The Early Impact of the Affordable Care Act upon Colorectal Cancer Screening Utilization in Florida

Background: Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Although preventable and curable through screening, early detection and treatment, a lack of health insurance is a major obstacle to receiving colorectal cancer screening (CRCS). Despite the Affordable Care Act (ACA) increasing access to health insurance by mandating coverage of CRCS, disparities in utilization rates continue. Therefore, researchers sought to better understand ACA related facilitators and impediments that affect the utilization of CRCS and collect specific recommendations from healthcare professionals to increase screening utilization rates in Florida. Methods: Researchers conducted in-depth interviews with 22 healthcare professionals. Data were coded and analyzed using an applied thematic analysis approach and interpreted according to levels of the Social Ecological Model. Results: Eight physicians and nurses, 7 healthcare workers/care coordinators, 5 administrators and insurers, and 2 health advocates completed interviews. In their view, the early days of the ACA facilitated CRCS uptake through use of frontline staff, patient provider communication, and increased access to healthcare. Barriers that remained, included out of pocket patient costs, limited Medicaid expansion, acceptance of ACA plans by only certain providers and removal of patient incentives. Recommendations for increasing CRCS included more promotion and awareness, removing costs and ensuring patient navigation. Conclusions: The ACA offered increased access to healthcare coverage, utilization of CRCS and encouraged better communication between healthcare providers and patients. However, persistent barriers remain and include varied CRCS-related patient costs and restricted provider networks included in ACA sponsored plans. Continued healthcare policy reform is needed to make CRCS affordable for all Americans

Cancer-Related Risk Behaviors and Screening Intention among Recreational Sport Athletes

The recreational sports arena provides a venue for young adults to increase physical activity and engage in a socially supportive environment. These are both important ways to decrease the risk for chronic diseases. It is assumed that physically active individuals lead healthier lifestyles and are more attuned to their long-term health needs. Recreational sport athletes also engage in risks for adverse cancer outcomes through increased sun exposure, intake of unhealthy diets, and recreational tobacco and alcohol use. It was of interest to assess cancer-related risk factors, cancer knowledge, and theory of planned behavior constructs in this group. This study involved a cross-sectional, web-based survey, with recruitment to participate in an online survey. The study was guided by the Theory of Planned Behavior (TPB) and included items that were adapted from national surveys including the Health Information National Trends (HINTS) survey and the Behavioral Risk Factor Surveillance System survey (BRFSS). Hierarchical linear regression analyses were conducted in IBM SPSS Statistics version 25.0. A total of 712 participants completed the survey. Gender representation was nearly equal with a slightly higher number of women (n = 359; 50.4%). Participants included in the study sample identified as black (n = 333; 46.8%), white (n = 316; 44.4%) or some other race (n = 63; 8.8%). The average number of days per week for physical activity was 3.97 (SD = 1.796) and nearly half of participants believed themselves to be ‘at low risk’ for getting cancer (n = 353; 49.6%). Regarding the outcome variable, higher scores for intention to screen for cancers were reported by participants who were older, female, users of sun protection, had higher perceived risk, higher cancer knowledge, higher perceived behavioral control (i.e. self-efficacy) and higher subjective norms. Theoretical constructs accounted for 34.2% of the variance in intention to screen for cancer. Results suggest that TPB is a relevant model for determining intention to screen for various cancer types among recreational sport athletes ages 18-49. Education regarding prevention behaviors, including cancer screening, early in adulthood is one strategy for reducing lifetime cancer risk and cancer death. The recreational sporting environment gathers wide attention from young adults and opportunities to encourage healthy behaviors for both short and long-term benefits

Cancer-Related Risk Behaviors and Screening Intention among Recreational Sport Athletes

The recreational sports arena provides a venue for young adults to increase physical activity and engage in a socially supportive environment. These are both important ways to decrease the risk for chronic diseases. It is assumed that physically active individuals lead healthier lifestyles and are more attuned to their long-term health needs. Recreational sport athletes also engage in risks for adverse cancer outcomes through increased sun exposure, intake of unhealthy diets, and recreational tobacco and alcohol use. It was of interest to assess cancer-related risk factors, cancer knowledge, and theory of planned behavior constructs in this group. This study involved a cross-sectional, web-based survey, with recruitment to participate in an online survey. The study was guided by the Theory of Planned Behavior (TPB) and included items that were adapted from national surveys including the Health Information National Trends (HINTS) survey and the Behavioral Risk Factor Surveillance System survey (BRFSS). Hierarchical linear regression analyses were conducted in IBM SPSS Statistics version 25.0. A total of 712 participants completed the survey. Gender representation was nearly equal with a slightly higher number of women (n = 359; 50.4%). Participants included in the study sample identified as black (n = 333; 46.8%), white (n = 316; 44.4%) or some other race (n = 63; 8.8%). The average number of days per week for physical activity was 3.97 (SD = 1.796) and nearly half of participants believed themselves to be ‘at low risk’ for getting cancer (n = 353; 49.6%). Regarding the outcome variable, higher scores for intention to screen for cancers were reported by participants who were older, female, users of sun protection, had higher perceived risk, higher cancer knowledge, higher perceived behavioral control (i.e. self-efficacy) and higher subjective norms. Theoretical constructs accounted for 34.2% of the variance in intention to screen for cancer. Results suggest that TPB is a relevant model for determining intention to screen for various cancer types among recreational sport athletes ages 18-49. Education regarding prevention behaviors, including cancer screening, early in adulthood is one strategy for reducing lifetime cancer risk and cancer death. The recreational sporting environment gathers wide attention from young adults and opportunities to encourage healthy behaviors for both short and long-term benefits

Racial, Lifestyle, and Healthcare Contributors to Perceived Cancer Risk among Physically Active Adolescent and Young Adult Women Aged 18–39 Years

The cancer incidence among adolescents and young adults (AYAs) has significantly increased in recent years, but there is limited information about the factors that influence the perceived cancer risk among AYAs. A cross-sectional, web-based survey of 281 physically active Black and White AYA women was administered to assess the influences of demographic characteristics, family history of cancer, cancer risk factor knowledge, and lifestyle-related risk and protective behaviors on perceived cancer risk. Linear regression analyses were performed in SAS version 9.4. Self-reported Black race (β = −0.62, 95% CI: −1.07, −0.17) and routine doctor visits (β = −0.62, 95% CI: −1.18, −0.07) were related to a lower perceived cancer risk. Family history of cancer (β = 0.56, 95% CI: 0.13, 0.99), cancer risk factor knowledge (β = 0.11, 95% CI: 0.03, 0.19), and current smoking status (β = 0.80, 95% CI: 0.20, 1.40) were related to a higher perceived cancer risk. Perceptions of cancer risk varied among this sample of physically active, AYA women. Lower perceptions of cancer risk among Black AYA women demonstrate a need for culturally tailored cancer educational information that presents objective data on lifetime cancer risk. Reportedly higher perceptions of cancer risk among AYA smokers presents an ideal opportunity to promote smoking cessation interventions. Future interventions to address cancer risk perception profiles among physically active, AYA women should tailor approaches that are inclusive of these unique characteristics