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Background Colorectal cancer is a leading cause of morbidity and mortality across U.S. racial/ethnic groups. Existing studies often focus on a particular race/ethnicity or single domain within the care continuum. Granular exploration of disparities among different racial/ethnic groups across the entire colon cancer care continuum is needed. We aimed to characterize differences in colon cancer outcomes by race/ethnicity across each stage of the care continuum. Methods We used the 2010–2017 National Cancer Database to examine differences in outcomes by race/ethnicity across six domains: clinical stage at presentation; timing of surgery; access to minimally invasive surgery; post-operative outcomes; utilization of chemotherapy; and cumulative incidence of death. Analysis was via multivariable logistic or median regression, with select demographics, hospital factors, and treatment details as covariates. Results 326,003 patients (49.6% female, 24.0% non-White, including 12.7% Black, 6.1% Hispanic/Spanish, 1.3% East Asian, 0.9% Southeast Asian, 0.4% South Asian, 0.3% AIAE, and 0.2% NHOPI) met inclusion criteria. Relative to non-Hispanic White patients: Southeast Asian (OR 1.39, p  < 0.01), Hispanic/Spanish (OR 1.11 p  < 0.01), and Black (OR 1.09, p  < 0.01) patients had increased odds of presenting with advanced clinical stage. Southeast Asian (OR 1.37, p  < 0.01), East Asian (OR 1.27, p  = 0.05), Hispanic/Spanish (OR 1.05 p  = 0.02), and Black (OR 1.05, p  < 0.01) patients had increased odds of advanced pathologic stage. Black patients had increased odds of experiencing a surgical delay (OR 1.33, p  < 0.01); receiving non-robotic surgery (OR 1.12, p  < 0.01); having post-surgical complications (OR 1.29, p  < 0.01); initiating chemotherapy more than 90 days post-surgery (OR 1.24, p  < 0.01); and omitting chemotherapy altogether (OR 1.12, p  = 0.05). Black patients had significantly higher cumulative incidence of death at every pathologic stage relative to non-Hispanic White patients when adjusting for non-modifiable patient factors ( p  < 0.05, all stages), but these differences were no longer statistically significant when also adjusting for modifiable factors such as insurance status and income. Conclusions Non-White patients disproportionately experience advanced stage at presentation. Disparities for Black patients are seen across the entire colon cancer care continuum. Targeted interventions may be appropriate for some groups; however, major system-level transformation is needed to address disparities experienced by Black patients.

Background There are well‐established disparities in colorectal cancer (CRC) outcomes between White and Black patients; however, assessments of CRC disparities for other racial/ethnic groups are limited. Methods The Surveillance, Epidemiology, and End Results database identified patients aged 50–74 years with CRC adenocarcinoma from 2000 to 2019. Trends in age‐adjusted incidence rates were computed by stage at diagnosis and subsite across five broad race/ethnic groups (White, Black, Asian/Pacific Islander [API], American Indian/Alaskan Native [AIAN], and Hispanic) and four API subgroups (East Asian, Southeast Asian, South Asian, and Pacific Islander) Multivariable logistic regression evaluated associations between race/ethnicity and diagnosis stage. Multivariable Cox proportional hazards models assessed differences in cause‐specific survival (CSS). Results Hispanic, AIAN, Southeast Asian, Pacific Islander, and Black patients were 3% to 28% more likely than Whites to be diagnosed with distant stage CRC, whereas East Asian and South Asians had similar or lower risk of distant stage CRC. From Cox regression analysis, Black, AIAN, and Pacific Islanders also experienced worse CSS, while East Asian and South Asian patient groups experienced better CSS. No significant differences in CSS were observed among Hispanic, Southeast Asian, and White patients. When stratified by stage, Black patients had worse CSS across all stages (early, hazard ratio (HR) = 1.38; regional, HR = 1.22; distant, HR: 1.07, p < 0.05 for all). Conclusion Despite advances in CRC screening, treatment and early detection efforts, marked racial/ethnic disparities in incidence, stage at diagnosis, and survival persist. Findings demonstrate the extent to which aggregating heterogenous populations masks significant variability in CRC outcomes within race/ethnic subgroups.

Background Type 2 diabetes (T2D) disproportionately affects individuals of South Asian descent. Additionally, diabetes distress (DD) may lead to complications with diabetes management. This study examines the prevalence of DD among foreign-born individuals of South Asian descent in New York City (NYC) and its association with sociodemographic and clinical factors. Methods Baseline data was collected from the Diabetes Research, Education, and Action for Minorities (DREAM) Initiative, an intervention designed to reduce hemoglobin A1c (HbA1c) among South Asian individuals with uncontrolled T2D at primary care practices in NYC. The Diabetes Distress Scale (DDS) measured DD, and Core Healthy Days Measures assessed physical and mental healthy days. Sociodemographic variables were analyzed using descriptive statistics, Chi-square tests assessed categorical variables, and Wilcoxon Rank Sum tests evaluated continuous variables (Type I error rate = 0.05). Logistic regression models examined associations between HbA1c, mental health, and other covariates with dichotomized DD subscales. Results Overall, 414 participants completed the DDS at baseline (median age = 55.2 years; SD = 9.8). All were born outside of the US; the majority were born in Bangladesh (69.8%) followed by India, Pakistan, and Nepal (24.7%) and Guyana and Trinidad and Tobago (5.5%). High emotional burden, regimen-related distress and physician-related distress were reported by 25.9%, 21.9%, and 6.2% of participants, respectively. In adjusted analyses, individuals with ≥ 1 day of poor mental health had higher odds of overall distress (OR:3.8, p  = 0.013), emotional burden (OR:4.5, p  < 0.001), and physician-related distress (OR:4.6, p  = 0.007) compared to individuals with no days of poor mental health. Higher HbA1c (OR:1.45, p = < 0.001) was associated with regimen-related distress; and lower emotional support was associated with overall distress (OR:0.92, p  < 0.001) and regimen-related distress (OR:0.95, p  = 0.012). Individuals born in Bangladesh had significantly lower odds of overall distress, emotional burden, and regimen-related distress compared to individuals born in Guyana and Trinidad and Tobago. Conclusions Findings highlight the rate and risk factors of DD among individuals of South Asian descent living in NYC. Screening for DD in patients with prediabetes or diabetes should be integrated to address mental and physical health needs. Future research can benefit from a longitudinal analysis of the impact of DD on diabetes self-management and health outcomes. Trial registration This study uses baseline data from “Diabetes Management Intervention for South Asians” (NCT03333044), which was registered with clinicaltrials.gov on 6/11/2017.

Women with limited English proficiency continue experiencing an unequal cancer burden. Non-White immigrant women present with more advanced breast and cervical cancer than non-Hispanic Whites, attributed to significant cultural barriers as well as low health literacy in attempting to navigate the United States health care system for cancer screening. Community-based Health litEracy-focused intervention for breast and cervical Cancer Control (CHECC-uP) was an in-person, community health worker-led intervention, addressing both cultural and health literacy barriers through health literacy education and follow-up counseling with navigation assistance. The in-person program was tested in a large cluster-randomized trial and yielded high efficacy in promoting mammogram and Papanicolaou test screening in Korean-speaking women. With over 90% of Americans now having online access, the in-person program was adapted to web-based delivery. This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of the web version of the intervention-e-CHECC-uP. A randomized pilot trial was conducted. A total of 40 women were enrolled and randomized (20 per arm). The study intervention consisted of web-based health literacy education followed by phone counseling with navigation assistance. Study assessments were done at baseline, 3 months, and 6 months. The study's primary outcomes were cancer screening behaviors verified by medical record review. Upon completion of final study assessments, intervention participants were invited to join postintervention interviews. In total, 34 women (intervention: n=15; control: n=19) completed the assessment at 6 months, yielding a retention rate of 85%. The intervention participants were highly satisfied with e-CHECC-uP with a median rating of 8 on a 10-point scale. Between-group differences in screening rates were 34.6%, 47.9%, and 37.5%, respectively, for completion of the mammogram, Papanicolaou test, and both at 6 months. We achieved a high retention rate and high participant satisfaction. Although the study was not powered for significance testing, the e-CHECC-uP intervention resulted in large group differences across all cancer screening outcomes in the pilot sample. Online technology can help address multiple logistical barriers associated with in-person intervention delivery. Our findings suggest that web-based delivery of CHECC-uP may be used to promote cancer screening among immigrant women with limited English proficiency, as a promising avenue to ultimately reduce health disparities in underserved communities.

Objectives. We conducted 1 of the first community-based trials to develop a multicomponent intervention that would increase colorectal cancer screening among an Asian American population. Methods. Filipino Americans (n = 548) nonadherent to colorectal cancer (CRC) screening guidelines were randomized into an intervention group that received an education session on CRC screening and free fecal occult blood test (FOBT) kits; a second intervention group that received an education session but no free FOBT kits; and a control group that received an education session on the health benefits of physical activity. Results. Self-reported CRC screening rates during the 6-month follow-up period were 30%, 25%, and 9% for participants assigned to intervention with FOBT kit, intervention without the kit, and control group, respectively. Participants in either of the 2 intervention groups were significantly more likely to report screening at follow-up than were participants in the control group. Conclusions. A multicomponent intervention that includes an educational group session in a community setting can significantly increase CRC screening among Filipino Americans, even when no free FOBT kits are distributed.

The HIV epidemic is rapidly growing among men who have sex with men (MSM) in China, yet HIV testing remains suboptimal. We aimed to determine the impact of HIV self-testing (HIVST) interventions on frequency of HIV testing among Chinese MSM and their sexual partners. This randomized controlled trial was conducted in 4 cities in Hunan Province, China. Sexually active and HIV-negative MSM were recruited from communities and randomly assigned (1:1) to intervention or control arms. Participants in the control arm had access to site-based HIV testing (SBHT); those in the intervention arm were provided with 2 free finger-prick-based HIVST kits at enrollment and could receive 2 to 4 kits delivered through express mail every 3 months for 1 year in addition to SBHT. They were encouraged to distribute HIVST kits to their sexual partners. The primary outcome was the number of HIV tests taken by MSM participants, and the secondary outcome was the number of HIV tests taken by their sexual partners during 12 months of follow-up. The effect size for the primary and secondary outcomes was evaluated as the standardized mean difference (SMD) in testing frequency between intervention and control arms. Between April 14, 2018, and June 30, 2018, 230 MSM were recruited. Mean age was 29 years; 77% attended college; 75% were single. The analysis population who completed at least one follow-up questionnaire included 110 (93%, 110/118) in the intervention and 106 (95%, 106/112) in the control arm. The average frequency of HIV tests per participant in the intervention arm (3.75) was higher than that in the control arm (1.80; SMD 1.26; 95% CI 0.97-1.55; P < 0.001). This difference was mainly due to the difference in HIVST between the 2 arms (intervention 2.18 versus control 0.41; SMD 1.30; 95% CI 1.01-1.59; P < 0.001), whereas the average frequency of SBHT was comparable (1.57 versus 1.40, SMD 0.14; 95% CI -0.13 to 0.40; P = 0.519). The average frequency of HIV tests among sexual partners of each participant was higher in intervention than control arm (2.65 versus 1.31; SMD 0.64; 95% CI 0.36-0.92; P < 0.001), and this difference was also due to the difference in HIVST between the 2 arms (intervention 1.41 versus control 0.36; SMD 0.75; 95% CI 0.47-1.04; P < 0.001) but not SBHT (1.24 versus 0.96; SMD 0.23; 95% CI -0.05 to 0.50; P = 0.055). Zero-inflated Poisson regression analyses showed that the likelihood of taking HIV testing among intervention participants were 2.1 times greater than that of control participants (adjusted rate ratio [RR] 2.10; 95% CI 1.75-2.53, P < 0.001), and their sexual partners were 1.55 times more likely to take HIV tests in the intervention arm compared with the control arm (1.55, 1.23-1.95, P < 0.001). During the study period, 3 participants in the intervention arm and none in the control arm tested HIV positive, and 8 sexual partners of intervention arm participants also tested positive. No other adverse events were reported. Limitations in this study included the data on number of SBHT were solely based on self-report by the participants, but self-reported number of HIVST in the intervention arm was validated; the number of partner HIV testing was indirectly reported by participants because of difficulties in accessing each of their partners. In this study, we found that providing free HIVST kits significantly increased testing frequency among Chinese MSM and effectively enlarged HIV testing coverage by enhancing partner HIV testing through distribution of kits within their sexual networks. Chinese Clinical Trial Registry ChiCTR1800015584.

Patient satisfaction scores are used to inform decisions about physician compensation, and there remains a lack of consensus regarding the need to adjust scores for patient race/ethnicity. Previous research suggests that patients prefer physicians of the same race/ethnicity as themselves and that Asian patients provide lower satisfaction scores than non-Hispanic white patients. To examine whether Asian physicians receive less favorable patient satisfaction scores relative to non-Hispanic white physicians. This population-based survey study used data from Press Ganey Outpatient Medical Practice Surveys collected from December 1, 2010, to November 30, 2014, which included 149 775 patient survey responses for 962 physicians. Every month, 5 patients per physician were randomly selected to complete a satisfaction survey after an outpatient visit. Hierarchical multivariable logistic regression was used to examine the association between Asian race/ethnicity of the physician and racial/ethnic concordance of the patient with the probability of receiving the highest score on the survey item rating the likelihood to recommend the physician. Statistical analysis was performed from April 2 to August 27, 2018. Physician characteristics included race/ethnicity, sex, years in practice, and proportion of Asian patient responders. Patient characteristics included race/ethnicity, sex, age, and language spoken. The highest score (a score of 5 on a 1-5 Likert scale, where 1 indicates very poor and 5 indicates very good) on the survey item rating the likelihood to recommend the physician on the Press Ganey Outpatient Medical Practice Survey. Of the 962 physicians in this study, 515 (53.5%) were women; physicians had a mean (SD) of 19.9 (9.1) years of experience since graduating medical school; 573 (59.6%) were white, and 350 (36.4%) were Asian. In unadjusted analyses, the odds of receiving the highest score on the survey item rating the likelihood to recommend the physician were lower for Asian physicians compared with non-Hispanic white physicians (odds ratio, 0.78; 95% CI, 0.72-0.84; P < .001). This association was not significant after adjusting for patient characteristics, including patient race/ethnicity. However, Asian patients were less likely to give the highest scores relative to non-Hispanic white patients (odds ratio, 0.56; 95% CI, 0.54-0.58; P < .001), regardless of physician race/ethnicity. This study suggests that Asian physicians may be more likely to receive lower patient satisfaction scores because they serve a greater proportion of Asian patients. Patient satisfaction scores should be adjusted for patient race/ethnicity.

Korean men and women have the highest current smoking rates across all Asian ethnic subgroups in the United States. This is a 2-arm randomized controlled study of a culturally adapted smoking cessation intervention. The experimental condition received eight weekly 40-min individualized counseling sessions that incorporated Korean-specific cultural elements, whereas the control condition received eight weekly 10-min individualized counseling sessions that were not culturally adapted. All participants also received nicotine patches for 8 weeks. One-hundred nine Korean immigrants (91 men and 18 women) participated in the study. The rate of biochemically verified 12-month prolonged abstinence was significantly higher for the experimental condition than the control condition (38.2 vs. 11.1 %, χ² = 10.7, p < 0.01). Perceived family norm significantly mediated the effect of cessation intervention on abstinence. Smoking cessation intervention for Korean Americans should be culturally adapted and involve family members to produce a longterm treatment effect.

Lifestyle interventions are effective in diabetes management, with smartphone apps that manage health data and dietary and exercise schedules gaining popularity. However, limited evidence from randomized clinical trials exists regarding the effectiveness of smartphone-based interventions among Asian adults with type 2 diabetes. To compare the effects of a culturally contextualized smartphone-based intervention with usual care on weight and metabolic outcomes. This randomized clinical trial conducted at multiple primary care centers in Singapore included 305 adults with type 2 diabetes and body mass index (BMI) of 23 or greater who had literacy in English and smartphone access. Participants were recruited between October 3, 2017, and September 9, 2019, and were randomly assigned (1:1; stratified by gender, age, and BMI) to intervention (99 participants) or control (105 participants) groups. Participants' data were analyzed using intention-to-treat analysis. Both control and intervention participants received diet and physical activity advice from a dietitian at a baseline face-to-face visit. Intervention participants additionally used a smartphone app to track weight, diet, physical activity, and blood glucose and then communicated with dietitians for 6 months. Primary outcome was change in body weight, while secondary outcomes were changes in hemoglobin A1c (HbA1c), fasting blood glucose, blood pressure, lipids, and diet. Post hoc analyses included glycemic changes in the subgroup with HbA1c levels of 8% or greater and diabetes medication changes. Among the 204 randomized participants (mean [SD] age, 51.2 [9.7] years; 132 [64.7%] men), baseline mean (SD) BMI was 30.6 (4.3). Compared with the control group, intervention participants achieved significantly greater reductions in weight (mean [SD] change, -3.6 [4.7] kg vs -1.2 [3.6] kg) and HbA1c levels (mean [SD] change, -0.7% [1.2] vs -0.3% [1.0]), with a greater proportion having a reduction in diabetes medications (17 participants [23.3%] vs 4 participants [5.4%]) at 6 months. The intervention led to a greater HbA1c reduction among participants with HbA1c levels of 8% or higher (mean [SD] change, -1.8% [1.4] vs -1.0% [1.4]; P = .001). Intergroup differences favoring the intervention were also noted for fasting blood glucose, diastolic blood pressure, and dietary changes. In this study, a smartphone-based lifestyle intervention was more effective in achieving weight and glycemic reductions among Asian adults with type 2 diabetes compared with usual care, supporting the use of apps in lifestyle intervention delivery. anzctr.org.au Identifier: ACTRN12617001112358.