Category: Racial Issues

Boston University School of Medicine's (BUSM) researchers have found that sociodemographic characteristics are related to a patients' willingness to participate in cancer screenings. They found this was more important than both attitudinal barriers and medical facilitators. This study appears in the March issue of the Journal of the National Medical Association.

Prior studies have shown that screenings are crucial in identifying cancer in its early stages and minorities have lower screening rates for certain types of cancer, such as cervical and colorectal cancer. Researchers at BUSM were seeking to find out why the screening rates among racial and ethnic minorities vary compared to those of the white, non-Hispanic community.

Researchers examined patients' agreeability to engage in cancer screening, in the context of varied symptoms and screening settings among a diverse group of individuals from multiple geographic areas. The study assessed the influences of race and ethnicity, relative to sociodemographic factors of both positive and negative attitudes and beliefs concerning cancer screening, as well as the willingness to utilize screenings in general.

A random sample was conducted using telephone interviews from three cities: San Juan, Puerto Rico, Baltimore and New York City. Respondents reported their sociodemographic characteristics and attitudes about barriers and facilitators of cancer screenings. These individuals also reported their amenability to have cancer screening within four scenarios: when done in the community as opposed to one's doctors' office and whether or not they had symptoms.

Less-educated individuals with lower incomes received fewer cancer screenings than those with higher levels of each. These rates may lead to disparities in cancer-related mortality. Racial and ethnic minority status, age and lower income were frequently associated with willingness to receiving a cancer screening. Prior findings suggest that negative attitudes towards screenings include fear of pain or diagnosis, disbelief in the efficiency of the tests or generalized distrust of others were most predominant among racial and ethnic minorities, and accounts for their lower rates of cancer screening.

The researchers also found that individuals were most willing to participate in a screening when they were examined by their personal doctor and had symptoms of cancer. Cancer screening campaigns should affect attitudinal changes whenever possible, and recognize that targeting specific population groups may be necessary.

"It is important to identify barriers for specific subsets of the population for different types of cancer screenings," explained lead author Nancy Kressin, PhD, director of the Healthcare Disparities Research Unit and associate professor, in the section of General Internal Medicine at Boston University School of Medicine. "There is value in understanding general attitudes of patients concerning cancer screenings in general, in order to highlight common barriers for future interventions. With this research, measures will be taken to educate this vulnerable population, allowing us to treat cancer in its early stages when the disease is more amenable to treatment or cure," said Kressin.

A large nationwide study that includes neurologists from Mayo Clinic has found that blacks are substantially less likely than whites to know that they have atrial fibrillation or to use warfarin, the most common treatment for the condition. Atrial fibrillation, an abnormal heart rhythm, significantly increases risk of stroke. Warfarin is known to reduce that risk.

Researchers say the findings could help explain why the black population in the U.S. has a higher incidence of both stroke and death from strokes, compared to the white population. They presented their findings at the American Heart Association's 2010 International Stroke Conference in San Antonio. The study will also be simultaneously published in Stroke: Journal of the American Heart Association.

"The reasons for the racial discrepancy are not known," says James Meschia, M.D., Mayo Clinic neurologist and director of the Comprehensive Stroke Center at Mayo's campus in Florida. "But they are consistent with other studies that show blacks are less likely to receive the care they need to treat stroke risk factors such as diabetes and hypertension."

"These findings should lend urgency to focused efforts to improve patient education and medical treatment across the board," says Dr. Meschia, who who is presenting the findings on behalf of investigators participating in the study, known as REGARDS (The Reasons for Geographic and Racial Differences in Stroke).

From 2003 to 2007, REGARDS enrolled 30,239 men and it deliberately "oversampled" blacks (42 percent) as well as residents of the Southeastern "Stroke Belt." Fifty-six percent were from North Carolina, South Carolina, Georgia, Alabama, Mississippi, Tennessee, Arkansas, and Louisiana, and 44 percent were from other areas of the country. All residents of Stroke Belt states are known to have high stroke death rates, but blacks are at even greater risk, Both blacks and residents of these states are known to have high stroke death rates according to the National Institutes of Health.

For this study, atrial fibrillation was diagnosed using an electrocardiogram (ECG) test given to participants in their homes. Before the visit, participants were asked by telephone if a physician or a health professional had ever told them that they had atrial fibrillation, and they were also asked what medications they were using.

Of those participants whose ECG showed atrial fibrillation, 88 (20 percent) were black, and 344 were white. While 60 percent of the total group (black and white) were aware of their diagnosis, the odds that blacks knew they had the condition were less than one-third of those reported for whites, researchers say.

They further found that the odds of blacks being treated with warfarin, which reduces stroke risk by 60 percent, were one-fourth those of whites.

In other words, blacks in this study with atrial fibrillation were two-thirds less likely to know they had the disorder and three-fourths less likely to be treated with warfarin, the standard of care.

Reasons for the racial disparity are not known from this study, but researchers suggest several explanations. Many study participants might have been undiagnosed because atrial fibrillation is often not symptomatic, Dr. Meschia says. Or, participants may have been diagnosed but did not remember or fully appreciate the significance of the condition, he says. Dr. Meschia says other possible reasons could include utilization or delivery of health care, reluctance by physicians to use warfarin in patients with multiple health conditions, or disinclination by patients to use the drug.

Insurance status was not a factor, the researchers add, because the majority of study participants were over age 65 and were covered by Medicare.

"Whatever the reasons behind these observations, it appears that there is a missed opportunity to prevent stroke and other thromboembolic complications from atrial fibrillation because many individuals may fail to have the condition diagnosed and/or fail to receive treatment with warfarin," Dr. Meschia says. "It would benefit public health if future research could tease out the reasons behind this disparity."

The study was funded by a grant from the National Institute for Neurological Disorders and Stroke, a branch of the National Institutes of Health.

 With the national trend toward quitting smoking flat, psychologists are finding some success with treatments aimed at helping smokers from underserved groups, including racial and ethnic minorities and those with psychiatric disorders.

In a special section of this month's issue of the Journal of Consulting and Clinical Psychology, published by the American Psychological Association, researchers report on several effective treatments that may help these smokers in an effort to increase national smoking cessation rates. The percentage of American smokers rose from 19.8 percent in 2007 to 20.6 percent in 2008, after a 10-year steady decline in smoking rates, according to the latest s from the Centers for Disease Control and Prevention.

"One of the reasons smoking rates have remained stagnant is because these underserved groups of smokers have not been adequately targeted by research and treatment," said the special section editor, Belinda Borrelli, PhD, who is with the Centers for Behavioral and Preventive Medicine at Brown University Medical School. Underserved smokers include those who have a 10 percent higher smoking rate than the general population, have less access to treatments, and are more likely to be excluded from long-term treatments trials, according to Borelli.

In one article, researchers found that success in stopping smoking differed for different psychiatric disorders. For example, compared to smokers with no psychiatric disorders, smokers who had an anxiety disorder were less likely to quit smoking six months after treatment.

In the same article, researchers found that people's barriers to quitting were directly related to what type of psychiatric disorder they had. For example, smokers who had ever been diagnosed with an anxiety disorder reported a strong emotional bond with their cigarettes while smokers ever diagnosed with a substance use disorder reported that social and environmental influences were especially likely to affect their smoking. "This information may help clinicians gauge relapse risk and identify treatment targets among smokers who have ever had psychological illnesses," said lead author Megan Piper, PhD, from the University of Wisconsin School of Medicine and Public Health.

Evidence-based smoking cessation treatments are addressed in another article in this special section. Researchers from the University of Miami looked at the effect of intensive cognitive-behavioral therapy on African-American smokers. They placed 154 African-American smokers wearing nicotine patches into one of two six-session interventions. Participants in the group using cognitive-behavioral techniques were taught relapse prevention strategies and coping skills, along with other techniques. The other group participated in a health education series that explained general medical conditions that are associated with smoking, such as heart disease and lung cancer.

Compared with general health education, participation in cognitive-behavioral therapy sessions more than doubled the rate of quitting at a six month follow-up, from 14 percent to 31 percent the researchers found. "We know cognitive-behavioral therapy helps people quit, but few studies have examined this treatment's effect on African-American smokers," said the study's lead author, Monica Webb, PhD, of the University of Miami. "Hopefully, our findings will encourage smoking cessation counselors and researchers to utilize cognitive-behavioral interventions in this underserved population."

Borrelli, the section editor, examined another minority group — Latinos. She measured the amount of second-hand smoke in participants' homes and gave feedback to smokers about how much smoke their child with asthma was exposed to. For example, they were told that their child was exposed to as much smoke as if the child smoked 'x' number of cigarettes him- or herself during the week of the measurement — this was the experimental group. Smokers in the control group underwent standard cognitive-behavioral treatment for smoking cessation. Smokers in the experimental group were twice as likely to quit as the control group, Borrelli found. "The child's asthma problems may provide a teachable moment for parents whereby they become more open to the smoking cessation messages," Borrelli said. "Providing treatment that is focused on the health needs of the family, and delivered in a culturally tailored manner, has the potential to address health care disparities for Latino families."

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Journal Reference:

1. . Smoking Cessation — Innovative Treatments and Understudied Populations. Journal of Consulting and Clinical Psychology, Vol. 78, No. 1