Cathy M. Tatum

Racial differences in knowledge, attitudes, and cancer Screening practices among a triracial rural population

Low‐income, minority, and rural women face a greater burden with regard to cancer‐related morbidity and mortality and are usually underrepresented in cancer control research. The Robeson County Outreach, Screening and Education Project sought to increase mammography use among low‐income, minority, and rural women age > 40 years. The current article reports on racial disparities and barriers to screening, especially those related to knowledge, attitudes, and behaviors.

The Ohio Patient Navigation Research Program: Does the American Cancer Society Patient Navigation Model Improve Time to Resolution in Patients with Abnormal Screening Tests?

Background: Patient navigation (PN) has been suggested as a way to reduce cancer health disparities; however, many models of PN exist and most have not been carefully evaluated. The goal of this study was to test the Ohio American Cancer Society model of PN as it relates to reducing time to diagnostic resolution among persons with abnormal breast, cervical, or colorectal cancer screening tests or symptoms. Methods: A total of 862 patients from 18 clinics participated in this group-randomized trial. Chart review documented the date of the abnormality and the date of resolution. The primary analysis used shared frailty models to test for the effect of PN on time to resolution. Crude HR were reported as there was no evidence of confounding. Results: HRs became significant at 6 months; conditional on the random clinic effect, the resolution rate at 15 months was 65% higher in the PN arm (P = 0.012 for difference in resolution rate across arms; P = 0.009 for an increase in the HR over time). Conclusions: Participants with abnormal cancer screening tests or symptoms resolved faster if assigned to PN compared with those not assigned to PN. The effect of PN became apparent beginning six months after detection of the abnormality. Impact: PN may help address health disparities by reducing time to resolution after an abnormal cancer screening test. Cancer Epidemiol Biomarkers Prev; 21(10); 1620–8. ©2012 AACR.

Racial differences in colorectal cancer screening practices and knowledge within a low-income population†

Although colorectal cancer (CRC) is the third leading cause of cancer death among US women and is particularly deadly among African Americans, CRC screening rates remain low. Within a low‐income population of women, the authors examined racial differences in practices, knowledge, and barriers related to CRC screening.

Evaluating the Efficacy of Lay Health Advisors for Increasing Risk-appropriate Pap Test Screening: A randomized controlled trial among Ohio Appalachian women

Background: Cervical cancer is a significant health disparity among women in Ohio Appalachia. The goal of this study was to evaluate the efficacy of a lay health advisor (LHA) intervention for improving Papanicolaou (Pap) testing rates, to reduce cervical cancer, among women in need of screening. Methods: Women from 14 Ohio Appalachian clinics in need of a Pap test were randomized to receive either usual care or an LHA intervention over a 10-month period. The intervention consisted of two in-person visits with an LHA, two phone calls, and four postcards. Both self-report and medical record review (MRR) data (primary outcome) were analyzed. Results: Of the 286 women, 145 and 141 were randomized to intervention and usual care arms, respectively. According to MRR, more women in the LHA arm had a Pap test by the end of the study compared with those randomized to usual care (51.1% vs. 42.0%; OR = 1.44, 95% CI: 0.89–2.33; P = 0.135). Results of self-report were more pronounced (71.3% vs. 54.2%; OR = 2.10, 95% CI: 1.22–3.61; P = 0.008). Conclusions: An LHA intervention showed some improvement in the receipt of Pap tests among Ohio Appalachian women in need of screening. Although biases inherent in using self-reports of screening are well known, this study also identified biases in using MRR data in clinics located in underserved areas. Impact: LHA interventions show promise for improving screening behaviors among nonadherent women from underserved populations. Cancer Epidemiol Biomarkers Prev; 20(5); 835–43. ©2011 AACR.

Cost as a barrier to screening mammography among underserved women

Background. Breast cancer is a troublesome health problem, particularly among underserved and minority women. Early detection through screening mammography can reduce the impact of this disease, yet it remains underused. Objective. We examined cost as a barrier to screening mammography and studied the accuracy of womens perceptions of the cost of a mammogram among a rural, low-income, tri-racial (white, Native American and African American) population in need of a mammogram. Design. We interviewed 897 women age 40 and older, asking about cost as a barrier to mammography and perceptions about the actual costs of a screening mammogram. Face-to-face interviews were conducted between 1998 and 2000 among women participating in a randomized, controlled study to evaluate a health education intervention to improve mammography screening rates in an underserved population. All data used in these analyses were from the baseline interviews. Results. Cost acted as a barrier to screening mammography for a majority of the participants (53%). More than half of these women (52%), however, overestimated the cost of a screening mammogram, and overestimation of the cost was significantly related to mentioning cost as a barrier (OR 1.56, 95% CI 1.04–2.33). Higher estimates of out-of-pocket costs were associated with reporting cost as a barrier to mammography (OR 2.25, 95% CI 1.43–3.52 for

Improving colorectal cancer screening by using community volunteers: results of the Carolinas cancer education and screening (CARES) project.

1–50 and OR 12.64, 95% CI 6.61–24.17 for >

Perceptions of insurance coverage for screening mammography among women in need of screening

50). Factors such as race, income and employment status were not related to reporting cost as a barrier to screening mammography. Conclusions. Among a group of tri-racial, low-income, rural women who were in need of a mammogram, cost was a common barrier. Overestimating the cost, however, was significantly and positively associated with reporting cost as a barrier. Providing information about the actual cost women have to pay for mammograms may lessen the role of cost as a barrier to mammography screening, especially for underserved women, potentially improving utilization rates.

Determinants of colorectal cancer screening in primary care.

The goal of the Carolinas Cancer Education and Screening (CARES) Project was to improve colorectal cancer (CRC) screening among low‐income women in subsidized housing communities in 11 cities in North and South Carolina who were traditionally underserved by cancer control efforts.

The contribution of social support and social strain to depressive symptoms in African American, Native American, and European American women

Breast carcinoma remains a significant health problem in the U.S., especially among underserved populations. Although screening mammography is recommended for early detection, in 2002, approximately 25% of women age > 40 years had not had a mammogram within the past 2 years. The current study examined perceptions of insurance coverage and cost as barriers to screening mammography within an underserved, predominantly low‐income population of women in need of a mammogram.

Results of a Multilevel Intervention Trial to Increase Human Papillomavirus (HPV) Vaccine Uptake among Adolescent Girls

Background. Colorectal cancer (CRC) is serious, yet a minority of US adults receive within-guideline screening exams. Methods. A random selection of patients attending clinics in 3 different settings completed a survey on CRC-related barriers, knowledge, and beliefs. Results. Participants with fewer barriers, better knowledge, and more positive beliefs toward screening were significantly more likely to be within screening guidelines. A physician’s screening recommendation was significantly related to screening in patients <65 years, but was not significant for older patients. Conclusions. Large-scale studies are needed. Results can be used to develop multifaceted, tailored education programs to improve CRC screening in primary care.