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The Association between Neighborhood Social Capital and Cancer Screening
Abstract
To examine the association between social capital and adherence to cancer screening exams.
Data from a population-based survey assessed perceived neighborhood social capital as well as cancer screening behavior. We analyzed the influence of social capital on adherence to screening guidelines for cervical, breast, and colorectal cancer.
Data from 2668 adults documented that those with greater perceived neighborhood social capital were more likely to be screened for cancer. The effect was strongest for colorectal cancer and weakest for cervical cancer.
Research on understanding the effect of the neighborhood social environment on efforts related to cancer screening behavior may be helpful for increasing cancer screening rates.
... Therefore, it is urgent to solve the problem of low screening rates. Previous studies have found that internal cognitive behavior factors, external social influencing factors, cervical cancer knowledge, and some demographic variables are the important influencing factors related to the behavior intentions for cervical cancer screening [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. This information may provide direction and methods for interventions to investigate how these factors influence the behavior intentions related to cervical cancer screening among Chinese women. ...
... Jensen et al. (2016) revealed a significant positive correlation between low social support and non-participation in breast cancer screening [16]. Leader and Michael (2013) discovered that social capital perception affects breast cancer screening participation among American women [17]. Moudatsou et al. (2014) revealed that social capital promoted knowledge about and compliance with cervical cancer screening among rural Greek women [18]. ...
... Jensen et al. (2016) revealed a significant positive correlation between low social support and non-participation in breast cancer screening [16]. Leader and Michael (2013) discovered that social capital perception affects breast cancer screening participation among American women [17]. Moudatsou et al. (2014) revealed that social capital promoted knowledge about and compliance with cervical cancer screening among rural Greek women [18]. ...
Objective: Exploring how the theory of planned behavior (TPB), social capital theory (SCT), cervical cancer knowledge (CCK), and demographic variables predict behavioral intentions (BI) related to cervical cancer screening among Chinese women. Methods: Self-administered questionnaires were distributed to 496 women, followed by a path analysis. Results: The three-level model was acceptable, χ 2 (26, 470) = 26.93, p > 0.05. Subjectively overcoming difficulties, support from significant others, screening necessity, and the objective promotion factor promoted BI, with effect sizes of 0.424, 0.354, 0.199, and 0.124. SCT and CCK promoted BI through TPB, with effect sizes of 0.262 and 0.208. Monthly income, education, age, and childbearing condition affected BI through TPB, SCT, and CCK, with effect sizes of 0.269, 0.105, 0.065, and −0.029. Conclusion: The three-level model systematically predicted behavioral intentions relating to cervical cancer screening.
... Therefore, it is urgent to solve the problem of low screening rates. Previous studies have found that internal cognitive behavior factors, external social influencing factors, cervical cancer knowledge, and some demographic variables are the important influencing factors related to the behavior intentions for cervical cancer screening [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. This information may provide direction and methods for interventions to investigate how these factors influence the behavior intentions related to cervical cancer screening among Chinese women. ...
... Jensen et al. (2016) revealed a significant positive correlation between low social support and non-participation in breast cancer screening [16]. Leader and Michael (2013) discovered that social capital perception affects breast cancer screening participation among American women [17]. Moudatsou et al. (2014) revealed that social capital promoted knowledge about and compliance with cervical cancer screening among rural Greek women [18]. ...
... Jensen et al. (2016) revealed a significant positive correlation between low social support and non-participation in breast cancer screening [16]. Leader and Michael (2013) discovered that social capital perception affects breast cancer screening participation among American women [17]. Moudatsou et al. (2014) revealed that social capital promoted knowledge about and compliance with cervical cancer screening among rural Greek women [18]. ...
: Objective: Exploring how the theory of planned behavior (TPB), social capital theory (SCT), cervical cancer knowledge (CCK), and demographic variables predict behavioral intentions (BI) related to cervical cancer screening among Chinese women.
Methods:
Self-administered questionnaires were distributed to 496 women, followed by a path analysis.
Results:
The three-level model was acceptable, χ2(26, 470) = 26.93, p > 0.05. Subjectively overcoming difficulties, support from significant others, screening necessity, and the objective promotion factor promoted BI, with effect sizes of 0.424, 0.354, 0.199, and 0.124. SCT and CCK promoted BI through TPB, with effect sizes of 0.262 and 0.208. Monthly income, education, age, and childbearing condition affected BI through TPB, SCT, and CCK, with effect sizes of 0.269, 0.105, 0.065, and -0.029.
Conclusion:
The three-level model systematically predicted behavioral intentions relating to cervical cancer screening.
... There are several reports on the impact of social capital in communities and populations on cancer screening participation behavior. A U.S. study of 2668 men and women aged 18-70 years reported that people with higher neighborhood social awareness were more likely to be screened for cancer and this effect was the strongest for colorectal cancer screening (Leader & Michael, 2013). A study of 2586 black U.S. women aged 40 years and older reported that individual perceptions of high social capital, especially collective efficacy, in their neighborhoods were associated with higher mammography screening participation (Dean et al., 2014). ...
... Using a group as a unit of analysis makes it impossible to analyze the effects of differences in individual predictors of interest on the "screened" and "not screened" categories. Most of the previous studies conducted logistic regression analyses for each individual using the binary variable "screened" and "not screened" as outcomes, with the results shown as odds ratios (Leader & Michael, 2013;Dean et al., 2014Dean et al., , 2015. The present study used multiple regression analysis with the outcome a continuous variable, and screening participation rates across the municipalities, which limits comparability with previous studies. ...
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The burden of colorectal cancer in developed countries is high, and it is a major public health concern in Japan. Improving the quality of evidence on colorectal cancer screening participation and further assessment participation rates is important to reduce this burden. This study examined the social-life factors that influence colorectal cancer screening programs in Japan, particularly the effects of the proportion of elderly people and social capital, using a municipality-level national database and existing health reports. Data from a national municipality-based study were analyzed to identify social-life factors associated with participation in colorectal cancer screening and further assessment. Administrative data on the Japanese municipal screening programs were drawn from the Report on Regional Public Health Services and Health Promotion Services 2017. Available data used as predictors of interest for all 1719 municipalities as of 2017 were from the national census, statistical reports on the land area by prefecture and municipality, municipal financial surveys, a survey of physicians, dentists and pharmacists, and other databases. The mean rate of participation in colorectal cancer screening was 13.8%, and that of further assessment was 73.6%. Multiple linear regression analyses of the two outcomes showed that the proportion of elderly people was most significantly positively associated with colorectal cancer screening programs (β = 0.51 for participation, β = 0.13 for further assessment participation), and the proportion of single-elderly-person households was most significantly negatively associated (β = −0.45 and −0.19, respectively). It is suggested that the health behaviors required for participation in colorectal cancer programs in Japanese elderly populations are greatly affected by family members.
... Furthermore, the relationship and dependencies between land use and transportation are well established in the literature, 6,84 and altering either element of the cycle can cause cascading effects across the built environment. Within the broad areas of land use and transportation lie additional concerns regarding the influence of spatial accessibility, 19,64 public service distribution, [85][86][87] and urban design 88,89 on cancer risks and outcomes. ...
... Furthermore, analytical units other than the neighborhood need to be deployed in statistical and spatial analyses. Social network-type methods, such as those used by Leader and Michael, 86 could be a promising approach to solving the modifiable areal unit problem in surveillance-type research. ...
The built environment is a significant determinant of human health. Globally, the growing prevalence of preventable cancers suggests a need to understand how features of the built environment shape exposure to cancer development and distribution within a population. This scoping review examines how researchers across disparate fields understand and discuss the built environment in primary and secondary cancer prevention. It is focused exclusively on peer‐reviewed sources published from research conducted in Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United States from 1990 to 2017. The review captured 9958 potential results in the academic literature, and this body of results was scoped to 268 relevant peer‐reviewed journal articles indexed across 13 subject databases. Spatial proximity, transportation, land use, and housing are well‐understood features of the built environment that shape cancer risk. Built‐environment features predominantly influence air quality, substance use, diet, physical activity, and screening adherence, with impacts on breast cancer, lung cancer, colorectal cancer, and overall cancer risk. The majority of the evidence fails to provide direct recommendations for advancing cancer prevention policy and program objectives for municipalities. The expansion of interdisciplinary work in this area would serve to create a significant population health impact.
... Regarding breast cancer specifically, research has shown that individuals with greater perceptions of neighbourhood social capital are more likely to be screened. 23 In addition, a study by Dean et al. 24 found that females with a sense of collective neighbourhood efficacy were nearly one and a half times more likely to receive a mammogram. It is indeed possible that social vulnerabilityindicative perhaps of a lack of social capital as wellexplains some of the variation in screening, incidence, and mortality rates among females; specifically, greater levels of social vulnerability might partially explain lower levels of screening for breast cancer, as well as greater mortality. ...
... Details regarding data availability can be found elsewhere. 23 The average county-level breast cancer incidence rate in the United States from 2010 to 2014 was 117.198 (SD ¼ 18.351). The average county-level breast cancer mortality rate in the United States from 2010 to 2014 was 22.372 (SD ¼ 4.923). ...
Introduction: Previous studies have shown that breast cancer incidence rates are higher among female Veterans than the general population due to factors such as increased lifetime exposure to breast cancer risk factors or more accurate detection and surveillance. The present study explored relationships between nationally representative county-level breast cancer outcomes, mammography screening rates, female Veteran population density, and social vulnerability. Methods: Data for the present ecological study were obtained at the county level from the United States Census Bureau, the University of South Carolina's Hazards and Vulnerability Research Institute (HVRI), and the National Cancer Institute. We conducted ordinary least squares (OLS) multiple regression analyses to determine the relative influence of female Veteran population density, social vulnerability, and mammography screening rates on breast cancer incidence and mortality rates between 2010 and 2014. County-level covariates such as liquor store density, cigarette smoking prevalence, air pollution, and access to healthy foods, were entered into each model to determine the unique influence of each of the main study variables on breast cancer outcomes. Results: County-level breast cancer incidence rates were higher in counties with greater female Veteran population density, lower social vulnerability, and higher mammography screening rates ( n=2,698, F=33.669, p<0.001). County-level breast cancer mortality rates were higher in counties with lower female Veteran population density, higher social vulnerability, and lower mammography screening rates ( n=1,803, F=18.180, p<0.001). Discussion: The results of the present exploratory study were preliminary, and thus further research on relationships examined in this study are needed. However, because female Veterans were shown to live in counties with relatively high mammography screening rates and lower social vulnerability, their risk for mortality from breast cancer may be lower than for the general population – in particular due to early detection and treatment.
... To our knowledge, this is the first review of social capital interventions in public health regarding HPV immunization and cervical cancer screening. Despite interest in the use of social capital to improve cancer outcomes (8,22,23), only seven papers met this review's inclusion criteria. Concerning primary prevention, education interventions containing social capital dimensions and/or functions were found to increase HPV immunization knowledge, attitudes and intentions. ...
Background
Social capital can be used as a conceptual framework to include social context as a predictor of human papillomavirus (HPV) vaccination and cervical cancer screening behaviours. However, the effectiveness of interventions that use social capital as a mechanism to improve uptake of immunization and screening remains elusive.
Objective
To synthesize empirical evidence on the impact of social capital interventions on HPV immunization and cervical cancer screening and describe key characteristics of such interventions.
Methods
Using a rapid review methodology, a search of literature published between 2012 and 2022 was conducted in four databases. Two researchers assessed the studies according to inclusion criteria in a three-step screening process. Studies were assessed for quality and data concerning social capital and equity components and intervention impact were extracted and analyzed using narrative synthesis.
Results
Seven studies met the inclusion criteria. Studies found improved knowledge, beliefs and intentions regarding HPV immunization and cervical cancer screening. None of the studies improved uptake of immunization; however, three studies found post-intervention improvements in uptake of cervical cancer screening. All studies either tailored their interventions to meet the needs of specific groups or described results for specific disadvantaged groups.
Conclusion
Limited evidence suggests that interventions that consider and reflect local context through social capital may be more likely to increase the uptake of HPV immunization and cervical cancer screening. However, further research must be done to bridge the gap in translating improvements in knowledge and intention into HPV immunization and cervical cancer screening behaviours.
... Social capital is considered an SDH related to better health status (Song & Jiang, 2022) and is an asset in community and neighborhood health that is of particular importance within the competencies of the family and community nurse in the area of health promotion (Kemppainen et al., 2013;Looman & Lindeke, 2005 Michael & Yen, 2014;Palumbo et al., 2019). The social capital of communities has been extensively studied in the field of genderbased violence (Benavides et al., 2018;Daoud et al., 2017;Ilabaca Baeza et al., 2022;Voith et al., 2021), alcohol consumption (Brenner et al., 2015;Jackson et al., 2014Jackson et al., , 2016Theall et al., 2009), cancer detection and screening (Beyer et al., 2016;Knott et al., 2020;Leader & Michael, 2013), or, in more current studies, related to the COVID-19 pandemic (Murayama et al., 2021;Ransome et al., 2021). However, most of this literature focuses on collecting negative health impacts in relation to the socio-demographic characteristics of a neighborhood. ...
Background
The Social Determinants of Health (SDH) influence the health of people throughout their lives, and can be positive, protective or risk factors for the population and, in turn, biological, psychological, or social. The social environment conditions the health status of the neighborhood, population, and social group, which can be a health asset due to its strong psychosocial and socio‐cultural influence. Social capital is a community asset of the healthy neighborhood that must be known in order to promote community health.
Objectives
The objective is to determine the relationship between social capital and neighborhood biopsychosocial health.
Methods
A systematic review was conducted based on PRISMA: PubMed, Wos, Scopus, Embase, and Cochrane databases. The search was conducted from January to March 2023. Three authors independently extracted data using a structured form.
Results
Out of 527 records, 17 results passed the inclusion and exclusion criteria. The positive and statistically significant relationship between neighborhood social capital (NSC) and the physical and mental health of neighbors is confirmed, that is, the higher the NSC, the more exercise, better oral health in children and physical health in pregnant women, lower tobacco consumption and lower prevalence of human immunodeficiency virus. At the psychological level, greater NSC leads to better mental health, mental well‐being, life satisfaction, quality of life, self‐perceived health, higher cognitive function, and less depression.
Conclusions
In conclusion, social capital is an important SDH and health asset that influences neighborhood biopsychosocial health and should be known and researched for health promotion in community settings. More evidence is needed to support the results obtained.
... The data was obtained from the Australian Institute of Health and Welfare and measures the participation rate of all men and women aged between 50 and 75 who were invited to take part in the screening program between 2018 and 2020. The socio-demographic variables were chosen with reference to data availability and within the context of the existing conceptual and empirical research [5][6][7][8][9]. All the independent variables were obtained from the Australian Bureau of Statistics 2021 Census of Population and Housing. ...
Objectives
The objective of this paper is to analyse the socio-demographic and spatial patterns associated with bowel cancer screening in Australia. Despite the importance of screening in reducing mortality via early intervention, it remains the case that overall screening rates are uneven between different socio-demographic groups and geographic regions. Notwithstanding this, there is limited knowledge in Australia regarding the interplay between socio-demographics and geography in relation to bowel cancer screening. Thus, this paper explores the socio-demographic and spatial patterns of screening participation across Australian regions to better inform public health policy and programs.
Study design
This is a nationwide ecological study based on aggregate spatial data.
Methods
An ecological study is conducted using bowel cancer screening rates and selected socio-demographic data measured at the Statistical Area 3 level. Geographically weighted regression software is used to conduct global and spatial regression analysis.
Results
The global regression results show that higher rates of screening participation were associated with employment/education disengagement and volunteering while in contrast, lower rates of participation were associated with higher rates of indigenous populations, people with chronic health conditions, and people with poor English skills. Considering the spatial analysis, the analysis shows that once the spatial non-stationarity in the data is considered the influence of the variables shown to be significant in the global model, has significant spatial variability.
Conclusion
From a public health perspective, addressing shortfalls in bowel cancer screening participation is an important priority. In order to understand differences in participation rates it is important to consider both socio-demographic factors as well as the geographic or spatial distribution of these factors.
... free of garbage, safe from crime) and distance to a screening facility, have an impact on adherence to CRC screening among all racial/ethnic groups (i.e., Whites, African Americans, Hispanic, Asians) (Kurani et al., 2020;Calo et al., 2015;Danos et al., 2018;Fukuda et al., 2005;Lian et al., 2008;Buehler et al., 2019;Beyer et al., 2016;Mayhand et al., 2021;Shariff-Marco, 2013;Schootman, 2006). Studies that have exclusively focused on African American populations have found that individual perceptions of the social environment such as social capital (Leader and Michael, 2013) and community satisfaction (Halbert et al., 2016) are associated with increased likelihood of being screened for CRC. Additionally, a study among African Americans in Philadelphia found that participants living in racially segregated areas were less likely to be screened for CRC (Buehler et al., 2019). ...
Historically, colorectal cancer (CRC) screening rates have been lower among African Americans. Previous studies that have examined the relationship between community characteristics and adherence to CRC screening have generally focused on a single community parameter, making it challenging to evaluate the overall impact of the social and built environment. In this study, we will estimate the overall effect of social and built environment and identify the most important community factors relevant to CRC screening. Data are from the Multiethnic Prevention and Surveillance Study (COMPASS), a longitudinal study among adults in Chicago, collected between May 2013 to March 2020. A total 2,836 African Americans completed the survey. Participants' addresses were geocoded and linked to seven community characteristics (i.e., community safety, community crime, household poverty, community unemployment, housing cost burden, housing vacancies, low food access). A structured questionnaire measured adherence to CRC screening. Weighted quantile sum (WQS) regression was used to evaluate the impact of community disadvantages on CRC screening. When analyzing all community characteristics as a mixture, overall community disadvantage was associated with less adherence to CRC screening even after controlling for individual-level factors. In the adjusted WQS model, unemployment was the most important community characteristic (37.6%), followed by community insecurity (26.1%) and severe housing cost burden (16.3%). Results from this study indicate that successful efforts to improve adherence to CRC screening rates should prioritize individuals living in communities with high rates of insecurity and low socioeconomic status.
... Therefore, it is urgent to conduct empirical studies to explain and predict individual behavior of rural women's BCS in China. Subsequently, there were some studies that investigated the personal health beliefs (18) and external environmental factors (19,20), such as the society or organizations. These studies were generally based on social psychological models, including health belief model (HBM) (18,21) and the theory of rational behavior (TRA) (21). ...
Background
It was reported that the incidence of breast cancer (BC) was the highest among cancers worldwide. The breast cancer screening (BCS) program is regarded as an effective preventive measure. However, rural women's willingness to participate in the BCS program is relatively low. To provide measures to prevent BC, it is necessary for the government to identify the influencing factors of rural women's BCS intention.
Methods
A cross-sectional study was conducted among 3,011 rural women by a convenience sampling method through face-to-face interviews on a self-designed questionnaire based on the theory of planned behavior (TPB). The partial least square structural equation model (PLS-SEM) was conducted to determine the predictors of BCS intention, and a multi-group analysis (MGA) of age was performed to identify if there were differences in all hypotheses between different age groups.
Results
There were still rural women who have not been screened for BC in five years (41.7%). The research model of rural women's intention to accept this prevention against BC was rational. All of the hypotheses are supported. Especially, subjective norm (SN) (β = 0.345, p < 0.001) is found to be the strongest predictor followed by the perceived behavioral control 1 (PBC 1) (personal factors, including distance, transportation, busyness, etc.) (β = 0.165, p < 0.001), attitude (β = 0.152, p < 0.001), past behavior (PB) (β = 0.150, p < 0.001), knowledge (β = 0.121, p < 0.001), and perceived behavioral control 2 (PBC 2) (pain and cultural-social factors including embarrassment from a physician, etc.) (β = 0.042, p < 0.05). The advocacy and education (A&E), medical level and service attitude (ML&SA) of township health centers and village clinics can affect behavior intention (BI) via attitude, SN, and PBC. The results of MGA of age indicate that there are significant differences among rural women of different ages regarding the relationship between A&E and PBC 2 (p < 0.01) and the effect of PB on BI (p < 0.001).
Conclusion
The TPB with the addition of PB, knowledge, ML&SA, and A&E can provide the theoretical basis for the policy intervention that aims to enhance the rural women's BCS willingness. MGA of age is conducive to promoting the implementation of the BCS policy. The findings are of great significance to improve rural women's health levels.
... Since OT works with clients who have mental and behavioral health issues (AOTA, 2020), this line of research is pertinent to the field of OT. In addition, regional characteristics where one lives or works are equally important for understanding facilitators and barriers to health care accessibility among African Americans and targeted OT needs (Bissonnette et al., 2012;Knott et al., 2020;Leader & Michael, 2013). ...
Background: Population-based research and community-based interventions are integral to occupational therapy’s scope of practice, yet they are underdeveloped in actual implementation. Therefore, this paper focuses on some health challenges facing the African American population, guided by the Person-Environment-Occupation-Performance Model.
Method: Using data from an observational cross-sectional nationwide telephone survey of African American adults, we examined differences between African Americans who are receiving disability payments (RDP) and those who are employed full time (FTE) on several physical health behaviors and psychosocial health indicators. We further compared the differences between African Americans RDP versus those FTE on those physical health behaviors and psychosocial health indicators across five US regions.
Results: Findings suggest that African Americans RDP are engaging in fewer positive physical health behaviors and experiencing worse psychosocial health compared to their counterparts FTE. There are also nuanced regional variations in the differences between African Americans RDP and FTE in physical health behaviors and psychosocial health indicators.
Conclusion: This research highlighted some health challenges of African Americans RDP and FTE using a regional lens, demonstrating the value of OT population-based research. There is a need for OT population-specific community-based practice to address the health disparities of underserved and minority populations, such as African Americans.
... Lastly, neighbourhood might affect healthcare utilization independent of need, i.e. neighbourhoods might differ in their level of neighbourhood social capital (and this might differently motivate people to demand and finally use preventive healthcare, e.g. screening for colorectal cancer (Leader and Michael 2013), preventive dental visits (Iida and Rozier 2013), and number of contacts with doctors (Nguyen, Ho, and Williams 2011)). ...
We investigated the additional predictive value of an individual’s neighbourhood (quality and location), and of changes therein on his/her healthcare costs. To this end, we combined several Dutch nationwide data sources from 2003 to 2014, and selected inhabitants who moved in 2010. We used random forest models to predict the area under the curve of the regular healthcare costs of individuals in the years 2011–2014. In our analyses, the quality of the neighbourhood before the move appeared to be quite important in predicting healthcare costs (i.e. importance rank 11 out of 126 socio-demographic and neighbourhood variables; rank 73 out of 261 in the full model with prior expenditure and medication). The predictive performance of the models was evaluated in terms of R ² (or proportion of explained variance) and MAE (mean absolute (prediction) error). The model containing only socio-demographic information improved marginally when neighbourhood was added ( R ² +0.8%, MAE −€5). The full model remained the same for the study population ( R ² = 48.8%, MAE of €1556) and for subpopulations. These results indicate that only in prediction models in which prior expenditure and utilization cannot or ought not to be used neighbourhood might be an interesting source of information to improve predictive performance.
... A fundamental principle of health geography is that where a person lives or their neighborhood, affects individual health. There is considerable literature on the impact of neighborhood factors and a wide range of cancer-related outcomes from prevention and early detection [1][2][3] to survivorship [4,5]. Studies have more recently begun to examine multilevel models of the role of individual and neighborhood factors in cancer-related outcomes [5][6][7]. ...
Background:
Recent years have seen increased interest in the role of neighborhood factors in chronic diseases such as cancers. Less is known about the role of neighborhood factors beyond individual demographics such as age or education. It is particularly important to examine neighborhood effects on health among African American men and women, considering the disproportionate impact of cancer on this group. This study evaluated the unique contribution of neighborhood characteristics (e.g., racial/ethnic diversity, income) beyond individual demographics, to cancer control behaviors in African American men and women.
Methods:
Individual-level data were drawn from a national survey (N = 2,222). Participants' home addresses were geocoded and merged with neighborhood data from the American Community Survey. Multi-level regressions examined the unique contribution of neighborhood characteristics beyond individual demographics, to a variety of cancer risk, prevention, and screening behaviors.
Results:
Neighborhood racial/ethnic diversity, median income, and percentage of home ownership made modest significant contributions beyond individual factors, in particular to smoking status where these factors were associated with lower likelihood of smoking (ps < .05). Men living in neighborhoods with older residents, and greater income and home ownership were significantly more likely to report prostate specific antigen testing (ps < .05). Regional analyses suggested different neighborhood factors were associated with smoking status depending on the region.
Conclusion:
Findings provide a more nuanced understanding of the interplay of social determinants of health and neighborhood social environment among African American men and women, with implications for cancer control interventions to eliminate cancer disparities.
... For priority clinical preventive services, such as cancer screening, knowledge of the attributes of patients' neighborhoods might illuminate variations in adherence to screening recommendations. Although population surveys have identified associations between respondents' characterization of their neighborhoods and cancer screening (8,9), studies using place-based measures have yielded inconsistent results (10). ...
Introduction:
Assessing individual social determinants of health in primary care might be complemented by consideration of population attributes in patients' neighborhoods. We studied associations between cervical and colorectal cancer screening and neighborhood attributes among an African American population in Philadelphia.
Methods:
We abstracted demographic and cancer screening information from records of patients seen during 2006 at 3 federally qualified health centers and characterized patients' census tracts of residence by using census, survey, and other data to define population metrics for poverty, racial segregation, educational attainment, social capital, neighborhood safety, and violent crime. We used generalized estimating equations to obtain adjusted relative risks of screening associated with individual and census tract attributes.
Results:
Among 1,708 patients for whom colorectal cancer screening was recommended, screening was up to date for 41%, and among 4,995 women for whom cervical cancer screening was recommended, screening was up to date for 75%. After controlling for age, sex (for colorectal cancer screening), insurance coverage, and clinic site, people living in the most racially segregated neighborhoods were nearly 10% more likely than others to be unscreened for colorectal cancer. Other census tract population attributes were not associated with differences in screening levels for either cancer.
Conclusions:
The association between lower rates of colorectal cancer screening and neighborhood racial segregation is consistent with known barriers to colonoscopy among African Americans combined with effects of segregation on health-related behaviors. Recognition of the association between segregation and lower colorectal cancer screening rates might be useful in informing and targeting community outreach to improve screening.
... Our results may be subject to residual confounding by individual-level SES, as we relied on insurance payer information as a proxy measure of this important potential confounder. With respect to our survey-based social environment measures, some of the social determinants we examined have been associated with health outcomes when considered at the individual level but not as a neighborhood attribute (Leader and Michael, 2013). Finally, we did not investigate the cumulative impact of multiple neighborhood characteristics or potential interactions between neighborhood characteristics. ...
For health care providers, information on community-level social determinants of health is most valuable when it is specific to the populations and health outcomes for which they are responsible. Diabetes and hypertension are highly prevalent conditions whose management requires an interplay of clinical treatment and behavioral modifications that may be sensitive to community conditions. We used geo-linked electronic health records from 2016 of African American patients of a network of federally qualified health centers in Philadelphia, PA to examine cross-sectional associations between characteristics of patients' residential neighborhoods and hypertension and diabetes control (n = 1061 and n = 2633, respectively). Hypertension and diabetes control were defined to align with the Health Resources and Services Administration (HRSA) Uniform Data System (UDS) reporting requirements for HRSA-funded health centers. We examined associations with nine measures of neighborhood socioeconomic status (poverty, education, deprivation index), social environment (violent crime, perceived safety and social capital, racial segregation), and built environment (land-use mix, intersection density). In demographics-adjusted log-binomial regression models accounting for neighborhood-level clustering, poor diabetes and hypertension control were more common in highly segregated neighborhoods (i.e., high proportion of African American residents relative to the mean for Philadelphia; prevalence ratio = 1.27 [1.02-1.57] for diabetes, 1.22 [1.12-1.33] for hypertension) and less common in more walkable neighborhoods (i.e., higher retail land use). Neighborhood deprivation was also weakly associated with poor hypertension control. An important consideration in making geographic information actionable for providers is understanding how specific community-level determinants affect the patient population beyond individual-level determinants.
... The neighborhood may influence willingness to consume healthcare [25,43]. For instance, the level of social capital, including social norms and values in a neighborhood may motivate people to seek out and use (preventive) healthcare, such as screening for colorectal cancer [47]. In neighborhoods with higher levels of social capital, information may be accessible and spread more easily ( [43], page 1190). ...
Background:
We propose using neighborhood characteristics as demand-related morbidity adjusters to improve prediction models such as the risk equalization model.
Results:
Since the neighborhood has no explicit 'place' in healthcare demand models, we have developed the "Neighborhood and healthcare utilization model" to show how neighborhoods matter in healthcare utilization. Neighborhood may affect healthcare utilization via (1) the supply-side, (2) need, and (3) demand for healthcare - irrespective of need. Three pathways are examined in detail to explain how neighborhood characteristics influence healthcare utilization via need: the physiological, psychological and behavioral pathways. We underpin this theoretical model with literature on all relevant neighborhood characteristics relating to health and healthcare utilization.
Conclusion:
Potential neighborhood characteristics for the risk equalization model include the degree of urbanization, public and open space, resources and facilities, green and blue space, environmental noise, air pollution, social capital, crime and violence, socioeconomic status, stability, and ethnic composition. Air pollution has already been successfully tested as an important predictive variable in a healthcare risk equalization model, and it might be opportune to add more neighborhood characteristics.
... In the general population, low cancer screening utilization has been mainly linked with individual factors such as older age, low income, less educated, low health literacy, lack of health insurance, lack of social support, and culture-related health belief [5][6][7][8]. Furthermore, a few studies highlight the importance of neighborhood-level factors on cancer screening behaviors [9,10]. Neighborhood features characterize the entire community contexts and impact the whole neighborhood. ...
This study aims to examine the association between neighborhood cohesion and cancer screening utilization in a community-dwelling Chinese American older population. Data were drawn from the Population Study of Chinese Elderly including 3159 Chinese American older adults aged 60 and above in the greater Chicago area. Cancer screening utilization was assessed by asking whether participants had undergone colon, breast, cervical, or prostate cancer screening. Neighborhood cohesion was measured through six questions. Logistic regression analysis showed that greater neighborhood cohesion was associated with higher likelihood of utilizing a mammogram (OR 1.32, 95% CI 1.14-1.52), a Pap test (OR 1.22, 95% CI 1.06-1.41), but not of a blood stool test (OR 1.10, 95% CI 0.98-1.23), a colonoscopy (OR 1.05, 95% CI 0.94-1.17), and a PSA test (OR 1.13, 95% CI 0.95-1.34). This study suggests positive associations between neighborhood cohesion and breast and cervical cancer screening utilization among a Chinese American older population.
... Social capital, a significant determinant of health, has been linked to health behaviors, including cancer screening (Leader & Michael, 2013). Dean and colleagues found that African American women 40 years and older who perceived that their neighborhoods had high social capital were more likely to receive a mammogram (Dean et al., 2014). ...
Background:
Neighborhood disorder, signs of physical and social disorganization, has been related to a range of poor mental and physical health outcomes. Although individual factors have been widely associated with getting a mammogram, little is known about the impact of the neighborhood environment on a woman's decision to get a mammogram.
Methods:
In a sample of women at risk for human immunodeficiency virus and sexually transmitted infections, we explored the role of perceptions of one's neighborhood on getting a mammogram. The study included two samples: women 40 to 49 years (n = 233) and women 50 years and older (n = 83). Data were collected from May 2006 through June 2008.
Results:
Women age 50 years and older who lived in a neighborhood with disorder were 72% less likely to get a mammogram compared with women who lived in neighborhoods without disorder. There was no relationship for women age 40 to 49 years.
Conclusions:
Interventions are needed to increase awareness and encourage women living in neighborhoods with disorder to get a mammogram. In addition to interventions to increase mammography, programs are needed to decrease neighborhood disorder. Increasing neighborhood cohesion, social control, and empowerment could integrate health promotion programs to both reduce disorder and increase health behaviors.
... But, census level measures of neighborhood status may not reflect the beliefs and perceptions that individuals have about where they live. Recent research has shown that how individuals perceive their social environment is important to cancer screening; greater levels of social capital were associated with an increased likelihood of being screened, particularly for CRC [11]. We recently found that perceptions of the social environment are important to preventive health behaviors in a community sample of African Americans [12]. ...
Social determinants are important to cancer screening among African Americans. To evaluate the association between social determinants (e.g., psychological characteristics, perceived social environment, cultural beliefs such as present temporal orientation) and colorectal cancer (CRC) screening among African Americans. African American adults (n = 262) ages 50-75 completed a telephone interview. Multivariate logistic regression analysis was used to identify factors having significant independent associations with CRC screening. Only 57 % of respondents reported having CRC screening. The likelihood of screening increased with greater neighborhood satisfaction (OR = 1.38, 95 % CI = 1.01, 1.90, p = 0.04), older age (OR = 1.75, 95 % CI = 1.24, 2.48, p = 0.002), greater self-efficacy (OR = 2.73, 95 % CI = 1.40, 5.35, p = 0.003), and health care provider communication (OR = 10.78, 95 % CI = 4.85, 29.94, p = 0.0001). Community resources are important precursors to CRC screening and outcomes among African Americans. In addition to addressing psychological factors and patient-provider communication, efforts to ensure the availability of quality health care facilities that provide CRC screening in the neighborhoods where African Americans live are needed.
... As block parties are most relevant to Black neighborhoods, interventionists may consider them an entry point to encourage health behaviors that can reduce health disparities in diseases for which Blacks are at higher risk, and for which disparities have persisted despite existing interventions. For example, there is some evidence that social capital is related to more cancer screening behaviors (Leader & Michael, 2013), which applies in Black neighborhoods (L. L. T. Dean et al., 2014). ...
While other indicators of social capital have been linked to health, the role of block parties on health in Black neighborhoods and on Black residents is understudied. Block parties exhibit several features of bonding social capital and are present in nearly 90% of Philadelphia's predominantly Black neighborhoods. This analysis investigated: (1) whether or not block parties are an indicator of bonding social capital in Black neighborhoods; (2) the degree to which block parties might be related to self-rated health in the ways that other bonding social indicators are related to health; and (3) whether or not block parties are associated with average self-rated health for Black residents particularly. Using census tract-level indicators of bonding social capital and records of block parties from 2003 to 2008 for 381 Philadelphia neighborhoods (defined by census tracts), an ecological-level propensity score was generated to assess the propensity for a block party, adjusting for population demographics, neighborhood characteristics, neighborhood resources and violent crime. Results indicate that in multivariable regression, block parties were associated with increased bonding social capital in Black neighborhoods; however, the calculation of the average effect of the treatment on the treated (ATT) within each propensity score strata showed no effect of block parties on average self-rated health for Black residents. Block parties may be an indicator of bonding social capital in Philadelphia's predominantly Black neighborhoods, but this analysis did not show a direct association between block parties and self-rated health for Black residents. Further research should consider what other health outcomes or behaviors block parties may be related to and how interventionists can leverage block parties for health promotion.
Copyright © 2015 Elsevier Ltd. All rights reserved.
... Recognizing the need for increasing preventive screenings among Black men, religious organizations, civic organizations, and community groups serving Black men have worked to promote screenings (Dean & Gilbert, 2013;Holt et al., 2009;Jakes, 2013;Moran, 2013;Simons, 2012;Wilson, 2013). The role of those organizations point to a direct usage of social capital to promote screening; however, social capital itself has not been explored as a contributor to promoting screening (Leader & Michael, 2013). ...
Despite higher rates of prostate cancer-related mortality and later stage of prostate cancer diagnosis, Black/African American men are significantly less likely than non-Hispanic White men to use early detection screening tools, like prostate-specific antigen (PSA) testing for prostate cancer. Lower screening rates may be due, in part, to controversy over the value of prostate cancer screenings as part of routine preventive care for men, but Black men represent a high-risk group for prostate cancer that may still benefit from PSA testing. Exploring the role of social factors that might be associated with PSA testing can increase knowledge of what might promote screening behaviors for prostate cancer and other health conditions for which Black men are at high risk. Using multilevel logistic regression, this study analyzed self-report lifetime use of PSA test for 829 Black men older than 45 years across 381 Philadelphia census tracts. This study included individual demographic and aggregated social capital data from the Public Health Management Corporation's 2004, 2006, and 2008 waves of the Community Health Database, and sociodemographic characteristics from the 2000 U.S. Census. Each unit increase in community participation was associated with a 3 to 3.5 times greater likelihood of having had a PSA test (odds ratio = 3.35). Findings suggest that structural forms of social capital may play a role in screening behaviors for Black men in Philadelphia. A better understanding of the mechanism underlying the link between social capital and screening behaviors can inform how researchers and interventionists develop tools to promote screening for those who need it.
Objective:
The objective of this study is to analyse the socio-spatial patterns of breast cancer screening across Australian regions.
Methods:
The research is an ecological study. Data for breast screening participation and associated social and demographic factors are obtained from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics. The unit of measurement for the analysis is spatially aggregated regions (Statistical Area 3). Geographically weighted regression is used to analyse the relationship between a dependent variable and one or more independent variables while considering the spatial or geographic relationships among the data points.
Results:
Globally, there was a significant (p<0.05) association between screening participation and income, English ability, education level, Indigenous background, and transport availability. The geographically weighted regression model represented an improved fit with a higher R2 (R2=0.89) and the Akaike information criterion (AIC) has improved, (AIC= 391.92). The Monte-Carlo tests for spatial variability were significant for all independent variables (p<0.05). Visually, there was marked spatial variation in the association between breast cancer screening rates and the significant independent variables from the global model.
Conclusion:
The identification of significant spatial variability in the association between breast cancer screening participation and important social and demographic factors provides important input into the design of programs aimed at increasing participation in screening regimes.
Background:
Patient participation in clinical trials is influenced by demographic and other individuallevel characteristics. However, there is less research on the role of geography and neighborhood-level factors on clinical trial participation. This study identifies the demographic, clinical, geographic, and neighborhood predictors of consenting to a clinical trial among cancer patients at a large, urban, NCI-designated cancer center in the Mid-Atlantic region.
Methods:
We used demographic and clinical data from patients diagnosed with cancer between 2015 and 2017. We geocoded patient addresses and calculated driving distance to the cancer center. Additionally, we linked patient data to neighborhood-level educational attainment, social capital and cancer prevalence. Finally, we used generalized linear mixed-effects conditional logistic regression to identify individual and neighborhood-level predictors of consenting to a clinical trial.
Results:
Patients with higher odds of consenting to trials were: Non-Hispanic White, aged 50-69, diagnosed with breast, GI, head/neck, hematologic, or certain solid tumor cancers, those with cancers at regional stage, never/former tobacco users, and those with the highest neighborhood social capital index. Patients who lived further from the cancer center had higher odds of consenting to a trial. With every 1-km increase in residential distance, there was a 4% increase in the odds that patients would consent to a trial. Neither of the additional neighborhood-level variables predicted consenting to a clinical trial.
Conclusions:
This study identifies important demographic, patient-level, and geographic factors associated with consenting to cancer clinical trials, and lays the groundwork for future research exploring the role of neighborhood-level factors in clinical trial participation.
Meeting the health needs of Americans must change as the population continues to live longer. A strategy that considers social well‐being is necessary. One way to improve social well‐being is through increased social capital, which includes networks among individuals and norms of reciprocity and trust between them. Supporting attainment of bonding social capital from close‐knit groups, such as family, and bridging or linking social capital from those who are dissimilar are vital. Research shows there is a relationship among social capital and self‐reported mental and physical health, health behaviors, healthcare utilization, and mortality. Because older adults are often dependent on others for their healthcare needs, it is posited that social capital plays a key role. Nurses can be instrumental in investigating levels of social capital for individuals and determining what type of social support is needed and who in the individual's network will provide that support. When support is absent, the nurse serves as the link between patients and available resources. The purpose of this article is to introduce a conceptual framework that can assist nurses and other healthcare providers to consider social capital in older adults in the context of relationships and the social environments to which they belong.
Evaluate associations of neighborhood social capital and mobility of older adults.
A community-based survey (Philadelphia, 2010) assessed mobility (Life-Space Assessment [LSA]; range = 0-104) of older adults (n = 675, census tracts = 256). Social capital was assessed for all adults interviewed from 2002-2010 (n = 13,822, census tracts = 374). Generalized estimating equations adjusted for individual- and neighborhood-level characteristics estimated mean differences and 95% confidence intervals (CIs) in mobility by social capital tertiles. Interactions by self-rated health, living arrangement, and race were tested.
Social capital was not associated with mobility after adjustment for other neighborhood characteristics (mean difference for highest versus lowest tertile social capital = 0.79, 95% CI = [-3.3, 4.8]). We observed no significant interactions. In models stratified by race, Black participants had higher mobility in high social capital neighborhoods (mean difference = 7.4, CI = [1.0, 13.7]).
Social capital may not contribute as much as other neighborhood characteristics to mobility. Interactions between neighborhood and individual-level characteristics should be considered in research on mobility.
© The Author(s) 2014.
We examined how different dimensions of social capital (i.e., family and friend connections, neighborhood and family cohesion, family conflict) were associated with smoking behavior among a nationally representative sample of Asian American men and whether the associations varied by ethnic group.
The sample consisted of 998 adult Asian American men who participated in the National Latino and Asian American Survey from 2002 to 2003. We conducted weighted multivariate logistic regressions on data for the sample and for each of 4 ethnic subgroups (Chinese, Vietnamese, Filipino, and Other).
Vietnamese American men had the highest prevalence of current smoking; Chinese American men, the lowest. After controlling for sociodemographics, socioeconomic status, acculturation, and perceived discrimination, neighborhood cohesion was inversely associated with smoking among Asian American men, and family and friend connections and family cohesion were not. An exception was family cohesion, which was associated with increased odds of smoking among Filipino American men.
The relationship between social capital and smoking among Asian American men varied according to specific dimensions of social capital and was ethnicity specific. These findings highlight the need for smoking prevention and cessation interventions to take into consideration the heterogeneity that exists among Asian Americans.
Although there is increasing evidence supporting the associations between social capital and health, less is known of potential effects in Latin American countries. Our objective was to examine associations of different components of social capital with self-rated health in Colombia. The study had a cross-sectional design, using data of a survey applied to a nationally representative sample of 3025 respondents, conducted in 2004-2005. Stratified random sampling was performed, based on town size, urban/rural origin, age, and sex. Examined indicators of social capital were interpersonal trust, reciprocity, associational membership, non-electoral political participation, civic activities and volunteering. Principal components analysis including different indicators of social capital distinguished three components: structural-formal (associational membership and non-electoral political participation), structural-informal (civic activities and volunteering) and cognitive (interpersonal trust and reciprocity). Multilevel analyses showed no significant variations of self-rated health at the regional level. After adjusting for sociodemographic covariates, interpersonal trust was statistically significantly associated with lower odds of poor/fair health, as well as the cognitive social capital component. Members of farmers/agricultural or gender-related groups had higher odds of poor/fair health, respectively. Excluding these groups, however, associational membership was associated with lower odds of poor/fair health. Likewise, in Colombians with educational attainment higher than high school, reciprocity was associated with lower odds of fair/poor health. Nevertheless, among rural respondents non-electoral political participation was associated with worse health. In conclusion, cognitive social capital and associational membership were related to better health, and could represent important notions for health promotion. Human rights violations related to political violence and gender based discrimination may explain adverse associations with health.
To examine the association between individual-level social capital and physical activity.
In February 2009, data were collected in a population-based cross-sectional survey in Okayama city, Japan. A cluster-sampling approach was used to randomly select 4,000 residents from 20 school districts. A total of 2260 questionnaires were returned (response rate: 57.4%). Individual-level social capital was assessed by an item inquiring about perceived trust of others in the community (cognitive dimension of social capital) categorized as low trust (43.0%), mid trust (38.6%), and high trust (17.3%), as well as participation in voluntary groups (structural dimension of social capital), which further distinguished between bonding (8.9%) and bridging (27.1%) social capital. Using logistic regression, we calculated the odds ratios (ORs) and 95% confidence intervals (CIs) for physical inactivity associated with each domain of social capital. Multiple imputation method was employed for missing data. Among total participants, 68.8% were physically active and 28.9% were inactive. Higher trust was associated with a significantly lower odds of physical inactivity (OR = 0.58, 95% CI = 0.42-0.79) compared with low trust. Both bridging and bonding social capital were marginally significantly associated with lower odds of physical inactivity (bridging, OR = 0.79, 95% CI = 0.62-1.00; bonding, OR = 0.71, 95% CI = 0.48-1.03) compared with lack of structural social capital.
Low individual-level social capital, especially lower trust of others in the community, was associated with physical inactivity among Japanese adults.
To examine whether specific dimensions of social capital are related to self-rated health and psychological well-being.
Cross-sectional data from a health survey representing the adult Finnish population (N = 8,028) were used. Logistic regression analysis was used to reveal and quantify the possible associations between three dimensions of social capital (social support; social participation and networks; trust and reciprocity) and two general health indicators (self-rated health and psychological well-being). The roles of age, gender, education, living arrangements, income, type of region, functional capacity, and long-standing illness were also assessed.
Good self-rated health was associated with high levels of social participation and networks and trust and reciprocity, but social support did not remain statistically significant after adjustment for socio-demographic factors, long-standing illness, and functional capacity. The association between social support and psychological well-being was explained by the other two dimensions of social capital. The strong positive association between trust and psychological well-being persisted after controlling for all the other factors in our model.
Our findings suggest that trust and reciprocity and social participation and networks contribute to good self-rated health and psychological well-being.
This article describes the influences of social context on women's health behavior through illustration of the powerful influences of social capital (the benefits and challenges that accrue from participation in social networks and groups) on experiences and perceptions of self-efficacy. The authors conducted inductive interviews with Latino and Filipino academics and social service providers and with U.S.-born and immigrant Latinas and Filipinas to explore direct and indirect influences of social context on health behaviors such as mammography screening. Iterative thematic analysis identified themes (meanings of efficacy, spheres of efficacy, constraints on efficacy, sources of social capital, and differential access to and quality of social capital) that link the domain of social capital with the behavioral construct perceived self-efficacy. The authors conclude that social capital addresses aspects of social context absent in the current self-efficacy construct and that these aspects have important implications for scholars' and practitioners' understandings of health behavior and intervention development.
The state of public health in Russia is undoubtedly poor compared with other European countries. The health crisis that has characterised the transition period has been attributed to a number of factors, with an increasing interest being focused on the impact of social capital - or the lack of it. However, there have been relatively few studies of the relation between social capital and health in Russia, and especially in Moscow. The aim of this study is to examine the relationship between social capital and self-rated health in Greater Moscow. The study draws on data from the Moscow Health Survey 2004, where 1190 Muscovites were interviewed. Our results indicate that among women, there is no relationship between any form of social capital and self-rated health. However, an association was detected between social capital outside the family and men's self-rated health. Men who rarely or never visit friends and acquaintances are significantly more likely to report less than good health than those who visit more often. Likewise, men who are not members of any voluntary associations have significantly higher odds of reporting poorer health than those who are, while social capital in the family does not seem to be of importance at all. We suggest that these findings might be due to the different gender roles in Russia, and the different socializing patterns and values embedded in them. In addition, different forms of social capital provide access to different forms of resources, influence, and support. They also imply different obligations. These differences are highly relevant for health outcomes, both in Moscow and elsewhere.
We sought to explore the relationship between social networks and colorectal cancer (CRC) screening among males and females.
We examined 960 men and 1,947 women aged 50 years or older who participated in the 2005 Health Information National Trends Survey.
Bivariate analysis showed that lower levels of social integration were associated with a lower likelihood of CRC screening for both genders. After controlling for sociodemographic variables, the level of social integration remained independently associated with CRC screening. The link between each component of social networks and CRC screening was also examined. Among men, those who did not have friends/family to talk to about their health were less likely to be screened (OR 0.48, 95% CI: 0.30-0.77). Among women, those who were unmarried (OR 0.67, 95% CI: 0.41-0.93), those who did not have friends/family to talk to about their health (OR 0.62, 95% CI: 0.43-0.77), and those who were not a member of any community organizations (OR 0.58, 95% CI: 0.43-0.90) were less likely to be screened.
For both men and women, individuals who were socially isolated were less likely to get CRC screening compared with individuals who were less isolated. The observed gender differences indicate the need for investigation of the social context and the meaning of elements of social networks in men and women.
The objective of this study was to determine the effectiveness of interventions targeted at providers to enhance the use of mammography. We performed a meta-analysis and included United States studies that used a randomized or nonrandomized concurrent control design, had defined outcomes, and presented data that could be abstracted for reanalysis. Interventions were classified as behavioral, cognitive, or sociological and further categorized by the type of control group (active versus usual care). Data were combined using DerSimonian and Laird random effects models to yield summary effect sizes. Thirty-five studies met the inclusion criteria. All types of interventions targeted at providers were effective in increasing mammography rates. Behavioral interventions increased screening by 13.2% [95% confidence interval (CI), 7.8-18.4] as compared with usual care and by 6.8% (95% CI, 4.8-8.7) as compared with active controls. Cognitive intervention strategies improved mammography rates by 18.6% (95% CI, 12.8-24.4). Sociological interventions also had a similar magnitude of effect on screening rates (13.1% increase; 95% CI, 6.8-19.3). Interventions targeting both patients and providers were not significantly better at increasing screening than those targeting providers alone, and multiple approaches (e.g., behavioral and cognitive) were generally not more effective than a single approach. All interventions targeted at physicians were effective in increasing screening rates. Decisions to use a particular approach will depend on resources, expertise, feasibility, and cost effectiveness.
To examine the relationship between women's reported social support and their adherence to recommended breast cancer screening guidelines.
Descriptive, cross-sectional survey.
Community women's organizations throughout the San Francisco Bay Area.
833 mostly low-income women with a mean age of 46.2 years from three racial or ethnic groups (i.e., Latina, Caucasian, and African American) who were not breast cancer survivors.
Social support was measured with a five-item, four-point, Likert scale developed for the study (Cronbach's alpha = 0.7248). Adherence to screening guidelines was measured by asking frequency of performing breast self-examination (BSE) and frequency of obtaining a clinical breast examination (CBE) and a mammogram. Research assistants and leaders of women's organizations conducted the survey in work and community settings.
Social support, performance of BSE, obtaining a CBE and a mammogram, income, education, spoken language, and level of acculturation.
Higher levels of social support were related to higher income and higher education. Lower levels of social support were associated with being Latina, completing the survey in Spanish, and being born abroad. Women who did not adhere to screening guidelines (for BSE or CBE) reported less social support.
Social support is associated with adherence to breast cancer screening guidelines.
Nurses should assess women's levels of social support as a factor when evaluating adherence to breast cancer screening guidelines.
Direct and interactive effects of social support, social burden (caregiving, negative life events, and social strain), education, and income on repeated use of breast cancer screening among a large (N=55,278), national sample of postmenopausal women participating in the Women's Health Initiative observational study were examined. Repeated screening decreased as emotional/informational support and positive social interactions decreased (ps<.01). Repeated mammography decreased with frequent caregiving (p<.01). Less social strain reduced the frequency of repeated breast self-examinations (BSEs; ps<.01), but frequent caregiving and more negative life events increased repeated use of BSE (ps<.01). Interactive effects suggested that emotional/informational but not tangible support is associated with repeated mammography and clinical breast examinations (ps<.01) and may be particularly important among low-income older women, especially those burdened by caregiving.
Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States, with African Americans having the highest incidence and mortality of all racial and ethnic groups. CRC screening is widely recommended but remains underused, especially in minority populations. This study's purpose was to enhance our understanding of factors contributing to low screening rates among patients from a variety of racial and ethnic groups.
We conducted individual interviews with 30 participants, ages 50 or above, with an equal number of African Americans, Hispanics, and whites at a university-based family medicine clinic. We used open-ended interviewing techniques to elicit patient knowledge and beliefs regarding cancer, CRC, screening, and CRC screening tests.
All groups, but particularly minority groups, lack knowledge of cancer, CRC, and screening. They did not understand the concept of screening, had difficulty listing common cancer and CRC screening tests, and had trouble understanding simplified medical terms and procedure names. Patients were hopeful about the benefit of early cancer diagnosis but remained reluctant to get tested if they are symptom free.
Lack of understanding of cancer, screening, and routine terminology is a barrier to CRC screening, especially among minority groups. Effective communication strategies that address these issues may help increase CRC screening rates.
Many breast cancer outreach programs assume that dissemination of information through social networks and provision of social support will promote screening. The authors prospectively examined the relationship between social network characteristics and adherence to screening guidelines.
Employed women age 40 years and older completed baseline and 2-year follow-up assessments (N=1,475) as part of an intervention trial. The authors modeled screening adherence at follow-up as a function of social network characteristics at baseline.
Baseline adherence explained most of the variation in adherence at follow-up. For women age 40 to 51 years, having a mammogram at follow-up was predicted by encouragement by family and/or friends and subjective norms at baseline (odds ratio=2.20 and 1.18, respectively). For women age 52 years and older, the perception that screening was normative was related to adherence at follow-up (odds ratio=1.46).
Previous mammography use is strongly predictive of future screening. Social network characteristics have a modest impact on screening. Outreach efforts should focus on those who have previously underutilized mammography.
A community-based participatory research intervention, Poder es Salud/Power for Health, employed Community Health Workers who used popular education to identify and address health disparities in Latino and African American communities in a metropolitan area in the United States. We assessed participants' social capital, self-rated health, and depressive symptoms at baseline and the end of the intervention. Social support and self-rated health improved while depressive symptoms decreased. Public health interventions involving diverse communities that are designed to build upon assets, such as existing levels of social capital, may improve health in those communities.
We measured the perception of breast, cervical, and colon cancer risks and screening in diverse women to examine the association between risk perception and screening behavior.
Cross-sectional telephone and in-person interviews of women aged 50 to 80 years were conducted in English, Spanish, or Chinese. The women were recruited from primary care practices in San Francisco, California (academic general internal medicine, family medicine, women's health practices, a community-based clinic in Chinatown, and the Community Health Network Clinics, which is affiliated with the San Francisco Department of Public Health), with at least 1 visit within the previous 2 years. Perceived personal risk for each cancer was measured on a word scale (no risk to very high risk) and compared with self-reported screening behavior by ethnicity.
A total of 1160 women participated: 338 (29%) were White, 167 (14%) were African American, 239 (21%) were Latina, and 416 (36%)were Asian. The average participant was 61 years old and a high school graduate; 18% had a personal history of cancer, and 42% had a family history of cancer. The perceived lifetime risk of cancer varied by ethnicity. Compared with White women, Latinas had a higher perceived risk for cervical cancer (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.8-4.6) and colon cancer (OR, 3.0; 95% CI, 1.8-5.0) after multivariate adjustment, and Asians had a lower perceived risk for cervical cancer (OR, 0.6; 95% CI, 0.4-0.9) and colon cancer (OR, 0.6; 95% CI, 0.3-0.9). Higher colon cancer risk perception was associated with having undergone colonoscopy within 10 years (OR, 2.8; 95% CI, 1.4-5.4).
Risk perception was significantly associated with colon cancer screening behavior (P=.001). Evaluation of patients' perceived risk of cancer may be useful to clinicians who are recommending screening tests.
Using data from the 2006 Social Capital Community Survey in Duluth, Minnesota, and Superior, Wisconsin, USA, we investigate associations between individual social capital measures (attitudes on trust, formal group involvement, informal socializing, organized group interaction, social support and volunteer activity) and self-rated health after controlling for individual and economic characteristics. In particular, we address issues of social capital as an endogenous determinant of self-reported health using instrumental variables probit estimation. After accounting for the endogeneity of these various measures of individual social capital, we find that individual social capital is a significant predictor of self-rated health.
Background. The aim was to investigate whether social network and social support factors can explain socioeconomic differences in the risk of consuming low amounts of vegetables, fruit and fruit juices. Method. The Malm Diet and Cancer Study was a prospective cohort study. The present cross-sectional study examined data from a subpopulation of 11,837 individuals that completed baseline examinations in 1992-1994. Dietary habits were assessed using a modified diet history method, and socioeconomic and social network factors were measured with a structured questionnaire. Low consumption was defined as the lowest consumption quartile for vegetables and fruit, while fruit juice consumption was dichotomised to separate users from non-users. Results. Socioeconomic differences were most pronounced regarding the consumption of vegetables and fruit juices. For both sexes, unskilled manual workers had a twice as high risk of low vegetable and fruit juice consumption as higher non-manual employees. No socioeconomic differences in fruit consumption were observed for men, and only moderate differences for women with a higher consumption in higher socioeconomic groups. When the psychosocial variables were introduced in the multivariate model, social participation moderately reduced the socioeconomic differences in vegetable consumption, and the female socioeconomic differences in fruit consumption, but had no effect on the socioeconomic differences in fruit juice consumption. The other psychosocial variables had no effect on the socioeconomic differences. Conclusion. Considerable socioeconomic differences in vegetable, fruit and fruit juice consumption were observed. Social participation seemed to be a strong determinant for these food choices. However, this effect was largely independent of the socioeconomic differences. (Less)
As part of the Harvard Cancer Prevention Program Project, we sought to address disparities reflected in social class and race/ethnicity by developing and testing a behavioral intervention model that targeted fruit and vegetable consumption, red meat consumption, multivitamin intake, and physical activity in working-class, multiethnic populations.
This paper examined the associations between change in leisure-time physical activity and individual and social contextual factors in participants employed in small businesses (n = 850) at both baseline and at 18-month final.
In bivariate analyses, age, language acculturation, social ties, and workplace social capital were significantly associated with physical activity at final. In multivariable analyses, being younger and having high language acculturation were significantly associated with greater leisure-time physical activity at final; high workplace social capital was significantly associated with a decline in physical activity at final.
These findings have implications for understanding factors that are integral to promoting change in physical activity among working-class, multiethnic populations.
BACKGROUND
Cervical carcinoma is the fifth most common cancer among African American women in the U.S. Although the Papanicolaou (Pap) smear is an efficacious screening tool in the early detection of the disease, disparities are known to persist in the utilization of this procedure across socioeconomic groups.METHODS
Data regarding cervical carcinoma screening and covariates were obtained from the 59,090 Black Women's Health Study participants across the U.S. via a mailed questionnaire in 1995. Logistic regression and multilevel techniques were used to assess the independent effects of the covariates on nonrecent cervical carcinoma screening.RESULTSIn all, 8.3% of the 40,009 women in the present analysis had not undergone a Pap smear examination within the previous 2 years (nonrecent screening). Lower educational attainment, older age, obesity, smoking, and neighborhood poverty were found to be independently related to increased risk of nonrecent screening. The adjusted odds ratio for nonrecent screening was 1.2 (95% confidence interval [95% CI], 1.1–1.4) for women residing in neighborhoods with 20% or more poverty compared with those in neighborhoods with less than 5% poverty. State of residence was also associated with nonrecent cervical carcinoma screening.CONCLUSION
These results suggest that among black women, residence in high-poverty (20%) neighborhoods is associated with an increased risk of nonrecent cervical carcinoma screening, independent of individual level risk factors. Cancer 2006. © 2005 American Cancer Society.
OBJECTIVE: To perform a meta-analysis on existing randomized controlled trials to investigate the efficacy of patient letter reminders on increasing cervical cancer screening using Pap smears.
METHODS: A search was conducted for all relevant published and unpublished studies between the years 1966 and 2000. Eligibility criteria included randomized controlled studies that examined populations due for Pap smear screening. The intervention studied was in the form of a reminder letter. The Mantel-Haenszel method was used to measure the summary effect of the intervention. A test for homogeneity using the Mantel-Haenszel method was performed.
RESULTS: Ten articles fulfilled the inclusion criteria, including one unpublished study. The test for homogeneity showed evidence of heterogeneity (x
2=31, 9 df, P<.001). An analysis for causes of heterogeneity was pursued. Division into subpopulations based on socioeconomic status resolved the heterogeneity (x
2=5.2, 8 df, P=.75). The studies evaluating those in lower socioeconomic groups had a smaller response (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.99 to 1.35) than those studies using mixed populations (OR, 2.02; 95% CI, 1.79 to 2.28). The pooled odds ratio showed that patients who received the intervention were significantly more likely to return for screening than those who did not (OR, 1.64; 95% CI, 1.49 to 1.80).
CONCLUSIONS: Patient reminders in the form of mailed letters increase the rate of cervical cancer screening. Patient letter reminders have less efficacy in lower socioeconomic groups.
This paper reports on a survey (N=3344) and in-depth interviews (N=80) from four socio-economically contrasting postcode areas in Adelaide. Logistic regression was used to examine locational differences in self-rated health, controlling for demographic, socio-economic factors, health behaviours, individual social capital (social networks, support, reciprocity, trust) and perceived neighbourhood cohesion and safety. Statistically significant locational differences in health emerged. Perceived neighbourhood cohesion and safety accounted for this difference. Interviews explored perceptions of cohesion and safety and found that they were intricately related and varied between the areas. The implications of the findings for understanding locational differences in health are discussed.
As the effectiveness of cytology-based screening programme for cervical cancer in mortality reduction has reached a plateau, various preventive strategies have been considered, including intensive Pap smear screening and the supplemental use of human papillomavirus (HPV) DNA test or HPV vaccination. Cost and effectiveness of these various preventive strategies are therefore of great concern for health policy makers.
We intended to assess whether the combination of HPV DNA testing or HPV vaccination with Pap smear screening programme or the sole annual Pap smear screening is more effective and cost-effective in prevention of cervical cancer than the existing triennial Pap smear screening programme.
A Markov decision model was constructed to compare total costs and effectiveness between different preventive strategies (including annual Pap smear, HPV DNA testing or HPV vaccination together with Pap smear screening programme) as opposed to the triennial Pap smear screening alone (the comparator). Probabilistic cost-effectiveness (C-E) analysis was adopted to plot a series of simulated incremental C-E ratios scattered over C-E plane and also to yield the acceptability curve for different comparisons of strategies. The threshold of vaccine cost and the influence of attendance rate were also investigated.
Compared with triennial Pap smear screening programme, most of preventive strategies cost more but gain additional life years (quadrant I of C-E plane) except HPV DNA testing with Pap smear every 5 years dominated by triennial Pap smear screening programme. The most cost-effective strategy was annual Pap smear (incremental C-E ratio = 36 627), and vaccination programme with triennial Pap smear screening (40 000 of willingness to pay. Vaccination combined with triennial Pap smear would be as cost-effective as annual Pap smear provided the cost of vaccination was lowered to $250 per full course of injection.
Among various preventive strategies annual Pap smear screening programme is still the most cost-effective and additional HPV DNA testing is a cost-effective choice under a reasonable threshold of willingness to pay. Vaccination programme in combination with triennial screening would be cost-effective if vaccine cost can be greatly reduced in a large economic scale.
Data from the 2003 National Survey on Drug Use and Health was utilized to elucidate the relationship between individual-level social capital and illicit drug use among racial/ethnic groups. Analysis of variance indicated that Whites had different perceptions of social capital compared to other groups, in measures of social participation, neighborhood cohesion, trust, and norms of reciprocity. Logistic regression analysis showed that individual-level social capital, measured by trust and norms of reciprocity, was weakly associated with illicit drug use. However, individuals with higher social participation were less likely to have used illicit drugs ever or during the month prior to the interview. The association between social capital and illicit drug use is discussed, as well as the role of social participation in illicit drug use. Rather than an individual-level measure of social capital, future research should employ a neighborhood-level measure of social capital that aggregates neighborhood cohesion, trust, norms of reciprocity, and social participation.
Pervasive, lifelong inequalities in physical health begin in early childhood and are driven, in part, by social gradients in risk factors such as smoking and obesity. Yet not all low-income children have elevated physical-health risks as adults. The relation between income-to-needs ratio at age 9 and smoking prevalence and body fat (body mass index) at age 17 was examined in a sample of 196 rural adolescents. Income-to-needs ratio is the U.S. federal government's defined index of household income as a proportion of the poverty line. This is the first study to show that links between childhood poverty and subsequent physical-health outcomes can be loosened. At-risk youth in communities with a relatively rich array of social capital did not smoke more or have greater excess body fat compared with their more affluent counterparts.
There are several modalities available for a colorectal cancer (CRC) screening program. When determining which CRC screening program to implement, the costs of such programs should be considered in comparison to the health benefits they are expected to provide. Cost-effectiveness analysis provides a tool to do this. In this paper we review the evidence on the cost-effectiveness of CRC screening. Published studies universally indicate that when compared with no CRC screening, all screening modalities provide additional years of life at a cost that is deemed acceptable by most industrialized nations. Many recent studies even find CRC screening to be cost-saving. However, when the alternative CRC screening strategies are compared against each other in an incremental cost-effectiveness analysis, no single optimal strategy emerges across the studies. There is consensus that the new technologies of stool DNA testing, computed tomographic colonography and capsule endoscopy are not yet cost-effective compared with the established CRC screening tests.
To investigate the association between political trust in the Riksdag and lack of belief in the possibility to influence one's own health (external locus of control), taking horizontal trust into account.
The 2008 public health survey in Skåne is a cross-sectional postal questionnaire study with a 55% participation rate. A random sample of 28,198 persons aged 18-80 years participated. Logistic regression models were used to investigate the associations between political trust in the Riksdag (an aspect of vertical trust) and lack of belief in the possibility to influence one's own health (external locus of control). The multiple regression analyses included age, country of birth, education, and horizontal trust in other people.
A 33.7% of all men and 31.8% of all women lack internal locus of control. Low (external) health locus of control is more common in higher age groups, among people born outside Sweden, with lower education, low horizontal trust, low political trust, and no opinion concerning political trust. Respondents with not particularly strong political trust, no political trust at all and no opinion have significantly higher odds ratios of external locus of control throughout the multiple regression analyses.
Low political trust in the Riksdag seems to be independently associated with external health locus of control.
Despite extensive research on the relationship between social capital and health, the specific pathways through which social capital is related to health have not been fully elucidated. Moreover, research has generally been cross-sectional, particularly in Canada, and hence not clearly attentive to the causal relationship between social capital and health. In this study we have examined the importance of multiple forms of individual social capital for the functional health status of adult Canadians, employing the Canadian National Population Health Survey (NPHS). We examine changes in health between 1996 and 2000, using individual level variables from 1996 as predictors. In our final model, the key aspect of social capital affecting changes in health status is being loved by someone. This is predicted by being married, frequency of family contacts, religious service attendance and being born in Canada. Insecurity about food also has a direct effect on changes in health status. The latter is affected by income, daily smoking and age. The results suggest that policies to support family stability and family unification, for example through immigration, and efforts to minimize the disruptions of divorce could contribute to the health of Canadians.
To investigate whether workplace social capital buffers the association between job stress and smoking status.
As part of the Harvard Cancer Prevention Project's Healthy Directions--Small Business Study, interviewer-administered questionnaires were completed by 1740 workers and 288 managers in 26 manufacturing firms (84% and 85% response). Social capital was assessed by multiple items measured at the individual level among workers and contextual level among managers. Job stress was operationalized by the demand-control model. Multilevel logistic regression was used to estimate associations between job stressors and smoking and test for effect modification by social capital measures.
Workplace social capital (both summary measures) buffered associations between high job demands and smoking. One compositional item--worker trust in managers--buffered associations between job strain and smoking.
Workplace social capital may modify the effects of psychosocial working conditions on health behaviors.
Using a multilevel study design, this study examined the associations between social characteristics of individuals and neighbourhoods and physical activity among women. Women (n = 1405) recruited from 45 Melbourne (Australia) neighbourhoods of varying socioeconomic disadvantage provided data on social factors and leisure-time: physical activity; walking; and walking in one's own neighbourhood. Individual level social factors were number of neighbours known and social participation. Neighbourhood-level social characteristics (interpersonal trust, norms of reciprocity, social cohesion) were derived by aggregating survey data on these constructs within neighbourhoods. Objective data on crimes within neighbourhoods were obtained from Victoria Police. In bivariable regression models, all social variables at both the individual and neighbourhood level were positively associated with odds of physical activity, walking, and walking in one's own neighbourhood. Associations with individual social participation (associated with all three physical activity variables) and neighbourhood interpersonal trust (associated with overall physical activity only) remained significant in multivariable models. Neither neighbourhood crime against the person nor incivilities were associated with any form of physical activity. These results demonstrate that women who participated in local groups or events and, less consistently, women living in neighbourhoods where residents trusted one another, were more likely to participate in leisure-time physical activity. While redressing macro-level social and economic policies that contribute to neighbourhood inequalities remains a priority, public health initiatives aimed at promoting physical activity could consider focusing on fostering social interactions targeting both individuals and communities. Further investigation of causal mechanisms underlying these associations is required.
Although previous research provides a compelling picture of social capital's role in predicting health outcomes, only a modicum of research has tested the more detailed roles of the dimensions of bonding and bridging social capital, with no research focusing exclusively on bonding and bridging neighborliness or ethnicity. To help fill this gap in the literature, the current study measures individual-level bonding and bridging neighborliness for four U.S. ethnic groups-and then, with cross-sectional data from a 2007 national telephone survey of U.S. adults, employs ordinal logistic regression and OLS regression to test the individual-level predictors of self-rated health and stress, when controlling for BMI and demographics. Bonding neighborliness was associated with self-rated health and inversely associated with stress, whereas bridging neighborliness was not significantly linked to either health outcome. When also controlling for neighborhood composition, the bonding neighborliness findings remained generally consistent, while the association between bridging neighborliness and self-rated health gained significance. These results indicate the protective effects that bonding neighborliness can have on health outcomes, as well as the more modest protective effects of bridging neighborliness. These findings have implications for future research and practice, highlighting the potential of health interventions and policies that target the development of bonding social capital.
Neighborhood characteristics such as racial composition and social capital have been widely linked to health outcomes, but the direction of the relationship between these characteristics and health of minority populations is controversial. Given this uncertainty, we examined the relationship between neighborhood racial composition, social capital, and black all-cause mortality between 1997 and 2000 in 68 Philadelphia neighborhoods. Data from the U.S. Census, the Philadelphia Health Management Corporation's 2004 Southeast Pennsylvania Community Health Survey, and city vital statistics were linked by census tract and then aggregated into neighborhoods, which served as the unit of analysis. Neighborhood social capital was measured by a summative score of respondent assessments of: the livability of their community, the likelihood of neighbors helping one another, their sense of belonging, and the trustworthiness of their neighbors. After adjustment for the sociodemographic characteristics of neighborhood residents, black age-adjusted all-cause mortality was significantly higher in neighborhoods that had lower proportion of black residents. Neighborhood social capital was also associated with lower black mortality, with the strongest relationship seen for neighborhoods in the top half of social capital scores. There was a significant interaction between racial composition and social capital, so that the effect of social capital on mortality was greatest in neighborhoods with a higher proportion of black residents and the effect of racial composition was greatest in neighborhoods with high social capital. These results demonstrate that age-adjusted all-cause black mortality is lowest in mostly black neighborhoods with high levels of social capital in Philadelphia.
There is very good evidence that screening for breast cancer reduces mortality in women older than 50 years and suggestive but inconsistent evidence that screening is effective in reducing long-term mortality in women younger than 50 years. The probability that an average-risk woman will be diagnosed with breast cancer in the coming 10 years is about 130 in 10,000 for a 40-year-old woman, 230 in 10,000 for a 55-year-old woman, and 280 in 10,000 for a 65-year-old woman. The chance of dying from breast cancer diagnosed in the coming 10 years is about 90 in 10,000, 123 in 10,000, and 120 in 10,000 for women age 40, 55, and 65, respectively. Mathematical models based on data from controlled trials of screening programs indicate that screening annually for 10 years with breast physical examination will decrease the probability of death from breast cancer by about 25 in 10,000 for women in the three age groups and increase life expectancy by about 20 days. Adding annual mammography will decrease the probability of death from breast cancer an additional 25 in 10,000 and increase life expectancy an additional 20 days. The actual reductions in mortality observed in controlled trials are slightly lower. If women are screened annually for 10 years with breast physical examination and mammography, the chance for a false-positive result over the 10-year period is approximately 2500 in 10,000. On the population level, if 25% of women age 40 to 75 are screened annually with both examinations, deaths from breast cancer would be decreased by about 4000 in the year 2000. Net annual costs would be approximately $1.3 billion. Recommending a screening strategy requires weighing the benefits against the risks and costs.
The objective of the Forsyth County Cancer Screening Project is to assess barriers to breast and cervical cancer screening among low-income women and to develop an educational program to address these barriers. To properly assess the barriers, it was first necessary to determine if self-reported rates of breast and cervical cancer screening were accurate. All women who participated in the baseline survey (n = 555) were asked to provide information regarding if, where, and when they had obtained mammograms and Pap smears. Identified health care facilities were then contacted to verify this information. Approximately 80% of responses were verified for at least one of the exams with the information provided. For mammography, 77% of self-reports were correct, whereas 67% of self-reports of Pap smear screening were correct (kappa = 0.54 and 0.15, respectively). For both tests, women thought they had received them more recently than they actually had, by an average of 3 months for mammography and 23 months for Pap smears. Using validated reports of screening did not substantially change identified predictors of screening for mammography. For Pap smear screening, however, most of the identified predictors of screening became nonsignificant when medical chart reports were used instead of self-reports, suggesting that caution should be used in relying on self-reports to design programs to improve cervical cancer screening practices.
End points for trials promoting cancer screening are often based on self-reported screening behavior. This study was designed to evaluate and optimize the reliability of a computer-assisted telephone interview for collecting self-reported colorectal cancer screening behavior. Cases who had received a fecal occult blood test (FOBT), flexible sigmoidoscopy, and/or colonoscopy, and controls who had no record of colorectal screening were identified among 40-75-year-old members of the Denver Kaiser Permanente Health Care Program and were contacted by telephone. Sensitivities and specificities of self-reported screening were calculated by comparison of subjects' recall with Kaiser Permanente records. The questionnaire was revised based upon results of the pilot phase of the study. Using the revised questionnaire, the sensitivity of self-reported screening was 96.2% for the FOBT, 94.9% for flexible sigmoidoscopy, 88.7% for colonoscopy, and 96.2% for either endoscopic screening test. The specificity of self-reported screening was 85.9% for the FOBT, 92.2% for flexible sigmoidoscopy, 96.8% for colonoscopy, and 92.0% for either endoscopic screening test. No marked differences in the accuracy of the self-reports were detected as a function of gender, age, ethnicity, or family history of colorectal cancer of the participants. Self-reports of colon cancer screening behavior can be reliably used as end points for intervention trials when carefully phrased questions are used.
Out primary objective was to examine sociodemographic and attitudinal factors that affect uptake of the Pap smear in a multi-ethnic Asian population.
We conducted a prevalence survey among women aged 50-64 years living in Singapore and ascertained by means of an in-person questionnaire interview their Pap screening history, demographic characteristics, informal social support and attitudes towards early detection.
We found that, after adjusting for demographic variables known to be predictors of Pap screening, women who reported ever having a Pap smear were more likely to have close friends with whom they could discuss health (adjusted odds ratio (OR) 2.1, 95% confidence intervals (CI) 1.2-3.6), and have a regular physician (adjusted OR 2.3 (1.3-4.1)). Based on responses to four indices measuring health attitudes, they were significantly less likely to express a fatalistic viewpoint towards health and illness (adjusted OR for highest vs. lowest tertile 0.3 (95% CI 0.1-0.7)), and more likely to believe that early detection could improve the outcome (adjusted OR 3.3 (95% CI 1.4-7.8)). The nature of the test itself was a significant barrier to having a Pap smear, but only among women with fewer years of education.
Our results suggest that, within this Asian population, a multi-pronged approach is required to reach unscreened women. The role of physicians and close friends should be emphasized, and health messages should be formulated to address specific, relevant attitudinal barriers to Pap screening.
Evidence shows that social relationships play an important role in health and health behavior. We examined the relationship between social networks and cancer screening among four U.S. Hispanic groups.
We used telephone surveys to collect data in eight U.S. regions that have concentrations of diverse Hispanic-origin populations. We interviewed 8903 Hispanic adults, for a response rate of 83%; analysis was restricted to the 2383 women aged > or =40. As a measure of social integration, we formed a social network index from items on the number of close relatives and friends, frequency of contact, and church membership. We used logistic regression to estimate the effects of social integration on screening, adjusting for sociodemographic factors.
Among Mexican, Cuban, and Central-American women, the effect of social integration on mammography screening was slight. The odds ratios (OR) per unit change in social integration category ranged from 1.16 to 1.22 with confidence intervals (CI) that overlapped with the null. For Pap smear screening, the effect was strongest among Mexican-American women (OR=1.44, 95% CI=1.21 to 1.72), but also evident among Central-American women (OR=1.22, 95% CI=0.72 to 2.06) and Cuban women (OR = 1.25, 95% CI = 0.81 to 1.93). Among Puerto Rican women, social integration had no effect on either mammography (OR=1.03) or Pap smear screening (OR=1.08).
Independent of socioeconomic factors, social integration appears to influence cancer screening participation of Hispanic women. The modest effect is not universal across Hispanic groups and was stronger for Pap smear than for mammography screening behavior. Researchers should recognize Hispanic group differences in social network characteristics and the potential of social networks to change screening behavior.
The aim of this study was to investigate whether psychosocial resources explain socioeconomic differences in smoking cessation and its maintenance.
A subpopulation of 11,837 individuals from the Malmö Diet and Cancer Study interviewed in 1992-94, age range 45-64 years, was investigated in this cross-sectional study. A multivariate logistic regression model was used to assess relative risks of having stopped smoking, adjusting for age, country of origin, previous/current diseases, and marital status.
An odds ratio of 1.9 (1.4-2.5; 95% CI) for men and 2.0 (1.4-2.7; 95% CI) for women of having stopped smoking was found for higher non-manual employees when compared with unskilled manual workers. A decrease in these odds ratios was found when social participation was introduced into the model. The other three social network and social support variables were non-significant.
High social participation is a predictor of maintenance of smoking cessation. It seems possible to interpret parts of the socioeconomic differences in smoking cessation and its maintenance as a consequence of differing social network resources and social capital between socioeconomic groups.
Native Hawaiian women have the highest breast and cervical cancer mortality rates and lowest screening rates in Hawai'i. This paper summarizes impacts of a breast and cervical cancer screening intervention spearheaded by a Native Hawaiian community.
Six hundred seventy-eight randomly selected Native Hawaiian women completed two telephone surveys assessing their cancer screening behaviors: 318 women from a community that implemented an intervention, known as a Kokua Group, to provide culturally tailored education and support in a group setting and 360 women from communities without this intervention. The surveys were conducted before intervention implementation and 3 years later, 4 to 5 months after the last intervention session.
At posttest, intervention community women reported positive changes in 4 of 12 screening activities (P < or = 0.05), while no changes were found among controls. Some women in both communities had heard about and/or participated in Kokua Groups. Hierarchical logistic regression showed that controlling for community, demographics, and pretest scores, Kokua Group knowledge or participation was a significant predictor (P < 0.05) of 9 of 12 screening-related behaviors.
Positive changes in screening activities among women aware of the intervention support the importance of information diffusion by community consumers. Diffusion may occur beyond the boundaries of the community as defined.
Several studies have shown socioeconomic differences in leisure-time physical activity. One explanation may be socioeconomic differences in relevant psychosocial conditions. The Malmö Diet and Cancer Study is a prospective cohort study including inhabitants in Malmö, Sweden. The baseline questionnaire used in this cross-sectional study was completed by the 11,837 participants born 1926-1945 in 1992-1994. Leisure-time physical activity was measured by an item presenting a variety of activities. These activities were aggregated into a summary measure of leisure-time physical activity that takes both the intensity and duration of each specific activity into consideration. The effects of the psychosocial variables on the socioeconomic differences in leisure-time physical activity were calculated in a multivariate logistic regression analysis. The quartile with the lowest degree of leisure-time physical activity was not evenly distributed between the socioeconomic groups. Socioeconomic differences were seen as odds ratios 1.5 for skilled and 1.5 for unskilled male manual workers, compared to the high level non-manual employees. An OR 1.6 was observed for female unskilled manual workers. Self-employed men and female pensioners also had a significantly increased risk of low leisure-time physical activity. Adjustment for age, country of origin and previous/current diseases had no effect on these SES differences. Finally, adjusting for social participation almost completely erased the SES differences. Among the psychosocial variables, social participation was the strongest predictor of low physical activity, and a strong predictor for socioeconomic differences in low leisure-time physical activity. Social participation measures the individual's social activities in, for example political parties and organisations. It therefore seems possible that some of the socioeconomic differences in leisure-time physical activity are due to differing social capital between socioeconomic groups.
The purpose of this study was to identify factors that influence the effectiveness of interventions in increasing women's use of mammography screening programs. To this end, we conducted a systematic literature review of studies published between 1966 and 1997. In this review, we recorded data about the year and country in which studies were completed, the study design, the methods for measuring screening rates, various sample characteristics, the nature of the intervention, and the resulting screening rates. The PRECEDE model was used as a framework to make distinctions between the various interventions. To synthesize evidence about the baseline screening rates and the effect of interventions on the incidence of mammography screening, we fit random-effects logistic regression models. These models revealed that more recent studies (those conducted from 1990 to 1996) were associated with higher screening rates (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.9). Conversely, those designed to target older women (minimum age, 50-65 years) and those set in clinics exhibited smaller screening rates (OR, 0.6, 95% CI, 0.3-1.0, and OR, 0.5; 95% CI, 0.3-0.8, respectively). The meta-analyses also suggested methodologic issues that must be considered before the relative strength of various interventions can be assessed rigorously.
This study examines mammography-enhancing intervention studies that focus on women in groups with historically lower rates of mammography use than the general population. These groups consist of women who are disproportionately older, poorer, of racial-ethnic minorities, have lower levels of formal education, and live in rural areas. We refer to them as diverse populations. The purpose of this report is to determine which types of mammography-enhancing interventions are most effective for these diverse populations. For this report, United States and international studies with concurrent controls that reported actual receipt of mammograms (usually based on self-report) as an outcome were eligible for inclusion. Intervention effects were measured by differences in intervention and control group screening rates postintervention and were weighted to reflect the certainty of each study's contribution. These effects differed significantly (Q = 218, 34 df), and the variation between studies was best explained by indicators of the use of access-enhancing approaches. Combined intervention effects were estimated for different categories of intervention types using random effects models for subgroups of studies. The strongest combination of approaches used access-enhancing and individual-directed strategies and resulted in an estimated 27% increase in mammography use (95% confidence interval, 9.9-43.9, nine studies). Additionally impressive was the access-enhancing and system-directed combination (20% increase and 95% confidence interval, 8.2-30.6, five studies). Access-enhancing strategies are an important complement to individual- and system-directed interventions for women with historically lower rates of screening.
This paper compares psychosocial and cognitive models of socioeconomic variation in participation in screening for colorectal cancer. The psychosocial model suggests that factors such as higher stress and lower social support explain, in part, why people from lower socioeconomic status (SES) environments are less likely to participate in screening. The cognitive model suggests that beliefs about cancer risk and screening will play an important part in differential participation. In practice both sets of factors may contribute to explaining socioeconomic differentials. The data for these analyses are drawn from a randomised controlled trial of colorectal cancer screening (the UK Flexible Sigmoidoscopy Trial). The participants are from the Scottish centre, where recruitment was stratified to generate a socioeconomically diverse sample. The dependent variable was interest in attending screening. A questionnaire covering demographic status, psychosocial and cognitive factors as well as interest in screening was sent to 10,650 adults. The results showed the predicted SES gradient in interest. There were also SES differences in both psychosocial and cognitive variables. A series of logistic regression models were used to test potential mediators of the association between SES and interest in attending screening by successively including psychosocial factors, cognitive factors, and then both, in the equation. Only the inclusion of the cognitive variables significantly reduced the variation associated with SES, providing better support for the cognitive than the psychosocial model.
Ethnic differences in breast cancer screening behaviors are well established. However, there is a lack of understanding regarding exactly what causes these differences and which characteristics in low-screening populations should be targeted in an effort to modify screening behavior.
Stratified cluster sampling was used to recruit 1364 women (ages 50-70 years) from 6 ethnic groups: African-American women; U.S.-born white women; English-speaking Caribbean, Haitian, and Dominican women; and immigrant Eastern-European women. In interviews, respondents provided information concerning demographic and structural variables related to mammogram utilization (age, education, income, marital status, physician recommendation, access, and insurance) and a set of cognitive variables (fatalism, perception of personal risk, health beliefs concerning cancer) and socioemotional variables (stress, cancer worry, embarrassment, and pain).
For data analysis, the authors used a 2-step logistic regression with frequency of mammograms over a 10-year period (< or = 4 mammograms over 10 years or > or = 5 mammograms over 10 years) as a dependent variable. U.S.-born African-American women and Dominican women were screened as frequently as European-American women, but the remaining minority groups were screened with less frequency. With one exception, ethnicity ceased to predict screening frequency once cognitive and emotional variables were controlled.
Although women from clearly operationalized ethnic groups continue to screen at rates substantially below those of the majority groups, these differences appear to be explained substantially by differences in psychologic variables. This is encouraging because, rather than targeting culture for intervention, variables can be targeted that are amenable to change, such as emotions and beliefs.
OBJECTIVES The study tested a behavioral and structural barriers model of breast cancer screening, while seeking to determine age effects of behavioral barriers, in order to identify the factors that inhibit screening among older, minority women.
405 older African-American women eligible for a federally funded cancer screening program were enrolled in the study. Participants were administered an intake questionnaire and followed for 3 months to determine mammography use.
Three months after enrollment in the program, 79% had not received breast cancer screening. The oldest cohort had significantly lower rates of mammography (just 16% of screened women were > or = 60, p<0.05). Behavioral barriers (knowledge/information deficits, cancer risk perception, cancer fears) inhibited mammography in the oldest group; their breast cancer information deficits included less knowledge of breast cancer risk, treatment, and survivability (all p<0.001).
Older women, with greater breast cancer risk than younger cohorts, should be targeted as a high need population for cancer screening. Even when financial and insurance barriers are removed mammography rates are 1/3 those of women <50. Since failure to be screened is related to knowledge and information barriers, health care providers have the potential to educate their older patients and subsequently increase the likelihood they will have regular cancer screening.
A growing number of studies have suggested a link between social capital and health. However, the association may reflect confounding by factors, such as personality or early childhood environment, that are unmeasured prior common causes of both social capital and health outcomes. The purpose of this study was to investigate the impact of social capital on physical and mental health among adult twins in the U.S.
A cross-sectional national survey of twins within the National Survey of Midlife Development in the U.S. (MIDUS), 1995--1996 was analyzed in 2007. The study population included 944 twin pairs (37.2% monozygotic [MZ] and 62.8% dizygotic [DZ]). Data were obtained on individual-level social capital variables (social trust, sense of belonging, volunteer activity, and community participation); health outcomes (perceived physical and mental health, depressive symptoms and major depression); and individual covariates (age, gender, race, education, working status, and marital status). A fixed-effects model was used to examine health status among twin pairs who were discordant on levels of social capital.
In the individual data analysis, social trust, sense of belonging, and community participation were each significantly associated with health outcomes. In the fixed-effects model, physical health remained significantly positively associated with social trust among MZ and DZ twins. However, major depression was not associated with social capital.
The present study is the first to find the independent positive effect of social trust on self-rated physical health using fixed-effects models of twin data. The results suggest that the association between social capital and physical health status is not explained by unobserved confounds, such as personality or early childhood environment.