Cancer treatment adherence among low‐income women with breast or gynecologic cancer

BACKGROUND:

The authors implemented a controlled, randomized trial that compared 2 interventions: the provision of written resource navigation information (enhanced usual care [EUC]) versus written information plus patient navigation (TPN) aimed at improving adjuvant treatment adherence and follow‐up among 487 low‐income, predominantly Hispanic women with breast cancer or gynecologic cancer.

METHODS:

Women were randomized to receive either TPN or EUC; and chemotherapy, radiation therapy, hormone therapy, and follow‐up were assessed over 12 months. Patients with breast cancer were analyzed separately from patients with gynecologic cancer.

RESULTS:

Overall adherence rates ranged from 87% to 94%, and there were no significant differences between the TPN group and the EUC group. Among women with breast cancer, 90% of the EUC group and 88% of the TPN group completed chemotherapy (14% of the EUC group and 26% of the TPN group delayed the completion of chemotherapy), 2% of the EUC group and 4% of the TPN group failed to complete chemotherapy, and 8% of the EUC group and 7% of the TPN group refused chemotherapy. Radiation treatment adherence was similar between the groups: Ninety percent of patients completed radiation (40% of the EUC group and 42% of the TPN group delayed the completion of radiation); in both groups, 2% failed to complete radiation, and 8% refused radiation. Among gynecologic patients, 87% of the EUC group and 94% of the TPN group completed chemotherapy (41% of the EUC group and 31% of the TPN group completed it with delays), 7% of the EUC group and 6% of the TPN group failed to complete chemotherapy, 6% of the EUC refused chemotherapy, 87% of the EUC group and 84% of the TPN group completed radiation (51% of the EUC group and 42% of the TPN with delays), 5% of the EUC group and 8% of the TPN group failed to complete radiation, and 8% of the EUC group and 5% of the TPN group refused radiation.

CONCLUSIONS:

Treatment adherence across randomized groups was notably higher than reported in previous studies, suggesting that active telephone patient navigation or written resource informational materials may facilitate adherence among low‐income, predominantly Hispanic women. Adherence also may have be facilitated by federal‐state breast and cervical cancer treatment funding. Cancer 2009. © 2009 American Cancer Society.     

Loneliness and negative life events as predictors of hopelessness and suicidal behaviors in hispanics: evidence for a diathesis‐stress model

In the present study, we examined loneliness and negative life events as predictors of suicide risk (viz., hopelessness and suicidal behaviors) in a sample of 160 Hispanic adults. Consistent with expectations, we found loneliness and negative life events to be positively associated with both hopelessness and suicidal behaviors. In addition, results of conducting hierarchical regression analyses indicated that loneliness accounted for significant amounts of variance in both measures of suicide risk, ranging from 24% to 29% of the variance. The inclusion of negative life events as a predictor was found to account for additional unique variance in hopelessness (3%), but not in suicidal behaviors, beyond what was predicted by loneliness. Finally, consistent with a diathesis‐stress model, the Loneliness × Negative Life Events interaction was found to account for an additional 3% of the variance in both suicide risk measures. Implications of the present findings for future research on suicide risk in Hispanics are discussed. © 2010 Wiley Periodicals, Inc. J Clin Psychol 66:1–12, 2010.     

Effects of physical activity interventions in youth: Review and synthesis

Introduction:Physical inactivity has been identified as an important public health concern for youth. School and community settings can be important infrastructures for promoting physical activity (PA). This paper reviews studies of physical activity in school and community settings among preschool through college-aged persons to determine characteristics and effects of interventions. Studies in progress are included.Methods: Studies from 1980 to 1997 testing physical activity interventions in schools and community settings were identified by computerized search methods and reference lists of published reviews. Studies needed to have used a quantitative assessment of PA, used a comparison or control group, included participants who were preschool through college age, and be conducted in the United States or foreign school or community settings. Significance of effects was examined overall and for various types of interventions.Results: Twenty-two school-based studies were reviewed, 14 completed and 8 in progress. Three studies were in countries other than the United States. The 8 studies in progress were all in the United States. Only 7 community studies were reviewed, all in the United States. Four studies were in progress. Several community studies involved a high percentage of African-American or Hispanic youth and their families. Studies showing the best results used randomized designs, valid and reliable measurements, and more extensive interventions. Some follow-up results showed PA was sustained after interventions ended.Conclusions: The collection of school and community studies is limited for several age groups with none below third grade and only three at college age. There are few community studies. The most is known about upper-elementary-age-students, including the first multicenter randomized trial to report significant results for increasing moderate to vigorous physical activity (MVPA) in physical education (PE) and increase vigorous PA outside of school. A number of older study designs were weak and assessments less than optimal, but studies in progress are stronger. Special attention is needed for girls, middle schools, and community settings for all youth. More objective assessments are needed for measuring PA outside of school and in younger children, since they cannot provide reliable self-report.     

Language and use of cancer screening services among border and non-border Hispanic Texas women

Objectives. Compared to other groups, Mexican American women screen less frequently for cervical and breast cancer. The most significant barriers reported by previous researchers include not having a usual source of care, lacking health insurance and English-language difficulties. In this paper we document and examine the factors associated with disparities in cancer screening between border and non-border residents by language of interview (Spanish or English) among Texas Hispanic women. We hypothesize that, controlling for socioeconomic and demographic characteristics, border residents are more likely to utilize screening services than non-border residents because of the greater presence of bilingual services in border counties.

Design. We follow the framework of the Behavioral Model for Vulnerable Populations proposed by Gelberg et al. (Health Services Research, vol. 34, no. 6, pp. 1273–1302, 2000). This model conceptualizes use of health care as an outcome of the interplay of predisposing, enabling and need factors and recognizes that vulnerable groups face additional barriers to health care utilization. Data come from the 2000, 2002 and 2004 Texas Behavioral Risk Factor Surveillance surveys.

Results. Group differences in cancer screenings are explained largely by socioeconomic characteristics and structural barriers to access. The significance of language of interview and of border residence disappear after controlling for factors such as health insurance, income and a usual source of care.

Conclusion. Women who selected to be interviewed in Spanish were less likely to report age-appropriate cancer examinations, health insurance and a regular health care provider than those who selected to be interviewed in English. Disparities in cancer screenings among vulnerable Hispanic populations could be reduced by promoting the establishment of a regular health care provider.     

Impact of english language proficiency on receipt of pap smears among hispanics

Our aim was to assess the impact of English language proficiency on Pap smear use among Hispanics. We performed a cross-sectional study using 2000 National Health Interview Survey data and included 2,331 Hispanic women, age ≥18 without a hysterectomy. After adjusting for sociodemographic and access factors, highly proficient English speakers were more likely to report a Pap smear in the past 3 years as compared to low proficient (adjusted prevalence ratio, 1.16; 95% confidence interval, 1.08 to 1.22). Also associated with Pap smear use were income, usual source of care, and health insurance. Our finding suggests that low English language proficiency is a barrier to receiving recent Pap smears among Hispanics. Supported by a grant from the American Cancer Society (CCCDA-03-197-01-CCCDA).     

Glucometer Use and Glycemic Control Among Hispanic Patients With Diabetes in Southern Florida

Background

Self-monitoring of blood glucose (SMBG) has been deemed a critical component of diabetes care in the United States. To be effective, patients must have some diabetes knowledge, glucometer proficiency, and an ability to take appropriate actions when certain readings are obtained. However, most patients take no action in response to out-of-range glucometer readings, and in many populations, SMBG practices are not associated with improved glycemic control. Thus, SMBG utilization is being reconsidered in other countries. Nonetheless, SMBG behaviors are increasingly recommended in the United States, where the Hispanic population represents the fastest-growing minority group and is disproportionately affected by suboptimal diabetes outcomes. Because a growing number of interventions aim to reduce diabetes disparities by improving glycemic control among minorities, it is essential to determine whether efforts should focus on SMBG practices. We present data on SMBG behaviors and glycemic control among participants from the Miami Healthy Heart Initiative (MHHI), a National Institutes of Health/National Heart, Lung, and Blood Institute–sponsored trial assessing a community health worker (CHW) intervention among Hispanic patients with poorly controlled diabetes.

Objective

This study examined the effects of a CHW intervention on SMBG practices, glycosylated hemoglobin (HbA_1c), and knowledge of appropriate responses to glucometer readings among Hispanic patients with diabetes.

Methods

This study was an ancillary investigation within MHHI, a randomized, controlled trial in 300 Hispanic patients. Participants were intervention-group members who received 12 months of CHW support. Assessments were administered at baseline and poststudy to determine potential barriers to optimal health. Items from validated instruments were used to determine knowledge of appropriate responses to different glucose readings. These data were linked to HbA_1c values. Means and frequencies were used to describe population characteristics and glucometer proficiency. Paired-sample t tests examined potential differences in HbA_1c outcomes and SMBG practices. Qualitative data were collected from the CHWs who worked with study participants.

Results

Our population was diverse, representing several countries. Mean HbA_1c improved significantly, from 10% to 8.8% (P ≤ 0.001). SMBG practices did not change. At baseline, 96% of patients reported owning a glucometer and 94% reported knowing how to use it. However, quantitative assessments and qualitative data suggested that participants had suboptimal knowledge regarding actions that could cause an out-of-range reading or how to respond to certain readings.

Conclusions

SMBG behaviors were not associated with glycemic control in our sample. We conclude that a CHW intervention may improve glycemic control without improving SMBG practices. Future interventions may reconsider whether efforts should be directed toward improving SMBG behaviors.     

Drinking patterns and alcohol problems among Hispanics in the U.S.: a review

The literature on drinking patterns and alcohol problems among Hispanic Americans is critically reviewed. The picture provided by studies which have been examined indirect indicators of alcohol problems is contradictory. Some results suggest that Hispanics in the U.S.A. are over-represented among alcohol-related deaths and among those arrested for drunk driving and in treatment in alcoholism programs. Other studies do not provide evidence of over-representation. Studies in the general population indicate that there is more heavy drinking and alcohol-related problems among Hispanics than among other ethnic groups in the U.S.A. general population. However, very few of these studies were specifically designed to evaluate alcohol use and problems among this ethnic group, and these results are based on the analysis of a small number of Hispanic respondents. In the conclusions this and other methodological limitations are discussed and new areas for study are proposed.