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大的群体之一，有4- 癌症发病率是其他女性的5倍。我们的研究团队在过去的8年里 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、妇女的生活环境和低宫颈健康素养是风险的促进者 以及关爱的障碍。但关于涉及正义的女性随着时间的推移进行筛查的轨迹仍然存在疑问 鉴于复杂的宫颈筛查建议以及与卫生系统和 在复杂的医疗保险环境中导航。因此，没有足够的信息可供告知 针对社区中涉及正义的妇女宫颈癌预防需求的干预措施。 这项研究的具体目的是为了更好地了解宫颈的自然历史。 社区参与司法的妇女的癌症风险和预防行为。的长期目标是 这项研究旨在确定在哪里以及如何进行干预的策略，以改变那些 构建女性宫颈健康风险结构。 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历史研究 在三个地理和人口结构不同的城市中，社区司法涉及妇女。 我们计划利用堪萨斯城现有的三个社区女性样本， 密歇根、伯明翰、亚利桑那州和奥克兰，加利福尼亚州-将成为首批长期癌症预防研究之一 美国各城市的高危女性。通过研究三个地理和人口结构不同的城市， 我们可以对不同研究地点的每个调查水平的因素得出结论，这解释了 并提高我们推广研究结果的能力。通过利用我们正在进行的 在每个城市的项目中，我们也提供了高性价比和可行的方式来从事长期跟踪的困难 接触女性，我们已经与她们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 参与社区司法的宫颈健康危险行为、筛查和治疗的历史 女性(N~600)在三个城市的5年内。在第二个目标中，我们使用混合方法来 解开BMVP的重要区域在一小部分女性的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产品上：1)开发多层次的 解释参与司法的妇女从事宫颈工作的环境的概念框架 癌症预防。2)建立干预模式，解决健康的“上游”决定因素 临床和服务环境，同时满足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.