Perceived Racial Discrimination and Nonadherence to Screening Mammography

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 (PAfrican American women may not be receiving the full benefit of screening mammograms because of inadequate communication of results, particularly when mammography results are abnormal

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

Neighborhood and Individual Level Socioeconomic Variation in Perceptions of Racial Discrimination

In approaching the study of racial discrimination and health, the neighborhood and individual-level antecedents of perceived discrimination need further exploration. We investigated the relationship between neighborhood and individual-level socioeconomic position (SEP), neighborhood racial composition, and perceived racial discrimination in a cohort of African-American and White women age 40-79 from Connecticut, USA. Design. The logistic regression analysis included 1249 women (39% African- American and 61% White). Neighborhood-level SEP and racial composition were determined using 1990 census tract information. Individual-level SEP indicators included income, education, and occupation. Perceived racial discrimination was measured as lifetime experience in seven situations. Results. For African-American women, living in the most disadvantaged neighborhoods was associated with fewer reports of racial discrimination (odds ratio (OR) 0.44; 95% confidence interval (CI) 0.26, 0.75), with results attenuated after adjustment for individual-level SEP (OR 0.54, CI: 0.29, 1.03), and additional adjustment for neighborhood racial composition (OR 0.70, CI: 0.30, 1.63). African-American women with 12 years of education or less were less likely to report racial discrimination, compared with women with more than 12 years of education (OR 0.57, CI: 0.33, 0.98 (12 years); OR 0.51, CI: 0.26, 0.99 (less than 12 years)) in the fully adjusted model. For White women, neither neighborhood-level SEP nor individual-level SEP was associated with perceived racial discrimination. Conclusion. Individual and neighborhood-level SEP may be important in understanding how racial discrimination is perceived, reported, processed, and how it may influence health. In order to fully assess the role of racism in future studies, inclusion of additional dimensions of discrimination may be warranted

Does Gender Discrimination Impact Regular Mammography Screening? Findings from the Race Differences in Screening Mammography Study

Objective: To determine if gender discrimination, conceptualized as a negative life stressor, is a deterrent to adherence to mammography screening guidelines. Methods: African American and white women (1451) aged 40–79 years who obtained an index screening mammogram at one of five urban hospitals in Connecticut between October 1996 and January 1998 were enrolled in this study. This logistic regression analysis includes the 1229 women who completed telephone interviews at baseline and follow-up (average 29.4 months later) and for whom the study outcome, nonadherence to age-specific mammography screening guidelines, was determined. Gender discrimination was measured as lifetime experience in seven possible situations. Results: Gender discrimination, reported by nearly 38% of the study population, was significantly associated with non-adherence to mammography guidelines in women with annual family incomes of $50,000 or greater (or 1.99, 95% CI 1.33, 2.98) and did not differ across racial/ethnic groups. Conclusions: Our findings suggest that gender discrimination can adversely influence regular mammography screening in some women. With nearly half of women nonadherent to screening mammography guidelines in this study and with decreasing mammography rates nationwide, it is important to address the complexity of nonadherence across subgroups of women. Life stressors, such as experiences of gender discrimination, may have considerable consequences, potentially influencing health prevention prioritization in women

The intrafamilial transmission of rheumatoid arthritis--V : Differences between rheumatoid arthritics and controls on selected personality variables

This study describes the differences between adult rheumatoid arthritics (RA's) and controls on a number of personality variables. The cases come both from a national interview sample and a university arthritis clinic, while the controls were part of a cluster which included the spouse of the RA, the RA's sib and his (her) spouse, a cousin of the RA, and an unrelated individual. The data were collected in the course of three structured interviews. The major findings were the following: 1. (1) RA's of both sexes score higher on several measures of poor mental health than the non-RA's. For the women, these differences are stronger and involve more diverse aspects of poor mental health.2. (2) Women with RA report more frequent anger-irritation and more frequent impulses to overt aggression than women without RA. Involved in these differences are scales reflecting both general anger-aggression and that which is directed at the husband.3. (3) Men with RA, compared with healthy men, report less frequent impulses to general overt aggression, less wife-directed aggression, stronger guilt about such aggression, and their anger episodes were of longer duration.4. (4) When a difference score was computed between two scales, frequency of impulses to overt aggression and frequency of actual aggressive acts, women with RA, compared with healthy women, showed stronger control over the expression of such impulses, but seemed unable to apply the control to all types of aggressive impulses equally.5. (5) Women with RA were unduly frequently found above median on `guilt about spouse-directed aggression' and above median on several measures of husband directed anger-aggression. It was suggested that this might indicate greater conflict among the RA women.6. (6) Comparing general and spouse-specific measures of overt aggression, (a) women with RA `preferred' to direct their aggression at their husbands more than healthy women; while (b) men with RA `avoided' directing their aggression at their wives more often than healthy men.7. (7) When husbands' self-reports of wife-directed anger-aggression were correlated with wives' self-reports of husband-directed anger-aggression, the associations were positive and moderate to strong.8. (8) Marriages of RA wives and healthy husbands were highest on mutually directed anger-aggression; marriages of RA husbands and healthy wives were the lowest, while the healthy husbands-healthy wives marriages were intermediate.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32908/1/0000288.pd

The intrafamilial transmission of rheumatoid arthritis--VIII : Summary of findings

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32911/1/0000291.pd

The intrafamilial transmission of rheumatoid arthritis--VII : Why do wives with rheumatoid arthritis have husbands with peptic ulcer?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32910/1/0000290.pd

Some psychological and social characteristics of patients hospitalized for rheumatoid arthritis, hypertension, and duodenal ulcer

This study has compared male patients in a Veterans Administration Hospital with rheumatoid arthritis, hypertension, duodenal ulcer, and certain surgical conditions with their brothers and brothers-in-law. With regard to achievement, desire for change and impulsive behavior, the ulcer patients were high and the rheumatoid arthritics were low. With regard to perception of parents the rheumatoids reported themselves similar to their fathers but more influenced by their mothers while the surgical patients were more influenced by their fathers. In the area of happiness the ulcer patients appear to have led quite happylives, possibly even happier than the non-hospitalized controls while the hypertensives are most unhappy. The perception discrepancy measure suggested that the rheumatoids communicate poorly with their relatives about their hurt feelings. And finally, the measures of aggressive and impulsive behavior separated the four groups of patients from their brothers and brothers-in-law and from each other in a way that is both striking and replicable.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31962/1/0000004.pd

Explaining the Race Difference in Prostate Cancer Stage at Diagnosis

Prostate cancer is the most frequently diagnosed cancer in males in the United States, accounting for an estimated 186,320 new cases in 2008. There are striking racial or ethnic differences in prostate cancer incidence and mortality rates in the United States, with Black males 1.6 times more likely to be diagnosed and 2.4 times more likely to die with prostate cancer than Whites. The stage at diagnosis is a key prognostic factor for prostate cancer survival, with African-Americans generally diagnosed at a more advanced stage. To identify factors that explain the race-stage disparity in prostate cancer, we conducted a population-based case-case study of 251 African-American (46%) and White (54%) prostate cancer cases diagnosed in Connecticut between January 1987 and October 1990. Multivariate logistic regression was used to identify potential explanatory factors, including clinical, sociodemographic, medical care, insurance, digital rectal examination screening history, and lifestyle factors. Cox proportional hazards models assessed the impact of study variables on race differences in long-term survival. Modifiable factors such as screening practice and sociodemographic factors accounted for \u3e60% of the race difference in prostate cancer stage at diagnosis. Histologic grade (Gleason score) accounted for comparatively less. Survival analyses confirmed the importance of tumor characteristics, education, and insurance in explaining observed race differences in survival. Although cases were identified before the widespread use of prostate-specific antigen (PSA) screening, the results should also be relevant to countries that have large underserved populations and/or disparities in access to medical care and cancer screening. (Cancer Epidemiol Biomarkers Prev 2008;17(10):2825–34