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标题：Psychosocial Factors Associated With Mouth and Throat Cancer Examinations in Rural Florida
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作者：Joseph L. Riley ; III ; Virginia J. Dodd 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2012
卷号：102
期号：2
页码：e7-e14
DOI：10.2105/AJPH.2011.300504
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined the knowledge and prevalence of mouth and throat cancer examinations in a sample drawn from rural populations in north Florida. Methods. Telephone interviews were conducted across rural census tracts throughout north Florida in 2009 and 2010, in a survey that had been adapted for cultural appropriateness using cognitive interviews. The sample consisted of 2526 respondents (1132 men and 1394 women; 1797 Whites and 729 African Americans). Results. Awareness of mouth and throat cancer examination (46%) and lifetime receipt (46%) were higher than reported in statewide studies performed over the past 15 years. Only 19% of the respondents were aware of their examination, whereas an additional 27% reported having the examination when a description was provided, suggesting a lack of communication between many caregivers and rural patients. Surprisingly, anticipated racial/ethnic differences were diminished when adjustments were made for health literacy and several measures of socioeconomic status. Conclusions. These findings support the notion that health disparities are multifactorial and include characteristics such as low health literacy, lack of access to care, and poor communication between patient and provider. Mouth or throat cancers make up approximately 3% of all diagnosed malignancies in the United States annually, with risk increasing with age. 1 Alarmingly, a median survival time of 37 months was recently reported, regardless of the tumor stage at diagnosis. 2 Considerable disparities exist, with greater mortality for African Americans compared with Whites, particularly among men. 1,2 Multiple factors are likely to account for these disparities, including differential stages of diagnosis. 3 Diagnosing cancers at a premalignant or early stage is crucial to reducing morbidity because survival varies dramatically by the stage of disease. 4,5 The principal screening test for mouth and throat cancer in asymptomatic persons is inspection and palpation of the oral cavity. The American Dental Association suggests an annual mouth and throat cancer examination for adults aged 40 years or older. 6 Although a mouth and throat cancer examination is fast and usually painless, many people report never having heard of it, and of those who have, many have not been examined. 7,8 National data from the 1992 National Health Interview Study (NHIS) Cancer Control Supplement indicated that only 15% of the US population aged 40 years and older had ever been examined for mouth and throat cancer. 8,9 Statewide surveys in Maryland, North Carolina, New York, and Florida have also assessed self-reported mouth and throat cancer examinations, with rates varying from 28% to 38% for lifetime prevalence. 10–13 With the exception of levels of educational attainment 10–13 or having a regular source of dental or preventive medical care, 11,12 psychosocial variables have not been tested for associations with receipt of an examination. The literature for prostate cancer, breast cancer, and cervical cancer provides some support for risk factors such as depression for women 14–16 or social support for men 17,18 and women. 19,20 An often overlooked, but potentially important, risk factor for screening rates is health literacy. 21 Although some studies have shown an association between health literacy and knowledge of colorectal cancer screening issues 22–25 and self-efficacy to be screened, 26 none have shown an association between low literacy and screening rates. Persons living in rural areas have the additional burden of limited access to health care and, in particular, of being less likely to receive preventive cancer services than urban residents. 27–29 These differences may be compounded for racial/ethnic minorities, who are more likely to have less education and live in counties with higher poverty rates and lower insurance rates, all of which are associated with reduced access to health care. 30 Existing studies have not reported data on mouth and throat cancer examinations for rural areas. Our primary aim was to test the hypothesis that, among rural north Floridians, African Americans would be less likely to report (1) having heard of a mouth and throat cancer examination, (2) having had an examination in their lifetime, and (3) having had an examination in the past year, and that in addition (4) psychosocial variables of financial status, education, depression, social support, and health literacy would be associated with these mouth and throat cancer examination outcomes.