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Nagpal N, McCready TM, Xia Y, Lin K, Glenn M, Ng S, Trinh-Shevrin C, Troxel AB, Kwon SC, Liang PS. Predictors of Colonoscopy Use Among Asian Indians in New York City, 2003 to 2016. J Clin Gastroenterol 2024; 58:875-881. [PMID: 37556383 PMCID: PMC10853482 DOI: 10.1097/mcg.0000000000001900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/06/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Asian Americans have the lowest colorectal cancer screening uptake of any racial and ethnic group in the United States. Asian Indians are among the most under-screened Asian American subgroups, but there is limited data for this population. We sought to characterize predictors of colonoscopy use among Asian Indians in New York City. METHODS Using 2003 to 2016 data from the New York City Community Health Survey, we identified all Asian Indian participants aged 50 years or older. We examined the association between sociodemographic and medical factors and up-to-date colonoscopy use (defined as colonoscopy within the last 10 y) using logistic regression over 4 time periods: 2003 to 2008, 2009 to 2012, 2013 to 2014, 2015 to 2016. RESULTS On multivariable analysis, language, age, income, recent exercise, body mass index, and influenza vaccination were associated with colonoscopy uptake in 1 time period. Compared with participants who preferred English, those who preferred an Indian language were less likely to have been up-to-date in 2013 to 2014 (odds ratio 0.12, 95% CI 0.02-0.66). Individuals older than 65 years were more likely than those aged 50 to 64 years to have received a colonoscopy in 2009 to 2012 (odds ratio 3.91, 95% CI 1.49-10.24), although the risk estimates were also consistently positive in the other 3 time periods. CONCLUSIONS Among Asian Indians living in New York City, several demographic, socioeconomic, and health-related characteristics predict colonoscopy use. These findings highlight the importance of examining determinants of colonoscopy uptake in this understudied population to inform future public health interventions.
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Affiliation(s)
- Neha Nagpal
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Taylor M. McCready
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Yuhe Xia
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Kevin Lin
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Matthew Glenn
- NYU Grossman School of Medicine, New York, New York, United States of America
| | - Sandy Ng
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Chau Trinh-Shevrin
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States of America
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Andrea B. Troxel
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Simona C. Kwon
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States of America
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Peter S. Liang
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States of America
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
- Department of Medicine, Veteran Affairs New York Harbor Health Care System, New York, New York, United States of America
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Pham LA, Clark PJ, Macdonald GA, Thomas JA, Dalais C, Fonda A, Kendall BJ, Thrift AP. Colorectal cancer screening participation in First Nations populations worldwide: a systematic review and data synthesis. EClinicalMedicine 2024; 73:102666. [PMID: 38828132 PMCID: PMC11139771 DOI: 10.1016/j.eclinm.2024.102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 06/05/2024] Open
Abstract
Background First Nations populations have poorer colorectal cancer (CRC) survival compared to non-First Nations populations. Whilst First Nations populations across the world are distinct, shared experiences of discrimination and oppression contribute to persistent health inequities. CRC screening improves survival, however screening rates in First Nations populations are poorly described. This study seeks to define participation rates in CRC screening in First Nations populations worldwide. Methods A systematic literature search was conducted of PubMed, Embase, Cochrane Library, CINAHL, MEDLINE, grey literature, national registries and ClinicalTrials.gov. All sources were searched from their inception date to 18 February 2024. Studies were included if they reported CRC screening rates in adult (≥18 years) First Nations populations. We aimed to undertake a meta-analysis if there were sufficient data. Quality of papers were assessed using the Joanna Briggs Institute (JBI) appraisal tool. The study was registered with PROSPERO, CRD42020210181. Findings The literature search identified 1723 potentially eligible published studies. After review, 57 studies were included, 50 from the United States (US), with the remaining studies from Australia, Aotearoa New Zealand (NZ), Canada, Dominica and Guatemala. Additionally, eleven non-indexed reports from national programs in Australia and NZ were included. There were insufficient data to undertake meta-analysis, therefore a systematic review and narrative synthesis were conducted. CRC screening definitions varied, and included stool-based screening, sigmoidoscopy and colonoscopy. US First Nations screening rates ranged between 4.0 and 79.2%, Australia reported 10.6-35.2%, NZ 18.4-49%, Canada 22.4-53.4%, Guatemala 2.2% and Dominica 4.2%. Fifty-five studies were assessed as moderate or high quality and two as low quality. Interpretation Our findings suggested that there is wide variation in CRC screening participation rates across First Nations populations. Screening data are lacking in direct comparator groups and longitudinal outcomes. Disaggregation of screening data are required to better understand and address First Nations CRC outcome inequities. Funding None.
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Affiliation(s)
- Lily A. Pham
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Paul J. Clark
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Graeme A. Macdonald
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - James A. Thomas
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Christine Dalais
- University of Queensland Library, The University of Queensland, Brisbane, Australia
| | - Annie Fonda
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, Brisbane, Australia
| | - Bradley J. Kendall
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Aaron P. Thrift
- Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, United States
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, United States
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Ramalingam N, Coury J, Barnes C, Kenzie ES, Petrik AF, Mummadi RR, Coronado G, Davis MM. Provision of colonoscopy in rural settings: A qualitative assessment of provider context, barriers, facilitators, and capacity. J Rural Health 2024; 40:272-281. [PMID: 37676061 PMCID: PMC10918036 DOI: 10.1111/jrh.12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/07/2023] [Accepted: 08/26/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Colonoscopy can prevent morbidity and mortality from colorectal cancer (CRC) and is the most commonly used screening method in the United States. Barriers to colonoscopy at multiple levels can contribute to disparities. Yet, in rural settings, little is known about who delivers colonoscopy and facilitators and barriers to colonoscopy access through screening completion. METHODS We conducted a qualitative study with providers in rural Oregon who worked in endoscopy centers or primary care clinics. Semistructured interviews, conducted in July and August, 2021, focused on clinician experiences providing colonoscopy to rural Medicaid patients, including workflows, barriers, and access. We used thematic analysis, through immersion crystallization, to analyze interview transcripts and develop emergent themes. FINDINGS We interviewed 19 providers. We found two categories of colonoscopy providers: primary care providers (PCPs) doing colonoscopy on their own patients (n = 9; 47%) and general surgeons providing colonoscopy to patients referred to their services (n = 10; 53%). Providers described barriers to colonoscopy at the provider, community, and patient levels and suggested patient supports could help overcome them. Providers found current colonoscopy capacity sufficient, but noted PCPs trained to perform colonoscopy would be key to continued accessibility. Finally, providers shared concerns about the shrinking number of PCP endoscopists, especially with anticipated increased screening demand related to the CRC screening guideline shift. CONCLUSIONS These themes reflect opportunities to address multilevel barriers to improve access, colonoscopy capacity, and patient education approaches. Our results highlight that PCPs are an essential part of the workforce that provides colonoscopy in rural areas.
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Affiliation(s)
- NithyaPriya Ramalingam
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3030 S Moody Avenue, Suite 160, Portland, OR 97201
| | - Jennifer Coury
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3030 S Moody Avenue, Suite 160, Portland, OR 97201
| | - Chrystal Barnes
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3030 S Moody Avenue, Suite 160, Portland, OR 97201
| | - Erin S. Kenzie
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3030 S Moody Avenue, Suite 160, Portland, OR 97201
- Department of Family Medicine & School of Public Health, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098
| | - Amanda F. Petrik
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227
| | - Rajasekhara R Mummadi
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227
| | - Gloria Coronado
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227
| | - Melinda M. Davis
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3030 S Moody Avenue, Suite 160, Portland, OR 97201
- Department of Family Medicine & School of Public Health, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098
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Nelson D, Selby P, Kane R, Harding-Bell A, Kenny A, McPeake K, Cooke S, Hogue T, Oliver K, Gussy M, Lawler M. Implementing the European code of cancer practice in rural settings. J Cancer Policy 2024; 39:100465. [PMID: 38184144 DOI: 10.1016/j.jcpo.2023.100465] [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: 04/12/2023] [Revised: 12/08/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
Existing evidence often indicates higher cancer incidence and mortality rates, later diagnosis, lower screening uptake and poorer long-term survival for people living in rural compared to more urbanised areas. Despite wide inequities and variation in cancer care and outcomes across Europe, much of the scientific literature explicitly exploring the impact of rurality on cancer continues to come from Australia and North America. The European Code of Cancer Practice or "The Code" is a citizen and patient-centred statement of the most salient requirements for good clinical cancer practice and has been extensively co-produced by cancer patients, cancer professionals and patient advocates. It contains 10 key overarching Rights that a cancer patient should expect from their healthcare system, regardless of where they live and has been strongly endorsed by professional and patient cancer organisations as well as the European Commission. In this article, we use these 10 fundamental Rights as a framework to argue that (i) the issues and needs identified in The Code are generally more profound for rural people with cancer; (ii) addressing these issues is also more challenging in rural contexts; (iii) interventions and support must explicitly account for the unique needs of rural residents living with and affected by cancer and (iv) new innovative approaches are urgently required to successfully overcome the challenges faced by rural people with cancer and their caregivers. Despite equitable healthcare being a key European policy focus, the needs of rural people living with cancer have largely been neglected.
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Affiliation(s)
- David Nelson
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK; Macmillan Cancer Support, London, UK.
| | - Peter Selby
- Faculty of Medicine and Health, University of Leeds, Leeds, UK; Lincoln Medical School, Universities of Nottingham and Lincoln, Lincoln, UK
| | - Ros Kane
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | | | - Amanda Kenny
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK; La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Kathie McPeake
- Macmillan Cancer Support, London, UK; NHS Lincolnshire Integrated Care Board, Sleaford, UK
| | - Samuel Cooke
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Todd Hogue
- School of Psychology, University of Lincoln, Lincoln, UK
| | | | - Mark Gussy
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK; La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Mark Lawler
- Patrick G Johnston Centre for Cancer Research, Faculty of Medicine, Health and Life Sciences, Queens University Belfast, Belfast, UK
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5
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Njoku A, Sawadogo W, Frimpong P. Racial and Ethnic Disparities in Cancer Occurrence and Outcomes in Rural United States: A Scoping Review. Cancer Control 2024; 31:10732748241261558. [PMID: 38857181 PMCID: PMC11165954 DOI: 10.1177/10732748241261558] [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: 01/07/2024] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Cancer is the second-leading cause of death in the United States. Most studies have reported rural versus urban and Black versus White cancer disparities. However, few studies have investigated racial disparities in rural areas. OBJECTIVE We conducted a literature review to explore the current state of knowledge on racial and ethnic disparities in cancer attitudes, knowledge, occurrence, and outcomes in rural United States. METHODS A systematic search of PubMed and Embase was performed. Peer-reviewed articles published in English from 2004-2023 were included. Three authors independently reviewed the articles and reached a consensus. RESULTS After reviewing 993 articles, a total of 30 articles met the inclusion criteria and were included in the present review. Studies revealed that underrepresented racial and ethnic groups in rural areas were more likely to have low cancer-related knowledge, low screening, high incidence, less access to treatment, and high mortality compared to their White counterparts. CONCLUSION Underrepresented racial and ethnic groups in rural areas experienced a high burden of cancer. Improving social determinants of health may help reduce cancer disparities and promote health.
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Affiliation(s)
- Anuli Njoku
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, CT, USA
| | - Wendemi Sawadogo
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, CT, USA
| | - Princess Frimpong
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, CT, USA
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Vilaro MJ, Bryan E, Palani T, Cooks EJ, Mertens G, Zalake M, Lok BC, Krieger JL. Rural adults' perceptions of nutrition recommendations for cancer prevention: Contradictory and conflicting messages. PREVENTIVE ONCOLOGY & EPIDEMIOLOGY 2023; 1:2237680. [PMID: 38390218 PMCID: PMC10883477 DOI: 10.1080/28322134.2023.2237680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Despite robust evidence linking alcohol, processed meat, and red meat to colorectal cancer (CRC), public awareness of nutrition recommendations for CRC prevention is low. Marginalized populations, including those in rural areas, experience high CRC burden and may benefit from culturally tailored health information technologies. This study explored perceptions of web-based health messages iteratively in focus groups and interviews with 48 adults as part of a CRC prevention intervention. We analyzed transcripts for message perceptions and identified three main themes with subthemes: (1) Contradictory recommendations, between the intervention's nutrition risk messages and recommendations for other health conditions, from other sources, or based on cultural or personal diets; (2) reactions to nutrition risk messages, ranging from aversion (e.g., "avoid alcohol" considered "preachy") to appreciation, with suggestions for improving messages; and (3) information gaps. We discuss these themes, translational impact, and considerations for future research and communication strategies for delivering web-based cancer prevention messages.
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Affiliation(s)
| | - Emma Bryan
- STEM Translational Communication Center, University of Florida
| | - Te Palani
- STEM Translational Communication Center, University of Florida
| | - Eric J Cooks
- STEM Translational Communication Center, University of Florida
| | - Gillian Mertens
- STEM Translational Communication Center, University of Florida
- Literacy Department, SUNY Cortland
| | - Mohan Zalake
- Computer and Information Sciences and Engineering, University of Florida
| | - Benjamin C Lok
- Computer and Information Sciences and Engineering, University of Florida
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7
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Zhu X, Zhang P, Kang H, Marla L, Robles Granda MI, Ebert-Allen RA, Stewart de Ramirez S, Oderwald T, McGee M, Handler JA. Derivation of a Unique, Algorithm-Based Approach to Cancer Patient Navigator Workload Management. JCO Clin Cancer Inform 2023; 7:e2200170. [PMID: 37207310 PMCID: PMC10569769 DOI: 10.1200/cci.22.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/05/2023] [Accepted: 03/15/2023] [Indexed: 05/21/2023] Open
Abstract
PURPOSE Cancer patient navigators (CPNs) can decrease the time from diagnosis to treatment, but workloads vary widely, which may lead to burnout and less optimal navigation. Current practice for patient distribution among CPNs at our institution approximates random distribution. A literature search did not uncover previous reports of an automated algorithm to distribute patients to CPNs. We sought to develop an automated algorithm to fairly distribute new patients among CPNs specializing in the same cancer type(s) and assess its performance through simulation on a retrospective data set. METHODS Using a 3-year data set, a proxy for CPN work was identified and multiple models were developed to predict the upcoming week's workload for each patient. An XGBoost-based predictor was retained on the basis of its superior performance. A distribution model was developed to fairly distribute new patients among CPNs within a specialty on the basis of predicted work needed. The predicted work included the week's predicted workload from a CPN's existing patients plus that of newly distributed patients to the CPN. Resulting workload unfairness was compared between predictor-informed and random distribution. RESULTS Predictor-informed distribution significantly outperformed random distribution for equalizing weekly workloads across CPNs within a specialty. CONCLUSION This derivation work demonstrates the feasibility of an automated model to distribute new patients more fairly than random assignment (with unfairness assessed using a workload proxy). Improved workload management may help reduce CPN burnout and improve navigation assistance for patients with cancer.
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Affiliation(s)
- Xiyitao Zhu
- University of Illinois at Urbana-Champaign, Champaign, IL
| | - Peng Zhang
- University of Illinois at Urbana-Champaign, Champaign, IL
| | - Hyojung Kang
- University of Illinois at Urbana-Champaign, Champaign, IL
| | - Lavanya Marla
- University of Illinois at Urbana-Champaign, Champaign, IL
| | | | | | - Sarah Stewart de Ramirez
- OSF HealthCare System, Peoria, IL
- University of Illinois College of Medicine at Peoria, Peoria, IL
| | | | | | - Jonathan A. Handler
- OSF HealthCare System, Peoria, IL
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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8
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Preston MA, Cadet D, Hunley R, Retnam R, Arezo S, Sheppard VB. Health Equity and Colorectal Cancer Awareness: a Community Health Educator Initiative. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:225-230. [PMID: 34677801 PMCID: PMC8532449 DOI: 10.1007/s13187-021-02102-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 06/13/2023]
Abstract
Disparities in colorectal cancer (CRC) incidence and mortality persist in rural and underserved communities. Our Community Outreach and Engagement (COE) activities are grounded in a bi-directional Community-to-Bench model in which the National Outreach Network Community Health Educator (NON CHE) Screen to Save (S2S) initiative was implemented. In this study, we assessed the impact of the NON CHE S2S in rural and underserved communities. Descriptive and comparative analyses were used to examine the role of the NON CHE S2S on CRC knowledge and CRC screening intent. Data included demographics, current CRC knowledge, awareness, and future CRC health plans. A multivariate linear regression was fit to survey scores for CRC knowledge. The NON CHE S2S engaged 441 participants with 170 surveys completed. The difference in participants' CRC knowledge before and after the NON CHE S2S intervention had an overall mean of 0.92 with a standard deviation of 2.56. At baseline, White participants had significantly higher CRC knowledge scores, correctly answering 1.94 (p = 0.007) more questions on average than Black participants. After the NON CHE S2S intervention, this difference was not statistically significant. Greater than 95% of participants agreed that the NON CHE S2S sessions impacted their intent to get screened for CRC. Equity of access to health information and the health care system can be achieved with precision public health strategies. The COE bi-directional Community-to-Bench model facilitated community connections through the NON CHE and increased awareness of CRC risk reduction, screening, treatment, and research. The NON CHE combined with S2S is a powerful tool to engage communities with the greatest health care needs and positively impact an individual's intent to "get screened" for CRC.
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Affiliation(s)
- Michael A Preston
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA.
| | - Debbie Cadet
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA
| | - Rachel Hunley
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA
| | - Reuben Retnam
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA
| | - Sarah Arezo
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA
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Barberan Parraga C, Singh R, Lin R, Tamariz L, Palacio A. Colorectal Cancer Screening Disparities Among Race: A Zip Code Level Analysis. Clin Colorectal Cancer 2023; 22:183-189. [PMID: 36842869 DOI: 10.1016/j.clcc.2023.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) screening can prevent disease by early identification. Existing disparities in CRC screening have been associated with factors including race, socioeconomic status, insurance, and even geography. Our study takes a deeper look into how social determinants related to zip code tabulation areas affect CRC screenings. MATERIALS AND METHODS We conducted a retrospective cross-sectional study of CRC screenings by race at a zip code level, evaluating for impactful social determinant factors such as the social deprivation index (SDI). We used publicly available data from CDC 500 Cities Project (2016-2019), PLACES Project (2020), and the American Community Survey (2019). We conducted multivariate and confirmatory factor analyses among race, income, health insurance, check-up visits, and SDI. RESULTS Increasing the tertile of SDI was associated with a higher likelihood of being Black or Hispanic, as well as decreased median household income (P < .01). Lower rates of regular checkup visits were found in the third tertile of SDI (P < .01). The multivariate analysis showed that being Black, Hispanic, lower income, being uninsured, lack of regular check-ups, and increased SDI were related to decreased CRC screening. In the confirmatory factor analysis, we found that SDI and access to insurance were the variables most related to decreased CRC screening. CONCLUSION Our results reveal the top 2 factors that impact a locality's CRC screening rates are the social deprivation index and access to health care. This data may help implement interventions targeting social barriers to further promote CRC screenings within disadvantaged communities and decrease overall mortality via early screening.
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Affiliation(s)
- Carla Barberan Parraga
- Department of Medicine and Epidemiology Universidad Catolica Santiago de Guayaquil, Guayaquil, Ecuador.
| | - Roshni Singh
- Miller School of Medicine, University of Miami, Miami, FL
| | - Rachel Lin
- Miller School of Medicine, University of Miami, Miami, FL
| | | | - Ana Palacio
- Miami Veterans Affairs Medical Center, Miami, FL
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10
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Blanchard J, Rhoades D, Nagykaldi Z, Campbell J, Cannady T, Hopkins M, Gibson M, Lonewolf H, Doescher M. Identifying Priorities and Strategies for Improving Colorectal Cancer Screening in Tribal Clinics. Cancer Control 2022; 29:10732748221132516. [PMID: 36224082 PMCID: PMC9561646 DOI: 10.1177/10732748221132516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the 3rd most frequently diagnosed cancer and the 2nd leading cause of cancer death in the United States (US), and incidence and mortality rates in Oklahoma are higher for many American Indian (AI) populations than other populations. The AI CRC Screening Consortium addresses major regional CRC screening disparities among AIs with shared objectives to increase CRC screening delivery and uptake in AIs aged 50 to 75 years at average risk for CRC and to assess the effectiveness of implementations of the interventions. This manuscript reports environmental scan findings related to current practices and multi-stakeholder experiences with CRC screening in two Oklahoma Indian health care systems. METHOD We conducted a mixed methods environmental scan across five clinical sites and with multiple stakeholders to determine the scope and scale of colorectal cancer screening in two separate AI health care delivery systems in Oklahoma. Data collection consisted of a mixture of individual interviews and group discussions at an urban site, and four clinical care sites within a tribal health system. RESULTS Sixty-two individuals completed interviews. Data from these interviews will inform the development of evidence-based intervention strategies to increase provider delivery, community access to, and community priority for CRC screening in diverse AI health care delivery systems. Conversations with patients, providers, and clinical leadership point to individual and system-level opportunities for improvement at each site, shaped in part by differences in the delivery of services, structure of the health care system, and capacity to implement new intervention strategies. The thematic areas most central to the process of evidenced-based intervention development included: current practices, needs and recommendations, and CRC site priorities. CONCLUSION Environmental scan data indicated clear opportunities for individual and system-level interventions to enhance CRC screening and was critical for understanding readiness for EBI implementation at each site.
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Affiliation(s)
- Jessica Blanchard
- University of
Oklahoma, Norman, OK, USA,Jessica Blanchard, University of Oklahoma,
201 Stephenson Parkway, Suite 4100, Norman, OK 73019, USA.
| | - Dorothy Rhoades
- University of Oklahoma College of
Medicine, Oklahoma, OK, USA
| | - Zsolt Nagykaldi
- Family Medicine Center Building,
University
of Oklahoma Health Sciences Center,
Oklahoma, OK, USA
| | | | | | | | | | | | - Mark Doescher
- University of Oklahoma College of
Medicine, Oklahoma, OK, USA
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Bhatia S, Landier W, Paskett ED, Peters KB, Merrill JK, Phillips J, Osarogiagbon RU. Rural-Urban Disparities in Cancer Outcomes: Opportunities for Future Research. J Natl Cancer Inst 2022; 114:940-952. [PMID: 35148389 PMCID: PMC9275775 DOI: 10.1093/jnci/djac030] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/27/2021] [Accepted: 02/01/2022] [Indexed: 01/12/2023] Open
Abstract
Cancer care disparities among rural populations are increasingly documented and may be worsening, likely because of the impact of rurality on access to state-of-the-art cancer prevention, diagnosis, and treatment services, as well as higher rates of risk factors such as smoking and obesity. In 2018, the American Society of Clinical Oncology undertook an initiative to understand and address factors contributing to rural cancer care disparities. A key pillar of this initiative was to identify knowledge gaps and promote the research needed to understand the magnitude of difference in outcomes in rural vs nonrural settings, the drivers of those differences, and interventions to address them. The purpose of this review is to describe continued knowledge gaps and areas of priority research to address them. We conducted a comprehensive literature review by searching the PubMed (Medline), Embase, Web of Science, and Cochrane Library databases for studies published in English between 1971 and 2021 and restricted to primary reports from populations in the United States and abstracted data to synthesize current evidence and identify continued gaps in knowledge. Our review identified continuing gaps in the literature regarding the underlying causes of rural-urban disparities in cancer outcomes. Rapid advances in cancer care will worsen existing disparities in outcomes for rural patients without directed effort to understand and address barriers to high-quality care in these areas. Research should be prioritized to address ongoing knowledge gaps about the drivers of rurality-based disparities and preventative and corrective interventions.
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Affiliation(s)
- Smita Bhatia
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Wendy Landier
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Balan N, Petrie BA, Chen KT. Racial Disparities in Colorectal Cancer Care for Black Patients: Barriers and Solutions. Am Surg 2022; 88:2823-2830. [PMID: 35757937 DOI: 10.1177/00031348221111513] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Racial disparities in colorectal cancer for Black patients have led to a significant mortality difference when compared to White patients, a gap which has remained to this day. These differences have been linked to poorer quality insurance and socioeconomic status in addition to lower access to high-quality health care resources, which are emblematic of systemic racial inequities. Disparities impact nearly every point along the colorectal cancer care continuum and include barriers to screening, surgical care, oncologic care, and surveillance. These critical faults are the driving forces behind the mortality difference Black patients face. Health care systems should strive to correct these disparities through both cultural competency at the provider level and public policy change at the national level.
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Affiliation(s)
- Naveen Balan
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Beverley A Petrie
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kathryn T Chen
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
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Geographic distribution of colonoscopy providers in the United States: An analysis of medicare claims data. Surg Endosc 2022; 36:7673-7678. [PMID: 35729404 DOI: 10.1007/s00464-022-09083-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/25/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Screening colonoscopy is one of the few procedures that can prevent cancer. While the majority of colonoscopies in the USA are performed by gastroenterologists, general surgeons play a key role in at-risk, rural populations. The aim of this study was to examine geographic practice patterns in colonoscopy using a nationwide Medicare claims database. METHODS AND PROCEDURES The 2017 Medicare Provider Utilization and Payment database was used to identify physicians performing colonoscopy. Providers were classified as gastroenterologists, surgeons, ambulatory surgical centers (ASCs), or other. Rural-Urban Commuting Area classification at the zip code level was used to determine whether the practice location for an individual provider was in a rural area/small town (< 10,000 people), micropolitan area (10-50,000 people), or metropolitan area (> 50,000 people). RESULTS Claims data from 3,861,187 colonoscopy procedures on Medicare patients were included. The majority of procedures were performed by gastroenterologists (57.2%) and ASCs (32.1%). Surgeons performed 6.8% of cases overall. When examined at a zip code level, surgeons performed 51.6% of procedures in small towns/rural areas and 21.7% of procedures in micropolitan areas. Individual surgeons performed fewer annual procedures as compared to gastroenterologists (median 51 vs. 187, p < 0.001). CONCLUSIONS Surgeons perform the majority of colonoscopies in rural zip codes on Medicare patients. High-quality, surgical training in endoscopy is essential to ensure access to colonoscopy for patients outside of major metropolitan areas.
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Stone GA, Fernandez M, DeSantiago A. Rural Latino health and the built environment: a systematic review. ETHNICITY & HEALTH 2022; 27:1-26. [PMID: 30999761 DOI: 10.1080/13557858.2019.1606899] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 04/08/2019] [Indexed: 05/21/2023]
Abstract
Objective: This study systematically reviewed literature examining the influence of the rural built environment on Latinos' health outcomes and behaviour in the United States. A secondary aim of the study was to identify strategies developed to address challenges in the rural built environment affecting Latinos' health.Design: This study followed the reporting guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles included in the final analysis clearly linked Latino health outcomes to characteristics of the rural built environment.Results: Of the nearly 2,500 articles identified in the initial search, the final review included approximately 146 full-text sources. The majority of the articles focused on aspects of Latinos' physical (n = 68), behavioural (n = 43), and mental health (n = 23).Conclusions: Rural Latino neighbourhoods in the United States possess limited access to health care, internet, transportation, and recreation infrastructure, which negatively impacts health outcomes and behaviours. Strategies developed to mitigate these issues include but are not limited to: the use of telecommunications to distribute health information; the use of community health workers and mobile clinics to increase awareness and availability of select health services; the use of worksite trainings and adaptations to the workplace; and the promotion of safety net programmes, such as the Supplemental Nutrition Programme for Women, Infants and Children (WIC). This review supports the need for a more robust research agenda documenting the health experiences of rural Latinos of various nationalities, age groups, and genders.
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Affiliation(s)
- Garrett A Stone
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, USA
| | - Mariela Fernandez
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, USA
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Rollet Q, Tron L, De Mil R, Launoy G, Guillaume É. Contextual factors associated with cancer screening uptake: A systematic review of observational studies. Prev Med 2021; 150:106692. [PMID: 34166675 DOI: 10.1016/j.ypmed.2021.106692] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/19/2021] [Accepted: 06/17/2021] [Indexed: 12/13/2022]
Abstract
We conducted a systematic review of a wide range of contextual factors related to cancer screening uptake that have been studied so far. Studies were identified through PubMed and Web of Science databases. An operational definition of context was proposed, considering as contextual factors: social relations directly aimed at cancer screening, health care provider and facility characteristics, geographical/accessibility measures and aggregated measures at supra-individual level. We included 70 publications on breast, cervical and/or colorectal cancer screening from 42 countries, covering a data period of 24 years. A wide diversity of factors has been investigated in the literature so far. While several of them, as well as many interactions, were robustly associated with screening uptake (family, friends or provider recommendation, provider sex and experience, area-based socio-economic status…), others showed less consistency (ethnicity, urbanicity, travel time, healthcare density …). Screening inequities were not fully explained through adjustment for individual and contextual factors. Context, in its diversity, influences individual screening uptake and lots of contextual inequities in screening are commonly shared worldwide. However, there is a lack of frameworks, standards and definitions that are needed to better understand what context is, how it could modify individual behaviour and the ways of measuring and modifying it.
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Affiliation(s)
- Quentin Rollet
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France.
| | - Laure Tron
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
| | - Rémy De Mil
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
| | - Guy Launoy
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
| | - Élodie Guillaume
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
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Vilaro MJ, Wilson-Howard DS, Zalake MS, Tavassoli F, Lok BC, Modave FP, George TJ, Odedina F, Carek PJ, Krieger JL. Key changes to improve social presence of a virtual health assistant promoting colorectal cancer screening informed by a technology acceptance model. BMC Med Inform Decis Mak 2021; 21:196. [PMID: 34158046 PMCID: PMC8218395 DOI: 10.1186/s12911-021-01549-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding how older, minoritized patients attend to cues when interacting with web-based health messages may provide opportunities to improve engagement with novel health technologies. We assess acceptance-promoting and acceptance-inhibiting cues of a web-based, intervention promoting colorectal cancer (CRC) screening with a home stool test among Black women. MATERIALS AND METHODS Focus group and individual interview data informed iterative changes to a race- and gender-concordant virtual health assistant (VHA). A user-centered design approach was used across 3 iterations to identify changes needed to activate cues described as important; such as portraying authority and expertise. Questionnaire data were analyzed using non-parametric tests for perceptions of cues. Analysis was guided by the Technology Acceptance Model. RESULTS Perceptions of interactivity, social presence, expertise, and trust were important cues in a VHA-delivered intervention promoting CRC screening. Features of the web-based platform related to ease of navigation and use were also discussed. Participant comments varied across the 3 iterations and indicated acceptance of or a desire to improve source cues for subsequent iterations. We highlight the specific key changes made at each of three iterative versions of the interactive intervention in conjunction with user perception of changes. DISCUSSION Virtual agents can be adapted to better meet patient expectations such as being a trustworthy and expert source. Across three evolving versions of a Black, VHA, cues for social presence were particularly important. Social presence cues helped patients engage with CRC screening messages delivered in this novel digital context. CONCLUSIONS When using a VHA to disseminate health information, cues associated with acceptability can be leveraged and adapted as needed for diverse audiences. Patient characteristics (age, identity, health status) are important to note as they may affect perceptions of a novel health technologies ease of use and relevancy according to the leading models.
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Affiliation(s)
- Melissa J Vilaro
- STEM Translational Communication Center (STCC), University of Florida, Weimer Hall 2043, PO Box 118400, Gainesville, FL, 32611, USA.
| | | | - Mohan S Zalake
- Computer and Information Science and Engineering, University of Florida, Gainesville, USA
| | - Fatemeh Tavassoli
- Computer and Information Science and Engineering, University of Florida, Gainesville, USA
| | - Benjamin C Lok
- Computer and Information Science and Engineering, University of Florida, Gainesville, USA
| | - François P Modave
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
| | - Thomas J George
- Hematology and Oncology, University of Florida, Gainesville, USA
| | - Folakemi Odedina
- College of Pharmacy and College of Medicine, University of Florida, Gainesville, USA
| | - Peter J Carek
- Community Health and Family Medicine, University of Florida, Gainesville, USA
| | - Janice L Krieger
- STEM Translational Communication Center (STCC), University of Florida, Weimer Hall 2043, PO Box 118400, Gainesville, FL, 32611, USA
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Sutton AL, Preston MA, Thomson M, Litzenberg C, Taylor TF, Cole EP, Sheppard VB. Reaching Rural Residents to Identify Colorectal Cancer Education and Intervention Targets. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:338-344. [PMID: 31654321 PMCID: PMC7182473 DOI: 10.1007/s13187-019-01635-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Disparities in cancer screening and care in rural communities warrant the need to determine effective ways to reach, engage, and educate the community residents. The purpose of this cross-sectional study was to pilot methods to engage rural residents in colorectal cancer (CRC) research and education activities and assess knowledge of CRC guidelines, symptoms, and screening behaviors in this sample. The community-engaged research approach was employed to develop and distribute a CRC knowledge and screening behavior assessment using various methods such as email and community drop boxes placed throughout the community. Bivariate analysis assessed the relationship between age and CRC knowledge items. Three hundred ninety-one surveys were returned with most received from community drop boxes (60%) followed by educational events (23%). The most ineffective method to distribute surveys was through community events. Most individuals were knowledgeable of CRC symptoms (70%) and screening facts (67%). Bivariate analysis showed that individuals 50 years or older had significantly more knowledge of CRC risks and screening than those under the age of 50. This study highlights the potential of community drop boxes as an effective method for engaging rural communities. Further, findings from the survey highlight the need to focus CRC education on younger individuals in which CRC incidence has increased.
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Affiliation(s)
- Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, MCV Campus, One Capitol Square, 9th floor, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA.
| | - Michael A Preston
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, MCV Campus, One Capitol Square, 9th floor, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Maria Thomson
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, MCV Campus, One Capitol Square, 9th floor, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Charlotte Litzenberg
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Trina F Taylor
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Eva Polly Cole
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, MCV Campus, One Capitol Square, 9th floor, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
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The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041384. [PMID: 33546168 PMCID: PMC7913122 DOI: 10.3390/ijerph18041384] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/15/2022]
Abstract
One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.
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Barré S, Leleu H, Benamouzig R, Saurin JC, Vimont A, Taleb S, De Bels F. Cost-effectiveness analysis of alternative colon cancer screening strategies in the context of the French national screening program. Therap Adv Gastroenterol 2020; 13:1756284820953364. [PMID: 33014138 PMCID: PMC7509710 DOI: 10.1177/1756284820953364] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/31/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A nationwide colorectal cancer (CRC) screening program was set up in France from 2009 for average-risk, asymptomatic people aged 50-74 years based on an immunochemical fecal occult blood test [faecal immunochemical test (FIT)] every 2 years, followed by colonoscopy if positive. The European standard recommends a participation rate of 45% for the program to be cost-effective, yet the latest published rate in France was 34%. The objective of this study was to compare the cost effectiveness of screening alternatives taking real-world participation rates into account. METHODS Eight screening strategies were compared, based either on a screening test (Guaiac or FIT testing, blood-based, stool DNA, computed tomography colonography, colon capsules, and sigmoidoscopy) followed by full colonoscopy if positive or direct colonoscopy. A microsimulation model was used to estimate the cost effectiveness associated with each strategy. RESULTS Compared with no screening, FIT was associated with a 14.0 quality-adjusted life year (QALY) increase of €50,520 per 1000 individuals, giving an incremental cost-effectiveness ratio (ICER) of €3600/QALY. Only stool DNA and blood-based testing were associated with a QALY increase compared with FIT, with stool DNA weakly dominated by blood-based testing, and the latter associated with an ICER of €154,600/QALY compared with FIT. All other strategies were dominated by FIT. CONCLUSION FIT every 2 years appears to be the most cost-effective CRC screening strategy when taking into account a real-world participation rate of 34%.
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Affiliation(s)
| | - Henri Leleu
- Public Health Expertise, 157 Rue du Faubourg Saint-Antoine, Paris, 75011, France
| | - R. Benamouzig
- Department of Gastroenterology, Hôpital Avicenne (AP-HP), Bobigny, France
| | - Jean-Christophe Saurin
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital (Hospices Civils de Lyon), Lyon, France
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Improving Colorectal Cancer Screening in a Rural Setting: A Randomized Study. Am J Prev Med 2020; 59:404-411. [PMID: 32684359 DOI: 10.1016/j.amepre.2020.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Colorectal cancer screening has been shown to prevent or detect early colorectal cancer and reduce mortality; yet, adherence to screening recommendations remains low, particularly in rural settings. STUDY DESIGN RCT. SETTING/PARTICIPANTS Adults (n=7,812) aged 50-75 years and due for colorectal cancer screening in a largely rural health system were randomly assigned to either the intervention (n=3,906) or the control (n=3,906) group in September 2016, with analysis following through 2018. INTERVENTION A mailed motivational messaging screening reminder letter with an option to call and request a free at-home fecal immunochemical screening test (intervention) or the standard invitation letter detailing that the individual was due for screening (control). Multifaceted motivational messaging emphasized colorectal cancer preventability and the ease and affordability of screening, and communicated a limited supply of test kits. MAIN OUTCOME MEASURES Colorectal cancer screening participation within 6 months after mailed invitation was ascertained from the electronic medical record. RESULTS Colorectal cancer screening participation was significantly improved in the intervention (30.1%) vs the usual care control group (22.5%; p<0.001). Individuals randomized to the intervention group had 49% higher odds of being screened over follow-up than those randomized to the control group (OR=1.49, 95% CI=1.34, 1.65). A total of 13.2 screening invitations were needed to accomplish 1 additional screening over the usual care. Of the 233 fecal immunochemical test kits mailed to participants, 154 (66.1%) were returned, and 18 (11.7%) tested positive. CONCLUSIONS A mailed motivational messaging letter with a low-cost screening alternative increased colorectal cancer screening in this largely rural community with generally poor adherence to screening recommendations. Mailed colorectal cancer screening reminders using motivational messaging may be an effective method for increasing screening and reducing rural colorectal cancer disparities.
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Whitaker DE, Snyder FR, San Miguel-Majors SL, Bailey LO, Springfield SA. Screen to Save: Results from NCI's Colorectal Cancer Outreach and Screening Initiative to Promote Awareness and Knowledge of Colorectal Cancer in Racial/Ethnic and Rural Populations. Cancer Epidemiol Biomarkers Prev 2020; 29:910-917. [DOI: 10.1158/1055-9965.epi-19-0972] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/20/2019] [Accepted: 02/14/2020] [Indexed: 11/16/2022] Open
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Carmichael H, Cowan M, McIntyre R, Velopulos C. Disparities in colorectal cancer mortality for rural populations in the United States: Does screening matter? Am J Surg 2019; 219:988-992. [PMID: 31604486 DOI: 10.1016/j.amjsurg.2019.09.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/08/2019] [Accepted: 09/24/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Rural compared to urban populations in the US have increased colorectal cancer (CRC) incidence with known disparity in screening rates and mortality. We hypothesize that rural-urban disparities are different at a regional level. METHODS We assessed screening rates according to the 2016 Behavioral Risk Factor Surveillance System guidelines using state and city-level data for county level estimates and correlating with county CRC mortality data from the National Cancer Institute. We used multivariable modeling to examine associations between rurality, screening rates, and mortality. RESULTS Highest screening rate states had the smallest urban-rural disparities; lowest screening rate states had the largest disparities. Percent screened and urban-rural classification correlated significantly with mortality. Rural counties experienced ∼5 more deaths per 100,000 population even controlling for screening rates. CONCLUSIONS National urban-rural disparities in CRC screening mask greater state/regional disparities, not fully explaining the urban-rural mortality gap. Other factors (i.e. access to care, treatment differences) must be considered.
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Affiliation(s)
| | - Michelle Cowan
- University of Colorado, 12631 E 17th Avenue, C305, United States
| | - Robert McIntyre
- University of Colorado, 12631 E 17th Avenue, C305, United States
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Triplette M, Thayer JH, Pipavath SN, Crothers K. Poor Uptake of Lung Cancer Screening: Opportunities for Improvement. J Am Coll Radiol 2019; 16:446-450. [DOI: 10.1016/j.jacr.2018.12.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/04/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022]
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Wittich AR, Shay LA, Flores B, De La Rosa EM, Mackay T, Valerio MA. Colorectal cancer screening: Understanding the health literacy needs of hispanic rural residents. AIMS Public Health 2019; 6:107-120. [PMID: 31297397 PMCID: PMC6606525 DOI: 10.3934/publichealth.2019.2.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/15/2018] [Indexed: 12/26/2022] Open
Abstract
Purpose Hispanics residing in rural areas are among those who are least likely to be screened for colorectal cancer (CRC) and more likely to present with late stage CRC than other racial or ethnic groups. We conducted a pilot study utilizing a mixed-method approach to explore perceptions of CRC and CRC screening among Hispanic adults residing in South Texas rural communities and to identify health literacy needs associated with CRC screening uptake. Methods A convenience sample of 58 participants, aged 35–65, were recruited to complete questionnaires and participate in focus groups, ranging in size from 4 to 13 participants. Six focus groups were conducted across 3 adjacent rural counties. A semi-structured moderator's guide was designed to elicit discussion about participants' experiences, knowledge, and perceptions of CRC and CRC screening. Findings Lack of knowledge of CRC and CRC screening as cancer prevention was a common theme across focus groups. A majority, 59%, reported never been screened. Thirty-nine percent reported they had been screened for colon cancer and 5% reported they did not know if they had been screened. Participants with lower educational levels perceived themselves at high risk for developing CRC polyps, would not want to know if they had CRC, and if they did have CRC, would not want to know until the very end. Limited information about CRC and CRC screening, a lack of specialized providers, limited transportation assistance, and compromised personal privacy in small-town medical facilities were perceived to be barriers to CRC screening. Conclusions Low screening rates persist among rural Hispanics. Improving CRC screening literacy and addressing factors unique to rural Hispanics may be a beneficial strategy for reducing screening disparities in this at-risk population.
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Affiliation(s)
- Angelina R Wittich
- UTHealth School of Public Health in San Antonio, Health Promotions and Behavioral Science, San Antonio, TX., USA
| | - L Aubree Shay
- UTHealth School of Public Health in San Antonio, Health Promotions and Behavioral Science, San Antonio, TX., USA
| | - Belinda Flores
- South Coastal AHEC (Area Health Education Center), University of Texas Health Science Center at San Antonio, Corpus Christi, TX., USA
| | - Elisabeth M De La Rosa
- Institute for Integration of Medicine & Science-Community Engagement, University of Texas Health Science Center at San Antonio, San Antonio, TX., USA
| | - Taylor Mackay
- UTHealth School of Public Health in San Antonio, Health Promotions and Behavioral Science, San Antonio, TX., USA
| | - Melissa A Valerio
- UTHealth School of Public Health in San Antonio, Health Promotions and Behavioral Science, San Antonio, TX., USA
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Wheeler SB, Leeman J, Hassmiller Lich K, Tangka FKL, Davis MM, Richardson LC. Data-Powered Participatory Decision Making: Leveraging Systems Thinking and Simulation to Guide Selection and Implementation of Evidence-Based Colorectal Cancer Screening Interventions. Cancer J 2019; 24:136-143. [PMID: 29794539 PMCID: PMC6047526 DOI: 10.1097/ppo.0000000000000317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A robust evidence base supports the effectiveness of timely colorectal cancer (CRC) screening, follow-up of abnormal results, and referral to care in reducing CRC morbidity and mortality. However, only two-thirds of the US population is current with recommended screening, and rates are much lower for those who are vulnerable because of their race/ethnicity, insurance status, or rural location. Multiple, multilevel factors contribute to observed disparities, and these factors vary across different populations and contexts. As highlighted by the Cancer Moonshot Blue Ribbon Panel working groups focused on Prevention and Early Detection and Implementation Science inadequate CRC screening and follow-up represent an enormous missed opportunity in cancer prevention and control. To measurably reduce CRC morbidity and mortality, the evidence base must be strengthened to guide the identification of (1) multilevel factors that influence screening across different populations and contexts, (2) multilevel interventions and implementation strategies that will be most effective at targeting those factors, and (3) combinations of strategies that interact synergistically to improve outcomes. Systems thinking and simulation modeling (systems science) provide a set of approaches and techniques to aid decision makers in using the best available data and research evidence to guide implementation planning in the context of such complexity. This commentary summarizes current challenges in CRC prevention and control, discusses the status of the evidence base to guide the selection and implementation of multilevel CRC screening interventions, and describes a multi-institution project to showcase how systems science can be leveraged to optimize selection and implementation of CRC screening interventions in diverse populations and contexts.
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Affiliation(s)
| | | | | | - Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Melinda M Davis
- Oregon Rural Practice-Based Research Network, Department of Family Medicine, and OHSU-PSU School of Public Health, Oregon Health and Sciences University, Portland, OR
| | - Lisa C Richardson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
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Josey MJ, Eberth JM, Mobley LR, Schootman M, Probst JC, Strayer SM, Sercy E. Should Measures of Health Care Availability Be Based on the Providers or the Procedures? A Case Study with Implications for Rural Colorectal Cancer Disparities. J Rural Health 2018; 35:236-243. [PMID: 30430641 DOI: 10.1111/jrh.12332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Patients with colorectal cancer (CRC) living in rural areas have lower survival rates than those in urban areas, potentially because of lack of access to quality CRC screening and treatment. The purpose of this study was to compare traditional physician density (ie, colonoscopy provider availability per capita) against a new physician density measure using an example case of colonoscopy volume and quality. The latter is particularly relevant for rural providers, who may have fewer patients and are more frequently nongastroenterologists. METHODS We conducted a secondary data analysis of the 2014 Medicare Provider Utilization and Payment Database and the National Cancer Institute State Cancer Profile Database. Volume-weighted physician density scores at the state and county levels were created, accounting for (1) the physician's annual colonoscopy volume and (2) whether the physician performs ≥100 procedures per year. We compared volume-weighted versus traditional density, overall and by rurality, and examined their correlation with CRC screening, incidence, and mortality rates. FINDINGS The difference between volume-weighted and traditional density scores was particularly large in rural parts of the West and Midwest, and it was most similar in the Northeast. Although weak, correlations with CRC outcomes were stronger for volume-weighted density, and they did not differ by rurality. CONCLUSIONS Our new method is an improvement over traditional methods because it considers the variation of physician procedure volume, and it has a stronger correlation with population health outcomes. Weighted density scores portray a more realistic picture of physician supply, particularly in rural areas.
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Affiliation(s)
- Michele J Josey
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina.,Statewide Cancer Prevention and Control Program, University of South Carolina Arnold School of Public Health, Columbia, South Carolina
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina.,Statewide Cancer Prevention and Control Program, University of South Carolina Arnold School of Public Health, Columbia, South Carolina.,Rural and Minority Health Research Center, University of South Carolina Arnold School of Public Health, Columbia, South Carolina
| | - Lee R Mobley
- School of Public Health and Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia
| | - Mario Schootman
- Department of Epidemiology, , College for Public Health and Social Justice, St. Louis University, St. Louis, Missouri
| | - Janice C Probst
- Rural and Minority Health Research Center, University of South Carolina Arnold School of Public Health, Columbia, South Carolina.,Department of Health Services Policy and Management, University of South Carolina Arnold School of Public Health, Columbia, South Carolina
| | - Scott M Strayer
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Erica Sercy
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina.,Statewide Cancer Prevention and Control Program, University of South Carolina Arnold School of Public Health, Columbia, South Carolina
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Briant KJ, Sanchez JI, Ibarra G, Escareño M, Gonzalez NE, Jimenez Gonzalez V, Marchello N, Louie S, Thompson B. Using a Culturally Tailored Intervention to Increase Colorectal Cancer Knowledge and Screening among Hispanics in a Rural Community. Cancer Epidemiol Biomarkers Prev 2018; 27:1283-1288. [PMID: 29871884 DOI: 10.1158/1055-9965.epi-17-1092] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/03/2018] [Accepted: 05/30/2018] [Indexed: 01/20/2023] Open
Abstract
Background: Disparities in colorectal cancer incidence and mortality rates exist among racial/ethnic minorities, especially those living in rural areas. There is an urgent need to implement interventions to improve colorectal cancer screening behaviors among such groups, particularly those living in rural areas in the United States.Methods: From a rural community of Hispanics, we recruited participants to attend home-based promotor(a)-led "home health parties" in which participants were taught about colorectal cancer screening; participants ages 50 and older were given a free fecal occult blood test (FOBT) kit to complete on their own. A pre- and posttest design was used to assess changes in colorectal cancer awareness, knowledge, and screening at baseline and at 1-month follow-up after the intervention.Results: We observed a statistically significant increase in colorectal cancer screening awareness and knowledge among participants. Colorectal cancer screening rates with FOBT increased from 51.0% to 80%. There was also a statistically significant increase in social engagement, that is, the intent to speak to friends and relatives about colorectal cancer screening.Conclusions: Findings indicate that culturally tailored colorectal cancer education facilitated by promotores in a rural environment, coupled with free stool-based test for colorectal cancer screening, is an effective way to increase colorectal cancer screening awareness, knowledge, and screening among Hispanics living in a rural area in Washington State. Impact: Culturally tailored home health interventions have the potential to achieve Healthy People 2020 colorectal cancer screening goals in Hispanic rural communities. Cancer Epidemiol Biomarkers Prev; 27(11); 1283-8. ©2018 AACR.
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Affiliation(s)
| | - Janeth I Sanchez
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Genoveva Ibarra
- Center for Community Health Promotion, Fred Hutchinson Cancer Research Center, Sunnyside, Washington
| | - Monica Escareño
- Center for Community Health Promotion, Fred Hutchinson Cancer Research Center, Sunnyside, Washington
| | - Nora E Gonzalez
- Center for Community Health Promotion, Fred Hutchinson Cancer Research Center, Sunnyside, Washington
| | - Virginia Jimenez Gonzalez
- Center for Community Health Promotion, Fred Hutchinson Cancer Research Center, Sunnyside, Washington
| | - Nathan Marchello
- Center for Community Health Promotion, Fred Hutchinson Cancer Research Center, Sunnyside, Washington
| | | | - Beti Thompson
- Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington
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Muthukrishnan M, Sutcliffe S, Hunleth JM, Wang JS, Colditz GA, James AS. Conducting a randomized trial in rural and urban safety-net health centers: Added value of community-based participatory research. Contemp Clin Trials Commun 2018; 10:29-35. [PMID: 29696155 PMCID: PMC5898527 DOI: 10.1016/j.conctc.2018.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 02/15/2018] [Accepted: 02/27/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most common cancer in the US. Despite evidence that screening reduces CRC incidence and mortality, screening rates are sub-optimal with disparities by race/ethnicity, income, and geography. Rural-urban differences in CRC screening are understudied even though approximately one-fifth of the US population lives in rural areas. This focus on urban populations limits the generalizability and dissemination potential of screening interventions. METHODS Using community-based participatory research (CBPR) principles, we designed a cluster-randomized trial, adaptable to a range of settings, including rural and urban health centers. We enrolled 483 participants across 11 health centers representing 2 separate networks. Both networks serve medically-underserved communities; however one is primarily rural and one primarily urban. RESULTS Our goal in this analysis is to describe baseline characteristics of participants and examine setting-level differences. CBPR was a critical for recruiting networks to the trial. Patient respondents were predominately female (61.3%), African-American (66.5%), and earned <$1200 per month (87.1%). The rural network sample was older; more likely to be female, white, disabled or retired, and have a higher income, but fewer years of education. CONCLUSIONS Variation in the samples partly reflects the CBPR process and partly reflects inherent differences in the communities. This confirmed the importance of using CBPR when planning for eventual dissemination, as it enhanced our ability to work within diverse settings. These baseline findings indicate that using a uniform approach to implementing a trial or intervention across diverse settings might not be effective or efficient.
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Affiliation(s)
- Meera Muthukrishnan
- Department of Epidemiology and Biostatistics, Saint Louis University College of Public Health and Social Justice, St. Louis, MO, USA
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jean M. Hunleth
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jean S. Wang
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Graham A. Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Aimee S. James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Preston MA, Glover-Collins K, Ross L, Porter A, Bursac Z, Woods D, Burton J, Crowell K, Laryea J, Henry-Tillman RS. Colorectal cancer screening in rural and poor-resourced communities. Am J Surg 2017; 216:245-250. [PMID: 28842164 DOI: 10.1016/j.amjsurg.2017.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/31/2017] [Accepted: 08/07/2017] [Indexed: 11/19/2022]
Abstract
To test the efficacy of a community-based intervention, Empowering Communities for Life (EC4L), designed to increase colorectal cancer (CRC) screening through fecal occult blood test (FOBT) in rural underserved communities in a randomized controlled trial. Participants were randomized into 3 groups (2 interventions and 1 control). Interventions were delivered by community lay health workers or by academic health professionals. The main outcome of interest was return rate of FOBT screening kit within 60 days. Participants included 330 screening-eligible adults. The overall return rate of FOBT kits within 60 days was 32%. The professional group (Arm 2) had the highest proportion of returned FOBTs within 60 days at 42% (n = 46/110), a significantly higher return rate than the lay group (Arm 1) [28%(n = 29/103);P = 0.0422] or control group (Arm 3) [25%(n = 29/117);P = 0.0099]. Thus, one arm (Arm 2) of our intervention produced significantly higher CRC screening through FOBT. Community-based participation partnered with academic health professionals enhanced CRC screening among rural and poor-resourced communities.
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Affiliation(s)
- Michael A Preston
- University of Arkansas for Medical Sciences, Department of Surgery, Health Initiatives and Disparities Research, 4301 West Markham Street #827, Little Rock, AR, 72205-7199, USA.
| | - Katherine Glover-Collins
- University of Arkansas for Medical Sciences, Department of Surgery, Health Initiatives and Disparities Research, 4301 West Markham Street #827, Little Rock, AR, 72205-7199, USA.
| | - Levi Ross
- The University of Alabama, Health Science, 461 Russell Hall, Box 870311, Tuscaloosa, AL, 35487, USA.
| | - Austin Porter
- University of Arkansas for Medical Sciences, College of Public Health, 4301 West Markham Street, Little Rock, AR, 72205-7199, USA.
| | - Zoran Bursac
- University of TN Health Science Center, Center for Population Sciences, Department of Preventive Medicine, 66 N Pauline St., Suite 307, Memphis, TN, 38163, USA.
| | - Delores Woods
- East Arkansas Enterprise Community, Inc., 1000 Airport Road, Forrest City, AR, 72336-2212, USA.
| | - Jacqueline Burton
- Mississippi County Arkansas EOC, 1400 North Division, Blytheville, AR, 72315, USA.
| | - Karen Crowell
- University of Arkansas for Medical Sciences, Department of Surgery, Health Initiatives and Disparities Research, 4301 West Markham Street #827, Little Rock, AR, 72205-7199, USA.
| | - Jonathan Laryea
- University of Arkansas for Medical Sciences, Department of Surgery, Health Initiatives and Disparities Research, 4301 West Markham Street #827, Little Rock, AR, 72205-7199, USA.
| | - Ronda S Henry-Tillman
- University of Arkansas for Medical Sciences, Department of Surgery, Health Initiatives and Disparities Research, 4301 West Markham Street #827, Little Rock, AR, 72205-7199, USA.
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Zahnd WE, James AS, Jenkins WD, Izadi SR, Fogleman AJ, Steward DE, Colditz GA, Brard L. Rural-Urban Differences in Cancer Incidence and Trends in the United States. Cancer Epidemiol Biomarkers Prev 2017; 27:1265-1274. [PMID: 28751476 DOI: 10.1158/1055-9965.epi-17-0430] [Citation(s) in RCA: 269] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/27/2017] [Accepted: 07/18/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Cancer incidence and mortality rates in the United States are declining, but this decrease may not be observed in rural areas where residents are more likely to live in poverty, smoke, and forego cancer screening. However, there is limited research exploring national rural-urban differences in cancer incidence and trends.Methods: We analyzed data from the North American Association of Central Cancer Registries' public use dataset, which includes population-based cancer incidence data from 46 states. We calculated age-adjusted incidence rates, rate ratios, and annual percentage change (APC) for: all cancers combined, selected individual cancers, and cancers associated with tobacco use and human papillomavirus (HPV). Rural-urban comparisons were made by demographic, geographic, and socioeconomic characteristics for 2009 to 2013. Trends were analyzed for 1995 to 2013.Results: Combined cancers incidence rates were generally higher in urban populations, except for the South, although the urban decline in incidence rate was greater than in rural populations (10.2% vs. 4.8%, respectively). Rural cancer disparities included higher rates of tobacco-associated, HPV-associated, lung and bronchus, cervical, and colorectal cancers across most population groups. Furthermore, HPV-associated cancer incidence rates increased in rural areas (APC = 0.724, P < 0.05), while temporal trends remained stable in urban areas.Conclusions: Cancer rates associated with modifiable risks-tobacco, HPV, and some preventive screening modalities (e.g., colorectal and cervical cancers)-were higher in rural compared with urban populations.Impact: Population-based, clinical, and/or policy strategies and interventions that address these modifiable risk factors could help reduce cancer disparities experienced in rural populations. Cancer Epidemiol Biomarkers Prev; 27(11); 1265-74. ©2017 AACR.
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Affiliation(s)
- Whitney E Zahnd
- Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois.
| | - Aimee S James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Wiley D Jenkins
- Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Sonya R Izadi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Amanda J Fogleman
- Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois
| | - David E Steward
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Laurent Brard
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, Illinois.,Simmons Cancer Institute at SIU, Southern Illinois University School of Medicine, Springfield, Illinois
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Hughes AG, Watanabe-Galloway S, Schnell P, Soliman AS. Rural-Urban Differences in Colorectal Cancer Screening Barriers in Nebraska. J Community Health 2016; 40:1065-74. [PMID: 25910484 DOI: 10.1007/s10900-015-0032-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Nebraska ranks 36th nationally in colorectal cancer screening. Despite recent increases in CRC screening rates, rural areas in Nebraska have consistently shown lower rates of CRC screening uptake, compared to urban areas. The objective of this study was to investigate reasons for lower CRC screening rates among Nebraska residents, especially among rural residents. We developed a questionnaire based on Health Belief Model (HBM) constructs to identify factors associated with the use of CRC screening. The questionnaire was mailed in 2014 to adults aged 50-75 years in an urban community in the east and a rural community in the west regions of the state. Multiple logistic regression models were created to assess the effects of HBM constructs, rural residence, and demographic factors on CRC screening use. Of the 1200 surveys mailed, 393 were returned (rural n = 200, urban n = 193). Rural respondents were more likely to perceive screening cost as a barrier. Rural residents were also more likely to report that CRC cannot be prevented and it would change their whole life. In multiple regression models, rural residence, perceived embarrassment, and perceived unpleasantness about screening were significantly associated with reduced odds of receiving colonoscopy. Older age (62 years and older), having a personal doctor, and perceived risk of getting CRC were significantly associated with increased odds of receiving colonoscopy. Interventions to increase uptake of colorectal cancer screening in rural residents should be tailored to acknowledge unique perceptions of screening methods and barriers to screening.
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Affiliation(s)
- Alejandro G Hughes
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA.
| | - Paulette Schnell
- Department of Community Health, Regional West Medical Center, 3700 Avenue B, Scottsbluff, NE, 69361, USA
| | - Amr S Soliman
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
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Caldwell JT, Ford CL, Wallace SP, Wang MC, Takahashi LM. Intersection of Living in a Rural Versus Urban Area and Race/Ethnicity in Explaining Access to Health Care in the United States. Am J Public Health 2016; 106:1463-9. [PMID: 27310341 PMCID: PMC4940644 DOI: 10.2105/ajph.2016.303212] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine whether living in a rural versus urban area differentially exposes populations to social conditions associated with disparities in access to health care. METHODS We linked Medical Expenditure Panel Survey (2005-2010) data to geographic data from the American Community Survey (2005-2009) and Area Health Resource File (2010). We categorized census tracts as rural and urban by using the Rural-Urban Commuting Area Codes. Respondent sample sizes ranged from 49 839 to 105 306. Outcomes were access to a usual source of health care, cholesterol screening, cervical screening, dental visit within recommended intervals, and health care needs met. RESULTS African Americans in rural areas had lower odds of cholesterol screening (odds ratio[OR] = 0.37; 95% confidence interval[CI] = 0.25, 0.57) and cervical screening (OR = 0.48; 95% CI = 0.29, 0.80) than African Americans in urban areas. Whites had fewer screenings and dental visits in rural versus urban areas. There were mixed results for which racial/ethnic group had better access. CONCLUSIONS Rural status confers additional disadvantage for most of the health care use measures, independently of poverty and health care supply.
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Affiliation(s)
- Julia T Caldwell
- At the time of study, Julia T. Caldwell was first with the Department of Community Health Sciences at the University of California, Los Angeles (UCLA), Fielding School of Public Health, and then with the Section of Hospital Medicine at the University of Chicago, Chicago, IL. Chandra L. Ford, Steven P. Wallace, and May C. Wang were with the Department of Community Health Sciences at the UCLA Fielding School of Public Health. Lois M. Takahashi was with the UCLA Luskin School of Public Affairs
| | - Chandra L Ford
- At the time of study, Julia T. Caldwell was first with the Department of Community Health Sciences at the University of California, Los Angeles (UCLA), Fielding School of Public Health, and then with the Section of Hospital Medicine at the University of Chicago, Chicago, IL. Chandra L. Ford, Steven P. Wallace, and May C. Wang were with the Department of Community Health Sciences at the UCLA Fielding School of Public Health. Lois M. Takahashi was with the UCLA Luskin School of Public Affairs
| | - Steven P Wallace
- At the time of study, Julia T. Caldwell was first with the Department of Community Health Sciences at the University of California, Los Angeles (UCLA), Fielding School of Public Health, and then with the Section of Hospital Medicine at the University of Chicago, Chicago, IL. Chandra L. Ford, Steven P. Wallace, and May C. Wang were with the Department of Community Health Sciences at the UCLA Fielding School of Public Health. Lois M. Takahashi was with the UCLA Luskin School of Public Affairs
| | - May C Wang
- At the time of study, Julia T. Caldwell was first with the Department of Community Health Sciences at the University of California, Los Angeles (UCLA), Fielding School of Public Health, and then with the Section of Hospital Medicine at the University of Chicago, Chicago, IL. Chandra L. Ford, Steven P. Wallace, and May C. Wang were with the Department of Community Health Sciences at the UCLA Fielding School of Public Health. Lois M. Takahashi was with the UCLA Luskin School of Public Affairs
| | - Lois M Takahashi
- At the time of study, Julia T. Caldwell was first with the Department of Community Health Sciences at the University of California, Los Angeles (UCLA), Fielding School of Public Health, and then with the Section of Hospital Medicine at the University of Chicago, Chicago, IL. Chandra L. Ford, Steven P. Wallace, and May C. Wang were with the Department of Community Health Sciences at the UCLA Fielding School of Public Health. Lois M. Takahashi was with the UCLA Luskin School of Public Affairs
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A Media and Clinic Intervention to Increase Colorectal Cancer Screening in Ohio Appalachia. BIOMED RESEARCH INTERNATIONAL 2015; 2015:943152. [PMID: 26509172 PMCID: PMC4609808 DOI: 10.1155/2015/943152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/29/2015] [Accepted: 08/16/2015] [Indexed: 12/25/2022]
Abstract
Objective. To test the effectiveness of a colorectal cancer (CRC) screening intervention among adults living in Ohio Appalachia. Methods. We conducted a group-randomized trial of a county-level intervention among adults living in 12 Ohio Appalachian counties who received a media campaign and clinic intervention focused on either CRC screening or fruits and vegetables. Participants' percentage within CRC screening guidelines was assessed with cross-sectional surveys conducted annually for four years, and validated with medical record review of screening. Results. On average, screening data were obtained on 564 intervention and 559 comparison participants per year. There was no difference in the Wave 4 CRC screening rates of intervention and comparison counties (35.2% versus 31.4%). Multivariate analyses found that high perceived risk of CRC, willingness to have a CRC test if recommended by a doctor, doctor recommendation of a CRC screening test, and patient-physician communication about changes in bowel habits, family history of CRC, and eating fruits and vegetables were significant (p < 0.05) predictors of being within CRC screening guidelines. Conclusions. The intervention was not effective in increasing CRC rates among Ohio Appalachian adults. Future research should determine how media and clinic-based interventions can be modified to improve CRC screening rates among this underserved population.
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Ojinnaka CO, Choi Y, Kum HC, Bolin JN. Predictors of Colorectal Cancer Screening: Does Rurality Play a Role? J Rural Health 2015; 31:254-68. [PMID: 25599819 DOI: 10.1111/jrh.12104] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to explore the associations between sociodemographic factors such as residence, health care access, and colorectal cancer (CRC) screening among residents of Texas. METHODS Using the 2012 Behavioral Risk Factor Surveillance Survey, we performed logistic regression analyses to determine predictors of CRC screening among Texas residents, including rural versus urban differences. Our outcomes of interest were previous (1) CRC screening using any CRC test, (2) fecal occult blood test (FOBT), or (3) endoscopy, as well as up-to-date screening using (4) any CRC test, (5) FOBT, or (6) endoscopy. The independent variable of interest was rural versus urban residence; we controlled for other sociodemographic and health care access variables such as lack of health insurance. RESULTS Multivariate analysis showed that individuals who were residents of a rural/non-Metropolitan Statistical Area (MSA) location (OR = 0.70, 95% CI = 0.51-0.97) or a suburban county (OR = 0.61, 95% CI = 0.39-0.95) were less likely to report ever having any CRC screening compared to residents of a center city of an MSA. Residents of a rural/non-MSA location were less likely (OR = 0.49, 95% CI = 0.28-0.87) than residents of a center city of an MSA to be up-to-date using FOBT. There was decreased likelihood of ever being screened for CRC among the uninsured (OR = 0.43, 95% CI = 0.31-0.59). CONCLUSIONS Effective development and implementation of strategies to improve screening rates should aim at improving access to health care, taking into account demographic characteristics such as rural versus urban residence.
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Affiliation(s)
- Chinedum O Ojinnaka
- Department of Health Policy and Management, Texas A&M Health Science Center School of Public Health, College Station, Texas
| | - Yong Choi
- Department of Health Policy and Management, Texas A&M Health Science Center School of Public Health, College Station, Texas
| | - Hye-Chung Kum
- Department of Health Policy and Management, Texas A&M Health Science Center School of Public Health, College Station, Texas
| | - Jane N Bolin
- Department of Health Policy and Management, Texas A&M Health Science Center School of Public Health, College Station, Texas
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35
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Pignone MP, Crutchfield TM, Brown PM, Hawley ST, Laping JL, Lewis CL, Lich KH, Richardson LC, Tangka FK, Wheeler SB. Using a discrete choice experiment to inform the design of programs to promote colon cancer screening for vulnerable populations in North Carolina. BMC Health Serv Res 2014; 14:611. [PMID: 25433801 PMCID: PMC4267137 DOI: 10.1186/s12913-014-0611-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 11/17/2014] [Indexed: 01/22/2023] Open
Abstract
Background Screening for colorectal cancer (CRC) is suboptimal, particularly for vulnerable populations. Effective intervention programs are needed to increase screening rates. We used a discrete choice experiment (DCE) to learn about how vulnerable individuals in North Carolina value different aspects of CRC screening programs. Methods We enrolled English-speaking adults ages 50–75 at average risk of CRC from rural North Carolina communities with low rates of CRC screening, targeting those with public or no insurance and low incomes. Participants received basic information about CRC screening and potential program features, then completed a 16 task DCE and survey questions that examined preferences for four attributes of screening programs: testing options available; travel time required; money paid for screening or rewards for completing screening; and the portion of the cost of follow-up care paid out of pocket. We used Hierarchical Bayesian methods to calculate individual-level utilities for the 4 attributes’ levels and individual-level attribute importance scores. For each individual, the attribute with the highest importance score was considered the most important attribute. Individual utilities were then aggregated to produce mean utilities for each attribute. We also compared DCE-based results with those from direct questions in a post-DCE survey. Results We enrolled 150 adults. Mean age was 57.8 (range 50–74); 55% were women; 76% White and 19% African-American; 87% annual household income under $30,000; and 51% were uninsured. Individuals preferred shorter travel; rewards or small copayments compared with large copayments; programs that included stool testing as an option; and greater coverage of follow-up costs. Follow-up cost coverage was most frequently found to be the most important attribute from the DCE (47%); followed by test reward/copayment (33%). From the survey, proportion of follow-up costs paid was most frequently cited as most important (42% of participants), followed by testing options (32%). There was moderate agreement (45%) in attribute importance between the DCE and the single question in the post-DCE survey. Conclusions Screening test copayments and follow-up care coverage costs are important program characteristics in this vulnerable, rural population. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0611-4) contains supplementary material, which is available to authorized users.
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