Mammography facilities serving vulnerable women have longer follow-up times.

ObjectiveTo investigate mammography facilities' follow-up times, population vulnerability, system-based processes, and association with cancer stage at diagnosis.Data sourcesProspectively collected from San Francisco Mammography Registry (SFMR) 2005-2011, California Cancer Registry 2005-2012, SFMR facility survey 2012.Study designWe examined time to biopsy for 17 750 abnormal mammogram results (BI-RADS 4/5), categorizing eight facilities as short or long follow-up based on proportion of mammograms with biopsy at 30 days. We examined facility population vulnerability (race/ethnicity, language, education), and system processes. Among women with a cancer diagnosis, we modeled odds of advanced-stage (≥IIb) cancer diagnosis by facility follow-up group.Data extraction methodsMerged SFMR, Cancer Registry and facility survey data.Principal findingsFacilities (N = 4) with short follow-up completed biopsies by 30 days for 82% of mammograms compared with 62% for facilities with long follow-up (N = 4) (P < 0.0001). All facilities serving high proportions of vulnerable women were long follow-up facilities. The long follow-up facilities had fewer radiologists, longer biopsy appointment wait times, and less communication directly with women. Having the index abnormal mammogram at a long follow-up facility was associated with higher adjusted odds of advanced-stage cancer (OR 1.45; 95% CI 1.10-1.91).ConclusionsProviding mammography facilities serving vulnerable women with appropriate resources may decrease disparities in abnormal mammogram follow-up and cancer diagnosis stage

Health literate organizations: Are clinical trial sites equipped to recruit minority and limited health literacy patients?

Background. Racial/ethnic minority patients are less likely than non-Latino white patients to participate in cancer clinical trials. A key barrier to participation is limited health literacy which is more common among minorities. At the organizational level, it is important that clinical trials sites become better equipped to recruit minority patients by expanding their organizational health literacy including language competency and outreach efforts. We explored the characteristics of clinical trial sites that are associated with these health literate behaviors. Methods. We identified 353 breast clinical trials recruiting participants in 2006 from four states (California, Florida, Illinois, and New York) through the National Cancer Institute Physician Data Query system. From October 2008 to November 2009, we contacted one research team member (RTM) from each site for a telephone survey to assess the site’s health literate characteristics. Results. Of 233 RTMs who responded, 93% were female and 89% were US-born. Overall, 48% of sites offered supplementary trial information, 80% offered materials to assist with patient navigation and 45% reported outreach efforts. Lower percentages offered information in other languages while 65% offered professional interpretation services. Sites with \u3e10% limited English proficiency (LEP) patients were more likely than their counterparts to offer consent forms (OR=3.13, 1.36-7.19) and supplementary information about trials in other languages (OR=2.52, 1.15-5.52). Sites with diverse patient populations (\u3e10% Latino) were also more likely than less diverse sites to engage in outreach (OR=1.97, 1.07-3.60), to offer consent forms (OR=2.72, 1.38-5.36), supplementary information about trials (OR=2.58, 1.24-5.36), and materials to improve patient navigation (OR=2.50, 1.22-5.13) in other languages. Conclusions. Efforts to recruit diverse participants were limited. Practice type and diversity of patient population were associated with sites’ efforts to accommodate these characteristics, suggesting that sites were responsive to the needs of their patients when diversity was prevalent

Latino and Black smokers in the Health and Retirement Study are more likely to quit: the role of light smoking

Abstract Background Older persons are more vulnerable to tobacco mortality and less likely to make quit attempts. Less is known, however, about the role of race and ethnicity on quit rates in the U.S. Using a nationally representative data source of older adults in U.S., we aimed to study racial and ethnic differences in smoking cessation rates. Methods We used data from all waves of the Health and Retirement Study (HRS) between 1992-2012. The HRS is a longitudinal nationally representative survey of adults over the age of 50 in the United States. We followed current smokers at baseline (year 1992) until time to first quit. Race/ethnicity was the main predictor; gender, age, education, marital status, count of chronic medical conditions, depressive symptoms, and drinking at baseline were control variables. Cox regression was used for analysis of time to quit. Results Hazard ratios of quitting during the first ten (Hazard ratio = 1.51, p < 0.05) and 20 years (Hazard ratio = 1.46, p < 0.05) were larger for Latinos over the age of 50 compared to Whites. In addition, hazard ratios of quitting during the first 20 years (Hazard ratio = 1.19, p < 0.05) were larger for Blacks over the age of 50 compared to Whites. These findings were partially explained by cigarette consumption intensity, such that Latinos were lighter smokers and therefore more likely to quit than Whites. Conclusion Latinos and Blacks were more likely than Whites to quit smoking cigarettes within 20 years. However, this finding may be explained by cigarette consumption intensity.http://deepblue.lib.umich.edu/bitstream/2027.42/134608/1/12971_2016_Article_90.pd

Evaluation of a Promotora-led Intervention on Colorectal Cancer among Hispanics: Findings Related to Perceptions and Communications

We implemented a home-based group educational intervention in the form of home health parties (HHPs) among Hispanic men and women in the Lower Yakima Valley of Washington State led by trained bilingual promotoras. Baseline and follow-up responses to questions among participants were compared and related to communications about colorectal cancer (CRC) screening. Participants’ perceptions of the CRC related educational information presented were documented as measures of effectiveness of the HHPs, as well as, possible indicators of their intentions to engage in timely CRC screenings. The group based educational sessions resulted in positive participants’ perceptions about the benefits of the CRC related information and improved communications about CRC screening. Results suggest the benefits of utilizing promotoras’ cultural knowledge and awareness to present content about cancers such as CRC in ways that are easily understandable to Hispanic participants that may result in improved communications and action about cancer screenings

Latinos and Cancer Information: Perspectives of Patients, Health Professionals and Telephone Cancer Information Specialists

Semi-structured interviews were conducted with 16 Latino cancer patients diagnosed in California; 10 health professionals from the San Francisco Bay Area and Fresno, California; and 10 Cancer Information Services (CIS) information specialists from the regional offices handling calls from Spanish-speakers. Interview guides were designed by the investigators to answer three main research questions: 1) How do Latinos obtain information about cancer and what types of information do they access?; 2) What sources of cancer information do they seek out and find credible?; and 3) What are the barriers and facilitators to Latinos obtaining cancer information? Stakeholders generally viewed health professionals as the most credible source of cancer information. All groups regarded family and friends as important sources of information. Patients and health professionals tended to differ on the value of print materials. Although patients found them generally useful, health professionals tended to view them as inadequate for meeting the informational needs of their Latino patients due to the challenge of low health literacy. Health professionals also tended to undervalue internet resources compared to patients and CIS specialists. All stakeholders viewed language, ethnic discordance and the impact on patients of the initial diagnosis as barriers to effective communication of cancer information. Health professionals and CIS specialists, but not patients, mentioned low literacy as a barrier. Our findings underscore the importance of the physician-patient relationship as a point of intervention to address the unmet informational and psychosocial needs of Latino cancer patients

Youth working in tobacco farming: effects on smoking behavior and association with health status

Background: Cultivation of tobacco raises concerns about detrimental health and social consequences for youth, but tobacco producing countries only highlight economic benefits. We compared sociodemographic and health-related characteristics of school-age youth who worked and did not work in tobacco farming and assessed the effects on smoking behavior and health at 1 year. Methods: We used existing data collected in the province of Jujuy, Argentina where 3188 youth 13 to 17 years of age from a random middle school sample responded to longitudinal questionnaires in 2005 and 2006. Multivariate logistic regression models predicted association of tobacco farming work with health status and smoking behavior at 1 year. Results: 22.8% of youth in the tobacco growing areas of the province were involved in tobacco farming. The mean age of initiation to tobacco farming was 12.6 years. Youth working in farming had higher rates of fair or poor versus good or excellent self-perceived health (30.3% vs. 19.0%), having a serious injury (48.5% vs. 38.5%), being injured accidentally by someone else (7.5% vs. 4.6%), being assaulted (5.5% vs. 2.6%), and being poisoned by exposure to chemicals (2.5% vs. 0.7%). Youth working in tobacco farming also had higher prevalence of ever (67.9% vs. 55.2%), current (48.0% vs. 32.6%) and established smoking (17.8% vs. 9.9%). In multivariate logistic regression models tobacco farming in 2005 was associated with significant increased reporting of serious injury (OR = 1.4; 95%CI 1.1-2.0), accidental injury by someone else (OR = 1.5; 95% 1.0-2.1), assault (OR = 2.2; 95% CI 1.3-3.8), and poisoning by exposure to chemicals (OR = 2.5; 95% CI 1.2-5.4). Tobacco farming in 2005 predicted established smoking 1 year later (OR = 1.5; 95% CI 1.1-2.0). Conclusion: Youth who work in tobacco faming face a challenging burden of adversities that increase their vulnerability. Risk assessments should guide public policies to protect underage youth working in tobacco farming. (298 words).Fil: Alderete, Ethel del Carmen. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades. Universidad Nacional de Jujuy. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades; ArgentinaFil: Livaudais Toman, Jennifer. University of California; Estados UnidosFil: Kaplan, Celia. University of California; Estados UnidosFil: Gregorich, Steven E.. University of California; Estados UnidosFil: Mejía, Raúl. Centro de Estudios de Estado y Sociedad; ArgentinaFil: Pérez Stable, Eliseo J.. National Institutes of Health; Estados Unido

Country and gender differences in the association between violence and cigarette smoking among youth

Background: Exposure to violence in youth may be associated with substance use and other adverse health effects. This study examined cigarette smoking in two middle-income areas with different levels and types of exposure to violence. Methods: Association of exposure to verbal and physical violence with cigarette smoking in the West Bank oPt (2008) and in Jujuy Argentina (2006) was examined using cross-sectional surveys of 14 to 17-year old youth in 7th to 10th grade using probabilistic sampling. Results: Violence exposure rates were more than double for Palestinian girls (99.6% vs. 41.2%) and boys (98.7% vs. 41.1%) compared with Argentinians. The rate of current cigarette smoking was significantly higher among Argentinian girls compared with Palestinian girls (33.1% vs. 7.1%, p < 0.001). Exposure to verbal violence from family and to physical violence increased the odds of current cigarette smoking, respectively, among Argentinian girls (aOR = 1.3, 95% CI = 1.0–1.7; aOR = 2.5, 95%CI = 1.7–3.8), Palestinian girls (aOR 2.2, 95%CI = 1.1–2.4; aOR = 2.0, 95%CI = 1.1–3.6) and Argentinian boys (aOR = 1.5, 95%CI = 1.1–2.0; aOR = 2.2, 95%CI = 1.6–3.0), but not among Palestinian boys. Conclusion: Findings highlight the importance of producing context and gender specific evidence from exposure to violence, to inform and increase the impact of targeted smoking prevention strategies.Fil: Abu Rmeileh, Niveen M. E.. Birzeit University; Palestina (ANP)Fil: Alderete, Ethel del Carmen. Universidad Nacional de Jujuy; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades. Universidad Nacional de Jujuy. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades; Argentina. Instituto de Ciencia y Tecnología Regional; ArgentinaFil: Husseini, Abdullatif. Birzeit University; Palestina (ANP)Fil: Livaudais Toman, Jennifer. University of California; Estados UnidosFil: Pérez Stable, Eliseo J.. National Institutes of Health; Estados Unido

Mammography facilities serving vulnerable women have longer follow-up times.

ObjectiveTo investigate mammography facilities' follow-up times, population vulnerability, system-based processes, and association with cancer stage at diagnosis.Data sourcesProspectively collected from San Francisco Mammography Registry (SFMR) 2005-2011, California Cancer Registry 2005-2012, SFMR facility survey 2012.Study designWe examined time to biopsy for 17&nbsp;750 abnormal mammogram results (BI-RADS 4/5), categorizing eight facilities as short or long follow-up based on proportion of mammograms with biopsy at 30&nbsp;days. We examined facility population vulnerability (race/ethnicity, language, education), and system processes. Among women with a cancer diagnosis, we modeled odds of advanced-stage (≥IIb) cancer diagnosis by facility follow-up group.Data extraction methodsMerged SFMR, Cancer Registry and facility survey data.Principal findingsFacilities (N&nbsp;=&nbsp;4) with short follow-up completed biopsies by 30&nbsp;days for 82% of mammograms compared with 62% for facilities with long follow-up (N&nbsp;=&nbsp;4) (P&nbsp;&lt;&nbsp;0.0001). All facilities serving high proportions of vulnerable women were long follow-up facilities. The long follow-up facilities had fewer radiologists, longer biopsy appointment wait times, and less communication directly with women. Having the index abnormal mammogram at a long follow-up facility was associated with higher adjusted odds of advanced-stage cancer (OR 1.45; 95% CI 1.10-1.91).ConclusionsProviding mammography facilities serving vulnerable women with appropriate resources may decrease disparities in abnormal mammogram follow-up and cancer diagnosis stage