Factors Influencing Breast Cancer Genetic Testing Among High Risk African American Women: A Systematic Review

African American women are disproportionately impacted by breast cancer and its associated effects. They have the highest breast cancer mortality rate of all racial and ethnic groups in the U.S., yet, many high risk African American women do not follow-up with genetic testing despite, having a shorter survival rate and more likely to develop malignancies or aggressive forms of breast cancer than white women. Purpose: This review explored breast cancer genetic follow up and barriers among African American women and made recommendations for designing tailored high risk breast cancer programs. Method: The Integrative Model of Behavioral Prediction framework provided the framework for the review. PubMed, PSYINFO, CINAHL and Cochrane Collection Plus databases were searched for articles published from 2007 to 2017 that focused on attitude and beliefs that influenced genetic testing follow up among African American women. Three reviewers independently reviewed and appraised articles. The quality of the articles was assessed to determine the evidence level and overall recommendations using the Joanna Bridge Institute grading criteria. Results: Sixteen of the 2275 articles reviewed met the inclusion criteria of which, seven showed statistically significance changes related to family concerns, medical mistrust and cost barriers; decreases in breast cancer worry and perceived risk after genetic counseling; and higher education level and diagnosed early increased genetic testing. Conclusions: This systematic review provides greater understanding of how the social determinants of health influence decisions about genetic testing and treatment to determine why African American women who are at risk for breast cancer, do not progress to genetic testing. It provided recommendations for designing sensitive curriculum content for African American women and providers to increase genetic follow-up and reduce breast cancer disparity. The results of this review could be used to design comprehensive, tailored interventions to address the identified barriers, increase breast cancer awareness and early detection, and help minority women make informed, value decisions about genetic testing and treatment options. Recommendations: Future research is required to examine the role communities, agencies and policy makers play in improving clinical outcomes for minorities

Exploring cancer health disparities among formerly incarcerated African Americans

Incarcerated populations have a higher burden of chronic disease and elevated risk factors for cancer (BJS, 2012). In 2013, cancer (31%) and heart disease (26%) accounted for over half of all prisoner deaths. The Genomics Research Program of the National Cancer Institute’s Division of Cancer Control and Population Sciences (2016) identified incarcerated persons as an understudied population about which there is limited data regarding cancer risks and outcomes. A majority of studies on corrections populations focus on health issues associated with reduction of infectious diseases such as HIV, Tuberculosis, and Hepatitis. Scant research has been conducted on issues associated with cancer prevention and control among African Americans with a history of incarceration. This qualitative, participatory, pilot research study explores the domains of cancer health disparities among African American men and women who were formerly incarcerated in Illinois prisons. Four qualitative focus groups will be conducted. The primary purpose of the focus groups is to collect and qualitatively analyze preliminary data on the barriers to access, utilization and treatment of cancer. This presentation seeks to: (1) describe the need for enhanced access to cancer care and treatment, (2) advocate for the inclusion of best practices in cancer care in corrections systems and, (3) identify policy recommendations and initiatives aimed at reducing cancer disparities among incarcerated and formerly incarcerated persons

Beyond Transitional Work and Low-Wages: Management Employment and Formerly Incarcerated African Americans

This dissertation reports on a phenomenological investigation of the experience of managerial employment among formerly incarcerated African American men and women. Little is known about the work experience of ex-prisoners. This study addressed that gap in criminology literature and sought to examine and deepen the understanding of the subjective meanings, processes, and experiences of employment for ex-prisoners who secure work beyond transitional and low-wage sector jobs. Transcendental phenomenology was employed as the research method for this study. Thirteen co-researchers were interviewed: (n = 7) men and (n = 6) women. Open-ended, semi-structured interviews were conducted to capture their lived and authentic experience and to allow data to emerge. Findings from the analysis of co-researchers’ narratives revealed five central themes: (1) injustice and corruption in the criminal justice system; (2) making change; (3) going to work; (4) no future nest egg; and, (5) giving back. These findings highlight culturally specific and nuanced cognitive processes, routines, and behaviors exercised by co-researchers in this study to turn away from crime and seek legitimacy through meaningful employment. Further, study findings provide new insights and important implications toward improving the effectiveness of corrections policy and practice and community interventions aimed at increasing the reentry success of formerly incarcerated persons

Understanding Prisoner Reentry: Employment, Parenting and Relationships Matter

The portrait of incarceration in America is deeply disturbing. The United States ranks number one in the world for its unprecedented rate of incarceration (Pew Charitable Trust, 2012). No other ethnic group is caught more in the grasp of the enduring legacy of mass incarceration than African American, inner-city, poor, men, women and children. African Americans represent 13.1% of the total U.S. population, but comprise approximately 36% (549,100) of America’s prison population (U.S. Census Bureau, 2013; BJS, 2013). The impact of mass incarceration on Black America is further compounded by the challenges of prisoner reentry. “Reentry is the process of leaving prison and returning to society” (Travis, 2005, p. xxi). This panel will address three components of the challenges of reentry: employment, re-establishing intimate relationships and the reconnection to parenting. Clearly, the personal, family and community costs associated with mass incarceration greatly exceeds investment in social programs that provide opportunities for stable employment, restoration of parenting and strengthened intimate relationships. Based on research conducted by the panelists, this presentation will explore the challenges associated with prisoner reentry and the opportunities to promote successful community reintegration after incarceration

Inside to Outside: A Collaborative Effort to Address Cancer Disparities among Incarcerated and Formerly Incarcerated Populations

Inmates experience higher rates of serious and chronic illness. Among the chronic illnesses experienced by this population is the diagnosis of cancer. During the past decade the incidence of cancer has slowly but steadily increased. One explanation for this increase in cancer diagnosis in correctional populations is the aging of the population. However, cancer diagnosis is not only evident in the aging inmate population (65 or older) but there is evidence of a younger population (30-45) presenting with cancer at intake or receiving a cancer diagnosis within months of admission to our jails and prisons. The consistent increase in patients with or diagnosis with cancer suggest a need to explore strategies to successfully manage and provide care meeting best practice standards for this special population. The increase in patients with a diagnosis of cancer further suggests a need to develop policies that decrease the risk of cancer disparities in the inmate population and among formerly incarcerated persons. Ensuring access to quality of care and continuity of care for patients with cancer requires health professionals to be vigilant in screening, health promotion, prevention and treatment. Presenters will discuss approaches to care and treatment and policy implications for this population

Creating a mobile device-based educational intervention for African American women with hereditary breast cancer risk

Background: Our foundational work found very low rates of attendance at a genetic counseling (GC) consultation among AA women with hereditary breast cancer (BC) risk who were referred for GC, and a strong desire among women and their primary care physicians (PCPs) for culturally sensitive educational material to help women understand the purpose of GC. We created a story-based educational intervention delivered on a mobile device platform that is designed to motivate AA women with familial BC risk to attend GC. Methods: Using an iterative process encompassing semi-structured, one-on-one interviews and group story circles with AA women referred for GC (primarily non-attenders), we identified themes that represent barriers and motivators to attendance for AA women. The storyline and educational content for the script were based on the themes identified. The script and artwork were tested with focus groups that included members of the target audience and key community stakeholders. We also conducted key informant interviews with PCPs providing care for AA women. Results: Findings from semi-structured interviews (N=20) were augmented with data collected from group story circle sessions with a subgroup of women who participated in the interviews (N=11). Nine themes emerged from the combined data and findings were used to create a story-based script. Focus groups conducted with community stakeholders and the target audience led to revision in the overall design and style of the intervention and additional content revisions. Additional findings from focus groups were presented and the completed educational video was previewed