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An overview of recent legislation promoting awareness of cancer health disparities

An overview of recent legislation promoting awareness of cancer health disparities. Linnea Laestadius, M.P.P, Kerri McGowan Lowrey, J.D., M.P.H., Blake Kline, and Jamie Weinstein, M.P.H. The MayaTech Corporation Regina el Arculli, M.A. The National Cancer Institute November 10, 2009

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An overview of recent legislation promoting awareness of cancer health disparities

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  1. An overview of recent legislation promoting awareness of cancer health disparities Linnea Laestadius, M.P.P, Kerri McGowan Lowrey, J.D., M.P.H., Blake Kline, and Jamie Weinstein, M.P.H. The MayaTech Corporation Regina el Arculli, M.A. The National Cancer Institute November 10, 2009 Presented at the American Public Health Association Annual Meeting Philadelphia, PA

  2. Presenter Disclosures Laestadius, Linnea, M.P.P. (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose

  3. Awareness Days, Weeks, and Months • Traditional way for state and federal governments to raise awareness of a disease or condition. • The American Cancer Society recognizes 35 cancer and health-related awareness months in 10 months of each year.1 • Can serve as opportunities for educational programs, new partnerships, screening programs, and grant programs.2

  4. Impact of Awareness Events • Fleming, et al. (1997). Sun Awareness Week increased appreciation of link between childhood sun exposure and risk to health in later life. • Improvements in attitude and behavior scores were observed after awareness week.3 • Pullyblank, et al. (2002). Bowel Cancer Awareness Week (BCAW) was found effective in increasing knowledge of colorectal cancer symptoms. • Patients aware of BCAW were 4.6 times more likely to have knowledge of colorectal cancer symptoms.4 • NCI (2005). October, Breast Cancer Awareness Month, remains the month in which most screening mammograms take place.5

  5. Need for Increased Awareness6 • For all cancers combined, the death rate is 25 percent higher for African Americans than for whites. • Though white women have the highest incidence rate for breast cancer, African American women are most likely to die from the disease. • Hispanic/Latino women have the highest cervical cancer incidence rate. • African American men have the highest incidence rate for prostate cancer in the United States and are more than twice as likely as white men to die of the disease.

  6. History of Awareness Events-National Negro Health Week • National Negro Health Week, initiated by Booker T. Washington, was first recognized in April 1915 and was observed annually for 35 years.7, 8 • Referred to as the ”forerunner to minority health month.” 8 • In 1930, the United States Public Health Service (USPHS) assumed operation of National Negro Health Week. Two years later, the USPHS established the Office of Negro Health Work.9 • 1922: 129,250 participants in 15 states. 1939: Approximately 2 million participants in 35 states.10

  7. National Negro Health Week, cont. • The Office of Negro Health Work was dismantled in 1951, thus ending the National Negro Health Week.8 • The dismantling of the Office of Negro Health Work was considered by some as important to the move towards integration during that time period.8 • In 1985, the Department of Health and Human Services (DHHS) created the Office of Minority Health in response to the DHHS Secretary's Task Force Report on Black and Minority Health.8 • 1987: First National Minority Cancer Awareness Week.

  8. Study Purpose • To describe the most common types of cancer disparities awareness legislation and assess their prevalence. • To determine if there is a correlation between state demographics and cancer disparities awareness legislation. • To identify related policy gaps and opportunities.

  9. Data Sources and Methodology Qualitative Analysis • Using National Cancer Institute’s State Cancer Legislative Database (SCLD), conducted search for state legislative data enacted or adopted between 2006 and 2008. • Using primary legal research, conducted Westlaw searches of state statutes and regulations enacted or adopted between 2000 and 2008. Quantitative Analysis • Using U.S. Census Bureau data on state-level demographics (2007), conducted regression analysis to determine probability of adopting awareness resolutions.

  10. Limitations • SCLD health disparities legislative data has a 2006 baseline. • Omitted regulations, proclamations, and informal state policy (e.g., awareness weeks not established by legislation). • Contingent on state classification of resolutions, Westlaw may not be comprehensive. • Only addressed resolutions that mentioned cancer disparities.

  11. Current Awareness Weeks/Months • National Minority Cancer Awareness Week. • National Minority Health Month. • National Multicultural Cancer Awareness Week (California specific)11 • Cancer-specific awareness legislation that mentions the incidence of disparities.

  12. National Minority Cancer Awareness Week • On April 8, 1987, the US House of Representatives Joint Resolution 119 designated the third week in April as “National Minority Cancer Awareness Week.” 12, 13 • The resolution drew attention to the fact that cancer has a disproportionately severe impact on minorities and the economically disadvantaged.12 • The week promotes increased awareness of prevention and treatment among those segments of the population that are at greater risk of developing cancer.12

  13. National Minority Health Month • In April 2001, the National Minority Health Month Foundation, in partnership with the Office of Minority Health (OMH), launched the first National Minority Health Month, in response to the Healthy People 2010 initiative.7 • Resolution language varies by state, but to date has always included some mention of cancer disparities. • OMH determines theme of month each year • April 2010: Theme: Man Up for Your Health! Healthy Men Carry Our Communities Forward14

  14. Cancer-Specific Awareness • Many states adopt annual or reoccurring cancer awareness months. • Prostate Cancer Awareness Month • Breast Cancer Awareness Month • Increasingly, these resolutions also have language to acknowledge cancer disparities (e.g., Kentucky’s S.R. 21 recognized January 2007 as Cervical Cancer Awareness Month and addressed cancer disparities.)

  15. Kentucky S.R. 2115 • Acknowledges, among other things, that: • cervical cancer disproportionately impacts certain racial and ethnic populations; • black women have the highest age-adjusted mortality rate from cervical cancer, followed by Hispanic women • cervical cancer cases in the United States are generally attributed to a lack of education, a lack of access to regular cervical cancer screening, and inaccurate screening; and • experience shows that increasing cervical cancer awareness among women, especially underserved women, significantly reduces the probability of mortality from the disease.

  16. States with Minority Cancer Awareness Weeks and Minority Health Months (n=13)(adopted 2000 to 2008) States with Minority Cancer Awareness Week and Minority Health Month resolutions (n=4) States with Minority Cancer Awareness Week resolutions (n=5) States with Minority Health Month resolutions (n=4)

  17. States with Cancer Disparities Awareness Resolutions (n=22)(adopted 2000 to 2008) States with only general cancer awareness resolutions not mentioning disparities (n=14) States with cancer disparities awareness resolutions (n=22) States that have adopted no cancer awareness resolutions (n=15)

  18. Number of States with Cancer Awareness Resolutions by Type of Cancer(adopted 2000 to 2008)

  19. Adopted Resolutions Occurring by Year (2000-2008)

  20. Correlations to State Demographics ** Correlation is significant at the 0.01 level (2-tailed). * Correlation is significant at the 0.05 level (2-tailed).

  21. Conclusions • While there is some association between demographics and adoption of resolutions, additional factors are key. • States are increasingly acknowledging cancer health disparities with awareness resolutions. • Legislative awareness events can serve as an opportunity for community groups to conduct awareness activities, even in the absence of state-level activities. • http://www.SCLD-NCI.net

  22. References • American Cancer Society. (2009). Cancer awareness calendar. Retrieved September 21, 2009, from http://www.cancer.org/docroot/MED/content/MED_1_Cancer_Calendar.asp • National Health Information Center, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services. (2009). 2009 National health observances. Retrieved September 21, 2009, from http://www.healthfinder.gov/nho/nho.asp • Fleming, C., Newell, J., Turner, S., & Mackie, R. (1997). A study of the impact of sun awareness week 1995. British Journal of Dermatology, 136(5), 719-724. • Pullyblank, A.M., Dixon, N., & Dison, A.R., (2002). The impact of bowel cancer awareness week. Colorectal Disease, 4(6), 483-485. • National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services (2005, October). Stat bite: Effect of breast cancer awareness month on mammography use. Journal of the National Cancer Institute, 97(20), 1493.

  23. References, cont. • National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services (2008). Cancer health disparities. Retrieved September 21, 2009, from http://www.cancer.gov/cancertopics/factsheet/cancer-health-disparities • National Minority Health Month Foundation (2009). History of the NMHM foundation. Retrieved September 21, 2009, from http://www.nmhm.org/history.html • Quinn, S.C., & Thomas, S.B. (2001). The national negro health week, 1915-1951: A descriptive account. Minority Health Today, 2(3), 44-49. Retrieved September 21, 2009, from http://minority-health.pitt.edu/view/subjects/practice_002.html • Gamble, V.N., & Stone, D. (2006). U.S. policy on health inequities: The interplay of politics and research. Journal of Health Politics, Policy and Law 31 93-122, 99-108. Excerpt retrieved September 21, 2009, from http://academic.udayton.edu/health/11Disparities/Disparities07.htm • Politt, P.A. (1996, December). From national negro health week to national public health week. Journal of Community Heath, 21, 6.

  24. References, cont. • S. Swanson. (May 8, 2008). National multicultural cancer awareness week resolution passes senate. News Release retrieved September 21, 2009, from State Capitol of California Web site: http://democrats.assembly.ca.gov/members/a16/newsroom 20080508AD16PR02.htm • American Cancer Society. (2000). Awareness week focuses on cancer in minorities. Retrieved September 21, 2009, from http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Awareness_Week_Focuses_on_Cancer_in_Minorities.asp • National Association of Social Workers. (2009). National minority cancer awareness week. Retrieved September 21, 2009, from http://www.naswdc.org/diversity/ethnic/041206nmcaw.asp

  25. References, cont. • The Office of Minority Health, U.S. Department of Health and Human Services. (2009). Theme: Man up for your health! Healthy men carry our communities forward. Retrieved September 21, 2009, from http://www.omhrc.gov/templates/browse.aspx?lvl=2&lvlid=182 • Kentucky Legislature. (n.d.). A resolution recognizing January, 2007, as Cervical Cancer Awareness Month in Kentucky. Retrieved September 21, 2009, from www.lrc.ky.gov/RECORD/07RS/SR21/bill.doc

  26. Contact For additional information About this presentation: About the SCLD Program: Regina el Arculli, M.A. Director, SCLD Program The National Cancer Institute (301) 496-5217 elarculli@nih.gov Linnea Laestadius, M.P.P. Legislative Research Associate The MayaTech Corporation (301) 587-1600 llaestadius@mayatech.com

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