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Gold N, Christensen RAG, Arneja J, Aminoleslami A, Anderson GM, Brooks JD. Screening behaviours, demographics, and stage at diagnosis in the publicly funded Ontario Breast Screening Program. Breast Cancer Res Treat 2023; 198:523-533. [PMID: 36800117 PMCID: PMC10036268 DOI: 10.1007/s10549-022-06848-1] [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: 05/10/2022] [Accepted: 12/01/2022] [Indexed: 02/18/2023]
Abstract
PURPOSE The Ontario Breast Screening Program (OBSP) offers free screening mammograms every 2 years, to women aged 50-74. Study objectives were to determine demographic characteristics associated with the adherence to OBSP and if women screened in the OBSP have a lower stage at diagnosis than non-screened eligible women. METHODS We used the Ontario cancer registry (OCR) to identify 48,927 women, aged 51-74 years, diagnosed with breast cancer between 2010 and 2017. These women were assigned as having undergone adherent screening (N = 26,108), non-adherent screening (N = 6546) or not-screened (N = 16,273) in the OBSP. We used multinomial logistic regression to investigate the demographic characteristics associated with screening behaviour, as well as the association between screening status and stage at diagnosis. RESULTS Among women with breast cancer, those living in rural areas (versus the largest urban areas) had a lower odds of not being screened (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.68, 0.78). Women in low-income (versus high-income) communities were more likely not to be screened (OR 1.42, 95% CI 1.33, 1.51). When stratified, the association between income and screening status only held in urban areas. Non-screened women were more likely to be diagnosed with stage II (OR 1.91, 95% CI 1.82, 2.01), III (OR 2.96, 95% CI 2.76, 3.17), or IV (OR 8.96, 95% CI 7.94, 10.12) disease compared to stage I and were less likely to be diagnosed with ductal carcinoma in situ (DCIS) (OR 0.91, 95% CI 0.84-0.98). CONCLUSIONS This study suggests that targeting OBSP recruitment efforts to lower income urban communities could increase screening rates. OBSP adherent women were more likely to be diagnosed with earlier stage disease, supporting the value of this initiative and those like it.
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Affiliation(s)
- Nicholas Gold
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada
| | - Rebecca A G Christensen
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada
| | - Jasleen Arneja
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada
| | - Arian Aminoleslami
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Geoffrey M Anderson
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jennifer D Brooks
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada.
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Manning M, Lucas T, Purrington K, Thompson H, Albrecht TL, Penner L. Moderators of the effects of perceived racism and discrimination on cancer-related health behaviors among two samples of African Americans. Soc Sci Med 2023; 316:114982. [PMID: 35484000 DOI: 10.1016/j.socscimed.2022.114982] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/02/2022] [Accepted: 04/15/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Assumptions regarding within-race variation in the associations between measures of discrimination racism and health-related behaviors among African Americans have been largely unexplored. METHODS We conducted secondary analyses of two studies to examine support for a model which describes several theoretical moderators of the effects of discrimination and racism on health behaviors. The first study examined the effects of group-based behavioral information and racial identity on the association between perceived racism and requests for at home colorectal cancer screening tests among a sample of 205 geographically diverse African Americans who participated in an online experiment from 2019 to 2020. RESULTS Group-based behavioral information attenuated the association between perceived racism and requests for at-home screening kit. In the absence of group-based behavioral information, perceived racism was positively associated with screening kit requests for African Americans with weaker racial identity and negatively associated with requests for African Americans with stronger racial identity. The second study examined the influence of personal and group-based perceived discrimination, and behavior-relevant affective information related to a breast cancer risk notification, on 89 Michigan dwelling African American women's self-reported physician communication from 2015 to 2016. Results showed that perceived group-based discrimination was positively associated with physician communication in the absence of negative affective information, and perceived personal discrimination was negatively associated with physician communication as positive affective information increased. CONCLUSIONS Together, these results support our theoretical model highlighting variation in the effects of discrimination and racism on health behaviors among African Americans, and indicates group-relevant behavioral information, racial identity, behavior relevant affective information, and target of discrimination as moderators of the effect. Implications for conceptualizing the effects of racism and discrimination and for examining racially targeted interventions are discussed.
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Affiliation(s)
- Mark Manning
- Department of Psychology, Oakland University, USA
| | - Todd Lucas
- Division of Public Health, Michigan State University, USA
| | | | - Hayley Thompson
- Department of Oncology, Wayne State University School of Medicine, USA
| | | | - Louis Penner
- Department of Oncology, Wayne State University School of Medicine, USA
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Vehling M, Canal C, Ziegenhain F, Pape HC, Neuhaus V. Short-term outcome of isolated lateral malleolar fracture treatment is independent of hospital trauma volume or teaching status: a nationwide retrospective cohort study. Eur J Trauma Emerg Surg 2021; 48:2237-2246. [PMID: 34398247 PMCID: PMC9192439 DOI: 10.1007/s00068-021-01771-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/09/2021] [Indexed: 11/20/2022]
Abstract
Introduction In light of current discussions about centralisation and teaching in medicine, we wanted to investigate the differences in in-hospital outcomes after surgical treatment of isolated ankle fractures, taking into account high-volume centres (HVCs) and low-volume centres (LVCs) and teaching procedures. Methods A retrospective analysis of malleolar fractures recorded in a National Quality Assurance Database (AQC) from the period 01-01-1998 to 31-12-2018 was carried out. Inclusion criteria were isolated, and operatively treated lateral malleolar fractures (ICD-10 Code S82.6 and corresponding procedure codes). Variables were sought in bivariate and multivariate analyses. A total of 6760 cases were included. By dividing the total cases arbitrarily in half, 12 HVCs (n = 3327, 49%) and 56 LVCs (n = 3433, 51%) were identified. Results Patients in HVCs were younger (48 vs. 50 years old), had more comorbidities (26% vs. 19%) and had more open fractures (0.48% vs. 0.15%). Open reduction and internal fixation was the most common operative treatment at HVCs and LVCs (95% vs. 98%). A more frequent use of external fixation (2.5% vs. 0.55%) was reported at HVCs. There was no difference in mortality between treatment at HVCs and LVCs. A longer hospitalisation of 7.2 ± 5 days at HVCs vs. 6.3 ± 4.8 days at LVCs was observed. In addition, a higher rate of complications of 3.2% was found at HVCs compared to 1.9% at LVCs. The frequency of teaching operations was significantly higher at HVCs (30% vs. 26%). Teaching status had no influence on mortality or complications but was associated with a prolonged length of stay and operating time. Conclusion We found significant differences between HVCs and LVCs in terms of in-hospital outcomes for ankle fractures. These differences could be explained due to a more severely ill patient population and more complex (also open) fracture patterns with resulting use of external fixation and longer duration of surgery. However, structural and organisational differences, such as an extended preoperative stays at HVCs and a higher teaching rate, were also apparent. No difference in mortality could be detected.
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Affiliation(s)
- Malte Vehling
- Division of Trauma Surgery, Department of Traumatology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Claudio Canal
- Division of Trauma Surgery, Department of Traumatology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Franziska Ziegenhain
- Division of Trauma Surgery, Department of Traumatology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Hans-Christoph Pape
- Division of Trauma Surgery, Department of Traumatology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Valentin Neuhaus
- Division of Trauma Surgery, Department of Traumatology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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Changing Mammography-Related Beliefs Among American Muslim Women: Findings from a Religiously-Tailored Mosque-Based Intervention. J Immigr Minor Health 2020; 21:1325-1333. [PMID: 30603838 DOI: 10.1007/s10903-018-00851-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background To advance the literature on religiously-tailored interventions and on Muslim cancer screening disparity research, we report on a behavioral intervention that used religiously-tailored messages to address salient mammography-related barrier beliefs. Methods We crafted specific, religiously-tailored messages and designed a two-session, peer-led, mosque-based educational program to deploy them. t-tests assessed pre- and post-intervention changes in mammography knowledge, intention to obtain mammography, and levels of agreement with mammography-related barrier and facilitator beliefs, while ordered logistic regression models assessed predictors of change. Results 58 women participated, 29 who were South-Asian and 18 Arab. Mean mammography knowledge increased post-intervention. Participants' overall mean agreement with facilitator beliefs trended upward and there was a significant decrease in agreement with the belief "Breast Cancer Screening is not important because God decides who will get cancer," Discussion Religiously-tailored messages provide an opportunity for addressing barriers to preventive health in a theologically consonant way.
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Padela AI, Malik S, Ally SA, Quinn M, Hall S, Peek M. Reducing Muslim Mammography Disparities: Outcomes From a Religiously Tailored Mosque-Based Intervention. HEALTH EDUCATION & BEHAVIOR 2018; 45:1025-1035. [PMID: 29673255 DOI: 10.1177/1090198118769371] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the design of, and participant-level outcomes related to, a religiously tailored, peer-led group education program aimed at enhancing Muslim women's mammography intention. METHOD Using a community-engaged approach and mixed methods, we identified and addressed barrier beliefs impeding mammography screening among Muslim American women. Our religiously tailored, mosque-based, peer-led intervention involved facilitated discussions and expert-led didactics conveying health-related religious teachings, and information about the benefits and process of mammography. Barrier beliefs were addressed through reframing, reprioritizing, or reforming such beliefs. Participant surveys were collected preintervention, postintervention, 6 months postintervention, and 1 year postintervention. These measured changes in mammography intention, likelihood, confidence, and resonance with barrier and facilitator beliefs. RESULTS A total of 58 Muslim women (mean age = 50 years) that had not had a mammogram in the past 2 years participated in the two-session program. Self-reported likelihood of obtaining a mammogram increased significantly ( p = .01) and coincided with a positive trend in confidence ( p = .08). Individuals with higher agreement with barrier beliefs preintervention had lower odds for positive change in likelihood (odds ratio = 0.80, p = .03), while those who were married had higher odds for positive change in likelihood (odds ratio = 37.69, p = .02). At 1-year follow-up, 22 participants had obtained a mammogram. CONCLUSION Our pilot mosque-based intervention demonstrated efficacy in improving Muslim women's self-reported likelihood of obtaining mammograms, and increased their mammography utilization, with nearly 40% obtaining a mammogram within 12 months of the intervention. IMPACT Our conceptual model for religiously tailoring messages, along with its implementation curriculum, proved effective in enhancing the likelihood and receipt of mammograms among Muslim American women. Accordingly, our work advances both the theory and practice of faith-based interventions and provides a model for addressing Muslim women's cancer screening disparities.
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Affiliation(s)
| | - Sana Malik
- 1 The University of Chicago, Chicago, IL, USA.,2 Stony Brook University, Stony Brook, NY, USA
| | | | | | | | - Monica Peek
- 1 The University of Chicago, Chicago, IL, USA
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Khanna S, Kim KN, Qureshi MM, Agarwal A, Parikh D, Ko NY, Rand AE, Hirsch AE. Impact of patient demographics, tumor characteristics, and treatment type on treatment delay throughout breast cancer care at a diverse academic medical center. Int J Womens Health 2017; 9:887-896. [PMID: 29255374 PMCID: PMC5723124 DOI: 10.2147/ijwh.s150064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose and objective The aim of this study was to examine the impact of patient demographics, tumor characteristics, and treatment type on time to treatment (TTT) in patients with breast cancer treated at a safety net medical center with a diverse patient population. Patients and methods A total of 1,130 patients were diagnosed and treated for breast cancer between 2004 and 2014 at our institution. We retrospectively collected data on patient age at diagnosis, race/ethnicity, primary language spoken, marital status, insurance coverage, American Joint Committee on Cancer (AJCC) stage, hormone receptor status, and treatment dates. TTT was determined from the date of breast cancer biopsy to treatment start date. Nonparametric Mann-Whitney U-test (or Kruskal-Wallis test when appropriate) and multivariable quantile regression models were employed to assess for significant differences in TTT associated with each factor. Results Longer median TTT was noted for Black (P=0.002) and single (P=0.002) patients. AJCC stage IV patients had shorter TTT (27.5 days) compared to earlier AJCC patients (36, 35, 37, 37 days for stage 0, I, II, III, respectively), P=0.028. Age, primary language spoken, insurance coverage, and hormone receptor status had no significant impact on TTT. On multivariate analysis, race/ethnicity remained the only significant factor with Black reporting longer TTT, P=0.025. However, race was not a significant factor for time from first to second treatment. More Black patients were noted to be single (P<0.0001) and received chemotherapy as first treatment (P=0.008) compared to White, Hispanic, or other race/ethnicity patients. Conclusion In this retrospective analysis, Black patients had longer TTT, were more likely to receive chemotherapy as first treatment, and have a single marital status. These patient factors will help identify vulnerable patients and guide further research to understand the barriers to care and the impact of treatment delays on outcomes.
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Affiliation(s)
- Shivani Khanna
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine
| | - Kristine N Kim
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine
| | - Muhammad M Qureshi
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine
| | - Ankit Agarwal
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine
| | - Divya Parikh
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine
| | - Naomi Y Ko
- Department of Hematology Oncology, Boston Medical Center, Boston MA, USA
| | - Alexander E Rand
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine
| | - Ariel E Hirsch
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine
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Ramos AK, Correa A, Trinidad N. Perspectives on Breast Health Education and Services Among Recent Hispanic Immigrant Women in the Midwest: a Qualitative Study in Lancaster County, Nebraska. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:666-672. [PMID: 26194778 DOI: 10.1007/s13187-015-0886-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Breast cancer is the most common cause of cancer death among Hispanic women in the USA. Throughout the country, Hispanic immigrants face many barriers to achieving optimal breast health. Three focus groups were conducted to explore challenges and opportunities in access to breast health services and information among recent Hispanic immigrant women in Lancaster Country, Nebraska. Respondents perceived breast cancer as a serious issue and were concerned about it, but there were few cues to action to improve health given the limited information and access to services available to low-income Spanish-speaking individuals in the community. Results highlighted the need for culturally and linguistically appropriate health education and services, accessibility and promotion of low-cost screening and treatment services, and inclusive policies to promote preventative healthcare services for all women regardless of immigration status. Health is more than just clinical care, and therefore, it is important to understand the contextual and cultural factors that have resulted in low screening rates and develop methods to address these them. Failure to address these aspects of social determinants of health could hamper efforts to improve breast health and reduce disparities.
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Affiliation(s)
- Athena K Ramos
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center, Omaha, NE, 68198-4340, USA.
| | - Antonia Correa
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center, Omaha, NE, 68198-4340, USA
| | - Natalia Trinidad
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center, Omaha, NE, 68198-4340, USA
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Keshinro A, Hatzaras I, Rifkind K, Dhage S, Joseph KA. The Impact of Primary Care Providers on Patient Screening Mammography and Initial Presentation in an Underserved Clinical Setting. Ann Surg Oncol 2016; 24:692-697. [PMID: 27766557 DOI: 10.1245/s10434-016-5618-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cancer screening is a key component of primary care, and access to regular screening mammography (SMG) is highly dependent on recommendation and referral by a primary care provider (PCP). Women with no health insurance or who are underinsured often lack access to a regular PCP and thus access to routine screening. METHODS We retrospectively reviewed the charts of 173 surgical patients diagnosed between January 2012 and December 2013. The main outcome variables were PCP status, method of cancer detection, and breast cancer stage at diagnosis. Additional variables included race, age at diagnosis, family history of breast and ovarian cancer, and medical comorbidities. RESULTS Patients with a PCP received more mammograms (SMG) compared with patients without a PCP (61 vs. 37 %; p = 0.003). The majority (73 %) of patients without a PCP presented symptomatically with a palpable mass versus 42 % of patients with a PCP. A significant difference was noted with regard to final pathologic stage of breast cancer between the two groups (p = 0.019), and Caucasian and African American patients were more likely to have locally advanced breast cancer. CONCLUSIONS Underserved patients with a PCP are more likely to present asymptomatically and at an earlier stage of breast cancer compared with patients without a PCP. Community engagement programs that build relationships with patients may help bring vulnerable patients into the healthcare system for routine screening. Moreover, PCP education regarding the subtleties of breast cancer screening guidelines and referral to a breast specialist is also critical in improving outcomes of underserved patients.
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Affiliation(s)
- Ajaratu Keshinro
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Medical Center, New York, NY, USA
| | - Ioannis Hatzaras
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Medical Center, New York, NY, USA
| | - Kenneth Rifkind
- Department of Surgery, NYU Langone Medical Center, NYU Lutheran Hospital, New York, NY, USA
| | - Shubhada Dhage
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Medical Center, New York, NY, USA
| | - Kathie-Ann Joseph
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Medical Center, New York, NY, USA.
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Florea KS, Novosel LM, Schlenk EA. Improvement in colon cancer screening through use of a multilevel intervention: A QI initiative. J Am Assoc Nurse Pract 2016; 28:362-9. [DOI: 10.1002/2327-6924.12320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/31/2015] [Indexed: 11/07/2022]
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Manning M, Purrington K, Penner L, Duric N, Albrecht TL. Between-race differences in the effects of breast density information and information about new imaging technology on breast-health decision-making. PATIENT EDUCATION AND COUNSELING 2016; 99:1002-10. [PMID: 26847421 PMCID: PMC4988060 DOI: 10.1016/j.pec.2016.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/02/2016] [Accepted: 01/15/2016] [Indexed: 05/08/2023]
Abstract
OBJECTIVES Some US states have mandated that women be informed when they have dense breasts; however, little is known about how general knowledge about breast density (BD) affects related health decision-making. We examined the effects of BD information and imaging technology information on 138 African-American (AA) and European-American (EA) women's intentions to discuss breast cancer screening with their physicians. METHODS Women were randomly assigned to receive BD information and/or imaging technology information via 2 by 2 factorial design, and completed planned behavior measures (e.g., attitudes, intentions) related to BC screening. RESULTS Attitudes mediated the effects of BD information, and the mediation was stronger for AA women compared to EA women. Effects were more robust for BD information compared to imaging technology information. Results of moderator analyses revealed suppressor effects of injunctive norms that were moderated by imaging technology information. CONCLUSION Information about BD favorably influences women's intentions to engage in relevant breast health behaviors. Stronger attitude mediated-effects for AA women suggest greater scrutiny of BD information. PRACTICE IMPLICATIONS Since BD information may influence women's intentions to discuss BC screening, strategies to effectively present BD information to AA women should be investigated given the likelihood of their increased scrutiny of BD information.
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Affiliation(s)
- Mark Manning
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States.
| | - Kristen Purrington
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Louis Penner
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Neb Duric
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Terrance L Albrecht
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
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Mayfield-Johnson S, Fastring D, Fortune M, White-Johnson F. Addressing Breast Cancer Health Disparities in the Mississippi Delta Through an Innovative Partnership for Education, Detection, and Screening. J Community Health 2015; 41:494-501. [DOI: 10.1007/s10900-015-0121-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Seven M, Akyüz A, Robertson LB. Interventional Education Methods for Increasing Women's Participation in Breast Cancer Screening Program. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:244-252. [PMID: 25077769 DOI: 10.1007/s13187-014-0709-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to evaluate the impact of the three methods of education-individual, individual with an educational brochure for spouses, and group-on participation on breast cancer screening in Turkey. A total of 550 home visits were made and 446 women were interviewed to accrue 327 women for the study, 26.7% of whom reported receiving a screening mammogram within the past 2 years. Participants were divided into one of the three educational groups, and following the educational session, they were invited to attend a breast cancer screening program. The results indicated that the decision to have a screening mammogram was influenced by the method of education and the knowledge score. Women, who were educated, within a group scored the highest. These results demonstrate that group education is an effective method of increasing breast cancer knowledge and screening awareness.
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Affiliation(s)
- Memnun Seven
- Koc University, School of Nursing, İstanbul, Turkey,
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Karcher R, Fitzpatrick DC, Leonard DJ, Weber S. A community-based collaborative approach to improve breast cancer screening in underserved African American women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:482-487. [PMID: 24446167 DOI: 10.1007/s13187-014-0608-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Although African American women in the United States have a lower incidence of breast cancer compared with white women, those younger than 40 years actually have a higher incidence rate; additionally, African American women are more likely to die from breast cancer at every age compared with white women. Racial disparities in breast cancer mortality rates are especially significant in Maryland, which ranks fifth in the nation for breast cancer mortality, and in Baltimore City, which has the second highest annual death rate for African American women in Maryland. To address this disparity in care, Med-IQ, an accredited provider of CME, collaborated with Sisters Network Baltimore Metropolitan, Affiliate Chapter of Sisters Network® Inc., the only national African American breast cancer survivorship organization, to sponsor their community-based educational outreach initiative. The collaborative mission was to engage at-risk African American women, their families, local organizations, healthcare professionals, and clinics, with the goals of increasing awareness, addressing fears that affect timely care and diagnosis, and encouraging women to obtain regular mammograms. Intervention strategies included (1) a "Survivor Stories" video, (2) patient outreach consisting of neighborhood walks and an educational luncheon, and (3) a community outreach utilizing direct mailings to local businesses, community groups, and healthcare professionals. Trusted and well-known community resources were presented as mediums to promote the initiative, yielding achievement of broader and more effective outcomes. As a result of this patient-friendly initiative, two (2) of the women who sought screening were diagnosed with breast cancer and underwent treatment.
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Affiliation(s)
- Rachel Karcher
- Med-IQ, 5523 Research Park Drive, Suite 210, Baltimore, MD, 21228, USA,
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Sheppard VB, Huei-yu Wang J, Eng-Wong J, Martin SH, Hurtado-de-Mendoza A, Luta G. Promoting mammography adherence in underserved women: the telephone coaching adherence study. Contemp Clin Trials 2013; 35:35-42. [PMID: 23415629 DOI: 10.1016/j.cct.2013.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 01/04/2013] [Accepted: 02/01/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite interventions to promote regular mammography, underserved women face barriers to mammography. This is evident in high no-show appointment rates in community-based clinics. Understanding why women fail to follow-through with appointments may help improve adherence. OBJECTIVES We conducted a focus group with women who were non-adherent to mammograms to evaluate psychosocial and structural barriers and design intervention messages. In phase two we conducted a small randomized controlled trial (RCT) to pilot test a brief telephone coaching adherence intervention (vs. control) to address barriers. METHOD Eligible women were non-adherent to their mammography screening appointment at a community-based setting. Psychosocial factors and perceptions of barriers were measured via a baseline survey and used to tailor the telephone coaching session. In the RCT, the primary outcome was whether women rescheduled and kept their appointment (yes vs. no). Descriptive statistics were used to summarize the results. RESULTS Fifty-four women participated in the study (17 in phase 1 and 31 in phase 2); 89% were Black and 11% were Latina. Overall, prior to the intervention, women had low perceptions of risk (m=4.2; SD=2.4) and cancer worry (m=4.2; SD=2.6) and these characteristics informed the telephone coaching. After the intervention, most women (94.5%) rescheduled their missed appointment. More women in the intervention group kept their appointment (54%) than those in the usual care group (46%). CONCLUSION It appears feasible to implement a RCT in non-adherent underserved women. Addressing psychosocial and structural barriers in a brief telephone intervention may reduce non-adherence. Future studies that will test the efficacy of this approach are warranted.
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Affiliation(s)
- Vanessa B Sheppard
- Breast Cancer Program, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street NW, Washington, DC 20007, United States.
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Jandorf L, Stossel LM, Cooperman JL, Graff Zivin J, Ladabaum U, Hall D, Thélémaque LD, Redd W, Itzkowitz SH. Cost analysis of a patient navigation system to increase screening colonoscopy adherence among urban minorities. Cancer 2012; 119:612-20. [PMID: 22833205 DOI: 10.1002/cncr.27759] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 05/08/2012] [Accepted: 06/27/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patient navigation (PN) is being used increasingly to help patients complete screening colonoscopy (SC) to prevent colorectal cancer. At their large, urban academic medical center with an open-access endoscopy system, the authors previously demonstrated that PN programs produced a colonoscopy completion rate of 78.5% in a cohort of 503 patients (predominantly African Americans and Latinos with public health insurance). Very little is known about the direct costs of implementing PN programs. The objective of the current study was to perform a detailed cost analysis of PN programs at the authors' institution from an institutional perspective. METHODS In 2 randomized controlled trials, average-risk patients who were referred for SC by primary care providers were recruited for PN between May 2008 and May 2010. Patients were randomized to 1 of 4 PN groups. The cost of PN and net income to the institution were determined in a cost analysis. RESULTS Among 395 patients who completed colonoscopy, 53.4% underwent SC alone, 30.1% underwent colonoscopy with biopsy, and 16.5% underwent snare polypectomy. Accounting for the average contribution margins of each procedure type, the total revenue was $95,266.00. The total cost of PN was $14,027.30. Net income was $81,238.70. In a model sample of 1000 patients, net incomes for the institutional completion rate (approximately 80%), the historic PN program (approximately 65%), and the national average (approximately 50%) were compared. The current PN program generated additional net incomes of $35,035.50 and $44,956.00, respectively. CONCLUSIONS PN among minority patients with mostly public health insurance generated additional income to the institution, mainly because of increased colonoscopy completion rates.
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Affiliation(s)
- Lina Jandorf
- Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Ma GX, Yin L, Gao W, Tan Y, Liu R, Fang C, Ma XS. Workplace-based breast cancer screening intervention in china. Cancer Epidemiol Biomarkers Prev 2011; 21:358-67. [PMID: 22155948 DOI: 10.1158/1055-9965.epi-11-0915] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Breast cancer continues to be the primary cause of death among East and Southeast Asian women. Although China, the most populous country in the world, is experiencing unprecedented economic growth, its health care system has yet to benefit from the current economic prosperity. Indeed, studies have shown a consistent increase in breast cancer rates among Chinese women over the past two decades in the absence of breast cancer screening guidelines. METHODS The primary objective of this study was to examine the impact of a workplace intervention on increasing breast cancer screening rates. The study was implemented at eight worksites in Nanjing, four of which were assigned to the intervention group (n = 232) and four to the control group (n = 221). The intervention group received breast cancer education and screening navigation. The control group was provided with general cancer education and received a delayed intervention after completion of the study. Study measures were completed at pre- and postprogram and at 6-month follow-up to assess uptake of mammography. RESULTS Baseline mammography use was low among both intervention and control groups. However, exposure to the workplace intervention dramatically increased the uptake of mammography from 10.3% at baseline to 72.6% at 6-month follow-up in the intervention group (P < 0.001). CONCLUSIONS Findings provide preliminary evidence that the implementation of a comprehensive workplace breast cancer screening intervention program in China can lead to increased uptake of mammography. These data may help facilitate the development of theory-based workplace cancer prevention programs and screening guidelines in China. IMPACT A workplace-based multifaceted intervention could have a strong impact in breast cancer prevention and early detection among women in China.
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Affiliation(s)
- Grace X Ma
- Department of Public Health, Center for Asian Health, College of Health Professions, Temple University, 913 Ritter Annex, Philadelphia, PA 19122, USA.
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Deavenport A, Modeste N, Marshak HH, Neish C. Closing the gap in mammogram screening: an experimental intervention among low-income Hispanic women in community health clinics. HEALTH EDUCATION & BEHAVIOR 2011; 38:452-61. [PMID: 21482702 DOI: 10.1177/1090198110375037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A low rate of mammogram screening exists among low-income Hispanic women. To address this disparity, an experimental intervention containing audiovisual and written media was conducted using the health belief model as a framework. The purpose of this study was to determine if low-income Hispanic women, more than 40 years of age, who received targeted cancer prevention education (n = 105) had a significantly greater perceived threat of breast cancer, greater benefits and lower barriers to screening, and stronger intentions to obtain mammograms compared to a control group (n = 105). Intervention participants reported significantly greater perceived benefits, self-efficacy, and mammogram screening intentions than the control group. Predictors of mammogram screening intentions, when controlling for covariates, included receiving the intervention, and having greater perceived benefits, self-efficacy, and lower barriers. Results demonstrate the effectiveness of a low-cost, theory-based intervention aimed at increasing mammogram screening to assist in the monitoring of Healthy People 2020 objectives.
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Ozmen V, Nilufer Ozaydin A, Cabioglu N, Gulluoglu BM, Unalan PC, Gorpe S, Oner BR, Aribal E, Thomas DB, Anderson BO. Survey on a mammographic screening program in Istanbul, Turkey. Breast J 2011; 17:260-7. [PMID: 21450016 DOI: 10.1111/j.1524-4741.2011.01065.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Breast cancers in Turkey tend to be diagnosed at advanced stages due to lack of organized comprehensive mammographic screening. In this study, factors associated with having a mammogram among healthy women of screening age in Bahcesehir county, a region in Istanbul, were investigated to assess the feasibility of organized breast cancer screening in Turkey. In this cross-sectional study, 659 healthy women aged between 40 and 69 years were surveyed. A multiple-choice questionnaire was used to obtain information regarding patient demographics, family history of cancer, and patient knowledge on mammographic screening. Factors associated with increased likelihood of having a mammogram included age older than 50 (OR=1.75; 95% CI=1.23-2.49), higher educational level (high school or university graduate; OR=1.55; 95% CI=1.07-2.25), and undergoing periodic gynecologic examinations (OR=5.53; 95% CI= 3.88-7.89). Women aged between 40 and 49 years, who were most likely to have a mammogram within the last 2 years were characterized by a higher educational level (OR=1.94; 95% CI=1.14-3.31), periodic gynecologic examinations (OR=4.06; 95% CI=2.53-6.51), and a first or second degree family history of breast cancer (OR=2.2; 95% CI= 1.06-4.50). In contrast, women aged between 50 and 69 years were more likely to have undergone mammography within the previous 2 years if they also had undergone periodic gynecologic examinations (OR=8.63; 5.04-14.77). Our findings suggest that women of lower educational level and those who do not undergo routine wellness visits with their gynecologist will need to be specifically targeted for educational outreach to achieve broad screening compliance within the population.
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Affiliation(s)
- Vahit Ozmen
- Department of Surgery, Istanbul Medical Faculty, University of Istanbul, Istanbul, Turkey.
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Schroepfer TA, Matloub J, Creswell P, Strickland R, Anderson DM. A community-specific approach to cancer research in Indian country. Prog Community Health Partnersh 2011; 3:317-25. [PMID: 20097993 DOI: 10.1353/cpr.0.0096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Health care leaders in a small, rural, American Indian community and university partners used the community-based participatory research (CBPR) method to survey cancer survivors. OBJECTIVES We sought to provide support for the use of CBPR to generate ideas for how to improve the detection and treatment of cancer in American Indian communities. METHODS Partners worked together to develop a mail-out survey and send it to the Indian health clinic's patients who had cancer in the past 5 years. The survey sought information on their experiences with cancer screenings, cancer diagnoses, and accessing and receiving cancer treatment. RESULTS Community leaders identified three priority areas for intervention: (1) high incidence of breast cancer; (2) lack of culturally appropriate cancer education; and (3) need for a more in-depth assessment. CONCLUSIONS CBPR's partnership principle allowed for results to be viewed within the community's context, availability of community resources, and relevant cultural beliefs and traditions.
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20
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Secginli S, Nahcivan NO. The effectiveness of a nurse-delivered breast health promotion program on breast cancer screening behaviours in non-adherent Turkish women: A randomized controlled trial. Int J Nurs Stud 2011; 48:24-36. [DOI: 10.1016/j.ijnurstu.2010.05.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 05/28/2010] [Accepted: 05/29/2010] [Indexed: 11/16/2022]
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Davis RE, Alexander G, Calvi J, Wiese C, Greene S, Nowak M, Cross WE, Resnicow K. A new audience segmentation tool for African Americans: the black identity classification scale. JOURNAL OF HEALTH COMMUNICATION 2010; 15:532-54. [PMID: 20677057 PMCID: PMC3151736 DOI: 10.1080/10810730.2010.492563] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Many health communications target African Americans in an attempt to remediate race-based health disparities. Such materials often assume that African Americans are culturally homogeneous; however, research indicates that African Americans are heterogeneous in their attitudes, behaviors, and beliefs. The Black Identity Classification Scale (BICS) was designed as a telephone-administered tool to segment African American audiences into 16 ethnic identity types. The BICS was pretested using focus groups, telephone pretests, and a pilot study (n = 306). The final scale then was administered to 625 Black adults participating in a dietary intervention study, where it generally demonstrated good internal consistency reliability. The construct validity of the BICS also was explored by comparing participants' responses to culturally associated survey items. The distribution of the 16 BICS identity types in the intervention study is presented, as well as select characteristics for participants with core identity components. Although additional research is warranted, these findings suggest that the BICS has good psychometric properties and may be an effective tool for identifying African American audience segments.
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Affiliation(s)
- Rachel E Davis
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan 48109-2029, USA.
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Zollinger TW, Champion VL, Monahan PO, Steele-Moses SK, Ziner KW, Zhao Q, Bourff SA, Saywell RM, Russell KM. Effects of personal characteristics on African-American women's beliefs about breast cancer. Am J Health Promot 2010; 24:371-7. [PMID: 20594093 PMCID: PMC2965407 DOI: 10.4278/ajhp.07031727] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study measured the effect of demographic and clinical characteristics on health and cultural beliefs related to mammography. DESIGN Cross-sectional study. SETTING Interviews were conducted during 2003 and 2004 in a Midwestern urban area. SUBJECTS Subjects were 344 low-income African-American women 40 years and older who had not had mammography within the previous 18 months. MEASURES The instrument measured personal characteristics, belief and knowledge scales, and participants' mammography experience and plans. ANALYSIS Multiple regression analysis assessed the effect of specific demographic and clinical characteristics on each of the scale values and on subjects' stages of readiness to change. RESULTS The subjects' levels of education significantly affected six of the 12 belief and knowledge scales. Higher-educated women felt less susceptible to breast cancer, had higher self-efficacy, had less fear, had lower fatalism scores, were less likely to be present-time oriented, and were more knowledgeable about breast cancer. Older women felt they were less susceptible to breast cancer, had higher fatalism scores, were more present-time oriented, and were less knowledgeable about breast cancer. CONCLUSIONS The findings suggest that mammography promotion programs for African-Americans should consider the education levels and ages of the target women to be most effective.
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Affiliation(s)
- Terrell W Zollinger
- Bowen Research Center and Department of Family Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Kim JH, Menon U, Wang E, Szalacha L. Assess the effects of culturally relevant intervention on breast cancer knowledge, beliefs, and mammography use among Korean American women. J Immigr Minor Health 2009; 12:586-97. [PMID: 19373555 DOI: 10.1007/s10903-009-9246-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 03/23/2009] [Indexed: 11/27/2022]
Abstract
A pre-post test, two-group study was conducted to examine the effects of a culturally competent targeted intervention titled GO EARLY Save Your Life on the breast cancer and early screening-related knowledge and beliefs and mammography use among 180 Korean American (KA) women aged 40 years or older who had not had mammograms within the past 12 months. The intervention group received an interactive education session focused on breast cancer, early screening guidelines, and beliefs (breast cancer-related and Korean cultural beliefs). The control group received no education. There was no statistically significant intervention effect on mammography use between the intervention (34%) and control groups (23%) at 24 weeks post baseline. The rates of mammography use for both groups significantly increased from 16 to 24 weeks post baseline. The education was effective in increasing breast cancer/early screening-related knowledge and modifying beliefs (decreasing barriers, fear, seriousness, and fatalism, and increasing preventive health orientation).
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Affiliation(s)
- Jin Hee Kim
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave. Chicago, IL 60612, USA.
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Katz RV, Claudio C, Kressin NR, Green BL, Wang MQ, Russell SL. Willingness to participate in cancer screenings: blacks vs whites vs Puerto Rican Hispanics. Cancer Control 2008; 15:334-43. [PMID: 18813201 DOI: 10.1177/107327480801500408] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In the United States, blacks and Hispanics have lower cancer screening rates than whites have. Studies on the screening behaviors of minorities are increasing, but few focus on the factors that contribute to this discrepancy. This study presents the self-reported willingness by blacks, Puerto Rican Hispanics, and non-Hispanic whites to participate in cancer screenings in differing cancer screening situations. METHODS The Cancer Screening Questionnaire (CSQ), a 60-item questionnaire, was administered via random-digit-dial telephone interviews to adults in three cities: Baltimore, Maryland; New York, New York; and, San Juan, Puerto Rico. RESULTS The 1,148 participants in the CSQ study sample consisted of 355 blacks, 311 Puerto Rican Hispanics, and 482 non-Hispanic whites. Response rates ranged from 45% to 58% by city. Multivariable logistic regression analyses revealed that blacks and Puerto Ricans were often more likely (OR 2.0-3.0) and never less likely than whites to self-report willingness to participate in cancer screenings regardless of who conducted the cancer screening, what one was asked to do in the cancer screening, or what type of cancer was involved (with the exception of skin cancer where blacks, compared with whites, had an OR of 0.5). CONCLUSIONS The findings from this study provide evidence that blacks and Hispanics self-report that they are either as willing or more willing than whites to participate in cancer screening programs.
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Affiliation(s)
- Ralph V Katz
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, NY 10012, USA.
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McAlearney AS, Reeves KW, Dickinson SL, Kelly KM, Tatum C, Katz ML, Paskett ED. Racial differences in colorectal cancer screening practices and knowledge within a low-income population. Cancer 2008; 112:391-8. [PMID: 18041073 DOI: 10.1002/cncr.23156] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although colorectal cancer (CRC) is the third leading cause of cancer death among US women and is particularly deadly among African Americans, CRC screening rates remain low. Within a low-income population of women, the authors examined racial differences in practices, knowledge, and barriers related to CRC screening. METHODS Face-to-face interviews were conducted with 941 women (white, n= 186; African American, n= 755) older than age 50 years who were living in subsidized housing communities in 11 cities in North and South Carolina. Women were asked questions about their CRC screening history and their knowledge and beliefs concerning CRC screening. RESULTS Half (49%) of the women interviewed were within CRC screening guidelines, and this did not vary by race (P= .17). However, African American women were half as likely as white women to report having had a screening colonoscopy within the past 10 years (odds ratio [OR], 0.46; P< .001). Awareness of tests for CRC was low overall (39%) and was lower among African Americans than whites (OR, 0.44; P< .001). Compared with white women, African American women were less likely to report embarrassment as a barrier (OR, 0.59; P= .008) and more likely to report lack of insurance coverage (OR, 1.75; P= .098). CONCLUSIONS Efforts must continue to increase women's knowledge of both CRC screening tests and colon cancer risk factors. Among these low-income women, routine encounters with the healthcare system may present opportunities to reduce deficits in CRC knowledge and to improve overall CRC screening rates.
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Affiliation(s)
- Ann Scheck McAlearney
- Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, Ohio 43210, USA.
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Barclay JS, Blackhall LJ, Tulsky JA. Communication Strategies and Cultural Issues in the Delivery of Bad News. J Palliat Med 2007; 10:958-77. [PMID: 17803420 DOI: 10.1089/jpm.2007.9929] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Good communication is a fundamental skill for all palliative care clinicians. Patients present with varied desires, beliefs, and cultural practices, and navigating these issues presents clinicians with unique challenges. This article provides an overview of the evidence for communication strategies in delivering bad news and discussing advance care planning. In addition, it reviews the literature regarding cultural aspects of care for terminally ill patients and their families and offers strategies for engaging them. Through good communication practices, clinicians can help to avoid conflict and understand patients' desires for end of life care.
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Affiliation(s)
- Joshua S Barclay
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27705-3860, USA.
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