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Hudson L, Burus T, Park L, Huang B, Hull PC, Vanderford NL. Cancer disparities in Appalachian Kentucky. J Rural Health 2024; 40:87-95. [PMID: 37095596 PMCID: PMC10593907 DOI: 10.1111/jrh.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/15/2023] [Accepted: 04/13/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Cancer is the second leading cause of death in the United States, and the disease burden is elevated in Appalachian Kentucky, due in part to health behaviors and inequities in social determinants of health. This study's goal was to evaluate Appalachian Kentucky's cancer burden compared to non-Appalachian Kentucky, and Kentucky compared to the United States (excluding Kentucky). METHODS The following data were analyzed: annual all-cause and all-site cancer mortality rates from 1968 to 2018; 5-year all-site and site-specific cancer incidence and mortality rates from 2014 to 2018; aggregated screening and risk factor data from 2016 to 2018 for the United States (excluding Kentucky), Kentucky, non-Appalachian Kentucky, and Appalachian Kentucky; and human papilloma virus vaccination prevalence by sex from 2018 for the United States and Kentucky. FINDINGS Since 1968, the United States has experienced a large decrease in all-cause and cancer mortality, but the reduction in Kentucky has been smaller and slower, driven by even smaller and slower reductions within Appalachian Kentucky. Appalachian Kentucky has higher overall cancer incidence and mortality rates and higher rates for several site-specific cancers compared to non-Appalachian Kentucky. Contributing factors include screening rate disparities and increased rates of obesity and smoking. CONCLUSIONS Appalachian Kentucky has experienced persistent cancer disparities, including elevated all-cause and cancer mortality rates for 50+ years, widening the gap between this region and the rest of the country. In addition to addressing social determinants of health, increased efforts aimed at improving health behaviors and increased access to health care resources could help reduce this disparity.
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Affiliation(s)
- Lauren Hudson
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Todd Burus
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Lee Park
- Department of Statistics, College of Arts & Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Bin Huang
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
- Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Pamela C. Hull
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Nathan L. Vanderford
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
- Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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Katz ML, Shoben AB, Newell S, Hall C, Emerson B, Gray DM, Chakraborty S, Reiter PL. Video brochures in a mailed fecal immunochemical test outreach program provide cancer screening information in a user-friendly format for rural Appalachian community members. J Rural Health 2024; 40:96-103. [PMID: 37296510 PMCID: PMC10709528 DOI: 10.1111/jrh.12772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Colorectal cancer (CRC) screening is recommended for average-risk adults, yet many adults are not up-to-date with screening. One recommended CRC screening approach is the annual completion of a fecal immunochemical test (FIT). However, usually, fewer than half of mailed FIT tests are returned. METHODS To address barriers to FIT return, a video brochure was developed providing targeted CRC screening information and step-by-step FIT instructions as a component in a mailed FIT program. This pilot study occurred in 2021-2022 and partnered with a federally qualified health center in Appalachian Ohio to send a FIT to patients who were 50-64 years old, of average risk, and not up-to-date on CRC screening. Patients were randomly assigned to 1 of 3 groups that differed on materials sent with the FIT: usual care (manufacturer's instructions), a video brochure (video instructions, disposable gloves, disposable stool collection device), or an audio brochure (audio instructions, disposable gloves, disposable stool collection device). FINDINGS Overall, 16 of 94 patients (17%) returned the FIT, and return was higher among those sent the video brochure (28%) compared to the other 2 groups (OR: 3.1; 95% CI: 1.02, 9.2; P = .046). Two patients had positive tests and were referred for colonoscopy. Patients sent the video brochure reported the content was important, relevant, and made them think about completing the FIT. CONCLUSIONS Using a video brochure to provide understandable information in a mailed FIT kit is a promising strategy to improve CRC screening outreach programs in rural regions.
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Affiliation(s)
- Mira L. Katz
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, United States
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States
| | - Abigail B. Shoben
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, United States
| | - Sabrina Newell
- Compass Community Health Center, Portsmouth, Ohio, United States
| | - Christina Hall
- Compass Community Health Center, Portsmouth, Ohio, United States
| | - Brent Emerson
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, United States
| | - Darrell M. Gray
- Formerly in the Department of Internal Medicine, College of Medicine, The Ohio State University and currently the Chief Health Equity Officer at Elevance Health, Indianapolis, Indiana
| | - Subhankar Chakraborty
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Paul L. Reiter
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, United States
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States
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Lee SJ, Jin DL, Kim YA, Seo HJ, Yoon SJ. How should the healthcare system support cancer survivors? Survivors' and health professionals' expectations and perception on comprehensive cancer survivorship care in Korea: a qualitative study. BMC Cancer 2023; 23:1255. [PMID: 38124040 PMCID: PMC10731886 DOI: 10.1186/s12885-023-11736-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Qualitative research on cancer survivors' need for comprehensive cancer survivorship care within the health care system is limited. Our study aimed to understand cancer survivors' and health professionals' expectations and perceptions for developing a comprehensive cancer survivorship care system in South Korea. METHODS An exploratory qualitative study was conducted. A total of 16 subjects (11 cancer survivors and 5 health professionals) were purposively sampled from Regional Cancer Survivorship Centers or Cancer Survivor Clinics in Korea. In-depth semi-structured online or face-to-face interviews were conducted. Six steps of thematic analysis were used to analyze data. RESULTS The following four primary themes emerged from the interviews: 1) introducing a customized follow-up care system to improve continuity of survivorship care, 2) implementing educational strategies for both survivors and health professionals to manage changed health, and 3) accepting cancer survivors as companions. These three themes included a total of nine subthemes. As a result, the comprehensive survivorship model identified needs in terms of 1) changes in the medical healthcare system and core services that can accommodate the cancer survivors' condition and 2) necessary care services and social support for cancer survivors. CONCLUSIONS This study identified the existing gaps in Korea's current healthcare system regarding comprehensive cancer survivorship care for cancer survivors. Further research on eHealth-based counseling and educational support, the payment models of cancer survivorship care within universal health coverage, and changing social perceptions to strengthen the biopsychosocial needs of cancer survivors is needed.
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Affiliation(s)
- Su Jung Lee
- College of Nursing, Institute of Health Science Research, and Inje Institute of Hospice & Palliative Care (IHPC), Inje University, Busan, South Korea
| | - Dal-Lae Jin
- Department of Public Health, Graduate School of Korea University, Seoul, South Korea
- Transdisciplinary Major in Learning Health Systems, Graduate School, Korea University, Seoul, South Korea
| | - Young Ae Kim
- Division of Cancer Control and Policy, National Cancer Center, Goyang, South Korea
| | - Hyun-Ju Seo
- College of Nursing, Chungnam National University, Daejeon, South Korea.
| | - Seok-Jun Yoon
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea.
- Institute for Future Public Health, Graduate School of Public Health, Korea University, Seoul, South Korea.
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Derricks V, Earl A, Carmichael AG, Jayaratne TE. Psychological Pathways Through Which Social Norms and Social Identity Influence Eating Behavior: Testing a Conceptual Model. Int J Behav Med 2023; 30:7-18. [PMID: 35286584 DOI: 10.1007/s12529-022-10064-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although interventions frequently promote healthy eating, failing to consider psychosocial factors, such as social norms, may limit the effectiveness of these efforts. Perceived social norms are a well-documented determinant of eating behavior; however, there is limited understanding of the processes through which, and for whom, this relationship emerges. Using identity-based motivation as a theoretical framework, we present a conceptual model identifying one route through which descriptive social norms-beliefs about how others behave-predict eating behavior, and test whether this process varies across social identities (e.g., self-perceived weight status). METHOD Structured telephone interviews were conducted for a national sample of non-diabetic adults who identified as non-Hispanic White, non-Hispanic Black, or Mexican American (n = 990). RESULTS Multigroup SEM analysis comparing individuals who self-identified as overweight (versus "about the right weight" and underweight) demonstrated that perceiving descriptive social norms that people do not eat healthy foods predicted greater perceived barriers to eating healthy foods. Perceived barriers, in turn, predicted stronger beliefs that body weight is uncontrollable, and this relationship was stronger for participants who self-identified as overweight (relative to participants who did not identify as overweight). These beliefs subsequently predicted greater self-reported consumption of unhealthy foods (e.g., sweets), but did not predict consumption of fruits or vegetables. CONCLUSIONS This study extends our understanding of a psychosocial process that predicts consumption of unhealthy foods and underscores the importance of social identities for shaping responses to perceived norms.
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Smalls BL, Lacy ME, Adegboyega A, Hieronymus L, Bacha N, Nathoo T, Westgate PM, Azam T, Westneat S, Schoenberg NE. A New Look at Barriers to Clinical Care Among Appalachian Residents Living With Diabetes. Diabetes Spectr 2023; 36:14-22. [PMID: 36818407 PMCID: PMC9935286 DOI: 10.2337/ds22-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In the United States, diabetes is the seventh leading cause of death and continues to rise in prevalence, with type 2 diabetes accounting for 90-95% of all cases. Rates of diabetes in Kentucky, and, in particular, the Appalachian region, are among the highest in the nation and are increasing faster than the national average. Despite this disproportionate burden, barriers to clinical appointment attendance have not been fully explored in this population. This article examines the association among perceived barriers to clinical attendance, glycemic control, and diabetes self-care as part of an ongoing study. We used a 25-item checklist developed using the Chronic Care Model to assess participants' barriers to clinic attendance. Glycemic control was assessed via A1C measurement. Diabetes self-care was assessed using the Summary of Diabetes Self-Care Activities measure. At the time of analysis, 123 of the 356 participants (34.6%) did not report any barriers to clinic attendance. For the remainder, the major reported barriers included forgetting appointments, inability to afford medicines or other treatment, and placing faith above medical care. The average A1C was 7.7%, and the average diabetes self-care summary score was 17.1 out of 35 points (with higher values indicating better self-care). Missing clinic appointments is associated with lower health outcomes, especially in vulnerable populations. This study can help educate clinic staff on perceived barriers to type 2 diabetes management among people with diabetes in Appalachia.
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Affiliation(s)
- Brittany L. Smalls
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY
- Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY
- Corresponding author: Brittany L. Smalls,
| | - Mary E. Lacy
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY
| | | | - Laura Hieronymus
- Barnstable-Brown Diabetes and Obesity Center, University of Kentucky, Lexington, KY
| | - Nicole Bacha
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY
| | - Tayla Nathoo
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY
| | - Philip M. Westgate
- Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY
| | - Tofial Azam
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY
| | - Susan Westneat
- Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY
| | - Nancy E. Schoenberg
- Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY
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Do T, Whittaker A. Trajectories to a cancer diagnosis: Why and when women seek help for breast symptoms in Vietnam. Health Soc Care Community 2022; 30:e6322-e6331. [PMID: 36245318 PMCID: PMC10092510 DOI: 10.1111/hsc.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/25/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Women in low- and middle-income countries where the prevalence and mortality of breast cancer are growing rapidly are more likely to be diagnosed at advanced stages, which negatively affects their treatment outcomes and chance of survival. The current literature in those settings tends to focus largely on explaining patient delay in seeking medical attention for breast symptoms. Meanwhile, little is known as to what prompts women to attend screening and diagnostic services after discovering symptomatic breasts. Drawn upon the data from in-depth interviews with 33 breast cancer patients in Central Vietnam conducted in 2019, this paper examines the context of women's decisions about breast screening and how the practice of seeking cancer diagnosis occurred. Our findings reveal an absence of a national screening program and that seeking medical advice was conducted on an ad hoc basis after self-detection of breast symptoms. Women's interpretations of symptomatic breasts as suspicious signs of cancer, the co-occurrence of important life events, or encouragement by people in their social network motivated women to seek medical attention at different public and private health facilities. Their encounters with the health sector often involved multiple visits across time and space in which they experienced various forms of diagnosis delay produced by the health system. Our study carries implications for interventions to encourage women's awareness of early cancer symptoms and prompt medical presentation after self-discovery of symptomatic breasts.
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Affiliation(s)
- Trang Do
- School of Social Sciences, Faculty of ArtsMonash UniversityClaytonVictoriaAustralia
| | - Andrea Whittaker
- Co‐Convener of Health and Biofutures Focus Programme, School of Social Sciences, Faculty of ArtsMonash UniversityClaytonVictoriaAustralia
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Xiang M, Liang Z, Gao Y, Feng X, Yao X. Prognostic value of final pathological stage in colon adenocarcinoma after neoadjuvant chemotherapy: A propensity score-matched study. Front Surg 2022; 9:1022025. [PMID: 36386548 PMCID: PMC9643450 DOI: 10.3389/fsurg.2022.1022025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/03/2022] [Indexed: 11/22/2022] Open
Abstract
Background Neoadjuvant chemotherapy (NAC) could improve local tumor control of locally advanced colon cancer (LACC), but the prognostic value of yp stage in colon cancer remains unknown. Here, we aimed to ascertain yp stage as an indicator for LACC prognosis after NAC. Methods The data of patients diagnosed with colon adenocarcinoma between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results database. After 1:2 propensity score matching, cancer-specific survival (CSS) and overall survival (OS) were compared between the NAC and Non-NAC groups of different stage classifications. The correlation between clinical and pathological factors and CSS was identified. Results A total of 49, 149, and 81 matched pairs of stage 0-I, II, and III patients, respectively, were generated for analysis. For stage 0-I (p = 0.011) and III (p = 0.015), only CSS in the NAC groups were inferior. Receiving NAC was an independent prognostic risk factor for patients with stage 0-I (hazard ratio, 7.70; 95% confidence interval, 1.820-32.5; p = 0.006) and stage III (hazard ratio, 1.73; 95% confidence interval, 1.11-2.68; p = 0.015). Conclusions The CSS was poorer among LACC patients who underwent NAC than among those who did not. The yp stage of colon cancer after NAC has distinctive significance, which may contribute to predicting the prognosis and guiding the treatment of LACC patients after NAC.
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Affiliation(s)
- Meijuan Xiang
- School of Medicine, South China University of Technology, Guangzhou, China,Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Department of General Surgery, Guangdong Provincial People's Hospital Ganzhou Hospital (Ganzhou Municipal Hospital), Ganzhou, China,Department of Anorectal Surgery, Foresea Life Insurance Shaoguan Hospital, Shaoguan, China
| | - Zongyu Liang
- Second Department of General Surgery, The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, China
| | - Yuan Gao
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xingyu Feng
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Correspondence: Xingyu Feng Xueqing Yao
| | - Xueqing Yao
- School of Medicine, South China University of Technology, Guangzhou, China,Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Department of General Surgery, Guangdong Provincial People's Hospital Ganzhou Hospital (Ganzhou Municipal Hospital), Ganzhou, China,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China,The Fifth School of Clinical Medicine, Gannan Medical University, Ganzhou, China,Correspondence: Xingyu Feng Xueqing Yao
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Ren S, Zhang Y, Qin P, Wang J. Factors Influencing Total Delay of Breast Cancer in Northeast of China. Front Oncol 2022; 12:841438. [PMID: 35311134 PMCID: PMC8924654 DOI: 10.3389/fonc.2022.841438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Delay in diagnosis and treatment, called total delay, could probably result in lower survival rates in breast cancer patients. This study aimed to investigate the factors associated with the comprehensive delay behaviors and to evaluate its effect on outcomes in patients with breast cancer in Dalian, a northeast city of China. Methods A retrospective chart review was conducted using a cancer registry dataset including 298 patients. The Kaplan–Meier survival analysis was used to identify the threshold of total delay, dividing the patients into a group with significant uncertainty and a group without substantial delay. The factors associated with the significant total delay were investigated from the potential candidates, like income level and marital status, by using the chi-squared test. The difference of the clinicopathologic characteristics between the patients grouped by the significant total delay, like tumor size and lymph node metastasis, was also investigated to find out the effect of the total delay. Results A total of 238 charts were used for analysis. The mean age was 57.3. The median of total delays was 3.75 months. Thirty days was identified as a threshold, more than which the total delay can lead to worse survival. Patients’ marital status (p = 0.010), income levels (p = 0.003), smoking status (p = 0.031), initial visiting hospital level (p = 0.005), self-health care (p = 0.001), and self-concern about initial symptom (p ≈ 0.000) were identified as the independent predictors of the total delay. Metastasis (p ≈ 0.000) was identified as the significant result relating to the significant total delay. Conclusions A total delay of more than 30 days predicts worse survival in breast cancer patients in Dalian. Several factors, like patients’ marital status and income levels, can be considered to be relevant to the significant total delay. We recommend that these factors be used to predict the potential patients with the significant total delay in the clinical practice.
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Affiliation(s)
- Sihang Ren
- Department of Breast Surgery, Institute of Breast Disease, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yuting Zhang
- Dalian No.3 People's Hospital, Dalian Medical University, Dalian, China
| | - Pan Qin
- Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, China
| | - Jia Wang
- Department of Breast Surgery, Institute of Breast Disease, The Second Hospital of Dalian Medical University, Dalian, China
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Jensen JD, Shannon J, Iachan R, Deng Y, Kim SJ, Demark-Wahnefried W, Faseru B, Paskett ED, Hu J, Vanderpool RC, Lazovich D, Mendoza JA, Shete S, Robertson LB, Balkrishnan R, Briant KJ, Haaland B, Haggstrom DA, Fuemmeler BF. Examining Rural-Urban Differences in Fatalism and Information Overload: Data from 12 NCI-Designated Cancer Centers. Cancer Epidemiol Biomarkers Prev 2022; 31:393-403. [PMID: 35091459 DOI: 10.1158/1055-9965.epi-21-0355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/01/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rural populations experience a disproportionate cancer burden relative to urban populations. One possibility is that rural populations are more likely to hold counterproductive cancer beliefs such as fatalism and information overload that undermine prevention and screening behaviors. METHODS Between 2016 and 2020, 12 U.S. cancer centers surveyed adults in their service areas using online and in-person survey instruments. Participants (N = 10,362) were designated as rural (n = 3,821) or urban (n = 6,541). All participants were 18 and older (M = 56.97, SD = 16.55), predominately non-Hispanic White (81%), and female (57%). Participants completed three items measuring cancer fatalism ("It seems like everything causes cancer," "There's not much you can do to lower your chances of getting cancer," and "When I think about cancer, I automatically think about death") and one item measuring cancer information overload ("There are so many different recommendations about preventing cancer, it's hard to know which ones to follow"). RESULTS Compared with urban residents, rural residents were more likely to believe that (i) everything causes cancer (OR = 1.29; 95% CI, 1.17-1.43); (ii) prevention is not possible (OR = 1.34; 95% CI, 1.19-1.51); and (iii) there are too many different recommendations about cancer prevention (OR = 1.26; 95% CI, 1.13-1.41), and cancer is always fatal (OR = 1.21; 95% CI, 1.11-1.33). CONCLUSIONS Compared with their urban counterparts, rural populations exhibited higher levels of cancer fatalism and cancer information overload. IMPACT Future interventions targeting rural populations should account for higher levels of fatalism and information overload.
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Affiliation(s)
- Jakob D Jensen
- Department of Communication, University of Utah, Salt Lake City, Utah.
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jackilen Shannon
- Oregon Health and Science University - Portland State University, School of Public Health, Oregon Health and Science University, Portland, Oregon
| | | | | | - Sunny Jung Kim
- Department of Health Behavior and Policy, Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences and O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Babalola Faseru
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas
- University of Kansas Cancer Center, Kansas City, Kansas
| | - Electra D Paskett
- Department of Internal Medicine, College of Medicine, and OSU Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Jinxiang Hu
- University of Kansas Cancer Center, Kansas City, Kansas
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Robin C Vanderpool
- Department of Health, Behavior and Society and Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Jason A Mendoza
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Sanjay Shete
- Department of Biostatistics and Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Linda B Robertson
- School of Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rajesh Balkrishnan
- Department of Public Health Sciences and UVA Cancer Center, University of Virginia, Charlottesville, Virginia
| | - Katherine J Briant
- Office of Community Outreach and Engagement, Fred Hutch/University of Washington Cancer Consortium, Seattle, Washington
| | - Benjamin Haaland
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
- Department of Population Sciences, University of Utah, Salt Lake City, Utah
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Trang NT, Jauffret-Roustide M, Giang LM, Visier L. "I'm not like others": stigma navigation by people who inject drugs in Vietnam. Drugs (Abingdon Engl) 2022; 29:85-94. [PMID: 35399201 PMCID: PMC8993137 DOI: 10.1080/09687637.2021.1874875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background People who inject drugs are subjected to great stigmatization in many parts of the world. How they deal with stigma is closely linked to how stigma means to them. Understanding the strategies individuals employ to cope with these negative attitudes and what resources they mobilize in this process gives useful insights for clinical work and policy development. Methods We conducted 12 months of field observation in 2017 and 2018 and 54 in-depth interviews with people who inject drugs in Haiphong, Vietnam. Grounded theory underpinned our sampling and data analysis. Results The strategies participants used to manage stigma were both information and tension management. Many participants not only concealed their drug use but actively cultivated a pro-social image based on Vietnamese cultural virtues such as selflessness, hard work or harmonious living with others. Participants withdrew from social relationships to distance themselves from the stereotype of a money-begging drug user. They used techniques of neutralization to emphasize their good character and reframe their drug-related issues in a different light in order to negotiate their social status with their interlocutors. Conclusion People who inject drugs endorse the same social values and aspirations as nonusers. A good support structure and resources could help them to cope more effectively with stigma.
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Affiliation(s)
- Nguyen Thu Trang
- Centre for Research and Training on Substance Abuse – HIV, Hanoi Medical University, Vietnam; Doctoral School of Law and Political Sciences, Montpellier University, France
| | - Marie Jauffret-Roustide
- Centre of Medicine, Sciences, Health, Mental Health and Health Policy (CERMES 3) (Inserm U988/CNRS UMR 8211/EHESS/Université Paris Descartes), Paris, France
| | - Le Minh Giang
- Centre for Research and Training on Substance Abuse – HIV, Hanoi Medical University, Vietnam
| | - Laurent Visier
- Doctoral School of Law and Political Sciences, Montpellier University, France
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Drew EM, Hanson BL, Huo K. Seasonal affective disorder and engagement in physical activities among adults in Alaska. Int J Circumpolar Health 2021; 80:1906058. [PMID: 33871315 PMCID: PMC8079121 DOI: 10.1080/22423982.2021.1906058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/22/2022] Open
Abstract
Seasonal affective disorder (SAD) is a type of depression in which symptoms occur during a particular season. While physical activity has been shown to improve symptoms for depression in general populations, the relationships between physical activity and experiences of seasonality and SAD remain underexplored. We conducted a survey with adult members of a recreational gym in Fairbanks, Alaska. The survey collected self-report data on sociodemographics, health behaviours, and elements of the Seasonal Pattern Assessment Questionnaire (SPAQ). Results indicate that 18.68% of our study participants meet the criteria for winter-pattern SAD and 43.96% meet the criteria for subsyndromal SAD ("winter blues"). We conducted two regressions to understand experiences of SAD and predictors of seasonality more generally. Gender was a significant predictor of SAD, with women more likely than men to experience SAD (p = .04). Being social at the gym, whether going to the gym with others or participating in activities with others, was associated with higher seasonality than being independent at the gym (p = .03). Younger age was also associated with higher seasonality (p < .001). This study contributes new insights about the relationship between engagement in physical activities and experiences of seasonality among adults in a northern latitude.
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Affiliation(s)
- Elaine M. Drew
- Department of Anthropology, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Bridget L. Hanson
- Institute of Social and Economic Research, University of Alaska Anchorage, Anchorage, AK, USA
| | - Kevin Huo
- Department of Anthropology, University of Alaska Fairbanks, Fairbanks, AK, USA
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Mendoza JA, Lasco G, Renedo A, Palileo-Villanueva L, Seguin M, Palafox B, Amit AML, Pepito V, McKee M, Balabanova D. (De)constructing 'therapeutic itineraries' of hypertension care: A qualitative study in the Philippines. Soc Sci Med 2021; 300:114570. [PMID: 34802782 PMCID: PMC7613024 DOI: 10.1016/j.socscimed.2021.114570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 10/11/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
Hypertension, a major risk factor for non-communicable diseases, remains poorly controlled in many countries. In the Philippines, it is still one of the leading causes of preventable deaths despite the accessibility and availability of essential technologies and medicine to detect and treat hypertension. This paper characterizes the ‘therapeutic itineraries’ of people with hypertension from poor communities in rural and urban settings in the Philippines. We employ longitudinal qualitative methodology comprised of repeat interviews and digital diaries using mobile phones from 40 recruited participants in 12 months. Our findings demonstrate that therapeutic itineraries, rather than being organized according to categories that stem from the structure of the health system (i.e., diagnosis, treatment, follow-up, adherence), diverge from clinical pathways. Therapeutic itineraries begin at a stage we label as ‘pre-diagnosis’ (PD). Following this, itineraries diverge according to two possible entry points into the healthcare system: via incidental diagnosis (ID) whereby participants were diagnosed with hypertension without deliberately seeking care for hypertension-related symptoms and symptom-driven diagnosis (SD) whereby their diagnosis was obtained during a clinical encounter specifically prompted by hypertension-related symptoms. Participants whose itineraries follow the SD route typically oscillated between periods of regular and intermittent medical treatment, while participants who were diagnosed incidentally (ID) typically opted for self-care As we follow our participants’ therapeutic itineraries, we explore the confluence of factors informing their care journey, namely, their conceptions of hypertension, their social relationships, as well the choices and trade-offs they make. We conclude with policy implications from our findings, chief of which is our proposition that models of care based on mere access and availability of clinical interventions fail to reflect the complexity of people’s lay understanding and their lived experiences of hypertension and are thus ultimately unhelpful in improving its control.
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Affiliation(s)
- Jhaki A Mendoza
- College of Medicine, University of the Philippines Manila, Manila, 1000, Philippines.
| | - Gideon Lasco
- Department of Anthropology, University of the Philippines Diliman, Quezon City, 1111, Philippines
| | - Alicia Renedo
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | | | - Maureen Seguin
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Benjamin Palafox
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Arianna Maever L Amit
- College of Medicine, University of the Philippines Manila, Manila, Philippines; School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Veincent Pepito
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Martin McKee
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Dina Balabanova
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
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Gan T, Chen Q, Huerta CT, Huang B, Evers BM, Patel JA. Neoadjuvant Therapy in Stage II/III Rectal Cancer: A Retrospective Study in a Disparate Population and the Effect on Survival. Dis Colon Rectum 2021; 64:1212-1221. [PMID: 34516443 DOI: 10.1097/dcr.0000000000001977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Kentucky has one of the highest rectal cancer incidences in the United States. High poverty rates have led to poor insurance coverage and inadequate access to care. The treatment of locally advanced rectal cancer utilizes a multimodal regimen requiring regular access to expert care. The rate of receipt of neoadjuvant therapy in Kentucky is unknown. OBJECTIVE This study aimed to evaluate the rate and factors associated with the receipt of neoadjuvant therapy for localized advanced rectal cancer in Kentucky and the effect on overall survival. DESIGN This is a retrospective database review. SETTINGS This study was conducted by utilizing the Kentucky Cancer Registry at an academic center. PATIENTS All patients diagnosed with stage II/III rectal adenocarcinoma from 2005 to 2015 in the Commonwealth of Kentucky were included. MAIN OUTCOME MEASURES The primary outcomes measured were the factors associated with nonreceipt of neoadjuvant therapy and overall survival. RESULTS Of 1896 patients, only 46.8% received neoadjuvant therapy. Factors associated with not receiving neoadjuvant therapy included older age, female sex, low education level, high poverty level, and treatment at nonacademic centers. Survival analysis demonstrated significantly improved survival in patients receiving neoadjuvant therapy compared with other treatment regimens. LIMITATIONS This study was limited by the retrospective nature of the review and by unmeasured confounders. CONCLUSIONS Our study was the first to evaluate the factors behind the low rates of neoadjuvant therapy for locally advanced rectal cancer in Kentucky. Neoadjuvant therapy in this population is beneficial for survival; efforts should be made in policy and education with focus on older patients, female patients, and treatment at nonacademic centers. Centralization of rectal cancer care improves outcomes, but we must be aware of the effect it may have on disparate populations with poor access. See Video Abstract at http://links.lww.com/DCR/B596. TERAPIA NEOADYUVANTE EN EL MANEJO DEL CNCER DE RECTO EN ESTADIO II / III UN ESTUDIO RETROSPECTIVO EN UNA POBLACIN DISPAR Y EL EFECTO EN LA SUPERVIVENCIA ANTECEDENTES:El estado de Kentucky tiene una de las mayores incidencias de cáncer de recto en los EE. UU. Debido a una alta tasa de pobreza, el porcentaje de la población que cuenta con seguro de salud, es muy limitado, y por lo tanto el acceso a una atención de alto nivel es muy bajo. El tratamiento del cáncer de recto localmente avanzado, es multidisciplinario, lo que exige acceso y disponibilidad a un grupo experto. Se desconoce la tasa de pacientes que reciben terapia neoadyuvante en Kentucky.OBJETIVO:Establecer la tasa y los factores asociados con el uso de terapia neoadyuvante en el tratamiento del cáncer de recto localmente avanzado en Kentucky, y su efecto en la supervivencia global.DISEÑO:Revisión retrospectiva de una base de datos.ESCENARIO:Este estudio se llevó a cabo utilizando el Registro de Cáncer de Kentucky en un centro académico.PACIENTES:Se incluyen todos los pacientes diagnosticados con adenocarcinoma de recto, de la Mancomunidad (Commonwealth) de Kentucky, en estadio II / III entre 2005 y 2015.PRINCIPALES MEDIDAS DE RESULTADO:Establecer los factores asociados con el hecho de no recibir terapia neoadyuvante; y establecer la supervivencia global.RESULTADOS:De 1896 pacientes evaluados, solo el 46,8% recibió terapia neoadyuvante. Los factores asociados, para no haber recibido terapia neoadyuvante fueron: la edad avanzada, sexo femenino, bajo nivel educativo, alto nivel de pobreza y tratamiento en centros no académicos. El análisis de la supervivencia mostró una supervivencia significativamente mejor en los pacientes que recibieron terapia neoadyuvante en comparación con otros esquemas de tratamiento.LIMITACIONES:Revisión retrospectiva, factores de confusión no medidos.CONCLUSIONES:Nuestro estudio ha sido el primero en evaluar los factores determinantes de las bajas tasas de terapia neoadyuvante para el tratamiento del cáncer de recto localmente avanzado en Kentucky. La terapia neoadyuvante mejora y favorece la supervivencia en esta población, por lo tanto se deben hacer esfuerzos en las políticas de salud, así como en educación, enfocados a los pacientes mayores, pacientes femeninas y tratamiento en centros no académicos. El centralizar la atención del cáncer de recto, mejora los resultados, pero debemos ser conscientes del efecto que puede tener en poblaciones desiguales económicamente, con acceso deficiente a la posibilidad de recibir atención de alto nivel. Consulte Video Resumen en http://links.lww.com/DCR/B596.
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Affiliation(s)
- Tong Gan
- Department of Surgery, Lexington, Kentucky
- Markey Cancer Center, Lexington, Kentucky
| | - Quan Chen
- Markey Cancer Center, Lexington, Kentucky
| | | | - Bin Huang
- Markey Cancer Center, Lexington, Kentucky
- Department of Internal Medicine, Lexington, Kentucky
| | - B Mark Evers
- Department of Surgery, Lexington, Kentucky
- Markey Cancer Center, Lexington, Kentucky
| | - Jitesh A Patel
- Department of Surgery, Lexington, Kentucky
- Markey Cancer Center, Lexington, Kentucky
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McGrady ML, Rowe JE, McMorrow SL, Lopez-Jeng C. Qualitative exploration of the reproductive health perceptions of middle-aged women in the United States. J Women Aging 2021; 34:341-350. [PMID: 34161197 DOI: 10.1080/08952841.2021.1936389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Empirical literature exploring the reproductive health experiences of middle-aged women is limited. Little is known about their experiences and decision-making processes related to reproductive health. The purpose of the Reproductive Health Seeking (RHS) study was to expand the understanding of reproductive health knowledge and influences impacting health decisions for middle-aged women. Thirty women aged 45-64 participated in semi-structured interviews and a focus group. Results highlighted a variety of experiences related to reproductive health including women's perceptions of reproductive health-related cancers, community resources for reproductive-related health education, and factors that influence reproductive health and healthcare seeking behavior. Results demonstrated that women are impacted by their conversations with family and friends, seek information through a variety of channels, and are calling for more information on a variety of reproductive health-related issues outside of breast cancer campaigns.
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Affiliation(s)
- Michele L McGrady
- College of Health and Human Services, School of Interdisciplinary Health Programs, Western Michigan University, Kalamazoo, Michigan, USA
| | - Jill E Rowe
- College of Health and Human Services, School of Interdisciplinary Health Programs, Western Michigan University, Kalamazoo, Michigan, USA
| | - Shannon L McMorrow
- College of Health and Human Services, School of Interdisciplinary Health Programs, Western Michigan University, Kalamazoo, Michigan, USA
| | - Cassie Lopez-Jeng
- College of Health and Human Services, School of Interdisciplinary Health Programs, Western Michigan University, Kalamazoo, Michigan, USA
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Moloney ME, Hansen A, Cockerham-Morris CT, Li J, Chavan NR. Appalachian Women's perspectives on preterm birth and transvaginal ultrasound cervical length screening: Implications for addressing disparities in preterm birth. Healthc (Amst) 2021; 9:100558. [PMID: 34098320 DOI: 10.1016/j.hjdsi.2021.100558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 05/06/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Preterm birth (PTB), a pressing issue for US maternal-child health, disproportionately impacts women in Appalachia. Transvaginal ultrasound (TVU) cervical length (CL) screening is the most accurate PTB risk predictor but remains underutilized. This study characterizes the knowledge, attitudes and beliefs of patients with prior PTB concerning PTB prevention efforts and TVU CL screening. METHODS Participants were recruited from community-based health centers in Appalachian Kentucky. Semi-structured interviews and likert-scale surveys were conducted with 22 pregnant women with a history of spontaneous PTB. Methods for data collection were guided by the Consolidated Framework for Implementation Research (CFIR). RESULTS Most participants reported that TVU was uncomfortable, but none refused it. Most women were able to articulate the benefits of TVU, but several had concerns about its safety in pregnancy. Participants suggested that pregnant women receive more PTB education and self-advocate. They urged providers to take patient concerns seriously, and better educate patients on PTB risks and TVU safety. DISCUSSION Our study contributes crucial insights about the experience of a vulnerable population as it pertains to PTB prevention and the uptake of TVU CL screening. Our findings emphasize the need for increased efforts to better educate patients on the impact of prematurity and the safety and benefits of TVU CL screening as an evidence-based strategy for PTB prevention.
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Affiliation(s)
- Mairead E Moloney
- Department of Sociology, University of Kentucky College of Arts and Sciences, Lexington, KY, USA
| | - Anna Hansen
- Department of Sociology, University of Kentucky College of Arts and Sciences, Lexington, KY, USA; College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Cynthia T Cockerham-Morris
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Jing Li
- Center for Health Services Research (CHSR), College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Niraj R Chavan
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, College of Medicine, University of Kentucky, Lexington, KY, USA; Center for Health Services Research (CHSR), College of Medicine, University of Kentucky, Lexington, KY, USA.
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Abstract
PURPOSE Women who receive an abnormal Pap result may experience negative psychological factors. The purpose of this study is to assess the baseline occurrence of negative psychological factors and evaluate the relationships between psychological factors and demographic characteristics among Appalachian women who received abnormal Pap results. METHODS We conducted a secondary analysis of data collected from Appalachia Kentucky women (N = 521) ages ≥18 enrolled in an intervention. Data included sociodemographics, Beck depression and anxiety inventories, fatalism, and personal control measures. Multiple variable logistic regression was used to investigate the association between demographics and psychological factors. FINDINGS Participants were predominantly White (96.2%), with mean age 28.93 ± 11.03 years, and the majority (77%) had yearly income below $20,000. Depression was reported by 34.6% (n = 173); 10% (n = 50) experienced moderate or severe anxiety; 20.6% (n = 107) had fatalistic beliefs; and 55.1% (n = 289) believed they lacked personal control over cancer. Women with lower income had higher occurrence of depression (P = .003). Women with moderate to severe anxiety were significantly older than those with low to moderate depression (34.44 vs 28.34, P < .001). Controlling for other variables, as age increased, the odds of fatalistic beliefs increased, OR (95%) = 1.042 (1.022, 1.062). When education level increased, the odds of fatalistic beliefs decreased, OR (95%) = 0.873 (0.800, 0.952). CONCLUSIONS Given the high occurrence of depression, anxiety, and fatalistic beliefs among this population, health care providers should assess for underlying mental health diagnoses and psychological distress during each patient encounter and provide recommendations to address them.
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Affiliation(s)
| | - Mark Dignan
- Prevention Research Center, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Shuying Sha
- School of Nursing, University of Louisville, Louisville, Kentucky, USA
| | - Chigozie Nkwonta
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Thompson JR, Risser LR, Dunfee MN, Schoenberg NE, Burke JG. Place, Power, and Premature Mortality: A Rapid Scoping Review on the Health of Women in Appalachia. Am J Health Promot 2021; 35:1015-1027. [PMID: 33906415 DOI: 10.1177/08901171211011388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Appalachian women continue to die younger than in other US regions. We performed a rapid scoping review to summarize women's health research in Appalachia from 2000 to 2019, including health topics, study populations, theoretical frameworks, methods, and findings. DATA SOURCE We searched bibliographic databases (eg, PubMed, PsycINFO, Google Scholar) for literature focusing on women's health in Appalachia. STUDY INCLUSION AND EXCLUSION CRITERIA Included articles were: (1) on women's health in Appalachia; (2) published January 2000 to June 2019; (3) peer-reviewed; and (4) written in English. We excluded studies without reported data findings. DATA EXTRACTION Two coders reviewed articles for descriptive information to create summary tables comparing variables of interest. DATA SYNTHESIS Two coders co-reviewed a sub-sample to ensure consensus and refine data charting categories. We categorized major findings across the social-ecological framework. RESULTS A search of nearly 2 decades of literature revealed 81 articles, which primarily focused on cancer disparities (49.4%) and prenatal/pregnancy outcomes (23.5%). Many of these research studies took place in Central Appalachia (eg, 42.0% in Kentucky) with reproductive or middle-aged women (82.7%). Half of the studies employed quantitative methods, and half used qualitative methods, with few mixed method or community-engaged approaches (3.7%). Nearly half (40.7%) did not specify a theoretical framework. Findings included complex multi-level factors with few articles exploring the co-occurrence of factors across multiple levels. CONCLUSIONS Future studies should: 1) systematically include Appalachian women at various life stages from under-represented sub-regions; 2) expand the use of rigorous methods and specified theoretical frameworks to account for complex interactions of social-ecological factors; and 3) build upon existing community assets to improve health in this vulnerable population.
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Affiliation(s)
- Jessica R Thompson
- Department of Behavioral and Community Health Sciences, 51303University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
| | - Lauren R Risser
- Department of Behavioral and Community Health Sciences, 51303University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
| | | | | | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, 51303University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
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Clarke N, Kearney PM, Gallagher P, McNamara D, O'Morain CA, Sharp L. Negative emotions and cancer fatalism are independently associated with uptake of Faecal Immunochemical Test-based colorectal cancer screening: Results from a population-based study. Prev Med 2021; 145:106430. [PMID: 33482227 DOI: 10.1016/j.ypmed.2021.106430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 12/24/2022]
Abstract
Although systematic colorectal cancer screening is efficacious, many programmes suffer from low uptake. Few behavioural or attitudinal factors have been identified as being associated with participation in colorectal cancer screening. We explored knowledge, beliefs about cancer, subjective health literacy, emotional attitudes to screening, and social influences among individuals invited to a population-based screening programme. Regression modelling of a cross-sectional survey of 2299 individuals (users and non-users) of a population-based Faecal Immunochemical Test (FIT) screening programme in Dublin was conducted. Questions were derived from previous theoretically-informed qualitative work and assessed using previously used and validated measures. The primary outcome variable was uptake status (User/Participation or Non-User/Non-participation); multivariable logistic regression was used to estimate the odds ratios (OR) for screening participation. Stronger fatalistic beliefs independently predicted lower uptake (OR = 0.94; 95% CI 0.90-0.98; P = 0.003). Those aged <65 who disagreed that "cancer can often be cured" also had lower uptake (OR = 0.43; 95% CI 0.22-0.82: P = 0.017). Agreement that the test was disgusting and tempting fate predicted lower uptake (OR = 0.16: 95% CI 0.10-0.27: p < 0.001), while the influence of a partner on decision to be screened was associated with higher uptake (OR = 1.32; 95% CI 1.15-1.50: P < 0.001). Negative cancer-related and screening-related beliefs and emotions are associated with non-participation in FIT (-based screening). Research is warranted to explore if these negative beliefs and emotions are modifiable and, if so, whether this would improve screening uptake. The association between the influence of a partner and screening participation present a challenge around improving uptake among those not in co-habiting relationships.
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Affiliation(s)
| | | | | | - Deirdre McNamara
- Department of Clinical Medicine, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin, Ireland.
| | - Colm A O'Morain
- Faculty of Health Science, Trinity College Dublin, Dublin, Ireland.
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, England, UK.
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Fraser GJ. Fatalism Knowledge and Inquiry in African American Family Stories of Death Premonition. American Anthropologist 2021. [DOI: 10.1111/aman.13554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Fuzzell LN, Perkins RB, Christy SM, Lake PW, Vadaparampil ST. Cervical cancer screening in the United States: Challenges and potential solutions for underscreened groups. Prev Med 2021; 144:106400. [PMID: 33388330 DOI: 10.1016/j.ypmed.2020.106400] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/09/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022]
Abstract
Cervical cancer screening rates in the United States are generally high, yet certain groups demonstrate disparities in screening and surveillance. Individuals at greatest risk for cervical cancer are often from marginalized or underserved groups who do not participate in regular screening for a variety of reasons. Using the Population-based Research to Optimize the Screening Process (PROSPR) Trans-Organ Conceptual Model, including concepts of individual-, provider-, facility-, system-, or policy-level factors, we provide a commentary to highlight reasons for low screening participation among subgroups in the U.S. These include racial and ethnic minorities, rural residents, sexual and gender minorities, those with limited English proficiency, those with particular religious beliefs, and various health conditions. We describe barriers and offer potential solutions for each group. In addition, we discuss cross-cutting barriers to screening including difficulty interacting with the healthcare system (limited knowledge and health literacy, lack of provider recommendation/contact), financial (cost, lack of insurance), and logistical barriers (e.g., lack of usual source of care, competing demands, scheduling issues). Solutions to address these barriers are needed to improve screening rates across all underscreened groups. Changes at state and national policy levels are needed to address health insurance coverage. Mobile screening, ensuring that interpreters are available for all visits, and targeted in reach at non-gynecological visits can further overcome barriers. Employing community outreach workers can increase community demand for screening, and patient navigators can improve adherence to both screening and follow-up diagnostic evaluation. HPV self-sampling can address multiple barriers to cervical cancer screening.
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Affiliation(s)
- Lindsay N Fuzzell
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America.
| | - Rebecca B Perkins
- Boston University School of Medicine, 85 E. Concord St., Boston, MA 02118, United States of America
| | - Shannon M Christy
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; University of South Florida, College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States of America
| | - Paige W Lake
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America
| | - Susan T Vadaparampil
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; University of South Florida, College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States of America.
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Kiyak E, Erkal E, Demir S, Demirkiran BC, Uren Y, Erguney S. Evaluation of attitudes toward epilepsy and health fatalism in northeastern Turkey. Epilepsy Behav 2021; 115:107495. [PMID: 33323342 DOI: 10.1016/j.yebeh.2020.107495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/04/2020] [Accepted: 09/12/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE This study was carried out to identify the attitudes toward epilepsy, health fatalism, and the factors affecting these in individuals living in Artvin in the northeast of Turkey. METHOD This descriptive and cross-sectional study involved 1443 healthy individuals at a hospital in Artvin in northeastern Turkey between January and March 2020. An individual information form, an epilepsy attitude scale, and a religious health fatalism scale were used to assess their views. An independent sample t-test, Mann-Whitney U test, one-way analysis of variance (ANOVA), and Pearson correlation analysis were used to analyze the data. RESULTS The mean score of participants' attitudes on epilepsy was 48.17 (standard deviation (SD) = 12.93), while the mean of their health fatalism score was 48.43 (SD = 17.41). There was a significant negative correlation between attitude scores and health fatalism (r = -0.084, p = 0.001). Significant differences were found among attitude, health fatalism mean scores, and misconceptions associated with religion about epilepsy being a contagious, psychiatric, and incurable disease that should be hidden. Significant differences were additionally observed among attitude, health fatalism mean scores, and education, marital status, income, employment status, and presence of chronic disease (p < 0.05). CONCLUSION It was found that most individuals had moderate level attitude toward epilepsy and had high health fatalism. Individuals with a high degree of health fatalism were found to have more negative attitude toward epilepsy. Attitude was found to be more negative, and health fatalism was found to be higher in individuals with low education level, low-income level, who were married, who were unemployed, who had a chronic disease, and in those who thought epilepsy was a contagious, psychiatric, and incurable disease associated with religion that should be hidden. IMPLICATIONS It is recommended that health professionals organize training programs to increase public understanding of epilepsy, improving individual attitudes toward the condition, and minimizing health fatalism.
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Rowther AA, Kazi AK, Nazir H, Atiq M, Atif N, Rauf N, Malik A, Surkan PJ. "A Woman Is a Puppet." Women's Disempowerment and Prenatal Anxiety in Pakistan: A Qualitative Study of Sources, Mitigators, and Coping Strategies for Anxiety in Pregnancy. Int J Environ Res Public Health 2020; 17:ijerph17144926. [PMID: 32650551 PMCID: PMC7400614 DOI: 10.3390/ijerph17144926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/05/2020] [Accepted: 06/29/2020] [Indexed: 12/19/2022]
Abstract
Common mental disorders are highly prevalent among pregnant women in low- and middle-income countries, yet prenatal anxiety remains poorly understood, particularly in the sociocultural context of South Asia. Our study explored sources, mitigators, and coping strategies for anxiety among symptomatic pregnant women in Pakistan, particularly in relation to autonomy in decision-making and social support. We interviewed 19 pregnant married women aged 18–37 years recruited from 2017–2018 at a public hospital in Rawalpindi who screened positive for anxiety. Thematic analysis was based on both inductive emergent codes and deductive a priori constructs of pregnancy-related empowerment. Gender norms emerged as an important dimension of Pakistani women’s social environment in both constraining pregnancy-related agency and contributing to prenatal anxiety. Women’s avenues of self-advocacy were largely limited to indirect means such as appeals to the husband for intercession or return to her natal home. The levels of autonomy during pregnancy depended on the area of decision-making, and peer/family support was a critical protective factor and enabling resource for maternal mental health. Women’s disempowerment is a key contextual factor in the sociocultural experience of prenatal maternal anxiety in South Asia, and further examination of the intersections between empowerment and perinatal mental illness might help inform the development of more context-specific preventive approaches.
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Affiliation(s)
- Armaan A Rowther
- Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St., Baltimore, MD 21205, USA; (A.K.K.); (P.J.S.)
- Correspondence:
| | - Asiya K Kazi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St., Baltimore, MD 21205, USA; (A.K.K.); (P.J.S.)
| | - Huma Nazir
- Human Development Research Foundation House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan; (H.N.); (M.A.); (N.A.); (N.R.); (A.M.)
| | - Maria Atiq
- Human Development Research Foundation House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan; (H.N.); (M.A.); (N.A.); (N.R.); (A.M.)
| | - Najia Atif
- Human Development Research Foundation House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan; (H.N.); (M.A.); (N.A.); (N.R.); (A.M.)
| | - Nida Rauf
- Human Development Research Foundation House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan; (H.N.); (M.A.); (N.A.); (N.R.); (A.M.)
| | - Abid Malik
- Human Development Research Foundation House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan; (H.N.); (M.A.); (N.A.); (N.R.); (A.M.)
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St., Baltimore, MD 21205, USA; (A.K.K.); (P.J.S.)
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Knaul FM, Doubova SV, Gonzalez Robledo MC, Durstine A, Pages GS, Casanova F, Arreola-Ornelas H. Self-identity, lived experiences, and challenges of breast, cervical, and prostate cancer survivorship in Mexico: a qualitative study. BMC Cancer 2020; 20:577. [PMID: 32571255 PMCID: PMC7310126 DOI: 10.1186/s12885-020-07076-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 06/15/2020] [Indexed: 01/01/2023] Open
Abstract
Background Qualitative research on cancer patients’ survivor-identity and lived experiences in low- and middle-income countries is scarce. Our study aimed at exploring the concept and experience of survivorship for Mexicans living with breast, cervical, and prostate cancer. Methods We conducted a qualitative study in Mexico City, Morelos, Nuevo León, and Puebla. The participants were breast, cervical, and prostate cancer patients ≥18 years of age with completed primary cancer treatment. Data were collected via in-depth interviews and analyzed using an inductive thematic approach. Results The study included 22 participants with a history of breast, 20 cervical, and 18 prostate cancer. Participants accepted the term “cancer survivor” as a literal interpretation of being alive, medical confirmation of treatment completion, or achievement of a clinical result possibly indicative of cure. The majority of respondents perceived that the future is out of their control and under God’s will. They linked cure to divine intervention and did not demonstrate the sense of empowerment that is often associated with the survivorship term. The principal themes of their narratives encompass: 1) adverse physical and sexual experiences; 2) emotional problems; 3) cancer-related stigma; 4) challenges to obtaining health-related information; 5) financial hardship; and 6) experience of strengthening family ties in order to provide them with support. In addition, women with breast cancer reported distress caused by changes in body image and positive experience with support groups. Conclusion In Mexico, cancer patients report complex survivorship experiences that demand post-treatment follow-up and support. There is the need to implement comprehensive, culturally-relevant survivorship programs focused on emotional, informational, and in-kind support and empowerment of cancer patients.
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Affiliation(s)
- Felicia Marie Knaul
- Sylvester Comprehensive Cancer Center. University of Miami, Miami, FL, USA.,Department of Public Health Sciences, Leonard M. Miller School of Medicine, Miami, FL, USA.,Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA.,Tómatelo a Pecho & Mexican Health Foundation (FUNSALUD), Mexico City, Mexico
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit, CMN Siglo XXI, Mexican Institute of Social Security, Av. Cuauhtemoc 330, Col. Doctores, Del. Cuauhtemoc, 06720, Mexico City, Mexico.
| | - María Cecilia Gonzalez Robledo
- Center for Research in Health Systems, National Institute of Public Health, Av. Universidad 655 cerr, Los Pinos y Caminera, Col. Santa María Ahuacatitlán C.P, 62100, Cuernavaca, Morelos, Mexico
| | | | - Gabriela Sophia Pages
- Department of Public Health Sciences, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA
| | - Felicia Casanova
- Department of Sociology, University of Miami, Coral Gables, FL, USA
| | - Hector Arreola-Ornelas
- Mexican Health Foundation (FUNSALUD), Mexico City, Mexico.,Tómatelo a Pecho, Mexico City, Mexico.,Centro de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Anáhuac Mexico Campus Norte, Naucalpan de Juárez, Mexico
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Molaei-Zardanjani M, Savabi-Esfahani M, Taleghani F. Fatalism in breast cancer and performing mammography on women with or without a family history of breast cancer. BMC Womens Health 2019; 19:116. [PMID: 31519195 PMCID: PMC6743202 DOI: 10.1186/s12905-019-0810-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/13/2019] [Indexed: 12/04/2022]
Abstract
Background Breast cancer is the most prevalent cancer in women, and in those with a positive family history, it is important to perform mammography. One of the probable barriers in doing mammography is fatalism. Methods This is a descriptive/cross-sectional study conducted on 400 women residing in Isfahan, Iran, randomly selected in 2017. Sampling was done randomly among the enrolled women in Health Integrity System. The data collection tool was a questionnaire regarding the demographic-fertility information and fatalism. The data analysis was done by SPSS software. A P-value < 0.05 was considered statistically significant. Results The results showed that the mean rate of fatalism was 59.5 ± 23.2 in women with the experience of mammography, and 65.9±18.7 in women without the experience. Moreover, the mean rate of fatalism was 73.1±15.2 in subjects with a family history of breast cancer, and 59.3 ± 22.5 in those no family history related to this condition. Accordingly, fatalism was statistically significant associated (P < 0.001) with a family history of breast cancer and experience of mammography. There was no significant relationship between demographic information and fatalism (P > 0.05). Conclusion The results indicated that fatalism in women with no experience of mammography was higher than in those with a positive history. Regarding the necessity of mammography in women with a family history of breast cancer, the required interventions seem to be essential to changing the viewpoints of women regarding the importance and effect of mammography as a screening method for breast cancer. Electronic supplementary material The online version of this article (10.1186/s12905-019-0810-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Mitra Savabi-Esfahani
- Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Fariba Taleghani
- Faculty of Nursing &Midwifery, Nursing& Midwifery care research center, Isfahan University of Medical Sciences, Isfahan, Iran
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Ramaswamy P, Mathew Joseph N, Wang J. Health Beliefs Regarding Cardiovascular Disease Risk and Risk Reduction in South Asian Immigrants: An Integrative Review. J Transcult Nurs 2019; 31:76-86. [PMID: 30957667 DOI: 10.1177/1043659619839114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The risk for cardiovascular disease (CVD) is higher in South Asians (SAs) than in other ethnic groups. The purpose of this review is to explore SAs' health beliefs regarding CVD risk and risk reduction behaviors including physical activity and healthy diet. Methodology: An integrative review was conducted to examine the peer-reviewed literature published before May 2017. Searches from PubMed, Scopus, and CINAHL yielded 1 mixed-method, 4 quantitative, and 14 qualitative studies. Results: Stress, lack of exercise, and high-fat diet were perceived as causes of CVD in most studies. Lack of time, sociocultural norms, and insufficient guidance from health care providers were perceived barriers to CVD risk reduction. Exercise and healthy diet were perceived to be beneficial in a few studies. Cues to action included information from community leaders and health care providers. Discussion: Understanding the unique health beliefs of SAs regarding CVD is important in planning and delivering culturally competent preventive and educational services.
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Affiliation(s)
| | | | - Jing Wang
- The University of Texas Health Science Center at San Antonio School of Nursing, San Antonio, TX, USA
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Powell W, Jacobs JA, Noble W, Bush ML, Snell-rood C. Rural Adult Perspectives on Impact of Hearing Loss and Barriers to Care. J Community Health 2019; 44:668-74. [DOI: 10.1007/s10900-019-00656-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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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: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Hunleth JM, Gallo R, Steinmetz EK, James AS. Complicating "the good result": narratives of colorectal cancer screening when cancer is not found. J Psychosoc Oncol 2019; 37:509-525. [PMID: 30714858 DOI: 10.1080/07347332.2018.1563581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES In this paper, we analyze narratives from a Photovoice project on colorectal cancer screening that was carried out with people who had undergone screening and were found to not have cancer. METHODS Three groups, totaling eighteen participants, took part in the project, meeting multiple times over the course of approximately 10 weeks, and discussing photos they took about colorectal cancer screening. RESULTS A common way in which the participants conveyed their screening experiences was through reflection on their own or other people's illnesses. Our findings highlight the multiple meanings of receiving a "good" or noncancerous screening result after undergoing cancer screening. CONCLUSION Such findings suggest that framing noncancerous results only in terms of relief or other positive emotions may ignore the realities people and their families face and their remaining concerns. This paper has broader implications for policies to reduce cancer disparities as well as public health and patient-provider communication about screening.
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Affiliation(s)
- Jean M Hunleth
- a Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine , St. Louis , Missouri , USA
| | - Robert Gallo
- a Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine , St. Louis , Missouri , USA
| | - Emily K Steinmetz
- b Department of Anthropology, Washington College , Chestertown , Maryland , USA
| | - Aimee S James
- a Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine , St. Louis , Missouri , USA
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Snell-Rood C, Feltner F, Schoenberg N. What Role Can Community Health Workers Play in Connecting Rural Women with Depression to the "De Facto" Mental Health Care System? Community Ment Health J 2019; 55:63-73. [PMID: 29299719 DOI: 10.1007/s10597-017-0221-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/26/2017] [Indexed: 01/18/2023]
Abstract
The prevalence of depression among rural women is nearly twice the national average, yet limited mental health services and extensive social barriers restrict access to needed treatment. We conducted key informant interviews with community health workers (CHWs) and diverse health care professionals who provide care to Appalachian women with depression to better understand the potential roles that CHWs may play to improve women's treatment engagement. In the gap created by service disparities and social barriers, CHWs can offer a substantial contribution through improving recognition of depression; deepening rural women's engagement within existing services; and offering sustained, culturally appropriate support.
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Affiliation(s)
- Claire Snell-Rood
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, 207H University Hall #7360, Berkeley, CA, 94720, USA.
| | | | - Nancy Schoenberg
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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30
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Snell-Rood C, Carpenter-Song E. Depression in a depressed area: Deservingness, mental illness, and treatment in the contemporary rural U.S. Soc Sci Med 2018; 219:78-86. [PMID: 30391873 PMCID: PMC6290352 DOI: 10.1016/j.socscimed.2018.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/11/2018] [Accepted: 10/16/2018] [Indexed: 11/26/2022]
Abstract
People with mental illness face public scrutiny that provokes questions about their ability to cope, membership in society, and entitlement to state support. Less attention has been focused on how such scrutiny occurs at the community level, particularly when shared economic distress has generated a high burden of poor mental health. We employ theorizations of health-related deservingness to examine the local moral economies through which residents of an economically depressed area question who deserves to be depressed, how those with depression should cope, and what forms of treatment are sincere. Drawing on a multi-phase study (2014-2016) in Appalachian Kentucky, we analyze interviews conducted with women with depression and the health practitioners who work with them. In the rural U.S., the dim economy and scarce healthcare resources are attributed to exclusion from broader society. Naturalized as a moral response for enduring dead-end jobs and poverty, participants described how depression coping can positively demonstrate individuals' commitment to providing for their families and mobility. However, when individuals are perceived to use depression diagnoses to access state entitlements or obtain medication as a "quick fix" that facilitates substance use, area residents question the veracity of symptoms and argue that treatment-seeking is insincere. In this way, rural moral concepts about work, entitlement, and self-sufficiency become embedded in contemporary ideas about mental health and its treatment. The tempered normalization of depression may offer possibilities for decreasing stigma and engendering conversations about patterned exclusions of rural Americans from broader U.S. prosperity. However, tense moral meanings about depression coping reveal both deepening and emergent social inequalities within rural communities. Attending to local moral economies that shape mental health deservingness is critical to understanding the complex overlaps and intersections between state, community, and family discourses.
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Affiliation(s)
- Claire Snell-Rood
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, USA.
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31
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Campeau K. Adaptive frameworks of chronic pain: daily remakings of pain and care at a Somali refugee women's health centre. Med Humanit 2018; 44:96-105. [PMID: 29779012 DOI: 10.1136/medhum-2017-011418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 06/08/2023]
Abstract
Pain is an intensely subjective experience and one that is difficult for healthcare professionals to treat. Chronic pain, often diffuse, cyclical and involving many systems of the body, is often not well treated in a medical system that relies on discrete symptoms, identifiable causes, external pathogens and physician specialisation. Pain has its own problems specific to Somali diaspora populations, where chronic pain is prevalent but often undertreated, and where Somali patients face barriers of access to medicine. This study, conducted in partnership with a Somali women's health centre, seeks to understand Somali women's use of informal and formal networks of healthcare. Drawing from qualitative interviews with Somali, refugee women, this article identifies four emerging frameworks through which participants experience chronic pain: (1) pain as a symptom of exile; (2) pain and the strength to bear pain as issues of faith; (3) medicine as powerful, curative and fluid; (4) medical discrimination and exclusion.
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Jones RK. Is pregnancy fatalism normal? An attitudinal assessment among women trying to get pregnant and those not using contraception. Contraception 2018; 98:255-259. [PMID: 29792840 DOI: 10.1016/j.contraception.2018.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVES To assess factors associated with pregnancy fatalism among U.S. adult women. STUDY DESIGN I used data from the Change and Consistency in Contraceptive Use study, which collected information from a national sample of 4634 U.S. women aged 18-39 at baseline (59% response rate). I assessed pregnancy fatalism based on agreement with the statement: "It doesn't matter whether I use birth control, when it is my time to get pregnant, it will happen." I compared fatalism among all respondents to fatalism among respondents who were trying to get pregnant and those who did not want to get pregnant but were not using contraception. I used logistic regression to assess associations between nonuse of contraception and pregnancy fatalism at baseline and whether respondents were trying to get pregnant 6 months later. RESULTS Overall, 36% of the sample expressed some degree of pregnancy fatalism, and proportions were higher for respondents trying to get pregnant (55%) and those not using contraception (57%). The association between pregnancy fatalism and trying to get pregnant was maintained after controlling for other characteristics [odds ratio (OR) 1.4, p=.01], as was the association for nonuse of contraception (OR 2.08, p<.001). Contraceptive nonusers at baseline were more likely than users to be trying to get pregnant 6 months later, especially if they expressed a fatalistic outlook at baseline. CONCLUSIONS Pregnancy fatalism may be a common outlook among women who are trying to get pregnant. Associations between fatalism and nonuse of contraception may be more complex than previously recognized. IMPLICATIONS Gaining a better understanding of the dynamics of pregnancy planning might inform our understanding of why some women do not use contraception.
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Affiliation(s)
- Rachel K Jones
- Guttmacher Institute, 125 Maiden Lane, New York, NY 10038.
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Wyndham-West M, Durand N, Santoro A. Betwixt and Between Well and Sick in Cervical Precancer: Canadian Women's Experiences of Recurring HPV Infections and HPV Vaccination. Can J Nurs Res 2018; 50:120-132. [PMID: 29759001 DOI: 10.1177/0844562118763496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Background This research fuses the experiences of a precancer diagnosis with the decision-making surrounding a vaccine that can protect against human papillomavirus strains that women may not have been exposed to. The interviewee cohort is of note as half the women were in their 30s and 40s and 75% were over the age of 26. These groupings are often overlooked in media discourses and narrative research surrounding human papillomavirus and the human papillomavirus vaccine. Purpose Womens' diagnoses and treatment experiences, including colposcopies, biopsies, and Loop Electrosurgical Excision Procedures, are chronicled to highlight a liminal, precancerous state-one in which they are not deemed healthy, but nor have they been diagnosed with cancer. These are emotion-filled experiences that are ridden with anxiety and fear, but also ones that are structured with self-care strategies to contain human papillomavirus infections and the risk of cervical cancer. Methods Twenty women who attended Sunnybrook Health Sciences Centre's human papillomavirus vaccination clinic were interviewed and their narratives were documented and analyzed to determine their experiences surrounding human papillomavirus infections and precancer as well as their motivations for human papillomavirus vaccination. Results The decision to undergo human papillomavirus vaccination was a self-care strategy that accompanied treatment procedures and was a means to reduce cervical cancer risk. While encouraged with the human papillomavirus vaccine's potential to curb cervical cancer, they had a tempered view of the vaccine and its effectiveness in their cases, given their medical histories. Conclusions The research provides an in-depth accounting of an often overlooked grouping in human papillomavirus and human papillomavirus vaccination research and media discourse which, generally, focuses upon middle-school-aged girls and university-/college-aged women. In addition, the research provides recommendations for practice for cervical precancer diagnoses going forward.
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Affiliation(s)
| | - Nancy Durand
- 2 Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aimee Santoro
- 3 Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Groshek J, Katz JE, Andersen B, Cutino C, Zhong Q. Media use and antimicrobial resistance misinformation and misuse: Survey evidence of information channels and fatalism in augmenting a global health threat. Cogent Medicine 2018. [DOI: 10.1080/2331205x.2018.1460898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Jacob Groshek
- Division of Emerging Media Studies, Boston University, 704 Commonwealth Ave., Boston, MA, USA
| | - James E. Katz
- Division of Emerging Media Studies, Boston University, 704 Commonwealth Ave., Boston, MA, USA
| | - Brittany Andersen
- Division of Emerging Media Studies, Boston University, 704 Commonwealth Ave., Boston, MA, USA
| | - Chelsea Cutino
- Division of Emerging Media Studies, Boston University, 704 Commonwealth Ave., Boston, MA, USA
| | - Qiankun Zhong
- Division of Emerging Media Studies, Boston University, 704 Commonwealth Ave., Boston, MA, USA
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Abstract
The role of fatalism in health behaviour has stirred significant controversy in literature across several disciplines. Some researchers have demonstrated a negative correlation between fatalistic beliefs and healthy behaviours such as cancer screening, arguing that fatalism is a barrier to health-seeking behaviours. Other studies have painted a more complicated picture of fatalistic beliefs and health behaviours that ultimately questions fatalism's causality as a distinct factor. Unpacking this debate raises thought-provoking questions about how epistemological and methodological frameworks present particular pictures about the connections between belief, race, class and behaviour. The discussion surrounding fatalism illuminates larger tensions between structural and cultural determinants of health behaviour. This article argues for a more rigorous delineation of culture and structure and suggests that future theory-informed and ethnographic research may more precisely parse the role of fatalism in health attitudes, beliefs and behaviours.
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Abstract
Biomedicine is often presented as the driving force behind improvements in cancer care, with genomics the latest innovation poised to change the meaning, diagnosis, treatment, prevention and lived experience of cancer. Reviewing sociological analyses of a diversity of patient and practitioner experiences and accounts of cancer during the last decade (2007-17), we explore the experiences of, approaches to and understandings of cancer in this period. We identify three key areas of focus: (i) cancer patient experiences and identities; (ii) cancer risk and responsibilities and (iii) bioclinical collectives. We explore these sociological studies of societal and biomedical developments and how sociologists have sought to influence developments in cancer identities, care and research. We end by suggesting that we extend our understanding of innovations in the fields of cancer research to take better account of these wider social and cultural innovations, together with patients, activists' and sociologists' contributions therein.
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Affiliation(s)
- Anne Kerr
- School of Sociology and Social PolicyUniversity of LeedsUK
| | - Emily Ross
- The Usher InstituteEdinburgh Medical SchoolUniversity of EdinburghUK
| | - Gwen Jacques
- School of Sociology and Social PolicyUniversity of LeedsUK
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Abstract
Researchers consider older women in rural Appalachia to have low levels of agency and high levels of fatalism regarding decision making about cancer treatment. Using the life course perspective, we examined older women's agency with information seeking about gynecological cancer. Semistructured interviews with 20 White women living in central Appalachia revealed four trajectories: Surrendering Control, Accepting Death, Self-Care, and Advocacy, each with its own forms of agency. Some women experienced personal transformation, increased self-efficacy, and a passion for community empowerment. Fatalism was not understood apart from placing trust in medical expertise. We implore researchers to further explore rural expressions of agency.
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Affiliation(s)
- Emma C Potter
- a Department of Human Development and Family Science, Virginia Tech , Blacksburg, Virginia, USA
| | - Katherine R Allen
- a Department of Human Development and Family Science, Virginia Tech , Blacksburg, Virginia, USA.,b Center for Gerontology, Virginia Tech , Blacksburg, Virginia, USA
| | - Karen A Roberto
- b Center for Gerontology, Virginia Tech , Blacksburg, Virginia, USA.,c Institute for Society, Culture, and Environment , Virginia Tech , Blacksburg, Virginia, USA
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Kemmanu V, Giliyar SK, Shetty BK, Singh AK, Kumaramanickavel G, McCarty CA. Parental inability to detect eye diseases in children: barriers to access of childhood eye-care services in south India. Eye (Lond) 2018; 32:467-468. [DOI: 10.1038/eye.2017.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
Appalachia has a higher incidence of and mortality from colon cancer (CC) than other regions of the United States; thus, it is important to know the potential impact of elevated risk on cancer worry. Guided by the Self-regulation model, we investigated the association of demographic, cultural (e.g., fatalism, religious commitment), and psychological factors (e.g., perceived risk, general mood) with CC worry among a sample of Appalachian women. A mixed method design was utilized. Appalachian women completed surveys in the quantitative section (n = 134) and semi-structured interviews in the qualitative section (n = 24). Logistic regression was employed to calculate odds ratios (OR) for quantitative data, and immersion/crystallization was utilized to analyze qualitative data. In the quantitative section, 45% of the participants expressed some degree of CC worry. CC worry was associated with higher than high school education (OR 3.63), absolute perceived risk for CC (OR 5.82), high anxiety (OR 4.68), and awareness of easy access (OR 3.98) or difficult access (OR 3.18) to health care specialists as compared to not being aware of the access. there was no association between CC worry and adherence to CC screening guidelines. The qualitative section revealed fear, disengagement, depression, shock, and worry. Additionally, embarrassment, discomfort, and worry were reported with regard to CC screening. Fears included having to wear a colostomy bag and being a burden on family. CC worry was common in Appalachians and associated with higher perceptions of risk for CC and general anxiety, but not with adherence to screening guidelines. The mixed method design allowed for enhanced understanding of CC-related feelings, especially CC worry, including social/contextual fears.
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Affiliation(s)
- Omar F Attarabeen
- Department of Pharmacy Practice, Administration, & Research, Marshall University, Coon Education Building, One John Marshall Drive, Huntington, WV, 25755, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems & Policy, Robert C. Byrd Health Sciences Center (North), West Virginia University, P.O. Box 9510, Morgantown, WV, 26506-9510, USA
| | - Kevin T Larkin
- Department of Psychology, Eberly College of Arts and Sciences, West Virginia University, Room 2220, Life Sciences Building, P. O. Box 6040, Morgantown, WV, 26506, USA
| | - Kimberly M Kelly
- Department of Pharmaceutical Systems & Policy, Robert C. Byrd Health Sciences Center (North), West Virginia University, P.O. Box 9510, Morgantown, WV, 26506-9510, USA.
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Mark KP, Crosby RA, Vanderpool RC. Psychosocial Correlates of Ever Having a Pap Test and Abnormal Pap Results in a Sample of Rural Appalachian Women. J Rural Health 2017; 34:148-154. [PMID: 28872699 DOI: 10.1111/jrh.12265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/02/2017] [Accepted: 07/19/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Despite known prevention and screening efforts, there are higher invasive cervical cancer rates in Appalachia than in other areas of the United States and higher mortality rates in the Appalachian region of Kentucky compared to Appalachian regions of other states. PURPOSE The primary purpose of this study was to investigate the association of psychosocial factors relevant to cervical cancer and the outcome of ever having a Pap test in a rural sample of women. The secondary purpose was to determine whether any of the same psychosocial factors were also associated with ever having an abnormal Pap test result among women with a self-reported history of having one or more Pap tests in their lifetime. METHODS Data were collected in fall of 2013 from 393 women in 8 economically distressed counties of rural Appalachian Kentucky. Women completed an interviewer-administered survey assessing sociodemographic and health information as well as beliefs about cervical cancer. FINDINGS Multivariate logistic regression results indicated that low income and greater perceived local fatalism were significant predictors of never having a Pap test. Lack of personal control over prevention, and peer and family influences were significant predictors of ever having an abnormal Pap test result. CONCLUSIONS Educational efforts targeted in rural Appalachia would be supported by encouraging the benefits of early and consistent screening, altering the established norms of community fatalism and lack of personal control over prevention, and creating targeted messages through public campaigns that convince rural Appalachian women that cervical cancer is highly preventable and screenable.
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Affiliation(s)
- Kristen P Mark
- Department of Kinesiology & Health Promotion, University of Kentucky, Lexington, Kentucky
| | - Richard A Crosby
- Department of Health, Behavior & Society, University of Kentucky, Lexington, Kentucky
| | - Robin C Vanderpool
- Department of Health, Behavior & Society, University of Kentucky, Lexington, Kentucky
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Abstract
This article shows the consequences of competing global health agendas within differential clinical and social worlds. Specifically, it examines how HIV's prominence in local clinical programming in Swaziland influences cervical cancer screening rates. Drawing on 2014 ethnographic research conducted in a semi-urban town in Swaziland, the interview and participant observation data show the relative scarcity of cervical cancer care and the consequences of HIV/AIDS funding and programming dominance. 20 women and 7 health workers were interviewed in homes, clinics and small businesses. Data were analysed using frameworks of medicoscapes and therapeutic citizenship. Results show that women's patterns of screening avoidance were based on lengthy diagnostic procedures, treatment expense, therapeutic travel to neighbouring South Africa, and frequent therapeutic failure. In sum, avoidance of cervical screening in Swaziland has structural components, and is a product of organisational and political choices at local and global levels. This study challenges culturalist assumptions about African women's avoidance of cervical cancer screening. In the future, delivering successful cervical cancer screening in Swaziland will depend on expanding cancer screening and treatment, which should be informed by perceptions of clinical care held by the very women public health practitioners aim to keep healthy.
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Affiliation(s)
| | - Susan Erikson
- a Faculty of Health Sciences , Simon Fraser University , Burnaby , Canada
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Affiliation(s)
- Rebecca Adkins Fletcher
- Department of Appalachian Studies; East Tennessee State University; Johnson City TN 37614 USA
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Abstract
Research demonstrates a disparity between need and utilization of mental health services for Latinos. Cultural variations in perceptions of mental illness may be partially responsible for this discrepancy. Past research with Latinos has shown links between fatalismo, a cultural value similar to external locus of control, and both depression and lower service utilization in medical care, while links to psychiatric care have not been investigated. The current study therefore aimed to explore the associations between fatalismo, depression, and past year mental health service utilization by Latinos. A community sample of 83 Latino adults were recruited during local cultural events. Participants completed self-report measures of depression, fatalism, and past year service utilization. Analyses using structural equation modeling showed fatalismo was directly negatively related to past year medical service utilization (β = -.35). In contrast, the link between fatalismo and past year mental health service utilization was mediated by self-reported depressive symptoms (indirect β = .19, p < .001). We conclude that while fatalismo is associated with depression in Latinos, other barriers likely serve as more salient deterrents of service utilization.
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Cadet TJ, Stewart K, Howard T. Psychosocial correlates of cervical cancer screening among older Hispanic women. Soc Work Health Care 2017; 56:124-139. [PMID: 27960632 PMCID: PMC5890332 DOI: 10.1080/00981389.2016.1263268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Early detection through screening can reduce mortality rates of cervical cancer, and yet Hispanic women who have incidence rates higher than their non-Hispanic White counterparts are least likely to participate in cancer screening initiatives. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the psychosocial correlates associated with older Hispanic women's participation in cervical cancer screening services. Logistic regression models were used. Findings indicated that greater life satisfaction and religiosity were associated with a greater likelihood of participating in cervical cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.
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Affiliation(s)
- Tamara J Cadet
- a School of Social Work, Simmons College , Boston , Massachusetts , USA
| | - Kathleen Stewart
- a School of Social Work, Simmons College , Boston , Massachusetts , USA
| | - Tenial Howard
- a School of Social Work, Simmons College , Boston , Massachusetts , USA
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Hamilton JG, Lillie SE, Alden DL, Scherer L, Oser M, Rini C, Tanaka M, Baleix J, Brewster M, Craddock Lee S, Goldstein MK, Jacobson RM, Myers RE, Zikmund-Fisher BJ, Waters EA. What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders. J Behav Med 2017; 40:52-68. [PMID: 27566316 PMCID: PMC5296255 DOI: 10.1007/s10865-016-9785-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 08/10/2016] [Indexed: 12/12/2022]
Abstract
Informed and shared decision making are critical aspects of patient-centered care, which has contributed to an emphasis on decision support interventions to promote good medical decision making. However, researchers and healthcare providers have not reached a consensus on what defines a good decision, nor how to evaluate it. This position paper, informed by conference sessions featuring diverse stakeholders held at the 2015 Society of Behavioral Medicine and Society for Medical Decision Making annual meetings, describes key concepts that influence the decision making process itself and that may change what it means to make a good decision: interpersonal factors, structural constraints, affective influences, and values clarification methods. This paper also proposes specific research questions within each of these priority areas, with the goal of moving medical decision making research to a more comprehensive definition of a good medical decision, and enhancing the ability to measure and improve the decision making process.
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Affiliation(s)
- Jada G Hamilton
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarah E Lillie
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Dana L Alden
- Shidler College of Business, University of Hawaii, Honolulu, HI, USA
| | - Laura Scherer
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Megan Oser
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christine Rini
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Miho Tanaka
- Health Services Research and Development Service, Department of Veterans Affairs, Washington, DC, USA
| | - John Baleix
- Hawaii Medical Service Association, BCBS of Hawaii, Honolulu, HI, USA
| | | | - Simon Craddock Lee
- Department of Clinical Sciences and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mary K Goldstein
- Geriatric Research Education and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Medicine, Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ronald E Myers
- Department of Medical Oncology, Sidney Kimmel Medical Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Erika A Waters
- Division of Public Health Sciences, Department of Surgery, Washington University, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA.
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Abstract
BACKGROUND Chagas disease (CD) profoundly affects the social and emotional dimensions of patients' lives, and disproportionately impacts poor, marginalized populations in Latin America. Biomedical treatment for CD fails to reach up to 99% of the people affected, and in any case seldom addresses the emotional health or socioeconomic conditions of patients. This study examines patient strategies for coping with CD in the department of Santa Cruz, Bolivia. METHODOLOGY In this ethnographic study, semistructured interviews took place from March-June 2013 with 63 patients who had previously tested positive for CD. During the fieldwork period, participant observation was conducted and patient family members, providers, community members, and public health officials were consulted. PRINCIPAL FINDINGS Patients often experienced emotional distress when diagnosed with CD, yet were generally unable to find biomedical treatment. Respondents stressed the need to avoid powerful emotions which would worsen the impact of CD symptoms. To manage CD, patients embraced a calm state of mind, described in Spanish as tranquilidad, which partially empowered them to return to a normal existence. CONCLUSIONS In the perceived absence of biomedical treatment options, patients seek their own means of coping with CD diagnosis. Rather than fatalism or resignation, patients' emphasis on maintaining calm and not worrying about CD represents a pragmatic strategy for restoring a sense of normalcy and control to their lives. Programs focused on treatment of CD should remain mindful of the emotional and social impact of the disease on patients.
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Affiliation(s)
- Colin J. Forsyth
- Department of Anthropology University of South Florida 4202 E. Fowler Avenue, SOC 107 Tampa, FL, United States of America
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Sohn MW, Kang H, Park JS, Yates P, McCall A, Stukenborg G, Anderson R, Balkrishnan R, Lobo JM. Disparities in recommended preventive care usage among persons living with diabetes in the Appalachian region. BMJ Open Diabetes Res Care 2016; 4:e000284. [PMID: 28074140 PMCID: PMC5220277 DOI: 10.1136/bmjdrc-2016-000284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/26/2016] [Accepted: 08/29/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine disparities in the receipt of preventive care recommended by the American Diabetes Association (ADA) between Appalachian and non-Appalachian counties and within Appalachian counties. RESEARCH DESIGN AND METHODS Behavioral Risk Factor Surveillance System (BRFSS) data for 2008-2010 were used to identify individuals with diabetes and their preventive care usage. Each Appalachian respondent county of residence was categorised into one of the five economic levels: distressed, at-risk, transitional, competitive and attainment counties. Competitive and attainment counties were combined and designated as competitive counties. We used logistic regressions to compare receipt of ADA preventive care recommendations by county economic level, adjusting for respondent demographic, socioeconomic, health and access-to-care factors. RESULTS Compared to the most affluent (competitive) counties, less affluent (distressed and at-risk) counties demonstrated equivalent or higher rates of self-care practices such as daily blood glucose monitoring and daily foot checks. But they showed 40-50% lower uptake of annual foot and eye examinations and 30% lower uptake of diabetes education and pneumococcal vaccinations compared to competitive counties. After adjusting for demographic factors, significant disparities still existed in the uptake of annual foot examinations, annual eye examinations, 2 or more A1c tests per year and pneumococcal vaccinations in distressed and at-risk counties compared to competitive counties. Appalachian counties as a whole were similar to non-Appalachian counties in the uptake of all recommendations with the absolute differences of ≤3%. CONCLUSIONS Our results show that there are significant disparities in the uptake of many recommended preventive services between less and more affluent counties in the Appalachian region.
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Affiliation(s)
- Min-Woong Sohn
- Department of Public Health Sciences , School of Medicine, University of Virginia , Charlottesville, Virginia , USA
| | - Hyojung Kang
- Department of Systems and Information Engineering , School of Engineering, University of Virginia , Charlottesville, Virginia , USA
| | - Joseph S Park
- Department of Orthopaedic Surgery , School of Medicine, University of Virginia , Charlottesville, Virginia , USA
| | - Paul Yates
- Department of Ophthalmology , School of Medicine, University of Virginia , Charlottesville, Virginia , USA
| | - Anthony McCall
- Department of Medicine , School of Medicine, University of Virginia , Charlottesville, Virginia , USA
| | - George Stukenborg
- Department of Public Health Sciences , School of Medicine, University of Virginia , Charlottesville, Virginia , USA
| | - Roger Anderson
- Department of Public Health Sciences , School of Medicine, University of Virginia , Charlottesville, Virginia , USA
| | - Rajesh Balkrishnan
- Department of Public Health Sciences , School of Medicine, University of Virginia , Charlottesville, Virginia , USA
| | - Jennifer M Lobo
- Department of Public Health Sciences , School of Medicine, University of Virginia , Charlottesville, Virginia , USA
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Heiniger LE, Sherman KA, Shaw LK, Costa D. Fatalism and health promoting behaviors in Chinese and Korean immigrants and Caucasians. J Immigr Minor Health 2015; 17:165-71. [PMID: 24072515 DOI: 10.1007/s10903-013-9922-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Fatalism has been associated with non-adherence to health behavior in the past. This study compared fatalism of Chinese and Korean immigrants with native-born Caucasians (N = 309) and examined whether the relationship between fatalism and exercise, nutrition and medical screening would be moderated by ethnicity. Chinese reported higher fatalism than Caucasians and Koreans. Higher fatalism was associated with greater exercise among Chinese and Koreans, but less reported exercise among Caucasians. Caucasian participants had higher scores for nutrition and medical screening compared with Chinese and Korean immigrants. These findings indicate that fatalism is more prevalent among Chinese immigrants; however, there is no evidence of a detrimental effect of fatalism on exercise, nutrition or medical screening among the Asian immigrants. Caucasians with higher fatalism may be at greater risk of future illnesses, given the association between fatalism and sedentary behavior in this group. Differences between cultural groups in the adoption of health behavior justify the development and assessment of targeted interventions to optimize health promoting behaviors.
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Abstract
Although cultural competence in practice is a common goal within the health care professions, little is known about the consequences of a lack of such competence in health and healing. We propose a novel theoretical framework of cultural distress to describe patient experiences of and reactions to care that does not incorporate attention to cultural needs. Use of the cultural distress model to guide research offers an innovative framework by which researchers may identify potential interventions such that patients never reach a level of cultural distress.
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Kagawa Singer M, Dressler W, George S, Baquet CR, Bell RA, Burhansstipanov L, Burke NJ, Dibble S, Elwood W, Garro L, Gravlee CC, Guarnaccia P, Hecht ML, Henderson J, Hruschka D, Lewis-fernández R, Like R, Mouton C, Myers HF, Page JB, Pasick R, Pescosolido B, Schoenberg N, Stoner B, Strayhorn G, Szalacha L, Trimble J, Weisner TS, Williams D. Culture: The missing link in health research. Soc Sci Med 2016; 170:237-46. [DOI: 10.1016/j.socscimed.2016.07.015] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 07/14/2016] [Accepted: 07/17/2016] [Indexed: 12/21/2022]
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