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Addressing Cancer Disparities in Minority Communities: Hispanics/Latinos

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

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Addressing Cancer Disparities in Minority Communities: Hispanics/Latinos

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  1. 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 ********

  2. 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

  3. Regional Population Distribution by Hispanic Origin:2002 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

  4. 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.

  5. 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.

  6. Incidence & Mortality Rates* by Site and Hispanic Ethnicity, US, 1997-2001 Source: American Cancer Society, Surveillance Research, 2005 * Per 100,000, age-adjusted to the 2000 US standard population

  7. 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

  8. 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

  9. 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

  11. Progress in Hispanic Cancer Prevention and Control Initiatives

  12. Hispanic/Latino Cancer Initiatives • 1992-1999: En Acción- Amelie G. RamirezDr.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

  13. 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 Hispanic/Latino Cancer Initiatives 3 New Jersey Pilot Projects Funded

  14. 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.

  15. 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

  16. 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

  17. 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

  18. 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

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