Improving Comprehensive Cancer Control State Plans for Colorectal Cancer Screening in the Four Corners Region of the United States

Abstract

Colorectal cancer (CRC) disparities continue to persist in the four corners region (states of New Mexico, Arizona, Utah, and Colorado) of the United States. The Comprehensive Cancer Control (CCC) state plans provide a policy and practice snapshot on how a state identifies and addresses its cancer burden. This study critically examines the four state plans to identify gaps and opportunities for cancer prevention and control. Using a conventional content analysis approach, we reviewed the CCC plans for CRC screening-related information, culminating in a conceptual framework that highlights three themes. First, states reported their cancer burden using national data from American Cancer Society, Centers for Disease Control and Prevention, or the NCI’s Surveillance, Epidemiology, and End Results. Although these data informed specific goals and objectives, not all plans reported state-level data on CRC differences by specific social determinants of health and other characteristics. Second, it was not clear whether the interventions chosen to address state plan objectives were evidence-based and whether or not clearly described criteria were used for the selection of the interventions. Third, very limited information was provided in terms of state-specific contextual challenges and practical implementation of interventions. Study findings highlight opportunities to improve state-level cancer prevention and control efforts: first, by promoting the selection and adaptation of contextually relevant evidence-based interventions for this unique region; and second, through multidirectional engagement with communities, researchers, and policy and practice stakeholders. Such synergies in research and policies are vital for a coordinated and integrated approach to cancer prevention and control.

Connected Community Classification (C3): Development, Validation, and Geospatial Application for Population Health Promotion and Equity

“…Comparatively, cancer prevalence was higher in the Four Corners states region (7.0%) than the national estimate of 5.4% 43. This region experiences unique environmental challenges, with expanding and aging populations that may affect these estimates 21,24. C3 was significantly associated with high-risk health behaviors and chronic disease in the Four Corners states region after accounting for population demographics and geography.…”

“…The Four Corners states region of the United States represents the political boundaries of 4 Mountain West states: Arizona, Colorado, New Mexico, and Utah 20. Compared with national averages, the Four Corners states experience greater economic poverty and health disparities while being home to a greater percentage of Hispanic and Indigenous populations 21. The Four Corners states share regional characteristics such as an arid environment, rural and frontier areas, rapidly expanding populations—including some of the cities with the highest growth rates—such as Phoenix and Denver, and large areas with Federal Tribal Lands—including the largest reservation in the United States 22,23.…”

“…43 This region experiences unique environmental challenges, with expanding and aging populations that may affect these estimates. 21,24 C3 was significantly associated with high-risk health behaviors and chronic disease in the Four Corners states region after accounting for population demographics and geography. Therefore, it may be possible that C3 is influential to the variance in estimates for chronic disease observed compared with national averages despite similar estimates for high-risk health behaviors.…”

“…20 Compared with national averages, the Four Corners states experience greater economic poverty and health disparities while being home to a greater percentage of Hispanic and Indigenous populations. 21 The Four Corners states share regional characteristics such as an arid environment, rural and frontier areas, rapidly expanding populations-including some of the cities with the highest growth rates-such as Phoenix and Denver, and large areas with Federal Tribal Lands-including the largest reservation in the United States. 22,23 Furthermore, this region encompasses a large part of the US-Mexico border and faces challenges related to climate change such as droughts, water shortages, and wildfires.…”