Adequacy of Communicating Results From Screening Mammograms to African American and White Women

Objective. We examined whether African American women were as likely as White women to receive the results of a recent mammogram and to self-report results that matched the mammography radiology report (i.e., were adequately communicated). We also sought to determine whether the adequacy of communication was the same for normal and abnormal results. Methods. From a prospective cohort study of mammography screening, we compared self-reported mammogram results, which were collected by telephone interview, to results listed in the radiology record of 411 African American and 734 White women who underwent screening in 5 hospital-based facilities in Connecticut between October 1996 and January 1998. Using multivariate logistic regression, we identified independent predictors of inadequate communication of mammography results. Results. It was significantly more common for African American women to experience inadequate communication of screening mammography results compared with White women, after adjustment for sociodemographic, access-to-care, biomedical, and psychosocial factors. Abnormal mammogram results resulted in inadequate communication for African American women but not White women (P\u3c.001). Conclusions. African American women may not be receiving the full benefit of screening mammograms because of inadequate communication of results, particularly when mammography results are abnormal

Understanding the Mississippi River Delta as a Coupled Natural-Human System: Research Methods, Challenges, and Prospects

A pressing question facing the Mississippi River Delta (MRD), like many deltaic communities around the world, is: Will the system be sustainable in the future given the threats of sea level rise, land loss, natural disasters, and depleting natural resources? An integrated coastal modeling framework that incorporates both the natural and human components of these communities, and their interactions with both pulse and press stressors, is needed to help improve our understanding of coastal resilience. However, studying the coastal communities using a coupled natural-human system (CNH) approach is difficult. This paper presents a CNH modeling framework to analyze coastal resilience. We first describe such a CNH modeling framework through a case study of the Lower Mississippi River Delta in coastal Louisiana, USA. Persistent land loss and associated population decrease in the study region, a result of interplays between human and natural factors, are a serious threat to the sustainability of the region. Then, the paper describes the methods and findings of three studies on how community resilience of the MRD system is measured, how land loss is modeled using an artificial neural network-cellular automata approach, and how a system dynamic modeling approach is used to simulate population change in the region. The paper concludes by highlighting lessons learned from these studies and suggesting the path forward for analysis of coupled natural-human systems