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Farr DE, Benefield T, Lee MH, Torres E, Henderson LM. Multilevel contributors to racial and ethnic inequities in the resolution of abnormal mammography results. Cancer Causes Control 2024; 35:995-1009. [PMID: 38478206 PMCID: PMC11216886 DOI: 10.1007/s10552-024-01851-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/08/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Multiple ecological levels influence racial inequities in the completion of diagnostic testing after receiving abnormal mammography results (diagnostic resolution). Yet, few studies examine more than two ecological levels. We investigated the contributions of county, imaging facility, and patient characteristics on our primary and secondary outcomes, the achievement of diagnostic resolution by (1)Black women and Latinas, and (2) the entire sample. We hypothesized that women of color would be less likely to achieve resolution than their White counterparts, and this relationship would be mediated by imaging facility features and moderated by county characteristics. METHODS Records for 25,144 women with abnormal mammograms between 2011 and 2019 from the Carolina Mammography Registry were merged with publicly available county data. Diagnostic resolution was operationalized as the percentage of women achieving resolution within 60 days of receiving abnormal results and overall time to resolution and examined using mixed effects logistic regression and Cox proportional hazard models, respectively. RESULTS Women of color with abnormal screening mammograms were less likely to achieve resolution within 60 days compared with White women (OR 0.83, CI 0.78-0.89; OR 0.74, CI.60-0.91, respectively) and displayed longer resolution times (HR 0.87, CI 0.84-0.91; HR 0.78, CI 0.68-0.89). Residential segregation had a moderating effect, with Black women in more segregated counties being less likely to achieve resolution by 60 days but lost statistical significance after adjustment. No mediators were discovered. CONCLUSION More work is needed to understand how imaging center and community characteristics impact racial inequities in resolution and resolution in general.
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Affiliation(s)
- Deeonna E Farr
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 2307 Carol G. Belk Building, Mail Stop 529, Greenville, NC, 27858, USA.
| | - Thad Benefield
- Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Mi Hwa Lee
- School of Social Work, College of Health and Human Performance, East Carolina University, Greenville, NC, 27858, USA
| | - Essie Torres
- Office of the Vice Chancellor for Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-4000, USA
| | - Louise M Henderson
- Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, USA
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Fink RM, Valenti KG, Kline DM, Fischer SM. Reality of Family Caregiving for Hispanics With Alzheimer's Disease and Related Dementias: A Qualitative Analysis. J Palliat Med 2023; 26:1618-1626. [PMID: 37311202 PMCID: PMC10714113 DOI: 10.1089/jpm.2023.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/15/2023] Open
Abstract
Background: Underserved Hispanic patients often experience unmet palliative care (PC) needs, particularly those with noncancer diagnoses such as Alzheimer's disease and related dementias. Most caregivers for Hispanic patients are family relatives who are less likely to use health care and community resources and experience high caregiver burden. We adapted a culturally tailored patient navigator (PN) intervention to provide support and improve PC outcomes for Hispanics with Alzheimer's disease and related dementias and their family caregivers (FCGs). Objectives: To explore Hispanic FCGs' experiences and perceptions of caregiving for a loved one, and how our PN intervention impacted their needs. Design: Qualitative descriptive. Setting/Subjects: FCG participants (n = 10) from our randomized control trial's intervention group were recruited from academic and safety net hospitals and community-based clinics across urban and rural Colorado in the United States. Measurements: Data obtained from individual, semistructured, 30-minute telephone interviews were recorded, transcribed, translated, and analyzed using NVivo and qualitative thematic analyses. Results: Four major themes emerged: Methods of Support, Cultural Expectations and Varying Family Contributions, Lack of Self-Care, and Awareness. Subthemes highlighted differing definitions of "contributing," role resentment, and interpersonal issues. Varying familial expectations underscore FCG strain when the burden of caregiving is not shared. Participants used various coping strategies as necessary support and gained awareness through education, guidance, and referrals to resources. Conclusions: PNs helped FCGs and patients beyond the intervention's scope. Providing support and awareness to FCGs, and incorporating cultural beliefs, may improve PC access to disparate populations and guide future interventions. Clinical Trial Registration Number NCT03181750.
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Affiliation(s)
- Regina M. Fink
- School of Medicine and College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Korijna G. Valenti
- School of Medicine and College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Danielle M. Kline
- School of Medicine and College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stacy M. Fischer
- School of Medicine and College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Maafs-Rodríguez A, Folta SC. Effectiveness of Theory-Based Physical Activity and Nutrition Interventions in Aging Latino Adults: A Scoping Review. Nutrients 2023; 15:2792. [PMID: 37375696 DOI: 10.3390/nu15122792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/04/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
In the United States (US), Latino individuals older than 50 years face health disparities compared to their White counterparts. Considering the rising life expectancy and the projected increase of older Latino adults in the US, this scoping review aimed to determine the effectiveness of theory-based and culturally relevant strategies that promote healthy aging in Latinos. Web of Science and PubMed databases were searched between December 2022 and February 2023 for peer-reviewed articles assessing healthy aging interventions tailored to community-dwelling aging Latino adults. We included nine studies describing the effects of seven interventions on physical activity- or nutrition-related outcomes. Although not always statistically significant, interventions had a beneficial impact on well-being indicators. The most commonly used behavioral theories were Social Cognitive Theory and Attribution Theory. Latino cultural elements in these studies included partnering with community organizations that serve Latinos (such as Catholic churches), delivery of in-person bilingual group sessions by trusted community members (such as promotoras or Latino dance instructors), and incorporating values such as family and religion into the health curriculum, among others. Future strategies that promote healthy aging in Latino adults should proactively culturally adapt the theoretical foundations and the design, recruitment, and implementation processes to ensure their relevance and effectiveness.
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Affiliation(s)
- Ana Maafs-Rodríguez
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Sara C Folta
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
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Moreno O, Garcia-Rodriguez I, Fuentes L, Hernandez C, Munoz G, Fluellen K, Hobgood S, Sargent L. Non-Latinx Healthcare Provider's Knowledge and Awareness of Latinx Geriatric Clinical Health Needs. Clin Gerontol 2023; 46:168-179. [PMID: 35482008 DOI: 10.1080/07317115.2022.2065943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Due to the exponential growth in the Latinx older adult population, culturally responsive services are needed, especially since most healthcare providers are non-Latinx with limited Spanish or bilingual skills. One place to start is by drawing a formative assessment of the healthcare providers' knowledge and awareness of the healthcare needs of Latinx older adults. METHODS Focus groups were conducted to explore the healthcare providers' knowledge and awareness of cultural and structural barriers and facilitators to accessing health care services for Latinx older adults. RESULTS Results note that healthcare providers perceived the healthcare needs for Latinx older adults to be underutilized for healthcare services, preventive interventions for healthy diet/lifestyle, and healthcare knowledge. Providers reported Latinx family over-involvement, religiosity, immigration, and language/lack of interpreters as barriers to seeking timely healthcare. Finally, healthcare providers said that family support, the location of healthcare services, and community-based partnerships were all facilitators for seeking healthcare. CONCLUSIONS Findings suggest providers' conflicting perspectives toward the Latinx communities. CLINICAL IMPLICATIONS Healthcare services can consider implementing trainings for non-Latinx providers to recognize conflicting perspectives and reduce implicit bias toward the Latinx communities.
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Affiliation(s)
- Oswaldo Moreno
- Psychology Department, La Esperanza Research, Virginia Commonwealth University, Richmond, Virginia, USA
- VCU Institute for Inclusion, Inquiry and Innovation (iCubed), Richmond, Virginia, USA
| | | | - Lisa Fuentes
- Psychology Department, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Cindy Hernandez
- Psychology Department, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Geovani Munoz
- Psychology Department, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kenya Fluellen
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sarah Hobgood
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lana Sargent
- VCU Institute for Inclusion, Inquiry and Innovation (iCubed), Richmond, Virginia, USA
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
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Angel JL, Rote S, Vega WA, Kim J, Chiu CT, Aranda M, Wang J. Duration of Dementia and Social Service Use in the U.S.-Born and Foreign-Born Mexican-American Population. J Aging Health 2022; 34:1291-1301. [DOI: 10.1177/08982643221125845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The study estimates the number of years after age 65 that Mexican Americans live with likely dementia and the impact of dementia on community-based services (CBS) use by nativity. Methods Using the Hispanic Established Populations for the Epidemiologic Studies of the Elderly Sullivan methods are employed to predict duration of dementia and logistic regressions identify the predictors of service utilization. Results Foreign-born women spend more years than other groups with dementia. The foreign-born are more likely to use out-of-home services, whereas U.S.-born are more likely to use in-home services. The foreign-born with dementia of relatively recent onset had the highest probability of service use. Discussion Given the high cost of institutional care and availability of family caregivers, community-based services are a potentially useful alternative for the growing Mexican-American population living with dementia. Expanded Medicaid and CBS programs could be an equitable and cost-effective alternative that should be investigated.
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Affiliation(s)
- Jacqueline L. Angel
- Lyndon B. Johnson School of Public Affairs, Center on Aging and Population Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Sunshine Rote
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | | | - Jiwon Kim
- Lyndon B. Johnson School of Public Affairs, Center on Aging and Population Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Chi-Tsun Chiu
- Institute of European and American Studies, Academia Sinica, Taipei, Taiwan
| | - Maria Aranda
- USC Suzanne Dworak-Peck School of Social Work, USC Edward R. Roybal Institute on Aging, Los Angeles, CA, USA
| | - Juwen Wang
- Institute of European and American Studies, Academia Sinica, Taipei, Taiwan
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Tucker-Seeley RD, Wallington SF, Canin B, Tang W, McKoy JM. Health Equity for Older Adults With Cancer. J Clin Oncol 2021; 39:2205-2216. [PMID: 34043411 DOI: 10.1200/jco.21.00207] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Reginald D Tucker-Seeley
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA.,USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Sherrie F Wallington
- The George Washington University School of Nursing & Milken Institute School of Public Health, Washington, DC
| | - Beverly Canin
- Cancer and Aging Research Group, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Weizhou Tang
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
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Larson KL, Mathews HF, Moye JP, Congema MR, Hoffman SJ, Murrieta KM, Johnson LA. Four Kinds of Hard: An Understanding of Cancer and Death among Latino Community Leaders. Glob Qual Nurs Res 2021; 8:23333936211003557. [PMID: 33816705 PMCID: PMC7992742 DOI: 10.1177/23333936211003557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/17/2022] Open
Abstract
Early integration of palliative care after a diagnosis of cancer improves outcomes, yet such care for Latino populations is lacking in rural regions of the United States. We used a participatory action research design with Latino community leaders from emerging immigrant communities in North Carolina to explore sociocultural perspectives on cancer and death. Thematic analysis was conceptualized as Four Kinds of Hard represented by four themes: Receiving an Eviction Notice, Getting in the Good Book, Talking is (Sometimes) Taboo, and Seeing Their Pain Makes us Suffer. These themes captured fears of deportation, coping with cancer through faithfulness, ambivalence about advance care planning, and a desire to spare families from suffering. Findings suggest strategies to improve conversations about end-of-life wishes when facing advanced illness and death. This study demonstrates the importance of training Latino community leaders to improve palliative care and bridge service gaps for Latino families living in emerging rural communities.
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Flores Morales J. Aging and undocumented: The sociology of aging meets immigration status. SOCIOLOGY COMPASS 2021; 15:e12859. [PMID: 33868455 PMCID: PMC8047879 DOI: 10.1111/soc4.12859] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/10/2021] [Accepted: 01/14/2021] [Indexed: 05/22/2023]
Abstract
Being undocumented is strongly correlated with low wages, employment in high risk occupations, and poor healthcare access. We know surprisingly little about the social lives of older undocumented adults despite the vast literature about youth and young undocumented migrants. Literature about the immigrant health paradox casts doubts on the argument that unequal social conditions translate to poorer self-reported health and mortality, but few of these studies consider immigration status as the dynamic variable that it is. Reviewing research about older migrants and minorities, I point to the emergence of undocumented older persons as a demographic group that merits attention from researchers and policymakers. This nexus offers important lessons for understanding stratification and inequality. This review offers new research directions that take into account multilevel consequences of growing old undocumented. Rather than arguing that older-aged undocumented migrants are aging into exclusion, I argue that we need careful empirical research to examine how the continuity of exclusion via policies can magnify inequalities on the basis of immigration status and racialization in older age.
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Affiliation(s)
- Josefina Flores Morales
- California Center for Population ResearchUniversity of California Los Angeles‐SociologyLos AngelesCaliforniaUSA
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9
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Markey K, O' Brien B, O' Donnell C, Martin C, Murphy J. Enhancing undergraduate nursing curricula to cultivate person-centred care for culturally and linguistically diverse older people. Nurse Educ Pract 2020; 50:102936. [PMID: 33276299 DOI: 10.1016/j.nepr.2020.102936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 09/09/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022]
Abstract
With an ageing global community and widening socio-cultural diversity, nurse educators are increasingly challenged to align responsive undergraduate nursing curricula to rapidly changing healthcare environments. In future-proofing nurse education, educators need to collectively examine ways of interconnecting and developing gerontological and cultural competence within undergraduate curricula. However, there is limited guidance as to how this can be achieved in already compacted curricula. We suggest that this could be achieved by critically examining undergraduate curricula to make explicit how they can be adapted to educate nurses in the provision of culturally competent person-centred care. This approach could help nurse educators adapt student nurse preparation to meet the needs of culturally diverse older people and their families.
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Affiliation(s)
- Kathleen Markey
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland.
| | - Brid O' Brien
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland.
| | - Claire O' Donnell
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland.
| | - Catherine Martin
- School of Modern Languages & Applied Linguistics, University of Limerick, Ireland.
| | - Jill Murphy
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland.
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Balakrishnan A, Jordan N. The Undocumented Elderly: Coverage Gaps and Low Health Care Use. J Health Care Poor Underserved 2020; 30:891-898. [PMID: 31422977 DOI: 10.1353/hpu.2019.0062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Near-elderly and elderly undocumented immigrants constitute a growing subpopulation in the U.S. with potentially high rates of preventable chronic conditions, but limited access to insurance coverage and low use of care. Associated impacts on health outcomes, safety-net resources, and health care costs are potentially significant. More research is needed to better understand the prevalence of avoidable conditions and the barriers to seeking care among the undocumented elderly.
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11
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Latinx Undocumented Older Adults, Health Needs and Access to Healthcare. J Immigr Minor Health 2020; 22:996-1009. [DOI: 10.1007/s10903-019-00966-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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