Geographical Proximity to Health Facilities and Breast Cancer Morbidity and Mortality Among Women in South Carolina\u27s Best Chance Network

Death rates for breast cancer have steadily decreased in women due to early detection, such as mammography, and improved treatments. Despite the benefit of mammography, many women are not up-to-date on screening and do not receive timely follow-up after abnormal mammogram finding. Breast cancer is a major contributor to morbidity and mortality among women in South Carolina. To reduce the disproportionate burden of breast cancer and cervical cancer among women in South Carolina, the South Carolina Best Chance Network (BCN) was established to provide service delivery and ensures timely and complete diagnostic follow-up and treatment initiation for underserved women. The purpose of this dissertation was to examine whether travel distance to the screening provider and mammography facility are associated with completion of abnormal mammography follow-up, breast cancer stage at diagnosis, and mortality among women in the BCN. Women enrolled in BCN between 1996 and 2009 were included in the study. Cox proportional hazard modeling was used to assess the relationship between travel distance and time to resolution. Multivariable logistic regression was used to assess the association between travel distance and breast cancer stage at diagnosis. Cox proportional hazard modeling and Kaplan-Meier survival methods were used to determine breast cancer-specific and all-cause survival probabilities. Women who lived farther from their diagnosing mammography facility had longer day to resolution compared to those who lived the closest (p=0.05). African American women had significantly longer day to resolution compared to European American women. There was no association between travel distance to the screening provider, mammography facility and breast cancer stage at diagnosis. There was also no association between travel distance and breast cancer-specific and all-cause mortality. Travel distance from patient\u27s residence to the diagnosing mammography facility may have an impact on the completion of abnormal mammographic finding. However, living farther from the screening provider and mammography facility do not increase late-stage breast cancer at diagnosis and mortality among women in BCN. Support to the BCN program to expand services should be promoted to reduce the disparity in days to completion of abnormal mammographic finding. Capturing an accurate measurement of travel distance/time will help better understand whether location of the health facilities affects breast cancer outcome

Prevalence of Hepatitis B Virus (HBV) Infection Among Hmong Immigrants in the San Joaquin Valley

Chronic hepatitis B infection (HBV) is the major cause of primary liver cancer worldwide and Asians are disproportionately affected. The prevalence of HBV among most Asian American groups has been well documented, except in Hmong immigrants in the United States. The aim of this study was to determine the prevalence of HBV among Hmong immigrants in the San Joaquin Valley of California. A convenient sample of 534 Hmong age ≥18 years was recruited at various locations throughout Fresno County. Blood samples from study participants were collected and tested for hepatitis B surface antigen (HBsAg) by enzyme-immunoassay. Two hundred and eighty-nine females and 245 males of Hmong descent (mean age, 43.93) were screened. Eighty-nine (41 males and 48 females) were positive for HBsAg, which accounts for a prevalence of 16.7% (95% C.I. 13.5–19.9). The majorities of HBsAg positive patients were ≥40 years (64.2%), married (66.7%), born in Laos (87.3%), and had lived in the United States ≥20 years (62.5%). Only 37.5% of the participants reported having a primary care physician. Our study revealed that approximately one out of every six Hmong immigrants screened was infected with HBV. Based on our findings, more than one-third of these infected patients have no primary care physician to provide further treatment, surveillance for liver cancer, or vaccination of their families. This supports the Institute of Medicine’s recent recommendations to the Center for Disease Control to engage in a national Hepatitis B surveillance system

Integrating Research Experiences Into Public Health Curricula: Effects on Undergraduate Students’ Knowledge of Neighborhood Inequalities, Perception of Research, and Motivation to Talk About Health Issues

Undergraduate research is defined as an inquiry or investigation conducted by an undergraduate student in collaboration with a faculty member that makes an intellectual or creative contribution to the discipline. This study assessed the impact of integrating undergraduate research experiences into public health curricula on students’ knowledge of neighborhood inequalities, perception of research, and motivation to talk about health issues. The sample consisted of 132 undergraduate students from two groups (intervention and comparison). The intervention group (n = 71) conducted a structured social observation in various zip codes to characterize assets and liabilities of the local built environment. Self-reported questionnaires assessing the key study variables were administered to the students at baseline and at postintervention. Compared with those in the comparison group, improvements were noted in knowledge among those in the intervention group from pretest to posttest. Participants in the intervention group were also more motivated to talk about health issues compared with those in the comparison group. Perception of research among those in the intervention group also improved over time when participants were divided into two research confidence level groups (confident and nonconfident). The evaluation of this intervention demonstrates the positive impact integrating undergraduate research experiences can have on a sample of students.https://doi.org/10.1177/237337991988146

Racial Disparities in Breast Cancer Mortality in a Multiethnic Cohort in the Southeast

BACKGROUND: Although much has been done to examine those factors associated with higher mortality among African American women, there is a paucity of literature which examines disparities among rural African Americans in South Carolina. The purpose of this investigation was to examine the association of race and mortality among BrCA patients in a large cohort residing in South Carolina for which treatment regimens are standardized for all patients. METHODS: Subjects included 1209 women diagnosed with BrCA between 2000–2002 at a large, local hospital containing a comprehensive breast center. Kaplan Meier survival curves were calculated to determine survival rates among AA and EA women, stratified by disease stage or other prognostic characteristics. Adjusting for various characteristics, Cox multivariable survival models were used to estimate the hazard ratio (HR) RESULTS: The 5-year overall all-cause mortality survival proportion was ~78% for AA women and ~89% for EA women, p<0.01. In analyses of sub-populations of women with identical disease characteristics, AA women had significantly higher mortality than EA women for the same type of breast cancer disease. In multivariable models, AA women had significantly higher mortality than EA women for both BrCA specific death (HR = 2.41; 1.21–4.79) and all-cause mortality (HR = 1.42; 1.06–1.89). CONCLUSION: AA women residing in rural South Carolina had lower survival for breast cancer even after adjustment for disease-related prognostic characteristics. IMPACT: These findings support health interventions among AA BrCA patients aimed at tertiary prevention strategies or further down-staging of disease at diagnosis