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Cancer Health Disparities and Public Health
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Cancer Health Disparities and Public Health

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 49661

Special Issue Editors

Dr. Ken Batai

E-Mail Website
Guest Editor
Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
Interests: cancer health disparities; kidney cancer; prostate cancer; cancer prevention
Special Issues, Collections and Topics in MDPI journals
Dr. Francine C. Gachupin

E-Mail Website
Guest Editor
Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ 85721, USA
Interests: chronic disease; American Indians; cancer health disparity; public health
Special Issues, Collections and Topics in MDPI journals
Dr. Yamilé Molina

E-Mail Website
Guest Editor
Department of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL 60607, USA
Interests: Latinx; LGBTQ; rural; breast cancer; cancer health equity; community engagement

Special Issue Information

Dear Colleagues,

Cancer burden varies across various populations, with higher incidence and mortality of specific cancer types in some populations compared to others, resulting from varying degree of interactions between genetic/biologic, behavioral, societal, and environmental risk factors.  Racial/ethnic and gender/sexual, and religious minority groups, rural populations, individuals from socioeconomically disadvantaged neighborhoods, and people living in developing nations often have multiple barriers to cancer prevention services (e.g., vaccines), screening, diagnostic care, and treatment.  Structural inequality is a root cause of cancer health disparities. In societies with structural inequality, natural and human-caused crises often pose extra burden to the underserved populations negatively impacting their healthcare access. Patients from underserved populations often experience prejudice in healthcare or clinicians’ bias may negatively affect patient care.  The structural inequality not only affects healthcare access, but also increases behavioral risk factors and environmental and occupational exposures to carcinogens in underserved populations.  Structural racism and other structural factors cause residential segregations, educational attainment, employment, and income disparities, and poor built environment that limits access to safe space for physical activities and availability of an access to nutritious foods.  Cultural values may also affect choice of care and treatment.  Research is necessary to further understand how structural inequality cause cancer disparities to develop policies, recommendations, and clinical practices to reduce cancer disparities and build equity in cancer prevention, treatment, and care.

Dr. Ken Batai
Dr. Francine C. Gachupin
Dr. Yamilé Molina
Guest Editors

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Health disparities
  • Structural racism
  • Health equity
  • Race and ethnicity
  • Gender
  • Socioeconomics
  • Rural health
  • Global health
  • Cancer prevention
  • Cancer treatment

Related Special Issue

Published Papers (19 papers)

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15 pages, 336 KiB  
Article
Adapting a Cancer Screening Education Program for Native American Women with Disabilities
by Julie S. Armin, Heather J. Williamson, Andria Begay, Jennifer Etcitty, Agnes Attakai, Kim Russell and Julie A. Baldwin
Int. J. Environ. Res. Public Health 2022, 19(15), 9280; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19159280 - 29 Jul 2022
Cited by 2 | Viewed by 1813
Abstract
Like other minoritized groups, people with disabilities experience lack of access to health care. People with intellectual and developmental disabilities (IDD), which are lifelong disabilities diagnosed in childhood requiring varying levels of support for completing daily activities, are less likely to receive preventive [...] Read more.
Like other minoritized groups, people with disabilities experience lack of access to health care. People with intellectual and developmental disabilities (IDD), which are lifelong disabilities diagnosed in childhood requiring varying levels of support for completing daily activities, are less likely to receive preventive health care such as cancer screening. Furthermore, Native American women are less likely than White women to receive cancer screenings. In this qualitative research with Native American women with IDD, their caregivers, healthcare and service providers, and community leaders, we asked, “What are the influences on breast and cervical cancer screening for Native American women with IDD?” with the goal of adapting an existing cancer screening education program. Semi-structured in-depth interviews (N = 48) were audio recorded and transcribed verbatim for analysis. Two coders used a constant comparative method to code and revise the a priori codebook with subthemes and new codes. Results highlighted individual, interpersonal, and community/institutional influences on screening, emphasizing the individual effects of social inequity on this population, the importance of ableist bias in recommending cancer screenings, and opportunities to integrate traditional ways of knowing with allopathic medicine. Results of this work were used to adapt a cancer screening education program for Native American women with IDD. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
12 pages, 317 KiB  
Article
Tribal Tobacco Use Project II: Planning, Implementation, and Dissemination Using Culturally Relevant Data Collection among American Indian Communities
by Kendra M. Roland, Madison D. Anderson, Dana M. Carroll, Anna G. Webber, Kristine L. Rhodes, John Poupart, Jean L. Forster, Melanie Peterson-Hickey and Wyatt J. Pickner
Int. J. Environ. Res. Public Health 2022, 19(13), 7708; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19137708 - 23 Jun 2022
Cited by 1 | Viewed by 1605
Abstract
American Indians have substantially higher commercial tobacco-related cancer rates when compared to the general population. To effectively combat commercial tobacco-related cancer, it is important that tribal nations obtain current and accurate community-specific data on commercial tobacco use and exposure-related attitudes and behaviors. With [...] Read more.
American Indians have substantially higher commercial tobacco-related cancer rates when compared to the general population. To effectively combat commercial tobacco-related cancer, it is important that tribal nations obtain current and accurate community-specific data on commercial tobacco use and exposure-related attitudes and behaviors. With the goal to collect, synthesize, and disseminate data on tobacco use, including the role traditional tobacco plays among American Indian people, the American Indian Cancer Foundation (AICAF) and various stakeholders developed and implemented the Tribal Tobacco Use Project II (TTUP II) during 2018–2021. Building upon its predecessor, the Tribal Tobacco Use Project I (TTUP I), TTUP II used principles of community-based participatory research and culturally appropriate methods, such as Reality-Based Research, in partnership with tribal nations. We describe the TTUP II rationale, methods for participant recruitment and data collection, emphasizing the importance of using culturally relevant survey items to disentangle commercial tobacco use from traditional tobacco use. American Indian traditional tobacco is viewed as medicine in these communities with a unique socio-cultural context that must be addressed when engaging in commercial tobacco control efforts in American Indian communities. This approach may be useful to other tribal nations who are interested in conducting culturally relevant tobacco surveillance efforts. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
9 pages, 336 KiB  
Article
Examining the Influencing Factors of Chronic Hepatitis B Monitoring Behaviors among Asian Americans: Application of the Information-Motivation-Behavioral Model
by Grace X. Ma, Lin Zhu, Wenyue Lu, Yin Tan, Jade Truehart, Cicely Johnson, Elizabeth Handorf, Minhhuyen T. Nguyen, Ming-Chin Yeh and Min Qi Wang
Int. J. Environ. Res. Public Health 2022, 19(8), 4642; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19084642 - 12 Apr 2022
Cited by 5 | Viewed by 2208
Abstract
Background: Compared to non-Hispanic whites, Asian Americans are 60% more likely to die from the disease. Doctor visitation for chronic hepatitis B (CHB) infection every six months is an effective approach to preventing liver cancer. Methods: This study utilized baseline data from an [...] Read more.
Background: Compared to non-Hispanic whites, Asian Americans are 60% more likely to die from the disease. Doctor visitation for chronic hepatitis B (CHB) infection every six months is an effective approach to preventing liver cancer. Methods: This study utilized baseline data from an ongoing randomized controlled clinical trial aimed at improving long-term adherence to CHB monitoring/treatment. Guided by the information-motivation-behavioral skills (IMB) model, we examined factors associated with CHB monitoring adherence among Asian Americans with CHB. Multivariable logistic regression was conducted to test the associations. Results: The analysis sample consisted of 382 participants. Multivariable logistic regression showed that HBV knowledge (OR = 1.24, p < 0.01) and CHB-management motivation (OR = 1.06, p < 0.05) are significant predictors of having a doctor’s visit in the past six months. Both factors were positively associated with the likelihood of having had blood tests for HBV in the past six months. Conclusion: We found that greater HBV-related knowledge and CHB-management motivation are significantly associated with performing CHB-monitoring behaviors in the past six months. The findings have critical implications for the development and implementation of evidence-based interventions for CHB monitoring and liver cancer prevention in the Asian American community. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
13 pages, 336 KiB  
Article
Cancer Screening among Rural People Who Use Drugs: Colliding Risks and Barriers
by Wiley D. Jenkins, Jennifer Rose, Yamile Molina, Minjee Lee, Rebecca Bolinski, Georgia Luckey and Brent Van Ham
Int. J. Environ. Res. Public Health 2022, 19(8), 4555; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19084555 - 10 Apr 2022
Cited by 1 | Viewed by 1823
Abstract
Rural cancer disparities are associated with lesser healthcare access and screening adherence. The opioid epidemic may increase disparities as people who use drugs (PWUD) frequently experience healthcare-associated stigmatizing experiences which discourage seeking routine care. Rural PWUD were recruited to complete surveys and interviews [...] Read more.
Rural cancer disparities are associated with lesser healthcare access and screening adherence. The opioid epidemic may increase disparities as people who use drugs (PWUD) frequently experience healthcare-associated stigmatizing experiences which discourage seeking routine care. Rural PWUD were recruited to complete surveys and interviews exploring cancer (cervical, breast, colorectal, lung) risk, screening history, and healthcare experiences. From July 2020–July 2021 we collected 37 surveys and 8 interviews. Participants were 24.3% male, 86.5% White race, and had a mean age of 44.8 years. Females were less likely to report seeing a primary care provider on a regular basis, and more likely to report stigmatizing healthcare experiences. A majority of females reporting receiving recommendations and screens for cervical and breast cancer, but only a minority were adherent. Similarly, only a minority of males and females reported receiving screening tests for colorectal and lung cancer. Screening rates for all cancers were substantially below those for the US generally and rural areas specifically. Interviews confirmed stigmatizing healthcare experiences and suggested screening barriers and possible solutions. The opioid epidemic involves millions of individuals and is disproportionately experienced in rural communities. To avoid exacerbating existing rural cancer disparities, methods to engage PWUD in cancer screening need to be developed. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
12 pages, 353 KiB  
Article
Consequences of Structural Urbanism: Urban–Rural Differences in Cancer Patients’ Use and Perceived Importance of Supportive Care Services from a 2017–2018 Midwestern Survey
by Marquita W. Lewis-Thames, Patricia Fank, Michelle Gates, Kathy Robinson, Kristin Delfino, Zachary Paquin, Aaron T. Seaman and Yamilé Molina
Int. J. Environ. Res. Public Health 2022, 19(6), 3405; https://doi.org/10.3390/ijerph19063405 - 14 Mar 2022
Cited by 3 | Viewed by 2873
Abstract
Background: Structural inequities, in part, undergird urban–rural differences in cancer care. The current study aims to understand the potential consequences of structural inequities on rural and urban cancer patients’ access to and perceived importance of supportive cancer care resources. Methods: We used data [...] Read more.
Background: Structural inequities, in part, undergird urban–rural differences in cancer care. The current study aims to understand the potential consequences of structural inequities on rural and urban cancer patients’ access to and perceived importance of supportive cancer care resources. Methods: We used data collected from November 2017 to May 2018 from a larger cross-sectional needs assessment about patients’ support needs, use of services, and perceptions at a Midwestern United States cancer center. Oncology patients received a study packet during their outpatient clinic visit, and interested patients consented and completed the questionnaires. Results: Among the sample of 326 patients, 27% of the sample was rural. In adjusted logistic regression models, rural patients were less likely to report using any secondary support services (15% vs. 27%; OR = 0.43, 95%CI [0.22, 0.85], p = 0.02) and less likely than urban counterparts to perceive secondary support services as very important (51% vs. 64%; OR = 0.57, 95%CI [0.33, 0.94], p = 0.03). Conclusion: Structural inequities likely have implications on the reduced access to and importance of supportive care services observed for rural cancer patients. To eliminate persistent urban–rural disparities in cancer care, rural residents must have programs and policies that address cancer care and structural inequities. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
17 pages, 363 KiB  
Article
Cancer Survivors’ Disability Experiences and Identities: A Qualitative Exploration to Advance Cancer Equity
by Susan Magasi, Hilary K. Marshall, Cassandra Winters and David Victorson
Int. J. Environ. Res. Public Health 2022, 19(5), 3112; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19053112 - 06 Mar 2022
Cited by 9 | Viewed by 2726
Abstract
Eliminating cancer-related disparities is a global public health priority. Approximately 40% of cancer survivors experience long-term effects of cancer which can lead to activity limitations and participation restrictions; yet discussions of disability are largely absent from clinical and research cancer health equity agendas. [...] Read more.
Eliminating cancer-related disparities is a global public health priority. Approximately 40% of cancer survivors experience long-term effects of cancer which can lead to activity limitations and participation restrictions; yet discussions of disability are largely absent from clinical and research cancer health equity agendas. The purpose of this study was to explore how cancer survivors experience and make sense of the long-term disabling effects of cancer and its treatments. In this qualitative study, data were collected via in-depth semi-structured interviews with survivors of breast cancer, head and neck cancer, and sarcoma (n = 30). Data were analyzed thematically using a 2-phase iterative process proceeding from descriptive to conceptual coding. Survivors experienced a wide range of long-term physical, sensory, cognitive, and emotional effects, that intertwined to restrict their participation in self-care, work, leisure, and social roles. While the interaction between impairments and participation restrictions meets the definition of disability; participants articulated a range of responses when asked about their disability identity, including (1) rejecting, (2) othering, (3) acknowledging, and (4) affirming. Findings may be indicative of structural and internalized ableism which can impede cancer care and survivorship. To support cancer survivors’ transition to post-treatment life, cancer care providers should implement anti-ableist practices and engage in frank discussions about cancer’s long-term impacts. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
12 pages, 367 KiB  
Article
Masculinity Barriers to Ever Completing Colorectal Cancer Screening among American Indian/Alaska Native, Black, and White Men (Ages 45–75)
by Charles R. Rogers, David G. Perdue, Kenneth Boucher, Kevin M. Korous, Ellen Brooks, Ethan Petersen, John M. Inadomi, Fa Tuuhetaufa, Ronald F. Levant and Electra D. Paskett
Int. J. Environ. Res. Public Health 2022, 19(5), 3071; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19053071 - 05 Mar 2022
Cited by 6 | Viewed by 2977
Abstract
Disparities in colorectal cancer (CRC) mortality among White, Black, and American Indian/Alaska Native (AIAN) men are attributable to differences in early detection screening. Determining how masculinity barriers influence CRC screening completion is critical for cancer prevention and control. To determine whether masculinity barriers [...] Read more.
Disparities in colorectal cancer (CRC) mortality among White, Black, and American Indian/Alaska Native (AIAN) men are attributable to differences in early detection screening. Determining how masculinity barriers influence CRC screening completion is critical for cancer prevention and control. To determine whether masculinity barriers to medical care are associated with lower rates of ever completing CRC screening, a survey-based study was employed from December 2020–January 2021 among 435 White, Black, and AIAN men (aged 45–75) who resided in the US. Logistic regression models were fit to four Masculinity Barriers to Medical Care subscales predicting ever completing CRC screening. For all men, being strong was associated with 54% decreased odds of CRC screening completion (OR 0.46, 95% CI 0.23 to 0.94); each unit increase in negative attitudes toward medical professionals and exams decreased the odds of ever completing CRC screening by 57% (OR 0.43, 95% CI 0.21 to 0.86). Black men who scored higher on negativity toward medical professionals and exams had decreased odds of ever screening. Consideration of masculinity in future population-based and intervention research is critical for increasing men’s participation in CRC screening, with more salience for Black men. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
10 pages, 319 KiB  
Article
Racial/Ethnic Disparities in Health and Life Insurance Denial Due to Cancer among Cancer Survivors
by Adrienne B. Lent, Carlos O. Garrido, Emily H. Baird, Ruta Viela and Robin B. Harris
Int. J. Environ. Res. Public Health 2022, 19(4), 2166; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19042166 - 15 Feb 2022
Cited by 3 | Viewed by 2641
Abstract
This study examined racial/ethnic differences in health/life insurance denial due to cancer among cancer survivors after the passage of the Affordable Care Act (ACA). Behavioral Risk Factor Surveillance System data were obtained from 2012–2020. The dependent variable asked: “Were you ever denied health [...] Read more.
This study examined racial/ethnic differences in health/life insurance denial due to cancer among cancer survivors after the passage of the Affordable Care Act (ACA). Behavioral Risk Factor Surveillance System data were obtained from 2012–2020. The dependent variable asked: “Were you ever denied health insurance or life insurance coverage because of your cancer?” Cancer survivors were included if they were diagnosed with cancer after the Affordable Care Act (N = 14,815). Unadjusted and adjusted logistic regressions for age, sex, income, and employment provided odds ratios of insurance denial due to cancer across racial/ethnic groups: Non-Hispanic White, Black, and Other/mixed race; and Hispanic. Statistically significant differences (p < 0.05) were found between those who were denied or not denied insurance across sex, age, race/ethnicity, income, and employment. Adjusted regressions found significantly higher odds ratios of insurance denial for Blacks (OR: 3.00, 95% CI: 1.77, 5.08), Other/mixed race (OR: 2.16, 95% CI: 1.16, 4.02), and Hispanics (OR: 2.13, 95% CI: 1.02, 4.42) compared to Whites. Differences were observed across sex, income, and employment. Cancer survivors report racial/ethnic disparities in health and life insurance denial due to their cancer despite policy changes. This may be harmful for those who are already financially vulnerable due to their cancer diagnosis and exacerbate racial/ethnic cancer disparities. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
11 pages, 342 KiB  
Article
Impacts of Neighborhood Characteristics and Surgical Treatment Disparities on Overall Mortality in Stage I Renal Cell Carcinoma Patients
by Alejandro Cruz, Faith Dickerson, Kathryn R. Pulling, Kyle Garcia, Francine C. Gachupin, Chiu-Hsieh Hsu, Juan Chipollini, Benjamin R. Lee and Ken Batai
Int. J. Environ. Res. Public Health 2022, 19(4), 2050; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19042050 - 12 Feb 2022
Cited by 2 | Viewed by 1677
Abstract
Racial/ethnic minority groups in the United States have high renal cell carcinoma (RCC) mortality rates. This study assessed surgical treatment disparities across racial/ethnic groups and impacts of neighborhood socioeconomic characteristics on surgical treatments and overall mortality. Stage I RCC patients diagnosed between 2004 [...] Read more.
Racial/ethnic minority groups in the United States have high renal cell carcinoma (RCC) mortality rates. This study assessed surgical treatment disparities across racial/ethnic groups and impacts of neighborhood socioeconomic characteristics on surgical treatments and overall mortality. Stage I RCC patients diagnosed between 2004 and 2016 from National Cancer Database were included (n = 238,141). We assessed differences in associations between race/ethnicity and treatment patterns using logistic regression and between race/ethnicity and overall mortality using Cox regression with and without neighborhood characteristics in the regression models. When compared to non-Hispanic Whites (NHWs), American Indians/Alaska Natives and non-Hispanic Blacks (NHBs) were more likely not to receive surgical care and all racial/ethnic minority groups had significantly increased odds of undergoing radical rather than partial nephrectomy, even after adjusting for neighborhood characteristics. Including surgical treatment and neighborhood factors in the models slightly attenuated the association, but NHBs had a significantly increased risk of overall mortality. NHBs who underwent radical nephrectomy had an increased risk of mortality (HR 1.15, 95% CI: 1.08–1.23), but not for NHBs who underwent partial nephrectomy (HR 0.92, 95% CI: 0.84–1.02). Neighborhood factors were associated with surgical treatment patterns and overall mortality in both NHBs and NHWs. Neighborhood socioeconomic factors may only partly explain RCC disparities. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
10 pages, 311 KiB  
Article
Renal Cell Carcinoma Surgical Treatment Disparities in American Indian/Alaska Natives and Hispanic Americans in Arizona
by Francine C. Gachupin, Benjamin R. Lee, Juan Chipollini, Kathryn R. Pulling, Alejandro Cruz, Ava C. Wong, Celina I. Valencia, Chiu-Hsieh Hsu and Ken Batai
Int. J. Environ. Res. Public Health 2022, 19(3), 1185; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031185 - 21 Jan 2022
Cited by 5 | Viewed by 1815
Abstract
American Indians/Alaska Natives (AI/AN) and Hispanic Americans (HA) have higher kidney cancer incidence and mortality rates compared to non-Hispanic Whites (NHW). Herein, we describe the disparity in renal cell carcinoma (RCC) surgical treatment for AI/AN and HA and the potential association with mortality [...] Read more.
American Indians/Alaska Natives (AI/AN) and Hispanic Americans (HA) have higher kidney cancer incidence and mortality rates compared to non-Hispanic Whites (NHW). Herein, we describe the disparity in renal cell carcinoma (RCC) surgical treatment for AI/AN and HA and the potential association with mortality in Arizona. A total of 5111 stage I RCC cases diagnosed between 2007 and 2016 from the Arizona Cancer Registry were included. Statistical analyses were performed to test the association of race/ethnicity with surgical treatment pattern and overall mortality, adjusting for patients’ demographic, healthcare access, and socioeconomic factors. AI/AN were diagnosed 6 years younger than NHW and were more likely to receive radical rather than partial nephrectomy (OR 1.49 95% CI: 1.07–2.07) compared to NHW. Mexican Americans had increased odds of not undergoing surgical treatment (OR 1.66, 95% CI: 1.08–2.53). Analysis showed that not undergoing surgical treatment and undergoing radical nephrectomy were statistically significantly associated with higher overall mortality (HR 1.82 95% CI: 1.21–2.76 and HR 1.59 95% CI: 1.30–1.95 respectively). Mexican Americans, particularly U.S.-born Mexican Americans, had an increased risk for overall mortality and RCC-specific mortality even after adjusting for neighborhood socioeconomic factors and surgical treatment patterns. Although statistically not significant after adjusting for neighborhood-level socioeconomic factors and surgical treatment patterns, AI/AN had an elevated risk of mortality. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
12 pages, 515 KiB  
Article
Helicobacter pylori Prevalence and Risk Factors in Three Rural Indigenous Communities of Northern Arizona
by Robin B. Harris, Heidi E. Brown, Rachelle L. Begay, Priscilla R. Sanderson, Carmenlita Chief, Fernando P. Monroy and Eyal Oren
Int. J. Environ. Res. Public Health 2022, 19(2), 797; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19020797 - 12 Jan 2022
Cited by 10 | Viewed by 3931
Abstract
Helicobacter pylori (H. pylori) is one of the most common bacterial stomach infections and is implicated in a majority of non-cardia gastric cancer. While gastric cancer has decreased in the United States (US), the incidence in the Navajo Nation is nearly [...] Read more.
Helicobacter pylori (H. pylori) is one of the most common bacterial stomach infections and is implicated in a majority of non-cardia gastric cancer. While gastric cancer has decreased in the United States (US), the incidence in the Navajo Nation is nearly four times higher than surrounding Non-Hispanic White populations. Little is known about H. pylori prevalence in this population or other Indigenous communities in the lower 48 states. In this cross-sectional study, 101 adults representing 73 households from three Navajo Nation chapter communities completed surveys and a urea breath test for active H. pylori. Accounting for intrahousehold correlation, H. pylori prevalence was 56.4% (95% CI, 45.4–66.8) and 72% of households had at least one infected person. The odds of having an active infection in households using unregulated water were 8.85 (95% CI, 1.50–53.38) that of the use of regulated water, and males had 3.26 (95% CI, 1.05–10.07) higher odds than female. The prevalence of H. pylori in Navajo is similar to that seen in Alaska Natives. Further investigation into factors associated with prevention of infection is needed as well as understanding barriers to screening and treatment. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
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21 pages, 942 KiB  
Article
Putting Policy into Practice: How Three Cancer Services Perform against Indigenous Health and Cancer Frameworks
by Emma V. Taylor, Marilyn Lyford, Lorraine Parsons, Michele Holloway, Karla Gough, Sabe Sabesan and Sandra C. Thompson
Int. J. Environ. Res. Public Health 2022, 19(2), 633; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19020633 - 06 Jan 2022
Cited by 3 | Viewed by 2636
Abstract
Improving cancer outcomes for Indigenous people by providing culturally safe, patient-centred care is a critical challenge for health services worldwide. This article explores how three Australian cancer services perform when compared to two national best practice guidelines: the National Aboriginal and Torres Strait [...] Read more.
Improving cancer outcomes for Indigenous people by providing culturally safe, patient-centred care is a critical challenge for health services worldwide. This article explores how three Australian cancer services perform when compared to two national best practice guidelines: the National Aboriginal and Torres Strait Islander Cancer Framework (Cancer Framework) and the National Safety and Quality Health Service (NSQHS) User Guide for Aboriginal and Torres Strait Islander Health (User Guide). The services were identified through a nationwide project undertaken to identify cancer services providing treatment to Indigenous cancer patients. A small number of services which were identified as particularly focused on providing culturally safe cancer care participated in case studies. Interviews were conducted with 35 hospital staff (Indigenous and non-Indigenous) and 8 Indigenous people affected by cancer from the three services. The interviews were analysed and scored using a traffic light system according to the seven priorities of the Cancer Framework and the six actions of the NSQHS User Guide. While two services performed well against the User Guide, all three struggled with the upstream elements of the Cancer Framework, suggesting that the treatment-focused Optimal Care Pathway for Aboriginal and Torres Strait Islander People with Cancer (Cancer Pathway) may be a more appropriate framework for tertiary services. This article highlights the importance of a whole-of-organisation approach when addressing and embedding the six actions of the User Guide. Health services which have successfully implemented the User Guide are in a stronger position to implement the Cancer Framework and Cancer Pathway. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
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14 pages, 1478 KiB  
Article
Population-Based Data Reveal Factors Associated with Organised and Non-Organised Colorectal Cancer Screening: An Important Step towards Improving Coverage
by Thuy Ngan Tran, Guido Van Hal, Marc Peeters, Svetlana Jidkova, Harlinde De Schutter and Sarah Hoeck
Int. J. Environ. Res. Public Health 2021, 18(16), 8373; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18168373 - 07 Aug 2021
Cited by 5 | Viewed by 2054
Abstract
We investigated factors associated with organised and non-organised colorectal cancer screening using faecal occult blood tests, based on data from 308 municipalities in Flanders (6.6 million residents, 57% of Belgium) during 2015–2017. Logistic regression with generalized estimating equations was used to assess the [...] Read more.
We investigated factors associated with organised and non-organised colorectal cancer screening using faecal occult blood tests, based on data from 308 municipalities in Flanders (6.6 million residents, 57% of Belgium) during 2015–2017. Logistic regression with generalized estimating equations was used to assess the associations between municipal characteristics and organised and non-organised screening coverages. Factors associated negatively with both organised and non-organised screening: percentage of people aged 70–74 in the target population [OR (odds ratios) = 0.98, 95%CI (confidence interval): 0.97–0.99 and OR = 0.98, 95%CI: 0.96–0.999, respectively]; negatively with organised screening: average income [OR = 0.97, 95%CI: 0.96–0.98], percentage of people with a non-Belgian/Dutch nationality [OR = 0.962, 95%CI: 0.957–0.967]; positively with organised screening: percentages of men in the target population [OR = 1.13, 95%CI: 1.11–1.14], jobseekers [OR = 1.12, 95%CI: 1.09–1.15] and people with at least one general practitioner (GP) visit in the last year [OR = 1.04, 95%CI: 1.03–1.05]; positively with non-organised screening: number of patients per GP [OR = 1.021, 95%CI: 1.016–1.026], percentage of people with a global medical dossier handled by a preferred GP [OR = 1.025, 95%CI: 1.018–1.031]. This study helps to identify the hard-to-reach subpopulations in CRC screening, and highlights the important role of GPs in the process of promoting screening among non-participants and encouraging non-organised participants to switch to organised screening. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
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15 pages, 693 KiB  
Article
Health Care Access Measures and Palliative Care Use by Race/Ethnicity among Metastatic Gynecological Cancer Patients in the United States
by Jessica Y. Islam, Veeral Saraiya, Rebecca A. Previs and Tomi Akinyemiju
Int. J. Environ. Res. Public Health 2021, 18(11), 6040; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18116040 - 04 Jun 2021
Cited by 6 | Viewed by 3503
Abstract
Palliative care improves quality-of-life and extends survival, however, is underutilized among gynecological cancer patients in the United States (U.S.). Our objective was to evaluate associations between healthcare access (HCA) measures and palliative care utilization among U.S. gynecological cancer patients overall and by race/ethnicity. [...] Read more.
Palliative care improves quality-of-life and extends survival, however, is underutilized among gynecological cancer patients in the United States (U.S.). Our objective was to evaluate associations between healthcare access (HCA) measures and palliative care utilization among U.S. gynecological cancer patients overall and by race/ethnicity. We used 2004–2016 data from the U.S. National Cancer Database and included patients with metastatic (stage III–IV at-diagnosis) ovarian, cervical, and uterine cancer (n = 176,899). Palliative care was defined as non-curative treatment and could include surgery, radiation, chemotherapy, and pain management, or any combination. HCA measures included insurance type, area-level socioeconomic measures, distance-to-care, and cancer treatment facility type. We evaluated associations of HCA measures with palliative care use overall and by race/ethnicity using multivariable logistic regression. Our population was mostly non-Hispanic White (72%), had ovarian cancer (72%), and 24% survived <6 months. Five percent of metastatic gynecological cancer patients utilized palliative care. Compared to those with private insurance, uninsured patients with ovarian (aOR: 1.80,95% CI: 1.53–2.12), and cervical (aOR: 1.45,95% CI: 1.26–1.67) cancer were more likely to use palliative care. Patients with ovarian (aOR: 0.58,95% CI: 0.48–0.70) or cervical cancer (aOR: 0.74,95% CI: 0.60–0.88) who reside >45 miles from their provider were less likely to utilize palliative care than those within <2 miles. Ovarian cancer patients treated at academic/research programs were less likely to utilize palliative care compared to those treated at community cancer programs (aOR: 0.70, 95%CI: 0.58–0.84). Associations between HCA measures and palliative care utilization were largely consistent across U.S. racial-ethnic groups. Insurance type, cancer treatment facility type, and distance-to-care may influence palliative care use among metastatic gynecological cancer patients in the U.S. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
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Review

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13 pages, 1531 KiB  
Review
Native and Indigenous Populations and Gastric Cancer: A Worldwide Review
by Felina M. Cordova-Marks, William O. Carson, Angela Monetathchi, Alyssa Little and Jennifer Erdrich
Int. J. Environ. Res. Public Health 2022, 19(9), 5437; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19095437 - 29 Apr 2022
Cited by 5 | Viewed by 2631
Abstract
Gastric cancer is a worldwide concern, particularly for Indigenous populations who face greater disparities in healthcare. With decreased access to screening and critical treatment delays, this group is experiencing adverse health effects. To determine what factors drive these disparities, a systematic review was [...] Read more.
Gastric cancer is a worldwide concern, particularly for Indigenous populations who face greater disparities in healthcare. With decreased access to screening and critical treatment delays, this group is experiencing adverse health effects. To determine what factors drive these disparities, a systematic review was performed in PubMed. This revealed a lack of research on gastric cancer specific to this population. The literature primarily focused on subset analyses and biological aspects with sparse focus on determinants of health. The results informed this presentation on factors related to Indigenous gastric cancer, which are influenced by colonialism. Indigenous populations encounter high rates of food shortage, exposure to harmful environmental agents, structural racism in the built environment, H. pylori, and compromised healthcare quality as an effect of colonialism, which all contribute to the gastric cancer burden. Putting gastric cancer into a cultural context is a potential means to respond to colonial perspectives and their negative impact on Indigenous patients. The objective of this manuscript is to examine the current state of gastric cancer literature from a global perspective, describe what is currently known based on this literature review, supplemented with additional resources due to lack of published works in PubMed, and to present a model of gastric cancer through the lens of a modified medicine wheel as a potential tool to counter colonial healthcare perspectives and to honor Indigenous culture. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
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16 pages, 708 KiB  
Review
Advancing Liver Cancer Prevention for American Indian Populations in Arizona: An Integrative Review
by Timian M. Godfrey, Edgar A. Villavicencio, Kimberly Barra, Priscilla R. Sanderson, Kimberly Shea, Xiaoxiao Sun and David O. Garcia
Int. J. Environ. Res. Public Health 2022, 19(6), 3268; https://doi.org/10.3390/ijerph19063268 - 10 Mar 2022
Cited by 2 | Viewed by 2626
Abstract
Liver cancer is a highly fatal condition disproportionately impacting American Indian populations. A thorough understanding of the existing literature is needed to inform region-specific liver cancer prevention efforts for American Indian people. This integrative review explores extant literature relevant to liver cancer in [...] Read more.
Liver cancer is a highly fatal condition disproportionately impacting American Indian populations. A thorough understanding of the existing literature is needed to inform region-specific liver cancer prevention efforts for American Indian people. This integrative review explores extant literature relevant to liver cancer in American Indian populations in Arizona and identifies factors of structural inequality affecting these groups. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the methodology, and a literature search was conducted in PubMed, EMBASE, CINAHL, and PsycInfo for articles including Arizona American Indian adults and liver disease outcomes. Seven articles met the inclusion criteria in the final review. Five of the studies used an observational study design with secondary analysis. One article used a quasiexperimental approach, and another employed a community-engagement method resulting in policy change. The results revealed a lack of empirical evidence on liver cancer prevention, treatment, and health interventions for American Indian populations in Arizona. Research is needed to evaluate the high rates of liver disease and cancer to inform culturally relevant interventions for liver cancer prevention. Community-engaged research that addresses structural inequality is a promising approach to improve inequities in liver cancer for American Indian people. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
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11 pages, 634 KiB  
Review
Interrogating Patterns of Cancer Disparities by Expanding the Social Determinants of Health Framework to Include Biological Pathways of Social Experiences
by Celina I. Valencia, Francine C. Gachupin, Yamilé Molina and Ken Batai
Int. J. Environ. Res. Public Health 2022, 19(4), 2455; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19042455 - 21 Feb 2022
Cited by 7 | Viewed by 3274
Abstract
The objective of this article is to call for integrating biological pathways of social experiences in the concept model of cancer disparities and social determinants of health (SDH) fields. Black, Indigenous, and People of Color (BIPOC) populations experience more negative outcomes across the [...] Read more.
The objective of this article is to call for integrating biological pathways of social experiences in the concept model of cancer disparities and social determinants of health (SDH) fields. Black, Indigenous, and People of Color (BIPOC) populations experience more negative outcomes across the cancer continuum. Social conditions are instrumental in better understanding the contemporary and historical constructs that create these patterns of disparities. There is an equally important body of evidence that points to the ways that social conditions shape biological pathways. To date, these areas of research are, for the most part, separate. This paper calls for a bridging of these two areas of research to create new directions for the field of cancer disparities. We discuss inflammation, epigenetic changes, co-morbidities, and early onset as examples of the biological consequences of social conditions that BIPOC populations experience throughout their lifespan that may contribute to disproportionate tumorigenesis and tumor progression. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
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Other

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12 pages, 540 KiB  
Project Report
Project COALESCE—An Example of Academic Institutions as Conveners of Community-Clinic Partnerships to Improve Cancer Screening Access
by Katherine Y. Tossas, Savannah Reitzel, Katelyn Schifano, Charlotte Garrett, Kathy Hurt, Michelle Rosado, Robert A. Winn and Maria D. Thomson
Int. J. Environ. Res. Public Health 2022, 19(2), 957; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19020957 - 15 Jan 2022
Cited by 2 | Viewed by 1781
Abstract
In Virginia, 56% of colorectal cancers (CRC) are diagnosed late, making it one of three enduring CRC mortality hotspots in the US. Cervical cancer (CCa) exhibits a similar pattern, with 48% late-stage diagnosis. Mortality for these cancers is worse for non-Latinx/e(nL)-Black people relative [...] Read more.
In Virginia, 56% of colorectal cancers (CRC) are diagnosed late, making it one of three enduring CRC mortality hotspots in the US. Cervical cancer (CCa) exhibits a similar pattern, with 48% late-stage diagnosis. Mortality for these cancers is worse for non-Latinx/e(nL)-Black people relative to nL-White people in Virginia, but preventable with equitable screening access and timely diagnostic follow-up. However, structural barriers, such as fractured referral systems and extended time between medical visits, remain. Because Federally Qualified Health Centers (FQHCs) care for a large proportion of racial and ethnic minorities, and underserved communities, regardless of ability to pay, they are ideal partners to tackle structural barriers to cancer screenings. We piloted a quality improvement initiative at five FQHCs in southcentral Virginia to identify and address structural, race-related barriers to CRC, as well as CCa screening and diagnostic follow-up using evidence-based approaches. Uniquely, FQHCs were paired with local community organizations in a didactic partnership, to elevate the community’s voice while together, increase support, acceptance, uptake, and intervention sustainability. We report on project development, and share preliminary data within the context of project goals, namely, to increase cancer screenings by 5–10%, improve knowledge and diagnostic follow-up processes, and build longitudinal partnerships. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
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5 pages, 776 KiB  
Commentary
Equitable COVID-19 Vaccination for Hispanics in the United States: A Success Story from California Border Communities
by Maria Elena Martinez, Jesse N. Nodora, Corinne McDaniels-Davidson, Noe C. Crespo and Amir Adolphe Edward
Int. J. Environ. Res. Public Health 2022, 19(1), 535; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19010535 - 04 Jan 2022
Cited by 2 | Viewed by 2006
Abstract
The ongoing 2019 novel coronavirus disease (COVID-19) pandemic continues to impact the health of individuals worldwide, including causing pauses in lifesaving cancer screening and prevention measures. From time to time, elective medical procedures, such as those used for cancer screening and early detection, [...] Read more.
The ongoing 2019 novel coronavirus disease (COVID-19) pandemic continues to impact the health of individuals worldwide, including causing pauses in lifesaving cancer screening and prevention measures. From time to time, elective medical procedures, such as those used for cancer screening and early detection, were deferred due to concerns regarding the spread of the infection. The short- and long-term consequences of these temporary measures are concerning, particularly for medically underserved populations, who already experience inequities and disparities related to timely cancer care. Clearly, the way out of this pandemic is by increasing COVID-19 vaccination rates and doing so in an equitable manner so that communities most affected receive preferential access and administration. In this article, we provide a perspective on vaccine equity by featuring the experience of the California Hispanic community, who has been disproportionately impacted by the pandemic. We first compared vaccination rates in two United States–Mexico border counties in California (San Diego County and Imperial County) to counties elsewhere in California with a similar Hispanic population size. We show that the border counties have substantially lower unvaccinated proportions of Hispanics compared to other counties. We next looked at county vaccination rates according to the California Healthy Places Index, a health equity metric and found that San Diego and Imperial counties achieved more equitable access and distribution than the rest of the state. Finally, we detail strategies implemented to achieve high and equitable vaccination in this border region, including Imperial County, an agricultural region that was California’s epicenter of the COVID-19 crisis at the height of the pandemic. These United States–Mexico border county data show that equitable vaccine access and delivery is possible. Multiple strategies can be used to guide the delivery and access to other public health and cancer preventive services. Full article
(This article belongs to the Special Issue Cancer Health Disparities and Public Health)
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