Department of Community Health and Social Medicine, CUNY School of Medicine, New York, New York.
Department of Radiology, Weill Cornell Medical College, New York, New York.
Cancer Epidemiol Biomarkers Prev. 2019 Mar;28(3):478-485. doi: 10.1158/1055-9965.EPI-18-0788. Epub 2019 Feb 7.
The Bedford-Stuyvesant (BS) and Bushwick (BW) communities of central Brooklyn, New York, are located within the 50-mile core radius of Memorial Sloan Kettering's main catchment area. Cancer is the second leading cause of death among the predominantly African American and Hispanic neighborhoods, with BS and BW having higher prostate cancer and colorectal mortality rates than New York City as a whole. There is significant opportunity to design cancer interventions that leverage the accessibility and acceptability of mobile health (mHealth) tools among the BS and BW communities.
The Cancer Health Impact Program (CHIP) is a collaborative that was formed for this purpose. Through CHIP, we used a tablet-based, Health Information National Trends (HINTS)-based multimodality survey to collect and analyze social and demographic patterns of prostate cancer and colorectal cancer screening, as well as mHealth access, among BS and BW residents.
Among 783 participants, 77% reported having a smartphone, 40% reported access to a mobile health application, 17% reported blood stool kit testing, and 26% of men reported PSA test screening. Multivariable logistic regression models results demonstrated that participants who reported owning smartphones, but were unsure whether they had access to a health app, were also significantly more likely to report blood stool kit testing compared with participants without smartphones. In fully adjusted models, access to a health app was not significantly associated with PSA testing. Non-Hispanic white participants were 86% less likely to report blood stool kit testing when compared with non-Hispanic black participants [OR = 0.15; 95% confidence interval (CI) 0.02-0.49]. Participants with a prior history of cancer were three times more likely to report blood stool kit testing when compared with those without cancer history (OR = 3.18; 95% CI, 1.55-6.63).
For blood stool kit testing, significant differences were observed by race/ethnicity, cancer history, age, and smartphone use; for PSA screening, only age was significant in fully adjusted models.
Our results demonstrate that while access to smartphones and mobile health apps may be prevalent among minority communities, other social and demographic characteristics are more likely to influence screening behaviors.
纽约布鲁克林中心区的贝德福德-斯图维森特（BS）和布什威克（BW）社区位于纪念斯隆凯特琳癌症中心主要集水区的 50 英里核心半径内。癌症是这些以非裔美国人和西班牙裔为主的社区中第二大致死原因，BS 和 BW 的前列腺癌和结直肠癌死亡率高于整个纽约市。在 BS 和 BW 社区中，利用移动医疗（mHealth）工具的可及性和可接受性来设计癌症干预措施具有重要意义。
为此成立了癌症健康影响计划（CHIP）合作组织。通过 CHIP，我们使用基于平板电脑的基于健康信息国家趋势（HINTS）的多模态调查，收集和分析 BS 和 BW 居民的前列腺癌和结直肠癌筛查的社会和人口统计学模式，以及 mHealth 可及性。
在 783 名参与者中，77%报告拥有智能手机，40%报告可访问移动健康应用程序，17%报告使用粪便潜血试剂盒检测，26%的男性报告进行 PSA 检测筛查。多变量逻辑回归模型结果表明，报告拥有智能手机但不确定是否可访问健康应用程序的参与者与没有智能手机的参与者相比，更有可能报告粪便潜血试剂盒检测。在完全调整的模型中，访问健康应用程序与 PSA 检测没有显著关联。与非西班牙裔黑人参与者相比，非西班牙裔白人参与者报告粪便潜血试剂盒检测的可能性低 86%[比值比（OR）=0.15；95%置信区间（CI）0.02-0.49]。与没有癌症病史的参与者相比，有癌症病史的参与者报告粪便潜血试剂盒检测的可能性高三倍[OR=3.18；95%CI，1.55-6.63]。
对于粪便潜血试剂盒检测，在种族/族裔、癌症病史、年龄和智能手机使用方面观察到显著差异；对于 PSA 筛查，仅年龄在完全调整的模型中具有统计学意义。
我们的研究结果表明，虽然智能手机和移动健康应用程序的可及性可能在少数族裔社区中很普遍，但其他社会和人口统计学特征更有可能影响筛查行为。
