Predictors of Endoscopy in Minority Women: METHODS

Posted by James

Recruitment

The protocol was approved by our institutional review board (IRB). English- and Spanish-speaking men and women age >18 who lived, worked or sought healthcare in East Harlem were considered eligible for the study. The participants were recruited from community health fairs, tenant association meetings, senior centers and local medical clinics (Settlement Health, Boriken Neighborhood Health Center and Metropolitan Hospital). Informed consent for participation in the study was obtained, and the survey was conducted by trained health educators and research interviewers between the months of July and December 2000.

A total of 383 people (0.35% of the men and women in the East Harlem community) were approached, and 248 (65%) agreed to participate in the survey. Minority subjects were defined as being African-American or Hispanic in this study. African Americans and Hispanics comprised 96% of those surveyed. The purpose of this analysis was to evaluate female screening practices with regard to mammography for breast cancer (Generic Danocrine treating endometriosis, symptoms of fibrocystic breast disease), Pap tests for cervical cancer and endoscopy for colon cancer screening. CRC screening begins at age 50 for average-risk individuals. Therefore, women age <50 were excluded. As this study focused on women, the data from the men in the larger study were excluded from this analysis. The data from the larger study have been described in a separate analysis [Fatone et al., East Harlem Partnership for Cancer Awareness (EHP-CA): collaborative cancer screening and prevention research in an urban minority community, submitted for publication 2004]. A total of 81 minority women age >50 participated in the study (44 African Americans and 37 Hispanics).

Interview

The instrument for the larger study was an IRB-approved survey designed to assess the socioeconomic demographics of the community, knowledge of and participation in cancer (Eulexin medication is used along with drugs such as Lupron to treat prostate cancer) screening, personal and family medical history of cancer, and the presence of physician recommendation of each screening test. In addition, specific questions pertaining to attitudes and knowledge toward breast, cervical, colon and prostate cancer screening were addressed. For this substudy of women, questions pertaining to prostate cancer were excluded. Using Likert-style questions, the survey assessed potential psychosocial barriers to screening, such as pros and cons, cancer (Hydrea canadian is an antineoplastic used to treat certain types of cancer) worry, acculturation, medical mistrust, fatalism and temporal orientation. After obtaining informed consent, the participants were administered the survey either face-to-face or via telephone by an ethnically and linguistically similar interviewer. The participants were given a phone card or supermarket coupon for completing the survey.

Measures

We analyzed how participants’ socioeconomic and medical characteristics may affect use of endoscopy. In addition, we analyzed how psychosocial factors affect endoscopy rates in the population studied. Endoscopy in the analyses refers to either flexible sigmoidoscopy or colonoscopy because both are accepted methods of performing CRC screening in average-risk individuals age >50 (as discussed below).

Socioeconomic Factors. We assessed whether any of the following factors had an impact on use of endoscopy: age (50-65 or >65), language of interview (English versus Spanish), race/ethnicity (African-American versus Hispanic), household income (less than or greater than $10,000 per year), marital status (married or living with partner versus not married or living with partner), level of education (less than or greater than high school), and insurance status (federal versus commercial versus none).

Medical History Factors. These items addressed past screening for CRC and patient medical history as it pertains to endoscopy as well as the use of mammography and Pap tests for breast and cervical cancer (Generic Revia is used for treating alcoholism and narcotic) screening, respectively. Multiple questions regarding personal and family cancer history, care of a family member or spouse with cancer, access to a primary care physician and whether their primary care doctor had ever recommended endoscopy were included (yes/no).

Psychosocial Factors. Cancer pros and cons: This is a 23-item scale adapted by Manne et al. to determine how an individual’s attitudes about the advantages (pros) and disadvantages (cons) of colon cancer screening affects their screening decisions (alpha pros=0.56 , alpha cons=0.766).

• Cancer Worry: This is a four-item scale adapted from Lerman et al. that assessed the degree to which people worried about being diagnosed with cancer and how much distress it caused them (alpha-0.86).

• Acculturation: This 10-item questionnaire assessed how assimilated one is in mainstream society. A modified version of the Snowden and Hines acculturation model was used. African Americans and Hispanics were asked similar questions regarding music choices, neighborhood and personal relationships with others (alpha= 0.70 for African Americans and alpha=0.74 for Hispanics).

• Medical Mistrust: This 12-item survey assessed the degree to which individuals believed that healthcare providers treat people of their racial/ethnic group unequally (alpha=0.59).

• Fatalism: Fatalism was assessed with the Powe Fatalism Inventory. This 15-item inventory assesses cancer (Drug Methotrexate interferes with the growth of certain cells of the body) fatalism. It has been used previously to examine African-American fatalism with respect to cancer (alpha=0.75).

• Temporal Orientation: The 26-item Jones Temporal Orientation scale was used to assess whether participants were more focused on past, present or future events (alpha past=0.826, alpha present=0.529, alpha fiiture=0.718).

• Decisional Balance: This is part of the transtheo-retical model for conceptualizing behavioral change. Decisional balance is determined by cal culating the difference between the cancer pros and cons score. Decisional balance is proposed to be associated with an individual moving from one stage to another in the continuum of behavioral change.

Statistical Analysis

The SPSS and SAS statistical package were used to analyze the data. Descriptive analysis was used to evaluate the demographic, medical and psychosocial factors in African Americans and Hispanics. A univariate analysis was performed by using Student’s t test and % to determine which factors were associated with ever having had sigmoidoscopy or colonoscopy. Based on the univariate analyses and the known literature, variables were selected to be included in the multiple regression model. SAS software was used to perform logistic regression analysis, in which endoscopy use was modeled as a function of the socioeconomic, medical and psychosocial factors to determine the predictors of minority women ever having had endoscopy.