Abstract
Mailed FIT to Improve Colorectal Cancer Screening in an Integrated Safety-Net System
Carly Rachocki, MPH1, Victoria Laleau1, Lisa Golden, MD2, Ellen Chen, MD3, Barbara Grimes, PhD1, Eric Vittinghoff, PhD1, Uri Ladabaum, MD4 and Ma Somsouk, MD, MAS1
(1)University of California, San Francisco, San Francisco, CA, (2)Department of Public Health, San Francisco, San Francisco, CA, (3)San Francisco Department of Public Health, San Francisco, CA, (4)Stanford University, Stanford, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Objective: An integrated electronic health record offers the opportunity to centralize care for metrics such as colorectal cancer (CRC) screening. Such models have worked in private health systems, but whether this model can succeed in the uninsured and underinsured remains to be determined.
Methods: Patients 50-75 years who were not up-to-date with CRC screening were randomized to usual care versus usual care plus outreach. For outreach, patients were mailed a fecal immunochemical test (FIT) with a preceding postcard and phone call. A follow-up phone call was triggered if the FIT kit was not returned after 3 weeks.
Results: Preliminary results are available for one clinic in which the screening rate in 2015 was 50%. 431 patients have been assigned to the intervention group and 433 to usual care. The population served is racially diverse with 21% White, 26% Hispanic, 23% Black, and 27% Asian. Within the intervention group, 76% were eligible to receive FIT kits. Among those with at least 28 days of follow-up after being mailed a FIT kit, the completion rate was 37% compared with 4% in the usual care only arm (P<0.01). Patients who previously completed a FIT test were more likely to complete the mailed FIT test (62% vs. 25%, P<0.01).
Conclusion: Short-term, active outreach increases participation in CRC screening. Whether the benefit persists at one year is not known. The effectiveness of the program in different clinical settings and different population demographics and the cost-effectiveness of this program in these varied settings will be examined.
Chronic disease management and prevention Implementation of health education strategies, interventions and programs Public health or related research
Abstract
Factors Associated with Colorectal Cancer Screening Behaviors Among Korean Americans
Grace X. Ma, PhD1, Yin Tan, MD, MPH1, Joanne Rhee, MSW1, Minsun Lee, PhD1, Brenda Seals, PhD2 and Ziding Feng, PhD3
(1)Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, (2)Lewis Katz School of Medicine, Temple University, Philadelphia, PA, (3)University of Texas MD Anderson Cancer Center, Houston, TX
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Screening reduces the burden of colorectal cancer (CRC) through early detection of cancerous lesions and removal of precancerous polyps. Despite screening benefits and high incidence, CRC screening rates are significantly low in Korean Americans. Understanding the components of a CRC screening intervention that facilitate behavioral change is important to enhance the effectiveness of intervention.
Objective: The purpose of the study was to identify psychosocial factors associated with CRC screening compliance among Korean Americans.
Methods: A clustered randomized trial was conducted at 30 Korean churches recruited in NJ and PA states to improve CRC screening among Korean Americans (N=1445). Based on the Health Belief Model and Social Cognitive Theory, the culturally appropriate intervention addressed knowledge of CRC, self-efficacy, and risk susceptibility, as well as perceived barriers, benefits, and severity. The ANCOVA was conducted on each psychosocial variable between the intervention and control groups at 12-month follow up. In addition, a logistic regression was conducted with the change scores of psychosocial variables as the predictor and the CRC screening at the 12-month follow-up as the dependent variable.
Results: At the 12-month follow-up, four psychosocial factors were significantly higher among the participants in the intervention compared to the control group: knowledge, self-efficacy, perceived severity, and risk susceptibility. The increased knowledge was associated with greater likelihood of having the CRC screening, even after controlling for treatment group.
Assessment of individual and community needs for health education Chronic disease management and prevention Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Public health or related education Public health or related research
Abstract
Breast and cervical cancer control in the 21st century: Results from a screen, result and treat in one-day screening model for medically underserved women
Jameisha B. Brown, M.S., CHES1 and Sonia C. Robazetti, MD, CCRC2
(1)Texas A&M University, College Station, TX, (2)University of Texas at Houston McGovern Medical School, Houston, TX
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
PURPOSE
Cervical cancer is detected among more than 12,000 women, annually. Adhering to pap-screening guidelines, cervical cancer can essentially be eliminated. Likewise, when breast cancer is detected at earlier stages the greater the likelihood of 5-year survival, 98%. The See, Test & Treat® Texas model provides free breast and cervical cancer screenings with same-day results to communities identified as underserved.
METHODS
Through a volunteer-led, multidisciplinary, health professional collaboration, this screening model targeted medically underserved women ages 21-65 with: 1) breast and cervical cancer screenings, 2) same-day results, 3) health education counseling, 4) and linkage to treatment and follow-up care in a culturally and linguistically competent setting at no cost.
RESULTS
Over 750 women attended the free special screening programs over a 3-year period. Of those that participated, 673 never or rarely been screened women received a pelvic, breast exam, and Pap test. Of these women, 55 had abnormal Pap tests, 28 of these underwent same-day colposcopy and 9 completed a Loop Electrosurgical Excision Procedure. Seventy-six mammograms were performed. Two Breast Fine Needle Aspirations were provided on-site for women with a palpable breast mass. Four breast malignancies were detected. All women participated in at least 3 of 8 health education counseling sessions offered to encourage risk-reduction behaviors related to cancer and chronic diseases. Participants were predominately minorities, low-income, uninsured or under-insured, and between 40-49 years.
CONCLUSIONS
Findings suggest that additional dissemination of same-day screen, result and treat models are promising to reach demographics most affected by breast and cervical cancer disparities.
Administer health education strategies, interventions and programs Clinical medicine applied in public health Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs
Abstract
Helping southern Idaho disparate populations get recommended colorectal cancer screening
Melanie Shouse-Gonzales, MSPH, MCHES
St Luke's Mountain States Tumor Institute, Twin Falls, ID
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background:
In Idaho, colorectal cancer (CRC) is the second leading cause of death for both sexes. In 2012, Idaho ranked 38th in the U.S. with only 60.6% of persons aged 50-75 current for CRC screening. Screening can detect CRC early by finding precancerous polyps which can be removed before turning cancerous. Southern Idaho has areas of rural communities with a larger percentage of foreign born, linguistically isolated, lower education levels and medically underserved people than the state as a whole, leading to a large portion of the population without recommended CRC screening.
Method: Since 2004, St. Luke's Mountain State Tumor Institute, a community cancer center has distributed screening kits, with expanded regional distribution of free home CRC screening kits beginning in 2011. Kits were distributed though both traditional and non-traditional clinical-community linkages, including collaborations with employers, community organizations and other local events. These linkages were chosen for their potential to impact the disparate population, ensuring at least one option for CRC screening is available.
Results:
An extensive distribution of kits, along with other educational and outreach efforts through a variety of non-traditional linkages, have helped increase awareness, educational opportunities and in certain areas, helped support efforts where trends are showing increased screening colonoscopy rates.
Conclusion:
Use of non-traditional linkages for CRC screening kit distribution provides cancer screening tools for disparate populations and can help improve screening colonoscopy rates.
Chronic disease management and prevention Implementation of health education strategies, interventions and programs Public health or related research
Abstract
Factors that determine concern about colorectal cancer
Nicholas Albaugh1, Barbara Curbow, PhD2, Evelyn King-Marshall, PhD, MPH1, Nora Mueller, MAA1 and Jonathan Chun, MD3
(1)University Of Maryland - College Park, College Park, MD, (2)University of Maryland - College Park, College Park, MD, (3)Providence Portland Medical Center, Portland, OR
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
background
Researchers have explored fear and other barriers that prevent screening for cancer; most importantly studying factors that might contribute to health disparities. Colorectal cancer is the fourth leading cause of cancer in the world but it can be prevented or caught at an early stage through colonoscopy. This study analyzed possible barriers to receiving a colonoscopy and follow up care relating to patient factors.
methods
Participants were recruited from two large university-based urban clinics in Maryland (n=115) on the morning of their colonoscopy. They were questioned about their demographics, perceived health literacy and perceptions of the upcoming colonoscopy surgery.
findings
Gender (p<.05) and yearly household income (p<.005) were significantly associated with concern about having colorectal cancer before the colonoscopy. Perceived health literacy (p<.005), gender (p<.05) and yearly household income (p<.005) were significantly associated with how informed patients perceived themselves to be about colorectal cancer before the colonoscopy. Males and those with lower yearly household incomes reported being more concerned and less informed about colorectal cancer than females and those with higher yearly household incomes. Higher perceived health literacy was associated with a higher perception of being informed of colorectal cancer.
conclusion
Results can be used to train providers to convey consequences of colorectal cancer to men in an effective manner to allay concerns and support their decision to have a colonoscopy. Interventions to educate those who are not as informed, such as those with low income or low health literacy, are needed to ensure everyone has equal access to health screening.
Chronic disease management and prevention Other professions or practice related to public health Public health or related research Social and behavioral sciences Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Investigating Travel Time to Mammogram Facilities as a Barrier for Early Detection of Breast Cancer among Underserved Women
Patricia Da Rosa, DDS, M.Sc.1, Yan Lin2, Ashley Miller, MPH3 and Karen Cudmore, BS3
(1)South Dakota State University (SDSU), BROOKINGS, SD, (2)South Dakota State University (SDSU), SD, (3)South Dakota Department of Health, SD
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Objective: To investigate whether the All Women Count! (AWC!) program has reached the underserved women in South Dakota and if travel time to a mammography facility was associated with screening rates. Methods: This study used data from the Small Area Health Insurance Estimates and the Minimum Data Elements (MDEs) to examine the number of women eligible for the program, and the number of women screened by AWC!, respectively. The proportion of eligible women aged 50-64 who received a program-funded mammogram during 2013-2014 was determined for the state and by county. Further, the shortest travel time to a mammography facility was measured in GIS. Using linear regression analysis, the association between screening rates and travel time to the nearest mammography facility was assessed. Results: Among all South Dakota women aged 50-64, 5,323 (6.3%) were eligible for the AWC! program, for being uninsured, and having a family income equal or below 200% of the federal poverty level. Of these women, 1,529 (28.7%) received a mammogram paid by the program. Rates varied substantially by county. The average travel time to the closest mammography facility ranged between 5 and 129 minutes. The regression results showed that screening rates were significantly associated with travel time (correlation coefficient -0.24 at 0.05 significance level).Conclusion: Although the AWC! program provided screening services to a large number of underserved women, 71.3% of the eligible women did not receive the recommended mammogram through the program. Travel time to a mammography facility was significantly associated with screening rates.
Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Epidemiology
Abstract
Adverse Childhood Experiences and Use of Colorectal Cancer Screening Among Women
Héctor Alcalá, MPH, PhD, Jessica Keim-Malpass, PhD, MPH, RN and Emma Mitchell, PhD, RN
University of Virginia, Charlottesville, VA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background:
Adverse Childhood Experiences (ACEs) have been associated with an increased risk for cancer. However, research has largely ignored the association between ACEs and cancer screening, a potentially mediating mechanism. As such, the present study examined the association between ACEs and ever using colorectal cancer (CRC) screening, among women age 50 and over.
Methods:
Analyses used the 2011 Behavioral Risk Factor Surveillance System (n=15,314) to model odds of ever engaging in CRC screening form nine different adversities. Bivariate and multivariate models were fit. Multivariate models controlled for age, race/ethnicity, educational attainment, state of residence and insurance status.
Results:
In bivariate models no ACE items were associated with CRC screening. In multivariate models that accounted for potential confounders, emotional abuse, sexual abuse, living with parents that were mentally ill and living with parents that were problem drinkers/alcoholics were each associated with higher odds of engaging in CRC.
Discussion:
Results highlight a potential mechanism by which early childhood experiences can impact health. However, because results showed a protective effect of adversity, additional research is needed to understand what motivates this pattern of behavior.
Chronic disease management and prevention Social and behavioral sciences
Abstract
Breast Cancer Screening Barriers and Medical Mistrust Among Arab American Women
Kim Jaffee, MSW, PhD1, Adnan Hammad, MPH, PhD2, Hiam Hamade, MPH3, Miri Cohen, PhD4, Faisal Azaiza, PhD4 and Hayley Thompson, Ph.D.5
(1)Wayne State University, Detroit, MI, (2)Global Health, Management & Solutions, Novi, MI, (3)Arab Community Center for Economic and Social Services (ACCESS), Dearborn, MI, (4)University of Haifa, Haifa, Israel, (5)Karmanos Cancer Institute - Wayne State University, Detroit, MI
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Breast cancer is the second most common cancer among women in the US (CDC, 2013). Studies suggest that cancer is diagnosed at later stages for Arab Americans and prevention efforts should be better understood (Arshad, 2011; Hirko et al., 2013). Cultural barriers and medical mistrust have been associated with breast cancer screening rates (Cohen & Azaiza, 2010; Thompson, et al, 2004). We examined the association between medical mistrust and breast cancer screening barriers – 1) environmental; 2) social; 3) body exposure; and 4) religious while controlling for demographic characteristics, employment, and religiosity. A heterogeneous sample of 196 women across different socioeconomic strata and Arab ancestry were recruited from a large health and social services agency and Mosques and administered a 15 minute paper and pencil questionnaire. A multiple regression analysis revealed a statistically significant association between the medical mistrust dimension of “suspicious of health care providers” and environment (β = .418, p=.000), social (β = .332, p=.001), body exposure (β = .226, p=.019), and religious (β = .208, p=.015) breast cancer screening barriers. Medical mistrust is positively associated with greater cultural barriers to breast cancer screening. These findings suggest that mistrust of medical care accentuates cultural barriers for Arab American women. This study illuminates the need to emphasize strategies that will target the medical care system and the cultural barriers to breast cancer screening among Arab American women.
Social and behavioral sciences
Abstract
Effective client-directed interventions in randomized controlled trials (RCTs) to improve colorectal cancer screening among underserved and underinsured populations: A Systematic Review
Aldenise Ewing, MPH1, Coralia Vazquez-Otero, JD, MPH, CPH1, Belinda-Rose Young, MSPH, CPH2, Claudia Aguado Loi, PhD, MPH, CHES2, Bria Thomas1, Carol A. Bryant, PhD2, Cathy Meade, PhD, RN, FAAN3 and Clement Gwede, PhD, MPH, RN, FAAN3
(1)University of South Florida, College of Public Health, Tampa, FL, (2)University of South Florida, Tampa, FL, (3)Moffitt Cancer Center and Morsani College of Medicine, University of South Florida, Tampa, FL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Colorectal cancer is the second leading cause of cancer-related deaths in the United States. It is also the third most commonly diagnosed cancer. Although many studies have been conducted regarding colorectal cancer screening (CRCS) interventions, evidence gaps on the effectiveness of client-directed interventions (CDIs) still exist. The purpose of this study was to assess the characteristics of CDIs based on their magnitude of effects.
We conducted a systematic review of the literature to identify promising evidence-based interventions (EBIs) for CRCS. Upon the review of published articles from August 2009 to December 2014, we identified 36 client-directed RCTs. These interventions were assessed in terms of magnitude of effects, population for which they worked, and intervention components.
Results: These interventions took place within a number of settings (e.g., health clinics, churches, community gatherings, within the homes of clients, etc.) and focused upon the CDIs for both genders and various racial/ethnic subgroups (e.g. African Americans, Asians, Native Americans, Hispanics and Whites). Uptake of screening ranged from 20-49% among the intervention groups and 2-30% among the usual care groups. Components of the effective CDIs included six broad categories: Patient Navigator/Promotora (n=6), Client Reminders/Telephone Outreach (n=9), FIT (fecal immunochemical test) kits (n=12), small media (n=19), One-on-One education and group education (combined n=22).
Conclusions: Multi-component CDIs involving client reminders, coupled with tailored and non-tailored educational information, and patient navigation demonstrated the greatest effectiveness. Interventions aimed at reducing structural barriers related to access, such as FIT kit distribution to patients, were also found to be effective.
Administer health education strategies, interventions and programs Chronic disease management and prevention Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Public health or related research Social and behavioral sciences
Abstract
Role of the Gulf War on Kuwaiti Breast Cancer: Environmental Factors and Stressful Life Events
Charles Cange, PhD, MSc
UMBC, Baltimore, MD
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction--Kuwait has experienced a dramatic increase in breast cancer rates since the late 1990s. The breast is a likely bodily site affected by chronic, sustained exposures to Gulf War-era polycyclic aromatic hydrocarbons. This study examines if there is an association with breast cancer prevalence and extreme, sustained stress, alienation.
Methods--This cross-sectional, case-control study (N=589) enrolled women between 18-86 years old. We created three groups: the cancer group (n=121), the “screening/at-risk” group (n=215) and the control group (n=253). Conducted in Kuwaiti clinics, the survey instrument was the European Quality of Life questionnaire. Traumatic impacts were measured using Falsetti's modified PDS scale.
Results--71% of the breast cancer group spent 9 months+ inside Kuwait during the war compared to 64% in the other two groups. For the 38% of women with traumatic event, the women in the breast cancer and screening groups were more likely to have clinically significant PTSD scores than the control group (18%, 16% vs. 6%). The breast cancer group reported the least functioning scores for cognitive and emotional subscores compared to controls (63 vs. 72; 64 vs. 75), and for emotional health, worse than the screening group (64 vs. 70).
Discussion--There may be associations with Gulf War-era. The breast cancer group reported mental health concerns with double the odds of either the other groups. Also, the breast cancer group recounted double the odds of experiencing a traumatic event over the control group. This study suggests that breast cancer may be associated with traumatic events post-Gulf War.
Assessment of individual and community needs for health education Diversity and culture Environmental health sciences Epidemiology Public health or related public policy Social and behavioral sciences