RESUMO
Background: Colorectal cancer is a common cause of screening preventable death in Chinese immigrants, but colorectal cancer screening rates remain low in this population. This study evaluated factors associated with colorectal cancer screening behaviors in Chinese Americans living in New York City. Methods: Participants were foreign-born Chinese Americans, aged 50 years or older, who completed internet surveys between November 2020 and May 2021 regarding their colorectal cancer screening behaviors. Data were collected on demographics, health care utilization, participants' levels of health literacy, English proficiency, colorectal cancer perceptions and current colorectal cancer screening behaviors. Bivariate analyses using chi-square or t-tests were performed to examine associations between colorectal cancer screening behaviors and participant characteristics. Results: 103 participants were surveyed with a mean age of 71.3 years. Most participants experienced high rates of socioeconomic disadvantage (i.e., less than a high school education, annual household income <$20,000, limited health literacy, and poor English proficiency). 92% were ever screened, 81% were up-to-date on screening, and 85% expressed intention to screen in the future. Almost all participants had a primary care provider and a language concordant provider. Individuals who intended to screen were more fearful of developing colorectal cancer (3.2 vs 2.8, p=0.02) and perceived a colorectal cancer diagnosis with greater severity (3.0 vs 2.7, p=0.07) than those without intention to screen. Conclusions: In our sample, Chinese immigrants were adversely impacted by multiple social determinants of health but reported high colorectal cancer screening rates. Community-based outreach is critical to ensuring cancer-screening engagement in medically vulnerable populations.
RESUMO
BACKGROUND: Mobile mammographic services (MM) have been shown to increase breast cancer screening in medically underserved women. However, little is known about MM patients' adherence to follow-up of abnormal mammograms and how this compares with patients from traditional, fixed clinics. OBJECTIVES: To assess delays in follow-up of abnormal mammograms in women screened using MM versus fixed clinics. DESIGN: Electronic medical record review of abnormal screening mammograms. SUBJECTS: Women screened on a MM van or at a fixed clinic with an abnormal radiographic result in 2019 (N = 1,337). MAIN MEASURES: Our outcome was delay in follow-up of an abnormal mammogram of 60 days or greater. Guided by Andersen's Behavioral Model of Health Services Utilization, we assessed the following: predisposing (age, ethnicity, marital status, preferred language), enabling (insurance, provider referral, clinic site), and need (personal breast cancer history, family history of breast/ovarian cancer) factors. KEY RESULTS: Only 45% of MM patients had obtained recommended follow-up within 60 days of an abnormal screening compared to 72% of fixed-site patients (p < .001). After adjusting for predisposing, enabling, and need factors, MM patients were 2.1 times more likely to experience follow-up delays than fixed-site patients (CI: 1.5-3.1; p < .001). African American (OR: 1.5; CI: 1.0-2.1; p < .05) and self-referred (OR: 1.8; CI: 1.2-2.8; p < .01) women were significantly more likely to experience delays compared to Non-Hispanic White women or women with a provider referral, respectively. Women who were married (OR: 0.63; CI: 0.5-0.9; p < .01), had breast cancer previously (OR: 0.37; CI: 0.2-0.8; p < .05), or had a family history of breast/ovarian cancer (OR: 0.76; CI: 0.6-0.9; p < .05) were less likely to experience delayed care compared to unmarried women, women with no breast cancer history, or women without a family history of breast/ovarian cancer, respectively. CONCLUSIONS: A substantial proportion of women screened using MM had follow-up delays. Women who are African American, self-referred, or unmarried are particularly at risk of experiencing delays in care for an abnormal mammogram.
