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Halbert CH, Weathers B, Delmoor E, Mahler B, Coyne J, Thompson HS, Have TT, Vaughn D, Malkowicz SB, Lee D. Racial differences in medical mistrust among men diagnosed with prostate cancer. Cancer 2009; 115:2553-61. [PMID: 19296516 DOI: 10.1002/cncr.24249] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Mistrust of healthcare providers and systems is a significant barrier to quality healthcare. However, limited empirical data are available on perceptions of medical mistrust among individuals who are diagnosed with cancer. The objective of this study was to identify sociodemographic, clinical, and cultural determinants of mistrust among men diagnosed with prostate cancer. METHODS The authors conducted an observational study among 196 African-American men (n = 71) and white men (n = 125) who were newly diagnosed with prostate cancer during 2003 through 2007. RESULTS Race, education, healthcare experiences, and cultural factors had significant effects on mistrust. African-American men (P = .01) and men who had fewer years of formal education (P = .001) reported significantly greater levels of mistrust compared with white men and men who had more education. Mistrust also was greater among men who had been seeing their healthcare provider for a longer period (P = .01) and among men with lower perceptions of interdependence (P = .01). CONCLUSIONS The current findings suggested that efforts to enhance trust among men who are diagnosed with prostate cancer should target African-American men, men with fewer socioeconomic resources, and men with lower perceptions of interdependence. Reasons for deterioration in trust associated with greater experience with specialty providers should be explored along with the effects of interventions that are designed to address the concerns of individuals who have greater mistrust.
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Weathers B, Kessler L, Collier A, Stopfer JE, Domchek S, Halbert CH. Utilization of religious coping strategies among African American women at increased risk for hereditary breast and ovarian cancer. FAMILY & COMMUNITY HEALTH 2009; 32:218-227. [PMID: 19525703 PMCID: PMC4155033 DOI: 10.1097/fch.0b013e3181ab3b53] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This observational study evaluated utilization of religious coping strategies among 95 African American women who were at increased risk for having a BRCA1/BRCA2 (BRCA1/2) mutation. Overall, women reported high levels of collaborative coping; however, women with fewer than 2 affected relatives (beta = -1.97, P = 0.04) and those who had a lower perceived risk of having a BRCA1/2 mutation (beta = -2.72, P = 0.01) reported significantly greater collaborative coping. These results suggest that African American women may be likely to use collaborative strategies to cope with cancer-related stressors. It may be important to discuss utilization of religious coping efforts during genetic counseling with African American women.
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Corneille LJ, Kessler L, Schmitz K, Domchek S, Halbert CH. Abstract B5: Cultural factors in obesity in African American women at increased risk for hereditary breast cancer. Cancer Prev Res (Phila) 2008. [DOI: 10.1158/1940-6207.prev-08-b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
B5
Obesity is an important risk factor for breast cancer, which disproportionately affects African American women. For women who have a personal or family history of disease that is suggestive of hereditary cancer, obesity may be particularly problematic. However, empirical data are not available on rates and correlates of obesity in this population. Therefore, the purpose of this study was to identify factors having significant independent associations with obesity in African American women at increased risk for hereditary breast cancer. Subjects were 126 African American women who had a personal and/or family history of breast cancer that was suggestive of BRCA1/2 mutations. Obesity was determined by self-report during a structured telephone interview. Reproductive factors (e.g., age at menarche), cultural beliefs (e.g., temporal orientation), and cancer-specific distress were also evaluated during the telephone interview. Overall, 43% of women were obese. Women who had a younger age at menarche were about four times more likely to be obese compared to women who had their first menstrual period at an older age (OR=3.88, 95% CI=1.65, 9.15, p=0.002). Obesity was also associated with greater levels of present temporal orientation (OR=0.67, 95% CI=0.46, 0.99, p=0.05). Intrusive thoughts about cancer was marginally related to obesity (OR=1.46, 95% CI=0.99, 2.15, p=0.06). The results of this study suggest that attention to cultural factors should be given in programs designed to address obesity among African American women at increased risk for hereditary breast cancer.
Citation Information: Cancer Prev Res 2008;1(7 Suppl):B5.
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Halbert CH, Weathers B, Delmoor E, Mahler B, Coyne J. Abstract CN11-02: Cultural considerations in outcomes among prostate cancer patients. Cancer Prev Res (Phila) 2008. [DOI: 10.1158/1940-6207.prev-08-cn11-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
CN11-02
Increasingly, cultural beliefs and values are being recognized as important to outcomes following cancer diagnosis. Although the way in which cultural beliefs and values are evaluated has implications for support programs that are developed to enhance survivorship, it is not known if cultural factors are best conceptualized as moderators or mediators of racial differences in psychological behaviors following prostate cancer diagnosis. Therefore, the purpose of this study was to determine if religiosity acted as a moderator or mediator of racial differences in coping efforts following prostate cancer diagnosis. Subjects were 224 African American and white men who were newly diagnosed with prostate cancer. Coping efforts and cultural factors were evaluated during a structured telephone interview. Overall, there were racial differences in religiosity (p=0.0001) and utilization of religious and spiritual coping (p=0.0001). African American men reported significantly greater levels of religiosity compared to white men and were most likely to use religion and spirituality to cope with their diagnosis. In the moderator analysis, the interaction between race and religiosity was not significant (p=0.22). However, in the mediation analysis, the effect for race became non-significant (p=0.36) when religiosity was entered into the model. Religiosity had a significant effect on religious and coping efforts (p=0.0001) in the final model; men with greater religiosity were most likely to use these strategies to cope with their diagnosis. These findings suggest that religiosity is not likely to be important to coping efforts only among African American men; rather, these beliefs and values are likely to influence how both African American and white men cope with their prostate cancer diagnosis.
Citation Information: Cancer Prev Res 2008;1(7 Suppl):CN11-02.
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Paskett ED, Reeves KW, McLaughlin JM, Katz ML, McAlearney AS, Ruffin MT, Halbert CH, Merete C, Davis F, Gehlert S. Recruitment of minority and underserved populations in the United States: the Centers for Population Health and Health Disparities experience. Contemp Clin Trials 2008; 29:847-61. [PMID: 18721901 PMCID: PMC2642621 DOI: 10.1016/j.cct.2008.07.006] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 07/22/2008] [Accepted: 07/28/2008] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The recruitment of minority and underserved individuals to research studies is often problematic. The purpose of this study was to describe the recruitment experiences of projects that actively recruited minority and underserved populations as part of The Centers for Population Health and Health Disparities (CPHHD) initiative. METHODS Principal investigators and research staff from 17 research projects at eight institutions across the United States were surveyed about their recruitment experiences. Investigators reported the study purpose and design, recruitment methods employed, recruitment progress, problems or challenges to recruitment, strategies used to address these problems, and difficulties resulting from Institutional Review Board (IRB) or Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements. Additionally, information was collected about participant burden and compensation. Burden was classified on a three-level scale. Recruitment results were reported as of March 31, 2007. RESULTS Recruitment attainment ranged from 52% to 184% of the participant recruitment goals. Commonly reported recruitment problems included administrative issues, and difficulties with establishing community partnerships and contacting potential participants. Long study questionnaires, extended follow-up, and narrow eligibility criteria were also problematic. The majority of projects reported difficulties with IRB approvals, though few reported issues related to HIPAA requirements. Attempted solutions to recruitment problems varied across Centers and included using multiple recruitment sites and sources and culturally appropriate invitations to participate. Participant burden and compensation varied widely across the projects, however, accrual appeared to be inversely associated with the amount of participant burden for each project. CONCLUSION Recruitment of minority and underserved populations to clinical trials is necessary to increase study generalizbility and reduce health disparities. Our results demonstrate the importance of flexible study designs which allow adaptation to recruitment challenges. These experiences also highlight the importance of involving community members and reducing participant burden to achieve success in recruiting individuals from minority and underserved populations.
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Armstrong K, McMurphy S, Dean LT, Micco E, Putt M, Halbert CH, Schwartz JS, Sankar P, Pyeritz RE, Bernhardt B, Shea JA. Differences in the patterns of health care system distrust between blacks and whites. J Gen Intern Med 2008; 23:827-33. [PMID: 18299939 PMCID: PMC2517897 DOI: 10.1007/s11606-008-0561-9] [Citation(s) in RCA: 195] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2007] [Revised: 01/26/2008] [Accepted: 02/06/2008] [Indexed: 01/26/2023]
Abstract
CONTEXT Although health care-related distrust may contribute to racial disparities in health and health care in the US, current evidence about racial differences in distrust is often conflicting, largely limited to measures of physician trust, and rarely linked to multidimensional trust or distrust. OBJECTIVE To test the hypothesis that racial differences in health care system distrust are more closely linked to values distrust than to competence distrust. DESIGN Cross-sectional telephone survey. PARTICIPANTS Two hundred fifty-five individuals (144 black, 92 white) who had been treated in primary care practices or the emergency department of a large, urban Mid-Atlantic health system. PRIMARY MEASURES Race, scores on the overall health care system distrust scale and on the 2 distrust subscales, values distrust and competence distrust. RESULTS In univariate analysis, overall health care system distrust scores were slightly higher among blacks than whites (25.8 vs 24.1, p = .05); however, this difference was driven by racial differences in values distrust scores (15.4 vs 13.8, p = .003) rather than in competence distrust scores (10.4 vs 10.3, p = .85). After adjustment for socioeconomic status, health/psychological status, and health care access, individuals in the top quartile of values distrust were significantly more likely to be black (odds ratio = 2.60, 95% confidence interval = 1.03-6.58), but there was no significant association between race and competence distrust. CONCLUSIONS Racial differences in health care system distrust are complex with far greater differences seen in the domain of values distrust than in competence distrust. This framework may be useful for explaining the mixed results of studies of race and health care-related distrust to date, for the design of future studies exploring the causes of racial disparities in health and health care, and for the development and testing of novel strategies for reducing these disparities.
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Kessler L, Domchek S, Stopfer J, Halbert CH. BRCA1 and BRCA2 risk perceptions among African American women at increased risk for hereditary breast-ovarian cancer. ACTA ACUST UNITED AC 2008; 11:193-200. [PMID: 18417966 DOI: 10.1159/000116879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To describe BRCA1 or BRCA2 (BRCA1/2) risk perceptions among African American women at increased risk for hereditary breast-ovarian cancer and to identify factors having independent associations with these perceptions. METHODS Risk perceptions were evaluated by self-report during a structured telephone interview among African American women (n = 162) at increased risk for hereditary cancer who were recruited from oncology clinics, general medical practices, and community oncology resources. RESULTS The majority of women (75%) believed that it was likely that they had a BRCA1/2 mutation. Women ages 50 and younger and those with greater cancer-specific worry were most likely to believe that they had a BRCA1/2 mutation. CONCLUSIONS Although BRCA1/2 risk perceptions may be consistent with objective risk levels among African American women, discussion about the basis of risk perceptions may enhance provision of genetic counseling and testing in this population.
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Halbert CH, Love D, Mayes T, Collier A, Weathers B, Kessler L, Stopfer J, Bowen D, Domchek S. Retention of African American women in cancer genetics research. Am J Med Genet A 2008; 146A:166-73. [PMID: 18076114 DOI: 10.1002/ajmg.a.32067] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although retention is a critical component of longitudinal cancer genetics research, limited empirical data are available on predictors of study retention among populations that are difficult to enroll. We evaluated predictors of retention in cancer genetics research among African American women at increased risk for having a BRCA1 and BRCA2 (BRCA1/2) mutation. Participants were African American women (n = 192) at increased risk for hereditary breast-ovarian cancer who were enrolled in a longitudinal genetic counseling research study. Retention was evaluated separately for the 1- and 6-month follow-ups and in terms of overall retention (e.g., completion of both telephone interviews). Seventy-three percent of women and 65% of women were retained at the 1- and 6-month follow-ups respectively; in terms of overall retention, 60% of women were retained in both follow-up telephone interviews. Predictors of retention at 1-month included being employed (OR = 2.47, 95% CI = 1.24, 4.93, P = 0.01) whereas predictors of overall retention included having a personal history of breast and/or ovarian cancer (OR = 2.06, 95% CI = 1.07, 3.95, P = 0.03) and having completed genetic counseling (OR = 2.63, 95% CI = 1.39, 4.98, P = 0.003). These data suggest that once enrolled in genetic counseling research, the majority of African American women will continue to participate, especially if concrete clinical services are provided.
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Halbert CH, Weathers B, Esteve R, Audrain-McGovern J, Kumanyika S, DeMichele A, Barg F. Experiences with weight change in African-American breast cancer survivors. Breast J 2008; 14:182-7. [PMID: 18282235 DOI: 10.1111/j.1524-4741.2007.00551.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although weight gain is a common side effect of breast cancer treatment, limited empirical data are available on how African-American breast cancer survivors react to changes in their weight following diagnosis and treatment. The purpose of this study was to explore psychological and behavioral reactions to weight change in African-American breast cancer survivors. We conducted a qualitative study to explore reactions to weight change following diagnosis and treatment in 34 African-American breast cancer survivors. Forty-seven percent of women reported gaining weight, 32% reported weight loss, and 21% reported no changes in their weight. Regardless of whether women gained or lost weight, these changes were viewed as stressors that caused psychological distress and health concerns. However, some women had positive reactions to weight loss, especially if they had been heavy prior to diagnosis. Women exercised and changed their dietary behaviors following treatment. Despite this, women reported being frustrated with not being able to control changes in their weight. These results suggest that changes in weight may be a critical component of breast cancer survivorship in African-American women. It may be important to provide African-American breast cancer survivors with information about the causes and implications of weight change and strategies for weight control after treatment as part of their follow-up care.
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Guerra CE, Schwartz JS, Armstrong K, Brown JS, Halbert CH, Shea JA. Barriers of and facilitators to physician recommendation of colorectal cancer screening. J Gen Intern Med 2007; 22:1681-8. [PMID: 17939007 PMCID: PMC2219836 DOI: 10.1007/s11606-007-0396-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2007] [Revised: 08/23/2007] [Accepted: 09/18/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Colorectal cancer screening (CRCS) has been demonstrated to be effective and is consistently recommended by clinical practice guidelines. However, only slightly over half of all Americans have ever been screened. Patients cite physician recommendation as the most important motivator of screening. This study explored the barriers of and facilitators to physician recommendation of CRCS. METHODS A 3-component qualitative study to explore the barriers of and facilitators to physician recommendation of CRCS: in-depth, semistructured interviews with 29 purposively sampled, community- and academic-based primary care physicians; chart-stimulated recall, a technique that utilizes patient charts to probe physician recall and provide context about the barriers of and facilitators to physician recommendation of CRCS during actual clinic encounters; and focus groups with 18 academic primary care physicians. Grounded theory techniques of analysis were used. RESULTS All the participating physicians were aware of and recommended CRCS. The overwhelmingly preferred test was colonoscopy. Barriers of physician recommendation of CRCS included patient comorbidities, prior patient refusal of screening, physician forgetfulness, acute care visits, lack of time, and lack of reminder systems and test tracking systems. Facilitators to physician recommendation of CRCS included patient request, patient age 50-59, physician positive attitudes about CRCS, physician prioritization of screening, visits devoted to preventive health, reminders, and incentives. CONCLUSION There are multiple physician, patient, and system barriers to recommending CRCS. Thus, interventions may need to target barriers at multiple levels to successfully increase physician recommendation of CRCS.
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Hughes Halbert C, Barg FK, Weathers B, Delmoor E, Coyne J, Wileyto EP, Arocho J, Mahler B, Malkowicz SB. Differences in cultural beliefs and values among African American and European American men with prostate cancer. Cancer Control 2007; 14:277-84. [PMID: 17615534 DOI: 10.1177/107327480701400311] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although cultural values are increasingly being recognized as important determinants of psychological and behavioral outcomes following cancer diagnosis and treatment, empirical data are not available on cultural values among men. This study evaluated differences in cultural values related to religiosity, temporal orientation, and collectivism among African American and European American men. METHODS Participants were 119 African American and European American men who were newly diagnosed with early-stage and locally advanced prostate cancer. Cultural values were evaluated by self-report using standardized instruments during a structured telephone interview. RESULTS After controlling for sociodemographic characteristics, African American men reported significantly greater levels of religiosity (Beta = 24.44, P < .001) compared with European American men. African American men (Beta = 6.30, P < .01) also reported significantly greater levels of future temporal orientation. In addition, men with more aggressive disease (eg, higher Gleason scores) (Beta = 5.11, P < .01) and those who were pending treatment (Beta = -6.42, P < .01) reported significantly greater levels of future temporal orientation. CONCLUSIONS These findings demonstrate that while ethnicity is associated with some cultural values, clinical experiences with prostate cancer may also be important. This underscores the importance of evaluating the effects of both ethnicity and clinical factors in research on the influence of cultural values on cancer prevention and control.
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Gariti P, Levin S, Whittingham T, Barou D, Kampman KM, Lynch K, Halbert CH, Alterman A. Why do those who request smoking treatment fail to attend the first appointment? J Subst Abuse Treat 2007; 35:62-7. [PMID: 17931823 DOI: 10.1016/j.jsat.2007.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Revised: 07/05/2007] [Accepted: 08/08/2007] [Indexed: 10/22/2022]
Abstract
As part of a larger trial of pharmacological and counseling interventions for light smokers, we performed a telephone-screening interview followed by a scheduled time for an in-person eligibility appointment. Of the 407 who screened positive and expressed interest in participation, 202 failed to attend the first scheduled appointment. This article examines person, study, and study-site characteristics that differentiated those who did follow through from those who did not. The study also examined the self-reported quit rates of both groups 12 weeks later, the time of the study termination. Analyses suggested that nonattendees were more likely to be younger, unemployed, and African American. The most frequently cited reasons for missing the eligibility appointment were work/family obligations, inconvenient appointment times, and personal schedule problems. Those who kept the initial appointment were more likely to report smoking abstinence at 12 weeks. The study has implications for increasing the utilization of potentially effective treatments for smokers.
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Kumanyika SK, Whitt-Glover MC, Gary TL, Prewitt TE, Odoms-Young AM, Banks-Wallace J, Beech BM, Halbert CH, Karanja N, Lancaster KJ, Samuel-Hodge CD. Expanding the obesity research paradigm to reach African American communities. Prev Chronic Dis 2007; 4:A112. [PMID: 17875256 PMCID: PMC2099277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Obesity is more prevalent among African Americans and other racial and ethnic minority populations than among whites. The behaviors that determine weight status are embedded in the core social and cultural processes and environments of day-to-day life in these populations. Therefore, identifying effective, sustainable solutions to obesity requires an ecological model that is inclusive of relevant contextual variables. Race and ethnicity are potent stratification variables in U.S. society and strongly influence life contexts, including many aspects that relate to eating and physical activity behaviors. This article describes a synthesis initiated by the African American Collaborative Obesity Research Network (AACORN) to build and broaden the obesity research paradigm. The focus is on African Americans, but the expanded paradigm has broader implications and may apply to other populations of color. The synthesis involves both community and researcher perspectives, drawing on and integrating insights from an expanded set of knowledge domains to promote a deeper understanding of relevant contexts. To augment the traditional, biomedical focus on energy balance, the expanded paradigm includes insights from family sociology, literature, philosophy, transcultural psychology, marketing, economics, and studies of the built environment. We also emphasize the need for more attention to tensions that may affect African American or other researchers who identify or are identified as members of the communities they study. This expanded paradigm, for which development is ongoing, poses new challenges for researchers who focus on obesity and obesity-related health disparities but also promises discovery of new directions that can lead to new solutions.
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Abstract
Although knowledge about genetic concepts is important for individuals to be active participants in medical technologies that use genetic science, limited information is available on knowledge about basic genetic concepts and terminology in African Americans. The purpose of this study was to evaluate knowledge about general genetic concepts and medical genetics terminology among African Americans and to identify factors having independent associations with knowledge. Participants were 109 adult African Americans enrolled in a study on attitudes about race, genetics, and smoking. The majority of respondents were knowledgeable about general genetic concepts, but were less knowledgeable about medical genetics terminology. Education was the only factor independently associated with knowledge about sporadic disorders in multivariate logistic regression analysis. Respondents with at least some college education were most likely to be knowledgeable about sporadic disorders (OR=2.70, 95% CI=1.10, 6.67, p=.03). The results of this study suggest that genetics education targeted to African Americans may need to focus on increasing understanding about technical concepts related to genetics.
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Brewster K, Wileyto EP, Kessler L, Collier A, Weathers B, Stopfer JE, Domchek S, Halbert CH. Sociocultural predictors of breast cancer risk perceptions in African American breast cancer survivors. Cancer Epidemiol Biomarkers Prev 2007; 16:244-8. [PMID: 17301256 DOI: 10.1158/1055-9965.epi-06-0481] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although African American breast cancer survivors are at increased risk for developing breast cancer again, empirical data are not available on breast cancer risk perceptions in these women. This study characterized perceived risk of developing breast cancer in African American breast cancer survivors at risk for having a BRCA1 or BRCA1 (BRCA1/2) mutation and identified factors having significant independent associations with risk perceptions. Participants were 95 African American breast cancer survivors at an increased risk for having a BRCA1/2 mutation. Risk perceptions and sociodemographic, clinical, treatment, and sociocultural factors were collected during a structured telephone interview. Most women reported that they had the same or lower risk of developing breast cancer again compared with other women (53%); however, a substantial minority of women (47%) reported that they had a higher or much higher risk. Factors having significant independent associations with heightened risk perceptions included having a >or=10% prior probability of having a BRCA1/2 mutation [odds ratio (OR), 2.91; 95% confidence interval (95% CI), 1.09-7.72; P = 0.03] and more years of formal education (OR, 2.74; 95% CI, 1.02-7.36; P = 0.05). In addition, women who thought about the past a lot were three times more likely to report heightened risk perceptions compared with those who did not think about the past a lot (OR, 3.72; 95% CI, 1.45-9.57; P = 0.01). These results suggest that it may be important to ensure adequate risk comprehension among African American women as part of genetic counseling for inherited breast-ovarian cancer risk. Discussion of risk perceptions within the context of existing beliefs and values may facilitate this process.
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Audrain-McGovern J, Halbert CH, Rodriguez D, Epstein LH, Tercyak KP. Predictors of participation in a smoking cessation program among young adult smokers. Cancer Epidemiol Biomarkers Prev 2007; 16:617-9. [PMID: 17337647 DOI: 10.1158/1055-9965.epi-06-0791] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated the predictors of participation in a smoking cessation trial for young adults ages 18 to 30 years old. Eligible smokers (n = 164) completed a telephone survey that measured demographic, smoking history, and psychosocial variables before the initiation of smoking cessation treatment. Young adult smokers who attended at least one smoking cessation session were compared with those who did not attend any sessions. Logistic regression analysis indicated that race and age were statistically significant multivariate predictors of participation. Caucasians were over six times (odds ratio, 6.03; 95% confidence interval, 2.41-15.05) more likely to participate in the smoking cessation program compared with non-Caucasians (61% versus 19%). For every SD increase in age (SD, 2.45), there was about a 2-fold increase in the likelihood that a young adult smoker participated in the smoking cessation program (odds ratio, 1.82; 95% confidence interval, 1.23-2.71). Future research should investigate how to promote participation in smoking cessation programs among smokers in emerging adulthood and among non-Caucasian young adult smokers to prevent a lifelong habit associated with disproportionate morbidity and mortality.
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Halbert CH, Gandy OH, Collier A, Shaker L. Beliefs about tobacco use in African Americans. Ethn Dis 2007; 17:92-8. [PMID: 17274216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES The purpose of this study was to describe beliefs about the influence of genetic and environmental factors on tobacco use among African Americans and to identify factors that are independently associated with these beliefs. DESIGN AND SETTING Participants were 94 adult African American men and women who were enrolled in a study on race, genetics, and smoking. MAIN OUTCOME MEASURES Beliefs about factors involved in smoking initiation and cessation were evaluated by self-report during a structured telephone survey. RESULTS Smoking status was not associated significantly with beliefs about the influence of genetic or environmental factors; however, gender and education level were associated significantly with beliefs about the influence of environmental factors. Men (beta = -1.71, P = .01) reported significantly greater beliefs about the influence of environmental factors on tobacco use compared to women. Higher education was also associated with greater beliefs about the influence of environmental factors (beta = 1.81, P = .01). Only income level was associated significantly with beliefs about the influence of genetic factors. Respondents with incomes < or = dollar 20,000 reported significantly greater beliefs about the influence of genetic factors compared to those with higher incomes (beta = -.92, P = .02). CONCLUSIONS These results suggest that African Americans believe that biological factors such as genes play a limited role in tobacco use behaviors. Sociodemographic factors, rather than tobacco use, are important to beliefs about tobacco use among African Americans.
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Halbert CH, Kessler L, Stopfer JE, Domchek S, Wileyto EP. Low rates of acceptance of BRCA1 and BRCA2 test results among African American women at increased risk for hereditary breast-ovarian cancer. Genet Med 2006; 8:576-82. [PMID: 16980814 DOI: 10.1097/01.gim.0000237719.37908.54] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study evaluated rates of BRCA1 and BRCA2 (BRCA1/2) test result acceptance among African American women and identified determinants of test result acceptance. METHODS Acceptance of BRCA1/2 test results was evaluated among 157 African American women at high and moderate risk for having a BRCA1/2 mutation who were offered genetic testing as part of a clinical genetic counseling research program. RESULTS Twenty-two percent of women received BRCA1/2 test results. Test result acceptance differed between women with > or =10% prior probability of having a BRCA1/2 mutation (34%) and those who had a 5% prior probability (8%). Among women with > or =10% prior probability, test result acceptors were most likely to be married (OR = 5.29, 95% CI = 1.82, 15.38, P = 0.002) and be less certain about their risk of developing cancer (OR = 3.18, 95% CI = 1.04, 9.80, P = 0.04). CONCLUSION These results demonstrate that acceptance of BRCA1/2 test results may be limited among African American women. Being married and having less certainty about one's cancer risk may motivate acceptance of BRCA1/2 test results among African American women. It may be important to emphasize the possibility that BRCA1/2 test results may not clarify cancer risks during pre-test counseling with African American women to ensure informed decision-making about testing.
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Halbert CH, Kessler L, Wileyto EP, Weathers B, Stopfer J, Domchek S, Collier A, Brewster K. Breast cancer screening behaviors among African American women with a strong family history of breast cancer. Prev Med 2006; 43:385-8. [PMID: 16860380 DOI: 10.1016/j.ypmed.2006.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Revised: 06/08/2006] [Accepted: 06/12/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite the importance of breast cancer screening to reduce morbidity and mortality, limited information is available on screening practices among African American women with a family history that is suggestive of hereditary breast cancer. OBJECTIVES To describe adherence to breast cancer screening recommendations among African American women with a family history that is suggestive of hereditary disease. METHODS Participants were unaffected African American women (n=65) who had a family history of cancer that was suggestive of hereditary breast cancer. Breast cancer screening practices were evaluated by self-report. The study was conducted at the University of Pennsylvania in Philadelphia, PA. Women were recruited to participate in the study from February 2003-December 2005. RESULTS Most women were adherent to recommendations for mammography (75%) and CBE (93%). A sizeable minority of women (41%) also performed excessive BSE. Being older than age 50 was associated significantly with mammography adherence (FET<0.05). Employment had a significant independent association with BSE; unemployed women were most likely to perform excessive BSE (OR=3.28, 95% CI: 1.05, 10.21, p<0.05). CONCLUSIONS The results of this study suggest a complex pattern of breast cancer screening practices among African American women at increased risk for hereditary breast cancer.
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95
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Charles S, Kessler L, Stopfer JE, Domchek S, Halbert CH. Satisfaction with genetic counseling for BRCA1 and BRCA2 mutations among African American women. PATIENT EDUCATION AND COUNSELING 2006; 63:196-204. [PMID: 16533589 DOI: 10.1016/j.pec.2005.10.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Revised: 10/14/2005] [Accepted: 10/23/2005] [Indexed: 05/07/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate satisfaction with genetic counseling for BRCA1 and BRCA2 (BRCA1/2) mutations among African American women. METHODS Participants were 54 African American women at moderate and high risk for BRCA1/2 mutations who were offered genetic testing as part of a randomized clinical trial designed to compare the effects of culturally tailored genetic counseling (CTGC) and standard genetic counseling (SGC). Satisfaction with genetic counseling was evaluated using a self-administered questionnaire following culturally tailored or standard pre-test education and counseling. RESULTS Overall, the majority of women (96%) were very satisfied with genetic counseling; however, only 26% reported that their worries were lessened and 22% reported that they were able to cope better. Women who received CTGC were significantly more likely than women who received SGC to report that their worries were lessened (p<0.05). In addition, women with household incomes less than US$ 35,000 were significantly more likely to report that the counselor lessened their worries compared to women with higher incomes (p<0.05). CONCLUSIONS Most African American women were satisfied with genetic counseling; however, women who received culturally tailored genetic counseling were significantly more likely to strongly agree that their worries were lessened compared to women who received standard genetic counseling. PRACTICE IMPLICATIONS Discussion of cultural beliefs and values during genetic counseling may be beneficial to African American women, especially those with low incomes.
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96
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Halbert CH. Genetic counseling and testing for breast cancer risk in African Americans. LDI ISSUE BRIEF 2006; 12:1-4. [PMID: 17302016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Genetic testing for susceptibility to breast and ovarian cancer (BRCA1/2 testing) has been available in clinical settings since 1996. Increasingly, such testing is helping women at increased risk make decisions about breast cancer screening and prevention. African American women have participated in genetic counseling and testing programs less than white women, despite greater rates of early onset disease and higher breast cancer mortality. The barriers and motivations for genetic testing among African American women are not well understood. This Issue Brief summarizes a series of studies that systematically explore African American women's beliefs and intentions about BRCA1/2 testing. The findings have been used to tailor genetic counseling programs to better serve this population.
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Rebbeck TR, Halbert CH, Sankar P. Genetics, epidemiology, and cancer disparities: is it black and white? J Clin Oncol 2006; 24:2164-9. [PMID: 16682735 DOI: 10.1200/jco.2005.05.1656] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Epidemiologic studies attempt to understand the distribution and determinants of human disease. Epidemiologic research often incorporates information about race, ethnicity, or ancestry, usually as a self-identified race or ethnicity (SIRE) variable. Differences in the distribution and determinants of disease on the basis of SIRE may be identified in these studies. In addition, genetic and other biologic differences according to SIRE are frequently reported. If these differences are real and meaningful, they may have value in identifying disease-causative or -preventive factors, and thus may be beneficial to human health. However, the concepts of race, ethnicity, or ancestry are often poorly considered or crudely applied, particularly in genetic studies of disease etiology or outcome. Consequently, results suggesting genetic differences with respect to disease etiology or outcome across SIRE groups may not be meaningful; in fact, these differences may prove harmful if they propagate stereotypes or spurious differences. Therefore, it is critical to properly consider the meaning, definitions, and use of race, ethnicity, or ancestry in molecular epidemiologic studies.
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Halbert CH, Armstrong K, Gandy OH, Shaker L. Racial Differences in Trust in Health Care Providers. ACTA ACUST UNITED AC 2006; 166:896-901. [PMID: 16636216 DOI: 10.1001/archinte.166.8.896] [Citation(s) in RCA: 289] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Although trust in health care providers (physicians, nurses, and others) may be lower among African Americans compared with whites, limited information is available on factors that are associated with low trust in these populations. This study evaluated the association between trust in health care providers and prior health care experiences, structural characteristics of health care, and sociodemographic factors among African Americans and whites. METHODS National survey of 954 non-Hispanic adult African Americans (n = 432) and whites (n = 522). RESULTS African Americans (44.7%) were more likely than whites (33.5%) to report low levels of trust in health care providers (chi(2) = 12.40, P<.001). Fewer quality interactions with health care providers had a significant effect on low trust among African Americans (odds ratio [OR], 3.23; 95% confidence interval [CI], 1.97-5.29; P<.001) and whites (OR, 3.99; 95% CI, 2.44-6.50; P<.001). Among African Americans, respondents whose usual source of care was not a physician's office were most likely to report low trust (OR, 1.73; 95% CI, 1.15-2.61; P = .02), whereas among whites, women (OR, 1.54; 95% CI, 1.04-2.30; P = .03) and respondents with fewer annual health care visits (OR, 1.52; 95% CI, 1.02-2.28; P = .04) were most likely to report low trust. CONCLUSIONS Compared with whites, African Americans were most likely to report low trust in health care providers. While fewer quality interactions with health care providers were associated significantly with low trust in both populations, usual source of medical care was only associated with low trust among African Americans, whereas sex and the number of annual health care visits were associated with low trust among whites. Different factors may influence trust in health care providers among African Americans and whites.
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Halbert CH, Gandy OH, Collier A, Shaker L. Intentions to participate in genetics research among African American smokers. Cancer Epidemiol Biomarkers Prev 2006; 15:150-3. [PMID: 16434602 DOI: 10.1158/1055-9965.epi-05-0437] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although prior studies have shown that African American smokers are likely to carry some of the genetic variants associated with smoking risk, additional research with African American smokers is needed to replicate these findings. Limited information is available on interest in participating in research to identify genetic risk factors for smoking among African American smokers; therefore, the goals of the present study were to describe intentions to participate in smoking and genetics research, and to determine factors that are associated with participation intentions. Subjects were 128 African American male and female adult smokers. Sociodemographic characteristics, clinical factors, attitudes about genetic testing, and intentions to participate in genetics research were evaluated during a structured telephone interview. Overall, 58% of respondents reported that they would be very likely to participate in research to identify genetic risk factors for smoking. Greater beliefs about the benefits of participating in medical research (odds ratio, 3.17; 95% confidence interval, 1.45-6.94; P = 0.004) and fewer perceptions of the limitations and risks of genetic testing (odds ratio, 0.90; 95% confidence interval, 0.82-0.98; P = 0.01) had significant independent associations with reporting a high likelihood of participating in this type of research. Recruitment messages and protocols that address the benefits of research participation, as well as concerns about the limitations and risks of genetic testing, may enhance African American participation in research on genetics and smoking.
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Hughes Halbert C, Weathers B, Delmoor E. Developing an academic-community partnership for research in prostate cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2006; 21:99-103. [PMID: 17020523 DOI: 10.1207/s15430154jce2102_13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Community-based participatory research (CBPR) is an important strategy for reducing racial disparities in health outcomes. Academic-community partnerships are central to CBPR; however, there are few examples of how to develop these partnerships for prostate cancer research. This report describes the methods used to develop an academic-community partnership between investigators at the University of Pennsylvania and members of the Philadelphia chapter of the National Black Leadership Initiative on Cancer for CBPR on quality of life following prostate cancer diagnosis. Our experiences demonstrate that a significant investment of time is needed to identify a community partner for prostate cancer research and develop an effective partnership.
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