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Rahemi Z, Bacsu JDR, Shalhout SZ, Sabet M, Sirizi D, Smith ML, Adams SA. Past Disparities in Advance Care Planning Across Sociodemographic Characteristics and Cognition Levels in the United States. medRxiv 2024:2024.05.09.24307125. [PMID: 38766186 PMCID: PMC11100925 DOI: 10.1101/2024.05.09.24307125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
We aimed to examine past advance care planning (ACP) in U.S. older adults across different sociodemographic characteristics and cognition levels. We established the baseline trends from 10 years ago to assess if trends in 2024 have improved upon future data availability. We considered two legal documents in the Health and Retirement Study 2014 survey as measures for ACP: a living will and durable power of attorney for healthcare (DPOAH). Logistic regression models were fitted with outcome variables (living will, DPOAH, and both) stratified by cognition levels (dementia/impaired cognition versus normal cognition). Predictor variables included age, gender, ethnicity, race, education, marital status, rurality, everyday discrimination, social support, and loneliness. Age, ethnicity, race, education, and rurality were significant predictors of ACP (having a living will, DPOAH, and both the living will and DPOAH) across cognition levels. Participants who were younger, Hispanic, Black, had lower levels of education, or resided in rural areas were less likely to complete ACP. Examining ACP and its linkages to specific social determinants is essential to understanding disparities and educational strategies needed to facilitate ACP uptake among different population groups. Accordingly, this study aimed to examine past ACP disparities in relation to specific social determinants of health and different cognition levels. Future studies are required to evaluate whether existing disparities have improved over the last 10 years when 2024 data is released. Addressing ACP disparities among diverse populations, including racial and ethnic minorities with reduced cognition levels, is crucial for enhancing health equity and access to care.
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Affiliation(s)
- Zahra Rahemi
- School of Nursing, Clemson University Clemson, SC, 29634-0743
| | | | - Sophia Z. Shalhout
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Mike Toth Cancer Research Center, Mass Eye and Ear, Harvard Medical School Boston, Massachusetts, USA, 02114
| | - Morteza Sabet
- School of Mechanical and Automotive Engineering, College of Engineering, Computing and Applied Sciences, Clemson University 4 Research Dr, Greenville, SC 29607
| | - Delaram Sirizi
- Department of Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson SC 29634
| | - Matthew Lee Smith
- Department of Health Behavior, School of Public Health, Center for Community Health and Aging Texas A&M University, College Station, TX 77843
| | - Swann Arp Adams
- College of Nursing and the Department of Epidemiology & Biostatistics, University of South Carolina Columbia, SC 29208
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Rahemi Z, Bacsu JDR, Sefcik JS, Sadafipoor MS, Demiris G, Adams SA. Advance care planning and outpatient visits among older adults across cognitive levels. Aging Health Res 2023; 3:100166. [PMID: 38076608 PMCID: PMC10703190 DOI: 10.1016/j.ahr.2023.100166] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
Advance care planning (ACP) can help reduce end-of-life care challenges for persons with Alzheimer's disease and related dementia and their care partners. Building on our previous work, we examined the impact of ACP on outpatient/doctor visits in older adults with dementia/impaired cognition and normal cognition. Using datasets from the 2014 Health and Retirement Study (HRS), we conducted a cross-sectional study of 17,698 participants aged 51 years and older. Our analyses included survey descriptive and logistic regression procedures. Our findings indicated that having at least one ACP measure was significantly associated with a higher mean number of outpatient visits in both cognition groups. Based on our findings, we recommend considering healthcare access and use as an intervening variable in future ACP research.
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Affiliation(s)
- Zahra Rahemi
- Clemson University School of Nursing, 605 Grove Road, Greenville, SC 29605, USA
| | | | - Justine S. Sefcik
- Drexel University College of Nursing and Health Professions, Philadelphia, PA, USA
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Harmon CS, Adams SA, Davis JE, Gephart SM, Donevant SB. Unintended consequences of the electronic health record and cognitive load in emergency department nurses. Appl Nurs Res 2023; 73:151724. [PMID: 37722792 DOI: 10.1016/j.apnr.2023.151724] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 09/20/2023]
Abstract
AIM The study aimed to explore the relationship between the unintended consequences of the electronic health record and cognitive load in emergency department nurses. METHODS The study utilized a correlational quantitative design with a survey method approach. This study had a 30.4 % response rate for a total of 304 ED nurse participants who were members of a national ED nursing organization. Data analysis included descriptive and correlational measurements of two instruments. RESULTS In this study, there was a statistically significant, weak negative relationship between CL and UC-EHR in ED nurses, rs (264) = -0.154, p 0.002. Although a significant weak relationship was identified in this study, the study variables, subscales, and demographic data groupings presented moderate-to-strong positive, statistically significant correlations. Descriptive frequency data unveiled EHR stimulated patient safety threats occurring once a week to monthly. CONCLUSIONS The novelty of this research study provided profound implications for the future of nursing practice, policy, and nursing science. EHR optimization to minimize patient safety risks is recommended with the inclusion of end-users from this study's identified subgroups. The researchers propose a reduction of EHR burden in nursing practice.
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Affiliation(s)
- Carolyn S Harmon
- Tennessee Center for Nursing Advancement at East Tennessee State University, American Nursing Informatics Association, USA.
| | - Swann Arp Adams
- College of Nursing and Arnold School of Public Health at the University of South Carolina in Columbia, SC, USA
| | - Jean E Davis
- College of Nursing at the University of South Carolina in Columbia, SC, USA
| | - Sheila M Gephart
- Biobehavioral Health Sciences Division at the University of Arizona in Tucson, AZ, USA
| | - Sara B Donevant
- College of Nursing at the University of South Carolina in Columbia, SC, USA
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Zahnd WE, Silverman AF, Self S, Hung P, Natafgi N, Adams SA, Merrell MA, Owens OL, Crouch EL, Eberth JM. The COVID-19 pandemic impact on independent and provider-based rural health clinics' operations and cancer prevention and screening provision in the United States. J Rural Health 2023; 39:765-771. [PMID: 36869430 DOI: 10.1111/jrh.12753] [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: 03/05/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has disrupted cancer care, but it is unknown how the pandemic has affected care in Medicare-certified rural health clinics (RHCs) where cancer prevention and screening services are critical for their communities. This study examined how the provision of these cancer services changed pre- and peri-pandemic overall and by RHC type (independent and provider-based). METHODS We administered a cross-sectional survey to a stratified random sample of RHCs to assess clinic characteristics, pandemic stressors, and the provision of cancer prevention and control services among RHCs pre- and peri-pandemic. We used McNemar's test and Wilcoxon signed rank tests to assess differences in the provision of cancer prevention and screening services pre- and peri-pandemic by RHC type. RESULTS Of the 153 responding RHCs (response rate of 8%), 93 (60.8%) were provider-based and 60 (39.2%) were independent. Both RHC types were similar in their experience of pandemic stressors, though a higher proportion of independent RHCs reported financial concerns and challenges obtaining personal protective equipment. Both types of RHCs provided fewer cancer prevention and screening services peri-pandemic-5.8 to 4.2 for provider-based and 5.3 to 3.5 for independent (P<.05 for both). Across lung, cervical, breast, and colorectal cancer-related services, the proportion of both RHC groups providing services dropped peri-pandemic. DISCUSSION The pandemic's impact on independent and provider-based RHCs and their patients was considerable. Going forward, greater resources should be targeted to RHCs-particularly independent RHCs-to ensure their ability to initiate and sustain evidence-based prevention and screening services.
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Affiliation(s)
- Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Allie F Silverman
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Stella Self
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Peiyin Hung
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Nabil Natafgi
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Swann Arp Adams
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Melinda A Merrell
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Otis L Owens
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- College of Social Work, University of South Carolina, Columbia, South Carolina, USA
| | - Elizabeth L Crouch
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Management and Policy, Dornsife College of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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Mathias W, Nichols KA, Golden-Wright J, Fairman CM, Felder TM, Workman L, Wickersham KE, Flicker KJ, Sheng J, Noblet SB, Adams SA, Eberth JM, Heiney SP, Wilcox S, Hébert JR, Friedman DB. Implementation During a Pandemic: Findings, Successes, and Lessons Learned from Community Grantees. J Cancer Educ 2023; 38:957-962. [PMID: 36056185 PMCID: PMC9439940 DOI: 10.1007/s13187-022-02213-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Accepted: 08/14/2022] [Indexed: 06/02/2023]
Abstract
Funding communities through mini-grant programs builds community capacity by fostering leadership among community members, developing expertise in implementing evidence-based practices, and increasing trust in partnerships. The South Carolina Cancer Prevention and Control Research Network (SC-CPCRN) implemented the Community Health Intervention Program (CHIP) mini-grants initiative to address cancer-related health disparities among high-risk populations in rural areas of the state. One community-based organization and one faith-based organization were funded during the most recent call for proposals. The organizations implemented National Cancer Institute evidence-based strategies and programs focused on health and cancer screenings and physical activity and promotion of walking trails. Despite the potential for the COVID-19 pandemic to serve as a major barrier to implementation, grantees successfully recruited and engaged community members in evidence-based activities. These initiatives added material benefits to their local communities, including promotion of walking outdoors where it is less likely to contract the virus when socially distanced and provision of COVID-19 testing and vaccines along with other health and cancer screenings. Future mini-grants programs will benefit from learning from current grantees' flexibility in program implementation during a pandemic as well as their intentional approach to modifying program aspects as needed.
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Affiliation(s)
- Wilhelmenia Mathias
- Health and Wellness Ministry, Trinity Baptist Church, Columbia, SC 29204, USA
| | | | - Jewel Golden-Wright
- Health and Wellness Ministry, Trinity Baptist Church, Columbia, SC 29204, USA
| | - Ciaran M Fairman
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Tisha M Felder
- College of Nursing, University of South Carolina, Columbia, SC 29208, USA
| | - Lauren Workman
- Department of Health Services Policy and Management & Center for Applied Research Evaluation, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Karen E Wickersham
- College of Nursing, University of South Carolina, Columbia, SC 29208, USA
| | - Kimberly J Flicker
- Department of Health Promotion, Education, and Behavior & Office for the Study of Aging, University of South Carolina, Arnold School of Public Health, Columbia, SC 29208, USA
| | - Jingxi Sheng
- College of Nursing, University of South Carolina, Columbia, SC 29208, USA
| | - Samuel B Noblet
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Swann Arp Adams
- College of Nursing, University of South Carolina, Columbia, SC 29208, USA.
- Department of Epidemiology and Biostatistics & Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Rural and Minority Health Research Center & Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Sue P Heiney
- College of Nursing, University of South Carolina, Columbia, SC 29208, USA
| | - Sara Wilcox
- Department of Exercise Science and Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - James R Hébert
- Department of Epidemiology and Biostatistics & Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior & Office for the Study of Aging, University of South Carolina, Arnold School of Public Health, Columbia, SC 29208, USA
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Miller MC, Bayakly R, Schreurs BG, Flicker KJ, Adams SA, Ingram LA, Hardin JW, Lohman M, Ford ME, McCollum Q, McCrary-Quarles A, Ariyo O, Levkoff SE, Friedman DB. Highlighting the value of Alzheimer's disease-focused registries: lessons learned from cancer surveillance. Front Aging 2023; 4:1179275. [PMID: 37214775 PMCID: PMC10196140 DOI: 10.3389/fragi.2023.1179275] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/26/2023] [Indexed: 05/24/2023]
Abstract
Like cancer, Alzheimer's disease and related dementias (ADRD) comprise a global health burden that can benefit tremendously from the power of disease registry data. With an aging population, the incidence, treatment, and mortality from ADRD is increasing and changing rapidly. In the same way that current cancer registries work toward prevention and control, so do ADRD registries. ADRD registries maintain a comprehensive and accurate registry of ADRD within their state, provide disease prevalence estimates to enable better planning for social and medical services, identify differences in disease prevalence among demographic groups, help those who care for individuals with ADRD, and foster research into risk factors for ADRD. ADRD registries offer a unique opportunity to conduct high-impact, scientifically rigorous research efficiently. As research on and development of ADRD treatments continue to be a priority, such registries can be powerful tools for conducting observational studies of the disease. This perspectives piece examines how established cancer registries can inform ADRD registries' impact on public health surveillance, research, and intervention, and inform and engage policymakers.
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Affiliation(s)
- Margaret C. Miller
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Office of the Study of Aging, University of South Carolina, Columbia, SC, United States
| | - Rana Bayakly
- Georgia Department of Public Health, Atlanta, GA, United States
| | - Bernard G. Schreurs
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Kimberly J. Flicker
- Office of the Study of Aging, University of South Carolina, Columbia, SC, United States
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Swann Arp Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Lucy A. Ingram
- Office of the Study of Aging, University of South Carolina, Columbia, SC, United States
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - James W. Hardin
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Matthew Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Office of the Study of Aging, University of South Carolina, Columbia, SC, United States
| | - Marvella E. Ford
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Quentin McCollum
- College of Social Work, University of South Carolina, Columbia, SC, United States
| | - Audrey McCrary-Quarles
- Department of Health Sciences, South Carolina State University, Orangeburg, SC, United States
| | - Oluwole Ariyo
- Department of Biology, Allen University, Columbia, SC, United States
| | - Sue E. Levkoff
- College of Social Work, University of South Carolina, Columbia, SC, United States
| | - Daniela B. Friedman
- Office of the Study of Aging, University of South Carolina, Columbia, SC, United States
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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Chen X, Song R, Zhang J, Adams SA, Sun L, Lu W. On estimating optimal regime for treatment initiation time based on restricted mean residual lifetime. Biometrics 2022; 78:1377-1389. [PMID: 34263933 DOI: 10.1111/biom.13530] [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] [Received: 11/03/2020] [Revised: 05/13/2021] [Accepted: 07/08/2021] [Indexed: 12/30/2022]
Abstract
When to initiate treatment on patients is an important problem in many medical studies such as AIDS and cancer. In this article, we formulate the treatment initiation time problem for time-to-event data and propose an optimal individualized regime that determines the best treatment initiation time for individual patients based on their characteristics. Different from existing optimal treatment regimes where treatments are undertaken at a pre-specified time, here new challenges arise from the complicated missing mechanisms in treatment initiation time data and the continuous treatment rule in terms of initiation time. To tackle these challenges, we propose to use restricted mean residual lifetime as a value function to evaluate the performance of different treatment initiation regimes, and develop a nonparametric estimator for the value function, which is consistent even when treatment initiation times are not completely observable and their distribution is unknown. We also establish the asymptotic properties of the resulting estimator in the decision rule and its associated value function estimator. In particular, the asymptotic distribution of the estimated value function is nonstandard, which follows a weighted chi-squared distribution. The finite-sample performance of the proposed method is evaluated by simulation studies and is further illustrated with an application to a breast cancer data.
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Affiliation(s)
- Xin Chen
- School of Statistics and Mathematics, Shanghai Lixin University of Accounting and Finance, Shanghai, China.,Interdisciplinary Research Institute of Data Science, Shanghai Lixin University of Accounting and Finance, Shanghai, China
| | - Rui Song
- Department of Statistics, North Carolina State University, Raleigh, North Carolina, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - Swann Arp Adams
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA.,College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Liuquan Sun
- Institute of Applied Mathematics, Chinese Academy of Science, Beijing, China
| | - Wenbin Lu
- Department of Statistics, North Carolina State University, Raleigh, North Carolina, USA
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8
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Leiphart RJ, Weiss SN, DiStefano MS, Mavridis AA, Adams SA, Dyment NA, Soslowsky LJ. Collagen V deficiency during murine tendon healing results in distinct healing outcomes based on knockdown severity. J Biomech 2022; 144:111315. [PMID: 36201909 PMCID: PMC10108665 DOI: 10.1016/j.jbiomech.2022.111315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/16/2022] [Revised: 09/11/2022] [Accepted: 09/16/2022] [Indexed: 10/31/2022]
Abstract
Tendon function is dependent on proper organization and maintenance of the collagen I tissue matrix. Collagen V is a critical regulator of collagen I fibrils, and while prior studies have shown a negative impact of collagen V deficiency on tendon healing outcomes, these studies are confounded by collagen V deficiency through tendon development. The specific role of collagen V in regulating healing tendon properties is therefore unknown. By using inducible Col5a1 knockdown models and analyzing gene expression, fibril and histological tendon morphology, and tendon mechanical properties, this study defines the isolated role of collagen V through tendon healing. Patellar tendon injury caused large changes in tendon gene expression, and Col5a1 knockdown resulted in dysregulated expression of several genes through tendon healing. Col5a1 knockdown also impacted collagen fibril size and shape without observable changes in scar tissue formation. Surprisingly, heterozygous Col5a1 knockdown resulted in improved stiffness of healing tendons that was not observed with homozygous Col5a1 knockdown. Together, these results present an unexpected and dynamic role of collagen V deficiency on tendon healing outcomes following injury. This work suggests a model of tendon healing in which quasi-static mechanics may be improved through titration of collagen fibril size and shape with modulation of collagen V expression and activity.
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Affiliation(s)
- R J Leiphart
- McKay Orthopedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - S N Weiss
- McKay Orthopedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - M S DiStefano
- McKay Orthopedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - A A Mavridis
- McKay Orthopedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - S A Adams
- University of South Florida, Morsani College of Medicine, Tampa, FL 33612, USA
| | - N A Dyment
- McKay Orthopedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - L J Soslowsky
- McKay Orthopedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Zahnd WE, Ranganathan R, Adams SA, Babatunde OA. Sociodemographic disparities in molecular testing for breast cancer. Cancer Causes Control 2022; 33:843-859. [PMID: 35474496 DOI: 10.1007/s10552-022-01575-w] [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] [Received: 10/20/2021] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Molecular testing is a critical component of breast cancer care used to identify the presence of estrogen and/or progesterone receptors (jointly hormone receptors-HRs) and the expression of human epidermal growth factor 2 (HER2) on a tumor. Our objective was to characterize trends and predictors of lack of molecular testing among female breast cancer patients overall and by sociodemographic characteristics. METHODS We examined data on female breast cancer patients diagnosed between 2010 and 2016 from Surveillance Epidemiology and End Results-18. Joinpoint regression analyses assessed annual percent change (APC) in lack of ER, PR, or HER2 testing. Multivariable, multilevel logistic regression models identified factors associated with lack of molecular testing. RESULTS A nominally lower proportion of rural patients did not receive molecular testing (e.g., 1.8% in rural vs. 2.3% in urban for HER2). For all tests, a higher proportion of Hispanic and non-Hispanic Black women were not tested. Across all characteristics, improvement in testing was noted, although disparities among groups remained. For example, lack of HER2 testing improved from 3.2 to 1.7% in White patients (APC = - 10.05) but was consistently higher in Black patients 3.9 to 2.3% (APC = - 8.21). Multivariable, multilevel models showed that older, non-Hispanic Black, and unpartnered women were at greater odds of not receiving molecular testing. CONCLUSIONS While lack of molecular testing of breast cancer patients is relatively rare, racial/ethnic, insurance status, and age-related disparities have been identified. To reduce testing and downstream treatment and outcome disparities, it is imperative for all breast cancer patients to receive molecular testing.
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Affiliation(s)
- Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA. .,Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA.
| | - Radhika Ranganathan
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Swann Arp Adams
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,College of Nursing, University of South Carolina, Columbia, SC, USA
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10
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Steck SE, Su LJ, Antwi SO, Morris BB, Crawford B, Adams SA, Hebert JR, Fontham ETH, Bensen JT, Mohler JL, Arab L. Recreational and occupational physical activity in relation to prostate cancer aggressiveness: the North Carolina-Louisiana Prostate Cancer Project (PCaP). Cancer Causes Control 2022; 33:875-887. [PMID: 35320830 PMCID: PMC10964168 DOI: 10.1007/s10552-022-01572-z] [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: 10/06/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine associations between recreational and occupational physical activity and prostate cancer aggressiveness in a population-based, case-only, incident prostate cancer study. METHODS Data were analyzed from the cross-sectional North Carolina-Louisiana Prostate Cancer Project of African-American (n = 1,023) and European-American (n = 1,079) men newly diagnosed with prostate cancer (CaP). High-aggressive CaP was defined as Gleason sum ≥ 8, or prostate-specific antigen > 20 ng/ml, or Gleason sum ≥ 7 and clinical stage T3-T4. Metabolic equivalent tasks (MET) were estimated from self-reported recreational physical activity in the year prior to diagnosis assessed retrospectively via a validated questionnaire and from occupational physical activity based on job titles. Associations between physical activity variables and high-aggressive prostate cancer were estimated using logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for multiple confounders. RESULTS There was suggestive evidence that walking for 75-150 min/week for exercise is associated with lower odds of high-aggressive prostate cancer compared to no walking (OR = 0.69, 95% CI 0.47-1.01). Physical activity at the current job was associated with 24% lower odds of high-aggressive prostate cancer (highest vs. lowest tertile OR = 0.76, 95% CI 0.56-1.04). However, total MET-h/week of recreational physical activity and accumulation of high-level physical activity at the longest-held job were not associated with high-aggressive prostate cancer. Results did not vary by race. CONCLUSIONS The odds of high-aggressive prostate cancer were lower among men who walk for exercise and those engaged in occupations with high activity levels.
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Affiliation(s)
- Susan E Steck
- Epidemiology and Biostatistics, and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Room 456, Columbia, SC, 29208, USA.
| | - L Joseph Su
- Department of Epidemiology, Fay W. Boozman College of Public Health, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Samuel O Antwi
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Bonny B Morris
- Wake Forest Baptist Medical Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Brittany Crawford
- Epidemiology and Biostatistics, and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Swann Arp Adams
- Epidemiology and Biostatistics, and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - James R Hebert
- Epidemiology and Biostatistics, and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Elizabeth T H Fontham
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jeannette T Bensen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lenore Arab
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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11
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Truman SC, Wirth MD, Arp Adams S, Turner-McGrievy GM, Reiss KE, Hébert JR. Meal timing, distribution of macronutrients, and inflammation among African-American women: A cross-sectional study. Chronobiol Int 2022; 39:976-983. [PMID: 35379042 DOI: 10.1080/07420528.2022.2053702] [Citation(s) in RCA: 1] [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: 01/03/2023]
Abstract
Chronic low-grade inflammation is an underlying risk factor for numerous chronic diseases, including cancer. Eating earlier in the day has been associated with a reduction in levels of inflammatory markers and inflammation-related health outcomes (e.g., obesity, metabolic disorders). This cross-sectional study of 249 obese African-American women examined the effect of various mealtime-related factors associated with macronutrient consumption in relation to chronic inflammation and Breast Imaging Reporting and Data System (BI-RAD) readings. During 2011 and 2013, a single 24-hour dietary recall was administered, blood samples were assayed for c-reactive protein (CRP) and interleukin-6 (IL-6), and BI-RAD ratings were assessed to determine the influence of mealtime on chronic inflammation and breast cancer risk score. Multiple linear and logistic regression models were used to assess these relationships. Higher carbohydrate consumption at breakfast was associated with a significantly lower CRP vs. higher carbohydrate consumption at dinner (6.99, vs. 9.56 mg/L, respectively, p = .03). Additionally, every 1-unit increase in percent energy consumed after 5PM resulted in a BI-RAD reading indicating a possibly suspicious abnormality (OR: 1.053, 95% CI: 1.003-1.105), suggesting an increase in breast cancer risk. Timing of energy and macronutrient intake may have important implications for reducing the risk of diseases associated with chronic inflammation.
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Affiliation(s)
- Samantha C Truman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Michael D Wirth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Swann Arp Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Gabrielle M Turner-McGrievy
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Kelly E Reiss
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - James R Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Department of Nutrition, Connecting Health Innovations, LLC, Columbia, South Carolina, USA
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12
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Babatunde OA, Eberth JM, Felder TM, Moran R, Halbert CH, Truman S, Hebert JR, Heiney S, Adams SA. Racial Disparities and Diagnosis-to-Treatment Time Among Patients Diagnosed with Breast Cancer in South Carolina. J Racial Ethn Health Disparities 2022; 9:124-134. [PMID: 33428159 PMCID: PMC8272729 DOI: 10.1007/s40615-020-00935-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Diagnosis-to-treatment interval is an important quality measure that is recognized by the National Accreditation Program for Breast Centers, and the American Society of Breast Surgeons and the National Quality Measures for Breast Care. The aim of this study was to assess factors related to delays in receiving breast cancer treatment. METHODS This retrospective cohort study (2002 to 2010) used data from the South Carolina Central Cancer Registry (SCCCR) and Office of Revenue and Fiscal Affairs (RFA) to examine racial differences in diagnosis-to-treatment time (in days), with adjuvant hormone receipt, surgery, chemotherapy, and radiotherapy assessed separately. Chi-square tests, and logistic regression and generalized linear models were used to compare diagnosis-to-treatment days. RESULTS Black women on average received adjuvant hormone therapy, surgery, chemotherapy, and radiotherapy 25, 8, 7, and 3 days later than their White counterparts, respectively. Black women with local stage cancer had later time to surgery (OR: 1.6; CI: 1.2-2.2) compared with White women with local stage cancer. Black women living in rural areas had higher odds (OR: 2.0; CI: 1.1-3.7) of receiving late chemotherapy compared with White women living in rural areas. Unmarried Black women also had greater risk (OR: 2.0; CI: 1.0-4.0) of receiving late radiotherapy compared to married White women. CONCLUSIONS To improve timely receipt of effective BrCA treatments, programs aimed at reducing racial disparities may need to target subgroups of Black breast cancer patients based on their social determinants of health and geographic residence.
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Affiliation(s)
- Oluwole A. Babatunde
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, 915 Greene Street, University of South Carolina, Columbia, SC, 29208
| | - Jan M. Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 915 Greene Street, University of South Carolina, Columbia, SC, 29208
| | - Tisha M. Felder
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208
| | - Robert Moran
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 915 Greene Street, University of South Carolina, Columbia, SC, 29208
| | - Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425
| | - Samantha Truman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 915 Greene Street, University of South Carolina, Columbia, SC, 29208
| | - James R. Hebert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 915 Greene Street, University of South Carolina, Columbia, SC, 29208.,College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208.,Connecting Health Innovations LLC, 1417 Gregg Street, Columbia, SC, 29201
| | - Sue Heiney
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208
| | - Swann Arp Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 915 Greene Street, University of South Carolina, Columbia, SC, 29208.,College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208
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13
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Yelton B, Lead JR, Adams SA, Brandt HM, Kulkarni S, Lewis KR, Fedrick D, Ureda JR, Friedman DB. How Do African-American Community Members' Perceptions About Environmental Risks of Breast Cancer Compare with the Current State of the Science? J Cancer Educ 2021; 36:1193-1200. [PMID: 32314309 PMCID: PMC7572772 DOI: 10.1007/s13187-020-01748-8] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
African-American (AA) women experience higher mortality from breast cancer than any other racial group. Understanding community-held perceptions of environmental contaminants as risk factors for breast cancer can inform the development of tailored prevention and education efforts for improve health outcomes. Six focus groups were conducted with AA participants in two counties in South Carolina, and themes were identified using open and axial coding. Perceived environmental risks for breast cancer most frequently discussed by participants were compared to findings from published systematic reviews. Frequently discussed environmental risk factors by participants were deodorants containing aluminum, plastics, pesticides, and air and water pollution. While perceptions of aluminum and air pollution as risk factors did not align with the state of the science, perceived risk factors of chemicals in plastics and pesticides were found to be in alignment. There is some congruence between perceived environmental risks for breast cancer within the AA community and the current state of the science; however, there is a need to communicate information that reflects current science regarding commonly held misconceptions. Development of evidence-based, clear, and culturally appropriate messaging that reflects the current state of the science is warranted.
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Affiliation(s)
- Brooks Yelton
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA
- College of Social Work, University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208, USA
| | - Jamie R Lead
- Department of Environmental Health Sciences, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC, 29208, USA
- Center for Environmental Nanoscience and Risk, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC, 29208, USA
| | - Swann Arp Adams
- Department of Epidemiology & Biostatistics, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
- Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Heather M Brandt
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA
- Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Shibani Kulkarni
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA
| | - Kaleea R Lewis
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA
| | - Delores Fedrick
- Chester County Literacy Council, 109 Ella Street, Chester, SC, 29706, USA
| | - John R Ureda
- , Insights Consulting, Inc., 2728 Wilmot Ave, Columbia, SC, 29205, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA.
- Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
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14
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Babatunde OA, Zahnd WE, Eberth JM, Lawson AB, Adams SA, Boakye EA, Jefferson MS, Allen CG, Pearce JL, Li H, Halbert CH. Association between Neighborhood Social Deprivation and Stage at Diagnosis among Breast Cancer Patients in South Carolina. Int J Environ Res Public Health 2021; 18:ijerph182211824. [PMID: 34831579 PMCID: PMC8625868 DOI: 10.3390/ijerph182211824] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to examine the association between neighborhood social deprivation and individual-level characteristics on breast cancer staging in African American and white breast cancer patients. We established a retrospective cohort of patients with breast cancer diagnosed from 1996 to 2015 using the South Carolina Central Cancer Registry. We abstracted sociodemographic and clinical variables from the registry and linked these data to a county-level composite that captured neighborhood social conditions-the social deprivation index (SDI). Data were analyzed using chi-square tests, Student's t-test, and multivariable ordinal regression analysis to evaluate associations. The study sample included 52,803 female patients with breast cancer. Results from the multivariable ordinal regression model demonstrate that higher SDI (OR = 1.06, 95% CI: 1.02-1.10), African American race (OR = 1.35, 95% CI: 1.29-1.41), and being unmarried (OR = 1.17, 95% CI: 1.13-1.22) were associated with a distant stage at diagnosis. Higher tumor grade, younger age, and more recent year of diagnosis were also associated with distant-stage diagnosis. As a proxy for neighborhood context, the SDI can be used by cancer registries and related population-based studies to identify geographic areas that could be prioritized for cancer prevention and control efforts.
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Affiliation(s)
- Oluwole Adeyemi Babatunde
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (M.S.J.); (C.H.H.)
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA;
- Department of Psychiatry, Prisma Health, 109 Physicians Drive, Greer, SC 29650, USA
- Correspondence: ; Tel.: +1-803-477-1675
| | - Whitney E. Zahnd
- Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29210, USA; (W.E.Z.); (J.M.E.)
| | - Jan M. Eberth
- Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29210, USA; (W.E.Z.); (J.M.E.)
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
| | - Andrew B. Lawson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (A.B.L.); (C.G.A.); (J.L.P.)
| | - Swann Arp Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
- Cancer Survivorship Center, College of Nursing, University of South Carolina, Columbia, SC 29208, USA
| | - Eric Adjei Boakye
- Department of Population Science and Policy, School of Medicine, Southern Illinois University, Springfield, IL 62794, USA;
| | - Melanie S. Jefferson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (M.S.J.); (C.H.H.)
| | - Caitlin G. Allen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (A.B.L.); (C.G.A.); (J.L.P.)
| | - John L. Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (A.B.L.); (C.G.A.); (J.L.P.)
| | - Hong Li
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (M.S.J.); (C.H.H.)
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA;
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
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15
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Warden DH, Hughes RG, Probst JC, Warden DN, Adams SA. Current turnover intention among nurse managers, directors, and executives. Nurs Outlook 2021; 69:875-885. [PMID: 34148657 DOI: 10.1016/j.outlook.2021.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 08/07/2020] [Revised: 03/31/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Nursing leadership turnover can adversely affect nurse retention and thus quality of care. Little research has examined the way nurses at differing levels of leadership experience their workplace and voluntarily decide to leave. PURPOSE Our study sought to explore and compare intent to leave and turnover experiences of acute care nurse managers, directors, and executives. METHODS Data were collected via an online survey. Participants included nurse managers, directors, and executives from 47 states (n = 1880) working in acute care settings. FINDINGS Over 50% of respondents intend to leave their current positions within the next 5 years with reasons for leaving differing by type of nurse leader. Retirement was a factor for slightly over 30% of those nurse leaders overall and almost 50% of nurse executives. DISCUSSION Nurse managers, directors, and executives experience turnover and intent to leave differently. Most frequently, voluntary factors for leaving a position include job dissatisfaction and a desire for promotion and advancement.
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Affiliation(s)
| | - Ronda G Hughes
- Center for Nursing Leadership, College of Nursing, University of South Carolina, Columbia, SC
| | - Janice C Probst
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - David N Warden
- Department of Sociology, University of South Carolina, Columbia, SC
| | - Swann Arp Adams
- College of Nursing, University of South Carolina, Columbia, SC
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16
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Adams SA, Zahnd WE, Ranganathan R, Hung P, Brown MJ, Truman S, Biesecker C, Kirksey VC, Eberth JM. Rural and racial disparities in colorectal cancer incidence and mortality in South Carolina, 1996 - 2016. J Rural Health 2021; 38:34-39. [PMID: 33964026 DOI: 10.1111/jrh.12580] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/17/2022]
Abstract
PURPOSE Colorectal cancer (CRC) is the third leading cause of cancer mortality among men and women in the United States and South Carolina (SC). Since SC has one of the highest proportions of Black (27.9%) and rural residents (33.7%), the purpose of this investigation was to describe the burden of CRC on racial disparities in rural populations. METHODS Count data from 2012 to 2016 were obtained from the state central cancer registry using an online data retrieval system. Rural-urban status was determined using Urban Influence Codes (1-2 = urban; 3-12 = rural). Chi-square tests were calculated to examine differences in CRC stage by rurality and race. Annual percent change and annual average percent change (AAPC) were calculated to examine trends in incidence and mortality rates across rural-urban and racial groups between 1996 and 2016. RESULTS Areas with high mortality-to-incidence ratios tended to be in rural counties. Furthermore, rural residents had higher proportions of distant stage CRC compared to urban residents, and Black populations had higher proportions of distant stage CRC compared to White populations (22.7% vs. 26.3% and 29.3% vs. 23.7%, respectively; P value < 0.05). From 1996 to 2016, Black and White urban-dwelling residents experienced a significant decline in incidence. Urban White, urban Black, and rural White populations experienced significant declines in mortality (AAPC = -2.6% vs -2.4% vs -1.6% vs -0.9%, respectively). CONCLUSIONS Despite improvements in CRC screening in recent decades, focused evidenced-based interventions for lowering incidence and mortality among rural and Black populations in South Carolina are necessary.
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Affiliation(s)
- Swann Arp Adams
- Cancer Survivorship Center, College of Nursing, University of South Carolina, Columbia, South Carolina, USA.,Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina, USA
| | - Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Radhika Ranganathan
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Peiyin Hung
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Monique J Brown
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,The Smart State Center for Health Care Quality, University of South Carolina, Columbia, South Carolina, USA
| | - Samantha Truman
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Claire Biesecker
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Victor C Kirksey
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Jan M Eberth
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina, USA
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17
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Yelton B, Brandt HM, Adams SA, Ureda JR, Lead JR, Fedrick D, Lewis K, Kulkarni S, Friedman DB. "Talk About Cancer and Build Healthy Communities": How Visuals Are Starting the Conversation About Breast Cancer Within African-American Communities. Int Q Community Health Educ 2021; 41:267-274. [PMID: 32660340 PMCID: PMC7854839 DOI: 10.1177/0272684x20942076] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
African-American (AA) women are at higher risk of breast cancer mortality than women of other races. Factors influencing breast cancer risk, including exogenous environmental exposures, and debate around timing of exposure and dose-response relationship, can cause misunderstanding. Collaboration with priority populations encourages culturally relevant health messaging that imparts source reliability, influences message adoption, and improves understanding. Through six focus groups with AA individuals in rural and urban counties in the southeastern United States, this study used a community-engaged participatory approach to design an innovative visual tool for disseminating breast cancer information. Results demonstrated that participants were generally aware of environmental breast cancer risks and were willing to share new knowledge with families and community members. Recommended communication channels included pastors, healthcare providers, social media, and the Internet. Participants agreed that a collaboratively designed visual tool serves as a tangible, focused "conversation starter" to promote community prevention and education efforts.
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Affiliation(s)
- Brooks Yelton
- College of Social Work, University of South Carolina
- South Carolina Cancer Prevention and Control Research Network, University of South Carolina
| | - Heather M. Brandt
- Department of Health Promotion, Education, and Behavior, University of South Carolina
- Statewide Cancer Prevention and Control Program, University of South Carolina
- The Graduate School, University of South Carolina
| | - Swann Arp Adams
- Statewide Cancer Prevention and Control Program, University of South Carolina
- Department of Epidemiology and Biostatistics, College of Nursing, University of South Carolina
| | | | - Jamie R. Lead
- Department of Environmental Health Sciences, Center for Environmental Nanoscience and Risk, University of South Carolina
| | | | - Kaleea Lewis
- Department of Health Sciences, University of Missouri
| | - Shibani Kulkarni
- Department of Health Promotion, Education, and Behavior, University of South Carolina
| | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina
- Statewide Cancer Prevention and Control Program, University of South Carolina
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18
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Parker PD, Heiney SP, Friedman DB, Adams SA, Dawson RM. The Experience of Chemotherapy Teaching and Readability of Chemotherapy Educational Materials for Women with Breast Cancer. J Cancer Educ 2021; 36:47-55. [PMID: 31392598 DOI: 10.1007/s13187-019-01596-1] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Chemotherapy is one of the most common forms of treatment for women with breast cancer. While chemotherapy is often effective, managing side effects can be challenging. Chemotherapy education is critical in assisting patients to manage side effects and to improve the treatment experience. However, materials are often not thoroughly assessed for readability and format which could be problematic for patients learning self-care while in treatment. We used a mixed-method design to illuminate chemotherapy teaching and focused on readability and format of education materials. We scored the materials using three readability assessments: (1) Flesch Reading Ease (FRE), (2) Flesch-Kincaid (F-K), and (3) a Simple Measure of Gobbledygook (SMOG). We evaluated the format of the materials using Suitability Assessment of Materials (SAM) guidelines. Lastly, we used thematic analysis to describe the experience of 37 women with breast cancer undergoing chemotherapy education. The mean readability of the materials ranged from "difficult" to "fairly difficult" based on the FRE scoring, and the material was written on a 9th- to 13th-grade reading level. Most of the materials scored as "adequate" using SAM guidelines but lacked incorporation of graphics or illustrations. The thematic analysis revealed three major findings: (1) finding control in learning, (2) receiving unexpected support, and (3) learning in unforeseen ways. Nurses need to supplement chemotherapy education materials with individualized teaching to ensure comprehension. Additionally, nurses and website developers may want to consider implementing culturally appropriate information and use videos to combat challenging readability.
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Affiliation(s)
- Pearman D Parker
- College of Nursing, University of Arkansas for Medical Sciences, 4301 W. Markham Street Slot #529, Little Rock, AR, 72205, USA.
| | - Sue P Heiney
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
| | - Daniela B Friedman
- Arnold School of Public Health and Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Swann Arp Adams
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
- Arnold School of Public Health and Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Robin M Dawson
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
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19
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Ranganathan R, Zahnd WE, Harrison SE, Brandt HM, Adams SA, Eberth JM. Spatial Access to Vaccines for Children Providers in South Carolina: Implications for HPV Vaccination. Prev Chronic Dis 2020; 17:E163. [PMID: 33357307 PMCID: PMC7784554 DOI: 10.5888/pcd17.200300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Radhika Ranganathan
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Big Data Health Science Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Dr, Ste 204, Columbia, SC 29210.
| | - Sayward E Harrison
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, South Carolina.,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Heather M Brandt
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina
| | - Swann Arp Adams
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina.,College of Nursing, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Big Data Health Science Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Ranganathan R, Zahnd W, Adams SA. Abstract PO-122: Rural urban and racial disparities in colorectal cancer survival among the residents of South Carolina, 2001 - 2016. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-122] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction: Colorectal cancer (CRC) is the third most common type of cancer & second leading cause of cancer deaths in both men and women. With the highest reported mortality & incidence for CRC in southern regions of US, South Carolina has a higher incidence rate of 38.1 per 100,000 population (2016) compared to national levels (36.9/100,000). Despite the improvements in treatment & increased screening initiatives, significant disparities in CRC burden exists which is a major public health concern in the United States. Our objective was to look at the rural-urban and racial disparities in CRC survival in South Carolina. Methods: We utilized surveillance data from South Carolina Central Cancer Registry (SCCCR), available at the SC Department of Health & Environmental Control (DHEC). Our cohort included 29,618 subjects of both men & women diagnosed with colon (21,611) & rectal (8,007) cancers between 2001 to 2016. Rural Urban Commuting Area codes were used to classify rural residence at the time of tumor diagnosis. Descriptive statistics were calculated and compared by rurality using a chi-square test. We constructed Kaplan-Meier curves and calculated 3, 5, and 10-year survival rates. Adjusting for rurality, race, age, gender, SEER staging, type of insurance & census tract poverty estimates, multivariable Cox regression models were used to estimate the hazard ratio (HR). All analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC). Results: The rural-urban distribution of cases was 90% urban & 10% rural where 33% of the rural cases were among Black residents. Significant rural & racial differences were observed in overall 10-year survival proportion [urban white 60% vs 53% in urban Black & ~59% in rural white vs 52% for rural Black persons, P<.001]. 10-year overall CRC survival proportion was very low for rural males [39% vs 41% urban, P<.05].
Similarly, rural residents with a localized tumor had significantly lower proportion of overall 10-year survival rates [59% vs 63% urban, P<.05]. In multivariable Cox regression models, even after accounting for rurality and other factors, the risk of death was much higher among those with distant stage cancer compared to those with a localized cancer for disease free survival (HR, 19.88; 95% CI, 18.59 – 21.26) and overall survival (HR, 8.36; 95% CI, 7.98 – 8.76). Females had significantly lower risk of death as compared to males for both disease survival (HR, 0.78; 95% CI, 0.68 – 0.88) and overall survival (HR, 0.78; 95% CI, 0.70 – 0.86). Conclusions: Significant rural and racial differences exist in CRC survival for South Carolina residents.
Assessing the rural-urban variations in survival among patients diagnosed with CRC can inform interventions to improve access to and utilization of screening (i.e., increase early detection) and reduce treatment disparities to improve CRC survival rates especially in rural, Black populations.
Citation Format: Radhika Ranganathan, Whitney Zahnd, Swann Arp Adams. Rural urban and racial disparities in colorectal cancer survival among the residents of South Carolina, 2001 - 2016 [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-122.
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Affiliation(s)
- Radhika Ranganathan
- 1Rural & Minority Health Research Center, University of South Carolina, Columbia, SC,
| | - Whitney Zahnd
- 1Rural & Minority Health Research Center, University of South Carolina, Columbia, SC,
| | - Swann Arp Adams
- 2Rural & Minority Health Research Center, College of Nursing, Department of Epidemiology & Biostatistics, University of South Carolina, Columbia, SC
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Ranganathan R, Zahnd W, Adams SA. Abstract PO-086: Disproportionate burden of cervical cancer survival by race and rurality in South Carolina, 2001 - 2016. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-086] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction: In 2020, an estimated 4,290 deaths in the United States (U.S.) will be attributed to cervical cancer, the most frequently detected in women of ages between 35 to 44 years of age. For the years 2011 to 2015, South Carolina (SC) ranked 19th in the U.S. for cervical cancer incidence and 14th for mortality. South Carolina has a higher proportion of both rural and Black residents compared to the U.S. population. Drastic differences in cervical cancer incidence by race exist with Black women having an approximately 18% higher incidence rate (8.9 per 100,000 women) compared to white women (7.5 per 100,000 women).The purpose of this study is to identify and compare cervical cancer survival by race and rural-urban status in South Carolina. Methods: We analyzed data from South Carolina Central Cancer Registry (SCCCR), available at the SC Department of Health & Environmental Control (DHEC). Our cohort included 3,016 women diagnosed with cervical cancer between 2001 to 2016. Rural Urban Commuting Area codes were used to classify rural residence based on place of residence at the time of diagnosis. Descriptive statistics were calculated and compared by rurality using a chi-square test. We constructed Kaplan-Meier curves and calculated 3, 5, and 10-year survival rates. Adjusting for rurality, race, age, SEER staging, type of insurance & census tract poverty estimates, multivariable Cox regression models were used to estimate the hazard ratio (HR). All analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC). Results: The 10-year overall survival proportion was 51% for rural residents [vs 58% urban, P<.05]. Significant rural & racial differences were observed in overall 10-year survival proportion [urban white 63% vs 46% in urban Black & 55% in rural white vs 44% for rural Black, P<.001]. Similarly, rural residents who live in 0% - 5% census tract poverty levels had much lower overall 10-year survival of <40% [vs urban 72%, P<.001]. In Cox multivariable model stratified by SEER staging of the disease, even after accounting for rurality and other factors, the risk of death was higher among Black women with regional stage as compared to white women for disease-free survival (HR,1.42; 95% CI, 1.16 – 1.74) and overall survival (HR, 1.40; 95% CI, 1.16 – 1.68). Women aged 66 or higher, with a localized cancer had significantly greater risk of death as compared to 30-49 year olds for both disease free survival (HR, 8.22; 95% CI, 5.22 – 12.94) and overall survival (HR, 8.92; 95% CI, 6.29 – 12.66). Conclusions: Significant racial & geographic disparities exist in cervical cancer survival for South Carolina residents with the poorest survival rate experienced by rural Black women. Assessing the geographic variations in survival among patients diagnosed with cervical cancer can inform opportunities to improve screening rates and treatment to improve mortality especially in high risk populations.
Citation Format: Radhika Ranganathan, Whitney Zahnd, Swann Arp Adams. Disproportionate burden of cervical cancer survival by race and rurality in South Carolina, 2001 - 2016 [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-086.
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Zahnd WE, Gomez SL, Steck SE, Brown MJ, Ganai S, Zhang J, Arp Adams S, Berger FG, Eberth JM. Rural-urban and racial/ethnic trends and disparities in early-onset and average-onset colorectal cancer. Cancer 2020; 127:239-248. [PMID: 33112412 DOI: 10.1002/cncr.33256] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 02/17/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incidence rates (IRs) of early-onset colorectal cancer (EOCRC) are increasing, whereas average-onset colorectal cancer (AOCRC) rates are decreasing. However, rural-urban and racial/ethnic differences in trends by age have not been explored. The objective of this study was to examine joint rural-urban and racial/ethnic trends and disparities in EOCRC and AOCRC IRs. METHODS Surveillance, Epidemiology, and End Results data on the incidence of EOCRC (age, 20-49 years) and AOCRC (age, ≥50 years) were analyzed. Annual percent changes (APCs) in trends between 2000 and 2016 were calculated jointly by rurality and race/ethnicity. IRs and rate ratios were calculated for 2012-2016 by rurality, race/ethnicity, sex, and subsite. RESULTS EOCRC IRs increased 35% from 10.44 to 14.09 per 100,000 in rural populations (APC, 2.09; P < .05) and nearly 20% from 9.37 to 11.20 per 100,000 in urban populations (APC, 1.26; P < .05). AOCRC rates decreased among both rural and urban populations, but the magnitude of improvement was greater in urban populations. EOCRC increased among non-Hispanic White (NHW) populations, although rural non-Hispanic Black (NHB) trends were stable. Between 2012 and 2016, EOCRC IRs were higher among all rural populations in comparison with urban populations, including NHW, NHB, and American Indian/Alaska Native populations. By sex, rural NHB women had the highest EOCRC IRs across subgroup comparisons, and this was driven primarily by colon cancer IRs 62% higher than those of their urban peers. CONCLUSIONS EOCRC IRs increased in rural and urban populations, but the increase was greater in rural populations. NHB and American Indian/Alaska Native populations had particularly notable rural-urban disparities. Future research should examine the etiology of these trends.
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Affiliation(s)
- Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Susan E Steck
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Monique J Brown
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Office of the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Sabha Ganai
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Swann Arp Adams
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Franklin G Berger
- Colorectal Cancer Prevention Network, University of South Carolina, Columbia, South Carolina
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Warden DH, Hughes RG, Probst JC, Adams SA, Warden DN. Turnover Intention Among Nurses in Nurse Managers, Directors, and Executives: Developing a Tool for Measuring Environmental Factors. J Nurs Meas 2020; 28:534-554. [DOI: 10.1891/jnm-d-19-00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and PurposeTurnover among nurse managers, directors, and executives is associated with staff nurse retention and patient outcomes. The purpose of this article is to describe the development of an instrument to evaluate factors associated with intent to leave among these leaders within acute care facilities.MethodsThe Nurse Leader Environment Support Survey (NLESS) was developed and evaluated using exploratory factor analysis and reliability testing (Cronbach's α). Data was obtained as part of a large nationwide electronic survey (N = 1,903).ResultsFactors converged into three major themes (organizational culture, professional vulnerability, and workplace relationships) which were consistent across all three leadership groups. Factor subscales exhibited Cronbach's α > .7.ConclusionsThe NLESS is a useful tool in comparing reasons for turnover among nursing leadership groups. Future refinement may prove useful in identifying and clarifying foundational causes of turnover.
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Parker PD, Heiney SP, Adams SA, Friedman DB, Dawson RM. Factors influencing chemotherapy knowledge in women with breast cancer. Appl Nurs Res 2020; 56:151335. [PMID: 32739071 DOI: 10.1016/j.apnr.2020.151335] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/17/2020] [Accepted: 07/16/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chemotherapy knowledge is linked to managing side effects, reducing exposure to potential infection, and adjusting lifestyle behaviors while going through treatment. However, no research exists regarding the influence of patients' personal attributes on chemotherapy knowledge. Aim The aim of this study was to describe the relationships of health literacy and demographics on chemotherapy knowledge among women with breast cancer undergoing treatment. METHOD We used a descriptive, exploratory design with convenience sampling of women with breast cancer receiving intravenous chemotherapy who completed one mandatory education session. Participants completed a demographic questionnaire and three instruments: 1) Rapid Estimate of Adult Literacy - Short Form (REALM-SF); 2) Shortened Test of Functional Health Literacy in Adults (S-TOFHLA); and 3) Leuven Questionnaire on Patient Knowledge of Chemotherapy (L-PaKC). We used univariate linear regression and ANOVA to identify how health literacy and demographics influenced chemotherapy knowledge. RESULTS The REALM-SF (p = .022) and S-TOFHLA (p = .023) scores were significantly associated with chemotherapy knowledge. Chemotherapy knowledge scores were affected by marital status (p = .018) and income (p < .001) where married women had significantly higher chemotherapy knowledge scores (M = 92.6, SD = 6.6) than women who were divorced (M = 83.3, SD = 16.7) with a knowledge score difference of -9.3 between the groups (p = .02). Comparisons showed significant differences of chemotherapy knowledge between women with differing income levels. CONCLUSIONS This study highlights the relevance of considering patients' health literacy and personal attributes such as marital status and income when teaching about chemotherapy.
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Affiliation(s)
- Pearman D Parker
- University of South Carolina, College of Nursing, 1601 Greene Street, Columbia 29208, SC, USA.
| | - Sue P Heiney
- University of South Carolina, College of Nursing, 1601 Greene Street, Columbia 29208, SC, USA.
| | - Swann Arp Adams
- University of South Carolina, College of Nursing, 1601 Greene Street, Columbia 29208, SC, USA; University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, 915 Greene Street, Columbia 29208, SC, USA.
| | - Daniela B Friedman
- University of South Carolina, Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, 915 Greene Street, Columbia 29208, SC, USA.
| | - Robin M Dawson
- University of South Carolina, College of Nursing, 1601 Greene Street, Columbia 29208, SC, USA.
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Heiney SP, Truman S, Babatunde OA, Felder TM, Eberth JM, Crouch E, Wickersham KE, Adams SA. Racial and Geographic Disparities in Endocrine Therapy Adherence Among Younger Breast Cancer Survivors. Am J Clin Oncol 2020; 43:504-509. [PMID: 32251120 PMCID: PMC7316591 DOI: 10.1097/coc.0000000000000696] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 12/29/2022]
Abstract
OBJECTIVES African American (AA) women with breast cancer (BrCA) have higher mortality than any other race. Differential mortality has been attributed to nonadherence to endocrine therapy (ET). ET can lower the risk of dying by one third; yet 50% to 75% of all women are nonadherent to ET. Despite the wealth of research examining adherence to ET, understanding which groups of women at risk for poor adherence is not well established. The aim of this investigation was to describe ET adherence by race and geographic location among a cohort of younger BrCA survivors. MATERIALS AND METHODS Cancer registry records were linked to administrative data from Medicaid and a private insurance plan in South Carolina. Inclusion criteria included: European American (EA) or AA race, 3 years of continuous enrollment in the insurance plan after diagnosis, and BrCA diagnosis between 2002 and 2010. Adherence was measured by computing a medication possession ratio (MPR) based upon refill service dates and the number of pills dispensed. Adjusted least squared means were calculated by racial and geographic group using analysis of covariance methods. RESULTS The average MPR for EA women was significantly higher at 96% compared with 92% for AA women (P<0.01). After adjustment for years on hormone therapy, age, and number of pharmacies utilized, rural AA women had an average MPR of 90% compared with 95% for EA women (P<0.01). CONCLUSIONS AA women residing in rural areas demonstrate significantly lower adherence compared with their EA counterparts. Interventions are needed to improve adherence that may ameliorate AA mortality disparities.
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Affiliation(s)
- Sue P. Heiney
- The Cancer Survivorship Center; College of Nursing; University of South Carolina; Columbia, SC 29208
| | - Samantha Truman
- The Department of Epidemiology & Biostatistics; Arnold School of Public Health; University of South Carolina; Columbia, SC 29208
| | - Oluwole A Babatunde
- The Department of Epidemiology & Biostatistics; Arnold School of Public Health; University of South Carolina; Columbia, SC 29208
| | - Tisha M. Felder
- The Cancer Survivorship Center; College of Nursing; University of South Carolina; Columbia, SC 29208
| | - Jan M. Eberth
- The Cancer Prevention and Control Program; Arnold School of Public Health; University of South Carolina; Columbia, SC 29208
- The Department of Epidemiology & Biostatistics; Arnold School of Public Health; University of South Carolina; Columbia, SC 29208
- Rural and Minority Health Research Center; Arnold School of Public Health; University of South Carolina; Columbia, SC 29210
| | - Elizabeth Crouch
- Rural and Minority Health Research Center; Arnold School of Public Health; University of South Carolina; Columbia, SC 29210
- The Department of Health Services Management and Policy; Arnold School of Public Health; University of South Carolina; Columbia, SC 29208
| | - Karen E. Wickersham
- The Cancer Survivorship Center; College of Nursing; University of South Carolina; Columbia, SC 29208
| | - Swann Arp Adams
- The Cancer Survivorship Center; College of Nursing; University of South Carolina; Columbia, SC 29208
- The Cancer Prevention and Control Program; Arnold School of Public Health; University of South Carolina; Columbia, SC 29208
- The Department of Epidemiology & Biostatistics; Arnold School of Public Health; University of South Carolina; Columbia, SC 29208
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Heiney SP, Truman SC, Babatunde O, Alvarado CR, Adams SA. Abstract B012: An investigation of travel distances for breast cancer treatment among a racially and socioeconomically diverse cohort. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-b012] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: In South Carolina, black women are less likely to be diagnosed with breast cancer, but yet are more likely to die with their disease. The disparity is estimated to be as great as 60% higher for black women compared to white women after accounting for the lower incidence. Distances that cancer patients travel to receive treatments are likely to influence treatment decisions and ultimately survival; however, this relationship is not well described.
Purpose: The purpose of this investigation was to compare average travel distances for each modality of breast cancer treatment including surgery, chemotherapy, radiation therapy, and hormonal therapy. We furthermore examined the impact of these distances on disease-free survival.
Methods: SC Central Cancer Registry data (2002-2010) were linked to administrative data from Medicaid or another private payor insurance plan. Eligibility criteria included white or black race and continuous enrollment in their respective insurance plan for 3 years post diagnosis. Network distances from the patient residence to the provider were calculated by Arc GIS. T-tests and chi-square tests were used to compare descriptive statistics as appropriate. Cox proportional hazards models were used to assess the relationship between treatment travel distances and survival.
Results: Patients in the cohort traveled an average distance of 20, 21, 19, and 7 miles for surgical, chemotherapy, radiation therapy, and hormone therapy (pharmacy). Travel distances were significantly higher for blacks for chemotherapy (23 vs 20 miles, p=0.03), but not for any other therapy modalities. As might be expected, patients residing in rural areas had significantly higher travel distances for all treatment modalities, including hormonal therapies. In comparison to urban-dwelling patients, rural residents traveled an average of 36 vs 17 miles for surgery (p<0.01), 37 vs. 17 miles for chemotherapy (p<0.01), 34 vs. 16 miles for radiation therapy (p<0.01), and 23 vs 6 miles for hormone therapy (p=0.01). In examining survival, no travel distance was significantly associated with increased morality.
Conclusion: Rural residents traveled significantly longer distances to receive their cancer care compared to urban-dwelling residents; however, this did not appear to impact survival in this cohort. Additional work is needed to fully understand the influence of travel distances on treatment decisions that may ultimately impact survival. These findings highlight the need for innovative solutions to improve access to care for rural residents.
Citation Format: Sue P. Heiney, Samantha C. Truman, Oluwole Babatunde, Christian R. Alvarado, Swann Arp Adams. An investigation of travel distances for breast cancer treatment among a racially and socioeconomically diverse cohort [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B012.
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Alvarado CR, Truman SC, Babatunde O, Heiney SP, Escareno JM, Adams SA. Abstract C019: The mediating effect of hormone therapy compliance in the relationship between race and survival among breast cancer patients in South Carolina: A causal mediation analysis. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-c019] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction: Among women, breast cancer is the most common type of cancer diagnosis. Hormone-receptor positive (HRP) cancers compose approximately 80% of all breast cancer diagnoses and are commonly treated with hormone therapies. An estimated 50% of women do not comply with their prescribed hormone therapies due to incorrect dosage or discontinued use. Empirical evidence has shown that hormone therapies have a significant effect on cancer prognosis and patient survival.
Purpose: This study was conducted to investigate the mediating effect of hormone therapy compliance in relation to race and breast cancer survival.
Methods: A retrospective cohort study was conducted on women identified through several administrative databases and the South Carolina Central Cancer Registry (SCCCR). A causal mediation analysis was conducted among women in South Carolina regarding their compliance to prescribed hormone therapy and their survival. Participants in this study were African American (AA) or European American (EA) and less than 65 years old. Counterfactual notation was applied to estimate the controlled direct effect (CDE) and the proportion mediated regarding the relationship between race, hormone therapy compliance, and overall survival. The CDE can be estimated by comparing EA and AA women on their survival while holding the mediator constant as having complied with their hormone therapies. The proportion mediated estimates the mediated effect of compliance on the survival of breast cancer patients in South Carolina.
Results: There were a total of 1,188 women from South Carolina who had HRP cancers. Among this cohort, 72% were EA and 28% were AA women. Approximately 87% of the participants were compliant with their prescribed hormone therapy. AA women were more likely to die from breast cancer compared to EA regardless of age. The odds ratio and 95% confidence interval for the CDE was 1.05 (1.02, 1.09). Finally, the proportion mediated through compliance was estimated to be 26%.
Conclusion: Hormone therapy compliance has been observed to significantly mediate the relationship between race and breast cancer survival among HRP women in South Carolina. The CDE showed a significant association between race and survival when participants were compliant to hormone therapies. Compliance to therapies and physician recommendations may influence the difference in survival that is commonly observed between these two groups. The controlled direct effect estimations can be useful for future policy evaluation. Policy implications include the implementation of effective means of the timely distribution of information concerning the potential side effects as well as education regarding management strategies for these hormone therapies. Finally, understanding the obstacles of compliance to hormone therapies will inform policymakers towards regulations that minimize the impact of these obstacles.
Citation Format: Christian R. Alvarado, Samantha C. Truman, Oluwole Babatunde, Sue P. Heiney, Jessica M. Escareno, Swann Arp Adams. The mediating effect of hormone therapy compliance in the relationship between race and survival among breast cancer patients in South Carolina: A causal mediation analysis [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C019.
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Truman SC, Babatunde O, Alvarado C, Heiney SP, Sellner JE, Reiss KE, Adams SA. Abstract B016: Predictors of nonadherence to adjuvant hormonal therapy among breast cancer patients. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-b016] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: This study aimed to investigate the predictive factors associated with nonadherence to adjuvant hormonal therapy (AHT) by year among patients with receptor-positive breast cancer.
Background: AHT is used to treat and manage hormone receptor-positive breast cancers, which comprise 70% of all breast cancers. Low adherence to these medications has been shown to increase the risk of death by approximately 20%. Despite the known benefits for reducing mortality and reoccurrence, adherence to AHT medications has proven to be a major challenge for patients. Previous studies have linked several demographic and clinical characteristics as predictors of adherence.
Methods: Women diagnosed with receptor-positive breast cancer between the years 2002 to 2010 were identified through the South Carolina Central Cancer Registry, which was linked to administrative databases, the South Carolina Medicaid Program, and a private payor plan. We identified 1,095 patients with breast cancer who met our eligibility criteria and filled at least two AHT medications. The medication possession ratio (MPR), the ratio of number of pills for each AHT and the number of days between each AHT refill, was derived using automated pharmacy records to identify AHT prescriptions and the dates of each refill. The average MPR was calculated for each year over a 3-year period. Regression models and t-tests were used to assess factors associated with nonadherence of AHT for each of the 3 years.
Results: The average adherence rate for AHT was 0.93, 0.90, and 0.90 following year 1, year 2, and year 3, respectively. For each of the 3 years, African Americans had a significantly lower adherence to AHT compared to European Americans. In addition, women under the age of 50 years had a significantly lower MPR for each year compared to women 50 and older (p = <.01). Insurance type also had a significant impact on compliance over the 3-year period (p = <.01). Women were more likely to be adherent to aromatase Inhibitors (AIs) compared to selective estrogen receptor modulators (SERMs) across all 3 years. Interestingly, geographic location (urban versus rural) did not affect adherence until the third year of treatment (0.91 ± 0.17 vs. 0.87 ± 0.20, p = 0.02, respectively). Treatment factors such as radiation and chemotherapy did not appear to impact AHT adherence. However, upon further investigation, following year 1 of treatment, women taking both AHT and chemotherapy simultaneously, as opposed to only taking AHT, had a significantly lower adherence rate (0.86 ± 0.19 vs. 0.92 ± 0.14, p = <.01, respectively).
Conclusion: Demographic characteristics such as age, race, and insurance type appeared to impact AHT adherence across the initial three years of AHT. However, there are other factors that should be considered at different timepoints during treatment, such as geographic location and treatment regimen. This study provides important insight into probable factors and characteristics that can be used to provide targeted interventions for improving AHT adherence.
Citation Format: Samantha C. Truman, Oluwole Babatunde, Christian Alvarado, Sue P. Heiney, Joshua E. Sellner, Kelly E. Reiss, Swann Arp Adams. Predictors of nonadherence to adjuvant hormonal therapy among breast cancer patients [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B016.
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Adams SA, Truman SC, Babatunde O, Felder TM, Eberth JM, Heiney SP, Alvarado CR, Hebert JR. Abstract B008: South Carolina's National Breast and Cervical Cancer Early Detection Program narrows the gap in South Carolina breast cancer disparities. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-b008] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides screening for breast cancer and, ultimately, navigation to treatment services for women who are economically disadvantaged and unable to afford such services. Consequently, SC's NBCCEDP, the Best Chance Network (BCN), is crucial in helping to address the excess burden of breast cancer mortality experienced by black women as well as those with lower socio-economic status.
Purpose: The purpose of this investigation was to compare time to each treatment modality (surgery, chemotherapy, radiation therapy, and hormonal therapy) between BCN participants and participants in Medicaid or a private payor insurance plan.
Methods: SC Central Cancer Registry data (2002-2010) were linked to administrative data from Medicaid or another private payor insurance plan. Eligibility criteria included white or black race and continuous enrollment in their respective insurance plan for 3 years post diagnosis. Time from diagnosis to date of first surgery, chemotherapy, radiation therapy, and hormonal therapy were calculated from administrative data files. T-tests and chi-square tests were used to compare descriptive statistics as appropriate. Cox proportional hazards models were used to assess the relationship among BCN participation, treatment times, and survival.
Results: No significant differences were noted for time to surgery, chemotherapy, or hormonal therapy between BCN participants and the rest of the cohort. Interestingly, significant differences were noted between the two groups for time to radiation therapy (178 days for BCN vs. 150 days for the rest of the cohort, p=0.05). In multivariable Cox models, there were no breast cancer survival differences by BCN participation (p=0.94) after adjusting for age, stage, and insurance type. Among BCN participants, Cox models did not demonstrate any relationship between treatment time (for any treatment type) or race with survival after adjusting for age and stage.
Conclusion: This work provides evidence that emphasizes the important role that state programs such as the BCN play in navigating women into timely treatment and eliminating the disparity that is often seen for the receipt of breast cancer treatment among economically disadvantaged women. Furthermore, this work highlights the potential for these programs to decrease mortality disparities experienced by black women in SC.
Citation Format: Swann Arp Adams, Samantha C. Truman, Oluwole Babatunde, Tisha M. Felder, Jan M. Eberth, Sue P. Heiney, Christian R. Alvarado, James R. Hebert. South Carolina's National Breast and Cervical Cancer Early Detection Program narrows the gap in South Carolina breast cancer disparities [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B008.
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Ranganathan R, Hung P, Adams SA, Hair NL, Bailey SS. Abstract A123: Legislation by states and its impact on factors causing divergence in HPV vaccination coverage: Analysis of 2013-2017 National Immunization Survey - Teens (NIS-TEENS). Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-a123] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Human papilloma virus (HPV) is strongly associated with multiple cancer types, affecting women, men and children of all races, ethnicities and backgrounds. HPV causes more than 30,000 cases of cancer every year and more than 70% of U.S population will experience at-least one HPV infection at some point. School-entry mandates and public health education campaigns though being separate entities, have significantly increased vaccine uptake, reduced disease prevalence and decreased racial disparities in disease rates. Furthermore, improvements in immunization against HPV are not equally distributed across gender, age, demographic and socioeconomic divisions within the recommended group of vaccine recipients. Objectives: To analyze and report the association between state-level policies and HPV vaccination uptake. We further explore predictors of HPV vaccination uptake using Aday & Anderson’s behavioral theory of healthcare utilization. Methods: A repeated cross-sectional survey of NIS-Teens data from 2013-2017 was used for the analysis. Bivariable associations and multivariable ordered logistic regression models were statistically performed using STATA 15/IC & SAS v9.4. Results: HPV vaccination completion rates were 17% higher in teens who lived in states with a legislative mandate irrespective of policy enactment. Relative to males, females had 72% higher odds of uptake. Compared to whites, Non-Hispanic blacks had a 21% lower odds of vaccination uptake. Compared to western region of the US, the north-east region reported 1.47 times higher odds of HPV vaccination. Provider recommendation was also significantly associated with HPV vaccination coverage rates. Conclusion: State legislative mandates had a profound impact of vaccination uptake. Additionally, racial minorities were significantly less likely to receive vaccination. Analysis of statewide adaptation of policy related bills and federal funding on VFC (Vaccine For Children) program could further inform those policy initiatives with the greatest uptake of vaccination.
Citation Format: Radhika Ranganathan, Peyin Hung, Swann Arp Adams, Nicole L Hair, Shiba Simon Bailey. Legislation by states and its impact on factors causing divergence in HPV vaccination coverage: Analysis of 2013-2017 National Immunization Survey - Teens (NIS-TEENS) [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A123.
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Affiliation(s)
| | - Peyin Hung
- University of South Carolina, Columbia, SC, USA
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Babatunde OA, Eberth JM, Felder T, Moran R, Truman S, Hebert JR, Zhang J, Adams SA. Social Determinants of Racial Disparities in Breast Cancer Mortality Among Black and White Women. J Racial Ethn Health Disparities 2020; 8:147-156. [PMID: 32385849 DOI: 10.1007/s40615-020-00766-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/09/2020] [Accepted: 04/22/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Mortality from breast cancer among Black women is 60% greater than that of White women in South Carolina (SC). The aim of this study was to assess racial differences in mortality among Black and White breast cancer patients based on variations in social determinants and access to state-based early detection programs. METHODS We obtained a retrospective record for breast cancer patients diagnosed between 2002 and 2010 from the SC Central Cancer Registry. Mortality was the main outcome while race-stratified Cox proportional hazard models were performed to assess disparities in mortality. We assessed effect modification, and we used an automated backward elimination process to obtain the best fitting models. RESULTS There were 3286 patients of which the majority were White women (2186, 66.52%). Compared with married White women, the adjusted hazard ratio (aHR) for mortality was greatest among Black unmarried women (aHR 2.31, CI 1.83, 2.91). Compared with White women who lived in the Low Country region mortality was greatest among Black women who lived in the Midland (aHR 2.17 CI 1.47, 3.21) and Upstate (aHR 2.96 CI 1.96, 2.49). Mortality was higher among Black women that were not receiving services in the Best Chance Network (BCN) program (aHR 1.70, CI 1.40, 2.04) compared with White women. CONCLUSIONS To reduce the racial disparity gap in survival in SC, Black breast cancer patients who live in the Upstate, are unmarried, and those that are not enrolled in the BCN program may benefit from more intense navigation efforts directed at early detection and linkage to breast cancer treatments.
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Affiliation(s)
- Oluwole Adeyemi Babatunde
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA. .,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA. .,Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA.
| | - Jan M Eberth
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Tisha Felder
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.,College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
| | - Robert Moran
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Samantha Truman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - James R Hebert
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.,College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA.,Connecting Health Innovations LLC, 1417 Gregg Street, Columbia, SC, 29201, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Swann Arp Adams
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.,College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
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Farr DE, Brandt HM, Friedman DB, Adams SA, Armstead CA, Fulton JK, Bull DM. False-positive mammography and mammography screening intentions among black women: the influence of emotions and coping strategies. Ethn Health 2020; 25:580-597. [PMID: 30676782 DOI: 10.1080/13557858.2019.1571563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 01/14/2019] [Indexed: 06/09/2023]
Abstract
Introduction: Abnormal mammograms confirmed as benign are known as false-positive mammography (FPM) results. Research indicates that a history of FPM results may be linked to diagnostic delays in Black women, yet much of the research on FPM has focused on White women.Objectives: The purpose of this study was to examine: 1) The influence of FPM on breast cancer (BrCa) screening beliefs and intentions among Black women and 2) Whether emotional states, personality traits or coping behaviors altered the previously described relationships.Design: BrCa-free, Black women, aged 40 and older who completed screening mammograms in 2016 were recruited for a case-control study from 2016 to 2017. Women with FPM results were cases, and women with normal results served as matched controls. Print surveys assessing demographics, personality traits, emotions, BrCa screening history, BrCa beliefs, and africentric coping behaviors were mailed to participants. The final sample consisted of 118 respondents (55 cases, 63 controls). Ordinary least squares (OLS) models were constructed. Personality traits and emotions were tested as mediators and coping behaviors as moderators of the relationship between FPM results and BrCa beliefs.Results: FPM status was associated with a higher perception of barriers to mammography, and an elevated perception of barriers was associated with lower intentions to complete mammography. Collective coping behaviors functioned as a moderator and were associated with a decreased perception of mammography barriers in women with FPM results.Conclusions: FPM status had a detrimental impact on mammography intention indirectly through the perception of mammography barriers, but the use of africentric coping behaviors moderated the relationship between FPM status and perceived barriers to mammography. Culturally specific research focused on Black women is needed to explore influences on BrCa screening beliefs and mammography completion in this population.
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Affiliation(s)
- Deeonna E Farr
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Heather M Brandt
- Department of Health Promotion, Education, and Behavior, South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Swann Arp Adams
- Department of Epidemiology and Biostatistics, South Carolina Statewide Cancer Prevention and Control Program, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Cheryl A Armstead
- Department of Psychology, University of South Carolina Health Equity Laboratory, South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
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Babatunde OA, Arp Adams S, Truman S, Sercy E, Murphy AE, Khan S, Hurley TG, Wirth MD, Choi SK, Johnson H, Hebert JR. The impact of a randomized dietary and physical activity intervention on chronic inflammation among obese African-American women. Women Health 2020; 60:792-805. [PMID: 32248760 DOI: 10.1080/03630242.2020.1746950] [Citation(s) in RCA: 2] [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: 10/24/2022]
Abstract
Lifestyle interventions may reduce inflammation and lower breast cancer (BrCa) risk. This randomized trial assessed the impact of the Sistas Inspiring Sistas Through Activity and Support (SISTAS) study on plasma C-reactive protein (CRP), interleukin-6 (IL-6) and Dietary Inflammatory Index (DII). This unblinded, dietary and physical activity trial was implemented in 337 obese (body mass index [BMI] ≥30 kg/m2) African American (AA) women recruited between 2011 and 2015 in South Carolina through a community-based participatory approach with measurements at baseline, 3 months, and 12 months. Participants were randomized into either intervention (n = 176) or wait-list control group (n = 161). Linear mixed-effect models were used for analyses of CRP and IL-6. Baseline CRP was significantly higher in those with greater obesity, body fat percentage, and waist circumference (all p <.01). No difference was observed between groups for CRP or IL-6 at 3 or 12 months; however, improvements in diet were observed in the intervention group compared to the control group (p = .02) at 3 months but were not sustained at 12 months. Although the intervention was not successful at reducing levels of CRP or IL-6, a significant decrease was observed in DII score for the intervention group, indicating short-term positive dietary change.
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Affiliation(s)
- Oluwole Adeyemi Babatunde
- Cancer Prevention and Control Program, University of South Carolina , Columbia, South Carolina, USA.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina, USA.,Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina , Charleston, South Carolina, USA
| | - Swann Arp Adams
- Cancer Prevention and Control Program, University of South Carolina , Columbia, South Carolina, USA.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina, USA.,College of Nursing, University of South Carolina , Columbia, South Carolina, USA
| | - Samantha Truman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina, USA
| | - Erica Sercy
- Cancer Prevention and Control Program, University of South Carolina , Columbia, South Carolina, USA
| | - Angela E Murphy
- Department of Pathology, Microbiology and Immunology, School of Medicine, University of South Carolina , Columbia, South Carolina, USA
| | - Samira Khan
- Cancer Prevention and Control Program, University of South Carolina , Columbia, South Carolina, USA
| | - Thomas G Hurley
- Cancer Prevention and Control Program, University of South Carolina , Columbia, South Carolina, USA
| | - Michael D Wirth
- Cancer Prevention and Control Program, University of South Carolina , Columbia, South Carolina, USA.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina, USA.,College of Nursing, University of South Carolina , Columbia, South Carolina, USA.,Connecting Health Innovations LLC , Columbia, South Carolina, USA
| | - Seul Ki Choi
- Cancer Prevention and Control Program, University of South Carolina , Columbia, South Carolina, USA.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina, USA
| | - Hiluv Johnson
- Cancer Prevention and Control Program, University of South Carolina , Columbia, South Carolina, USA
| | - James R Hebert
- Cancer Prevention and Control Program, University of South Carolina , Columbia, South Carolina, USA.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina, USA.,College of Nursing, University of South Carolina , Columbia, South Carolina, USA.,Connecting Health Innovations LLC , Columbia, South Carolina, USA
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Heiney SP, Donevant SB, Arp Adams S, Parker PD, Chen H, Levkoff S. A Smartphone App for Self-Management of Heart Failure in Older African Americans: Feasibility and Usability Study. JMIR Aging 2020; 3:e17142. [PMID: 32242822 PMCID: PMC7165307 DOI: 10.2196/17142] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 11/26/2019] [Revised: 02/26/2020] [Accepted: 03/12/2020] [Indexed: 12/23/2022] Open
Abstract
Background Mobile health (mHealth) apps are dramatically changing how patients and providers manage and monitor chronic health conditions, especially in the area of self-monitoring. African Americans have higher mortality rates from heart failure than other racial groups in the United States. Therefore, self-management of heart failure may improve health outcomes for African American patients. Objective The aim of the present study was to determine the feasibility of using an mHealth app, and explore the outcomes of quality of life, including self-care maintenance, management, and confidence, among African American patients managing their condition after discharge with a diagnosis of heart failure. Methods Prior to development of the app, we conducted qualitative interviews with 7 African American patients diagnosed with heart failure, 3 African American patients diagnosed with cardiovascular disease, and 6 health care providers (cardiologists, nurse practitioners, and a geriatrician) who worked with heart failure patients. In addition, we asked 6 hospital chaplains to provide positive spiritual messages for the patients, since spirituality is an important coping method for many African Americans. These formative data were then used for creating a prototype of the app, named Healthy Heart. Specifically, the Healthy Heart app incorporated the following evidence-based features to promote self-management: one-way messages, journaling (ie, weight and symptoms), graphical display of data, and customized feedback (ie, clinical decision support) based on daily or weekly weight. The educational messages about heart failure self-management were derived from the teaching materials provided to the patients diagnosed with heart failure, and included information on diet, sleep, stress, and medication adherence. The information was condensed and simplified to be appropriate for text messages and to meet health literacy standards. Other messages were derived from interviews conducted during the formative stage of app development, including interviews with African American chaplains. Usability testing was conducted over a series of meetings between nurses, social workers, and computer engineers. A pilot one-group pretest-posttest design was employed with participants using the mHealth app for 4 weeks. Descriptive statistics were computed for each of the demographic variables, overall and subscales for Health Related Quality of Life Scale 14 (HQOL14) and subscales for the Self-Care of Heart Failure Index (SCHFI) Version 6 using frequencies for categorical measures and means with standard deviations for continuous measures. Baseline and postintervention comparisons were computed using the Fisher exact test for overall health and paired t tests for HQOL14 and SCHFI questionnaire subscales. Results A total of 12 African American participants (7 men, 5 women; aged 51-69 years) diagnosed with heart failure were recruited for the study. There was no significant increase in quality of life (P=.15), but clinically relevant changes in self-care maintenance, management, and confidence were observed. Conclusions An mHealth app to assist with the self-management of heart failure is feasible in patients with low literacy, low health literacy, and limited smartphone experience. Based on the clinically relevant changes observed in this feasibility study of the Healthy Heart app, further research should explore effectiveness in this vulnerable population.
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Affiliation(s)
- Sue P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Sara B Donevant
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Swann Arp Adams
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Pearman D Parker
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Hongtu Chen
- Environment and Health Group, Boston, MA, United States
| | - Sue Levkoff
- College of Social Work, University of South Carolina, Columbia, SC, United States
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Adams SA, Haynes VE, Brandt HM, Choi SK, Young V, Eberth JM, Hébert JR, Friedman DB. Cervical cancer screening behaviors and proximity to federally qualified health centers in South Carolina. Cancer Epidemiol 2020; 65:101681. [PMID: 32035294 DOI: 10.1016/j.canep.2020.101681] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/18/2019] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Lack of participation in cervical cancer screening in underserved populations has been attributed to access to care, particularly among women in rural areas. Federally Qualified Health Centers (FQHCs) were created to address this need in medically underserved populations. This study observed proximity to three health centers in relation to cervical cancer screening rates in South Carolina. METHODS Data were obtained from FQHC patient visits (from 3 centers) between 2007-2010 and were limited to women eligible for cervical cancer screening (n = 24,393). ArcGIS was used to geocode patients addresses and FQHC locations, and distance was calculated. Modified Poisson regression was used to estimate relative risk of obtaining cervical cancer screening within one yearor ever, stratified by residential area. RESULTS Findings differed markedly by center and urban/rural status. At two health clinics, rural residents living the furthest away from the clinic (∼9 miles difference between quartile 4 and quartile 1) were more likely to be ever screened (RRs = 1.05 and 1.03, p-values < 0.05), while urban residents living the furthest away were less likely to be ever screened (RR = 0.85, p-value < 0.05). At the third center, only urban residents living the furthest away were more likely to be ever screened (RR = 1.02, p-value < 0.05). CONCLUSIONS Increased travel distance significantly increased the likelihood of cervical cancer screening at two FQHC sites while significantly decreasing the likelihood of screening at the 3rd site. These findings underscore the importance of contextual and environmental factors that impact use of cervical cancer screening services.
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Affiliation(s)
- Swann Arp Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; College of Nursing, University of South Carolina, 1601 Greene Street Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - Venice E Haynes
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - Heather M Brandt
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - Seul Ki Choi
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States; Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, South Korea.
| | - Vicki Young
- South Carolina Primary Care Association, 3 Technology Circle Columbia, SC, 29203, United States.
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - James R Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
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Biesecker C, Zahnd WE, Brandt HM, Adams SA, Eberth JM. A Bivariate Mapping Tutorial for Cancer Control Resource Allocation Decisions and Interventions. Prev Chronic Dis 2020; 17:E01. [PMID: 31895673 PMCID: PMC6977777 DOI: 10.5888/pcd17.190254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Bivariate choropleth mapping is a straightforward but underused method for displaying geographic health information to use in public health decision making. Previous studies have recommended this approach for state comprehensive cancer control planning and similar efforts. In this method, 2 area-level variables of interest are mapped simultaneously, often as overlapping quantiles or by using other classification methods. Variables to be mapped may include area-level (eg, county level) measures of disease burden, health care use, access to health care services, and sociodemographic characteristics. We demonstrate how geographic information systems software, specifically ArcGIS, can be used to develop bivariate choropleth maps to inform resource allocation and public health interventions. We used 2 types of county-level public health data: South Carolina’s Behavioral Risk Factor Surveillance System estimates of ever having received cervical cancer screening, and a measure of availability of cervical cancer screening providers that are part of South Carolina’s Breast and Cervical Cancer Early Detection Program. Identification of counties with low screening rates and low access to care may help inform where additional resources should be allocated to improve access and subsequently improve screening rates. Similarly, identifying counties with low screening rates and high access to care may help inform where educational and behavioral interventions should be targeted to improve screening in areas of high access.
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Affiliation(s)
- Claire Biesecker
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Dr, Ste 204, Columbia, SC 29210.
| | - Heather M Brandt
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Swann Arp Adams
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Crimarco A, Dias CH, Turner-McGrievy GM, Wilson M, Adams SA, Macauda M, Blake CE, Younginer N. Outcomes of a short term dietary intervention involving vegan soul food restaurants on African American adults’ perceived barriers, benefits, and dietary acceptability of adopting a plant-based diet. Food Qual Prefer 2020. [DOI: 10.1016/j.foodqual.2019.103788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Donevant SB, Estrada RD, Culley JM, Habing B, Adams SA. Exploring app features with outcomes in mHealth studies involving chronic respiratory diseases, diabetes, and hypertension: a targeted exploration of the literature. J Am Med Inform Assoc 2019; 25:1407-1418. [PMID: 30137383 DOI: 10.1093/jamia/ocy104] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/10/2018] [Indexed: 01/06/2023] Open
Abstract
Objectives Limited data are available on the correlation of mHealth features and statistically significant outcomes. We sought to identify and analyze: types and categories of features; frequency and number of features; and relationship of statistically significant outcomes by type, frequency, and number of features. Materials and Methods This search included primary articles focused on app-based interventions in managing chronic respiratory diseases, diabetes, and hypertension. The initial search yielded 3622 studies with 70 studies meeting the inclusion criteria. We used thematic analysis to identify 9 features within the studies. Results Employing existing terminology, we classified the 9 features as passive or interactive. Passive features included: 1) one-way communication; 2) mobile diary; 3) Bluetooth technology; and 4) reminders. Interactive features included: 1) interactive prompts; 2) upload of biometric measurements; 3) action treatment plan/personalized health goals; 4) 2-way communication; and 5) clinical decision support system. Discussion Each feature was included in only one-third of the studies with a mean of 2.6 mHealth features per study. Studies with statistically significant outcomes used a higher combination of passive and interactive features (69%). In contrast, studies without statistically significant outcomes exclusively used a higher frequency of passive features (46%). Inclusion of behavior change features (ie, plan/goals and mobile diary) were correlated with a higher incident of statistically significant outcomes (100%, 77%). Conclusion This exploration is the first step in identifying how types and categories of features impact outcomes. While the findings are inconclusive due to lack of homogeneity, this provides a foundation for future feature analysis.
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Affiliation(s)
- Sara Belle Donevant
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | | | - Joan Marie Culley
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Brian Habing
- Department of Statistics, University of South Carolina, Columbia, South Carolina, USA
| | - Swann Arp Adams
- College of Nursing/Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Eberth JM, Zahnd WE, Adams SA, Friedman DB, Wheeler SB, Hébert JR. Mortality-to-incidence ratios by US Congressional District: Implications for epidemiologic, dissemination and implementation research, and public health policy. Prev Med 2019; 129S:105849. [PMID: 31679842 PMCID: PMC7393609 DOI: 10.1016/j.ypmed.2019.105849] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/16/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 02/07/2023]
Abstract
The mortality-to-incidence ratio (MIR) can be computed from readily accessible, public-use data on cancer incidence and mortality, and a high MIR value is an indicator of poor survival relative to incidence. Newly available data on congressional district-specific cancer incidence and mortality from the U.S. Cancer Statistics (USCS) database from 2011 to 2015 were used to compute MIR values for overall (all types combined), breast, cervix, colorectal, esophagus, lung, oral, pancreas, and prostate cancer. Congressional districts in the South and Midwest, including MS, AL, and KY, had higher (worse) MIR values for all cancer types combined than for the U.S. as a whole. For all cancers combined, there was a positive correlation between each district's percent of rural residents and the MIR (r = 0.47; p < .001). The MIR for all cancer types combined was lower in districts within states that expanded Medicaid vs. those states that did not expand Medicaid (0.36 vs. 0.38; p < .001). A positive correlation was seen between the proportion of non-Hispanic Black residents and MIR (r = 0.15; p < .01 for all cancers). Lower MIRs were observed in districts in New England and in states that expanded Medicaid. However, there also were some interesting departures from this rule (e.g., Wyoming, South Dakota, parts of Wisconsin and Florida). Rural congressional districts have generally higher MIRs than more urban districts. There is some concern that poorer, more rural states that did not expand Medicaid may experience greater disparities in MIRs relative to Medicaid expansion states in the future.
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Affiliation(s)
- Jan M Eberth
- University of South Carolina, Cancer Prevention and Control Program, Rural and Minority Health Research Center, Department of Epidemiology and Biostatistics, United States of America
| | - Whitney E Zahnd
- University of South Carolina, Rural and Minority Health Research Center, United States of America
| | - Swann Arp Adams
- University of South Carolina, Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics and College of Nursing, United States of America
| | - Daniela B Friedman
- University of South Carolina, Cancer Prevention and Control Program, Department of Health Promotion, Education, and Behavior, United States of America
| | - Stephanie B Wheeler
- University of North Carolina, Chapel Hill, Department of Health Policy and Management, Gillings School of Global Public Health, CPCRN Coordinating Center, United States of America
| | - James R Hébert
- University of South Carolina, Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, United States of America.
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Adams SA, Rohweder CL, Leeman J, Friedman DB, Gizlice Z, Vanderpool RC, Askelson N, Best A, Flocke SA, Glanz K, Ko LK, Kegler M. Use of Evidence-Based Interventions and Implementation Strategies to Increase Colorectal Cancer Screening in Federally Qualified Health Centers. J Community Health 2019; 43:1044-1052. [PMID: 29770945 DOI: 10.1007/s10900-018-0520-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
While colorectal cancer (CRC) screening rates have been increasing in the general population, rates are considerably lower in Federally Qualified Health Centers (FQHCs), which serve a large proportion of uninsured and medically vulnerable patients. Efforts to screen eligible patients must be accelerated if we are to reach the national screening goal of 80% by 2018 and beyond. To inform this work, we conducted a survey of key informants at FQHCs in eight states to determine which evidence-based interventions (EBIs) to promote CRC screening are currently being used, and which implementation strategies are being employed to ensure that the interventions are executed as intended. One hundred and forty-eight FQHCs were invited to participate in the study, and 56 completed surveys were received for a response rate of 38%. Results demonstrated that provider reminder and recall systems were the most commonly used EBIs (44.6%) while the most commonly used implementation strategy was the identification of barriers (84.0%). The mean number of EBIs that were fully implemented at the centers was 2.4 (range 0-7) out of seven. Almost one-quarter of respondents indicated that their FQHCs were not using any EBIs to increase CRC screening. Full implementation of EBIs was correlated with higher CRC screening rates. These findings identify gaps as well as the preferences and needs of FQHCs in selecting and implementing EBIs for CRC screening.
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Affiliation(s)
- Swann Arp Adams
- Department of Epidemiology and Biostatistics & Cancer Prevention and Control Program, Arnold School of Public Health & College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Catherine L Rohweder
- UNC Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, CB #7424, Carrboro, NC, 27510, USA
| | - Jennifer Leeman
- School of Nursing, The University of North Carolina at Chapel Hill, CB #7460, Chapel Hill, NC, 27599, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior & Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Ziya Gizlice
- UNC Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, CB #7426, Chapel Hill, NC, 27599, USA
| | - Robin C Vanderpool
- Department of Health, Behavior & Society, University of Kentucky College of Public Health, 2365 Harrodsburg Road, Ste. A230, Lexington, KY, 40504, USA
| | - Natoshia Askelson
- Department of Community & Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, 100 CPHB, Iowa City, IA, 52242, USA
| | - Alicia Best
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612-3805, USA
| | - Susan A Flocke
- Family Medicine and Epidemiology & Biostatistics, The Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, 11000 Cedar Ave, Suite 402, Cleveland, OH, 44106-7136, USA
| | - Karen Glanz
- Department of Biostatistics and Epidemiology, George A. Weiss University Professor, University of Pennsylvania School of Medicine, 801 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
| | - Linda K Ko
- Department of Health Services, Fred Hutchinson Cancer Research Center, University of Washington, 1100 Fairview Ave. N. M3-B232, Seattle, WA, 98109-1024, USA
| | - Michelle Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory Prevention Research Center, Emory University, 1518 Clifton Road NE Rm 530, Atlanta, GA, 30322, USA
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Farr DE, Brandt HM, Adams SA, Haynes VE, Gibson AS, Jackson DD, Rawlinson KC, Ureda JR, Hébert JR. Examining Breast Cancer Screening Behavior Among Southern Black Women After the 2009 US Preventive Services Task Force Mammography Guideline Revisions. J Community Health 2019; 45:20-29. [PMID: 31385186 DOI: 10.1007/s10900-019-00697-8] [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] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Updated United States Preventive Services Task Force (USPSTF) and American Cancer Society mammography screening recommendations push for increased age of initiation and lengthened breast cancer screening intervals. These changes have implications for the reduction of breast cancer mortality in Black women. The purpose of this study was to examine breast cancer screening behavior in a cohort of Southern Black women after the release of the 2009 USPSTF recommendations. Surveys assessing cancer screening information were collected from members of Black churches between 2006 and 2013. The sample was restricted to women aged 40 to 74 years, who did not report a breast cancer diagnosis, or a recent diagnostic mammogram (n = 789). Percentages of women ever completing a mammogram (age 40-49) and annual mammography (age 50-74) in 2006-2009 and 2010-2013 were compared using chi-square statistics. Logistic regression models were fit to determine the predictors of adherence to pre-2010 screening guidelines. No significant changes in mammography rates were found for women in the 40-49 age group (X2 = 0.42, p = 0.52) nor for those in the 50-74 age group (X2 = 0.67, p = 0.41). Completing an annual clinical breast exam was a significant predictor of adherence to pre-2010 screening guidelines for both age groups (OR 19.86 and OR 33.27 respectively) and participation in education sessions (OR 4.26). Stability in mammography behavior may be a result of PCP's advice, or community activities grounded pre-2010 screening recommendations. More research is needed to understand how clinical interactions and community-based efforts shape Black women's screening knowledge and practices.
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Affiliation(s)
- Deeonna E Farr
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 2307 Carol G. Belk Building, Mail Stop 529, Greenville, NC, 27858, USA.
| | - Heather M Brandt
- South Carolina Statewide Cancer Prevention and Control Program, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Swann Arp Adams
- South Carolina Statewide Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, College of Nursing, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Venice E Haynes
- South Carolina Statewide Cancer Prevention and Control Program, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Andrea S Gibson
- South Carolina Office of Rural Health, 107 Saluda Pointe Drive, Lexington, SC, 29072, USA
| | - Dawnyéa D Jackson
- Research Department, Rescue
- The Behavior Change Agency, 660 Pennsylvania Ave. SE, Suite 400, Washington, DC, 20003, USA
| | - Kimberly C Rawlinson
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
| | - John R Ureda
- Insights Consulting, Inc, 2728 Wilmot Avenue, Columbia, SC, 29205, USA
| | - James R Hébert
- South Carolina Statewide Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
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Eberth JM, Crouch EL, Josey MJ, Zahnd WE, Adams SA, Stiles BM, Schootman M. Rural-Urban Differences in Access to Thoracic Surgery in the United States, 2010 to 2014. Ann Thorac Surg 2019; 108:1087-1093. [PMID: 31238030 DOI: 10.1016/j.athoracsur.2019.04.113] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 08/17/2018] [Revised: 03/15/2019] [Accepted: 04/29/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Because of recent lung cancer screening recommendations and corresponding insurance coverage, it is expected that more early stage cases will be identified that require thoracic surgery. However, these services may not be equally available in all regions. Our objective is to describe the availability of thoracic surgeons by examining geographic variation, rural-urban differences, and temporal changes before and after screening recommendation and insurance coverage policy changes. METHODS We examined the U.S. thoracic surgery workforce using the 2010 and 2014 Area Health Resource Files. We calculated the density of thoracic surgeons per 100,000 persons for each year at the state and county level. We performed descriptive statistics and developed maps highlighting changes over time and geographic regions. RESULTS Despite an overall increase in thoracic surgeons from 2010 to 2014, we observed declining density nationwide (1.5% change) and in sparsely populated states. The difference in thoracic surgeon density widened slightly between 2010 from 0.80 per 100,000 compared with 0.84 per 100,000 in 2014 in all rural counties compared with urban counties (P < .001 for both years). The difference in thoracic surgeon density was most pronounced between small adjacent rural and urban counties (0.95 and 0.96 per 100,000 for 2010 and 2014, respectively; P < .001 for both years). The Northeast held a disproportionate share of the thoracic surgery workforce. CONCLUSIONS Limited access to thoracic surgeons in rural areas is a concern, given an older and retiring surgical workforce, the higher burden of lung cancer in rural areas, and recent policy changes for screening reimbursement.
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Affiliation(s)
- Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
| | - Elizabeth L Crouch
- Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Michele J Josey
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Whitney E Zahnd
- Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Swann Arp Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Brendon M Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York, New York
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Friedman DB, Adams SA, Brandt HM, Heiney SP, Hébert JR, Ureda JR, Seel JS, Schrock CS, Mathias W, Clark-Armstead V, Dees RV, Oliver RP. Rise Up, Get Tested, and Live: an Arts-Based Colorectal Cancer Educational Program in a Faith-Based Setting. J Cancer Educ 2019; 34:550-555. [PMID: 29492800 PMCID: PMC6113121 DOI: 10.1007/s13187-018-1340-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/02/2023]
Abstract
Engaging community members in efforts to reduce cancer-related health disparities through community mini-grant programs has been shown to have meaningful impact. A predominantly African-American church in South Carolina was awarded a community mini-grant to increase awareness about colorectal cancer (CRC) screening among disproportionally high-risk African-American communities through culturally appropriate arts-based cancer education. The church's pastor, health and wellness ministry, and drama ministry created a theatrical production called Rise Up, Get Tested, and Live. Over 100 attendees viewed the play. A pre/post-test evaluation design assessed the effectiveness of the production in increasing participants' knowledge about CRC and examined their intentions to be screened. Results showed increased knowledge about CRC, increased awareness and understanding about the importance of CRC screening, and favorable intentions about CRC screening. Findings suggest that arts-based cancer education may be an effective tool for the dissemination of information about CRC screening.
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Affiliation(s)
- Daniela B Friedman
- Department of Health Promotion, Education, and Behavior & Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
| | - Swann Arp Adams
- Department of Epidemiology and Biostatistics & Cancer Prevention and Control Program, Arnold School of Public Health and the College of Nursing, University of South Carolina, Columbia, SC, 29208, USA
| | - Heather M Brandt
- Department of Health Promotion, Education, and Behavior & Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Sue P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, 29208, USA
| | - James R Hébert
- Department of Epidemiology and Biostatistics & Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - John R Ureda
- Insights Consulting, Inc., Columbia, SC, 29205, USA
| | - Jessica S Seel
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Courtney S Schrock
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Wilhelmenia Mathias
- Health and Wellness Ministry, Trinity Baptist Church, Columbia, SC, 29204, USA
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Bell N, Arrington A, Adams SA, Jones M, Sakran JV, Mehta A, Eberth JM. Incidental Cancer Diagnoses in Trauma Patients: A Case-Control Study Evaluating Long-term Outcomes. J Surg Res 2019; 242:304-311. [PMID: 31128411 DOI: 10.1016/j.jss.2019.03.008] [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] [Received: 09/12/2018] [Revised: 01/02/2019] [Accepted: 03/06/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study evaluates whether trauma patients who incidentally learned about a malignancy have similar long-term outcomes as patients who organically learned about their malignancy. MATERIALS AND METHODS Incidental findings (IF) patients were matched to noninjured cancer controls on age group, sex, cancer site, stage, and year of diagnosis. Unadjusted covariates included race, insurance type, rural residence, and time from diagnosis to first cancer intervention. Cox proportional hazard regression models were used to measure adjusted all-cause and cancer-specific mortality risk. RESULTS Adjusted long-term mortality risk among IF cases was 1.42 (95% confidence interval [1.11-1.81]) compared with noninjured cancer controls. There was no statistically significant difference in all-cause mortality among IF cases who survived at least 30 d (1.24 [0.88-1.74]). IF cases had no increased risk of cancer-related mortality compared with controls (1.26 [0.96-1.64]). CONCLUSIONS Long-term mortality risks among trauma patients with incidental cancer diagnoses are no different than the cancer population as a whole among patients who survive at least 30 d after injury. IF trauma patients are not more susceptible to cancer-related causes of death as a result of a physiological stress response due to injury.
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Affiliation(s)
- Nathaniel Bell
- College of Nursing, University of South Carolina, Columbia, South Carolina.
| | | | - Swann Arp Adams
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Mark Jones
- Department of Surgery, University of South Carolina, Columbia, South Carolina
| | - Joseph V Sakran
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ambar Mehta
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Sorrell M, Wickersham K, Adams SA, Heiney SP. Racial disparities in setting of care in women with breast cancer in South Carolina. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18146] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18146 Background: African American (AA) women with breast cancer (BrCa) suffer a 40% higher mortality burden than White women despite having about equal incidence nationally and lower incidence in South Carolina. Our aim was to describe inpatient and emergency department visits by race and geographic location among BrCa survivors. Methods: We analyzed data from a study (1R15CA179355-01A1; Adams, PI) that combined administrative claims data from South Carolina’s Medicaid Program and a state-based, private-payor health plan to matching BrCA cases from the SC Central Cancer Registry. Race was determined by patient self-report. Geographic location was assigned using designations from the Rural-Urban Commuting Area Codes (RUCA). We used descriptive statistics to characterize the study sample and Chi-square test of independence to compare the descriptive statistics by race and rural/urban continuum. Results: The sample (N = 2723) was 33.6% AA, 91.8% non-Hispanic, primarily married 48.8%, and ranged in age from 14 to 64 years. Most women in the sample lived in an urban area (74.9 %). Most women had Stage I (16.9%), IIA (13.9%), or IIB (7.5%) disease. Women were primarily treated in an outpatient setting; 1.3% (n = 36) were seen in an emergency room and 1.2% (n = 34) were hospitalized. When comparing women living in a rural versus urban area, there were significant differences in TNM stage of disease (by pathology), marital status, race, and setting of care (all p’s ≤ 0.001). When comparing women by race, there were significant differences in age, ethnicity, marital status, stage of disease, and setting of care (all p’s ≤ 0.001). Conclusions: Women with BrCA in SC continue to experience disparities with regard to stage of disease at diagnosis and setting of care. Future research should focus on specific predictors of hospitalization and the relationship of rurality and race with setting of care.
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Affiliation(s)
- McKenzie Sorrell
- Palmetto Health/ University of South Carolina Internal Medicine Residency, Columbia, SC
| | | | - Swann Arp Adams
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Sue P. Heiney
- University of South Carolina, College of Nursing, Columbia, SC
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Lewis K, Kulkarni S, Adams SA, Brandt HM, Lead JR, Ureda JR, Fedrick D, Mathews C, Friedman DB. "For lack of knowledge, our people will perish": Using focus group methodology to explore African-American communities' perceptions of breast cancer and the environment. Environ Int 2018; 121:111-118. [PMID: 30195624 PMCID: PMC6221986 DOI: 10.1016/j.envint.2018.08.062] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/15/2018] [Accepted: 08/28/2018] [Indexed: 05/27/2023]
Abstract
Among women living in the United States, breast cancer is the second leading cause of cancer death. Disproportionate racial disparities in breast cancer exist, with African American (AA) women consistently having the highest rates of breast cancer related mortality despite lower incidence. This study attends to the Institute of Medicine's (IOM) call to action recommending the identification of effective strategies for communicating accurate and reliable breast cancer risk information to diverse audiences. Using focus group methodology, this study explores how AAs perceive and decipher information related to breast cancer and its relationship to their environment. Six focus groups were conducted. The sample (n = 50) was African American, 98% female, with an average age of 50.1 years. The focus group protocol consisted of open-ended questions designed to elicit information about participants' perceptions of their environment and its link to breast cancer. Focus groups were audio recorded and professionally transcribed. Analysis of the focus group transcripts revealed themes pertaining to these categories: (1) general knowledge and beliefs about breast cancer, (2) perceived environmental risks factors for breast cancer, (3) importance of seeking knowledge about breast cancer and the environment, and (4) recommended communication strategies. The emergent themes reflect the knowledge participants possessed about breast cancer and environmental risk factors, in addition to concerns about the importance of possessing accurate information, and how culturally appropriate health communication strategies can be used to disseminate breast cancer knowledge in the community. Findings from this study can be used for culturally appropriate communication about breast cancer and the environment with AA communities.
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Affiliation(s)
- Kaleea Lewis
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC 29208; Lewis: ; Kulkarni: ; Brandt: ; Friedman
| | - Shibani Kulkarni
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC 29208; Lewis: ; Kulkarni: ; Brandt: ; Friedman
| | - Swann Arp Adams
- Department of Epidemiology & Biostatistics, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC 29208; Adams:
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC 29208
- Statewide Cancer Prevention and Control Program, University of South Carolina, Discovery 1 Building, Suite 200, 915 Greene Street Columbia, SC 29208
| | - Heather M. Brandt
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC 29208; Lewis: ; Kulkarni: ; Brandt: ; Friedman
- Statewide Cancer Prevention and Control Program, University of South Carolina, Discovery 1 Building, Suite 200, 915 Greene Street Columbia, SC 29208
| | - Jamie R. Lead
- Department of Environmental Health Sciences, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC 29208; Lead:
- Center for Environmental Nanoscience and Risk, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC 29208
| | - John R. Ureda
- Insights Consulting, Inc., 1441 St Andrews Rd, Columbia, SC 29210; Ureda:
| | - Delores Fedrick
- Chester County Literacy Council, 109 Ella Street Chester, SC 29706; Fedrick:
| | - Chris Mathews
- Turning Pages Greater Columbia Literacy Council, 4840 Forest Drive, Suite 6B-PMB 267 Columbia, SC 29206; Mathews:
| | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC 29208; Lewis: ; Kulkarni: ; Brandt: ; Friedman
- Statewide Cancer Prevention and Control Program, University of South Carolina, Discovery 1 Building, Suite 200, 915 Greene Street Columbia, SC 29208
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Heiney SP, Parker PD, Felder TM, Adams SA, Omofuma OO, Hulett JM. A systematic review of interventions to improve adherence to endocrine therapy. Breast Cancer Res Treat 2018. [PMID: 30387003 DOI: 10.1007/s10549-018-5012-7.] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Adherence to endocrine therapy for hormone positive breast cancer is a significant problem, especially in minority populations. Further, endocrine therapy reduces recurrence and thus mortality. However, little data are available on interventions to improve adherence. The authors conducted a systematic review to examine the impact of interventions, strategies, or approaches aimed to improve endocrine therapy adherence among women with breast cancer. A secondary aim was to determine if interventions had any cultural modifications. METHODS Two of the authors examined articles published between 2006 and 2017 from a wide variety of databases using Covidence systematic review platform. RESULTS In total, 16 eligible studies met criteria for review including 4 randomized controlled trials, 4 retrospective studies, and 8 with various observational designs. Eligible studies used a broad range of definitions for adherence and measured adherence by self-report, medical records, claims data, and combinations of these. All used 80% medication possession ratio as a standard for adherence. Patient information/education was the most frequent intervention strategy but did not demonstrate a significant effect except in one study. Significant results were noted when education was combined with communication strategies. CONCLUSIONS Researchers need a standard definition for adherence and a reliable measure that is feasible to use in a variety of studies. While education may be a necessary component of an intervention, when used alone, it is not a sufficient approach to change behavior.
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Affiliation(s)
- Sue P Heiney
- College of Nursing, School of Medicine, University of South Carolina, 1601 Greene St, Columbia, 29208, SC, USA.
| | | | - Tisha M Felder
- College of Nursing, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Swann Arp Adams
- College of Nursing, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Omonefe O Omofuma
- Arnold School of Public Health, University of South Carolina, Columbia, USA
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Heiney SP, Parker PD, Felder TM, Adams SA, Omofuma OO, Hulett JM. A systematic review of interventions to improve adherence to endocrine therapy. Breast Cancer Res Treat 2018; 173:499-510. [PMID: 30387003 DOI: 10.1007/s10549-018-5012-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 06/08/2018] [Accepted: 10/15/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE Adherence to endocrine therapy for hormone positive breast cancer is a significant problem, especially in minority populations. Further, endocrine therapy reduces recurrence and thus mortality. However, little data are available on interventions to improve adherence. The authors conducted a systematic review to examine the impact of interventions, strategies, or approaches aimed to improve endocrine therapy adherence among women with breast cancer. A secondary aim was to determine if interventions had any cultural modifications. METHODS Two of the authors examined articles published between 2006 and 2017 from a wide variety of databases using Covidence systematic review platform. RESULTS In total, 16 eligible studies met criteria for review including 4 randomized controlled trials, 4 retrospective studies, and 8 with various observational designs. Eligible studies used a broad range of definitions for adherence and measured adherence by self-report, medical records, claims data, and combinations of these. All used 80% medication possession ratio as a standard for adherence. Patient information/education was the most frequent intervention strategy but did not demonstrate a significant effect except in one study. Significant results were noted when education was combined with communication strategies. CONCLUSIONS Researchers need a standard definition for adherence and a reliable measure that is feasible to use in a variety of studies. While education may be a necessary component of an intervention, when used alone, it is not a sufficient approach to change behavior.
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Affiliation(s)
- Sue P Heiney
- College of Nursing, School of Medicine, University of South Carolina, 1601 Greene St, Columbia, 29208, SC, USA.
| | | | - Tisha M Felder
- College of Nursing, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Swann Arp Adams
- College of Nursing, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Omonefe O Omofuma
- Arnold School of Public Health, University of South Carolina, Columbia, USA
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Kulkarni S, Lewis K, Adams SA, Brandt HM, Lead JR, Ureda JR, Fedrick D, Mathews C, Friedman DB. A Comprehensive Analysis of How Environmental Risks of Breast Cancer are Portrayed on the Internet. Am J Health Educ 2018; 49:222-233. [PMID: 30079123 PMCID: PMC6075842 DOI: 10.1080/19325037.2018.1473182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Effective online communication about the environmental risk factors of breast cancer is essential because of the multitude of environmental exposures and debate regarding the conclusiveness of scientific evidence. PURPOSE The aim of this study was to assess the content, readability, and cultural sensitivity of online resources focused on the environmental risks factors of breast cancer. METHODS A purposive sample of webpages focused on environmental risk factors of breast cancer was obtained through a Google search using 17 search terms. Using nonparametric statistics, we assessed the content, readability, and cultural appropriateness of 235 webpages. RESULTS Eighty-two percent of webpages referred to research studies in their content. For the majority of sites, readability was at a high-school reading grade level. Webpages were not explicitly intended for specific racial/ethnic groups. DISCUSSION Technical language and non-culturally specific messages may hinder users' attention to and comprehension of online breast cancer information. Additional research is needed to examine in-depth the accuracy of this online content. TRANSLATION TO HEALTH EDUCATION PRACTICE Findings suggest that collaborations between scientists, health educators, website designers/media professionals, and the community will be critical to the delivery of accurate, up-to-date, plain-language, and culturally sensitive information about breast cancer and the environment.
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Affiliation(s)
- Shibani Kulkarni
- Department of Health Promotion, Education, and Behavior, University of South Carolina, 915 Greene Street, Room 529, Columbia, SC 29208
| | - Kaleea Lewis
- Department of Health Promotion, Education, and Behavior, University of South Carolina, 915 Greene Street, Room 529, Columbia, SC 29208
| | - Swann Arp Adams
- Department of Epidemiology & Biostatistics, University of South Carolina
- College of Nursing, University of South Carolina
- Statewide Cancer Prevention and Control Program, 915 Greene Street, Room 244, Columbia SC 29208
| | - Heather M Brandt
- Department of Health Promotion, Education, and Behavior, University of South Carolina
- Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Discovery I Building, Columbia, SC 29208
| | - Jamie R Lead
- Department of Environmental Health Sciences, University of South Carolina
- Center for Environmental Nanoscience and Risk, University of South Carolina, 921 Assembly Street, Public Health Research Center, Suite 511, Columbia, SC 29208
| | - John R Ureda
- Insights Consulting, Inc. 2728 Wilmot Ave., Columbia, SC 29205-254
| | - Delores Fedrick
- Chester County Literacy Council, 109 Ella Street, Chester, SC, 29706
| | - Chris Mathews
- Turning Pages Greater Columbia Literacy Council, 4711 Forest Drive, Suite 3, PMB 267, Columbia SC 29206
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina
- Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Suite 557, Columbia SC, 29208
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Ersek JL, Symanowski JT, Kim ES, Adams SA, Hébert JR, Eberth JM. Factors predicting molecular testing and its impact on survival in racially diverse patients with advanced, non-small cell lung cancer: A retrospective, population-based analysis using administrative claims data. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18691] [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: 11/20/2022] Open
Affiliation(s)
| | | | - Edward S. Kim
- Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Swann Arp Adams
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - James R. Hébert
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia. Connecting Health Innovations LLC., Columbia, SC
| | - Jan Marie Eberth
- Arnold School of Public Health, University of South Carolina, Columbia, SC
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