Self-stigma, Stress, and Smoking among African American and American Indian Female Smokers: An Exploratory Qualitative Study

Research suggests that negative emotions and difficulty coping with stressful events might impede women’s ability to quit smoking. This study uses qualitative methods to explore interrelationships between smoking behavior and negative emotions among a sample of racial/ethnic minority female smokers with the aims of theory-building and hypothesis generation. Data were derived from a larger study involving sixteen focus groups with current and former smokers from ethnic minority communities. The present study consisted of three focus groups of female African American and American Indian smokers (N = 16). Data was analyzed following standard methods for in vivo coding of qualitative data. Consistent with prior research, participants reported using smoking as a tool to cope with stress and negative emotions. Deprivation from smoking was associated with negative states such as anger, irritability, and distress. However, continued smoking was also a source of negative emotion, as women felt shame, guilt and low self-esteem over their inability to quit, which was perceived by some as indicative of weakness. These negative self-perceptions are consistent with stigmatized views of smokers held by the public. Women also expressed feelings of defiance about their smoking despite pressure to quit and identified external factors which contributed to their inability to quit. The negative emotions, self-stigma and shame experienced by low income American Indian and African American women smokers may contribute to continued smoking and disrupt quit attempts. Additional research is needed in order to develop effective tobacco cessation interventions for this group

Barriers, control and identity in health information seeking among African American women

Qualitative research methods were used to examine the role of racial, cultural, and socio-economic group (i.e., communal) identities on perceptions of barriers and control related to traditional and internet resources for seeking health information. Eighteen lower income, African American women participated in training workshops on using the internet for health, followed by two focus groups. Transcripts were analyzed using standardized coding methods. Results demonstrated that participants perceived the internet as a tool for seeking health information, which they believed would empower them within formal healthcare settings. Participants invoked racial, cultural, and socio-economic identities when discussing barriers to seeking health information within healthcare systems and the internet. The findings indicate that the internet may be a valuable tool for accessing health information among lower income African American women if barriers are reduced. Recommendations are made that may assist health providers in improving health information seeking outcomes of African American women

Association between pain outcomes and race and opioid treatment: Retrospective cohort study of Veterans

We examined whether pain outcomes (pain interference, perceived pain treatment effectiveness) vary by race and then whether opioid use moderates these associations. These analyses are part of a retrospective cohort study among 3,505 black and 46,203 non-Hispanic, white Department of Veterans Affairs (VA) patients with diagnoses of chronic musculoskeletal pain who responded to the 2007 VA Survey of Healthcare Experiences of Patients (SHEP). We used electronic medical record data to identify prescriptions for pharmacologic pain treatments in the year after diagnosis (Pain Diagnosis index visit) and before the SHEP index visit (the visit that made one eligible to complete the SHEP); pain outcomes came from the SHEP. We found no significant associations between race and pain interference or perceived effectiveness of pain treatment. VA patients with opioid prescriptions between the Pain Diagnosis index visit and the SHEP index visit reported greater pain interference on the SHEP than those without opioid prescriptions during that period. Opioid prescriptions were not associated with perceived treatment effectiveness for most patients. Findings raise questions about benefits of opioids for musculoskeletal pain and point to the need for alternative treatments for addressing chronic noncancer pain

The Relationship Between Race, Patient Activation, and Working Alliance: Implications for Patient Engagement in Mental Health Care

This study explored the relationship between race and two key aspects of patient engagement—patient activation and working alliance—among a sample of African-American and White veterans (N = 152) seeking medication management for mental health conditions. After adjusting for demographics, race was significantly associated with patient activation, working alliance, and medication adherence scores. Patient activation was also associated with working alliance. These results provide support for the consideration of race and ethnicity in facilitating patient engagement and patient activation in mental healthcare. Minority patients may benefit from targeted efforts to improve their active engagement in mental healthcare

Quantifying lexical usage: vocabulary pertaining to ecosystems and the environment

A recent development in corpus linguistics has been the integration of critical discourse methodologies, which allow in-depth contextual and qualitative analyses, with corpus linguistic methodologies, which allow broader quantitative analyses. Our study is a contribution to this approach. We present the methods used in a study of vocabulary pertaining to the environment, undertaken as part of the UK National Ecosystem Assessment. A clear and replicable methodology was developed and applied to three custom-built specialised web corpora and a reference web corpus; automatic analysis of collocations found using the Sketch Engine was complemented by manual analysis; and a small-scale replicability check was carried out to ensure that investigator divergence was minimal. We outline the approach and some of the key findings, and we also suggest areas for further refinement/investigation. </jats:p

Contribution of patient, physician, and environmental factors to demographic and health variation in colonoscopy follow-up for abnormal colorectal cancer screening test results

BACKGROUND: Patient, physician, and environmental factors were identified, and the authors examined the contribution of these factors to demographic and health variation in colonoscopy follow-up after a positive fecal occult blood test/fecal immunochemical test (FOBT/FIT) screening. METHODS: In total, 76,243 FOBT/FIT-positive patients were identified from 120 Veterans Health Administration (VHA) facilities between August 16, 2009 and March 20, 2011 and were followed for 6 months. Patient demographic (race/ethnicity, sex, age, marital status) and health characteristics (comorbidities), physician characteristics (training level, whether primary care provider) and behaviors (inappropriate FOBT/FIT screening), and environmental factors (geographic access, facility type) were identified from VHA administrative records. Patient behaviors (refusal, private sector colonoscopy use) were estimated with statistical text mining conducted on clinic notes, and follow-up predictors and adjusted rates were estimated using hierarchical logistic regression. RESULTS: Roughly 50% of individuals completed a colonoscopy at a VHA facility within 6 months. Age and comorbidity score were negatively associated with follow-up. Blacks were more likely to receive follow-up than whites. Environmental factors attenuated but did not fully account for these differences. Patient behaviors (refusal, private sector colonoscopy use) and physician behaviors (inappropriate screening) fully accounted for the small reverse race disparity and attenuated variation by age and comorbidity score. Patient behaviors (refusal and private sector colonoscopy use) contributed more to variation in follow-up rates than physician behaviors (inappropriate screening). CONCLUSIONS: In the VHA, blacks are more likely to receive colonoscopy follow-up for positive FOBT/FIT results than whites, and follow-up rates markedly decline with advancing age and comorbidity burden. Patient and physician behaviors explain race variation in follow-up rates and contribute to variation by age and comorbidity burden. Cancer 2017;123:3502-12. Published 2017. This article is a US Government work and is in the public domain in the USA

Veterans’ perceptions of racial bias in VA mental healthcare and their impacts on patient engagement and patient-provider communication

Objectives Drawing from social identity threat theory, which posits that stigmatized groups are attuned to situational cues that signal racial bias, we examined how African-American veterans evaluate verbal and non-verbal cues in their mental health encounters. We also explored how their evaluations of perceived racial bias might influence their healthcare engagement behaviors and communication. Methods We interviewed 85 African-American veterans who were receiving mental health services from the US Department of Veterans Affairs (VA), examining their views and experiences of race in healthcare. We analyzed the data using a constructivist grounded theory approach. Results Participants identified several identity threatening cues that include lack of racial diversity representation in healthcare settings, and perceptions of providers’ fears of Black patients. We describe how participants evaluated situational cues as identity threats, and how these cues affected their engagement behaviors and healthcare communication. Conclusion Our findings revealed situational cues within clinical encounters that create for Black veterans, fear of being negatively judged based on stereotypes that have characterized African-Americans

Gender Differences in Demographic and Clinical Correlates among Veterans with Musculoskeletal Disorders

Background Studies suggest that women may be at greater risk for developing chronic pain and pain-related disability. Methods Because musculoskeletal disorders (MSD) are the most frequently endorsed painful conditions among veterans, we sought to characterize gender differences in sociodemographic and clinical correlates among veterans upon entry into Veterans Health Administration's Musculoskeletal Disorders Cohort (n = 4,128,008). Results Women were more likely to be younger, Black, unmarried, and veterans of recent conflicts. In analyses adjusted for gender differences in sociodemographics, women were more likely to have diagnoses of fibromyalgia, temporomandibular disorders, and neck pain. Almost one in five women (19.4%) had more than one MSD diagnosis, compared with 15.7% of men; this higher risk of MSD multimorbidity remained in adjusted analyses. Adjusting for sociodemographics, women with MSD were more likely to have migraine headache and depressive, anxiety, and bipolar disorders. Women had lower odds of cardiovascular diseases, substance use disorders, and several MSDs, including back pain conditions. Men were more likely to report “no pain” on the pain intensity Numeric Rating Scale, whereas more women (41%) than men (34%) reported moderate to severe pain (Numeric Rating Scale 4+). Conclusions Because women veterans are more likely to have conditions such as fibromyalgia and mental health conditions, along with greater pain intensity in the setting of MSD, women-specific pain services may be needed