Health Promotion - Cervical Cancer, Obesity, and Hypertension - Research Paper Example

?Health promotion Health promotion is the provision of information and education to individuals, families and communities that encourage family unity, community commitment and traditional spirituality that make positive contributions to their health status. According to Lynch and Hanson (2004), the Ottawa Charter identifies three basic strategies for health promotion which includes advocating for health to create the essential conditions for health; enabling all people to achieve potential; and mediating between the different interests in society in the pursuit of health. These strategies are supported by five priority action areas as outlined in the Ottawa Charter for health promotion; build healthy public policy, create supportive environments for health, strengthen community action for health, develop personal skills and re-orient health services. Three of the most common health problems that affect people include cervical cancer, obesity and Hypertension (HTN). Cervical Cancer Considered a prevalent condition among the immigrant Americans, cervical cancer is associated with numerous risk factors; against which campaign are fostered to curb the its effects. Although vaccination against cervical cancer is available, timely testing and screening aid in the prevention and management; ultimately reducing the incidence by 80%. Rampant cases in the US are reported among the Vietnamese and non-Latina women immigrants largely associated with limited access to Pap testing. Drastic measures to curb the disparities include awareness campaigns, encouraging administration of primary care by PCPs, and increase patient-provider communication. Cervix in relation to upper part of vagina and posterior portion of uterus The cervix is the narrow portion of the uterus where it joins with the top of the vagina. Most cancers of the cervix are squamous cell carcinomas which are in the flattened epithelial cells that line the cervix. Symptoms such as pelvic pain, heavy bleeding from the vagina, leaking of urine or faeces from the vagina, back pain, leg pain, single swollen leg, loss of appetite, weight loss, fatigue, and bone fractures indicate advanced cervical cancer (Green & Kreuter, 1991). Certain risk factors according to the American cancer society include: Chlamydia infection, multiple pregnancies, exposure to the hormonal drug diethylstilbestrol stress and stress related disorders, HPV infection, smoking, HIV infection, diatary factors, hormonal contraception, and family history of cervical cancer. Other risk factors especially for young persons are: early age at first intercourse and first pregnancy, compounded by early use of oral contraceptives. There has not been any definitive evidence to support the claim that circumcision of the male partner reduces the risk of cervical cancer, although some researchers say there is compelling epidemiological evidence that men who have been circumcised are less likely to be infected with HPV. However, in men with low-risk sexual behaviour and monogamous female partners, circumcision makes no difference to the risk of cervical cancer (Green & Kreuter, 1991). According to Pham, et al (2003), biopsy procedures is an effective screening test, confirmation of the diagnosis of cervical cancer which is done through colposcopy aided by dilute acetic acid like vinegar solution to highlight abnormal cells on the surface of the cervix. Precancerous lesions are exposed to cervical intraepithelial neoplasia the potential precursor to cervical cancer which is often diagnosed by a pathologist. For premalignant dysplastic changes the cervical intraepithelial neoplasia (CIN) grading is used. The subtypes of cancer include; squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma, small cell carcinoma, neuroendocrine tumour, glassy cell carcinoma, villoglandular adenocarcinoma. Non-carcinoma malignancies which can rarely occur in the cervix include; melanoma and lymphoma. According to Mock, et al (2007), prevention of cervical cancer can be done through vaccination whereby gardasil vaccine is used against HPV different types. HPV types 16 and 18 currently cause about 70% of cervical cancer cases. HPV types 6 and 11 cause about 90% of genital wart cases. HPV vaccines have also been shown to prevent precursors to some other cancers associated with HPV. However, HPV vaccines are targeted at girls and women of age 9 to 26 because the vaccine only works if given before infection occurs; therefore, public health workers are targeting girls before they begin having sex. The use of the vaccine in men to prevent genital warts, and interrupt transmission to women or other men is initially considered only a secondary market. The high cost of this vaccine has been a cause for concern. Several countries have or are considering programs to fund HPV vaccination (McCracken et al., 2007). Considerably, condoms offer some protection against cervical cancer and also protection against genital warts and the precursors to cervical cancer. On the contrary, smoking which exposes one to carcinogens from tobacco increase the risk for cancer types including cervical cancer, and women who smoke have about double the chance of a nonsmoker to develop cervical cancer. Nutrition also contributes a lot towards cancer prevention and avoidance by eating a balanced diet (Parkin, 2006). Screening has been credited with dramatically reducing the incidence and mortality of cervical cancer in developed countries. Pap smear screening every 3–5 years with appropriate follow-up can reduce cervical cancer incidence by up to 80%. Cervical cancer screening is typically recommended starting three years or more after first sex, or starting at age 21 to 25. Automated technologies have been developed with the aim of improving on the interpretation of smears, normally carried out by cytotechnologists. Unfortunately these on the whole have proven less useful; although the more recent reviews suggest that generally they may be no worse than human interpretation (Yi, 1998). Cervical cancer in U.S. Vietnamese population The United States Vietnamese population now exceeds 1,250,000. Cervical cancer among Vietnamese American women has been identified as an important health disparity. Available data indicate the cervical cancer disparity may be due to low Papanicolaou (Pap) testing rates rather than variations in human papillomavirus infection rates and/or types. The cervical cancer incidence rates among Vietnamese and non-Latina White women in California during 2000 to 2002 were 14.0 and 7.3 per 100,000, respectively. Only 70% of Vietnamese women who participated in the 2003 California Health Interview Survey reported a recent Pap smear compared with 84% of non-Latina White women. Higher levels of cervical cancer screening participation among Vietnamese women are strongly associated with current/previous marriage, having a usual source of care/doctor, and previous physician recommendation (Niedzweicki & Tuong, 2004). Statistically, the Vietnamese-Americans have high rate of cancer rates because they significantly receive low rates of Pap smear tests, immunization and cancer screening. These high rates are also associated with cultural barriers that dissuade women from receiving important tests. Despite government-supported health care programs, Vietnamese-American women have the lowest rate of Pap test receipt among the various ethnic and racial groups in the United States and the highest rate of cervical cancer (Smith et al., 2004). The “medical practitioner’ is a belief held by Vietnamese-Americans that western medicine is too harsh on the body which contributes to cultural disparity between Vietnamese and American medical practices (Smith et al., 2004) hence Vietnamese may utilize traditional eastern medicine to treat symptoms of cervical cancer and there is no comparative procedure in Vietnamese traditional medicine to the pap test. Vietnamese in America often are compelled to conceal their use of time-honored Vietnamese health practices because of fear of American doctors’ unsupportive and/or condescending attitudes towards traditional Vietnamese medicine (Yi, 1998). Additional research on college-aged Vietnamese women in the United States concluded that Vietnamese-American women most often seek medical attention only after they experience physical symptoms. The instead, tend to focus on curative, rather than preventative health care). Primarily, miscommunication between health care providers and Vietnamese-American clients regarding time frames may result in missed or skipped medical appointments (Smith et al., 2004). Other cultural factors that contribute to lack of receipt of Pap tests are a Vietnamese woman’s sense of modesty, the fact that young women model their mothers’ behavior and do not readily receive Pap tests, as well as a general lack of communication about, and an unwillingness to discuss, sexuality among Vietnamese-American women of all ages (Mc Phee et al., 1997). Comfort with self-examination according to Mc Phee’s (1997) research compared the receipt of breast self-examinations and Pap tests among Vietnamese-American women. As a result it was evident that they have a fairly high rate of breast self-examination. They also are more likely to administer the test because breast self-examinations are “self-administered.” A Pap test, on the other hand, is initiated by the health care provider (Mc Phee et al., 1997). Social-cultural fatalism in Vietnamese-American women Nguyen et al. (2002) found that awareness of the high rate of cervical cancer among Vietnamese-American women might also act as a deterrent to receipt of Pap tests. Vietnamese-American women may avoid Pap tests as a means of protection from the discovery of cervical cancer. Demographic barriers which involve a research on awareness of Pap test and receipt of a pap test in Vietnamese-American women demonstrated that the oldest women in the study were least likely to have received a Pap test. Additionally, unmarried women were perceived as not needing a Pap test due to cultural taboos against premarital sex. In response, Vietnamese language media campaigns and lay health worker intervention programs have been effective in increasing Pap smear used in Vietnamese American communities. Cervical cancer control programs for Vietnamese women should address knowledge deficits, enable women who are without a usual source of care to find a primary care doctor, and improve patient-provider communication by encouraging health-care providers to recommend Pap testing as well as by empowering women to ask for testing (Mock et al., 2007). It is important to create awareness and prevent cervical cancer because by doing so it will help curb the increasing rates of the cancer. It’s important to create awareness so that those affected directly and indirectly can get to know both the signs and symptoms of the killer cervical cancer. The importance of creating cervical cancer awareness too is to know how to leave with it and the possible remedies that can be applied. Cervical cancer can also be prevented by knowing about it and seeking treatment in advance (Mc Phee, 1998). Table 1: Cervical cancer screening rates among Vietnamese Women ages ?18 years Author, publication year Survey year(s) Geographic area Survey method Cooperation rate* (%) Sample size Ever screened (%) Screened last year†(%) Screened last 3 y†(%) Nguyen, 2002 (22) 2000 Harris County, Texas Telephone 54 768 74‡ 66‡ — Nguyen, 2002 (22) 2000 Santa Clara County, California Telephone 63 798 78‡ 60‡ — Kandula, 2006 (23)§ 2001 California Telephone 64? 425 — — 62 Centers for Disease Control, 2004 (24) 2001-2002 Los Angeles, Orange, and Santa Clara Counties, California Telephone 72 1,667 — — 66‡ Taylor, 2004 (25)¶ 2002§ King County, Washington In-person 84 544 74 45 68 Holtby, 2006 (26)§ 2003 California Telephone — — — — 70 Nguyen, 2006 (27) 2004 Harris County, Texas Telephone 50 1,005 71 53 — Unpublished data** 2006-2007 King County, Washington In-person 72 1,332 93 56 84 Unpublished data†† 2007 Harris County, Texas Telephone 74 765 76 49 66 Key * Response among reachable and eligible women (completed/completed and refused). † National guidelines for interval Pap testing changed from every year to every 3 years in 2002. ‡ Includes women without uteri. § Study used California Health Interview Survey data. ? Cooperation rate for all racial/ethnic groups. ¶ Women ages 18 to 64 years. ** Women ages 20 to 69 years. †† Women ages ?40 years. From the above table, McPhee and Nguyen previously summarized findings from population-based surveys of Pap testing used among Vietnamese women, conducted before 2000. These California and Massachusetts surveys found that only about one-half (between 43% and 53%) of Vietnamese women ages ?18 years had ever received a Pap smear. Surveys conducted in Texas during 2000, 2004, and 2007; California during 2000; and Washington during 2002 consistently found that approximately three-quarters (between 74% and 78%) of Vietnamese women had ever been screened for cervical cancer. In contrast, a Washington survey of Vietnamese women, conducted during 2006 and 2007, found that 93% had received at least one Pap smear and 84% were adherent to interval screening guidelines (Pham, et al., 2003). California Health Interview Survey data from 2003 provide the most recent direct comparisons of cervical cancer screening rates among Vietnamese and other racial/ethnic groups. This survey found that 70% of Vietnamese women ages ?18 years reported Pap testing in the previous 3 years compared with 84% of White, 87% of Black, and 85% of Latina women. Pap testing levels among Filipino, Japanese, South Asian, Chinese, and Korean women were 86%, 75%, 73%, 68%, and 67%, respectively. Overall, recent survey data indicate that Vietnamese women have lower levels of adherence to Pap testing guidelines than most other racial/ethnic groups. However, recent survey data also indicate that adherence levels among Vietnamese women vary by geographic area of the United States. Role in providing changes and creating awareness Introduction of community-based health care study representatives from various Vietnamese community organizations in Nguyen’s (2006) study cited the need for health education that was not sponsored by county or other government agencies. The representatives stated that the county lacked cultural understanding, did not work with Vietnamese community contacts, and hence lacked credibility to deliver effective health education messages. Nguyen’s (2006) research concluded that Vietnamese-Americans’ health culture is transmitted and reinforced through surrounding social networks. When health care centers are community-based, rather than clinic-based, the cultural needs of the Vietnamese-American clients are more adequately assessed, thus improving the rate of compliance with health standards Consequently, training lay health workers to provide education has proven to be an effective tool for increasing both knowledge and receipt of Pap tests among Vietnamese-American women. McPhee et al (2002) oversaw an intervention with Vietnamese-American women in San Francisco’s Vietnamese community that utilized lay health workers to inform Vietnamese-American women about cervical cancer risks, early detection, and prevention. Missed opportunity whereby because Vietnamese-Americans are accessing health care centers for their children, and because mothers are most often present when their children receive treatment, pediatric clinics could serve as potential sites for health education, outreach and even cervical cancer screening if appropriate resources are available. Therefore, education materials should be available in addition to providing on-site Peer Educators who are knowledgeable about cervical cancer screenings, culturally sensitive, Vietnamese-language educational materials on the subject of Pap tests should be readily available in pediatric clinics (Smith et al 2004). Furthermore, Pap tests among Vietnamese-American women could be offered on a drop-in or pre-scheduled basis at the pediatric clinic. Because a physician does not need to administer a Pap test, ideally a female nurse, with a Peer Educator acting as “stand-by,” could perform the test. Once a Vietnamese-American woman actually receives a Pap test, hopefully she will be less reluctant to receive future screenings (Mc Phee, 1998). Once the barriers to cancer prevention and early detection have been identified, a number of factors at the patient, care-provider and system levels should be changed. Thus, availability of primary care reduces obstacles to prevention and early detection, mortality reduction and promotes health; primarily by providing high-quality health care. First, effective prevention and detection at the patient level requires that the patients are well informed; can afford the tests; embrace the screening procedure; believe in the health care provider; and can access the facilities. Secondly, at the provider level, should match the gender of the patient; ensure adequate information on screening guidelines; adequate knowledge for counseling patients; and avoid distraction from patient co-morbidities. Lastly, at the system level, should provide health insurance coverage for screening procedure; provide personal health care provider; avail adequate staff and spacing; and curb time constraints on the provider (Wender, 1993). Proposed changes on the role of the primary Nurse practitioner In order to assist primary care to increase cancer prevention and screening, policies should be implemented to support and expand the supply of care givers; thus increasing access to primary care. First, increase in the numbers of primary care practitioners (PCPs) should be ensured by encouraging more providers to enter the primary care practices. One way to do this may be to improve primary care reimbursement rates for both common conditions and for primary care characteristics like referrals. Secondly, they should encourage a more equitable distribution of PCPs, by tailoring licensing policies to health needs in different areas or by providing financial incentives for practicing in underserved areas. Thirdly, they should encourage more incoming medical students to specialize in primary care. Federal funds supporting graduate medical training and expansion of loan forgiveness programs can be directed toward training primary care providers, especially those that serve in medically underserved areas. Lastly, adequate support should be channeled to primary care quality improvement and research. For instance, more research dollars be allocated toward quality improvement and research on primary care. Conclusion There is a paucity of information about effective cervical cancer control interventions for Vietnamese women in the United States. Survey data indicate that efforts to increase Pap testing receipt among Vietnamese women must address both cognitive and contextual influences. Future community intervention studies should use adequately-powered, group-randomized designs to further evaluate Vietnamese language media campaigns and lay health worker programs as well as interventions targeting the health-care providers who serve Vietnamese women. When possible, such intervention programs should be evaluated using medical records verification of Pap testing self-reports. In the future, dissemination studies will be needed to examine effective methods of disseminating evidence-based cervical cancer control interventions to Vietnamese communities throughout the United States). References Green, L. W, & Kreuter, M.W. (1991). Health Promotion Planning: An Educational and Environmental Approach, 2nd ed. Mountain View, Calif: Mayfield. Lam, T. K., McPhee, S. J., Mock, J., Wong, C., Doan, H. T., Nguyen, T., et al. (2003). Encouraging Vietnamese-American women to obtain Pap tests through lay health worker outreach and media education. Journal of General Internal Medicine, 18:516-524. Lynch, E.W., & Hanson, M. J. (2004). Developing cross-cultural competence: A guide for working with children and their families. Baltimore: Paul Brookes. Mc Phee, S. J, Bird, J. A, Davis, T, Ha, N. T, Jenkins, C. N. & Le, B. (1997). Barriers to breast and cervical cancer screening among Vietnamese-American women. Am J Prev Med.,13: 205–13. Mc Phee, S. J, Nguyen, T. T, & Shema, S. J, et al. (2002). Validation of recall of breast and cervical cancer screening by women in an ethnically diverse population. Prev Med, 35:463–73. Mc Phee, S. J. (1998). Promoting breast and cervical cancer screening among Vietnamese American women: two interventions. Asian Am Pac Isl J Health, 6: 344–50. McCracken M, Olsen M, Chen MS, et al. (2007). Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese ethnicities. CA Cancer J Clin, 57:190–205. Mock J, McPhee S. J, Nguyen, T, et al. (2007). Effective lay health worker outreach and media-based education for promoting cervical cancer screening among Vietnamese American women. Am J Public Health, 97:1693–700. Nguyen, B. H, Vo, P. H, Doan, H. T, & McPhee, S. J. (2006). Using focus groups to develop interventions to promote colorectal cancer screening among Vietnamese Americans. Journal of Cancer Education, 21:80–83. Niedzweicki, M, & Tuong, T. C, (2004). Southeast Asian American statistical profile. Washington (DC): Southeast Asia Resource Action Center. Parkin, D. M. (2006). The global health burden of infection-associated cancers in the year 2000. Int J Cancer, 118:3030–44. Pham, T. H, Nguyen, T. H, & Herrero, R, et al. (2003). Human papillomavirus infection among women in South and North Vietnam. Int J Cancer, 104:213–20. Smith, E. M, Johnson, S. R, & Ritchie, J. M, et al. (2004). Persistent HPV infection in postmenopausal age women. International Journal of Gynaecological Obstetricians, 87:131–7. Wender, R. C. (1993). Cancer screening and prevention in primary care: Obstacles for physicians. Cancer, 72(3):1093?9. Yi, J. K. (1998). Acculturation and Pap smear screening practices among college-aged Vietnamese women in the United States. Cancer Nursing, 21: 335–41. Read More