Environmental, social and cultural determinants

Before improvements can made in cancer prevention and mortality for different groups of cancer patients, the environmental, social and cultural factors that affect cancer incidence and outcomes must be addressed. Only when these factors are better understood can innovative and appropriate approaches to cancer prevention, enhanced treatment and survivorship programs be developed and implemented. At UC Davis Comprehensive Cancer Center, researchers are examining these differences so that every group has the best chance against cancer.

Our work on the social and cultural determinants of disparities includes:

Disparities in regular breast cancer screening for uninsured or underinsured populations

Every Woman Counts is a state program that provides regular breast cancer screening to women who are uninsured or underinsured. Joy Melnikow, professor of Family and Community Medicine and her colleagues at the Center for Healthcare Policy & Research are developing a cost-effectiveness model for the program to assist California health policy makers as they allocate resources for use of new screening technology. The model takes into account differences between film and digital mammography, state budget reductions that have limited enrollment and eligibility for the program and data on breast cancers found as a result of screening.

Exposure to second-hand smoke greater among less-educated Asian American women

Elisa Tong, an assistant professor of medicine, is an expert in tobacco use among Asian groups. Most recently, she has determined that Asian American women who are less educated are more likely to be exposed to second-hand smoke in the workplace or at home than those who are better educated, despite anti-smoking rules.

Related Publications:
Smoking prevalence and factors associated with smoking status among Vietnamese in California 

Smoke-free policies among Asian-American women: comparisons by education status

Adherence to hormone therapy among Spanish-speaking women

Melnikow and fellow researcher Debora Paterniti wanted to understand factors associated with adherence to hormone therapy among Spanish-speaking women with breast cancer. They created focus groups to develop a survey on the topic.

Related Publications:
"I'm going to die of something anyway": women's perceptions of tamoxifen for breast cancer risk reduction 

Consistent cervical cancer screening equalizes incidence rates for Latinas

Lydia Howell, professor and interim chair of the Department of Pathology and Laboratory Medicine, researches on disparities in cervical cancer screening among Latino women, who have the highest cervical cancer rates in the United States. Howell found that when women participate in a program providing consistent screening resources, incidence rates among Latinas are no different than among other groups.

Effective communication of laboratory results is essential to effective health care delivery, particularly for low-income women who are less likely to receive regular cervical cancer screening or get follow-up care. Howell also studied use of a new system to report Pap smear test results that indicate pre-cancer and cancerous lesions that would require diagnostic follow-up. Her research on use of uniform terminology among medically underserved California women, found that introduction of the term – “Atypical squamous cells, cannot rule out HSIL (ASC-H)” more effectively communicated equivocal findings and reduced time to follow-up care.

Related Publications:
Cervical cancer screening in medically underserved California Latina and non-Latina women: effect of age and regularity of Pap testing 

Improving physician-patient communication about cancer pain with a tailored education-coaching intervention