Fear, fatalism and breast cancer screening in low-income African-American women: the role of clinicians and the health care system.
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ABSTRACT:
SUBMITTER: Peek ME
PROVIDER: S-EPMC2585682 | biostudies-other | 2008 Nov
REPOSITORIES: biostudies-other
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Project description:BackgroundLittle is known about health care and service utilization patterns among low-income African-American women, particularly those who report intimate partner violence (IPV).Objectives(1) Identify utilization patterns among low-income African-American women. (2) Demonstrate utilization differences by IPV status.ParticipantsOne hundred and fifty-three African-American women from medical care clinics at a large inner-city public hospital.DesignCase-control study. Predictor variable IPV assessed by the Index of Spouse Abuse. Outcome variables, health care, and service utilization, determined using the Adult Service Utilization Form.ResultsOf the 153 participants, 68 reported high IPV levels. The mean age was 32 years, majority were poor and unemployed, and 15.7% were homeless. The overall utilization rates were low. When controlled for homelessness and relationship status, high IPV levels were associated with greater psychiatric outpatient utilization. We found differences in the use of other medical or community services by IPV group.ConclusionsWomen reporting high IPV levels are more likely to receive mental health services than women reporting low IPV levels, but may not have access to other needed services. Primary care providers should assess the mental health, legal, and social service needs of abused women, which will facilitate receipt of services.
| S-EPMC1484669 | biostudies-literature
Project description:Study objectivesThe current study examined the prevalence and correlates of obstructive sleep apnea in a sample of low-income, predominantly African-American women using two waves of data.MethodsParticipants were adults from two urban neighborhoods who enrolled in the PHRESH Zzz Study (N = 828; Pittsburgh Hill/Homewood Research on Neighborhoods, Sleep, and Health). A subsample who reported never receiving OSA diagnosis completed home sleep apnea testing in 2016 (n = 269, mean age 55.0 years, 79.6% female) and again in 2018 (n = 135). Correlates of OSA tested included demographic and anthropometric variables, health behavior/conditions, psychological distress and general health, smoking status, actigraphy-measured sleep, and neighborhood factors measured at baseline.Results18.0% of all 2016 participants reported receiving physician diagnoses of OSA. Among those who completed in-home assessment, 19.3% had AHI ≥15 and 33.8% had AHI ≥5 plus one or more sleep symptoms. Estimates of the prevalence of OSA in all 2016 participants were 33.8%-45.7% based on physician diagnoses and AHI results, depending on the criteria used. Age, gender, BMI, blood pressure, habitual snoring, neighborhood walkability, actigraphy-measured sleep characteristics, and smoking were concurrently associated with OSA in 2016. Changes in AHI categories from 2016 to 2018 were documented.ConclusionsLow-income African Americans, including women, are a high-risk group for OSA, but remain under-diagnosed and under-treated. The current findings show a high prevalence of OSA in African-American women and are among the first to demonstrate that both individual and neighborhood factors are implicated in OSA prevalence.
| S-EPMC8329940 | biostudies-literature
Project description:A history of childhood trauma has been found to have a robust influence on juvenile delinquency, and evidence suggests that childhood sexual abuse is particularly common among female youth involved in the juvenile justice system. The current study sought to investigate impulsivity as a potential mediator of the relationship between childhood sexual abuse (CSA) and juvenile incarceration amongst a community sample of low-income, urban, African American adult women. Although impulsivity has been studied among justice-involved youth, few studies have examined the influence of impulsivity within the relationship between CSA and juvenile incarceration and no known studies have explored their relationship in community populations of African American women with histories of juvenile incarceration. Results revealed that impulsivity mediated the relationship between CSA and previous juvenile incarceration. As an exploratory analysis, overall emotion dysregulation as well as other facets of emotion dysregulation did not serve as significant mediators in this relationship. These findings suggest that difficulties in impulse control may be one mechanism through which childhood sexual abuse increases risk for juvenile justice system involvement among African American women.
| S-EPMC8171029 | biostudies-literature
Project description:Bronx County, New York is the poorest urban county in the U.S.A., and residents are almost entirely Latino or African American. Cancer is the leading cause of premature death in the Bronx, with morality rates significantly higher than for New York City as a whole. Low-income/minority populations are more likely to be diagnosed with preventable and late-stage cancers than the general population, in part, due to lower screening rates. While research has addressed screening barriers in low-income/minority groups, depression, a common,potentially critical barrier, has received scant attention. Research suggests that depressed women are less likely to engage in cancer screening, especially mammography and Pap testing. The link between mental health and cancer screening is particularly important to address in the Bronx, which has the highest rates of self-reported serious psychological distress (a measure closely related to depression) in New York City. Depression affects almost 1 in 4 minority women, and while minorities often seek help for depression in primary care, primary care depression management often does not meet evidence-based standards. Drawing on the expertise and close collaboration of Bronx medical and social service providers and patient stakeholders, this study will determine whether a collaborative care intervention that addresses both depression and cancer screening needs simultaneously among women ages 50-64 is more effective at improving cancer screening and patient-reported outcomes for women with depression than an existing evidence-based cancer screening intervention alone.
To achieve this, the investigators will compare the effectiveness of these two interventions using a randomized controlled trial (RCT). In partnership with six Bronx Federally Qualified Health Centers (FQHCs), the investigators will recruit approximately 800 women ages 50-64 who screen positive for depression and are non-adherent with recommended cervical, breast, and/or colorectal cancer screenings. The investigators specific aims are to: 1) compare the impact of the two interventions on patient-reported outcomes, including cancer screening knowledge and attitudes, self-efficacy, depression-related stigma, provider referrals, participation in mental health care, medication adherence, quality of life, satisfaction with care and treatment decisions, and depression; 2) compare the effectiveness of the two interventions in increasing breast, cervical, and colorectal cancer screening; 3) determine whether reducing depression increases the likelihood that low-income women 50-64 will receive cancer screening; 4) determine whether effectiveness of the two interventions in increasing cancer screening varies according to patient characteristics, such as duration of depression, presence of other chronic conditions, and obesity.
This study is designed to increase the investigators understanding of how to enhance primary care systems’ ability to improve a range of outcomes related to cancer screening and depression among low-income minority women, and how to best support this population in making cancer-screening decisions.
| 2176921 | ecrin-mdr-crc
Project description:BackgroundCigarette smoking is a common risk factor for diseases and cancers. Oral microbiota is also associated with diseases and cancers. However, little is known about the impact of cigarette smoking on the oral microbiota, especially among ethnic minority populations.MethodsWe investigated cigarette smoking in relationship with the oral microbiota in a large population of predominately low-income and African-American participants. Mouth rinse samples were collected from 1616 participants within the Southern Community Cohort Study, including 592 current-smokers, 477 former-smokers and 547 never-smokers. Oral microbiota was profiled by 16S ribosomal RNA gene deep sequencing.ResultsCurrent-smokers showed a different overall microbial composition from former-smokers (p=6.62×10-7) and never-smokers (p=6.00×10-8). The two probiotic genera, Bifidobacterium and Lactobacillus, were enriched among current-smokers when compared with never-smokers, with Bonferroni-corrected p values (PBonferroni ) of 1.28×10-4 and 5.89×10-7, respectively. The phylum Actinobacteria was also enriched in current-smokers when compared with never-smokers, with a median relative abundance of 12.35% versus 9.36%, respectively, and with a PBonferroni =9.11×10-11. In contrast, the phylum Proteobacteria was depleted in current smokers (PBonferroni =5.57×10-13), with the relative abundance being almost three times that of never-smokers (7.22%) when compared with that of current-smokers (2.47%). Multiple taxa within these two phyla showed differences in abundance/prevalence between current-smokers and never-smokers at PBonferroni <0.05. The differences in the overall microbial composition and abundance/prevalence of most taxa were observed among both African-Americans and European-Americans. Meanwhile, such differences were not observed between former-smokers and never-smokers.ConclusionSmoking has strong impacts on oral microbial community, which was recovered after smoking cessation.
| S-EPMC6913090 | biostudies-literature
Project description:Researchers have long observed that problem behaviors tend to cluster together, particularly among adolescents. Epidemiological studies have suggested that this covariation is due, in part, to common genetic influences, and a number of plausible candidates have emerged as targets for investigation. To date, however, genetic association studies of these behaviors have focused mostly on unidimensional models of individual phenotypes within European American samples. Herein, we compared a series of confirmatory factor models to best characterize the structure of problem behavior (alcohol and marijuana use, sexual behavior, and disruptive behavior) within a representative community-based sample of 592 low-income African American adolescents (50.3% female), ages 13 to 18. We further explored the extent to which 3 genes previously implicated for their role in similar behavioral dimensions (CHRM2, GABRA2, and OPRM1) independently accounted for variance within factors specified in the best-fitting model. Supplementary analyses were conducted to derive comparative estimates for the predictive utility of these genes in more traditional unidimensional models. Findings provide initial evidence for a bifactor structure of problem behavior among African American adolescents and highlight novel genetic correlates of specific behavioral dimensions otherwise undetected in an orthogonal syndromal factor. Implications of this approach include increased precision in the assessment of problem behavior, with corresponding increases in the reliability and validity of identified genetic associations. As a corollary, the comparison of primary and supplementary association analyses illustrates the potential for overlooking and/or overinterpreting meaningful genetic effects when failing to adequately account for phenotypic complexity.
| S-EPMC4851603 | biostudies-literature
Project description:BackgroundChronic stress increases the risk of excess intake of calorie-dense foods. Low-income minority caregivers in the United States are cumulatively exposed to stressors and unhealthy foods, but evidence of this association is limited in this population group. The objective of the current study was to assess the association between chronic stress and unhealthy dietary behaviors among low-income African-American caregivers in Detroit, Michigan.MethodsData came from Detroit Dental Health Project, a longitudinal study of pairs of African-American caregivers and children during 2002-2007. A sample of 912 female caregivers were included and their baseline (2002-2003) survey responses were analyzed to identify those with chronic stress and patterns of dietary behaviors. The likelihood of having unhealthy dietary behaviors was compared between chronically stressed caregivers and others, and the mediator role of depressive symptoms or current smoking was tested.ResultsApproximately 10% of caregivers experienced chronic stress as they all reported discrimination, residential movement, and lack of social support. Twenty-five percent of the caregivers were found to have an unhealthy dietary pattern characterized by excess intake of high fatty foods and soda. Chronically stressed caregivers were more likely to exhibit unhealthy dietary behaviors (prevalence ratio: 1.39; 95% CI: 1.05, 1.84), and this relation was significantly mediated by depressive symptoms, not current smoking.ConclusionsThese findings suggest that chronic stress played a role in negatively influencing dietary behaviors. As this association might be mediated by depressive symptoms, an intervention to reduce depressive symptoms can be considered as an effective strategy to promote healthy dietary behaviors among chronically stressed minority caregivers.
| S-EPMC7085306 | biostudies-literature
Project description:ObjectiveMedicaid coverage for low-income women may play an important role in ensuring access to preventive care. This study examines how Medicaid eligibility expansions to nonelderly adults impact cervical cancer screening among low-income women.Data sourcesWe use data from the Behavioral Risk Factor Surveillance System from 2000 to 2010. The primary outcome of interest is whether women in the relevant guideline consistent age range reported having a Pap test in the previous year.Study designWe use a difference-in-differences approach with matched treatment and comparison states and a simulated eligibility approach based on a continuous measure of Medicaid generosity.Principal findingsOur results indicate that cervical cancer screening increased among low-income women in expansion states relative to comparison states. Increases in screening rates are largest among low-income Hispanic women.ConclusionsMedicaid expansions during the period from 2000 to 2010 were associated with improved cervical cancer screening rates, which is critical for early cervical cancer detection and prevention of cancer morbidity and mortality in women. The results suggest that more widespread Medicaid expansions may have positive effects on preventive health care for women.
| S-EPMC6056586 | biostudies-literature
Project description:PURPOSE:Breast cancer mortality rates are higher for African American women (AAW) than for any other ethnic group in the United States. Recent reports suggest that outcome disparities between AAW and European American women (EAW) are present in the ER+HER2- subtype. To improve our understanding, pathological characteristics, mortality and molecular profiles from women treated within an equal-access health care system were evaluated. PROCEDURES:All AAW (n=90) and EAW (n=308) with ER+HER2- tumors were identified. Gene expression profiles were generated from primary breast tumors from 57 AAW and 181 EAW. Pathological characteristics, survival and gene expression analysis were evaluated using chi-square analysis, log-rank tests and ANOVA. RESULTS:Tumors from AAW were significantly more likely to be PR-, Ki67+ and of higher grade. Tumor stage, size and lymph node status did not differ significantly, nor did mortality rates (P=.879). At the molecular level, genes PSPHL and CRYBB2P1 were expressed at significantly higher levels in tumor tissues as well as normal stroma and blood from AAW. Polymorphisms controlling expression of each gene were identified with minor allele frequencies differing significantly between populations but not between cases and controls within each population. CONCLUSIONS:Survival disparities were not detected in patients with ER+HER2- tumors treated within an equal-access health care system and molecular differences in tumors were not causal. Thus, outcome disparities in AAW with ER+HER2- tumors are largely attributable to socioeconomic factors affecting access to screening and treatment, rather than reflecting underlying biological differences.
| S-EPMC4948809 | biostudies-literature
Project description:Infant feeding is a well-established topic of interest in obesity research, yet few studies have focused on contributions of nonmaternal caregivers (NMCs)-such as fathers, grandparents, and daycare providers-to infant feeding. Data from the Infant Care, Feeding and Risk of Obesity Project in North Carolina were used to investigate (a) which factors were associated with NMC feeding styles and (b) how NMCs' and mothers' feeding styles compared. Multivariate regression models utilizing random effects were used to analyse data from 108 NMCs who were identified by mothers as being heavily involved in infant feeding. Feeding styles were measured using the Infant Feeding Style Questionnaire. Several individual characteristics were important. Higher laissez faire-attention scores were reported by men and NMCs who lived in the same household as infant. Men reported higher indulgent-coax and indulgent-pamper scores. Perceptions of fussier infants, older infant age, and higher infant weight-for-length z-scores were also important. Mothers' and NMCs' feeding styles differed. Compared with mothers, grandparents reported lower laissez faire and indulgent-permissive scores. Fathers reported higher pressure-soothe and indulgent scores. Daycare providers reported higher restriction-diet quality and responsive satiety. Feeding styles were also predicted to change over time for all caregiver types. These findings highlight the importance of helping all caregivers develop skills that will promote optimal infant feeding outcomes. Given the paucity of research in this area, it is important to improve our understanding of what influences caregivers' feeding styles, especially among diverse populations, and how exposure to different feeding styles may shape children's obesity risk.
| S-EPMC6156936 | biostudies-literature