Psychosocial Risk Profiles and Colorectal Cancer Screening: A Latent Profile Analysis in a Colorectal Cancer Screening Intervention Setting.

Health behavior theories have identified predictors of colorectal cancer screening. This study aimed to determine the psychosocial profiles of a predominantly Hispanic population of primarily Mexican origin receiving a colorectal cancer screening intervention and whether a specific combination of psychosocial profiles modified the effect of colorectal cancer screening intervention on colorectal cancer screening uptake.A total of 467 participants aged 50 to 75 years due for colorectal cancer screening received an educational intervention. Latent profile analysis (LPA) was performed on baseline psychosocial constructs to identify the homogenous clustering of individuals with similar psychosocial constructs. In addition, colorectal cancer screening rates and changes in psychosocial scores between the latent groups were compared.Three psychosocial profiles, including a low benefit and high susceptibility group (LBHS), a high benefit and low susceptibility group (HBLS), and a high barrier and high susceptibility group (HBHS), were identified in this study. The HBLS group had the lowest susceptibility, with no improvement in benefits and barriers. This group had the lowest screening rate (80.85%) compared with 88.8% in LBHS and 86.3% in HBHS following the intervention. Finally, the intervention effect size on psychosocial score changes was smaller in HBLS than in other groups.This subgroup analysis suggests that colorectal cancer educational interventions should be tailored to improve the benefits and barriers among individuals with high susceptibility scores. PREVENTION RELEVANCE: This LPA analysis provides some direction for tailoring colorectal cancer educational interventions to improve the benefits and barriers among individuals with high susceptibility scores in hard-to-screen populations such as our border population.

Effectiveness of a Breast Cancer Education Screening and NavigaTion (BEST) Intervention among Hispanic Women.

BACKGROUND: In the United States, breast cancer remains one of the most diagnosed cancers among females and remains the second leading cause of cancer death. In addition, breast cancer is most likely diagnosed at an advanced stage among Hispanic females in the United States due to lower mammogram utilization. AIMS: The objective of this study was to determine the effectiveness of a multilevel, multicomponent community-based breast cancer screening intervention called the Breast Cancer Education Screening and NavigaTion (BEST) program. The primary outcome was the completion of a screening mammogram 4 months post-intervention. METHOD: We used a pragmatic approach for evaluation, utilizing a quasi-experimental delayed intervention design. We recruited women from the community aged between 50 and 75, uninsured or underinsured, and overdue for screening. RESULTS: Six hundred participants were recruited (300 intervention and 300 control). Among completers, the screening rate was 97% in the intervention group and 4.4% in the control group (RR = 22.2, 95% CI: 12.5-39.7, p < .001). In multivariable analysis, age ≥ 65 (RR = 1.29, p = .047), perceived benefits (RR = 1.04, p = .026), curability (RR = 1.24, p < .001), subjective norms (RR = 1.14, p = .014), and fatalism (RR = .96, p = .004) remained significantly associated with screening outcome. CONCLUSION: A multicomponent, bilingual, and culturally tailored intervention effectively facilitated breast cancer screening completion in an underserved population of Hispanic women. Individuals with improved screening outcomes were more likely to have higher positive beliefs. Our study has important implications regarding using multicomponent interventions in increasing breast cancer screening completion in poorly screened populations. It also highlights differences in health belief motivation for breast cancer screening completion.

Effect of Text Message Reminders on Attendance at Cervical Cancer Screening Appointments in a Predominantly Hispanic Population.

Hispanic women have the highest rates of incident cervical cancer in the United States (U.S.) and are 1.9 times more likely to die from cervical cancer than non-Hispanic Whites. Objective: Assess the impact of text message reminders on cervical cancer screening attendance and completion. Design: Pragmatic non-randomized study design using propensity matched analysis. Setting: Community-dwelling low-income females in the U.S./Mexico border community. A total of 2,255 mainly Hispanic females aged 21-65. Methods: Text message reminders in addition to usual care (telephone call reminders). Results: After adjusting for significant factors and propensity score matching, individuals in the text reminder group had 11% lower screening incidence than individuals without text reminders (risk difference [RD] = -0.11, 95% CI: -0.16, -0.05; p < .001). Conclusion: Participants with text reminders were less likely to complete cervical screening than usual practice in a predominantly Hispanic population. Our study demonstrates that reminders' content rather than method may be vital to improving our population's cancer screening rates.

Improving Medical Students Learning Through an Interprofessional Pharmacotherapy Selective.

PURPOSE: Current trends in medical school education indicate an existing need for increasing medical student exposure to pharmacotherapy education. The objectives of this study are to describe the development of an interprofessional, application-based Pharmacotherapeutics in Primary Care selective for 3rd year medical students and to assess its influence on knowledge, attitudes, and skills related to pharmacotherapy of high-risk medications and patient populations. METHODS: The selective was implemented across fourteen cohorts of medical students that were evaluated over a 5-year academic period (n = 68). Our curriculum was unique in that it merged basic pharmacology and pharmacotherapy concepts with application-based medication management of high-risk patients in addition to the incorporation of an interprofessional home visit experience. RESULTS: Pre- and post-assessment analyses found statistically significant improvements in students' pharmacotherapeutic knowledge and skills. There was a significant increase in the knowledge post-test mean score (71.8; SD = 11.2) compared to the pre-test mean score (57.3; SD = 11.9; P < .001). A similar trend was observed for the skills mean score in which the post-test average (63; SD = 16.9) was significantly higher than the pretest average (23.3; SD = 14.4; P < 0.001). Students' attitudes also improved when rating their confidence in completing specific tasks such as recommending dosing regimens and utilizing drug information resources. CONCLUSION: This intervention provided 3rd-year medical students with opportunities to improve their knowledge, attitudes, and skills related to the pharmacotherapeutic management of high-risk medications and patient populations while exploring meaningful interprofessional interactions with faculty and learners from other disciplines.

Effect of Educational Intervention on Self-Sampling Acceptability and Follow-Up Paps in Border Dwelling Hispanic Females.

OBJECTIVE: The aims of the study were to evaluate the effect of a community outreach worker (promotora)-led high-intensity educational intervention compared with control without promotora-led intervention on cervical cancer screening preference (Pap smear vs self-sampling) and to determine the effect of this preference on subsequent screening completion. MATERIALS AND METHODS: This randomized controlled trial compared the effect of educational intervention on women's preferences for self-sampling for human papillomavirus. Inclusion criteria were women aged 30 to 65 years and no cervical cancer screening in 3 years or more. Community-based study with intervention group receiving culturally tailored education by promotora vs control group who received written education pamphlet. We evaluated participants' test preference, knowledge, and Pap completion at 12-months postintervention. RESULTS: Two hundred one predominantly Hispanic women were randomly assigned to high-intensity (n = 100) education vs low-intensity education (n = 101). The mean age was 46.4 years (SD = 8.2 years). There was no difference in test preference between high- and low-intensity groups (49% vs 41%, both tests equally; 28.6% vs 35.1%, self-sampling; and 22% vs 23%, Pap, p = .536). High-intensity intervention resulted in a significantly higher self-sampling acceptability score (25.02 vs 24.06, p = .039).Testing preference did not significantly affect Pap completion (Pap vs self-sampling vs unsure/both equally, 60.0% vs 43.6% vs 48.9%, p = 0.24). Human papillomavirus knowledge was found to be significantly associated with completion of Pap at 12 months. Human papillomavirus-positive result on self-sampling trended toward increased likelihood of screening completion (16.3% vs 7.8%, p = .058). CONCLUSIONS: We found a high level of acceptability of self-sampling regardless of intensity of education in a largely Hispanic female population living on the US-Mexico border and a trend toward increased Pap smear follow-up in participants who tested positive.

Impact of Targeted Education on Colorectal Cancer Screening Knowledge and Psychosocial Attitudes in a Predominantly Hispanic Population.

Colorectal cancer remains a leading cause of cancer-related morbidity and mortality, with screening behavior found to be influenced by knowledge and other psychosocial attitudes. We recruited 784 participants 50 to 70 years of age. The intervention arm received a culturally sensitive, literacy-appropriate educational intervention by a promotora. Surveys were completed at baseline and 6 months post. Our intervention significantly increased knowledge at 6 months when compared with control (0.74 vs 0.18, P < .0001). We also report increase in perceived susceptibility to colorectal cancer and perceived benefits of colorectal cancer screening while decreasing sense of fatalism. Perceived barriers to screening did significantly increase.

Association of Metabolic Syndrome and Human Papillomavirus Infection in Men and Women Residing in the United States.

Background: An estimated 33% of adults in the United States have metabolic syndrome (MetS), which has been associated with an increased risk for various cancer types. Theories of synergism among components of MetS that increase cancer risk via chronic inflammation and oxidative stress have been proposed. We hypothesize that men and women with MetS may have compromised immunological response resulting in increased risk for persistent human papillomavirus (HPV) infection. The goal of this study is to determine the association of MetS with HPV types 6, 11, 16, and 18 and to explore variation of these associations by gender using data from a national survey.Methods: We conducted a retrospective cross-sectional study using data from the National Health and Nutrition Examination Survey.Results: Thirty-two percent of the population sampled met the criteria for MetS (16% men and 33% women). Nineteen percent tested positive for HPV (6, 11, 16, and 18). Prevalence of HPV infection was estimated at 13% for men and 30% for females. MetS was found to be significantly associated with increased risk of HPV6, 11, 16, or 18 in the entire cohort [RR = 1.24; 95% confidence interval (CI), 1.03-1.48] and in females (RR = 1.26; 95% CI, 1.02-1.56). Although the adjusted risk of HPV+ve status was found to be 21% higher in men with MetS compared with those without, this difference did not attain statistical significance.Conclusions: We observed a significant association between metabolic syndrome and HPV sero-positivity among the overall population and among females. Although not significant, a similar effect was noted in men. Further prospective studies are needed to better understand this relationship.Impact: To the best of our knowledge, this is the first study evaluating the impact of metabolic syndrome on HPV positivity in both males and females. Cancer Epidemiol Biomarkers Prev; 26(8); 1321-7. ©2017 AACR.

Decision-Making Preferences Among Older Hispanics Participating in a Colorectal Cancer (CRC) Screening Program.

Shared decision making has been shown to improve patients experience and satisfaction with care within the health care setting but it is not clear that all patients want to play an active role in health care decisions. The aim of this study is to describe general decision control preferences among a predominantly Spanish speaking Hispanic population. This is a cross-sectional study using the Control Preference Scale to assess decision-making preference. A total of 780 subjects completed the survey (response rate 89.9%). The majority preferred a collaborative role (53.3%) compared to a passive (26.4%) or active role (20.3%). We observed that individuals who were married or living with a partner were more likely to prefer an active or collaborative role than their unmarried counterparts (RRR 1.78 P value 0.017; RRR 1.56 p value 0.012). Less acculturated individuals (i.e. more Spanish speaking at home were less likely to prefer an active vs. passive role) (RRR 0.296, P value 0.029). Our predominantly Spanish speaking Hispanic population showed a preference for collaborative versus active or passive roles. There are several demographic factors that are associated with this preference but it remains important to determine individual's preference for decision making in health care settings.

Reproductive characteristics and risk of kidney cancer: Iowa Women's Health Study.

OBJECTIVES: Kidney (renal cell) cancer accounts for approximately 3-4% of all new cases of primary cancer diagnosed in the United States. A relationship between kidney cancer and female reproductive factors has been hypothesized but supporting evidence is inconsistent. Our objectives were to explore the relationship between female reproductive factors and kidney cancer and identify independent risk factors related to female reproductive history and its effects on development of kidney cancer. METHODS: We measured risk factors for kidney cancer and reproductive characteristics in a group of 37,440 postmenopausal women in Iowa. From 1986 to 2003, 165 cases of incident kidney cancer were identified through a statewide cancer registry. RESULTS: After adjustment for age and other risk factors, past use of estrogen showed an increased risk of renal cancer (RR 1.56; 95% CI 1.13-2.17) when compared to no use. Women with no live birth (RR 1.91, p=0.02) and women with three to four live births (RR 1.62, p=0.02) also had an increased risk of kidney cancer when compared with women who had one to two live births. There was also a lower risk of kidney cancer with greater lifetime duration of ovulation. CONCLUSION: Although most reproductive variables were not significantly associated with kidney cancer, our study indicates that a greater exposure to estrogens may increase risk for kidney cancer.