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The U.S. Department of Education made recent technical changes reducing eligibility for the Rural and Low-Income School Program. Given smaller budgets and lower economies of scale, rural districts may be less able to absorb short-term funding cuts and experience stronger negative achievement effects. Kansas implemented a state-level finance change (block grant funding) after 2015, which froze district revenue regardless of enrollment and reduced funding in districts where enrollment increased. Difference-in-differences models compare achievement before and after block grant implementation to estimate effects of funding cuts separately in rural and nonrural districts. Between-state and within-state comparisons offer complementary identification strategies in which the strengths of one approach help address limitations of the other. Revenue/spending reductions are similar by geography but represent a larger fraction of rural district budgets. Results indicate that revenue reductions have larger implications for achievement in rural areas, where they represent a larger proportion of the total budget.

Objective: For colon cancer patients, one goal of health insurance is to improve access to screening that leads to early detection, early-stage diagnosis, and polyp removal, all of which results in easier treatment and better outcomes. We examined associations among health insurance status, mode of detection (screen detection vs symptomatic presentation), and stage at diagnosis (early vs late) in a diverse sample of patients recently diagnosed with colon cancer from the Chicago metropolitan area. Methods: Data came from the Colon Cancer Patterns of Care in Chicago study of racial and socioeconomic disparities in colon cancer screening, diagnosis, and care. We collected data from the medical records of non-Hispanic Black and non-Hispanic White patients aged ≥50 and diagnosed with colon cancer from October 2010 through January 2014 (N = 348). We used logistic regression with marginal standardization to model associations between health insurance status and study outcomes. Results: After adjusting for age, race, sex, and socioeconomic status, being continuously insured 5 years before diagnosis and through diagnosis was associated with a 20 (95% CI, 8-33) percentage-point increase in prevalence of screen detection. Screen detection in turn was associated with a 15 (95% CI, 3-27) percentage-point increase in early-stage diagnosis; however, nearly half (47%; n = 54) of the 114 screen-detected patients were still diagnosed at late stage (stage 3 or 4). Health insurance status was not associated with earlier stage at diagnosis. Conclusions: For health insurance to effectively shift stage at diagnosis, stronger associations are needed between health insurance and screening-related detection; between screening-related detection and early stage at diagnosis; or both. Findings also highlight the need to better understand factors contributing to late-stage colon cancer diagnosis despite screen detection. [ABSTRACT FROM AUTHOR]

Background: Early detection of colon cancer is essential to successful treatment and survival, yet most patients are diagnosed only after onset of symptoms. Previous studies suggest differences in colon cancer screening and presentation by gender and race, but reasons for this are not understood. The purpose of this study was to identify barriers and facilitators to early detection of colon cancer and to compare by gender and race. Materials and Methods: In the Colon Cancer Patterns of Care in Chicago study, non-Hispanic Black and White (NHB, NHW) patients aged 30–79 newly diagnosed with colon cancer between 2010 and 2014 (n = 249) underwent in-depth semistructured interviews regarding the pathway to colon cancer diagnosis. Mixed qualitative and quantitative methods were used to analyze patient narratives and to compare response patterns by gender and race within prespecified domains: health care access factors, provider-related factors, patient-related factors, and diagnostic workup factors. Results: Women reported more barriers than facilitators to early detection than men (barrier: facilitator ratio of 0.60 vs. 0.48). Thematic differences were seen, with women reporting more barriers related to health care access, scheduling of follow-ups, symptom recognition, and inappropriate or inconclusive diagnostic tests. Fewer women than men reported facilitators related to provider factors such as ease of scheduling follow-ups and receiving referrals for screening or a specialist. NHBs and NHWs reported similar ratios of barriers to facilitators (0.55 vs. 0.53), but more NHBs than NHWs reported barriers related to health care access, scheduling follow-ups, and clinical delays, and fewer NHBs reported facilitators related to health care accessibility (existing relationship with provider, ease of scheduling follow-ups). Conclusions: In this diverse population of patients recently diagnosed with colon cancer, we identified substantive gender- and race-based differences in the types and burden of barriers and facilitators to early detection experienced in the path to diagnosis. These differences should be explored further as they may contribute to disparities in the diagnosis and prognosis of colon cancer. [ABSTRACT FROM AUTHOR]

The article discusses a study on the role of cultural beliefs (CB) and acculturation in delays in breast cancer (BC) care in Latina women. Topics mentioned include the CB that are prevalent among Latina BC patients including one about the link between BC and mammogram, the factors contributing to the high number of CB including low education and lack of health insurance, and the association of provider mistrust with the patients' lack of willingness to accept medical care.

Hispanic and non-Hispanic black breast cancer patients are more likely than non-Hispanic white patients to be diagnosed with breast cancer that is negative for estrogen and progesterone receptors (ER/PR-negative). This disparity might be transmitted through socioeconomic and reproductive factors. Data on 746 recently diagnosed breast cancer patients (300 non-Hispanic white, 303 non-Hispanic black, 143 Hispanic) were obtained from the population-based Breast Cancer Care in Chicago Study (Chicago, Illinois, 2005-2008). Income, educational level, and census tract measures of concentrated disadvantage and affluence were combined into a single measure of socioeconomic position (SEP). Parity and age at first birth were combined into a single measure of reproductive factors (RPF). We constructed path models to estimate direct and indirect associations of SEP and RPF, and we estimated average marginal controlled direct associations. Compared with non-Hispanic white patients, non-Hispanic black patients and Hispanic patients were more likely to have ER/PR-negative disease (28% and 20% for non-Hispanic black patients and Hispanic patients, respectively, vs. 12% for non-Hispanic white patients; P≤0.001). The ethnic disparity in ER/PR-negative breast cancer (prevalence difference = 0.13, 95% confidence interval: 0.07,0.18) was reduced by approximately 60% (prevalence difference = 0.05, 95% confidence interval: -0.04, 0.13) after control for SEP and RPF. At least part of the ethnic disparity in the aggressiveness of breast tumors might be transmitted through social influences on tumor biology. [ABSTRACT FROM AUTHOR]

Background: Black and Hispanic women are diagnosed at a later stage of breast cancer than white women. Differential access to specialists, diffusion of technology, and affiliation with an academic medical center may be related to this stage disparity. Methods: We analyzed data from a mammography facility survey for the metropolitan region of Chicago, Illinois, to assess in part whether quality breast imaging services were equally accessed by non-Hispanic white, non-Hispanic black, and Hispanic women and by women with and without private insurance. Of 49 screening facilities within the city of Chicago, 43 facilities completed the survey, and 40 facilities representing about 149,000 mammograms, including all major academic facilities, provided data on patient race/ethnicity. Results: Among women receiving mammograms at the facilities we studied, white women were more likely than black or Hispanic women to have mammograms at academic facilities, at facilities that relied exclusively on breast imaging specialists to read mammograms, and at facilities where digital mammography was available ( p<0.001). Women with private insurance were similarly more likely than women without private insurance to have mammograms at facilities with these characteristics ( p<0.001). Conclusions: Black and Hispanic women and women without private insurance are more likely than white women and women with private insurance to obtain mammography screening at facilities with less favorable characteristics. A disparity in use of high-quality mammography may be contributing to disparities in breast cancer mortality. [ABSTRACT FROM AUTHOR]

Both African American and Hispanic women are more likely to be diagnosed with later-stage breast cancer than Caucasian women in the United States. Women commonly delay in seeking medical care for three or more months after self-discovery of a breast symptom, and cultural factors may play an important role. The purpose of this study was to identify cultural beliefs contributing to the diagnosis of late-stage breast cancer in African-American and Latina women in Chicago. An inductive approach was used to identify cultural beliefs, using Strauss and Corbin's (1990) coding techniques. A set of questions were then developed based on the cultural beliefs identified, which were used to collect data in the subsequent interviews. First, cultural beliefs were identified, using a community participatory model to conduct four focus groups with Latinas (in Spanish and in English), African-American, and Caucasian women. Second, interviews with 117 women demonstrated that these beliefs were commonly held. Third, these cultural beliefs were assessed in women with newly-diagnosed breast cancer (n =136). African American, Latina, and Caucasian women were interviewed within 3-4 months of diagnosis using rapid case ascertainment from hospitals throughout Chicago. Significant differences were found among the three ethnic groups that would contribute to later-stage diagnosis in the African American and Latina women. Beliefs contributing to non- participation in mammography and delay in seeking medical evaluation after finding a breast symptom were identified. Four categories of cultural beliefs were identified among the three ethnic groups: (1) incorrect ideas about breast lumps; (2) use of self-help techniques; (3) faith-based beliefs; (4) futility of treatment. Findings from each group will be incorporated into community-based interventions to promote early detection of breast cancer, both by addressing cultural beliefs and by advocating for increased capacity for diagnostic and screening mammography. The use of a community participatory model resulted in richer data with greater cultural saliency, through the active collaboration of community partners in all phases of the study. Funding Sources: National Cancer Institute P50 CA106743 [ABSTRACT FROM AUTHOR]

Purpose: We explored a potential racial disparity in clinical delay among non-Hispanic (nH) Black and White colon cancer patients and examined factors that might account for the observed disparity.Methods: Patients aged 30-79 years with a newly diagnosed colon cancer from 2010 to 2014 (n = 386) were recruited from a diverse sample of nine public, private, and academic hospitals in and around Chicago. Prolonged clinical delay was defined as 60 days or more or 90 days or more between medical presentation (symptoms or a screen-detected lesion) and treatment initiation (surgery or chemotherapy). Multivariable logistic regression with model-based standardization was used to estimate the disparity as a difference in prevalence of prolonged delay by race.Results: Prevalence of delay in excess of 60 days was 12 percentage points (95% confidence interval: 2%, 22%) higher among nH Blacks versus Whites after adjusting for age, facility, and county of residence. Travel burden (time and distance traveled from residence to facility) explained roughly one-third of the disparity (33%, P = .05), individual and area-level socioeconomic status measures explained roughly one-half (51%, P = .21), and socioeconomic measures together with travel burden explained roughly four-fifths (79%, P = .08).Conclusions: Low socioeconomic status and increased travel burden are barriers to care disproportionately experienced by nH Black colon cancer patients. [ABSTRACT FROM AUTHOR]