Prevalence of Colorectal Cancer Testing and Screening in a Multiethnic Primary Care Population

Colorectal cancer (CRC) screening is strongly supported by evidence and widely recommended, but remains underutilized. This study reports the prevalence of CRC diagnostic testing and CRC screening in three racial/ethnic groups attending the same primary care clinic. A cross-sectional survey was conducted to elicit past history of CRC testing, including test type, indication and timing. A comparable number of African American, Hispanic and non-Hispanic white patients aged 50–80 were recruited. 560 surveys were completed: mean age was 63.4 years, 64% reported minority race/ethnicity, and 96.8% had insurance. Overall, 62.5% [95% CI: 58.5%, 66.5%] of patients were current with any type of CRC test, when diagnostic and screening procedures were included. However, 48.6% [95% CI: 44.5%, 52.7%] of the sample was current with CRC screening, when only procedures performed for screening in asymptomatic patients were included. Patients least likely to be current with testing were those of minority race/ethnicity (48.2% of Hispanics, 56.7% of African Americans and 67.5% of non Hispanic whites, p < 0.05), younger age, (57.6% of those aged 50–64, and 71.4% of those aged 65–80, p < 0.005), and those with private insurance alone (56.0% private, 67.7% public and 68.1% mixed, p < 0.05). Our findings indicate that racial/ethnic and age related disparities in CRC screening exist even in a patient population that has the same source of health care and no differences in insurance status. These results underline the need for providers to emphasize CRC screening in their practices to minority patients and those younger than 65 years of age.     

Colorectal Cancer Screening and Race in an Equal Access Medical System

National colorectal cancer (CRC) screening rates have improved, but significant racial disparities have been identified. Improved access to care has been proposed as a solution to eliminate such disparities. To determine if racial disparities in CRC screening rates persist in a medical system without barriers to access or cost. A retrospective review study was performed, examining the healthcare effectiveness data and information set data from patients between the ages of 50 and 65 years who were eligible for CRC screening. Data on the type of CRC screening and rates of up-to-date screening were also examined. Data were available for 14,196 patients of whom 8809 (62 %) reported race. Subjects included were 53 % male and 47 % female, with breakdown by race as follows: 53 % White, 34 % Asian/Pacific Islander, 11 % Black, 1 % Hispanic, and <1 % Native-American. Overall, CRC screening and up-to-date rates were higher than the national average (81 and 72 %, respectively). Blacks were less likely than non-Blacks to have undergone CRC screening (75 vs. 82 %, p < 0.001), and were also less likely to be up-to-date with CRC screening (66 vs. 72 %, p < 0.001). Despite elimination of access and cost barriers, racial disparities in CRC screening persist. Equal access to CRC screening tools will be necessary, but not sufficient, to eliminate the currently observed national trends. Further study should focus on elucidating patient-specific barriers to successful completion and maintenance of CRC screening.     

Original Research: Racial/Ethnic Patterns of HIV Sexual Risk Behaviors Among Young Men Who Have Sex with Men

Objectives: Not enough is known about the HIV high-risk sexual behaviors of young men who have sex with men (YMSM), and this is especially the case among ethnic minorities. This study examined racial/ethnic differences in the prevalence of HIV risk behaviors among YMSM across the United States. Design: Face-to-face interviews were conducted among randomly selected participants in venues identified with large samples of ethnic minority YMSM. Methods: Participants (N = 2612) were systematically sampled from venues in 13 U.S. cities representing four ethnic strata (African American, Asian/Pacific Islander, Hispanic, and mixed ethnicity). Results: Twenty-two percent of the sample reported that their last sexual contact with their main sexual partner, someone other than a main sexual partner, or both involved unprotected anal intercourse. Participants from Asian/Pacific Islander sites, mixed sites, and Hispanic sites were more likely than participants from African American sites to report unprotected anal intercourse. Moreover, within the mixed sites, Hispanic participants, followed by Asian/Pacific Islander and White participants, were more likely than African American participants to report unprotected anal intercourse. Conclusions: Interventions are needed that are responsive to the racial/ethnic differences in HIV risk behaviors of YMSM throughout urban American cities.     

More accurate racial and ethnic codes for Medicare administrative data

Analyses of health care disparities in Medicare using administrative race and ethnicity data have typically been limited to Black and White beneficiaries. This is in part due to the small size of the other categories, inaccuracies in the race and ethnicity codes, and caveats that more extensive analyses would produce biased results. While previous Medicare efforts certainly improved the accuracy of race and ethnicity coding, we have developed an imputation algorithm that dramatically improves the accuracy of coding for Hispanic and Asian or Pacific Islander beneficiaries. When compared with self-reported race and ethnicity, sensitivity increased from 29.5 to 76.6 percent for Hispanic and from 54.7 to 79.2 percent for Asian and Pacific Islander beneficiaries, with no loss of specificity, and Kappa coefficients reaching 0.80. As a result, 2,245,792 beneficiaries were recoded to Hispanic and 336,363 to Asian or Pacific Islander.     

Factors associated with racial/ethnic differences in colorectal cancer screening

Introduction: Racial/ethnic differences in colorectal cancer (CRC) screening rates are thought to account, in part, for the racial/ethnic differences in CRC disease burden. The purpose of this study was to examine which factors mediate racial/ethnic differences in CRC screening. METHODS: Five hundred sixty participants attending a primary care clinic, aged 50 to 80 years, and of African-American, Hispanic, or non-Hispanic white race/ethnicity were interviewed. The goal was to assess the contribution of sociodemographic characteristics, knowledge, beliefs about CRC, and the health care experience with their primary care doctor to racial/ethnic differences in CRC screening. The outcome variable was self-reported screening. All analyses were weighted; bivariate testing and multivariate logistic regression was conducted. RESULTS: The response rate was 55.7%, with no sociodemographic differences noted between respondents and nonrespondents. Respondents were African-American (n = 194), Hispanic (n = 162), and non-Hispanic white (n = 204); 64.5% were aged 50 to 64 years; 63.1% were women; 96.9% were insured; and over half reported a total annual income of less than $25,000. Overall 62.5% were current with CRC screening: 67.5% of non-Hispanic whites, 54.3% of African-Americans, and 48.6% of Hispanics (P < .001). A doctor's recommendation (odds ratio, 3.86); awareness of screening (odds ratio, 3.32); older age (odds ratio, 2.88); greater education (odds ratio, 2.02); and perceived susceptibility (odds ratio, 1.74) contributed to racial/ethnic differences in CRC screening. CONCLUSIONS: Interventions to address CRC screening disparities among racial/ethnic groups should focus on the health care setting and patient education about CRC screening; differences in attitudes and beliefs seem to be less important.     

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.     

Process evaluation in an intervention designed to improve rates of colorectal cancer screening in a VA medical center

Colorectal cancer (CRC) is the third most common cancer in the United States. Although CRC screening is recommended for individuals 50 years and older, screening completion rates are low. This can be attributed to provider and patient barriers. We developed an intervention to improve provider recommendation and patient screening among noncompliant male veterans in a 2-year randomized controlled trial and examined the relationship between participation and study outcomes among patients and providers. Overall, providers who attended intervention sessions recommended CRC screening during 64% of patient visits and providers who did not attend any intervention sessions recommended screening during 54% of visits (p < .01). Patients of providers who attended intervention sessions also were more likely to be screened (42% versus 29%, p < .05). The patient intervention did not have the desired impact. The subgroup of patients in the patient intervention was not more likely to complete CRC screening.     

Pregnancy-related deaths among Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women--United States, 1991-1997

In the United States in 1997, the Hispanic, Asian/Pacific Islander, and American Indian/ Alaska Native population represented 16% of all reproductive-age women (aged 15-49 years) but accounted for 23.5% of all live births (1,2). Although statistics by race/ethnicity are available for maternal deaths (3), pregnancy-related mortality ratios (PRMRs) have been reported regularly only for black and white women. Pregnancy-related deaths in Hispanic women have been studied (4); however, combining pregnancy-related mortality risk among Asians/Pacific Islanders and American Indians/Alaska Natives into an "other" category masks differences in their health status. This report presents PRMRs among Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women in the United States during 1991-1997. The findings indicate that these groups have higher PRMRs than non-Hispanic white (white) women and lower ratios than non-Hispanic black (black) women and underscore the need for targeted interventions that address the maternal health needs of racial/ethnic minority women.     

Racial and Ethnic Disparities in Incidence of SARS-CoV-2 Infection, 22 US States and DC,January 1–October 1, 2020

We examined disparities in cumulative incidence of severe acute respiratory syndrome coronavirus 2 by race/ethnicity, age, and sex in the United States during January 1–October 1, 2020. Hispanic/Latino and non-Hispanic Black, American Indian/Alaskan Native, and Native Hawaiian/other Pacific Islander persons had a substantially higher incidence of infection than non-Hispanic White persons.     

Assessing Colorectal Cancer Knowledge Among Puerto Rican Hispanics: Implications for Cancer Prevention and Control

In Puerto Rico, colorectal cancer (CRC) incidence and mortality rates are increasing. Moreover, adherence rates to CRC screening (52.2%) are still below the goals (70.5%) established by Healthy People 2020. Lack of knowledge is described as a significant barrier to adherence to CRC screening. The aim of this study was to assess CRC knowledge and screening rates among Puerto Rican Hispanics. Participants aged 40–85 years were recruited from the internal medicine outpatient clinics at the University of Puerto Rico. Demographic characteristics and knowledge about CRC, including risk factors and CRC screening tests, were obtained through face-to-face interviews. A mean CRC knowledge score was calculated based on correct responses to 13 validated questions. Mean knowledge scores were evaluated according to demographic characteristics using the Wilcoxon-Mann-Whitney test. A total of 101 participants were recruited with mean age of 63 (±10.6) years. Fifty-eight (58%) of participants were females, 59% reported ≥12 years of education, and 71% reported ever screening for CRC. The mean CRC knowledge score was significantly lower (p?<?0.05) among participants with lower annual family income, those who had never received a recommendation for CRC screening by a healthcare provider, and those who had no history of CRC screening. Knowledge about CRC must be improved in Puerto Rico. Efforts must be made to promote and develop culturally appropriate CRC educational strategies. Future studies should focus on identifying other barriers and factors that may limit CRC screening in the Puerto Rican Hispanic population.     

Influence of provider discussion and specific recommendation on colorectal cancer screening uptake among U.S. adults

ObjectivesIt is unclear if provider recommendations regarding colorectal cancer (CRC) screening modalities affect patient compliance. We evaluated provider–patient communications about CRC screening with and without a specific screening modality recommendation on patient compliance with screening guidelines.MethodsWe used the 2007 Health Information National Trends Survey (HINTS) and identified 4283 respondents who were at least 50 years of age and answered questions about their communication with their care providers and CRC screening uptake. We defined being compliant with CRC screening as the use of fecal occult blood testing (FOBT) within 1 year, sigmoidoscopy within 5 years, or colonoscopy within 10 years. We used survey weights in all analyses.ResultsCRC screening discussions occurred with 3320 (76.2%) respondents. Approximately 95% of these discussions were with physicians. Overall, 2793 (62.6%) respondents were current with CRC screening regardless of the screening modality. Discussion about screening (odds ratio (OR) = 8.83; 95% confidence interval (CI): 7.20–10.84) and providers making a specific recommendation about screening modality rather than leaving it to the patient to decide (OR = 2.04; 95% CI: 1.54–2.68) were associated with patient compliance with CRC screening guidelines.ConclusionCompliance with CRC screening guidelines is improved when providers discuss options and make specific screening test recommendations.     

Socioeconomic Gradients in Infant Health Across Race and Ethnicity

The objective of this study was to examine socioeconomic (SES) gradients in infant health across a number of racial and ethnic groups in the United States. The study was based on data from a new nationally representative sample of children born in the US in 2001 (N = 8,650). The data include oversamples of several minority groups and a rich set of socioeconomic indicators, as well as demographic, health, and health behavior characteristics. Proportion of low birth weight (LBW) and small for gestational age (SGA) (and 95% CIs) across categories of several indicators of SES (maternal education, income, income adjusted for family size, and wealth) was presented for the full sample of children and disaggregated by race/ethnicity: non-Hispanic white, non-Hispanic black, Hispanic, Asian/Pacific Islander (A/PI), and American Indian/Alaskan Native (AI/AN). A graded relationship was found between all measures of SES and infant health for white mothers, and between adjusted income and LBW for Asian and Hispanic mothers. There was no relationship between any indicator of SES and either LBW or SGA for either black or AI/AN mothers. The finding that some minority racial/ethnic groups do not reap the same health benefits from higher levels of SES as do whites suggests that approaches to reducing health disparities must address not only the structural barriers that lead some minority groups to have fewer resources but also barriers that prevent these groups from taking advantage of those resources to improve the health of their families.     

<Emphasis Type="Italic">Celebremos La Salud</Emphasis>: A Community-Based Intervention for Hispanic and Non-Hispanic White Women Living in a Rural Area

The evaluation for Celebremos La Salud, a community randomized trial of Hispanic cancer prevention found no differences in mammography screening rates between intervention and control communities. The goal of the present study was to determine reasons for the intervention's lack of effectiveness. In the first aim, we assessed reach of the intervention. In the second, we assessed which intervention activities were associated with mammography use. In the third, we examined whether factors related to health care access, education level, or age modified the effect of the intervention. Data were used from a post-intervention survey of 20 rural communities in Washington State. Hispanic (N = 202) and non-Hispanic White (N = 389) women, over age 40 formed the sample. Reporting having awareness of or having participated in intervention activities was positively associated with Hispanic ethnicity and intervention group and negatively associated with lack of health insurance and having a lower education level. Only one intervention activity was associated with screening use. Having participated in presentations at organizations was positively associated with having had a mammogram in the previous 2 years for Hispanic women. No individual level modifiers influenced the intervention's effectiveness. Heavily targeting the intervention to Hispanic women and not reaching as many White women may have contributed to the lack of intervention effect. Increasing mammography screening rates among women living in a rural area may require improved access to health care and reaching women with lower education levels and lack of health insurance.     

The Association Between Exposure to Maternal Depression During Year 2 of a Child’s Life and Future Child Problem Behavior

Introduction

We examined the association of exposure to maternal depression during year 2 of a child’s life with future child problem behavior. We conducted a secondary analysis to investigate whether race/ethnicity is a moderator of this relationship.

Methods

We used Fragile Families and Child Well-Being Study data (age 3 N?=?3288 and 49% Black, 26% Hispanic, 22% non-Hispanic White; age 5 N?=?3001 and 51% Black, 25% Hispanic, 21% non-Hispanic White; age 9 N?=?3630 and 50% Black, 25% Hispanic, 21% non-Hispanic White) and ordinal logistic regression to model problem behavior at ages 3, 5, and 9 on maternal depression status during year 2.

Results

At age 9, children whose mother was depressed during year 2 were significantly more likely to have higher internalizing (AOR?=?1.92, 95% CI: 1.42,2.61) and externalizing (AOR?=?1.65, 95% CI: 1.10,2.48) problem behavior scores. In our secondary analysis, race/ethnicity did not have moderating effects, potentially due to a limitation of the data that required use of maternal self-reported race/ethnicity as a proxy for child race/ethnicity.

Discussion

Exposure to maternal depression after the prenatal and perinatal periods may have a negative association with children’s behavioral development through age 9. Interventions that directly target maternal depression during this time should be developed. Additional research is needed to further elucidate the role of race/ethnicity in the relationship between maternal depression and child problem behavior.

     

Breast and cervical cancer screening in Hispanic women: a literature review using the health belief model.

The aim of this study was to review published studies that examined factors influencing breast and cervical cancer screening behavior in Hispanic women, using the Health Belief Model (HBM). MEDLINE and PsycINFO databases and manual search were used to identify articles. Cancer screening barriers common among Hispanic women include fear of cancer, fatalistic views on cancer, linguistic barriers, and culturally based embarrassment. In addition, Hispanic women commonly feel less susceptible to cancer, which is an important reason for their lack of screening. Positive cues to undergo screening include physician recommendation, community outreach programs with the use of Hispanic lay health leaders, Spanish print material, and use of culturally specific media. Critical review of the literature using the theoretical framework of the Health Belief Model identified several culturally specific factors influencing cancer screening uptake and compliance among Hispanic women. Future interventions need to be culturally sensitive and competent.     

An exploration of family influences on smoking among ethnically diverse adolescents.

In an attempt to better understand mechanisms through which families might influence adolescent smoking, focus group data collected as part of a larger study of ethnic and gender differences in teen smoking were analyzed for family-related themes. Across six sites, 132 focus groups were conducted with African American, American Indian, Hispanic, Asian/Pacific Islander, and White youth. Similarities across race/ethnicity were evident in the content of antismoking messages and the feeling among youth that they would get in trouble with their parents if caught smoking. African American and Asian/Pacific Islander youth appeared more concerned about their parents thinking less of them if they smoked than were youth from other racial/ethnic groups. White and American Indian youth were more likely to discuss that their parents felt it was their own decision as to whether or not to smoke than were the other groups.     

Understanding the Barriers and Facilitators of Colorectal Cancer Screening Among Low Income Immigrant Hispanics

Colorectal cancer (CRC) screening rates are low among Hispanics; thus understanding screening barriers and facilitators is essential. A survey, based on blended health promotion theories, was conducted with low income, mostly immigrant, Hispanics at community based organizations and health clinics in New York City. Correlates of undergoing colonoscopy screening were examined. Four hundred men (28%) and women were interviewed. Older age, longer US residence, having a regular health care provider and provider recommendation predicted colonoscopy receipt (P values <0.01). Greater fear and worry concerning colonoscopy and fewer perceived screening benefits were associated with reduced screening likelihood (P values <0.05). In a multivariate model, colonoscopy receipt was negatively associated with Medicaid and positively associated with English preference, physician recommendation for and encouragement of screening and less fear. Interventions that educate physicians and patients regarding colonoscopy screening guidelines, increase physicians’ screening referrals, and reduce patients’ fear are needed.     

Peer Reviewed: Barriers to Colorectal Cancer Screening: Physician and General Population Perspectives,New Mexico, 2006

Introduction

Colorectal cancer (CRC) screening rates are low in New Mexico. We used statewide surveys of primary care physicians and the general population to characterize CRC screening practices and compare perceptions about screening barriers.

Methods

In 2006, we surveyed 714 primary care physicians in New Mexico about their CRC screening practices, beliefs, and perceptions of patient, provider, and system barriers. A 2004 state-specific CRC screening module for the Behavioral Risk Factor Surveillance System (BRFSS) survey asked 3,355 participants aged 50 years or older why they had not ever or had not recently completed a fecal occult blood test (FOBT) or lower endoscopy.

Results

The 216 physicians (30% response rate) reported offering screening to a median 80% of their average-risk patients in the past year and estimated that a median 50% were current with screening. They attributed low screening proportions mainly to patient factors (embarrassment, fear of pain, lack of insurance). However, just 51% of physician respondents used health maintenance flow sheets, and only 13% used electronic medical records to identify patients due for CRC screening. The BRFSS respondents most often reported that lack of physician discussion was responsible for not being current with screening (45% FOBT, 34% endoscopy); being asymptomatic was also often cited as an explanation for lack of screening (22% FOBT, 36% endoscopy).

Conclusion

Physicians and adults in the general population had markedly different perspectives on barriers to CRC screening. Increasing screening may require system supports to help physicians readily identify patients due for CRC testing and interventions to educate patients about the rationale for screening.