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Jones SC, Schlundt D, Williams N, Smalls M, Idrizi K, Alexander L, Anthony M, Selove R. Challenges in Disseminating Evidence-Based Health Promotion Programs in Faith Community Settings: What We Need to Include. Health Promot Pract 2024:15248399241259688. [PMID: 39066625 DOI: 10.1177/15248399241259688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Effective dissemination of information about evidence-based programs (EBPs) is essential for promoting health equity. Faith-based and other community organizations have difficulty locating EBPs for implementation in their settings. A research team engaged in a systematic search to identify a menu of EBPs that could be offered to African American FBOs as part of a community-engaged implementation study. Methods. A four-stage process was developed to search for EBPs meeting seven inclusion criteria for dissemination in faith-based organizations (FBOs). Criteria included relevance to identified health disparity topics, endorsement on a federal website, free access to downloadable program materials, facilitator guidance, no requirements for health care providers, and culturally relevant materials for African American communities. RESULTS Nineteen government websites were searched. Sixty-six potential EBPs were identified. Six EBPs met all inclusion criteria. DISCUSSION The search for EBPs that met seven criteria for implementation in African American FBOs demonstrated challenges that have been described in the literature. Researchers encountered a lack of standardized terminology for identifying EBPs on federal websites, frequent requirement for health care providers or clinics and/or fees for training and materials. FBOs are supportive and safe places to offer EBPs to promote health, and EBPs need to be designed and disseminated to meet the needs and preferences of FBOs. Including members of FBOs and others in the community in EBP development, design, and dissemination, such as searchable health promotion EBP registries, can increase the likelihood that effective programs intended to address health disparities are readily accessible to FBOs for implementation.
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Affiliation(s)
| | | | - Neely Williams
- Tennessee Community Engaged Alliance, Nashville, TN, USA
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2
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Kruse-Diehr AJ, Cegelka D, Combs C, Wood R, Holtsclaw E, Stapleton JL, Williams LB. Using the consolidated framework for implementation research to identify church leaders' perspectives on contextual determinants of community-based colorectal cancer screening for Black Kentuckians. Implement Sci Commun 2024; 5:83. [PMID: 39054557 PMCID: PMC11271043 DOI: 10.1186/s43058-024-00621-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/14/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Black Kentuckians experience more deleterious colorectal cancer (CRC) outcomes than their White counterparts, a disparity that could be reduced by increased screening in Black communities. Previous research has shown that Black Kentuckians may not be equitably informed of different CRC screening options by health care providers, making community-based screening a potentially effective option among this disparate population. We used the Consolidated Framework for Implementation Research (CFIR) to identify church leaders' perspectives of contextual factors that might influence community-based screening and explore the feasibility of using church-based screening outreach. METHODS Six participants were selected, based on leadership roles and interest in CRC screening, from five established Louisville-area church partners that had previously participated in community health initiatives. Data were collected, both virtually and in-person, in Summer 2021 using semi-structured interview guides developed with guidance from the CFIR Guide that focused on domains most relevant to community-based interventions. Data were transcribed verbatim, coded by two independent researchers, and member checked for accuracy. RESULTS Data were aligned primarily with six CFIR constructs: key stakeholders, champions, opinion leaders, tension for change, compatibility, and culture. Participants noted a strong tension for change in their community due to perceptions of inadequacy with clinical approaches to CRC screening. Additionally, they stressed the importance of identifying individuals both within the church who could champion CRC screening and help implement program activities, as well as those outside the church who could collaborate with other local organizations to increase participant reach. Finally, participants agreed that faith-based CRC screening aligned with church culture and would also likely be compatible with overall community values. CONCLUSIONS Overall, our church partners strongly endorsed the need for, and importance of, community-based CRC screening. Given a history of successful implementation of health promotion programs within our partner churches, it is highly likely that a CRC screening intervention would also be effective. Findings from this study will be used to identify implementation strategies that might positively impact a future faith-based CRC screening intervention, as well as CFIR constructs that are most positively associated with CRC screening completion.
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Affiliation(s)
- Aaron J Kruse-Diehr
- University of Kentucky College of Medicine, Lexington, KY, USA.
- University of Kentucky Markey Cancer Center, Lexington, KY, USA.
- Center for Implementation, Dissemination & Evidence-based Research, University of Kentucky, Lexington, KY, USA.
| | - Derek Cegelka
- Hawai'i Pacific University College of Nursing, Honolulu, Hawai'i, USA
| | - Carlee Combs
- University of Kentucky College of Public Health, Lexington, KY, USA
| | - Rose Wood
- University of Kentucky College of Public Health, Lexington, KY, USA
| | | | - Jerod L Stapleton
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
- University of Kentucky College of Public Health, Lexington, KY, USA
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3
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King LM, Barnett TE, Allen AC, Maizel JL, Wilson RE. Tobacco-related health inequalities among Black Americans: A narrative review of structural and historical influences. J Ethn Subst Abuse 2024; 23:381-411. [PMID: 35839212 DOI: 10.1080/15332640.2022.2093812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We conducted a narrative literature review to examine contributing factors of disparities in tobacco usage and outcomes affecting Black Americans. We propose potential solutions that can be used to effectively address these disparities. We identified historical factors; socioeconomic factors; targeted marketing/advertising; the influence of racism/discrimination; neighborhood socioeconomic disadvantage; and mass incarceration. We call for more thorough examinations of these factors as a key element of tobacco-focused research and interventions to eliminate the disproportionate burdens faced by Black Americans. We advocate for greater emphases on the impacts of personal and structural racism on tobacco usage and outcomes affecting Black Americans.
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Affiliation(s)
| | - Tracey E Barnett
- University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas
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4
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Gwathmey TM, Williams KL, Caban-Holt A, Starks TD, Foy CG, Mathews A, Byrd GS. Building a Community Partnership for the Development of Health Ministries Within the African American Community: The Triad Pastors Network. J Community Health 2024; 49:559-567. [PMID: 38265538 PMCID: PMC10981582 DOI: 10.1007/s10900-023-01315-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 01/25/2024]
Abstract
African Americans continue to have worse health outcomes despite attempts to reduce health disparities. This is due, in part, to inadequate access to healthcare, but also to the health care and medical mistrust experienced by communities of color. Churches and worship centers have historically served as cultural centers of trusted resources for educational, financial, and health information within African American communities and a growing number of collaborations have developed between academic institutions and community/faith entities. Herein, we describe the infrastructure of a true and sustainable partnership developed with > 100 prominent faith leaders within the Piedmont Triad region of North Carolina for the purpose of developing or expanding existing health ministries within houses of worship, to improve health literacy and overall health long-term. The Triad Pastors Network is an asset-based partnership between the Maya Angelou Center for Health Equity at Wake Forest University School of Medicine and faith leaders in the Piedmont Triad region of North Carolina that was created under the guiding principles of community engagement to improve health equity and decrease health disparities experienced by African American communities. A partnership in which co-equality and shared governance are the core of the framework provides an effective means of achieving health-related goals in a productive and efficient manner. Faith-based partnerships are reliable approaches for improving the health literacy needed to address health disparities and inequities in communities of color.
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Affiliation(s)
- TanYa M Gwathmey
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
- Hypertension and Vascular Research Center, Department of Surgery, Wake Forest University School of Medicine, Biotech Place - 575 N. Patterson Avenue, Suite #340, Winston-Salem, NC, 27101, USA.
| | - K Lamonte Williams
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Allison Caban-Holt
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Takiyah D Starks
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Capri G Foy
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Allison Mathews
- COMPASS Initiative Faith Coordinating Center, Wake Forest University School of Divinity, Winston-Salem, NC, USA
| | - Goldie S Byrd
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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5
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Dhingra LS, Aminorroaya A, Camargos AP, Khunte A, Sangha V, McIntyre D, Chow CK, Asselbergs FW, Brant LC, Barreto SM, Ribeiro ALP, Krumholz HM, Oikonomou EK, Khera R. Using Artificial Intelligence to Predict Heart Failure Risk from Single-lead Electrocardiographic Signals: A Multinational Assessment. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.27.24307952. [PMID: 38854022 PMCID: PMC11160804 DOI: 10.1101/2024.05.27.24307952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Importance Despite the availability of disease-modifying therapies, scalable strategies for heart failure (HF) risk stratification remain elusive. Portable devices capable of recording single-lead electrocardiograms (ECGs) can enable large-scale community-based risk assessment. Objective To evaluate an artificial intelligence (AI) algorithm to predict HF risk from noisy single-lead ECGs. Design Multicohort study. Setting Retrospective cohort of individuals with outpatient ECGs in the integrated Yale New Haven Health System (YNHHS) and prospective population-based cohorts of UK Biobank (UKB) and Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Participants Individuals without HF at baseline. Exposures AI-ECG-defined risk of left ventricular systolic dysfunction (LVSD). Main Outcomes and Measures Among individuals with ECGs, we isolated lead I ECGs and deployed a noise-adapted AI-ECG model trained to identify LVSD. We evaluated the association of the model probability with new-onset HF, defined as the first HF hospitalization. We compared the discrimination of AI-ECG against the pooled cohort equations to prevent HF (PCP-HF) score for new-onset HF using Harrel's C-statistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Results There were 194,340 YNHHS patients (age 56 years [IQR, 41-69], 112,082 women [58%]), 42,741 UKB participants (65 years [59-71], 21,795 women [52%]), and 13,454 ELSA-Brasil participants (56 years [41-69], 7,348 women [55%]) with baseline ECGs. A total of 3,929 developed HF in YNHHS over 4.5 years (2.6-6.6), 46 in UKB over 3.1 years (2.1-4.5), and 31 in ELSA-Brasil over 4.2 years (3.7-4.5). A positive AI-ECG screen was associated with a 3- to 7-fold higher risk for HF, and each 0.1 increment in the model probability portended a 27-65% higher hazard across cohorts, independent of age, sex, comorbidities, and competing risk of death. AI-ECG's discrimination for new-onset HF was 0.725 in YNHHS, 0.792 in UKB, and 0.833 in ELSA-Brasil. Across cohorts, incorporating AI-ECG predictions in addition to PCP-HF resulted in improved Harrel's C-statistic (Δ=0.112-0.114), with an IDI of 0.078-0.238 and an NRI of 20.1%-48.8% for AI-ECG vs. PCP-HF. Conclusions and Relevance Across multinational cohorts, a noise-adapted AI model with lead I ECGs as the sole input defined HF risk, representing a scalable portable and wearable device-based HF risk-stratification strategy.
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Affiliation(s)
- Lovedeep S Dhingra
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Arya Aminorroaya
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Aline Pedroso Camargos
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Akshay Khunte
- Department of Computer Science, Yale University, New Haven, CT, USA
| | - Veer Sangha
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Daniel McIntyre
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Folkert W Asselbergs
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
- Institute of Health Informatics, University College London, London, UK
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, UK
| | - Luisa Cc Brant
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center and Cardiology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sandhi M Barreto
- Department of Preventive Medicine, School of Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antonio Luiz P Ribeiro
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center and Cardiology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Evangelos K Oikonomou
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, CT, USA
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, USA
- Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
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Kwarteng JL, White K, Nevels D, Brown S, Stolley MR. Equipping Faith-Based Communities for Cancer Support Ministry: A Pilot Study of Cancer Support Training for Members of African-American Churches in the USA. JOURNAL OF RELIGION AND HEALTH 2024; 63:1523-1537. [PMID: 38453721 DOI: 10.1007/s10943-024-02013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/09/2024]
Abstract
Church-academic partnerships focused on cancer, generally target cancer screening and prevention, with few focusing explicitly on cancer survivors. With the population of cancer survivors steadily increasing, highlighting the value of faith-based cancer support ministry is paramount. However, many churches may not have the resources to integrate relevant cancer support ministry and may need to identify ways to reach cancer survivors. We piloted cancer support training to help church members to start a cancer support ministry with African-American churches in Milwaukee, WI. We sought to measure the feasibility of a two-day training workshop to build the capacity of churches through recruiting and training church members on how to foster social support and to disseminate cancer information and resources throughout their churches. Our study was guided by the social networks and social support framework, which we applied to cancer survivorship. Our study supports the feasibility of engaging churches in a virtual training to support the development of cancer support ministries to address the needs of African-American cancer survivors. Based on our recruitment success, workshop attendance, evaluation and retention, our results suggest that a two-day workshop was successful in facilitating the initiation of cancer support ministries within African-American churches.
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Affiliation(s)
- Jamila L Kwarteng
- Division of Community Health, Institute for Health and Equity, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
- Cancer Center, Medical College of Wisconsin, Milwaukee, USA.
| | - Karen White
- Breast Cancer Support Ministry, United4theCause, San Bernardino, USA
| | - Debra Nevels
- Cancer Center, Medical College of Wisconsin, Milwaukee, USA
| | - Sharon Brown
- Cancer Center, Medical College of Wisconsin, Milwaukee, USA
| | - Melinda R Stolley
- Cancer Center, Medical College of Wisconsin, Milwaukee, USA
- Department of Medicine, Division of Hematology and Oncology, Milwaukee, USA
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7
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Jacobs J, Walsh JL, Valencia J, DiFranceisco W, Hirschtick JL, Hunt BR, Quinn KG, Benjamins MR. Associations Between Religiosity and Medical Mistrust: An Age-Stratified Analysis of Survey Data from Black Adults in Chicago. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01979-1. [PMID: 38514511 DOI: 10.1007/s40615-024-01979-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
Medical mistrust is associated with poor health outcomes, ineffective disease management, lower utilization of preventive care, and lack of engagement in research. Mistrust of healthcare systems, providers, and institutions may be driven by previous negative experiences and discrimination, especially among communities of color, but religiosity may also influence the degree to which individuals develop trust with the healthcare system. The Black community has a particularly deep history of strong religious communities, and has been shown to have a stronger relationship with religion than any other racial or ethnic group. In order to address poor health outcomes in communities of color, it is important to understand the drivers of medical mistrust, which may include one's sense of religiosity. The current study used data from a cross-sectional survey of 537 Black individuals living in Chicago to understand the relationship between religiosity and medical mistrust, and how this differs by age group. Descriptive statistics were used to summarize data for our sample. Adjusted stratified linear regressions, including an interaction variable for age group and religiosity, were used to model the association between religiosity and medical mistrust for younger and older people. The results show a statistically significant relationship for younger individuals. Our findings provide evidence for the central role the faith-based community may play in shaping young peoples' perceptions of medical institutions.
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Affiliation(s)
- Jacquelyn Jacobs
- Sinai Urban Health Institute, Sinai Health System, 1500 S. Fairfield Ave, Chicago, IL, 60608, USA.
| | - Jennifer L Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jesus Valencia
- Sinai Urban Health Institute, Sinai Health System, 1500 S. Fairfield Ave, Chicago, IL, 60608, USA
| | - Wayne DiFranceisco
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jana L Hirschtick
- Advocate Aurora Research Institute, Advocate Health Center, Chicago, IL, USA
| | - Bijou R Hunt
- Sinai Infectious Disease Center, Sinai Health System, Chicago, IL, USA
| | - Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Maureen R Benjamins
- Sinai Urban Health Institute, Sinai Health System, 1500 S. Fairfield Ave, Chicago, IL, 60608, USA
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8
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Singh H, Fulton J, Mirzazada S, Saragosa M, Uleryk EM, Nelson MLA. Community-Based Culturally Tailored Education Programs for Black Communities with Cardiovascular Disease, Diabetes, Hypertension, and Stroke: Systematic Review Findings. J Racial Ethn Health Disparities 2023; 10:2986-3006. [PMID: 36508135 PMCID: PMC10645635 DOI: 10.1007/s40615-022-01474-5] [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: 09/28/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Community-based culturally tailored education (CBCTE) programs for chronic diseases may reduce health disparities; however, a synthesis across chronic diseases is lacking. We explored (1) the characteristics and outcomes of CBCTE programs and (2) which strategies for culturally appropriate interventions have been used in CBCTE programs, and how they have been implemented. METHODS A systematic review was conducted by searching three databases to identify empirical full-text literature on CBCTE programs for Black communities with cardiovascular disease, hypertension, diabetes, or stroke. Studies were screened in duplicate, then data regarding study characteristics, participants, intervention, and outcomes were extracted and analyzed. Cultural tailoring strategies within programs were categorized using Kreuter and colleagues' framework. RESULTS Of the 74 studies, most were conducted in the USA (97%) and delivered in one site (53%; e.g., church/home). CBCTE programs targeted diabetes (65%), hypertension (30%), diabetes and hypertension (1%), cardiovascular disease (3%), and stroke (1%). Reported program benefits included physiological, medication-related, physical activity, and literacy. Cultural tailoring strategies included peripheral (targeted Black communities), constituent-involving (e.g., community informed), evidential (e.g., integrated community resources), linguistic (e.g., delivered in community's dialect/accent), and sociocultural (e.g., integrated community members' religious practices). CONCLUSIONS CBCTE programs may have beneficial outcomes, but a small sample size limited several. The strategies identified can be adopted by programs seeking to culturally tailor. Future interventions should clearly describe community members' roles/involvement and deliver programs in multiple locations to broaden reach. TRIAL REGISTRATION PROSPERO CRD42021245772.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada.
- KITE, Toronto Rehabilitation Institute, University Health Network, 520 Sutherland Drive, Toronto, ON, Canada.
- Temerty Faculty of Medicine, Rehabilitation Science Institute, University of Toronto, 500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada.
| | - Joseph Fulton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- March of Dimes Canada, 10 Overlea Blvd, Toronto, ON, Canada
| | - Sofia Mirzazada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada
| | - Marianne Saragosa
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, ON, Canada
| | | | - Michelle L A Nelson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- March of Dimes Canada, 10 Overlea Blvd, Toronto, ON, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, ON, Canada
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9
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Gamble C, Woodard TJ, Yakubu AI, Chapman-Davis E. An Intervention-Based Approach to Achieve Racial Equity in Gynecologic Oncology. Obstet Gynecol 2023; 142:957-966. [PMID: 37678907 PMCID: PMC10510810 DOI: 10.1097/aog.0000000000005348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 09/09/2023]
Abstract
Racial inequities within gynecologic oncology exist at every step of the cancer continuum. Although the disparities have been well described, there is a significant gap in the literature focused on eliminating inequities in gynecologic cancer outcomes. The goal of this narrative review is to highlight successful, evidence-based interventions from within and outside of gynecologic oncology that alleviate disparity, providing a call to action for further research and implementation efforts within the field. These solutions are organized in the socioecologic framework, where multiple levels of influence-societal, community, organizational, interpersonal, and individual-affect health outcomes.
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Affiliation(s)
- Charlotte Gamble
- Division of Gynecologic Oncology, MedStar Washington Hospital Center, and Georgetown University, Washington, DC; the Division of Gynecologic Oncology, Washington University School of Medicine in St. Louis, St. Louis, Missouri; the Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia; and the Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
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10
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Brockhoven F, Raphael M, Currier J, Jäderholm C, Mody P, Shannon J, Starling B, Turner-Uaandja H, Pashayan N, Arteaga I. REPRESENT recommendations: improving inclusion and trust in cancer early detection research. Br J Cancer 2023; 129:1195-1208. [PMID: 37689805 PMCID: PMC10575902 DOI: 10.1038/s41416-023-02414-8] [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: 01/20/2023] [Revised: 08/01/2023] [Accepted: 08/21/2023] [Indexed: 09/11/2023] Open
Abstract
Detecting cancer early is essential to improving cancer outcomes. Minoritized groups remain underrepresented in early detection cancer research, which means that findings and interventions are not generalisable across the population, thus exacerbating disparities in cancer outcomes. In light of these challenges, this paper sets out twelve recommendations to build relations of trust and include minoritized groups in ED cancer research. The Recommendations were formulated by a range of stakeholders at the 2022 REPRESENT consensus-building workshop and are based on empirical data, including a systematic literature review and two ethnographic case studies in the US and the UK. The recommendations focus on: Long-term relationships that build trust; Sharing available resources; Inclusive and accessible communication; Harnessing community expertise; Unique risks and benefits; Compensation and support; Representative samples; Demographic data; Post-research support; Sharing results; Research training; Diversifying research teams. For each recommendation, the paper outlines the rationale, specifications for how different stakeholders may implement it, and advice for best practices. Instead of isolated recruitment, public involvement and engagement activities, the recommendations here aim to advance mutually beneficial and trusting relationships between researchers and research participants embedded in ED cancer research institutions.
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Grants
- EICEDAAP\100011 Cancer Research UK
- Cancer Research UK (CRUK)
- The International Alliance for Cancer Early Detection, an alliance between Cancer Research UK [EICEDAAP\100011], Canary Center at Stanford University, the University of Cambridge, OHSU Knight Cancer Institute, University College London and the University of Manchester.
- This work was supported by the International Alliance for Cancer Early Detection, an alliance between Cancer Research UK [EICEDAAP\100011], Canary Center at Stanford University, the University of Cambridge, OHSU Knight Cancer Institute, University College London and the University of Manchester.
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Affiliation(s)
| | - Maya Raphael
- Department of Social Anthropology, University of Cambridge, Cambridge, UK
| | - Jessica Currier
- Division of Oncological Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Christina Jäderholm
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Perveez Mody
- Department of Social Anthropology, University of Cambridge, Cambridge, UK
| | - Jackilen Shannon
- Division of Oncological Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Bella Starling
- Vocal, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Nora Pashayan
- Department of Applied Health Research, University College London, London, UK
| | - Ignacia Arteaga
- Department of Social Anthropology, University of Cambridge, Cambridge, UK.
- Early Cancer Institute, University of Cambridge, Cambridge, UK.
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Bridi L, Kaki DA, Albahsahli B, Abu Baker D, Khan X, Aljenabi R, Bencheikh N, Schiaffino MK, Moore AA, Al-Rousan T. The influences of faith on illness representations and coping procedures of mental and cognitive health among aging Arab refugees: a qualitative study. Front Psychiatry 2023; 14:1083367. [PMID: 37223492 PMCID: PMC10200919 DOI: 10.3389/fpsyt.2023.1083367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/27/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Refugees experience higher rates of mental illness such as depression and post-traumatic stress disorder (PTSD) which are documented risk factors for dementia. Faith and spiritual practices have been shown to play a significant role in patients' understanding and coping with illness, however, this field of study among refugee populations remains lacking. This study aims to address this literature gap by examining the role of faith on mental health and cognitive health among Arab refugees resettled in Arab and Western countries. Materials and methods A total of 61 Arab refugees were recruited through ethnic community-based organizations in San Diego, California, United States (N = 29) and Amman, Jordan (N = 32). Participants were interviewed through in-depth, semi-structured interviews or focus groups. Interviews and focus groups were transcribed, translated, and coded using inductive thematic analysis and organized based on Leventhal's Self-Regulation Model. Results Faith and spiritual practices significantly impact participants' illness perceptions and coping procedures regardless of resettlement country or gender. Several themes emerged: (1) participants believe in the interdependent relationship between mental and cognitive health. (2) There is a self-awareness of the impact of the refugee experience and trauma on participants' mental health problems, leading to a belief of increased personal risk for developing dementia. (3) Spiritual fatalism (belief that events are predetermined by God, fate, or destiny) greatly informs these perceptions of mental and cognitive health. (4) Participants acknowledge that practicing faith improves their mental and cognitive health, and many read scripture to prevent dementia. (5) Finally, spiritual gratitude and trust are important coping procedures that build resilience among participants. Conclusions Faith and spirituality play an important role in shaping Arab refugees' illness representations and coping procedures of mental and cognitive health. Holistic public health and clinical interventions tailored to the spiritual needs of aging refugees and incorporating religion in prevention strategies are increasingly needed to improve the brain health and wellbeing of refugees.
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Affiliation(s)
- Lana Bridi
- School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Dahlia A. Kaki
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
| | - Behnan Albahsahli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
| | - Dania Abu Baker
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
- School of Social Work, San Diego State University, San Diego, CA, United States
| | - Xara Khan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
- School of Social Sciences, University of California, San Diego, San Diego, CA, United States
| | - Raghad Aljenabi
- School of Social Sciences, University of California, San Diego, San Diego, CA, United States
| | - Nissma Bencheikh
- School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Melody K. Schiaffino
- School of Public Health, San Diego State University, San Diego, CA, United States
- Center for Health Equity, Education, and Research, UCSD Moores Cancer Center, San Diego, CA, United States
| | - Alison A. Moore
- School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
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12
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Riggan KA, Rousseau A, Halyard M, James SE, Kelly M, Phillips D, Allyse MA. "There's not enough studies": Views of black breast and ovarian cancer patients on research participation. Cancer Med 2023; 12:8767-8776. [PMID: 36647342 PMCID: PMC10134334 DOI: 10.1002/cam4.5622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Black breast and ovarian cancer patients are underrepresented in clinical cancer trials disproportionate to the prevalence of these cancers in Black females. Historically, lower enrollment has been attributed to individualized factors, including medical mistrust, but more recently structural factors, including systemic racism, have received additional scrutiny. We interviewed Black women with a personal or family history of breast and ovarian cancer to understand their views and experiences related to research participation. METHODS Qualitative interviews were conducted via telephone or video conference and transcribed verbatim. Transcripts were qualitatively analyzed for iterative themes related to the offer and participation in cancer clinical trials and research studies, impact on cancer care, and recommendations to increase enrollment of Black patients. RESULTS Sixty-one Black women completed an interview. Participants expressed that Black women are underrepresented in cancer research, and that this negatively impacted their own care. Many cited past historical abuses, including the Tuskegee syphilis trial, as a potential factor for lower enrollment but suggested that lower enrollment was better understood in the context of the entirety of their healthcare experiences, including present-day examples of patient mistreatment or dismissal. Participants suggested that proactive community engagement, transparency, and increased representation of Black research team members were strategies likely to foster trust and bolster research participation. CONCLUSION(S) Medical mistrust is only a partial factor in the lower participation of Black patients in cancer research. Researchers should implement the strategies identified by our participants to promote diverse enrollment and ensure that Black patients are included in future therapeutic advances.
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Affiliation(s)
| | - Abigail Rousseau
- Biomedical Ethics Research ProgramMayo ClinicRochesterMinnesotaUSA
| | - Michele Halyard
- Department of Radiation OncologyMayo ClinicPhoenixArizonaUSA
- Coalition of Blacks Against Breast CancerPhoenixArizonaUSA
- ADVANCE Community Advisory BoardPhoenixArizonaUSA
| | - Sarah E. James
- Department of Radiation OncologyMayo ClinicPhoenixArizonaUSA
- Coalition of Blacks Against Breast CancerPhoenixArizonaUSA
| | - Marion Kelly
- Coalition of Blacks Against Breast CancerPhoenixArizonaUSA
- ADVANCE Community Advisory BoardPhoenixArizonaUSA
- Department of Community EngagementMayo ClinicScottsdaleArizonaUSA
| | - Daphne Phillips
- ADVANCE Community Advisory BoardPhoenixArizonaUSA
- Department of Speech PathologyMayo ClinicPhoenixArizonaUSA
| | - Megan A. Allyse
- Biomedical Ethics Research ProgramMayo ClinicRochesterMinnesotaUSA
- Department of Obstetrics & GynecologyMayo ClinicRochesterMinnesotaUSA
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13
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Bergin RJ, Short CE, Davis N, Marker J, Dawson MT, Milton S, McNamara M, Druce P, Milley K, Karnchanachari N, Skaczkowski G. The nature and impact of patient and public involvement in cancer prevention, screening and early detection research: A systematic review. Prev Med 2023; 167:107412. [PMID: 36592674 DOI: 10.1016/j.ypmed.2022.107412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/23/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
Patient and public involvement can produce high-quality, relevant research that better addresses the needs of patients and their families. This systematic review investigated the nature and impact of patient and public involvement in cancer prevention, screening and early detection research. Two patient representatives were involved as members of the review team. Databases (Medline, EMBASE, Emcare, Involve Evidence Library) were searched for English-language studies published 1995-March 2022. Titles/abstracts were screened by two reviewers independently. For eligible studies, data were extracted on study characteristics, patient and public involvement (who, when, how, and impact on research outcomes), and reporting quality using the Guidance for Reporting Involvement of Patients and the Public 2-Short Form. Of 4095 articles screened, 58 were eligible. Most research was from the United States (81%) and examined cancer screening or prevention (82%). Community members/organisations/public were the most involved (71%); fewer studies involved patients and/or carers (14%). Over half reported a high-level of involvement (i.e. partner and/or expert involvement), although this declined in later stages of the research cycle, e.g. data analysis. Common positive impacts included improved study design, research methods and recruitment, although most papers (62%) did not describe methods to determine impact. Reporting quality was sub-optimal, largely due to failure to consider challenges. This review found that high-level involvement of patients and the public in cancer prevention, screening and early detection research is feasible and has several advantages. However, improvements are needed to encourage involvement across the research cycle, and in evaluating and reporting its impact.
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Affiliation(s)
- Rebecca J Bergin
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia; Department of General Practice/Centre for Cancer Research, University of Melbourne, Melbourne, Australia.
| | - Camille E Short
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences and Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Nikki Davis
- Patient representative, Primary Care Collaborative Cancer Clinical Trials Group (PC4) Community Advisory Group, Melbourne, Australia
| | - Julie Marker
- Patient representative, Primary Care Collaborative Cancer Clinical Trials Group (PC4) Community Advisory Group, Melbourne, Australia; Patient representative, Cancer Voices South Australia, Adelaide, Australia
| | | | - Shakira Milton
- Department of General Practice/Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Mairead McNamara
- Department of General Practice/Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Paige Druce
- Department of General Practice/Centre for Cancer Research, University of Melbourne, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Kristi Milley
- Department of General Practice/Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Napin Karnchanachari
- Department of General Practice/Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Gemma Skaczkowski
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia; School of Psychology & Public Health, La Trobe University, Melbourne, Australia
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14
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Cénat JM, Dromer É, Darius WP, Dalexis RD, Furyk SE, Poisson H, Mansoub Bekarkhanechi F, Shah M, Diao DG, Gedeon AP, Lebel S, Labelle PR. Incidence, factors, and disparities related to cancer among Black individuals in Canada: A scoping review. Cancer 2023; 129:335-355. [PMID: 36436148 DOI: 10.1002/cncr.34551] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Canada, two of five individuals will be diagnosed with cancer in their lifetime and one in four will die from this disease. Given the disparities observed in health research among Black individuals, we conducted a scoping review to analyze the state of cancer research in Canadian Black communities regarding prevalence, incidence, screening, mortality, and related factors to observe advances and identify gaps and disparities. METHODS A comprehensive search strategy was developed and executed in December 2021 across 10 databases (e.g., Embase). Of 3451 studies generated by the search, 19 were retained for extraction and included in this study. RESULTS Studies were focused on a variety of cancer types among Black individuals including anal, breast, cervical, colorectal, gastric, lung, and prostate cancers. They included data on incidence, stage of cancer at diagnosis, type of care received, diagnostic interval length, and screening. A few studies also demonstrated racial disparities among Black individuals. This research reveals disparities in screening, incidence, and quality of care among Black individuals in Canada. CONCLUSIONS Given the gaps observed in cancer studies among Black individuals, federal and provincial governments and universities should consider creating special funds to generate research on this important health issue. PLAIN LANGUAGE SUMMARY Important gaps were observed on research on cancer among Black communities in Canada. Studies included in the scoping review highlights disparities in screening, incidence, and quality of care among Black individuals in Canada.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.,Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada.,University of Ottawa Research Chair on Black Health, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Élisabeth Dromer
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Wina Paul Darius
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Hannah Poisson
- Faculty of Science, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Muhammad Shah
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Guangyu Diao
- Faculty of Arts and Science, McGill University, Montreal, Quebec, Canada
| | | | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
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15
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Taffere GR, Abebe HT, Zerihun Z, Mallen C, Price HP, Mulugeta A. Systematic review of community engagement approach in research: describing partnership approaches, challenges and benefits. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-022-01799-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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16
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Carter BJ, Chen TA, Cho D, Connors SK, Siddiqi AD, McNeill LH, Reitzel LR. Examining Associations between Source of Cancer Information and Mammography Behavior among Black Church-Going Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13004. [PMID: 36293643 PMCID: PMC9602462 DOI: 10.3390/ijerph192013004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Black women have a slightly lower breast cancer incidence rate than White women, but breast cancer mortality is approximately 40% higher among Black women than among White women. Early detection by mammography may improve survival outcomes. Outlets providing information on cancer and cancer screening often present data, including mammography recommendations, that are unreliable, accessible, and/or inconsistent. We examined associations between sources of cancer information and mammography behavior among Black church-going women. A logistic regression model was used to examine associations between self-reported preferred source of cancer information (provider, cancer organization, social network, internet, or other media (e.g., books, magazines)) and self-reported most recent source of cancer information (same categories as preferred sources), respectively, and having received a mammogram within the prior 12 months. Participants were 832 Black women over 40 years old, recruited from three churches in Houston, Texas. Data were collected in 2012. Overall, 55.41% of participants indicated their preferred source of cancer information was a provider, 21.88% the internet, 11.54% other media, 10.22% a cancer organization, and 0.96% their social network. In contrast, 17.88% of participants indicated their most recent source of cancer information was a provider, 63.02% the internet, 12.04% other media, 4.50% a cancer organization, and 2.55% their social network. About 70% of participants indicated receiving a mammogram in the prior 12 months. Results indicated that women who most recently sought information from the internet had lower odds of having a mammogram than those who most recently sought information from a provider (aOR: 0.546, CI95%: 0.336-0.886, p = 0.014). These results reveal an opportunity to advance health equity by encouraging Black church-going women to obtain cancer information from providers rather than from the internet as a method to enhance mammography use. These results also reveal an opportunity to investigate what modifiable social determinants or other factors prevent Black church-going women from seeking cancer information from their preferred source, which was a provider for the majority of the sample, and designing interventions to better actualize this preference.
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Affiliation(s)
- Brian J. Carter
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4349 Martin Luther King Boulevard, Houston, TX 77204, USA
| | - Dalnim Cho
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Shahnjayla K. Connors
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
- Department of Social Sciences, University of Houston-Downtown, Houston, TX 77002, USA
| | - Ammar D. Siddiqi
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Biosciences, Rice University, 6100 Main St., Houston, TX 77005, USA
| | - Lorna H. McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lorraine R. Reitzel
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
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17
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Housten AJ, Hoover DS, Britton M, Bevers TB, Street RL, McNeill LH, Strong LL, Hersch J, McCaffery K, Volk RJ. Perceptions of Conflicting Breast Cancer Screening Recommendations Among Racially/Ethnically Diverse Women: a Multimethod Study. J Gen Intern Med 2022; 37:1145-1154. [PMID: 35015260 PMCID: PMC8971222 DOI: 10.1007/s11606-021-07336-w] [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: 04/02/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Conflicting breast cancer screening recommendations have the potential to diminish informed decision making about screening. OBJECTIVE We examined the knowledge, attitudes, and intentions related to divergent recommendations for breast cancer screening among racially/ethnically diverse women. DESIGN We used a multimethod study design employing focus groups and questionnaires. Focus groups included: (1) two 10-min presentations on the national screening recommendations and the potential benefits and harms of screening and (2) an interactive discussion. Data were collected: 8/3/2017 to 11/19/2019. Analysis occurred from 1/21/2019 to 7/24/2020. PARTICIPANTS Participants were (1) women 40-75 years; (2) English or Spanish speaking; (3)self-identified as Latina, Black, or non-Latina White; and (4) no known increased risk for breast cancer. MAIN MEASURES Main outcomes were participants' knowledge and perceptions of benefits and harms of screening mammography and their screening intentions. Focus groups were transcribed and analyzed using a qualitative descriptive approach. Quantitative data were summarized using descriptive statistics. KEY RESULTS One hundred thirty-four women (n=52, 40-49 years; n=82, 50-75 years) participated in 28 focus groups. Participants were Latina (n=44); Black (n=51); and non-Latina White (n=39). Approximately one-quarter (n=32) had limited health literacy and almost one-fifth (n=23) had limited numeracy. In the context of differing national screening recommendations, participants questioned the motives of the recommendation-making agencies, including the role of costs and how costs were considered when making screening recommendations. Participants expressed concern that they were not represented (e.g., race/ethnicity) in the data informing the recommendations. Immediately following the focus groups, most participants expressed intention to screen within the upcoming year (pre n=100 vs. post n=107). CONCLUSIONS Divergent breast cancer screening recommendations may lead to mistrust and paradoxically reinforce high overall enthusiasm for screening.
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Affiliation(s)
- Ashley J Housten
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Diana S Hoover
- Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maggie Britton
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - Therese B Bevers
- Department of Clinical Cancer Prevention, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard L Street
- Department of Communication, College of Liberal Arts, Texas A&M University, College Station, Texas, TX, USA
| | - Lorna H McNeill
- Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Larkin L Strong
- Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jolyn Hersch
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Kirsten McCaffery
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Robert J Volk
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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18
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Vincent-Doe A, Sneed R, Jordan T, Key K, Bailey RS, Jefferson BB, Sanders RPE, Brewer A, Scott JB, Calvin K, Summers M, Farmer B, Johnson-Lawrence V. Exploring the Readiness of African-American Churches to Engage in a Community-Engaged Blood Pressure Reduction Research Study: Lessons Learned from the Church Challenge. JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP 2022; 14:10. [PMID: 35734421 PMCID: PMC9207767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction The Transtheoretical Model (TTM) has been used to assess individual readiness for health behavior change. We describe our use of the TTM to assess organizational readiness of African-American churches to participate in the Church Challenge (CC) in Flint, Michigan; the processes of change that moved churches toward readiness for change; and lessons learned. Methods The CC was a faith-based, multilevel intervention to reduce chronic disease risk. A community-based participatory approach was used to engage and recruit churches. We used the TTM to capture church readiness for change and track church progress through the five stages. Results We engaged with 70 churches: 35 remained in Stage 1 (precontemplation), 10 remained in Stage 2 (contemplation), 3 remained in Stage 3 (preparation), 5 made it to Stage 4 (action), and 17 finished within Stage 5 (maintenance). Churches engaged in several processes of change as they moved through the various stages of change. Lessons Learned Utilizing processes of change, establishing rapport, and having previous participants share success stories helped move churches from stage-to-stage. However, certain barriers prevented progression, such as burnout/trauma from the Flint Water Crisis and scheduling conflicts. Discussion Faith-based organizational readiness greatly impacted participation in the CC. Researchers should utilize established social capital, build rapport, and remain flexible when working with African-American churches. Conclusion Although traditionally used at the individual level, the TTM works well at the organizational level to assess and monitor church readiness to participate in community-engaged research and health programming to improve health in an African-American faith community.
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Affiliation(s)
| | - Rodlescia Sneed
- Division of Public Health, Michigan State University, Flint, MI
| | - Tamara Jordan
- Division of Public Health, Michigan State University, Flint, MI
| | - Kent Key
- Division of Public Health, Michigan State University, Flint, MI,Community Based Organization Partners, Flint, MI
| | - Rev. Sarah Bailey
- Bridges to the Future, Flint, MI,Community Based Organization Partners, Flint, MI
| | | | | | - Allysoon Brewer
- Division of Public Health, Michigan State University, Flint, MI
| | - Jamil B. Scott
- Division of Public Health, Michigan State University, Flint, MI,National Human Genome Research Institute, National Institute of Health
| | - Kahlil Calvin
- Division of Public Health, Michigan State University, Flint, MI
| | - Monicia Summers
- Division of Public Health, Michigan State University, Flint, MI
| | - Bridget Farmer
- Division of Public Health, Michigan State University, Flint, MI
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19
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Gamboa CJ, Julion WA, Fogg L, Bounds DT. Using Vignette-Based Methodology to Examine Study Recruitment in Older African American Adults: A Methods Paper. J Urban Health 2021; 98:103-114. [PMID: 34322834 PMCID: PMC8501170 DOI: 10.1007/s11524-021-00567-6] [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] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
This study's objective was to assess which caring recruitment behaviors correlate with the successful recruitment of older African-American adults-a two-step cross-sectional design employing a vignette-based survey methodology. Kristen Swanson's middle-range theory of caring was used to guide the examination of African-American adults' (65 years of age and older) perceptions of research-study-recruiter recruitment behaviors. This study's main findings are twofold: Step 1: Seven of ten invited experts identified major revisions of the two core vignettes, written at an eighth-grade reading level and high school comprehension. Step 2: A 51% response rate yielded findings that this methodology successfully captured older African-American adults' perception of research study recruiters' behavioral characteristics during the recruitment process. Older African-Americans who received the hypothetical caring vignette were twice as likely to indicate their willingness to enroll in a research study with a high commitment (i.e., brain donation) compared to their counterparts who received the hypothetical uncaring recruitment scenario. Vignette-based survey methodology holds promise as a tool for informing the recruitment of older African-American adults and other minorities into federally funded health-related research studies.
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Affiliation(s)
- Charlene J Gamboa
- College of Nursing, Rush University Medical Center, 600 S. Paulina Street | Suite 1080, Chicago, Illinois, 60612, USA.
| | - Wrenetha A Julion
- College of Nursing, Rush University Medical Center, 600 S. Paulina Street | Suite 1080, Chicago, Illinois, 60612, USA
| | - Louis Fogg
- College of Nursing, Rush University Medical Center, 600 S. Paulina Street | Suite 1080, Chicago, Illinois, 60612, USA
| | - Dawn T Bounds
- University of California, Irvine, Sue & Bill Gross School of Nursing, California, CA, USA
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20
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Nitturi V, Chen TA, Zvolensky MJ, McNeill LH, Obasi EM, Reitzel LR. Anxiety Sensitivity and Fast-Food Ordering Habits Among Black Adults. HEALTH BEHAVIOR RESEARCH 2021; 4. [PMID: 34541461 DOI: 10.4148/2572-1836.1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Black adults experience high rates of overweight/obesity, which is linked to chronic diseases and is exacerbated by fast-food consumption. Anxiety sensitivity, a relative stable fear of anxiety-related sensations, has been linked to high caloric intake. Here, we examine whether anxiety sensitivity is associated with fast-food ordering habits within a convenience sample of Black adults. Methods Of 124 adults (79.4% women; Mage=49.3±11.6; 84.8% overweight/obese), 107 (86.3%) reported eating from a fast-food restaurant in the last month. Participants completed the Anxiety Sensitivity-Index 3, which has a total score and physical, cognitive, and social concerns subscales. Investigator-generated items queried frequency of ordering "supersized" quantities of fast-food (e.g., cheeseburgers, fries), and healthy items (e.g., salads, oatmeal, yogurt), respectively, from "never" to "always." Covariate-adjusted ordinal logistic regression models were used to assess relations between measures of interest. Results Anxiety sensitivity (total and physical concerns) was associated with greater odds of more frequently ordering supersized unhealthy fast-food; and anxiety sensitivity (total and cognitive concerns) was associated with lower odds of more frequently ordering healthy items from fast-food restaurants. Conclusions Results suggest that adults with greater anxiety sensitivity may engage in fast-food ordering habits that can contribute to the overweight/obesity epidemic. Future studies should replicate results and determine the potential for anxiety sensitivity-reduction interventions to affect dietary choices that contribute to overweight/obesity.
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Affiliation(s)
- Vijay Nitturi
- The University of Houston, Department of Psychological, Health, and Learning Sciences, and the University of Houston, HEALTH Research Institute, Houston, Texas
| | - Tzu-An Chen
- The University of Houston, Department of Psychological, Health, and Learning Sciences, and the University of Houston, HEALTH Research Institute, Houston, Texas
| | - Michael J Zvolensky
- The University of Houston, HEALTH Research Institute, The University of Houston, College of Liberal Arts and Social Sciences, Department of Psychology, and The University of Texas MD Anderson Cancer Center, Department of Behavioral Sciences, Houston, Texas
| | - Lorna H McNeill
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX
| | - Ezemenari M Obasi
- The University of Houston, Department of Psychological, Health, and Learning Sciences, and the University of Houston, HEALTH Research Institute, Houston, Texas
| | - Lorraine R Reitzel
- The University of Houston, Department of Psychological, Health, and Learning Sciences, and the University of Houston, HEALTH Research Institute, Houston, Texas
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21
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Heredia NI, Nguyen N, Martinez BA, Obasi EM, McNeill LH. The positive association between physical activity and alcohol use in African American adults. Prev Med Rep 2021; 23:101487. [PMID: 34381666 PMCID: PMC8333140 DOI: 10.1016/j.pmedr.2021.101487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/26/2021] [Accepted: 07/03/2021] [Indexed: 12/27/2022] Open
Abstract
African Americans have highest incidence and mortality from obesity-related cancers. Physical activity (PA), minimal alcohol use, and maintaining a low body mass index (BMI) are important cancer prevention behaviors, though there is little research on how these behaviors are associated with one another in African Americans. The purpose of this study is to assess the relationship between PA, alcohol use, and BMI using secondary data from an African American cohort recruited from Houston-area churches. Self-administered questionnaires measured self-reported PA, alcohol use, height, weight, and sociodemographic factors. Univariate and multivariable analyses assessed the relation between PA, alcohol use, BMI, controlling for covariates. Participants (N = 1009) were mostly female (77%), employed (72%), and college graduates (55%). Most (53%) reported both light-to-moderate alcohol use & moderate-to-high levels of PA. There was a statistically significant positive linear association between PA and alcohol use (Pearson's r = 0.15, p < 0.001). We also found that every one hour increase per week in PA was associated with 3% increased odds of being a heavy drinker (>2 drinks/day men, >1 drink/day women), as compared to an abstainer (Adjusted OR = 1.03, 95%CI 1.01-1.06). There was a statistically significant inverse association between PA and BMI, but no statistically significant association between alcohol use and BMI. In this sample of African Americans, PA and alcohol use were positively associated, mirroring results among Non-Hispanic Whites. However, alcohol use and BMI were not statistically significantly associated. Cancer and obesity prevention for African Americans should stress PA promotion while emphasizing messaging to curtail any associated increases in alcohol use.
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Affiliation(s)
- Natalia I. Heredia
- The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Nga Nguyen
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Bryan A. Martinez
- The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Ezemenari M. Obasi
- University of Houston, HEALTH Research Institute, Houston, TX, United States
| | - Lorna H. McNeill
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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22
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Irwin ML, Lowry D, Neuhouser ML, Ligibel J, Schmitz K, Patterson RE, Colditz G, Li F, Nebeling L. Transdisciplinary Research in Energetics and Cancer early career investigator training program: first year results. Transl Behav Med 2021; 11:549-562. [PMID: 32065834 DOI: 10.1093/tbm/ibaa009] [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] [Indexed: 01/11/2023] Open
Abstract
Energy imbalance increases cancer burden by increasing cancer risk and mortality. Training early career investigators on conducting impactful energy balance and cancer research is needed. We developed a Transdisciplinary Research in Energetics and Cancer (TREC) Training Program for early career investigators. This analysis examined program satisfaction, knowledge gained, publications, and awards among Year 1 participants (i.e., fellows). The program consists of an in-person course, followed by 1 year of mentorship. Faculty and fellows completed precourse and postcourse surveys. Following the mentorship period, we surveyed fellows for TREC-related research productivity, including publications and grant funding attributed to the program. Twenty fellows were accepted into the program: 3 basic, 7 clinical, and 10 population scientists. Sixteen fellows were junior faculty and four were postdoctoral fellows. The course included ~50 lectures, small group sessions, and faculty-fellow sessions. 96.7% of attendees rated the course in the highest categories of "good/very good." Knowledge significantly improved in 37 of 39 research competencies (94.8%). In the 18 months following the course, fellows published 25 manuscripts, with 3 published in journals with impact factor ≥10. Nineteen grants were funded to TREC fellows (i.e., 7 National Institutes of Health awards, 2 American Cancer Society [ACS] awards, and 10 foundation/pilot awards), and 7 fellows received career promotions. The program's impact will be defined by the degree to which TREC fellows produce discoveries that could improve the health of populations at risk for and/or surviving cancer. Upon the conclusion of our fifth year in 2021, we will publicly disseminate the program material.
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Affiliation(s)
- Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
| | - Diana Lowry
- Cancer Prevention Program/Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marian L Neuhouser
- Cancer Prevention Program/Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Kathryn Schmitz
- Division of Health Services and Behavioral Research, Pennsylvania State University, Hershey, PA, USA
| | - Ruth E Patterson
- Department of Family and Preventive Medicine, Division of Epidemiology, University of California, La Jolla, CA, USA
| | - Graham Colditz
- Division of Public Health Sciences, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Fangyong Li
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
| | - Linda Nebeling
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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23
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Agrawal P, Chen TA, McNeill LH, Acquati C, Connors SK, Nitturi V, Robinson AS, Martinez Leal I, Reitzel LR. Factors Associated with Breast Cancer Screening Adherence among Church-Going African American Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168494. [PMID: 34444241 PMCID: PMC8392666 DOI: 10.3390/ijerph18168494] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022]
Abstract
Relative to White women, African American/Black women are at an increased risk of breast cancer mortality. Early detection of breast cancer through mammography screening can mitigate mortality risks; however, screening rates are not ideal. Consequently, there is a need to better understand factors associated with adherence to breast cancer screening guidelines to inform interventions to increase mammography use, particularly for groups at elevated mortality risk. This study used the Andersen Behavioral Model of Health Services Use to examine factors associated with adherence to National Comprehensive Cancer Network breast cancer screening guidelines amongst 919 African American, church-going women from Houston, Texas. Logistic regression analyses measured associations between breast cancer screening adherence over the preceding 12 months (adherent or non-adherent) and predisposing (i.e., age, education, and partner status), enabling (i.e., health insurance status, annual household income, employment status, patient-provider communication, and social support), and need (i.e., personal diagnosis of cancer, family history of cancer, and risk perception) factors, separately and conjointly. Older age (predisposing: OR = 1.015 (1.007-1.023)), having health insurance and ideal patient-provider communication (enabling: OR = 2.388 (1.597-3.570) and OR = 1.485 (1.080-2.041)), and having a personal diagnosis of cancer (need: OR = 2.244 (1.058-4.758)) were each associated with greater odds of screening adherence. Only having health insurance and ideal patient-provider communication remained significantly associated with screening adherence in a conjoint model; cancer survivorship did not moderate associations between predisposing/enabling factors and screening adherence. Overall, results suggest that interventions which are designed to improve mammography screening rates amongst African American women might focus on broadening health insurance coverage and working to improve patient-provider communication. Implications for multi-level intervention approaches, including the role of churches in their dissemination, are proposed.
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Affiliation(s)
- Pooja Agrawal
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Tzuan A. Chen
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Lorna H. McNeill
- MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX 77230, USA; (L.H.M.); (C.A.)
| | - Chiara Acquati
- MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX 77230, USA; (L.H.M.); (C.A.)
- Graduate College of Social Work, University of Houston, Houston, TX 77204, USA
| | - Shahnjayla K. Connors
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Department of Social Sciences, University of Houston-Downtown, Houston, TX 77002, USA
| | - Vijay Nitturi
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Angelica S. Robinson
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Isabel Martinez Leal
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Lorraine R. Reitzel
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
- Correspondence: ; Tel.: +1-713-743-6679
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24
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Bhuiyan N, McNeill LH, Bopp M, Downs DS, Mama SK. Fostering spirituality and psychosocial health through mind-body practices in underserved populations. Integr Med Res 2021; 11:100755. [PMID: 34354922 PMCID: PMC8322296 DOI: 10.1016/j.imr.2021.100755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/23/2021] [Accepted: 05/30/2021] [Indexed: 01/07/2023] Open
Abstract
Background This study examined changes in spirituality and psychosocial outcomes among African American and rural adults participating in a culturally-adapted mind-body intervention. Methods African American (n = 22) and rural (n = 38) adults in Harmony & Health attended mind-body sessions twice a week for eight weeks and completed questionnaires on spirituality and psychosocial distress at baseline and post-intervention. Linear regression and repeated measures analyses were used to examine associations between intervention attendance and spirituality. Results Attendance was significantly associated with increased spirituality (β=0.168, p = 013). Repeated measures analyses revealed a significant three-way interaction between attendance, spirituality, and study site (F(9,31)=2.891, p = 013). Urban African American participants who attended ≥75% of sessions reported greater increases in spirituality. Conclusion Findings suggest that mind-body practices may foster spirituality in urban African American adults. Additional adaptations are needed to strengthen spirituality in rural residents and to improve psychosocial health and wellbeing in this underserved population.
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Affiliation(s)
- Nishat Bhuiyan
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Lorna H. McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Melissa Bopp
- Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Danielle Symons Downs
- Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
- Department of Obstetrics and Gynecology, The Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Scherezade K. Mama
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Corresponding author at: Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1440, Houston, TX 77030, United States.
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25
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Connors SK, Leal IM, Nitturi V, Iwundu CN, Maza V, Reyes S, Acquati C, Reitzel LR. Empowered Choices: African-American Women's Breast Reconstruction Decisions. Am J Health Behav 2021; 45:352-370. [PMID: 33888195 PMCID: PMC8383809 DOI: 10.5993/ajhb.45.2.14] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives: Breast reconstruction (BR) potentially can improve quality of life in postmastectomy breast cancer survivors (BCS); however, African-American women are less likely to undergo BR than Caucasian women. This qualitative study was undertaken to explore individual, sociocultural, and contextual factors influencing African-American women's BR decision-making processes and preferences. Methods: Postmastectomy African-American BCS with and without BR participated in semi-structured interviews. We adopted a grounded theory approach using the constant comparison method to understand the contexts and processes informing participants' BR decision-making. Results: Twenty-three women participated, of whom 17 elected BR and 6 did not. Whereas women's primary reasons for deciding for or against BR differed, our core category, "empowered choices ," describes both groups' decision-making as a process focused on empowering themselves physically and/or psychologically, through self-advocacy, informed and shared decision-making, and giving back/receiving communal and spiritual support from church and African-American survivor groups. Socioeconomic factors influenced women's access to BR. Women preferred autologous BR and expressed the need for greater culturally-matched resources and support to inform treatment and shared BR decision-making. Conclusions: Understanding and supporting African-American women's BR preferences and empowerment is essential to ensuring equal access, and culturally-relevant, high-quality, and informed patient-centered care.
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Affiliation(s)
- Shahnjayla K Connors
- Shahnjayla K. Connors, Assistant Professor, Department of Social Sciences, University of Houston-Downtown, Houston, TX, United States
| | - Isabel Martinez Leal
- Isabel Martinez Leal, Research Associate II, Social and Behavioral Science, Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, United States;,
| | - Vijay Nitturi
- Vijay Nitturi, Research Assistant, Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, United States
| | - Chisom N Iwundu
- Chisom N. Iwundu, Postdoctoral Fellow, Department of Psychological Health and Learning Sciences, University of Houston, Houston, TX, United States
| | - Valentina Maza
- Valentina Maza, Research Assistant, Department of Psychological, Health, and Learning Sciences, University, Houston, Houston, TX, United States
| | - Stacey Reyes
- Stacey Reyes, Research Assistant, Department of Social Sciences, University of Houston-Downtown, Houston, TX, United States
| | - Chiara Acquati
- Chiara Acquati, Assistant Professor, Graduate College of Social Work, University of Houston, Houston, TX, United States
| | - Lorraine R Reitzel
- Lorraine R. Reitzel, Professor, Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, United States
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26
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Anton SD, Cruz-Almeida Y, Singh A, Alpert J, Bensadon B, Cabrera M, Clark DJ, Ebner NC, Esser KA, Fillingim RB, Goicolea SM, Han SM, Kallas H, Johnson A, Leeuwenburgh C, Liu AC, Manini TM, Marsiske M, Moore F, Qiu P, Mankowski RT, Mardini M, McLaren C, Ranka S, Rashidi P, Saini S, Sibille KT, Someya S, Wohlgemuth S, Tucker C, Xiao R, Pahor M. Innovations in Geroscience to enhance mobility in older adults. Exp Gerontol 2020; 142:111123. [PMID: 33191210 PMCID: PMC7581361 DOI: 10.1016/j.exger.2020.111123] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023]
Abstract
Aging is the primary risk factor for functional decline; thus, understanding and preventing disability among older adults has emerged as an important public health challenge of the 21st century. The science of gerontology - or geroscience - has the practical purpose of "adding life to the years." The overall goal of geroscience is to increase healthspan, which refers to extending the portion of the lifespan in which the individual experiences enjoyment, satisfaction, and wellness. An important facet of this goal is preserving mobility, defined as the ability to move independently. Despite this clear purpose, this has proven to be a challenging endeavor as mobility and function in later life are influenced by a complex interaction of factors across multiple domains. Moreover, findings over the past decade have highlighted the complexity of walking and how targeting multiple systems, including the brain and sensory organs, as well as the environment in which a person lives, can have a dramatic effect on an older person's mobility and function. For these reasons, behavioral interventions that incorporate complex walking tasks and other activities of daily living appear to be especially helpful for improving mobility function. Other pharmaceutical interventions, such as oxytocin, and complementary and alternative interventions, such as massage therapy, may enhance physical function both through direct effects on biological mechanisms related to mobility, as well as indirectly through modulation of cognitive and socioemotional processes. Thus, the purpose of the present review is to describe evolving interventional approaches to enhance mobility and maintain healthspan in the growing population of older adults in the United States and countries throughout the world. Such interventions are likely to be greatly assisted by technological advances and the widespread adoption of virtual communications during and after the COVID-19 era.
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Affiliation(s)
- Stephen D Anton
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Yenisel Cruz-Almeida
- University of Florida, Department of Community Dentistry and Behavioral Science, 1329 SW Archer Road, Gainesville, FL 32610, United States.
| | - Arashdeep Singh
- University of Florida, Department of Pharmacodynamics, College of Pharmacy, 1345 Center Drive, Gainesville, FL 32610, United States.
| | - Jordan Alpert
- University of Florida, College of Journalism and Communications, Gainesville, FL 32610, United States.
| | - Benjamin Bensadon
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Melanie Cabrera
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - David J Clark
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Natalie C Ebner
- University of Florida, Department of Psychology, 945 Center Drive, Gainesville, FL 32611, United States.
| | - Karyn A Esser
- University of Florida, Department of Physiology and Functional Genomics, 1345 Center Drive, Gainesville, FL, United States.
| | - Roger B Fillingim
- University of Florida, Department of Community Dentistry and Behavioral Science, 1329 SW Archer Road, Gainesville, FL 32610, United States.
| | - Soamy Montesino Goicolea
- University of Florida, Department of Community Dentistry and Behavioral Science, 1329 SW Archer Road, Gainesville, FL 32610, United States.
| | - Sung Min Han
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Henrique Kallas
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Alisa Johnson
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Christiaan Leeuwenburgh
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Andrew C Liu
- University of Florida, Department of Physiology and Functional Genomics, 1345 Center Drive, Gainesville, FL, United States.
| | - Todd M Manini
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Michael Marsiske
- University of Florida, Department of Clinical & Health Psychology, 1225 Center Drive, Gainesville, FL 32610, United States.
| | - Frederick Moore
- University of Florida, Department of Surgery, Gainesville, FL 32610, United States.
| | - Peihua Qiu
- University of Florida, Department of Biostatistics, Gainesville, FL 32611, United States.
| | - Robert T Mankowski
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Mamoun Mardini
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Christian McLaren
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Sanjay Ranka
- University of Florida, Department of Computer & Information Science & Engineering, Gainesville, FL 32611, United States.
| | - Parisa Rashidi
- University of Florida, Department of Biomedical Engineering. P.O. Box 116131. Gainesville, FL 32610, United States.
| | - Sunil Saini
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Kimberly T Sibille
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Shinichi Someya
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Stephanie Wohlgemuth
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Carolyn Tucker
- University of Florida, Department of Psychology, 945 Center Drive, Gainesville, FL 32611, United States.
| | - Rui Xiao
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Marco Pahor
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
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27
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John JC, Wang J, McNeill LHM, Basen-Engquist K, Hoover DS, Daniel CR, Strong LL. A Mixed Methods Study on Engagement and Satisfaction with a Digitally-Enhanced Pilot Intervention Among African American and Hispanic Women. J Immigr Minor Health 2020; 23:1011-1020. [PMID: 33043411 DOI: 10.1007/s10903-020-01095-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Abstract
African American and Hispanic women report less physical activity (PA) than non-Hispanic White women. As such, a digitally-enhanced 16-week social support pilot intervention was conducted to promote PA among African American and Hispanic women dyads. This study quantitatively and qualitatively examined the engagement and satisfaction of participants (N = 30; 15 dyads) assigned to the intervention. Intervention participants received telephone counseling calls based on motivational interviewing and a Jawbone UP activity monitor. Intervention engagement and satisfaction data were collected from the Jawbone UP, call logs, self-report questionnaires conducted at the 16-week follow-up, and two post-intervention focus groups. Nonparametric tests assessed group differences across engagement and satisfaction measures, and a manually-driven coding scheme was used to evaluate emerging themes from qualitative text. Participants demonstrated high engagement in the telephone counseling sessions and moderate engagement with the Jawbone UP. Friend/co-worker dyads and participants who were 45 years and older were more likely to use the device. Qualitative results emphasized participants' appreciation for the counseling calls, the Jawbone UP, and the overall dyadic framework of the study to collectively nurture social support and accountability for PA. Overall, the intervention group reacted positively to study components. Additional research is needed to understand the role of technology in facilitating long-lasting PA change via social support in minority populations.
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Affiliation(s)
- J C John
- The University of Texas Health Science Center, Houston, TX, 77030, USA. .,The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - J Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - L H M McNeill
- The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - K Basen-Engquist
- The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - D S Hoover
- The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,, Asheville, NC, USA
| | - C R Daniel
- The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - L L Strong
- The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
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28
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Heredia N, Nguyen N, McNeill LH. The Importance of the Social Environment in Achieving High Levels of Physical Activity and Fruit and Vegetable Intake in African American Church Members. Am J Health Promot 2020; 34:886-893. [PMID: 32410458 DOI: 10.1177/0890117120925361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE African Americans experience a high burden of chronic diseases and cancers that are prevented and ameliorated with physical activity (PA) and fruit and vegetable (FV) intake. The purpose of this study is to identify individual, social, and neighborhood variables associated with African Americans attaining high levels of both behaviors. DESIGN This study is a cross-sectional analysis. SETTINGS AND PARTICIPANTS Cohort of African Americans adults recruited from black churches in the Greater Houston area. MEASURES Self-administered questionnaires collected in 2012 assessed correlates and behavioral outcome variables (PA and FV consumption). A combined 4-category behavioral outcome was created: high PA/high FV, low PA/high FV, high PA/low FV, and low PA/low FV. ANALYSIS Standard and stepwise multinomial logistic regression examined the association between the various variables and the behavioral outcome. RESULTS This sample (n = 1009) had a mean age of 49 years, was mostly female, and obese. Compared to the low PA/low FV intake group, the high PA/high FV intake group had significantly lower odds of individual-level variables (worrying about getting cancer, perceived stress, loneliness, and financial strain) and higher odds of social-level variables (social status, social cohesion, social organization involvement, and social norms). Only social-level variables remained significantly associated with higher odds of high PA/high FV intake in stepwise regression. CONCLUSION These findings indicate that social influences may be most critical for high PA and FV intake in African Americans adults.
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Affiliation(s)
- Natalia Heredia
- Department of Health Disparities, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nga Nguyen
- Department of Health Disparities, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lorna H McNeill
- Department of Health Disparities, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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29
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Cho D, Milbury K, McNeill LH. Stress and cancer-related lifestyle factors among African American heterosexual couples. PLoS One 2020; 15:e0232577. [PMID: 32384125 PMCID: PMC7209253 DOI: 10.1371/journal.pone.0232577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 04/17/2020] [Indexed: 01/13/2023] Open
Abstract
Intimate partners can have a profound influence on individuals' health behaviors. In this exploratory research, we investigated the concordance of cancer-related lifestyle factors including smoking, body mass index, physical activity, fruit and vegetable intake, red meat intake, and alcohol use within African American heterosexual couples. We also examined whether females' stress is associated with their own (actor effect) and males' cancer-related lifestyle factors (partner effect), and vice versa. We analyzed a total of 216 heterosexual couples (i.e., N = 432 individuals) recruited from black churches. Intraclass correlation coefficients (ICCs) were calculated and multilevel modeling in which individuals are nested within couples was conducted. Results showed that there was high concordance of body mass index (ICC = 1.68, p < .001), fruit and vegetable intake (ICC = 1.62, p < .001), red meat intake (ICC = 1.50, p = .001), and alcohol use (ICC = 1.74, p < .001) between spouses. A multilevel analysis showed that there were actor and partner effects of stress on females' BMI; females' stress was positively associated with their own BMI (actor effect; β = .42, p = .006) and males' stress was positively associated with females' BMI (partner effect; β = .39, p = .026). Also, females' stress was positively associated with their own red meat intake (actor effect; β = .20, p = .019). In conclusion, high concordance of cancer-related lifestyle factors (BMI, fruit and vegetable intake, red meat intake and alcohol use) exists between African American spouses. Given the identified actor and partner effects of stress on females' BMI, a couple-based lifestyle or weight management intervention that targets both male and female spouses' stress and coping will be promising, particularly to enhance African American women's health behaviors. Future studies need to investigate mechanisms underlying concordance and discordance of cancer-related lifestyle factors in African American couples. Also, factors that explain African American male spouses' health behaviors need to be uncovered.
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Affiliation(s)
- Dalnim Cho
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Kathrin Milbury
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Lorna H. McNeill
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
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Cuevas AG, Kawachi I, Ortiz K, Pena M, Reitzel LR, McNeill LH. Greater social cohesion is associated with lower body mass index among African American adults. Prev Med Rep 2020; 18:101098. [PMID: 32382494 PMCID: PMC7200308 DOI: 10.1016/j.pmedr.2020.101098] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/16/2020] [Accepted: 04/19/2020] [Indexed: 12/03/2022] Open
Abstract
Obesity remains a public health issue, especially for Blacks (or African Americans). Obesity is thought to reflect a complex interaction of socioenvironmental, biological, and cognitive factors. Yet, insufficient attention has been given to psychosocial factors like social cohesion within the African American community. Using multivariable linear regression, we examined the association between social cohesion, measured by the Social Cohesion and Trust scale, and body mass index (BMI) with cross-sectional data (n = 1467) from a cohort study (2008–2009). Greater social cohesion was associated with lower BMI (b = -0.88; 95% CI: −1.45, −0.32) in an unadjusted model. The association was strengthened after further adjusting for relevant covariates (i.e., individual-level sociodemographic factors, health behaviors, and depressive symptoms) (b = -1.26; 95% CI: −1.94, −0.58). Future research should examine potential mechanisms underlying the association between social cohesion and BMI with longitudinal data. In the meantime, obesity prevention and intervention measures should consider promoting social ties and bonds to lower BMI in African American communities.
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Affiliation(s)
- Adolfo G Cuevas
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kasim Ortiz
- Department of Sociology, University of New Mexico, Albuquerque, NM, USA
| | - Mariam Pena
- Department of Psychology, City College of New York, New York, NY, USA
| | - Lorraine R Reitzel
- Department of Psychological Health and Learning Sciences, University of Houston, Houston, TX, USA
| | - Lorna H McNeill
- Department of Health Disparities Research, MD Anderson Cancer Center, Houston, TX, USA
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Nooruddin M, Scherr C, Friedman P, Subrahmanyam R, Banagan J, Moreno D, Sathyanarayanan M, Nutescu E, Jeyaram T, Harris M, Zhang H, Rodriguez A, Shaazuddin M, Perera M, Tuck M. Why African Americans say "No": A Study of Pharmacogenomic Research Participation. Ethn Dis 2020; 30:159-166. [PMID: 32269457 DOI: 10.18865/ed.30.s1.159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective To identify reasons for nonparticipation by African Americans in cardiovascular pharmacogenomic research. Design Prospective, open-ended, qualitative survey. Setting Research staff approached patients eligible for the Discovery Project of The African American Cardiovascular pharmacogenomics CONsorTium in the inpatient or outpatient setting at four different institutions during September and October 2018. Participants Potential Discovery Project participants self-identified as African American, aged >18 years, were on one of five cardiovascular drugs of interest, and declined enrollment in the Discovery Project. Main Outcome Measures Reasons for nonparticipation. Methods After declining participation in the Discovery Project, patients were asked, "What are your reasons for not participating?" We analyzed their responses using a directed content analytic approach. Ultimately, responses were coded into one of nine categories and analyzed using descriptive statistics. Results Of the 194 people approached for the Discovery Project during an eight-week period, 82 declined participation and provided information for this study. The most common reason for refusal was concern about the amount of blood drawn (19.5%). The next most common reasons for refusal to participate included concerns about genetic testing (14.6%) and mistrust of research (12.2%). Across study sites, significantly more patients enrolled in the inpatient than outpatient setting (P<.001). Significantly more women and younger individuals declined participation due to concerns about genetic testing and too little compensation (P<.05). Conclusions Collection of blood samples and concerns about genetic testing are obstacles for the recruitment of African Americans to pharmacogenomics studies. Efforts to overcome these barriers to participation are needed to improve representation of minorities in pharmacogenomic research. Enrolling participants from inpatient populations may be a solution to bolster recruitment efforts.
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Affiliation(s)
- Mohammed Nooruddin
- Department of Pharmacology, Center for Pharmacogenomics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Courtney Scherr
- Department of Communication Studies, Northwestern University, Chicago, IL
| | - Paula Friedman
- Department of Pharmacology, Center for Pharmacogenomics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | - Diana Moreno
- Department of Pharmacy Systems, Outcomes and Policy and Personalized Medicine Program, University of Illinois, College of Pharmacy, Chicago, IL
| | - Myurani Sathyanarayanan
- Department of Pharmacy Systems, Outcomes and Policy and Personalized Medicine Program, University of Illinois, College of Pharmacy, Chicago, IL
| | - Edith Nutescu
- Department of Pharmacy Systems, Outcomes and Policy and Personalized Medicine Program, University of Illinois, College of Pharmacy, Chicago, IL
| | - Tharani Jeyaram
- Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, IL
| | - Mary Harris
- Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, IL
| | - Honghong Zhang
- Department of Pharmacology, Center for Pharmacogenomics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Adriana Rodriguez
- Department of Pharmacology, Center for Pharmacogenomics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mohammed Shaazuddin
- Department of Pharmacology, Center for Pharmacogenomics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Minoli Perera
- Department of Pharmacology, Center for Pharmacogenomics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Matthew Tuck
- Washington DC VA Medical Center, Washington, DC.,The George Washington University, Washington, DC
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Wu IHC, Strong LL, Nguyen NT, Cho D, John J, McNeill LH. Psychosocial Stressors, Depression, and Physical Activity among African Americans. Am J Health Behav 2019; 43:717-728. [PMID: 31239015 PMCID: PMC10486259 DOI: 10.5993/ajhb.43.4.6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: In this study, we examined how racial discrimination and neighborhood perceptions relate to physical activity and sedentary behavior mediated through depression symptoms. Methods: Data were from the first year of a longitudinal cohort study, Project Creating a Higher Understanding of cancer Research and Community Health (CHURCH), based on a convenience community sample of church-attending African Americans collected between April 2012 and March 2013 (N = 370) in Houston, Texas. Measures included racial discrimination, perceived neighborhood problems and vigilance, depression (CES-D), physical activity (IPAQ-short), and sedentary behavior. Results: Main effects from the structural equation model showed that racial discrimination (b = .20, p < .01) was related to greater depression symptoms. The same pattern emerged for neighborhood problems, but the effect was not significant (b = .20, p = .07). Further, depression symptoms were related to less physical activity (b = -.62, p = .03) and greater sedentary behavior (b = .64, p < .01). Indirect effects showed that depression mediated the relationship between racial discrimination and neighborhood problems on physical activity and sedentary behavior. Conclusions: Depression symptoms are an important mechanism by which racial discrimination and perceived neighborhood problems impact physical activity and sedentary behavior.
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Affiliation(s)
- Ivan H C Wu
- Postdoctoral Research Fellow, University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX;,
| | - Larkin L Strong
- Assistant Professor, University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX
| | - Nga T Nguyen
- Senior Statistical Analyst, University of Texas MD Anderson Cancer Center, Department of Biostatistics, Houston, TX
| | - Dalnim Cho
- Instructor, University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX
| | - Jemima John
- Postdoctoral Research Fellow, University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX
| | - Lorna H McNeill
- Associate Professor and Chair, University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX
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Scherr CL, Ramesh S, Marshall-Fricker C, Perera MA. A Review of African Americans' Beliefs and Attitudes About Genomic Studies: Opportunities for Message Design. Front Genet 2019; 10:548. [PMID: 31258547 PMCID: PMC6587098 DOI: 10.3389/fgene.2019.00548] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 05/24/2019] [Indexed: 12/19/2022] Open
Abstract
Precision Medicine, the practice of targeting prevention and therapies according to an individual’s lifestyle, environment or genetics, holds promise to improve population health outcomes. Within precision medicine, pharmacogenomics (PGX) uses an individual’s genome to determine drug response and dosing to tailor therapy. Most PGX studies have been conducted in European populations, but African Americans have greater genetic variation when compared with most populations. Failure to include African Americans in PGX studies may lead to increased health disparities. PGX studies focused on patients of African American descent are needed to identify relevant population specific genetic predictors of drug responses. Recruitment is one barrier to African American participation in PGX. Addressing recruitment challenges is a significant, yet potentially low-cost solution to improve patient accrual and retention. Limited literature exists about African American participation in PGX research, but studies have explored barriers and facilitators among African American participation in genomic studies more broadly. This paper synthesizes the existing literature and extrapolates these findings to PGX studies, with a particular focus on opportunities for message design. Findings from this review can provide guidance for future PGX study recruitment.
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Affiliation(s)
- Courtney L Scherr
- Department of Communication Studies, Center for Communication and Health, Northwestern University, Chicago, IL, United States
| | - Sanjana Ramesh
- Department of Communication Studies, Center for Communication and Health, Northwestern University, Chicago, IL, United States
| | - Charlotte Marshall-Fricker
- Department of Communication Studies, Center for Communication and Health, Northwestern University, Chicago, IL, United States
| | - Minoli A Perera
- Department of Pharmacology, Center for Pharmacogenomics, Feinberg School of Medicine, Chicago, IL, United States
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Cho D, Nguyen NT, Strong LL, Wu IHC, John JC, Escoto KH, Wetter DW, McNeill LH. Multiple Health Behaviors Engagement in an African American Cohort: Clustering Patterns and Correlates. HEALTH EDUCATION & BEHAVIOR 2019; 46:506-516. [PMID: 30776919 PMCID: PMC10069919 DOI: 10.1177/1090198119826207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We investigated class clustering patterns of four behaviors—physical activity, fruit and vegetable (F&V) intake, smoking, and alcohol use—in a faith-based African American cohort. Guided by socio-ecological models, we also examined the psychosocial and neighborhood social environmental factors associated with the clustering patterns. Participants were 1,467 African American adults recruited from a mega church in the metropolitan Houston, TX, in 2008-2009. They completed a survey and health assessment. Latent class analysis and multinomial regression analysis were conducted. Results supported a three-class model: Class 1 was characterized by low physical activity, low F&V intake, and low substance use (smoking and alcohol use). Class 2 was characterized by high physical activity, low F&V intake, and mild drinking. Class 3 seemed to be the healthiest group, characterized by high physical activity, moderate-to-high F&V intake, and low substance use. The probabilities of being included in Classes 1, 2, and 3 were .33, .48, and .19, respectively. Participants in Class 1 (vs. Class 3) reported lower physical activity norm ( p < .001) and higher smoking norm ( p = .002) and lower neighborhood social cohesion ( p = .031). Participants in Class 2 (vs. Class 3) reported higher cancer risk perception ( p < .001), lower F&V norm ( p = .022), lower physical activity norm ( p < .001), higher smoking norm ( p < .001), and lower social cohesion ( p = .047). As health behaviors are clustered together, future interventions for African Americans may consider targeting multiple health behaviors instead of targeting a single health behavior. Interventions addressing social norm and neighborhood social cohesion may enhance multiple health behaviors engagement in this population.
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Affiliation(s)
- Dalnim Cho
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nga T. Nguyen
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Larkin L. Strong
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ivan H. C. Wu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jemima C. John
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - David W. Wetter
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lorna H. McNeill
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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35
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Bruce MA, Norris KC, Beech BM, Bowie JV, Thorpe RJ. Perspective: A Call for Precision in Faith-based Initiatives Promoting Health among African Americans. Ethn Dis 2019; 29:17-20. [PMID: 30713411 DOI: 10.18865/ed.29.1.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Ethn Dis. 2019;29(1):17-20; doi:10.18865/ed.29.1.17
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Affiliation(s)
- Marino A Bruce
- Program for Research on Faith and Health, Center for Research on Men's Health, Vanderbilt University.,Center for Medicine, Health and Society, Vanderbilt University.,Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center
| | - Keith C Norris
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center.,David Geffen School of Medicine at UCLA
| | - Bettina M Beech
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center
| | - Janice V Bowie
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health
| | - Roland J Thorpe
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health
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36
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Wu IHC, Nguyen N, Balachandran DD, Lu Q, McNeill LH. Sleep and obesity: the mediating role of health behaviors among African Americans. Sleep Health 2019; 5:193-200. [PMID: 30928121 DOI: 10.1016/j.sleh.2018.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/20/2018] [Accepted: 12/10/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To examine the role of health behaviors (eg, physical activity, sedentary behaviors, and diet) in the relationship between sleep (ie, duration and quality) and BMI among African American adults. DESIGN A cross-sectional self-report questionnaire included questions related to health and health-related behaviors. SETTING This study was based on data from the CHURCH study, which aimed to address cancer health disparities among church-going African Americans in Houston, TX. PARTICIPANTS African American adults were recruited from three large community churches. The sample included a total of 1837 participants (75.2% female; mean age 48.2 ± 13.7y; mean BMI 32.0 ± 7.5 kg/m2). MEASUREMENTS Linear regression models and path analyses controlling for demographic characteristics and depression estimated the associations between sleep and BMI as well as the mediating roles of health behaviors. RESULTS The average self-reported sleep duration was 6.2 ± 1.5 h/night with 61%, 35.8%, and 1.6% reporting short (≤6 h/night), normal (7-9 h/night), and long sleep (≥10 h/night), respectively. Short sleep was related to greater BMI (b = 1.37, SE = 0.38, P = .01), and the relationship was mediated by sedentary behaviors (est. = 0.08, SE = 0.04, 95% CI: 0.02, 0.17). CONCLUSIONS Short sleep and poor quality sleep was related to poor diet and physical activity-related health behaviors, and BMI. The link between sleep and obesity is, in part, due to energy imbalance from increased sedentary behavior.
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Affiliation(s)
- Ivan H C Wu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Nga Nguyen
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Diwakar D Balachandran
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX; Department of Psychology, University of Houston, Houston, TX
| | - Lorna H McNeill
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX
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Lassiter JM, Brewer R, Wilton L. Black Sexual Minority Men's Disclosure of Sexual Orientation Is Associated With Exposure to Homonegative Religious Messages. Am J Mens Health 2018; 13:1557988318806432. [PMID: 30311832 PMCID: PMC6771123 DOI: 10.1177/1557988318806432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Previous research has highlighted the homonegative atmospheres of many religious communities in Western society and their harmful impact on Black sexual minority (SM) people's mental and physical health. However, few studies have examined the relationship between sexual orientation disclosure to church members and exposure to homonegative religious messages in religious settings. This online quantitative study investigated this relationship among a sample of 320 Black SM men. The participants for this study were recruited nationally from across the United States and had a mean age of 34 years. Descriptive statistics and linear regression analyses were conducted. Findings indicated that sexual orientation disclosure to church members was significantly associated with exposure to homonegative religious messages, even when controlling for geographic region of residence and denominational affiliation. Black SM men who had higher levels of disclosure were exposed to fewer homonegative religious messages. The implications of these findings for health research and clinical work with Black SM men are discussed in detail.
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Affiliation(s)
| | - Russell Brewer
- 2 Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Leo Wilton
- 3 Department of Human Development, State University of New York at Binghamton, NY, USA
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