Surveillance of Colorectal Cancer Screening in New Mexico Hispanics and Non-Hispanic Whites

The incidence of colorectal cancer (CRC) among Hispanics in the state of New Mexico has increased in the past decade while that among whites has declined significantly. Using the 2006 New Mexico Behavioral Risk Factor Surveillance System (BRFSS) survey, we compared CRC screening among Hispanics and whites by gender to examine the influence of demographic, socioeconomic, preventive health, and clinical measures on the utilization of CRC screening. Although we found no ethnic differences in the prevalence of current breast, cervical and cancer screening, Hispanics were less likely to be current with CRC screening than whites. These differences were observed across a range of socioeconomic and other explanatory measures and in both genders. Hispanics also had a higher prevalence of CRC-related risk factors than whites, including inactivity, obesity, and diabetes, and ranked lower for most socioeconomic measures. Adjusting for healthcare coverage, education, and income in logistic regression models eliminated the Hispanic-white differences in CRC screening among men, and substantially reduced but did not eliminate screening differences among women. Innovative methods are needed to reach Hispanics to raise awareness of and participation in CRC screening. Because many CRC risk factors are potentially modifiable, appropriate cultural and linguistic interventions tailored to specific Hispanic subgroups and aimed at promoting CRC screening and reducing CRC risk factors may decrease ethnic disparities in CRC incidence.     

Colorectal Cancer Screening and State Health Insurance Mandates

Colorectal cancer (CRC) is the third most deadly cancer in the USA. CRC screening is the most effective way to prevent CRC death, but compliance with recommended screenings is very low. In this study, we investigate whether CRC screening behavior changed under state mandated private insurance coverage of CRC screening in a sample of insured adults from the 1997 to 2008 Behavioral Risk Factor Surveillance Survey (BRFSS). We present difference‐in‐difference‐in‐differences (DDD) estimates that compare insured individuals age 51 to 64 to Medicare age‐eligible individuals (ages 66 to 75) in mandate and non‐mandate states over time. Our DDD estimates suggest endoscopic screening among men increased by 2 to 3 percentage points under mandated coverage among 51 to 64 year olds relative to their Medicare age‐eligible counterparts. We find no clear evidence of changes in screening behavior among women. DD estimates suggest no evidence of a mandate effect on either type of CRC screening for men or women. Copyright © 2014 John Wiley & Sons, Ltd.     

Colorectal Cancer Screening Compliance among Asian and Pacific Islander Americans

Colorectal cancer (CRC) screening prevalence remains low among Asians and Pacific Islanders. This study examined disparities and predictors of CRC screening compliance in adults age 50–75 years in Asians and Pacific Islanders in Hawai‘i. Hawai‘i Behavioral Risk Factor Surveillance System (BRFSS) data for 2011–2014 were analyzed. CRC screening status was dichotomized. Logistic regression was used to examine ethnic differences in and predictors of CRC screening status. Filipinos (OR 0.56), Chinese (OR 0.70), and Hawaiians (OR 0.75) were significantly less likely than whites to be CRC compliant. Higher education and income, employment, regular health provider, and routine checkups were important predictors of CRC compliance. Findings confirm lower CRC screening compliance in three of the four largest Asian and Pacific Islander groups in Hawai‘i and that CRC screening compliance is influenced by several factors. Culturally tailored education and navigation services may be effective in reducing these disparities.     

Knowledge, attitudes, and screening practices among older men regarding prostate cancer

OBJECTIVES: This study determined population-based rates of reported prostate cancer screening and assessed prostate cancer-related knowledge, attitudes, and screening practices among men in New York aged 50 years and older. METHODS: Two telephone surveys were conducted. One was included in the 1994 and 1995 statewide Behavioral Risk Factor Surveillance System interviews, and the other was a community-level survey that targeted Black men (African-American Men Survey). Prevalence estimates were computed for each survey, and prostate cancer screening practices were assessed with logistic regression models. RESULTS: Overall, fewer than 10% of the men in each survey perceived their prostate cancer risk to be high; almost 20% perceived no risk of developing the disease. Approximately 60% of the men in each survey reported ever having had a prostate-specific antigen (PSA) test. In both surveys, physician advice was significantly associated with screening with a PSA test or a digital rectal examination. Also, race was significantly associated with screening in the statewide survey. CONCLUSIONS: Many New York men appear to be unaware of risk factors for prostate cancer. However, a substantial percentage reported having been screened for the disease; physician advice may have been a major determining factor in their decision to be tested.     

Screening Mammography Utilization in Tennessee Women: The Association With Residence

ABSTRACT:  Context: Approximately 70% of US women over age 40 report mammography screening within 2 years. However, rates are likely to vary by age, income, educational level, and residence. Purpose: To describe the prevalence of screening mammography and associated factors in women living in rural and urban areas of Tennessee. Methods: Using pooled data from the Tennessee Behavioral Risk Factor Surveillance System (BRFSS; 2001 and 2003), utilization of screening mammography within a 2-year period was examined for a sample of 1,922 women, 40 years and older. Demographic, behavior, and health-related variables were used to examine associations with utilization. Findings: The prevalence of screening mammography utilization (71.3% 95% CI 67.4-75.2) in women living in rural areas of Tennessee was significantly lower than utilization among women living in urban areas (78.3% 95% CI 75.9-80.7). Higher utilization was associated with having attained at least a high school education, having health insurance, identifying a personal health care provider, being a nonsmoker, recent use of alcohol, having had a recent clinical breast exam or Papanicolau (Pap) test done, and meeting the Healthy People 2010 (HP 2010) recommendation for physical activity. After controlling for all other factors, rural residence was not associated with utilization. For rural women, identifying a personal health care provider was significantly associated with increased likelihood of utilization. Conclusions: Lower income and lower education, each associated with lower screening utilization, were more common in rural Tennessee women. The significance of a personal health care provider for utilization in rural women is meaningful for service providers.     

Predictors of Compliance with Recommended Cervical Cancer Screening Schedule: A Population-Based Study

Background: The prevalence of routine cervical cancer screening and compliance with screening schedules are low compared to the Year 2000 objectives. Identifying predictors of routine screening and screening schedule compliance will help achieve these objectives. Methods: We analyzed data from probability samples of 1,609 Missouri women responding to both the 1994 Behavioral Risk Factor Surveillance System (BRFSS) and the Missouri Enhanced Survey (ES). We generated prevalence odds ratios to identify predictors of non-compliance to cervical cancer screening guidelines. Also, among a sample of women reporting a reason for last Pap test, we estimated the relative odds of a screening v. diagnostic exam. Results: In the combined probability sample, compliance with screening schedule was likely among women younger than 50 years of age and women who had either a recent mammography or a clinical breast exam. Being African-American, not experiencing a cost barrier when seeking medical care, having at least a high-school education and health coverage were each associated with an increased compliance with a screening schedule in the combined probability sample. Among women in the combined probability sample, whites, those who experienced no cost barrier to seeking medical care, the non-obese, and those who had a recent mammography were each more likely to have had a screening as opposed to a diagnostic exam. Discussion: Cancer control and cardiovascular (CVD) prevention programs should consider jointly targeting those at high risk for cervical cancer and CVD because of aging and associated high-risk behavior such as non-compliance with cervical cancer screening, smoking, and obesity. Also, further research is needed to examine whether the increased compliance with cervical cancer screening guidelines among African American women may be in part due to higher occurrence of diagnostic Pap smears.     

Cardiovascular disease risk reduction in the Behavioral Risk Factor Surveillance System

BACKGROUND: Cardiovascular disease (CVD) risk-reduction practices are suboptimal in populations at high risk for CVD, and this problem may be worse in women than in men. METHODS: In 2003, CVD risk-reduction practices were compared between men and women after stratification by CVD risk status (high, intermediate, low) in a cross-sectional analysis of the 1999 Behavioral Risk Factor Surveillance System (BRFSS), a random-digit telephone survey of state population-based samples of the civilian non-institutionalized population of adults. This analysis included persons aged >40 years who answered questions regarding lipid and blood pressure screening, recommendations for lifestyle modification, that is, exercise and reduced fat intake, and aspirin use. Risk status was defined according to Adult Treatment Panel III definitions. RESULTS: In the 97,387 adults included in this analysis, high CVD risk was associated with lipid and blood pressure screening, lifestyle modification, and aspirin use in both men and women compared to intermediate-risk and low-risk (p <0.001). Among high-risk adults, men and women reported similar frequency of blood pressure and cholesterol measurement and physician advice on lifestyle modification; among intermediate- and low-risk adults, women reported slightly more frequent screening and lifestyle modification than men (p <0.001). In all CVD risk categories, women reported significantly less aspirin use than in men (p <0.001). CONCLUSIONS: Among people at high risk for CVD, women report lifestyle modification more often than men, while men report use of aspirin more often than women. These findings may assist with targeting interventions to reduce CVD risk to the unique needs of men and women.     

Population surveillance for physical violence among adult men and women, Montana 1998

BACKGROUND: Few epidemiologic studies of physical violence or intimate partner violence provide population-based surveillance data. OBJECTIVES: To estimate the prevalence and describe the characteristics associated with physical violence among adult men and women in the past year. METHODS: A random sample of Montana households was contacted via the Behavioral Risk Factor Surveillance System telephone survey in 1998 (N=1804). RESULTS: Five percent of men (39/787) and 3% of women (33/1017) reported experiencing physical violence in the past year. Among respondents reporting physical violence in the past year, women were more likely than men to report that the perpetrator was a current/former partner (58% vs 10%, p/=0.05). Men who reported experiencing physical violence in the past year were more likely to be younger and not to be living with a current partner. Women who reported experiencing physical violence in the past year were more likely to be younger, not currently living with a partner, have no health insurance, and have more days with mental health problems in the past month. CONCLUSIONS: Recent physical violence is common for both men and women; however, the perpetrators, locations, and demographic characteristics differ. Further study is needed to better understand the factors associated with physical violence among men and women in the context of designing and implementing appropriate interventions to reduce violence.     

Gender Differences in the Association between Adverse Childhood Experiences and Cancer

ObjectivesAdverse childhood experiences (ACEs) have been linked to a variety of diseases in adulthood, including cancer. However, current research has yet to determine if all abuse types are associated with cancer and if women are more adversely impacted by ACEs than men.MethodsData from the 2011 Behavioral Risk Factor Surveillance System, a national survey of American adults 18 and older (N = 111,964) were analyzed. Logistic regression models were fit to estimate odds of ever being diagnosed with cancer after experiencing one or more of eight different ACEs, while adjusting for potential confounders. These analyses were then stratified by gender.ResultsAmong women, childhood experiences of physical abuse, sexual abuse, emotional abuse, living with someone who was mentally ill, living with a problem drinker, living with a drug user, and living in a household where adults treated each other violently were associated with higher odds of cancer. Among men, only emotional abuse was associated with higher odds of cancer.ConclusionsResults suggest that ACEs increase risk of cancer later in life. However, this impact occurs mostly among women. This finding may be because women experience many ACEs at higher rates than men and because women, via sexual abuse, can be exposed to cancer-causing viruses.     

Correlates of underutilization of colorectal cancer screening among U.S. adults,age 50 years and older

BACKGROUND: Although effective screening for colorectal cancer (CRC) exists, only 37% of incident CRC are diagnosed at a localized stage at which treatment is effective. We identified demographic and other characteristics of adults (> or = 50 years old) who reported no CRC screening. METHODS: We calculated the prevalence of never having had a fecal occult blood test and/or a sigmoidoscopy or colonoscopy by age, sex, and other factors using the 1999 Behavioral Risk Factor Surveillance System data. RESULTS: CRC screening tests were underutilized across all segments of the population. Underutilization was highest in persons aged 50-64 years and those with lower education and a lack of health insurance and preventive services. CONCLUSIONS: The data indicate that large proportions of average-risk adults across various sociodemographics and behavioral factors are not utilizing recommended CRC screening tests. There is a need to increase the awareness of the importance of utilizing effective CRC screening tests for the early detection of colorectal cancers.     

Use of colorectal cancer tests--United States, 2002, 2004, and 2006

Colorectal cancer is the second-leading cause of cancer-related deaths in the United States among cancers that affect both men and women. The U.S. Preventive Task Force and other national organizations recommend that persons aged > or =50 years at average risk be screened for colorectal cancer using one or more of the following methods: fecal occult blood testing (FOBT) every year, sigmoidoscopy or double-contrast barium enema every 5 years, or colonoscopy every 10 years. To estimate rates of use of colorectal cancer tests and to evaluate changes in test use, CDC compared data from the 2002, 2004, and 2006 Behavioral Risk Factor Surveillance System (BRFSS) surveys. This report describes the results of that comparison, which indicated that the proportion of respondents aged > or =50 years reporting use of FOBT and/or sigmoidoscopy or colonoscopy increased overall from 2002 to 2006; however, certain populations, such as racial/ethnic minorities and those who reported no health insurance coverage, had lower prevalence of testing. Specific measures to increase colorectal cancer screening and address disparities in screening are needed.     

Peer Reviewed: Factors Associated With Cervical Cancer Screening in Puerto Rico

Introduction

Racial/ethnic disparities in cervical cancer screening exist in the United States; rates are lowest among women who live in Puerto Rico. We identified factors associated with cervical cancer screening among women aged 18 years or older living in Puerto Rico.

Methods

We included women who participated in the Puerto Rico Behavioral Risk Factor Surveillance System in 2006 who had not had a hysterectomy (n = 2,206). We calculated the weighted population prevalence estimates of Papanicolaou (Pap) test screening in the past 3 years and used logistic regression models to assess factors associated with screening.

Results

Most participants (71.9% [95% confidence interval (CI)Most participants (71.9% [95% confidence interval (CI) = 69.4%-74.4%]) reported having had a Pap test in the preceding 3 years. Factors associated with screening in multivariate analysis included routine checkup in the past year and leisure-time physical activity. Compared with women with a household income less than $15,000, those with higher incomes were more likely to have had a Pap test. Similarly, divorced or separated women were more likely to have been screened (odds ratio [OR] = 1.13; 95% CI = 1.12-1.15) than those who were married/living together. We did not find associations between screening behavior and education, health care coverage, body mass index, or smoking status.

Conclusion

The prevalence of cervical cancer screening in Puerto Rico is below the 90% recommendation established by Healthy People 2010. Our findings regarding factors associated with Pap screening behavior identified population subgroups who are underscreened and who may benefit from targeted interventions and screening programs.     

Receipt of cancer screening services: surprising results for some rural minorities

Background: Evidence suggests that rural minority populations experience disparities in cancer screening, treatment, and outcomes. It is unknown how race/ethnicity and rurality intersect in these disparities. The purpose of this analysis is to examine the cancer screening rates among minorities in rural areas. Methods: We utilized the 2008 Behavioral Risk Factor Surveillance System (BRFSS) to examine rates of screening for breast, cervical, and colorectal cancer. Bivariate analysis estimated screening rates by rurality and sociodemographics. Multivariate analysis estimated the factors that contributed to the odds of screening. Results: Rural residents were less likely to obtain screenings than urban residents. African Americans were more likely to be screened than whites or Hispanics. Race/ethnicity and rurality interacted, showing that African American women continued to be more likely than whites to be screened for breast or cervical cancer, but the odds decreased with rurality. Conclusions: This analysis confirmed previous research which found that rural residents were less likely to obtain cancer screenings than other residents. We further found that the pattern of disparity differed according to race/ethnicity, with African Americans having favorable odds of receipt of service regardless of rurality. These results have the potential to create better targeted interventions to those groups that continue to be underserved.     

Breast and cervical cancer screening practices among American Indian and Alaska Native women in the United States, 1992-1997.

BACKGROUND: Recent studies suggest that American Indian and Alaska Native women have important barriers to cancer screening and underuse cancer screening tests. METHODS: We examined the breast and cervical cancer screening practices of 4,961 American Indian and Alaska Native women in 47 states from 1992 through 1997 by using data from the Behavioral Risk Factor Surveillance System. RESULTS: About 65.1% [95% confidence interval (CI) 60.2 to 69.9%] of women in this sample aged 50 years or older had received a mammogram in the past 2 years. About 82.6% (95% CI 80.1 to 85.2%) of women aged 18 years or older who had not undergone a hysterectomy had received a Papanicolaou test in the past 3 years. Older women and those with less education were less likely to be screened. Women who had seen a physician in the past year were much more likely to have been screened. CONCLUSIONS: These results underscore the need for continued efforts to ensure that American Indian and Alaska Native women who are elderly or medically underserved have access to cancer screening services.     

Caregiving associated with selected cancer risk behaviors and screening utilization among women: cross-sectional results of the 2009 BRFSS

ABSTRACT: BACKGROUND: Informal caregiving is increasingly common as the U.S. population ages, and there is concern that caregivers are less likely than non-caregivers to practice health-promoting behaviors, including cancer screening. We examined caregiving effects on cancer risk behaviors and breast and cervical cancer screening in the 2009 Behavioral Risk Factor Surveillance System. METHODS: Women age [GREATER-THAN OR EQUAL TO]41 with data on breast and cervical cancer screening were included (weighted frequency 3,478,000 women). Cancer screening was classified according to American Cancer Society guidelines. We evaluated the association of caregiving with cancer risk behaviors (obesity, physical activity, alcohol intake, smoking status, and fruit/vegetable consumption) and cancer screening (mammography, clinical breast exam [CBE], and Pap test) using logistic regression overall and with stratification on age (<65, [GREATER-THAN OR EQUAL TO]65) or race (white, non-white). RESULTS: Caregivers had greater odds of being obese, physically active, and current smokers. Subgroup analyses revealed that caregiving was associated with obesity in younger women and whites, and with less obesity in older women. Also, caregiving was associated with smoking only among younger women and non-whites. Caregivers had greater odds of ever having had a mammogram or CBE, yet there was no association with mammogram, CBE, or Pap test within guidelines. CONCLUSIONS: Caregiving was associated with some health behaviors that increase cancer risk, yet not with cancer screening within guidelines. Effects of caregiving by age and race require confirmation by additional studies.     

Factors Associated with Never Being Screened for Colorectal Cancer

Colorectal cancer (CRC) screening is underused in the United States, and non-adherence with screening recommendations is high in some populations. This study describes the characteristics of people who have never been screened for CRC. In addition, we use the health belief model to examine the constructs associated with screening behavior. We used data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) to create three study outcomes: people who have been screened for CRC and are up-to-date with current recommendations, people who have been screened but are not up-to-date, and people who have never been screened. We used multivariate logistic regression modeling to calculate predicted marginal estimates examining the associations between the screening outcomes and demographic and Health Belief Model (HBM) characteristics. Overall 29 % of respondents had never been screened for CRC. In the adjusted model, 36.6 % of US adults age 50–59 years and 29.1 % of US men reported never being screened for CRC. More Asian/Native Hawaiian/Pacific Islander, non-Hispanics (38.2 %) reported never being screened than members of other racial and ethnic groups. Nearly 37 % of people with less than a high school diploma reported never being screened. We found statistically significant differences among screening outcomes for all demographics and HBM constructs except could not see a doctor because of costs in the last 12 months, where approximately 29 % reported no CRC screening. New interventions should focus on those subpopulations that have never been screened for CRC.     

Breast and cervical cancer screening among women in metropolitan areas of the United States by county-level commuting time to work and use of public transportation, 2004 and 2006

Background  

Commuting times and behaviors have been associated with a variety of chronic disease outcomes and health behaviors. We examined the relationships between ecologic measures of commuting time and use of public transportation in relation to breast and cervical cancer screening among women in U.S. metropolitan areas who participated in the 2004 and 2006 Behavioral Risk Factor Surveillance System (BRFSS) surveys.     

Demographic correlates of HIV testing, high-risk behaviors, and condom/STD consultation among a multi-ethnic sample of women

BACKGROUND: In the United States, HIV rates are disproportionately high among black women, with 78% of cases attributed to heterosexual transmission. This analysis examined HIV testing, high risk behaviors and condom use consultation for the prevention of sexually transmitted diseases (STD) among a diverse sample of women. METHODS: Secondary analyses were conducted using data from the 2004 Behavioral Risk Factor Surveillance System (BRFSS). This dataset included a sample of 43,550 (12% black, 79% white, and 9% Hispanic) women aged 18 to 49 years, living in the United States. Both bivariate and multivariate statistical analyses were conducted. RESULTS: Multivariate logistic regression analyses revealed that ethnic group differences existed for past-year HIV test, high-risk behaviors, and condom use consultation even after we controlled for age, education,income, employment status, and region of residence. Black women were three times more likely than white women to report a past-year HIV test and Hispanic women were 50% more likely than white women and report a past-year HIV test. Women who reported receiving condom use consultations were most likely to be Hispanic, 30 to 34 years old, and residents of the northeast. CONCLUSIONS: Initiatives to promote HIV testing appeared to have affected HIV testing behaviors among black women. However, increased HIV testing among black women was not associated with an increased likelihood of condom use counseling by a healthcare professional. More emphasis on HIV counseling is warranted to assist with HIV risk reduction and to complement HIV testing initiatives.     

Compliance rates and predictors of cancer screening recommendations among Appalachian women

High rates of morbidity and mortality in the Appalachian region of the country warrant examination of the preventive care behavior of its residents. This study determined compliance rates for breast and cervical cancer screening recommendations for women residing in Appalachian states and identified predictors of such compliance using the Behavioral Risk Factor Surveillance System data (1995-97). Healthy People 2000 goals were used as benchmarks for progress. Appalachian women have made good progress toward goals pertaining to breast and cervical cancer screening. Compliance with other preventive services, having insurance coverage, residing in urban areas, better self-reported health, and higher education were independently associated with increased odds of compliance with annual-screening recommendations. Risk factors of obesity and smoking were associated with decreased odds of compliance. Findings should be useful to health care providers, policy makers, and researchers in their efforts to educate, encourage, and promote preventive care behavior among residents of Appalachia.