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Second Edition: Cancer Health Disparities and Public Health

Special Issue Editors

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
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
Department of Public Health, School of Health & Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC 28403, USA
Interests: racial health disparities; social support; cancer prevention

Special Issue Information

Dear Colleagues,

Cancer burden varies across populations, with higher incidence and mortality of specific cancer types in medically underserved populations compared to others, resulting from varying degrees 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, tobacco cessation, and weight loss and management), screening, diagnostic care, and treatment. Upstream factors, such as structural inequality, not only affect healthcare access but also increase behavioral risk factors and environmental and occupational exposures to carcinogens in underserved populations. and other structural factors cause residential segregations; educational attainment, employment, and income disparities; and poor built environments that limit access to safe space for physical activities and nutritious foods. Patients from underserved populations often experience prejudice and/or discrimination in healthcare, or clinicians’ bias may negatively affect patient care. Cultural values or personal beliefs may also affect choice of care and treatment. During and after the COVID-19 pandemic crisis, these underlying factors were exacerbated, and racial/ethnic minority and other underserved populations experienced marked challenges undergoing cancer screening, treatment, and care. Research is necessary to further understand the underlying causes, contributing and underlying factors, intersectionality of these, and impacts on cancer screening, treatment, and care in order to develop education, outreach, 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. Shaila Strayhorn
Guest Editors

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Keywords

  • health disparities
  • health equity
  • race and ethnicity
  • gender
  • socioeconomics
  • rural health
  • structural racism
  • global health
  • Indigenous health
  • cancer treatment

Related Special Issue

Published Papers (8 papers)

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18 pages, 1294 KiB  
Article
Equity in Cancer and Chronic Disease Prevention through a Multi-Pronged Network Intervention: Works-in-Progress
Int. J. Environ. Res. Public Health 2024, 21(2), 213; https://doi.org/10.3390/ijerph21020213 - 12 Feb 2024
Viewed by 751
Abstract
The increasing rates of cancer incidence are disproportionately borne by populations that are ineligible for screening and historically marginalized populations. To address this need, our community-centered model seeks to catalyze the widespread diffusion of evidence-based information and resources (e.g., community-based organizations, federally qualified [...] Read more.
The increasing rates of cancer incidence are disproportionately borne by populations that are ineligible for screening and historically marginalized populations. To address this need, our community-centered model seeks to catalyze the widespread diffusion of evidence-based information and resources (e.g., community-based organizations, federally qualified health centers) to reduce the risks of cancer, chronic disease, and other conditions. In this study, we tested whether improving personal health literacy (i.e., confidence in seeking information) and enabling successful information transfer (i.e., intention to share the specific information learned through the program) among community residents could contribute to greater diffusion intention (i.e., number of network members with whom residents plan to share information and resources). The current study used post-intervention surveys, which were administered to Chicago residents who were 18 years or older and had participated in the program. Among the 1499 diverse Chicago residents, improved personal health literacy was associated with greater diffusion intention (ORs = 2.00–2.68, 95% CI [1.27–4.39], p ≤ 0.003). Successful information transfer was associated with greater diffusion, especially for cancer and other chronic disease risk reductions (ORs = 3.43–3.73, 95% CI [1.95–6.68], p < 0.001). The findings highlight the potential gains for health equity through sustainable, scalable, multi-sectoral partnerships. Full article
(This article belongs to the Special Issue Second Edition: Cancer Health Disparities and Public Health)
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20 pages, 385 KiB  
Article
“A Huge Gap”: Health Care Provider Perspectives on Cancer Screening for Aboriginal and Torres Strait Islander People in the Northern Territory
Int. J. Environ. Res. Public Health 2024, 21(2), 141; https://doi.org/10.3390/ijerph21020141 - 27 Jan 2024
Viewed by 1266
Abstract
Cancer is one of the leading causes of death for Aboriginal and Torres Strait Islander people in the Northern Territory (NT). Accessible and culturally appropriate cancer screening programs are a vital component in reducing the burden of cancer. Primary health care plays a [...] Read more.
Cancer is one of the leading causes of death for Aboriginal and Torres Strait Islander people in the Northern Territory (NT). Accessible and culturally appropriate cancer screening programs are a vital component in reducing the burden of cancer. Primary health care plays a pivotal role in facilitating the uptake of cancer screening in the NT, due to the significant challenges caused by large distances, limited resources, and cultural differences. This paper analyses health care provider perspectives and approaches to the provision of cancer screening to Aboriginal people in the NT that were collected as part of a larger study. Semi-structured interviews were conducted with 50 staff from 15 health services, including 8 regional, remote, and very remote primary health care (PHC) clinics, 3 hospitals, a cancer centre, and 3 cancer support services. Transcripts were thematically analysed. Cancer screening by remote and very remote PHC clinics in the NT is variable, with some staff seeing cancer screening as a “huge gap”, while others see it as lower priority compared to other conditions due to a lack of resourcing and the overwhelming burden of acute and chronic disease. Conversely, some clinics see screening as an area where they are performing well, with systematic screening, targeted programs, and high screening rates. There was a large variation in perceptions of the breast screening and cervical screening programs. However, participants universally reported that the bowel screening kit was complicated and not culturally appropriate for their Aboriginal patients, which led to low uptake. System-level improvements are required, including increased funding and resourcing for screening programs, and for PHC clinics in the NT. Being appropriately resourced would assist PHC clinics to incorporate a greater emphasis on cancer screening into adult health checks and would support PHCs to work with local communities to co-design targeted cancer screening programs and culturally relevant education activities. Addressing these issues are vital for NT PHC clinics to address the existing cancer screening gaps and achieving the Australian Government pledge to be the first nation in the world to eliminate cervical cancer as a public health problem by 2035. The implementation of the National Lung Cancer Screening Program in 2025 also presents an opportunity to deliver greater benefits to Aboriginal communities and reduce the cancer burden. Full article
(This article belongs to the Special Issue Second Edition: Cancer Health Disparities and Public Health)
12 pages, 1026 KiB  
Article
Improving Guideline-Recommended Colorectal Cancer Screening in a Federally Qualified Health Center (FQHC): Implementing a Patient Navigation and Practice Facilitation Intervention to Promote Health Equity
Int. J. Environ. Res. Public Health 2024, 21(2), 126; https://doi.org/10.3390/ijerph21020126 - 24 Jan 2024
Viewed by 968
Abstract
Background: Colorectal cancer (CRC) screening is effective in the prevention and early detection of cancer. Implementing evidence-based screening guidelines remains a challenge, especially in Federally Qualified Health Centers (FQHCs), where current rates (43%) are lower than national goals (80%), and even lower in [...] Read more.
Background: Colorectal cancer (CRC) screening is effective in the prevention and early detection of cancer. Implementing evidence-based screening guidelines remains a challenge, especially in Federally Qualified Health Centers (FQHCs), where current rates (43%) are lower than national goals (80%), and even lower in populations with limited English proficiency (LEP) who experience increased barriers to care related to systemic inequities. Methods: This quality improvement (QI) initiative began in 2016, focused on utilizing patient navigation and practice facilitation to addressing systemic inequities and barriers to care to increase CRC screening rates at an urban FQHC, with two clinical locations (the intervention and control sites) serving a diverse population through culturally tailored education and navigation. Results: Between August 2016 and December 2018, CRC screening rates increased significantly from 31% to 59% at the intervention site (p < 0.001), with the most notable change in patients with LEP. Since 2018 through December 2022, navigation and practice facilitation expanded to all clinics, and the overall CRC screening rates continued to increase from 43% to 50%, demonstrating the effectiveness of patient navigation to address systemic inequities. Conclusions: This multilevel intervention addressed structural inequities and barriers to care by implementing evidence-based guidelines into practice, and combining patient navigation and practice facilitation to successfully increase the CRC screening rates at this FQHC. Full article
(This article belongs to the Special Issue Second Edition: Cancer Health Disparities and Public Health)
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15 pages, 690 KiB  
Article
Mi-CARE: Comparing Three Evidence-Based Interventions to Promote Colorectal Cancer Screening among Ethnic Minorities within Three Different Clinical Contexts
Int. J. Environ. Res. Public Health 2023, 20(22), 7049; https://doi.org/10.3390/ijerph20227049 - 10 Nov 2023
Viewed by 1326
Abstract
Multiple evidence-based interventions (EBIs) have been developed to improve the completion of colorectal cancer (CRC) screening within Federally Qualified Health Centers (FQHCs) and other safety net settings in marginalized communities. Little effort has been made, however, to evaluate their relative effectiveness across different [...] Read more.
Multiple evidence-based interventions (EBIs) have been developed to improve the completion of colorectal cancer (CRC) screening within Federally Qualified Health Centers (FQHCs) and other safety net settings in marginalized communities. Little effort has been made, however, to evaluate their relative effectiveness across different clinical contexts and populations. To this end, we tested the relative effectiveness of three EBIs (mailed birthday cards, lay navigation, and provider-delivered education) among a convenience sample of 1252 patients (aged 50–75 years old, who were due for CRC screening and scheduled for a visit at one of three clinics within a network of Federally Qualified Health Centers (FQHCs) in the United States. To be eligible for the study, patients had to identify as African American (AA) or Latino American (LA). We compared the effects of the three EBIs on CRC screening completion using logistic regression. Overall, 20% of the study population, an increase from a baseline of 13%, completed CRC screening. Clinical demographics appeared to influence the effectiveness of the EBIs. Mailed birthday reminders appeared to be the most effective within the multi-ethnic clinic (p = 0.03), provider-delivered education within the predominantly LA clinic (p = 0.02), and lay navigation within the predominantly AA clinic (p = 0.03). These findings highlight the importance of understanding clinical context when selecting which evidence-based interventions to deploy. Full article
(This article belongs to the Special Issue Second Edition: Cancer Health Disparities and Public Health)
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13 pages, 323 KiB  
Article
Provider- and System-Level Barriers and Facilitators to Colonoscopy and Multi-Target Stool DNA for Colorectal Cancer Screening in Rural/Remote Alaska Native Communities
Int. J. Environ. Res. Public Health 2023, 20(22), 7030; https://doi.org/10.3390/ijerph20227030 - 07 Nov 2023
Viewed by 1289
Abstract
The Alaska Tribal Health System is working to increase colorectal cancer (CRC) screening among Alaska Native people, who experience the highest CRC rates in the world. This study examined CRC screening provider- and system-level barriers and facilitators from the perspective of healthcare providers [...] Read more.
The Alaska Tribal Health System is working to increase colorectal cancer (CRC) screening among Alaska Native people, who experience the highest CRC rates in the world. This study examined CRC screening provider- and system-level barriers and facilitators from the perspective of healthcare providers serving Alaska Native people in rural/remote communities. A total of 28 provider (physicians, advanced practice, and Community Health Aides/Practitioners) interviews were held from 1 February to 30 November 2021. Colonoscopy provider-level barrier themes included time, competing priorities, and staffing, while system-level barriers included travel costs, weather, and the COVID-19 pandemic. Multi-target stool DNA (mt-sDNA) barrier themes included test viability and unfamiliarity, and previous stool tests experiences. For both tests, limited medical record reminders was a major barrier. Facilitator themes for both tests included community outreach, cultural competency and patient navigation, and clinic/system improvements. In-depth interviews with tribal health providers showed that adding mt-sDNA testing may help address system-level colonoscopy barriers such as waitlists and travel costs, but other barriers remain. Further research is needed into patient barriers and facilitators, as well as the effectiveness of integrating mt-sDNA into a geographically dispersed tribal health system to reduce cancer disparities and build equity in CRC prevention among Alaska Native people. Full article
(This article belongs to the Special Issue Second Edition: Cancer Health Disparities and Public Health)
8 pages, 310 KiB  
Article
An Exploration of Black Men’s Attitudes and Experiences Communicating with Dentists about Oral and Pharyngeal Cancer
Int. J. Environ. Res. Public Health 2023, 20(19), 6859; https://doi.org/10.3390/ijerph20196859 - 28 Sep 2023
Viewed by 1309
Abstract
Background: Poor oral and pharyngeal cancer (OPC) survival among Black men is partially due to their limited knowledge about OPCs, which is exacerbated by dentists’ limited training and discomfort in discussing OPC risk factors. The purpose of this study was to assess the [...] Read more.
Background: Poor oral and pharyngeal cancer (OPC) survival among Black men is partially due to their limited knowledge about OPCs, which is exacerbated by dentists’ limited training and discomfort in discussing OPC risk factors. The purpose of this study was to assess the attitudes and experiences that Black men have communicating with dentists about OPCs. Methods: To qualitatively assess these attitudes and experiences, a focus group guide and recruitment strategy were developed using a community engagement approach. Data were analyzed using grounded theory. Results: Twenty-three self-identified Black men participated in three focus groups through the Zoom platform (mean age of 46.1 years). Four main themes emerged, which identified that participants: (1) had little knowledge of OPCs; (2) felt that addressing OPC risk among Black men was not a priority for dentists; (3) stressed the importance of dentists acknowledging the complexity of how race and gender affects Black men’s healthcare experiences; and (4) expressed a benefit to receiving information from multiple social networks. Conclusion: The focus groups provided context for how dentists might engage with Black men in discussions about OPC prevention and treatment. Full article
(This article belongs to the Special Issue Second Edition: Cancer Health Disparities and Public Health)
14 pages, 547 KiB  
Article
Cancer Screening Prevalence among Participants in the Southcentral Alaska Education and Research towards Health (EARTH) Study at Baseline and Follow-Up
Int. J. Environ. Res. Public Health 2023, 20(16), 6596; https://doi.org/10.3390/ijerph20166596 - 18 Aug 2023
Viewed by 1415
Abstract
Alaska Native communities are working to prevent cancer through increased cancer screening and early detection. We examined the prevalence of self-reported colorectal (CRC), cervical, and breast cancer screening among Alaska Native participants in the southcentral Alaska Education and Research toward Health (EARTH) study [...] Read more.
Alaska Native communities are working to prevent cancer through increased cancer screening and early detection. We examined the prevalence of self-reported colorectal (CRC), cervical, and breast cancer screening among Alaska Native participants in the southcentral Alaska Education and Research toward Health (EARTH) study at baseline (2004–2006) and ten-year follow-up (2015–2017); participant characteristics associated with screening; and changes in screening prevalence over time. A total of 385 participants completed questionnaires at follow-up; 72% were women. Of those eligible for CRC screening, 53% of follow-up participants reported a CRC screening test within the past 5 years, significantly less than at baseline (70%) (p = 0.02). There was also a significant decline in cervical cancer screening between baseline and follow-up: 73% of women at follow-up vs. 90% at baseline reported screening within the past three years (p < 0.01). There was no significant difference in reported breast cancer screening between baseline (78%) and follow-up (77%). Colorectal and cervical cancer screening prevalence in an urban, southcentral Alaska Native cohort declined over 10 years of follow-up. Increased cancer screening and prevention are needed to decrease Alaska Native cancer-related morbidity and mortality. Full article
(This article belongs to the Special Issue Second Edition: Cancer Health Disparities and Public Health)
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6 pages, 948 KiB  
Commentary
Are We the Problem? A Call to Action for Addressing Institutional Challenges to Engaging Community Partners in Research
Int. J. Environ. Res. Public Health 2024, 21(2), 236; https://doi.org/10.3390/ijerph21020236 - 17 Feb 2024
Viewed by 541
Abstract
Community-engaged research (CEnR) is a potent tool for addressing health inequities and fostering equitable relationships among communities, researchers, and institutions. CEnR involves collaboration throughout the research process, demonstrating improvements in study recruitment and retention, intervention efficacy, program sustainability, capacity building among partners, and [...] Read more.
Community-engaged research (CEnR) is a potent tool for addressing health inequities and fostering equitable relationships among communities, researchers, and institutions. CEnR involves collaboration throughout the research process, demonstrating improvements in study recruitment and retention, intervention efficacy, program sustainability, capacity building among partners, and enhanced cultural relevance. Despite the increasing demand for CEnR, institutional policies, particularly human participation protection training (HPP), lag behind, creating institutional barriers to community partnerships. Here, we highlight challenges encountered in our ongoing study, Fostering Opportunities in Research through Messaging and Education (FOR ME), focused on promoting shared decision-making around clinical trial participation among Black women diagnosed with breast cancer. Grounded in CEnR methods, FOR ME has a partnership with a community-based organization (CBO) that addresses the needs of Black women with breast cancer. Our CBO partner attempted to obtain HPP training, which was administratively burdensome and time-consuming. As CEnR becomes more prevalent, academic and research institutions, along with researchers, are faced with a call to action to become more responsive to community partner needs. Accordingly, we present a guide to HPP training for community partners, addressing institutional barriers to community partner participation in research. This guide outlines multiple HPP training pathways for community partners, aiming to minimize institutional barriers and enhance their engagement in research with academic partners. Full article
(This article belongs to the Special Issue Second Edition: Cancer Health Disparities and Public Health)
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