Personal, social, enviromental, health services that prevent them from getting a Colorectal Cancer Screening among Asians

Personal, social, enviromental, health services that prevent them from getting a Colorectal Cancer Screening among Asians Personal, social, enviromental, health services that prevent them from getting a Colorectal Cancer Screening among Asians APA Format can use the http://www.healthypeople 2020.gov for some info Cite 4 current ( 2014 or newer) professional journals , use the articles listed below for as some that you cite Https://doi.org/10.1016/j.nutres.2017.10.003 Https://doi.org/10.1186/s13104-017-3098-3 discuss factors like :physical environment, financials , social environment , biology and genetics , health services as to why Asians people ( Japanese ,Koreans ,Chinese,etc ) do not get routine colon rectal cancer screening or the risk of colon/gastric cancer in this cultural group What local agencies are available to assist this culturally diverse population? final_professional_paper_health_disparities_1__2___1___6_.docx colorectal_cancer_screening_among_korean_americans.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS NURS 3355 Final Professional Health Disparities Paper Purpose Statement: Harkness & DeMarco (2017) define healthcare disparities as “gaps in care experienced by one population, as compared to another,” p. 4. This has been identified by Healthy People 2020 (http://www.healthypeople2020.gov/) as one of their benchmark goals to decrease healthcare disparities. Using the culture specific to your interviewee, determine how his/her culture access healthcare to include the social determinants embedded within HP 2020 framework. Steps to Guide You in the Writing Process 1. Use your interviewee who represents a member of a disparate population within your community. All rules of confidentiality and HIPAA apply. Determine the “problem” of focus using the benchmark goals from HP 2020. An example of this would be noncompliance with immunizations. a Perform a database search using the WTAMU Library link and find 5 evidencebased practice/research articles that are peer-reviewed using your “problem” as the subject. You can use limiters to help refine your search. When you are in the CINAHL portal, you can click on “research” in the left column and “peerreviewed” in the right column to make for more meaningful search results. T The paper should be written in APA format; i.e. includes title page, abstract with key words, body of report and reference page. Make sure that direct quotes include a page number for citations and quotation marks around the quote. If you need assistance with APA formatting, please refer to “Resources/Purdue OWL (Online Writing Lab) link. The length of the paper should be 5 to 7 pages, excluding your title page, abstract and reference page. You need a minimum of 5 references (articles) plus textbook reference. . Using the Healthy People 2020 “Determinants” describe the following specific to your patient. a. Physical Environment, Social Environment, Individual Behavior, Biology & Genetics and Health Services; what local agencies are available to assist this culturally diverse patient population? P Proofread your paper for typographical errors, grammar errors, and citation errors. It is often helpful to get another set of eyes to look at your paper. Due date for the paper is 5/6 at 11:59 p.m. Submit paper to Safe Assign and review originality report prior to going to “Assignments” and submitting your paper as an attachment (Word document) to the text box. A good rule of thumb is to limit similarity to fewer than 15%. If your reference page is what is highlighted for similarity, you are okay. If for any reason, you are unable to submit your paper, please notify me immediately via text message to 309-3974441. DOI:10.22034/APJCP.2018.19.5.1387 Location of Colorectal Cancer Screening Utilization RESEARCH ARTICLE Editorial Process: Submission:01/31/2018 Acceptance:05/03/2018 Colorectal Cancer Screening among Korean Americans in Chicago: Does It Matter Whether They had the Screening in Korea or the US? Shin Young Lee* Abstract Background: Colorectal cancer (CRC) is one of the most common cancers in Korean Americans (KAs) and CRC screening can detect CRC early and may reduce the incidence of CRC by leading to removal of precancerous polyps. Personal, social, enviromental, health services that prevent them from getting a Colorectal Cancer Screening among Asians Many KAs in the US leave the country, primarily to travel to Korea, for health screening. The aim of this study was to (a) assess CRC screening rates, including fecal occult blood test (FOBT), flexible sigmoidoscopy, and colonoscopy and (b) explore factors related to these tests among KAs by location of CRC screening. Methods: Descriptive and correlational research design with cross-sectional surveys was used with 210 KAs. Socio-demographics (age, gender, years in the US, marital status, education, employment, household income, and proficiency in spoken English), access to health care (health insurance and usual source of health care), and location of CRC screening utilization (Korea, the US, or both Korea and US) were measured and analyzed using descriptive statistics and multinominal logistic regression. Results: Out of 133 KA participants who had had lifetime CRC screening (i.e., had ever had FOBT, flexible sigmoidoscopy, or colonoscopy), 19% had visited Korea and undergone CRC screening in their lifetimes. Among socio-demographic factors and access to health care factors, having a usual source of health care in the US (OR=8.45) was significantly associated with having undergone lifetime CRC screening in the US. Having health insurance in the US and having had lifetime CRC screening in the US were marginally significant (OR=2.54). Conclusion: Access to health care in the US is important for KAs to have CRC screening in the US. As medical tourism has been increasing globally, the location of CRC screening utilization must be considered in research on cancer screening to determine correlates of CRC screening. Keywords: Colorectal cancer- screening- Korean Americans- medical tourism Asian Pac J Cancer Prev, 19 (5), 1387-1395 Introduction Korean Americans (KAs) constitute one of the fastest-growing Asian groups in the U.S. The KA population increased from 799,000 to 1,700,000 between 1990 and 2010 (U.S. Census Bureau, 2001; US Census Bureau, 2012). Among Asian American/Pacific Islander groups, KAs represent 9.9% of the total Asian American population (US Census Bureau, 2012). Colorectal cancer (CRC) was the second most commonly diagnosed cancer for both KA men and women (Gomez et al., 2013). Compared to other racial and ethnic groups in the US, KAs have higher incidence rates than non-Hispanic whites and Asian Americans. Because CRC incidence can be decreased through CRC screening for the early detection of precancerous polyps and cancers, the US Preventive Services Task Force (2017) has recommended that individuals aged 50 to 75 years at average risk for developing CRC have an annual fecal occult blood test (FOBT), a flexible sigmoidoscopy every 5 years, or a colonoscopy every 10 years. However, KAs consistently had lower rates of CRC screening utilization than whites, African Americans, Latinos, and other Asian subgroups, including Chinese, Filipino, Japanese, and Vietnamese in the US (Homayoon et al., 2013; Lee et al., 2011; Maxwell and Crespi, 2009). Although previous studies have examined CRC screening behavior among KAs (Jo et al., 2008; Jo et al., 2017; Juon et al., 2003; Kim et al., 1998; Lu et al., 2016; Maxwell et al., 2000; Oh et al., 2013), researchers have not considered where KAs undergo their CRC screening. Approximately 750,000 US residents travel abroad for health care each year, according to the Centers for Disease Control and Prevention (Deloitte, 2008). A large number of medical tourists are immigrants in the US returning to their home country for care (Deloitte, 2008). In fact, many KAs in the US leave the country, primarily to travel to Korea, to obtain health-screening packages at a lower price than in the US (Ko et al., 2016; Oh et al., 2014). Despite the large number of KAs having Department of Nursing, Chosun University 309 Pilmun-daero, Dong-gu, Gwangju, 501-759 Republic of Korea. Personal, social, enviromental, health services that prevent them from getting a Colorectal Cancer Screening among Asians *For Correspondence: [email protected] Asian Pacific Journal of Cancer Prevention, Vol 19 1387 Shin-Young Lee health check-ups in Korean health care services in Korea, previous cancer screening studies (Jo et al., 2008; Jo et al., 2017; Juon et al., 2003; Kim et al., 1998; Lu et al., 2016; Maxwell et al., 2000; Oh et al., 2013) have asked the question, “Have you had CRC screening?” and have used this as an outcome variable, without asking the participants about where they had the CRC screening. Studies that have reported CRC screening might have included both KA medical tourists who traveled to Korea for CRC screening as well as those who had CRC screening in the US. But the characteristics of KAs screened in Korea could be different from the characteristics of those who have had CRC screening in the US. For example, not having a usual source of health care and health insurance in the US (defined as access to health care) could force persons to travel to Korea for CRC screening. In fact, studies on medical tourism report that medical tourists often do not have access to health care (Gan and Frederick, 2013; Karuppan and Karuppan, 2010). In this situation, KA medical tourists who were asked the question, “Have you had CRC screening?” would say “yes” if they had undergone CRC screening in Korea. However, they would more likely answer “no” to the question about whether they have health insurance, which would make it difficult to identify associations between having the access to health care in the US and CRC screening utilization. Because of these limitations, research needs to be conducted with KAs to examine CRC screening test options by location of screening, such as in Korea or the US. To date, CRC screening rates and factors associated with CRC screening for KAs by location of screening have not been investigated, although this information is essential to accurately determine factors associated with CRC screening behaviors to improve low CRC screening rates for this group. The purpose of this study was (a) to assess CRC screening rates, including FOBT, flexible sigmoidoscopy, and colonoscopy by location of CRC screening including Korea, US, or both countries, and (b) to explore factors related to these tests among KAs by location of CRC screening. This will help us identify the relationship between medical tourism and CRC screening behaviors among KAs. This is the first study to investigate CRC screening for KAs by location of screening, and knowledge gained from this study can make an important contribution to better understanding and predicting the international care accessed by immigrant populations including KAs. Materials and Methods Study design A descriptive and correlational research design with a cross-sectional survey was used to assess CRC screening rates and to explore factors related to CRC screening tests among KAs by location of CRC screening. Participants The sample for this study included KAs who were: born in Korea, immigrants to the US, fluent in spoken Korean, aged 50 and older, and at average risk of CRC (such as who had no history of Crohn’s disease, ulcerative colitis, CRC, or first-degree relative with 1388 Asian Pacific Journal of Cancer Prevention, Vol 19 CRC) according to ACS guidelines (American Cancer Society, 2017). A total of 210 KAs living in the Chicago metropolitan area, which has one of the largest KA populations in the US, participated in this study. Ethical considerations After the Institutional Review Board at the University approved the research protocol, the survey was conducted in the Chicago metropolitan area. Written consent forms that included the purpose and procedures of the study, possible benefits to and risks of participation in the study, and a statement about the protection of privacy and confidentiality were given to participants. Participants were informed that they could withdraw from the study at any time without any consequences of any kind. Participant ID numbers, rather than personal identifiers such as names, were used for participants in the survey. Personal, social, enviromental, health services that prevent them from getting a Colorectal Cancer Screening among Asians Measures Socio-demographics (age, gender, years in the US, marital status, education, employment, household income, and level of spoken English); access to health care (health insurance and usual source of health care); and CRC screening utilization by location (Korea, the US, or both Korea and the US) were measured. All the socio-demographic measures except level of spoken English and access to health care measures were adapted from previous studies (Lee et al., 2016; Menon et al., 2007). Among the socio-demographic variables, we measured years in the US (length of time in the US) as a continuous variable and then categorized it as more than or less than 20 years because we wanted to compare our results with those of previous studies. Household income was measured as a categorical variable because income questions are sensitive to ask and studies have shown that the item nonresponse to income questions is 20% – 40% (Tourangeau and Yan, 2007). Having health insurance, such as commercial insurance, Medicare, or Medicaid, and usual source of care (i.e., a regular doctor or a regular place to go for health care) was measured as a proxy of access to health care. FOBT, flexible sigmoidoscopy, and colonoscopy utilization were measured as the outcome variables of this study. Participants were asked for the time and place of each CRC screening test. We first asked participants whether they had undergone each CRC screening test in their lifetime. If they answered ‘yes’, we asked them if they had it either in Korea, the US, or both Korea and the US. Lifetime CRC screening (had undergone either FOBT, flexible sigmoidoscopy, or colonoscopy) and up-to-date (had undergone either FOBT in the previous year, flexible sigmoidoscopy in the previous 5 years, or colonoscopy in the previous 10 years) were calculated according to the ACS guidelines on CRC screening (American Cancer Society, 2017). This study was conducted with a Korean language questionnaire after the English version of the scales was translated into Korean by three bilingual translators using a committee translation method. DOI:10.22034/APJCP.2018.19.5.1387 Location of Colorectal Cancer Screening Utilization Data collection The PI recruited a convenience sample of participants from a Korean church and two community centers in the Chicago metropolitan area. The PI explained the project and asked KAs to participate in the survey. If they were eligible and agreed to participate, the PI gave them a survey package including a self-administered questionnaire, a consent form, and a stamped return envelope. The participants returned the consent form and the survey questionnaire to the PI in person or by mail depending on the participant’s preference. Out of a total of 285 distributed, 210 surveys were completed and returned (response rate = 72.9%). Ninety-seven completed surveys (46.2%) were received in person, and 113 (53.8%) were received by mail. Comparing the data collected in person or by mail, no differences were found in socio-demographics, access to health care, or CRC screening rates between the two groups. Participants did not report having any difficulties with the survey. Each participant received a $20 grocery store gift certificate in person or by mail after the PI received the completed questionnaire. Data analysis Data were entered and all analyses were conducted using SPSS Version 23 (Statistical Package for Social Sciences Inc, 2016). Descriptive statistics were calculated for participants’ characteristics and use of CRC screening. Regarding socio-demographic variables, access to health care variables, and CRC screening utilization by locations, means, standard deviations, and ranges were reported for interval or ratio variables, and numbers and percentages were reported for categorical variables. To determine the associations between socio-demographic variables and access to health care with CRC screening utilization by location of tests, multinomial logistic regression was conducted. Results Sample Characteristics Socio-demographic and health-related characteristics are shown in Table 1. A total of 210 KAs aged 50 and older living in the Chicago metropolitan area were surveyed. The mean age was 62.54, ranging from 50-84. Both women (61%) and men (39%) participated in this study. The majority of participants were married (81.9%), reported an annual household income of more than $50,000 (74.8%) and had lived in the US for more than 20 years (74.8%). More than half of the participants spoke some English (67.6%) and their usual source of health care was in the US (61.4%). More than half of the participants (57.9%) had health insurance such as commercial insurance, Medicare, or Medicaid, and 15.2% had two or three kinds of health insurance. Prevalence of CRC Screening Overall, 133 (63.3%) of the participants had had CRC screening during their lifetime, and 119 (56.7%) had had up-to-date CRC screening (Table 2). When the screening data were examined by location, a total of 40 (19.0%) KAs had visited Korea to undergo CRC screening, including those who had had the lifetime CRC screening only in Korea (N = 28, 13.3%) as well as in both Korea and the US (N = 12, 5.7%) while 93 (44.3%) had had the lifetime CRC screening only in the US (Table 2). Table 3 summarizes the results of screening rates for FOBT, flexible sigmoidoscopy, and colonoscopy, along with the locations of each lifetime screening test. Among the 210 participants, 48 (22.9%) had had lifetime FOBT, 8 (3.8%) had had FOBT in the previous year, 49 (23.3%) had had lifetime sigmoidoscopy, 42 (20.0%) had had sigmoidoscopy in the preceding 5 years, 122 (58.1%) had had lifetime colonoscopy, and 115 (54.8%) had had colonoscopy in the previous 10 years. Regarding the locations of lifetime CRC screening, of the 210 KAs, a total of 15 (7.1%) visited Korea for FOBT, including KAs who had had FOBT in Korea only (N = 12, 5.7%) and in both Korea and the US (N = 3, 1.4%), whereas 33 (15.7%) had had FOBT in the US only. A total of 9 (4.3%) KAs visited Korea for flexible sigmoidoscopy, including those who had had it in Korea only (N = 6, 2.9%) and in both Korea and the US (N = 3, 1.4%), whereas 40 (19.0%) had had it in the US only. A total of 32 (15.2%) KAs visited Korea for colonoscopy, including KAs who had had it in Korea only (N = 30, 14.3%) only and in both Korea and the US (N = 2, 1.0%), whereas 90 (42.9%) had had it in the US only (Table 3). Factors Associated with KA CRC Screening Utilization by Location To determine relationships among socio-demographic factors, access to health care, and lifetime CRC screening utilization by location, multinomial logistic regression using SPSS was conducted. KA participants who had lifetime CRC screening in both Korea and the US were rare (n=12), which could affect statistical test results. Therefore, three groups of KA participants who had had lifetime CRC screening in Korea, in the US, and had not had lifetime CRC screening were included in multinomial logistic regression. All variables were entered into the multinomial logistic regression model. Table 4 shows the results of the multinomial logistic regression analysis. Based on the multinomial logistic regression, the variable “usual source of health care in the US” were significantly associated with higher odds of having had lifetime CRC screening in the US when the reference category was KAs who had not had CRC screening (P<0.05) (Table 4). The variable “health insurance in the US” and having had lifetime CRC screening were marginally significant. After controlling for other variables, KAs who had a usual source of care in the US had more than 8 times greater odds of having had CRC screening in the US (OR=8.45, 95% CI 3.39, 21.10) compared to KAs who did not have a usual source of health care in the US. Additionally, KAs who had health insurance in the US had marginally higher odds of having had lifetime CRC screening in the US (OR = 2.54, 95% CI 0.98, 6.59) than those who did not have health insurance in the US. Asian Pacific Journal of Cancer Prevention, Vol 19 1389 Shin-Young Lee Table 1. Socio-Demographic and Health-Related Characteristics of KAs (n = 210) Variable n (%) M ± SD Range 50-64 130 (61.9) 62.54 ± 8.75 50–84 ?65 80 (38.1) 25.18 ± 10.13 1-52 Age (year) Gender Male 82 (39.0) Female 128 (61.0) Years in the US <20 53 (25.2) ?20 157 (74.8) Marital Status Currently married 172 (81.9) Not married 38 (18.1) Education ?High school graduate 85 (40.5) >High school graduate 125 (59.5) Employment Unemployed 131 (62.4) Employed 79 (37.6) Usual source of health care in the US Yes 129 (61.4) No 81 (38.6) Health insurance in the US Yes 1 … Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10