This book presents analysis of data collected from patients of a safety-net healthcare system in Fort Worth, Texas. It examined three objectives, including explaining the utilization of Pap smear tests among the low-income women, by ascertaining the determinants of using these services. The existence of a race/ethnicity/immigration status effect was found. Anglos were more likely to have had a Pap smear, followed by African Americans, Hispanic immigrants and finally by, Hispanic Americans. The persistence of the race/ethnicity/immigration status effect may be explained by several factors, including cultural differences between the different groups studied. The race/ethnicity/immigration status effect on Pap smear screening changed with the introduction of age, usual source of care, check-up for current pregnancy, and having multiple competing needs for food, clothing and housing into the models studied. The findings may be attributed to the use of a hospital-based sample who had regular access to subsidized health insurance from a publicly funded safety-net healthcare network system. Publicly funded health programs for underserved populations should be maintained and strengthened.

Cancer ranks second only to heart disease as a leading cause of death in the United States, making it a tremendous burden in years of life lost, patient suffering, and economic costs. Fulfilling the Potential for Cancer Prevention and Early Detection reviews the proof that we can dramatically reduce cancer rates. The National Cancer Policy Board, part of the Institute of Medicine, outlines a national strategy to realize the promise of cancer prevention and early detection, including specific and wide-ranging recommendations. Offering a wealth of information and directly addressing major controversies, the book includes: A detailed look at how significantly cancer could be reduced through lifestyle changes, evaluating approaches used to alter eating, smoking, and exercise habits. An analysis of the intuitive notion that screening for cancer leads to improved health outcomes, including a discussion of screening methods, potential risks, and current recommendations. An examination of cancer prevention and control opportunities in primary health care delivery settings, including a review of interventions aimed at improving provider performance. Reviews of professional education and training programs, research trends and opportunities, and federal programs that support cancer prevention and early detection. This in-depth volume will be of interest to policy analysts, cancer and public health specialists, health care administrators and providers, researchers, insurers, medical journalists, and patient advocates.

Most women who die from cervical cancer, particularly in developing countries, are in the prime of their life. They may be raising children, caring for their family, and contributing to the social and economic life of their town or village. Their death is both a personal tragedy, and a sad and unnecessary loss to their family and their community. Unnecessary, because there is compelling evidence, as this Guide makes clear, that cervical cancer is one of the most preventable and treatable forms of cancer, as long as it is detected early and managed effectively. Unfortunately, the majority of women in developing countries still do not have access to cervical cancer prevention programmes. The consequence is that, often, cervical cancer is not detected until it is too late to be cured. An urgent effort is required if this situation is to be corrected. This Guide is intended to help those responsible for providing services aimed at reducing the burden posed by cervical cancer for women, communities and health systems. It focuses on the knowledge and skills needed by health care providers, at different levels of care.

Cervical cancer prevention has undergone significant changes over recent decades. Evolving evidence and practices have shifted towards upstream prevention, less frequent screening, and more conservative follow-up. Understanding how these changes have been adopted among ethnic minority and low-income populations, groups disproportionately impacted by cervical cancer in the U.S., is important to optimizing prevention strategies. In three distinct studies, this dissertation advances evidence on adherence to recommendations for primary prevention (human papillomavirus (HPV) vaccination) and secondary prevention (early detection) of cervical cancer among high-risk populations. The first study assesses changes in adolescent HPV vaccination following vaccine approval in the U.S., using two cycles of population-based survey data from Los Angeles County. Between 2007 and 2011, ethnic and income differences in parental HPV vaccine awareness diminished, and HPV vaccine uptake rates markedly increased among older adolescent girls and those with access barriers. Yet, five years after vaccine approval, overall only half of adolescent girls had initiated vaccination. The second study evaluates adoption of evidence-based guidelines for management of abnormal screening tests among young women, using four years of administrative claims data from California's Medicaid family planning program. A difference-in-differences approach was used to estimate the impact of updated guidelines on receipt of a colposcopy, a procedure that could lead to potential harmful interventions. Among a sample of low-income, predominantly Hispanic women, results suggested the guideline was associated with a 2-fold reduction in colposcopies for young women relative to a comparison group, which has implications for reducing future risk of adverse obstetric outcomes. Given provider recommendations can influence patient adherence, the third study explores provider communication around cervical cancer screening and follow-up recommendations, including lengthened screening intervals. Semi-structured interviews were conducted among safety net providers in Southern California. Findings revealed that clinicians perceived explaining the rationale for guidelines, in addition to addressing patient emotions, uncertainty, and preferences, facilitated patient understanding and acceptance of recommended care. Collectively, these studies highlight opportunities to maximize the benefits of primary prevention and early detection strategies, while minimizing the harms of unnecessary intervention, among high-risk populations.

"Being poor is a health risk (Wells et al., 2019). When we wrote Poverty and Place, Cancer Prevention among Low Income Women of Color (2019), we demonstrated the potent forces of poverty and place and the prevalence of cancer among low-income women of color. That initial volume was the inspiration for this volume, entitled Cancer Navigation: Charting the Pathway Forward for Low Income Women of Color. In Poverty and Place, we had academics and researchers in mind. Our purpose was to examine how and why racial and class disparities have become potent forces in health and longevity rates in the United States. Conducting original research drawn from North City St. Louis, Missouri and the river city of East St. Louis, Illinois, we sought to understand the combination of factors that facilitate or pose a barrier to cancer treatment and adherence, for marginalized low- income women of color"--