Geospatial Determinants of Increased Screening Mammography in U.S. Black Women

Black women have the highest mortality rate due to breast cancer compared to any other racial/ethnic group in the U.S. and are more likely to be diagnosed with late-stage breast cancer compared to White women. Though the causes of these disparities are multifactorial, early detection by mammography, in combination with improved treatment, is related to improved breast cancer survival outcomes. Recently, the rate of Black women reporting having had a screening mammogram in the last two years has increased, and by some accounts surpassed, that of White women. This dissertation assesses this change in mammography among Black women in order to help inform future policies impacting preventive health care, which can lead to early diagnoses, and thus improvements in women’s health and reductions in the economic impact of treatment costs. The objective of the study was to identify factors, including geographic place and space, associated with the spatial variation of the increased screening mammography observed for Black women in the U.S. from 2008 to 2012. The central hypothesis was that the spatial distribution of the change in screening utilization is not random, and that the geospatial pattern of change is associated with changes in access to health care when controlling for education, income, demographic factors, and the larger ecological sociodemographic context. The central hypothesis was tested by pursuing the following aims: 1) Assess whether the geographic pattern of change from 2008-2012 of screening mammography among Black women in the U.S. is spatially clustered; and 2) Identify individual- and ecological-level factors associated with the geographic pattern of change from 2008-2012 of screening mammography among Black women in the U.S. Statistical software was used for assessing aspatial data, and Geographic Information Systems (GIS) was used for descriptive mapping and implementing spatial statistical analyses. Results indicate that changes in screening are not consistent across the U.S., Black and White women have increased and decreased screening in different regions, and the impact of variables associated with screening varies by location

\u3cem\u3eMy Crown and Glory\u3c/em\u3e: Community, Identity, Culture, and Black Women’s Concerns of Hair Product-Related Breast Cancer Risk

Breast cancer (BC) incidence rates for Black and non-Hispanic White women have recently converged; however, Black women continue to die at higher rates from the disease. Black women also use hair products containing hormonally active chemicals at higher rates than other races and ethnic groups. Studies now link chemical components in hair and personal care products to breast cancer risk. Using a community-based participatory research approach, this qualitative study explored community concerns about the role of hair products on breast cancer risk. Focus groups and key informant interviews using triangulation to assure relevant perspectives (women with and without breast cancer as well as younger and older women of differing SES, stylists) explored women’s perceived risk and knowledge of breast cancer risk factors. Data analysis used grounded theory methods of coding facilitated by QDA-Miner. Findings from 91 participants indicated varying levels of awareness but near universal concerns about the potential link of hair products to BC. Breast cancer is a significant concern for Black women and their loved ones. While women were concerned and some respondents believed ingredients in hair products may be harmful to their health, they wrestled with the idea of making changes as hair for most is aligned with beauty, individuality, and identity. For many altering their product use patterns to potentially less risky choices pits health against identity. Health education interventions to minimize harmful hair product usage must acknowledge and incorporate cultural normative beliefs of hair for Black women

Life threatening illness in popular movies-a first descriptive analysis

In the last two decades, public attention towards illness, dying and death has evolved. In particular, advance care planning, living wills, end-of-life care, and autonomy are increasingly discussed. How this change in public awareness has influenced the presentation of dying and death in cinema needs clarification. Over a one year period, November 2011 until October 2012, a systematic search was conducted to identify movies dealing with incurable diseases produced in 1991–2010 35 movies could be identified and were analyzed in detail and investigated the presentation of illness and death. The number of movies focusing on terminal illness, dying, and death has increased since 1991. The total number of movies that made the yearly German Federal Film Board (FFA) hit list and included a focus on terminal illness, dying, and death increased from 1991 (1 movie) to 2011 (6 movies). The gender of the main characters suffering from terminal illness was distributed equally; three movies portrayed terminally ill children. More than one third of the terminally ill characters died in hospital. The terms “palliative” or “hospice care” were not mentioned once in any films. The number of movies dealing with terminal illness continues to increase and a considerable audience has shown interest in these films. Due to a limited true-to-life performance in the films, a presentation closer to reality could be a major public educational resource

Consensus-based recommendations for psychosocial support measures for parents and adult children at the end of life: results of a Delphi study in Germany

The availability of psychosocial support measures has a significant impact on the quality of life of terminally ill and dying patients and the burden experienced by their relatives. To date, no intervention has specifically focused on promoting interaction within the dyads of the following: (1) terminally ill adult children and their parents and (2) terminally ill parents and their adult children. A national Delphi study was conducted to provide appropriate recommendations for dyadic psychosocial support measures.Recommendations were formulated from qualitative interview data on the experiences and wishes of patients and family caregivers within these two dyads. Experts from palliative and hospice care providers rated the relevance and feasibility of 21 recommendations on two 4-point Likert-type scales, respectively. Additional suggestions for improvement were captured via free text fields. Individual items were considered consented when >= 80% of participants scored 1 (strongly agree) or 2 (somewhat agree) regarding both relevance and feasibility. A total of 27 experts (35% response rate) completed two Delphi rounds. Following the first round, 13 recommendations were adjusted according to participants' comments. After the second round, consensus was achieved for all 21 of the initially presented recommendations.The Delphi-consented recommendations for parents and adult children at the end of life provide the first guidance for hands-on dyadic psychosocial support measures for parent-adult child relationships, specifically. The next step could involve the structured implementation of the recommendations, accompanied by scientific research

A review of hair product use on breast cancer risk in African American women

The incidence rate of breast cancer for African American women has recentlyconverged with that of non-HispanicWhite women in the United States, although African Americans have a higher mortality rate due to this disease.Although most research exploring health disparities associated with this phenomenon has focused on differences between women based on biology andbehavior, both the academic and lay communities have begun to explore thepotential role of environmental exposure to estrogen and endocrine disruptingchemicals (EDCs). This study reviews the current state of the science associatingone such means of exposure, hair products containing EDCs, with breast cancer risk in African American women. We found a growing body of evidence linking:(1) environmental estrogen and EDC exposures to breast cancer risk, (2)the presence of such chemicals in personal care products, including hair products,and (3) the use of certain hair products with potential breast cancer risk inAfrican Americans. At the same time, there is also increasing concern in thelay community about this risk. These results indicate the need for additionalresearch, and the opportunity to benefit from strategic partnerships in community-collaborative approaches in order to better understand the potential “cost ofbeauty.

A review of hair product use on breast cancer risk in African American women

The incidence rate of breast cancer for African American women has recentlyconverged with that of non-HispanicWhite women in the United States, although African Americans have a higher mortality rate due to this disease.Although most research exploring health disparities associated with this phenomenon has focused on differences between women based on biology andbehavior, both the academic and lay communities have begun to explore thepotential role of environmental exposure to estrogen and endocrine disruptingchemicals (EDCs). This study reviews the current state of the science associatingone such means of exposure, hair products containing EDCs, with breast cancer risk in African American women. We found a growing body of evidence linking:(1) environmental estrogen and EDC exposures to breast cancer risk, (2)the presence of such chemicals in personal care products, including hair products,and (3) the use of certain hair products with potential breast cancer risk inAfrican Americans. At the same time, there is also increasing concern in thelay community about this risk. These results indicate the need for additionalresearch, and the opportunity to benefit from strategic partnerships in community-collaborative approaches in order to better understand the potential “cost ofbeauty.

Reflections and Analysis on Sex, Gender and Diversity in Palliative Care Research – How can we Apply Intersectionality in our Scientific Practice?

Verdonk P, Gawinski L, Herbst F, et al. Reflexionen und Analysen zu Geschlecht, Gender und Diversität in der Palliativmedizinischen Forschung - Wie können wir Intersektionalität in unserer wissenschaftlichen Praxis umsetzen? . Zeitschrift für Palliativmedizin. 2020;21(3):129-135

Psychosocial Stress, Glucocorticoid Signaling, and Prostate Cancer Health Disparities in African American Men

Recent advances in our understanding of racial disparities in prostate cancer (PCa) incidence and mortality have provided important insights into the psychosocial, socioeconomic, environmental, and molecular contributors. There is, however, limited mechanistic knowledge of how the interplay between these determinants influences prostate tumor aggressiveness in African American (AA) men and other men of African Ancestry. Growing evidence indicates that chronic psychosocial stress in AA populations leads to sustained glucocorticoid signaling through the glucocorticoid receptor (GR), with negative physiological and pathological consequences. Compelling evidence indicates that treatment of castration-resistant prostate cancer (CRPC) with anti-androgen therapy activates GR signaling.  This enhanced GR signaling bypasses androgen receptor (AR) signaling and transcriptionally activates AR-target genes and GR-target genes, resulting in increased prostate tumor resistance to anti-androgen therapy, chemotherapy, and radiotherapy. Given its enhanced signaling in AA men, GR—together with specific genetic drivers—may promote CRPC progression and exacerbate tumor aggressiveness in this population, potentially contributing to PCa mortality disparities.  Ongoing and future CRPC clinical trials that combine standard of care therapies with GR modulators, both agonists and antagonists, should increase the participation of AA patients and carefully assess racial differences in therapy response and clinical outcomes.&nbsp