Aisha T. Langford

Clinical trial awareness among racial/ethnic minorities in HINTS 2007: sociodemographic, attitudinal, and knowledge correlates.

The purpose of this study was (1) to examine the association of race/ethnicity on clinical trial awareness, controlling for several sociodemographic, attitudinal, and knowledge variables, and (2) to inform future communication campaigns to increase clinical trial awareness and participation. Secondary analysis was conducted among 6,754 Hispanic, Black, and White adult respondents to the National Cancer Institutes 2007 Health Information National Trends Survey (HINTS). The dependent variable was awareness of clinical trials. Logistic regression was used to examine possible correlates of clinical trial awareness including sociodemographics, trust of sources of health information, beliefs about safety of health information, family/personal history of cancer, health seeking information, and awareness of three health agencies. Compared with Whites, Blacks and Hispanics were significantly less likely to have heard of a clinical trial. Other significant correlates of clinical trial awareness included education, income, belief that health information is safely guarded, family history of cancer, awareness of the Centers for Disease control, trust of health information from the Internet and charitable organizations, and distrust of health information from religious institutions. Blacks and Hispanics are significantly less aware of clinical trials. Campaigns that exploit unique beliefs and delivery channels for racial/ethnic subgroups should be considered.

Racial/ethnic differences in clinical trial enrollment, refusal rates, ineligibility, and reasons for decline among patients at sites in the National Cancer Institute's Community Cancer Centers Program

This study examined racial/ethnic differences among patients in clinical trial (CT) enrollment, refusal rates, ineligibility, and desire to participate in research within the National Cancer Institutes Community Cancer Centers Program (NCCCP) Clinical Trial Screening and Accrual Log.

Racial and Ethnic Differences in Direct-to-Consumer Genetic Tests Awareness in HINTS 2007: Sociodemographic and Numeracy Correlates

To examine the association of 1) race/ethnicity and 2) numeracy with awareness of DTC genetic tests. Secondary analysis of 6,754 Hispanic, black, and white adult respondents to the National Cancer Institute’s 2007 Health Information National Trends Survey (HINTS). Logistic regression was used to examine sociodemographic predictors of DTC genetic tests awareness including race/ethnicity, income, education, and gender. Next, two numeracy variables were added to the model. After controlling for sociodemographic variables, black respondents were significantly less likely to have heard of DTC genetic tests compared to white respondents (OR = 0.79; CI: 0.65–0.97). When numeracy variables were added to the model, the effect of black race was no longer significant (OR = 0.84; CI: 0.69–1.04). Hispanic respondents did not significantly differ from white respondents in awareness of DTC genetic tests. Other significant correlates of DTC genetic tests awareness in the full model included education, income, age, and numeracy variables including degree to which people use medical statistics and numbers to make health decisions, and preference for words or numbers when discussing “the chance of something happening.” Although black respondents were generally less aware of DTC genetic tests than white respondents, this relationship appears to be partially mediated by numeracy.

Increasing donor designation through black churches: results of a randomized trial

Context African Americans are disproportionately represented among those awaiting a transplant, but many are reluctant to donate their organs. Objective To test the effectiveness of using lay health advisors to increase organ donation among church members. Design Churches were pair-matched by average estimated income and size and then randomized to 1 of 2 interventions: one addressing organ donation and the other addressing increasing consumption of fruits and vegetables. Setting Twenty-two African American churches in Southeast Michigan. Patients or Other Participants Church members were trained to serve as lay health advisors (called peer leaders). Interventions Peer leaders conducted organ donation discussions with church groups and showed a DVD created for this program that was tailored to African American churches. Main Outcome Measures The primary outcome was verified registration in the states donor registry. Participants also completed pre/post questionnaires regarding their attitudes about organ donation. Results Once clustering, baseline value, and demographics were adjusted for, the intervention and comparison groups did not differ on any of the 3 attitude scales on the posttest. In logistic regression analysis, with baseline donation status, demographics, and church clustering controlled for, the odds of self-reported enrollment at 1-year posttest did not differ by condition (odds ratio, 1.23; 95% CI, 0.87–1.72). A total of 211 enrollments in the state registry from participating churches were verified. Of these, 163 were from intervention churches and 48 were from comparison churches. Conclusions Use of lay health advisors through black churches can increase minority enrollment in a donor registry even absent change in attitudes.

Men on the Move A Pilot Program to Increase Physical Activity Among African American Men

Despite the important contribution increasing physical activity levels may play in reducing chronic disease morbidity and mortality, there is a paucity of interventions and research indicating how to improve physical activity levels in African American men. Men on the Move was a pilot study to increase African American men’s levels of physical activity by improving access to age and ability-appropriate, male-focused physical activity opportunities and facilitating access to social support from male peers. Forty-one African American men ages 35 to 70 enrolled (mean age = 53.8). Groups of 5 to 10 men met once a week with a certified personal trainer for 10 weeks. Each meeting addressed barriers to physical activity, provided men with community resources, and incorporated activities that promoted flexibility, strength, balance, and conditioning. Improvements (p < .05) were detected for the following outcome measures: perceived self-efficacy to sustain physical activity, endurance, overall health status, and stress level. Physiological and fitness outcome measures improved, although not to significant levels. Whereas 40% of the men met the recommendation of 150 minutes of moderate or vigorous physical activity weekly at baseline, 68% of the men met this recommendation by the end of the project. These positive results attest to the feasibility of successfully engaging middle-aged and older African American men in a physical activity intervention, and our findings demonstrate the initial efficacy of this intervention approach. More research is needed that includes a more intensive intervention and one that helps motivate men to be physically active outside of the structured, small-group sessions.

Ethnic Identity predicts loss-to-follow-up in a health promotion trial.

BACKGROUND Higher rates of attrition in health research have been reported for African Americans (AAs). However, little is known about which AAs are more prone to drop out and why. One potential predictor that has not been explored is Ethnic Identity (EI). This study examined the association between EI and loss-to-follow-up among AAs enrolled in a health promotion intervention to increase fruit and vegetable intake. METHODS Five hundred and sixty AA adults from two integrated health care delivery systems in Atlanta and Detroit were enrolled into a randomized intervention trial. At baseline, all participants were classified into six EI core groups: Afrocentric, Black American, Bicultural, Multicultural, Assimilated, and High Cultural Mistrust. We examined loss-to-follow-up rates by these EI type. RESULTS Overall, 92 participants (16%) were lost to follow up. Loss-to-follow-up rates were higher among those classified as Afrocentric (24%) than those without an Afrocentric identity (13%). After adjustment for covariates, Afrocentric participants were 1.9 times (CI: 1.1-3.6) more likely to be lost to follow up than participants without this identity type. CONCLUSIONS Assessing EI of AAs in research studies may help identify groups at risk for dropout and/or non-response.

Development of a Scale to Measure African American Attitudes toward Organ Donation

African American attitudes toward organ donation differ from other racial and ethnic groups. However, existing measures of organ donation attitudes do not adequately address ethnic identity and cultural factors. We examined the psychometric properties of a new 18-item organ donation scale among 1225 members of 21 African American churches in Southeast Michigan. We identified three factors: (1) Barriers; (2) Family/Race Benefits; and (3) Altruism. More positive donation attitudes on each subscale were observed for individuals who reported being enrolled as a donor. Among individuals not enrolled, higher scores were observed on scales two and three for those with stronger intentions to enroll.

Outcomes from the Body & Soul Clinical Trials Project: A university-church partnership to improve African American enrollment in a clinical trial registry

OBJECTIVES Historically, African Americans have been underrepresented in clinical trials (CTs) compared to whites. A growing number of research institutions have created CT registries to match volunteers with appropriate studies. In a sample of 745 African Americans from 16 churches, we tested the impact of a culturally tailored intervention aimed at increasing enrollment in a university-based CT registry. METHODS Half of the churches received a culturally tailored CT education program (intervention) and half of the churches received a program about healthy eating (comparison). The main outcomes were the odds of post-test self-reported enrollment and verified enrollment. Using linear regression, post-test willingness to participate in a CT was also assessed. RESULTS Odds of verified enrollment were higher in the intervention than comparison group (OR=2.95, 95% CI: 1.33-6.5, p=0.01). Post-test self-reported enrollment in the registry was also higher among the intervention group than comparison group members (OR=1.94, 95% CI: 1.08-3.47, p=0.03). Willingness to participate in a future CT was higher in the intervention group (β=0.74, p=0.02). CONCLUSIONS A culturally tailored education program about CTs can increase enrollment of African Americans in a university-based clinical trials registry. PRACTICE IMPLICATIONS Community engagement and health education workshops may improve minority CT enrollment over time.

A Cancer Center's Approach to Engaging African American Men About Cancer: The Men's Fellowship Breakfast, Southeastern Michigan, 2008-2014

Background Despite disproportionate rates of cancer morbidity and mortality among African American men, few community-based efforts have been developed and sustained to educate African American men about cancer. The University of Michigan Comprehensive Cancer Center implemented a series of breakfasts to improve cancer awareness, screening, and education among African American men. This article describes the rationale for and history of the community intervention. Community Context The 21 breakfasts were held from 2008 through mid-2014 in Ypsilanti and Ann Arbor, Michigan. Ypsilanti ranks below Michigan and the nation on most socioeconomic indicators, although most residents are high school graduates (88% in Ypsilanti and 96.5% in Ann Arbor). African American men in Ypsilanti have higher death rates for diseases associated with poor diet and inadequate physical activity compared with Ypsilanti whites and general populations in Michigan and the nation. Methods We conducted a multicomponent qualitative process evaluation including staff meetings, conversations with participants, and focus groups. We collected 425 post-event surveys to evaluate the breakfasts quantitatively. Outcomes Participants were African American (85%), were aged 51 to 70 years (54%), had health insurance (89%), and had some college education (38%). Fifty-three percent of participants reported interest in the breakfast topics including nutrition; 46%, prostate cancer; 34%, colorectal cancer, and 32%, pain management; 62% reported willingness to participate in a clinical trial. Interpretation African American men are interested in learning about health and are willing to attend a health-focused breakfast series. The Men’s Fellowship Breakfast is a promising strategy for bringing men together to discuss cancer screening and risk reduction.

Adolescent knowledge and attitudes related to clinical trials.

Background or aims Poor enrollment plagues most clinical trials. Furthermore, despite mandates to improve minority representation in clinical trial participation, little progress has been made. We investigated the knowledge and attitudes of adolescents related to clinical trials and made race/ethnicity comparisons in an attempt to identify a possible educational intervention target. Methods Students aged 13–18 years in southeast Michigan were offered participation through a class at one high school or two academic summer enrichment programs that drew from multiple high schools (73% response). Questionnaires previously validated in adults were administered. Non-Hispanic whites were compared with minorities using Wilcoxon rank-sum tests. Results Of the 82 respondents, the median age was 16 years (interquartile range: 15–17 years); 22 (28%) were white, 41 (51%) were African American, 11 (14%) were multiracial, 2 (2%) were American Indian or Alaska Native, 1 (1%) was Asian, 3 (4%) were Native Hawaiian or other Pacific Islander, and 2 respondents did not report a race (but did report Hispanic ethnicity). Nine (12%) were Hispanic. Only 27 (33%) had ever heard of a clinical trial. On a scale from 1 (most receptive) to 5 (least receptive) for learning more about a clinical trial for a relevant medical condition, the median score was 2 (interquartile range: 1–3) and for participating in a clinical trial for a relevant medical condition was 2 (interquartile range: 2–3). Overall knowledge was poor, with a median of 46% (interquartile range: 23%−62%) of knowledge answers correct. Knowledge was reduced (p = 0.0006) and attitudes were more negative (p = 0.05) in minorities than non-Hispanic whites, while minorities also endorsed more substantial barriers to trial participation (p = 0.0002). Distrust was similar between minority students and non-Hispanic whites (p = 0.15), and self-efficacy was greater in non-Hispanic whites (p = 0.05). Conclusion Educational interventions directed toward adolescents that address knowledge, attitudes, and distrust in order to improve clinical trial awareness and receptivity overall are needed and may represent a tool to address disparities in minority enrollment in clinical trials.