Hugo Vilchis

Increasing Cervical Cancer Screening in the United States‐Mexico Border Region

PURPOSE Hispanic women living on the United States-México border experience health disparities, are less likely to access cervical cancer screening services, and have a higher rate of cervical cancer incidence compared to women living in nonborder areas. Here we investigate the effects of an intervention delivered by community health workers (CHWs, known as lay health educators or Promotores de Salud in Spanish) on rates of cervical cancer screening in Hispanic women who were out of compliance with recommended screening guidelines. METHODS Hispanic women out of compliance with screening guidelines, attending clinics in southern New Mexico, were identified using medical record review. All eligible women were offered the intervention. The study was conducted between 2009 and 2011, and data were analyzed in 2012. Setting/participants--162 Hispanic women, resident in New Mexico border counties, aged 29-80 years, who had not had a Pap test within the past 3 years. Intervention--a CHW-led, culturally appropriate, computerized education intervention. Main outcome measures--the percentage of women who underwent cervical cancer screening within 12 months of receiving the intervention. Change in knowledge of, and attitudes toward cervical cancer and screening as assessed by a baseline and follow-up questionnaire. RESULTS 76.5% of women had a Pap test after the intervention. Women displayed increased knowledge about cervical cancer screening and about HPV. CONCLUSIONS A culturally appropriate promotora-led intervention is successful in increasing cervical cancer screening in at-risk Hispanic women on the United States-México border.

Recommendations for Cancer Epidemiologic Research in Understudied Populations and Implications for Future Needs

Medically underserved populations in the United States continue to experience higher cancer burdens of incidence, mortality, and other cancer-related outcomes. It is imperative to understand how health inequities experienced by diverse population groups may contribute to our increasing unequal cancer burdens and disparate outcomes. The National Cancer Institute convened a diverse group of scientists to discuss research challenges and opportunities for cancer epidemiology in medically underserved and understudied populations. This report summarizes salient issues and discusses five recommendations from the group, including the next steps required to better examine and address cancer burden in the United States among our rapidly increasing diverse and understudied populations. Cancer Epidemiol Biomarkers Prev; 25(4); 573–80. ©2016 AACR. See all articles in this CEBP Focus section, “Multilevel Approaches to Addressing Cancer Health Disparities.”

Latino Beliefs About Biomedical Research Participation: A Qualitative Study on the U.S.-Mexico Border

Latinos are under-represented in biomedical research conducted in the United States, impeding disease prevention and treatment efforts for this growing demographic group. We gathered perceptions of biomedical research and gauged willingness to participate through elicitation interviews and focus groups with Latinos living on the U.S.–Mexico border. Themes that emerged included a strong willingness to participate in biomedical studies and suggested that Latinos may be under-represented due to limited formal education and access to health information, not distrust. The conflation of research and clinical care was common and motivated participation. Outreach efforts and educational interventions to inform Latinos of participation opportunities and clarify harms and benefits associated with biomedical research participation will be essential to maintain trust within Latino communities.

Genetic variation in metallothionein and metal-regulatory transcription factor 1 in relation to urinary cadmium, copper, and zinc.

BACKGROUND Metallothionein (MT) proteins play critical roles in the physiological handling of both essential (Cu and Zn) and toxic (Cd) metals. MT expression is regulated by metal-regulatory transcription factor 1 (MTF1). Hence, genetic variation in the MT gene family and MTF1 might influence excretion of these metals. METHODS 321 women were recruited in Seattle, WA and Las Cruces, NM and provided demographic information, urine samples for measurement of metal concentrations by mass spectrometry and creatinine, and blood or saliva for extraction of DNA. Forty-one single nucleotide polymorphisms (SNPs) within the MTF1 gene region and the region of chromosome 16 encoding the MT gene family were selected for genotyping in addition to an ancestry informative marker panel. Linear regression was used to estimate the association of SNPs with urinary Cd, Cu, and Zn, adjusted for age, urinary creatinine, smoking history, study site, and ancestry. RESULTS Minor alleles of rs28366003 and rs10636 near the MT2A gene were associated with lower urinary Cd, Cu, and Zn. Minor alleles of rs8044719 and rs1599823, near MT1A and MT1B, were associated with lower urinary Cd and Zn, respectively. Minor alleles of rs4653329 in MTF1 were associated with lower urinary Cd. CONCLUSIONS These results suggest that genetic variation in the MT gene region and MTF1 influences urinary Cd, Cu, and Zn excretion.

Urinary heavy metals in Hispanics 40–85 years old in Doña Ana County, New Mexico

ABSTRACT Exposure to As, Cd, Pb, and U among older Hispanic adults residing in underserved communities in southern New Mexico was investigated. Personal information was obtained by standardized interview from 188 adults aged 40–85 years. Urinary metal concentrations were measured and compared to results from the National Health and Nutritional Examination Survey (NHANES). Urinary As and U in study participants significantly (p < .05) exceeded NHANES reference values. Elevated urinary As concentration was significantly associated with older age, Latin American birthplace, clinic site, private-well drinking water, higher self-rated health, and diabetes. Higher urinary Cd was significantly associated with older age, clinic site, female sex, agricultural work, and current cigarette smoking. No personal characteristics were significantly associated with urinary Pb or U. Our results suggest elevated levels of As and U in this population.

Increasing Cervical Cancer Screening in the US-Mexico Border Region

PURPOSE Hispanic women living on the United States-México border experience health disparities, are less likely to access cervical cancer screening services, and have a higher rate of cervical cancer incidence compared to women living in nonborder areas. Here we investigate the effects of an intervention delivered by community health workers (CHWs, known as lay health educators or Promotores de Salud in Spanish) on rates of cervical cancer screening in Hispanic women who were out of compliance with recommended screening guidelines. METHODS Hispanic women out of compliance with screening guidelines, attending clinics in southern New Mexico, were identified using medical record review. All eligible women were offered the intervention. The study was conducted between 2009 and 2011, and data were analyzed in 2012. Setting/participants--162 Hispanic women, resident in New Mexico border counties, aged 29-80 years, who had not had a Pap test within the past 3 years. Intervention--a CHW-led, culturally appropriate, computerized education intervention. Main outcome measures--the percentage of women who underwent cervical cancer screening within 12 months of receiving the intervention. Change in knowledge of, and attitudes toward cervical cancer and screening as assessed by a baseline and follow-up questionnaire. RESULTS 76.5% of women had a Pap test after the intervention. Women displayed increased knowledge about cervical cancer screening and about HPV. CONCLUSIONS A culturally appropriate promotora-led intervention is successful in increasing cervical cancer screening in at-risk Hispanic women on the United States-México border.

Increasing Cervical Cancer Screening in the United States-Mexico Border Region: Cervical Cancer Screening Intervention

PURPOSE Hispanic women living on the United States-México border experience health disparities, are less likely to access cervical cancer screening services, and have a higher rate of cervical cancer incidence compared to women living in nonborder areas. Here we investigate the effects of an intervention delivered by community health workers (CHWs, known as lay health educators or Promotores de Salud in Spanish) on rates of cervical cancer screening in Hispanic women who were out of compliance with recommended screening guidelines. METHODS Hispanic women out of compliance with screening guidelines, attending clinics in southern New Mexico, were identified using medical record review. All eligible women were offered the intervention. The study was conducted between 2009 and 2011, and data were analyzed in 2012. Setting/participants--162 Hispanic women, resident in New Mexico border counties, aged 29-80 years, who had not had a Pap test within the past 3 years. Intervention--a CHW-led, culturally appropriate, computerized education intervention. Main outcome measures--the percentage of women who underwent cervical cancer screening within 12 months of receiving the intervention. Change in knowledge of, and attitudes toward cervical cancer and screening as assessed by a baseline and follow-up questionnaire. RESULTS 76.5% of women had a Pap test after the intervention. Women displayed increased knowledge about cervical cancer screening and about HPV. CONCLUSIONS A culturally appropriate promotora-led intervention is successful in increasing cervical cancer screening in at-risk Hispanic women on the United States-México border.

Abstract 1360: Reaching minority and low-income women with breast cancer prevention mobile messages: Implications for health promotion and clinical office collaboration.

Background: While growing literature for breast cancer information supports the use of the Internet, little is known about breast cancer prevention and the use of mobile messages especially for women of different ages, race/ethnicity, income, and education levels. Minority and low-income women are more likely to be diagnosed with breast cancer at a later stage. Purpose: We examined differences for breast cancer risk factor knowledge, current channels, and mobile message preferences among Hispanic and non-Hispanic women in southern New Mexico. The study was guided using a conceptual framework of McGuire9s Input-Output Persuasion Model. Methods: Women ages 40 and older at an imaging center completed a survey assessing their knowledge of breast cancer risk factors, channels of information, mobile message preferences, and demographics. In bivariate analysis, relationships between age, income, race/ethnicity and education of women and their mobile message preferences were examined. Results: A total of 157 women ages 40 to 91 (mean = 61, SD = 12.07) completed the survey. Breast cancer risk factor knowledge was significantly higher for non-Hispanic (p=.035), women with higher education levels (p=.023) and higher income levels (p=.000). The most common channels were television, magazines, Internet, and brochures. Overall, 87% used cell phones. Cell phone use was more likely among younger women ages 40-59 (p=.017), non-Hispanic women (p=.013), and women with incomes

Abstract B101: Cervical cancer screening along the U.S./Mexico border

20,000 or higher (p=.032). Of the cell phone users, 20% preferred breast cancer prevention messages. Breast cancer prevention cell message preferences were more likely among younger women ages 40-59 (p=.001), Hispanic women (p=.000), and women with lower incomes (p=.011). Nearly 47% used text messaging. Of the text users, 36% preferred breast cancer prevention text messages and 37% preferred mammogram appointment text reminders. Text message preferences were more likely among Hispanic women (p=.001). Conclusions: Traditional and mobile messages for breast cancer information are preferred by women. Targeting lower income, Hispanic, and younger women with mobile messages may help to reduce health disparities. Further research is needed for mobile technology use in health promotion. Health promotion specialists may partner with clinical offices to develop and target breast cancer prevention mobile messages for improved mammography adherence, patient education, and best practices in managing screening appointments. Citation Format: Cynthia Kratzke, Hugo Vilchis. Reaching minority and low-income women with breast cancer prevention mobile messages: Implications for health promotion and clinical office collaboration. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1360. doi:10.1158/1538-7445.AM2013-1360

Reaching rural women: breast cancer prevention information seeking behaviors and interest in Internet, cell phone, and text use.

Latinas are at nearly double the risk for cervical cancer than non-Hispanic whites (NHW). The problem is especially severe in the border communities between Mexico and the United States. The border region includes some of the poorest areas in the United States and health services in the region remain scarce. Cervical cancer rates among the border population are high. In this project, we worked with three local health care systems that provide services to the poor and underserved along the New Mexican/Mexican border. One system was the intervention health care system, while the other two were controls. We obtained names from the intervention clinic system of women who were out of compliance with pap testing; that is, they had not had a pap for three or more years. Promotoras (lay health workers) in the clinic system were trained to contact the non-compliant women. We prepared a PowerPoint presentation that described cervical cancer, explained how cervical cancer spread, and showed a brief video of a cartoon woman receiving a pap test. The PowerPoint was developed as a result of focus group discussions and was approved by the promotoras. The promotoras (lay health workers) went to the homes of the non-compliant women and used the PowerPoint presentation to educate the women about the importance of pap testing; they also helped arrange clinic appointments for women to receive pap testing. A total of 198 non-compliant women in the intervention clinic system were contacted. Of these, 78% received pap testing within six months of being contacted. A baseline survey asked the women about knowledge of and attitudes toward cervical cancer screening. Data suggest that knowledge was not linked to compliance with pap testing. A final survey suggested that women who did not receive pap testing intended to be tested in the next six months. Comparisons with the control clinic is currently being made. The project supports the idea that border women can be motivated to receive cervical cancer screening. Given that Latinas are at high risk for cervical cancer and given that a promotora approach is common in the border communities of New Mexico, this study shows that screening for cervical cancer can be increased among women at high risk. This approach may be useful in other border communities. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B101.