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      Mapping Cancer for Community Engagement

      research-article
      , MPH , , PhD
      Preventing Chronic Disease
      Centers for Disease Control and Prevention

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          Abstract

          Introduction

          Two research strategies may reduce health disparities: community participation and the use of geographic information systems. When combined with community participation, geographic information systems approaches, such as the creation of disease maps that connect disease rates with community context, can catalyze action to reduce health disparities. However, current approaches to disease mapping often focus on the display of disease rates for political or administrative units. This type of map does not provide enough information on the local rates of cancer to engage community participation in addressing disparities.

          Methods

          We collaborated with researchers and cancer prevention and control practitioners and used adaptive spatial filtering to create maps that show continuous surface representations of the proportion of all colorectal cancer cases diagnosed in the late stage. We also created maps that show the incidence of colorectal cancer.

          Results

          Our maps show distinct patterns of cancer and its relationship to community context. The maps are available to the public on the Internet and through the activities of Iowa Consortium for Comprehensive Cancer Control partners.

          Conclusion

          Community-participatory approaches to research are becoming more common, as are the availability of geocoded data and the use of geographic information systems to map disease. If researchers and practitioners are to engage communities in exploring cancer rates, maps should be made that accurately represent and contextualize cancer in such a way as to be useful to people familiar with the characteristics of their local areas.

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          Most cited references29

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          Cancer disparities by race/ethnicity and socioeconomic status.

          This article highlights disparities in cancer incidence, mortality, and survival in relation to race/ethnicity, and census data on poverty in the county or census tract of residence. The incidence and survival data derive from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) Program; mortality data are from the National Center for Health Statistics (NCHS); data on the prevalence of major cancer risk factors and cancer screening are from the National Health Interview Survey (NHIS) conducted by NCHS. For all cancer sites combined, residents of poorer counties (those with greater than or equal to 20% of the population below the poverty line) have 13% higher death rates from cancer in men and 3% higher rates in women compared with more affluent counties (less than 10% below the poverty line). Differences in cancer survival account for part of this disparity. Among both men and women, five-year survival for all cancers combined is 10 percentage points lower among persons who live in poorer than in more affluent census tracts. Even when census tract poverty rate is accounted for, however, African American, American Indian/Alaskan Native, and Asian/Pacific Islander men and African American and American Indian/Alaskan Native women have lower five-year survival than non-Hispanic Whites. More detailed analyses of selected cancers show large variations in cancer survival by race and ethnicity. Opportunities to reduce cancer disparities exist in prevention (reductions in tobacco use, physical inactivity, and obesity), early detection (mammography, colorectal screening, Pap tests), treatment, and palliative care.
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            Community based participatory research: a promising approach for increasing epidemiology's relevance in the 21st century.

            Despite the advances of modern epidemiology, the field remains limited in its ability to explain why certain outcomes occur and to generate the kind of findings that can be translated into programmes or policies to improve health. Creating community partnerships such that community representatives participate in the definition of the research problem, interpretation of the data, and application of the findings may help address these concerns. Community based participatory research (CBPR) is a framework epidemiologists can apply to their studies to gain a better understanding of the social context in which disease outcomes occur, while involving community partners in the research process, and insuring that action is part of the research process itself. The utility of CBPR principles has been particularly well demonstrated by environmental epidemiologists who have employed this approach in data gathering on exposure assessment and advancing environmental justice. This article provides examples of how popular epidemiology applies many of CBPR's key principles. At this critical juncture in its history, epidemiology may benefit from further incorporating CBPR, increasing the field's ability to study and understand complex community health problems, insure the policy and practice relevance of findings, and assist in using those findings to help promote structural changes that can improve health and prevent disease.
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              GIS and health care.

              GIS and related spatial analysis methods provide a set of tools for describing and understanding the changing spatial organization of health care, for examining its relationship to health outcomes and access, and for exploring how the delivery of health care can be improved. This review discusses recent literature on GIS and health care. It considers the use of GIS in analyzing health care need, access, and utilization; in planning and evaluating service locations; and in spatial decision support for health care delivery. The adoption of GIS by health care researchers and policy-makers will depend on access to integrated spatial data on health services utilization and outcomes and data that cut across human service systems. We also need to understand better the spatial behaviors of health care providers and consumers in the rapidly changing health care landscape and how geographic information affects these dynamic relationships.
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                Author and article information

                Contributors
                Dept of Geography, University of Iowa
                ,
                University of Iowa, Iowa City, Iowa
                Journal
                Prev Chronic Dis
                Preventing Chronic Disease
                Centers for Disease Control and Prevention
                1545-1151
                January 2009
                15 December 2008
                : 6
                : 1
                : A03
                Affiliations
                Dept of Geography, University of Iowa
                University of Iowa, Iowa City, Iowa
                Article
                PCDv61_08_0029
                2644580
                19080009
                f5b0a437-4789-42cd-8bf3-aec018178d78
                Copyright @ 2009
                History
                Categories
                Original Research
                Peer Reviewed

                Health & Social care
                Health & Social care

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