J Natl Med Assoc
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Comparative Study
Perceptions of colorectal cancer among three ethnic subgroups of US blacks: a qualitative study.
Colorectal cancer (CRC) is currently associated with one of the highest burdens of morbidity and mortality among American men and women. Racial/ethnic disparities are well documented and the subject of intense research and intervention. Our understanding of disparities related to awareness and perceptions about causes, risk factors, and screening for CRC among subgroups of blacks in the United States is limited. ⋯ Qualitative findings revealed no stark differences among the 3 ethnic subgroups in their overall perceptions of cancer as well as their attitudes related to barriers, motivation, and resources for CRC screening. However, there were subtle differences in perceptions of curability, preventive practices, and preferred sources of information among the three ethnic subgroups of US blacks. The study has important implications for the design of educational materials and targeted interventions for diverse groups of US blacks.
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To assess barriers to colorectal cancer screening among urban publicly insured women and to evaluate how barriers among underscreened urban women have changed between 2001 and 2007-2008. ⋯ A lack of information, no clinician recommendation, misconceptions, and worry persist as barriers to colon cancer screening among this underscreened urban population. An increased focus on clinician recommendation and patient education about stool-based as well as endoscopic screening methods could lead to greater screening compliance.
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Lipid dysregulation is a major contributor to cardiovascular disease (CVD) risk and is attributed to numerous biological, psychosocial, and behavioral risk factors. Psychological stress has been examined as a predictor of lipid dysregulation; however, the role of coping with perceived racism, a stressor unique to the African American experience, has not been addressed. The current study sought to determine the impact of behavioral coping responses to perceived racism and perceived daily stress on lipid levels in African Americans. ⋯ The relationship between elevated levels of LDL and behavioral coping responses to perceived racism suggests that African Americans may be at increased risk for CVD due to the unique stress encountered by racism in our culture. Behavioral pathways used to counteract the negative effects of perceived discrimination may better explain this relationship. Further research is necessary to determine other biobehavioral and pathophysiological mechanisms that explain this relationship.
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Reducing racial disparities in postdisaster mental health requires the integration of unique and complex community challenges in disaster planning. We conducted focus group discussions with 13 community leaders and 7 clinical providers in eastern North Carolina to inform the adaptation of a competency-based training model in postdisaster mental health for black communities. The audience-specific perspectives on disaster mental health and training priorities were identified by structured thematic analyses. ⋯ All participants identified training in coordination, outreach to reduce mental health stigma, and cultural competence as priority training needs. Black community leaders also were concerned about their inclusion in local planning and leveraging resources. These inputs and suggestions made for tailoring with culturally appropriate language and processes guided the development of learning objectives, content, and field testing of the feasibility of trainer the trainer delivery of postdisaster mental health training for clinical providers and community leaders serving vulnerable black populations.
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Although the goals of end-of-life care and hospice are to mitigate suffering and improve quality of life for patients with terminal illnesses, they remain underutilized by a significant number of African Americans. While sociocultural issues play a role in the underutilization of these resources among African Americans, other confounding factors affect the ability of African Americans to adequately access quality care at the end of life. Here, the authors examine the various barriers preventing increased use of hospice care and palliative therapy among African Americans. A particular focus of this examination will revolve around suggestions for increasing the use of end-of-life care among African Americans in the future.