Transcript Addressing Cancer Disparities in Minority Communities

Addressing Cancer Disparities in Minority
Communities: Hispanics/Latinos
Marielos L. Vega, BSN, RN; Stanley H. Weiss, MD;
Ping-Hsin Chen, PhD; Jeanne Ferrante, MD; Ana NatalePereira, MD, MPH; Sue Rovi, PhD; Steven K. Keller, PhD;
Mark S. Johnson, MD, MPH
UMDNJ-New Jersey Medical School
Dept. Family Medicine, Dept. Preventive Medicine &
Community Health/Epidemiology, and Dept. Internal Medicine
Newark, NJ
********
Who are the Hispanics/Latinos?
• As of March 2004, there were 40.4 million (1 of 9) Hispanics in the
civilian non-institutional population of the United States
• By 2050, the Hispanic population is projected to number around
100 MILLION or 25% of the population (1 of 4)
• Four major geographical areas: Spain, Central America/Mexico, South
America, and the Caribbean basin (Cuba, Dominican Republic, and
Puerto Rico)
• The 14.4% of the U.S. population that are Hispanics make up 30.4%
of the nation's uninsured
• In 2000, the median age for Hispanics was 25.9 years [35.3 white]
• In 2000 Hispanic educational benchmarks:
- high school graduate 57.0% [88.4%]
- college graduate 10.6% [ 28.1%]
- < 9th grade school 27.3% [4.2%]
Source: Current Population Survey, US
Census gov, PGP-4
Regional Population Distribution by Hispanic Origin:2002
14% of NJ population
[2004]
13.3%
44.2%
7.7%
Northeast
34.8%
14% of US population
[2004]
Source: Current Population Survey, March 2002, PGP-5
Census Bureau's March 2004 and 2005 Current Population Survey
Midwest
South
West
Undocumented Number of Hispanics 2002-2004
 Really Bad news: Who will pay to screen/diagnose/treat the Undocumented?
Hispanic/Latino(a)?
Source: Pew Hispanic Center estimates based on March 2002, 2003, and 2004
Passel, Jeffrey S., Randolph Capps, and Michael E. Fix. 2004. Undocumented Immigrants: Facts and Figures. Urban Institute
Fact Sheet. Urban Institute: Washington, DC. January 12. Also, http://www.urban.org/url.cfm?ID=1000587.
Barriers to Healthcare Access
Lack of insurance
Low income
Lack of transportation
Under-representation in healthcare fields
Cultural factors
Language differences
Source: Morales LS., et al., Socioeconomic, cultural, and behavioral factors affecting Hispanic health outcomes
.Journal of Health Care for the Poor & Underserved. 13(4):477-503, 2002 Nov.
Incidence & Mortality Rates* by Site and Hispanic
Ethnicity, US, 1997-2001
Lung
CRC
Breast
Prostate
Males
45.2
49.6
n/a
140.0
Females
23.9
32.5
89.6
n/a
Males
39.6
18.0
n/a
23.5
Females
14.9
11.6
17.3
n/a
Incidence*
Mortality*
Source: American Cancer Society, Surveillance Research, 2005
* Per 100,000, age-adjusted to the 2000 US standard population
Cancer and Hispanics
Leading cancer sites for Hispanic are the same
as those for Whites: prostate, breast, lung, and
colon and rectum
Incidence rates among Hispanics for each of
these cancers are at least 30% lower than
rates for Whites
However, Hispanic are diagnosed at later
stages due to lack of access to care and low
participation in pre-screening prevention
programs
Source: American Cancer Society, Surveillance Research, 2005
Redes en Acción, The National Hispanic/Latino Cancer Network
Cancer and Hispanics- 1997-2001 [cont..]
The incidence rate of stomach cancer [28.6 vs.
15.8 whites] and mortality [15.0 vs. 8.6 whites]
is highest among Hispanics/Latinos
The incidence rate of liver cancer [19.3 vs. 10.1
whites] and mortality [15.7 vs. 8.8 whites] is
highest among Hispanics/Latinos
The incidence rate of cervical cancer [16.2 vs.
8.9 whites] and mortality [3.6 vs. 2.6 whites] is
highest in Hispanic/Latina women
Source: American Cancer Society, Surveillance Research, 2005
Cancer and Hispanics [cont….]
However, there is evidence that high variation exists
among Hispanics subgroups in terms of:
- demographics,
- socioeconomic status,
- behavioral risks (smoking, diet, obesity, physical activity, etc),
- access to, and use of, health care services, and
- health status
Length of stay within the US, also had an impact in
relative risk of death – Acculturation
- 23% to 45% lower for Hispanics who lived in the US for
less than 15 year
Source: Morales LS., et al., Socioeconomic, cultural, and behavioral factors affecting Hispanic health outcomes
.Journal of Health Care for the Poor & Underserved. 13(4):477-503, 2002 Nov.
Cancer and Hispanics [cont….]
Differences also exist among Hispanics born
in the US vs. Hispanics who are foreign-born
Data available regarding incidence, morbidity,
and mortality by Hispanic subgroup is scarce
and incomplete
It has been assumed that all Hispanic have
same cancer risk factors, morbidity, and
experience similar barriers to access health
care - 23 different countries
Progress in Hispanic Cancer Prevention and Control Initiatives
Year
Initiative
1987
The NCI establishes the first Hispanic Cancer Control Program
1988
Three working groups assess needs – Experts working with Cuban, Mexican, and Puerto Rican communities
1989 *
RFA for Hispanic intervention research – 5 studies funded
1990
National Hispanic Cancer Control Research Network established – Primary objective to increase the pool of
Hispanic cancer research investigators
1991
North American Conference on Cancer in Hispanics & Grantsmanship Workshop for Hispanic Investigators
1992*
Quick Guide for the Preparation of Grant Applications & RFA for National Hispanic Leadership Initiative on
Cancer (NHLIC) issued
1993
Preliminary findings of Hispanic intervention research projects presented at APHA in special session
1994
Grantsmanship Workshop for Hispanic Investigators & NHLIC preliminary findings presented at APHA in
special session
1995
Cancer Research in Hispanic Populations, NCI monograph published
The National Latino Cancer Research Network
19921999
En Acción (In Action) Amelie G. Ramirez, Dr.P.H., M.P.H.
20002004
Redes en Acción (Networks in Action) Amelie G. Ramirez, Dr.P.H., M.P.H.
20052010
Redes en Acción (Networks in Action): Community Networks Program (CNP) initiative
Amelie G. Ramirez, Dr.P.H., M.P.H.
Other regional networks have been established: 1). Latin American Cancer Research Coalition (Huerta, 2000
Washington area), 2). The Latino Research and Policy Center (Flores, 1997 Denver area),3). Latinos in a Network for
Cancer Control (Fernandez, 2002. Texas)
Hispanic/Latino Cancer Initiatives
1992-1999: En Acción- Amelie G. Ramirez Dr.P.H.,
[NCI funded] initiated the first comprehensive assessment of
cancer risk factors among the major populations of
Hispanic/Latino men and women in the United States
- Sites: Brooklyn, NY, Miami, FL, San Francisco, CA, San Diego, CA
San Antonio, TX, and Brownsville, TX
Program activities included:
- Recruitment of 955 community networkes & 399 role models
- Distributed 768,000 monthly newsletters a year
- 750 community partnerships developed
- Mass media outreach – 900 stories
- Expanding our knowledge cancer risk factors in diverse Hispanic
populations
Hispanic/Latino Cancer Initiatives
2000-2004: Redes En
Acción: The National Latino
Cancer Research Network Amelie G. Ramirez Dr.P.H.,
[NCI]
Core activities include:
• Promoting training and
research opportunities for
Latino students and
researchers,
• Generating research projects
on key Latino cancer issues,
• Supporting cancer awareness
activities within the Latino
community
3 New Jersey
Pilot Projects Funded
New Jersey Initiatives Through Redes en Acción
“Improving Cultural Competency in a Medical
Residency Program”
PI: Debbie Salas-Lopez, MD MPH
Aims of Study
To develop a cultural competency cancer education program for
medical residents that will promote equities in health care for
Latinos in Newark, NJ
To demonstrate that a cultural competency cancer education
program developed for internal medicine residents will:
Increase their Latino patients’ completion rate of cancer screening
examination;
Result in higher levels of patient satisfaction; and
Improve their attitudes and knowledge of cancer in Latinos.
New Jersey Initiatives Through Redes en Acción
“Improving Colorectal Cancer Screening among
Hispanics/Latinos”
PI: Ana Natale-Pereira, MD MPH
Aims of Study
To determine the factors that influence colorectal cancer (CRC)
screening among Hispanics/Latinos
To design a culturally and linguistically appropriate CRC multicomponent educational module
To evaluate the effectiveness of the CRC educational module in
increasing screening rates among Hispanic/Latinos
New Jersey Initiatives Through Redes en Acción
“Barriers to Colorectal Screening among
Hispanics/Latinos”
PI: Mark S. Johnson, MD MPH
Aims of Study
To evaluate cultural and linguistic barriers to colorectal cancer
screening among Hispanics/ Latinos
To design a survey that will help to improve our understanding of
CRC among Hispanic/Latinos
To translate into Spanish and pilot test the reading level, cultural
sensitivity, and acceptability of two FOBT kits
Other Programs Addressing Cancer among
Hispanics/Latinos in New Jersey
New Jersey Cancer Education and Early Detection
Screening Program (NJCEED) funded by the CDC.
Provides comprehensive screening services for breast,
cervical, prostate, and CRC cancers for many uninsured
and under-insured Hispanics/Latinos in NJ
New Jersey Cancer Connect Trial in Spanish allows noEnglish users to search for cancer clinical trials throughout
the state
Evaluation of reading level and cultural sensitivity of
cancer educational materials distributed by Health
Departments in New Jersey
Conclusion
Collaboration & partnerships with Hispanic
community members and researchers at the local,
regional, statewide, and national level is what will
help advance our understanding of Cancer among
Hispanics/Latinos
Cancer screening and prevention programs will not
be successful to reach Hispanics/Latinos unless they
are cultural and linguistically sensitive to meet their
needs