COVID-19 Testing Practices, Preventive Behaviors, and Factors Associated With Test Positivity: Population-Based Statewide Survey Study.

BACKGROUND: The COVID-19 pandemic has challenged public health efforts globally. Timely population-based surveillance is crucial to support public health programs and policies to limit the spread of COVID-19. The South Carolina (SC) Sampling and Testing Representative Outreach for Novel Coronavirus Guidance (SC STRONG) statewide initiative was established to estimate population-level prevalence and immunity and characterize the transmission dynamics of SARS-CoV-2 using community testing and online surveys. OBJECTIVE: This paper aimed to leverage the survey data collected as part of the initiative to understand risk perceptions, testing practices, and preventive behaviors and identify risk factors for COVID-19 test positivity in SC over time. METHODS: Probability proportionate to size cluster random sampling was used to select SC residents to participate in testing for COVID-19 infection and antibodies and to complete an online survey. This paper focuses on data from the online surveys completed between November 2020 and June 2021. Descriptive statistics were used to describe risk perceptions, attitudes and behaviors, and associated changes over time. Univariate and multivariate logistic regression models were used to identify factors associated with self-reported COVID-19 test positivity. RESULTS: Among the 7170 online survey respondents, 58.7% (4213/7170) self-reported ever testing for COVID-19. The most commonly cited barriers to testing were inconvenient dates, time, and location, as well as discomfort. Overall, 18.7% (790/7170) of respondents reported a history of COVID-19 test positivity. Multivariate logistic regression results indicated that individuals who were aged 50 years or older, self-identified as Black/African American, were obese, and were employed as frontline health care workers or nursing home staff were more likely to self-report COVID-19 test positivity. By contrast, there was a decreased likelihood of test positivity among respondents who were concerned about the burden of COVID-19 in their community and about being infected. CONCLUSIONS: Strategies to remove testing barriers should be implemented to improve access. Our findings provide insights on statewide testing patterns, adoption of prevention behaviors, and risk factors for infection and may inform public health strategies to curb transmission.

An Analysis of the Social Determinants of Health in South Carolina's I-95 Corridor.

BACKGROUND: One in four South Carolinians lives in a county along a nearly 200-mile stretch of Interstate 95 (I-95). Stretching from North Carolina to Georgia, this region is among the most rural, economically depressed, and racially/ethnically diverse in the state. Research is needed to identify social factors contributing to adverse health outcomes along the I-95 corridor, guide interventions, and establish a baseline for measuring progress. This study assessed social determinants of health in counties in South Carolina's I-95 corridor relative to the rest of the state. METHOD: Data for South Carolina's 46 counties were extracted from the Centers for Disease Control and Prevention Minority Health Social Vulnerability Index (SVI), which grouped 34 census variables into six themes: socioeconomic status, household composition and disability, minority status and language, housing type and transportation, health care infrastructure, and medical vulnerability. Each theme was ranked from 0 (least vulnerable) to 1 (most vulnerable). Measures between regions were compared using the Wilcoxon-Mann-Whitney test. RESULTS: Compared with counties outside the I-95 corridor (n = 29), counties in the corridor (n = 17) scored higher on socioeconomic status vulnerability (.67 and .82, respectively) and medical vulnerability (.65 and .79, respectively). No statistically significant differences were found across other themes. CONCLUSION: Identifying social determinants of health in South Carolina's I-95 corridor is a crucial first step toward alleviating health disparities in this region. Interventions and policies should be developed in collaboration with local stakeholders to address distal social factors that create and reinforce health disparities.

Differences in Motivating Factors for SARS-CoV-2 Vaccination and Perceptions of Infection Risk among Healthcare and EMS Personnel in South Carolina.

OBJECTIVES: Although medical workers were prioritized to receive the coronavirus disease 2019 (COVID-19) vaccination, many have declined. Even though studies have investigated differences in COVID-19-related attitudes and vaccination for workers in hospitals and long-term care facilities, none have included emergency medical services (EMS) personnel. We investigated the association between type of medical worker (EMS vs healthcare worker [HCW]) and COVID-19 vaccination, vaccine beliefs, vaccine motivators, personal protection behaviors, and risk perceptions. METHODS: The data for self-identified HCWs came from surveys distributed to randomly selected residents of South Carolina and EMS personnel recruited at a targeted surveillance testing event during the South Carolina EMS Symposium. Pearson χ2 and Fisher exact tests analyzed differences in the distribution of demographic characteristics and self-reported COVID-19 vaccination attitudes by medical workers. Multivariable logistic regression assessed the association between COVID-19 vaccination and type of medical worker, adjusting for age, sex, race, and frontline status, and assessed the associations among vaccine beliefs, vaccine motivators, personal protection behaviors, and risk perceptions by type of medical worker, adjusting for age, sex, race, frontline status, and vaccination status. RESULTS: Of the 126 respondents 57.9% were EMS, 42.1% were HCWs, and 73.6% of the cohort were self-reported frontline medical workers. Approximately two-thirds of respondents received a vaccine for COVID-19, with no significant differences between EMS and HCWs; however, EMS workers were significantly less likely to receive the vaccination out of concern about exposures at work/school (adjusted odds ratio [aOR] 0.22, 95% confidence interval [CI] 0.08-0.57), concern about exposures within the community (aOR 0.18, 95% CI 0.07-0.48), or to do their part to control the pandemic (aOR 0.20, 95% CI 0.06-0.69). EMS workers also were significantly less likely to wear a mask all/most of the time when outside the home (aOR 0.04, 95% CI 0.0-0.21) and less concerned about the spread of COVID-19 in their community as compared with HCWs (aOR 0.19, 95% CI 0.06-0.56). CONCLUSIONS: EMS personnel were significantly less concerned about the spread of COVID-19 in their community and significantly less likely to wear a mask all/most of the time while outside the home as compared with HCWs. Differences in the COVID-19-related attitudes and personal protection behaviors of EMS personnel should be used to develop targeted interventions to increase vaccine motivation and adherence to personal protection protocols.

Factors Associated with COVID-19 Vaccine Intentions among South Carolina Residents.

Despite evidence of vaccine safety and efficacy, vaccine hesitancy remains a major global health threat. The COVID-19 vaccine has presented unique vaccine hesitancy concerns compared to parental vaccine hesitancy towards childhood vaccines. South Carolina (SC) is home to a largely conservative population and historically has some of the lowest vaccination coverage rates in the United States of America. The goal of the current study was to identify factors associated with COVID-19 vaccine intentions among SC residents. From November 2020 to September 2021, 300,000 invitations to participate in community testing and complete an online survey were mailed to randomly selected SC residents. The survey collected data about behaviors and attitudes towards COVID-19 vaccines, as well as demographic and health characteristics. Of the 10,626 survey participants, 69.9% reported being vaccinated against COVID-19. Among those not vaccinated, 65.5% reported vaccine intentions. Logistic regression analyses were performed to examine factors associated with COVID-19 vaccine intentions. Multivariate logistic regression results indicated that confidence in the safety of the COVID-19 vaccines increased the likelihood of vaccine intentions, while younger age (<60 years) decreased the likelihood of vaccine intentions. To increase vaccine intentions and uptake, public health and government officials in South Carolina and other conservative states should target younger populations and address concerns about COVID-19 vaccine safety.

SARS-CoV-2 Viral Incidence, Antibody Point Prevalence, Associated Population Characteristics, and Vaccine Attitudes, South Carolina, February 2021.

The SARS-CoV-2 outbreak from October 2020 through February 2021 was the largest outbreak as of February 2021, and timely information on current representative prevalence, vaccination, and loss of prior antibody protection was unknown. In February 2021, the South Carolina Department of Health and Environmental Control conducted a random sampling point prevalence investigation consisting of viral and antibody testing and an associated health survey, after selecting participants aged ≥5 years using a population proportionate to size of South Carolina residents. A total of 1917 residents completed a viral test, 1803 completed an antibody test, and 1463 completed ≥1 test and a matched health survey. We found an incidence of 2.16 per 100 residents and seroprevalence of 16.4% among South Carolina residents aged ≥5 years. Undetectable immunoglobulin G and immunoglobulin M antibodies were noted in 28% of people with a previous positive test result, highlighting the need for targeted education among people who may be susceptible to reinfection. We also found a low rate of vaccine hesitancy in the state (13%). The results of this randomly selected surveillance and associated health survey have important implications for prospective COVID-19 public health response efforts. Most notably, this article provides a feasible framework for prompt rollout of a statewide evidence-based surveillance initiative.

Determinants of COVID-19 Vaccinations among a State-Wide Year-Long Surveillance Initiative in a Conservative Southern State.

By the end of 2021, the COVID-19 pandemic resulted in over 54 million cases and more than 800,000 deaths in the United States, and over 350 million cases and more than 5 million deaths worldwide. The uniqueness and gravity of this pandemic have been reflected in the public health guidelines poorly received by a growing subset of the United States population. These poorly received guidelines, including vaccine receipt, are a highly complex psychosocial issue, and have impacted the successful prevention of disease spread. Given the intricate nature of this important barrier, any single statistical analysis methodologically fails to address all convolutions. Therefore, this study utilized different analytical approaches to understand vaccine motivations and population-level trends. With 12,975 surveys from a state-wide year-long surveillance initiative, we performed three robust statistical analyses to evaluate COVID-19 vaccine hesitancy: principal component analysis, survival analysis and spatial time series analysis. The analytic goal was to utilize complementary mathematical approaches to identify overlapping themes of vaccine hesitancy and vaccine trust in a highly conservative US state. The results indicate that vaccine receipt is influenced by the source of information and the population's trust in the science and approval process behind the vaccines. This multifaceted statistical approach allowed for methodologically rigorous results that public health professionals and policy makers can directly use to improve vaccine interventions.

Travel distance to screening facilities and completion of abnormal mammographic follow-up among disadvantaged women.

PURPOSE: Although many studies have examined factors in predicting incomplete and delay in abnormal mammogram follow-up, few have used geospatial methods to examine these factors. Consequently, the purpose of this study was to examine the relationship between travel distance to health facilities and completion of abnormal mammogram follow-up among disadvantaged women in South Carolina. METHODS: Women participating in South Carolina's Best Chance Network between 1996 and 2009 with abnormal mammogram were included in the study. Kaplan-Meier survival was used to describe the probability of work-up completion after abnormal mammogram among different distance categories, and Cox proportional hazards model was used to further assess the relationship between work-up completion and travel distance to the screening provider and mammography facility. RESULTS: Among 1,073 women, there was significant difference in time to completion of abnormal mammogram work-up by race; African American women had longer time to completion compared to European American women. Accounting for race, age, previous mammograms, income, and insurance status, women who lived closest to their diagnosing mammography facility were more likely to complete their work-up compared to those who lived the farthest (HR = 1.41; 95% CI = 1.00-1.80). CONCLUSIONS: Distance to the diagnosing mammography facility may play a role on the completion of abnormal mammogram work-up.

An Integrated Approach to Addressing Chronic Disease Risk Factors in Financially Disadvantaged Women in South Carolina.

PURPOSE: We combined data from the National Breast and Cervical Cancer Early Detection (NBCCEDP) and Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) programs in South Carolina to assess whether cancer screening outcomes in NBCCEDP impacted participation in WISEWOMAN lifestyle interventions, and whether the status of WISEWOMAN baseline risk factors (obesity, diabetes, hypercholesterolemia, hypertension, and smoking) determined subsequent completion of lifestyle interventions. DESIGN: Case-control. SETTING: Three WISEWOMAN implementation sites in South Carolina. SUBJECTS: The study comprised 7841 NBCCDEP participants in three WISEWOMAN program sites. The two programs serve financially disadvantaged women. MEASURES: Outcome measures were participation in WISEWOMAN lifestyle interventions and completion of lifestyle interventions. The main predictor measures were cancer screening outcomes and baseline chronic disease risk factors. Covariate measures included age, race, body mass index, smoking status, and education. ANALYSIS: We used multivariable logistic regression models to examine the odds of participation in and completion of WISEWOMAN lifestyle interventions. RESULTS: The association between cancer screening outcome and participation in WISEWOMAN lifestyle interventions among NBCCEDP participants differed significantly by education and smoking status. Among smokers or highly educated women, having an outcome of cancer or precancerous lesion through the NBCCEDP screening compared to normal screening outcomes was significantly associated with participation in lifestyle interventions, with odds ratios of 2.69 (95% confidence interval [CI], 1.10-6.58) for highly educated women and 1.82 (95% CI, 1.00-3.31) for smokers. Similarly, smokers or diabetics were more likely than nonsmokers or nondiabetics, respectively, to complete lifestyle interventions. CONCLUSION: Nonsmokers and women with lower education in NBCCEDP may need additional navigation to lifestyle interventions in an integrated program implementation approach to improve participation in and completion of WISEWOMAN interventions.

Optimal colorectal cancer screening in states' low-income, uninsured populations­the case of South Carolina.

OBJECTIVE: To determine whether, given a limited budget, a state's low-income uninsured population would have greater benefit from a colorectal cancer (CRC) screening program using colonoscopy or fecal immunochemical testing (FIT). DATA SOURCES/STUDY SETTING: South Carolina's low-income, uninsured population. STUDY DESIGN: Comparative effectiveness analysis using microsimulation modeling to estimate the number of individuals screened, CRC cases prevented, CRC deaths prevented, and life-years gained from a screening program using colonoscopy versus a program using annual FIT in South Carolina's low-income, uninsured population. This analysis assumed an annual budget of $1 million and a budget availability of 2 years as a base case. PRINCIPAL FINDINGS: The annual FIT screening program resulted in nearly eight times more individuals being screened, and more important, approximately four times as many CRC deaths prevented and life-years gained than the colonoscopy screening program. Our results were robust for assumptions concerning economic perspective and the target population, and they may therefore be generalized to other states and populations. CONCLUSIONS: A FIT screening program will prevent more CRC deaths than a colonoscopy-based program when a state's budget for CRC screening supports screening of only a fraction of the target population.

Determinants of major cardiovascular risk factors among participants of the South Carolina WISEWOMAN program, 2009-2012.

INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of death among US women, accounting for 25% of all deaths in this population. Approximately 65% of these deaths occur in asymptomatic women. Hypertension, hypercholesterolemia, and diabetes mellitus (diabetes) are major risk factors for CVD and can be treated effectively if identified at an early stage. METHODS: Data were available from 3,572 uninsured first-time female participants aged 40 to 65 years, referred by their health professional to the South Carolina Well-Integrated Screening and Evaluation for Women Across the Nation (SC WISEWOMAN), 2009-2012. All women completed a structured health-risk and behavior questionnaire. Anthropometric measures were recorded and data on clinical risk-factors were collected. Prevalence-ratios (PRs) were obtained by predictive multivariable log-linear modeling. RESULTS: The prevalence of risk factors was 34.7% for uncontrolled hypertension, 9.3% for hypercholesterolemia, and 21% for diabetes. Prevalence of untreated hypertension was 15.6%; hypercholesterolemia, 8%; and diabetes, 4%. The greatest significant predictor of hypercholesterolemia was hypertension (PR = 4.37) and vice versa (PR = 2.39). The greatest significant predictors of diabetes were obesity (PR = 2.23), family history of diabetes (PR = 2.02), and hypercholesterolemia (PR = 1.85). Being obese (PR = 1.36), overweight (PR = 1.23), aged 60 years or more (PR = 1.26), and black (PR = 1.14) were significant predictors of having at least one CVD risk factor. Being black (PR = 1.09) was the only significant predictor of having comorbid conditions. CONCLUSION: Prevalence of uncontrolled CVD risk factors was high among participants in the SC WISEWOMAN program. These findings confirm that the program is reaching high-risk women who are in need of interventions to reduce their risk for CVD through lifestyle changes.

Proportion of gestational diabetes mellitus attributable to overweight and obesity among non-Hispanic black, non-Hispanic white, and Hispanic women in South Carolina.

Objective was to estimate race-specific proportions of gestational diabetes mellitus (GDM) attributable to overweight and obesity in South Carolina. South Carolina birth certificate and hospital discharge data were obtained from 2004 to 2006. Women who did not have type 2 diabetes mellitus before pregnancy were classified with GDM if a diagnosis was reported in at least one data source. Relative risks (RR) and 95 % confidence intervals were calculated using the log-binomial model. The modified Mokdad equation was used to calculate population attributable fractions for overweight body mass index (BMI: 25.0-29.9 kg/m(2)), obese (30.0-34.9 kg/m(2)), and extremely obese (≥35 kg/m(2)) women after adjusting for age, gestational weight gain, education, marital status, parity, tobacco use, pre-pregnancy hypertension, and pregnancy hypertension. Overall, the adjusted RR of GDM was 1.6, 2.3, and 2.9 times higher among the overweight, obese, and extremely obese women compared to normal-weight women in South Carolina. RR of GDM for extremely obese women was higher among White (3.1) and Hispanic (3.4) women than that for Black women (2.6). The fraction of GDM cases attributable to extreme obesity was 14.0 % among White, 18.1 % among Black, and 9.6 % among Hispanic women. The fraction of GDM cases attributable to obesity was about 12 % for all racial groups. Being overweight (BMI: 25.0-29.9) explained 8.8, 7.8, and 14.4 % of GDM cases among White, Black, and Hispanic women, respectively. Results indicate a significantly increased risk of GDM among overweight, obese, and extremely obese women. The strength of the association and the proportion of GDM cases explained by excessive weight categories vary by racial/ethnic group.

Reducing Colorectal Cancer Incidence and Disparities: Performance and Outcomes of a Screening Colonoscopy Program in South Carolina.

This study evaluated the efficiency, effectiveness, and racial disparities reduction potential of Screening Colonoscopies for People Everywhere in South Carolina (SCOPE SC), a state-funded program for indigent persons aged 50-64 years (45-64 years for African American (AA)) with a medical home in community health centers. Patients were referred to existing referral network providers, and the centers were compensated for patient navigation. Data on procedures and patient demographics were analyzed. Of 782 individuals recruited (71.2% AA), 85% (665) completed the procedure (71.1% AA). The adenoma detection rate was 27.8% (males 34.6% and females 25.1%), advanced neoplasm rate 7.7% (including 3 cancers), cecum intubation rate 98.9%, inadequate bowel preparation rate 7.9%, and adverse event rate 0.9%. All indicators met the national quality benchmarks. The adenoma rate of 26.0% among AAs aged 45-49 years was similar to that of older Whites and AAs. We found that patient navigation and a medical home setting resulted in a successful and high-quality screening program. The observed high adenoma rate among younger AAs calls for more research with larger cohorts to evaluate the appropriateness of the current screening guidelines for AAs, given that they suffer 47% higher colorectal cancer mortality than Whites.

Outcome evaluation of a state comprehensive cancer control plan: laying the foundation.

CONTEXT: Rigorous outcome evaluation is essential to monitor progress toward achieving goals and objectives in comprehensive cancer control plans (CCCPs). OBJECTIVE: This report describes a systematic approach for an initial outcome evaluation of a CCCP. DESIGN: Using the Centers for Disease Control and Prevention evaluation framework, the evaluation focused on (1) organizing cancer plan objectives by anatomic site and risk factors, (2) rating each according to clarity and data availability, (3) the subsequent evaluation of clearly stated objectives with available outcome data, and (4) mapping allocation of implementation grants for local cancer control back to the CCCP objectives. SETTING: South Carolina. MAIN OUTCOME MEASURES: Evaluation outcomes included (1) a detailed account of CCCP objectives by topic area, (2) a systematic rating of level of clarity and availability of data to measure CCCP objectives, (3) a systematic assessment of attainment of measurable objectives, and (4) a summary of how cancer control grant funds were allocated and mapped to CCCP objectives. RESULTS: A system was developed to evaluate the extent to which cancer plan objectives were measurable as written with data available for monitoring. Twenty-one of 64 objectives (33%) in the South Carolina's CCCP were measurable as written with data available. Of the 21 clear and measurable objectives, 38% were not met, 38% were partially met, and 24% were met. Grant allocations were summarized across CCCP chapters, revealing that prevention and early detection were the most heavily funded CCCP areas. CONCLUSIONS: This evaluation highlights a practical, rigorous approach for generating evidence required to monitor progress, enhance planning efforts, and recommend improvements to a CCCP.

Racial disparities in colorectal cancer incidence by type 2 diabetes mellitus status.

PURPOSE: Type 2 diabetes mellitus (T2DM) prevalence has increased dramatically in the United States since the early 1970s. Though T2DM is known to be associated with colorectal cancer (CRC), information on racial differences in the relationship between T2DM and CRC is limited. METHODS: Using a retrospective cohort design, we compared the association between T2DM and CRC, including subsites of the colon, in African Americans (AAs) and European Americans (EAs) in South Carolina, a region with large racial disparities in rates of both diseases. A total of 91,836 individuals who were ≥30 years old on 1 January 1990 and had ≥12 months of South Carolina Medicaid eligibility between 1 January 1990 and 31 December 1995 were included in the analyses. Cancer data from 1996 to 2007 included information on anatomic subsite. RESULTS: Subjects who had T2DM (n = 6,006) were >50 % more likely to be diagnosed with colon cancer compared to those without T2DM (n = 85,681). The association between T2DM and colon cancer was higher in AAs [odds ratio (OR) = 1.72 (95 % confidence interval: 1.21, 2.46); n = 47,984] than among EAs (OR = 1.24; 0.73, 2.11; n = 43,703). Overall, individuals with T2DM were over twice as likely to be diagnosed with in situ or local colon cancer (OR = 2.12; 1.40, 3.22; n = 191) compared to those without T2DM, with a higher likelihood among AAs (OR = 2.49; 1.52, 4.09; n = 113). CONCLUSIONS: Results from a Medicaid population in a high-risk region of the United States showed an increased likelihood of CRC with T2DM and suggest a racial disparity that disfavors AAs and provides further impetus for efforts aimed at diabetes prevention in this group.

Creating a cadre of junior investigators to address the challenges of cancer-related health disparities: lessons learned from the community networks program.

Community-based participatory research (CBPR) initiatives such as the National Cancer Institute's Community Networks Program (CNP) (2005-2010) often emphasize training of junior investigators from underrepresented backgrounds to address health disparities. From July to October 2010, a convenience sample of 80 participants from the 25 CNP national sites completed our 45-item, web-based survey on the training and mentoring of junior investigators. This study assessed the academic productivity and CBPR-related experiences of the CNP junior investigators (n=37). Those from underrepresented backgrounds reported giving more presentations in non-academic settings (nine vs. four in the last 5 years, p=0.01), having more co-authored publications (eight vs. three in the last 5 years, p=0.01), and spending more time on CBPR-related activities than their non-underrepresented counterparts. Regardless of background, junior investigators shared similar levels of satisfaction with their mentors and CBPR experiences. This study provides support for the success of the CNP's training program, especially effort directed at underrepresented investigators.

Mapping cancer mortality-to-incidence ratios to illustrate racial and sex disparities in a high-risk population.

BACKGROUND: Comparisons of incidence and mortality rates are the metrics used most commonly to define cancer-related racial disparities. In the US, and particularly in South Carolina, these largely disfavor African Americans (AAs). Computed from readily available data sources, the mortality-to-incidence rate ratio (MIR) provides a population-based indicator of survival. METHODS: South Carolina Central Cancer Registry incidence data and Vital Registry death data were used to construct MIRs. ArcGIS 9.2 mapping software was used to map cancer MIRs by sex and race for 8 Health Regions within South Carolina for all cancers combined and for breast, cervical, colorectal, lung, oral, and prostate cancers. RESULTS: Racial differences in cancer MIRs were observed for both sexes for all cancers combined and for most individual sites. The largest racial differences were observed for female breast, prostate, and oral cancers, and AAs had MIRs nearly twice those of European Americans (EAs). CONCLUSIONS: Comparing and mapping race- and sex-specific cancer MIRs provides a powerful way to observe the scope of the cancer problem. By using these methods, in the current study, AAs had much higher cancer MIRs compared with EAs for most cancer sites in nearly all regions of South Carolina. Future work must be directed at explaining and addressing the underlying differences in cancer outcomes by region and race. MIR mapping allows for pinpointing areas where future research has the greatest likelihood of identifying the causes of large, persistent, cancer-related disparities. Other regions with access to high-quality data may find it useful to compare MIRs and conduct MIR mapping.

Racial disparities in colon cancer. Primary care endoscopy as a tool to increase screening rates among minority patients.

Colon cancer is a condition whose far-reaching effects have been well documented nationally and within the state of South Carolina. Fortunately, the disease is amenable to both primary and secondary prevention through screening colonoscopy. Despite the conceptual simplicity of recommending colonoscopy, barriers exist to universal (or even widespread) screening. Currently the infrastructure necessary to achieve screening goals set by the American Cancer Society (ACS), the American College of Gastroenterology (ACG), and the South Carolina Department of Health and Environmental Control (DHEC) has not been established. At current rates of training gastroenterologists, the medical community will not be able to come close to achieving widespread screening. Given the discrepancy between the public health benefit of achieving the goals and the deaths that have occurred because of the resource shortfall, we propose alternative measures to screen the at-risk population for consideration. This need is most acute in the black community, in which where screening rates tend to be lower and polyps have been found to progress more quickly than among white populations. In South Carolina, one model has used primary care physicians as the labor force to provide routine screening colonoscopy for their own patients. This model makes screening much more accessible to minority patients, as the wait is shorter and the cost typically lower. In combination with a faith-based partnership with minority religious organizations, this model has begun to make needed inroads toward addressing the disparities associated with colon cancer. Cancer 2007. (c) 2006 American Cancer Society.

Esophageal cancer disparities in South Carolina: early detection, special programs, and descriptive epidemiology.

Because of its high fatality rate and our inability to detect esophageal disease early in its development, esophageal cancer represents a significant medical and public health challenge. The mortality statistics underline the importance of focusing on prevention of these conditions as a matter of state and national public health priority. Unfortunately, the measures needed for primary prevention of these conditions do not seem as clear-cut for populations at highest risk of this disease (i.e., AAs) as for the populations represented in most epidemiologic studies. Our incomplete knowledge about the etiology of esophageal cancer, especially squamous cell carcinomas in AAs and adenocarcinomas in EAs, preclude developing and disseminating effective preventive measures. Clearly, the prevention and control of esophageal cancers represent a different paradigm compared to other tobacco-related cancers of the upper aerodigestive tract. Data from a number of studies indicate that disparities exist in esophageal cancer incidence between racial groups and between geographical locations within South Carolina, and that these disparities are continuing to increase. The reasons for these disparities are only beginning to receive attention. They probably will be found to be complex and multifaceted. A combination of genetic factors, environmental influences (e.g., those related to diet), and the deleterious changes associated with smoking and alcohol consumption are the obvious parameters that should be the focus of initial epidemiologic data collection and assessment. Issues around dietary assessment, a major area of expertise among researchers in South Carolina, must be addressed in these studies. Much remains to be done for us to understand how research, health care, and educational efforts in the state of South Carolina might influence the detection, care, treatment, and, ultimately, reduction in esophageal cancer incidence and mortality rates. An important step in the process will be to coordinate data-collection efforts between clinicians, researchers, and concerned community members in South Carolina. This would allow comprehensive background profiles of patients to be collected for studies ranging from those focusing on the basic biology of the disease and its etiology to those aimed at understanding the role of health services and the effect of policy. In order to design and implement the full range of research needed to understand what we can do to prevent and control esophageal cancer in our state, it is our intention to engage all of the stakeholders within South Carolina; including community members, cancer survivors, cancer care providers, researchers, and individuals at high risk of esophageal cancer. With its large proportion of rural, socioeconomically deprived African Americans, what is learned about esophageal cancer in South Carolina will have national, and perhaps international, relevance.

Head and neck cancer disparities in South Carolina: descriptive epidemiology, early detection, and special programs.

Recognizing that relatively easily detected precancerous lesions precede many cancers, there is a need to investigate the effectiveness of early interventions on the reduction of incidence rates in well-designed large randomized control trials. If early detection can reduce mortality rates of OPCA, evaluation of the capacity of dentists and physicians to screen or detect precancerous lesions related to oral cancers may have merit. Presently, there is a paucity of research regarding ecological barriers in the healthcare system, and improving access to adequate dental and medical care among the rural minority population in South Carolina certainly deserves emphasis. Additional research, specific to South Carolina, which includes comprehensive assessment of multiple social, behavioral, and biological factors, is needed. Interdisciplinary collaboration will be particularly important to dissect key factors contributing to the racial disparities observed in South Carolina. These differences should be taken into account while recommending and implementing public health strategies for the control of these cancers.