Perspectives on Human Papilloma Virus Vaccination Barriers, Knowledge and Beliefs, and Practices: Providers Serving Arab-American Populations.

Little is known of HPV vaccination (HPVV) recommendation practices among healthcare providers who treat the Arab American community. Evidence indicates that HPVV patient uptake is low in this population. A survey was administered to healthcare providers (N = 46, 63% response rate) who treated ≥ 5% Arab American patients aged 9-26 years in areas of New York City and New Jersey with large Arab American populations. They were asked about barriers to HPVV recommendation and uptake among their Arab American patients. Providers (Doctors of Medicine and Osteopathy, Nurse Practitioners, and Physician Assistants) mostly worked in pediatrics (41%), primary care/internal medicine (26%), obstetrics/gynecology (20%), and family medicine (15%). Most (91%) were confident in their ability to effectively counsel their patients on HPVV. The most frequent provider-reported barriers to administering the HPVV to Arab American patients were patient cultural/religious practices (reported by 67%) and patient and provider difficulties with insurance reimbursement (44%). Most providers (84%) agreed that organizations/programs to increase HPVV uptake among Arab American patients were needed. Providers felt that HPVV uptake could be increased with educational materials in the patients' native languages ("very useful," 81%) and provider cultural competency training ("very useful," 65%). In responses to open-ended questions, cultural and religious HPVV barriers were a salient topic, as were linguistic barriers and provider burdens related to HPVV costs and regulations. HPVV uptake could potentially be improved with Arabic language education materials, provider education that is culturally and linguistically tailored to the Arab American community, and policies to address HPVV financial and regulatory burdens.

An opportunity to increase human papillomavirus vaccination rates: Change the guidelines.

Given the low rates of Human Papillomavirus (HPV) vaccination initiation and timely series completion in 11- and 12-year old children, we sought to assess potential opportunities for initiating routine vaccination at a younger age. A cross-sectional study of Latino parents of HPV vaccine-eligible 9- or 10-year-old children in New York City assessed whether there were opportunities to discuss the HPV vaccine during their most recent primary care provider (PCP) visit. Parents were approached between November, 2016 and January, 2018. Of 86 parents who participated, 97% reported having visited the child's PCP in the previous year for an annual checkup and 85% reported that they had neither discussed the HPV vaccine nor received a recommendation for the vaccine during that visit. In a population of Latino parents, predominantly Mexican immigrants with less than a high school education and limited English proficiency, most 9- to 10-year-old children followed the recommendation for an annual PCP visit. Lowering the recommended age for routine vaccination with the HPV vaccine to 9 - 10 years of age should be considered as an important strategy to increase HPV vaccination rates in this and other populations.

Arab American Mothers' HPV Vaccination Knowledge and Beliefs.

Little is known of Arab Americans' human papilloma virus vaccination (HPVV) behaviors. We explored associations between US Arab immigrant mothers' beliefs regarding HPVV for their children with socioeconomic, medical, and religious/cultural factors. A cross-sectional survey was conducted in New York City (August 2019-April 2021) with 162 Arab American immigrant women who had at least one child aged 9 through 26 years. Among those reporting that their child/children had not received the HPVV (63.5%), reasons included not having heard of it (67.3%) and lack of provider recommendation (59.4%). HPVV awareness and uptake, respectively, were more likely among those with education ≥ 10 years (p < .001 and p < .001, respectively), with more years in the US (p < .001 and p < .001), and with higher household income (p < .001 and p = .002). Participants with limited English proficiency were less likely to have HPVV awareness and uptake (p < .001 and p < .001). Christian religious affiliation was positively associated with HPVV awareness and uptake (p = .014 and p = .048). A greater number of years in the US was significantly associated with willingness to vaccinate if recommended by the doctor (p = .031). In open-ended responses, mothers indicated that they did not receive strong provider HPVV recommendations, potentially because of their providers' perceptions of their cultural backgrounds. Mothers indicated a desire for HPVV educational materials in Arabic to help them with decision making. Potential opportunities to augment HPVV uptake among Arab immigrants' children include increasing population knowledge, increasing provider recommendation, and providing culturally/religiously responsive HPVV education in English and Arabic.

COVID-19 Imperils Access to Health and Human Services in El Paso, Texas and New York City: Perspectives from Hispanic Parents.

Low-income Hispanic communities are disproportionately impacted by the COVID-19 pandemic through exacerbated financial vulnerabilities and health challenges. The aim of this study is to assess and compare the self-reported impact and challenges caused by COVID-19 in Mexican-origin parents in New York City (NYC), NY and El Paso, TX. Data is based on routine follow-up calls used to assess uptake of the HPV vaccine and COVID-19 concerns conducted between March and August 2020. Three salient themes emerged: (1) financial insecurities; (2) emotional distress associated with COVID-19; and (3) limited access to health and human services. This study revealed increased financial insecurities and emotional distress, and disruptions to health and human services to low-income Mexican-born parents during the pandemic.

The Impact of Restrictive Policies on Mexican Immigrant Parents and Their Children's Access to Health Care.

Background: This study assessed whether policies that limit Mexican immigrants' access to care affects their children's access to a regular source of care, health insurance, and timely preventive health visits. Method: This was a cross-sectional study among Mexican immigrant parents who attended a health promotion program in Texas, Nevada, New York, and Illinois. A sociodemographic survey, including parental and child variables, was administered. Results: Children of parents without health insurance were almost four times more likely to be uninsured and eight times more likely to lack a regular source of care. Children of parents without a regular source of care were less than half as likely to have their own regular source of care than children whose parents had a regular source of care. Discussion: Findings suggest when parents are uninsured/lack a regular source of care, a child's health disparity is created. Reducing disparities in health care coverage, affecting foreign-born parents, positively impacts their children's access to care. Clinical Trial Registration number: NCT03209713.

Disparities in Care Management During Terminal Hospitalization Among Adults With Metastatic Cancer From 2010 to 2017.

Importance: Many patients with metastatic cancer receive high-cost, low-value care near the end of life. Identifying patients with a high likelihood of receiving low-value care is an important step to improve appropriate end-of-life care. Objective: To analyze patterns of care and interventions during terminal hospitalizations and examine whether care management is associated with sociodemographic status among adult patients with metastatic cancer at the end of life. Design, Setting, and Participants: This retrospective, population-based cross-sectional study used data from the Healthcare Cost and Utilization Project to analyze all-payer, encounter-level information from multiple inpatient centers in the US. All utilization and hospital charge records from national inpatient sample data sets between January 1, 2010, and December 31, 2017 (n = 58 761 097), were screened. The final cohort included 21 335 patients 18 years and older at inpatient admission who had a principal diagnosis of metastatic cancer and died during hospitalization. Data for the current study were analyzed from January 1, 2010, to December 31, 2017. Exposures: Patient demographic characteristics, patient insurance status, hospital location, and hospital teaching status. Main Outcomes and Measures: Receipt of systemic therapy (including chemotherapy and immunotherapy), receipt of invasive mechanical ventilation, emergency department (ED) admission, time from hospital admission to death, and total charges during a terminal hospitalization. Results: Among 21 335 patients with metastatic cancer who had terminal hospitalizations between 2010 and 2017, the median age was 65 years (interquartile range, 56-75 years); 54.0% of patients were female; 0.5% were American Indian, 3.3% were Asian or Pacific Islander, 14.1% were Black, 7.5% were Hispanic, 65.9% were White, and 3.1% were identified as other; 58.2% were insured by Medicare or Medicaid, and 33.2% were privately insured. Overall, 63.2% of patients were admitted from the ED, 4.6% received systemic therapy, and 19.2% received invasive mechanical ventilation during hospitalization. Racial and ethnic minority patients had a higher likelihood of being admitted from the ED (Asian or Pacific Islander patients: odds ratio [OR], 1.43 [95% CI, 1.20-1.72]; P < .001; Black patients: OR, 1.39 [95% CI, 1.27-1.52]; P < .001; and Hispanic patients: OR, 1.45 [95% CI, 1.28-1.64]; P < .001), receiving invasive mechanical ventilation (Black patients: OR, 1.59 [95% CI, 1.44-1.75]; P < .001), and incurring higher total charges (Asian or Pacific Islander patients: OR, 1.35 [95% CI, 1.13-1.60]; P = .001; Black patients: OR, 1.23 [95% CI, 1.13-1.34]; P < .001; and Hispanic patients: OR, 1.50 [95% CI, 1.34-1.69]; P < .001) compared with White patients. Privately insured patients had a lower likelihood of being admitted from the ED (OR, 0.47 [95% CI, 0.44-0.51]; P < .001), receiving invasive mechanical ventilation (OR, 0.75 [95% CI, 0.69-0.82]; P < .001), and incurring higher total charges (OR, 0.64 [95% CI, 0.59-0.68]; P < .001) compared with Medicare and Medicaid beneficiaries. Conclusions and Relevance: In this study, patients with metastatic cancer from racial and ethnic minority groups and those with Medicare or Medicaid coverage were more likely to receive low-value, aggressive interventions at the end of life. Further studies are needed to evaluate the underlying factors associated with disparities at the end of life to implement prospective interventions.

Epidemiology and incidence of HPV-related cancers of the head and neck.

Globally, 4.5% of cancers are due to the human papillomavirus (HPV). In the United States, 80 million people are infected with HPV, and the incidence of HPV oropharyngeal cancer has surpassed HPV cervical cancer. The highest burden of oropharyngeal cancer is seen in middle-aged and increasingly older White men. HPV vaccination promises to change the epidemiology of this disease, but HPV vaccination rates remain too low today to reduce disease transmission.

Predictors of Health Insurance, Life Insurance, and Retirement Savings Among NYC's Immigrant Taxi and For-Hire Vehicle Drivers.

Taxi and for-hire vehicle (FHV) drivers are a predominantly immigrant population facing a range of occupational stressors, including lack of workplace benefits and increasing financial strain from tumultuous industry changes and now COVID-19's devastating impact. Bilingual research staff surveyed 422 New York City taxi/FHV drivers using a stratified sampling approach in driver-frequented locations to examine drivers' health and financial planning behaviors for the first time. Drivers lacked health insurance at double the NYC rate (20% vs. 10%). Life insurance and retirement savings rates were lower than U.S. averages (20% vs. 60%, 25% vs. 58%, respectively). Vehicle ownership was a significant predictor of health insurance, life insurance, and retirement savings. Compared to South Asian drivers, Sub-Saharan African drivers were significantly less likely to have health insurance and North African, and Middle Eastern drivers were significantly less likely to have retirement savings. Although most drivers indicated the importance of insurance and benefits, < 50% understood how to use them. Drivers felt primary care coverage to be most important followed by other health-related coverage, retirement benefits, and life insurance. Results reveal compelling addressable gaps in insurance and benefits coverage and the need to implement accessible financial literacy with navigation and advising services and programs.

Colorectal Cancer Screening and Access to Healthcare in New York City Taxi Drivers.

This study examined differences in colorectal cancer screening across sociodemographic, migration, occupational, and health-related factors in a sample of male taxi drivers. Male drivers eligible for colorectal cancer screening (CRCS) (≥ 50 years old) were recruited in 55 community-based health fairs conducted during November 2015 to February 2017 in 16 taxi garages or community locations located in Queens, Brooklyn, Manhattan and Bronx. Participants completed a survey that included sociodemographic, migration, occupational, health-related, and cancer screening practices. For this study 33 questions were analyzed. The sample consisted of 137 male drivers, 27% of them had undergone CRCS. Occupation-related factors, including night shifts and driving high numbers of weekly hours, were associated with lower CRCS rates; having a family history of cancer, health insurance, a regular source of primary care, and a routine check-up in the last year, were associated with higher CRCS rates. The findings suggest that drivers with health insurance and better access to primary care are more likely to be up-to-date with CRCS. The results provide important information that can inform occupation-based public health interventions.

Step On It! Workplace Cardiovascular Risk Assessment of New York City Yellow Taxi Drivers.

Multiple factors associated with taxi driving can increase the risk of cardiovascular disease (CVD) in taxi drivers. This paper describes the results of Step On It!, which assessed CVD risk factors among New York City taxi drivers at John F. Kennedy International Airport. Drivers completed an intake questionnaire and free screenings for blood pressure, glucose and body mass index (BMI). 466 drivers participated. 9 % had random plasma glucose values >200 mg/dl. 77 % had elevated BMIs. Immigrants who lived in the US for >10 years had 2.5 times the odds (CI 1.1-5.9) of having high blood pressure compared to newer immigrants. Abnormalities documented in this study were significant, especially for immigrants with greater duration of residence in the US, and underscore the potential for elevated CVD risk in this vulnerable population, and the need to address this risk through frameworks that utilize multiple levels of intervention.

Association of socioeconomic and practical unmet needs with self-reported nonadherence to cancer treatment appointments in low-income Latino and Black cancer patients.

OBJECTIVE: Treatment adherence, with minimal numbers of missed appointments, is an important determinant of survival among cancer patients. This study aims to determine if unmet financial, logistic, and supportive care needs predict self-reported adherence to cancer treatment appointments of chemotherapy and/or radiation among low-income ethnic minority patients. DESIGN: The sample included 1098 underserved Latino and Black patients recruited from cancer clinics in New York City through the Cancer Portal Project. Participants completed a survey which included sociodemographic, health-related questions and a needs assessment, in their preferred language. Patients' adherence to chemotherapy and/or radiation treatment appointments was assessed using a self-report. RESULTS: A sample of 1098 patients (581 Latino and 517 Black cancer patients) was recruited. Forty-two Latino cancer patients (7.4%) and 78 Black cancer patients (15.5%) reported missing treatment appointments. Patients, who experienced four or more unmet needs (odds ratios [OR] = 2.02-3.36), and those with unmet housing needs (OR = 3.10-3.31), were more likely to report missing cancer treatment appointments, regardless of their ethnicity/race. Black patients with unmet supportive care (OR = 2.27) and health insurance needs (OR = 3.80) were more likely to miss appointments. Amongst Latinos, legal health-related issues (OR = 2.51) was a significant predictor of missed appointments. CONCLUSIONS: Among ethnic minority cancer patients, unmet socioeconomic and supportive care needs, housing needs in particular, predicted patient-reported missed radiation, and/or chemotherapy appointments. Future research should focus on exploring the impact of practical and supportive unmet needs on adherence and development of interventions aiming to improve cancer treatment adherence.

HPV Vaccine and Latino Immigrant Parents: If They Offer It, We Will Get It.

HPV vaccination rates remain low in the fast growing Latino children population while we continue to observe large HPV-associated cancer disparities in the Latino population. In this study, we sought to elucidate Latino immigrant parents' barriers to obtaining the HPV vaccine for their children. Five focus groups were conducted with Latino immigrant parents of minors (i.e., 9-17 year old) who had not yet initiated the HPV vaccine series. Three major findings were identified from the focus groups: (1) low levels of awareness and knowledge of HPV and the HPV vaccine, (2) high confidence that parent can get the vaccine for their eligible child and (3) lack of provider recommendation as the main barrier to vaccination. Children of Latino immigrant parents could benefit from increased provider recommendation for the HPV vaccine while providing tailored HPV information to parents.

Health-Related Quality of Life of Food-Insecure Ethnic Minority Patients With Cancer.

PURPOSE: The association between food insecurity and health-related quality of life (QOL) of racial/ethnic minority patients with cancer has not been examined. The purpose of this study is to determine the relationship between food insecurity and health-related QOL reported by racial/ethnic minority patients with cancer. METHODS: A consecutive sample of 1,390 underserved ethnic minority patients receiving cancer care in 10 cancer clinics and hospitals in New York City participated in this study. Health-related QOL was measured by the Functional Assessment of Cancer Therapy-General (FACT-G) and food security was assessed by the US Department of Agriculture Core Food Security Module. RESULTS: Of the 1,390 patients, 581 (41.8%) were classified as food secure, 571 (41.1%) with low food security, and 238 (17.1%) with very low food security. Health-related QOL decreased with each lower food security level. Patient self-reported physical, functional, social, and emotional well-being subscale scores decrease significantly with increasing food insecurity. After controlling for demographic and medical-related factors, the decreases in QOL, physical, functional, social and emotional well-being scores with increasing food insecurity remained significant. CONCLUSION: Food insecurity was associated with lower QOL in this sample of underserved racial/ethnic minority patients with cancer. Underserved ethnic minority patients diagnosed with cancer are a vulnerable patient population, at significant risk for inadequate food access and the related lower QOL.

Psychosocial correlates of appointment keeping in immigrant cancer patients.

This study aims to determine the psychosocial correlates of self-reported adherence to cancer treatment appointments and treatment delays and interruptions. The sample included 622 immigrant cancer patients from New York City. Patients completed a survey that included sociodemographic and health-related questions, questions assessing missed appointments and delays/or interruptions, and quality of life and depression scales. After controlling for sociodemographic characteristics, having a positive depression screen and poor physical and emotional well-being were significant predictors of missed appointments and delays and/or interruptions of treatment. Non-adherence to treatment appointments in immigrant cancer patients is a complex outcome related to important modifiable or treatable factors.

Parental education and text messaging reminders as effective community based tools to increase HPV vaccination rates among Mexican American children.

OBJECTIVE: Latino populations, particularly Mexican-Americans who comprise 65% of the Latinos in the U.S., are disproportionately affected by HPV-related diseases. The HPV vaccination completion rates remain low, well below the Healthy People 2020 goal. In this study we assessed the effect of parental education and a text messaging reminder service on HPV vaccine completion rates among eligible children of Mexican American parents. STUDY DESIGN: Nonequivalent group study of Mexican parents of HPV vaccine eligible children attended the Health Window program at the Mexican Consulate in New York City, a non-clinical, trusted community setting, during 2012-2013. 69 parents received HPV education onsite, 45 of whom also received a series of text message vaccination reminders. We measured HPV vaccination completion of the youngest eligible children of Mexican parents as the main outcome. RESULTS: 98% of those in the education plus text messaging group reported getting the first dose of the vaccine for their child and 87% among those in the educational group only (p = 0.11). 88% of those receiving the 1st dose in the text messaging group reported completing the three doses versus 40% in the educational group only (p = 0.004). CONCLUSIONS: Parental text messaging plus education, implemented in a community based setting, was strongly associated with vaccine completion rates among vaccine-eligible Mexican American children. Although pilot in nature, the study achieved an 88% series completion rate in the children of those who received the text messages, significantly higher than current vaccination levels.

Identifying human papillomavirus vaccination practices among primary care providers of minority, low-income and immigrant patient populations.

OBJECTIVE: Minority populations in the United States are disproportionally affected by human papillomavirus (HPV) infection and HPV-related cancer. We sought to understand physician practices, knowledge and beliefs that affect utilization of the HPV vaccine in primary care settings serving large minority populations in areas with increased rates of HPV-related cancer. STUDY DESIGN: Cross-sectional survey of randomly selected primary care providers, including pediatricians, family practice physicians and internists, serving large minority populations in Brooklyn, N.Y. and in areas with higher than average cervical cancer rates. RESULTS: Of 156 physicians randomly selected, 121 eligible providers responded to the survey; 64% were pediatricians, 19% were internists and 17% were family practitioners. Thirty-four percent of respondents reported that they routinely offered HPV vaccine to their eligible patients. Seventy percent of physicians reported that the lack of preventive care visits for patients in the eligible age group limited their ability to recommend the HPV vaccine and 70% of those who reported this barrier do not routinely recommend HPV vaccine. The lack of time to educate parents about the HPV vaccine and cost of the vaccine to their patients were two commonly reported barriers that affected whether providers offered the vaccine. CONCLUSIONS: Our study found that the majority of providers serving the highest risk populations for HPV infection and HPV-related cancers are not routinely recommending the HPV vaccine to their patients. Reasons for providers' failure to recommend the HPV vaccine routinely are identified and possible areas for targeted interventions to increase HPV vaccination rates are discussed.

Characterization of the Hispanic or latino population in health research: a systematic review.

The size and diversity of the Hispanic population in the United States has dramatically increased, with vast implications for health research. We conducted a systematic review of the characterization of the Hispanic population in health research and described its implications. Relevant studies were identified by searches of PubMed, Embase Scopus, and Science/Social Sciences Citation Index from 2000 to 2011. 131 articles met criteria. 56% of the articles reported only "Hispanic" or "Latino" as the characteristic of the Hispanic research population while no other characteristics were reported. 29% of the articles reported language, 27% detailed country of origin and 2% provided the breakdown of race. There is great inconsistency in reported characteristics of Hispanics in health research. The lack of detailed characterization of this population ultimately creates roadblocks in translating evidence into practice when providing care to the large and increasingly diverse Hispanic population in the US.

Cancer stage knowledge and desire for information: mismatch in Latino cancer patients?

Having more health knowledge has a crucial and positive impact on cancer outcomes. Patients' cancer knowledge influences their ability to participate actively in decision-making processes for medical care and in treatment choices. The purpose of this study was to determine the demographic and medical correlates of lack of cancer stage knowledge and desire for information among Latino cancer patients. The sample included 271 underserved Latino cancer patients recruited from four cancer clinics in New York City. Participants completed a needs assessment survey in their preferred language, which included sociodemographic and health-related questions. Close to two-thirds of the sample (65%) had no knowledge of their stage, and 38% were unaware of the metastatic state of their tumor. Only 15% of the patients expressed that they would like additional information about their diagnosis and/or treatment. After controlling for sociodemographic characteristics, being an immigrant with limited English proficiency and monolingual in Spanish were predictors of stage unawareness and less desire/need for cancer information. Patients needing interpretation for health care were less likely to know whether their tumor had metastasized and their cancer stage and to desire information about their cancer diagnosis and/or treatment. This study shows considerably low levels of stage awareness among Latinos diagnosed with cancer. This lack of knowledge might adversely impact their treatment decisions and disease management. Future studies should focus on identifying barriers to acquisition of disease information and other disease-specific informational deficits.

Attitudes surrounding implementation of the HPV vaccine for males among primary care providers serving large minority populations.

BACKGROUND: Minority populations are disproportionally affected by human papilloma virus (HPV) infection. We examined the attitudes of primary care providers serving large minority populations towards the implementation of the HPV vaccine for males in their practices. DESIGN: Cross-sectional survey of randomly selected primary care providers in Brooklyn, N.Y. RESULTS: Ninety-three eligible providers were surveyed, of whom 62% were pediatricians. Sixty-two percent of all participants reported that they were very likely or will definitely be offering the vaccine to their male patients. The rate was higher among providers who reported higher numbers of minority patient population and who acknowledged high risk among their patient population. CONCLUSIONS: Primary care providers included in the study were likely to report incorporation of the HPV vaccine for males as part of their regular clinical practice. Their adoption and dissemination of the vaccine will be a significant factor in determining whether its full benefits are achieved.

A randomized controlled trial of a multilevel intervention to increase colorectal cancer screening among Latino immigrants in a primary care facility.

BACKGROUND: Latino immigrants face a higher burden of colorectal cancer (CRC) and screening rates are low. OBJECTIVE: To assess the effectiveness of a multilevel intervention in increasing the rate of CRC screening among Latino immigrants. DESIGN: A randomized controlled trial, with randomization at the physician level. PARTICIPANTS: Pairs of 65 primary care physicians and 65 Latino immigrant patients participated, 31 in the intervention and 34 in the control group. INTERVENTION: CRC educational video in Spanish on a portable personal digital video display device accompanied by a brochure with key information for the patient, and a patient-delivered paper-based reminder for their physician. MEASUREMENTS: Completed CRC screening, physician recommendation for CRC screening, and patient adherence to physician recommended CRC screening. RESULTS: The overall rate of completed screening for CRC was 55% for the intervention and 18% for the control group (p = 0.002). Physicians recommended CRC screening for 61% of patients in the intervention group versus 41% in the control group (p = 0.08). Of those that received a recommendation, 90% in the intervention group adhered to it versus 26% in the control group (p = 0.007). CONCLUSIONS: The intervention was successful in increasing rates of completed CRC screening primarily through increasing adherence after screening was recommended. Additional efforts should focus on developing new strategies to increase physician recommendation for CRC screening, while employing effective patient adherence interventions.