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Spees LP, Jackson BE, Raveendran Y, Morris HN, Emerson MA, Baggett CD, Bell RA, Salas AI, Meernik C, Akinyemiju TF, Wheeler SB. Characterizing Cancer Burden in the American Indian Population in North Carolina. Cancer Epidemiol Biomarkers Prev 2024; 33:838-845. [PMID: 38578081 PMCID: PMC11147726 DOI: 10.1158/1055-9965.epi-24-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/27/2024] [Accepted: 04/03/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The American Indian (AI) population in North Carolina has limited access to the Indian Health Service. Consequently, cancer burden and disparities may differ from national estimates. We describe the AI cancer population and examine AI-White disparities in cancer incidence and mortality. METHODS We identified cancer cases diagnosed among adult AI and White populations between 2014 and 2018 from the North Carolina Central Cancer Registry. We estimated incidence and mortality rate ratios (IRR and MRR) by race. In addition, between the AI and White populations, we estimated the ratio of relative frequency differences [RRF, with 95% confidence limits (CL)] of clinical and sociodemographic characteristics. Finally, we evaluated the geographic distribution of incident diagnoses among AI populations. RESULTS Our analytic sample included 2,161 AI and 204,613 White individuals with cancer. Compared with the White population, the AI population was more likely to live in rural areas (48% vs. 25%; RRF, 1.89; 95% CL, 1.81-1.97) and to have Medicaid (18% vs. 7%; RRF, 2.49; 95% CL, 2.27-2.71). Among the AI population, the highest age-standardized incidence rates were female breast, followed by prostate and lung and bronchus. Liver cancer incidence was significantly higher among the AI population than White population (IRR, 1.27; 95% CL, 1.01-1.59). AI patients had higher mortality rates for prostate (MRR, 1.72; CL, 1.09-2.70), stomach (MRR, 1.82; 95% CL, 1.15-2.86), and liver (MRR, 1.70; 95% CL, 1.25-2.33) cancers compared with White patients. CONCLUSIONS To reduce prostate, stomach, and liver cancer disparities among AI populations in North Carolina, multi-modal interventions targeting risk factors and increasing screening and treatment are needed. IMPACT This study identifies cancer disparities that can inform targeted interventions to improve outcomes among AI populations in North Carolina.
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Affiliation(s)
- Lisa P Spees
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, UNC-CH, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, North Carolina
| | - Bradford E Jackson
- Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, North Carolina
| | | | - Hayley N Morris
- Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, North Carolina
| | - Marc A Emerson
- Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, UNC-CH, Chapel Hill, North Carolina
| | - Christopher D Baggett
- Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, UNC-CH, Chapel Hill, North Carolina
| | - Ronny A Bell
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, UNC-CH, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, North Carolina
| | - Ana I Salas
- Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, North Carolina
| | - Clare Meernik
- Duke Cancer Institute (DCI), Chapel Hill, North Carolina
| | | | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, North Carolina
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, North Carolina
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Lee H, Singh GK, Jemal A, Islami F. Living alone and cancer mortality by race/ethnicity and socioeconomic status among US working-age adults. Cancer 2024; 130:86-95. [PMID: 37855867 DOI: 10.1002/cncr.35042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/26/2023] [Accepted: 08/28/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Previous studies have shown an association between living alone and cancer mortality; however, findings by sex and race/ethnicity have generally been inconsistent, and data by socioeconomic status are sparse. The association between living alone and cancer mortality by sex, race/ethnicity, and socioeconomic status in a nationally representative US cohort was examined. METHODS Pooled 1998-2019 data for adults aged 18-64 years at enrollment from the National Health Interview Survey linked to the National Death Index (N = 473,648) with up to 22 years of follow-up were used to calculate hazard ratios (HRs) for the association between living alone and cancer mortality. RESULTS Compared to adults living with others, adults living alone were at a higher risk of cancer death in the age-adjusted model (HR, 1.32; 95% CI, 1.25-1.39) and after additional adjustments for multiple sociodemographic characteristics and cancer risk factors (HR, 1.10; 95% CI, 1.04-1.16). Age-adjusted models stratified by sex, poverty level, and educational attainment showed similar associations between living alone and cancer mortality, but the association was stronger among non-Hispanic White adults (HR, 1.33; 95% CI, 1.25-1.42) than non-Hispanic Black adults (HR, 1.18; 95% CI, 1.05-1.32; p value for difference < .05) and did not exist in other racial/ethnic groups. These associations were attenuated but persisted in fully adjusted models among men (HR, 1.13; 95% CI, 1.05-1.23), women (HR, 1.09; 95% CI, 1.01-1.18), non-Hispanic White adults (HR, 1.13; 95% CI, 1.05-1.20), and adults with a college degree (HR, 1.22; 95% CI, 1.07-1.39). CONCLUSIONS In this nationally representative study in the United States, adults living alone were at a higher risk of cancer death in several sociodemographic groups.
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Affiliation(s)
- Hyunjung Lee
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Gopal K Singh
- Office of Health Equity, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Farhad Islami
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
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Lee YS, Roh S, Hsieh YP, Park Y. Determinants of Life Satisfaction and Quality of Life Among American Indian Women Cancer Survivors: The Role of Psychosocial Resources. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2023; 20:536-555. [PMID: 37330683 DOI: 10.1080/26408066.2023.2185561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE This study assessed the relationship of spirituality, social support, and sense of mastery to life satisfaction and quality of life to identify viable psychosocial coping resources among American Indian (AI) women cancer survivors. METHOD We conducted a cross-sectional survey of 73 AI women cancer survivors residing in South Dakota. A series of multivariate hierarchical regression analyses was conducted. RESULTS Findings indicated that lower self-rated physical health was consistently associated with lower levels of life satisfaction and quality of life. Spirituality was found to be the most influential predictor for life satisfaction, while social support and sense of mastery were two significant predictors for quality of life. DISCUSSION Our data underscored the importance of spirituality, social support, and sense of mastery to the well-being of AI women cancer survivors and as effective coping strategies to mitigate life stressors. Implications of this evidence for the design of cancer preventions and interventions are discussed.
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Affiliation(s)
- Yeon-Shim Lee
- School of Social Work, San Francisco State University, San Francisco, California, United States
| | - Soonhee Roh
- Department of Social Work, University of South Dakota, Sioux Falls, South Dakota, United States
| | - Yi-Ping Hsieh
- Department of Social Work, University of North Dakota, Grand Forks, North Dakota, United States
| | - Yeddi Park
- Department of Family Therapy and Social Work, Fairfield University, Connecticut, United States
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Carlson TA, Liddell JL. The importance of community support for women in a Gulf Coast Indigenous tribe. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE 2023; 16:162-175. [PMID: 38770245 PMCID: PMC11104765 DOI: 10.1108/ijhrh-06-2022-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose – Community support is an integral aspect of health and well-being for Indigenous peoples. The purpose of this paper is to demonstrate the valuable role of community support for Indigenous women specifically, who experience reproductive health disparities at alarming rates. This study helps fill an important gap in Indigenous scholarship by centering the resilience of women and Indigenous tribes and by using a framework that is consistent with Indigenous holistic views of health. Design/methodology/approach – The data for this paper was collected as part of a larger study exploring the reproductive health experiences of a state-recognized Gulf Coast tribe. A total of 31 semi-structured interviews were conducted with individuals who identify as women and as members of this tribe using qualitative descriptive methodology. This method is recommended for research with Indigenous communities. A community advisory board with representatives from this tribe provided feedback throughout the project. Findings – Themes expressed by participants included Community Closeness and Support; Community Support in Raising Children; Informal Adoption Common; and Community Values of Mutual Aid and Self-Sufficiency. The findings support current literature noting the value of generational and communal ties for Indigenous peoples. Implications of this research include the need to value and support community networks in programs serving tribes, in addition to meaningfully including Indigenous communities in developing interventions. Originality/value – This paper centers Indigenous women's resilience, approaches the health and well-being of Indigenous tribes holistically and helps to fill an important gap in literature describing informal adoption (outside the legal system) in state-recognized Indigenous communities.
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Affiliation(s)
- Tess A Carlson
- School of Social Work, University of Montana, Missoula, Montana, USA
| | - Jessica L Liddell
- School of Social Work, University of Montana, Missoula, Montana, USA
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Hodge FS, Line-Itty T, Arbing RHA. Cancer-Related Symptom Management Intervention for Southwest American Indians. Cancers (Basel) 2022; 14:cancers14194771. [PMID: 36230694 PMCID: PMC9563929 DOI: 10.3390/cancers14194771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Quality of life during, and even after, cancer treatment is greatly affected by cancer symptoms that include pain, fatigue, and changes to mental state and activities of daily living, to name a few. American Indians living in the Southwestern United States have cancer experiences which may be different than the general population and have long been understudied. A randomized controlled trial designed to test the impact of a culturally tailored intervention on the management of individual cancer symptoms was implemented. Outcomes included improvement in pain, depression, fatigue and loss of function management in adult American Indians. Study evaluations at post-test show a significant improvement in scores from pre-test and compared to the control group, demonstrating increased knowledge levels in managing cancer-related symptoms. Study findings guide researchers towards a better understanding of the meaning and impact of cancer symptoms for American Indian cancer survivors, thus their improving care and quality of life. Abstract There is limited literature related to culturally embedded meanings of cancer and related symptoms among American Indians. A culturally appropriate intervention to improve management of cancer-related symptoms, including pain, depression, fatigue and loss of function, was tested. Two-hundred and twenty-two adult American Indians with cancer were recruited from eight Southwest sites for a randomized clinical trial. The intervention group received tailored education, a toolkit with a video, and participated in discussion sessions on cancer symptom management; the control group received information on dental care. Pre- and post-test questionnaires were administered to control and intervention groups. Measures included socio-demographics, cancer-related symptom management knowledge and behavior, and quality of life measures. Male cancer survivors reported poorer self-assessed health status and lower scores on quality-of-life indicators as compared to female cancer survivors. Significant improvement was reported in symptom management knowledge scores following the intervention: management of pain (p = 0.003), depression (p = 0.004), fatigue (p = 0.0001), and loss of function (p = 0.0001). This study is one of the first to demonstrate a change in physical symptom self-management skills, suggesting culturally appropriate education and interventions can successfully enhance cancer-related symptom management knowledge and practice.
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Affiliation(s)
- Felicia S. Hodge
- School of Nursing, University of California, Los Angeles, 700 Tiverton Avenue, Room 5-934A Factor Building, Los Angeles, CA 90095, USA
- Fielding School of Public Health, University of California, Los Angeles, 640 Charles E Young Drive South, Los Angeles, CA 90095, USA
- Correspondence: ; Tel.: +1-310-210-9887
| | - Tracy Line-Itty
- School of Nursing, University of California, Los Angeles, 700 Tiverton Avenue, Room 5-934A Factor Building, Los Angeles, CA 90095, USA
| | - Rachel H. A. Arbing
- School of Nursing, University of California, Los Angeles, 700 Tiverton Avenue, Room 5-934A Factor Building, Los Angeles, CA 90095, USA
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Lee YS, Roh S, Moon H, Lee KH, McKinley C, LaPlante K. Andersen's Behavioral Model to Identify Correlates of Breast Cancer Screening Behaviors among Indigenous Women. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2020; 17:117-135. [PMID: 32211512 PMCID: PMC7092411 DOI: 10.1080/26408066.2019.1650316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
This study examined predictive models of utilization of mammograms among Indigenous women adapting Andersen's behavioral model. Using a sample of 285 Indigenous women residing in South Dakota, nested logistic regression analyses were conducted to assess predisposing (age and marital status), need (personal and family cancer history), and enabling factors (education, monthly household income, mammogram screening awareness, breast cancer knowledge, self-rated health, and cultural practice to breast cancer screening). Results indicated that only 55.5% of participants reported having had a breast cancer screening within the past 2 years. After controlling for predisposing and need factors, higher education, greater awareness of mammogram, and higher utilization of traditional Native American approaches were significant predictors of mammogram uptake. The results provide important implications for intervention strategies aimed at improving breast cancer screening and service use among Indigenous women.
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Affiliation(s)
- Yeon-Shim Lee
- School of Social Work, San Francisco State University, San Francisco, California, USA
| | - Soonhee Roh
- Department of Social Work, University of South Dakota, Sioux Falls, South Dakota, USA
| | - Heehyul Moon
- Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
| | - Kyoung Hag Lee
- School of Social Work, Wichita State University, Wichita, Kansas, USA
| | | | - Kathy LaPlante
- Department of Social Work, University of South Dakota, Sioux Falls, South Dakota, USA
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