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Boyle J, Ward MH, Cerhan JR, Rothman N, Wheeler DC. Assessing and attenuating the impact of selection bias on spatial cluster detection studies. Spat Spatiotemporal Epidemiol 2024; 49:100659. [PMID: 38876558 PMCID: PMC11180222 DOI: 10.1016/j.sste.2024.100659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 06/16/2024]
Abstract
Spatial cluster analyses are commonly used in epidemiologic studies of case-control data to detect whether certain areas in a study region have an excess of disease risk. Case-control studies are susceptible to potential biases including selection bias, which can result from non-participation of eligible subjects in the study. However, there has been no systematic evaluation of the effects of non-participation on the findings of spatial cluster analyses. In this paper, we perform a simulation study assessing the effect of non-participation on spatial cluster analysis using the local spatial scan statistic under a variety of scenarios that vary the location and rates of study non-participation and the presence and intensity of a zone of elevated risk for disease for simulated case-control studies. We find that geographic areas of lower participation among controls than cases can greatly inflate false-positive rates for identification of artificial spatial clusters. Additionally, we find that even modest non-participation outside of a true zone of elevated risk can decrease spatial power to identify the true zone. We propose a spatial algorithm to correct for potentially spatially structured non-participation that compares the spatial distributions of the observed sample and underlying population. We demonstrate its ability to markedly decrease false positive rates in the absence of elevated risk and resist decreasing spatial sensitivity to detect true zones of elevated risk. We apply our method to a case-control study of non-Hodgkin lymphoma. Our findings suggest that greater attention should be paid to the potential effects of non-participation in spatial cluster studies.
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Affiliation(s)
- Joseph Boyle
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA.
| | - Mary H Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - James R Cerhan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Nathaniel Rothman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - David C Wheeler
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
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2
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Chen YT, Duncan DT, Del Vecchio N, Timmins L, Pagkas-Bather J, Knox J, Lacap S, Hanson H, Schneider JA. COVID-19 Conspiracy Beliefs are not Barriers to HIV Status Neutral Care Among Black Cisgender Sexual Minority Men and Black Transgender Women at the Initial Peak of the COVID-19 Pandemic in Chicago, USA. AIDS Behav 2022; 26:3939-3949. [PMID: 35731308 PMCID: PMC9214465 DOI: 10.1007/s10461-022-03720-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/24/2022]
Abstract
We examined associations between COVID-19 conspiracy beliefs and HIV status neutral care engagement among Black cisgender sexual minority men (BCSMM) and Black transgender women (BTW). Throughout April–July 2020, a total of 226 (222 in the current analysis: 196 BCSMM, 20 BTW, and 6 other) participants in Chicago’s Neighborhoods and Networks (N2) cohort study completed virtual assessments. Participants reported their HIV status, changes in the frequency of PrEP/ART use, and COVID-19 conspiracy beliefs. Three-quarters of the sample believed at least one conspiracy theory that COVID-19 was either government-created or lab-created accidentally or purposefully. Believing one or more COVID-19 conspiracy theories was significantly associated with better PrEP or ART engagement (using PrEP more frequently or continuously using PrEP/Missing ART less or continuously using ART) (aPR = 0.75 [95% CI 0.56–0.99], p < 0.05). Believing COVID-19 came about naturally was strongly associated with worse PrEP engagement (i.e., use PrEP less or not on PrEP) or worse ART engagement (i.e., missed ART more or not on ART) (aPR = 1.56 [95% CI 1.23, 1.98], p < 0.001). Findings suggested substantial COVID-19 conspiracies among BCSMM and BTW, and this was associated with HIV care engagement.
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Affiliation(s)
- Yen-Tyng Chen
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA. .,Department of Public Health, William Paterson University of New Jersey, Wayne, NJ, USA. .,Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Natascha Del Vecchio
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.,Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Liadh Timmins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,School of Psychology, Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, Wales, UK
| | - Jade Pagkas-Bather
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.,Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Shaina Lacap
- Department of Public Health, William Paterson University of New Jersey, Wayne, NJ, USA
| | | | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.,Department of Medicine, University of Chicago, Chicago, IL, USA.,Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.,Crown School of Social Work, University of Chicago, Chicago, IL, USA
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3
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Jaurretche M, Levy M, Castel AD, Happ LP, Monroe AK, Wyche KF. Factors Influencing Successful Recruitment of Racial and Ethnic Minority Patients for an Observational HIV Cohort Study in Washington, DC. J Racial Ethn Health Disparities 2021; 9:767-778. [PMID: 33721291 DOI: 10.1007/s40615-021-01015-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 01/07/2023]
Abstract
The process of recruiting racial and ethnic minority persons living with HIV (PLWH) is important for research studies to ensure inclusivity of underrepresented groups. To understand factors associated with recruitment of minority PLWH, this study examined the recruitment process of PLWH for an observational study of their routine medical care at 14 clinics in Washington, DC. Research assistant (RA) recruiters were interviewed to assess their consenting processes and strategies. Data were collected on clinic services, patient demographics, and recruitment logs of patient approaches for obtaining informed consent resulting in agreement or refusal. A median of 96% of eligible patients was approached to obtain consent, yielding a median consent rate of 78% across all sites. A total of 8438 patients consented and 1326 refused study participation. Clinical sites with more comprehensive services had higher consent rates. black/African American and Hispanic/Latinx PLWH consented or refused study participation in similar proportions, while significantly more white patients enrolled than refused. More men, compared with women, enrolled than refused study participation. The most frequent reasons for refusing study participation were the lack of interest in research (33.2%) and no specific reason provided (28%). RAs identified that effective recruitment strategies used culturally sensitive approaches, built rapport with patients, and obtained provider support for the study. Recruitment strategies that are gender sensitive to address the disparity of underrepresentation of women, address perceived barriers, and examine clinic-specific services are needed to maximize research participation for minority PLWH to improve prevention and health outcomes.
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Affiliation(s)
- Maria Jaurretche
- Milken Institute School of Public Health, Department of Epidemiology, The George Washington University, Washington, DC, USA
| | - Matthew Levy
- Milken Institute School of Public Health, Department of Epidemiology, The George Washington University, Washington, DC, USA.,Westat, Rockville, MD, USA
| | - Amanda D Castel
- Milken Institute School of Public Health, Department of Epidemiology, The George Washington University, Washington, DC, USA
| | - Lindsey Powers Happ
- Milken Institute School of Public Health, Department of Epidemiology, The George Washington University, Washington, DC, USA
| | - Anne K Monroe
- Milken Institute School of Public Health, Department of Epidemiology, The George Washington University, Washington, DC, USA
| | - Karen F Wyche
- School of Nursing, The George Washington University, Washington, DC, USA.
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4
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A shot at equity? Addressing disparities among Black MSM in the coming era of long-acting injectable preexposure prophylaxis. AIDS 2019; 33:2110-2112. [PMID: 31577579 DOI: 10.1097/qad.0000000000002341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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5
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D’Avanzo PA, Bass SB, Brajuha J, Gutierrez-Mock L, Ventriglia N, Wellington C, Sevelius J. Medical Mistrust and PrEP Perceptions Among Transgender Women: A Cluster Analysis. Behav Med 2019; 45:143-152. [PMID: 31343968 PMCID: PMC6943929 DOI: 10.1080/08964289.2019.1585325] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/06/2019] [Accepted: 02/16/2019] [Indexed: 02/06/2023]
Abstract
Transgender (trans) women experience unique barriers in accessing preventative health services such as HIV preexposure prophylaxis (PrEP). These barriers may be exacerbated by past real or anticipated mistreatment in health care settings, but little is known about the relationship between medical mistrust and poor PrEP uptake and knowledge. Using a multistep approach, this study used a novel survey instrument administered to a pilot sample of 78 trans women. Item responses on a 0-10 scale were subjected to a TwoStep cluster analysis to explore how perceptions of PrEP and experiences with health care vary among trans women. Two distinct clusters (C1,C2) were defined on the basis of race (C1: 82% White, C2: 69% Black) and highest level of education completed (C1: 53% college or above, C2: 42% high school diploma or GED). Analyses suggest that varying levels of medical mistrust exist between clusters. Higher mean scores on medical mistrust items were reported in C1. A similar relationship was found on attitudes toward PrEP. Differences in intention to use PrEP and differences in past PrEP use were not significant; however, C2 members were more likely to have heard of PrEP from a doctor. Results suggest that levels of medical mistrust and PrEP perceptions vary among distinct subpopulations in this community, which may affect willingness to use PrEP. Interventions aimed at addressing unique perceptions in subpopulations could move trans women from intention to PrEP use.
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Affiliation(s)
- Paul A. D’Avanzo
- Department of Social and Behavioral Sciences, Temple University College of Public Health
- Risk Communication Laboratory, Temple University College of Public Health
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, Temple University College of Public Health
- Risk Communication Laboratory, Temple University College of Public Health
| | - Jesse Brajuha
- Risk Communication Laboratory, Temple University College of Public Health
| | - Luis Gutierrez-Mock
- Center of Excellence for Transgender Health, University of California, San Francisco
| | - Nicole Ventriglia
- Risk Communication Laboratory, Temple University College of Public Health
| | - Carine Wellington
- Risk Communication Laboratory, Temple University College of Public Health
| | - Jae Sevelius
- Center of Excellence for Transgender Health, University of California, San Francisco
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco
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6
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Jaiswal J, Singer SN, Siegel K, Lekas HM. HIV-related 'conspiracy beliefs': lived experiences of racism and socio-economic exclusion among people living with HIV in New York City. CULTURE, HEALTH & SEXUALITY 2019; 21:373-386. [PMID: 29883299 PMCID: PMC7535109 DOI: 10.1080/13691058.2018.1470674] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 04/25/2018] [Indexed: 06/08/2023]
Abstract
HIV-related 'conspiracy beliefs' include ideas about the genocidal origin of HIV and the nature and purpose of HIV-related medications. These ideas have been widely documented as affecting myriad health behaviours and outcomes, including birth control use and HIV testing. Most HIV-related research has quantitatively explored this phenomenon, and further qualitative research is necessary to better understand the complexity of these beliefs as articulated by those who endorse them. Moreover, public health in general has over-emphasised the role of the Tuskegee Syphilis Study in explaining mistrust, rather than focus on ongoing social inequalities. Twenty-seven semi-structured interviews were conducted with low-income Black and Latinx people living with HIV who were currently, or had been recently, disengaged from HIV medical care. Beliefs about the role and intentions of the government and pharmaceutical industry in the epidemic highlighted the racism and classism experienced by participants. Notably, however, HIV care providers were not perceived as part of the government-pharmaceutical collusion. Interventions should focus on fostering positive beliefs about HIV medication and building trust between HIV care providers and populations that have experienced ongoing social and economic exclusion. Replacing the phrase 'conspiracy beliefs' with more descriptive terms, such as HIV-related beliefs, could avoid discrediting people's lived experiences.
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Affiliation(s)
- Jessica Jaiswal
- Department of Sociomedical Sciences, Columbia University, New York, USA
- Center for the Psychosocial Study of Health and Illness, Columbia University, New York, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, USA
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, USA
| | - Stuart N. Singer
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, USA
| | - Karolynn Siegel
- Department of Sociomedical Sciences, Columbia University, New York, USA
- Center for the Psychosocial Study of Health and Illness, Columbia University, New York, USA
| | - Helen-Maria Lekas
- Department of Sociomedical Sciences, Columbia University, New York, USA
- Center for the Psychosocial Study of Health and Illness, Columbia University, New York, USA
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7
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Benkert R, Cuevas A, Thompson HS, Dove-Meadows E, Knuckles D. Ubiquitous Yet Unclear: A Systematic Review of Medical Mistrust. Behav Med 2019; 45:86-101. [PMID: 31343961 PMCID: PMC6855383 DOI: 10.1080/08964289.2019.1588220] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/22/2019] [Accepted: 02/24/2019] [Indexed: 12/21/2022]
Abstract
Peer-reviewed articles (n = 124) examining associations between medical mistrust (MM) and health outcomes from four databases, between January 1998 and May 2018, were reviewed; 36 qualitative and 88 quantitative studies met the inclusion criteria. The Williams and Mohammed framework guided our narrative synthesis of the studies; it argues that basic causes (e.g., biased institutions) affect the social status of marginalized groups which in turn effects multiple proximal pathways leading to responses and poor health. Most studies were cross-sectional with US-based samples. The MM in qualitative studies were categorized as interpersonal (n = 30), systemic (n = 22), and/or vicarious (n = 18); 25% did not explicitly note the basic causes of MM and race/ethnicity was often confounded with socioeconomic status (SES). All but three studies discussed an association between MM and a behavior response; no study focused on an actual health outcome. Most quantitative studies used multivariate regression analyses; only 15 of the 88 utilized advanced modeling techniques (e.g., mediation). Most (75%) studies did not describe basic causes for MM and 43% utilized low income samples. MM was conceptualized as a predictor/proximal pathway (in 73 studies) associated with a variety of responses, most commonly behavioral (e.g., diminished adherence); 14 studies found an association between MM and a specific health measure. This review underscores the need for future qualitative studies to place MM central to their research questions as in-depth descriptions of MM were limited. Future quantitative studies should replicate findings using more advanced analytical strategies that examine the relationship between MM and health outcomes.
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Affiliation(s)
| | | | - Hayley S. Thompson
- Community Outreach & Engagement, Faculty Director, Office of Cancer Health Equity & Community Engagement Karmanos Cancer Institute
- Department of Oncology, Wayne State University School of Medicine
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Jaiswal J. Whose Responsibility Is It to Dismantle Medical Mistrust? Future Directions for Researchers and Health Care Providers. Behav Med 2019; 45:188-196. [PMID: 31343959 PMCID: PMC7808309 DOI: 10.1080/08964289.2019.1630357] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Medical mistrust persists and appears to be growing. The public health literature on medical mistrust has largely focused on mistrust among Black and African American populations due to legacies of abuse and mistreatment, such as the infamous Tuskegee Syphilis Study. However, research is now emerging that explores mistrust among various populations and in varying contexts, and the literature now largely emphasizes the role of ongoing, present-day social and economic inequalities in shaping and sustaining mistrust, particularly among populations who experience staggering health disparities. This special issue showcased nine articles exploring medical mistrust among diverse populations, exploring a wide array of topics and spanning myriad methodologies. In addition to a rigorous systematic review of the literature, this issue covers several critical subareas of the health disparities literature, including preventative health screenings among Black men, discrimination and cultural factors among rural Latinx communities, health care satisfaction among Latina immigrant women, the complex relationship between HIV testing and "conspiracy beliefs" among Black populations, pre-exposure prophylaxis use among transgender women, the impacts of mass incarceration on HIV care, eHealth interventions to address chronic diseases among sexual minority men of color, and participatory research to engage underserved populations as co-researchers. The purpose of this article is to provide a brief summary of the nine manuscripts in this special issue and to outline some recommendations and future directions for research on medical mistrust.
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Affiliation(s)
- Jessica Jaiswal
- Department of Health Science, University of Alabama,Center for Health, Behavior and Prevention Studies, Rutgers University,Center for Drug Use and HIV/HCV Research, New York University,Center for Interdisciplinary Research on AIDS, Yale University
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9
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Abstract
Mistrust of medical advances and the medical professions continues to persist, and is perhaps increasing. The popular press has documented the growing number of parents globally whose concerns around childhood vaccination, albeit based on faulty scientific information, has led to the anti-vax movement which has already resulted in outbreaks of measles in various parts of the U.S. In recent years, the AIDS Healthcare Foundation has increased speculation and mistrust with regard to the denialism of the effectiveness of pre-exposure prophylaxis (PrEP) to avert HIV infections, again based on misinformation. However, in other cases, medical mistrust reflects the very real historical and ongoing injustices experienced by socially and economically marginalized groups. Whether the genesis of the mistrust is based on fact or fallacy, the results may be similar. There are myriad negative consequences associated with medical mistrust, including lower utilization of healthcare and poorer management of health conditions. Mistrust is thought to provide a partial explanation for staggering health disparities, particularly among Black and African American people, and much of the public health and medical literature cites the infamous Tuskegee Study as a main catalyst for this persistent health-related mistrust among people of color and other groups who experience social and economic vulnerability. While mistrust is often referred to as a phenomenon existing within an individual or community, we must rethink this conceptualization and instead locate mistrust as a phenomenon created by and existing within a system that creates, sustains and reinforces racism, classism, homophobia and transphobia, and stigma. The purpose of this article is to briefly address the state of the medical mistrust literature, and to provide a summary of the articles included in this special issue on medical mistrust. Although the scholarship in this issue addresses diverse methodologies, outcomes and populations, they share a message: social inequality drives mistrust.
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Affiliation(s)
- Jessica Jaiswal
- Department of Health Science, University of Alabama, Russell Hall, Box 870311, Tuscaloosa, AL 35487,Center for Health, Behavior, Identity and Prevention Studies, Rutgers University,Center for Interdisciplinary Research on AIDS, Yale University, 135 College St., Ste. 200, New Haven, CT 06510
| | - Perry N. Halkitis
- Center for Health, Behavior, Identity and Prevention Studies, Rutgers University,Department of Social and Behavioral Health Sciences, Rutgers University, 683 Hoes Lane West Piscataway, NJ 08854,Graduate School of Applied & Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Busch Campus, Piscataway, NJ 08854,Robert Wood Johnson School of Medicine, Rutgers University, 675 Hoes Ln W, Piscataway Township, NJ 08854,School of Public Policy and Administration, Rutgers University, 401 Cooper Street, Camden, NJ 08102
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