Thesis (MPH.) -- University of Limpopo, 2017 / Refer to document

Despite the evidence that colorectal cancer screening is effective in reducing the incidence of and mortality from colorectal cancer, racial and ethnic disparities in colorectal cancer screening persist in the United States. African-born immigrants in the United States have lower colorectal cancer screening rates than native-born Americans. The purpose of this quantitative, retrospective, cross-sectional study was to examine how family income, health insurance status, language of interview, length of stay in the United States, perceived health status, level of education, and having a usual place for medical care affect colorectal cancer screening among African-born immigrants in the United States. The immigrant health services utilization model provided the framework for the study. Secondary data collected in 2010, 2013, and 2015 through the National Health Interview Survey from 349 African-born immigrants age 40 years and above were analyzed using logistic regression and a chi-square test of independence. A stratified multistage sampling procedure was used to select the sample for the study. Results showed a significant association between colorectal cancer screening and health insurance status, length of stay in the United States, perceived health status, and having a usual place for medical care. However, no association was found between colorectal cancer screening and family income, education level, and interview language. Findings may be used to impact positive social change and guide policy decisions on colorectal cancer preventive interventions targeting African-born immigrants living in the United States.

L'inici del programa de detecció precoç del càncer de mama en els districtes de Ciutat Vella i Sant Martí de la ciutat de Barcelona, va motivar la realització del primer estudi en el barri de la Barceloneta, amb l'objectiu d'analitzar diferents factors associats a la participació. La resposta després de la primera citació ha estat del 65%. S'ha relacionat amb l'historial clínic previ augmentant en quasi 4 vegades l'ods de resposta, i amb el receptor de la carta de citació, variant del 75% quan és la mateixa interessada fins el 47% quan la carta és dipositada a la bústia, i el 32% quan l'adreça és insegura. La resposta després de les citacions successives ha estat del 26%. S'ha relacionat amb l'historial clínic previ augmentant en quasi 8 vegades l'ods de resposta, i amb la raó de no haver vingut després de la primera citació, passant del 50% quan és circumstancial fins el 11% quan s'atribueix a manca d'interès. La taxa de cobertura (79%) disminueix amb l'edat, i augmenta amb el nivell educatiu.El segon estudi permet apreciar com prèviament al programa les mamografies no s'adequaven a les directrius europees. Un 59% de les dones entrevistades dels barris El Clot, Camp de l'Arpa i La Verneda, s'han fet una mamografia de cribratge en els últims quatre anys. Existeix una major utilització en dones més joves, de major nivell educatiu i que tenen historial clínic. La periodicitat era anyal en un 35%, biennal en un 38% i cada 2-4 anys en el 27% restant. El 58% de les mamografies s'han realitzat en la sanitat pública, que mostra el major percentatge (42%) de periodicitat biennal. En les dones participants, la visita al ginecòleg i la pràctica de citologia uterina han presentat la major associació (probabilitats 4 vegades superiors) amb la mamografia prèvia de cribratge. També s'han associat a una major utilització els antecedents personals de patologia mamària i familiars de càncer de mama, l'autoexploració mamària i la visita mèdica recent, mentre que l'autopercepció de salut ha presentat una relació inversa.Finalment, el tercer estudi és un assaig controlat aleatoritzat on s'han comparat tres diferents estratègies utilitzades per a invitar dones d'entre 50 a 64 anys a participar en el programa. L'estratègia del contacte directe incrementa de forma significativa fins un 22% la probabilitat de resposta després de la primera citació en les dones del barri de Raval Nord invitades. En el grup de contacte directe aquesta resposta era del 63%, comparat amb un 55% quan la carta era enviada pels professionals sanitaris del CAP, i un 52% quan era remesa pels responsables del programa. Aquest increment en el grup de contacte directe s'observa encara que sols s'ha aconseguit contactar en un 45% dels casos directament amb la mateixa dona. Quan aquest fet s'assoleix la resposta és del 72%. La utilització de professionals no sanitaris per a aconsellar les dones sembla ser una estratègia efectiva, particularment entre les dones de baix nivell educatiu. / The beginning of the breast cancer screening program in the Ciutat Vella and Sant Martí districts of Barcelona was the origin of the first study in the Barceloneta quarter, with the aim of analyzing different factors related to participation. The response after the first citation was 65%. Having a previous clinical history, increased in nearly 4 times the response odds. Response after the first citation was influenced by who the recipient of the citation letter was, ranging from 75% when this was the same person concerned to 47% when the letter was left in the letter-box, and to 32% when the address was uncertain. The response after subsequent citations was 26%. Having previous clinical history increased the response odds in almost 8 times. The response after successive citations, ranged from 50% when it was for circumstantial reasons, to 11 % when it was due to lack of interest. Coverage rate (79%) decreased with age, and increased with education level.The second study shows that, previously to the program, mammography screening did not comply with European guidelines. A screening mammography had been performed on 59 % of women interviewed in the El Clot, Camp de l'Arpa and La Verneda quarters. The utilization of mammography was higher among younger women, women with a higher education level, or who had previous visits to a physician. Periodicity was once a year in 35% of cases, once every two years in 38%, and every 2-4 years in the remaining 27 %. Mammographies were performed at the Public Heath Service in 58 % of cases. The Public Health Service shows the highest percentage (42 %) of biennial periodicity. The variables more strongly associated with the use of screening mammography (probabilities 4 times higher) were: visit to a gynecologist and performance of a pap smear. Also related to the utilization of screening mammography were: personal history of breast pathology, family history of breast cancer, breast self-examination, and recent visit to a general practitioner. Self-perceived health presented an inverse relation with screening mammography use.Finally, the third study is a randomized controlled trial where three different strategies of inviting 50 to 64 years old women to participate in the program were compared. The strategy of direct contact increased in a significant way, up to 22%, the possibility of response after the first citation among women invited in the Raval Nord quarter. The response rate in the direct contact group was 62%, compared to 55% when the letter was sent by Primary Health Care Team, and 52% when it was sent by those responsible of the program. This increase in the direct contact group is noticeable even though only in 45 % of cases it was possible to contact the subject herself. When this was achieved, response raised to 72%. Use of non-health professionals to advise women seems to be an effective strategy, especially among women with a lower educational level.

Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among men in the United States. In African American men, the disease is typically detected at a more advanced stage and mortality is twice the rate of Caucasian men. However, African American men are less likely to participate in prostate cancer screening. The purpose of this descriptive study was to assess the relationship between health beliefs, knowledge, and selected demographic variables (age, income and education) and a man’s decision to participate in prostate cancer screening among African American men dwelling in rural communities. The conceptual framework for the study was the Health Belief Model. Participants for the study were recruited through contacts within rural communities within west central Alabama. A convenience sample of 90 African American men between the ages of 40-82 years of age was recruited. Analysis of the research data indicated that there was a statistically significant difference in motivation (health belief), knowledge, and age of men who participated in prostate cancer screening compared to those who did not participate in prostate cancer screening. Forward logistic regression was used to determine which independent variables [health beliefs (benefits, barriers, motivation); knowledge; age; income; and education] were predictors of prostate cancer screening. Results indicated the overall model of one predictor, motivation, was statistically reliable in predicting prostate cancer screening participation among the rural dwelling men surveyed. The model accounted for 15 to 20% of the variance. The sensitivity of the model in predicting those who would participate in prostate cancer screening was 85%. The odds of those who would participate in prostate cancer screening were 1.3 times greater for each one unit increase in motivation. Results indicate a need for more educational and motivational interventions to promote informed decision making by African American men in regards to prostate screening activities. These interventions need to be culturally sensitive and geared toward African American men, specifically those living in rural areas.

Cancer is the leading cause of death for Hispanics, and cervical cancer incidence is higher (64%) for Hispanics than for non-Hispanic whites. In Texas Hispanic women 50 and older are the lowest screened and present with higher incidence of invasive cervical cancer as compared to non-Hispanic white women. They are diagnosed at a peak age of 65-74, which suggests that Hispanic women need to be screened past the recommended screening age. An estimated 90 million people in the U.S. lack basic literacy skills and low literacy may contribute to low screening. Few studies have addressed the relationship between low health literacy and cervical cancer screening among older women of Mexican-American ancestry. This study sought to uncover the cervical cancer screening beliefs, practices, health literacy, knowledge, and experiences of English and/or Spanish-speaking older women of Mexican-American ancestry. Thirty women participated in focus group or individual interviews in English and/or Spanish. Women 50 years of age or older living in the community were recruited from senior centers in South Texas from a purposeful convenience sample. Data collection was conducted through audio-taped semi-structured interviews following a moderator guide developed using Zarcadoolas, Pleasant, and Greer’s (2005) health literacy model. Data were transcribed, analyzed in original language, translated for meaning, aggregated for analysis using qualitative content analysis; matrices were developed and analyzed individually, and then data were aggregated. The Newest Vital Sign, a health literacy tool, was used to partially assess fundamental literacy. Major themes elucidated were (a) Reasons “I don’t go” [fundamental literacy], (b), Prevention of cancer and “everything else” [science literacy], (c) We are different,[cultural literacy], (d) There is always “consejos” (advice, messages) [civic literacy], and media literacy, (e) Telenovelas (soap-operas) teach a lot, and (f) Learning from Internet brochures. The study supports a multidimensional model of health literacy and focus group research, accounting for the group’s cultural norms, language, and educational preferences. It adds information for nurse clinicians about providing holistic care, for nurse educators regarding communication strategies for diverse older populations, and for researchers to continue developing strategies that improve health literacy and health outcomes for minority older women. / text

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An estimated 5-10% of breast cancers are hereditary in nature and are due to the presence of a mutation in a breast cancer predisposition gene; approximately half of these cases possess a mutation in BRCA1 or BRCA2. Many BRCA1/BRCA2 mutations result in a truncated protein and hence are unequivocally disease-causing. However another class of mutations, the Variants of Unknown Significance (VUS), are more problematic as the effect of these mutations on protein function is unclear. The inability to classify these mutations as disease causing generates significant problems in risk evaluation, counseling and preventive care. Accordingly we sought to determine whether carriers of either a BRCA1 or BRCA2 mutation could be identified from non-carriers based on the gene expression patterns of non-cancerous cells. EBV-transformed lymphoblastoid cell lines established from BRCA1/BRCA2 mutation carriers and normal individuals were obtained through the NIH Breast Cancer Family Registries. Cell lines were mock-irradiated or treated with ionizing radiation (2 Gy). Following a recovery period of 6 hours total RNA was extracted and whole genome gene expression profiling was carried out. Molecular classifiers comparing the baseline expression profiles and the radiation-dependent expression profiles of BRCA1/BRCA2 mutation carriers to control individuals were created using a Support Vector Machine (SVM) coupled with a recursive feature removal (RFR) algorithm. Our results suggest that cell populations derived from BRCA1/BRCA2 mutation carriers display unique expression phenotypes from those of control individuals in both the basal and radiation-induced cases. In the task of classification using baseline expression, the BRCA1-classifier correctly classified 15/18 test samples using feature selection based on the training set only, while feature selection using the entire dataset (AD) improved classification to 16/18 samples. The BRCA2-baseline classifier correctly classified 13/17 and 14/17 (AD) samples, respectively. In the task of radiation-dependent classification, the BRCA1-IR classifier correctly classified 12/18 and 16/18 (AD) test samples respectively while the BRCA2-IR classifier correctly classified 13/17 and 16/17 (AD) test samples respectively. These results suggest the possibility of development of this assay into a novel hereditary breast cancer screening diagnostic able to accurately identify the presence of BRCA1 or BRCA2 mutations via a functional assay thereby improving patient outcomes. / Thesis (Master, Pathology & Molecular Medicine) -- Queen's University, 2008-03-27 15:38:19.269 / Canadian Breast Cancer Foundation-Ontario Chapter, Department of Pathology & Molecular Medicine Clinical Trust Fund

Background: The number of Foreign Born (FB) individuals in the United States (US) is growing and their health behaviors and beliefs are important to know. In the US, cancer is the second leading cause of death, and there is need to explore factors that are associated with the use of cancer prevention strategies among FB individuals. Objective: The study aimed to compare cancer screening rates, assess factors associated with use of cancer screening tests across FB and Non-Foreign Born (NFB) individuals and association between length of stay and use of selected cancer screening tests among FB people. Methodology: Using the 2012 Health Information National Trends Survey (HINTS) 4, cycle 2 data, which comprised of 3,630 participants of which 513 were FB, logistic regression analyses were conducted to identify predictors of selected cancer screening tests. Independent variables included demographic and selected healthcare, beliefs, and information seeking factors. Results: There were no significant differences in screening rates for cervical, breast, and colon cancers among the FB and NFB individuals. For breast cancer screening, having had a routine checkup in the last year was found to be associated with increased likelihood of having a mammography exam. For cervical cancer screening, none of the selected healthcare, beliefs and information seeking factors was found to be significant among the FB individuals. For colon cancer screening, only the information seeking factor “it took a lot of effort to get cancer information” was found to be significant among FB individuals. Length of stay in the US for FB individuals was found be associated with increased likelihood of colon cancer test only. Conclusion: Inventive and ethnically appropriate strategies are essential to increase awareness for cancer prevention strategies. Well-designed information strategies that take into account the diversity of the US population can lead to benefits such as increased cancer screening.

Aisha Kamilah O. Lofters Cervical Cancer Screening Among Ontario’s Urban Immigrants Doctor of Philosophy, 2012 Institute of Health Policy, Management and Evaluation University of Toronto Background: The majority of cervical cancers can be prevented because of the highly effective screening tool, the Papanicolaou (Pap) test. Relevant guidelines recommend routine screening for nearly all adult women. However, inequities in screening exist in Ontario. This dissertation, consisting of three studies, uses administrative data to advance knowledge on barriers to cervical cancer screening for Ontario’s urban immigrant population. Methods: First, we developed and validated a billing code-based algorithm for cervical cancer screening. We then implemented this algorithm to examine screening rates in Ontario among women with various sociodemographic characteristics for 2003-2005. Second, we compared the prevalence of appropriate cervical cancer screening in Ontario in 2006-2008 among immigrant women from all major geographic regions of the world and Canadian-born women. Third, we used a stratified multivariate analysis to determine if the independent effects of various factors that could serve as screening barriers were modified by region of origin for immigrant women for 2006-2008. Results: Our first study showed that our algorithm was 99.5% sensitive and 85.7% specific, and that screening inequities in Ontario’s urban areas are largest among women 50 years and older, living in the lowest-income neighbourhoods and new to the province. In our second study, we determined that immigrant women had significantly lower screening rates than their peers, with the most pronounced differences seen for South Asian women aged 50 years and above. In the final study, we demonstrated that living in the lowest-income neighbourhoods, being younger than 35 years or older than 49 years, not being enrolled in a primary care enrolment model, having a male provider, and having a provider from the same region of the world each significantly influenced screening for immigrant women regardless of region of origin. Conclusion: These results add to the literature on health equity in cancer screening. Our findings demonstrate that Ontario’s urban immigrant women experience significant inequities in cervical cancer screening, and may offer guidance toward targeted patient and physician interventions to decrease screening gaps.

Aisha Kamilah O. Lofters Cervical Cancer Screening Among Ontario’s Urban Immigrants Doctor of Philosophy, 2012 Institute of Health Policy, Management and Evaluation University of Toronto Background: The majority of cervical cancers can be prevented because of the highly effective screening tool, the Papanicolaou (Pap) test. Relevant guidelines recommend routine screening for nearly all adult women. However, inequities in screening exist in Ontario. This dissertation, consisting of three studies, uses administrative data to advance knowledge on barriers to cervical cancer screening for Ontario’s urban immigrant population. Methods: First, we developed and validated a billing code-based algorithm for cervical cancer screening. We then implemented this algorithm to examine screening rates in Ontario among women with various sociodemographic characteristics for 2003-2005. Second, we compared the prevalence of appropriate cervical cancer screening in Ontario in 2006-2008 among immigrant women from all major geographic regions of the world and Canadian-born women. Third, we used a stratified multivariate analysis to determine if the independent effects of various factors that could serve as screening barriers were modified by region of origin for immigrant women for 2006-2008. Results: Our first study showed that our algorithm was 99.5% sensitive and 85.7% specific, and that screening inequities in Ontario’s urban areas are largest among women 50 years and older, living in the lowest-income neighbourhoods and new to the province. In our second study, we determined that immigrant women had significantly lower screening rates than their peers, with the most pronounced differences seen for South Asian women aged 50 years and above. In the final study, we demonstrated that living in the lowest-income neighbourhoods, being younger than 35 years or older than 49 years, not being enrolled in a primary care enrolment model, having a male provider, and having a provider from the same region of the world each significantly influenced screening for immigrant women regardless of region of origin. Conclusion: These results add to the literature on health equity in cancer screening. Our findings demonstrate that Ontario’s urban immigrant women experience significant inequities in cervical cancer screening, and may offer guidance toward targeted patient and physician interventions to decrease screening gaps.