Eliminating cancer disparities

Spiritual expressions of African Americans and Whites in cancer pain

BACKGROUND

Spiritual practices are one way that individuals cope with cancer pain.

PURPOSE

Describe and contrast expressions and values about the use of spirituality for pain in African American (AA) and White (WH) oncology patients.

METHODS

Six groups (3 AA; 3 WH; n=42; mean age 58) were conducted. Focus group and qualitative methodology with a cultural interpretive lens was utilized. The Model of Integrated Spirituality provided the conceptual framework for understanding the narratives.

FINDINGS

AAs and WHs did not differ on demographics, pain status, or integrative therapies. Three spirituality themes emerged: 1) pain and distress as antecedents to the use of spirituality; 2) active and existential attributes of the use of spirituality; and 3) mobilization of internal and external resources as outcomes. There were commonalities between AAs and WHs but greater frequency of certain subthemes and keywords in AAs.

CONCLUSIONS

Future studies should examine whether differences in overt expressions translate into different types and levels of spiritual usage.

IMPLICATIONS FOR PRACTICE

Clinicians should recognizing similar as well as different uses and descriptions of spirituality between African Americans and Whites.

Unhealthy partnerships: the tobacco industry and African American and Latino labor organizations

The tobacco industry in the 1980s began to form relationships with outside groups for assistance on key policy issues due to its own poor credibility in the policy arena. This strategy allowed the industry to advance its own interests while seeming to match the agendas of very different organizations. Between 1988 and 1998, the tobacco industry developed coalitions with the A. Philip Randolph Institute (APRI), representing African American trade unionists, and the Labor Coalition on Latin American Advancement (LCLAA), representing Latino trade unionists. APRI and LCLAA each adopted resolutions supporting industry positions on smokefree worksites and excise taxes, issues on which they had not previously taken positions, and promoted these positions to their members, political leaders and the public. They also supported the industry's youth programs. This research relied upon a review of background literature and document searches through the Legacy Tobacco Documents Library and Tobacco Documents Online to examine the development of the excise tax coalition. The tobacco industry built support with APRI and LCLAA by framing policy positions in line with the organizations' interests, creating institutional arrangements that circumvented direct funding from the industry, and enhancing the industry's ability to influence excise tax debates indirectly. Although tobacco control advocates do not have the financial resources of the tobacco industry at their disposal, they can learn from tobacco industry techniques as they seek to build coalitions with people of color in the labor movement. Tobacco control advocates can both counter tobacco industry issue frames and also align their interests with those of working people of color by working on other issues of interest to this population, including health care and worker health and safety.

Health care utilization by adult Hispanic long-term survivors of hematopoietic stem cell transplantation: report from the Bone Marrow Transplant Survivor Study

BACKGROUND

Long-term hematopoietic cell transplantation (HCT) survivors have a high prevalence of severe and chronic health conditions, placing significant demands on the healthcare system. The objective of the current study was to evaluate and compare the healthcare utilization by adult Hispanic and non-Hispanic white long-term survivors of HCT.

METHODS

A mailed questionnaire was used to assess self-reported healthcare utilization in 3 domains: general contact with healthcare system, general physical examination outside cancer center (GPE), and cancer/HCT center visit. Eligible individuals had undergone HCT between 1974 and 1998, at age > or =21 years, and had survived > or =2 years after HCT.

RESULTS

The cohort included 681 non-Hispanic white and 137 Hispanic survivors. The median age at HCT was 38.3 years, and the median length of follow-up was 6.6 years. Hispanic survivors had lower family income and education and were more likely to lack health insurance. The prevalence of GPE increased significantly over time among non-Hispanic whites (67% at 2-5 years to 76% at 11+ years) but remained unchanged among Hispanics (66% to 61%). Cancer/HCT center visits declined over time among both Hispanics and non-Hispanic whites, but a higher proportion of Hispanics reported cancer/HCT center visits at 11+ years after HCT (81% vs 54%).

CONCLUSIONS

Compared with non-Hispanic whites, Hispanic survivors are less likely to establish contact with primary care providers years after HCT and to continue to receive care at cancer/HCT centers. Future studies of this population are needed to establish the factors responsible for this pattern of healthcare utilization.

Surveillance for health behaviors of American Indians and Alaska Natives-findings from the behavioral risk factor surveillance system, 2000-2006

BACKGROUND

The authors compared estimates for cancer risk factors, use of cancer screening tests, health status indicators, and access to care for American Indians and Alaska Natives (AI/ANs) and non-Hispanic whites (NHWs) in the US and for AI/ANs in 6 Indian Health Service regions.

METHODS

Behavioral Risk Factor Surveillance System data were aggregated from the years 2000 through 2006 and were used to calculate weighted prevalence estimates by gender for key variables except demographic variables.

RESULTS

Compared with NHWs, AI/ANs had lower prevalence estimates for income, educational attainment, insurance coverage, and access to personal healthcare providers. AI/ANs in Alaska and NHWs had similar estimates for diabetes (approximately 6%); however, the prevalence was nearly twice as high among AI/ANs in the other regions. The prevalence of obesity was higher for AI/ANs (29.6%) than for NHWs (20.9%). The prevalence of binge drinking was higher among AI/AN males (24.9%) than among AI/AN females (8.5%). Heavy drinking was more prevalent among NHW females (5.3%) than among AI/AN females (3.5%). AI/ANs were more likely to be current smokers (31.1%) than NHWs (22.8%). The prevalence of AI/ANs who never smoked ranged from 31.5% in Alaska to 56.9% in the Southwest. In 5 of the 6 regions, AI/AN females had lower prevalence estimates of both Papanicolaou and mammography testing than NHW females. The use of colorectal cancer screening tests was more common among NHWs (53.8%) than among AI/ANs (44%).

CONCLUSIONS

Although cancer health disparities persist among AI/ANs, the current analysis indicated that variation in the prevalence of their chronic disease risk factors may be obscured when national data are not examined by smaller geographic areas such as regions.