RESUMO
Geographic location of a patient directly impacts access to care, including preventive screenings and early detection. Although there is a higher prevalence of the most common cancers in urban areas, mortality rates are higher in rural communities. Notably, indigenous communities residing on tribal lands often experience heightened access issues and environmental exposure to known and probable human carcinogens. The burdens associated with a cancer diagnosis can be exacerbated by various barriers to accessing quality care; however, there are emerging best practices to overcome these barriers. Understanding the interplay between geography and a patient's access to cancer care services is crucial for addressing existing disparities and ensuring equitable health care provision across regions. By leveraging innovative policy and practice solutions, communities can begin to close care gaps and establish bidirectional trust between patients and providers across the care continuum, which is necessary to enact meaningful reforms. To advance the conversation on geographic disparities and strategies that mitigate associated barriers to care, NCCN hosted the Policy Summit "Cancer Across Geography" on June 15, 2023, at the National Press Club in Washington, DC. Through keynote addresses and multistakeholder panel discussions, this hybrid event explored care imbalances across geography, recent policy and technology advancements, and current challenges associated with cancer care. This created a forum for a diverse group of attendees to thoughtfully discuss policies and practices to advance high-quality, effective, efficient, equitable, and accessible cancer care for all. Speakers and attendees featured multidisciplinary clinicians, epidemiologists, community oncologists, researchers, payers, patient advocates, industry, providers, policymakers, and leaders representing underserved communities, among others.
Assuntos
Acessibilidade aos Serviços de Saúde , Neoplasias , Humanos , Neoplasias/terapia , Neoplasias/epidemiologia , Neoplasias/diagnóstico , Acessibilidade aos Serviços de Saúde/normas , Disparidades em Assistência à Saúde , Política de Saúde , GeografiaRESUMO
While there is a growing interest in the development of cancer control intervention initiatives, there continues to be a need to understand how the nuances of different Latino cultures translate to opportunities and barriers for access to cancer screening and care. The diversity by country of origin for Latinas in the United States is often overlooked in cancer control initiatives, and the application of qualitative research can expose processes of inequity and cultural variation to improve these initiatives. This paper presents an interpretation of diverse Latina immigrants' perceptions, experiences and knowledge about breast and cervical cancer screening and demonstrates the use of the PEN-3 model to analyze these data to develop an effective outreach intervention. We conducted 13 focus groups consisting of a total of 112 Latinas in New York City (nine groups) and rural and urban sites in Arkansas (four groups) in 2003 through 2004. Through nonprobability theoretical sampling, we included women from Puerto Rico, the Dominican Republic and Mexico in New York and recent Mexican immigrants in Arkansas. Findings demonstrated that country of origin and current geographic residency in the U.S. were significant determinants of women's perspectives on community-based religious organizations, knowledge of anatomy, experiences with the medical system, and access to services which are essential factors to consider in developing effective cancer control interventions. Although breast and cervical cancer are considered women's health issues, they cannot be addressed outside the sociopolitical structures of local communities, especially for the most recent immigrant women. Applying the PEN-3 framework to these data demonstrated a valuable method to interpret and transform qualitative data into intervention content and structure that responds to characteristics and perspectives within diverse Latino communities, such as gender relations, religious affiliations and experiences.
Assuntos
Neoplasias da Mama/etnologia , Cultura , Detecção Precoce de Câncer/psicologia , Emigrantes e Imigrantes/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Hispânico ou Latino/psicologia , Neoplasias do Colo do Útero/etnologia , Adulto , Arkansas , Neoplasias da Mama/prevenção & controle , Diversidade Cultural , República Dominicana/etnologia , Feminino , Grupos Focais , Acessibilidade aos Serviços de Saúde , Humanos , México/etnologia , Pessoa de Meia-Idade , Cidade de Nova Iorque , Porto Rico/etnologia , Pesquisa Qualitativa , Neoplasias do Colo do Útero/prevenção & controleRESUMO
INTRODUCTION: Hispanics are the fastest growing demographic group in the United States; however, "Hispanic" is a broad term that describes people who are from or whose ancestors are from multiple countries of origin. This study examines, separately, the social, cultural, and behavioral factors associated with overweight and obesity among Mexican American adults and among Central American adults. METHODS: To estimate the prevalence of overweight and obesity among Mexican and Central Americans living in California, we conducted a cross-sectional analysis of data from the 2001 California Health Interview Survey using SUDAAN software to account for the survey's multistage sampling design. RESULTS: Of the 8304 Mexican Americans participating in the survey, 36.8% were overweight and 26.2% were obese. Of the 1019 Central Americans, 39.2% were overweight and 22.2% were obese. Among Mexican American men, age and marital status were associated with overweight and obesity; and education, acculturation, health insurance status, health status, and use of vitamins were associated with obesity only. Among Mexican American women, age, education, number of children, health status, and health behavior were associated with overweight and obesity. Among Central American men, age, education, and access to health care were associated with overweight, whereas marital status, acculturation, health care, and binge drinking were associated with obesity. Among Central American women, number of children was associated with overweight and obesity; and age and education were associated with obesity only. CONCLUSION: Our findings of high rates of overweight and obesity among Mexican and Central Americans in California indicate the need for a wide variety of effective weight-loss interventions targeting these populations, and the differences we found in the factors associated with overweight and obesity may suggest the need for unique intervention strategies for different Hispanic subgroups.