Measuring quality of life among cervical cancer survivors: preliminary assessment of instrumentation validity in a cross-cultural study

Background With growing interest in cross-cultural and multicultural cancer-related quality of life studies, the need to assess reliability and validity of quality of life measures for linguistically and culturally diverse cancer survivors is pressing. Methods Reliability and validity of the English and Spanish versions of the Functional Assessment of Cancer Therapy (FACT)-G subscales were tested with a sample of English-speaking European American (n = 273) and ethnic minority American (n = 194), and Spanish-speaking Latina (n = 199) cervical cancer survivors in the U.S. Results Reliability coefficients (Cronbach’s alpha) were 0.76 or higher across ethnic/linguistic groups except for the emotional wellbeing subscale among Spanish-speaking Latinas (α = 0.64). Factor analyses demonstrated overall measurement equivalence across groups with some ethnic/linguistic variations: there were greater differences between linguistic groups than between ethnic groups. Additionally, the scale’s factor structure was less satisfactory for Spanish-speaking Latinas. The subscales had good concurrent validity with appropriate subscales of the Short Form (SF)-12 and Rand/SF-36 General Health subscale (Pearson’s r 0.53–0.66), suggesting each subscale was assessing its intended construct. Conclusion The overall psychometric properties of the FACT-G were cross-culturally equivalent. However, more validation studies are needed for non-English speaking populations particularly with emotional wellbeing. In addition, disaggregated analyses on linguistic groups are recommended unless cross-cultural equivalence is established. All participants in this study have provided written informed consent as required by the University of California at Los Angeles Institutional Review Board.     

Understanding the breast cancer experience of women: a qualitative study of African American, Asian American, Latina and Caucasian cancer survivors

Breast cancer is the most common form of cancer in American women across most ethnic groups. Although the psychosocial impact of breast cancer is being studied, there is little information on women from diverse ethnic and socioeconomic backgrounds. We conducted a qualitative study with breast cancer survivors (BCS) of various ethnicities. A total of 102 BCS participated in focus group interviews (24 African Americans, 34 Asians, 26 Latinas and 18 Caucasians); 20 health professionals participated in key informant interviews. Important ethnic differences in type of treatment were noted, Asians and Latinas were more likely to receive mastectomies and African American BCS were least likely to receive adjuvant therapies, including radiation and chemotherapy. These BCS enjoyed a fairly good overall health-related quality of life (HRQOL) with some persistent concerns. The prevailing concerns among all women included overall health, moderate physical concerns, cancer recurrence or metastases, psychosocial concerns related to worry about children and burdening the family, and body image and sexual health concerns. Additional challenges included: lack of knowledge about breast cancer; medical care issues such as insurance, cost and amount of time spent with physician; cultural sensitivity of providers, language barriers, cultural factors related to beliefs about illness, gender role and family obligations (e.g. self-sacrifice). These BCS, particularly the women of color, voiced that their spiritual beliefs and practices are central to their coping. This study accomplishes two goals; it adds to the sparse literature concerning the psychosocial sequelae of breast cancer among women of color, and it increases our knowledge of specific cultural influences (e.g. dietary practices, coping) and socio-ecological factors on HRQOL. More importantly, the study addressed areas that have not been studied before, specifically, an in-depth study on BCS QOL comparing multiple ethnic groups in the US. The results of this investigation will provide preliminary information to survivors and health-care providers about the impact of culture and socio-ecological contexts on survivorship. Among women of all major ethnic groups, breast cancer is the most common form of cancer and the second leading cause of cancer death (American Cancer Society (ACS), 2002). In 2002, over 203,000 women in the United States will be diagnosed with breast cancer (ACS, 2002). Ethnic disparities exist for cancer stage, diagnosis, survival, morbidity and mortality. In general, ethnic minority women are diagnosed with more advanced disease and experience greater morbidity and mortality (Haynes & Smedley, 1999; Miller et al., 1996; Ries et al., 2000; Shinagawa, 2000). In general, increases in survival rates have prompted greater interest in the quality of life (QOL) of breast cancer survivors (BCS) over the past two decades. Additionally, the QOL of cancer survivors from diverse ethnic, cultural and socioeconomic backgrounds is an emerging priority area for studies on survivorship research and clinical care (Haynes and Smedley, 1999; National Cancer Institute (NCI), 2002; President's Cancer Panel, 2000).     

Solar ultraviolet exposures at ground level in tree shade during summer in south east Queensland

Data are presented on the effect of the tree canopy transmittance in the visible waveband (VT), canopy width, height and height of the start of the tree canopy (CH) on the solar UV in tree shade on a horizontal plane at ground level during a Southern Hemisphere summer. Of these factors, the VT and CH have an influence on the UV irradiances in the tree shade. The shade ratios (UV in tree shade to that in full sun) for erythemal UV ranged from 0.71 to 0.42, 0.54 to 0.29 and 0.63 to 0.41 for morning, noon and afternoon, respectively, for the VT range of 0.4-1.0. Over the same VT range, the shade ratios for UVA ranged from 0.61 to 0.28, 0.50 to 0.22 and 0.49 to 0.29 for morning, noon and afternoon, respectively. The UV exposures in the tree shade decreased with the VT with a marginally higher decrease in the irradiances for the UVA compared to the erythemal UV. Despite the protection by the tree shade, significant UV in the tree shade of approximately 4 MED (minimum erythemal dose) were received for the latitude in this research on a cloud free summer day on a horizontal plane over a 2-h period centred about solar noon.     

Effect of stretch on the ultraviolet spectral transmission of one type of commonly used clothing

The spectral ultraviolet (UV) transmission through stockings was measured in field and laboratory based trials using a spectroradiometer. From these spectral UV measurements, the ultraviolet protection factor (UPF) was calculated. The UPF of stockings measured in the field was generally higher than that measured in the laboratory when using a quartz tungsten halogen light as the UV source. The UPF of 50 denier stockings decreased 868% when stretched 30% from their original size. Doctors recommending and patients using high denier stockings for patient photoprotection should be aware of the dramatic decrease in UPF when the stocking is in a stretched position, such as over a human leg.     

Health behavior change models and their socio-cultural relevance for breast cancer screening in African American women.

Models of health behavior provide the conceptual bases for most of the breast cancer screening intervention studies. These models were not designed for and have not been adequately tested with African American women. The models discussed in this paper are: The Health Belief Model, the Theory of Reasoned Action/Theory of Planned Behavior, and the Transtheoretical Model. This paper will examine the socio-cultural relevance of these health behavior models, and discuss specific socio-cultural dimensions that are not accounted for by these paradigms. It is critical that researchers include socio-cultural dimensions, such as interconnectedness, health socialization, ecological factors and health care system factors into their intervention models with African American women. Comprehensive and socio-culturally based investigations are necessary to guide the scientific and policy challenge for reducing breast cancer mortality in African American women.     

The impact of cultural characteristics on colorectal cancer screening adherence among Filipinos in the United States: a pilot study

Objectives: Studies on colorectal cancer screening among specific Asian American groups are limited despite the fact that Asians are comprised of culturally distinct subgroups. The purpose of this study was to investigate the impact of cultural characteristics on colorectal cancer screening adherence among Filipinos in the United States. Methods: One hundred and seventeen Filipino men and women aged 50 years or older participated in the cross‐section research design. Lifetime proportion of immigration, language preference and cultural beliefs of personal control regarding health outcomes measured cultural characteristics. Demographic and healthcare variables were also measured to describe the study sample. Participant recruitment employed culturally responsive sampling methods. Results: There was no significant association between language preference and screening. Likewise, perceived personal internal control of health outcome was not related to screening. However, personal external control revealed a marginally significant association. The percent of lifetime residence in the United States was significantly greater among those who were adherent to screening than those who were not adherent. After adjusting for demographic and healthcare variables, the relationship between length of immigration and screening adherence was no longer significant. Finally, age and doctor's recommendation showed significant impact on colorectal cancer screening adherence. Discussion: This pilot study adds to the knowledge regarding cultural factors associated with colorectal cancer screening behaviors among Filipino Americans. Future research is needed to confirm findings that will be useful in developing culturally appropriate strategies to increase screening adherence. Copyright © 2010 John Wiley & Sons, Ltd.     

Exploring the association between functional strain and emotional well‐being among a population‐based sample of breast cancer survivors

Objective: Breast cancer survival and survivorship outcomes have improved dramatically; yet, there are still considerable morbidities associated with this illness. Functional strain is conceptualized as the unfavorable outcome of the functional well‐being domain of health‐related quality of life. This study intends to (1) examine the adequacy of the functional strain concept; (2) describe the level of functional strain and emotional well‐being by ethnicity and job types; and (3) investigate the salient functional strain components influencing emotional well‐being for breast cancer survivors (BCS) after controlling for ethnicity and job types. Methods: A cross‐sectional design with mixed sampling methods was used. BCS were recruited from the California Cancer Surveillance Program, hospital registries and community agencies in Southern California. Functional strain was measured by assessing family and work burdens. Results: Confirmatory factor analysis established the adequacy of the two factors (family and work burdens) defining the functional strain. Findings demonstrated significant differences in functional strain by ethnicity and job types. Latina‐Americans and homemakers/housewives showed the worst scores in functional strain variables. The final model examining the impact of functional strain components on emotional well‐being explained 34% of the variance of emotional well‐being. Conclusion: Findings suggest the impact of cancer on family and work life varies by ethnic and demographic characteristics, such that Latino ethnicity and homemaker/housewife status may be risk factors for functional strain. Our findings imply that functional strain provides a reasonable concept that can be used to deepen our understanding and examination of the impact of functional status on emotional well‐being. Copyright © 2009 John Wiley & Sons, Ltd.