Abstract
Predictors of women’s non-adherence to pap test screening national recommendations: Use of the modified integrated behavioral model
Rachel Mahas, PhD, MS, MPH1, Jiunn-Jye Sheu, PhD, MSPH, MCHES2, Shipra Singh, MBBS, MPH, PhD2, Timothy Jordan, M.Ed., Ph.D2 and Andrew Geers, PhD2
(1)Madonna University, Livonia, MI, (2)University of Toledo, Toledo, OH
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
BACKGROUND: Reports from the CDC showed that cervical cancer screening has declined by 5.5% from 2008-2013. This is concerning considering that Healthy People 2020 states a 93% cervical cancer screening rate as its’ objective. This study used a modified Integrated Behavioral Model (IBM) to predict women’s non-adherence to Pap test screening national recommendations.
METHODS: 398 women were surveyed to examine the direct and indirect influences on self-reported Pap test screening behaviors. Bivariate analysis was used to examine demographic factors. A Path analysis was conducted to evaluate the relationships among the modified IBM constructs in predicting Pap test screening Intentions and women’s non-adherence to Pap test screening national recommendations.
RESULTS: Bivariate analyses showed that women aged 36-49 were about three times more likely to have not adhered to Pap test screening national recommendations (OR= 2.75, 95% CI 1.40-5.41) than women aged 21-35. Results of the path analysis indicated that an increase in Instrumental Attitude (β= 0.19, p<.05), Experiential Attitude (β= 0.15, p<.05), Injunctive Norm (β= 0.16, p<.05), Self-efficacy (β= 0.24, p<.05), and Perceived Risk (β= 0.13, p<.05) were associated with an increased likelihood of Pap test screening Intentions (β= -0.10, p<.05) (R2=.32).
CONCLUSIONS: Findings showed that Self-efficacy was the strongest positive predictor of women’s non-adherence to Pap test screening national recommendations therefore is suggested to be most targeted in improving Pap test screening Intentions. Our results emphasize the need for various dimensions of Attitude subscales- Experiential Attitude and Instrumental Attitude- to be considered when developing Pap test screening interventions.
Epidemiology Public health or related education Public health or related research Social and behavioral sciences
Abstract
South Dakota breast cancer screening for underserved women, 2001-2015
Patricia Da Rosa, DDS, M.Sc.1, Karen Cudmore, BS2, Ashley Miller, MPH2 and K.M. Reeder, PhD, RN, FAHA1
(1)South Dakota State University (SDSU), BROOKINGS, SD, (2)South Dakota Department of Health, SD
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background. Breast cancer incidence in South Dakota is ranked second highest in the United States. The All Women Count! (AWC!) Program was designed to provide breast cancer screening to low-income, and underserved women throughout the state. This study aims to evaluate the AWC! Program breast cancer screening results over a 15-year period.
Methods: A secondary analysis was conducted using AWC! Program data between 2001-2015. Univariate and bivariate analysis were used to describe breast cancer screening results.
Results. A total of 21,375 unique women were enrolled in the Program between 2001-2015, with an estimated reach of 20% of eligible women, statewide. Overall, 15,383 (72%) women were White, non-Hispanic, 3,547 (17%) were American Indian/Alaska Native, 1,708 (8%) were Hispanic, and 737(3%) unknown. A total of 21,319 mammograms were performed. For all ages, 3,302 (16%) initial mammograms had abnormalities and 306 (14.4 per 1,000 mammograms) breast cancers were detected, excluding lobular carcinoma in situ. Of these, 202 (66%) breast cancers were invasive, and more likely to occur among women aged 50 years and older (OR=2.0, 95%CI: 1.2, 3.1). A decline in the number of mammograms performed over the 15 years was observed, with an average decrease of 16% per year between 2012-2015.
Conclusions. The AWC!Program provides breast cancer screening services to underserved, vulnerable populations in South Dakota who might otherwise lack access to breast cancer screening services. Preliminary data show that opportunities exist for focusing screening efforts on early detection, and performing analyses to better understand mammography and breast cancer trends over time.
Chronic disease management and prevention Epidemiology Other professions or practice related to public health Planning of health education strategies, interventions, and programs Public health or related research
Abstract
Presence of asbestos in consumer talc products: Evaluating a “zero tolerance” policy
Joan Steffen, BA1, Ella Fassler, BS2, David Egilman, MD, MPH3 and Triet Tran3
(1)Never Again Consulting, Attleboro, MA, (2)Cornell University, Brooklyn, NY, (3)Brown University, Attleboro, MA
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: In 1973, the FDA proposed regulation to assure that cosmetic products were at least 99.9% asbestos-free. Instead, the talc industry established voluntary standards for testing asbestos in talc in 1976 and set a “zero tolerance” standard. Talc mining and manufacturing companies have since claimed that their pharmaceutical and cosmetic grade talc is asbestos-free.
Objective: Evaluate the claim that consumer talc is “asbestos-free” by reviewing records produced by talc mining and manufacturing companies.
Methods: The authors employed systematic search techniques and a grounded theory approach to review corporate documents. Talc-related documents were initially searched for asbestos-related terms. The authors conducted additional searches, focusing on terms associated with testing protocols, quality control measures, and specific talc mines and mills. The authors also reviewed depositions of individuals connected to talc litigation.
Results: Corporate tests indicate that talc used in cosmetics contained asbestos, arsenic and silica. The test methods adopted by the industry had a high limit of detection and therefore could never assure that talc was asbestos-free. Even with insensitive methods, company tests identified asbestos in talc mines and in talc products. Talc that tested positive for asbestos was sometimes re-tested to achieve a negative result before it was sent to market.
Discussion: Talc companies cannot assure a “zero tolerance” standard for asbestos in talc. IARC has classified asbestos as an ovarian carcinogen and epidemiologic studies have shown as association between talc use and ovarian cancer. The presence of asbestos in talc provides a possible explanation for this association.
Public health or related public policy
Abstract
An exploration of African American parents and daughters’ health beliefs towards HPV infection and HPV vaccine acceptance
Kayoll Galbraith Gyan, PhD, RN1, Coretta Jenerette, PhD, RN, CNE, AOCN2, Julia Lechuga, MA, PhD3, Jill B. Hamilton, PhD, RN, FAAN4, LTC Angelo D. Moore (ret.), PhD, MSN, FNP-BC5 and Mary H. Palmer, PhD6
(1)Harvard T. H. Chan School of Public Health, Boston, MA, (2)UNC Chapel Hill School of Nursing, Chapel Hill, NC, (3)Lehigh University, Bethlehem, PA, (4)Emory University, Atlanta, GA, (5)Moore & Moore Healthcare Consulting, LLC., Cumberland, NC, (6)University of North Carolina at Chapel Hill, Chapel Hill, NC
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Objective: To explore the health beliefs of African American parents and daughters ages 12-17 years old on HPV infection and HPV vaccine acceptance.
Methods: Grounded theory techniques of theoretical sampling and constant comparison analysis guided the study of African American parents (n=30) and daughters (n=34). Participants primarily resided in urban areas, and had economically diverse income levels.
Results: Few parents (n=2, 6.7%) and no daughter perceived susceptibility to HPV infection. A majority of parents (n=30, 100%) and daughters (n=31, 93.9%) perceived getting HPV infection as severe, and subsequently getting genital warts and cervical cancer as severe. This perceived severity was based on the belief that (1) an HPV infection would signal to parents that daughters were sexually active, and (2) an HPV infection would put daughters at risk for developing genital warts and cancer. Parents (n=20, 66.7%) and daughters (n=29, 87.9%) perceived benefits based on its genital warts and cancer prevention benefits. Though perceived barriers among parents (n=17, 56.7%) and daughters (n=11, 34.4%) varied, many barriers were similar such as concerns about side effects, safety, newness of the vaccine, and having limited information to determine the value of vaccination. Cues to action varied among parents and daughters, and self-efficacy was much higher among parents (n=29, 96.7%) than daughters (n=2, 7.1%).
Conclusion: Understanding the health beliefs that promote HPV vaccine acceptance, while identifying and addressing beliefs that are barriers among parents and daughters will assist in the development of appropriate HPV vacine initiatives for this population.
Social and behavioral sciences
Abstract
Predictors of cervical cancer screening among women in the United States
Stephanie Miles-Richardson, DVM, PhD, Diamond Elston, Reinetta Thompson Waldrop, DrPH, MSHS, FACHE, Mechelle Claridy, MPH and Gemechu Gerbi, PhD, MSc
Morehouse School of Medicine, Atlanta, GA
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: Every year, about 12,000 women are diagnosed with cervical cancer, and over 4000 will die from the disease in the United States (US). Cervical cancer screening is critical to prevent cervical cancer and reduce cervical cancer disparities. The objective of this study was to examine the factors associated with cervical cancer screening among women ages 14-45 years of age in the US.
Methods: Data were analyzed from 2013-2015 National Survey of Family Growth (NSFG). Multivariable analyses were used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) for factors associated with cervical cancer screening. Analyses were conducted using SAS 9.4.
Results: After adjusting for socio-demographic and socio-economic factors, having less than a college level of education, an annual household income of less than $50,000, and having never been married reduced the likelihood of participation in cervical cancer screening. Factors that increased the likelihood of participation in cervical cancer screening included having used birth control pills (AOR= 1.81; 95% CI=1.64, 2.01), having used condoms (AOR= 1.52; 95% CI=1.28, 1.79), having been diagnosed with genital warts (AOR= 1.47; 95% CI=1.28, 1.69) and having been diagnosed with herpes (AOR= 1.23; 95% CI=1.01, 1.50).
Conclusion: Results of this study suggest that socio-demographic factors, contraceptive use, and having been diagnosed with genital warts and herpes are significant predictors of cervical cancer screening. These findings highlight the need to identify potential prevention strategies to promote cervical cancer screening among at-risk groups.
Chronic disease management and prevention Epidemiology Public health or related public policy Public health or related research Social and behavioral sciences
Abstract
Breast cancer incidence by stage before and after screening interval change (year 2009): No adverse effect of prolonged interval
Fangjian Guo, MD, PhD, Yong-Fang Kuo, PhD and Abbey Berenson, MD, PhD, MMS
University of Texas Medical Branch, Galveston, TX
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: The US Preventive Services Task Force (USPSTF) changed breast cancer screening with mammogram from every 1-2 years among women ≥40 years old to personalized screening decisions for women 40-49 years and screening every 2 years for women 50-74 years in 11/2009. Since then, annual mammography rates have declined significantly.
Objective: To assess the impact of 2009 guideline change on breast cancer incidence.
Methods: We compared the trends, incidences, and compositions of breast cancer by size and stage among women 40-74 years old between 2006-2009 and 2010-2013, using data from the Surveillance, Epidemiology, and End Results (SEER) Program (18 registry areas, covering ~30% of targeted US population).
Results: Age-adjusted incidence among women 50-74 years old had no change during 2010-2013 (from 396.7 to 404.8/100,000), and there was no difference in the trends between 2006-2009 and 2010-2013. No significant trends or difference in trends were observed among women 40-49 years old during 2010-2013 (from 198.0 to 208.2/100,000) and 2006-2009 (from 201.5 to 208.6/100,000). The average annual incidence in breast cancer, and the composition of breast cancer by stage (ductal carcinoma in situ (DCIS), localized, regional, and distant) or size were all similar between 2006-2009 and 2010-2013 among both women 40-49 and 50-74 years old. We observed similar patterns in Whites, Blacks, and Hispanics.
Conclusion: Prolonged screening interval has no immediate adverse effects on the detection of breast cancer. Reducing healthcare usage by mammogram will provide an opportunity for reallocating resources to other urgent public health matters towards creating the healthiest nation.
Advocacy for health and health education Epidemiology Public health or related organizational policy, standards, or other guidelines
Abstract
Chronic comorbidities and cervical cancer screening and adherence among US-born and foreign-born women
Leslie Cofie, PhD, Jacqueline Hirth, PhD, MPH and Abbey Berenson, MD, PhD, MMS
University of Texas Medical Branch, Galveston, TX
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: Chronic comorbidities have been associated with lower cervical cancer screening participation. However, it is unknown how immigration status affects provider recommendation and cervical cancer screening among those with chronic conditions. This study examined whether chronic comorbidities are associated with cervical cancer screening recommendation and adherence, and whether associations vary between foreign-born and US-born women.
Methods: Data from the 2013 and 2015 National Health Interview Survey on women age 21-65 years (N= 23166) were used for this study. Bivariate associations of cervical cancer screening recommendation and adherence (screened in the last 3 years) between foreign and US-born women were examined using chi-square analysis. Multivariate binary logistic regression analysis was used to examine the relationship between provider pap screening recommendation and participant screening adherence, controlling for chronic comorbidities (hypertension, diabetes and obesity).
Results:Pap screening recommendation (63.77% vs. 61.31%, p<.05) and adherence (86.84% vs. 84.23 p<.001) were higher among foreign-born than US-born women. Chronic comorbidities were not associated with pap screening recommendations. In stratified analysis, among US-born but not foreign-born women, having health insurance (OR: 1.49, CI: 1.13-1.95) and usual source of care (OR: 1.67, CI: 1.17-2.38) were positively associated with screening recommendations. Chronic comorbidities, were not associated with pap screening adherence among foreign-born women, but US-born women with diabetes were less likely to report pap screening compared to those without diabetes (OR: 0.77, CI: 0.63-0.94).
Conclusion: Public health intervention efforts must improve regular access to preventive care for foreign-born women, and encourage pap screening for US-born women diagnosed with diabetes.
Chronic disease management and prevention Provision of health care to the public Public health or related education Public health or related nursing
Abstract
Results of focus groups to explore culturally- facilitators and barriers to colposcopy
Melissa DeNomie, MS1, Leslie Ruffalo, PhD, MS1, Maria Barker, CHW2, Ken Schellhase, MD3, Susanne Krasovich, MD4, Anna Witt, MD4 and Karen McHugh5
(1)Medical College of Wisconsin, Milwaukee, WI, (2)Planned Parenthood of Wisconsin, Milwaukee, WI, (3)Medical College of WI, Milwaukee, WI, (4)Medical College of WI, Waukesha, WI, (5)Waukesha Family Practice Center, Waukesha, WI
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Introduction: 12,000 women are diagnosed annually with cervical cancer, and 4,000 will ultimately die from the disease. Once a leading cause of death for American women, improved screening has reduced cervical cancer mortaility by more than 50%. Regular Papinicolaou (“pap”) tests are a crucial first step in the screening process, with abnormal results often indicating a need for additional evaluation in the form of a colposcopy. Despite the effectiveness of this process in detecting/preventing cervical cancer, women often fail to obtain recommended colposcopies; in 2016, at the clinical sites participating in this project, fewer than 50% of women obtained physician-recommended colposcopies. The issue is compounded by ethnic disparities in cervical cancer prevention, screening, diagnosis, treatment and survival.
To better understand the topic, researchers partnered with Planned Parenthood of Wisconsin and a family medicine clinic to conduct a community-engaged research project to explore barriers/facilitators to colposcopy.
Methods:
We recruited clinic patients according to adherence/nonadherence to past colposcopy recommendations, race/ethnicity (Spanish-speaking Latinas, English-speaking white women, and English-speaking non-white women), and insurance status. We conducted twelve focus groups and used open coding strategies to generate grounded theory related to colposcopy barriers/facilitators.
Results:
Identified themes can be mapped to the social ecological framework for health. Women reported colposcopy facilitators/barriers at individual, interpersonal, organizations, community, and policy levels.
Discussion:
Cervical cancer is a preventable cancer yet many women fail to adhere to colposcopy recommendations. Few qualitative studies have explored the nuanced roles that culture and insurance status might play in decision-making related to colposcopy adherence.
Diversity and culture Planning of health education strategies, interventions, and programs Provision of health care to the public Social and behavioral sciences
Abstract
Body mass index as a predictor for breast and cervical cancer screening: Results from the Brazos Valley community health needs assessment
Elfreda Samman, MPH, MS, CHES, Rahma Mkuu, PhD, MPH, CPH, Xiaoying Zhang, MPH, Shelby Cummings, MS and James Burdine, DrPH
Texas A&M University, College Station, TX
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Introduction: In the United States, breast and cervical cancer are leading cancer causes of death in women. Cancer screening is associated with reduced mortality. Overweight and obese women have an increased risk of breast and cervical cancer and are diagnosed at later stages. We examined the association between Body Mass Index (BMI) and breast and cervical cancer screening.
Methods: 2013 Brazos Valley Community Health Needs Assessment was utilized (n=3298). A total of (n=2204 and n=2346) met age recommendation for breast cancer and cervical cancer screening respectively. Descriptive analysis, chi square tests, and multiple regression analysis were conducted using SPSS.
Results: The majority met breast and cervical cancer screening recommendations (80% and 85.2% respectively). After adjusting for sociodemographic factors, BMI was not significantly associated with breast or cervical cancer screening. For breast cancer, African Americans (OR=0.27, CI: 0.07-0.99), ever smokers (OR=0.54. CI: 0.39 - 0.75) and putting off health (OR=0.38, CI: 0.27-0.54) decreased screening odds and insurance (OR=7.00, CI: 3.92-12.81) increased screening. For cervical cancer, smokers (OR=0.431 CI: 0.26-0.71) had low odds of screening while older age (OR 1.07, CI: 1.03-1.11), never married (OR: 20.64 CI:3.54-120.51) and having insurance (OR= 4.47 CI: 2.26-8.85) increased odds of screening.
Conclusion: BMI was not significantly associated with breast or cervical cancer screening after controlling for sociodemographic characteristics contributing to existing contradictory results. Further research is needed to identify facilitators and barriers for screening among overweight and obese women as they are at increased risk of being diagnosed at more advanced stages of cancer.
Assessment of individual and community needs for health education Chronic disease management and prevention Provision of health care to the public Public health or related research Social and behavioral sciences
Abstract
Assessing the underlying beliefs and perceptions of ‘doers’ vs. 'non-doers’ regarding getting a mammogram
Alireza Geshnizjani, PhD, MPH, MS
University of Maine, Farmington, ME
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: Breast cancer is one of the most common types of cancer in the US; Getting a mammogram is an effective method of secondary prevention. The purpose of this study was to compare and contrast the underlying beliefs and circumstances towards getting a mammogram across women who get a mammogram for the first time and those who did not utilizing the Reasoned Action Approach (RAA).
Methods: A sample of 610 women was recruited from a rural community in the US. The RAA-based survey instrument consisted of 70 close-ended measures of demographic variables, socioeconomic status, preventive behaviors, previous mammogram experience, health care access, and doctor’s experience. Two multivariate analyses of variance (MANOVA) were conducted to compare women who had a mammogram to those who had not on the underlying determinants.
Results: The results revealed that women who had a mammogram differed from those who had not on their assessment of six of the eleven beliefs: cost, side effects, pain, embarrassment, and protection against breast cancer. Additionally, women differed on three of the seven control belief measures: having time, mammogram being covered by health insurance, and having a healthcare provider that makes them feel comfortable.
Implications: Findings suggest that public health professionals should design interventions that are tailored to changing specific beliefs and circumstances in order to increase mammogram use. For example, educational interventions that can increase knowledge about side effects, pain, and protection towards breast cancer as well as policy changes on providing discounted mammograms in rural areas may be effective.
Chronic disease management and prevention Clinical medicine applied in public health Program planning Public health biology Public health or related research Social and behavioral sciences