Hispanic Men and Women's Knowledge, Beliefs, Perceived Susceptibility, and Barriers to Clinical Breast Examination and Mammography Practices in South Texas Colonias

Breast cancer is the second leading cause of cancer death among women of all ethnicities. Though the disease is not a primary concern within male populations male perceptions and beliefs of breast cancer screening may contribute to a partner's or loved one's decision to engage in regular mammograms or clinical breast examinations. The current study seeks to explore a comparative analysis of breast cancer knowledge, beliefs, susceptibility, and barriers to female breast cancer and breast cancer screening among Hispanic men and women residing in the Colonias of South Texas. Using a multistage systematic sampling design, 2,812 men and women were surveyed from the two South Texas Counties; Maverick and Val Verde. Individuals between the ages of 20 and 75 (n = 2360) were included in the analysis. T-tests and linear regression models were used to examine gender differences in, knowledge, beliefs, susceptibility, and barriers to breast cancer and breast cancer screening. Significant differences were found between males and females across all measures. Regression analysis demonstrates Hispanic women hold more favorable beliefs about breast cancer and early detection, display higher perceived barriers to clinical breast examinations and mammography, and view themselves more susceptible to the development of breast cancer than their male counterparts. Results framed within a cultural context suggest outreach efforts within South Texas Colonias should consider inclusion of male family members in efforts to increase favorable views toward and engagement in regular breast cancer screening.

Interventions Promoting Colorectal Cancer Screening Among Latino Men: A Systematic Review

Introduction

Colorectal cancer, the second leading cause of cancer death in the United States, is also among the most preventable cancers. However, Latino men are less likely than non-Latino men to engage in preventive screening. Compared with 60% of non-Latino white men and women, only 42% of Latino men are up to date with colorectal cancer screening guidelines, which may result in diagnosis at advanced disease stages and increased deaths. We evaluated the literature on colorectal cancer screening interventions among Latino men to characterize intervention components effective in increasing colorectal cancer screening.

Methods

Two independent reviewers searched MEDLINE, CINAHL, and PsycINFO to identify articles on intervention studies that promote colorectal cancer screening among Latino men. Inclusion criteria were randomized controlled or comparative effectiveness trials, an outcome of any colorectal cancer screening test, published in English, US-based, results published from January 2004 through December 2016, Latino or Spanish-speaking male participants, and a minimum of one patient-level component. Two other reviewers independently assessed article quality and conducted data abstraction.

Results

Forty-four studies met the inclusion criteria; only 7 studies with 20% or more Latinos and 39% or more men were included in the final analyses. The most common intervention strategies included one-on-one interactions with a patient navigator and reducing structural barriers (eg, providing fecal occult blood tests). Interventions using small media produced mixed results.

Conclusion

Although intervention studies focused on colorectal cancer screening among men of racial/ethnic minorities are scarce, our findings highlight promising strategies that were effective at increasing colorectal cancer screening among Latino men. Additional research in the area of Latino men’s health is needed, especially to further develop and test theoretically grounded interventions that promote colorectal cancer screening with larger samples of men and across diverse geographic areas in the United States.

Cultural and emotional determinants of cervical cancer screening among older Hispanic women

Older adults are at highest risk of cancer and yet have the lowest rates of cancer screening participation. Older minority adults bear the burden of cancer screening disparities leading to late stage cancer diagnoses. This investigation, utilization data from the 2008 wave of the Health and Retirement study examined the cultural and emotional factors thought to influence cervical cancer screening among older Hispanic women. We utilized logistic regression models to conduct the analyses. Findings indicate that the emotional factors were not significant but the cultural factor, time orientation was a significant predictor for older Hispanics' cervical cancer screening behaviors.

Breast, Cervical, and Colorectal Cancer Education and Navigation

Now that cancer has surpassed heart disease as the top cause of death for Hispanics in the United States, it is even more critical to focus on early detection of cancer in this population. We report the results of a theory-driven education-plus-navigation pilot intervention delivered by bilingual, bicultural community health workers (CHWs) with the goal of increasing cancer screening rates and knowledge among low-income Latinas. CHWs enrolled 691 eligible women, ages 18 to 75 years, considered rarely or never screened for breast, cervical, and colorectal cancer. Eligible women were scheduled for an education session and offered health care navigation support with appointment scheduling and reminder/follow-up calls. CHWs provided education to 535 (77%) eligible women, and arranged mammograms, Pap tests, or stool blood tests for 174 (25%) participants, with another 94 (14%) placed on a waiting list at a local health center. Statistically significant positive changes on knowledge of screening guidelines for breast, cervical, and colorectal cancer, and beliefs/attitudes regarding early detection were observed from pre- to posttest among eligible women who attended an educational session. Results highlight the effectiveness of CHW-directed interventions in recruiting individuals for programs, educating them, and influencing cancer knowledge and screening behavior.

The relationship between psychosocial factors and breast cancer screening behaviors of older Hispanic women

Guided by the theory of planned behavior, this study utilized data from the 2008 wave of the Health and Retirement Study to investigate psychosocial factors associated with older Hispanic women's participation in breast cancer screening services. Hierarchical logistic regression models were used to assess the odds of breast cancer screening participation. Findings indicate that satisfaction with aging and constraints were associated with a reduced likelihood of participating in breast cancer screening. These findings suggest the continued importance to assess older women's attitudes when discussing preventive services.

Predictors of never being screened for cervical cancer by metropolitan area

Previous studies have shown an association between cervical cancer screening and racial/ethnic minority status, no usual source of care, and lower socioeconomic status. This study describes the demographics and health beliefs of women who report never being screened for cervical cancer by area of residence. Data from the 2010 Behavioral Risk Factor Surveillance System were used to study women aged 21-65 years who reported never being screened for cervical cancer. Multivariate logistic regression modeling was used to calculate predicted marginals to examine associations between never being screened and demographic characteristics and health belief model (HBM) constructs by metropolitan statistical area (MSA). After adjusting for all demographics and HBM constructs, prevalence of never being screened was higher for the following women: non-Hispanic Asians/Native Hawaiians/Pacific Islanders (16.5 %, 95 % CI = 13.7 %, 19.8 %) who live in MSAs; those with only a high school diploma who live in MSAs (5.5 %, 95 % CI = 4.7 %, 6.5 %); those living in non-MSAs who reported "fair or poor" general health (4.1 %, 95 % CI = 3.1 %, 5.4 %); and those living in either MSAs and non-MSAs unable to see a doctor within the past 12 months because of cost (MSA: 4.4 %, 95 % CI = 4.0 %, 4.8 %; non-MSA: 3.4 %, 95 % CI = 2.9 %, 3.9 %). The Affordable Care Act will expand access to insurance coverage for cervical cancer screening, without cost sharing for millions of women, essentially eliminating insurance costs as a barrier. Future interventions for women who have never been screened should focus on promoting the importance of screening and reaching non-Hispanic Asians/Native Hawaiians/Pacific Islanders who live in MSAs.

Religious beliefs and cancer screening behaviors among Catholic Latinos: implications for faith-based interventions

Although most U.S. Latinos identify as Catholic, few studies have focused on the influence of this religious tradition on health beliefs among this population. This study explores the role of Catholic religious teachings, practices, and ministry on cancer screening knowledge, attitudes, and behaviors among Latinos. Eight focus groups were conducted with 67 Catholic Latino parishioners in Massachusetts. Qualitative analysis provided evidence of strong reliance on faith, God, and parish leaders for health concerns. Parishes were described as vital sources of health and social support, playing a central role in the community's health. Participants emphasized that their religious beliefs promote positive health behaviors and health care utilization, including the use of cancer screening services. In addition, they expressed willingness to participate in cancer education programs located at their parishes and provided practical recommendations for implementing health programs in parishes. Implications for culturally appropriate health communication and faith-based interventions are discussed.

Reducing time-to-treatment in underserved Latinas with breast cancer: the Six Cities Study

BACKGROUND

The interaction of clinical and patient-level challenges following a breast cancer diagnosis can be a significant source of health care disparities. Failure to address specific cultural features that create or exacerbate barriers can lead to less-than optimal navigation results, specifically in Hispanic/Latino women.

METHODS

To address these disparities, the study leaders in San Antonio, Texas, and 5 other regional partners of the federally-funded Redes En Acción: The National Latino Cancer Research Network developed a culturally-tailored patient navigation intervention model for Latinas with breast cancer.

RESULTS

Compared with control patients, a higher percentage of navigated subjects initiated treatment within 30 days (69.0% versus 46.3%, P = .029) and 60 days (97.6% versus 73.1%, P = .001) following their cancer diagnosis. Time from cancer diagnosis to first treatment was lower in the navigated group (mean, 22.22 days; median, 23.00 days) than controls (mean, 48.30 days; median, 33.00 days). These results were independent of cancer stage at diagnosis and numerous characteristics of cancer clinics and individual participants.

CONCLUSIONS

Successful application of patient navigation increased the percentage of Latinas initiating breast cancer treatment within 30 and 60 days of diagnosis. This was achieved through navigator provision of services such as accompaniment to appointments, transportation arrangements, patient telephone support, patient-family telephone support, Spanish-English language translation, and assistance with insurance paperwork.

Reducing time-to-treatment in underserved Latinas with breast cancer: the Six Cities Study

BACKGROUND

The interaction of clinical and patient-level challenges following a breast cancer diagnosis can be a significant source of health care disparities. Failure to address specific cultural features that create or exacerbate barriers can lead to less-than optimal navigation results, specifically in Hispanic/Latino women.

METHODS

To address these disparities, the study leaders in San Antonio, Texas, and 5 other regional partners of the federally-funded Redes En Acción: The National Latino Cancer Research Network developed a culturally-tailored patient navigation intervention model for Latinas with breast cancer.

RESULTS

Compared with control patients, a higher percentage of navigated subjects initiated treatment within 30 days (69.0% versus 46.3%, P = .029) and 60 days (97.6% versus 73.1%, P = .001) following their cancer diagnosis. Time from cancer diagnosis to first treatment was lower in the navigated group (mean, 22.22 days; median, 23.00 days) than controls (mean, 48.30 days; median, 33.00 days). These results were independent of cancer stage at diagnosis and numerous characteristics of cancer clinics and individual participants.

CONCLUSIONS

Successful application of patient navigation increased the percentage of Latinas initiating breast cancer treatment within 30 and 60 days of diagnosis. This was achieved through navigator provision of services such as accompaniment to appointments, transportation arrangements, patient telephone support, patient-family telephone support, Spanish-English language translation, and assistance with insurance paperwork.

Characteristics of male attendees of health education interventions for Latinos

Latino subgroups in the US often shoulder a greater burden of some common diseases, including cancer. The cultural norm of patriarchy in health-related decision-making has been found to be common among Latinos, and thus male members may be important in the adoption of health practices amongst family members. Demographic information was collected from 488 male attendees (20% of the total sample) as part of a larger randomized trial focused on promoting breast and cervical cancer screening among Latinas in which attendance was open to the entire community. The majority of male attendees were over the age of 40 (62%) and originally from Mexico (39%) or Puerto Rico (25%). Approximately half of attendees reported having no health coverage and living less than 5 years in the United States. Male attendees demonstrated significant increases in knowledge relevant to their group attendance. There were few significant differences between the characteristics of male attendees at a female focused cancer program (intervention) versus more general diabetes program (control). The current study describes characteristics of a group that may be influential in guiding health behaviors and decisions. This information extends our understanding of community participation in health interventions and will assist in the development of effective interventions in the Latino community.