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The Distribution of Mammography Facility Characteristics in Metropolitan Chicago
670
Abstracts / Annals of Epidemiology 22 (2012) 661e680
Purpose: Colon cancer screening rates are lower than targeted in Ontario. Further investigation indicated that a large proportion of the under and never screened population is illiterate and that the written fecal occult blood test (FOBT) instructions are too complex and wordy for illiterate, low literacy, and English as a second language populations. Our purpose was to develop a humourous FOBT instructional video to overcome this barrier. Methods: The Ontario FOBT written instructions were as the basis for the instructional video script. Artist sketches and group consensus was used to develop an appropriate character. An iterative process with focus group feedback was used to work towards a final video. Results: Various versions of the video were tested on the regional under/ never screened project teams (physicians, nurses, outreach workers), rural community members (n¼7 groups) and suburban community members (n¼2 groups). Men had a strong and uniformly positive reaction to the video, requesting that it be on TV and stating that it was “superbowl brilliant”. Women's reactions ranged from reserved positive to strongly positive. All felt confident and optimistic about performing the test after watching the video. Conclusions: Providing an uncomplicated, humourous instructional video can increase awareness of cancer screening, alleviate test fear, increase confidence in performing test, and change attitudes towards screening.
P41. Accelerating the Use of Study Findings for Community Benefit: the Six Nations Sexual Health Study Dionne Gesink,1 Debra Jonathan,2 Amber Skye1. 1 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, 2 Gane Yohs Health Centre, First Nations and Inuit Health, Ohsweken, Canada Purpose: Practicing community based participatory research (CBPR) principles has been a restorative way for indigenous communities and researchers to come together to end the legacy of research trauma and have research benefit the community first. We describe how we accelerated the use of study findings to benefit the Six Nations of the Grand River community. Methods: The Six Nations Sexual Health Study is a CBPR project. The nursein-charge and members of the community advisory board participated in data collection activities, which enabled immediate response to preliminary study findings. Results: The following actions were implemented in response to focus group discussions and in-depth interviews: HIV signs were replaced with sexual health information line signs located more strategically inside the community. The language used when interviewing cases for sexual contacts was changed so the term ‘partners’ is no longer used to identify sexual partners. The in school program has an Elder and public health nurse teaching about sex and sexual health. A youth role model campaign messaging respect was initiated. Conclusions: Taking a CBPR approach allowed researchers and community members to accelerate the translation of results to inform community programs, health care practice and policy.
P42-S. The Distribution of Mammography Characteristics in Metropolitan Chicago
Facility
J. Khan, J. Orsi, A.M. Murphy, D. Dupuy, G.H. Rauscher. Division of Epidemiology and Biostatistics, University of Illinois at Chicago, IL Purpose: Radiologists who read breast images >75% of the time (dedicated) and digital (vs. analog) mammography machines tend to provide better quality screening results. In Chicago, a highly segregated city, unequal distribution of services is a potentially important aspect of unequal access to care. We explored the distribution of mammography facility characteristics in metropolitan Chicago in relation to the populations of black and nonHispanic (nH) white women age 40 and older. Methods: Mammography facilities participating in the Metropolitan Chicago Breast Cancer Task Force 2010 Mammography Capacity Survey were categorized by whether they had dedicated radiologists or digital machines, and overlaid on a census tract-level (US 2010) map of women 40 and older by race. We created 1- and 3-mile (city vs. non-city, respectively) buffers around facilities to calculate the percentage of women age 40 and older by race who lived near a mammography facility. Results: Black women were less likely than nH white women to live in proximity to any mammography facility (70% vs. 75%), to one with at least one dedicated radiologist (61% vs. 68%), or to one with at least one digital machine (59% vs. 71%) (p < 0.0001 for all).
Conclusion: There is an unequal geographic distribution of mammography facility quality screening characteristics between the populations of black and nH white women in metropolitan Chicago. This inequity could potentially account for a portion of the large racial disparity in late stage diagnosis found in Chicago.
P43. Changes in Deaths Due to Drugs, Wisconsin 1999-2008 D.L. Nordstrom, M.L. Yokoi-Shelton. Department of Occupational and Environmental Safety and Health, University of Wisconsin-Whitewater, Whitewater, WI Purpose: To achieve the Healthy People 2020 objective of reducing drugrelated deaths by 10%, state and local groups need accurate information on local drug death trends. Methods: Using information from death certificates, we assessed changes in rates, causes, and circumstances of Wisconsin drug deaths during 10 recent years. Cases included all deaths with one or more of 270 cause of death codes from a National Center of Health Statistics scheme. Each death certificate had one “underlying” cause, one “immediate” cause, and up to 18 “contributing” causes. Results: Of the 4828 drug deaths identified, the average occurred at age 43. A majority of deaths, 3,410 (71%), were unintentional, and 1,053 (22%) were suicide. The unintentional-to-suicide death rate ratio grew from 1.6 in 1999 to 3.5 in 2008. Drug death rates increased during the 10- year period, and the male-to-female death ratio rose from 1.2 to 1.7. Black and Native American residents had drug death rates that were twice those of white residents. Opioid analgesics surpassed both cocaine and heroin to become the most frequent drugs leading to death. Of the specific individual drugs coded as causes of death, methadone ranked highest with 118 deaths in 2008 versus 10 deaths in 1999, an increase of 1080%. Conclusion: Leading to death in middle age, drug use and abuse is a public health epidemic that is out of control. Harm reduction strategies should fit the needs of each state and local area.
P44. Recent Trends in Screening Mammography Utilization Among Female Employees at a Large U.S. Company S.E. Starks, K.H. Kreckmann, H.Q. Le, J.M. Symons. DuPont Epidemiology Program, Newark, DE, 19711, USA Purpose: Breast cancer screening recommendations have been the subject of debate in recent years and differ widely with respect to the frequency and initial age for routine screening mammography. The study objective was to describe the prevalence of screening mammography utilization for a cohort of female employees of a large U.S. company who were eligible to receive annual mammograms beginning at age 40 years. Methods: We examined the annual prevalence of breast cancer screening mammography among insured female employees aged 40 to 64 years using employee health insurance claims data from 2006 through 2010. Results: Approximately 3,950 employees were eligible to receive a screening mammogram each year from 2006 through 2010. The annual prevalence of screening mammography utilization for this cohort varied from 47% in 2006 to 53% in 2010. Among employees aged 50 to 64 years, the prevalence of screening was consistently higher compared to employees aged 40 to 49 years with an annual average increase of 5.4% for the older age group. Conclusion: Overall, approximately one-half of insured female employees utilized the annual screening mammography benefit. Given that early detection of breast cancer through routine screening may reduce morbidity and mortality, especially for women aged 50 years and older, breast cancer awareness and the benefits of screening should be promoted through occupational health programs.
P45. Progression and Treatment of Incident Lower Urinary Tract Symptoms (LUTS) Among Men in the California Men'S Health Study L.P. Wallner, J.M. Slezak, D.S. Fong, R.K. Loo. SJ Jacobsen Research and Evaluation, Kaiser Permanente Southern California
Abstracts / Annals of Epidemiology 22 (2012) 661e680
Purpose: Colon cancer screening rates are lower than targeted in Ontario. Further investigation indicated that a large proportion of the under and never screened population is illiterate and that the written fecal occult blood test (FOBT) instructions are too complex and wordy for illiterate, low literacy, and English as a second language populations. Our purpose was to develop a humourous FOBT instructional video to overcome this barrier. Methods: The Ontario FOBT written instructions were as the basis for the instructional video script. Artist sketches and group consensus was used to develop an appropriate character. An iterative process with focus group feedback was used to work towards a final video. Results: Various versions of the video were tested on the regional under/ never screened project teams (physicians, nurses, outreach workers), rural community members (n¼7 groups) and suburban community members (n¼2 groups). Men had a strong and uniformly positive reaction to the video, requesting that it be on TV and stating that it was “superbowl brilliant”. Women's reactions ranged from reserved positive to strongly positive. All felt confident and optimistic about performing the test after watching the video. Conclusions: Providing an uncomplicated, humourous instructional video can increase awareness of cancer screening, alleviate test fear, increase confidence in performing test, and change attitudes towards screening.
P41. Accelerating the Use of Study Findings for Community Benefit: the Six Nations Sexual Health Study Dionne Gesink,1 Debra Jonathan,2 Amber Skye1. 1 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, 2 Gane Yohs Health Centre, First Nations and Inuit Health, Ohsweken, Canada Purpose: Practicing community based participatory research (CBPR) principles has been a restorative way for indigenous communities and researchers to come together to end the legacy of research trauma and have research benefit the community first. We describe how we accelerated the use of study findings to benefit the Six Nations of the Grand River community. Methods: The Six Nations Sexual Health Study is a CBPR project. The nursein-charge and members of the community advisory board participated in data collection activities, which enabled immediate response to preliminary study findings. Results: The following actions were implemented in response to focus group discussions and in-depth interviews: HIV signs were replaced with sexual health information line signs located more strategically inside the community. The language used when interviewing cases for sexual contacts was changed so the term ‘partners’ is no longer used to identify sexual partners. The in school program has an Elder and public health nurse teaching about sex and sexual health. A youth role model campaign messaging respect was initiated. Conclusions: Taking a CBPR approach allowed researchers and community members to accelerate the translation of results to inform community programs, health care practice and policy.
P42-S. The Distribution of Mammography Characteristics in Metropolitan Chicago
Facility
J. Khan, J. Orsi, A.M. Murphy, D. Dupuy, G.H. Rauscher. Division of Epidemiology and Biostatistics, University of Illinois at Chicago, IL Purpose: Radiologists who read breast images >75% of the time (dedicated) and digital (vs. analog) mammography machines tend to provide better quality screening results. In Chicago, a highly segregated city, unequal distribution of services is a potentially important aspect of unequal access to care. We explored the distribution of mammography facility characteristics in metropolitan Chicago in relation to the populations of black and nonHispanic (nH) white women age 40 and older. Methods: Mammography facilities participating in the Metropolitan Chicago Breast Cancer Task Force 2010 Mammography Capacity Survey were categorized by whether they had dedicated radiologists or digital machines, and overlaid on a census tract-level (US 2010) map of women 40 and older by race. We created 1- and 3-mile (city vs. non-city, respectively) buffers around facilities to calculate the percentage of women age 40 and older by race who lived near a mammography facility. Results: Black women were less likely than nH white women to live in proximity to any mammography facility (70% vs. 75%), to one with at least one dedicated radiologist (61% vs. 68%), or to one with at least one digital machine (59% vs. 71%) (p < 0.0001 for all).
Conclusion: There is an unequal geographic distribution of mammography facility quality screening characteristics between the populations of black and nH white women in metropolitan Chicago. This inequity could potentially account for a portion of the large racial disparity in late stage diagnosis found in Chicago.
P43. Changes in Deaths Due to Drugs, Wisconsin 1999-2008 D.L. Nordstrom, M.L. Yokoi-Shelton. Department of Occupational and Environmental Safety and Health, University of Wisconsin-Whitewater, Whitewater, WI Purpose: To achieve the Healthy People 2020 objective of reducing drugrelated deaths by 10%, state and local groups need accurate information on local drug death trends. Methods: Using information from death certificates, we assessed changes in rates, causes, and circumstances of Wisconsin drug deaths during 10 recent years. Cases included all deaths with one or more of 270 cause of death codes from a National Center of Health Statistics scheme. Each death certificate had one “underlying” cause, one “immediate” cause, and up to 18 “contributing” causes. Results: Of the 4828 drug deaths identified, the average occurred at age 43. A majority of deaths, 3,410 (71%), were unintentional, and 1,053 (22%) were suicide. The unintentional-to-suicide death rate ratio grew from 1.6 in 1999 to 3.5 in 2008. Drug death rates increased during the 10- year period, and the male-to-female death ratio rose from 1.2 to 1.7. Black and Native American residents had drug death rates that were twice those of white residents. Opioid analgesics surpassed both cocaine and heroin to become the most frequent drugs leading to death. Of the specific individual drugs coded as causes of death, methadone ranked highest with 118 deaths in 2008 versus 10 deaths in 1999, an increase of 1080%. Conclusion: Leading to death in middle age, drug use and abuse is a public health epidemic that is out of control. Harm reduction strategies should fit the needs of each state and local area.
P44. Recent Trends in Screening Mammography Utilization Among Female Employees at a Large U.S. Company S.E. Starks, K.H. Kreckmann, H.Q. Le, J.M. Symons. DuPont Epidemiology Program, Newark, DE, 19711, USA Purpose: Breast cancer screening recommendations have been the subject of debate in recent years and differ widely with respect to the frequency and initial age for routine screening mammography. The study objective was to describe the prevalence of screening mammography utilization for a cohort of female employees of a large U.S. company who were eligible to receive annual mammograms beginning at age 40 years. Methods: We examined the annual prevalence of breast cancer screening mammography among insured female employees aged 40 to 64 years using employee health insurance claims data from 2006 through 2010. Results: Approximately 3,950 employees were eligible to receive a screening mammogram each year from 2006 through 2010. The annual prevalence of screening mammography utilization for this cohort varied from 47% in 2006 to 53% in 2010. Among employees aged 50 to 64 years, the prevalence of screening was consistently higher compared to employees aged 40 to 49 years with an annual average increase of 5.4% for the older age group. Conclusion: Overall, approximately one-half of insured female employees utilized the annual screening mammography benefit. Given that early detection of breast cancer through routine screening may reduce morbidity and mortality, especially for women aged 50 years and older, breast cancer awareness and the benefits of screening should be promoted through occupational health programs.
P45. Progression and Treatment of Incident Lower Urinary Tract Symptoms (LUTS) Among Men in the California Men'S Health Study L.P. Wallner, J.M. Slezak, D.S. Fong, R.K. Loo. SJ Jacobsen Research and Evaluation, Kaiser Permanente Southern California