Predictors of Breast Cancer Screening in a Panel Study of African American Women

ABSTRACT

Purpose: This study examines the predictors of breast cancer screening participation in a panel study of African American women over age 40. We examine the effect of depression, age, beliefs and concerns about breast cancer and its risk, communication with social networks regarding screening, marital status, participation in religious organizations, breast cancer family history, and participation in a breast cancer education program.

Methods: Participants were recruited from 30 African American churches, two low-income housing projects, and from a health fair at a historically African American University (N = 364). Participants were interviewed upon recruitment, and three months later. Multinomial logistic regression models are estimated to assess the relative impact of covariates on the odds of getting a mammogram while controlling for other factors. We also assess predicted probabilities of screening at specific levels of covariates.

Results: We find that age, marriage, an educational intervention, talking with friends, and believing that early detection can lead to cure had a positive impact on getting a mammogram between T1 and T2. In contrast, depression significantly reduces the odds of getting a mammogram. Family histories of breast cancer and church participation have no effect on rates of mammography net of other factors.     

Social Network Characteristics and HIV Sexual Risk Behavior among Urban African American Women

HIV/AIDS has emerged as a significant health threat for African American women with well-documented disparities. The purpose of this study was to assess the association between social network characteristics and high-risk sexual behaviors among a sample of urban African American women at risk of heterosexually acquired HIV/STIs. We performed a cross-sectional study of baseline data collected from the CHAT study, a randomized HIV-prevention trial targeting urban HIV-at-risk women in Baltimore, MD. Our primary outcomes were risky sexual behaviors defined as either (a) two or more sexual partners or (b) having a risky sex partner within the past 90 days. Bivariable and multivariable logistic regression examining the associations between individual and social network factors and our two outcomes of interest were conducted. The study population included 513 sexually active African American women with a mean age of 41.1 years. High levels of unemployment (89.5%), depressive symptoms (60.0%), and drug use (68.8%) were present among this high-risk urban cohort. Controlling for individual factors including participant drug use, age, and depression, having two or more sex partners within the past 90 days was associated with having a larger personal network (OR = 1.11; 95% CI, 1.06 and 1.17); more network members who pitched in to help (OR = 1.22; 95% CI, 1.04 and 1.44), provided financial support (OR = 1.33; 95% CI, 1.11 and 1.60), or used heroin or cocaine (OR = 1.26; 95% CI, 1.14 and 1.40). Having a risky sexual partner within the past 90 days was associated with having a larger social network (OR = 1.06; 95% CI, 1.00 and 1.12) and having more social networks who used heroin or cocaine (OR = 1.30; 95% CI, 1.14 and 1.49).In summary, social network characteristics are associated with HIV sexual risk behaviors among African American urban women. Social-network-based interventions that promote norms pertaining to HIV risk reduction and provide social support are needed for African American women at risk of heterosexually acquired HIV/STIs.     

青年乳腺癌121例临床分析

目的探讨青年乳腺癌临床特点,分析常见延误诊治原因.方法回顾性分析本院收治的121例青年组(年龄≤35岁)和40例对照组(年龄≥40岁)乳腺癌患者,所有病例均经外科治疗.结果青年组和对照组腋窝淋巴结阳性率和浸润性肿瘤阳性率有显著性或非常显著性差异(P＜0.05或P＜0.01);青年乳腺癌患者按病程分为1月以内、1～3月、3～6月、6～12月和12月以上5组,临床分期和腋窝淋巴结转移率在不同病程间有显著性差异(P＜0.01).结论强调青年乳腺癌侵袭性强的同时要强调早期诊治减少延搁.早期诊断主要依赖于医患双方的警惕.     

Determinants of Low-fat Eating Behaviors among Midlife African American Women

ObjectiveThe purpose of this study was to explore midlife African American women's low-fat eating habits in the context of health attitudes, social support, and food preferences.DesignA cross-sectional design was used.SettingsOne Midwestern and 1 national African American women's organization were targeted for data collection.ParticipantsAfrican American women between the ages of 45 and 64.Main Outcome MeasuresHealth Attitudes Scale, Social Support Scale, Eating Behaviors subscale, and Low-Fat Eating subscale.AnalysisA hierarchical multiple regression analysis was performed.ResultsHighly educated women did not engage in better eating habits than women with less education. Family members provided more criticism and friends provided more encouragement for healthful eating. However, only family encouragement and criticism for healthful eating and food preferences remained predictive of low-fat eating habits in midlife African American women in the final regression model.Conclusions and ImplicationsChanging attitudes may not influence changes in behaviors. Women experience family support as a significant influence to eating habits. Future nutrition interventions should be inclusive of women at every educational level and have a multidimensional focus that targets family involvement and changing behaviors.     

Perceptions and Practices of Infant Feeding among African American Women

A large urban hospital in Florida implemented changes to achieve the Baby-Friendly Hospital Initiative (BFHI) designation in 2015 resulting in an increase of exclusive breastfeeding rates at hospital discharge; however, African American women continue to have the lowest rates overall. Qualitative interviews were conducted with 20 African American women who received prenatal care at a low-income women’s clinic and gave birth at an affiliated BFHI hospital. Using a medical anthropology analytical framework to examine predisposing, enabling, and service-related factors that affect breastfeeding, this study investigated interpersonal, sociocultural, and institutional barriers to breastfeeding. Common challenges experienced by participants included lack of maternity leave from work, lack of access to electric pumps, social pressures to initiate formula supplementation, fears that breastfeeding renders infants overly dependent on their mother’s care, and a lack of breastfeeding role models and/or support networks to normalize longer-term breastfeeding. We conclude that efforts to increase breastfeeding rates for African American women and promote culturally sensitive interventions must address underlying socioeconomic and structural barriers, women’s perceptions of breastfeeding benefits and difficulties, and the need for improvements in postnatal lactation and doula support to foster a more inclusive culture of breastfeeding.     

Apartment-Based Breast Cancer Education Program for Low Income Vietnamese American Women

The purpose of the project was to develop and implement an apartment-based intervention that would improve the knowledge and preventive health habits of hard to reach low income Vietnamese women regarding breast cancer. The targets were Vietnamese women aged 40 and older who resided in apartments in low-income communities in Houston. Twenty apartments were identified and randomly assigned to intervention and control groups. A total of 345 Vietnamese women participated in the project. Follow-up telephone interviews were conducted at five months. Results showed that the intervention group demonstrated significant changes in knowledge and attitudes about breast cancer. Implications of this study include support for culturally appropriate education offered at convenient locations that emphasizes the benefits of early detection of breast cancer for low-income Vietnamese women.     

Body Size Perception Among African American Women

ObjectiveTo assess body size perception among African American women using cultural definitions of body size terms.MethodsSixty-nine African American women classified Body Image Scale figures as overweight, obese, and too fat, and independently selected the figure they considered closest to their current body size.ResultsBody size classifications of figures did not vary by participant weight status. Overweight figures were not considered too fat. For 86% of overweight (body mass index [BMI], 25–29.9) women and 40% of obese (BMI > 30) women, the self figure was not defined as overweight, obese, or too fat. Among participants with BMI ≥ 35, 65% did not classify their self figure as obese and 29% did not classify their self figure as overweight.Conclusions and ImplicationsThe difference between cultural (folk) and medical definitions of body size terms may serve as a barrier to effective communication between patients and providers about health effects of excess adiposity.     

HIV Risk Reduction in Rural African American Women Who Use Cocaine

ABSTRACT

Research has demonstrated associations between cocaine use and sexually transmitted infections (STIs), including Human Immunodeficiency Virus (HIV). More research has been conducted among the sub-population of women, with less focus on rural African American women. Investigation of the social context that influences rural African American women's behavior that places them at risk for STI/HIV has received limited attention. The results of one component of the comprehensive study presented here focused on perceived STI/HIV risk reduction strategies of U.S. southern rural African American women who used cocaine. This ethnographic study of 30 rural African American women using cocaine was conducted over four years. Respondents described HIV risk reduction strategies and their motives for using them. Condoms were used more with casual partners (80%) than primary partners (16%) and with partners who were less known, less trusted, young, or physically or sexually “dirty.” Condoms were also used to prevent pregnancy (60%) more than to prevent STI/HIV (40%). HIV testing patterns varied, as did the motives for seeking testing. The sexual behavior of the women in this study exposed them to increased risk of STI/HIV. Although many perceived that they were using sexual risk reduction strategies, these strategies were not scientifically sound risk reduction strategies. Consequently, their exposure to STI/HIV continued as they used ineffective strategies both in assessing partner risk and in implementing risk reduction behaviors.     

Influence of Nativity Status on Breast Cancer Risk Among US Black Women

Black women are at increased risk for breast cancer mortality. The black category is assumed to be homogeneous, an assumption that may be misleading. This study aims to examine the relationship between nativity and breast cancer risk factors among women identified as black. A sample of 236 black women over 18 years of age in Brooklyn, New York, was recruited. Data were collected on race/ethnicity, breast cancer risk factors, and other sociodemographic, behavioral, and early life experience factors. Logistic regression analyses were used to estimate prevalence ratios for association between nativity and breast cancer risk factors. US-born blacks were more likely to be unemployed, smoke, not breastfeed, and breastfeed for a shorter duration than foreign-born blacks (all p≤0.01). Foreign-born blacks were more likely to have parents who achieved at least a high school education (p<0.05). After adjustment for smoking, employment, and parental education, US-born blacks were twice as likely to never breastfeed (PR 2.2, 95% CI: 1.1, 4.46) compared to foreign-born blacks. Among women who breastfed, US-born blacks were also less likely to breastfeed for 6–11 months or more than 12 months, but these associations were not statistically significant. Because lactation reduces breast cancer risk and is a leading modifiable risk factor, understanding its variation within black women will help physicians and public health practitioners to target patient counseling and education of breast cancer risk. Borrell, Castor, and Terry are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Conway is affiliated at Adelphi University, New York, NY, USA.     

Safer sexual practices among African American women: intersectional socialisation and sexual assertiveness

Scholars have posited that childhood socialisation experiences may play a key role in influencing behaviours and attitudes that contribute to the acquisition of HIV. This study examined the links between past ethnic-racial and gender socialisation, sexual assertiveness and the safe sexual practices of African American college women utilising a cluster analytic approach. After identifying separate racial-gender and ethnic-gender socialisation profiles, results indicated that ethnic-gender socialisation cluster profiles were directly associated with sexual assertiveness and safer sex behaviour. Greater levels of ethnic socialisation and low traditional gender role socialisation were found to be associated with greater sexual assertiveness and safer sex behaviour. Further analysis showed that sexual assertiveness mediated the links between the identified ethnic-gender socialisation profiles and safer sex behaviour. Implications for policy and programme development are discussed.     

Physically Active,Low-Income African American Women: An Exploration of Activity Maintenance in the Context of Sociodemographic Factors Associated with Inactivity

Increasing physical activity among low-income African American women is an important target for addressing racial and economic disparities in chronic conditions and related risk factors. While barriers to physical activity for women have been examined empirically, successful strategies for navigating those barriers among physically active, low-income women have not been thoroughly explored. Informed by grounded theory, we conducted in-depth individual interviews between 2007–2010 with 14 low-income African American women who were physically active at nationally recommended levels for one year or more. We analyzed the data using thematic analysis techniques. Key themes emerged in three main categories: motivation for maintaining active lifestyle, strategies for maintaining physical activity, and challenges to maintaining physical activity. Important motivations included getting or staying healthy, social connections, and gratification. Two planning strategies emerged: flexibility and freedom. Critical challenges included financial constraints, physical strain and history of sedentary relapse. The motivations, strategies and challenges reported by low-income African American women who successfully maintained an active lifestyle provided important information for developing effective health promotion strategies for their inactive and underactive counterparts. A qualitative, asset-based approach to physical activity research contributes rich data to bridge the gap between epidemiological knowledge and community health improvement.     

Breast Cancer Screening among Employed American Women

Abstract

From the 1990 National Health Interview Survey Health Promotion and Disease Prevention supplement, the authors estimated the 1990 baseline prevalence of breast cancer screening among employed U.S. women aged 50–70 years. Proportions of women screened for breast cancer were calculated by occupational category and demographic characteristics, and were compared with the Healthy People 2000 objective that 60% of women aged 50 and older have had mammography and a clinical breast examination within the preceding two years. The objective was exceeded for white-collar workers (61.8%) and workers with some college (64.1%), but was not met by any blue-collar/service workers (40.8%); or any workers with only a high school diploma (54.7%) or less than a high school diploma (38.5%). Identification of occupational categories and demographic subgroups among working women will be helpful to those planning breast cancer screening program, in both the public and the private sectors.     

Using Formative Research to Develop a Worksite Health Promotion Program for African American Women

ABSTRACT

Objectives: To describe the development of a culturally appropriate worksite health promotion program (WHPP) designed to promote increased physical activity and improved nutrition in a high risk group of African American women.

Methods: The program was based on EatRight, which is a lifestyle-oriented weight control program that focuses on food volume, rather than calories. Formative research included four nominal group technique (NGT) sessions conducted with 14 African American women from the selected worksite to gather input on job factors that affected their weight and daily life factors that affected their amount of physical activity. Their responses were used to adapt existing EatRight materials to target areas of special need for this unique group.

Results: Themes emerged from the NGT sessions that indicated stress at work and an environment of unhealthy eating, in addition to social eating and lack of social support for healthy eating added to unhealthy eating patterns at work. In response to physical activity, the primary themes included lack of time to exercise, stress of multiple family roles and responsibilities, and perceived physical barriers to physical activity.

Discussion: Based on the NGT themes, EatRight materials were adapted and additional topics (e.g., increasing social support, overcoming limitations, and time management) were included to develop a WHPP that addressed issues that the participants identified as relevant for their work and home lives. Conducting the NGT sessions and EatRight classes in the work environment, we were able to provide a convenient, familiar environment which fostered social support among participants. We believe that a culturally appropriate modification of EatRight holds great promise in addressing health disparities seen among African American women by offering education on lifestyle changes that will decrease weight through nutrition and physical activity.     

Predictors of Adherence and Treatment Delays among African American Women Recommended to Receive Breast Cancer Chemotherapy

Background

Recognition of potential explanations for nonadherence or treatment delays is crucial to improving survival, particularly among African American women, for whom there is limited research assessing patient factors that influence adherence to breast cancer chemotherapy.

Determinants of Late Prenatal Care Initiation by African American Women in Washington,DC

Objectives: The objective of this study was to identify the determinants of late prenatal care (PNC) initiation among minority women in Washington, DC. Methods: DC-resident, African American women (n = 303) were recruited at 14 PNC facilities, representing the various types of PNC facilities located in DC: 4 hospital-based clinics, 5 community-based clinics, and 5 private practices. The women were interviewed at their first prenatal care visits to determine their perceptions of 63 barriers, motivators and facilitators influencing PNC initiation; substance use; and sociodemographic background. PNC initiation was classified as early (prior to the 20th week of gestation) or late (after the 20th week of gestation). The responses of women who initiated PNC early versus late were compared using bivariate and multivariate statistical procedures. Classification and Regression Trees analysis was used to identify groups at risk of late initiation. Results: Variables contributing to late PNC initiation included maternal age not between 20 and 29 years, unemployment, no history of previous abortions, consideration of abortion, lack of money to pay for PNC, and no motivation to learn how to protect ones health. Three risk groups for late PNC initiation included 1) women considering abortion and not employed outside their homes; 2) women not considering abortion who had no previous abortion experience; and 3) teenagers not considering abortion and with no previous abortions. Conclusions: The results of this study indicate that psychosocial barriers are more important than structural barriers. Of the psychosocial barriers, the major determinants of late PNC initiation were consideration of abortion and previous abortion experience.     

Increasing mammography screening among low-income African American women with limited access to health information

BACKGROUND: Previous research showed low-income African American women with limited access to breast screening information through mass media to have a low likelihood of obtaining screening. This report describes a controlled evaluation of a component of a community-based breast screening promotion program focused on increasing screening among low-income African American women. METHODS: A direct-contact screening promotion component tailored to the needs of low-income African American women was conducted between 1990 and 1997 in one of two matched Florida study areas. Before and after assessments of breast screening, behavior and psychosocial mediators of screening were examined using logistic regression analyses for 1201 women with differing levels of exposure to media information about breast screening. RESULTS: Recent/repeat mammography use increased significantly in the program area for women with limited access to media information, although there was no significant program impact on hypothesized psychosocial mediators of screening. CONCLUSIONS: The program led to increased mammography use among low-income African Americans having limited access to screening information through the media. For these women, using direct contact to deliver educational messages and facilitation of access to services may be the best method available to promote regular mammography.