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Alvarez VHA, Amboree TL, Mitchell P, Badr HJ, Montealegre JR. Nativity Disparities in Colorectal Cancer Screening Among Hispanics in the United States. J Immigr Minor Health 2024:10.1007/s10903-024-01590-w. [PMID: 38635108 DOI: 10.1007/s10903-024-01590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/19/2024]
Abstract
Hispanics in the United States (U.S.) have previously exhibited lower guideline-concordant colorectal cancer (CRC) screening uptake than non-Hispanic (NH) Whites, with disparities accentuated in foreign-born Hispanics, however it is unclear whether nativity-related CRC screening disparities have changed in the last two decades and whether these disparities are attenuated after adjusting for socioeconomic and demographic characteristics. We evaluated CRC screening adherence in foreign- and U.S.-born Hispanics compared to U.S.-born NH Whites. We used 2019 National Health Interview Survey data to compare the prevalence of up-to-date CRC screening per the 2019 U.S. Preventive Services Task Force recommendations among Hispanic nativity subgroups (i.e., foreign- and U.S.-born) and U.S.-born NH Whites using unadjusted and adjusted weighted log-linked binomial regression. Foreign- and U.S.-born Hispanics had a significantly lower unadjusted prevalence of up-to-date screening than U.S.-born NH Whites (47.18% and 64.18% versus 70.70%; p < 0.0001 and p = 0.0109, respectively). After adjusting for socioeconomic and demographic differences, the prevalence of up-to-date screening was lower in foreign-born Hispanics compared to U.S.-born NH Whites [adjusted prevalence ratio 0.80 (95% confidence interval 0.70-0.91)]; however, no statistically significant difference was observed between U.S.-born Hispanics and NH Whites. Our results suggest a low screening uptake in foreign-born Hispanics independent of socioeconomic and demographic differences. Future interventions should target foreign-born Hispanics to address disparities and promote early detection and prevention of CRC regardless of socioeconomic factors.
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Affiliation(s)
- Victor H Albornoz Alvarez
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Trisha L Amboree
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Parker Mitchell
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hoda J Badr
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jane R Montealegre
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Fiallos K, Owczarzak J, Bodurtha J, Margarit S, Erby LH. Latina immigrants' breast and colon cancer causal attributions: genetics is key. J Community Genet 2024; 15:59-73. [PMID: 38032519 PMCID: PMC10857993 DOI: 10.1007/s12687-023-00681-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
Latinos in the US suffer health disparities including stage of disease at time of breast or colon cancer diagnosis. Understanding Latinas' causal attributions of breast and colon cancer may provide insight into some of the individual level determinants of cancer disparities in this population. Cultural consensus analysis (CCA) is one way to study causal beliefs. The objective of this study was to describe Latina immigrants' causal attributions of breast and colon cancer. We conducted Spanish-language interviews with 22 Latina immigrants using a qualitative exploratory design comprised of freelisting, ranking, and open-ended questions. Participants freelisted causes and risk factors for breast and colon cancer then ranked risk factors according to their perceived role in the development of each cancer. CCA was conducted on rank orders to identify whether a cultural consensus model was present. Participants answered semi-structured, open-ended questions regarding the risk factors and rankings. Interviews were transcribed and subjected to thematic analysis. CCA showed no consensus around rank of causes for either cancer, and residual agreement analysis suggested the presence of two subcultural groups. "Genetics" and "hereditary factors" ranked first and second on average across participants for both cancers. Based on interview data, participants were less aware of colon cancer than breast cancer. Participants' endorsement of heredity as a cause of breast and colon cancer was similar to beliefs reported in studies of primarily non-Latina populations.
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Affiliation(s)
- Katie Fiallos
- National Human Genome Research Institute, Bethesda, MD, USA.
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Jill Owczarzak
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joann Bodurtha
- Johns Hopkins McKusick-Nathans Department of Genetic Medicine, Baltimore, MD, USA
| | - Sonia Margarit
- Clínica Alemana, Santiago, Chile
- Universidad del Desarrollo, Santiago, Chile
| | - Lori H Erby
- National Human Genome Research Institute, Bethesda, MD, USA
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Jadallah K, Khatatbeh M, Mazahreh T, Sweidan A, Ghareeb R, Tawalbeh A, Masaadeh A, Alzubi B, Khader Y. Colorectal cancer screening barriers and facilitators among Jordanians: A cross-sectional study. Prev Med Rep 2023; 32:102149. [PMID: 36852311 PMCID: PMC9958352 DOI: 10.1016/j.pmedr.2023.102149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/23/2022] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
The factors affecting the adherence of Jordanians to colorectal cancer (CRC) screening remain underexplored. We examined the inhibitory and facilitating factors that influence the uptake of CRC screening among Jordanians. We conducted questionnaire interviews between April 2020 and June 2021 with 861 Jordanians aged 50-75. We analyzed the differences between proportions using the chi-square test. Binary logistic regression was conducted to determine factors associated with awareness of CRC and its screening. Of all participants, 41.7 % were aware of the necessity of screening for CRC, and 27.2 % were aware of at least one of the tests for CRC screening. However, only 17.2 % of participants underwent screening. In the multivariate analysis, participants with higher income (p-value < 0.001, odds ratio[OR] = 1.9, 95 % confidence interval [CI]: 1.4-2.7), higher level of education (p-value < 0.001, OR = 2.6, 95 % CI: 1.8-3.7), family history of colon cancer (p-value < 0.001, OR = 2.8, 95 % CI = 1.7-4.5), and those who had been screened for other cancers (p-value = 0.003, OR = 1.7, 95 % CI: 1.2-2.5) were more aware of the necessity of screening. Concerning barriers to screening, 'feeling well,' lack of physician endorsement, and difficult access to health care were the most commonly reported inhibitory factors (53.9 %, 52.3 %, and 31.9 %, respectively). The most commonly stated incentivizing factor was physician endorsement (82.3 %). Screening rates for CRC in eligible Jordanians remain low, albeit more than one-third of participants are aware of the necessity of screening. Enhanced awareness of barriers and incentivizing factors should help to prioritize national strategies to improve screening rates.
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Affiliation(s)
- Khaled Jadallah
- Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Moawiah Khatatbeh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan, and School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | - Tagleb Mazahreh
- Department of Surgery, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Aroob Sweidan
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Razan Ghareeb
- Department of Internal Medicine, Jordan University Hospital, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Aya Tawalbeh
- Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ansam Masaadeh
- Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Bara Alzubi
- Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef Khader
- Department of Community Medicine, Public Health, and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Ratnapradipa KL, Chen K, Watanabe-Galloway S, Farazi PA. Cross-sectional Study of Colorectal Cancer Screening Barriers in a Latino-Serving Federally Qualified Health Center. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:193-200. [PMID: 34599456 DOI: 10.1007/s13187-021-02097-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 06/13/2023]
Abstract
Compared to other races/ethnicities, the Latino population has a lower rate of adherence to colorectal cancer (CRC) screening guidelines. Previous studies have identified a variety of barriers to CRC screening in Latino populations but have not explored factors associated with barriers. The purpose of this study was to identify barriers to CRC screening and associated factors in a Midwest Latino population visiting an urban Federally Qualified Health Center (FQHC). We conducted a cross-sectional investigation of 68 Latinos at a FQHC from June to October 2017. We examined factors associated with scheduling, psychological, and financial barriers using t-test, ANOVA, and multiple linear regression analyses. Our participants reported low educational level, low income, and limited access to insurance or a primary care provider. Scheduling barriers are the highest barrier compared with psychological and financial barriers. Being married or coupled was the only predictor of higher scheduling barriers (P < .05). Being married or coupled was associated with higher psychological barriers in both univariate and multivariate analysis (P < .05). Higher education level was associated with higher psychological barriers in univariate (P < .05) but not multivariate analysis. Participants with lower vs. higher English proficiency had a higher financial barrier score in univariate (P < .05) but not multivariate analysis. Despite interventions targeting CRC screening barriers, including the provision of free at-home testing, perceived barriers persist. Bilingual patient navigators may help address needs for those with limited English proficiency to find and schedule free or reduced-fee colonoscopy services. People who are well educated are also at high risk of psychological barriers and should be targeted and given more education on the importance of CRC screening.
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Affiliation(s)
- Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Nebraska Medical Center, 984395, Omaha, NE, 68198-4395, USA
| | - Ken Chen
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Nebraska Medical Center, 984395, Omaha, NE, 68198-4395, USA
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Nebraska Medical Center, 984395, Omaha, NE, 68198-4395, USA
| | - Paraskevi A Farazi
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Nebraska Medical Center, 984395, Omaha, NE, 68198-4395, USA.
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Alpert EN, Clark T, Garcia-Alcaraz C, Eddington SN, Carrizosa C, Haughton J, de la Torre CL, Garcia-Bigley F, Arredondo EM, Ramers C, Nodora J, Wells KJ. Comparing Latino Community Members' and Clinical Staff's Perspectives on Barriers and Facilitators to Colorectal Cancer Screening. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1645-1653. [PMID: 33893616 PMCID: PMC8536794 DOI: 10.1007/s13187-021-02007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
Latinos in the United States have low rates of colorectal cancer (CRC) screening even though CRC is the third leading cause of cancer death among Latinos. This qualitative study aimed to understand and compare the perspectives of clinical staff (CS) and Latino community members (LCMs) in an urban Southern California community regarding barriers and facilitators of CRC screening. Through purposive sampling, 39 LCMs (mean age: 59.4 years, 79.5% female) were recruited to participate in one of five focus groups, and 17 CS (mean age: 38.8 years, 64.7% female) were recruited to participate in semi-structured in-depth interviews, along with a demographic survey. Interviews and focus group recordings were transcribed verbatim, translated, and analyzed using direct content analysis. Demographic data were summarized using descriptive statistics. Findings suggest that CS and LCMs have both similar and opposing perspectives with regard to barriers and facilitators of CRC screening. Themes discussed included attitudes towards CRC screening, CRC knowledge, access to resources, commitments and responsibilities, social support, vicarious learning, patient-provider communication, trust, and social relationships. Study findings can be used to guide interventions and policies to improve access to CRC screening among LCMs.
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Affiliation(s)
- Elizabeth N Alpert
- San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120-4913, USA
- UC San Diego Moores Cancer Center, San Diego, CA, USA
| | - Tatiana Clark
- San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120-4913, USA
| | | | | | | | - Jessica Haughton
- San Diego State University Research Foundation, San Diego, CA, USA
| | | | | | - Elva M Arredondo
- San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120-4913, USA
| | | | | | - Kristen J Wells
- San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120-4913, USA.
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
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Ou JY, Warner EL, Nam GE, Martel L, Carbajal-Salisbury S, Fuentes V, Wetter DW, Kirchhoff AC, Kepka D. Colorectal cancer knowledge and screening adherence among low-income Hispanic employees. HEALTH EDUCATION RESEARCH 2019; 34:400-414. [PMID: 31329867 PMCID: PMC6646949 DOI: 10.1093/her/cyz013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/28/2019] [Indexed: 05/16/2023]
Abstract
Hispanics have the lowest colorectal cancer (CRC) screening rates of all racial/ethnic groups and comprise the largest proportion of low-income manual laborers in the nation. We partnered with businesses to implement a community health worker (CHW)-led intervention among Hispanic workers in service-related and manual labor occupations, which often pay low wages and do not provide health insurance. CHWs measured knowledge, screening adherence and perceptions of CRC risk before and after educational interventions via interview. CHWs provided fecal immunochemical tests (FITs) to participants aged ≥50 years. Chi-square tests and logistic regression identified pre-intervention predictors of CRC knowledge of all participants and adherence among eligible participants. Adherence among participants increased from 40% (n = 307) pre-intervention to 66% post-intervention. Knowledge about CRC was associated with age ≥50 years (OR = 8.90 [95% CI = 2.61-30.35]; ref = 18-30) and perceived personal risk for CRC (Likely, OR = 3.06 [95% CI = 1.40-6.67]; ref = Not likely). Insurance status was associated with screening adherence pre-intervention (OR = 3.00 [95% CI 1.10-8.12]; ref = No insurance). Improvement in adherence post-intervention was associated with income between $25 000 and ≥$55 000 (OR = 8.49 [95% CI 1.49-48.32]; ref = $5000-<$10 000). Community-based health programs can improve CRC screening adherence among Hispanic workers in service-related and manual labor positions, but lowest-income workers may need additional support.
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Affiliation(s)
- Judy Y Ou
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Division of Epidemiology, Department of Internal Medicine
| | - Echo L Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Gina E Nam
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Laura Martel
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Utah AIDS Education and Training Center, University of Utah, Salt Lake City, UT, USA
| | | | | | - David W Wetter
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Department of Population Health Sciences
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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Warner EL, Martel L, Ou JY, Nam GE, Carbajal-Salisbury S, Fuentes V, Kirchhoff AC, Kepka D. A Workplace-Based Intervention to Improve Awareness, Knowledge, and Utilization of Breast, Cervical, and Colorectal Cancer Screenings Among Latino Service and Manual Labor Employees in Utah. J Community Health 2018; 44:256-264. [DOI: 10.1007/s10900-018-0581-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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