Health Literacy and Cancer Screening Disparities in Asian American Populations

亚裔美国人的健康素养和癌症筛查差异

• 批准号: 8437136
• 负责人: Tetine L. Sentell
• 金额: $ 6.42万
• 依托单位: UNIVERSITY OF HAWAII AT MANOA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-02 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8437136
• 关键词: Address; Adult; Advanced Malignant Neoplasm; Area; Asian Americans; Asians; Behavioral Model; Breast Cancer Detection; California; Cardiovascular Diseases; Caring; Cause of Death; Censuses; Colon Carcinoma; Colorectal Cancer; Communities; Data; Data Analyses; Detection; Effectiveness; Ethnic group; Funding; Future; Goals; Grant; Health; Health Services Accessibility; Health behavior; Healthcare; Healthy People 2010; High Prevalence; Incidence; Individual; Information Services; Interview; Japanese Population; K-Series Research Career Programs; Knowledge; Language; Linguistics; Link; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Medical; Medicare/Medicaid; Morbidity - disease rate; Neighborhoods; Not Hispanic or Latino; Oral; Outcome; Patients; Policies; Population; Portraits; Preparation; Prevalence; Process; Research; Research Project Grants; Role; Screening for cancer; Services; Specific qualifier value; Stream; Subgroup; Surveys; Testing; Time; United States National Institutes of Health; Variant; Woman; Writing; cancer health disparity; cancer risk; contextual factors; density; evidence base; health care service utilization; health disparity; health literacy; improved; knowledge base; literate; malignant breast neoplasm; meetings; mortality; novel; population based; racial and ethnic; screening

DESCRIPTION (provided by applicant): Cancer is the leading cause of death among Asian Americans (AA), yet screening rates for breast, colorectal, and cervical cancer are lower for AA than for many other racial/ethnic groups. Adult health literacy (HL), defined in Healthy People 2010 as the "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services for appropriate health decisions" is an established correlate to cancer screening that is not well studied in AA. Understanding the relationship of HL to cancer screening in AA is particularly important due to the high prevalence of limited English proficiency (LEP) in many AA populations. LEP is associated with less cancer screening in AA, and may contribute to and exacerbate the consequences of low HL in AA. Contextual factors, such as screening facility availability and neighborhood ethnic density, are also associated with health behaviors. Contextual factors are understudied in HL research, but may impact the relationship of individual HL to cancer screening, especially in AA with LEP. Currently, our core knowledge base: 1) lacks population-based rates of, and individual and contextual-level correlates to, cancer screening by HL for AA overall and within diverse AA subpopulations; 2) has not established if low HL explains health disparities among AA as it does in other populations; and 3) has not specified the interaction of HL with individual or contextual-level linguistic access variables. This R03 will use the Behavioral Model of Health Services Utilization as a conceptual guide to fill in these critical knowledge gaps through a secondary data analysis of the 2007 California Health Interview Survey (CHIS), a population-based study with rich data on AA populations, merged with contextual-level data from Census and CMS at the policy-relevant level of the Medical Service Study Area. Specifically we will: (1) Determine if breast, cervical, and colon cancer screening rates differ by HL in AA generally and in AA subpopulations when relevant individual and contextual-level factors are considered; (2) Test if HL explains cancer screening disparities a) for AA compared to non-Hispanic whites, and b) within AA subpopulations; and (3) Quantify the interaction of HL with individual LEP as well as contextual linguistic access variables (doctor- patient language concordance, community LEP, AA ethnic density) for cancer screening in AA. This study is an important addition to, and a novel synthesis of, four emerging streams of research with distinct implications for improving cancer morbidity/mortality and reducing health disparities: 1) the role of HL in explaining health disparities; 2) the importance of LEP to health and health care access; 3) variation in cancer correlates and outcomes in AA subpopulations, and 4) contextual/individual-level interactions in health. We address the stated NCI/NIH goals of improving HL, reducing cancer screening disparities, and gaining detailed portraits of AA subpopulations using a novel combination of NCI-funded data. This study also provides key background for our future research to reduce cancer incidence, mortality, and health disparities among AA. 1

描述（由申请人提供）：癌症是亚裔美国人 (AA) 的首要死因，但 AA 的乳腺癌、结直肠癌和宫颈癌筛查率低于许多其他种族/族裔群体。成人健康素养 (HL) 在《2010 年健康人》中定义为“个人有能力获取、处理和理解基本健康信息和服务以做出适当健康决策的程度”，它与癌症筛查相关，但与癌症筛查无关。 AA学得很好。由于许多 AA 人群的英语水平有限 (LEP) 普遍存在，了解 HL 与 AA 癌症筛查的关系尤为重要。 LEP 与 AA 癌症筛查较少相关，并且可能导致并加剧 AA 低 HL 的后果。背景因素，例如筛查设施的可用性和社区种族密度，也与健康行为相关。 HL 研究中并未充分研究背景因素，但可能会影响个体 HL 与癌症筛查的关系，特别是在 AA 伴 LEP 中。目前，我们的核心知识库：1) 缺乏基于人群的 HL 癌症筛查率以及与个体和背景水平相关的 AA 整体和不同 AA 亚群内的癌症筛查； 2) 尚未确定低 HL 是否可以解释 AA 之间的健康差异（就像其他人群一样）； 3) 没有指定 HL 与个体或上下文级别语言访问变量的相互作用。本 R03 将使用健康服务利用行为模型作为概念指南，通过 2007 年加州健康访谈调查 (CHIS) 的二次数据分析来填补这些关键知识空白，CHIS 是一项基于人群的研究，拥有有关 AA 人群的丰富数据，与医疗服务研究领域政策相关层面的人口普查和 CMS 的背景数据合并。具体来说，我们将： (1) 在考虑相关个体和背景水平因素时，确定 AA 中的乳腺癌、宫颈癌和结肠癌筛查率是否因 HL 的不同而存在差异； (2) 测试 HL 是否可以解释 a) AA 与非西班牙裔白人之间的癌症筛查差异，以及 b) AA 亚群内的癌症筛查差异； (3) 量化 HL 与个人 LEP 的相互作用以及用于 AA 癌症筛查的语境语言访问变量（医患语言一致性、社区 LEP、AA 种族密度）。这项研究是对四个新兴研究流的重要补充和新颖综合，对改善癌症发病率/死亡率和减少健康差异具有独特的意义：1）HL 在解释健康差异中的作用； 2) LEP 对于健康和医疗保健获取的重要性； 3) 癌症的变异与 AA 亚群的相关性和结果，以及 4) 健康方面的背景/个人水平相互作用。我们利用 NCI 资助的数据的新颖组合来实现 NCI/NIH 提出的改善 HL、减少癌症筛查差异以及获得 AA 亚群详细描述的目标。这项研究还为我们未来减少癌症发病率、死亡率和 AA 之间的健康差异的研究提供了关键背景。 1