African American Adults’ Experiences with the Health Care System: In Their Own Words

African Americans suffer a disproportionate burden of death and illness from a number of different chronic diseases. Inequalities in health care practices and poor patient and provider communication between African American patients and health care professionals contribute to these disparities. We describe findings from focus groups with 79 urban African Americans in which the participants discussed their interactions with the healthcare system as well as beliefs and opinions of the healthcare system and professionals. Analysis revealed five major themes: (1) historical and contextual foundations; (2) interpersonal experiences with physicians and other health care workers; (3) discrimination; (4) trust, opinions and attitudes, and (5) improving health care experiences. These findings indicate that perceptions of discrimination and racism were prevalent among African Americans in this study, and that the expectation of a negative interaction is a barrier to seeking care. Authors discuss prevention and public health implications of these findings and make recommendations for health care practitioners

Who Can I Turn To? Emotional Support Availability in African American Social Networks

African Americans disproportionately experience psychological distress, such as feelings of sadness, hopelessness, and worthlessness and are disproportionately exposed to risk factors associated with mental illness, such as racial discrimination, violence and poverty. To effectively address African Americans’ mental health needs, it is imperative to identify who African Americans turn to when they experience stressors. The purpose of this study was to assess the extent to which emotional support is provided within African Americans’ social networks and determine the characteristics of social network members who African Americans rely upon for emotional support. Results indicate that African Americans rely on social network members for spiritual and physical health support more so than emotional support. Among both male and female participants, social network members were significantly more likely to be relied upon for emotional support if they were a non-familial network contact, had a close relationship to the participant, and if they also were someone the participant spoke to about his or her physical health. Findings have implications for the development of culturally-sensitive strategies for increasing emotional support provision within African Americans’ social networks

Use of culturally focused theoretical frameworks for adapting diabetes prevention programs: A qualitative review

INTRODUCTION: Diabetes disproportionately affects underserved racial/ethnic groups in the United States. Diabetes prevention interventions positively influence health; however, further evaluation is necessary to determine what role culture plays in effective programming. We report on the status of research that examines cultural adaptations of diabetes prevention programs. METHODS: We conducted database searches in March and April 2014. We included studies that were conducted in the United States and that focused on diabetes prevention among African Americans, American Indians/Alaska Natives, Asian Americans/Pacific Islanders, and Latinos. RESULTS: A total of 58 studies were identified for review; 29 were excluded from evaluation. Few adaptations referenced or followed recommendations for cultural adaptation nor did they justify the content modifications by providing a rationale or evidence. Cultural elements unique to racial/ethnic populations were not assessed. CONCLUSION: Future cultural adaptations should use recommended processes to ensure that culture’s role in diabetes prevention–related behavioral changes contributes to research

The utility of cancer-related cultural constructs to understand colorectal cancer screening among African Americans

Background. Data suggest that colorectal cancer could be cut by approximately 60% if all people aged 50 years or older received regular screening. Studies have identified socio-cultural attitudes that might inform cancer education and screening promotion campaigns. This article applies item response theory (IRT) to a set of survey items selected to assess sociocultural attitudes in order to determine how current measures may affect what we know about how these attitudes affect colorectal cancer screening (CRCS).Design and Methods. A survey of colorectal cancer screening, screening attitudes and cultural beliefs was administered to 1021 African Americans – 683 women and 338 men, ages 50 to 75. Eligibility crite ria for participation included being born in the United States, self-identified African American male or female, age 50 to 75 years. The IRT analysis was performed on 655 individuals with complete data for the 43 observed variables. Results. Twenty-nine items comprise the Multi-construct African American Cultural Survey (MAACS) that addresses seven cultural con- structs: mistrust/distrust, privacy, ethnic identity, collectivism, empowerment, and male gender roles. The items provide adequate information about the attitudes of the population across most levels of the constructs assessed. Among the sociocultural variables considered, empowerment (OR=1.078; 95% CI: 1.008, 1.151) had the strongest association with CRCS adherence and privacy showed promise. Conclusions. The MAACS provides a fixed length questionnaire to assess African American CRCS attitudes, two new constructs that might assist in CRCS promotion, and a suggested focus for identification of additional constructs of interest

Discussing Cancer: Communication With African Americans

Regular screening for colorectal cancer (CRC) facilitates earlier detection, lowers mortality, and may reduce incidence through detection and removal of pre-cancerous polyps. Optimizing health professional delivery of CRC screening information and recommendations can assist in reducing CRC disparity in the African American community. This paper presents qualitative data on African Americans’ attitudes about health professional CRC communications based on the analysis of focus groups (N=79). Using a social-ecological framework, colorectal cancer and professional communication themes are examined to offer four general and nine cancer specific theoretically based and culturally appropriate strategies for improving health professional cancer communication with African Americans

Perceptions of the US National Tobacco Quitline among adolescents and adults: A qualitative study, 2012–2013

INTRODUCTION: Tobacco quitlines are critical components of comprehensive tobacco control programs. However, use of the US National Tobacco Quitline (1-800-QUIT-NOW) is low. Promoting quitlines on cigarette warning labels may increase call volume and smoking cessation rates but only if smokers are aware of, and receptive to, quitline services. METHODS: We conducted qualitative interviews with a diverse subset (n = 159) of adolescent (14–17 y) and adult (≥18 y) participants of a larger quantitative survey about graphic cigarette warning labels (N = 1,590). A convenience sample was recruited from schools and community organizations in 6 states. Interviews lasted 30 to 45 minutes and included questions to assess basic knowledge and perceptions of the quitline number printed on the warning labels. Data were analyzed using content analysis. RESULTS: Four themes were identified: available services, caller characteristics, quitline service provider characteristics, and logistics. Participants were generally knowledgeable about quitline services, including the provision of telephone-based counseling. However, some adolescents believed that quitlines provide referrals to “rehab.” Quitline callers are perceived as highly motivated — even desperate — to quit. Few smokers were interested in calling the quitline, but some indicated that they might call if they were unable to quit independently. It was generally recognized that quitline services are or should be free, confidential, and operated by governmental or nonprofit agencies, possibly using tobacco settlement funds. CONCLUSION: Future marketing efforts should raise awareness of the nature and benefits of quitline services to increase use of these services and, consequently, reduce tobacco use, improve public health, and reduce tobacco-related health disparities

Understanding disruptions in cancer care to reduce increased cancer burden

BACKGROUND: This study seeks to understand how and for whom COVID-19 disrupted cancer care to understand the potential for cancer health disparities across the cancer prevention and control continuum. METHODS: In this cross-sectional study, participants age 30+residing in an 82-county region in Missouri and Illinois completed an online survey from June-August 2020. Descriptive statistics were calculated for all variables separately and by care disruption status. Logistic regression modeling was conducted to determine the correlates of care disruption. RESULTS: Participants (N=680) reported 21% to 57% of cancer screening or treatment appointments were canceled/postponed from March 2020 through the end of 2020. Approximately 34% of residents stated they would need to know if their doctor\u27s office is taking the appropriate COVID-related safety precautions to return to care. Higher education (OR = 1.26, 95% CI:1.11-1.43), identifying as female (OR = 1.60, 95% CI:1.12-2.30), experiencing more discrimination in healthcare settings (OR = 1.40, 95% CI:1.13-1.72), and having scheduled a telehealth appointment (OR = 1.51, 95% CI:1.07-2.15) were associated with higher odds of care disruption. Factors associated with care disruption were not consistent across races. Higher odds of care disruption for White residents were associated with higher education, female identity, older age, and having scheduled a telehealth appointment, while higher odds of care disruption for Black residents were associated only with higher education. CONCLUSIONS: This study provides an understanding of the factors associated with cancer care disruption and what patients need to return to care. Results may inform outreach and engagement strategies to reduce delayed cancer screenings and encourage returning to cancer care. FUNDING: This study was supported by the National Cancer Institute\u27s Administrative Supplements for P30 Cancer Center Support Grants (P30CA091842-18S2 and P30CA091842-19S4). Kia L. Davis, Lisa Klesges, Sarah Humble, and Bettina Drake were supported by the National Cancer Institute\u27s P50CA244431 and Kia L. Davis was also supported by the Breast Cancer Research Foundation. Callie Walsh-Bailey was supported by NIMHD T37 MD014218. The content does not necessarily represent the official view of these funding agencies and is solely the responsibility of the authors

Understanding drivers of coronavirus disease 2019 (COVID-19) racial disparities: A population-level analysis of COVID-19 testing among black and white populations

BACKGROUND: Disparities in coronavirus disease 2019 (COVID-19) testing-the pandemic\u27s most critical but limited resource-may be an important but modifiable driver of COVID-19 inequities. METHODS: We analyzed data from the Missouri State Department of Health and Senior Services on all COVID-19 tests conducted in the St Louis and Kansas City regions. We adapted a well-established tool for measuring inequity-the Lorenz curve-to compare COVID-19 testing rates per diagnosed case among Black and White populations. RESULTS: Between 14/3/2020 and 15/9/2020, 606 725 and 328 204 COVID-19 tests were conducted in the St Louis and Kansas City regions, respectively. Over time, Black individuals consistently had approximately half the rate of testing per case than White individuals. In the early period (14/3/2020 to 15/6/2020), zip codes in the lowest quartile of testing rates accounted for only 12.1% and 8.8% of all tests in the St Louis and Kansas City regions, respectively, even though they accounted for 25% of all cases in each region. These zip codes had higher proportions of residents who were Black, without insurance, and with lower median incomes. These disparities were reduced but still persisted during later phases of the pandemic (16/6/2020 to 15/9/2020). Last, even within the same zip code, Black residents had lower rates of tests per case than White residents. CONCLUSIONS: Black populations had consistently lower COVID-19 testing rates per diagnosed case than White populations in 2 Missouri regions. Public health strategies should proactively focus on addressing equity gaps in COVID-19 testing to improve equity of the overall response