Addressing Cancer Disparities in Minority Communities: Hispanics/Latinos

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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
Natale-Pereira, 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
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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
• - lt 9th grade school
  27.3 4.2

Source Current Population Survey, US Census
gov, PGP-4
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Regional Population Distribution by Hispanic
Origin2002
14 of NJ population 2004
Northeast
14 of US population 2004
Midwest
South
Source Current Population Survey, March 2002,
PGP-5
West
Census Bureau's March 2004
and 2005 Current Population Survey
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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?ID1000587.
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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.
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Incidence Mortality Rates by Site and Hispanic
Ethnicity, US, 1997-2001
Lung CRC Breast Prostate
Incidence Incidence Incidence Incidence Incidence
Males 45.2 49.6 n/a 140.0
Females 23.9 32.5 89.6 n/a
Mortality Mortality Mortality Mortality Mortality
Males 39.6 18.0 n/a 23.5
Females 14.9 11.6 17.3 n/a
Source American Cancer Society, Surveillance
Research, 2005 Per 100,000, age-adjusted to
the 2000 US standard population
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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
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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
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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.
10
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

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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 The National Latino Cancer Research Network
1992-1999 En Acción (In Action) Amelie G. Ramirez, Dr.P.H., M.P.H.
2000-2004 Redes en Acción (Networks in Action) Amelie G. Ramirez, Dr.P.H., M.P.H.
2005-2010 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) 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)
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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

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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
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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.

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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 multi-component educational
  module
• To evaluate the effectiveness of the CRC
  educational module in increasing screening rates
  among Hispanic/Latinos

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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

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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
  no-English 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

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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