Desiree Rivers

Cancer Health Disparities

There have been great improvements in the health and health outcomes of the United States population. Unfortunately, there are segments of the population that do not experience these same improvements and thus have disproportionate health outcomes compared to other groups, known as health disparities. Disparities in cancer and cancer-related outcomes are also experienced by these groups. This chapter discusses the disparities among five specific cancer sites (female breast, cervical, colorectal, prostate, and lung cancers), outlines potential causes of these cancer health disparities, and highlights effective strategies for reducing and eliminating them.

Innovative Approaches to Reducing Cancer Health Disparities: The Moffitt Cancer Center Patient Navigator Research Program

The Moffitt Cancer Center Patient Navigation Research Program (Moffitt PNRP) is evaluating the efficacy of patient navigation in reducing delays from screening abnormality to diagnostic resolution of a breast or colorectal abnormality. The Moffitt PNRP was conducted in three phases: (1) developing an acceptable, appealing, and culturally appropriate patient navigation program; (2) conducting a group randomized controlled trial to evaluate the patient navigation program; and (3) disseminating research findings and Moffitt PNRP intervention model. The patient navigation program was developed through significant formative research, input from the Moffitt PNRP Community Advisory Board, and through a close collaboration with the Tampa Bay Community Cancer Network. 1367 patients were enrolled in the Phase 2 group randomized trial of the Moffitt PNRP. Most Moffitt PNRP group randomized trial participants are Hispanic, female, and Spanish speaking, with minimal education and income. Analyses are currently being conducted to evaluate efficacy of the Moffitt PNRP.

Recruitment of black women for a study of inherited breast cancer using a cancer registry-based approach.

INTRODUCTION We sought to understand the factors associated with recruitment activities while conducting a registry-based study of black women found to have breast cancer <age 50 to investigate mutations in the BRCA1 and BRCA2 genes. METHODS State mandated recruitment methods included TWO mailings, followed by a telephone response card for patients who did not wish to be contacted by phone. If no response was received within 3 weeks of the second mailing, the study team contacted the patient by phone. RESULTS Of the 209 eligible patients identified by the cancer registry, contact was established in 87, of whom 82 were eligible for study participation. The overall rate of interest in study participation was 80% (including 93% for those with passive follow-up and 68% for those with active follow-up), with the primary factor cited being the desire to understand more about the risk of cancer for family members. CONCLUSION This is the first study conducted through a State Cancer Registry, in which the primary goal was to recruit participants for genetic counseling and testing for inherited breast cancer. In contrast to many prior studies, our results suggest that young black women with breast cancer are interested in participating in genetics studies.

Application of Geographic Information Systems (GIS) and Asset Mapping to Facilitate Identification of Colorectal Cancer Screening Resources

Objective We sought to identify and map the geographic distribution of available colorectal cancer screening resources; following identification of this priority within a needs assessment of a local community-academic collaborative to reduce cancer health disparities in medically underserved communities. Methods: We used geographic information systems (GIS) and asset mapping tools to visually depict resources in the context of geography and a population of interest. We illustrate two examples, offer step-by-step directions for mapping, and discuss the challenges, lessons learned, and future directions for research and practice. Results: Our positive asset driven, community-based approach illustrated the distribution of existing colonoscopy screening facilities and locations of populations and organizations who might use these resources. A need for additional affordable and accessible colonoscopy resources was identified. Conclusion: These transdisciplinary community mapping efforts highlight the benefit of innovative community-academic partnerships for addressing cancer health disparities by bolstering infrastructure and community capacity-building for increased access to colonoscopies.

A Closer Look at Effect Sizes and Their Relevance to Health Education

Abstract A number of academic disciplines are engaged in scholarly discussions regarding statistical practice reform, particularly the use of effect sizes. Health education must stimulate a similar conversation by adopting strategies for generating, reporting, and interpreting effect size estimates for various statistical analyses within journal articles. The purpose of this article is to demonstrate the practical applications of effect size reporting and interpretation in health education research. Congruent with previous recommendations in the American Journal of Health Education, this article will provide examples and techniques used for effect size reporting that educate the researcher and practitioner, thus improving the scholarship of health education publications. Effect size reporting should become the rule for health education and concerted efforts should be made to equip researchers and practitioners with the proficiency to perform this task effectively. Such skill building will increase the scholarship and readability of health education research.

Affecting African American Men's Prostate Cancer Screening Decision-making through a Mobile Tablet-Mediated Intervention

African American men experience a 60% higher incidence of prostate cancer and are more than twice as likely to die from it than White men. Evidence is insufficient to conclude that definitively screening for prostate cancer reduces the likelihood of morbidity or death. Patients are encouraged to discuss screening alternatives with health care providers for informed decision-making (IDM). The extent of IDM in clinical or community setting is not known. This study uses data from a community-based, computer-mediated, IDM intervention that targeted 152 African American aged 40 to 70. Pretest-posttest differences in means for prostate cancer knowledge, screening decisional conflict, and screening decisional self-efficacy were examined by two-tailed t-tests. Overall, the intervention significantly improved respondents’ prostate cancer knowledge (p<.0001), significantly improved decisional self-efficacy (p<.0001) and significantly reduced decisional conflict (p<.0001). Specifically, the intervention significantly promoted IDM among men who reported more education, being married, having financial resources, and younger age.

Establishing the Infrastructure to Comprehensively Address Cancer Disparities: A Model for Transdisciplinary Approaches

The Center for Equal Health (CEH), a transdisciplinary Center of Excellence, was established to investigate cancer disparities comprehensively and achieve health equity through research, education, training, and community outreach. This paper discusses challenges faced by CEH, strategies employed to foster collaborations, lessons learned, and future considerations for establishing similar initiatives.

Predictors of Cancer Screening Among Culturally Diverse Men

Men have higher rates of all cancers and are more likely to die from cancer than women; however, men are less likely to utilize disease prevention services. African American/Black men and Hispanic men have lower cancer survival rates and are less likely to utilize health care services than non-Hispanic White men. The present study examined demographic variables (age, household income, education, marital status, race/ethnicity, health insurance status), motivators to engage in healthy eating, and motivators to engage in physical activity as predictors of culturally diverse, medically underserved men’s likelihood of getting a cancer screening (a) at the present time, (b) if no cancer symptoms are present, and (c) if a doctor discovers some cancer symptoms. Analyses were conducted using data from 243 men (47.3% non-Hispanic Black, 29.5% Hispanic, 16.5% non-Hispanic White, and 6.8% “other”) recruited at the Men’s Health Forum in Tampa, Florida. Age, having a medical or health condition that benefits from eating healthy, and having a commitment to physical activity were significant positive predictors of the likelihood of receiving a cancer screening. Motivation to engage in physical activity because of a personal priority was a significant negative predictor of the likelihood of getting a cancer screening. The findings from this study suggest that interventions to increase cancer screenings among culturally diverse, medically underserved men should be informed at least in part by an assessment of participating men’s motivators for engaging in health promoting lifestyle behaviors such as physical activity and healthy eating.

A community-academic partnership to explore informational needs of African American women as a primer for cancer clinical trial recruitment

ABSTRACT Background: African Americans (AAs) are less likely to participate in cancer clinical trials (CCTs) despite experiencing disproportionately higher rates of cancer mortality. As a way to address these ongoing disparities, this study sought to qualitatively explore informational needs regarding CCTs among AA women and identify message considerations for educational information targeting AA women and their community. Methods: Three focus groups were conducted in which AA women viewed a DVD created as a decisional tool for CCT participation and provided feedback regarding content. Results: Results indicated general fear regarding CCTs, which is partially attributable to the impact of historic research abuses, lack of information regarding CCTs, and lack of cultural relevance of the education and outreach materials for AA communities. Recruitment of AAs to CCTs may be enhanced by educational and outreach approaches that increase awareness of CCTs as well as involvement of the AA community in developing such interventions. Conclusion: Interventions should include the perspectives of AA women, as key stakeholders and decision-makers for their family and provide research information in a multimedia format that will facilitate family discussion and decision-making regarding CCTs.

A Community-Level Assessment of Barriers to Preventive Health Behaviors Among Culturally Diverse Men:

There are significant gender disparities in health outcomes and health care utilization in the United States, with men experiencing more of these disparities. It is critical to ascertain the interplay between societal conditions, health behaviors, and access to services and the impact of these factors on health outcomes and utilization of health care. The present study is part of a larger initiative titled, The Men’s Health Study: Addressing Healthy Lifestyle Behaviors, which has two purposes—to annually assess the motivators of and barriers to health-promoting behaviors among culturally diverse men attending the Men’s Health Forum (MHF) and to use this information to develop an intervention program that facilitates healthy lifestyle behaviors among men. The MHF is a community-driven initiative for medically underserved men in Tampa, Florida that offers free health screenings and wellness exhibitors in order to empower men to lead a healthy lifestyle. The purpose of this article is to identify barriers to engaging in health-smart behaviors (e.g., cancer screenings, physical activity) among culturally diverse men who participated in the MHF and to detect any demographic differences among these barriers. A total of 254 men participated in the study. Findings identify that age was the only demographic variable that had a statistically significant association with any of the cancer-screening barriers. Some cancer-screening barriers appear to exist among all demographic groups since no statistical demographic differences were discovered. Income and education were significantly associated with barriers to engaging in health-smart behaviors. This may give researchers, health educators, and providers information needed to customize interventions to promote health and preventive health care among culturally diverse men.