Toward the Elimination of Cancer Disparities (eBook)

Toward the Elimination of Cancer Disparities 3
Preface 5
Contents 7
Contributors 9
Part I Dimensions of Cancer Disparities 12
Defining, Investigating, and Addressing Cancer Inequities: Critical Issues 13
Definitions and Debates 14
Critical Components of a Research Agenda on Cancer Inequities 17
A Systematic Approach to Identifying Research Questions: ‘‘The Cancer Disparities Research Grid’’ 29
Conclusion: Research for Health and Cancer Equity 31
References 32
Cancer Disparities: Data Systems, Sources, and Interpretation 39
Definitions of Disparities and Implications for Data Interpretation 40
Overview of Current Data Tracking Systems 42
Cancer Disparities by Race/Ethnicity and Socioeconomic Status 43
Socioeconomic Status 53
International Cancer Disparities 54
Implications 56
Conclusion 57
References 57
Genes, Environment, and Cancer Disparities 59
Role of Genetics in Explaining Cancer Risk and Cancer Disparities 61
Gene-Environment Interaction Research and Its Application to the Investigation of Cancer Risk 69
Contribution of GEI Research to Reducing Cancer Disparities 76
Leveraging GEI Research to Address Health Disparities 81
Summary 85
References 86
Work and Occupation: Important Indicators of Socioeconomic Position and Life Experiences Influencing Cancer Disparities 93
Occupational Disparities in Cancer Morbidity and Mortality 94
Occupational Disparities in Cancer Risk-Related Behaviors 95
Tobacco 95
Diet 95
Physical Activity 96
Overweight and Obesity 97
Contributions of the Work Environment to Cancer Disparities 98
Hazardous Occupational Exposures 99
Psychosocial Work Environment 100
Additional Links to Risk-Related Behaviors 101
Implications for Interventions 102
Occupational Health and Safety 102
Worksite Health Promotion 103
Integrated Approaches to Cancer Prevention Using a Social Contextual Framework 104
Summary and Conclusion 106
References 107
Part II Specific Challenges in Cancer Disparities 116
Disparities in Tobacco Use and Lung Cancer 117
Introduction 117
Data Sources and Scope 117
Current Status of Disparities in Tobacco Use, Especially Socioeconomic Status 118
Socioeconomic Status 119
Race/Ethnicity 120
American Indian and Alaskan Natives 121
Non-Hispanic White Americans 121
Non-Hispanic Black Americans 121
Hispanic Americans 122
Asian Americans 122
Youth 122
Geography 123
Gender 123
Special Populations 123
Disparities in Secondhand Smoke Exposure 124
Factors Contributing to Tobacco Disparities 124
Tobacco Industry Marketing 125
Disparities in Cessation Services 126
Disparate Perceptions About Cessation Methods 127
Level of awareness regarding Medicaid coverage for TDTs 127
Clinical Disparities and Lung Cancer 128
Lung Cancer Incidence, Mortality, and Survival 128
Disparities in Lung Cancer Incidence and Mortality 128
Racial and Ethnic Disparities in the Smoking-Related Risk of Lung Cancer 130
Racial and Ethnic Disparities in Cancer Treatment 131
Types of Lung Cancer Treatment 131
Access to Clinical Trials 134
Interventions and Recommendations 135
WHO Framework Convention for Tobacco Control 135
CDC Best Practices 136
2007 IOM Report on Tobacco Control 136
Specific Interventions 137
Statewide Efforts: California, Massachusetts, and Florida 137
Targeted Efforts 138
References 139
Socioeconomic Status and Breast Cancer Disparities 144
Background 145
Breast Cancer Disparities Along the Cancer Continuum 146
Incidence and Mortality/Survival 147
Screening 149
Diagnosis 151
Treatment 152
Prevention 153
Other Factors Linked To Breast Cancer Disparities 154
Racial/Ethnic Pathological Differences 155
Discrimination and Racism 156
Health Care Access and Utilization 156
Insurance Status 157
Comorbid Disease 158
Health Communications 158
Geography 159
Summary and Recommendations 160
References 161
Disparities and Colorectal Cancer 168
Disparities in Colorectal Cancer Incidence and Survival 169
Age 169
Gender 169
Race/Ethnicity 170
Socioeconomic Position 171
Other Factors 171
Explaining Observed Disparities in Colorectal Cancer Incidence and Survival 172
Disease Biology 172
Environmental Exposures 173
Personal Behaviors 174
Colorectal Cancer Screening 174
Colorectal Cancer Treatment Quality 177
Reducing Social Disparities in Colorectal Cancer 178
Public Health Interventions 178
Delivery System Interventions 179
Conclusion 180
References 181
Disparities in Prostate Cancer 186
Introduction 186
Race and Population Categorization 189
Prostate Cancer Screening 189
Prostate Cancer Risk 192
Patterns of Care 198
Treatment Outcomes 199
Conclusion 200
References 202
Disparities and Cervical Cancer 210
Introduction 210
Epidemiology 211
Worldwide 211
United States of America 211
Disparity in Incidence and Mortality 212
Disparity in Prevention/HPV Vaccination 213
Disparity in Screening 214
Cultural/Personal Barriers 214
Socioeconomic Barriers 216
Structural Barriers 217
Lack of Knowledge Regarding HPV, Cervical Cancer, and Screening 218
Disparity in Treatment 219
Disparity in Survival 220
Disparities, Demographics, and Potential Societal Impact 221
Proposed Approaches to Reducing Disparities in Cervical Cancer Prevention 222
National and State Initiatives 223
Community-Based Initiatives 224
Telephone-Based Intervention 226
Lay Health Care Workers 226
Other Approaches 227
Conclusion 227
References 228
Melanoma and Primary Hepatocellular Carcinoma 233
Melanoma 233
Clinical and Public Health Significance of Melanoma 233
Current Language Regarding Melanoma Screening 234
Magnitude of Melanoma 234
Etiology and Risk Factors for Melanoma 235
Disparities in Access and by Geography 235
Suggested Next Steps for Addressing Disparities 240
Conclusion 242
Primary Hepatocellular Carcinoma (HCC) 243
Clinical and Public Health Significance of HCC 243
Public Health Significance 244
Disparities 246
Status of HCC Prevention, Detection, and Treatment 250
Future Directions with Respect to Interventions 254
References 255
Part III Some Avenues to Address Cancer Disparities 263
Interventions, Policy, and Advocacy 264
I. Context and Framework for Action 264
Background 264
Principles and Model for Reducing Cancer Disparities 265
II. Interventions to Reduce Cancer Disparities: Current Knowledge Base 267
Knowledge About the Existence of Cancer Disparities 268
Knowledge About Reducing Disparities in the Major Risk Factors Related to Cancer 269
Interventions to Reduce Disparities in Cancer Screening 269
Interventions to Reduce Disparities in Tobacco Control 270
Promising Individual and Community Interventions for Reducing Disparities 271
III. Social Strategies Needed to Implement Current Knowledge 275
General Approach for Pursuing Policy Changes and Interventions 275
IV. Current Recommendations 277
References 277
Health Communication and Communication Inequalities in Addressing Cancer Disparities 282
Introduction 282
Communication and the Cancer Control Continuum 283
Representation of Health and Cancer in the Media and the Internet 284
Mainstream vs. Ethnic Media 285
Health Journalists, Occupational Practices, and Disparities 286
Potentiating Inequalities 287
Message Construction, Communication Effects, and Disparities 287
Communication Inequalities and Cancer Disparities 289
The Structural Influence Model (SIM) 289
Access to and Use of Channels of Information 290
Attention to and Processing of Health Information 290
Information Seeking Inequalities and Cancer 291
Learning from Communication Channels 293
Acting on Information 293
E-Health and Communication Technology 294
Inaccessibility of Web-Based Information 295
Importance of Other Technology-Based Approaches to Address Disparities 295
Conclusion 296
References 297
Overcoming Barriers to Cancer Care: Patient and Public Perspectives 304
Introduction 304
I. Measuring Public and Patient Perceptions of Cancer and Health 305
Public Perceptions of Cancer 305
Surveying Public Perceptions of Disadvantaged Populations 306
Definitions 306
Representativeness 307
Sample Size and Design 307
Questionnaire Development 308
Response Rate Effort 308
II. Unequal Access: Barriers Along the Cancer Continuum 308
Information and Education Barriers 309
Financial Barriers, Financial Consequences 310
Discrimination and Bias 311
System Barriers 311
III. Overcoming Barriers: Solutions to Reduce Cancer Disparities 312
Improving Consumer Health Information 312
Electronic Medical Records and Patient Access 313
Improving Cultural Competency of Health Providers 313
Improving Patient Navigation 314
IV. Conclusion 316
References 317
Community-Based Approaches to Cancer Disparities 321
I. Introduction 321
II. Community-Level Factors Leading to Cancer Disparities 321
What Is Community? 322
Physical Attributes of Community: Exposures and Resources 322
Integrating Environmental Exposures and Social Conditions with Behavior and Genetic Factors 323
Systemic Gaps in Supply and Access to Appropriate Health and Cancer-Related Resources 325
Knowledge Barriers, Attitudes, and Belief Systems 325
Language and Literacy Barriers 327
Other Communication Issues 327
Comorbidities 328
Location of Resources 329
Clinical Trial Participation Rates 329
Summary 330
III. Promising Approaches to Research and Collaboration 330
Community-Based Participatory Research 331
Need for Community-Based Programs 331
Attributes of Community-Based Participatory Research 332
Challenges for CBPR 334
Community-Based Approaches to Cancer 336
Location of Interventions 336
Sustainability 338
Targeting Individuals and Their Social Environment 338
Using Traditional Community Networks and Organizing Strategies 339
Churches as Sites for Health-Related Activities 340
Identifying Key Community Leaders 342
Relationship Building 343
Targeting Interventions to Specific Community Needs 343
Building Capacity Through Collaboration and Coordination 345
Infrastructure: Community-Academic Partnerships 345
Addressing Social Determinants Through Partnerships 346
Summary 347
IV. Recommendations 348
Importance of Local Data 348
Measuring Relevant Constructs 349
Community-Specific, Validated Tools 349
Linking Health to Community Voice, Community Empowerment 350
Identifying Key Targets in Eliminating Cancer-Related Disparities 351
Changing Public Policy Focus 352
Coordinating Systems and Building Infrastructure 354
Structural Changes 354
Looking Critically at Community-Based Programs 355
What Are the Most Effective Strategies for Engaging Communities? 355
To what Extent Is the Ecological Model Actually Implemented? 355
V. Conclusion 356
References 356
Index 362