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Wall NR, Fuller RN, Morcos A, De Leon M. Pancreatic Cancer Health Disparity: Pharmacologic Anthropology. Cancers (Basel) 2023; 15:5070. [PMID: 37894437 PMCID: PMC10605341 DOI: 10.3390/cancers15205070] [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: 09/20/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Pancreatic cancer (PCa) remains a formidable global health challenge, with high mortality rates and limited treatment options. While advancements in pharmacology have led to improved outcomes for various cancers, PCa continues to exhibit significant health disparities, disproportionately affecting certain populations. This paper explores the intersection of pharmacology and anthropology in understanding the health disparities associated with PCa. By considering the socio-cultural, economic, and behavioral factors that influence the development, diagnosis, treatment, and outcomes of PCa, pharmacologic anthropology provides a comprehensive framework to address these disparities and improve patient care.
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Affiliation(s)
- Nathan R. Wall
- Division of Biochemistry, Department of Basic Science, Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA 92350, USA; (R.N.F.); (A.M.)
| | - Ryan N. Fuller
- Division of Biochemistry, Department of Basic Science, Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA 92350, USA; (R.N.F.); (A.M.)
| | - Ann Morcos
- Division of Biochemistry, Department of Basic Science, Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA 92350, USA; (R.N.F.); (A.M.)
| | - Marino De Leon
- Division of Physiology, Department of Basic Science, Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA 92350, USA;
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Huq MR, He X, Woodard N, Chen C, Knott CL. The role of community health advisors' cancer history in implementation and efficacy of a cancer control intervention. HEALTH EDUCATION RESEARCH 2023; 38:350-361. [PMID: 36892605 PMCID: PMC10558036 DOI: 10.1093/her/cyad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/24/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Community health advisors (CHAs) play a key role in promoting health in medically underserved communities, including in addressing cancer disparities. There is a need to expand the research on what characteristics make for an effective CHA. We examined the relationship between CHA personal and family history of cancer, and implementation and efficacy outcomes in a cancer control intervention trial. Twenty-eight trained CHAs implemented a series of three cancer educational group workshops for N = 375 workshop participants across 14 churches. Implementation was operationalized as participant attendance at the educational workshops, and efficacy as workshop participants' cancer knowledge scores at the 12-month follow-up, controlling for baseline scores. CHA personal history of cancer was not significantly associated with implementation, nor knowledge outcomes. However, CHAs with family history of cancer had significantly greater participant attendance at the workshops than CHAs without family history of cancer (P = 0.03) and a significant, positive association with male workshop participants' prostate cancer knowledge scores at 12 months (estimated beta coefficient = 0.49, P < 0.01) after adjusting for confounders. Findings suggest that CHAs with family history of cancer may be particularly suitable for cancer peer education, although further research is needed to confirm this and identify other factors conducive to CHA success.
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Affiliation(s)
- Maisha R Huq
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA
| | - Xin He
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA
| | - Nathaniel Woodard
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA
| | - Chang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA
| | - Cheryl L Knott
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA
- Community Outreach and Engagement, University of Maryland Greenebaum Comprehensive Cancer Center, 22 S Greene St, Baltimore, MD 21201, USA
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Ahmed AM, Hardy CM, Bowman T, Akinyele O, Tipre M, Richardson MB, Baskin ML, Niranjan SJ. Training and Dissemination of Lung Cancer Education Curriculum Among Community Health Advisors in the Deep South: a Program Evaluation. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:538-544. [PMID: 35254629 DOI: 10.1007/s13187-022-02149-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 05/20/2023]
Abstract
Lung cancer is the leading cause of cancer mortality in the USA. In the rural Black Belt region of Alabama, high rates of lung cancer incidence and mortality coupled with disproportionate lack of access to health services stresses the need for navigating high risk and disproportionately affected groups towards successfully obtaining lung cancer screenings. We utilized our well-accepted Community Health Advisor (CHA) model for education and awareness. This study seeks to evaluate the results of the Alabama Lung Cancer Awareness, Screening, and Education (ALCASE) training on CHAs, program evaluation, and lessons learned. A total of 202 participants were eligible and enrolled for CHA training. One hundred thirty CHAs were included for the final analyses. Descriptive statistics were computed; differences in pre-test and post-test scores were compared across demographic characteristics of the participants using paired t-test/one-way ANOVA. Of the 130 CHAs, 46% were 65 years or older; 98% were African Americans, and 87% were female; 17% of participants were cancer survivors. The mean post-test scores were 2.2 points greater than mean pre-test scores, and the difference was significant (mean (SD): pre-test = 20.8 (2.8) versus post-test = 23 (2.2); p = 0.001). No notable difference in pre-test and post-test scores were observed by CHA's demographic characteristics except by their county of residence or work (p = 0.0019). We demonstrate the capability and value of successfully recruiting and training motivated community members to be able to serve educators to better reach medically underserved and historically excluded communities.
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Affiliation(s)
- Amir M Ahmed
- University of Alabama School of Medicine, Birmingham, AL, USA
| | - Claudia M Hardy
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tara Bowman
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Olusean Akinyele
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meghan Tipre
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Molly B Richardson
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monica L Baskin
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soumya J Niranjan
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 1720 2nd Avenue South, 540A, Birmingham, AL, 35294, USA.
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Maxwell AE, Lucas-Wright A, Gatson J, Vargas C, Santifer RE, Chang LC, Tran K. Community health advisors assessing adherence to national cancer screening guidelines among African Americans in South Los Angeles. Prev Med Rep 2020; 18:101096. [PMID: 32368438 PMCID: PMC7190749 DOI: 10.1016/j.pmedr.2020.101096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/13/2020] [Accepted: 04/12/2020] [Indexed: 11/29/2022] Open
Abstract
Community Health Advisors were able to assess cancer screening in South Los Angeles. About half of African American men and women were up to date with all screening tests. Screening rates in South LA regions are consistent with social determinants of health. Providers should recommend all screening tests to their patients. Our data confirm that South LA is a high priority area for promoting cancer screening.
We partnered with African American churches in South Los Angeles (LA) and trained Community Health Advisors (CHAs) to assess cancer screening. The purpose of this analysis is to report adherence to national cancer screening guidelines among African Americans in South LA, to assess relationships between adherence to colorectal cancer and other cancer screening guidelines, and to explore regional differences in screening rates. Between 2016 and 2018, 44 CHAs surveyed 777 African Americans between 50 and 75 years of age. Among 420 South LA residents, 64% of men and 70% of women were adherent to colorectal cancer screening guidelines. Adherence to mammography screening guidelines was 73%. Adherence to cervical cancer screening guidelines among women 50 to 65 years of age without hysterectomy was 80%. Fifty-nine percent of men had ever discussed the Prostate Specific Antigen (PSA) test with a physician. Adherence to colorectal cancer screening guidelines was significantly higher among respondents who were adherent to other cancer screening guidelines compared to their peers who were not adherent to other cancer screening guidelines (all p < 0.05). The fact that 22% of women who were adherent to breast cancer screening, 32% of women adherent to cervical cancer screening and 16% of men who had discussed the PSA test with a physician were not adherent to colorectal cancer screening guidelines suggests that providers should redouble their efforts to review all screening guidelines with their patients and to make appropriate recommendations. Regional differences in screening rates within South Los Angeles should inform future screening promotion efforts.
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Affiliation(s)
- Annette E Maxwell
- Center for Cancer Prevention and Control Research, University of California, Los Angeles Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095-6900, USA
| | - Aziza Lucas-Wright
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Juana Gatson
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Claudia Vargas
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Rhonda E Santifer
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - L Cindy Chang
- Center for Cancer Prevention and Control Research, University of California, Los Angeles Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095-6900, USA.,Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Khoa Tran
- Center for Cancer Prevention and Control Research, University of California, Los Angeles Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095-6900, USA
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Maxwell AE, Lucas-Wright A, Santifer RE, Vargas C, Gatson J, Chang LC. Promoting Cancer Screening in Partnership With Health Ministries in 9 African American Churches in South Los Angeles: An Implementation Pilot Study. Prev Chronic Dis 2019; 16:E128. [PMID: 31538568 PMCID: PMC6795066 DOI: 10.5888/pcd16.190135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose and Objectives We conducted a pilot study to assess the degree to which an intervention led by community health advisors (CHAs) to promote cancer screening was delivered as intended and to estimate the potential effect of the intervention on receipt of screening. In contrast to previous studies and to maximize its potential public health impact, the intervention targeted 4 screening tests and only participants who were not up to date with screening guidelines for at least 1 cancer. Because CHAs had to both determine baseline adherence and provide counseling on 4 screening tests, the protocol was complex. Complex protocols can reduce implementation fidelity. Intervention Approach In partnership with health ministries at 9 African American churches in South Los Angeles, we conducted a 1-group pretest–posttest pilot study to assess the feasibility of implementing the intervention. CHAs recruited and obtained consent from church members aged 50 to 75 years; assessed adherence to national screening guidelines for breast, cervical, colorectal, and prostate cancer; and provided evidence-based strategies (one-on-one counseling, print materials, reminder calls) to encourage screening for tests that were overdue. Evaluation Methods We assessed implementation fidelity by reviewing baseline screening assessments and counseling scripts completed by CHAs. We estimated potential effect of the intervention on receipt of screening by using data from 3-month follow-up surveys, conducted by the research team, of participants who were nonadherent at baseline. Results From June 2016 to June 2018, 44 CHAs conducted baseline assessments of 775 participants, of whom 338 (44%) were nonadherent to national guidelines for 1 or more cancer screening tests. CHAs provided counseling to most nonadherent participants. At follow-up, about one-third of participants reported that they had discussed cancer screening with their provider and a smaller proportion reported receipt of a screening test; 13% of men and 25% of women reported receipt of colorectal cancer screening. Implications for Public Health This study demonstrates that with training and ongoing technical assistance, CHAs at African American health ministries can implement complex research protocols with good fidelity.
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Affiliation(s)
- Annette E Maxwell
- Center for Cancer Prevention and Control Research, University of California, Los Angeles Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California.,UCLA Center for Cancer Prevention and Control Research, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, A2-125 CHS, Box 956900, Los Angeles, CA 90095-6900.
| | - Aziza Lucas-Wright
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Rhonda E Santifer
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Claudia Vargas
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Juana Gatson
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - L Cindy Chang
- Center for Cancer Prevention and Control Research, University of California, Los Angeles Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California.,Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, California
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