The association of perceived discrimination with low back pain

A handful of recent studies have documented perceived discrimination as a correlate of poor physical and mental health status among ethnic and racial minority groups. To date, however, despite a proliferation of research on ethnic disparities in the severity and impact of a number of persistent pain conditions, there have been no reports on associations between perceived discrimination and pain-related symptoms. Using data from a national survey (the National Survey of Midlife Development in the United States; MIDUS), we explore the relationships between perceived discriminatory events and the report of back pain among African-American and white men and women. As expected, African-American participants reported substantially greater perceptions of discrimination than white participants. Moreover, in models that included a variety of physical and mental health variables, episodes of major lifetime discriminatory events were the strongest predictors of back pain report in African-Americans, and perceived day-to-day discrimination was the strongest predictor of back pain report specifically in African-American women. Among white participants, perceptions of discrimination were minimally related or unrelated to back pain. To our knowledge, these are the first data documenting an association between perceived discrimination and report of back pain; the fact that perceptions of discrimination were stronger predictors than physical health variables highlights the potential salience and adverse impact of perceived discrimination in ethnic and racial minority groups.     

Family history and perceptions about risk and prevention for chronic diseases in primary care: A report from the Family Healthware™ Impact Trial

PurposeTo determine whether family medical history as a risk factor for six common diseases is related to patients' perceptions of risk, worry, and control over getting these diseases.MethodsWe used data from the cluster-randomized, controlled Family Healthware™ Impact Trial (FHITr). At baseline, healthy primary care patients reported their perceptions about coronary heart disease, stroke, diabetes, and breast, ovarian, and colon cancers. Immediately afterward, intervention group participants used Family Healthware™ to record family medical history; this web-based tool stratified familial disease risks. Multivariate and multilevel regression analyses measured the association between familial risk and patient perceptions for each disease, controlling for personal health and demographics.ResultsFor the 2330 participants who used Family Healthware™ immediately after providing baseline data, perceived risk and worry for each disease were strongly associated with family history risk, adjusting for personal risk factors. The magnitude of the effect of family history on perceived risk ranged from 0.35 standard deviation for ovarian cancer to 1.12 standard deviations for colon cancer. Family history was not related to perceived control over developing diseases. Risk perceptions seemed optimistically biased, with 48–79% of participants with increased familial risk for diseases reporting that they were at average risk or below.ConclusionsParticipants' ratings of their risk for developing common diseases, before feedback on familial risk, parallels but is often lower than their calculated risk based on family history. Having a family history of a disease increases its salience and does not change one's perceived ability to prevent the disease.     

Perceived Threat of Illness and Health Protective Behaviors in Offspring of Adults With Non-Insulin-Dependent Diabetes Mellitus

Abstract

Self-reported measures of perceived threat of illness, health protective behaviors, psychological well-being, and family modeling of health behaviors of 30 adults with a parental history of non-insulin-dependent diabetes mellitus (NIDDM) were compared with responses from 29 adults with a parental history of hypertension and 30 adults with no parental history of chronic illness. The NIDDM risk group reported significantly more perceived threats of NIDDM and hypertension and more weight-control efforts than the controls did. Reports of the NIDDM risk respondents concerning physician screening, healthy diet, and exercise did not differ from reports of individuals without a family history of NIDDM. Perceived threat, psychological well-being, and family modeling did not correlate with health-protective behaviors. The findings suggest that offspring of adults diagnosed with NIDDM perceive themselves to be at risk of NIDDM and engage in health behaviors, such as weight control, to protect themselves from NIDDM onset.     

African-American sexual minority adolescents and sexual health disparities: An exploratory cross-sectional study

PurposeTo better understand sexual health disparities among African-American sexual minority adolescents.MethodsAfrican-American adolescents (N = 1120; mean age = 15.24 years) were recruited from 4 cities (Columbia, SC; Macon, GA; Providence, RI; Syracuse, NY) to a larger trial. The current analyses used data from the 18-month follow-up when adolescents reported on their sexual partnerships, condom use knowledge, self-efficacy and outcome expectancies for condom use, sexual risk behavior, and STI testing history.ResultsCompared with heterosexual adolescents, sexual minority adolescents reported more concerns about potential relationship harms resulting from safer sex negotiation. Sexual minority adolescents were also more likely to engage in riskier sexual behaviors, with females reporting more sexual partners and drug use prior to sex, and males reporting inconsistent condom use and higher rates of HIV.ConclusionsAfrican-American sexual minority adolescents evidence disparities in sexual risk behavior and STI history that appear to result from interpersonal and relationship concerns. These concerns need to be targeted in sexual health interventions for sexual minority adolescents.     

Colorectal cancer risk perceptions and screening intentions in a minority population

This is a 2-year follow-up to a previously reported baseline paper. We focused on a predominantly low-income African-American population from a community health center and investigated the relationships among perceptions of perceived risks for colorectal cancer (CRC), concerns about getting CRC, screening intentions, and whether participants had a fecal occult blood test (FOBT) on schedule at follow-up. Baseline absolute risk did not predict screening intentions or being on schedule (15% of sample), nor did it predict follow-up perceived absolute risk, comparative risk, or CRC concerns. Participants who expressed greater perceived absolute risk, comparative risk, and concerns at follow-up were more likely to report thinking about or definitely planning to get an FOBT within the next 2 years (49% of the sample). In addition, baseline absolute risk and whether or not a person had an FOBT on schedule at baseline did not predict being on schedule at follow-up. A significant percentage of the population (20%) were not able to state whether their CRC risk was below average, average, or above average. In addition, 44% of the population viewed their risks as lower than their peers, and 58% reported being not at all or slightly concerned about getting CRC. These results suggest that educational efforts are needed especially for low-income minority populations to enhance knowledge and accuracy of risk perceptions for CRC and interventions that explicitly manipulate risk are needed to assess to what extent risk perceptions can be modified and subsequently affect screening.     

Health beliefs and regimen adherence in minority adolescents with type 1 diabetes

OBJECTIVE: To examine the appraisal of short- and long-term diabetes health risk and adherence, determine whether health risk predicts adherence and glycemic control in an ethnic minority sample, and determine whether perceptions of personal risk differ from risk to others. METHODS: Seventy-four youths with type 1 diabetes (ages 11-16) completed measures of risk perception and regimen adherence during their clinic visit; parents completed a measure of their children's adherence. Glycosylated hemoglobin A1c level was measured as part of the clinic visit. RESULTS: Regression analyses predicting parental report and self-reported adherence from appraisal of risk yielded nonsignificant results; perceived short-term complications to self predicted glycemic control. Appraisal of risk was higher for short- and long-term complications occurring to someone else with diabetes than to self. Greater risk for short-term complications than for long-term complications to self and other was found. CONCLUSIONS: The distinction between long-term and short-term complications and complications occurring to ones' self or someone else with diabetes was supported. Assessment of perceived risks for short-term complications is important for this age group and should be addressed in interventions to improve adherence.     

Readiness for lifestyle advice: self-assessments of coronary risk prior to screening in the British family heart study. Family Heart Study Group.

BACKGROUND. Where health professionals and patients hold similar views of a problem, health outcomes may be better. AIM. The aims of this paper were to document how attenders at primary care cardiovascular screening clinics perceived their risks of coronary heart disease prior to screening; the degree of similarity between perceived level of risk and an epidemiologically derived risk score; and the relative importance assigned to individual risk factors by subjects compared with those assigned by the risk score. METHOD: These issues were investigated in 3725 middle aged men and women who accepted an invitation to attend health screening as part of the British family heart study. RESULTS. Overall, there was a tendency for subjects to be optimistic (37%) rather than pessimistic (21%) when judging their risk of coronary heart disease. Nevertheless, there were strong significant associations between perceived risk and the levels of individual risk factors, particularly personal and family medical history and body mass index. There was also a strong association with the overall risk score though a large minority (31%) held views of their risk of coronary heart disease that were quite different from those based upon the epidemiologically derived index of risk. Respondents accorded greater importance to smoking and parental death from coronary heart disease and less importance to cholesterol level and blood pressure than did the risk score. CONCLUSION. Possible explanations for the observed disagreement are over-optimism or the relative importance given to individual risk factors. The relationships between patients' perceptions of risk and the epidemiological indices likely to be espoused by health professionals are important in understanding the difficulties in communication that might arise in offering lifestyle advice after screening for cardiovascular risk.     

Predictors of intentions to use tobacco among adolescent survivors of cancer

OBJECTIVE: To examine the relationship between knowledge of tobacco-related health risks, perceptions of vulnerability to these health risks, and future intentions to use tobacco in a sample of adolescent survivors of cancer. METHODS: Written self-report questionnaires were administered to 46 survivors, 10-18 years of age (61% males, 93.5% Caucasian). RESULTS: Overall, survivors were generally knowledgeable about tobacco-related health risks, perceived themselves to be vulnerable to these health risks, and reported low future intentions to use tobacco. Regression analyses indicated that demographic factors, treatment-related variables, knowledge, and perceived vulnerability explained 28% of the variance in intentions scores, F:(6, 39) = 2.52, p <.05. Age and knowledge were significant predictors, indicating that older adolescent survivors and those with lower knowledge scores reported greater intentions to use tobacco. CONCLUSIONS: Young survivors will benefit from risk counseling interventions that educate them about their susceptibility to specific tobacco-related health risks secondary to their cancer treatment. Intensive tobacco prevention programs that target older adolescents should be developed.     

Perceptions of cardiovascular risk among patients with hypertension or diabetes

We aimed to examine risk perceptions among patients at moderate to high cardiovascular risk. A questionnaire about perceived absolute risk of myocardial infarction and stroke was sent to 2424 patients with hypertension or diabetes. Response rate was 86.3% and 1557 patients without atherosclerotic disease were included. Actual cardiovascular risk was calculated by using Framingham risk functions. A total of 363 (23.3%) of the 1557 patients did not provide any risk estimates and these were particularly older patients, patients with a lower educational level, and patients reporting no alcohol consumption. The remaining 1194 patients tended to overestimate their risk. In 42.3% (497/1174) and 46.8% (541/1155) of the cases, patients overestimated their actual 10-year risk for myocardial infarction and stroke, respectively, by more than 20%. Older age, smoking, familial history of cardiovascular disease (CVD), and actual absolute risk predicted higher levels of perceived absolute risk. Male sex, higher scores for an internal health locus of control, lower scores for a physician locus of control, and self-rated excellent or (very) good health were positively related to higher accuracy. In conclusion, patients showed inadequate perceptions of their absolute risk of cardiovascular events and physicians should thus provide greater information about absolute risk when offering preventive therapy.     

Components of family history associated with women's disease perceptions for cancer: A report from the Family Healthware™ Impact Trial

PurposeTo determine the specific components of family history and personal characteristics related to disease perceptions about breast, colon, and ovarian cancers.MethodsBaseline, cross-sectional data on 2,505 healthy women aged 35–65 years enrolled from 41 primary care practices in the cluster-randomized Family Healthware™ Impact Trial, assessed for detailed family history and perceived risk, perceived severity, worry, and perceived control over getting six common diseases including breast, colon, and ovarian cancers.ResultsParticipants provided family history information on 41,841 total relatives. We found evidence of underreporting of paternal family history and lower perceived breast cancer risk with cancer in the paternal versus maternal lineage. We observed cancer-specific perceived risks and worry for individual family history elements and also found novel “spillover” effects where a family history of one cancer was associated with altered disease perceptions of another. Having a mother with early-onset breast or ovarian cancer was strongly associated with perceived risk of breast cancer. Age, parenthood, and affected lineage were associated with disease perceptions and ran counter to empiric risks.ConclusionsUnderstanding patients' formulation of risk for multiple diseases is important for public health initiatives that seek to inform risk appraisal, influence disease perceptions, or match preventive interventions to existing risk perceptions.     

Awareness and use of the prostate-specific antigen test among African-American men

Although African-American men have a greater burden of prostate cancer than whites and other racial and ethnic groups, few studies on the burden of prostate cancer have focused on African Americans specifically. We used a sample of African-American men (N = 736) who participated in the 2000 National Health Interview Survey to explore their awareness of the prostate-specific antigen (PSA) test. Among African-American men aged > or = 45 with no history of prostate cancer, 63% had heard of the PSA test and 48% had been tested. Bivariate analyses showed significant associations between sociodemographic, family composition, health status and perceived risk with having heard of the PSA test and having been tested. The multivariate model showed significant associations between having heard of the PSA test and age, level of education, living in an MSA, and having private or military health insurance. For ever being tested, the multivariate model showed significant associations for age, private or military health insurance, being in fair or poor health, and having a family history of prostate cancer. Some of the correlates, such as age, increased levels of education and being married, were consistent with previous studies, but other correlates, such as metropolitan statistical area, health status and perceived risk, differed from previous studies.     

PERCEIVED NEIGHBORHOOD VIOLENCE,PARENTING STYLES,AND DEVELOPMENTAL OUTCOMES AMONG SPANISH ADOLESCENTS

This article analyzed perceptions of neighborhood violence of Spanish adolescents (N = 1,015) from authoritative, authoritarian, indulgent, and neglectful families, and its association with three sets of developmental outcomes (psychological, behavioral, and academic). Tests of main and interactive effects were conducted to answer research questions regarding the potential moderating role of perceived neighborhood violence on the relationship between parenting styles and developmental outcomes. Results yielded only main effects of parenting styles and perceived neighborhood violence on developmental outcomes, as well as an interaction between gender and perceived neighborhood violence. Parenting styles and perceived neighborhood violence made an independent contribution to adolescent outcomes. Adolescents from authoritative and indulgent families were those who performed better in all developmental domains examined, and adolescents who perceived their neighborhoods as violent performed worse in all outcomes. Results suggested, however, that irrespective of parental behavior, perceived neighborhood violence was a developmental risk in adolescence.     

The psychosocial impact of anaphylaxis on young people and their parents

BACKGROUND: Anaphylaxis is a potentially life-threatening disorder that can affect people of all ages. Young people are at a disproportionately increased risk of anaphylaxis deaths for reasons that include a failure to institute appropriate long-term management regimens. A pre-requisite for effective supported self-management of young people with anaphylaxis is a better understanding of the factors that contribute to risk-taking behaviour. OBJECTIVE: To explore the psychosocial impact of living with anaphylaxis on adolescents and their parents; their management of the condition; and perceptions of health care provision. METHODS: In-depth interviews were conducted with 15 participants, these comprising of seven adolescents aged between 13 and 16 years with a history of clinician-diagnosed anaphylaxis and eight of their parents, in this Scottish community-based exploratory qualitative study. RESULTS: Adolescents in this study typically perceived anaphylaxis as 'no big deal', describing a relatively low impact on their day-to-day life when compared with their parents. This could largely be explained by the fact that most adolescents could not remember an anaphylactic reaction. Key obstacles to effective long-term self-management included inadequate knowledge to support detailed situation-specific risk assessment, this being compounded by a lack of confidence to make further enquiries about the ingredients of meals when with peers. Parents reported anxiety about 'handing over' the main responsibility for avoidance and emergency management to their children. Medical support for these families was very limited, with primary care teams in some cases actively hindering effective self-management. CONCLUSION: Having a child with anaphylaxis can have a significant long-term psychological impact on parents and this anxiety may in some cases be transferred from parents onto their children. Parents and adolescents may benefit from tailored information to support the transition from parental- to self-management by adolescents. Access to appropriate national health service primary and specialist care was in some cases currently inadequate to support effective long-term management. Further, more in-depth research in a more heterogeneous group of adolescents is needed.     

Risk Perception and Self-Management in Urban,Diverse Adults with Type 2 Diabetes: The Improving Diabetes Outcomes Study

Purpose and Background

The relationship between risk perceptions and diabetes self-care remains ambiguous. This study aimed to assess baseline, 1-year follow-up, and change score relationships among perceived risk, diabetes self-care, and glycemic control for adult individuals participating in a behavioral intervention that improved glycemic control relative to the active control.

Method

One-year randomized trial compared a behavioral telephonic intervention with a print only intervention. Participants (N?=?526) are members of a union/employer sponsored health benefit plan, with HbA_1c?≥?7.5 %, prescribed at least one oral diabetes medication. Participants rated perceived risk of diabetes and its complications and diabetes self-care at baseline and 1 year. Data were collected in a large urban area in the USA.

Results

There were no relationships between risk perceptions and glycemic control during the study. Baseline perceived risk predicted follow-up self-care. Additionally, participants assigned to the intervention group showed significant changes in dietary and exercise adherence at high levels of risk knowledge and low levels of optimistic bias.

Conclusion

Perceived risk relates to dietary, exercise, and medication adherence in diabetes. The perceived risk construct might foster a more coherent conceptualization of the relationship between one’s diabetes, possible complications, and diabetes self-care behaviors.     

Factors that influence personal perceptions of the risk of an acute myocardial infarction

Personal risk perceptions of acute myocardial infarction (AMI) affect people's preventive health behaviors as well as their beliefs during a heart attack episode. The authors investigated factors that are associated with personal risk perceptions of having an AMI. A random-digit-dial survey was conducted among 1294 respondents, aged 18 years or older, in 20 communities across the nation as part of the Rapid Early Action for Coronary Treatment (REACT) trial. Results of two mixed-model linear regression analyses suggested that worse perceived general health, more risk factors, and greater knowledge were associated with greater perception of AMI risk. The results also showed that women who answered, incorrectly, that heart disease is not the most common cause of death for women in the United States reported significantly lower risk perceptions than women who answered this question correctly. The findings in this study suggest that interventions need to target specific misconceptions regarding AMI risk.     

Mothers', fathers', and children's perceptions of parental diabetes responsibility in adolescence: examining the roles of age, pubertal status, and efficacy

Objectives To examine how perceptions of parental responsibilityfor diabetes management are associated with age, pubertal status,adolescents’ self-efficacy, and parental perceptions ofadolescents’ efficacy, and if parental responsibilityis associated with better metabolic control as a function ofadolescents’ self-efficacy and parental perceptions ofadolescents’ efficacy. Methods Questionnairesassessing parental responsibility, pubertal status, adolescents’self-efficacy, and parental perceptions of adolescents’efficacy were given to 185 adolescents with type 1 diabetes,185 mothers, and 145 fathers. Results Greater parentalresponsibility was negatively associated with age, perceptionsof pubertal status, and efficacy for all reporters. Interactionsbetween parental responsibility and parental perceptions ofadolescents’ efficacy indicated that parental responsibilitywas associated with better metabolic control when adolescentswere perceived to have lower efficacy. Conclusions Adolescents’and parents’ perceptions of parental responsibility arerelated to multiple factors. Metabolic control is best whenhigh parental responsibility is maintained among adolescentswith lower efficacy.     

Perceived body image among African Americans with type 2 diabetes

OBJECTIVE: To assess current, desired and best body image in the opposite sex and examine correlates of body image dissatisfaction. METHODS: We conducted a cross-sectional analysis at baseline of 185 (141 women, 44 men) African Americans with type 2 diabetes in Project Sugar 1, a randomized controlled trial of primary care-based interventions to improve diabetic control. RESULTS: Women had a significantly lower desired body image compared to their current body image (BMI approximately 27.7 versus approximately 35.3). Men preferred a body image for women that was similar to the body image that women desired for themselves (BMI approximately 28.3 versus approximately 27.7). Significant correlates of body image dissatisfaction included self-perception of being overweight and attempting weight-loss (P < 0.05). PRACTICAL IMPLICATIONS: Among overweight and obese African-American women with diabetes, it is important to first address an individual's perceived body image, perceived risk of disease, desired body image, and weight-loss perceptions. In addition to the aesthetic benefits of weight-loss, there is a need to focus on the health benefits in order to intervene among African Americans with diabetes.     

Dynamic association between parental monitoring and communication and adolescent risk involvement among African-American adolescents

PURPOSE: To examine: (1) the relationship between parental monitoring and communication and adolescent risk involvement over time, including consideration of their potential interaction; and (2) the effect of consistent versus inconsistent monitoring and communication over time on adolescent risk behaviors. METHODS: Baseline and follow-up data were collected from 1999-2003. A total of 817 African-American adolescents and their parents were recruited from 35 low-income urban communities in Baltimore, MD. Perceived parental monitoring, parent-adolescent communication and seven risk behaviors were assessed. Logistic general estimating equation (GEE) models were performed to assess the dynamic association. RESULTS: Perceived parental monitoring had protective effects on concurrent adolescent risk involvement over two-year observation. The protective effect on girls' sexual abstinence increased significantly over time. Perceived problem communication was associated with increased risk of concurrent involvement in violent behaviors, but the effect did not change over time. For girls, the probability of engaging in sex increased greatly (from 0.3 to 0.6) for those who perceived problem communication, while it remained stable (about 0.4) for those perceiving less problem communication. CONCLUSIONS: The data confirm the protective effect of perceived parental monitoring on adolescent risk involvement. It also extends previous findings by showing the importance of consistent parental monitoring and communication.     

Knowledge,beliefs, and risk factors for osteoporosis among African-American and Hispanic women

The purpose of this work was to develop and conduct a needs and risk instrument to assess knowledge of osteoporosis risk factors, identify beliefs and attitudes about this disease, and delineate the presence and/or absence of healthy behaviors associated with osteoporosis among African American and Hispanic women. The survey findings suggest that African-American and Hispanic women are not well-versed in behaviors that would promote and maintain optimal bone mass. Consequently, they are not practicing appropriate lifestyle and dietary habits to decrease their risk of osteoporosis. Such behaviors include inadequate physical activity, inadequate calcium intake, cigarette smoking, and long-term steroid use. Less than 10% of women in the study were getting adequate daily dietary calcium intake, with only 13% taking daily calcium supplements to augment this deficit and less than one-half of women exercising at a minimal level (20 minutes/3 times a week). Women in this study also had limited knowledge about osteoporosis, perceived this condition to be less of a health threat as compared to breast cancer, heart disease, diabetes, and Alzheimer's disease, and very few had the perception that being Hispanic or African American was a factor to consider in assessing their risk of osteoporosis. Our findings suggest that osteoporosis education and prevention initiatives are needed, specifically for African-American and Hispanic women, to promote healthy behaviors, identify women at-risk, and encourage early diagnosis and treatment.     

Assessment of preventive health knowledge and behaviors of African-American and Afro-Caribbean women in urban settings

OBJECTIVES: This report measures the extent of health knowledge and preventive behaviors of African-American and Afro-Caribbean women in New York City. METHODS: Two-hundred-twenty-one females in 10 Brooklyn-area beauty salons were surveyed in mid-June 2004. Participants completed a 30-item questionnaire (Cronbach's alpha=0.76) focusing on six domains: heart health, breast health, prostate health, second-hand smoke, asthma and sexual health. The instrument included 10 items on preventive behaviors related to the aforementioned domains. Mean knowledge scores were calculated, and analyses were performed to evaluate the factors associated with higher knowledge scores and with greater likelihood of preventive health behaviors. RESULTS: Despite a high level of knowledge about risk factors and symptoms for several common diseases, a large percentage of the sample engaged in high-risk behaviors. In addition, higher knowledge scores were associated with family history of heart disease (p=0.035), family history of prostate cancer (p=0.032) and being a member of an HMO (p=0.001). Higher scores, in turn, were associated with not currently smoking (p=0.049) and going for a blood cholesterol screening in the past year (p=0.045). CONCLUSION: Future intervention efforts should place greater focus on educating participants about symptoms and risk factors for commonly occurring diseases in the community, and on generating behavioral changes.