School of Public Administration, University of New Mexico, Albuquerque, NM, USA.
Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA.
J Cancer Educ. 2023 Jun;38(3):1023-1033. doi: 10.1007/s13187-022-02227-y. Epub 2022 Nov 5.
American Indians experience disparities in cancer screening, stage at disease diagnoses, and 5-year cancer survival. This study investigates how health literacy and health numeracy may be linked to cancer screening behaviors of Zuni Pueblo members using a survey exploring screening behaviors related to breast, cervical, and colorectal cancers. As part of a larger community-based cancer prevention and control project, Zuni Health Initiative staff conducted surveys from October 2020 through April 2021 of 281 participants (men ages 50-75 and women ages 21-75) from the Zuni Pueblo. Bivariate and multivariable analyses investigated associations between health literacy/numeracy measures and cancer screening behaviors. Bivariate analyses showed some associations between distinct measures of health literacy/numeracy and colorectal cancer (CRC) screening, including both colonoscopy (health literacy) and fecal occult blood testing (FOBT) (health numeracy), as well as cervical cancer screening (health literacy). There were no statistically significant associations between health literacy/numeracy measures and mammogram screening for breast cancer. In multivariable analyses, there were no consistent patterns between health literacy/numeracy and screening for any cancer. There are some individual findings worth noting, such as statistically significant findings for health numeracy and FOBT (those reporting lower health numeracy were less likely to report FOBT). An important finding of this study is that questions used to assess health literacy/numeracy did not identify associations aligned with previous research. We reflect on the ways the "standard" questions may not be sufficiently tailored to the Zuni experience and may contribute to health equity barriers.
美国印第安人在癌症筛查、疾病诊断阶段和 5 年癌症生存率方面存在差异。本研究通过一项调查，探讨了健康素养和健康数商如何与祖尼部落成员的癌症筛查行为相关联，该调查探讨了与乳腺癌、宫颈癌和结直肠癌相关的筛查行为。作为一个基于社区的癌症预防和控制项目的一部分，祖尼健康倡议工作人员于 2020 年 10 月至 2021 年 4 月对来自祖尼部落的 281 名参与者（男性年龄在 50-75 岁之间，女性年龄在 21-75 岁之间）进行了调查。单变量和多变量分析调查了健康素养/数商测量值与癌症筛查行为之间的关联。单变量分析显示，健康素养/数商的某些特定测量值与结直肠癌（CRC）筛查之间存在一些关联，包括结肠镜检查（健康素养）和粪便潜血检测（FOBT）（健康数商），以及宫颈癌筛查（健康素养）。健康素养/数商测量值与乳腺癌乳房 X 光检查筛查之间没有统计学上显著的关联。在多变量分析中，健康素养/数商与任何癌症的筛查之间没有一致的模式。有一些个别发现值得注意，例如健康数商和 FOBT 有统计学意义的发现（报告健康数商较低的人不太可能报告 FOBT）。这项研究的一个重要发现是，用于评估健康素养/数商的问题没有识别出与先前研究一致的关联。我们反思了“标准”问题可能没有充分针对祖尼人的经验进行调整，并可能导致健康公平障碍的方式。
