Tri-City Cervical Cancer Prevention Study among Women in the Justice System

摘要 有刑事司法史的妇女仍然是受宫颈癌影响最严重的群体之一， 癌症的发病率是其他女性的5倍。我们的研究团队花了8年时间 调查造成这种差异的因素。我们发现异常的巴氏试验很高， 性健康风险、创伤、妇女的生活环境和宫颈健康知识水平低是风险的促进因素 和护理障碍。但随着时间的推移，涉及正义的妇女的筛查轨迹仍然存在问题 考虑到复杂的子宫颈检查建议和与卫生系统接口的困难， 在复杂的健康保险环境中导航。因此，没有足够的信息可以告知 在社区采取干预措施，解决涉及司法的妇女预防宫颈癌的需求。 本研究的具体目的是更好地了解宫颈癌的自然史， 社区参与司法的妇女的癌症风险和预防行为。的长期目标 这项研究旨在确定在何处以及如何干预以改变影响环境的因素和环境的策略， 妇女宫颈健康风险。 我们有一个独特的机会来进行宫颈健康风险和筛查的自然史研究 在三个地理和人口结构各异的城市，社区参与司法的妇女中， 我们计划利用现有的三个以社区为基础的、参与司法的妇女样本--在堪萨斯城， 密苏里州，伯明翰，阿拉巴马州和奥克兰，加利福尼亚州-成为第一个长期的癌症预防研究， 通过研究三个地理和人口统计学上不同的城市， 我们可以得出结论的因素，在每一个层次的调查跨研究中心，占变异， 城市和提高我们概括发现的能力。通过利用我们正在进行的 项目在每个城市，我们也提供了一个具有成本效益和可行的方式来从事长期的后续工作， 我们已经与女性建立了信任和融洽的关系。 在我们的第一个目标中，我们使用弱势群体行为模型（BMVP）来解释自然现象。 社区司法介入妇女宫颈健康危险行为史、筛查和治疗 妇女（N~600）在三个城市的5年期间。在第二个目标中，我们使用混合方法来 解开BMVP重要领域在女性子样本日常生活中的运作方式 （N~60）从较大样本中招募。 本研究的公共卫生意义主要集中在两个方面：1）开发多层次的 解释参与司法的妇女从事宫颈癌治疗的环境的概念框架 癌症预防。2)建立干预模式，解决健康的"上游"决定因素， 诊所和服务环境，同时解决涉及司法的妇女的独特需求。

ABSTRACT Women with criminal justice histories persist as one of the groups most affected by cervical cancer, with 4- 5 times the rates of cancer compared to other women. Our research team has spent the last 8 years investigating the factors that account for this disparity. We have found that abnormal Pap tests are high, with sexual health risk, trauma, women's life circumstances, and low cervical health literacy as facilitators of risk and barriers to care. But questions remain about justice-involved women's screening trajectories over time given complex cervical screening recommendations and the difficulty of interfacing with health systems and navigating complex health insurance environments. Thus, there is insufficient information available to inform interventions that address justice-involved women's cervical cancer prevention needs in the community. The specific objective of this study is to develop a better understanding of the natural history of cervical cancer risk and prevention behaviors among community-based justice-involved women. The long-term goal of this study is to identify strategies for where and how to intervene to change the factors and environments that structure women's cervical health risk. We have a unique opportunity to conduct a natural history study of cervical health risk and screening among community-based justice-involved women in three geographically and demographically diverse cities. We plan to leverage three existing samples of community-based, justice-involved women – in Kansas City, MO, Birmingham, AL, and Oakland, CA – to become one of the first long-term cancer prevention studies of high-risk women across cities in the U.S. By studying three geographically and demographically diverse cities, we can draw conclusions about factors at each level of inquiry across study sites, accounting for variation in cities and increasing our ability to generalize findings. By leveraging samples generated by our ongoing projects in each city, we also offer a cost-effective and feasible way to engage in long-term follow-up of hard to reach women, with whom we've already established trust and rapport. In our first aim, we use the Behavioral Model for Vulnerable Populations (BMVP) to explain the natural history of cervical health risk behaviors, screening, and treatment among community-based justice-involved women (N~600) over a 5-year period in three cities. In the second aim, we use a mixed methods approach to unpack the ways in which significant domains of the BMVP operate in the daily lives of a subsample of women (N~60) recruited from the larger sample. Public health significance of this study centers on two products: 1) Development of a multi-level conceptual framework that explains the environment in which justice-involved women engage in cervical cancer prevention. 2) Creation of intervention models that address “upstream” determinants of health in clinical and service settings, while addressing justice-involved women's unique needs.