Kelly A Hirko1, Huiwen Xu2, Laura Q Rogers3, Michelle Y Martin4, Siddhartha Roy5, Kimberly M Kelly6, Shannon M Christy7, Kimlin Tam Ashing8, Jean C Yi9, Marquita W Lewis-Thames10, Cathy D Meade7, Qian Lu11, Clement K Gwede7, Julianna Nemeth12, Rachel M Ceballos13, Usha Menon14, Katie Cueva15, Karen Yeary16, Lisa M Klesges17, Monica L Baskin3, Kassandra I Alcaraz18, Sabrina Ford19. 1. Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Fee Road, East Lansing, MI, 48824, USA. hirkokel@msu.edu. 2. Department of Preventive Medicine and Population Health and Sealy Center On Aging, University of Texas Medical Branch, Galveston, TX, USA. 3. Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. 4. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. 5. Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA. 6. Department of Pharmaceutical Systems & Policy, West Virginia University, Morgantown, WV, USA. 7. Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. 8. Division of Health Equities, City of Hope Comprehensive Cancer Center and Beckman Institute, Duarte, CA, USA. 9. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 10. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 11. Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 12. Department of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, OH, USA. 13. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 14. College of Nursing, University of South Florida, Tampa, FL, USA. 15. Institute of Social and Economic Research, University of Alaska, Anchorage, AK, USA. 16. Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA. 17. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA. 18. Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 19. Department of Obstetrics, Gynecology & Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
Abstract
PURPOSE: Prior cancer research is limited by inconsistencies in defining rurality. The purpose of this study was to describe the prevalence of cancer risk factors and cancer screening behaviors across various county-based rural classification codes, including measures reflecting a continuum, to inform our understanding of cancer disparities according to the extent of rurality. METHODS: Using an ecological cross-sectional design, we examined differences in cancer risk factors and cancer screening behaviors from the Behavioral Risk Factor Surveillance System and National Health Interview Survey (2008-2013) across rural counties and between rural and urban counties using four rural-urban classification codes for counties and county-equivalents in 2013: U.S. Office of Management and Budget, National Center for Health Statistics, USDA Economic Research Service's rural-urban continuum codes, and Urban Influence Codes. RESULTS: Although a rural-to-urban gradient was not consistently evident across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all ptrend < 0.03), while colorectal, cervical and breast cancer screening decreased (all ptrend < 0.001) with increasing rurality. Differences in the prevalence of risk factors and screening behaviors across rural areas were greater than differences between rural and urban counties for obesity (2.4% vs. 1.5%), physical activity (2.9% vs. 2.5%), binge alcohol use (3.4% vs. 0.4%), cervical cancer screening (6.8% vs. 4.0%), and colorectal cancer screening (4.4% vs. 3.8%). CONCLUSIONS: Rural cancer disparities persist across multiple rural-urban classification codes, with marked variation in cancer risk factors and screening evident within rural regions. Focusing only on a rural-urban dichotomy may not sufficiently capture subpopulations of rural residents at greater risk for cancer and cancer-related mortality.
PURPOSE: Prior cancer research is limited by inconsistencies in defining rurality. The purpose of this study was to describe the prevalence of cancer risk factors and cancer screening behaviors across various county-based rural classification codes, including measures reflecting a continuum, to inform our understanding of cancer disparities according to the extent of rurality. METHODS: Using an ecological cross-sectional design, we examined differences in cancer risk factors and cancer screening behaviors from the Behavioral Risk Factor Surveillance System and National Health Interview Survey (2008-2013) across rural counties and between rural and urban counties using four rural-urban classification codes for counties and county-equivalents in 2013: U.S. Office of Management and Budget, National Center for Health Statistics, USDA Economic Research Service's rural-urban continuum codes, and Urban Influence Codes. RESULTS: Although a rural-to-urban gradient was not consistently evident across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all ptrend < 0.03), while colorectal, cervical and breast cancer screening decreased (all ptrend < 0.001) with increasing rurality. Differences in the prevalence of risk factors and screening behaviors across rural areas were greater than differences between rural and urban counties for obesity (2.4% vs. 1.5%), physical activity (2.9% vs. 2.5%), binge alcohol use (3.4% vs. 0.4%), cervical cancer screening (6.8% vs. 4.0%), and colorectal cancer screening (4.4% vs. 3.8%). CONCLUSIONS: Rural cancer disparities persist across multiple rural-urban classification codes, with marked variation in cancer risk factors and screening evident within rural regions. Focusing only on a rural-urban dichotomy may not sufficiently capture subpopulations of rural residents at greater risk for cancer and cancer-related mortality.
Authors: Tomas Nuño; Joe K Gerald; Robin Harris; Maria Elena Martinez; Antonio Estrada; Francisco García Journal: Cancer Causes Control Date: 2012-06-19 Impact factor: 2.506
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