A scoping review of whole-of-community interventions on six modifiable cancer prevention risk factors in youth: A systems typology.

Whole-of-community interventions delivered across entire geospatial areas show promise for improving population health for youth cancer prevention. The aims of this scoping review were to synthesize the whole-of-community intervention literature on six modifiable risk factors in youth for cancer prevention (alcohol use, diet, obesity, physical activity, sun exposure, tobacco use) and to develop and apply a typology describing the inclusion of fundamental control system functional characteristics. A systematic search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, and Scopus for studies published to the end of 2019. Eligible studies included a geospatially defined whole-of-community intervention; youth 0-18 years; and at least one of the six cancer risk factor outcomes. An iterative process was undertaken to create a typology describing the functions for whole-of-community interventions guided by systems theory, and the typology was used to code the included interventions. A total of 41 interventions were included. Most interventions (43.9%) assessed multiple cancer risk factors. Few interventions provided fundamental functions necessary for community system coordination: sensor, controller, effector. Although communities are a patchwork quilt of microsystems where individuals interact in geographically bounded places nested within larger whole systems of influence, a control systems approach has not been used to frame the literature. Whole-of-community interventions can be characterized by the fundamental system functions necessary for coordinating population health improvement. Future whole-of-community intervention efforts should draw on fundamental knowledge of how systems operate and test whether adoption of the key functions is necessary for whole-of-community population health improvement.

Cancer care in East and Central Harlem: community partnership needs assessment.

In the largely African American and Hispanic communities of East and Central Harlem in New York City (NYC), health inequities are glaring. Mortality from cancer is 20-30 % higher than in Manhattan and 30-40 % higher than rates in the general population in NYC. Despite advances in risk assessment, early detection, treatment, and survivorship, individuals in Harlem and similar urban communities are not benefiting equally. Guided by community-based participatory research, this study serves as an important step in understanding cancer care needs and the range of factors that impact the disparate rates of cancer in East and Central Harlem. Forty individual interviews were conducted with community leaders and residents. Major themes included: need for appropriate supportive services; health care access and financial challenges; beliefs related to stigma, trust, and accountability; and the impact of the physical environment on health. Education was seen as a critical area of need and intervention.

Esperanza y Vida: a culturally and linguistically customized breast and cervical education program for diverse Latinas at three different United States sites.

Breast cancer is the most common cause of cancer and the leading cause of cancer death among Latinas in the United States. In addition, Latinas experience a disproportionate burden of cervical cancer incidence, morbidity, and mortality compared with non-Hispanic White women. Lower use of breast and cervical cancer screening services may contribute to these disparities. To address the underutilization of breast and cervical cancer screening among diverse subgroups of Latinas, a peer-led education program called Esperanza y Vida ("Hope and Life") was developed and administered at 3 sites (2 in New York and 1 in Arkansas). Immigrant Latina women and their partners were educated about the importance of breast and cervical cancer screening, with the goals of increasing their knowledge about these cancers and their screening behavior. An analysis of the intervention's findings at baseline among female participants demonstrated significant sociodemographic, interpersonal, cultural, health care system, and program variability in 3 distinct geographic regions in the United States. These data indicate the need for and feasibility of customizing cancer outreach and educational programs for diverse Latina subgroups living in various U.S. regions, with implications for informing the expansion and replication of the program in other regions of the country.

Screening adherence for colorectal cancer among immigrant Hispanic women.

PURPOSE: We sought to assess factors related to colorectal cancer (CRC) screening adherence among immigrant, Hispanic women in Harlem, New York City. METHOD: Adherence for colonoscopy and fecal occult blood test (FQBT) screening was measured among 255 women based on self-reported screening behaviors using American Cancer Society guidelines. RESULTS: Univariate results showed that age, language of the interview (English/Spanish), years in the United States, physician recommendation for either test, marital status (living alone/living with someone), and mammography adherence were associated with CRC screening adherence (p's < .05). In the multivariate analysis, having an age greater than 65 years, being interviewed in Spanish, having lived in the United States longer, having a regular doctor and a physician recommendation, and being currently adherent for mammography were associated with higher CRC screening adherence. CONCLUSION: Among this sample, there proved to be differences between having ever been screened and adherence with a greater proportion of women having ever completed either colonoscopy and/or FOBT compared to women who were adherent (72.9% vs 58.8%). Therefore, it is important to determine factors associated with adherence, not just screening utilization, in order to design strategies to increase adherence among immigrant Hispanic women.

The influence of sociocultural factors on colonoscopy and FOBT screening adherence among low-income Hispanics.

Few studies have examined barriers and facilitators to colorectal cancer (CRC) screening among Hispanics, particularly sociocultural factors that may be relevant. This paper examines the influence of sociocultural factors on adherence to fecal occult blood testing (FOBT) and colonoscopy. A survey was conducted among a sample of 400 low-income Hispanics in East Harlem, New York. Fatalism and health literacy were both significantly associated with colonoscopy screening adherence in bivariate models, though fatalism became non-significant and health literacy became less significant in multivariable models. With respect to adherence to colonoscopy or FOBT, both fatalism and health literacy were associated in bivariate models, though only fatalism remained significant in multivariable models (p=.03; OR: .94; 95% CI: .881-.992). These findings suggest fatalism and health literacy may play a role in shaping CRC screening adherence among low-income Hispanics. Researchers should continue investigating how sociocultural factors influence screening adherence among Hispanics, using larger and more geographically diverse samples.

Assessment of the Short Acculturation Scale for Hispanics (SASH) among low-income, immigrant Hispanics.

The present analysis sought to determine the usefulness and validity of the Short Acculturation Scale for Hispanics (SASH) in assessment of acculturation among Hispanics participating in a colorectal cancer screening study. Primary data was collected from 2008 to 2009 through surveys in East Harlem community-based sites and health clinics among Hispanics. Bivariate correlations and independent samples t tests assessed SASH correlation with acculturation proxies and relationships between proxies, SASH, and sociodemographics. SASH was highly correlated with commonly used acculturation proxies; inter-scale correlations and alpha scores were high. Sociodemographics associated with proxy variables were associated with SASH. In conclusion, SASH is useful and valid for assessing acculturation among Hispanics; however, a shortened version or acculturation proxy variables could also be utilized.

Colonoscopy screening information preferences among urban hispanics.

Existing disparities are evident in colorectal cancer (CRC) screening. We sought to assess preferred sources of colonoscopy screening information among Hispanics in East Harlem, NY. Face-to-face interviews were conducted among average-risk for CRC, non-symptomatic Hispanics in community-based sites and health clinics. SPSS 16 analysis explored the relationships between sociodemographic and health care variables and preferred sources of colonoscopy information for 395 participants. The top four preferred information sources were doctor/provider, brochures, television, and from someone who speaks the same language. We found significant differences in preferred information sources by a Chi-Square analysis of age (50-64 years; 65 or older), education (0-8th grade; 9th or above), language preferred (English; Spanish), and origin (US-born; foreign-born). Using the identified preferences for sources of information among this growing segment of the US population could inform interventions to address the important public health issue of CRC disparities.

Understanding the barriers and facilitators of colorectal cancer screening among low income immigrant hispanics.

Colorectal cancer (CRC) screening rates are low among Hispanics; thus understanding screening barriers and facilitators is essential. A survey, based on blended health promotion theories, was conducted with low income, mostly immigrant, Hispanics at community based organizations and health clinics in New York City. Correlates of undergoing colonoscopy screening were examined. Four hundred men (28%) and women were interviewed. Older age, longer US residence, having a regular health care provider and provider recommendation predicted colonoscopy receipt (P values <0.01). Greater fear and worry concerning colonoscopy and fewer perceived screening benefits were associated with reduced screening likelihood (P values <0.05). In a multivariate model, colonoscopy receipt was negatively associated with Medicaid and positively associated with English preference, physician recommendation for and encouragement of screening and less fear. Interventions that educate physicians and patients regarding colonoscopy screening guidelines, increase physicians' screening referrals, and reduce patients' fear are needed.