Racism and Cancer Screening among Low-Income, African American Women: A Multilevel, Longitudinal Analysis of 2-1-1 Texas Callers

Although racism is increasingly being studied as an important contributor to racial health disparities, its relation to cancer-related outcomes among African Americans remains unclear. The purpose of this study was to help clarify the relation between two indicators of racism—perceived racial discrimination and racial residential segregation—and cancer screening. We conducted a multilevel, longitudinal study among a medically underserved population of African Americans in Texas. We assessed discrimination using the Experiences of Discrimination Scale and segregation using the Location Quotient for Racial Residential Segregation. The outcome examined was “any cancer screening completion” (Pap test, mammography, and/or colorectal cancer screening) at follow-up (3–10 months post-baseline). We tested hypothesized relations using multilevel logistic regression. We also conducted interaction and stratified analyses to explore whether discrimination modified the relation between segregation and screening completion. We found a significant positive relation between discrimination and screening and a non-significant negative relation between segregation and screening. Preliminary evidence suggests that discrimination modifies the relation between segregation and screening. Racism has a nuanced association with cancer screening among African Americans. Perceived racial discrimination and racial residential segregation should be considered jointly, rather than independently, to better understand their influence on cancer screening behavior.

Implementation of a Teleophthalmology Screening Network Using a Novel Handheld Fundus Camera on a Remote Island: Physician and Patient Perceptions from Real World Experience (Preprint)

BACKGROUND While teleophthalmology is gaining traction in recent years, it is taking center stage in the COVID-19 pandemics. However, most hospitals are yet ready due to a severe lack of real-world experience. Furthermore, there are limited number of studies evaluating the telemedicine application on remote islands. OBJECTIVE To evaluate the real-world clinical and referral accuracy, image quality, physician perceived diagnostic certainty, and patient satisfaction of a telemedicine eye screening using a novel handheld fundus camera in a rural and medically underserved population. METHODS This prospective study enrolled 176 eyes from a remote island. All participants underwent a comprehensive ophthalmic examination. Nonmydriatic retinal images obtained using a handheld fundus camera were reviewed by two retinal specialists to determine the image quality, diagnosis, and need for referrals. The agreement of diagnosis between image-based assessments was compared to that of binocular indirect ophthalmoscopic assessment. RESULTS Image quality of fundus photograph was considered ideal or acceptable in 97.7% and 95.5% eyes. There was considerable agreement in diagnosis between the indirect ophthalmoscopic assessment and image-based assessment by two reviewers (Cohen’s kappa=0.80 and 0.78, respectively). Likewise, substantial agreement in referrals was achieved. The sensitivity for referable retinopathy from the two reviewers was 78% [95% CI, 57%-91%] and 78% [95% CI, 57%-91%], whereas specificity was 99% [95% CI, 95%-99%] and 98% [95% CI, 93%-99%], respectively. For physician perceived certainty in diagnosis, 93.8% and 90.3% were considered either certain or reliable. Overall, 97.4% of participants were satisfied with their experience and greatly valued the telemedicine service. CONCLUSIONS The novel fundus camera-based telemedicine screening demonstrated high accuracy in detecting clinically significant retinopathy in real-world settings. It achieved high patient satisfaction and physician perceived certainty in diagnosis with reliable image quality, which may be scaled internationally to overcome the geographical barriers under global pandemic. CLINICALTRIAL N/A

Traditional Cultural Practices Provide More Frequent Feelings of Happiness and Calm for Native American Elders

Though American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) elders are an understudied population, available data demonstrates higher rates of depressive symptoms among these elders. In addition, AI/AN/NH elders are a medically underserved population, with geographic isolation a common barrier to accessing emotional/mental health services. However, cultural practices are important sources of resilience for AI/AN/NH elders. Survey data from “Identifying our Needs: A Survey of Elders” Cycle VI (2014-2017), conducted by the National Resource Center on Native American Aging, were analyzed using ordinal logistic regression; N=18,134 adults age 55+ from 164 tribal survey sites. Respondents indicated how often (from none to all of the time) they participate in cultural practices (e.g., traditional food, music, customs). Frequency of participation varied; 27% of elders reported participating in traditional cultural practices a good bit of the time or more, 28% some of the time, 18% a little of the time, and 27% did not ever participate. We explored the relationship between frequency of cultural practices and frequency of feelings of happiness, calm/peacefulness, nervousness, and being downhearted/blue. A significant positive association was found between higher frequency of cultural participation and feelings of happiness and calm/peacefulness; no association was found with nervousness or depressive symptoms. While the frequency of participation by elders in cultural practices is directly related to better self-reported levels of happiness and peacefulness, nearly half (45%) never/almost never participated in these types of practices, which underscores the need to support availability of and elders’ participation in cultural practices.

Increasing uptake of colon cancer screening in a medically underserved population with the addition of blood-based testing

Adherence to colorectal cancer screening is suboptimal, particularly in medically underserved populations. We report here on our assessment of the impact of offering a blood-based screening test on screening rates in a health fair setting. Patients attending student-run health fairs who met colon cancer screening guideline eligibility criteria received a recommendation to attend that screening station. Patients were offered recommended accepted screening methods, and if they declined they were offered blood-based testing. Screening rates, test outcomes, and the rate of follow up completion of colonoscopy were measured and compared with historic screening outcomes. Of 1401 screening eligible patients, 640 (45.7%) attended the colon cancer screening station, of whom 460 were eligible for assessment. Amongst these, none selected colonoscopy, 30 (6.5%) selected FIT, and 430 (93.5%) selected blood-based testing. Only 2 patients returned the FIT. For the blood test, 88 were positive, and 20 of these received a follow up colonoscopy. Based on this assessment, blood-based testing is an effective method to increase screening rates in medically underserved populations, though efforts to further improve access to follow up colonoscopy are necessary.

Factors Associated with Antenatal Influenza Vaccination in a Medically Underserved Population

Influenza infection in pregnant women is associated with increased risk of morbidity and mortality. Despite recommendations for all women to receive the seasonal influenza vaccine during pregnancy, vaccination rates among pregnant women in the U.S. have remained around 50%. The objective of this study was to evaluate clinical and demographic factors associated with antenatal influenza vaccination in a medically underserved population of women. We conducted a retrospective cohort study at Grady Memorial Hospital, a large safety-net hospital in Atlanta, Georgia, from July 1, 2016, to June 30, 2018. Demographic and clinical characteristics were abstracted from the electronic medical record. The Kotelchuck index was used to assess prenatal care adequacy. Relative risks and 95% confidence intervals for associations between receipt of influenza vaccine and prenatal care adequacy, demographic characteristics, and clinical characteristics were calculated using multivariable log-binominal models. Among 3723 pregnant women with deliveries, women were primarily non-Hispanic black (68.4%) and had Medicaid as their primary insurance type (87.9%). The overall vaccination rate was 49.8% (1853/3723). Inadequate prenatal care adequacy was associated with a lower antenatal influenza vaccination rate (43.5%), while intermediate and higher levels of prenatal care adequacy were associated with higher vaccination rates (66.9–68.3%). Hispanic ethnicity, non-Hispanic other race/ethnicity, interpreter use for a language other than Spanish, and preexisting diabetes mellitus were associated with higher vaccination coverage in multivariable analyses. Among medically underserved pregnant women, inadequate prenatal care utilization was associated with a lower rate of antenatal influenza vaccination. Socially disadvantaged women may face individual and structural barriers when accessing prenatal care, suggesting that evidenced-based, tailored approaches may be needed to improve prenatal care utilization and antenatal influenza vaccination rates.

Implementing Immunizing Pharmacy Technicians in a Federal Healthcare Facility

Background: Pharmacy technicians are legally allowed to administer immunizations in specific U.S. states, provided they meet certain criteria, including the completion of an accredited immunization training course. Immunizing pharmacy technicians were incorporated into an Indian Health Services federal facility, Whiteriver Service Unit (WRSU), in 2018. The objective of this research was to gather information about implementing immunizing pharmacy technicians in a federal facility serving a large rural and medically underserved population. Methods: WRSU launched a Pharmacy Technician Immunization Program in June 2018 after seven federally employed pharmacy technicians participated in the Washington State University accredited technician immunization training. The types of vaccinations administered, and the ages of patients immunized by pharmacy technicians, were tracked from July 1, 2018 to June 30, 2019. Results: Seven immunization-trained pharmacy technicians administered 4394 injections for a total of 4852 vaccinations in one year. Vaccinations were administered to patients ranging in age from 2 months old to 85 years old and included protection against diphtheria, tetanus, polio, hepatitis A and B, H. influenza, human papillomavirus, seasonal influenza, meningococcal, measles, mumps, rubella, varicella, pneumonia, and rotavirus. Conclusion: In one year, seven pharmacy technicians administered more than 4800 vaccinations to underserved patients. Pharmacy technicians trained and certified to administer immunizations increase access to vaccination care and have the potential to drastically increase the number of immunizations given and reduce the number of deaths from vaccine-preventable diseases.