Influence of Place of Residence in Access to Specialized Cancer Care for African Americans

Context: Disparities in cancer care for rural residents and for African Americans have been documented, but the interaction of these factors is not well understood.
Purpose: The authors examined the simultaneous influence of race and place of residence on access to and utilization of specialized cancer care in the United States.
Methods: Access to specialized cancer care was measured using: (1) travel time to National Cancer Institute (NCI) Cancer Centers, academic medical centers, and any oncologist for the entire continental US population, and (2) per capita availability of oncologists for the entire United States. Utilization was measured as attendance at NCI Cancer Centers, specialized hospitals, and other hospitals in the Surveillance, Epidemiology, and End Results (SEER) program Medicare population from 1998-2004.
Findings: In urban settings, travel times were shorter for African Americans compared with Caucasians for all three cancer care settings, but they were longer for rural African Americans traveling to NCI Cancer Centers. Per capita oncologist availability was not significantly different by race or place of residence. Urban African American patients were almost 70% more likely to attend an NCI Cancer Center than urban Caucasian patients (OR = 1.66; 95% CI 1.51-1.83), whereas rural African American patients were 58% less likely to attend an NCI Cancer Center than rural Caucasian patients (OR = 0.42; 95% CI 0.26-0.66).
Conclusions: Urban African Americans have similar or better access to specialized cancer care than urban Caucasians, but rural African Americans have relatively poor access and lower utilization compared with all other groups.     

Racial disparities in African Americans with diabetes: process and outcome mismatch

Background: Over the past 2 decades, numerous studies have demonstrated the existence of racial disparities in patient care in the United States. Specifically, African Americans with diabetes are less likely to have recommended process of care measures performed and outcome benchmarks for quality of care. Objectives: To evaluate the delivery of diabetes care (processes and outcomes) associated with racial categories using a national web-based registry-the American Osteopathic Association Clinical Assessment Program (AOA-CAP). Study Design: A retrospective analysis of data retrieved from the AOA-CAP database on outcomes and process measures for diabetes. Methods: A total of 10,699 Caucasian and African American patients who received diabetes care had data entered into the AOA-CAP registry between July 1, 2005, and October 30, 2010. African Americans represented 3123 patients (29%), Caucasians 7576 (71%). Demographic, process of care, and outcomes comparisons between ethnicities were carried out using ?2 and t tests. Composite measures of process and outcomes of diabetes care were created to investigate the effect of race on care. Results: The process of care composite measure was significantly different among African American patients (P = .02) who were more likely to receive all indicated care than Caucasian patients (33.9% vs 31.6%). Evaluation of the composite outcome measure, which quantifies the percentage of patients achieving control of all 3 intermediate outcomes, was (P <.001) lower in African Americans than in Caucasians (8.1% vs 12.3%). Conclusions: African American patients with diabetes were as likely or more likely to have recommended process of care measures performed. In spite of this, intermediate diabetes outcomes were still poorer in the same African American population.     

Health care utilization and risk behaviors among HIV positive minority drug users

This study compared health care utilization and HIV-related risk behaviors between HIV-infected African American (n=123) and Hispanic (n=97) drug users recruited in New York City. African Americans were more likely to use crack, while Hispanics were more likely to use heroin and speedball. African Americans were more likely than Hispanics to report having traded sex for drugs or money. The two groups did not significantly differ in HIV care utilization (e.g., taking HIV medications). In multiple logistic regression analyses, for African Americans, taking HIV medications was significantly related to enrollment in HIV clinics and non-use of crack, while for Hispanics, being married and attending HIV support groups were significant factors. Drug treatment enrollment was significantly related to non-use of crack and injection drug use among African Americans, and a trend (p=.07) was found between injection drug use and drug treatment enrollment among Hispanics. The findings indicate the continuing need for harm reduction programs for HIV positive drug using populations. Programs for these populations should also take into account the different risk behaviors among different racial/ethnic groups, in order to tailor culturally sensitive programs for HIV care and intervention.     

Socioeconomic Characteristics,Dietary and Lifestyle Patterns,and Health and Weight Status of Older Adults in NHANES, 1999–2002: A Comparison of Caucasians and African Americans

There are disparities among older Caucasian and African American adults in many areas. The study used data from the National Health and Nutrition Examination Survey conducted from 1999 to 2002 and compared the self-reported dietary intakes, physical activity, and economic and health status of Caucasian (N = 1,398) and African American (N = 354) adults aged 65 years and older. Regression models and t-tests (α = 0.05) were used for comparisons. More African Americans than Caucasians lived in low-income households (40.4% vs. 21.3%), lived in households that were not fully food-secure (15.6% vs. 4.9%), watched five or more hours of television (34% vs. 20%), and were told that they had diabetes (10% vs. 4%) or high blood pressure (67 % vs. 52 %). They consumed 253 fewer calories than Caucasians. About 75 % of African American women were overweight. Our findings indicate that for those greater than 65 years of age, low-income African Americans are at a greater risk for poor nutrition and chronic health conditions than Caucasians.     

Risky Sex: Interactions Among Ethnicity, Sexual Sensation Seeking, Sexual Inhibition, and Sexual Excitation

Rates of sexually transmitted infections, including HIV, vary across ethnic minority groups, yet few studies have evaluated sexual risk behaviors and their psychological correlates to determine if risk and protective factors vary by ethnicity. The purpose of the current study was to assess sexual sensation seeking (SSS), sexual inhibition (SIS1 and SIS2), and sexual excitation (SES) as correlates of risky sexual behaviors in 106 (55 male and 51 female) Asian Americans, African Americans, and Caucasian Americans. Results revealed that higher SSS was associated with more vaginal and anal sex partners. Further, the association between SSS and the number of anal sex partners was positive among Asian Americans and Caucasians, but non-significant among African Americans. SIS1 was positively associated with unprotected sex on the first date among Asian Americans and African Americans. However, the association was not significant for Caucasians. SIS2 was negatively associated with general unprotected sex, and SES was positively associated with the number of vaginal sex partners. Findings suggest that ethnicity plays an important moderating role in the relationship between sexual traits and risky sexual behaviors.     

Binge eating and psychological distress in ethnically diverse undergraduate men and women

Binge eating symptomatology affects African Americans and Caucasians at similar rates. Moreover, compared to anorexia nervosa (AN) and bulimia nervosa (BN), binge eating and BED are more evenly distributed across genders. Undergraduates are likely to be affected by binge eating, yet, relatively few studies have investigated this behavior and its correlates in college samples. This study examined the influence of alexithymia, depression, and anxiety on binge eating among ethnically diverse undergraduates. Results indicated that these variables significantly predicted eating symptomatology among Caucasian and African American women but not among Caucasian men. Further, among Caucasian women, depression was the only unique predictor of eating pathology. In contrast, anxiety was the only unique predictor of disordered eating in African American women. There were no differences between Caucasians and African Americans in severity of disordered eating symptomatology; however, in both ethnic groups, women reported greater eating pathology than men. Eating disorders of all types may be more prevalent among African American undergraduates than previously thought. These results highlight the need to study binge eating and its correlates in this traditionally underserved group.     

Adolescents' health behaviors and obesity: Does race affect this epidemic?

This study explores the influence of health behaviors and individual attributes on adolescent overweight and obesity using data from Wave II (Add Health). Structural equation model/path analysis using maximum likelihood estimation was utilized to analyze the relationships of health behaviors and attributes with obesity. Results of the model reveal that the causal paths (adolescents'' attributes and health behaviors) for overweight and obesity were different for African American and Caucasian adolescents. Generally, African Americans were more susceptible to overweight and obesity than Caucasians. Although increasing levels of vigorous physical activities lowers the risk for obesity among African American and Caucasian adolescents alike, low family SES and being sedentary were associated with overweight and obesity among Caucasians. No significant associations were found among African Americans. Increased hours of sleep at night relate positively with obesity among African Americans. These findings suggest important elements in the consideration of race in developing effective intervention and prevention approaches for curbing the obesity epidemic among U.S. adolescents.     

Disordered eating among a multi-racial/ethnic sample of female high-school athletes

PurposeTo determine the prevalence of disordered eating (DE) attitudes and behaviors in a multi-racial/ethnic sample of female high-school athletes.MethodsThe Eating Disorders Examination Questionnaire (EDE-Q) was administered to 453 suburban female high-school athletes (277 Caucasian, 103 Latina, and 73 African American; aged 15.7 ± 1.2 years) during their competitive season.ResultsThe prevalence of DE in the total sample was 19.6%; among the three ethnic groups, prevalence estimates were 19.2%, 18.4%, and 23.3% for African Americans, Caucasians, and Latinas, respectively. The prevalence estimates of binge eating (12.6%) and vomiting (7.8%) were significantly higher in Latinas as compared to African Americans (5.5%, 1.4%) and Caucasians (5.4%, 2.2%; χ² p < .05). The prevalence of diuretic and laxative use was low among all athletes (< 3%), with no differences by ethnicity (p > .05). After adjusting for body mass index (BMI) and sport, analysis of covariance (ANCOVA) with Bonferroni post-hoc pair-wise comparisons indicated that Caucasian and Latina athletes scored higher than African Americans on all EDE-Q subscales except eating restraint, which was higher only in Caucasians compared to African Americans (p = .001–.046).ConclusionsCaucasian and Latina female high-school athletes may be at greater risk for eating disorders than their African American peers. Furthermore, Latina athletes may be particularly at risk for binge-eating disorder. Culturally-sensitive behavioral interventions targeted specifically for high-school athletes are needed to reduce the risk of eating disorders and associated long-term health consequences in this population.     

Racial differences in risk of spontaneous abortions associated with periconceptional over-the-counter nonsteroidal anti-inflammatory drug exposure

PurposeNonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most common medications reported in pregnancy. NSAIDs directly impact prostaglandin pathways and have been proposed as potential risk factors for spontaneous abortions (SABs, gestation <20 weeks). SAB risk and drug response across several medications differ by race; therefore, we evaluated whether associations between NSAIDs and SAB risk differ by race.MethodsWomen were enrolled in the Right from the Start (2004–2010) prospective cohort. Data regarding over-the-counter NSAIDs up to the sixth week of pregnancy were obtained from interviews. Race was self-reported. Cox proportional hazards regression models were used to estimate the association between NSAID exposure and SAB, adjusted for confounders.ResultsAmong 2493 pregnancies, 12% were African American and 88% were Caucasian. NSAID exposure was reported by 40% (n = 124) of African Americans and 43% (n = 945) of Caucasians. Race-stratified analyses showed protection from SAB among African Americans (adjusted hazard ratio [aHR], 0.84; 95% confidence interval [CI], 0.73–0.96) but no effect in Caucasians (aHR, 1.01; 95% CI 0.88–1.16).ConclusionsOur findings suggest that risk for SAB due to over-the-counter NSAIDs in early pregnancy is modified by race. Further investigation of dose, timing in gestation, and indication may help to further reconcile the relationship between race, NSAIDs, and SAB.     

Dietary magnesium intake in a national sample of US adults

Despite the role of magnesium in maintaining health, much of the U.S. population has historically not consumed adequate amounts of magnesium. Furthermore, significant racial or ethnic disparities in magnesium intake exist. Our objective was to provide more recent data about magnesium intake in the U.S. population. We analyzed the 24-h dietary recall data from 4257 participants aged >or=20 y from the National Health and Nutrition Examination Survey 1999-2000. The median intake of magnesium was 326 mg/d (mean 352 mg/d) among Caucasian men, 237 mg/d (mean 278 mg/d) among African American men, 297 mg/d (330 mg/d) among Mexican American men, 237 mg/d (mean 256 mg/d) among Caucasian women, 177 mg/d (mean 202 mg/d) among African American women, and 221 mg/d (mean 242 mg/d) among Mexican American women. Among men and women, Caucasians had significantly higher mean intakes of dietary magnesium than African Americans but not Mexican Americans. Magnesium intake decreased with increasing age (P for linear trend = 0.035 for Caucasians; P for linear trend <0.001 for African Americans and Mexican Americans). Men had higher intakes of magnesium than women for each of the three race or ethnic groups (P < 0.001 in each group). Caucasian men, African American men and Caucasian women who used vitamin, mineral or dietary supplements consumed significantly more magnesium in their diets than did those who did not. Substantial numbers of U.S. adults fail to consume adequate magnesium in their diets. Furthermore, racial or ethnic differences in magnesium persist and may contribute to some health disparities.     

Racial disparities in tobacco use and social influences in a rural southern middle school

This study investigated racial differences of tobacco use and social exposure to tobacco products in a sample of middle school students. Questionnaires were administered in January 2005 to 290 students in a Mississippi Delta-area middle school. The participants were 51.0% female and 56.6% African American. Unadjusted odds ratios revealed that Caucasian students were statistically more likely than were African American students to (1) have ever tried smoking, (2) have ever been a daily smoker, (3) have smoked in the past 30 days, (4) live with someone who smokes, (5) have seen a parent or guardian smoke, and (6) have friends who smoke. In contrast, African Americans were more likely to report "no one is allowed to smoke" in their home. Caucasian females had the highest rates of smoking, as well as the highest exposure to social smoking behaviors. This study not only showed that Caucasians were indeed smoking more but also that African American adolescents do not have the same exposure to social smoking, particularly African American females. Of particular interest was why the differences eventually dissipate and smoking rates are virtually the same in adulthood. A greater understanding of the impact of exposure to tobacco use on an adolescent's own tobacco use is vital to prevention efforts, especially in regard to racial differences. Future research on youth tobacco prevention and cessation programs should focus on sociocultural and racial differences in the development of tobacco use in adolescents.     

Physical activity levels of overweight and nonoverweight high school students during physical education classes

Background:  This study examined physical activity (PA) levels of overweight and nonoverweight African American and Caucasian students (n = 198) during game play in physical education classes.
Methods:  Body fat percentages (%BFs) were determined using the skinfold technique and Slaughter et al prediction equations. Girls were classified as overweight if their %BF was ≥32; boys were classified as overweight if their %BF was ≥25. PA was monitored using pedometers during flag football, ultimate Frisbee, and soccer game play. Three 2 (weight classification) × 2 (gender) × 2 (race) factorial analyses of variance were conducted.
Results:  Results indicated no significant difference in steps per minute between overweight and nonoverweight students regardless of game. Males were more active than females, and Caucasians were more active than African Americans.
Conclusions:  The most important implication of the current study is that the overweight and nonoverweight students accumulated similar amounts of PA during physical education. This emphasizes the importance physical education plays in providing both overweight and nonoverweight students with opportunities for PA. For many students, it may be their only source of regular PA.     

Saving Lives Branch by Branch: The Effectiveness of Driver Licensing Bureau Campaigns to Promote Organ Donor Registry Sign-Ups to African Americans in Michigan

African Americans are disproportionately represented on the national waiting list for organ transplantation. Promoting organ donor registries is one way to improve the possibility that those on the waiting list can receive a life saving transplant. Driver licensing bureaus have been suggested as an efficient site for campaigns aimed at increasing state-based registry sign-ups. Previous research has suggested these campaigns work well for Caucasian populations, but there is less evidence supporting this approach in more diverse populations. To determine whether more diverse populations demonstrate similar sign-up rates when receiving a driver licensing bureau campaign, the present study used a previously successful strategy as the basis for designing and disseminating materials that would appeal to African Americans and Caucasians in two diverse counties in the state of Michigan (Wayne and Oakland Counties). Communication design and media priming served as the theoretical foundations of a three-prong campaign that used mass media, point-of-decision, and interpersonal components. Results from countywide and zip code data indicate that the campaign greatly increased sign-ups among African American residents (700% increase above baseline). Although more Caucasians still signed up than did African Americans, the inclusion of an interpersonal component resulted in similar numbers of registry sign-ups during 2 intervention months. The study provides evidence supporting the use of driver licensing bureau campaigns to promote organ donation registries to diverse audiences.     

Saving lives branch by branch: the effectiveness of driver licensing bureau campaigns to promote organ donor registry sign-ups to African Americans in Michigan

African Americans are disproportionately represented on the national waiting list for organ transplantation. Promoting organ donor registries is one way to improve the possibility that those on the waiting list can receive a life saving transplant. Driver licensing bureaus have been suggested as an efficient site for campaigns aimed at increasing state-based registry sign-ups. Previous research has suggested these campaigns work well for Caucasian populations, but there is less evidence supporting this approach in more diverse populations. To determine whether more diverse populations demonstrate similar sign-up rates when receiving a driver licensing bureau campaign, the present study used a previously successful strategy as the basis for designing and disseminating materials that would appeal to African Americans and Caucasians in two diverse counties in the state of Michigan (Wayne and Oakland Counties). Communication design and media priming served as the theoretical foundations of a three-prong campaign that used mass media, point-of-decision, and interpersonal components. Results from countywide and zip code data indicate that the campaign greatly increased sign-ups among African American residents (700% increase above baseline). Although more Caucasians still signed up than did African Americans, the inclusion of an interpersonal component resulted in similar numbers of registry sign-ups during 2 intervention months. The study provides evidence supporting the use of driver licensing bureau campaigns to promote organ donation registries to diverse audiences.     

The reliability of the Diabetes Care Profile for African Americans

The Diabetes Care Profile (DCP) is an instrument used to assess social and psychological factors related to diabetes and its treatment. The reliability of the DCP was established in populations consisting primarily of Caucasians with type 2 diabetes. This study tests whether the DCP is a reliable instrument for African Americans with type 2 diabetes. Both African American (n = 511) and Caucasian (n = 235) patients with type 2 diabetes were recruited at six sites located in the metropolitan Detroit area. Scale reliability was calculated by Cronbach's coefficient alpha. The scale reliabilities ranged from .70 to .97 for African Americans. These reliabilities were similar to those of Caucasians, whose scale reliabilities ranged from .68 to .96. The Feldt test was used to determine differences between the reliabilities of the two patient populations. No significant differences were found. The DCP is a reliable survey instrument for African American and Caucasian patients with type 2 diabetes.     

Menstrual and Oral Contraceptive Use Patterns Among Deployed Military Women by Race and Ethnicity

Menstrual cycle patterns and concerns and oral contraceptive use in the combat environment were examined in Caucasian, Asian, Hispanic, and African American women to guide the development of educational resources for women soldiers. An anonymous, questionnaire was completed by 455 U.S. Army women—Caucasian (CA: n = 141); Asian (AS: n = 67); Hispanic (HIS: n = 67); and African American (AA: n = 184) to compare menstrual patterns and concerns, dysmenorrhea, and oral contraceptive patterns. Total menstrual concerns were significantly lower among African Americans relative to Caucasians, Asians, or Hispanics; Asians and Hispanics reported the greatest concern. Overall, secondary amenorrhea was noted by 14.9% of women. Severe dysmenorrhea rates were significantly lower in African American (6.1%) compared to Caucasian (11.6%), Asian (20.9%) and Hispanic (19.7%) women. Asian women reported missing less work—only 9.3% with moderate to severe dysmenorrhea missed work compared to 25.1% of all other women. Only 9.2% of women with mild, compared to 25.8% with moderate to severe (OR = 3.44; p ≤ 0.0001) dysmenorrhea sought health care. Less than 50% of women took oral contraceptive, and less than half of those women took oral contraceptive continuously. African Americans seemed to experience menstruation as less bothersome than others, despite no difference in the proportion with menstrual irregularities, mean duration of menses, and/or mean time between cycles.     

The role of attitudes in understanding disparities in adult influenza vaccination

BACKGROUND: Racial/ethnic disparities in influenza vaccine coverage of adults aged 65 years and older persist even after controlling for access, healthcare utilization, and socioeconomic status. Differences in attitudes toward vaccination may help explain these disparities. The purpose of this study was to describe patient characteristics and attitudes toward influenza vaccination among whites and African Americans aged 65 years and older, and to examine their effect on racial disparities in vaccination coverage. METHODS: A cross-sectional telephone survey of Medicare beneficiaries in five U.S. sites, sampled on race/ethnicity and ZIP code. Multivariate analysis controlling for demographics, healthcare utilization, and attitudes toward influenza vaccination was conducted in 2005 to assess racial disparities in vaccine coverage during the 2003-2004 season. RESULTS: The analysis included 1859 white and 1685 African-American respondents; 79% of whites versus 50% of African Americans reported influenza vaccination in the past year (p < 0.00001). Both vaccinated and unvaccinated African Americans were significantly less likely than whites to report positive attitudes toward influenza vaccination. Even among respondents with provider recommendations, respondents with positive attitudes were more likely to be vaccinated than those with negative attitudes. After multivariate adjustment, African Americans had significantly lower odds of influenza vaccination than whites (odds ratio = 0.55, 95% confidence interval = 0.42-0.72). CONCLUSIONS: A significant gap in vaccination coverage between African Americans and whites persisted even after controlling for specific respondent attitudes. Future research should focus on other factors such as vaccine-seeking behavior.     

Source Credibility and Evidence Format: Examining the Effectiveness of HIV/AIDS Messages for Young African Americans

Using experimental methodology, this study tests the effectiveness of HIV/AIDS prevention messages tailored specifically to college-aged African Americans. To test interaction effects, it intersects source role and evidence format. The authors used gain-framed and loss-framed information specific to young African Americans and HIV to test message effectiveness between statistical and emotional evidence formats, and for the first time, a statistical/emotional combination format. It tests which source—physician or minister—that young African Americans believe is more effective when delivering HIV/AIDS messages to young African Americans. By testing the interaction between source credibility and evidence format, this research expands knowledge on creating effective health messages in several major areas. Findings include a significant interaction between the role of physician and the combined statistical/emotional format. This message was rated as the most effective way to deliver HIV/AIDS prevention messages.     

Racial/ethnic differences in body image and eating behaviors

There is a growing literature on the relationship between race/ethnicity and body image and eating disorders, but the conclusions are still unclear. We therefore examined racial/ethnic influences on body image and eating behaviors in 108 Caucasian, 46 African American, and 40 Asian female undergraduates. Participants completed the Figure Rating Scale (FRS) and the Eating Habits Questionnaire (EHQ) to assess body image and eating pathology. Caucasians had greater body discrepancy (difference between current and ideal) than Asians (P=.05) and higher EHQ scores (P<.0001) than both Asians and African Americans. African Americans chose a larger ideal body size than the other groups (P=.005). However, Asian women had a significantly lower body mass index (BMI) than both groups (P<.0001). After controlling for BMI, ideal body size differences were minimized (P=.08). Also, now, both Caucasians and Asians had greater body discrepancy (P<.0001) and EHQ scores (P<.0001) than African Americans. Our findings help reconcile inconsistencies in the literature by demonstrating the impact of controlling for BMI when comparing body image and eating behaviors in individuals from different racial/ethnic backgrounds.