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Modra LJ, Higgins AM, Pilcher DV, Cheung AS, Carpenter MN, Bailey M, Zwickl S, Bellomo R. Epidemiology of Intensive Care Patients Classified as a Third Sex in Australia and New Zealand. Chest 2024; 165:1120-1128. [PMID: 38081578 DOI: 10.1016/j.chest.2023.11.043] [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: 08/22/2023] [Revised: 11/14/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Patient sex affects treatment and outcomes in critical illness. Previous studies of sex differences in critical illness compared female and male patients. In this study, we describe the group of patients classified as a third sex admitted to ICUs in Australia and New Zealand. RESEARCH QUESTION What are the admission characteristics and outcomes of ICU patients classified as belonging to a third sex group compared with patients classified as female or male? STUDY DESIGN AND METHODS Retrospective observational study of admissions to 200 ICUs, recorded in the Australian and New Zealand Intensive Care Society's Adult Patient Database from 2018 to 2022. We undertook mixed effect logistic regression to compare hospital mortality across the sex groups, adjusted for illness severity, diagnosis, treatment limitation, year, and hospital. RESULTS We examined 892,161 admissions, of whom 525 (0.06%) were classified as third sex. Patients classified as third sex were represented across all diagnostic categories, jurisdictions, and hospital types. On average, they were younger than the groups classified as female (59.2 ± 20.0 vs 61.3 ± 18.4 years; P = .02) or male (63.2 ± 16.7 years; P < .001), respectively. Patients classified as third sex were more likely to be admitted after orthopedic surgery (10.1% third sex admissions [95% CI, 7.7%-13.0%]; 6.2% female [95% CI, 6.1%-6.3%]; 4.8% male [95% CI, 4.7%-4.9%]) and drug overdose (8.8% third sex admissions [95% CI, 6.5%-11.5%]; 4.2% female [95% CI, 4.1%-4.2%]; 3.1% male [95% CI, 3.0%-3.1%]). There was no difference in the adjusted hospital mortality of patients classified as third sex compared with the other groups. INTERPRETATION Patients classified as third sex composed a small minority group of adult ICU patients. This group had a different diagnostic case mix but similar outcomes to the groups classified as female or male. Further characterizing a third sex group will require improved processes for recording sex and gender in health records.
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Affiliation(s)
- Lucy J Modra
- Department of Critical Care, University of Melbourne, Melbourne, VIC; Intensive Care Unit, Austin Health, Melbourne, VIC.
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC
| | - David V Pilcher
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC; Intensive Care Unit, Alfred Health, Melbourne, VIC; The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Camberwell, Melbourne, VIC
| | - Ada S Cheung
- Trans Health Research Group, Department of Medicine, The University of Melbourne, Melbourne, VIC
| | | | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC
| | - Sav Zwickl
- Trans Health Research Group, Department of Medicine, The University of Melbourne, Melbourne, VIC
| | - Rinaldo Bellomo
- Department of Critical Care, University of Melbourne, Melbourne, VIC; Intensive Care Unit, Austin Health, Melbourne, VIC; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC; Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
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2
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Gomez SL, Cheng I. Next-generation epidemiologic cohorts for cancer aetiology. Nat Rev Cancer 2024; 24:93-94. [PMID: 38102343 DOI: 10.1038/s41568-023-00652-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Affiliation(s)
- Scarlett Lin Gomez
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA.
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
| | - Iona Cheng
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
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3
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Herbach EL, Nash SH, Lizarraga IM, Carnahan RM, Wang K, Ogilvie AC, Curran M, Charlton ME. Patterns of Evidence-Based Care for the Diagnosis, Staging, and First-line Treatment of Breast Cancer by Race-Ethnicity: A SEER-Medicare Study. Cancer Epidemiol Biomarkers Prev 2023; 32:1312-1322. [PMID: 37436422 PMCID: PMC10592343 DOI: 10.1158/1055-9965.epi-23-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/18/2023] [Accepted: 07/10/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in guideline-recommended breast cancer treatment are well documented, however studies including diagnostic and staging procedures necessary to determine treatment indications are lacking. The purpose of this study was to characterize patterns in delivery of evidence-based services for the diagnosis, clinical workup, and first-line treatment of breast cancer by race-ethnicity. METHODS SEER-Medicare data were used to identify women diagnosed with invasive breast cancer between 2000 and 2017 at age 66 or older (n = 2,15,605). Evidence-based services included diagnostic procedures (diagnostic mammography and breast biopsy), clinical workup (stage and grade determination, lymph node biopsy, and HR and HER2 status determination), and treatment initiation (surgery, radiation, chemotherapy, hormone therapy, and HER2-targeted therapy). Poisson regression was used to estimate rate ratios (RR) and 95% confidence intervals (CI) for each service. RESULTS Black and American Indian/Alaska Native (AIAN) women had significantly lower rates of evidence-based care across the continuum from diagnostics through first-line treatment compared to non-Hispanic White (NHW) women. AIAN women had the lowest rates of HER2-targeted therapy and hormone therapy initiation. While Black women also had lower initiation of HER2-targeted therapy than NHW, differences in hormone therapy were not observed. CONCLUSIONS Our findings suggest patterns along the continuum of care from diagnostic procedures to treatment initiation may differ across race-ethnicity groups. IMPACT Efforts to improve delivery of guideline-concordant treatment and mitigate racial-ethnic disparities in healthcare and survival should include procedures performed as part of the diagnosis, clinical workup, and staging processes.
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Affiliation(s)
- Emma L Herbach
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Sarah H Nash
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Ingrid M Lizarraga
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Ryan M Carnahan
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Kai Wang
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Amy C Ogilvie
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Michaela Curran
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Mary E Charlton
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
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4
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Garcia S, Hopfer S, Amaro H, Tanjasiri S. HPV vaccine delay and refusal among unvaccinated Mexican American young adult women: a qualitative investigation of Mexican-born and US-born HPV vaccine decision narratives. J Behav Med 2023; 46:88-99. [PMID: 35610490 PMCID: PMC9130004 DOI: 10.1007/s10865-022-00326-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/29/2022] [Indexed: 12/23/2022]
Abstract
Low HPV vaccination rates among Latina young adults perpetuate HPV-associated cancer disparities. Using qualitative methods, this study explored individual, interpersonal, and community factors that influence HPV vaccine delay and refusal among Mexican- and U.S.-born Mexican American young adult women. Participants (N = 30) between 18 and 26 years old were purposively sampled from two federally qualified health centers in Orange County, California. The National Institute on Minority Health and Health Disparities research framework and narrative engagement theory guided semi-structured phone interviews coded inductively and deductively. Participants primarily attributed vaccine status to individual and interpersonal reasons. Emerging themes included low HPV vaccine knowledge, insufficient provider communication, negative perceptions about HPV and the vaccine, motherhood responsibilities, mother's communication about HPV, cultural family norms, health care access, and misinformation. Compared to U.S.-born Latinas, Mexican-born participants more frequently expressed avoiding health care discussions with family. HPV vaccine recommendations for young Mexican American women should include socioculturally tailored messages that may improve HPV vaccination acceptance and uptake.
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Affiliation(s)
- Samantha Garcia
- Department of Health, Society, and Behavior, Program in Public Health, University of California, 653 E. Peltason Drive, AIRB, Room 2020D, Irvine, CA 92697-3957 USA
| | - Suellen Hopfer
- Department of Health, Society, and Behavior, Program in Public Health, University of California, 653 E. Peltason Drive, AIRB, Room 2020D, Irvine, CA 92697-3957 USA
| | - Hortensia Amaro
- Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC4 Room 419, Miami, FL 33199 USA
| | - Sora Tanjasiri
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California, 653 E. Peltason Drive, AIRB, Room 3072, Irvine, CA 92697-3957 USA
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5
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Brockie T, Decker E, Barlow A, Cwik M, Ricker A, Aguilar T, Wetsit L, Wilson D, Haroz EE. Planning for implementation and sustainability of a community-based suicide surveillance system in a Native American community. Implement Sci Commun 2023; 4:1. [PMID: 36600290 DOI: 10.1186/s43058-022-00376-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/09/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Native American youth, primarily living on reservations, suffer the highest burden of suicide of any racial group in the USA. Implementation and sustainability of culturally grounded, evidence-based interventions are needed to address suicide in Native American populations. For nearly 40 years, Montana has ranked at or near the top nationwide for suicide. Fort Peck Tribal leadership declared a state of emergency in 2010 after six suicides and 20 attempts that occurred over a 5-month period. METHODS We used a community-based participatory research approach for adapting the Celebrating Life (CL) program with a specific focus on long-term sustainability, which has demonstrated efficacy in addressing suicide with the White Mountain Apache. The aims were to (1) adapt the CL program intake forms through roundtable discussions, (2) conduct asset and resource mapping to identify community and cultural resources to leverage for the CL program within the Fort Peck context, and (3) develop a sustainability plan for CL in Fort Peck through qualitative approaches informed by the Program Sustainability Assessment Tool. RESULTS Roundtable discussions resulted in adapted intake forms that capture variables relevant to the Fort Peck context. Asset mapping identified 13 community assets and 10 cultural resources to incorporate within the CL implementation process. Focus group discussions yielded four key themes that were incorporated into a plan for sustainability: (1) strategic partnerships, (2) long-term funding, (3) communication planning, and (4) workforce planning and engagement. CONCLUSIONS This paper outlines an avenue for using culturally adapted tools to design an implementation system driven by community and cultural assets within tribal communities and for integrating program planning for sustainability early in the implementation process.
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Affiliation(s)
- Teresa Brockie
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA. .,Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, 415 North Washington St., 4th Floor, Baltimore, MD, 21231, USA.
| | - Ellie Decker
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA
| | - Allison Barlow
- Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, 415 North Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Mary Cwik
- Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, 415 North Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Adriann Ricker
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA
| | - Theresa Aguilar
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA
| | - Lawrence Wetsit
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA
| | - Deborah Wilson
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA
| | - Emily E Haroz
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.,Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, 415 North Washington St., 4th Floor, Baltimore, MD, 21231, USA
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6
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Nash SH, Zimpelman GL, Miller KN, Clark JH, Britton CL. The Alaska Native Tumour Registry: fifty years of cancer surveillance data for Alaska Native people. Int J Circumpolar Health 2022; 81:2013403. [PMID: 34918619 PMCID: PMC8725679 DOI: 10.1080/22423982.2021.2013403] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Like other Indigenous Circumpolar populations, Alaska Native (AN) people experience different patterns of cancer than their non-Indigenous counterparts. Every 5 years, the Alaska Native Tumour Registry releases a comprehensive report on cancer among AN people; this study provides 50 years of cancer surveillance data. Five-year annual-average age-adjusted incidence rates were calculated for time-periods ranging 1969-2018. AN data were compared with data for US whites (SEER 9). Mortality rates were calculated for 1994-2018 using data from the National Center for Health Statistics. During 2014-2018, there were 2,401 cases of invasive cancer among AN people. Among these, the most commonly diagnosed cancers were colorectal (405 cases, 17% of all cancers), lung and bronchus (373 cases, 16% of all cancers), and female breast (340 cases, 14% of all cancers). Lung cancer was the leading cause of cancer death, followed by colorectal and female breast cancers. These leading cancers are screenable, and preventable through lifestyle modifications including tobacco cessation, healthy eating and engaging in physical activity. These data provide important information to support cancer prevention and control among AN people. Cancer surveillance has been a valuable tool throughout the Circumpolar North to support reducing the burden of cancer among Indigenous populations.Abbreviations: ANAI: Alaska Native/American Indian; AN: Alaska Native; USW: U.S. White(s); ANMC: Alaska Native Medical Center; ANTR: Alaska Native Tumour Registry; IR: Incidence Rate; CI: Confidence Interval; RR: Rate Ratio; ICD-O-3: International Classification of Diseases for Oncology - Third Edition; SEER: Surveillance, Epidemiology and End Results.
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Affiliation(s)
- Sarah H Nash
- Alaska Native Epidemiology Center, Community Health Services, Anchorage, AK, USA
| | - Garrett L Zimpelman
- Alaska Native Epidemiology Center, Community Health Services, Anchorage, AK, USA
| | - Keri N Miller
- Alaska Native Epidemiology Center, Community Health Services, Anchorage, AK, USA
| | - James H Clark
- Alaska Native Epidemiology Center, Community Health Services, Anchorage, AK, USA
| | - Carla L Britton
- Alaska Native Epidemiology Center, Community Health Services, Anchorage, AK, USA
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7
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Vadaparampil ST, Tiro JA. Catchment Area: An Opportunity for Collective Impact, Strategic Collaboration, and Complementary Focus. Cancer Epidemiol Biomarkers Prev 2022; 31:952-954. [PMID: 35255137 DOI: 10.1158/1055-9965.epi-22-0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
Since NCI's 2016 guidance to define a catchment area and describe aims for community outreach and engagement to address community needs and priorities, cancer center leaders and researchers have begun to see how this focused attention brings impact. DelNero, Buller, and colleagues highlight coverage of the United States based on catchment areas of 63 NCI-Designated Cancer Centers. The data visualization naturally lends itself to consideration of future opportunities for strategic collaboration and complementary focus among the 63 designated cancer centers included in their analysis. See related article by DelNero et al., p. 965.
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Affiliation(s)
- Susan T Vadaparampil
- Office of Community Outreach, Engagement, and Equity, Moffitt Cancer Center, Tampa, Florida.,Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Jasmin A Tiro
- Office of Community Outreach, Engagement, and Equity, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
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8
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Croyle RT, Sanchez JI, Doose M, Kennedy AE, Srinivasan S. Avoiding Pro Forma: A Health Equity-Conscious Approach to Cancer Control Research. Am J Prev Med 2022; 62:799-802. [PMID: 34953667 DOI: 10.1016/j.amepre.2021.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/31/2021] [Accepted: 09/27/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Robert T Croyle
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Rockville, Maryland
| | - Janeth I Sanchez
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Rockville, Maryland
| | - Michelle Doose
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Rockville, Maryland
| | - Amy E Kennedy
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Rockville, Maryland
| | - Shobha Srinivasan
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Rockville, Maryland.
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9
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Rouse SL, Florentine MM, Taketa E, Chan DK. Racial and ethnic disparities in genetic testing for hearing loss: a systematic review and synthesis. Hum Genet 2022; 141:485-494. [PMID: 34494120 PMCID: PMC9035011 DOI: 10.1007/s00439-021-02335-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022]
Abstract
Racial/ethnic disparities in the diagnostic efficacy of genetic testing for hearing loss have been described. These disparities may relate to differences in variant classification between different racial/ethnic groups, which may, in turn, derive from disparate representation of these groups in the published literature. We sought to quantify racial/ethnic disparities in the published literature on the human genetics of hearing loss. We conducted a search of PubMed for articles describing single-gene, multiple-gene, or whole-exome sequencing for individuals with sensorineural hearing loss. Data on the included subjects, including race/ethnicity and/or region of origin, a number of subjects tested, and method of testing, were extracted. 1355 populations representing 311,092 subjects from 1165 studies were included. Overall, subjects of European and Asian ancestry were equivalently represented, but those of Latino American, African, and indigenous North American ancestry were significantly underrepresented; over 96% of all subjects in the published literature were European or Asian. Within populations, the majority of subjects derived from a small subset of countries. The observed disparity was greater for multiple-gene and whole-exome sequencing than for single-gene sequencing. These findings illustrate the large disparity in the published literature on the genetics of hearing loss, and demonstrate the need for increased representation of Latino American, African, and indigenous North American populations.
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Affiliation(s)
| | - Michelle M Florentine
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emily Taketa
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA
| | - Dylan K Chan
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA.
- Division of Pediatric Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA.
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10
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Supporting rural public health practice to address local-level social determinants of health across Northwest states: Development of an interactive visualization dashboard. J Biomed Inform 2022; 129:104051. [DOI: 10.1016/j.jbi.2022.104051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 01/24/2023]
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Nash SH, Britton C, Redwood D. Characteristics of colorectal cancers among Alaska Native people before and after implementing programs to promote screening. J Cancer Policy 2021; 29:100293. [PMID: 35559952 PMCID: PMC8357310 DOI: 10.1016/j.jcpo.2021.100293] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/28/2021] [Accepted: 07/11/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Alaska Native (AN) people have the highest rates of colorectal cancer (CRC) globally. Increasing CRC screening has been effective in reducing CRC-related morbidity and mortality in other populations. OBJECTIVE To examine recent descriptive epidemiology and longer-term CRC trends among AN people. To determine any changes in the descriptive epidemiology of CRC among AN people concurrent with increases in screening prevalence. METHODS We estimated age-specific CRC incidence and mortality rates 2000-2017. To examine longer-term trends in incidence and mortality 1990-2017, we conducted Joinpoint regression analyses of three-year rolling average incidence and mortality rates. We calculated descriptive statistics for two time-periods: 2000-2008, and 2009-2017. Finally, we examined five-year survival probability. RESULTS CRC incidence increased over time (1990-2017) among AN people aged less than 50 years, while there were modest declines in AN people older than 50 years old since 2000. Overall, AN CRC mortality rates declined between 1990 and 2004, but have been increasing steadily since that time. Comparing 2000-2008 with 2009-2017 we observed no difference in CRC incidence and mortality, age at diagnosis, tumor size, tumor location, or stage distribution. Survival analyses indicated no change in hazard of death between 2004-2008 and 2009-2017 (HR 1.02, 95 % CI: 0.74, 1.38, P = 0.93). CONCLUSIONS Colorectal cancer prevention and control efforts across the Alaska Tribal Health System have not yet resulted in reduced mortality rates, or induced earlier stage migration. POLICY SUMMARY STATEMENT Intensified efforts will be necessary to reduce the burden of CRC among this high-risk population. Continued and increased focus on primary and secondary prevention efforts is warranted.
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Affiliation(s)
- Sarah H Nash
- Alaska Native Epidemiology Center, Community Health Services, Alaska Native Tribal Health Consortium, 3900 Ambassador Drive, Anchorage, AK, 99508, United States.
| | - Carla Britton
- Alaska Native Epidemiology Center, Community Health Services, Alaska Native Tribal Health Consortium, 3900 Ambassador Drive, Anchorage, AK, 99508, United States
| | - Diana Redwood
- Alaska Native Epidemiology Center, Community Health Services, Alaska Native Tribal Health Consortium, 3900 Ambassador Drive, Anchorage, AK, 99508, United States
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12
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DeRouen MC, Thompson CA, Canchola AJ, Jin A, Nie S, Wong C, Jain J, Lichtensztajn DY, Li Y, Allen L, Patel MI, Daida YG, Luft HS, Shariff-Marco S, Reynolds P, Wakelee HA, Liang SY, Waitzfelder BE, Cheng I, Gomez SL. Integrating Electronic Health Record, Cancer Registry, and Geospatial Data to Study Lung Cancer in Asian American, Native Hawaiian, and Pacific Islander Ethnic Groups. Cancer Epidemiol Biomarkers Prev 2021; 30:1506-1516. [PMID: 34001502 PMCID: PMC8530225 DOI: 10.1158/1055-9965.epi-21-0019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/18/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A relatively high proportion of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) females with lung cancer have never smoked. We used an integrative data approach to assemble a large-scale cohort to study lung cancer risk among AANHPIs by smoking status with attention to representation of specific AANHPI ethnic groups. METHODS We leveraged electronic health records (EHRs) from two healthcare systems-Sutter Health in northern California and Kaiser Permanente Hawai'i-that have high representation of AANHPI populations. We linked EHR data on lung cancer risk factors (i.e., smoking, lung diseases, infections, reproductive factors, and body size) to data on incident lung cancer diagnoses from statewide population-based cancer registries of California and Hawai'i for the period between 2000 and 2013. Geocoded address data were linked to data on neighborhood contextual factors and regional air pollutants. RESULTS The dataset comprises over 2.2 million adult females and males of any race/ethnicity. Over 250,000 are AANHPI females (19.6% of the female study population). Smoking status is available for over 95% of individuals. The dataset includes 7,274 lung cancer cases, including 613 cases among AANHPI females. Prevalence of never-smoking status varied greatly among AANHPI females with incident lung cancer, from 85.7% among Asian Indian to 14.4% among Native Hawaiian females. CONCLUSION We have developed a large, multilevel dataset particularly well-suited to conduct prospective studies of lung cancer risk among AANHPI females who never smoked. IMPACT The integrative data approach is an effective way to conduct cancer research assessing multilevel factors on cancer outcomes among small populations.
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Affiliation(s)
- Mindy C DeRouen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Caroline A Thompson
- San Diego State University School of Public Health, San Diego, California
- University of California San Diego School of Medicine, San Diego, California
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Anqi Jin
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Sixiang Nie
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Carmen Wong
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Jennifer Jain
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Daphne Y Lichtensztajn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Yuqing Li
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Laura Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Manali I Patel
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- VA Palo Alto Health Care System, Palo Alto, California
| | - Yihe G Daida
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Harold S Luft
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Peggy Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Su-Ying Liang
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Beth E Waitzfelder
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
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13
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Kim JHJ, Lu Q, Stanton AL. Overcoming constraints of the model minority stereotype to advance Asian American health. AMERICAN PSYCHOLOGIST 2021; 76:611-626. [PMID: 34410738 PMCID: PMC8384115 DOI: 10.1037/amp0000799] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Asian Americans are the fastest growing U.S. immigrant group, projected to become the largest immigrant group by 2065, but the quantity of research on Asian Americans' health has not mirrored changing demographics. Asian Americans have been understudied for more than 25 years, with only 0.17% of National Institutes of Health (NIH) expenditures allocated to projects including Asian American, Native Hawaiian, and Pacific Islander populations (Ðoàn et al., 2019). This disproportionality may result in part from the model minority stereotype (MMS) being extended to health, perpetuating the ideas that Asian Americans are well-positioned with regard to health status and that associated research is not essential. Accordingly, the aims for this article are threefold: (a) bring attention to the inadequate representation of the Asian American population in health-related science, (b) question the MMS in health, and (c) outline potential pathways through which the MMS limits what is knowable on Asian American health issues and needs. We discuss the limited meaningfulness of nonrepresentative aggregated statistics purporting the model minority image and provide counterexamples. We also present a stereotype-constraints model with the MMS contributing to a bottleneck for Asian American health-related knowledge, accompanied by present-day circumstances (e.g., sparse data, few psychologists/behavioral medicine scientists focused on Asian American health). We conclude with initial recommendations for addressing MMS-associated constraints in psychology and more broadly. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center
| | - Annette L. Stanton
- Department of Psychology, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
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Abstract
It is widely accepted that race and related social factors largely underpin patients' access to healthcare, and even have a direct impact on patients' care. The reality that racism is the source of these health inequalities, and that racism within health organisations compounds the issue, undeniably means that racism is a public health issue. The ongoing pandemic has not only shone a light on underlying issues that have silently plagued the Black, Asian and minority ethnic community but has helped us understand the devastating impact of racism. Closing the gap in these populations is required to ensuring equitable access. This article aims to highlight how racism impacts people of colour within the healthcare system and beyond and calls for dismantling of the structural racism that exists within the NHS and other UK organisations.
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Affiliation(s)
- Adwoa Danso
- Barking, Havering and Redbridge University Hospitals NHS Trust.,joint first authors
| | - Yaa Danso
- Pennine Acute NHS Trust, Bury, UK.,joint first authors
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15
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Nash SH, Zimpelman G, Schulz L, Hirschfeld M. Pediatric Cancers among Alaska Native People. J Pediatr 2020; 227:288-294.e1. [PMID: 32679200 PMCID: PMC8108443 DOI: 10.1016/j.jpeds.2020.07.036] [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: 04/14/2020] [Revised: 06/24/2020] [Accepted: 07/09/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the descriptive epidemiology of pediatric cancers among Alaska Native people. STUDY DESIGN We used data from the Alaska Native Tumor Registry, a population-based registry capturing cancer information among Alaska Native people 1969-present. Specifically, we examined all cases of cancer diagnosed among individuals ages 0-19 years. Cases were classified according to the International Classification of Childhood Cancers, 3rd edition (ICCC-3). We estimated incidence and distribution of cases by ICCC-3 cancer site, comparing between the time periods 1969-1996 and 1997-2016. We assessed 12-month and 5-year cause-specific survival, and examined differences over the time period, adjusted for age, sex, and ICCC-3 site. RESULTS Incidence rates of pediatric cancers increased between 1969 and 1996 (n = 134) and 1997 and 2016 (n = 186) among Alaska Native people, from 139.8 in 1 000 000 (95% CI, 116.99-165.7) to 197.54 in 1 000 000 (95% CI, 170.1-228.1). Distribution of ICCC-3 sites differed between time periods (P < .0001). Finally, cancer survival was high; the 12-month survival probability from all ICCC-3 sites combined was 0.88 (95% CI, 0.84-0.92) and the 5-year survival probability was 0.76 (95% CI, 0.70-0.81) for 1969-2016. After adjusting for age, sex, and ICCC-3 site, we observed a 57% decrease in the risk of death when comparing Alaska Native pediatric cancer cases diagnosed in 1997-2016 with those diagnosed in 1969-1996. CONCLUSIONS This information will be of value for our understanding of pediatric cancers among Indigenous peoples of the US, and will also be informative for clinicians providing care to this population.
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Affiliation(s)
- Sarah H Nash
- Alaska Native Epidemiology Center, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK.
| | - Garrett Zimpelman
- Alaska Native Epidemiology Center, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK
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16
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Zahnd WE, Gomez SL, Steck SE, Brown MJ, Ganai S, Zhang J, Arp Adams S, Berger FG, Eberth JM. Rural-urban and racial/ethnic trends and disparities in early-onset and average-onset colorectal cancer. Cancer 2020; 127:239-248. [PMID: 33112412 DOI: 10.1002/cncr.33256] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incidence rates (IRs) of early-onset colorectal cancer (EOCRC) are increasing, whereas average-onset colorectal cancer (AOCRC) rates are decreasing. However, rural-urban and racial/ethnic differences in trends by age have not been explored. The objective of this study was to examine joint rural-urban and racial/ethnic trends and disparities in EOCRC and AOCRC IRs. METHODS Surveillance, Epidemiology, and End Results data on the incidence of EOCRC (age, 20-49 years) and AOCRC (age, ≥50 years) were analyzed. Annual percent changes (APCs) in trends between 2000 and 2016 were calculated jointly by rurality and race/ethnicity. IRs and rate ratios were calculated for 2012-2016 by rurality, race/ethnicity, sex, and subsite. RESULTS EOCRC IRs increased 35% from 10.44 to 14.09 per 100,000 in rural populations (APC, 2.09; P < .05) and nearly 20% from 9.37 to 11.20 per 100,000 in urban populations (APC, 1.26; P < .05). AOCRC rates decreased among both rural and urban populations, but the magnitude of improvement was greater in urban populations. EOCRC increased among non-Hispanic White (NHW) populations, although rural non-Hispanic Black (NHB) trends were stable. Between 2012 and 2016, EOCRC IRs were higher among all rural populations in comparison with urban populations, including NHW, NHB, and American Indian/Alaska Native populations. By sex, rural NHB women had the highest EOCRC IRs across subgroup comparisons, and this was driven primarily by colon cancer IRs 62% higher than those of their urban peers. CONCLUSIONS EOCRC IRs increased in rural and urban populations, but the increase was greater in rural populations. NHB and American Indian/Alaska Native populations had particularly notable rural-urban disparities. Future research should examine the etiology of these trends.
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Affiliation(s)
- Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Susan E Steck
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Monique J Brown
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Office of the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Sabha Ganai
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Swann Arp Adams
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Franklin G Berger
- Colorectal Cancer Prevention Network, University of South Carolina, Columbia, South Carolina
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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17
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Zhang CH, Schwartz GG. Spatial Disparities in Coronavirus Incidence and Mortality in the United States: An Ecological Analysis as of May 2020. J Rural Health 2020; 36:433-445. [PMID: 32543763 PMCID: PMC7323165 DOI: 10.1111/jrh.12476] [Citation(s) in RCA: 147] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose This ecological analysis investigates the spatial patterns of the COVID‐19 epidemic in the United States in relation to socioeconomic variables that characterize US counties. Methods Data on confirmed cases and deaths from COVID‐19 for 2,814 US counties were obtained from Johns Hopkins University. We used Geographic Information Systems (GIS) to map the spatial aspects of this pandemic and investigate the disparities between metropolitan and nonmetropolitan communities. Multiple regression models were used to explore the contextual risk factors of infections and death across US counties. We included population density, percent of population aged 65+, percent population in poverty, percent minority population, and percent of the uninsured as independent variables. A state‐level measure of the percent of the population that has been tested for COVID‐19 was used to control for the impact of testing. Findings The impact of COVID‐19 in the United States has been extremely uneven. Although densely populated large cities and their surrounding metropolitan areas are hotspots of the pandemic, it is counterintuitive that incidence and mortality rates in some small cities and nonmetropolitan counties approximate those in epicenters such as New York City. Regression analyses support the hypotheses of positive correlations between COVID‐19 incidence and mortality rates and socioeconomic factors including population density, proportions of elderly residents, poverty, and percent population tested. Conclusions Knowledge about the spatial aspects of the COVID‐19 epidemic and its socioeconomic correlates can inform first responders and government efforts. Directives for social distancing and to “shelter‐in‐place” should continue to stem the spread of COVID‐19.
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Affiliation(s)
- Charlie H Zhang
- Department of Geography & Geosciences, University of Louisville, Louisville, Kentucky
| | - Gary G Schwartz
- Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, North Dakota
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18
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Vanderpool RC, Chen Q, Johnson MF, Lei F, Stradtman LR, Huang B. Financial distress among cancer survivors in Appalachian Kentucky. Cancer Rep (Hoboken) 2019; 3:e1221. [PMID: 32672003 DOI: 10.1002/cnr2.1221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rural residence may exacerbate cancer-related financial distress. Limited research has focused on Appalachian cancer survivors' experience with financial distress. AIMS The primary aim of this study was to estimate the prevalence of financial distress among cancer survivors residing in Appalachian Kentucky with a specific focus on the impact of rurality and to elucidate the risk factors impacting financial distress among this population. METHODS AND RESULTS Appalachian Kentucky residents were sampled for receipt of a health survey based on county-level rurality. Analyses describe the prevalence and predictors of financial distress among cancer survivors. Subsequent analyses were conducted with Health Information National Trends Survey (HINTS) data to compare local versus national estimates of financial distress. Almost two-thirds of Appalachian survivors reported financial distress compared to one-third of the HINTS sample. Appalachian survivors residing in the most rural counties reported higher distress; this finding was not supported in the national sample. In multivariable analyses, gender, current age, and household income were associated with financial distress among Appalachians; only income was significant among the national sample. CONCLUSION Appalachian cancer survivors have higher than national estimates of financial distress; rurality and socioeconomics are drivers of this disparity.
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Affiliation(s)
- Robin C Vanderpool
- University of Kentucky Markey Cancer Center, 2365 Harrodsburg Road, Suite A230, Lexington, KY, 40504, USA.,Department of Health, Behavior & Society, University of Kentucky College of Public Health, Lexington, KY, 40506, USA
| | - Quan Chen
- University of Kentucky Markey Cancer Center, 2365 Harrodsburg Road, Suite A230, Lexington, KY, 40504, USA
| | - Meghan F Johnson
- University of Kentucky Markey Cancer Center, 2365 Harrodsburg Road, Suite A230, Lexington, KY, 40504, USA
| | - Feitong Lei
- University of Kentucky Markey Cancer Center, 2365 Harrodsburg Road, Suite A230, Lexington, KY, 40504, USA
| | - Lindsay R Stradtman
- Department of Health, Behavior & Society, University of Kentucky College of Public Health, Lexington, KY, 40506, USA
| | - Bin Huang
- University of Kentucky Markey Cancer Center, 2365 Harrodsburg Road, Suite A230, Lexington, KY, 40504, USA.,Department of Health, Behavior & Society, University of Kentucky College of Public Health, Lexington, KY, 40506, USA
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19
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Zahnd WE, Askelson N, Vanderpool RC, Stradtman L, Edward J, Farris PE, Petermann V, Eberth JM. Challenges of using nationally representative, population-based surveys to assess rural cancer disparities. Prev Med 2019; 129S:105812. [PMID: 31422226 PMCID: PMC7289622 DOI: 10.1016/j.ypmed.2019.105812] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/08/2019] [Accepted: 08/14/2019] [Indexed: 12/16/2022]
Abstract
Population-based surveys provide important information about cancer-related health behaviors across the cancer care continuum, from prevention to survivorship, to inform cancer control efforts. These surveys can illuminate cancer disparities among specific populations, including rural communities. However, due to small rural sample sizes, varying sampling methods, and/or other study design or analytical concerns, there are challenges in using population-based surveys for rural cancer control research and practice. Our objective is three-fold. First, we examined the characterization of "rural" in four, population-based surveys commonly referenced in the literature: 1) Health Information National Trends Survey (HINTS); 2) National Health Interview Survey (NHIS); 3) Behavioral Risk Factor Surveillance System (BRFSS); and 4) Medical Expenditures Panel Survey (MEPS). Second, we identified and described the challenges of using these surveys in rural cancer studies. Third, we proposed solutions to address these challenges. We found that these surveys varied in use of rural-urban classifications, sampling methodology, and available cancer-related variables. Further, we found that accessibility of these data to non-federal researchers has changed over time. Survey data have become restricted based on small numbers (i.e., BRFSS) and have made rural-urban measures only available for analysis at Research Data Centers (i.e., NHIS and MEPS). Additionally, studies that used these surveys reported varying proportions of rural participants with noted limitations in sufficient representation of rural minorities and/or cancer survivors. In order to mitigate these challenges, we propose two solutions: 1) make rural-urban measures more accessible to non-federal researchers and 2) implement sampling approaches to oversample rural populations.
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Affiliation(s)
- Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Dr. Suite 204, Columbia, SC 29210, United States of America.
| | - Natoshia Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, United States of America.
| | - Robin C Vanderpool
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY 40536, United States of America.
| | - Lindsay Stradtman
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY 40536, United States of America.
| | - Jean Edward
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, United States of America.
| | - Paige E Farris
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America.
| | - Victoria Petermann
- School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall Campus Box #7460, Chapel Hill, NC 27599-7460, United States of America.
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Dr. Suite 204, Columbia, SC 29210, United States of America; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America; Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America.
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20
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Odahowski CL, Zahnd WE, Zgodic A, Edward JS, Hill LN, Davis MM, Perry CK, Shannon J, Wheeler SB, Vanderpool RC, Eberth JM. Financial hardship among rural cancer survivors: An analysis of the Medical Expenditure Panel Survey. Prev Med 2019; 129S:105881. [PMID: 31727380 PMCID: PMC7190004 DOI: 10.1016/j.ypmed.2019.105881] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/19/2019] [Accepted: 10/30/2019] [Indexed: 11/14/2022]
Abstract
Some cancer survivors report spending 20% of their annual income on medical care. Undue financial burden that patients face related to the cost of care is referred to as financial hardship, which may be more prevalent among rural cancer survivors. This study examined contrasts in financial hardship among 1419 rural and urban cancer survivors using the 2011 Medical Expenditure Panel Survey supplement - The Effects of Cancer and Its Treatment on Finances. We combined four questions, creating a measure of material financial hardship, and examined one question on financial worry. We conducted multivariable logistic regression analyses, which produced odds ratios (OR) for factors associated with financial hardship and worry, and then generated average adjusted predicted probabilities. We focused on rural and urban differences classified by metropolitan statistical area (MSA) designation, controlling for age, education, race, marital status, health insurance, family income, and time since last cancer treatment. More rural cancer survivors reported financial hardship than urban survivors (23.9% versus 17.1%). However, our adjusted models revealed no significant impact of survivors' MSA designation on financial hardship or worry. Average adjusted predicted probabilities of financial hardship were 18.6% for urban survivors (Confidence Interval [CI]: 11.9%-27.5%) and 24.2% for rural survivors (CI: 15.0%-36.2%). For financial worry, average adjusted predicted probabilities were 19.9% for urban survivors (CI: 12.0%-31.0%) and 18.8% for rural survivors (CI: 12.1%-28.0%). Improving patient-provider communication through decision aids and/or patient navigators may be helpful to reduce financial hardship and worry regardless of rural-urban status.
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Affiliation(s)
- Cassie L Odahowski
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, United States of America; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, United States of America
| | - Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, United States of America; Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, United States of America
| | - Anja Zgodic
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, United States of America; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, United States of America
| | - Jean S Edward
- College of Nursing, University of Kentucky, United States of America
| | - Lauren N Hill
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, United States of America
| | - Melinda M Davis
- Oregon Rural Practice-based Research Network, Department of Family Medicine, School of Medicine, Oregon Health & Science University, United States of America; OHSU-PSU School of Public Health, Oregon Health & Sciences University, United States of America
| | - Cynthia K Perry
- School of Nursing, Oregon Health & Sciences University, United States of America
| | - Jackilen Shannon
- OHSU-PSU School of Public Health, Oregon Health & Sciences University, United States of America
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States of America
| | - Robin C Vanderpool
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, United States of America
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, United States of America; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, United States of America.
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21
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Kennedy AE, Vanderpool RC, Croyle RT, Srinivasan S. An Overview of the National Cancer Institute's Initiatives to Accelerate Rural Cancer Control Research. Cancer Epidemiol Biomarkers Prev 2019; 27:1240-1244. [PMID: 30385495 DOI: 10.1158/1055-9965.epi-18-0934] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 08/30/2018] [Accepted: 09/07/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- Amy E Kennedy
- Center for Research Strategy, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Robin C Vanderpool
- Department of Health, Behavior and Society, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Robert T Croyle
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
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22
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Breen N, Berrigan D, Jackson JS, Wong DW, Wood FB, Denny JC, Zhang X, Bourne PE. Translational Health Disparities Research in a Data-Rich World. Health Equity 2019; 3:588-600. [PMID: 31720554 PMCID: PMC6844128 DOI: 10.1089/heq.2019.0042] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Despite decades of research and interventions, significant health disparities persist. Seventeen years is the estimated time to translate scientific discoveries into public health action. This Narrative Review argues that the translation process could be accelerated if representative data were gathered and used in more innovative and efficient ways. Methods: The National Institute on Minority Health and Health Disparities led a multiyear visioning process to identify research opportunities designed to frame the next decade of research and actions to improve minority health and reduce health disparities. "Big data" was identified as a research opportunity and experts collaborated on a systematic vision of how to use big data both to improve the granularity of information for place-based study and to efficiently translate health disparities research into improved population health. This Narrative Review is the result of that collaboration. Results: Big data could enhance the process of translating scientific findings into reduced health disparities by contributing information at fine spatial and temporal scales suited to interventions. In addition, big data could fill pressing needs for health care system, genomic, and social determinant data to understand mechanisms. Finally, big data could lead to appropriately personalized health care for demographic groups. Rich new resources, including social media, electronic health records, sensor information from digital devices, and crowd-sourced and citizen-collected data, have the potential to complement more traditional data from health surveys, administrative data, and investigator-initiated registries or cohorts. This Narrative Review argues for a renewed focus on translational research cycles to accomplish this continual assessment. Conclusion: The promise of big data extends from etiology research to the evaluation of large-scale interventions and offers the opportunity to accelerate translation of health disparities studies. This data-rich world for health disparities research, however, will require continual assessment for efficacy, ethical rigor, and potential algorithmic or system bias.
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Affiliation(s)
- Nancy Breen
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - David Berrigan
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - James S. Jackson
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - David W.S. Wong
- Department of Geography and Geoinformation Science, George Mason University, Fairfax, Virginia
| | | | - Joshua C. Denny
- Biomedical Informatics and Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Xinzhi Zhang
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Philip E. Bourne
- Data Science Institute and Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia
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23
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Rural-urban differences in financial burden among cancer survivors: an analysis of a nationally representative survey. Support Care Cancer 2019; 27:4779-4786. [PMID: 30972645 DOI: 10.1007/s00520-019-04742-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Rural cancer survivors may disproportionately experience financial problems due to their cancer because of greater travel costs, higher uninsured/underinsured rates, and other factors compared to their urban counterparts. Our objective was to examine rural-urban differences in reported financial problems due to cancer using a nationally representative survey. METHODS We used data from three iterations of the National Cancer Institute's Health Information and National Trends Survey (2012, 2014, and 2017) to identify participants who had a previous or current cancer diagnosis. Our outcome of interest was self-reported financial problems associated with cancer diagnosis and treatment. Rural-urban status was defined using 2003 Rural-Urban Continuum Codes. We calculated weighted percentages and Wald chi-square statistics to assess rural-urban differences in demographic and cancer characteristics. In multivariable logistic regression models, we examined the association between rural-urban status and other factors and financial problems, reporting the corresponding adjusted predicted probabilities. FINDINGS Our sample included 1359 cancer survivors. Rural cancer survivors were more likely to be married, retired, and live in the Midwest or South. Over half (50.5%) of rural cancer survivors reported financial problems due to cancer compared to 38.8% of urban survivors (p = 0.02). This difference was attenuated in multivariable models, 49.3 and 38.7% in rural and urban survivors, respectively (p = 0.06). CONCLUSIONS A higher proportion of rural survivors reported financial problems associated with their cancer diagnosis and treatment compared to urban survivors. Future research should aim to elucidate these disparities and interventions should be tested to address the cancer-related financial problems experienced by rural survivors.
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24
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Vanderpool RC, Huang B, Deng Y, Bear TM, Chen Q, Johnson MF, Paskett ED, Robertson LB, Young GS, Iachan R. Cancer-Related Beliefs and Perceptions in Appalachia: Findings from 3 States. J Rural Health 2019; 35:176-188. [PMID: 30830984 DOI: 10.1111/jrh.12359] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Appalachians experience increased rates of cancer incidence and mortality compared to non-Appalachians. Many factors may contribute to the elevated cancer burden, including lack of knowledge and negative beliefs about the disease. METHODS Three National Cancer Institute (NCI)-designated cancer centers with Appalachian counties in their respective population-based geographic service areas-Kentucky, Ohio, and Pennsylvania-surveyed their communities to better understand their health profiles, including 5 items assessing cancer beliefs. Weighted univariate and bivariate statistics were calculated for each of the 3 state's Appalachian population and for a combined Appalachian sample. Weighted multiple linear regression was used to identify factors associated with a cancer beliefs composite score. Data from the combined Appalachian sample were compared to NCI's Health Information National Trends Survey (HINTS). RESULTS Data from 1,891 Appalachian respondents were included in the analysis (Kentucky = 798, Ohio = 112, Pennsylvania = 981). Significant differences were observed across the 3 Appalachian populations related to income, education, marital status, rurality, perceptions of present income, and body mass index (BMI). Four of 5 cancer beliefs were significantly different across the 3 states. Education, BMI, perceptions of financial security, and Kentucky residence were significantly associated with a lower composite score of cancer beliefs. When comparing the combined Appalachian population to HINTS, 3 of 5 cancer belief measures were significantly different. CONCLUSIONS Variations in cancer beliefs were observed across the 3 states' Appalachian populations. Interventions should be tailored to specific communities to improve cancer knowledge and beliefs and, ultimately, prevention and screening behaviors.
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Affiliation(s)
| | - Bin Huang
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | | | - Todd M Bear
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Quan Chen
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Meghan F Johnson
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Linda B Robertson
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gregory S Young
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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Local Health Departments' Engagement in Addressing Health Disparities: The Effect of Health Informatics. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 25:171-180. [PMID: 29975343 DOI: 10.1097/phh.0000000000000842] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Health disparities and health inequities can lead to poor health outcomes. However, health disparities continue to persist in communities across the United States, presenting a crucial public health challenge. Persisting budget cuts and workforce challenges tend to hinder local health departments' (LHDs') ability to assess and address health disparities. OBJECTIVES To examine the extent to which LHDs' use of informatics effects their engagement in strategies and activities addressing health disparities. METHODS Data from the 2016 Profile of LHDs were used in examining the association of informatics with 9 activities addressing health disparities/inequities. RESULTS Fifty-nine percent of LHDs used data and described health disparities in their jurisdiction, and 12% conducted original research to link health disparities to differences in social or environmental conditions. Less than 40% of LHDs prioritized resources for the reduction of health disparities. LHDs that implemented information systems had increased odds of describing the disparities in their jurisdiction (P < .01) and having prioritized resources for the reduction of disparities (P < .01). Per capita expenditures, participation in a national accreditation program process, and a larger LHD population were also positively associated with 7 of 9 activities for addressing health disparities/inequities. CONCLUSIONS As LHDs advance efforts to reduce health disparities and inequities, leadership will find informatics a useful strategy. National initiatives aimed to boost LHDs' engagement in the reduction of disparities might benefit from our findings, positing a positive influence of informatics.
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Haring RC, Jim MA, Erwin D, Kaur J, Henry WAE, Haring ML, Seneca DS. Mortality disparities: A comparison with the Haudenosaunee in New York State. CANCER HEALTH DISPARITIES 2018; 2:10.9777/chd.2018.10009. [PMID: 31777774 PMCID: PMC6880943 DOI: 10.9777/chd.2018.10009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Identifying health status and disparities for Indigenous populations is the first logical step toward better health. We compare the mortality profile of the American Indian and Alaska Native (AI/AN) population with that of non-Hispanic whites in the Haudenosaunee Nations in New York State, the Indian Health Service (IHS) East region (Nashville Area) and the United States. Data from the linkage of IHS registration records with decedents from the National Death Index (1990-2009) were used to identify AI/AN deaths misclassified as non-AI/AN. Analyses were limited to persons of non-Hispanic origin. We analyzed trends for 1990-2009 and compared AI/AN and white persons in the Haudenosaunee Nations in New York State, IHS East region and the United States. All-cause death rates over the past two decades for Haudenosaunee men declined at a greater percentage per year than for AI/AN men in the East region and United States. This decrease was not observed for Haudenosaunee women with all-cause death rates appearing to be stable over the past two decades. Haudenosaunee all-cause death rates were 16% greater than that for whites in the Haudenosaunee Nations. The most prominent disparities between Haudenosaunee and whites are concentrated in the 25-44 year age group (Risk Ratio=1.85). Chronic liver disease, diabetes, unintentional injury, and kidney disease death rates were higher in Haudenosaunee than in whites in the Haudenosaunee Nations. The Haudenosaunee cancer death rate (180.8 per 100,000) was higher than that reported for AI/AN in the East (161.5 per 100,000).Haudenosaunee experienced higher rates for the majority of the leading causes of death than East AI/AN. These results highlight the importance of Haudenosaunee-specific data to target prevention efforts to address health disparities and inequalities in health.
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Affiliation(s)
- Rodney C Haring
- Office of Community Outreach and Engagement, Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Melissa A Jim
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, NM
| | - Deborah Erwin
- Office of Community Outreach and Engagement, Department of Cancer Prevention and Control, Roswell Park Comprensive Cancer Center, Buffalo, NY
| | | | - Whitney Ann E Henry
- Office of Community Outreach and Engagement, Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Marissa L Haring
- Student Research Experience Program in Cancer Science, Department of Educational Affairs, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Dean S Seneca
- Partnership Support Unit, Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA
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Dean LT, Gehlert S, Neuhouser ML, Oh A, Zanetti K, Goodman M, Thompson B, Visvanathan K, Schmitz KH. Social factors matter in cancer risk and survivorship. Cancer Causes Control 2018; 29:611-618. [PMID: 29846844 PMCID: PMC5999161 DOI: 10.1007/s10552-018-1043-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/25/2018] [Indexed: 12/14/2022]
Abstract
Greater attention to social factors, such as race/ethnicity, socioeconomic position, and others, are needed across the cancer continuum, including breast cancer, given differences in tumor biology and genetic variants have not completely explained the persistent Black/White breast cancer mortality disparity. In this commentary, we use examples in breast cancer risk assessment and survivorship to demonstrate how the failure to appropriately incorporate social factors into the design, recruitment, and analysis of research studies has resulted in missed opportunities to reduce persistent cancer disparities. The conclusion offers recommendations for how to better document and use information on social factors in cancer research and care by (1) increasing education and awareness about the importance of inclusion of social factors in clinical research; (2) improving testing and documentation of social factors by incorporating them into journal guidelines and reporting stratified results; and (3) including social factors to refine extant tools that assess cancer risk and assign cancer care. Implementing the recommended changes would enable more effective design and implementation of interventions and work toward eliminating cancer disparities by accounting for the social and environmental contexts in which cancer patients live and are treated.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and Department of Oncology, Johns Hopkins School of Medicine, 615 N Wolfe St, E6650, Baltimore, MD, 21205, USA.
| | - Sarah Gehlert
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Marian L Neuhouser
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - April Oh
- Behavioral Research Program Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States
| | - Krista Zanetti
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Melody Goodman
- Department of Biostatistics, College of Global Public Health, New York University, New York, NY, USA
| | - Beti Thompson
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and Department of Oncology, Johns Hopkins School of Medicine, 615 N Wolfe St, E6650, Baltimore, MD, 21205, USA
| | - Kathryn H Schmitz
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, PA, USA
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Valera P, Lian Z, Brotzman L, Reid A. Fatalistic Cancer Beliefs and Information Seeking in Formerly Incarcerated African-American and Hispanic Men: Implications for Cancer Health Communication and Research. HEALTH COMMUNICATION 2018; 33:576-584. [PMID: 28278604 PMCID: PMC5623655 DOI: 10.1080/10410236.2017.1283564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
African-American and Hispanic men are disproportionately affected by cancer experiencing higher rates of cancer-related morbidity and mortality for many cancers (but not all). These challenges may be magnified for a subpopulation of African-American and Hispanic men who have been incarcerated. A survey assessing demographics, incarceration experience, psychosocial, behavioral, and cancer health information seeking was administered to 230 previously incarcerated men aged 35 years and older. Data analysis was performed to assess the association between fatalism, perceived susceptibility, and health information seeking in this population. This study revealed the following: the majority of the participants (68.7%) held the fatalistic belief: "When I think of cancer, I automatically think of death." Second, the fatalistic belief, "There's not much you can do to lower your chances of getting cancer," is more prevalent among those who perceived a higher risk of developing cancer. Third, older participants (those between 55 and 70 years old) and widowed are less likely to think of death when they think of cancer. In addition, those who use the Internet to look for health or medical information (i.e., engaging in health information seeking) are less likely to agree with the fatalistic belief: "It seems like everything causes cancer." Given the high incidence of certain cancers among African-American and Hispanic men and the vulnerability of those involved in the criminal justice system, our findings highlight the importance of understanding perceived susceptibility to cancer, fatalistic beliefs about cancer, and information seeking in formerly incarcerated men.
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Affiliation(s)
- Pamela Valera
- Nathan Kline Institute for Psychiatric Research, Division of Social Solutions and Services Research
- Department of Psychiatry, New York School of Medicine
| | - Zi Lian
- Teachers College, Columbia University
| | - Laura Brotzman
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health
| | - Andrea Reid
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health
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Zahnd WE, Jenkins WD, James AS, Izadi SR, Steward DE, Fogleman AJ, Colditz GA, Brard L. Utility and Generalizability of Multistate, Population-Based Cancer Registry Data for Rural Cancer Surveillance Research in the United States. Cancer Epidemiol Biomarkers Prev 2018; 27:1252-1260. [PMID: 29563132 DOI: 10.1158/1055-9965.epi-17-1087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 02/02/2018] [Accepted: 03/16/2018] [Indexed: 11/16/2022] Open
Abstract
More than 46 million Americans live in rural areas, but rural populations remain relatively understudied in cancer disparities research. However, several analyses of multistate cancer registry data that describe the rural cancer incidence burden have been recently published. In light of this, our article aims to characterize the utility and generalizability of multistate, population-based cancer registry datasets for rural cancer surveillance research. First, we describe the accessibility, geographic coverage, available variables, and strengths and weaknesses of five data sources. Second, we evaluate two of these data sources-the North American Association of Central Cancer Registries (NAACCR) public use dataset (93% population coverage) and the Surveillance Epidemiology and End Results (SEER) 18 dataset (28% population coverage)-on their characterization of rural-urban cancer incidence rates and sociodemographic representation. The five data sources varied in geographic coverage and extent of available variables. SEER 18's cancer rates sociodemographic representation differed from the more geographically representative NAACCR data. We suggest that SEER increase its geographic coverage to improve their generalizability and to take advantage of their utility to assess disparities along the cancer control continuum. We also suggest that non-SEER data sources be utilized more frequently to capitalize on their extensive geographic coverage. Cancer Epidemiol Biomarkers Prev; 27(11); 1252-60. ©2018 AACR.
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Affiliation(s)
- Whitney E Zahnd
- Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois.
| | - Wiley D Jenkins
- 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, and Siteman Cancer Center St. Louis, Missouri
| | - Sonya R Izadi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, and Siteman Cancer Center St. Louis, Missouri
| | - David E Steward
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Amanda J Fogleman
- Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, and Siteman Cancer Center 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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Gehlert S, Mozersky J. Seeing Beyond the Margins: Challenges to Informed Inclusion of Vulnerable Populations in Research. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:30-43. [PMID: 30093794 PMCID: PMC6077979 DOI: 10.1177/1073110518766006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Although the importance of including vulnerable populations in medical research is widely accepted, identifying how to achieve such inclusion remains a challenge. Ensuring that the language of informed consent is comprehensible to this group is no less of a challenge. Although a variety of interventions show promise for increasing the comprehensibility of informed consent and increasing a climate of exchange, consensus is lacking on which interventions should be used in which situations and current regulations provide little guidance. We argue that the notion of individual autonomy — a foundational principle of informed consent — may be too narrow for some vulnerable populations by virtue of its failure to acknowledge their unique histories and current circumstances. It has a different meaning for members of structured groups like American Indians than for unstructured groups, such as African Americans, whose complicated histories foster group identity. Ensuring broad participation in research and selecting appropriate methods for obtaining informed consent — namely, methods aligned with the source of vulnerability and level of risk — require new ways of thinking that might produce guidelines for matching informed consent models and processes with subpopulations.
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Affiliation(s)
- Sarah Gehlert
- Sarah Gehlert, Ph.D., is the E. Desmond Lee Professor of Racial and Ethnic Diversity at Washington University in St. Louis. She holds an M.A. in Anthropology and an M.S.W. from the University of Missouri-Columbia and a Ph.D. in Social Work from Washington University (St. Louis). Jessica Mozersky, Ph.D., is an Assistant Professor at Washington University in St. Louis. She holds an M.B.E. from the University of Pennsylvania and a Ph.D. in Anthropology from University College London's Interdisciplinary Institute for Human Genetics and Health
| | - Jessica Mozersky
- Sarah Gehlert, Ph.D., is the E. Desmond Lee Professor of Racial and Ethnic Diversity at Washington University in St. Louis. She holds an M.A. in Anthropology and an M.S.W. from the University of Missouri-Columbia and a Ph.D. in Social Work from Washington University (St. Louis). Jessica Mozersky, Ph.D., is an Assistant Professor at Washington University in St. Louis. She holds an M.B.E. from the University of Pennsylvania and a Ph.D. in Anthropology from University College London's Interdisciplinary Institute for Human Genetics and Health
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Allen J, Rasmus SM, Fok CCT, Charles B, Henry D. Multi-Level Cultural Intervention for the Prevention of Suicide and Alcohol Use Risk with Alaska Native Youth: a Nonrandomized Comparison of Treatment Intensity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 19:174-185. [PMID: 28786044 PMCID: PMC5803385 DOI: 10.1007/s11121-017-0798-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Suicide and alcohol use disorders are primary determinants of health disparity among Alaska Native people in contrast to the US general population. Qungasvik, a Yup'ik word for toolbox, is a strengths-based, multi-level, community/cultural intervention for rural Yup'ik youth ages 12-18. The intervention uses "culture as intervention" to promote reasons for life and sobriety in young people using local expertise, high levels of community direction, and community based staff. The intervention is grounded in local practices and adaptive to local cultural differences distinctive to rural Yup'ik communities. The current study compares the effectiveness of high-intensity intervention in one community (treatment), operationalized as a high number of intervention activities, or modules, implemented and attended by youth, contrasted to a lower intensity intervention in a second community (comparison) that implemented fewer modules. A Yup'ik Indigenous theory of change developed through previous qualitative and quantitative work guides intervention. In the model, direct intervention effects on proximal or intermediate variables constituting protective factors at the individual, family, community, and peer influences levels lead to later change on the ultimate prevention outcome variables of Reasons for Life protective from suicide risk and Reflective Processes about alcohol use consequences protective from alcohol risk. Mixed effects regression models contrasted treatment and comparison arms, and identified significant intervention effects on Reasons for Life (d = 0.27, p < .05) but not Reflective Processes.
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Affiliation(s)
- James Allen
- Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, MN, 55812-3301, USA.
| | - Stacy M Rasmus
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Carlotta Ching Ting Fok
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Billy Charles
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - David Henry
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
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Zhang X, Pérez-Stable EJ, Bourne PE, Peprah E, Duru OK, Breen N, Berrigan D, Wood F, Jackson JS, Wong DWS, Denny J. Big Data Science: Opportunities and Challenges to Address Minority Health and Health Disparities in the 21st Century. Ethn Dis 2017; 27:95-106. [PMID: 28439179 DOI: 10.18865/ed.27.2.95] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Addressing minority health and health disparities has been a missing piece of the puzzle in Big Data science. This article focuses on three priority opportunities that Big Data science may offer to the reduction of health and health care disparities. One opportunity is to incorporate standardized information on demographic and social determinants in electronic health records in order to target ways to improve quality of care for the most disadvantaged populations over time. A second opportunity is to enhance public health surveillance by linking geographical variables and social determinants of health for geographically defined populations to clinical data and health outcomes. Third and most importantly, Big Data science may lead to a better understanding of the etiology of health disparities and understanding of minority health in order to guide intervention development. However, the promise of Big Data needs to be considered in light of significant challenges that threaten to widen health disparities. Care must be taken to incorporate diverse populations to realize the potential benefits. Specific recommendations include investing in data collection on small sample populations, building a diverse workforce pipeline for data science, actively seeking to reduce digital divides, developing novel ways to assure digital data privacy for small populations, and promoting widespread data sharing to benefit under-resourced minority-serving institutions and minority researchers. With deliberate efforts, Big Data presents a dramatic opportunity for reducing health disparities but without active engagement, it risks further widening them.
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Affiliation(s)
- Xinzhi Zhang
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH)
| | - Eliseo J Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH)
| | | | | | | | - Nancy Breen
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH)
| | | | | | - James S Jackson
- College of Literature, Science and the Arts, University of Michigan
| | - David W S Wong
- Department of Geography and GeoInformation Science, College of Science, George Mason University
| | - Joshua Denny
- Departments of Biomedical Informatics and Medicine, Vanderbilt University Medical Center
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Martin DN, Lam TK, Brignole K, Ashing KT, Blot WJ, Burhansstipanov L, Chen JT, Dignan M, Gomez SL, Martinez ME, Matthews A, Palmer JR, Perez-Stable EJ, Schootman M, Vilchis H, Vu A, Srinivasan S. Recommendations for Cancer Epidemiologic Research in Understudied Populations and Implications for Future Needs. Cancer Epidemiol Biomarkers Prev 2017; 25:573-80. [PMID: 27196089 DOI: 10.1158/1055-9965.epi-15-1297] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/10/2016] [Indexed: 11/16/2022] Open
Abstract
Medically underserved populations in the United States continue to experience higher cancer burdens of incidence, mortality, and other cancer-related outcomes. It is imperative to understand how health inequities experienced by diverse population groups may contribute to our increasing unequal cancer burdens and disparate outcomes. The National Cancer Institute convened a diverse group of scientists to discuss research challenges and opportunities for cancer epidemiology in medically underserved and understudied populations. This report summarizes salient issues and discusses five recommendations from the group, including the next steps required to better examine and address cancer burden in the United States among our rapidly increasing diverse and understudied populations. Cancer Epidemiol Biomarkers Prev; 25(4); 573-80. ©2016 AACR SEE ALL ARTICLES IN THIS CEBP FOCUS SECTION, "MULTILEVEL APPROACHES TO ADDRESSING CANCER HEALTH DISPARITIES".
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Affiliation(s)
- Damali N Martin
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland.
| | - Tram Kim Lam
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
| | - Katy Brignole
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
| | - Kimlin T Ashing
- Center for Community Alliance for Research and Education, City of Hope Cancer Center, Duarte, California
| | - William J Blot
- Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee. International Epidemiology Institute, Rockville, Maryland
| | - Linda Burhansstipanov
- Native American Cancer Research Corporation, Denver, Colorado. Native American Cancer Initiatives, Incorporated, Colorado
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mark Dignan
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California
| | - Maria Elena Martinez
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Alicia Matthews
- School of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Eliseo J Perez-Stable
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Mario Schootman
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Hugo Vilchis
- Burrell College of Osteopathic Medicine/Burrell Institute for Health Policy & Research, Las Cruces, New Mexico
| | - Alexander Vu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
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Estabrooks P, You W, Hedrick V, Reinholt M, Dohm E, Zoellner J. A pragmatic examination of active and passive recruitment methods to improve the reach of community lifestyle programs: The Talking Health Trial. Int J Behav Nutr Phys Act 2017; 14:7. [PMID: 28103935 PMCID: PMC5248490 DOI: 10.1186/s12966-017-0462-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/05/2017] [Indexed: 01/30/2023] Open
Abstract
Background A primary challenge for behavior change strategies is ensuring that interventions can be effective while also attracting a broad and representative sample of the target population. The purpose of this case-study was to report on (1) the reach of a randomized controlled trial targeting reduced sugary beverages, (2) potential participant characteristic differences based on active versus passive recruitment strategies, and (3) recruitment strategy cost. Methods Demographic and recruitment information was obtained for 8 counties and for individuals screened for participation. Personnel activities and time were tracked. Costs were calculated and compared by active versus passive recruitment. Results Six-hundred and twenty, of 1,056 screened, individuals were eligible and 301enrolled (77% women; 90% white; mean income $21,981 ± 16,443). Eighty-two and 44% of those responding to passive and active methods, respectively, enrolled in the trial. However, active recruitment strategies yielded considerably more enrolled (active = 199; passive = 102) individuals. Passive recruitment strategies yielded a less representative sample in terms of gender (more women), education (higher), and income (higher; p’s <0.05). The average cost of an actively recruited and enrolled participant was $278 compared to $117 for a passively recruited and enrolled participant. Conclusions Though passive recruitment is more cost efficient it may reduce the reach of sugary drink reduction strategies in lower educated and economic residents in rural communities. Trial registration Clinicaltrials.gov; ID: NCT02193009, July 2014, retrospectively registered.
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Affiliation(s)
- Paul Estabrooks
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA.
| | - Wen You
- Department of Applied and Agricultural Economics, Virginia Tech, 304 Hutcheson Hall, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Valisa Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 335A Wallace Hall, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Margaret Reinholt
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive, 1031 ILSB, Blacksburg, VA, 24060, USA
| | - Erin Dohm
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive, 1031 ILSB, Blacksburg, VA, 24060, USA
| | - Jamie Zoellner
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive, 1031 ILSB, Blacksburg, VA, 24060, USA
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Bingham BA, Duong MT, Ricks M, Mabundo LS, Baker RL, Utumatwishima JN, Udahogora M, Berrigan D, Sumner AE. The Association between Stress Measured by Allostatic Load Score and Physiologic Dysregulation in African Immigrants: The Africans in America Study. Front Public Health 2016; 4:265. [PMID: 27933289 PMCID: PMC5122568 DOI: 10.3389/fpubh.2016.00265] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/10/2016] [Indexed: 01/15/2023] Open
Abstract
Introduction Allostatic load score (ALS) summarizes the physiological effect of stress on cardiovascular, metabolic and immune systems. As immigration is stressful, ALS could be affected. Objective Associations between age of immigration, reason for immigration, and unhealthy assimilation behavior and ALS were determined in 238 African immigrants to the United States (age 40 ± 10, mean ± SD, range 21–64 years). Methods ALS was calculated using 10 variables from three domains; cardiovascular (SBP, DBP, cholesterol, triglyceride, homocysteine), metabolic [BMI, A1C, albumin, estimated glomerular filtration rate (eGFR)], and immunological [high-sensitivity C-reactive protein (hsCRP)]. Variables were divided into sex-specific quartiles with high-risk defined by the highest quartile for each variable except for albumin and eGFR, which used the lowest quartile. One point was assigned if the variable was in the high-risk range and 0 if not. Unhealthy assimilation behavior was defined by a higher prevalence of smoking, alcohol consumption, or sedentary activity in immigrants who lived in the US for ≥10 years compare to <10 years. Results Sixteen percent of the immigrants arrived in the US as children (age < 18 years); 84% arrived as adults (age ≥ 18 years). Compared to adulthood immigrants, childhood immigrants were younger (30 ± 7 vs. 42 ± 9, P < 0.01) but had lived in the US longer (20 ± 8 vs. 12 ± 9 years, P < 0.01). Age-adjusted ALS was similar in childhood and adulthood immigrants (2.78 ± 1.83 vs. 2.73 ± 1.69, P = 0.87). For adulthood immigrants, multiple regression analysis (adj R2 = 0.20) revealed older age at immigration and more years in the US were associated with higher ALS (both P < 0.05); whereas, current age, education, income, and gender had no significant influence (all P ≥ 0.4). The prevalence of smoking, alcohol intake, and physical activity did not differ in adulthood immigrants living in the US for ≥10 years vs. <10 years (all P ≥ 0.2). Reason for immigration was available for 77 participants. The reasons included: family reunification, lottery, marriage, work, education, and asylum. Compared to all other reasons combined, immigration for family reunification was associated with the lowest ALS (1.94 ± 1.51 vs. 3.03 ± 1.86, P = 0.03). Conclusion African immigrants do not appear to respond to the stress of immigration by developing unhealthy assimilation behaviors. However, older age at immigration and increased duration of stay in the US are associated with higher ALS; whereas, family reunification is associated with lower ALS. Clinical Trials.gov Identifier NCT00001853
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Affiliation(s)
- Brianna A Bingham
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH) , Bethesda, MD , USA
| | - Michelle T Duong
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH) , Bethesda, MD , USA
| | - Madia Ricks
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH) , Bethesda, MD , USA
| | - Lilian S Mabundo
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH) , Bethesda, MD , USA
| | - Rafeal L Baker
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH) , Bethesda, MD , USA
| | - Jean N Utumatwishima
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), Bethesda, MD, USA; National Institute of Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD, USA
| | | | - David Berrigan
- Health Behavior Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health (NIH) , Bethesda, MD , USA
| | - Anne E Sumner
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), Bethesda, MD, USA; National Institute of Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD, USA
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Etz KE, Arroyo JA. Small Sample Research: Considerations Beyond Statistical Power. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 16:1033-6. [PMID: 26281902 DOI: 10.1007/s11121-015-0585-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Small sample research presents a challenge to current standards of design and analytic approaches and the underlying notions of what constitutes good prevention science. Yet, small sample research is critically important as the research questions posed in small samples often represent serious health concerns in vulnerable and underrepresented populations. This commentary considers the Special Section on small sample research and also highlights additional challenges that arise in small sample research not considered in the Special Section, including generalizability, determining what constitutes knowledge, and ensuring that research designs match community desires. It also points to opportunities afforded by small sample research, such as a focus on and increased understanding of context and the emphasis it may place on alternatives to the randomized clinical trial. The commentary urges the development and adoption of innovative strategies to conduct research with small samples.
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Affiliation(s)
- Kathleen E Etz
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd., Bethesda, MD, 20852, USA.
| | - Judith A Arroyo
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Bethesda, MD, 20852, USA
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Philip J, Ford T, Henry D, Rasmus S, Allen J. Relationship of Social Network to Protective Factors in Suicide and Alcohol Use Disorder Intervention for Rural Yup'ik Alaska Native Youth. INTERVENCION PSICOSOCIAL 2016; 25:45-54. [PMID: 27110094 PMCID: PMC4836384 DOI: 10.1016/j.psi.2015.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Suicide and alcohol use disorders are significant Alaska Native health disparities, yet there is limited understanding of protection and no studies of social network factors in protection in this or other populations. The Qungasvik intervention enhances protective factors from suicide and alcohol use disorders through activities grounded in Yup'ik cultural practices and values. Identification of social network factors associated with protection within the cultural context of these tight, close knit, and high density rural Yup'ik Alaska Native communities in southwest Alaska can help identify effective prevention strategies for suicide and alcohol use disorder risk. Using data from ego-centered social network and protective factors from suicide and alcohol use disorders surveys with 50 Yup'ik adolescents, we provide descriptive data on structural and network composition variables, identify key network variables that explain major proportions of the variance in a four principal component structure of these network variables, and demonstrate the utility of these key network variables as predictors of family and community protective factors from suicide and alcohol use disorder risk. Connections to adults and connections to elders, but not peer connections, emerged as predictors of family and community level protection, suggesting these network factors as important intervention targets for intervention.
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Affiliation(s)
- Jacques Philip
- Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks
| | - Tara Ford
- Aleutian Pribilof Islands Association
| | - David Henry
- Department of Psychology and Institute for Health Research and Policy, University of Illinois at Chicago
| | - Stacy Rasmus
- Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks
| | - James Allen
- University of Minnesota Medical School, Duluth Campus
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Local Health Departments' Activities to Address Health Disparities and Inequities: Are We Moving in the Right Direction? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010044. [PMID: 26703693 PMCID: PMC4730435 DOI: 10.3390/ijerph13010044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 12/27/2022]
Abstract
Context: Health disparities are among the critical public health challenges. Objectives: To analyze the extent to which local health departments (LHDs) perform activities for addressing health disparities, changes in proportion of LHDs’ performing those activities since 2005, and factors associated with variation in such engagement. Methods: We used the 2013 National Profile of LHDs Survey to perform Logistic Regression of activities LHDs performed to address health disparities. Results: About 20 percent of LHDs did not perform any activity to address health disparities. Significant decreases occurred since 2005 in the proportion of LHDs that performed health disparity reduction/elimination activities for four activities. LHD characteristics significantly associated (p≤0.05) with the increased likelihood of performing activities to address health disparities were: recent completion of community health assessment, community health improvement plan and agency wide strategic plan. Other significant positive impacts on such activities included per capita expenditures, local governance, having one or more local boards of health, larger population size and metropolitan status of the LHD jurisdiction. Conclusions: Reduced infrastructural capacity of LHDs has resulted in fewer LHDs addressing health disparities in their jurisdictions. LHD characteristics associated with higher performance of activities for health disparity reduction identified by this research have important policy implications.
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Monteith S, Glenn T, Geddes J, Bauer M. Big data are coming to psychiatry: a general introduction. Int J Bipolar Disord 2015; 3:21. [PMID: 26440506 PMCID: PMC4715830 DOI: 10.1186/s40345-015-0038-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/18/2015] [Indexed: 12/26/2022] Open
Abstract
Big data are coming to the study of bipolar disorder and all of psychiatry. Data are coming from providers and payers (including EMR, imaging, insurance claims and pharmacy data), from omics (genomic, proteomic, and metabolomic data), and from patients and non-providers (data from smart phone and Internet activities, sensors and monitoring tools). Analysis of the big data will provide unprecedented opportunities for exploration, descriptive observation, hypothesis generation, and prediction, and the results of big data studies will be incorporated into clinical practice. Technical challenges remain in the quality, analysis and management of big data. This paper discusses some of the fundamental opportunities and challenges of big data for psychiatry.
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Affiliation(s)
- Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, 1400 Medical Campus Drive, Traverse City, MI, 49684, USA.
| | - Tasha Glenn
- ChronoRecord Association, Inc., Fullerton, CA, 92834, USA.
| | - John Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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Konkel L. Racial and Ethnic Disparities in Research Studies: The Challenge of Creating More Diverse Cohorts. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:A297-302. [PMID: 26625444 PMCID: PMC4670264 DOI: 10.1289/ehp.123-a297] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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