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Inequities in Cancer Prevention and Control among Vulnerable Populations

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

Deadline for manuscript submissions: closed (31 May 2022) | Viewed by 30343

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Special Issue Editors

Dr. Pamela Valera

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Guest Editor

Community Health Justice Lab & Department of Urban-Global Public Health, Rutgers University School of Public Health, Newark, NJ 07102, USA
Interests: community engagement; cancer; smoking cessation; digital health; telehealth; health of marginalized communities (criminal justice populations, people living with HIV, LGBTQ, Black and Latino men); COVID-19
Special Issues, Collections and Topics in MDPI journals

Dr. Adana A.M. Llanos

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Guest Editor

Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
Interests: understanding the molecular factors (epigenetic, genetic/genomic, proteomic) and sociobiologic mechanisms (integration of social determinants of health, biomarkers, and biological pathways) that cause cancer disparities, with a particular focus on racial/ethnic minorities, medically underserved, and vulnerable populations (including immigrants and non-US-based populations). Specific focus on breast, cervical and other HPV-associated cancers

Dr. Luis Alzate-Duque

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Guest Editor

Rutgers New Jersey Medical School, Department of Medicine, Newark, NJ, USA
Interests: coloretcal screening; primary care; health equity; health disparities; community engagement

Special Issue Information

Dear Colleagues,

Advancing health equity requires the ability for vulnerable and/or marginalized communities to prevent, detect, treat, and survive cancer. Systemic racism and structural cancer inequities have numerous impacts across the cancer care continuum, and in order to understand and address these issues as a pathway to health equity, we must integrate social science, basic science, and lay knowledge.

This Special Issue invites the submission of original qualitative and quantitative research papers, systematic reviews and meta-analyses, conceptual papers, action-oriented papers related to the advancement of cancer health equity across various vulnerable populations for broader impacts.

We are particularly interested in manuscripts that explicitly focus on the epidemiology of cancer disparities; cancer prevention and control in vulnerable and marginalized communities; intersectionality; medical mistrust; social and built environment factors; sociobiologic factors; barriers to access and care; international issues in cancer disparities; and pathways towards eliminating cancer health disparities in marginalized populations.

Dr. Valera Pamela
Dr. Adana A.M. Llanos
Dr. Luis Alzate-Duque
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

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

cancer prevention and control
cancer inequities
racial/ethnic minorities
medically underserved
immigrant populations
uninsured and underinsured
LGBTQ
sociobiologic mechanisms
social determinants of health
systemic racism and structural cancer inequities

Published Papers (11 papers)

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Research

11 pages, 805 KiB

Open AccessArticle

Cancer Survivors in Saint Lucia Deeply Value Social Support: Considerations for Cancer Control in Under-Resourced Communities

by Aviane Auguste, Shania Cox, JoAnn S. Oliver, Dorothy Phillip, Owen Gabriel, James St. Catherine, Carlene Radix, Danièle Luce and Christine Barul

Int. J. Environ. Res. Public Health 2022, 19(11), 6531; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19116531 - 27 May 2022

Cited by 1 | Viewed by 2082

Abstract

Understanding the views of cancer survivors on their experience is important for informing community-based interventions. We studied, for the first time, the views of cancer survivors residing in Saint Lucia on their overall care experience. We used interview data from a cohort of adult cancer survivors from Saint Lucia between 2019 and 2020. We performed a thematic analysis to derive themes from codes. Forty-four survivors provided responses to at least one of the three questions. The majority of survivors were black, female and diagnosed with breast cancer. Survivors were interviewed on average five years after diagnosis. Four common themes emerged; “Availability of support groups”, “Importance of support from family and friends”, “Access to finances” and “Health education and patient navigation”. Travel overseas for health services was common among survivors. Survivors expressed emotional distress during travel due to isolation from family and local providers. This is typical among island populations and is distinct from existing patient frameworks. Survivors also suggested that networking amongst providers and interventions assisted families of cancer survivors. Although tertiary care services are limited, we showed that survivors deeply value and depend on their inter-personal relationships during care. Interventions aimed at strengthening the inter-personal environment of survivors are warranted. Full article

(This article belongs to the Special Issue Inequities in Cancer Prevention and Control among Vulnerable Populations)

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15 pages, 363 KiB

Open AccessArticle

Belonging to Three Worlds: Somali Adolescent–Parent Relationships in the United States and Implications for Tobacco Prevention

by April K. Wilhelm, Michele L. Allen and Rebekah J. Pratt

Int. J. Environ. Res. Public Health 2022, 19(6), 3653; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19063653 - 19 Mar 2022

Viewed by 1644

Abstract

Immigrant family relationships help to buffer the adolescent adoption of health risk behaviors but can be strained by post-immigration structural and cultural barriers. This study qualitatively examines how Somali adolescent–parent relationship factors influence Somali adolescent tobacco use and identifies areas for further family support to prevent Somali adolescent tobacco use. We conducted fifteen key informant interviews with professionals serving the Somali community in clinical, educational, religious, or other community organization roles in one Minnesota metropolitan region. Data were collected and analyzed using approaches rooted in Grounded Theory. Key informants contrasted parenting experiences in Somalia with those in the United States and described how four key factors—structural and cultural barriers, multicultural identity formation, evolving parental expectations and responsibilities, and shifting family resources and support—have influenced Somali parent–child relationship quality and function following immigration. Informants shared the implications of these factors on parental ability to address adolescent tobacco use and discussed potential strategies to support parents that fell into two categories: assisting parents in adapting their parenting approaches to a new context and supporting knowledge and skill development in addressing tobacco use prevention specifically. Incorporating strategies that support Somali parents in their evolving parental roles and attend to structural and cultural barriers to tobacco prevention are essential to consider when developing family-centered tobacco prevention interventions in this population. Full article

(This article belongs to the Special Issue Inequities in Cancer Prevention and Control among Vulnerable Populations)

14 pages, 696 KiB

Open AccessArticle

The Role of Medical Mistrust in Concerns about Tumor Genomic Profiling among Black and African American Cancer Patients

by Ariel Hoadley, Sarah Bauerle Bass, Yana Chertock, Jesse Brajuha, Paul D’Avanzo, Patrick J. Kelly and Michael J. Hall

Int. J. Environ. Res. Public Health 2022, 19(5), 2598; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19052598 - 23 Feb 2022

Cited by 6 | Viewed by 2538

Abstract

Tumor genomic profiling (TGP) is used in oncology practice to optimize cancer treatment and improve survival rates. However, TGP is underutilized among Black and African American (AA) patients, creating potential disparities in cancer treatment outcomes. Cost, accuracy, and privacy are barriers to genetic testing, but medical mistrust (MM) may also influence how Black and AA cancer patients perceive TGP. From December 2019 to February 2020, 112 Black and AA adults from two outpatient oncology sites in Philadelphia, PA without a known history of having TGP testing conducted completed a cross-sectional survey. Items queried included sociodemographic characteristics, clinical factors, patient–oncologist relationship quality, medical mistrust, and concerns about TGP. A k-means cluster analysis revealed two distinct psychographic clusters: high (MM-H) versus low (MM-L) medical mistrust. Clusters were not associated with any sociodemographic or clinical factors, except for age (MM-H patients older than MM-L patients, p = 0.006). Eleven TGP concerns were assessed; MM-H patients expressed greater concerns than MM-L patients, including distrust of the government, insurance carriers, and pharmaceutical companies. TGP concerns varied significantly based on level of medical mistrust, irrespective of sociodemographic characteristics. Targeted communications addressing TGP concerns may mitigate disparities in TGP uptake among those with medical mistrust. Full article

(This article belongs to the Special Issue Inequities in Cancer Prevention and Control among Vulnerable Populations)

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11 pages, 347 KiB

Open AccessArticle

The We Can Quit2 Smoking Cessation Trial: Knowledge Exchange and Dissemination Following a Community-Based Participatory Research Approach

by Stefania Castello, Catherine Darker, Joanne Vance, Nadine Dougall, Linda Bauld and Catherine B. Hayes

Int. J. Environ. Res. Public Health 2022, 19(4), 2333; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19042333 - 18 Feb 2022

Cited by 1 | Viewed by 2173

Abstract

Background: ‘We Can Quit2’ pilot randomised controlled trial determined the feasibility [of conducting a community-based trial of We Can Quit, a peer-delivered stop-smoking programme (group support, combination nicotine replacement therapy (NRT), and tailored individual support) for women living in socioeconomically disadvantaged areas in Ireland. Lessons from a knowledge exchange (KE) workshop that reengaged trial stakeholders are presented. Methods: The trial dissemination plan included invitation of community, regional and national stakeholders (n = 176) to a KE interactive workshop, who received an accessible brief beforehand. Trial findings were presented. Enhancements to community engagement, participants’ recruitment and retention, and policy priorities arising from the research were discussed. Field notes and responses to a post-event anonymous questionnaire were analysed using thematic content analysis. Results: Workshop attendees (41/176, 23%) recommended: dedicated additional time to engage community stakeholders; social prescribing pathways to enhance recruitment; more adaptation of trial-related information and assistance in completion of data forms for low literacy individuals; encouraging women to join healthy community programmes to facilitate retention and sustainability; removal of barriers to access NRT; and ongoing provision of cessation services tailored to disadvantaged groups. Conclusions: The findings are relevant to the implementation of other community-based health interventions for disadvantaged groups, to policy makers and to service providers. Full article

(This article belongs to the Special Issue Inequities in Cancer Prevention and Control among Vulnerable Populations)

14 pages, 591 KiB

Open AccessArticle

Exploring Tobacco and E-Cigarette Use among Queer Adults during the Early Days of the COVID-19 Pandemic

by Pamela Valera, Madelyn Owens, Sarah Malarkey and Nicholas Acuna

Int. J. Environ. Res. Public Health 2021, 18(24), 12919; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182412919 - 08 Dec 2021

Cited by 4 | Viewed by 2964

Abstract

The purpose of this narrative study is to describe the vaping and smoking characteristics of Queer people ages 18–34 before March of 2020 and to better understand how the COVID-19 pandemic has impacted those behaviors since March of 2020. In total, 31 participants were screened. Thirteen participants were screened prior to the emergence of COVID-19, and 18 were screened when study protocols transitioned to a remote setting (pre and during). Of the 27 eligible participants, a total of 25 participants completed the study. Most participants (n = 13) self-identified as male, followed by five identified as female, four self-identified as gender non-binary, and three identified as transgender. The most common sexual orientation amongst participants was gay (n = 10), with bisexual being the second-most reported. Approximately 20 Queer participants reported using cigarettes, 14 participants self-reported using electronic devices, and 11 reported using hookah. Twenty participants reported smoking ten or less, and four self-reported using 11–20 cigarettes per day. Approximately, 92% of participants (n = 23) indicate that they are using an e-cigarette and regular cigarettes, and 57% of participants (n = 12) report using one pod or cartridge per day. The three themes that emerged in this study are: (1) Queer people during COVID-19 are experiencing heightened minority stress; (2) Queer people are unfamiliar with smoking cessation; and (3) vaping and smoking are attributed to stress and anxiety. Queer participants are likely to be dual users of cigarette and vaping products. This present study provides increasing evidence that Queer people are experiencing heightened stress and anxiety and using cigarette smoking and vaping to cope during the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Inequities in Cancer Prevention and Control among Vulnerable Populations)

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9 pages, 338 KiB

Open AccessArticle

Cervical Visual Inspection with Acetic Acid (VIA) and Oncogenic Human Papillomavirus Screening in Rural Indigenous Guatemalan Women: Time to Rethink VIA

by Anne Jeffries, Consuelo M. Beck-Sagué, Ariel Bernardo Marroquin-Garcia, Michael Dean, Virginia McCoy, Diego Aurelio Cordova-Toma, Eric Fenkl and Purnima Madhivanan

Int. J. Environ. Res. Public Health 2021, 18(23), 12406; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182312406 - 25 Nov 2021

Cited by 3 | Viewed by 1760

Abstract

Single-visit “screen-and-treat” strategies using visual inspection with acetic acid (VIA) and cryotherapy (liquid nitrous oxide ablation) in low-resource settings are commonly used to detect and treat precancerous lesions for cervical cancer prevention. This study compared VIA sensitivity and specificity in rural indigenous Guatemalan communities, to that of oncogenic human papillomavirus (HPV) testing for detection of precancerous changes, using cytology as the reference standard. Between 3–8 September 2017, trained nurses examined 222 women aged 23–58 years with VIA. Specimens for liquid-based cytology and HPV testing were obtained prior to VIA with a cytobrush and transported in PreservCyt to a US clinical laboratory. VIA and HPV test sensitivities were assessed as proportions of women with abnormal cytology that had abnormal VIA or HPV results, respectively, and specificities, as proportions with normal cytology with normal VIA or negative HPV tests. Of 222 women, 18 (8.1%) had abnormal cytology (1 carcinoma in a participant who received VIA-based cryotherapy in 2015, 4 high- and 5 low-grade squamous intraepithelial lesions, and 8 atypical squamous cells of undetermined significance (ASCUS)). Excluding ASCUS, sensitivities of VIA and HPV were 20.0% and 100%, respectively. VIA-based screening may not be acceptable for detecting precancerous lesions, and field cryotherapy for preventing malignancy. The World Health Organization recommended in 2021 “…using HPV DNA detection as the primary screening test rather than VIA or cytology”. Full article

(This article belongs to the Special Issue Inequities in Cancer Prevention and Control among Vulnerable Populations)

11 pages, 342 KiB

Open AccessArticle

Abnormal Pap Follow-Up among Criminal-Legal Involved Women in Three U.S. Cities

by Chelsea Salyer, Ashlyn Lipnicky, Meredith Bagwell-Gray, Jennifer Lorvick, Karen Cropsey and Megha Ramaswamy

Int. J. Environ. Res. Public Health 2021, 18(12), 6556; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18126556 - 18 Jun 2021

Cited by 5 | Viewed by 2385

Abstract

Criminal-legal involved women experience significant barriers to preventive cervical care, and consequently there is a higher incidence of cervical cancer in this population. The purpose of this study is to identify variables that may facilitate abnormal Pap follow-up among criminal-legal involved women living in community settings. The study included n = 510 women with criminal-legal histories, from three U.S. cities—Birmingham, AL; Kansas City, KS/MO; Oakland, CA. Participants completed a 288-item survey, with questions related to demographics, social advantages, provider communication, and reasons for missing follow-up care. There were n = 58 women who reported abnormal Pap testing, and n = 40 (69%) received follow-up care. Most women received either repeat Pap/HPV testing (n = 15, 38%), or colposcopy and/or biopsy (n = 14, 35%). Women who did not follow-up (n = 15, 26%) cited that they forgot (n = 8, 53%), were uninsured (n = 3, 20%), or were reincarcerated (n = 3, 20%). In a multivariate analysis, both having a primary care provider (OR 4.6, 95% CI 1.3–16.0) and receiving specific provider communication about follow-up (OR 3.8, 95% CI 1.1–13.2) were independent predictors for abnormal Pap follow-up. Interventions that offer linkages to providers in the community or ensure abnormal Pap care plans are communicated effectively may mitigate the disparate incidence of cervical cancer among criminal-legal involved women. Full article

(This article belongs to the Special Issue Inequities in Cancer Prevention and Control among Vulnerable Populations)

14 pages, 1495 KiB

Open AccessArticle

Oncotype DX Test Receipt among Latina/Hispanic Women with Early Invasive Breast Cancer in New Jersey: A Registry-Based Study

by Nicholas Acuna, Jesse J. Plascak, Jennifer Tsui, Antoinette M. Stroup and Adana A. M. Llanos

Int. J. Environ. Res. Public Health 2021, 18(10), 5116; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105116 - 12 May 2021

Cited by 1 | Viewed by 2363

Abstract

Oncotype DX^® (ODX) is a valid test of breast cancer (BC) recurrence risk and chemotherapy benefit. The purpose of this study was to examine prevalence of and factors associated with receipt of ODX testing among eligible Latinas/Hispanics diagnosed with BC. Sociodemographic and tumor data of BC cases diagnosed between 2008 and 2017 among Latina/Hispanic women (n = 5777) were from the New Jersey State Cancer Registry (NJSCR). Eligibility for ODX testing were based on National Comprehensive Cancer Network guidelines. Multivariable logistic regression models of ODX receipt among eligible women were used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI) by demographic and clinicopathologic factors. One-third of Latinas/Hispanics diagnosed with BC were eligible for ODX testing. Among the eligible, 60.9% received ODX testing. Older age (AOR 0.08, 95% CI: 0.04, 0.14), low area-level SES (AOR 0.58, 95% CI: 0.42, 0.52), and being uninsured (AOR 0.58, 95% CI: 0.39, 0.86) were associated with lower odds of ODX testing. While there was relatively high ODX testing among eligible Latina/Hispanic women with BC in New Jersey, our findings suggest that age, insurance status, and area-level SES contribute to unequal access to genetic testing in this group, which might impact BC outcomes. Full article

(This article belongs to the Special Issue Inequities in Cancer Prevention and Control among Vulnerable Populations)

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13 pages, 1077 KiB

Open AccessArticle

Difficulties in Accessing Cancer Care in a Small Island State: A Community-Based Pilot Study of Cancer Survivors in Saint Lucia

by Aviane Auguste, Glenn Jones, Dorothy Phillip, James St. Catherine, Elizabeth Dos Santos, Owen Gabriel and Carlene Radix

Int. J. Environ. Res. Public Health 2021, 18(9), 4770; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094770 - 29 Apr 2021

Cited by 1 | Viewed by 3011

Abstract

Developing robust systems for cancer care delivery is essential to reduce the high cancer mortality in small island developing states (SIDS). Indigenous data are scarce, but community-based cancer research can inform care in SIDS where formal research capacity is lacking, and we describe the experiences of cancer survivors in Saint Lucia in accessing health services. Purposive and snowball sampling was used to constitute a sample of survivors for interviews. Subjects were interviewed with a questionnaire regarding socio-demographics, clinical characteristics, health services accessed (physicians, tests, treatment), and personal appraisal of experience. We recruited 50 survivors (13 men, 37 women). Only 52% of first presentations were with general practitioners. The mean turnaround for biopsy results in Saint Lucia was three times longer than overseas (p = 0.0013). Approximately half of survivors commenced treatment more than one month following diagnosis (median of 32 days, IQR 19–86 days), and 56% of survivors traveled out-of-country for treatment. Most survivors (60%) paid for care with family/friends support, followed by savings and medical insurance (38% each). In conclusion, cancer survivors in Saint Lucia are faced with complex circumstances, including access-to-care and health consequences. This study can guide future research, and possibly guide practice improvements in the near term. Full article

(This article belongs to the Special Issue Inequities in Cancer Prevention and Control among Vulnerable Populations)

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17 pages, 385 KiB

Open AccessArticle

Effect of Neighborhood and Individual-Level Socioeconomic Factors on Colorectal Cancer Screening Adherence

by Kiara N. Mayhand, Elizabeth A. Handorf, Angel G. Ortiz, Evelyn T. Gonzalez, Amie Devlin, Kristen A. Sorice, Nestor Esnaola, Susan Fisher and Shannon M. Lynch

Int. J. Environ. Res. Public Health 2021, 18(9), 4398; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094398 - 21 Apr 2021

Cited by 19 | Viewed by 4011

Abstract

Despite the effectiveness of screenings in reducing colorectal cancer (CRC) mortality, ~25% of US adults do not adhere to screening guidelines. Prior studies associate socioeconomic status (SES) with low screening adherence and suggest that neighborhood deprivation can influence CRC outcomes. We comprehensively investigated the effect of neighborhood SES circumstances (nSES), individual SES, and race/ethnicity on adherence to CRC screening in a multiethnic cross-sectional study. Participant surveys assessing 32 individual-level socioeconomic and healthcare access measures were administered from 2017 to 2018. Participant data were joined with nine nSES measures from the US Census at the census tract level. Univariate, LASSO, and multivariable mixed-effect logistic regression models were used for variable reduction and evaluation of associations. The total study population included 526 participants aged 50–85; 29% of participants were non-adherent. In the final multivariable model, age (p = 0.02) and Non-Hispanic Black race (p = 0.02) were associated with higher odds of adherence. Factors associated with lower adherence were home rental (vs. ownership) (p = 0.003), perception of low healthcare quality (p = 0.006), no routine checkup within two years (p = 0.002), perceived discrimination (p = 0.02), and nSES deprivation (p = 0.02). After comprehensive variable methods were applied, socioeconomic indicators at the neighborhood and individual level were found to contribute to low CRC screening adherence. Full article

(This article belongs to the Special Issue Inequities in Cancer Prevention and Control among Vulnerable Populations)

20 pages, 378 KiB

Open AccessFeature PaperArticle

Barriers and Facilitators of Smoking Cessation among Latinos Living with HIV: Perspectives from Key Leaders of Community-Based Organizations and Clinics

by Francisco Cartujano-Barrera, Michelle Lee D’Abundo, Evelyn Arana-Chicas, Surina Chock, Pamela Valera, Charles S. Kamen and Ana Paula Cupertino

Int. J. Environ. Res. Public Health 2021, 18(7), 3437; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18073437 - 26 Mar 2021

Cited by 10 | Viewed by 2926

Abstract

The purpose of this study was to identify the perspectives from key leaders of community-based organizations (CBOs) and clinics serving people living with HIV on barriers and facilitators of smoking cessation among Latino smokers living with HIV. Semi-structured interviews were conducted in English and Spanish with 10 key leaders. Using a social ecological model, qualitative theoretical analysis was used to analyze the results. Participants identified barriers at the individual (e.g., low education level, HIV, and financial stress), interpersonal (e.g., language barriers, low social support), organizational (e.g., lack of smoking cessation resources and targeted interventions), community (e.g., HIV and mental health stigma), and policy (e.g., paperwork for insurance) level. Participants identified facilitators at the individual (e.g., high participation in trials, good medication adherence), interpersonal (e.g., no smoking in social circles), organizational (e.g., bilingual staff, culturally competent care), community (e.g., providing transportation, the coronavirus disease 2019 as an opportunity for smoking cessation), and policy level (e.g., existence of funding, comprehensive insurance programs). These results provide operational strategies to address smoking disparities among Latino smokers living with HIV. Further research is needed on how to integrate these perspectives into effective smoking cessation interventions. Full article

(This article belongs to the Special Issue Inequities in Cancer Prevention and Control among Vulnerable Populations)

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