Estimating lifetime risk for breast cancer as a screening tool for identifying those who would benefit from additional services among women utilizing mobile mammography.

BACKGROUND: To estimate lifetime risk of breast cancer among women utilizing mobile mammography and to determine the proportion that might benefit from additional services, such as genetic counseling and educational programs. METHODS: Retrospective analysis of electronic health records for 2214 women screened for breast cancer on a mobile mammography van was conducted. Participants answered questions about their demographic characteristics, breast health, and family history of cancer. Logistic regression analyses were used to assess the odds of being recommended for additional services by the Tyrer-Cuzick (TC) lifetime risk score. RESULTS: The average TC ten-year risk score was 2.76 % ± 2.01 %, and the average TC lifetime risk score was 7.30 % ± 4.80 %. Using lifetime risk scores ≥ 10 %, it was determined that 444 patients (20.23 %) could be referred to additional services. Less than one percent of patients had been tested for the BRCA genes previously. The odds of being recommended for additional services by the TC model were significantly greater among those who were eligible for the New York Cancer Services Program (i.e., a proxy for lack of insurance) when compared to those who were ineligible (OR=1.31, 95 % CI: 1.03-1.66). After adjustment, screening borough and race/ethnicity were not significantly associated with being recommended for services. CONCLUSION: Genetic counseling and education are some of the tools available to promote awareness and early detection of breast cancer; however, screening guidelines do not mandate genetic counseling or referrals for individuals at high-risk. POLICY SUMMARY: Patients and providers should have discussions about predicted TC lifetime risk scores at follow-up breast cancer screening appointments, as this is a missed opportunity to improve care at both fixed sites and mobile clinics.

M.I.C.A.H. Project HEAL: Sustainability of a Faith-Based Community Health Advisor Training Program in Urban Underserved Communities in the USA.

Faith-based organizations (FBOs) can play an important role in improving health outcomes. Lay community health advisors (CHAs) are integral to these efforts. This paper assesses the sustainability of a CHA training program for congregants in African-American and Latino FBOs and subsequent implementation of educational workshops. The program is unique in that a health care chaplain in an academic medical center was central to the program's development and implementation. Forty-eight CHAs in 11 FBOs were trained to teach workshops on cardiovascular health, mental health, diabetes, and smoking cessation. Two thousand four hundred and forty-four participants attended 70 workshops. This program has the potential to be a model to educate individuals and to address health inequities in underserved communities. Health care chaplains in other medical centers may use this as a model for enhancing community engagement and education.

Disability and COVID-19: Impact on Workers, Intersectionality With Race, and Inclusion Strategies.

This article discusses the impact of the COVID-19 pandemic on workers with disabilities. Given that most employment-related literature about COVID-19 does not include people with disabilities, an in-depth exploration of the impact of COVID-19 on this population is warranted. Additionally, this article discusses the unique issues this population is facing during the pandemic, including the intersectionality of disability, race, and economic disadvantage. Suggestions for supporting people with disabilities in counseling and career-related activities, both during the COVID-19 pandemic and postpandemic, are provided.

Development of a tablet app designed to improve African Americans' screening colonoscopy rates.

Compared with other racial/ethnic groups, African Americans have the highest colorectal cancer (CRC) morbidity and mortality rates. It is critical to help improve African Americans' CRC prevention efforts in order to reduce the burden of CRC in this community. The aim of this study was to develop and field test a tablet app, called e-Motivate, designed to improve African Americans' screening colonoscopy rates. The e-Motivate app was field tested, using an iterative approach. The first version of the app, e-Motivate 1.0, was field tested on 20 African Americans over the age of 50. Participants engaged in a think aloud exercise and provided feedback regarding the app's usability and acceptability. The results of the first field test were used to modify the app and develop e-Motivate 2.0. The field test procedures were repeated on a new group of participants (N = 18). The results from the second field test were used to make final modifications to the app. Overall, participants responded positively to the app. Qualitative analyses showed that participants found the app to be easy to use and helpful. Furthermore, descriptive statistics revealed that participants found the app to be highly usable and acceptable, exceeding recommended benchmarks for usability and acceptability. Critiques of the app were used to modify and finalize the intervention. The results from the proposed study suggest that the e-Motivate app is highly feasible and acceptable. The next step in this line of research is to conduct a randomized clinical trial to formally test the efficacy of the e-Motivate app for improving screening colonoscopy rates among African Americans.