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Yeh PG, Choh AC, Fisher-Hoch SP, McCormick JB, Lairson DR, Reininger BM. The association of cancer-preventive lifestyle with colonoscopy screening use in border Hispanic adults along the Texas-Mexico border. Cancer Causes Control 2024:10.1007/s10552-024-01885-1. [PMID: 38743343 DOI: 10.1007/s10552-024-01885-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE The relationship between engaging in two domains of cancer-preventive behaviors, lifestyle behaviors and colonoscopy screening, is unknown in Hispanic adults. Accordingly, the study examined the association between lifestyle and colonoscopy screening in Hispanic adults along the Texas-Mexico border, where there is suboptimal colorectal cancer prevention. METHODS Lifestyle behavior adherence and compliance with colonoscopy screening schedules were assessed using 2013-2023 data from the Cameron County Hispanic Cohorta population-based sample of Hispanic adults living along the Texas-Mexico border. The 2018 World Cancer Research Fund scoring system characterized healthy lifestyle engagement. Multivariable logistic regression quantified the association between lifestyle behaviors and colonoscopy screening. RESULTS Among 914 Hispanic adults, there was a mean adherence score of 2.5 out of 7 for recommended behaviors. Only 33.0% (95% CI 25.64-41.39%) were up-to-date with colonoscopy. Complete adherence to fruit and vegetable (AOR [adjusted odds ratio] 5.2, 95% CI 1.68-16.30; p = 0.004), fiber (AOR 2.2, 95% CI 1.06-4.37; p = 0.04), and ultra-processed foods (AOR 2.8, 95% CI 1.30-6.21; p = 0.01) consumption recommendations were associated with up-to-date colonoscopy screening. Having insurance versus being uninsured (AOR 10.8, 95% CI 3.83-30.62; p < 0.001) and having local medical care versus in Mexico (AOR 7.0, 95% CI 2.26-21.43; p < 0.001) were associated with up-to-date colonoscopy. CONCLUSIONS Adherence to dietary lifestyle recommendations was associated with being up-to-date with colonoscopy screenings. Those with poor dietary behavior are at risk for low-colonoscopy use. Improving lifestyle behaviors may complement colonoscopy promotion interventions. Healthcare accessibility influences up-to-date colonoscopy prevalence. Our findings can inform cancer prevention strategies for the Hispanic population.
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Affiliation(s)
- Paul Gerardo Yeh
- Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health, 1200 Pressler Street RAS E-311, Houston, TX, 77030, USA.
| | - Audrey C Choh
- Department of Epidemiology, University of Texas Health Science Center School of Public Health, Brownsville Regional Campus, Brownsville, TX, USA
| | - Susan P Fisher-Hoch
- Department of Epidemiology, University of Texas Health Science Center School of Public Health, Brownsville Regional Campus, Brownsville, TX, USA
| | - Joseph B McCormick
- Department of Epidemiology, University of Texas Health Science Center School of Public Health, Brownsville Regional Campus, Brownsville, TX, USA
| | - David R Lairson
- Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health, 1200 Pressler Street RAS E-311, Houston, TX, 77030, USA
| | - Belinda M Reininger
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center School of Public Health, Brownsville Regional Campus, Brownsville, TX, USA
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Layne TM, Agarwal P, Rapkin BD, Jandorf LH, Bickell NA. Cancer beliefs and screening behaviors: The impact of neighborhood and other social determinants of health. Front Oncol 2023; 13:1072259. [PMID: 36776291 PMCID: PMC9911808 DOI: 10.3389/fonc.2023.1072259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/04/2023] [Indexed: 01/28/2023] Open
Abstract
Background Beliefs about cancer influence breast and colorectal cancer (CRC) screening behavior. Screening rates for these cancers differ in the contiguous neighborhoods of East Harlem (EH), Central Harlem (CH), and the Upper East Side (UES), which have distinct socio-demographic compositions. We assessed the belief-screening behavior relationship in these neighborhoods. Methods The 2019 Community Cancer Needs Survey included adults eligible for breast and/or colorectal cancer screening. Raking was used to generate neighborhood-specific distribution estimates. Categorical variables were compared using Chi-square tests. Stepwise logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between cancer beliefs and screening. Results Our weighted sample included 147,726 respondents. Screening was 75% in CH, 81% in EH, and 90% in the UES for breast cancer, and 71%, 76%, and 92% for CRC, respectively. The fatalistic belief "There's not much you can do to lower your chances of getting cancer" differed by neighborhood with screening more likely in CH respondents (breast OR =1.45 and colorectal OR =1.11), but less likely in EH (OR= 0.77 and 0.37, respectively). UES ORs were not generated due to too few unscreened respondents. Conclusions Cancer beliefs were inconsistently associated with breast and CRC screening across three NYC neighborhoods. This suggests that a given belief may either motivate or deter screening, depending upon context or interpretation. Once access is addressed, efforts seeking to enhance screening rates should consider implications of communities' varying beliefs.
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Affiliation(s)
- Tracy M. Layne
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology, and Reproductive Science, the Blavatnik Family Women’s Health Research Institute and the Center for Scientific Diversity at the Icahn School of Medicine at Mount Sinai, New York, NY, United States,*Correspondence: Tracy M. Layne,
| | - Parul Agarwal
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States,The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bruce D. Rapkin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, United States,Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, NY, United States
| | - Lina H. Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States,The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nina A. Bickell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States,The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Ratnapradipa K, Watanabe-Galloway S, Hymel E, High R, Farazi PA. Predictors of behavioral cancer risk factors and preventive behaviors among Nebraskans. Cancer Epidemiol 2022; 81:102264. [PMID: 36195016 DOI: 10.1016/j.canep.2022.102264] [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: 06/30/2022] [Revised: 09/02/2022] [Accepted: 09/16/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND The overall incidence rate of cancer in Nebraska is higher than the national average with cancer being the second leading cause of death in the state. Interventions are required to reduce the cancer burden; however, further research is first needed to identify behavioral cancer risk factors and preventive behaviors among Nebraskans that can be targeted. METHODS A statewide cross-sectional survey of Nebraskans aged 19 and older was conducted in 2019 using an address-based sampling method (n = 1640). Multivariable logistic regression was used to examine factors associated with being up-to-date on cancer screening and with behavioral cancer risk factors and preventive behaviors. RESULTS 93.42% of Nebraskans did not meet the daily recommended consumption of fruits and vegetables, and 71.51% did not meet weekly physical activity guidelines. The proportion of adults up to date on cancer screening was 64.57% for breast, 68.83% for cervical, 69.01% for colorectal, and 24.07% for skin cancers. Individuals 65-74 (OR: 3.40, 95% CI: 1.52-7.62) and 75 or older (OR: 3.30, 95% CI: 1.35-8.07) were more likely to be current with their colorectal cancer screening compared to ages 50-64. Hispanics were less likely to be current with mammograms (OR: 0.06, 95% CI: 0.01-0.71) and ever screened for cervical cancer (OR:0.13, 95% CI: 0.02-0.94) compared to Non-Hispanic Whites. CONCLUSIONS Disparities in cancer screening and risk and preventive behaviors exist in Nebraska. IMPACT The study highlights a need for continuing efforts to improve preventive cancer behaviors for the entire population as well as some high-risk populations in Nebraska.
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Affiliation(s)
- Kendra Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, United States
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, United States
| | - Emma Hymel
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, United States
| | - Robin High
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, United States
| | - Paraskevi A Farazi
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, United States.
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De Jesus M, Ramachandra S, De Silva A, Liu S, Dubnansky E, Iyawe K, Jimenez A, Logie L, Jackson MC. A Mobile Health Breast Cancer Educational and Screening Intervention Tailored for Low-Income, Uninsured Latina Immigrants. WOMEN'S HEALTH REPORTS 2021; 2:325-336. [PMID: 34476415 PMCID: PMC8409237 DOI: 10.1089/whr.2020.0112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 12/20/2022]
Abstract
Objective: To investigate the efficacy of mobile health (mHealth) intervention strategies that delivered either personalized, culturally, and linguistically tailored cell phone voice messages or text messages related to breast cancer and prevention, compared to the control group, to determine which strategy is more likely to increase breast cancer knowledge and screening mammography among low-income Latina immigrants. Methods: This randomized controlled trial assigned 256 Latina immigrants 40 years of age or older to one of three groups: an automated cell phone voice message group, an automated text message group, or the control group (mail). The mHealth intervention employed a comprehensive approach that included breast cancer and prevention education and free mammography screening. Outcome measures included knowledge of breast cancer and breast cancer prevention, and adherence to screening mammography. Results: There was a general increase in breast cancer knowledge after the educational intervention for all the groups [p = 0.01, t(199) = 3.996]. Knowledge increase and mammography adherence did not differ based on group. Conclusion: More important than the actual method of communication is how breast cancer and prevention messages are constructed, who the messenger is, and the enabling factors that facilitate screening adherence. A breast cancer preventive intervention program that is personalized, culturally and linguistically tailored, and offers a free or low-cost mammogram holds promise to be an effective method in reaching an underserved Latina population with a high breast cancer burden.
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Affiliation(s)
- Maria De Jesus
- Center on Health, Risk, and Society, School of International Service, American University, Washington, District of Columbia, USA
| | - Shalini Ramachandra
- Department of Mathematics and Statistics, American University, Washington, District of Columbia, USA
| | - Alexis De Silva
- Department of Mathematics and Statistics, American University, Washington, District of Columbia, USA
| | - Shirley Liu
- Department of Mathematics and Statistics, American University, Washington, District of Columbia, USA
| | - Ethan Dubnansky
- Department of Mathematics and Statistics, Connecticut College, New London, Connecticut, USA
| | - Kingsley Iyawe
- Department of Mathematics and Statistics, American University, Washington, District of Columbia, USA
| | | | | | - M C Jackson
- Department of Mathematics and Statistics, American University, Washington, District of Columbia, USA
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Park SJ, Wai A, Pavithran K, Kunheri B, Valsraj K. Cancer and severe mental illness in low- and middle-income countries: The challenges and outlook for the future. Psychooncology 2021; 30:2002-2011. [PMID: 34449954 DOI: 10.1002/pon.5796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/18/2021] [Accepted: 08/09/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Patients with severe mental illness (SMI) face health inequalities that lead to under treatment of diseases such as cancer and result in increased mortality. There is literature addressing this issue for SMI patients in high-income countries but few for those in low- and middle-income countries. This review aims to draw attention to the health inequalities and the compounding factors faced by SMI patients in low- and middle-income countries. The relevance of integration of psycho-oncology in the care of SMI patients with cancer is integral to reduce disparities and address varied contributory factors. METHODS The literature review was conducted by searching through two databases which includes PubMed and Google Scholar. We searched for articles using keyword search terms: severe mental illness, SMI, schizophrenia, bipolar disorder, cancer, low- middle-income countries, low- and middle-income countries, psycho-oncology, HPV vaccine, cancer incidence, cancer mortality, cancer control, cancer screening, cancer treatment and palliative care. RESULTS A total of 80 research articles were included in our literature review. We found that there was an increased requirement for adapting to the changing disease landscape in low- and middle-income countries. An improvement on aspects such as vaccination, screening and prevention is necessary, and also efforts to change social stance towards SMI is crucial. CONCLUSION There is an increase incidence of cancer in low- and middle-income countries, and the number of patients with SMI in low- and middle-income countries is also rising. This is due to social, psychological, economical and healthcare factors. Low- and middle-income countries must consider improving these aspects in order to adapt to the changing landscape.
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Affiliation(s)
- Sung Jin Park
- Department of Academic Psychiatry, Institute of Psychiatry, Psychology and Neurosciences at King's College London, London, UK
| | - Alisa Wai
- Department of Academic Psychiatry, Institute of Psychiatry, Psychology and Neurosciences at King's College London, London, UK
| | - Keechilat Pavithran
- Department of Medical Oncology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | | | - Koravangattu Valsraj
- Department of Academic Psychiatry, Institute of Psychiatry, Psychology and Neurosciences at King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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De Jesus M, Rodrigue CM, Rahmani S, Balamou C. Addressing Cancer Screening Inequities by Promoting Cancer Prevention Knowledge, Awareness, Self-Efficacy, and Screening Uptake Among Low-Income and Illiterate Immigrant Women in France. Int J Public Health 2021; 66:1604055. [PMID: 34744595 PMCID: PMC8565258 DOI: 10.3389/ijph.2021.1604055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Cancer screening rates are suboptimal for disadvantaged populations in France, yet little evidence exists on their cancer-related knowledge and screening barriers. The main objective of this study was to examine cancer-related knowledge, awareness, self-efficacy, and perceptions of screening barriers among low-income, illiterate immigrant women in France following an 8-weeks cancer educational intervention. Methods: Semi-structured qualitative interviews were conducted with 164 female participants in the Ain department of France between January 2019 and March 2020. Adopting the Health Belief Model as an intervention and analytic framework, salient themes were identified using qualitative thematic analysis. Results: Increased levels of perceived susceptibility to and perceived severity of cancer contributed to higher motivation to get screened. Barriers to screening included low French proficiency, shame surrounding illiteracy, and constant worries due to precarious living conditions. Perceived benefits (e.g., valuing one's health and health-promoting behaviors), cues to action from a trusted source, and greater self-efficacy (e.g., more autonomous in healthcare-seeking) outweighed perceived barriers, including cultural barriers. Conclusions: Implications include developing audience-responsive targeted cancer screening communication strategies and educational materials to increase screening rates and reduce cancer and cancer screening inequities.
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Affiliation(s)
- Maria De Jesus
- Collegium de Lyon, Université de Lyon, Lyon, France
- School of International Service, American University, Washington, DC, United States
- Center on Health, Risk, and Society, American University, Washington, DC, United States
| | - Christelle M. Rodrigue
- Centre Régional de Coordination des Dépistages des Cancers Auvergne-Rhône-Alpes (CRCDC AuRA), Site de l’Ain Bourg-en-Bresse, France
| | - Sarah Rahmani
- Centre Régional de Coordination des Dépistages des Cancers Auvergne-Rhône-Alpes (CRCDC AuRA), Site de l’Ain Bourg-en-Bresse, France
| | - Christian Balamou
- Centre Régional de Coordination des Dépistages des Cancers Auvergne-Rhône-Alpes (CRCDC AuRA), Site de l’Ain Bourg-en-Bresse, France
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A lay health worker intervention to improve breast and cervical cancer screening among Latinas in El Paso, Texas: A randomized control trial. Prev Med 2021; 145:106446. [PMID: 33548363 DOI: 10.1016/j.ypmed.2021.106446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION We examined the effectiveness of a lay health worker (promotora)-delivered intervention on increasing breast and cervical cancer screening among low-income, primarily uninsured Latinas living in El Paso, Texas. METHODS In 2015, Breast and Cervical Cancer Screening (BCCS) program promotoras recruited Latinas overdue for breast and/or cervical cancer screening in community settings. Promotoras consented eligible women and conducted baseline surveys before individually randomizing women into control (n = 313) or intervention (n = 314) groups. Control participants received printed material providing basic information about breast and cervical cancer screening.Intervention participants received promotora-delivered one-on-one breast and cervical cancer screening education followed by navigation calls, providing assistance to address personal and logistic barriers to accessing clinical services. We assessed breast and cervical cancer screening outcomes using a 6-month follow-up survey. Per protocol (PP) and intent to treat (ITT) analyses are reported. RESULTS At follow-up, among women in need of breast cancer screening, those in the intervention group were significantly more likely to complete a mammogram than those in the control group (PP: 53.4% vs. 40.1%, p = .013; ITT: 47.9% vs. 35.2%, p = .011). Among women in need of Pap screening, only intervention group women 50 years and older were more likely to complete a Pap screening compared with control group women (PP: 64.5% vs. 43.5%, p = .019). CONCLUSIONS A promotora-delivered behavioral intervention, embedded in a community-based organization, increased mammography uptake in all women and Pap uptake among women 50 years and older in a sample of low-income Latinas. NCT04397744.
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Enhancing equitable access to cancer information for culturally and linguistically diverse (CALD) communities to complement beliefs about cancer prognosis and treatment. Support Care Cancer 2021; 29:5957-5965. [PMID: 33768373 DOI: 10.1007/s00520-021-06125-9] [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: 08/09/2020] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Populations affected by cancer from culturally and linguistically diverse (CALD) backgrounds with low English proficiency have poorer health outcomes than the Australian population. They also have limited access to cancer information and may hold health beliefs that affect health-seeking behaviour. A leading cancer support organisation in Australia conducted research with the largest language groups in Australia with the lowest English proficiency to guide the development of appropriate translated resources. METHOD Six focus groups were conducted with Arabic, Chinese (Mandarin and Cantonese) and Vietnamese speaking cancer survivors, carers and those significantly affected by cancer to understand their health beliefs, information needs and preferred modes of access. Thirteen interviews were also conducted with service providers supporting these communities. RESULTS Communities lacked access to, and knowledge of, cancer information in their language on Australian cancer-related websites. They had easier access to information in their language from overseas health and local ethnic organisations, and from family and friends. Participants trusted health professionals but were dissatisfied with the information and care provided. Cultural beliefs, combined with a lack of information in their language, were not conducive to accessing appropriate information. The impact of beliefs about fate was significant, but they did not rule out using Western treatment or actively seeking cancer information. CONCLUSIONS The results reinforce the need to fully explore the cultural beliefs and the structural barriers to accessing cancer information. They also demonstrate that religious-based fatalistic beliefs need not prevent access to information but can co-exist with Western medical treatments.
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Tatari CR, Andersen B, Brogaard T, Badre-Esfahani SK, Jaafar N, Kirkegaard P. Perceptions about cancer and barriers towards cancer screening among ethnic minority women in a deprived area in Denmark - a qualitative study. BMC Public Health 2020; 20:921. [PMID: 32532227 PMCID: PMC7291658 DOI: 10.1186/s12889-020-09037-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/03/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Screening programmes for cervical cancer, breast cancer and colorectal cancer have been implemented in many Western countries to reduce cancer incidence and mortality. Ethnic minority women are less likely to participate in cancer screening than the majority population. In worst case this can result in higher incidence rates, later diagnosis and treatment and ultimately inferior survival. In this paper we explored the perceptions about cancer and perceived barriers towards cancer screening participation among ethnic minority women in a deprived area in Denmark. METHODS Interview study with ethnic minority women in a deprived area in Denmark. The interviews were transcribed verbatim followed by an inductive content analysis. RESULTS Cancer was perceived as a deadly disease that could not be treated. Cancer screening was perceived as only relevant if the women had symptoms. Knowledge about cancer screening was fragmented, often due to inadequate Danish language skills and there was a general mistrust in the Danish healthcare system due to perceived low medical competences in Danish doctors. There was, however, a very positive and curious attitude regarding information about the Danish cancer screening programmes and a want for more information. CONCLUSION Ethnic minority women did not have sufficient knowledge about cancer and the purpose of cancer screening. Perceptions about cancer screening were characterised by openness and the study showed positive and curious attitudes towards screening participation. The findings emphasise the importance of culturally adapted interventions for ethnic minority women in attempts to reduce inequality in screening participation.
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Affiliation(s)
- Camilla Rahr Tatari
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark.
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Sara Koed Badre-Esfahani
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Negin Jaafar
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Pia Kirkegaard
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
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Adunlin G, Cyrus JW, Asare M, Sabik LM. Barriers and Facilitators to Breast and Cervical Cancer Screening Among Immigrants in the United States. J Immigr Minor Health 2019; 21:606-658. [PMID: 30117005 DOI: 10.1007/s10903-018-0794-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To summarize the literature on barriers and facilitators to breast and cervical cancer screening among immigrants to the US. A literature review was conducted for studies on breast and cervical cancer screening among immigrant populations. A thematic analysis of 180 studies identified a variety of barriers and facilitators to screening at the personal and system levels. Personal barriers included lack of knowledge and insurance coverage, high cost of care, and immigration status. System barriers included poor access to services, lack of interpreter services, and insensitivity to patient needs. Facilitators to screening included knowledge of disease, access to information sources, physician recommendation, and social networks. Cultural norms and resource availability at the individual and system levels influence screening among immigrants. Health insurance coverage was found to be an important predictor of preventative screening use. Future research should seek to identify the best way to address this and other barriers to cancer screening among immigrants groups.
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Affiliation(s)
- Georges Adunlin
- McWhorter School of Pharmacy, Samford University, 2100 Lakeshore Dr, Homewood, AL, 35229, USA.
| | - John W Cyrus
- Tompkins-McCaw Library, Virginia Commonwealth University, 509 N 12th St, Richmond, VA, 23298-0430, USA
| | - Matthew Asare
- Department of Public Health, Baylor University, One Bear Place #97313, Waco, TX, 76798-7313, USA
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, 130 De Soto St., Pittsburgh, PA, 15261, USA
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Ertl MM, Rentería R, Dillon FR, Babino R, De La Rosa M, Brenner RE. Longitudinal associations between marianismo beliefs and acculturative stress among Latina immigrants during initial years in the United States. J Couns Psychol 2019; 66:665-677. [PMID: 31219267 PMCID: PMC6813856 DOI: 10.1037/cou0000361] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Acculturative stress is commonly experienced among Latinx immigrants in the United States who may feel pressured to maintain their heritage cultural norms and beliefs and/or adopt norms and beliefs of the dominant culture. The present study examined longitudinal relations between acculturative stress and endorsement of traditional Latina gender role beliefs (i.e., marianismo). We determined strength of the relations and temporal precedence of acculturative stress and endorsement of marianismo across 3 time points during participants' initial 3 years in the United States using a random intercept cross-lagged panel model. Participants were 530 Latina young adult women (ages 18-23) recruited from Miami-Dade County, Florida. Results suggested that acculturative stress levels at Time 1 positively predicted endorsement of the Family Pillar belief at Time 2, but acculturative stress levels at Time 2 negatively predicted the Virtuous and Chaste and Subordinate to Others beliefs at Time 3. In terms of marianismo beliefs predicting acculturative stress levels over time, the Virtuous and Chaste belief at Time 1 positively predicted acculturative stress at Time 2, and the Silencing Self to Maintain Harmony belief at Time 2 positively predicted acculturative stress at Time 3. Findings suggest that the Family Pillar belief, or feeling responsibility for the family's unity, may be protective against acculturative stress over time. Endorsing certain gender role beliefs (i.e., Virtuous and Chaste, Subordinate to Others) may lead to greater acculturative stress, and Latina young adult women experiencing acculturative stress may alter their endorsement of marianismo beliefs in an attempt to resolve culturally conflicting stress experienced after immigration. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Barriers to mammography screening among racial and ethnic minority women. Soc Sci Med 2019; 239:112494. [PMID: 31513931 DOI: 10.1016/j.socscimed.2019.112494] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 07/04/2019] [Accepted: 08/13/2019] [Indexed: 11/21/2022]
Abstract
RATIONALE Breast cancer is the second leading cause of cancer death among women. Disparities in breast cancer mortality rates adversely affect racial/ethnic minority women. Mammography screening is the most effective early detection method and means of reducing mortality rates. Yet, barriers prevent racial/ethnic minority women from participating in regular screening. OBJECTIVE This review aimed to summarize self-reported barriers to mammography screening in racial/ethnic minority women in studies using open-ended assessments and closed-ended assessments. METHOD Literature searches were conducted in two databases, PsycINFO and PubMed. Barriers were detailed in full by barrier type (psychological/knowledge-related, logistical, cultural/immigration-related, and social/interpersonal) and summarized briefly by race/ethnicity (African American/Black, Asian/Pacific Islander, Hispanic, American Indian/Native American, and Middle Eastern). RESULTS Twenty-two open-ended and six closed-ended studies were identified as eligible for this review. Overall, racial/ethnic minority women identified common logistical and psychological/knowledge-related barriers. Additionally, women reported cultural/immigration-related and social/interpersonal barriers that were closely tied to their racial/ethnic identities. CONCLUSIONS It was concluded that cultural/immigration-related barriers may be the only barrier type that is unique to racial/ethnic minority women. Thus, designing studies of barriers around race and ethnicity is not always appropriate, and other demographic factors are sometimes a more important focus. The variability in 'barrier' definitions, how data were collected and reported, and the appropriateness of closed-ended measures were also examined. This literature may benefit from detailed and strategically designed studies that allow more clear-cut conclusions and better comparison across studies as well as improving closed-ended measures by incorporating insights from investigations using open-ended inquiry.
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Luque JS, Logan A, Soulen G, Armeson KE, Garrett DM, Davila CB, Ford ME. Systematic Review of Mammography Screening Educational Interventions for Hispanic Women in the United States. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:412-422. [PMID: 29330754 PMCID: PMC6043417 DOI: 10.1007/s13187-018-1321-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the United States (U.S.), Hispanics experience breast cancer disparities. Breast cancer is the leading cause of cancer-related death among Hispanic women, and Hispanic women receive mammography screening at lower rates than some other ethnic groups. This low rate of screening mammography is associated with increased risk for possible late-stage diagnosis and lower survival rates. Educational interventions could play a role in increasing screening mammography rates among Hispanic women. This systematic review synthesized the current literature on educational interventions to increase mammography screening among Hispanic women. The review included studies published between May 2003 and September 2017 with experimental and quasi-experimental interventions to increase mammography screening among Hispanics in the U.S. Five studies out of an initial 269 studies met inclusion criteria for the review. All studies employed an interpersonal intervention strategy with community health workers, or promotoras, to deliver the mammography screening intervention. For each study, odds ratios (OR) were calculated to estimate intervention effectiveness based on similar follow-up time periods. The study ORs resulted in a narrow range between 1.02 and 2.18, indicating a low to moderate intervention effect for these types of interpersonal cancer education interventions. The summary OR for the random effects model was 1.67 (CI 1.24-2.26). Hispanics exhibit lower levels of adherence to screening mammography than non-Hispanic whites. Interpersonal cancer education interventions such as the use of promotoras may help to mediate the impact of barriers to receiving a mammogram such as low health literacy, deficits in knowledge about the benefits of screening, and low awareness of the availability of screening services.
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Affiliation(s)
- John S Luque
- Institute of Public Health, Science Research Center, Florida A&M University, 1515 South MLK Blvd. Suite 207B, Tallahassee, FL, 32307, USA.
| | - Ayaba Logan
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Grace Soulen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kent E Armeson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | | | - Caroline B Davila
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Marvella E Ford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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Kwok C, Lee MJ, Lee CF. Breast Cancer Perceptions and Screening Behaviours Among Korean Women in Australia. J Immigr Minor Health 2019; 22:126-133. [DOI: 10.1007/s10903-019-00876-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hou SI, Cao X. A Systematic Review of Promising Strategies of Faith-Based Cancer Education and Lifestyle Interventions Among Racial/Ethnic Minority Groups. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1161-1175. [PMID: 28905305 DOI: 10.1007/s13187-017-1277-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Church-based interventions have been used to reach racial/ethnic minorities. In order to develop effective programs, we conducted a comprehensive systematic review of faith-based cancer prevention studies (2005~2016) to examine characteristics and promising strategies. Combination terms "church or faith-based or religion," "intervention or program," and "cancer education or lifestyle" were used in searching the five major databases: CINAHL; ERIC; Health Technology Assessments; MEDLINE; and PsycInfo. A total of 20 studies met study criteria. CDC's Community Guide was used to analyze and review group interventions. Analyses were organized by two racial groups: African American (AA) and Latino/Hispanic American groups. Results showed most studies reviewed focused on breast cancer alone or in combination with other cancers. Studies of Latino/Hispanic groups targeted more on uninsured, Medicare, or Medicaid individuals, whereas AA studies generally did not include specific insurance criteria. The sample sizes of the AA studies were generally larger. The majority of these studies reviewed used pre-post, posttest only with control group, or quasi-experience designs. The Health Belief Model was the most commonly used theory in both groups. Community-based participatory research and empowerment/ecological frameworks were also used frequently in the Latino/Hispanic studies. Small media and group education were the top two most popular intervention strategies in both groups. Although one-on-one strategy was used in some Latino studies, neither group used reducing client out-of-pocket costs strategy. Client reminders could also be used more in both groups as well. Current review showed church-based cancer education programs were effective in changing knowledge, but not always screening utilization. Results show faith-based cancer educational interventions are promising. To maximize intervention impact, future studies might consider using stronger study designs, incorporating a variety of proven effective strategies, including those frequently used evidence-based strategies, as well as exploring promising strategies among specific target groups.
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Affiliation(s)
- Su-I Hou
- Doctoral Program in Public Affairs/Health Management & Informatics, College of Health & Public Affairs, University of Central Florida, HPA I, Room 217, 12805 Pegasus Drive, Orlando, FL, 32816-1600, USA.
| | - Xian Cao
- Doctoral Program in Public Affairs/Health Management & Informatics, College of Health & Public Affairs, University of Central Florida, HPA I, Room 217, 12805 Pegasus Drive, Orlando, FL, 32816-1600, USA
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Ramírez AS, Arellano Carmona K. Beyond fatalism: Information overload as a mechanism to understand health disparities. Soc Sci Med 2018; 219:11-18. [PMID: 30342382 PMCID: PMC6240483 DOI: 10.1016/j.socscimed.2018.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 10/03/2018] [Accepted: 10/12/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Fatalism - beliefs about the causes and controllability of disease - has been negatively associated with prevention behaviors. Fatalism has been suggested as a mechanism for health disparities because ethnic minorities are especially likely to hold fatalistic beliefs. However, the construct has been criticized: Fatalism fails to account for structural barriers to health faced by vulnerable populations that also score highly on measures of fatalism. Another critique suggests that operationalizations of fatalism expose communication failures: "Fatalism" rather reflects information overload from an environment riddled with misinformation and contradictions. This study aimed to expand understanding of one mechanism through which communication may contribute to disparities by considering the context of nutrition among bicultural Latinas, who face increased risk from dietary acculturation. METHOD Mixed-methods (semi-structured in-depth interview, survey) with Mexican-American women ages 18-29 (n = 24) in rural California. RESULTS Contrary to previous studies, the majority of this sample of Mexican-American women did not endorse fatalistic beliefs; most demonstrated clear understanding of the link between diet and risk of diseases: Diabetes and heart disease were understood to result from behaviors within one's control. Yet despite articulating links between diet and disease, participants felt overloaded and confused about conflicting information from public and interpersonal sources. Moreover, despite reporting feeling inundated with information, participants noted critical information gaps, distinguishing between information available and information needed. CONCLUSIONS We found minimal support for fatalistic beliefs among a sample of Mexican-American women, but considerable information overload and confusion, together with a desire for specific knowledge and skills. Results extend understanding of how communication may influence disparities: Information overload may be conflated with fatalism, challenging the notion that fatalism is a cultural belief. Moreover, inequalities in access to and ability to process information compound overload effects. We discuss opportunities to improve the clarity of communication about nutrition science and dietary recommendations.
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Affiliation(s)
- A Susana Ramírez
- School of Social Sciences, Humanities, and Arts, University of California, Merced 5200 North Lake Road, Merced, CA, 95343, USA.
| | - Kimberly Arellano Carmona
- School of Social Sciences, Humanities, and Arts, University of California, Merced 5200 North Lake Road, Merced, CA, 95343, USA.
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Jerome-D’Emilia B, Gachupin FC, Suplee PD. A Systematic Review of Barriers and Facilitators to Mammography in American Indian/Alaska Native Women. J Transcult Nurs 2018; 30:173-186. [DOI: 10.1177/1043659618793706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The purpose of this systematic review was to synthesize the current knowledge of factors that enable or impede American Indian and Alaska Native (AI/AN) women from accessing breast cancer screening. Methodology: A systematic search of MEDLINE and CINAHL databases identified relevant research studies published from 2007 to 2017. Results: Consistent with other low-income populations, socioeconomic factors were related to lower rates of screening in AI/AN women. However, some factors, such as reliance on the Indian Health Service, cultural issues, and traditionality were unique to this population. Discussion: AI/AN women appear to face many of the difficulties that other low-income minority women face in accessing preventive care; however, they may face unique challenges and circumstances in accessing care. Efforts to work with tribes in the development of interventions framed by community-based participatory research are needed to tackle the disparities in the AI/AN community.
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Dillon FR, Ertl MM, Corp DA, Babino R, De La Rosa M. Latina young adults' use of health care during initial months in the United States. Health Care Women Int 2018; 39:343-359. [PMID: 29043912 PMCID: PMC6089526 DOI: 10.1080/07399332.2017.1388382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We examined social ecological predictors of health care utilization among Latina young adults during their initial year after immigration to the United States. Participants were 530 Latinas (ages 18-23) who immigrated to Miami-Dade County, Florida, 11.5 months before assessment. We used multiple logistic regression to test predictors of health care usage. Approximately 36% utilized care. Dimensions of marianismo differentially associated with usage. Usage also was more likely for participants who reported more social network attachment, better health, greater neighborhood cohesion, and possessed a job and health insurance. Findings inform interventions to increase health care usage globally among women after immigration.
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Affiliation(s)
- Frank R Dillon
- a Department of Counseling & Counseling Psychology , Arizona State University , Tempe , Arizona , USA
| | - Melissa M Ertl
- b Department of Educational & Counseling Psychology , University at Albany, State University of New York , Albany , New York , USA
| | - Dylan A Corp
- b Department of Educational & Counseling Psychology , University at Albany, State University of New York , Albany , New York , USA
| | - Rosa Babino
- c Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University , Miami , Florida , USA
| | - Mario De La Rosa
- c Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University , Miami , Florida , USA
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Sinky TH, Faith J, Lindly O, Thorburn S. Cancer Fatalism and Preferred Sources of Cancer Information: an Assessment Using 2012 HINTS Data. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:231-237. [PMID: 27650861 DOI: 10.1007/s13187-016-1115-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cancer fatalism is associated with lower participation in cancer screening, nonadherence to cancer screening guidelines, and avoidance of medical care. Few studies, however, have examined the relationship between cancer fatalism and health information seeking. The purpose of this study was to examine the relationship between endorsement of fatalistic beliefs regarding cancer and preferred sources of cancer information. We analyzed data from the Health Information National Trends Survey 4 Cycle 2, which were collected in late 2012 and early 2013 (N = 3630). When weighted, the data are representative of the non-institutionalized US population aged 18 or older. In bivariate and multivariate analyses, we assessed three cancer fatalism beliefs as predictors of preferred use of healthcare provider versus preferred use of the Internet for cancer information. Results indicate the majority of US adults endorse one or more fatalistic beliefs about cancer. Unadjusted results indicate endorsing the fatalistic belief that "there's not much you can do to lower your chances of getting cancer" was significantly associated with lower odds of preferring the Internet (versus healthcare providers) as the source of cancer information (OR: 0.70; CI: 0.50, 0.98). In the adjusted model, however, none of the three cancer fatalism measures were significantly associated with preferred source of cancer information. In conclusion, fatalistic beliefs about cancer are common, and further research is warranted to understand cancer fatalism and whether and how it may impact health information-seeking behaviors.
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Affiliation(s)
- Tassnym H Sinky
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR, 97331-6406, USA.
| | - Jennifer Faith
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR, 97331-6406, USA
| | - Olivia Lindly
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR, 97331-6406, USA
| | - Sheryl Thorburn
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR, 97331-6406, USA
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Luque JS, Tarasenko YN, Bryant DC, Davila C, Soulen G. An Examination of Sociocultural Factors Associated With Mammography Screening Among Latina Immigrants. HISPANIC HEALTH CARE INTERNATIONAL 2017; 15:113-120. [PMID: 29164938 DOI: 10.1177/1540415317726952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The study hypothesized that sociocultural factors would be associated with breast cancer screening within the past 2 years among Latina immigrant women. METHOD This study employed a survey design and included 82 Latina immigrant female participants 40 to 64 years of age for the analysis. Two multivariable binary logistic regression models were estimated, one for the sociocultural deterrents and the other for the symptomatic deterrents from the Cultural Cancer Screening Scale. RESULTS The results indicated two constructs of the Cultural Cancer Screening Scale, sociocultural deterrents (odds ratio = 2.00; 95% confidence interval = 1.04-3.86) and symptomatic deterrents (odds ratio = 1.65; 95% confidence interval = 1.08-2.54), were associated with screening in the past 2 years, when adjusting for sociodemographic and health-related characteristics. CONCLUSION These findings provide evidence for the importance of sociocultural factors in Latina immigrant women's timely mammography screening.
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Affiliation(s)
- John S Luque
- 1 Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | - Grace Soulen
- 1 Medical University of South Carolina, Charleston, SC, USA
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Madhivanan P, Valderrama D, Krupp K, Ibanez G. Family and cultural influences on cervical cancer screening among immigrant Latinas in Miami-Dade County, USA. CULTURE, HEALTH & SEXUALITY 2015; 18:710-722. [PMID: 26671002 DOI: 10.1080/13691058.2015.1116125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cervical cancer disproportionately affects minorities, immigrants and low-income women in the USA, with disparities greatest among Latino immigrants. We examined barriers and facilitators to cervical cancer screening practices among a group of immigrant Latino women in Florida, USA. Between January and May 2013, six focus group discussions, involving 35 participants, were conducted among Hispanic women in Miami to explore their knowledge, beliefs about cervical cancer and facilitators and barriers to cervical cancer screening using a theoretical framework. The data showed that family support, especially from female relatives, was an important facilitator of screening and treatment. Women, however, reported prioritising family health over their own, and some expressed fatalistic beliefs about cancer. Major obstacles to receiving a Pap smear included fear that it might result in removal of the uterus, discomfort about being seen by a male doctor and concern that testing might stigmatise them as being sexually promiscuous or having a sexually transmitted disease. Targeted education on cancer and prevention is critically needed in this population. Efforts should focus on women of all ages since younger women often turn to older female relatives for advice.
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Affiliation(s)
- Purnima Madhivanan
- a Department of Epidemiology , Robert Stempel College of Public Health & Social Work, Florida International University , USA
| | - Diana Valderrama
- a Department of Epidemiology , Robert Stempel College of Public Health & Social Work, Florida International University , USA
| | - Karl Krupp
- b Department of Health Promotion and Disease Prevention , Robert Stempel College of Public Health & Social Work, Florida International University , USA
| | - Gladys Ibanez
- a Department of Epidemiology , Robert Stempel College of Public Health & Social Work, Florida International University , USA
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Witharana C, Wijesiriwardhana P, Jayasekara K, Kumari P, Rodrigo C. Awareness of female malignancies among women and their partners in Southern Sri Lanka and implications for screening: a cross sectional study. BMC Public Health 2015; 15:1179. [PMID: 26608133 PMCID: PMC4660802 DOI: 10.1186/s12889-015-2531-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 11/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidences of breast, cervical and uterine malignancies continue to increase in Sri Lanka. It is important to explore the awareness of both women and their male partners regarding these malignancies and available screening services as it would determine the health seeking behaviours of females. METHODS This was a cross sectional survey of couples residing in the Galle District of the Southern province of Sri Lanka. The sample was selected from all 17 health administrative divisions of the district. An interviewer administered questionnaire was used to collect data on demography and level of awareness (risk factors, symptoms, signs, screening services) of breast, cervical and uterine cancers. Same questionnaire was used for both sexes except for gender specific questions. RESULTS A total of 282 (n-282, 564 individuals) couples were interviewed. The level of awareness regarding all malignancies was low. More than 50% of participants in both sexes scored less than half the points on a questionnaire testing awareness. Better family income, better education and permanent employment showed a significant association with better awareness in both sexes (univariate analysis). Encouragement by male partner was associated with better participation in some instances. CONCLUSIONS Community based health education on female malignancies needs to target both sexes. Educating males is important as, i) male partners can encourage females to utilize screening services and ii) some screening and preventive measures are relevant to males also. Better awareness of males may increase the uptake of screening services by females in societies with male dominant gender roles.
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Affiliation(s)
- Chamindri Witharana
- Allied Health Sciences, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
| | | | - Kalani Jayasekara
- Allied Health Sciences, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
| | - Priyanka Kumari
- Allied Health Sciences, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
| | - Chaturaka Rodrigo
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo 08, Sri Lanka.
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