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

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