Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death among women in Puerto Rico (PR). The purpose of this study was to identify factors associated with never screened status among a sample of women nonadherent to the 2013 American Cancer Society guidelines. The inclusion criteria for this study were being a woman (1) aged ≥40 years old and (2) nonadherent to breast cancer screening guidelines. We used baseline data from participants ( N = 300; aged ≥40 years old) enrolled in the intervention trial Cultivando la Salud, implemented in Canóvanas, Puerto Rico, from 2012 to 2014. We used multivariate logistic regression models to identify factors associated with never screening status, adjusting by sociodemographical variables and psychosocial constructs about mammography (self-efficacy, beliefs about mammography pros [benefits] and cons [disadvantages], and subjective norms) as well as by health care insurance, usual source of care, and Pap test adherence. Among nonadherent women, 18.0% reported never having a mammography. Never screened women were significantly younger than previously screened women (adjusted prevalence odds ratio [aPOR] = 7.32, 95% confidence interval (CI): [2.38, 22.50]) and almost four times as likely to have the governmental health plan (GHP; aPOR = 3.78, 95% CI: [1.15, 12.46]). In addition, never screened women perceived more cons (disadvantages) to mammography than previously screened women (aPOR = 1.81, 95% CI: [1.18, 2.78]). We found that women who were younger, had GHP insurance, and had higher levels of beliefs against mammography were more likely to have never been screened. Results from this study can be used to target never screened women with health education messages addressing perceived cons of mammography. Additionally, women with GHP insurance may experience disparities in health care access and should be targeted with policies that facilitate access to mammography screening.
The purpose of this study was to describe the psychosocial factors influencing participation in colorectal cancer screening (CRCS) among Puerto Rican men and women. We conducted seven focus groups in metropolitan and rural areas of Puerto Rico (PR) with men and women (using gender specific groups) aged 50 to 80 years (n = 51) who were non-adherent to CRC guidelines. The focus group guide included questions related to colorectal cancer (CRC) and CRC screening knowledge, attitudes, and beliefs. We analyzed data using a modified grounded theory approach to identify emergent themes. Focus groups revealed seven major themes that represented barriers to CRCS: (1) lack of CRC knowledge, (2) lack of knowledge about colorectal cancer screening tests as well as the required preparation, (3) embarrassment, (4) low perceived benefit of CRCS and sense of fatalism, (5) transportation (mostly among participants in rural areas), (6) lack of time, and (7) financial burden. All participants understood the benefits of CRCS once the procedure was explained. Additionally, participants reported a lack of provider recommendation for CRCS. In this group of Puerto Rican participants who were non-adherent to CRCS, there were misconceptions about CRC, screening tests available, and preparation and testing procedures. Participants’ low levels of knowledge and negative attitudes concerning CRCS and low reported provider recommendation were important deterrents to screening. These findings suggest the need for educational efforts to increase knowledge and attitudes about CRCS and improved patient-provider communication to reduce missed opportunities to recommend.
Background: Human Papillomavirus (HPV) is a common sexually transmitted infection among college students, a group still eligible for HPV vaccination. The President's Cancer Panel has identified missed opportunities in the promotion for catch-up vaccination for older adolescents and young adults, a group identified for cancer prevention. Community-academic alliances targeting college students can be used to improve HPV vaccination rates in those who have not initiated or completed the 3-doses series. Objective: The purpose of this ongoing effort is to build a community-academic alliance aiming to promote a sustainable infrastructure of research, outreach and service for HPV vaccination among college students. Methods: A multilevel approach consisting of a series of research and outreach activities; training, as well as vaccination clinics targeting college students or parents, has been implemented since December 2014. Our group, the Puerto Rico Community Cancer Control Outreach Program (PRCCCOP) from the U54 University of Puerto Rico (UPR) and the MD Anderson Cancer Center Partnership for Excellence in Cancer Research, established alliances with the Puerto Rico Comprehensive Cancer Control Program, the Puerto Rico Breast and Cervical Early Detection Program and the HPV Committee from the Puerto Rico Cancer Coalition. A new alliance with the UPR system served as the foundation to conduct these activities. Results: Research activities entitled ¡Habla de VPH! educated a total of 40 students and 468 parents. Both groups, significantly increased their HPV and HPV vaccine knowledge (from an average score of 66% and 72% up to an average score 95% and 93%, respectively) (p-value<0.05). Outreach activities reached over 500 students; 34% of them want to receive notifications for future vaccination clinics. To this date, training activities such as capacity building of health professionals and train-the-trainers for peers reached a total of 71 participants. A total of 137 students attended to at least one of the 5 vaccination clinics held in two campuses, where more than half (61%; mean age=20 years old) received their first dose of the HPV vaccine. Conclusion: College students represent a captive community that can benefit from multiple activities, designed in partnerships, aiming to increase HPV vaccination uptake. Existing alliances of PRCCCOP were a facilitator in the design and development of those activities. Another facilitator for these effort was having a contact-person in campus, as part of the alliance, who helped navigate through the administrative process within campus, resulting in less time and resources involved by other alliance members. This ongoing alliance have various milestones: (1) the addition of new partners in the efforts of HPV vaccination uptake; (2) over one-thousand people reached with research, outreach or training activities; and (3) the effectiveness of the educational intervention ¡Habla de VPH! in increasing HPV knowledge. Despite these achievements, and understanding that our educational activities alone does not increase HPV vaccination, we developed a new plan to promote vaccination, with the implementation of vaccination clinics on campus. During the implementation of HPV vaccine clinics, other challenges emerged such as campus size, complexity and diversity of the groups within the university. To address these challenges, future activities will aim at specific targets within the campus, such as faculty or schools, and to engage more professors and students-groups in those specific targets. Citation Format: Aleli M. Ayala-Marin, Vivian Colon-Lopez, Camille Velez-Alamo, Hernan Rosado-Carpena, Marievelisse Soto-Salgado, Marta Sanchez-Aracil, Omayra Salgado-Cruz, VOCES Puerto Rico Vaccination Coalition, Dianedis Toro, Shelciy Collazo-Castro, Maria Figueroa-Gonzalez, Willmar Contreras, Guillermo Tortolero-Luna, Maria E. Fernandez. Catching up: Building sustainable community-academic alliance to increase human papillomavirus vaccination uptake among college students. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A36.
From 2010-2014, colorectal cancer (CRC) was the second highest incident cancer and leading cause of cancer-related deaths in Puerto Rico (PR). Although preventable through screening and treatment, colorectal cancer screening (CRCS) using fecal occult blood test (FOBT) or colonoscopy remains low for adults in PR. Data from the 2016 Behavioral Risk Factor Surveillance System indicated that 18.0% of the PR population aged 50 to 75 had undergone an FOBT within the past year compared to 8.0% in the United States (US). Additionally, 50.1% of age-eligible Puerto Ricans report ever having a colonoscopy in the past 10 years compared to 63.5% in the US. Given the higher burden of CRC and the low CRCS rates in PR, we developed ¡Salud!, por la Vida (SPLV), an educational program which aims to increase CRCS in non-adherent men and women aged 50 and 75 who attend Federally Qualified Health Clinics (FQHCs) in PR. We used Intervention Mapping (IM) as framework to develop an educational intervention that is theoretically sound and grounded in evidence. For the development of SPLV, steps 1 to 4 of IM were completed. Step 1: a needs assessment conducted through focus groups and key informant interviews to gather quantitative and qualitative data for the development of the logic model and the program; step 2: development of a logic model of change and matrices of change objectives; step 3: selection of theory and evidence-based methods and strategies; and step 4: program production, components, and materials. Step 1 revealed 5 main themes: (1) lack of knowledge about CRC and CRCS practices; (2) patient’s fear of the CRC test results; (3) low risk perception of CRC; (4) lack of provider CRCS recommendation; and (5) the importance of social support. Interviews revealed that the majority of clinics offer FOBT as part of their CRCS protocol; where 74.0% of these had a clinical laboratory on-site. Over half (53.0%) had implemented electronic medical records and 82.0% had health educators on staff. A logic model was developed by combining personal behaviors with behavioral determinants and identifying beliefs targeted by the intervention (step 2). Tailored interactive multimedia intervention (TIMI) and small media were selected as the practical application to deliver the intervention (step 3). Development of the program included 5 components: script development; testimonials; animations; written materials; and newsletter. Pre-testing was conducted to evaluate the usability of the program. Our educational program, SPLV, is completed and currently being implemented, using a randomized trial. Trial is being conducted in 10 FQHCs and will recruit 710 participants aged 50 to 75 who have no prior history of CRC and are not adherent to CRCS guidelines. Clinics are randomized to either the intervention group (TIMI) or the control group (usual care). We aim that this intervention will significantly increase CRCS rates and provide evidence to disseminate this educational effort to FQHCs in PR. Citation Format: Vivian Colón-López, Camille Vélez-Alamo, Adrianna Acevedo-Fontanez, Marievelisse Soto-Salgado, Jorge L Rodríguez-Lebrón, Josheili Y Llavona-Ortiz, Yolanda Serra-Martínez, Ileska Valencia-Torres, María Fernández. ¡Salud!, por la Vida, an educational intervention to increase colorectal cancer screening in Puerto Ricans [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B009.
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