Racial and Ethnic Disparities in Laryngeal Cancer Care.

There is a long history of racial and ethnic disparities in healthcare and they continue to persist in contemporary society. These disparities have the potential to negatively affect morbidity and mortality in racial and ethnic minorities diagnosed with laryngeal cancer. Diagnosis, medical treatment, and rehabilitation for laryngeal cancer have improved considerably, leading to improvements in overall survival rates and physical, social, and psychological functioning. Yet members of minority and underrepresented groups are at an increased risk for experiencing reduced access to quality care and delays between diagnosis and treatment, and as a result have lower survival rates. Increasing health providers' awareness of racial and ethnic disparities in laryngeal cancer is necessary to facilitate changes in patient and provider education, clinical practice, and health policies. The purpose of this review is to summarize current literature on disparities in laryngeal cancer diagnosis, treatment, and rehabilitation among Black and Hispanic patients. We present recent data from the Surveillance, Epidemiology, and End Results database to examine trends in laryngeal cancer and patient, provider, and health systems factors that may perpetuate these disparities. In addition, we offer interventions to address racism and other racial and ethnic biases in laryngeal cancer care and describe research and legislative actions that are needed to reduce disparities in this area.

Factors associated with consistent condom use among internally displaced women in Leogane, Haiti: results from a cross-sectional tablet-based survey.

OBJECTIVES: Scant research has examined factors associated with condom use among internally displaced women in postdisaster settings, such as in postearthquake Haiti. The study objective was to examine social ecological factors associated with consistent condom use among internally displaced women in postearthquake Haiti. METHODS: A cross-sectional survey was conducted in 2012 with a peer-driven recruitment sample of internally displaced women in Leogane, Haiti. Peer health workers administered tablet-based structured interviews to a convenience sample of 175 internally displaced women. RESULTS: The 128 participants who reported being sexually active in the last 4 weeks were included in the analyses. Two-thirds (65.2%) reported consistent condom use in the last month. In multivariate logistic regression analyses controlled for age and income, participants that reported sex work, depression, higher number of sex partners and shorter relationship duration had lower odds of consistent condom use in the past month. Participants who reported no experiences of intimate partner violence, lower self-rated health, higher sexual relationship power and more meals per day, had a higher likelihood of reporting consistent condom use. CONCLUSIONS: This research provides the first assessment of contextual factors associated with consistent condom use among women displaced from a natural disaster such as Haiti's 2010 earthquake. Findings demonstrate the importance of social ecological approaches to understand intrapersonal (eg, sex work and depression), interpersonal (eg, relationship power, intimate partner violence and relationship duration) and structural (eg, food insecurity) factors associated with internally displaced women's condom use. Results can inform future sexual health research and interventions in international disaster contexts. TRIAL REGISTRATION NUMBER: NCT01492829, pre-results.

'My body is mine': Qualitatively exploring agency among internally displaced women participants in a small-group intervention in Leogane, Haiti.

The 2010 earthquake resulted in the breakdown of Haiti's social, economic and health infrastructure. Over one-quarter of a million people remain internally displaced (ID). ID women experience heightened vulnerability to intimate partner violence (IPV) due to increased poverty and reduced community networks. Scant research has examined experiences of IPV among ID women in post-earthquake Haiti. We conducted a qualitative study to explore the impact of participating in Famn an Aksyon Pou Santé Yo (FASY), a small-group HIV prevention intervention, on ID women's agency in Leogane, Haiti. We conducted four focus groups with ID women, FASY participants (n = 40) and in-depth individual interviews with peer health workers (n = 7). Our study was guided by critical ethnography and paid particular attention to power relations. Findings highlighted multiple forms of IPV (e.g., physical, sexual). Participants discussed processes of intrapersonal (confidence), interpersonal (communication), relational (support) and collective (women's rights) agency. Yet structural factors, including patriarchal gender norms and poverty, silenced IPV discussions and constrained women's agency. Findings suggest that agency among ID women is a multi-level, non-linear and incremental process. To effectively address IPV among ID women in Haiti, interventions should address structural contexts of gender inequity and poverty and concurrently facilitate multi-level processes of agency.

'Life under the tent is not safe, especially for young women': understanding intersectional violence among internally displaced youth in Leogane, Haiti.

BACKGROUND: Haiti's 2010 earthquake devastated social, health, and economic infrastructure and left 2 million persons homeless. Over 6 years later 61,000 people remain displaced, most lacking protection, services, and durable solutions. Structural contexts elevate risks of gender-based violence (GBV) targeting internally displaced (ID) girls and women. OBJECTIVE: We used an intersectionality framework to explore lived experiences and understanding of violence among ID young men and women in Leogane, Haiti. METHODS: We conducted six focus groups, three with ID young women (n = 30) and three with ID young men (n = 30) aged 18-24 years, and 11 in-depth individual interviews with frontline workers in Leogane. Focus groups and interviews were conducted in Kreyol, transcribed verbatim, translated into English, and analyzed using narrative thematic techniques. RESULTS: Findings revealed violence experienced by ID youth was (re)produced at the intersection of gender, poverty, displacement, and age. Multi-level forms of violence included structural (e.g. poverty), community (e.g. gender norms, and interpersonal (e.g. family expectations) dimensions. Coping strategies spanned intrapersonal (hope), community (social support), and structural (employment/education) dimensions. CONCLUSIONS: Interventions to reduce violence should be tailored to address the social inequities that emerge at the intersection of youth, poverty, displacement, and hegemonic gender norms.

A psycho-educational HIV/STI prevention intervention for internally displaced women in Leogane, Haiti: results from a non-randomized cohort pilot study.

BACKGROUND: Little evidence exists regarding efficacious HIV and sexually transmitted infections (STI) prevention interventions with internally displaced populations. Internally displaced women are at elevated risk for HIV/STI due to limited access to health services, heightened poverty and social network breakdown. The FASY (Famn an Aksyon Pou Sante' Yo) (Women Taking Action For Their Health) study examined the effectiveness of a peer health worker (PHW) delivered psycho-educational HIV/STI pilot study with internally displaced women in Leogane, Haiti. METHOD: This was a non-randomized cohort pilot study. Participants completed a computer-assisted pre-test programmed on Android tablet PCs followed by an HIV/STI educational video-based session and a 6-week psycho-educational group program of weekly meetings. Participants completed a post-test upon completion of group sessions. The primary outcome was HIV knowledge; our pre-specified index of clinically significant change was an effect size of 0.30. Secondary outcomes included: STI knowledge, condom use, social support, resilient coping, depression and relationship control. We used mixed-effects regression to calculate mean outcome pre-post score change. This study was registered (clinicaltrials.gov, NCT01492829). RESULTS: Between January 1-April 30, 2012 we assigned 200 participants to the study. The majority of participants (n = 176, 88%) completed the study and were followed up at 8 weeks, finishing April 30, 2012. Adjusted for socio-demographic characteristics, HIV knowledge (ß = 4.81; 95% CI 4.36-5.26), STI knowledge (ß = 0.84; 95% CI 0.70-0.99), condom use (AOR = 4.05, 95% CI 1.86-8.83), and depression (ß = -0.63, 95% CI -0.88--0.39) scores showed statistically significant change post-intervention (p<0.05). CONCLUSIONS: This pilot study evaluated a PHW psycho-educational HIV/STI prevention intervention among internally displaced women in post-earthquake Haiti. Pilot studies are an important approach to understand feasibility and scientific impacts of HIV prevention strategies in disaster contexts. Study results may inform HIV prevention interventions among internally displaced women in Haiti and can be tested for applicability with internally displaced women globally. ClinicalTrials.gov: Identifier NCT01492829, URL: http://clinicaltrials.gov/ct2/show/NCT01492829?term=logie&rank=1.

An HIV/STI prevention intervention for internally displaced women in Leogane, Haiti: study protocol for an N-of-1 pilot study.

INTRODUCTION: Haiti has the highest HIV infection rate in the Western hemisphere, with approximately one in 50 people infected. The January 2010 earthquake led to the collapse of Haiti's social, economic and health infrastructure, exacerbating social and structural HIV risk factors. Internally displaced (ID) women are particularly at high risk for HIV infection due to breakdown of community networks, increased poverty and sexual violence. The authors present the rationale and study protocol for pilot-testing FASY (Famn an Aksyon Pou Santé Yo) (Women Taking Action For Their Health), a psychoeducational HIV/STI prevention intervention with ID women in Haiti. METHODS AND ANALYSIS: This is a single-centre pragmatic N-of-1 pilot study. The target population is ID women in Leogane, Haiti. The authors aim to recruit 200 participants using purposive peer-driven recruitment methods. ID women will be trained as community health workers to deliver the FASY intervention in Kreyol. Participants will conduct a pretest that involves an individual HIV/STI educational video-based component followed by a 6-week group programme of 2 h women's health meetings. The primary outcome is HIV knowledge; our prespecified index of clinically significant change is an effect size of 0.30. Secondary outcomes include: sexually transmitted infections knowledge, condom use, social support, resilient coping, depression and relationship control. Multivariate analysis of variance will be used to compare pretest and post-test differences across variables to assess if the intervention influenced primary or secondary outcomes. Significant multivariate analysis of variance will be followed up with both univariate tests and discriminant function analyses to understand significant effects. ETHICS AND DISSEMINATION: Research Ethics Board approval (2011-0033-E) was attained from the Women's College Hospital, University of Toronto, Toronto, Ontario, Canada. Trial results will be published according to the CONSORT statement, modified for the N-of-1 pilot study design, regardless of the outcomes. TRIAL REGISTRATION NUMBER: This study is registered at http://clinicaltrials.gov, registration number NCT01492829.