Background Childhood cancers typically require rigorous treatment at specialized centers in urban areas, which can create substantial challenges for families residing in remote communities. We evaluated the impact of residence and travel time on the burden of care for families of childhood cancer patients. Procedure We conducted a cross-sectional, self-administered survey of 354 caregivers of pediatric cancer patients at a children’s hospital serving a seven state area. Measures included the impact of cancer treatment on relocation, employment, schooling and finances. We evaluated these domains by rural/urban residence and travel time (>1 hour and >2 hours) to the hospital in multivariable regression models. Results Of the 29% of caregivers who reported moving residences since their child was diagnosed, 33% reported that the move was due to their child’s cancer. Rural and remote (e.g., >1 hour travel time) caregivers missed more days of work during the first month after diagnosis than did urban and local caregivers, however, these differences did not persist over the first six months of therapy. One-third of caregivers reported quitting or changing jobs as a direct result of their child being diagnosed with cancer. Rural respondents had greater out-of-pocket travel expenses and reported a significantly greater perceived financial burden. Rural patients missed more school days and were at an increased risk of having to repeat a grade. Conclusions Childhood cancer has an appreciable impact on the lives of patients and caregivers. The burden is greater for those living far from a treatment center.

Background Women in low and middle-income countries (LMICs) do not have equal access to resources, such as education, employment, or healthcare compared to men. We sought to explore health disparities and associations between gender prioritization, sociocultural factors, and household decision-making in Central Malawi. Methods From June–August 2017, a cross-sectional study with 200 participants was conducted in Central Malawi. We evaluated respondents’ access to care, prioritization within households, decision-making power, and gender equity which was measured using the Gender-Equitable Men (GEM) scale. Relationships between these outcomes and sociodemographic factors were analyzed using multivariable mixed-effect logistic regression. Results We found that women were less likely than men to secure community-sourced healthcare financial aid (68.6% vs. 88.8%, p < 0.001) and more likely to underutilize necessary healthcare (37.2% vs. 22.4%, p = 0.02). Both men and women revealed low GEM scores, indicating adherence to traditional gender norms, though women were significantly less equitable (W:16.77 vs. M:17.65, p = 0.03). Being a woman (Odds Ratio (OR) 0.41, 95% confidence interval (CI) 0.21–0.78) and prioritizing a woman as a decision-maker for large purchases (OR 0.38, CI 0.15–0.93) were independently associated with a lower likelihood of prioritizing women for medical treatment and being a member of the Chewa tribal group (OR 3.87, CI 1.83–8.18) and prioritizing women for education (OR 4.13, CI 2.13–8.01) was associated with a higher odds. Conclusion Women report greater barriers to healthcare and adhere to more traditional gender roles than men in this Central Malawian population. Women contribute to their own gender’s barriers to care and economic empowerment alone is not enough to correct for these socially constructed roles. We found that education and matriarchal societies may protect against gender disparities. Overall, internal and external gender discrimination contribute to a woman’s disproportionate lack of access to care.

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Latinos suffer a disproportionate burden of human papillomavirus (HPV)-preventable cancers, yet uptake and completion of the HPV vaccine among Latinos is below recommendations. Reasons for low HPV vaccine uptake among Latinos in Utah are unknown. We surveyed Latino parents of HPV vaccine age-eligible adolescents (N=118). Univariable analyses identified sociodemographic characteristics associated with HPV vaccine awareness, interest, and uptake for daughter(s) and/or son(s) using chi-square tests or Fisher's exact tests. More parents who had lived in the USA for 15 years or more had vaccinated their daughter (43.6 vs. 32.5%, p=0.035) compared to those living in the USA for shorter time periods. Parents born in Mexico reported their son had not received the HPV vaccine (74.6 vs. 58.3%, p=0.049) more than those born elsewhere. Parents with Mexican birthplace and ancestry reported not knowing about the HPV vaccine as the main barrier to vaccinating daughters (47.1 vs. 5.9%, p=0.002 for both) and sons (birthplace 38.3 vs. 10.3%, p=0.007; ancestry 37.1 vs. 11.1%, p=0.013) compared to those born or descending elsewhere. Non-acculturated parents with a son were more likely to report not knowing about the HPV vaccine as the main barrier to vaccine receipt (47.6 vs. 12.5%, p<0.001). Our results focus on Latinos in an understudied region and complement prior research in other regions. This study may have implications for designing culturally tailored interventions to improve uptake of the HPV vaccine among the growing population of Latinos in Utah, and other states in the Intermountain West.