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Social Determinants Of Health And Uptake Of Colorectal Cancer Screening In Canada, Seth F. Kadish

Electronic Thesis and Dissertation Repository

Colorectal cancer (CRC) screening uptake may be associated with social determinants of health and could indicate potential barriers to health service access. The goal of this thesis was to evaluate the association of social determinants with CRC screening in screen-eligible adults. We used Andersen’s Behavioural Model of Health Service Utilization and the PROGRESS-Plus Framework to conceptualize potential social determinants. Our first study was a systematic review of peer-reviewed Canadian studies, and the second was a cross-sectional analysis of data from the Canadian Longitudinal Study on Aging (CLSA). The systematic review found lower uptake was associated with non-White ethno-racial identity, less …

Geographic And Intra-Racial Disparities In Early-Onset Colorectal Cancer In The Seer 18 Registries Of The United States, Wesal H. Abualkhair, Meijiao Zhou, Carolina O. Ochoa, Leonel Lacayo, Caitlin Murphy, Xiao Cheng Wu, Jordan J. Karlitz

School of Medicine Faculty Publications

Background: Although early-onset colorectal cancer (EOCRC) incidence rates (IRs) are increasing, geographic and intra-racial IR disparities are not well defined. Methods: 2000-2015 Surveillance, Epidemiology, and End Results (SEER) program CRC IR Analysis (170,434 cases) was performed from ages 30 to 60 in four US regions, 18 individual registries, metropolitan and nonmetropolitan locations and stratified by race. Analyses were conducted in 1-year and 5-year age increments. Results: Wide US regional EOCRC IR variations exist: For example, age 45 IRs in the south are 26.8/100,000, 36.0% higher than the West, 19.7/100,000 (p < 0.0001). Disparities magnify between individual registries: EOCRC IRs in highest risk registries were 177-348% (Alaska Natives), 75-200% (Hawaii), 76-128% (Louisiana), and 61-125% (Kentucky) higher than lowest risk registries depending on age. EOCRC IRs are 18.2%-25.6% higher in nonmetropolitan versus metropolitan settings. Wide geographic intra-racial disparities exist. Within the White population, the greatest IR difference (78.8%) was between Kentucky (5.9/100,000) and Los Angeles (3.3/100,000) in 30- to 34-year-olds (p <.0001). Within the Black population, the greatest difference (136.2%) was between rural Georgia (30.7/100,000) and California excluding San Francisco-Oakland/San Jose-Monterey/Los Angeles (13/100,000) in 40- to 44-year-olds (p = 0003). Conclusion: Marked geographic EOCRC disparities exist with disproportionately high IRs in Alaska Natives, Hawaii, and southern registries. Geographic intra-racial disparities are present within White and Black populations. In Blacks, there are disproportionately high EOCRC IRs in rural Georgia. Although vigilance is required in all populations, attention must be paid to these higher risk populations. Potential interventions include assuring early investigation of symptoms, targeting modifiable risk factors and utilizing earlier age 45 screening options supported by some guidelines.

The Impact Of Dietary Intake On Mortality Risk In Colorectal Cancer Survivors, Ellen Chow

Walden Dissertations and Doctoral Studies

The colorectal cancer (CRC) survivor population is increasing in the United States. The lack of effective dietary recommendations in recurrence prevention undermines the health-related quality of life of survivors. Grounded in the socioecological model, dietary behavior is a personal-level risk factor that individuals may control. This study investigated the CRC-specific mortality risk as predicted by diet quality, dietary fiber intake, and dietary fat intake in hope of contributing to future dietary recommendations. A secondary analysis using data from 1,166 CRC survivors in the Multiethnic Cohort Study was analyzed via Cox proportional hazard regression models to estimate mortality risk. Results from …

Dietary Inflammatory Index, Dietary Non-Enzymatic Antioxidant Capacity, And Colorectal And Breast Cancer Risk(Mcc-Spain Study), Mireia Obón-Santacana, Dora Romaguera, Esther Gracia-Lavedan, Amaia Molinuevo, Esther Molina-Montes, Nitin Shivappa, James R. Hébert, Adonia Tardón, Gemma Castaño-Vinyals, Ferran Moratalla, Elisabet Guinó, Rafael Marcos-Gragera, Mikel Azpiri Leire Gil, Rocío Olmedo-Requena, Macarena Lozano-Lorca, Juan Alguacil, Tania Fernández-Villa, Vicente Martín, Antonio J. Molina, María Ederra, Beatriz Perez, Nuria Aragonés, Adela Castello, José Mª Huerta, Trinidad Dierssen-Sotos, Ana Molina-Barceló, Marina Pollán, Manolis Kogevinas, Victor Moreno, Pilar Amiano

Faculty Publications

Inflammation and antioxidant capacity have been associated with colorectal and breast cancer. We computed the dietary inflammatory index (DII®), and the total dietary non-enzymatic antioxidant capacity (NEAC) and associated them with colorectal and breast cancer risk in the population-based multi case-control study in Spain (MCC-Spain). We included 1852 colorectal cancer and 1567 breast cancer cases, and 3447 and 1486 population controls, respectively. DII score and NEAC were derived using data from a semi-quantitative validated food frequency questionnaire. Unconditional logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) for energy-adjusted DII (E-DII), and a score …

Dietary Inflammatory Index, Dietary Non-Enzymatic Antioxidant Capacity, And Colorectal And Breast Cancer Risk (Mcc-Spain Study), Mireia Obon-Santacana, Dora Romaguera, Esther Gracia-Lavedan, Amaia Molinuevo, Esther Molina-Montes, Nitin Shivappa, James R. Hébert, Adonina Tardon, Gemma Castano-Vinyals, Ferran Moratalla, Elisabet Guino, Rafael Marcos-Gragera, Mikel Azpiri, Leire Gil, Rocio Olmedo-Requena, Macarena Lozano-Lorca, Juan Alguacil, Tania Fernandez-Villa, Vicente Martin, Antonio J. Molina, Maria Ederra, Conchi Moreno-Iribas, Beatriz Perez, Nuria Aragones

Faculty Publications

Inflammation and antioxidant capacity have been associated with colorectal and breast cancer. We computed the dietary inflammatory index (DII^®), and the total dietary non-enzymatic antioxidant capacity (NEAC) and associated them with colorectal and breast cancer risk in the population-based multi case-control study in Spain (MCC-Spain). We included 1852 colorectal cancer and 1567 breast cancer cases, and 3447 and 1486 population controls, respectively. DII score and NEAC were derived using data from a semi-quantitative validated food frequency questionnaire. Unconditional logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) for energy-adjusted DII (E-DII), and …

Dietary Inflammatory Index And Odds Of Colorectal Cancer And Colorectal Adenomatous Polyps In A Case-Control Study From Iran, Pegah Rafiee, Nitin Shivappa, James R. Hébert, Saeede Jaafari Nasab, Alireza Bahrami, Azita Hekmatdoost, Bahram Rashidkhani, Amir Sadeghi, Mohammad Houshyari, Ehsan Hejazi

Faculty Publications

Background: Chronic inflammation is implicated in the development of colorectal cancer (CRC) and its precursor; colorectal adenomatous polyps (CAP). Some dietary factors are important triggers for systemic inflammation. Therefore, the present study aimed to investigate the association between the dietary inflammatory index (DII^®) and the risk of CRC and CAP in an Iranian case-control study. Methods: 134 newly diagnosed CRC patients, 130 newly diagnosed CAP patients, and 240 hospitalized controls were recruited using convenience sampling. Energy-adjusted DII (E-DII) scores were computed based on dietary intake assessed using a reproducible and valid 148-item food frequency questionnaire. Logistic regression models …

Determinants Of Disparities In The Colorectal Cancer Burden, Karen Elizabeth Callahan

UNLV Theses, Dissertations, Professional Papers, and Capstones

Colorectal cancer (CRC) is the third leading cause of cancer incidence and mortality in the United States, with an estimated 140,000 new cases and 51,000 deaths expected in 2018. Like most cancers, the burden of CRC is unequally distributed among population groups. The current dissertation included two studies filling gaps in knowledge about CRC disparities. Study 1 characterized the relationship between educational attainment and CRC mortality by race/ethnicity. Six years of CRC mortality data (2012-2017) from the diverse state of California, with 30,180 deaths were analyzed. Sex-specific mortality rate ratios (MRR) stratified by race/ethnicity as well as by educational level …

Factors Affecting Colorectal Cancer Screening Among African-Born Immigrants In The United States, Chidoziri Chibundu

Walden Dissertations and Doctoral Studies

Despite the evidence that colorectal cancer screening is effective in reducing the incidence of and mortality from colorectal cancer, racial and ethnic disparities in colorectal cancer screening persist in the United States. African-born immigrants in the United States have lower colorectal cancer screening rates than native-born Americans. The purpose of this quantitative, retrospective, cross-sectional study was to examine how family income, health insurance status, language of interview, length of stay in the United States, perceived health status, level of education, and having a usual place for medical care affect colorectal cancer screening among African-born immigrants in the United States. The …

The Role Of Pre-Existing Type 2 Diabetes Mellitus In Colorectal Cancer Stage And Survival In Elderly Americans: A Seer-Medicare Population-Based Study 2002-~2011, Sanae El Ibrahimi

UNLV Theses, Dissertations, Professional Papers, and Capstones

Diabetes is a common comorbid condition among colorectal cancer (CRC) patients, yet its effects in CRC outcomes, particularly stage at diagnosis, risk of death and variations by diabetes severity (complications vs no complications) and Hispanic ethnicity have not been adequately studied. The purpose of this study was to investigate the association between pre-existing T2DM and advanced stage at diagnosis in elderly patients with CRC; to examine whether diabetes is an independent predictor of poor survival from all-cause and CRC-specific mortality; to assess whether variations exist by diabetes severity and to analyze the outcomes for the Hispanic group.

The Surveillance Epidemiology …

Dietary Inflammatory Index And Colorectal Cancer Risk – A Meta-Analysis, Nitin Shivappa, Justyna Godos, James R. Hébert, Michael David Wirth, Gabriele Piuri, Attilio Speciani, Giuseppe Grosso

Faculty Publications

Diet and chronic inflammation of the colon have been suggested to be risk factors in the development of colorectal cancer (CRC). The possible link between inflammatory potential of diet, measured through the Dietary Inflammatory Index (DII®), and CRC has been investigated in several populations across the world. The aim of this study was to conduct a meta-analysis on studies exploring this association. Data from nine studies were eligible, of which five were case-control and four were cohort studies. Results from meta-analysis showed a positive association between increasing DII scores, indicating a pro-inflammatory diet, and CRC. Individuals in the highest versus …

Trends And Determinants Of Up-To-Date Status With Colorectal Cancer Screening In Tennessee, 2002-2008, Sreenivas P. Veeranki, Shimin Zheng

Shimin Zheng

BACKGROUND: Screening rates for colorectal cancer (CRC) are increasing nationwide including Tennessee (TN); however, their up-to-date status is unknown. The objective of this study is to determine the trends and characteristics of TN adults who are up-to-date status with CRC screening during 2002-2008. METHODS: We examined data from the TN Behavioral Risk Factor Surveillance System for 2002, 2004, 2006 and 2008 to estimate the proportion of respondents aged 50 years and above who were up-to-date status with CRC screening, defined as an annual home fecal occult blood test and/or sigmoidoscopy or colonoscopy in the past 5 years. We identified trends …

Type 2 Diabetes Mellitus And Colorectal Cancer Risk And Survival In Oman, Rose Ngozi Mafiana

Walden Dissertations and Doctoral Studies

Type 2 diabetes mellitus (T2DM) and colorectal cancer (CRC) are 2 chronic diseases with common risk factors related to physical inactivity, obesity, and diet. Literature on T2DM as a risk factor for CRC development and survival in Oman is scarce. Using de-identified archival data provided by Sultan Qaboos University Hospital (SQUH) Oman, a retrospective, case-control, and time-to-event study designs were used to compare odds of developing CRC, and survival rates among adults with and without T2DM. The ecosocial theory provided the theoretical base for this research. Logistic regression was used to examine the odds of developing CRC among 114 cases …

Effects Of Serum Levels Of Vitamin A And Precursors On Colorectal Cancer Mortlaity, Chimuanya Okoli

GS4 Georgia Southern Student Scholars Symposium

Objective: To examine the relationship between serum levels of Vitamin A and precursors on Colorectal cancer mortality. Methods: A retrospective cohort study was conducted with 14,358 adults who participated in NHANES III. Data was collected via in home interviews and visits by participants to a mobile examination centre for blood sample collection. Characteristics such as family income, educational attainment, marital status, race and ethnicity, alcohol consumption, cigarette smoking, self reported health, type of resident, body size, cancer status at base line, vegetable consumption and fruit juice consumption were examined. Hazard ratio estimates for all-cause and cancer-related deaths among individuals with …

Trends And Determinants Of Up-To-Date Status With Colorectal Cancer Screening In Tennessee, 2002-2008, Sreenivas P. Veeranki, Shimin Zheng

ETSU Faculty Works

BACKGROUND:

Screening rates for colorectal cancer (CRC) are increasing nationwide including Tennessee (TN); however, their up-to-date status is unknown. The objective of this study is to determine the trends and characteristics of TN adults who are up-to-date status with CRC screening during 2002-2008.

METHODS:

We examined data from the TN Behavioral Risk Factor Surveillance System for 2002, 2004, 2006 and 2008 to estimate the proportion of respondents aged 50 years and above who were up-to-date status with CRC screening, defined as an annual home fecal occult blood test and/or sigmoidoscopy or colonoscopy in the past 5 years. We identified trends …

Prevalence Of Colorectal Cancer Screening Among A Multimorbid Rural Appalachian Population, Steven T. Fleming, Nancy E. Schoenberg, Yelena N. Tarasenko, Kevin A. Pearce

Yelena N. Tarasenko

Objectives: The purpose of this study was to determine the relation among multiple morbidities and the prevalence of colorectal cancer (CRC) screening among older adult Appalachian residents of Kentucky. This is the first known study to address multiple morbidities exclusively with a health-disparities population.

Methods: This was a cross-sectional study of 1153 subjects, aged 50 to 76 years, from Appalachian Kentucky.

Results: White race, post-high school education, and perception of having more than enough income on which to survive were associated with higher rates of any guideline concordant CRC screening. Statistically significant trends in the outcome of …

Physician Colorectal Cancer Screening Recommendations: An Explanation Based On Informed Decision-Making, Yelena N. Tarasenko, Sarah B. Wackerbarth, Jennifer M. Joyce, Steven A. Haist

Yelena N. Tarasenko

Objective: The purpose of this research was to examine the content of physicians’ colorectal cancer screening recommendations. More specifically, using the framework of informed decision making synthesized by Braddock and colleagues, we conducted a qualitative study of the content of recommendations to describe how physicians are currently presenting this information to patients.

Methods: We conducted semi-structured interviews with 65 primary care physicians. We analyzed responses to a question designed to elicit how the physicians typically communicate their recommendation.

Results: Almost all of the physicians (98.5%) addressed the “nature of decision” element. A majority of physicians discussed “uncertainties …