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Schwartz C, Chukwudozie IB, Tejeda S, Vijayasiri G, Abraham I, Remo M, Shah HA, Rojas M, Carillo A, Moreno L, Warnecke RB, Hoskins KF. Association of Population Screening for Breast Cancer Risk With Use of Mammography Among Women in Medically Underserved Racial and Ethnic Minority Groups. JAMA Netw Open 2021; 4:e2123751. [PMID: 34505886 PMCID: PMC8433603 DOI: 10.1001/jamanetworkopen.2021.23751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Black women bear a disproportionate burden of breast cancer mortality in the US, in part due to inequities in the use of mammography. Population screening for breast cancer risk in primary care is a promising strategy for mitigating breast cancer disparities, but it is unknown whether this strategy would be associated with increased mammography rates in underserved women of racial and ethnic minority groups. OBJECTIVE To examine whether providing individualized breast cancer risk estimates is associated with an increase in the rate of screening mammography. DESIGN, SETTING, AND PARTICIPANTS A cohort study was conducted in women receiving individualized risk estimates as part of routine primary health care at federally qualified health centers in medically underserved communities in Chicago, Illinois. The study was conducted from November 5, 2013, to December 19, 2014, with data acquisition completed on March 5, 2017; data analysis was performed from December 30, 2020, to February 2, 2021. A total of 347 women aged 25 to 69 years without a personal history of breast cancer presenting for an annual visit with their primary care clinician were enrolled. EXPOSURES Breast cancer risk estimates were obtained with validated risk assessment tools as a standard component of the clinic check-in process. One of 4 women at average risk and all women at high risk were invited to participate in the study. MAIN OUTCOMES AND MEASURES The primary outcome was the mammography rate during 18 months of usual care compared with the rate during 18 months after implementation of risk assessment. RESULTS Of the 347 women enrolled, 188 were age-eligible for mammography and were included in the analysis (mean [SD] age, 50.8 [7.04] years); 70 women (37.2%) were Hispanic, 114 (60.6%) were non-Hispanic African American, and 4 (2.1%) were from other racial and ethnic groups (4 non-Hispanic White women). Ninety-eight women (52.1%) had an average risk of developing breast cancer and 90 (47.9%) were at high risk. Overall, there was a nonsignificant increase in the mammography rate, from 38.8% during usual care to 48.9% following implementation of risk assessment (odds ratio, 1.37; 95% CI, 0.92-2.03). In preplanned subgroup analysis, the mammography rate among women at high risk was significantly higher after vs before risk assessment (51.1% vs 36.6%; odds ratio, 1.88; 95% CI, 1.10-3.23). CONCLUSIONS AND RELEVANCE In this study, providing individualized breast cancer risk estimates as a component of primary health care in federally qualified health centers was associated with increased use of mammography among women of racial and ethnic minority groups who were at high risk. Implementation of this approach in underserved communities could promote equity in the use of mammography and reduce racial disparities in breast cancer mortality. This strategy warrants further investigation.
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Affiliation(s)
- Candice Schwartz
- Division of Hematology/Oncology, University of Illinois at Chicago
| | | | - Silvia Tejeda
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Ganga Vijayasiri
- Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor
| | - Ivy Abraham
- Division of Hematology/Oncology, University of Illinois at Chicago
- Now with Primary Healthcare Associates SC, Harvey, Illinois
| | - Mylene Remo
- Division of Hematology/Oncology, University of Illinois at Chicago
- Now with Affiliated Oncologists, Tinley Park, Illinois
| | - Hiral A. Shah
- Division of Hematology/Oncology, University of Illinois at Chicago
- Now with Ohio Health, Mansfield, Ohio
| | - Maria Rojas
- Chicago Family Health Center, Chicago, Illinois
| | | | | | | | - Kent F. Hoskins
- Division of Hematology/Oncology, University of Illinois at Chicago
- Translational Oncology Program, University of Illinois Cancer Center, Chicago
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Sánchez-Díaz CT, Strayhorn S, Tejeda S, Vijayasiri G, Rauscher GH, Molina Y. What mediates the racial/ethnic disparity in psychosocial stress among breast cancer patients? Cancer Causes Control 2021; 32:357-367. [PMID: 33559770 PMCID: PMC7946668 DOI: 10.1007/s10552-021-01392-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 01/05/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prior studies have observed greater levels of psychosocial stress (PSS) among non-Hispanic (nH) African American and Hispanic women when compared to nH White patients after a breast cancer diagnosis. We aimed to determine the independent and interdependent roles of socioeconomic position (SEP) and unmet support in the racial disparity in PSS among breast cancer patients. METHODS Participants were recruited from the Breast Cancer Care in Chicago study (n = 989). For all recently diagnosed breast cancer patients, aged 25-79, income, education, and tract-level disadvantage and affluence were summed to create a standardized socioeconomic position (SEP) score. Three measures of PSS related to loneliness, perceived stress, and psychological consequences of a breast cancer diagnosis were defined based on previously validated scales. Five domains of unmet social support needs (emotional, spiritual, informational, financial, and practical) were defined from interviews. We conducted path models in MPlus to estimate the extent to which PSS disparities were mediated by SEP and unmet social support needs. RESULTS Black and Hispanic patients reported greater PSS compared to white patients and greater unmet social support needs (p = 0.001 for all domains). Virtually all of the disparity in PSS could be explained by SEP. A substantial portion of the mediating influence of SEP was further transmitted by unmet financial and practical needs among Black patients and by unmet emotional needs for Hispanic patients. CONCLUSIONS SEP appeared to be a root cause of the racial/ethnic disparities in PSS within our sample. Our findings further suggest that different interventions may be necessary to alleviate the burden of SEP for nH AA (i.e., more financial support) and Hispanic patients (i.e., more emotional support).
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Affiliation(s)
- C T Sánchez-Díaz
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612, USA.
| | - S Strayhorn
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, USA
| | - S Tejeda
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, USA
| | - G Vijayasiri
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, USA
| | - G H Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612, USA
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, USA
| | - Y Molina
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, USA
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Ivy T, Chukwudozie I, Henderson V, Tejeda S, Vijayasiri G, Balthazar C, Winn R, Hoskins K. Abstract A058: Examining preferential mode of obtaining health information in African American women with elevated risk for breast cancer. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-a058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Breast cancer is the second leading cause of cancer death in the U.S. and is substantially higher in African American (AA) women. Early detection is crucial in decreasing breast cancer mortality and racial disparities. Research shows that low-income minority women are less likely to get breast cancer screening. Previous studies demonstrate that use of technology increases cancer screening rates. However, there are limited studies on the preferred mode of consuming health information for AA women, particularly those with increased risk of developing cancer.
Objectives: The objective of this study is to examine preferences in receiving and accessing health information among AA women with a family history of breast and/or ovarian cancer.
Methods: We conducted a mixed-methods study to address our research objective. For quantitative data, African American women (aged 26-67) were recruited from a Federally Qualified Health Center in the Southside of Chicago who were identified with elevated breast cancer risk via a risk assessment tool. Women were asked to complete a survey that assessed their preferred method of receiving health information. Data were analyzed using SPSS software. To supplement the quantitative data, qualitative data were collected during two focus groups conducted with AA women aged 25-69 with a family history of breast cancer. Bivariate analyses were performed to determine women's preferences in receiving and accessing health information, and if these preferences differed by age (<40 and ≥40).
Results: The analytical sample consisted of 85 AA women with increased breast cancer risk. Sixty-nine women completed the surveys and 16 women attended focus group sessions. The majority of the study participants found reading materials (100%), listening to recordings (73%), and watching videos (96%) or animation (62%) were useful modes of receiving health information. There were no differences in these preferences by age groups. All women aged ≥40 years preferred receiving information explained by a person (p-value = 0.032). Most of the women had a cell phone with texting capabilities (90%). Seventy-eight percent of cell phone owners used their cell phone to access health information on the Internet, and 64% of these women were aged <40 years (p-value = 0.004). Other vital avenues of accessing health information that emerged from the focus groups included social media and health fairs.
Conclusion: Understanding African American women's preferences for receiving and accessing health information can inform development of interventions designed to improve adherence to cancer screening recommendations. Additional research is needed to better understand the impact that accessing health information through various media has on cancer screening rates.
Citation Format: Tera Ivy, Ifeanyi Chukwudozie, Vida Henderson, Silvia Tejeda, Ganga Vijayasiri, Catherine Balthazar, Robert Winn, Kent Hoskins. Examining preferential mode of obtaining health information in African American women with elevated risk for breast cancer [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A058.
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Affiliation(s)
- Tera Ivy
- 1Governors State University, University Park, IL,
| | | | | | | | | | | | - Robert Winn
- 2University of Illinois Cancer Center, Chicago, IL,
| | - Kent Hoskins
- 3University of Illinois at Chicago, Chicago, IL,
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Schwartz C, Chukwudozie IB, Tejeda S, Vijayasiri G, Abraham I, Remo MH, Shah HA, Ferrans CE, Warnecke R, Hoskins K. Mammography adherence among medically underserved women undergoing cancer genetic risk assessment. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1554 Background: Medically underserved women bear a disproportionate burden of breast cancer (BC) mortality. Early detection is vital for reducing BC deaths. Cancer genetic risk assessment (CGRA) provides an opportunity to identify women at highest risk so that risk-adapted screening can be implemented. The effect of CGRA on mammography adherence among underserved women is unknown. Methods: We conducted a study to test the feasibility of performing cancer genetic risk assessment (CGRA) as part of standard primary healthcare at two Federally Qualified Health Centers in Chicago, IL. Racial/ethnically diverse women age 25-69 without a personal history of BC underwent CGRA at the time of an annual well-visit and received the result from their PCP. Medical record review provided data on mammography adherence. Demographic data and measures of perceived BC risk, BC cultural beliefs, fatalism, and BC worry were collected with an enrollment survey. McNemar’s test compared the rate of adherence to screening mammography before and after implementation of CGRA, defined as completing a screening mammogram within 18 months prior to or following CGRA, resp., among women eligible for screening (age > 40 at study enrollment). Logistic regression models tested for associations between mammography adherence and demographic characteristics/health beliefs. Results: Data was available for 90 participants with increased BC risk (IR) who were eligible for screening and 98 eligible, average risk (AR) participants (in total, 61% black and 37% Latina). Overall, adherence improved from 38% at baseline to 49% following CGRA (p = 0.03). Adherence increased from 35% to 51% among IR participants (p = 0.04), and from 40% to 47% among AR participants (p = 0.39). Data on predictors of adherence will be presented. Conclusions: Implementing CGRA as a standard component of primary healthcare improved adherence to screening mammography among racial/ethnically diverse underserved women. The effect was seen primarily in those with increased risk. This intervention could be used to improve uptake of mammography in the subgroup of underserved women who benefit the most from screening.
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Affiliation(s)
- Candice Schwartz
- University of Illinois at Chicago College of Medicine, Division of Medical Oncology, Chicago, IL
| | | | - Silvia Tejeda
- Los Angeles County Department of Public Health, Los Angeles, CA
| | - Ganga Vijayasiri
- University of Michigan, Division of Geriatric & Palliative Medicine, Ann Arbor, MI
| | - Ivy Abraham
- University of Illinois at Chicago College of Medicine, Division of Medical Oncology, Chicago, IL
| | - Mylene Hernandez Remo
- University of Illinois at Chicago College of Medicine, Division of Medical Oncology, Chicago, IL
| | - Hiral A. Shah
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Richard Warnecke
- University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, IL
| | - Kent Hoskins
- University of Illinois at Chicago College of Medicine, Division of Medical Oncology, Chicago, IL
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Hoskins KF, Tejeda S, Vijayasiri G, Chukwudozie IB, Remo MH, Shah HA, Abraham IE, Balay LE, Maga TK, Searles ER, Korah VJ, Biggers A, Stolley MR, Warnecke RB. A feasibility study of breast cancer genetic risk assessment in a federally qualified health center. Cancer 2018; 124:3733-3741. [PMID: 30320429 PMCID: PMC6214782 DOI: 10.1002/cncr.31635] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND The US Preventive Services Task Force (USPSTF) endorses routine screening for genetic risk of breast and/or ovarian cancer as a component of primary health care. Implementation of this recommendation may prove challenging, especially in clinics serving disadvantaged communities. METHODS The authors tested the feasibility of implementing the USPSTF mandate at a federally qualified health center (FQHC) to identify women who were eligible for genetic counseling (GC). A 12-month usual-care phase was followed by a 12-month intervention phase, during which time cancer genetic risk assessment (CGRA) was systematically performed for all women aged 25 to 69 years who presented for an annual examination. Women who were eligible for GC were recruited to participate in the study. RESULTS After initiating CGRA, 112 women who were eligible for GC consented to study participation, and 56% of them received a referral for GC from their primary care physician. A subgroup of 50 participants were seen by the same primary care physician during both the usual-care and intervention phases. None of these patients was referred for GC during usual care, compared with 64% after the initiation of CGRA (P < .001). Only 16% of referred participants attended a GC session. CONCLUSIONS Implementing USPSTF recommendations for CGRA as a standard component of primary health care in FQHCs is feasible and improves referral of minority women for GC, but more work is needed to understand the beliefs and barriers that prevent many underserved women from accessing cancer genetic services.
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Affiliation(s)
- Kent F Hoskins
- Section of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Silvia Tejeda
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Ganga Vijayasiri
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Ifeanyi Beverly Chukwudozie
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Mylene H Remo
- Section of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Hiral A Shah
- Section of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Ivy E Abraham
- Section of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Lara E Balay
- Section of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Tara K Maga
- Section of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | | | | | - Alana Biggers
- Section of General Internal Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Melinda R Stolley
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Richard B Warnecke
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
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Vijayasiri G, Molina Y, Chukwudozie IB, Tejeda S, Pauls HA, Rauscher GH, Campbell RT, Warnecke RB. Racial Disparities in Breast Cancer Survival: The Mediating Effects of Macro-Social Context and Social Network Factors. J Health Dispar Res Pract 2018; 11:6. [PMID: 34026339 PMCID: PMC8136761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study attempts to clarify the associations between macro-social and social network factors and the continuing racial disparities in breast cancer survival. The study improves on prior methodologies by using a neighborhood disadvantage measure that assesses both economic and social disadvantage and an ego-network measurement tool that assesses key social network characteristics. Our population-based sample included 786 breast cancer patients (nHWhite=388; nHBlack=398) diagnosed during 2005-2008 in Chicago, IL. The data included census-derived macro-social context, self-reported social network, self-reported demographic and medically abstracted health measures. Mortality data from the National Death Index (NDI) were used to determine 5-year survival. Based on our findings, neighborhood concentrated disadvantage was negatively associated with survival among nHBlack and nHWhite breast cancer patients. In unadjusted models, social network size, network density, practical support, and financial support were positively associated with 5-year survival. However, in adjusted models only practical support was associated with 5-year survival. Our findings suggested that the association between network size and breast cancer survival is sensitive to scaling of the network measure, which helps to explain inconsistencies in past findings. Social networks of nHWhites and nHBlacks differed in size, social support dimensions, network density, and geographic proximity. Among social factors, residence in disadvantaged neighborhoods and unmet practical support explained some of the racial disparity in survival. Differences in late stage diagnosis and comorbidities between nHWhites and nHBlacks also explained some of the racial disparity in survival. Our findings highlight the relevance of social factors, both macro and inter-personal in the racial disparity in breast cancer survival. Findings suggest that reduced survival of nHBlack women is in part due to low social network resources and residence in socially and economically deprived neighborhoods. To improve survival among breast cancer patients social policies need to continue improving health care access as well as racially patterned social and economic disadvantage.
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Affiliation(s)
- Ganga Vijayasiri
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
| | - Yamile Molina
- School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612
| | - Ifeanyi Beverly Chukwudozie
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
| | - Silvia Tejeda
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
| | - Heather A. Pauls
- College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave, Chicago, IL 60612
| | - Garth H Rauscher
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
- School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612
| | - Richard T. Campbell
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
| | - Richard B. Warnecke
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
- School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612
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Tejeda S, Stolley MR, Vijayasiri G, Campbell RT, Estwing Ferrans C, Warnecke RB, Rauscher GH. Negative psychological consequences of breast cancer among recently diagnosed ethnically diverse women. Psychooncology 2017; 26:2245-2252. [PMID: 28499328 DOI: 10.1002/pon.4456] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/23/2017] [Accepted: 05/08/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Breast cancer has psychological consequences that impact quality of life. We examined factors associated with negative psychological consequences of a breast cancer diagnosis, in a diverse sample of 910 recently diagnosed patients (378 African American, 372 white, and 160 Latina). METHODS Patients completed an in-person interview as part of the Breast Cancer Care in Chicago study within an average of 4 months from diagnosis. The Cockburn negative psychological consequences of breast cancer screening scale was revised to focus on a breast cancer diagnosis. Path analysis assessed predictors of psychological consequences and potential mediators between race/ethnicity and psychological consequences. RESULTS Compared to white counterparts, bivariate analysis showed African American (β = 1.4, P < .05) and Latina (β = 3.6, P < .001) women reported greater psychological consequences. Strongest predictors (P < .05 for all) included unmet social support (β = .38), and provider trust (β = .12), followed by stage at diagnosis (β = .10) and perceived neighborhood social disorder (β = .09).The strongest mediator between race/ethnicity and psychological consequences was unmet social support. CONCLUSIONS African American and Latina women reported greater psychological consequences related to their breast cancer diagnosis; this disparity was mediated by differences in unmet social support. Social support represents a promising point of intervention.
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Affiliation(s)
- Silvia Tejeda
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Melinda R Stolley
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA.,Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ganga Vijayasiri
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Richard T Campbell
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA.,Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Carol Estwing Ferrans
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA.,Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Richard B Warnecke
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Garth H Rauscher
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA.,Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago (UIC), Chicago, IL, USA
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Tejeda S, Gallardo RI, Ferrans CE, Rauscher GH. Breast cancer delay in Latinas: the role of cultural beliefs and acculturation. J Behav Med 2016; 40:343-351. [PMID: 27572092 DOI: 10.1007/s10865-016-9789-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/22/2016] [Indexed: 01/07/2023]
Abstract
Cultural beliefs about breast cancer may act as a barrier to Latina women seeking preventive services or timely follow-up for breast symptoms regardless of access. This study examines the association between factors and breast cancer cultural beliefs and the extent to which cultural beliefs are associated with delays in breast cancer care. Participants who were Latina, ages 30-79, and had been diagnosed with a primary breast cancer were examined (n = 181). Interviews included a 15-item cultural beliefs scale spanning beliefs inconsistent with motivation to seek timely healthcare. Self-reported date of symptom discovery, date of first medical presentation, and date of first treatment were used to construct measures of prolonged patient, clinical, and total delay. Logistic regression with model-based standardization was used to estimate crude and confounder-adjusted prevalence differences for prolonged delay by number of cultural beliefs held. Women held a mean score of three cultural beliefs. The belief most commonly held was, "Faith in God can protect you from breast cancer" (48 %). Holding three or more cultural beliefs was associated with lower acculturation, lower socioeconomic status and less access to care (p < 0.01). After adjusting for age, education, income, acculturation, trust, and insurance, likelihood of prolonged total delay remained 21 percentage points higher in women who held a higher number cultural beliefs (p = 0.02). Cultural beliefs may predispose Latina women to prolong delays in seeking diagnosis and treatment for breast symptoms. Cultural beliefs represent a potential point of intervention to decrease delays among Latina breast cancer patients.
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Affiliation(s)
- Silvia Tejeda
- School of Public Health, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Rani I Gallardo
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Carol Estwing Ferrans
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Garth H Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street (M/C 923), Chicago, IL, 60612, USA.
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Macedo-Miranda G, Avila-Pérez P, Gil-Vargas P, Zarazúa G, Sánchez-Meza JC, Zepeda-Gómez C, Tejeda S. Accumulation of heavy metals in mosses: a biomonitoring study. Springerplus 2016; 5:715. [PMID: 27375984 PMCID: PMC4908085 DOI: 10.1186/s40064-016-2524-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 06/06/2016] [Indexed: 11/10/2022]
Abstract
The metropolitan area of the Toluca Valley (MATV) extends over an area of 1208.55 km(2) and has 1,361,500 inhabitants making it the fifth highest populated area in the country and the second highest in the state. The MATV has several environmental problems, with regards to the air quality. Particles PM10 and PM2.5 are considered to be the main pollutant due to these particles frequently exceeding the limit laid down in the standards of the air quality in the country. For this reason, samples of the mosses Fabriona ciliaris and Leskea angustata were collected at different sites in MATV, Mexico in order to establish the atmospheric deposition of heavy metals by means of the analysis of the mosses tissues. Results show the average metal concentrations in the mosses in the order of: Zn > Pb > Cr > Cd. The concentration capacities of heavy metals were higher in Fabriona ciliaris than Leskea angustata. Enrichment factors for Cr, Zn, Pb and Cd were obtained using the soils from the same sampling area. Enrichment factors results show that Cr is conservative in both sampling seasons with a terrigenous origin; Zn is moderately enriched in both sampling seasons and mainly associated to pedological-soil or substrate contribution and anthropogenic activities and Cd is highly enriched in the rainy season and Pb is highly enriched in both sampling seasons, with a predominantly anthropogenic origin. This study provides information to be considered in the strategies for similar environmental problems in the world.
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Affiliation(s)
- G Macedo-Miranda
- Laboratorio de Investigación en Ingeniería Ambiental, Instituto Tecnológico de Toluca, Av. Tecnológico S/N, Colonia Ex-Rancho La Virgen, 52140 Metepec, Estado de México Mexico
| | - P Avila-Pérez
- Laboratorio de Investigación en Ingeniería Ambiental, Instituto Tecnológico de Toluca, Av. Tecnológico S/N, Colonia Ex-Rancho La Virgen, 52140 Metepec, Estado de México Mexico ; Instituto Nacional de Investigaciones Nucleares, Dirección de Investigación Tecnológica, Apartado Postal 18-1027, 11801 México, D.F. Mexico
| | - P Gil-Vargas
- Laboratorio de Investigación en Ingeniería Ambiental, Instituto Tecnológico de Toluca, Av. Tecnológico S/N, Colonia Ex-Rancho La Virgen, 52140 Metepec, Estado de México Mexico ; Instituto Nacional de Investigaciones Nucleares, Dirección de Investigación Tecnológica, Apartado Postal 18-1027, 11801 México, D.F. Mexico
| | - G Zarazúa
- Instituto Nacional de Investigaciones Nucleares, Dirección de Investigación Tecnológica, Apartado Postal 18-1027, 11801 México, D.F. Mexico
| | - J C Sánchez-Meza
- Facultad de Química, Universidad Autónoma del Estado de México, Instituto Literario 100, 50000 Toluca, Estado De México Mexico
| | - C Zepeda-Gómez
- Facultad de Ciencias, Universidad Autónoma del Estado de México, Instituto Literario 100, 50000 Toluca, Estado De México Mexico
| | - S Tejeda
- Instituto Nacional de Investigaciones Nucleares, Dirección de Investigación Tecnológica, Apartado Postal 18-1027, 11801 México, D.F. Mexico
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Anderson EE, Tejeda S, Childers K, Stolley MR, Warnecke RB, Hoskins KF. Breast Cancer Risk Assessment Among Low-Income Women of Color in Primary Care: A Pilot Study. J Oncol Pract 2015; 11:e460-7. [PMID: 26036266 PMCID: PMC4507393 DOI: 10.1200/jop.2014.003558] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE The US Preventive Services Task Force recommends identifying candidates for breast cancer (BC) chemoprevention and referring them for genetic counseling as part of routine care. Little is known about the feasibility of implementing these recommendations or how low-income women of color might respond to individualized risk assessment (IRA) performed by primary care providers (PCPs). METHODS Women recruited from a federally qualified health center were given the option to discuss BC risk status with their PCP. Comprehensive IRA was performed using a software tool designed for the primary care environment combining three assessment instruments and providing risk-adapted recommendations for screening, prevention, and genetic referral. Logistic regression models assessed factors associated with wanting to learn and discuss BC risk with PCP. RESULTS Of 237 participants, only 12.7% (n = 30) did not want to discuss IRA results with their PCP. Factors associated with lower odds of wanting to learn results included having private insurance and reporting ever having had a mammogram. Factors associated with higher odds of wanting to learn results included older age (50 to 69 years) and increased BC worry. For all women wishing to learn results, IRA was successfully completed and delivered to the PCP immediately before the encounter for incorporation into the well-visit evaluation. CONCLUSION Incorporation of US Preventive Services Task Force recommendations as part of routine primary care is feasible. Interest in IRA seems high among underserved women. This approach warrants further investigation as a strategy for addressing disparities in BC mortality.
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Affiliation(s)
- Emily E Anderson
- Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, Maywood; College of Medicine, University of Illinois at Chicago; Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI; and Disney Family Center at Providence St Joseph Medical Center, Burbank, CA
| | - Silvia Tejeda
- Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, Maywood; College of Medicine, University of Illinois at Chicago; Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI; and Disney Family Center at Providence St Joseph Medical Center, Burbank, CA
| | - Kimberly Childers
- Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, Maywood; College of Medicine, University of Illinois at Chicago; Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI; and Disney Family Center at Providence St Joseph Medical Center, Burbank, CA
| | - Melinda R Stolley
- Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, Maywood; College of Medicine, University of Illinois at Chicago; Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI; and Disney Family Center at Providence St Joseph Medical Center, Burbank, CA
| | - Richard B Warnecke
- Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, Maywood; College of Medicine, University of Illinois at Chicago; Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI; and Disney Family Center at Providence St Joseph Medical Center, Burbank, CA
| | - Kent F Hoskins
- Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, Maywood; College of Medicine, University of Illinois at Chicago; Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI; and Disney Family Center at Providence St Joseph Medical Center, Burbank, CA
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11
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Martinez T, Tejeda S, Lartigue J, Zarazua G, Avila-Perez P, Ramos A, Navarrete M, Mulller G. Chemical composition of marine sediments in the Pacific Ocean from Sinaloa to Jalisco, Mexico. J Radioanal Nucl Chem 2014. [DOI: 10.1007/s10967-013-2704-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Tejeda S, Darnell JS, Cho YI, Stolley MR, Markossian TW, Calhoun EA. Patient barriers to follow-up care for breast and cervical cancer abnormalities. J Womens Health (Larchmt) 2013; 22:507-17. [PMID: 23672296 DOI: 10.1089/jwh.2012.3590] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Women with breast or cervical cancer abnormalities can experience barriers to timely follow-up care, resulting in delays in cancer diagnosis. Patient navigation programs that identify and remove barriers to ensure timely receipt of care are proliferating nationally. The study used a systematic framework to describe barriers, including differences between African American and Latina women; to determine recurrence of barriers; and to examine factors associated with barriers to follow-up care. METHODS Data originated from 250 women in the intervention arm of the Chicago Patient Navigation Research Program (PNRP). The women had abnormal cancer screening findings and navigator encounters. Women were recruited from a community health center and a publicly owned medical center. After describing proportions of African American and Latina women experiencing particular barriers, logistic regression was used to explore associations between patient characteristics, such as race/ethnicity, and type of barriers. RESULTS The most frequent barriers occurred at the intrapersonal level (e.g., insurance issues and fear), while institutional-level barriers such as system problems with scheduling care were the most commonly recurring over time (29%). The majority of barriers (58%) were reported in the first navigator encounter. Latinas (81%) reported barriers more often than African American women (19%). Differences in race/ethnicity and employment status were associated with types of barriers. Compared to African American women, Latinas were more likely to report an intrapersonal level barrier. Unemployed women were more likely to report an institutional level barrier. CONCLUSION In a sample of highly vulnerable women, there is no single characteristic (e.g., uninsured) that predicts what kinds of barriers a woman is likely to have. Nevertheless, navigators appear able to easily resolve intrapersonal-level barriers, but ongoing navigation is needed to address system-level barriers. Patient navigation programs can adopt the PNRP barriers framework to assist their efforts in assuring timely follow-up care.
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Affiliation(s)
- Silvia Tejeda
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois 60608, USA.
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13
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Tejeda S, Thompson B, Coronado GD, Martin DP, Heagerty PJ. Predisposing and enabling factors associated with mammography use among Hispanic and non-Hispanic white women living in a rural area. J Rural Health 2009; 25:85-92. [PMID: 19166566 DOI: 10.1111/j.1748-0361.2009.00203.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Women who do not receive regular mammograms are more likely than others to have breast cancer diagnosed at an advanced stage. PURPOSE To examine predisposing and enabling factors associated with mammography use among Hispanic and non-Hispanic White women. METHODS Baseline data were used from a larger study on cancer prevention in rural Washington state. In a sample of 20 communities, 537 women formed the sample for this study. The main outcomes were ever having had a mammogram and having had a mammogram within the past 2 years. FINDINGS Reporting ever having had a mammogram was inversely associated with lack of health insurance (OR = 0.37, 95% CI: 0.16-0.84), ages under 50 years (OR = 0.23, 95% CI: 0.12-0.45), high cost of exams (OR = 0.48, 95% CI: 0.27-0.87), and lack of mammography knowledge (OR = 0.16, 95% CI: 0.07-0.37), while increasing education levels were positively associated (OR = 1.72, 95% CI: 1.09-2.70). Reporting mammography use within the past 2 years was inversely associated with ages under 50 years (OR = 0.49, 95% CI: 0.27-0.88) and over 70 years (OR = 0.47, 95% CI: 0.24-0.94), lack of health insurance (OR = 0.23, 95% CI: 0.10-0.50), and high cost of exams (OR = 0.55, 95% CI: 0.35-0.87). CONCLUSIONS Continued resources and programs for cancer screening are needed to improve mammography participation among women without health insurance or low levels of education.
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Affiliation(s)
- Silvia Tejeda
- Program for Cancer Control and Population Science, University of Illinois, Chicago, Ill 60608, USA.
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14
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Macedo-Miranda MG, Zarazua G, Mejía-Zarate E, Avila-Pérez P, Barrientos-Becerra B, Tejeda S. Simultaneous determination of elemental content in water samples by total reflection X-ray fluorescence and atomic absorption spectrometry. J Radioanal Nucl Chem 2009. [DOI: 10.1007/s10967-009-0539-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Martinez T, Lartigue J, Avila-Perez P, Carapio-Morales L, Zarazua G, Navarrete M, Tejeda S, Cabrera L. Characterization of particulate matter from the Metropolitan Zone of the Valley of Mexico by scanning electron microscopy and energy dispersive X-ray analysis. J Radioanal Nucl Chem 2008. [DOI: 10.1007/s10967-008-0635-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Coronado GD, Thompson B, Tejeda S, Godina R, Chen L. Sociodemographic factors and self-management practices related to type 2 diabetes among Hispanics and non-Hispanic whites in a rural setting. J Rural Health 2007; 23:49-54. [PMID: 17300478 DOI: 10.1111/j.1748-0361.2006.00067.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
CONTEXT Hispanics in the United States have a higher prevalence of non-insulin-dependent diabetes mellitus (type 2 diabetes) and experience more complications for the disease than non-Hispanic whites. Differences in medical management or self-management practices may, in part, explain the relative high risk for diabetes complications among Hispanics. PURPOSE Using data from a community-randomized intervention study on cancer prevention, we examined the medical management and self-management practices of Hispanics and non-Hispanic whites who have diabetes. METHODS Locally hired bilingual personnel conducted in-person interviews of a random selection of 1,863 adults in 20 communities in the Yakima Valley of eastern Washington State. FINDINGS A total of 70 Hispanics (11% age-adjusted prevalence) and 87 non-Hispanic whites (7.3% age-adjusted prevalence) reported having type 2 diabetes. Hispanics with a high level of acculturation were slightly more likely to have diabetes, compared to those with a low level of acculturation, though the association was nonsignificant. Hispanics were significantly less likely than non-Hispanic whites to treat their diabetes with diet and exercise (36% vs 61.3%; P < or = .001). Annual eye examinations were less commonly reported among Hispanics (48.9%) than among non-Hispanic whites (72.7%). CONCLUSIONS Our data indicate that Hispanics engage less frequently in self-management practices to control diabetes than non-Hispanic whites.
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Affiliation(s)
- Gloria D Coronado
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
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Tejeda S, Thompson B, Coronado GD, Rees JM. A cervical cancer curriculum for Hispanic adolescents in rural high schools: a pilot study. J Health Care Poor Underserved 2007; 17:734-44. [PMID: 17242527 DOI: 10.1353/hpu.2006.0136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We assessed the effectiveness of a one-hour curriculum about cervical cancer for high school students. The curriculum was developed and delivered to 142 female students in the 9th to 12th grade at two high schools in rural Eastern Washington State. Self-administered questionnaires assessed changes in knowledge, beliefs, and attitudes related to cervical cancer and Pap smears. Baseline results from a predominantly Hispanic adolescent sample (73%) indicated low pre-test knowledge and negative beliefs and attitudes. Post-test results indicated that there was a significant change in the intervention group for knowledge questions when compared with the control group. Only some changes to more positive beliefs and attitudes about cervical cancer and screening were significant in the post-test. The findings suggest that a culturally appropriate high school curriculum may inform young Hispanic women about important cervical cancer screening practices.
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Affiliation(s)
- Silvia Tejeda
- University of Washington School of Public Health and Community Medicine, Seattle, USA
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Martinez T, Lartigue J, Avila-Perez P, Zarazua G, Navarrete M, Tejeda S, Ramírez A. Determination of trace elements in blood samples by TXRF analysis. J Radioanal Nucl Chem 2004. [DOI: 10.1023/b:jrnc.0000020928.45385.5f] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
Hispanics in the United States have a disproportionately high risk for non-insulin-dependent diabetes mellitus (type 2 diabetes) compared with non-Hispanic whites. Little is known of the attitudes and beliefs about diabetes in this group. Using data from six focus groups of 42 Mexican Americans (14 men and 28 women), we characterized perceptions about the causes of and treatments for type 2 diabetes. Many participants believed diabetes is caused by having a family history of the disease, eating a diet high in fat or sugar, and engaging in minimal exercise. Experiencing strong emotions such as fright (susto), intense anger (coraje), or sadness and depression (tristeza) was also thought to precipitate diabetes. Nearly all participants expressed the belief that it is important to follow doctors' recommendations for diet and exercise, oral medication or insulin; many also cited herbal therapies, such as prickly pear cactus (nopal) and aloe vera (savila) as effective treatments. These findings may be useful in designing interventions to reduce the burden of diabetes in Hispanic populations.
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Affiliation(s)
- Gloria D Coronado
- Cancer Prevention Program, the Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Tejeda S. [Oxyphenbutazone in pediatrics. Acute infection of the upper portion of the respiratory tract]. Prensa Med Mex 1972; 37:236-8. [PMID: 5069463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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