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ABSTRACT: Purpose – To provide an overview of racial/ethnic disparities in human papillomavirus (HPV) infection, HPV vaccination, and cervical cancer on domestic and international levels.Design/methodology/approach – The literature, cervical cancer prevention guidelines, and Centers for Disease Control and Prevention resources were culled to aggregate information on epidemiology, racial/ethnic disparities, and knowledge and attitudes related to HPV, HPV vaccination, and cervical cancer. Original data supplement information about HPV and HPV vaccination knowledge and attitudes.Findings – Cervical cancer is among the leading causes of female death worldwide, with substantial racial/ethnic and geographic disparities. In the United States, African American and Hispanic women suffer disproportionate cervical cancer incidence and mortality compared to their Caucasian counterparts. Globally, the greatest burden of cervical cancer (and HPV infection) is shouldered by developing regions. Prevention efforts, such as HPV vaccination and adaption of screening programs to resource-poor areas, have the potential to reduce such disparities, but cultural context is critical to successful development and implementation of such interventions.Research limitations/implications – As this is not a systematic review, but rather a viewpoint on issues related to disparities in cervical cancer, the literature review is not exhaustive.Practical implications – This chapter provides a context for examining cervical cancer disparities domestically and globally and serves as a starting point for formulating future research.Originality – This perspective on HPV and cervical cancer presents disparities both within the United States and worldwide. The chapter supplements the literature with new data that provide additional insight into knowledge and attitudes about these health issues.
Advances in Education in Diverse Communities: Research, Policy and Praxis 07/2012; 9:135-156.
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ABSTRACT: This study describes attitudes and social and environmental factors that affect African American parents' intent to vaccinate their daughters against human papillomavirus (HPV). Thirty African American parents of daughters aged nine to 17 years and no history of HPV infection completed semi-structured interviews. Interviews addressed factors that influenced intent to vaccinate, perception of community norms related to vaccination, vaccination scenarios involving place of vaccination, and vaccination prior to or after the child's initiation of sexual activity. A recurring theme was the influence of physician recommendation on African American parents' intent to obtain HPV vaccination for their daughters. Most parents reported that they could overcome barriers to vaccination, except vaccine costs and lack of insurance. While religious beliefs were important to parents, they reported that they would not interfere with vaccination decisions; fears of early sexuality due to vaccination were limited. The implications of these findings are discussed.
Journal of Health Care for the Poor and Underserved 01/2012; 23(1):290-301. · 1.10 Impact Factor
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Archives of internal medicine 04/2011; 171(8):768-9. · 11.46 Impact Factor
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ABSTRACT: This study sought to determine knowledge about human papillomaviruses (HPV), vaccination acceptability and intent to vaccinate, and describe the individual characteristics, and sociocultural attitudes that affect African American parents' intent to vaccinate their daughters. Two hundred African Americans completed self-administered surveys that assessed factors that may influence HPV vaccination behavior, HPV and cervical cancer knowledge and risk perception, cultural attitudes, and preferences for location and timing of vaccination. Eligibility criteria included men and women who had a daughter aged 9 to 17 years, whether the daughter had or had not been told that she had an HPV infection. Approximately two-thirds of the African American parents surveyed were aware of HPV and HPV vaccination. Responders were likely to be female, younger, employed, and to have social resources. They were also knowledgeable about HPV, but knowledge did not necessarily lead to vaccination. Among parents knowledgeable about HPV, vaccination status was significantly affected by whether a pediatrician had recommended the vaccine. There were no significant differences in demographic characteristics or sociocultural attitudes between the parents who had vaccinated their daughters and those who had not, although more of the parents who had vaccinated daughters were worried about STIs.
Ethnicity & disease 01/2011; 21(3):335-41. · 0.90 Impact Factor
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ABSTRACT: In the 20th century, public health education in the United States existed as a professional degree program, with training at the masters (MPH) and doctoral (PhD, DrPH, and ScD) levels. Today, the system is rapidly evolving as undergraduate majors, minors, and concentrations are establishing themselves around the country. This new focus of public health education, rooted in a liberal arts environment, is distinct from the professional training of graduate school. As such, undergraduate public health students have unique characteristics and needs that should be considered as part of the advisors' responsibility to provide meaningful, relevant advising. The perspective and comments presented here are largely based on the authors' nearly 30 years of combined experience in undergraduate public health education.
American Journal of Public Health 08/2010; 100(8):1374-80. · 3.93 Impact Factor
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ABSTRACT: Studies that examine colorectal cancer screening (CRCS) behaviors and correlates rely on self-reports of screening status. Self-reports of CRCS may be more biased than other self-reported cancer screening because of multiple screening options, tests may be offered in combination, and screening schedules differ for each test. The National Cancer Institute (NCI) sponsored the development of a core set of questions to measure self-reported CRCS that are consistent with current guidelines, the NCI Colorectal Cancer Screening questionnaire (NCI CRCS). Several studies support the validity and reliability of this measure; however, none of the existing studies have described African American (AA) responses to items that might be important to clinical decision making and research related to screening adherence. This paper addresses the limited descriptions of AA response patterns to items that comprise the NCI CRCS. The NCI CRCS was administered to 439 AAs 50 to 75 years, participating in the baseline survey of a Center for Excellence in Cancer Communication CRC study. The survey measured self-reported CRCS, factors associated with screening, and response patterns to items that might affect estimates of screening and screening adherence. AA participants reported on CRCS, the test used, and time interval since last screening. Except for queries related to month and year of screening, few participants reported uncertainty in response to items. Two thirds of participants reported receiving CRCS; however, less than half of participants were adherent to guidelines. Less than half reported healthcare provider recommendations to screen. AA participants responded to items on the NCI CRCS as developed. Until new strategies or items are available, interval since last screening appears to be the most appropriate item to estimate AA self-reported CRCS adherence. Strategies are needed to increase physician recommendation to screen.
Journal of Cancer Education 03/2010; 25(3):431-6. · 0.76 Impact Factor
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Cancer Epidemiology Biomarkers & Prevention 03/2010; 19(3):888-9. · 4.12 Impact Factor
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ABSTRACT: Between 2001 and 2005, Blacks from the United States experienced a 32% higher pancreatic cancer death rate than Whites. Smoking, diabetes, and family history might explain some of this disparity, but prospective analyses are warranted. From 1984 to 2004, there were 6,243 pancreatic cancer deaths among Blacks (n = 48,525) and Whites (n = 1,011,864) in the Cancer Prevention Study II cohort. Multivariate Cox proportional hazards models yielded hazards ratios (HR) for known and suspected risk factors. Population attributable risks were computed and their effect on age-standardized mortality rates were evaluated. Blacks in this cohort had a 42% increased risk of pancreatic cancer mortality compared with Whites (HR, 1.42; 95% confidence intervals (CI), 1.28-1.58). Current smoking increased risk by >60% in both races; although Blacks smoked less intensely, risks were similar to Whites (HR(Black), 1.67; 95% CI, 1.28-2.18; HR(White), 1.82; 95% CI, 1.7-1.95). Obesity was significantly associated with pancreatic cancer mortality in Black men (HR, 1.66; 95% CI, 1.05-2.63), White men (HR, 1.42; 95% CI, 1.25-1.60), and White women (HR, 1.37; 95% CI, 1.22-1.54); results were null in Black women. The population attributable risk due to smoking, family history, diabetes, cholecystectomy, and overweight/obesity was 24.3% in Whites and 21.8% in Blacks. Smoking and overweight/obesity play a substantial a role in pancreatic cancer. Variation in the effect of these factors underscores the need to evaluate disease on the race-sex level. The inability to attribute excess disease in Blacks to currently known risk factors, even when combined with suspected risks, points to yet undetermined factors that play a role in the disease process.
Cancer Epidemiology Biomarkers & Prevention 09/2009; 18(9):2397-405. · 4.12 Impact Factor
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ABSTRACT: To estimate the annual incidence of vulvodynia-like symptoms and evaluate triggers of vulvar pain in a sample of U.S. women.
After a 1-year interval, women who previously participated in a national vulvodynia prevalence study were recontacted and administered a telephone questionnaire that assessed self-reported vulvodynia-like symptoms and triggers of symptoms.
From the original cohort of 425 women, 285 (67%) participated in this follow-up study. Symptoms consistent with vulvodynia occurring within 1 year of initial contact were reported by 4.7% of previously asymptomatic women. Nearly 50% of the original patients again reported a history of vulvodynia-like symptoms, with 68.6% of these as persistent over the past year. Of significance, pain or discomfort with first-time tampon use was 2.15 times more likely (95% CI 1.0-4.62) in symptomatic women. These women were also 2.4 times more likely (95% CI 1.29-4.53) to use a combination of tampons and pads for sanitary protection rather than one method alone.
Over the course of 1 year, as many as 1 in 20 women may experience new-onset chronic genital pain. Despite a higher likelihood of having discomfort or pain with first tampon use, symptomatic women did not exhibit a preference for sanitary napkins. This indicates that lack of tampon use because of pain may not be an effective screening criterion for vulvodynia. We recommend additional studies with symptomatic and diagnosed women to explore in more detail the issues surrounding tampon use history and chronic genital pain.
Journal of Women s Health 10/2008; 17(8):1285-92. · 1.57 Impact Factor
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ABSTRACT: Vulvodynia is a chronic pain syndrome of unknown origin with scant data on frequency. This study assessed the prevalence of vulvodynia symptoms in a sample of US women and compared health characteristics of symptomatic and asymptomatic women.
A phone survey contacted 2127 US households to identify 100 symptomatic women, who were matched on age and time zone to 325 asymptomatic controls. Odds ratios (ORs) and logistic regression were used to model associations between pain, medical conditions, and health care utilization variables.
Current vulvar pain of at least 6 months duration was reported by 3.8% of respondents, with a 9.9% lifetime prevalence. Forty-five percent of women with pain reported an adverse effect on their sexual life and 27% an adverse effect on their lifestyle. Cases more frequently reported repeated urinary tract infections (OR, 6.15; 95% CI, 3.51-10.77) and yeast infections (OR, 4.24; 95% CI, 2.47-7.28). Associations existed with chronic fatigue syndrome (OR, 2.78; 95% CI, 1.33-6.19), fibromyalgia (OR, 2.15; 95% CI, 1.06-4.36), depression (OR, 2.99; 95% CI, 1.87-4.80), and irritable bowel syndrome (OR, 1.86; 95% CI, 1.07-3.23).
Lifetime chronic vulvar pain was less prevalent in this national sample of women than previous data suggest and was correlated with several comorbid chronic medical conditions and substantial reduction in self-reported quality of life.
American journal of obstetrics and gynecology 03/2007; 196(2):128.e1-6. · 3.28 Impact Factor
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ABSTRACT: This case-control survey compared health history and health care use of women with vulvodynia with a control group reporting absence of gynecologic pain.
Women with a clinically assessed diagnosis of vulvodynia and asymptomatic controls were matched for age and mailed a confidential survey that evaluated demographics, health history, use of the health care system, and history of vulvodynia. Participants were all current or former ambulatory patients within a university health care system.
Of the 512 questionnaires mailed to valid addresses, 70% (n = 91) of cases and 72% (n = 275) of controls responded, with 77 cases and 208 controls meeting eligibility criteria. Women with vulvodynia reported a substantial negative impact on quality of life, with 42% feeling out of control of their lives and 60% feeling out of control of their bodies. Forty-one percent indicated a severe impact on their sexual lives. When comorbidities were evaluated individually and adjusted for age, fibromyalgia (odds ratio 3.84, 95% confidence interval 1.54-9.55) and irritable bowel syndrome (odds ratio 3.11, 95% confidence interval 1.60-6.05) were significantly associated with vulvodynia. On a multivariate level, vulvodynia was correlated with a history of chronic yeast vaginitis and urinary tract infections.
This survey highlights the psychological distress associated with vulvodynia and underscores the need for prospective studies to investigate the relationship between chronic bladder and vaginal infections as etiologies for this condition. As well, the association of vulvodynia with other comorbid conditions, such as fibromyalgia and irritable bowel syndrome, needs to be further evaluated.
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Obstetrics and Gynecology 04/2006; 107(3):617-24. · 4.73 Impact Factor
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Obstetrics and Gynecology 10/2005; 106(3):639; author reply 639. · 4.73 Impact Factor
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Journal of Health Care for the Poor and Underserved 23(1):290-301. · 1.10 Impact Factor
