CARE Risky Sexual Behavior Index
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Transcript of CARE Risky Sexual Behavior Index
CARE Risky Sexual Behavior Index
Paul Reiter, MPH, Electra Paskett, PhD, Mira Katz, PhD, Amy Ferketich, PhD,
and Mack Ruffin, MD, MPH
Cells to Society: Overcoming Health Disparities
Neighborhood/Community Context
Community Engagement
Preclinical and Clinical
Studies
Impact on Patient and Community
Biomarker & Animal Model
Studies
CPHHD Transdisciplinary Research Framework:
Emerging Cross-Center Themes
Genetics, Biological Basis of
Disparities, Biomarkers for
Risk Assessment and Screening
Etiology, Screening, Treatment
Dissemination of Research, Quality of Life, Access to
Care, Policy
Reducing Disparities in Cervical Abnormalities in
Appalachia
P50-CA105632 The Ohio State University
National Cancer Institute
Goal To understand why Appalachian
Ohio women have high incidence and mortality rates
for cervical cancer.
OSU Center For Population Health
And Health Disparities
Average, Annual, Age-Adjusted Cervical Cancer Incidence and Mortality Rates,
Appalachia Ohio, per 100,000 Females, >14y, Whites, 2000-2004
Region Incidence Rates
Mortality Rates
United States 11.2 2.3Ohio 10.9 2.7Non-Appalachia Ohio
10.3 2.5
Appalachia Ohio 14.5 3.8
Theoretical Framework:Social Determinants of Health
CultureAppalachian Norms
PsychologicalMotivationKnowledge/ Risk
WorkOccupationRegulations
BrainStressDepressionNicotine dependence
Morbidity/MortalityHealth Status/OutcomesGeneral HealthCervical Health
Pathophysiological ChangesHPVCINCarcinogenesis
Health BehaviorCervical screeningTobacco UseSexual activityContraceptionAlcohol useDiet
Social EnvironmentSocial capitalSocial cohesionSocial networkNeighborhood disadvantage
Early life
Social StructureEducationHealth Care Delivery
Genes
Material FactorsIncomeTransportation
Marmot and Wilkinson, 2001
ScreeningRisky Behaviors
Follow-upOf Abnormalities
- HPV- Smoking
- Pap Smear
Cervical Cancer
Rationale Certain behaviors put women at increased risk for
cervical abnormalities and HPV infection
Cervical cancer “risk” from sexual behaviors has not been quantified in a manner like other types of “risk”, e.g. breast cancer
An easy to use tool could be used to identify and target high risk women for education, surveillance, screening, and interventions
The CARE study provides an opportunity to develop and validate such a tool for cervical cancer in a high risk population
14 Clinics
Observational Study N=571
Multi-level factors associated with tobacco use and Pap testing
Project 1 N=281
Pap smear use:•Risk appropriate
guidelines•Barriers counseling
Project 2 N=301
Smoking cessation:•Biochemical
validation•Pharma-based
intervention with behavioral component
RCT testing LHA vs. usual care
Project 3 N=1360
Case-control study•HPV testing, Pap smear, EBV
titers, Cotinine•TGF-alpha receptor
ADAMS
ATHENS
BROWNGALLIA
HIGHLAND
HOCKING
JACKSON
LAWRENCE
MEIGS
MONROE
MORGAN
NOBLEPERRY
PIKE
ROSS
SCIOTO
VINTON
WASHINGTON
CLERMONT
SON
CARROLL
COLUMBIANA
BELMONT
COSHOCTON
GUERNSEY
HARRISON
HOLMESJEFFER
Region 1Region 2Region 3Region 4
Regions 1-4
MUSKINGHAM
12
2
3
4
56
7
8
9
10
11
1
13
14
TUSCARAWAS
Clinic locations
Eligibility Criteria
Age 18 and older No history of cervical cancer English speaking Not pregnant Randomly selected from clinic population Agree to participate
Baseline Survey Face-to-Face Interview
Home interview administered using CAPI system with an audio portion to collect sensitive data
Conducted with research interviewer present
and averaged 1.5 hours to complete
Self-Administered Survey Given/mailed to participant to complete Completed surveys given to interviewer
or mailed to OSU
Methods Creation (n=300): Association of 8 individual risky
sexual behaviors with history of abnormal Pap smear was used to determine weights Overall scores calculated using weighting scheme
and history of each behavior
Validation (n=128): Goodness-of-fit in model containing overall index scores and history of abnormal Pap smear
Lowess curve examined (n=428) to determine cutoff points for high, medium, low group
Results Weighting Scheme:
Past STI=20 Age at 1st sexual
intercourse and number of lifetime sexual partners=5
Condom use, sex for money, partners with IV drug use, male partners sex with other men, partners past STI=1
Validation Sample: Hosmer-Lemshow test
did not indicate lack of fit (p=0.2999)
Cutoff Points: Low=5 or less Medium=6 – 10 High=11+
Risky Sexual Behahavior I ndex
Classification (n=428)
0102030405060
Low Med HighPe
rcen
t (%
)
Overall Level Abnormal Papn=134 n=131 n=163
Mean = 9.71 Median = 6.00
Future Use Predict who is more likely to develop
cervical abnormalities/compare by population group
Target women with higher scores for more frequent Pap tests and HPV vaccination
Direct interventions to high risk women to reduce risk
Educate women about their risk for cervical abnormalities
Comprehensive Cancer CenterCathy TatumCecilia DeGraffinreidMelissa HicksDarla Fickle Jill Oliveri
University of MichiganMack RuffinPaula Lantz
College of NursingKaren AhijevychJudy HarnessPamela Salsberry
Center For Population Health And Health Disparities“Reducing Cervical Cancer In Appalachia”
College of MedicineDavid CohnDouglas Post
ConsultantsBeti ThompsonElizabeth Unger
Department of EconomicsPatricia Reagan
College of Public HealthElectra PaskettMary Ellen WewersStanley LemeshowMira KatzAmy FerketichAnn McAlearney
Department of Pathology Scott Jewell
Center For BiostatisticsAmy LehmanErinn HadeBryan BallDale Rhoda