Cancer Screening Behavior in Hispanic/Latinas Living in the Northeast United Stat

居住在美国东北部的西班牙裔/拉丁裔的癌症筛查行为

基本信息

批准号：
8258207
负责人：
BETH A JONES
金额：
$ 61.89万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-08-05 至 2016-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8258207
关键词：
Acculturation Address Adherence Adopted African American Age Appointment Behavior Birth Place Breast Cancer Detection Cancer Control Clinical Communication Communities Connecticut Country Data Data Analyses Data Sources Diagnosis Diagnostic Neoplasm Staging Disadvantaged Ethnic group Evaluation First Births Funding Goals Guidelines Health Health Services Accessibility Health behavior Healthcare Systems Hispanics Immigrant Interview Investigation Latina Latino Life Literature Mammography Measures Methods Modeling National Health Interview Survey Outcome Patient Self-Report Patients Pattern Population Population Heterogeneity Process Prospective Studies Relative (related person)Reporting Risk Role Screening Result Screening for cancer Screening procedure Stage at Diagnosis Staging Subgroup Sum Surveys System Tumor stage United States Woman Work age group base cancer risk caucasian American cohort design experience follow-up health belief health disparity health literacy high risk interest low socioeconomic status malignant breast neoplasm older women primary outcome prospective racial and ethnic racial difference racial/ethnic difference reproductive theories

项目摘要

DESCRIPTION (provided by applicant): Hispanic /Latino (H/L) women are less likely to be diagnosed with breast cancer than are White (W) women, but more likely to be diagnosed with late stage tumors and to have worse survival. Compared to White and African American women, their self-reported mammography screening rates are lower. The recent demographic shift toward a rapidly growing H/L population throughout the U.S. underscores the need for a proactive approach to cancer control in this relatively understudied population. Because relatively little is known about cancer screening behavior in H/L women living in the Northeast US, particularly among recent immigrants, we propose to establish a cohort of 1,600 H/L women, ages 40-75, living in Connecticut, and to study their screening experience over a 2-4 year period. Employing a prospective design, we will: 1) identify predictors of non-adherence to recommended mammography screening guidelines over the study period; 2) identify predictors of inadequate communication of mammography screening results; and 3) identify predictors of inadequate follow-up of abnormal mammograms in this culturally diverse H/L population. Our hypothesis is that the increased risk of poor adherence to guidelines, poor communication of results, and inadequate follow-up for abnormal mammograms in some H/L women can be explained by their higher risk status with respect to selected constructs of health behavior models. Specifically, adapting the Health Belief Model to our study aims, we will examine established predictors as well as measures that may be of particular relevance to H/L women (e.g., health literacy). We will also determine if the predictors associated with specific mammography screening outcomes differ by birthplace (foreign born vs U.S. born) or other acculturation indicators, as well as age cohort (younger versus older women). In sum, a strategy of studying ethno-regionally distinct subgroups of the larger H/L population is needed to inform effective breast cancer control efforts. As this population is disproportionately poor, less likely to speak English, and is unlikely to be adequately insured, we can anticipate the probable consequences: later stage at diagnosis and decreased survival. This proposal is a critical first step in cancer control for H/L women as they are certain to represent a growing proportion of new breast cancer cases as their numbers increase, as they adopt higher risk reproductive patterns (e.g., later age at first birth), and as they reach the ages in which breast cancer risk increases for all women. PUBLICH HEALTH RELEVANCE: Hispanic /Latino (H/L) women are less likely to be diagnosed with breast cancer than are White (W) women, but more likely to be diagnosed with late stage tumors and to have worse survival. Although relatively few studies have focused on the growing Hispanic/Latino population residing in the Northeast, U.S., it is known that the mammography screening rates are low in this ethno- regionally diverse population, relative to White and African American women. This prospective evaluation of mammography screening adherence and related outcomes in a community-based cohort of 1,600 H/L women represents a critical first step in cancer control for H/L women- as they are certain to represent a growing proportion of new breast cancer cases as their numbers increase, as they adopt higher risk reproductive patterns (e.g., later age at first birth), and as they reach the ages in which breast cancer risk increases for all women.

描述（由申请人提供）：西班牙裔 /拉丁裔（H /L）女性被诊断出患有乳腺癌的可能性少于白人（W）女性，但更有可能被诊断出患有晚期肿瘤，并且生存率较差。与白人和非裔美国妇女相比，他们自我报告的乳房X线摄影筛查率较低。在美国，最近的人口转变朝着整个美国的迅速增长的H/L人群的转变，强调了在这个相对研究的人群中需要积极的癌症控制方法。由于对居住在美国东北部的H/L妇女的癌症筛查行为相对较少，尤其是在最近的移民中，我们建议建立一个居住在康涅狄格州40-75岁的1,600 H/L妇女的队列，并在2 - 4年的时间内研究其筛查经验。采用前瞻性设计，我们将：1）在研究期间确定不依从性的预测指标； 2）确定乳房X线摄影筛查结果不足的预测指标； 3）确定在这种文化上多样化的H/L种群中异常乳房X线照片随访的预测指标。我们的假设是，遵守准则的依从性不佳，结果的沟通不良以及某些H/L妇女中异常乳房X线照片的随访不足的风险增加，可以通过其针对健康行为模型所选结构的较高风险状态来解释。具体而言，将健康信念模型适应我们的研究目标，我们将研究既定的预测因素以及可能与H/L妇女特别相关的措施（例如，健康素养）。我们还将确定与特定的乳房X线摄影筛查结果相关的预测因素是否因出生地（外国出生与美国出生）或其他适应指标以及年龄段（年轻女性与年龄较大的女性）是否有所不同。总而言之，需要研究较大的H/L种群的民族区域不同亚组的策略，以告知有效的乳腺癌控制工作。由于该人群不成比例差，说英语的可能性较小，而且不可能得到足够的保险，我们可以预料到可能的后果：诊断和生存下降的后期。该提案是H/L女性癌症控制的关键第一步，因为随着数量的增加，她们肯定会代表越来越多的新乳腺癌病例，因为它们采用了较高的风险生殖模式（例如，在首次出生时期的后期年龄），并且随着年龄的增长，所有女性的乳腺癌风险会增加。公共健康相关性：西班牙裔 /拉丁裔（H /L）女性被诊断出患有乳腺癌的可能性少于白人（W）女性，但更有可能被诊断出患有晚期肿瘤，并且生存率较差。尽管相对较少的研究集中在美国东北部的西班牙裔/拉丁裔人口增长，但众所周知，相对于白人和非裔美国妇女，乳房X线摄影筛查率很低。在1,600 h/l女性的基于社区的同类群体中，这种对乳房X线摄影筛查遵守性和相关结果的预期评估代表了H/L女性癌症控制的关键第一步，因为它们肯定会随着新乳腺癌病例的越来越多，随着其数量的增加，它们的数量会增加，因为它们采用了更高的风险生殖模式（例如，在所有妇女中都会增加妇女的较高的妇女，并且会增加乳腺癌的危险。