Disparities in the use of screening breast magnetic resonance imaging persist in Louisiana after the Affordable Care Act: A question of access, policy, institutional support, or something else?

BACKGROUND: Louisiana continues to have one of the highest breast cancer mortality rates in the nation, and Black women are disproportionally affected. Louisiana has made advances in improving access to breast cancer screening through the expansion of Medicaid. There remains, however, broad underuse of advanced imaging technology such as screening breast magnetic resonance imaging (MRI), particularly for Black women. METHODS: Breast MRI has been proven to be very sensitive for the early detection of breast cancer in women at high risk. MRI is more sensitive than mammography for aggressive, invasive breast cancer types, which disproportionally affect Black women. Here the authors identify potential barriers to breast MRI screening in Black women, propose strategies to address disparities in access, and advocate for specific recommendations for change. RESULTS: Cost was identified as one of the greatest barriers to screening breast MRI. The authors propose implementation of cost-saving, abbreviated protocols to address cost along with lobbying for further expansion of the Affordable Care Act (ACA) to include coverage for screening breast MRI. In addition, addressing gaps in communication and knowledge and facilitating providers' ability to readily identify women who might benefit from MRI could be particularly impactful for high-risk Black women in Louisiana communities. CONCLUSIONS: Since the adoption of the ACA in Louisiana, Black women have continued to have disproportionally high breast cancer mortality rates. This persistent disparity provides evidence that additional change is needed. This change should include exploring innovative ways to make advanced imaging technology such as breast MRI more accessible and expanding research to specifically address community and culturally specific barriers.

Trends and disparities in telehealth use among Louisiana Medicaid beneficiaries with type 2 diabetes.

AIM: To examine trends in telehealth use among Medicaid beneficiaries with type 2 diabetes (T2D) before and during the coronavirus disease 2019 (COVID-19) pandemic and identify factors related to telehealth use. METHODS: We compared monthly proportions of outpatient visits delivered by telehealth by race/ethnicity, geography and age among Louisiana Medicaid beneficiaries with T2D using claims data from January 2018 to August 2021. We also examined the changes in provider types delivering telehealth. Multivariable logistic regression was conducted to identify individual level and zip code-level factors associated with telehealth use during the COVID-19 pandemic. RESULTS: The monthly proportion of outpatient visits delivered by telehealth was low (< 1%) before the pandemic, spiked in April 2020 (> 15%), then remained at approximately 5%. Telehealth use varied across different racial/ethnic groups, geography and age groups over years. Older beneficiaries were less probable to use telehealth during the pandemic (adjusted odds ratio [AOR] = 0.874, 95% confidence interval [CI]: 0.831-0.919). Females used more telehealth than males (AOR = 1.359, 95% CI: 1.298-1.423). Black beneficiaries used more telehealth than White beneficiaries (AOR = 1.067, 95% CI: 1.000-1.139). More telehealth services were used by Medicaid beneficiaries who were living in urban areas, with more primary care utilization, and with more chronic conditions at baseline. CONCLUSIONS: We found disparities in the uptake of telehealth during the COVID-19 pandemic, but they might have been narrowed for some groups (Hispanic and rural) among Louisiana Medicaid beneficiaries with T2D. Future studies should explore strategies to improve access to telehealth services and reduce related disparities for the low-income population.

Mixed Method Evaluation of Louisiana's Prerelease Medicaid Enrollment Program, 2017-2019.

BACKGROUND: Over 600,000 people leave US prisons annually. Many are eligible for Medicaid upon release but may need support to enroll. Carceral facilities in nearly half of states have implemented systems to facilitate Medicaid access for those leaving incarceration, but there is limited information on program implementation models or outcomes. OBJECTIVES: To evaluate implementation and initial outcomes of Louisiana's prison-based Prerelease Medicaid Enrollment Program. METHODS: In this mixed-methods study, we assessed enrollment in Louisiana Medicaid at time of release from prison in the 2 years (2017-2018) after Program implementation, as well as reasons for Medicaid closure (ie, loss of coverage) and health services use 6 months postrelease. In May-June 2019, we conducted interviews statewide with program implementers (n=16) and focus groups in New Orleans, Louisiana with formerly incarcerated Program participants (n=16). RESULTS: A total of 4476 people were included in the quantitative analysis. There was a 34.3 (95% confidence interval: 20.7-47.9) percentage point increase in Medicaid enrollment upon release. Nearly all (98.6%) attended at least 1 outpatient visit and almost half (46.7%) had 1 emergency department visit within 6 months of release. Not responding to information requests was the most common reason for Medicaid closure. Program implementers and formerly incarcerated participants identified Program strengths, barriers, and suggestions for improvement. CONCLUSIONS: The program was successful in rapidly increasing Medicaid enrollment at the time of prison release and facilitating the use of health care services.

Check It: A Community-Based Chlamydia Seek, Test, and Treat Program for Young Black Men Who Have Sex With Women in New Orleans, Louisiana.

BACKGROUND: Check It is a novel, bundled, community-based seek, test, and treat Chlamydia trachomatis (Ct) screening program for 15- to 24-year-old Black men in New Orleans who have sex with women. The program design addressed barriers and facilitators to Ct screening/treatment by enlisting trusted community partners, incorporating participant input, providing free index/partner expedited treatment, developing relatable marketing materials and an educational Web site, encouraging peer referral, and providing a modest monetary incentive. METHODS: Areas of high poverty were identified using census data; ethnographic/key informant interviews identified sites in those areas where the target population congregated. Black youth informed Web site design and social marketing. Content was inspirational/educational/amusing and endorsed recruitment and brand awareness. A community advisory board, participant interviews, community partner feedback, and recruitment staff involvement in the process evaluation helped refine the program in an ongoing manner. RESULTS: During formative stages, 41 key informant/community advisory board members informed program refinement. Community partners provided venue locations (n = 65) and participant referrals. Between May 22, 2017, and February 28, 2020, 1890 men were enrolled (acceptance rate, 96.0%) with Ct infection rate of 10.2%. Overall study treatment was provided to 86.1% (71.4%-90.9%) of participants who tested positive and 28.5% (14.5%-41.5%) of their partners. Findings from in-depth interviews with participants (n = 43) led to increased treatment uptake. CONCLUSIONS: C. trachomatis community screening of young Black men was successful through collaboration with trusted community partners, by tailoring implements/marketing with participant input, reducing barriers to treatment, and providing modest monetary incentives. The Check It program can serve as a roadmap for reducing health disparities in this population.

Understanding perinatal patient's health preferences and patient-provider relationships to prevent congenital syphilis in California and Louisiana.

BACKGROUND: Congenital syphilis (CS) has reemerged as a global maternal and child health crisis. Kern County, California and East Baton Rouge Parish, Louisiana are among the highest CS morbidity regions in the United States. We previously reported on social-ecological and structural barriers to prenatal care and maternal syphilis testing and treatment in these two regions. The aim of this study was to examine perinatal patient's health preferences and perceptions of patient-provider relationships in the prenatal care clinic setting. METHODS: Between May 2018 and January 2019 we conducted 20 in-depth qualitative interviews with prenatal providers and 8 focus group discussions with pregnant and postpartum individuals in Kern County and East Baton Rouge Parish. We applied an adapted health services framework to analyze participants' understanding of health disparities and vulnerable populations; perinatal patient's health and prenatal care preferences; and participants' perspectives of clinical encounters in the context of prenatal care and maternal syphilis testing and treatment. RESULTS: Site-specific determinants of syphilis infection emerged but participants from both locations felt CS prevention efforts should be prioritized among youth, racial/ethnic minority populations, people experiencing socioeconomic limitations and people with other commonly occurring health conditions. Although perinatal patients expressed clear health preferences, they reported inconsistent receipt of respectful, patient-centered care. Inconsistencies were connected with limited ethnic and cultural competence among providers, and implicit, negative attitudes toward patients using substances, experiencing homelessness, or engaging in sex work. Providers clearly aimed to offer high quality prenatal care. However, some clinic and health systems level factors were thought to reduce positive and communicative patient-provider relationships, contributing to gaps in use of prenatal care and syphilis testing and treatment. CONCLUSIONS: Our findings suggest that interventions tailored to address setting-specific determinants (including clinic and health system factors) of disparities in CS risk could improve pregnant people's access to prenatal care and ensure they and their sex partners receive timely syphilis screening and treatment. We recommend all prenatal care providers receive training on how to identify and mitigate implicit biases and provide competent and compassionate patient-centered care.

Using Application Programming Interfaces (APIs) to Access Google Data and Gain Insights Into Searches on Birth Control in Louisiana and Mississippi, 2014-2018: Infoveillance Study.

BACKGROUND: It is now common to search for health information online. A 2013 Pew Research Center survey found that 77% of online health seekers began their query at a search engine. The widespread use of online health information seeking also applies to women's reproductive health. Despite online interest in birth control, not much is known about related interests and concerns reflected in the search terms in the United States. OBJECTIVE: In this study, we identify the top search terms on Google related to birth control in Louisiana and Mississippi and compare those results to the broader United States, examining how Google searches on birth control have evolved over time and identifying regional variation within states. METHODS: We accessed search data on birth control from 2014-2018 from 2 Google application programming interfaces (APIs), Google Trends and Google Health Trends. We selected Google as it is the most commonly used search engine. We focused our analysis on data from 2017 and compared with 2018 data as appropriate. To assess trends, we analyzed data from 2014 through 2018. To compare the relative search frequencies of the top queries across Louisiana, Mississippi, and the United States, we used the Google Health Trends API. Relative search volume by designated marketing area (DMA) gave us the rankings of search volume for each birth control method in each DMA as compared to one another. RESULTS: Results showed that when people searched for "birth control" in Louisiana and the broader United States, they were searching for information on a diverse spectrum of methods. This differs from Mississippi, where the data indicated people were mainly searching for information related to birth control pills. Across all locations, searches for birth control pills were significantly higher than any other queries related to birth control in the United States, Louisiana, and Mississippi, and this trend remained constant from 2014 to 2018. Regional level analysis showed variations in search traffic for birth control across each state. CONCLUSIONS: The internet is a growing source of health information for many users, including information on birth control. Understanding popular Google search queries on birth control can inform in-person discussions initiated by family planning practitioners and broader birth control messaging campaigns. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/16543.

Impact of the Federal Conservation Program Participation on Conservation Practice Adoption Intensity in Louisiana, USA.

Conservation practices focusing on improving the soil and water quality of working lands are implemented across the United States, supported partially through the United States Department of Agriculture Natural Resources Conservation Service cost-share or incentive payment programs. We assess whether participation in federal conservation support programs induces a change in the number of conservation practices adopted by farmers. We also identify the factors that affect the adoption intensity of different best management practices. We use survey data collected from Louisiana farmers and estimate models using the matching method and Poisson quasi-likelihood model. We find that participation in the cost-share or incentive program leads to an increase in the number of conservation practices on the farms. Similarly, the use of precision technology application and farm being integrated are likely to have a higher number of on-farm conservation practices. Results have implications for federal working lands conservation support programs in the United States.

Fifteen Years After Katrina: Paving the Way for Health Care Transformation.

Following the devastation of the Greater New Orleans, Louisiana, region by Hurricane Katrina, 25 nonprofit health care organizations in partnership with public and private stakeholders worked to build a community-based primary care and behavioral health network. The work was made possible in large part by a $100 million federal award, the Primary Care Access Stabilization Grant, which paved the way for innovative and sustained public health and health care transformation across the Greater New Orleans area and the state of Louisiana.

Public Health Response to COVID-19 Cases in Correctional and Detention Facilities - Louisiana, March-April 2020.

Correctional and detention facilities face unique challenges in the control of infectious diseases, including coronavirus disease 2019 (COVID-19) (1-3). Among >10 million annual admissions to U.S. jails, approximately 55% of detainees are released back into their communities each week (4); in addition, staff members at correctional and detention facilities are members of their local communities. Thus, high rates of COVID-19 in correctional and detention facilities also have the potential to influence broader community transmission. In March 2020, the Louisiana Department of Health (LDH) began implementing surveillance for COVID-19 among correctional and detention facilities in Louisiana and identified cases and outbreaks in many facilities. In response, LDH and CDC developed and deployed the COVID-19 Management Assessment and Response (CMAR) tool to guide technical assistance focused on infection prevention and control policies and case management with correctional and detention facilities. This report describes COVID-19 prevalence in correctional and detention facilities detected through surveillance and findings of the CMAR assessment. During March 25-April 22, 489 laboratory-confirmed COVID-19 cases, including 37 (7.6%) hospitalizations and 10 (2.0%) deaths among incarcerated or detained persons, and 253 cases, including 19 (7.5%) hospitalizations and four (1.6%) deaths among staff members were reported. During April 8-22, CMAR telephone-based assessments were conducted with 13 of 31 (42%) facilities with laboratory-confirmed cases and 11 of 113 (10%) facilities without known cases. Administrators had awareness and overall understanding of CDC guidance for prevention of transmission in these facilities but reported challenges in implementation, related to limited space to quarantine close contacts of COVID-19 patients and inability of incarcerated and detained persons to engage in social distancing, particularly in dormitory-style housing. CMAR was a useful tool that helped state and federal public health officials assist multiple correctional and detention facilities to better manage COVID-19 patients and guide control activities to prevent or mitigate transmission.

Early Season Pediatric Influenza B/Victoria Virus Infections Associated with a Recently Emerged Virus Subclade - Louisiana, 2019.

Multiple genetically distinct influenza B/Victoria lineage viruses have cocirculated in the United States recently, circulating sporadically during the 2018-19 season and more frequently early during the 2019-20 season (1). The beginning of the 2019-20 influenza season in Louisiana was unusually early and intense, with infections primarily caused by influenza B/Victoria lineage viruses. One large pediatric health care facility in New Orleans (facility A) reported 1,268 laboratory-confirmed influenza B virus infections, including 23 hospitalizations from July 31 to November 21, 2019, a time when influenza activity is typically low. During this period, Louisiana also reported one pediatric death associated with influenza B virus infection. An investigation of the influenza B virus infections in Louisiana, including medical and vaccine record abstraction on 198 patients, primarily from facility A, with sporadic cases from other facilities in the state, found that none of the patients had received 2019-20 seasonal influenza vaccine, in part because influenza activity began before influenza vaccination typically occurs. Among 83 influenza B viruses sequenced from 198 patients in Louisiana, 81 (98%) belonged to the recently emerged B/Victoria V1A.3 genetic subclade. Nationally, to date, B/Victoria viruses are the most commonly reported influenza viruses among persons aged <25 years (2). Of the 198 patients in the investigation, 95% were aged <18 years. Although most illnesses were uncomplicated, the number of hospitalizations, clinical complications, and the reported pediatric death in Louisiana serve as a reminder that, even though influenza B viruses are less common than influenza A viruses in most seasons, influenza B virus infection can be severe in children. All persons aged ≥6 months should receive an annual influenza vaccination if they have not already received it (3). Antiviral treatment of influenza is recommended as soon as possible for all hospitalized patients and for outpatients at high risk for influenza complications (including children aged <2 years and persons with underlying medical conditions) (4).

Effectiveness of sodium-glucose co-transporter-2 inhibitors on ischaemic heart disease.

AIM: To compare the cardiovascular risks between users and non-users of sodium-glucose co-transporter-2 (SGLT2) inhibitors based on electronic medical record data from a large integrated healthcare system in South Louisiana. MATERIALS AND METHODS: Demographic, anthropometric, laboratory and medication prescription information for patients with type 2 diabetes who were new users of SGLT2 inhibitors, either as initial treatments or as add-on treatments, were obtained from electronic health records. Mediation analysis was performed to evaluate the association of use of SGLT2 inhibitors and changes of metabolic risk factors with the risk of incident ischaemic heart disease. RESULTS: A total of 5338 new users of SGLT2 inhibitors were matched with 13 821 non-users. During a mean follow-up of 3.26 years, 2302 incident cases of ischaemic heart disease were defined. After adjusting for multiple confounding factors, patients using SGLT2 inhibitors had a lower risk of incident ischaemic heart disease compared to patients not using SGLT2 inhibitors (hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.54-0.73). Patients using SGLT2 inhibitors also had a lower risk of incident ischaemic heart disease within 6 months (HR 0.36, 95% CI 0.25-0.44), 12 months (HR 0.40, 95% CI 0.32-0.49), 24 months (HR 0.53, 95% CI 0.43-0.60) and 36 months (HR 0.65, 95% CI 0.54-0.73), respectively. Reductions in systolic blood pressure partly mediated lowering risk of ischaemic heart disease among patients using SGLT2 inhibitors. CONCLUSIONS: The real-world data in the present study show the contribution of SGLT2 inhibitors to reducing risk of ischaemic heart disease, and their benefits beyond glucose-lowering.

Direct marketing in health and medicine: using direct mail, email marketing, and related communicative methods to engage patients.

BACKGROUND: Direct marketing-the delivery of messages via mail, the Internet, and similar routes directly to consumers-is used extensively by healthcare organizations to attract and inform current and prospective patients of health and medical offerings and opportunities. Examples of direct marketing include direct-mail marketing, telemarketing, and Internet marketing, with routes being selected on the basis of their ability to reach desired audiences. The various avenues offered by direct marketing afford options to address most any sought group. DISCUSSION: Direct marketing is one of the most recognized forms of marketing communication, thanks in large part to its widespread use and direct engagement of consumers. While some applications clearly have the potential to irritate consumers (e.g., junk mail in post boxes, spam in email inboxes), direct marketing can be deployed in manners respectful of recipients and, in such cases, it can prove to be a helpful communications asset. To aid others in understanding this particular conveyance method, this article presents an overview of direct marketing and shares deployment insights and experiences from Willis-Knighton Health System. CONCLUSIONS: Direct marketing provides a useful communications pathway, permitting health and medical institutions to educate and enlighten desired audiences. Given instances of overuse and misuse by organizations, however, great care must be taken to design and deploy direct marketing initiatives inoffensively. If well designed and respectfully implemented, direct marketing affords significant communications utility, earning a valued place in the marketing communications arsenals of healthcare establishments.

Reflecting on "Marketing communications in health and medicine: perspectives from Willis-Knighton Health System": understanding the big picture.

BACKGROUND: Willis-Knighton Health System's special supplement in BMC Health Services Research, "Marketing communications in health and medicine: perspectives from Willis-Knighton Health System," focuses on advertising, public relations, sales promotion, and related communicative avenues, associated theory, and more. Across the supplement's articles, insights from the institution's experiences are presented, addressing the components of the marketing communications mix, foundational elements of communication, the patronage process, and the necessity for integrating marketing communications. DISCUSSION: As an understanding of the big picture is crucial in marketing communications, especially given that many of its components must be effected simultaneously, this particular article takes the insights provided in the supplement and presents them in an operational framework, demonstrating the marketing communications process. This framework concisely summarizes the facets profiled in the associated articles, permitting readers to see how these pieces work in concert with one another in health and medical settings, providing a basic communications structure which healthcare establishments can use to advance their patient engagement initiatives. CONCLUSIONS: Health and medical providers must ensure that they possess a detailed understanding of core marketing communications facets, but as they acquire associated knowledge, they also must direct attention toward understanding the interrelationships between and among these facets, permitting a global perspective of communicative operations. This particular article summarizes insights from Willis-Knighton Health System's special supplement in BMC Health Services Research, providing a pathway toward realizing big picture marketing communications perspectives.

Foundational elements of communication in health and medicine: avenues for strengthening the marketing communications mix.

BACKGROUND: When one thinks of opportunities to engage patients, the marketing communications mix often is the first thing that comes to mind. Its five components of advertising, personal selling, sales promotion, public relations, and direct marketing represent tried and true pathways for establishing productive dialogues with customers of healthcare institutions. But in formulating and deploying the marketing communications mix, health and medical establishments must not neglect foundational elements which play vital communicative roles, impacting the perspectives of patients and influencing associated patronage. DISCUSSION: Many things communicate on behalf of healthcare organizations, including the people employed by them, the places in which they deliver services, and the brands that represent them. As foundational elements of communication, these must be addressed prior to formulating the marketing communications mix, as they influence and impact an institution's entire communicative potential. Their initial development, however, is just the beginning, as these elements must be managed and maintained continually over the course of organizational life. This article profiles foundational elements of communication and discusses their importance in healthcare marketing, generally, and marketing communications, specifically, providing useful insights for maximizing communicative synergies. CONCLUSIONS: Given the importance of engaging current and prospective patients, healthcare establishments must take steps to ensure exceptional prowess in this area, with communicative skills and abilities being of paramount importance. Proficient deployment of the marketing communications mix is essential, but healthcare providers must also be certain to direct attention toward foundational elements, ensuring that given institutions realize their full communicative potential.

Public relations in health and medicine: using publicity and other unpaid promotional methods to engage audiences.

BACKGROUND: Public relations-a marketing communications method involving the use of publicity and other unpaid promotional methods to deliver messages-historically has served as the communicative workhorse of the health services industry, representing the predominant pathway over many decades by which health and medical facilities conveyed stories to the public. While other components of the marketing communications mix, perhaps most notably that of advertising, have now captured a significant portion of interest, attention, and use by healthcare establishments, public relations remains a valuable communicative avenue when deployed properly. DISCUSSION: As an unpaid method of promotion, public relations is uniquely positioned among its counterparts in the marketing communications mix which require direct expenditures to reach audiences. Typically effected by preparing and submitting press releases to news media firms in hopes that they, in turn, will present given stories to their audiences, limitations are somewhat obvious as transmission control rests with external entities. But overcoming limitations is possible with prudent strategies. This article presents Willis-Knighton Health System's associated strategies, along with a range of public relations insights from decades of deployment experience. CONCLUSIONS: Prudently deployed and led by guiding strategies, public relations offers health and medical organizations opportunities to engage audiences in an efficient and highly credible manner. Courtesy of its unique properties, public relations capably can complement other marketing communications, operating synergistically to help healthcare institutions achieve their conveyance goals, fostering exchange and bolstering market share. Careful operationalization of this marketing communications avenue can help healthcare establishments realize their full communicative potential.

Variation in Postpartum Use of Most and Moderately Effective Contraceptive Methods Among Louisiana Women.

BACKGROUND: Women experiencing unintended and short-interval pregnancies are at increased risk for adverse outcomes. Nationally, researchers report disparities in women's use of effective contraceptive methods based on demographic, cultural, financial and system-level factors. Despite 58% of Louisiana births being unplanned, researchers have not reported on these relationships in Louisiana. METHODS: We used Louisiana Pregnancy Risk Assessment Monitoring System data from 2015 to 2018. Among postpartum women who were not abstinent, pregnant, or trying to become pregnant, we estimated use of five categories of effective contraception versus no effective method. We used multivariable multinomial logistic regression to investigate the association between effective contraceptive use and race/ethnicity, postpartum insurance and education. RESULTS: Among Louisiana postpartum women who were not abstinent, pregnant, or trying to become pregnant, 35.4% were not using effective contraception. Women with public insurance had greater odds of using long-acting reversible contraception than women with private insurance (adjusted odds ratio [AOR] 1.55; 95% confidence interval [CI] 1.11-2.16). Compared to women with a bachelor's or higher, women with less than high school (AOR 2.09; CI 1.22-3.56), high school (AOR 3.11; CI 2.01-4.82) or some college education (AOR 2.48; CI 1.64-3.75) had greater odds of using permanent contraception. Black (AOR 3.83; CI 2.66-5.54) and Hispanic (AOR 3.85; CI 2.09-7.11) women, women with less than high school (AOR 6.79; CI 2.72-16.94), high school (AOR 7.26; CI 3.06-17.21) and some college (AOR 7.22; CI 3.14-16.60), and women with public insurance (AOR 1.91; CI 1.28-2.87) had greater odds of using injectable contraception. DISCUSSION: Results showed variation in effective contraceptive method use by race/ethnicity, insurance and education. These findings highlight the need for state-level research into the individual, provider, and policy-level factors that influence women's contraceptive choices.

Implementing Policy, Systems, and Environmental Change Through Community Coalitions and Extension Partnerships to Address Obesity in Rural Louisiana.

Community coalitions and agents funded by the Louisiana State University Agricultural Center's Healthy Communities program implemented multilevel obesity prevention interventions in 3 rural parishes (ie, counties) with an obesity prevalence of 40% or higher. The Healthy Communities coalitions appraised local health concerns through needs assessments and community forums. On the basis of local needs and the evidence base, the coalitions identified and implemented policy, systems, and environmental (PSE) strategies and supporting education to promote healthy behavior change among residents, overcoming barriers in the process. Interventions varied by parish but included Complete Streets implementation plans, healthy retail initiatives, play space improvements, downtown beautification projects, and Smarter Lunchrooms.

Community Assessment of Colorectal Cancer Screening Compliance in Northwest Louisiana.

BACKGROUND: In the United States, colorectal cancer (CRC) screening rates have steadily increased. The state of Louisiana has persistent lower screening rates compared to the United States and other states, and with African Americans experiencing the highest CRC incidence rates. Aggregate national and state data can be problematic in isolating key health issues and data in rural areas. Study Purpose: At the Louisiana parish-level, which is comparable to county municipalities in other U.S. states, the research study examined endoscopy CRC screening among African American Medicare beneficiaries. METHOD: Using cluster sampling, survey-based data from two neighboring parishes in northwest Louisiana were collected. The survey instrument was adapted from the Medicare Current Beneficiary Survey. RESULTS: The key study variables were CRC screening compliance, residence location, self-reported CRC knowledge, and physician recommendation. The findings showed significant differences in CRC screening compliance between the two parishes. Participants with CRC knowledge score of at least 3 out of 5 were more likely to be compliant with CRC screening. The findings demonstrated the importance of isolating geo-specific data, especially in rural areas, to plan effective health education or intervention strategies.