Increasing Cervical Cancer Screening in the United States-Mexico Border Region

摘要: The United States-Mexico border region includes parts of 4 US states (including 44 counties) and 6 Mexican 80 municipios) that lie within 100 kilometers north or south the US-Mexico border. population this area is estimated to be approximately 13 million, it expected double by year 2025.1 In 2010, Border Health Commission identified as rapidly growing, with a young population, where 52% Hispanic. characterized lower educational attainment, income status, higher poverty rates, almost twice high in compared whole.1 also has rates uninsured people: 2007, 23% residents lacked health insurance coverage, 14.7% nationally, an inadequate number care providers. All these issues contribute diminished health, well-being, access care. disparities are predicted worsen region.2,3 Barriers receiving needed can include cost, language knowledge barriers, structural logistical factors, such long waiting times not having transportation.4 Barriers socioeconomic, racial ethnic, geographic differences utilization status. Women more likely than men live poverty, Hispanic women living non-Hispanic white (23.8% vs. 10.1%),5 they experience disparities. were report delayed due barriers past (13.0% 9.6%, respectively). Unmet needs for varied race ethnicity. Eleven twelve percent black had unmet need 8.5% whites.5 Hispanic have highest cervical cancer incidence age-adjusted 12.5 cases/100,000 2004-2008, 7.0 population.6 With rate 9.7/100,000 1998-2003, exhibits non-border counties (9.3/100,000, all combined), overall (8.7/100,000).7 addition, diagnosed at late stage other states, states.7 While Preventative Task Force guidelines Pap testing every 3 years routine screening over age 21, from after initiation sexual activity, whichever earlier,8 less whites test. Data National Interview Survey show 74.6% test 81.4% women.9 Similarly, non-adherence recommended follow-up been reported several regional studies range 20%to 90%,10,11 recent women.7 Thus low-cost, easily adaptable interventions increase vulnerable populations needed. Successful programs aimed increasing behaviors used variety methods including Spanish-language media, fairs community workers (CHWs, known lay educators Promotores de Salud Spanish),12 CHWs educate peers culturally appropriate manner.13 Systematic reviews one-on-one education effective method screening.14 self-efficacy, perceived benefits test, subjective norms, survivability significantly increased when involved motivate aged ≥50 years, receive test.15 However, limited tested using region, significant care.12,16 In paper, we describe effect CHW-led tailored, (as ascertained focus groups women) computerized intervention, uptake (Papanicolaou (Pap) tests) on who non-compliant (3 since test).