Community Health Workers’ Support for Cancer Clinical Trials: Description and Explanation

Ethnic differences in participation in cancer clinical trials slow advances in medical knowledge that can reduce health care disparities. Community health workers (CHWs) are an increasingly important bridge between the health care system and underserved communities and could play an important role in increasing rates of clinical trial participation. We investigated community health workers’ orientations to medical research and cancer clinical trials with a mixed methods design: two focus groups, 11 intensive interviews, and a structured survey of 76 CHW training workshop participants. CHWs demonstrated high levels of commitment to improving the health of community members but considerable distrust of researchers’ motives, low levels of knowledge about cancer clinical trials, and frequent perceptions of bias in the health care system. Support for research is associated with more research experience, self-assessed knowledge, and Hispanic ethnicity, but with less seniority as a CHW. Neither actual knowledge of cancer clinical trials nor perceptions of bias in the health care system were related to degree of support for medical research. Community health workers perceive bias in the health care system but recognize the importance of medical research and are interested in learning more about cancer clinical trials. Research experience increases support for medical research; education increases perceptions of health care system bias.     

Economic Evaluations in National Cancer Institute–Sponsored Network Cancer Clinical Trials

ObjectivesAmid a rapid increase in cancer care costs, we examined the extent to which economic evaluations (EEs) were conducted for new treatments evaluated in clinical trials at SWOG, a large National Cancer Institute–sponsored cancer research network.MethodsWe investigated phase III cancer treatment clinical trials activated from 1980 onward with primary articles reporting the protocol-designated endpoints published in scientific journals by 2017. Using PubMed, Web of Science, and EconLit, we searched for EEs using trial name, cancer type, information on the comparison arms, and refined keywords for EE designs. We reported the overall proportion of trials with associated EEs and trends of this proportion over time. We synthesized and analyzed information on funding sources, health outcomes, and sources of quality-of-life and cost data from the EEs.ResultsAmong 182 examined trials, 15 EEs were associated with 13 (7.1%) trials. Among the EEs, almost half (7 of 15) were either unfunded or did not report funding information, whereas nearly half (7 of 15) were funded by pharmaceutical companies and 2 (2 of 15, 13.3%) were supported by federal funding. All EEs reported a healthcare payer perspective. The proportion of trials with an associated EE increased from 1980 to 1989 and 2000 to 2009, but never exceeded 11%. Sources for cost and quality-of-life data for the EEs primarily came from outside the clinical trials.ConclusionsFew economic studies of treatments evaluated in National Cancer Institute–sponsored clinical trials have been conducted. Policymakers, payers, and patients lack economic evidence to consider newly evaluated cancer treatments, despite an urgent need to control healthcare costs.     

Adolescent Participation in HPV Vaccine Clinical Trials: Are Parents Willing?

Approximately one-quarter of human papillomavirus (HPV) infections are acquired by adolescents, with a higher burden among racial/ethnic minorities. However, racial/ethnic minorities have been underrepresented in previous HPV vaccine trials. Ongoing and future HPV vaccine optimization trials would benefit from racially- and ethnically-diverse sample of adolescent trial participants. This study examined factors influencing parental willingness to consent to their adolescents’ participation in HPV vaccine clinical trials and tested for possible racial differences. A convenience sample of parents of adolescents (N?=?256) completed a cross-sectional survey. Chi square analyses were used to assess racial differences in parental HPV vaccine awareness and intentions and willingness to consent to their child participating in an HPV vaccine clinical trial. Ordinal logistic regression was used to identify factors associated with willingness. Approximately 47% of parents were willing to allow their adolescent to participate in HPV vaccine clinical trials (30.7% African American and 48.3% Caucasian, p?=?.081). African Americans had lower HPV vaccine awareness (p?=?.006) but not lower intentions to vaccinate (p?=?.086). Parental willingness was positively associated with the following variables: Child’s age (p?<?.039), Perceived Advantages of HPV Vaccination for Adolescents (p?=?.002), Parental Trust in Medical Researchers (p?<?.001), and Level of Ease in Understanding Clinical Trial Information (p?=?.010). Educating parents about the advantages of HPV vaccines for younger adolescents using low-literacy educational materials and building trust between parents and researchers may increase parental willingness to consent to adolescent participation in HPV vaccine clinical trials.     

Women’s Patterns of Participation in Mammography Screening in Denmark

The objective of the study is to analyse individual women’s participation patterns in mammography screening in Denmark. The study is set in the capital of Copenhagen and the county of Fyn representing around 95,000 women aged 50–69. The Central Population Register (CPR) was used to define the total target group, and supply information on migrations and deaths. Invitation and participation data came from the mammography screening programmes in Copenhagen (1991–1999) and Fyn (1993–2001), containing personal identification number, data on invitation date, participation and examination date for each screening round. In Copenhagen the coverage went from 70.5% in the first round to 63.1% in the fourth round, and the equivalent data for Fyn is 84.6% in the first round and 82.8% in the fourth round. Of the women eligible for at least three invitation rounds, 52.6% in Copenhagen and 76.4% in Fyn were faithful users, i.e. had participated in all screenings they were invited to. The conclusion is that the programme participation rates tend to overestimate the protection of the individual women covered by the programme. Behind the urban–rural gradient in programme participation is an even greater gradient in programme protection.     

Punjabi Immigrant Women’s Breast Cancer Stories

The breast cancer experiences of Punjabi immigrant women, who represent the most populace group of South Asians in Canada, need to be understood in order to inform culturally appropriate cancer services. The purpose of this qualitative study was to explore women’s stories of breast cancer in order to uncover how they made sense of their experiences. Interviews with twelve Punjabi immigrant women who had breast cancer within the last 8 years were available for this study. The four storylines that emerged from the ethnographic narrative analysis were: getting through a family crisis, dealing with just another health problem, living with never-ending fear and suffering, and learning a “lesson from God.” A minor theme, “being part of a close-knit family,” highlighted the family context as the most pronounced influence on the women’s experiences. These findings provide valuable insights into how women’s experiences of breast cancer were shaped by the intersections of culture, family, community, cancer treatments, and interactions with health care professionals.     

Young Asian Americans’ Knowledge and Perceptions of Cervical Cancer and the Human Papillomavirus

Cervical cancer is a major health disparity among Asian Americans, with cervical cancer rates of Vietnamese women being significantly higher than for the general US female population and low screening rates reported for Asian American females. Focus groups and interviews were conducted with young Vietnamese, Filipino, and Korean adults (ages 18–29) to collect information on knowledge, perceptions and sources of information regarding cervical cancer, Pap tests and the human papillomavirus. 16 Korean, 18 Vietnamese, and 18 Filipino (50% female) adults participated in the study. Many participants had never heard of HPV, cervical cancer and Pap testing. Cervical cancer screening rates were low for Korean and Vietnamese females and were influenced by moral beliefs and lack of awareness. Culturally relevant education materials that consider specific Asian ethnicity and language are needed to increase awareness of cervical cancer, Pap testing, and HPV among Asian American young adults     

Korean American Women’s Perceptions about Physical Examinations and Cancer Screening Services Offered in Korea: The Influences of Medical Tourism on Korean Americans

Cancer is the leading cause of death for Korean-Americans (KAs), while cancer screening rates among KAs have been consistently low. Seven semi-structured focus group interviews with 34 KA women aged 40 or older in the Washington, DC metropolitan area were conducted to explore the perceptions of KA women about seeking physical examinations and cancer screening services in Korea. Data were analyzed using a framework approach. Informants positively perceived the use of health screening services in Korea in comparison to seeking such services in the US. Decision-making factors included cost benefits, high quality services, and more convenient screening procedures in Korea. These benefits outweighed the risks of delaying health care and travelling a vast distance with incurring additional travel costs. Motivations to seek these services in Korea included opportunities to visit their homeland and to enjoy comfortable communication with their native language. The increase of available information about Korean medical services due to the industry's aggressive marketing/PR was identified as a facilitator. Most informants did not recognize possible negative health outcomes of obtaining services in Korea such as inappropriate follow up care if having abnormal findings. Educational programs are needed to educate KAs about the benefits and risks of getting the services in Korea and proper follow up care in the US. Health care providers need to know the different cancer risks and screening needs for this population.     

Advance Care Planning Engagement and End-of-life Preference Among Older Chinese Americans: Do Family Relationships and Immigrant Status Matter?

ObjectivesTo examine how immigrant status and family relationships are associated with advance care planning (ACP) engagement and end-of-life (EOL) preference in burial planning among older Chinese Americans, the largest subgroup of Asian Americans.DesignCross-sectional survey.SettingCommunities in Honolulu, Hawai'i.ParticipantsParticipants were 430 older Chinese Americans aged 55 years and older.MeasuresMeasures included ACP contemplation, ACP discussion, and EOL preference in burial planning, immigrant status, family cohesion, family conflict, demographic information, and health status.ResultsResults show that in comparison to foreign-born Chinese Americans, US-born Chinese Americans were more likely to have ACP contemplation [odds ratio (OR) 2.80, 95% confidence interval (CI) 1.39-5.63], ACP discussion (OR 3.02, 95% CI 1.50-6.08), and preferences for burial plans at the end of life (OR 4.56, 95% CI 2.04-10.18). Family conflict increased the possibility of having ACP contemplation (OR 1.21, 95% CI 1.07-1.38), ACP discussion (OR 1.22, 95% CI 1.07-1.39), and EOL preference in burial planning (OR 1.22, 95% CI 1.04-1.42), whereas family cohesion was not associated with these study outcomes.Conclusions and ImplicationsThis study suggests that ACP should be adapted to be more culturally appropriate, especially in a time of coronavirus and xenophobia, such as framing ACP as a tool to help families reduce stress while fulfilling filial obligations, in order to ensure equitable access to ACP.     

Food Insecurity Screening in Pediatric Clinical Settings: A Caregivers’ Perspective

Maternal and Child Health Journal - Food insecurity (FI) has serious academic, social, and physical health consequences for children. A recent clinical recommendation suggests FI screening during...     

Chinese Immigrant Religious Institutions’ Variability in Views on Preventing Sexual Transmission of HIV

Objectives. We examined Chinese immigrant religious institutions’ views on teaching about preventing sexual transmission of HIV and the consistency of their views with public health best practices in HIV prevention.Methods. We used 2009 to 2011 survey data from 712 members of 20 New York City–based Chinese immigrant religious institutions to analyze their views on (1) teaching adolescents about condoms, (2) discussing homosexuality nonjudgmentally, and (3) promoting abstinence until marriage.Results. Religion type was a significant predictor of views in the 3 domains, with Evangelical Protestants in least agreement with public health best practices, Buddhists in most agreement, and mainline Protestants between them. Greater HIV knowledge was significantly associated with agreement with best practices in all 3 domains. The frequency of prayer, meditation, or chanting and the level of acculturation were significant predictors of views on teaching adolescents about condoms and promoting abstinence until marriage.Conclusions. The best practice messages about HIV prevention that Chinese immigrant religious institutions find acceptable vary according to religion type and several other key factors, including HIV knowledge; frequency of prayer, meditation, or chanting; and level of acculturation.In recognition of their important role and reach in communities, policy initiatives encourage religious institution involvement in community health promotion.1,2 We examined whether the benefits of religious institution involvement in health promotion extend to HIV prevention education, particularly regarding sexual transmission. It is unclear whether religious institutions are well positioned to lead evidence-based education programs on preventing sexual transmission of HIV. To examine this question, we analyzed religious institution leaders’ and members’ views on acceptable approaches to HIV prevention education by using data from a National Institute of Health–funded study of Chinese immigrant Christian churches and Buddhist temples in New York City (NYC). We compared views across 3 religion types (Evangelical Protestant, mainline Protestant, and Buddhist) and accounted for other potentially relevant factors, such as HIV knowledge and intensity of religious practice.We aimed to learn specifically about an Asian American population and to increase understanding of religious institution involvement in HIV prevention more generally. Although HIV prevalence in Asian American populations has been relatively low, addressing HIV prevention in Asian American communities remains important because studies of Asian Americans show low levels of HIV knowledge3–5 and testing,6 and high levels of stigma3,4,7–16 and risk behavior.4,7,8,14,17–22 According to the Centers for Disease Control and Prevention, between 2001 and 2004, among all US racial groups, Asians were the only racial group with statistically significant percentage increases in annual HIV/AIDS diagnosis rates.23,24 A follow-up analysis examining the period 2001 to 2008 found a similar trend.25     

Women’s Benefits and Harms Trade-Offs in Breast Cancer Screening: Results from a Discrete-Choice Experiment

Background

Over the past decade, the benefits and harms balance of breast cancer (BC) screening has been widely debated.

“Screening” for Prostate Cancer in New York’s Skid Row: History and Implications

The Bowery series, open perineal biopsies performed on more than 1200 alcoholic men recruited from homeless shelters in New York City’s Bowery section, began in 1951 and persisted for more than a decade. If frozen sections revealed prostate cancer, men typically underwent radical perineal prostatectomy, orchiectomy, and diethylstilbestrol treatment. This poorly informed, vulnerable population was subjected to health risks that investigators knew others would not accept. Although the knowledge produced had little impact on practice, the Bowery practices foreshadowed and have troubling continuities with later developments. Currently, more than a million American men each year undergo prostatic biopsies. But the efficacy of prostate-specific antigen screening and the treatment that typically follows has never been established. The Bowery series and subsequent developments are part of one continuous story of how medical and lay people came to believe in the efficacy of population screening followed by aggressive treatment without solid supporting scientific evidence.THE RECENT US PREVENTIVE Services Task Force recommendation against prostate-specific antigen (PSA) screening for prostate cancer is the latest salvo in a controversy that has existed since it was introduced in the late 1980s.1 But looking for prostate cancer in asymptomatic men and treating detected cases with radical interventions has a longer—if forgotten—history.Starting in 1951 and continuing for more than a decade, urologist Perry Hudson and his colleagues recruited more than 1200 homeless, alcoholic men from New York City’s skid row, the Bowery, to come to a new municipal cancer hospital for invasive tests and procedures, including open perineal biopsy (OPB) of the prostate gland. If frozen biopsy sections revealed cancer, the patients typically underwent radical prostatectomy and orchiectomy, followed by a course of diethylstilbestrol.To present-day observers, the unethical aspects of these practices—the failure to provide full informed consent and exposing a vulnerable population to undue risk—are disturbing. Yet the Bowery series, as Hudson called these practices, were published in leading medical journals and frequently cited, joining the long list of unethical studies performed in full public view, such as those revealed in Henry Beecher’s influential 1966 exposé.2I have detailed the history of the Bowery series, providing the medical and social context for why and how these practices were begun, persisted, and eventually faded away. Examining this history does more than explain—without excusing—an important but hitherto forgotten large-scale ethical misadventure. It also reveals continuities with prostate screening beliefs and practices today. Recounting and recovering this history is a window into what is at stake—ethically and scientifically—in the long-running controversy over the early detection and treatment of prostate cancer. The juxtaposition of past and present also opens up for ethical analysis new developments, such as the mass diffusion of interconnected clinical practices, each understood to work on the basis of limited endpoints by well-intentioned actors, before—and potentially subverting—robust evidence of their overall efficacy.     

Examining Breast Cancer Screening Barriers Among Central American and Mexican Immigrant Women: Fatalistic Beliefs or Structural Factors?

Researchers have examined “cancer fatalism” (the belief that cancer is predetermined, beyond individual control, and necessarily fatal) as a major barrier to breast cancer screening among Latinas. The authors examine perceptions of breast cancer, its causes, and experiences with screening among Salvadoran, Guatemalan, Mexican, and Bolivian immigrant women in Washington, DC. Two salient themes emerged: (a) perceptions of breast cancer causes and breast cancer screening; and (b) structural factors are the real barriers to breast cancer screening. Findings demonstrate participants’ awareness and motivation to get screened and elucidate structural barriers that are obscured by the discourse of fatalism and hinder breast cancer screening.     

Peer Reviewed: Association of Regional Variation in Primary Care Physicians’ Colorectal Cancer Screening Recommendations with Individual Use of Colorectal Cancer Screening

Introduction

Studies show that the recommendations of a primary care physician for colorectal cancer screening may be one important influence on an individual''s use of screening. However, another possible influence, the effect of regional differences in physicians'' beliefs and recommendations on screening use, has not been assessed.

Methods

We linked data from the National Health Interview Survey on the use of colorectal cancer screening by respondents aged 50 years or older, by hospital-referral region, with data from the Survey of Colorectal Cancer Screening Practices on the colorectal cancer screening recommendations of primary care physicians, by region. Our principal independent variables were the proportion of physicians in a region who recommended screening at age 50 and continuing screening at the recommended frequency.

Results

On average, 53.3% of physicians in a region correctly recommended initiating colorectal cancer screening, and 64.8% advised screening at the recommended frequency. Of adults who lived in regions where less than 30% of physicians correctly recommended initiating screening, 47.3% had been screened, in contrast to 54.8% in areas where 70% or more of physicians made correct recommendations. Seventy-one percent of respondents living in regions where less than 30% of physicians advised screening at the recommended frequency were current on screening, in contrast to 79.9% of respondents living in regions where 70% or more of physicians made this recommendation. These differences were statistically significant after adjustment for individual characteristics.

Conclusion

Strategies to improve colorectal cancer screening recommendations of primary care physicians may improve the use of screening for millions of Americans.     

Changes in neighborhood-level socioeconomic disadvantage and older Americans’ cognitive functioning

BackgroundWhile associations of neighborhood conditions with cognitive functioning at older ages have been established, few studies have investigated with a dynamic perspective if changing neighborhood socioeconomic conditions affect older residents’ cognitive declines, and which putative factors mediate this relationship.MethodUsing data from waves 2 (2010–2011) and 3 (2015–2016) of the National Social Life, Health, and Aging Project (NSHAP) survey (n = 1837), ordinary least squares regressions and mediation analyses were conducted, adjusting for multiple confounders and testing eight putative mediators.ResultsWorsening neighborhood socioeconomic circumstances were associated with cognitive declines. Changes in depressive symptoms, sizes of close social networks, and physical activity substantially mediated this relationship.DiscussionWhile 18.10% of the total effect occurred through these mechanisms, further pathways may work through contextual- and individual-level variables not assessed in the NSHAP.     

Immigrant women’s food choices in pregnancy: perspectives from women of Chinese origin in Canada

Objective: Following migration, pregnant immigrant women may encounter social, cultural, and economic challenges that negatively affect their food choices and subsequent health outcomes. Culturally appropriate health care is crucial during the perinatal period to ensure the health of immigrant mothers and their children. This project aims to explore and understand how the health beliefs and practices of Chinese immigrant women affect their food choices during the perinatal period.

Design: This qualitative study used the methodology of focused ethnography. Women participated in one semi-structured interview, followed by a second photo-assisted, semi-structured interview which incorporated photographs taken by the women themselves.

Results: The food choices and health behaviors of immigrant women were influenced by their general health beliefs, cultural knowledge concerning particular types of foods, traditional Chinese medical beliefs, social advice and information, and socio-economic factors.

Conclusion: The provision of culturally appropriate health care is crucial during the perinatal period, as it is not only a vulnerable life stage for women and their children but also a sensitive period of interaction with the Canadian health-care system. Understanding these intersecting factors can help to ensure culturally appropriate care and optimized health outcomes for Chinese immigrant women during the perinatal period.