assessment content, refining the study design, providing input on outcomes measures, and designing the implementation workflow. Study outcomes include the intervention reach (percent of patients offered and completing the MOHR assessment), effectiveness (patients reporting being asked about topics, setting change goals, and receiving assistance in early versus delayed intervention practices), contextual factors influencing outcomes, and intervention costs. DISCUSSION The MOHR study shows how a participatory design can be used to promote the consistent collection and use of patient-reported health behavior and psychosocial assessments in a broad range of primary care settings. While pragmatic in nature, the study design will allow valid comparisons to answer the posed research question, and findings will be broadly generalizable to a range of primary care settings. Per the pragmatic explanatory continuum indicator summary (PRECIS) framework, the study design is substantially more pragmatic than other published trials. The methods and findings should be of interest to researchers, practitioners, and policy makers attempting to make healthcare more patient-centered and relevant. TRIAL REGISTRATION Clinicaltrials.gov: NCT01825746.
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Affiliation(s)
- Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, PO Box 980251, Richmond, VA 23298-0251, USA
| | - Beth A Glenn
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095-1772, USA
| | - Russell E Glasgow
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, Room 6144, Rockville, MD 20852, USA
| | - Bijal A Balasubramanian
- Division of Epidemiology, Human Genetics, and Environmental Science, University of Texas Health Science Center at Houston, School of Public Health, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - David A Chambers
- Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Blvd., Room 7144, Bethesda, MD 20892-9631, USA
| | - Maria E Fernandez
- University of Texas Health Science Center at Houston, School of Public Health, 7000 Fannin Suite 2558, Houston, TX 77030, USA
| | - Suzanne Heurtin-Roberts
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, Room 6144, Rockville, MD 20852, USA
| | - Rodger Kessler
- Department of Family Medicine, Vermont College of Medicine, S458 Courtyard at Given, 89 Beaumont Ave., Burlington, VT 05405, USA
| | - Marcia G Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Sciences Center School of Rural Public Health, College Station, TX 77843-1266, USA
| | - Siobhan M Phillips
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, Room 6144, Rockville, MD 20852, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, 10065 E. Harvard Ave., Denver, CO 80231, USA
| | - Dylan H Roby
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095-1772, USA
| | - Hector P Rodriguez
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095-1772, USA
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, PO Box 980032, Richmond, VA 23298-0032, USA
| | - Sherri N Sheinfeld Gorin
- SAIC-Frederick, NIH, NCI, DCCPS, 6130 Executive Plaza, Bethesda, MD, USA
- New York Physicians against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Kurt C Stange
- Family Medicine & Community Health, Epidemiology & Biostatistics, Sociology and Oncology, Case Western Reserve University, 11000 Cedar Ave, Suite 402, Cleveland, OH 44106, USA
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Tsui J, Singhal R, Rodriguez HP, Gee GC, Glenn BA, Bastani R. Proximity to safety-net clinics and HPV vaccine uptake among low-income, ethnic minority girls. Vaccine 2013; 31:2028-34. [PMID: 23474310 DOI: 10.1016/j.vaccine.2013.02.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 01/30/2013] [Accepted: 02/25/2013] [Indexed: 01/25/2023]
Abstract
PURPOSE Human Papillomavirus (HPV) vaccine uptake remains low. Although publicly funded programs provide free or low cost vaccines to low-income children, barriers aside from cost may prevent disadvantaged girls from getting vaccinated. Prior studies have shown distance to health care as a potential barrier to utilizing pediatric preventive services. This study examines whether HPV vaccines are geographically accessible for low-income girls in Los Angeles County and whether proximity to safety-net clinics is associated with vaccine initiation. METHODS Interviews were conducted in multiple languages with largely immigrant, low-income mothers of girls ages 9 to 18 via a county health hotline to assess uptake and correlates of uptake. Addresses of respondents and safety-net clinics that provide the HPV vaccine for free or low cost were geo-coded and linked to create measures of geographic proximity. Logistic regression models were estimated for each proximity measure on HPV vaccine initiation while controlling for other factors. RESULTS On average, 83% of the 468 girls had at least one clinic within 3-miles of their residence. The average travel time on public transportation to the nearest clinic among all girls was 21min. Average proximity to clinics differed significantly by race/ethnicity. Latinas had both the shortest travel distances (2.2 miles) and public transportation times (16min) compared to other racial/ethnic groups. The overall HPV vaccine initiation rate was 25%. Increased proximity to the nearest clinic was not significantly associated with initiation. By contrast, daughter's age and insurance status were significantly associated with increased uptake. CONCLUSIONS This study is among the first to examine geographic access to HPV vaccines for underserved girls. Although the majority of girls live in close proximity to safety-net vaccination services, rates of initiation were low. Expanding clinic outreach in this urban area is likely more important than increasing geographic access to the vaccine for this population.
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Affiliation(s)
- Jennifer Tsui
- Department of Health Policy & Management, Fielding School of Public Health and Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center University of California, Los Angeles 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA 90095-6900, USA.
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Maxwell AE, Stewart SL, Glenn BA, Wong WK, Yasui Y, Chang LC, Taylor VM, Nguyen TT, Chen MS, Bastani R. Theoretically informed correlates of hepatitis B knowledge among four Asian groups: the health behavior framework. Asian Pac J Cancer Prev 2013; 13:1687-92. [PMID: 22799389 DOI: 10.7314/apjcp.2012.13.4.1687] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Few studies have examined theoretically informed constructs related to hepatitis B (HBV) testing, and comparisons across studies are challenging due to lack of uniformity in constructs assessed. The present analysis examined relationships among Health Behavior Framework factors across four Asian American groups to advance the development of theory-based interventions for HBV testing in at-risk populations. METHODS Data were collected from 2007-2010 as part of baseline surveys during four intervention trials promoting HBV testing among Vietnamese-, Hmong-, Korean- and Cambodian-Americans (n = 1,735). Health Behavior Framework constructs assessed included: awareness of HBV, knowledge of transmission routes, perceived susceptibility, perceived severity, doctor recommendation, stigma of HBV infection, and perceived efficacy of testing. Within each group we assessed associations between our intermediate outcome of knowledge of HBV transmission and other constructs, to assess the concurrent validity of our model and instruments. RESULTS While the absolute levels for Health Behavior Framework factors varied across groups, relationships between knowledge and other factors were generally consistent. This suggests similarities rather than differences with respect to posited drivers of HBV-related behavior. DISCUSSION Our findings indicate that Health Behavior Framework constructs are applicable to diverse ethnic groups and provide preliminary evidence for the construct validity of the Health Behavior Framework.
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Affiliation(s)
- Annette E Maxwell
- School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, USA.
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Abstract
This study assessed HPV vaccination and its correlates among culturally diverse 18-26 year-old community college women in Los Angeles. Specific research questions were: (1) What proportion of respondents have initiated the HPV vaccine, and what proportion have completed the three-dose series? (2) What demographic (e.g., age, ethnicity), psychosocial (e.g., vaccine-related beliefs, perceived social norms), and health care-related variables (e.g., health insurance status, provider recommendation, health care trust and satisfaction) are associated with vaccine initiation for this sample? Participants were recruited from the campus of a community college in central Los Angeles. All female students between 18 and 26 were eligible to participate. An anonymous web-based survey assessed number of HPV vaccine doses received as well as demographic information, HPV- and HPV vaccine-related knowledge, attitudes, and behavior, perceived social norms, provider & health care system factors, sexual behavior, cervical health, and mother-daughter communication about sex. Analyses were conducted using 178 surveys. Multivariate logistic regression tested the relationships of statistically significant bivariate predictors to vaccine initiation. Those who initiated the vaccine were younger, more often had a health-related academic major, thought the vaccine to be safer, perceived HPV severity lower, and perceived higher social approval for HPV vaccination than those unvaccinated. All who had initiated the vaccine had a doctor's recommendation. To increase uptake among 18-26-year-old women, research should explore provider interventions to increase vaccine recommendation, and also identify individuals and groups who may have negative beliefs about vaccine safety and efficacy to provide support in vaccine decision-making.
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Affiliation(s)
- Erica Marchand
- UCLA Center for Cancer Prevention and Control Research, School of Public Health, Los Angeles, CA 90095, USA.
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Glenn BA, Bastani R, Maxwell AE. The perils of ignoring design effects in experimental studies: lessons from a mammography screening trial. Psychol Health 2013; 28:593-602. [PMID: 23289517 DOI: 10.1080/08870446.2012.756880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Threats to external validity, including pretest sensitisation and the interaction of selection and an intervention, are frequently overlooked by researchers despite their potential to significantly influence study outcomes. The purpose of this investigation was to conduct secondary data analyses to assess the presence of external validity threats in the setting of a randomised trial designed to promote mammography use in a high-risk sample of women. DESIGN During the trial, recruitment and intervention, implementation took place in three cohorts (with different ethnic composition), utilising two different designs (pretest-posttest control group design and posttest only control group design). RESULTS Results reveal that the intervention produced different outcomes across cohorts, dependent upon the research design used and the characteristics of the sample. CONCLUSION These results illustrate the importance of weighing the pros and cons of potential research designs before making a selection and attending more closely to issues of external validity.
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Affiliation(s)
- Beth A Glenn
- Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA.
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Glenn BA, Bastani R, Chang LC, Khanna R, Chen K. Sun protection practices among children with a family history of melanoma: a pilot study. J Cancer Educ 2012; 27:731-737. [PMID: 22610837 DOI: 10.1007/s13187-012-0377-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The goal of this pilot study was to assess sun protection practices and correlates among children with a family history of melanoma, a high risk and understudied group. Sixty-eight melanoma cases, recruited through the Los Angeles County cancer registry, completed a survey. Survivors provided data on 110 children (mean age = 8.11 years). Although most children used sunscreen (79 %), half experienced a recent sunburn. The mean sun protection level for the sample was similar to levels observed among average risk children. Efforts to reduce sunburn frequency and improve sun protection among these vulnerable children appear warranted.
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Affiliation(s)
- Beth A Glenn
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, CHS, Los Angeles, CA 90095-6900, USA.
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Glenn BA, Bastani R, Maxwell AE, Mojica CM, Herrmann AK, Gallardo NV, Swanson KA, Chang LC. Prostate cancer screening among ethnically diverse first-degree relatives of prostate cancer cases. Health Psychol 2012; 31:562-70. [PMID: 22708522 DOI: 10.1037/a0028626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined potential ethnic differences in prostate cancer screening behavior and correlates of screening in an ethnically diverse sample of first-degree relatives of prostate cancer cases. METHODS The California Cancer Registry was used to identify a sample of prostate cancer cases who were contacted and invited to refer male first-degree relatives to the study. Telephone surveys with 1,029 first-degree relatives (354 non-Latino Whites, 228 Latinos, 272 African Americans, 175 Asians) assessed prostate cancer screening behavior and correlates of screening. RESULTS Less than half of the participants had received a prostate specific antigen (PSA) test in the past year, with lowest rates observed among Latinos. Factors independently associated with an increased likelihood of the PSA test receipt in the total sample included: prior PSA testing, having a physician recommendation to be screened, and reporting fewer barriers to screening. Being the brother versus the son of the case predicted a higher likelihood of screening for all ethnic groups except for African Americans. In addition, the negative influence of barriers on screening was significantly greater for Latinos compared with Asians. CONCLUSIONS Although ethnicity was not an independent predictor of screening, ethnic variations were observed in the relationship between some predictors and screening and in the modifiable correlates of screening. Findings may inform future intervention research that aims to enhance informed decision-making regarding prostate cancer screening and ultimately reduce prostate cancer health disparities.
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Affiliation(s)
- Beth A Glenn
- Department of Health Services, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095-6900, USA.
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Hopkins JM, Glenn BA, Cole BL, McCarthy W, Yancey A. Implementing organizational physical activity and healthy eating strategies on paid time: process evaluation of the UCLA WORKING pilot study. Health Educ Res 2012; 27:385-398. [PMID: 22323279 PMCID: PMC3337424 DOI: 10.1093/her/cys010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 01/12/2012] [Indexed: 05/31/2023]
Abstract
Integrating organizationally targeted wellness strategies into the routine conduct of business has shown promise in engaging captive audiences at highest risk of obesity and obesity-related health consequences. This paper presents a process evaluation of the implementation of the University of California, Los Angeles, Working Out Regularly Keeps Individuals Nurtured and Going (WORKING) pilot study. WORKING focuses on integrating physical activity and nutrition practices into workplace routine during non-discretionary paid work time. The purpose of the evaluation was to assess the quality of implementation and to understand factors that facilitated or hindered organizations' full uptake of the intervention. Fifteen worksites were randomly assigned to an intervention condition. Qualitative data were gathered through routine site visits and informant interviews conducted throughout each worksite's intervention period. Worksites were classified into one of four implementation success categories based on their level of adoption and maintenance of core intervention strategies. Six key factors emerged that were related to implementation success: site layout and social climate, wellness infrastructure, number and influence of Program Champions, leadership involvement, site innovation and creativity. This pilot study has informed the conduct of WORKING II; a cluster randomized controlled trial aimed at enrolling 60-70 worksites in Los Angeles County.
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Affiliation(s)
- Jammie M Hopkins
- Department of Health Services, School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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Glenn BA, Chawla N, Bastani R. Barriers to genetic testing for breast cancer risk among ethnic minority women: an exploratory study. Ethn Dis 2012; 22:267-273. [PMID: 22870568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND/AIMS To assess awareness of genetic testing for breast cancer risk and identify influences on the decision-making process regarding counseling and testing among an ethnically-diverse sample of women. METHODS Semi-structured interviews were conducted with 33 women who were breast or ovarian cancer survivors or first degree relatives of survivors. Interviews were audiotaped, translated, and transcribed. Analysis of transcripts identified relevant themes and quotes were extracted for illustration. RESULTS Low levels of awareness were observed in minority women, including those with a significant family history of cancer. A number of potential influences on the decision-making process emerged including beliefs about risk factors for cancer and opinions about the options following testing. Distinct issues were identified within ethnic groups that may function as barriers such as concern about the misuse of genetic information (African Americans), unfamiliarity with Western preventive medicine (Asians), and women prioritizing family obligations over personal health needs (Latinas). CONCLUSIONS Results suggest there may be a need for interventions to raise awareness about genetic counseling and testing among minorities. Our findings contribute to the literature by using in-depth interviews to uncover potential barriers and facilitators to counseling and testing and by including Asians and Latinas, groups under-represented in previous research.
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Affiliation(s)
- Beth A Glenn
- Fielding School of Public Health, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA 90095-6900, USA. USA.
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