Genomic medicine in primary care: Texas physicians' adoption of an innovation

New applications of genomic medicine stemming from the Human Genome Project are predicted to become routine components of primary care. Primary care physicians (PCPs) will increasingly become responsible for screening patients for inherited diseases, recommending genetic testing, and making referrals to genetic services. Clinical applications of genomic medicine will occur at a variable pace. Characteristics of an innovation such as genomic medicine are strong indicators of its potential for adoption. The purpose of this study is to assess whether (and to what extent) physicians' perceptions of genomic medicine as an innovation influence their likelihood of adopting this innovation into primary care. The study's sample consists of 400 primary care physicians in Texas and employs a survey design. Based on Rogers' Diffusion of Innovations Theory, the perceived characteristics of genomic medicine - Relative Advantage, Compatibility, Complexity, Trialability, and Observability - are the study's independent/predictor variables. Likelihood of PCPs Adopting Genomic Medicine is the dependent variable. The nature of the social system (private or group practice) is examined as a possible moderator variable. The study suggests that Texas PCPs who are likely to adopt genomic medicine strongly perceive its clinical uses (such as genetic testing for carrier status or susceptibility to common diseases, testing an embryo for genetic disorders before it is implanted, and supplementing a family history) to be highly advantageous. For half of the PCPs, genetic services such as genetic counseling and genetic testing are not compatible with current practice. Perceived complexity of the innovation is the strongest predictor of likelihood of PCPs adopting genomic medicine. Many PCPs find it difficult to stay updated on genomic medicine and locate genetic services. Although Texas PCPs feel genomic medicine can be gradually incorporated into primary care practice, most are not presently observing their colleagues adopting genomic medicine or assisting their patients to make decisions regarding genetic services. Future efforts to advance the use of genomic medicine in primary care will require more emphasis on genetics in medical school curriculum and continuing education programs. Links with specialists trained in genetic counseling and health education will be essential to translate relevant information to patients and families

Genomic medicine in primary care: Texas physicians' adoption of an innovation

New applications of genomic medicine stemming from the Human Genome Project are predicted to become routine components of primary care. Primary care physicians (PCPs) will increasingly become responsible for screening patients for inherited diseases, recommending genetic testing, and making referrals to genetic services. Clinical applications of genomic medicine will occur at a variable pace. Characteristics of an innovation such as genomic medicine are strong indicators of its potential for adoption. The purpose of this study is to assess whether (and to what extent) physicians' perceptions of genomic medicine as an innovation influence their likelihood of adopting this innovation into primary care. The study's sample consists of 400 primary care physicians in Texas and employs a survey design. Based on Rogers' Diffusion of Innovations Theory, the perceived characteristics of genomic medicine - Relative Advantage, Compatibility, Complexity, Trialability, and Observability - are the study's independent/predictor variables. Likelihood of PCPs Adopting Genomic Medicine is the dependent variable. The nature of the social system (private or group practice) is examined as a possible moderator variable. The study suggests that Texas PCPs who are likely to adopt genomic medicine strongly perceive its clinical uses (such as genetic testing for carrier status or susceptibility to common diseases, testing an embryo for genetic disorders before it is implanted, and supplementing a family history) to be highly advantageous. For half of the PCPs, genetic services such as genetic counseling and genetic testing are not compatible with current practice. Perceived complexity of the innovation is the strongest predictor of likelihood of PCPs adopting genomic medicine. Many PCPs find it difficult to stay updated on genomic medicine and locate genetic services. Although Texas PCPs feel genomic medicine can be gradually incorporated into primary care practice, most are not presently observing their colleagues adopting genomic medicine or assisting their patients to make decisions regarding genetic services. Future efforts to advance the use of genomic medicine in primary care will require more emphasis on genetics in medical school curriculum and continuing education programs. Links with specialists trained in genetic counseling and health education will be essential to translate relevant information to patients and families

Let’s Talk Sex: A Pilot Study of Sexual History Elicitation by Providers of STD Services in Leon County, Florida

An estimated one million sexually transmitted diseases (STDs) are reported annually in the United States. Florida has some of the highest HIV and STD rates in the country. STDs are a particular problem for minorities, women, and adolescents. Sexual history elicitation is a tool available to clinicians to assess patients’ sexual risk behaviors and to counsel, test, and treat STDs. Previous barriers to sexual history elicitation include subject matter, patient –physician communications, provider training, and physician perceptions. This pilot study was designed to test a survey questionnaire that measures primary care provider (PCP) sexual elicitation practices. PCPs included obstetricians and gynecologists, family practitioners, internal medicine physicians, pediatricians, nurse practitioners, and physician assistants in Leon County Florida. Between January 2010 and March 2010 a convenience sample of 50 PCPs in Florida were administered a pencil-and-paper survey. The survey instrument was constructed and tested to measure PCP sexual elicitation practices. The survey instrument was found to be an internally consistent and reliable assessment tool for sexual history elicitation. These preliminary pilot study findings warrant a larger study

Practice Patterns for Sexual History-taking among Florida Nurses

Florida has some of the highest reported sexually transmitted disease (STD) rates in the country. STDs are a particular problem for minorities, women, and adolescents. Sexual history elicitation is a tool available to clinicians to assess patients’ sexual risk behaviors and to counsel, test, and treat STDs. Nurses play an important role in caring for patients’ sexual health problems, including unwanted pregnancies and STDs. We examined the sexual history-taking practices among advanced registered nurse practitioners (ARNPs) in Florida. We mailed an anonymous pencil-and- paper survey to measure sexual history-taking practices to a stratified random sample of 795 ARNPs. We analyzed the data with SPSS. Overall, 185 ARNPs completed the survey (23% response rate). We found that sexual history-taking practices varied. Approximately 71% of Florida ARNPs reported taking sexual histories. Targeted interventions are needed to increase sexual history-taking practices

Meaning of Pregnancy Terms Among African-American Women

The concept of pregnancy intendedness is complex and may not bear the same meaning to all women. Moreover, researcher definition and women’s meaning were thought to be different. Some researchers have indicated that it is unclear how well women understand and relate to questions used by the National Survey of Family Growth (NSFG) and how the classifications relate to women’s lives. The purpose of this study was to explore the meaning of terms such as planned and/or intended pregnancy among African-American women of childbearing age using a qualitative exploratory descriptive method. Although African-American women want children, they are three times as likely to experience an unintended pregnancy as white women. Data extracted from transcripts were coded and analyzed for recurrent patterns and themes. For this study, the Theory of Planned Behavior (Ajzen & Fishbein, 1980) was employed to frame interview questions and to interpret data. Findings suggest participants and partners often did not have the same perceptions or meanings of pregnancy planning or intentions. These findings have implications for research and family planning policy

Sexual Hookups via Dating Apps: A Qualitative Study Exploring the Experiences of Black Men Who Have Sex with Men in Florida

Background: Sexual hookups via social media dating apps have been understudied among Black men who have sex with men (BMSM). Purpose: The objective of this qualitative study was to explore the role of dating apps on hookup culture and to describe the sexual experiences among BMSM in Florida. Specifically, this research delves into various sexual hookup themes. Methods: Seventeen semi-structured interviews were conducted with BMSM participants aged 18 to 25 in Florida who self-identified as frequent dating app users. A grounded theory approach was applied to thematically analyze the hookup encounters and the factors that drive these perceptions and experiences among BMSM. QSR NVIVO 12 was used to code, categorize, and collect emergent themes. Results: Three major themes emerged depicting the complexities of hookup culture using social media dating applications among BMSM. 1. Positive hookup experiences were linked to feelings of “no strings attached” to some participants, while others associated this positive experience to the use of alcohol and drugs; 2. Negative hookup experiences revolved around miscommunication on sexual roles, catfishing, and disclosure of HIV status; 3. Psychological aspects of hookups were centered on feelings of regret, disbelief, and disgust after a sexual hookup encounter. Discussion: Understanding BMSM hookup culture could aid in the development of prioritized evidence-based interventions for behavioral change to improve safer sexual health encounters among this vulnerable populatio

Exploring the Association of Physician Characteristics to Patient Requests for Genetic Testing

Background: Cancer genomic testing improves health outcomes for individuals at risk, drives cost-efficiency, and facilitates healthcare equity; however, little is known about how physician demographic and practice characteristics influence patient requests for genetic testing. Purpose: To explore whether (and to what extent) physician demographic and practice characteristics are associated with patient requests for cancer genetic testing. Methods: A cross-sectional quantitative design survey was distributed to 1240 primary care physicians registered with the state health department who had active licenses and main practices in Florida. Primary care physicians were defined as those who practice family medicine, internal medicine, obstetrics, and gynecology. The survey tool was developed from a search of the literature and two previously validated surveys. It was administered using a modified Dillmanstrategy. The study sample size was 317 physicians, with an 85% response rate based upon a targeted sample of 372. Statistical calculations were performed using SPSS version 27 and STATA release 17.Results: Logistic regression model found significant associations between patient requests and physicians\u27 race and professional practice size. Physicians identified as White were 1.840 times as likely to have patient requests for genetic testing (p=.036) than physicians whose race was other than White. Physicians whose professional practices were solo or small groups were 2.39 times as likely to have patient requests (p=.001) than physicians affiliated with larger practices. Discussion: Patient requests may be leveraged by physicians, other healthcare providers, and public health professionals; patient requests present a significant opportunity for increasing genetic testing and thus promoting better health outcomes for patients with Lynch syndrome-related colorectal cancer

An Exploratory Study of the Likelihood of Adopting Genetic Counseling and Testing for Lynch Syndrome-related Colorectal Cancer Among Primary Care Physicians in Florida

Genetic counseling and testing for inherited cancer syndromes have the potential to save lives and may be an avenue for addressing health care disparities among African Americans newly diagnosed with colorectal cancer (CRC); and their close relatives. African Americans are more likely to be diagnosed with CRC at younger ages (under age 50 years), and diagnosed at later stages when cancer is more aggressive and difficult to treat, which are factors associated with hereditary cancers such as Lynch syndrome-related CRC. Considering the benefits of genetic testing for hereditary cancer syndromes - risk stratification, preventive surveillance, targeted treatment, and subsequent reduction in morbidity and mortality among patients by up to 60% - it appears that genetic testing may have a role in prevention, early intervention and reduction of CRC disparities in African Americans. Primary care physicians (PCPs), often the access point to the healthcare system, were anticipated to be at the forefront of genetic counseling and testing. However, a growing body of literature indicates that PCPs see genetic testing as the role of a specialist. This quantitative survey research study, based on the constructs of the Diffusion of Innovation Theory (Rogers, 2003), explored the factors which influence the likelihood of adoption of genetic counseling and testing for Lynch syndrome-related colorectal cancer among PCPs in Florida

Community-Based Participatory Research at Jacksonville, Florida Superfund Ash Site: Toxicology Training to Improve the Knowledge of the Lay Community

Until the late 1960’s, Jacksonville, Florida incinerated its solid waste with the resultant ash deposited in landfills or used to fill flood-prone areas. These filled areas were later developed into parks, school sites and residential areas. Lead in soil at these sites was the major toxicant of concern and driver of clean-up actions. During the period of assessment of lead-levels in soil, there were no established lines of communication between the City and residents of affected neighborhoods resulting in mistrust in the community. To address communication issues, a community-based, culturally sensitive Community Environmental Toxicology Curriculum (CETC) and a short video were developed for community stakeholders to inform them of risks, health effects, remediation processes and preventive measures. Pre-and post-tests were developed to measure knowledge gained from the toxicology training. Learning gains averaged 47% and 24% for the community leaders and residents respectively. Most participants strongly agreed that the community toxicology curriculum was a useful tool for promoting awareness of environmental risks in their community and addressing the gap in trust between residents and agencies involved in site remediation

Microarray comparison of prostate tumor gene expression in African-American and Caucasian American males: a pilot project study

African American Men are 65% more likely to develop prostate cancer and are twice as likely to die of prostate cancer, than are Caucasian American Males. The explanation for this glaring health disparity is still unknown; although a number of different plausible factors have been offered including genetic susceptibility and gene-environment interactions. We favor the hypothesis that altered gene expression plays a major role in the disparity observed in prostate cancer incidence and mortality between African American and Caucasian American Males. To discover genes or gene expression pattern(s) unique to African American or to Caucasian American Males that explain the observed prostate cancer health disparity in African American males, we conducted a micro array pilot project study that used prostate tumors with a Gleason score of 6. We compared gene expression profiling in tumors from African-American Males to prostate tumors in Caucasian American Males. A comparison of case-matched ratios revealed at least 67 statistically significant genes that met filtering criteria of at least +/- 4.0 fold change and p < 0.0001. Gene ontology terms prevalent in African American prostate tumor/normal ratios relative to Caucasian American prostate tumor/normal ratios included interleukins, progesterone signaling, Chromatin-mediated maintenance and myeloid dendritic cell proliferation. Functional in vitro assays are underway to determine roles that selected genes in these onotologies play in contributing to prostate cancer development and health disparity