Understanding Racial and Ethnic Disparities in Arrest: The Role of Individual, Home, School, and Community Characteristics

Contact with the justice system can lead to a range of poor health and social outcomes. While persons of color are disproportionately represented in both the juvenile and criminal justice systems, reasons for these patters remain unclear. This study sought to examine the extent and sources of differences in arrests during adolescence and young adulthood among blacks, whites, and Hispanics in the USA. Multilevel cross-sectional logistic regression analyses were conducted using data from waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (n = 12,752 respondents). Results showed significantly higher likelihood of having ever been arrested among blacks, when compared to whites, even after controlling for a range of delinquent behaviors (odds ratio = 1.58, 95 % confidence interval = 1.27, 1.95). These black-white disparities were no longer present after accounting for racial composition of the neighborhood, supporting the growing body of research demonstrating the importance of contextual variables in driving disproportionate minority contact with the justice system.

Understanding HPV vaccination among Latino adolescent girls in three U.S. regions

A multi-site study was conducted to assess HPV vaccine initiation and correlates of initiation among Latina adolescents. The study was a collaboration of the CDC/NCI-funded Cancer Prevention and Control Research Network. Data were collected in 2009 from caregivers of Latina adolescents recruited from Los Angeles Country (n = 274), Washington State (Yakima Valley region; n = 90), and Texas (Houston, n = 38; Lower Rio Grande Valley, n = 42). A set of 24 survey items assessed use of the HPV vaccine and awareness, attitudes and barriers to vaccination. Moderate levels of vaccine awareness among caregivers and low uptake of the vaccine (26-37%) among girls were observed. Attitudinal barriers such as concerns about negative effects of the vaccine on daughter's sexual behavior, fertility, and future health were infrequently endorsed. Efforts to understand regional similarities and differences may help inform interventions.

Healthcare Access and Utilization among Korean Americans: The Mediating Role of English Use and Proficiency

The literature suggests that Korean Americans underutilize health services. Cultural factors and language barriers appear to influence this pattern of low utilization but studies on the relationships among length of stay in the US, English use and proficiency, and utilization of health services among Korean Americans have yielded inconsistent results. This study examines whether English language use and proficiency plays a mediating role in the relationships between length of stay in the US and health insurance coverage, access to and use of care. Structural equation modeling was used for mediation analysis with multiple dependent variables among Korean Americans (N = 555) using baseline data from a large trial designed to increase Hepatitis B testing. The results show 36% of the total effect of proportion of lifetime in the US on having health insurance was significantly mediated by English use and proficiency (indirect effect = 0.166, SE = 0.07, p<.05; direct effect = 0.296, SE = 0.13, p<.05). Proportion of lifetime in the US was not associated with usual source of care and health service utilization. Instead, health care utilization was primarily driven by having health insurance and a usual source of care, further underscoring the importance of these factors. A focus on increasing English use and proficiency and insurance coverage among older, female, less educated Korean Americans has the potential to mitigate health disparities associated with reduced access to health services in this population.

Sun protection practices and sun exposure among children with a parental history of melanoma

BACKGROUND

First-degree relatives of melanoma survivors have a substantially higher lifetime risk for melanoma than individuals with no family history. Exposure to ultraviolet radiation (UVR) is the primary modifiable risk factor for the disease. Reducing UV exposure through sun protection may be particularly important for children with a parental history of melanoma. Nonetheless, limited prior research has investigated sun protection practices and sun exposure among these children.

METHODS

The California Cancer Registry was used to identify melanoma survivors eligible to participate in a survey to assess their children's sun protection practices and sun exposure. The survey was administered by mail, telephone, or web to Latino and non-Latino white melanoma survivors with at least one child (0-17 years; N = 324).

RESULTS

Sun exposure was high and the rate of sunburn was equivalent to or higher than estimates from average-risk populations. Use of sun protection was suboptimal. Latino children were less likely to wear sunscreen and hats and more likely to wear sunglasses, although these differences disappeared in adjusted analyses. Increasing age of the child was associated with lower sun protection and higher risk for sunburn, whereas higher objective risk for melanoma predicted improved sun protection and a higher risk for sunburns. Perception of high barriers to sun protection was the strongest modifiable correlate of sun protection.

CONCLUSIONS

Interventions to improve sun protection and reduce sun exposure and sunburns in high-risk children are needed.

IMPACT

Intervening in high-risk populations may help reduce the burden of melanoma in the United States.

Cluster-Randomized Trial to Increase Hepatitis B Testing among Koreans in Los Angeles

BACKGROUND

In the United States, Korean immigrants experience a disproportionately high burden of chronic hepatitis B (HBV) viral infection and associated liver cancer compared with the general population. However, despite clear clinical guidelines, HBV serologic testing among Koreans remains persistently suboptimal.

METHODS

We conducted a cluster-randomized trial to evaluate a church-based small group intervention to improve HBV testing among Koreans in Los Angeles. Fifty-two Korean churches, stratified by size (small, medium, large) and location (Koreatown versus other), were randomized to intervention or control conditions. Intervention church participants attended a single-session small-group discussion on liver cancer and HBV testing, and control church participants attended a similar session on physical activity and nutrition. Outcome data consisted of self-reported HBV testing obtained via 6-month telephone follow-up interviews.

RESULTS

We recruited 1,123 individuals, 18 to 64 years of age, across the 52 churches. Ninety-two percent of the sample attended the assigned intervention session and 86% completed the 6-month follow-up. Sample characteristics included were as follows: mean age 46 years, 65% female, 97% born in Korea, 69% completed some college, and 43% insured. In an intent-to-treat analysis, the intervention produced a statistically significant effect (OR = 4.9, P < 0.001), with 19% of intervention and 6% of control group participants reporting a HBV test.

CONCLUSION

Our intervention was successful in achieving a large and robust effect in a population at high risk of HBV infection and sequelae.

IMPACT

The intervention was fairly resource efficient and thus has high potential for replication in other high-risk Asian groups.

Randomized trial to increase colorectal cancer screening in an ethnically diverse sample of first-degree relatives

BACKGROUND

Ethnic minorities, especially African Americans and Latinos, bear a disproportionate burden of colorectal cancer (CRC), as reflected in incidence, cancer stage, and mortality statistics. In all ethnic groups, first-degree relatives (FDRs) of CRC cases are at an elevated disease risk. However, underuse of CRC screening persists and is particularly evident among minority groups. The current study tested a stepped intervention to increase CRC screening among an ethnically diverse sample of FDRs of CRC cases.

METHODS

A statewide cancer registry was used to recruit CRC cases and through them their FDRs. Relatives who were not current on CRC screening were randomized to intervention or usual-care control arms. The stepped intervention consisted of ethnically targeted and individually tailored print materials followed by telephone counseling for those unscreened at 6 months.

RESULTS

The study sample of 1280 individuals consisted of 403 Latino, 284 African American, 242 Asian, and 351 white FDRs. Statistically significant effects were observed for the cumulative print plus telephone intervention at 12 months (26% in the intervention vs 18% in the control group) and the print intervention alone at 6 months (15% in the intervention vs 10% in the control group). The effect of the print intervention alone versus the cumulative interventions was not statistically significantly different. Stratified analyses indicated that the intervention was effective among white, Latino, and Asian individuals, but not among African-Americans.

CONCLUSIONS

Overall, the intervention was effective in increasing screening rates. Oversampling racial/ethnic minorities allowed for the examination of effects within subgroups, revealing no effect among African American individuals. This finding illustrates the importance of including sufficient numbers of participants from diverse ethnic subgroups in intervention research to enable such stratified analyses.

Training Mixtec promotores to assess health concerns in their community: a CBPR pilot study

An academic institution and a community organization partnered for one of the first studies assessing health needs of Mixtecs, indigenous immigrants from Southern Mexico, residing in Ventura County, California. Ten bilingual Spanish- and Mixteco-speaking promotores received a 1-day focus group training, participated in a focus group themselves and conducted 5 focus groups with 42 Mixtec community members. The focus group training is described. Health concerns discussed in the focus groups include outdoor exercise among women viewed as flirtatious; reluctance to ask for governmental assistance due to fear that children will have to pay back later; soda consumption perceived as a symbol of socio-economic status; and unwillingness to obtain mammograms or pap smears because private body parts are to be touched by husbands only. Training promotores to conduct focus groups can increase organizational capacity to identify pressing health needs in under-represented and hard-to-reach population groups.

Factors associated with HPV awareness among mothers of low-income ethnic minority adolescent girls in Los Angeles

Among caregivers of adolescent girls, awareness of human papillomavirus (HPV) is strongly associated with vaccine uptake. Little is known, however, about the predictors of HPV awareness among low-income ethnic minority groups in the U.S. The purpose of this study is to understand demographic factors associated with HPV awareness among low-income, ethnic minority mothers in Los Angeles County. We conducted a cross-sectional study of caregivers of adolescent girls through the Los Angeles County Department of Public Health Office of Women's Health's hotline. The majority of the participants were foreign-born (88%), one quarter lacked a usual source of care, and one quarter lacked public or private health insurance for their daughter. We found that one in three participants had never heard of HPV or the vaccine. Mothers that were unaware of HPV were significantly more likely to conduct the interview in a language other than English and to lack health insurance for their daughters. HPV vaccine awareness was much lower in our caregiver sample (61%) than in a simultaneous national survey of caregivers (85%). The associations between lack of awareness and use of a language other than English, as well as lack of health insurance for their daughter indicate the need for HPV vaccine outreach efforts tailored to ethnic minority communities in the U.S.

Frequency and prioritization of patient health risks from a structured health risk assessment

PURPOSE

To describe the frequency and patient-reported readiness to change, desire to discuss, and perceived importance of 13 health risk factors in a diverse range of primary care practices.

METHODS

Patients (n = 1,707) in 9 primary care practices in the My Own Health Report (MOHR) trial reported general, behavioral, and psychosocial risk factors (body mass index [BMI], health status, diet, physical activity, sleep, drug use, stress, anxiety or worry, and depression). We classified responses as "at risk" or "healthy" for each factor, and patients indicated their readiness to change and/or desire to discuss identified risk factors with providers. Patients also selected 1 of the factors they were ready to change as most important. We then calculated frequencies within and across these factors and examined variation by patient characteristics and across practices.

RESULTS

On average, patients had 5.8 (SD = 2.12; range, 0-13) unhealthy behaviors and mental health risk factors. About 55% of patients had more than 6 risk factors. On average, patients wanted to change 1.2 and discuss 0.7 risks. The most common risks were inadequate fruit/vegetable consumption (84.5%) and overweight/obesity (79.6%). Patients were most ready to change BMI (33.3%) and depression (30.7%), and most wanted to discuss depression (41.9%) and anxiety or worry (35.2%). Overall, patients rated health status as most important.

CONCLUSIONS

Implementing routine comprehensive health risk assessments in primary care will likely identify a high number of behavioral and psychosocial health risks. By soliciting patient priorities, providers and patients can better manage counseling and behavior change.

HPV vaccination and sexual behavior in a community college sample

Many US parents are concerned that vaccinating daughters against human papillomavirus (HPV) will communicate implicit approval for sexual activity and be associated with early or risky sexual behavior (Scarinci et al. in J Womens Health 16(8):1224-1233, 2007; Schuler et al. in Sex Transm Infect 87:349-353, 2011). The aims of this study were to understand (a) whether the HPV vaccine was associated with risky sexual behavior among a diverse sample of female adolescents and young adults, and (b) to better understand the chronology of HPV vaccination and sexual behavior. An anonymous web-based survey was used to collect data from 114 female community college students. T test and Chi square analyses were used to compare vaccinated and unvaccinated groups on age at first intercourse and proportion who had ever had sexual intercourse. Linear multiple regression was used to predict frequency of condom use and number of sexual partners in the past year, using vaccination status and demographic factors as predictors. About 38% reported receiving at least one dose of the HPV vaccine. Many of those vaccinated (45%) received the vaccine after having initiated sexual activity. The proportion of women who were sexually experienced did not differ by HPV vaccine status, nor did age at first intercourse, number of partners in the past year, or frequency of condom use. Current findings suggest that HPV vaccination is not associated with riskier sexual activity for the young women in this sample. Adolescents and their parents may benefit from education about the need to receive the HPV vaccine before onset of sexual activity.

Exploring the role of neighborhood socio-demographic factors on HPV vaccine initiation among low-income, ethnic minority girls

Little is known about whether neighborhood factors are associated with human papillomavirus (HPV) vaccine uptake, especially among disadvantaged groups that can benefit most from the vaccine. We used data collected from immigrant, low-income mothers of adolescent girls and data from the 2005-2009 American Community Survey to investigate the relationship between HPV vaccine initiation and neighborhood characteristics. We compared initiation rates across levels of neighborhood disadvantage and employed multilevel logistic regression models to examine contextual effects on uptake. Overall, 27 % of girls (n = 479) initiated the vaccine. Initiation rates were highest among girls from the most disadvantaged neighborhoods (30 %), however, neighborhood factors were not independently associated with vaccine initiation after adjusting for individual factors. Mother's awareness of HPV, age, and insurance status were strong predictors for initiation. Future interventions should focus on improving awareness among low-income mothers as well as targeting vulnerable families outside the catchment area of public programs.

Developing theoretically based and culturally appropriate interventions to promote hepatitis B testing in 4 Asian American populations, 2006-2011

Introduction

Hepatitis B infection is 5 to 12 times more common among Asian Americans than in the general US population and is the leading cause of liver disease and liver cancer among Asians. The purpose of this article is to describe the step-by-step approach that we followed in community-based participatory research projects in 4 Asian American groups, conducted from 2006 through 2011 in California and Washington state to develop theoretically based and culturally appropriate interventions to promote hepatitis B testing. We provide examples to illustrate how intervention messages addressing identical theoretical constructs of the Health Behavior Framework were modified to be culturally appropriate for each community.

Methods

Intervention approaches included mass media in the Vietnamese community, small-group educational sessions at churches in the Korean community, and home visits by lay health workers in the Hmong and Cambodian communities.

Results

Use of the Health Behavior Framework allowed a systematic approach to intervention development across populations, resulting in 4 different culturally appropriate interventions that addressed the same set of theoretical constructs.

Conclusions

The development of theory-based health promotion interventions for different populations will advance our understanding of which constructs are critical to modify specific health behaviors.

Designing a valid randomized pragmatic primary care implementation trial: the my own health report (MOHR) project

BACKGROUND

There is a pressing need for greater attention to patient-centered health behavior and psychosocial issues in primary care, and for practical tools, study designs and results of clinical and policy relevance. Our goal is to design a scientifically rigorous and valid pragmatic trial to test whether primary care practices can systematically implement the collection of patient-reported information and provide patients needed advice, goal setting, and counseling in response.

METHODS

This manuscript reports on the iterative design of the My Own Health Report (MOHR) study, a cluster randomized delayed intervention trial. Nine pairs of diverse primary care practices will be randomized to early or delayed intervention four months later. The intervention consists of fielding the MOHR assessment--addresses 10 domains of health behaviors and psychosocial issues--and subsequent provision of needed counseling and support for patients presenting for wellness or chronic care. As a pragmatic participatory trial, stakeholder groups including practice partners and patients have been engaged throughout the study design to account for local resources and characteristics. Participatory tasks include identifying MOHR assessment content, refining the study design, providing input on outcomes measures, and designing the implementation workflow. Study outcomes include the intervention reach (percent of patients offered and completing the MOHR assessment), effectiveness (patients reporting being asked about topics, setting change goals, and receiving assistance in early versus delayed intervention practices), contextual factors influencing outcomes, and intervention costs.

DISCUSSION

The MOHR study shows how a participatory design can be used to promote the consistent collection and use of patient-reported health behavior and psychosocial assessments in a broad range of primary care settings. While pragmatic in nature, the study design will allow valid comparisons to answer the posed research question, and findings will be broadly generalizable to a range of primary care settings. Per the pragmatic explanatory continuum indicator summary (PRECIS) framework, the study design is substantially more pragmatic than other published trials. The methods and findings should be of interest to researchers, practitioners, and policy makers attempting to make healthcare more patient-centered and relevant.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT01825746.

Proximity to safety-net clinics and HPV vaccine uptake among low-income, ethnic minority girls

PURPOSE

Human Papillomavirus (HPV) vaccine uptake remains low. Although publicly funded programs provide free or low cost vaccines to low-income children, barriers aside from cost may prevent disadvantaged girls from getting vaccinated. Prior studies have shown distance to health care as a potential barrier to utilizing pediatric preventive services. This study examines whether HPV vaccines are geographically accessible for low-income girls in Los Angeles County and whether proximity to safety-net clinics is associated with vaccine initiation.

METHODS

Interviews were conducted in multiple languages with largely immigrant, low-income mothers of girls ages 9 to 18 via a county health hotline to assess uptake and correlates of uptake. Addresses of respondents and safety-net clinics that provide the HPV vaccine for free or low cost were geo-coded and linked to create measures of geographic proximity. Logistic regression models were estimated for each proximity measure on HPV vaccine initiation while controlling for other factors.

RESULTS

On average, 83% of the 468 girls had at least one clinic within 3-miles of their residence. The average travel time on public transportation to the nearest clinic among all girls was 21min. Average proximity to clinics differed significantly by race/ethnicity. Latinas had both the shortest travel distances (2.2 miles) and public transportation times (16min) compared to other racial/ethnic groups. The overall HPV vaccine initiation rate was 25%. Increased proximity to the nearest clinic was not significantly associated with initiation. By contrast, daughter's age and insurance status were significantly associated with increased uptake.

CONCLUSIONS

This study is among the first to examine geographic access to HPV vaccines for underserved girls. Although the majority of girls live in close proximity to safety-net vaccination services, rates of initiation were low. Expanding clinic outreach in this urban area is likely more important than increasing geographic access to the vaccine for this population.

Theoretically informed correlates of hepatitis B knowledge among four Asian groups: the health behavior framework

BACKGROUND

Few studies have examined theoretically informed constructs related to hepatitis B (HBV) testing, and comparisons across studies are challenging due to lack of uniformity in constructs assessed. The present analysis examined relationships among Health Behavior Framework factors across four Asian American groups to advance the development of theory-based interventions for HBV testing in at-risk populations.

METHODS

Data were collected from 2007-2010 as part of baseline surveys during four intervention trials promoting HBV testing among Vietnamese-, Hmong-, Korean- and Cambodian-Americans (n = 1,735). Health Behavior Framework constructs assessed included: awareness of HBV, knowledge of transmission routes, perceived susceptibility, perceived severity, doctor recommendation, stigma of HBV infection, and perceived efficacy of testing. Within each group we assessed associations between our intermediate outcome of knowledge of HBV transmission and other constructs, to assess the concurrent validity of our model and instruments.

RESULTS

While the absolute levels for Health Behavior Framework factors varied across groups, relationships between knowledge and other factors were generally consistent. This suggests similarities rather than differences with respect to posited drivers of HBV-related behavior.

DISCUSSION

Our findings indicate that Health Behavior Framework constructs are applicable to diverse ethnic groups and provide preliminary evidence for the construct validity of the Health Behavior Framework.

Low HPV vaccine coverage among female community college students

This study assessed HPV vaccination and its correlates among culturally diverse 18-26 year-old community college women in Los Angeles. Specific research questions were: (1) What proportion of respondents have initiated the HPV vaccine, and what proportion have completed the three-dose series? (2) What demographic (e.g., age, ethnicity), psychosocial (e.g., vaccine-related beliefs, perceived social norms), and health care-related variables (e.g., health insurance status, provider recommendation, health care trust and satisfaction) are associated with vaccine initiation for this sample? Participants were recruited from the campus of a community college in central Los Angeles. All female students between 18 and 26 were eligible to participate. An anonymous web-based survey assessed number of HPV vaccine doses received as well as demographic information, HPV- and HPV vaccine-related knowledge, attitudes, and behavior, perceived social norms, provider & health care system factors, sexual behavior, cervical health, and mother-daughter communication about sex. Analyses were conducted using 178 surveys. Multivariate logistic regression tested the relationships of statistically significant bivariate predictors to vaccine initiation. Those who initiated the vaccine were younger, more often had a health-related academic major, thought the vaccine to be safer, perceived HPV severity lower, and perceived higher social approval for HPV vaccination than those unvaccinated. All who had initiated the vaccine had a doctor's recommendation. To increase uptake among 18-26-year-old women, research should explore provider interventions to increase vaccine recommendation, and also identify individuals and groups who may have negative beliefs about vaccine safety and efficacy to provide support in vaccine decision-making.

The perils of ignoring design effects in experimental studies: lessons from a mammography screening trial

OBJECTIVE

Threats to external validity, including pretest sensitisation and the interaction of selection and an intervention, are frequently overlooked by researchers despite their potential to significantly influence study outcomes. The purpose of this investigation was to conduct secondary data analyses to assess the presence of external validity threats in the setting of a randomised trial designed to promote mammography use in a high-risk sample of women.

DESIGN

During the trial, recruitment and intervention, implementation took place in three cohorts (with different ethnic composition), utilising two different designs (pretest-posttest control group design and posttest only control group design).

RESULTS

Results reveal that the intervention produced different outcomes across cohorts, dependent upon the research design used and the characteristics of the sample.

CONCLUSION

These results illustrate the importance of weighing the pros and cons of potential research designs before making a selection and attending more closely to issues of external validity.

Sun protection practices among children with a family history of melanoma: a pilot study

The goal of this pilot study was to assess sun protection practices and correlates among children with a family history of melanoma, a high risk and understudied group. Sixty-eight melanoma cases, recruited through the Los Angeles County cancer registry, completed a survey. Survivors provided data on 110 children (mean age = 8.11 years). Although most children used sunscreen (79 %), half experienced a recent sunburn. The mean sun protection level for the sample was similar to levels observed among average risk children. Efforts to reduce sunburn frequency and improve sun protection among these vulnerable children appear warranted.

Prostate cancer screening among ethnically diverse first-degree relatives of prostate cancer cases

OBJECTIVE

This study examined potential ethnic differences in prostate cancer screening behavior and correlates of screening in an ethnically diverse sample of first-degree relatives of prostate cancer cases.

METHODS

The California Cancer Registry was used to identify a sample of prostate cancer cases who were contacted and invited to refer male first-degree relatives to the study. Telephone surveys with 1,029 first-degree relatives (354 non-Latino Whites, 228 Latinos, 272 African Americans, 175 Asians) assessed prostate cancer screening behavior and correlates of screening.

RESULTS

Less than half of the participants had received a prostate specific antigen (PSA) test in the past year, with lowest rates observed among Latinos. Factors independently associated with an increased likelihood of the PSA test receipt in the total sample included: prior PSA testing, having a physician recommendation to be screened, and reporting fewer barriers to screening. Being the brother versus the son of the case predicted a higher likelihood of screening for all ethnic groups except for African Americans. In addition, the negative influence of barriers on screening was significantly greater for Latinos compared with Asians.

CONCLUSIONS

Although ethnicity was not an independent predictor of screening, ethnic variations were observed in the relationship between some predictors and screening and in the modifiable correlates of screening. Findings may inform future intervention research that aims to enhance informed decision-making regarding prostate cancer screening and ultimately reduce prostate cancer health disparities.

Implementing organizational physical activity and healthy eating strategies on paid time: process evaluation of the UCLA WORKING pilot study

Integrating organizationally targeted wellness strategies into the routine conduct of business has shown promise in engaging captive audiences at highest risk of obesity and obesity-related health consequences. This paper presents a process evaluation of the implementation of the University of California, Los Angeles, Working Out Regularly Keeps Individuals Nurtured and Going (WORKING) pilot study. WORKING focuses on integrating physical activity and nutrition practices into workplace routine during non-discretionary paid work time. The purpose of the evaluation was to assess the quality of implementation and to understand factors that facilitated or hindered organizations' full uptake of the intervention. Fifteen worksites were randomly assigned to an intervention condition. Qualitative data were gathered through routine site visits and informant interviews conducted throughout each worksite's intervention period. Worksites were classified into one of four implementation success categories based on their level of adoption and maintenance of core intervention strategies. Six key factors emerged that were related to implementation success: site layout and social climate, wellness infrastructure, number and influence of Program Champions, leadership involvement, site innovation and creativity. This pilot study has informed the conduct of WORKING II; a cluster randomized controlled trial aimed at enrolling 60-70 worksites in Los Angeles County.

Barriers to genetic testing for breast cancer risk among ethnic minority women: an exploratory study

BACKGROUND/AIMS

To assess awareness of genetic testing for breast cancer risk and identify influences on the decision-making process regarding counseling and testing among an ethnically-diverse sample of women.

METHODS

Semi-structured interviews were conducted with 33 women who were breast or ovarian cancer survivors or first degree relatives of survivors. Interviews were audiotaped, translated, and transcribed. Analysis of transcripts identified relevant themes and quotes were extracted for illustration.

RESULTS

Low levels of awareness were observed in minority women, including those with a significant family history of cancer. A number of potential influences on the decision-making process emerged including beliefs about risk factors for cancer and opinions about the options following testing. Distinct issues were identified within ethnic groups that may function as barriers such as concern about the misuse of genetic information (African Americans), unfamiliarity with Western preventive medicine (Asians), and women prioritizing family obligations over personal health needs (Latinas).

CONCLUSIONS

Results suggest there may be a need for interventions to raise awareness about genetic counseling and testing among minorities. Our findings contribute to the literature by using in-depth interviews to uncover potential barriers and facilitators to counseling and testing and by including Asians and Latinas, groups under-represented in previous research.

A midpoint process evaluation of the Los Angeles Basin Racial and Ethnic Approaches to Community Health Across the US (REACH US) Disparities Center, 2007-2009

BACKGROUND

Racial/ethnic minority groups have higher risks for disease resulting from obesity.

COMMUNITY CONTEXT

The University of California, Los Angeles, and the Los Angeles County Department of Public Health partnered with community organizations to disseminate culturally targeted physical activity and nutrition-based interventions in worksites.

METHODS

We conducted community dialogues with people from 59 government and nonprofit health and social service agencies to develop wellness strategies for implementation in worksites. Strategies included structured group exercise breaks and serving healthy refreshments at organizational functions. During the first 2 years, we subcontracted with 6 community-based organizations (primary partners) who disseminated these wellness strategies to 29 organizations within their own professional networks (secondary worksites) through peer modeling and social support. We analyzed data from the first 2 years of the project to evaluate our dissemination approach.

OUTCOME

Primary partners had difficulty recruiting organizations in their professional network as secondary partners to adopt wellness strategies. Within their own organizations, primary partners reported significant increases in implementation in 2 of the 6 core organizational strategies for promoting physical activity and healthy eating. Twelve secondary worksites that completed organizational assessments on 2 occasions reported significant increases in implementation in 4 of the 6 core organizational strategies.

INTERPRETATION

Dissemination of organizational wellness strategies by trained community organizations through their existing networks (train-the-trainer) was only marginally successful. Therefore, we discontinued this dissemination approach and focused on recruiting leaders of organizational networks.