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16. Multilevel predictors of colorectal cancer testing modality among publicly and privately insured people turning 50

Author

Wheeler, Stephanie B, Kuo, Tzy-Mey, Meyer, Anne Marie, Martens, Christa E, Lich, Kristen M Hassmiller, Tangka, Florence KL, Richardson, Lisa C, Hall, Ingrid J, Smith, Judith Lee, Mayorga, Maria E, Brown, Paul, Crutchfield, Trisha M, and Pignone, Michael P

Subjects
Public Health, Health Sciences, Clinical Research, Aging, Health Services, Colo-Rectal Cancer, Digestive Diseases, Cancer, Prevention, Cancer screening tests, Colonoscopy, Colorectal cancer, Fecal occult blood test, Medicaid, Medicare, Multilevel analysis, Public Health and Health Services, Epidemiology, Health services and systems, Public health
Abstract

Understanding multilevel predictors of colorectal cancer (CRC) screening test modality can help inform screening program design and implementation. We used North Carolina Medicare, Medicaid, and private, commercially available, health plan insurance claims data from 2003 to 2008 to ascertain CRC test modality among people who received CRC screening around their 50th birthday, when guidelines recommend that screening should commence for normal risk individuals. We ascertained receipt of colonoscopy, fecal occult blood test (FOBT) and fecal immunochemical test (FIT) from billing codes. Person-level and county-level contextual variables were included in multilevel random intercepts models to understand predictors of CRC test modality, stratified by insurance type. Of 12,570 publicly-insured persons turning 50 during the study period who received CRC testing, 57% received colonoscopy, whereas 43% received FOBT/FIT, with significant regional variation. In multivariable models, females with public insurance had lower odds of colonoscopy than males (odds ratio [OR] = 0.68; p

Published
2017

20. Using a discrete choice experiment to inform the design of programs to promote colon cancer screening for vulnerable populations in North Carolina

Author

Pignone, Michael P, Crutchfield, Trisha M, Brown, Paul M, Hawley, Sarah T, Laping, Jane L, Lewis, Carmen L, Lich, Kristen Hassmiller, Richardson, Lisa C, Tangka, Florence KL, and Wheeler, Stephanie B

Subjects
Public Health, Health Sciences, Colo-Rectal Cancer, Behavioral and Social Science, Cancer, Clinical Research, Digestive Diseases, Health Services, Black or African American, Bayes Theorem, Choice Behavior, Colorectal Neoplasms, Early Detection of Cancer, Ethnicity, Female, Health Promotion, Humans, Male, Middle Aged, North Carolina, Patient Acceptance of Health Care, Program Development, Rural Population, Surveys and Questionnaires, Vulnerable Populations, White People, Early detection of cancer, Colorectal neoplasms, Vulnerable populations, Rural population, Choice behavior, Decision making, Economics, Behavioral, Questionnaires, Health policy, Library and Information Studies, Nursing, Public Health and Health Services, Health Policy & Services, Health services and systems, Public health
Abstract

BackgroundScreening for colorectal cancer (CRC) is suboptimal, particularly for vulnerable populations. Effective intervention programs are needed to increase screening rates. We used a discrete choice experiment (DCE) to learn about how vulnerable individuals in North Carolina value different aspects of CRC screening programs.MethodsWe enrolled English-speaking adults ages 50-75 at average risk of CRC from rural North Carolina communities with low rates of CRC screening, targeting those with public or no insurance and low incomes. Participants received basic information about CRC screening and potential program features, then completed a 16 task DCE and survey questions that examined preferences for four attributes of screening programs: testing options available; travel time required; money paid for screening or rewards for completing screening; and the portion of the cost of follow-up care paid out of pocket. We used Hierarchical Bayesian methods to calculate individual-level utilities for the 4 attributes' levels and individual-level attribute importance scores. For each individual, the attribute with the highest importance score was considered the most important attribute. Individual utilities were then aggregated to produce mean utilities for each attribute. We also compared DCE-based results with those from direct questions in a post-DCE survey.ResultsWe enrolled 150 adults. Mean age was 57.8 (range 50-74); 55% were women; 76% White and 19% African-American; 87% annual household income under $30,000; and 51% were uninsured. Individuals preferred shorter travel; rewards or small copayments compared with large copayments; programs that included stool testing as an option; and greater coverage of follow-up costs. Follow-up cost coverage was most frequently found to be the most important attribute from the DCE (47%); followed by test reward/copayment (33%). From the survey, proportion of follow-up costs paid was most frequently cited as most important (42% of participants), followed by testing options (32%). There was moderate agreement (45%) in attribute importance between the DCE and the single question in the post-DCE survey.ConclusionsScreening test copayments and follow-up care coverage costs are important program characteristics in this vulnerable, rural population.

Published
2014

32. Variation in State-Level Mammography Use, 2012 and 2020.

Author

Howard, David H., Tangka, Florence K.L., Miller, Jacqueline, and Sabatino, Susan A.

Subjects
*CONFIDENCE intervals, *TIME, *MAMMOGRAMS, *MEDICAL screening, *EARLY detection of cancer, *STATE governments, *COMPARATIVE studies, *SOCIAL classes, *QUESTIONNAIRES, *HEALTH behavior, *DESCRIPTIVE statistics, *RESEARCH funding, *MEDICAID, *BREAST tumors, *INSURANCE
Abstract

Objectives: Mammography is a screening tool for early detection of breast cancer. Uptake in screening use in states can be influenced by Medicaid coverage and eligibility policies, public health outreach efforts, and the Centers for Disease Control and Prevention–funded National Breast and Cervical Cancer Early Detection Program. We described state-specific mammography use in 2020 and changes as compared with 2012. Methods: We estimated the proportion of women aged ≥40 years who reported receiving a mammogram in the past 2 years, by age group, state, and demographic and socioeconomic characteristics, using 2020 Behavioral Risk Factor Surveillance System data. We also compared 2020 state estimates with 2012 estimates. Results: The proportion of women aged 50-74 years who received a mammogram in the past 2 years was 78.1% (95% CI, 77.4%-78.8%) in 2020. Across measures of socioeconomic status, mammography use was generally lower among women who did not have health insurance (52.0%; 95% CI, 48.3%-55.6%) than among those who did (79.9%; 95% CI, 79.3%-80.6%) and among those who had a usual source of care (49.4%; 95% CI, 46.1%-52.7%) than among those who did not (81.0%; 95% CI, 80.4%-81.7%). Among women aged 50-74 years, mammography use varied across states, from a low of 65.2% (95% CI, 61.4%-69.0%) in Wyoming to a high of 86.1% (95% CI, 83.8%-88.3%) in Massachusetts. Four states had significant increases in mammography use from 2012 to 2020, and 8 states had significant declines. Conclusion: Mammography use varied widely among states. Use of evidence-based interventions tailored to the needs of local populations and communities may help close gaps in the use of mammography. [ABSTRACT FROM AUTHOR]

Published
2024
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45. Young Breast Cancer Survivors: Employment Experience and Financial Well-Being

Author

Tangka, Florence K. L., primary, Subramanian, Sujha, additional, Jones, Madeleine, additional, Edwards, Patrick, additional, Hoover, Sonja, additional, Flanigan, Tim, additional, Kaganova, Jenya, additional, Smith, Kevin, additional, Hawkins, Nikki A., additional, Rodriguez, Juan, additional, Hanson, Arin Ahlum, additional, Guglielmino, Janine, additional, Esser, Michelle, additional, Guy Jr., Gery P., additional, Thomas, Cheryll C., additional, and Fairley, Temeika, additional

Published
2020
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47. Additional file 2 of Improving the efficiency of integrated cancer screening delivery across multiple cancers: case studies from Idaho, Rhode Island, and Nebraska

Author

Tangka, Florence K. L., Subramanian, Sujha, Hoover, Sonja, Cariou, Charlene, Creighton, Becky, Hobbs, Libby, Marzano, Amanda, Marcotte, Andrea, Norton, Deirdre Denning, Kelly-Flis, Patricia, Leypoldt, Melissa, Larkins, Teri, Poole, Michelle, and Boehm, Jennifer

Abstract

Additional file 2: Supplemental Appendix 2. Facilitators and barriers to integrating policies, interventions, and strategies across cancer screening programs identified from informant interviews.

Published
2023
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48. Additional file 1 of Improving the efficiency of integrated cancer screening delivery across multiple cancers: case studies from Idaho, Rhode Island, and Nebraska

Author

Tangka, Florence K. L., Subramanian, Sujha, Hoover, Sonja, Cariou, Charlene, Creighton, Becky, Hobbs, Libby, Marzano, Amanda, Marcotte, Andrea, Norton, Deirdre Denning, Kelly-Flis, Patricia, Leypoldt, Melissa, Larkins, Teri, Poole, Michelle, and Boehm, Jennifer

Abstract

Additional file 1: Supplemental Appendix 1. Pre-Implementation: Evidence-based Intervention Checklist. This document is Idaho’s complete checklist.

Published
2023
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