Addressing Cervical Cancer Disparities Among People Experiencing Homelessness

解决无家可归者之间的宫颈癌差异

• 批准号: 10687561
• 负责人: Natalia Maria Rodriguez
• 金额: $ 138.26万
• 依托单位: PURDUE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10687561
• 关键词: Address; Age; Behavioral Research; Biomedical Research; Cancer Burden; Caring; Cervical; Cervical Cancer Screening; Communities; Community Health Aides; Data; Discrimination; Ethnic Origin; Exclusion; Gender Identity; General Population; Genotype; Health Services; Health behavior; Homeless persons; Homelessness; Human Papillomavirus; Incidence; Indiana; Individual; Infection; Malignant neoplasm of cervix uteri; Medical; Mental Health; Methods; Modality; Pap smear; Persons; Population; Prevalence; Prevention strategy; Preventive; Preventive healthcare; Primary Prevention; Provider; Public Health; Race; Risk; Role; Sampling; Secondary Prevention; Social Work; Substance Use Disorder; Underserved Population; Vaccinated; Vulnerable Populations; Woman; acceptability and feasibility; anticancer research; barrier to care; cancer health disparity; community based participatory research; community partnership; experience; follow-up; health care delivery; health disparity; low health literacy; mortality; programs; routine screening; screening; service organization; service providers; sexual trauma; sexual violence; social; social stigma

PROJECT SUMMARY People experiencing homelessness are at increased risk of cervical cancer incidence and mortality and have disproportionately low screening rates compared to the general population. Innumerable social and structural barriers keep this underserved population from accessing preventive healthcare, including mental health and substance use disorders, low health literacy levels, mistrust in medical providers due to stigma and discrimination, and living conditions that disenfranchise them from health and social services. Homeless women also experience high rates of sexual violence and trauma, often leading to discomfort with cervical cancer screening and delays or refusals of Pap tests. Despite these issues, a common inability to engage these “hard-to-reach” communities has largely excluded people experiencing homelessness from cancer research or public health programs, resulting in a major paucity of data on this uniquely vulnerable population with excess cancer burden. The proposed community-based participatory research will meaningfully engage people experiencing homelessness and local health and social service organizations to: 1) estimate cervical cancer screening coverage and factors associated with unscreened or underscreened individuals in two major homeless communities in Indiana; 2) identify key barriers and facilitators to cervical cancer screening, follow-up, and linkage to care; 3) determine the acceptability of HPV self-sampling delivered by community health workers, as an alternative to traditional cervical cancer screening methods; 4) elucidate the feasibility of HPV self-sampling in terms of the ability of people experiencing homelessness to acquire an adequate cervical sample; and 5) provide an estimate of HPV point prevalence and distribution of infections by genotype, age, gender identity, and race/ethnicity, which is critical to informing primary and secondary prevention strategies for this highly mobile and undervaccinated population. By triangulating the perspectives of people experiencing homelessness and the medical and homelessness social service providers who serve them, this study will lead to a holistic understanding of multilevel influences on preventive health behaviors and the potential role of alternative cervical cancer screening modalities. Leveraging an established multisectoral campus-community partnership examining and addressing health disparities among homeless communities in Indiana, this project will integrate behavioral and biomedical research to identify optimal strategies that facilitate routine screening and preventive healthcare delivery for people experiencing homelessness.

项目摘要 经历无家可归的人患宫颈癌的风险增加， 死亡率，与一般人群相比，筛查率不成比例地低。 难以克服的社会和结构性障碍使这些得不到充分服务的人口无法获得 预防性保健，包括心理健康和药物使用障碍，健康知识普及率低 由于污名化和歧视而对医疗提供者的不信任，以及 剥夺他们享有卫生和社会服务的权利。无家可归的妇女也经历了高 性暴力和创伤的发生率，往往导致宫颈癌筛查的不适 以及推迟或拒绝巴氏试验。尽管存在这些问题， “难以到达”的社区在很大程度上将无家可归的人排除在 癌症研究或公共卫生计划，导致这方面的数据非常缺乏， 癌症负担过重的弱势群体。拟议的社区参与式 研究将有意义地吸引无家可归者和当地健康， 社会服务机构：1）估计子宫颈癌普查的覆盖率和影响因素 在两个主要的无家可归者社区， 在印第安纳州; 2）确定宫颈癌筛查，随访， 与护理的联系; 3）确定社区提供的HPV自我采样的可接受性 卫生工作者，作为传统宫颈癌筛查方法的替代方法; 4）阐明 就无家可归者的能力而言，HPV自我采样的可行性 获得足够的宫颈样本;以及5）提供HPV点患病率的估计值 以及按基因型、年龄、性别认同和种族/民族划分的感染分布， 对于为这种高度移动的和 接种不足的人群。通过三角测量人们的视角， 无家可归者和为他们服务的医疗和无家可归者社会服务提供者， 研究将导致对预防性健康行为的多层次影响的整体理解 以及其他宫颈癌筛查方式的潜在作用。利用 建立多部门校园-社区伙伴关系，审查和解决健康问题 在印第安纳州无家可归的社区之间的差距，这个项目将整合行为和 生物医学研究，以确定促进常规筛查和预防的最佳策略 为无家可归者提供医疗服务。