Carolyn Y. Fang

The effects of racial stressors and hostility on cardiovascular reactivity in African American and Caucasian men.

This study examined the effects of race-related stressors and hostility on cardiovascular reactivity in 31 African American and 31 Caucasian men. Participants viewed 3 film excerpts that depicted neutral, anger-provoking (but race-neutral), and racist situations. Participants exhibited significantly greater diastolic blood pressure reactivity to anger-provoking and racist stimuli compared with neutral stimuli. In addition, high hostility was associated with higher recovery systolic and diastolic blood pressure levels after exposure to the films. Although the results failed to confirm previous reports of greater reactivity to racism in African Americans, the findings suggest that diastolic blood pressure levels may remain elevated after exposure to racist stimuli. These results indicate that even indirect exposure to interpersonal conflict elicits significant reactivity, which can persist after exposure to the stressor, especially among high-hostile men.

Functional impairment, marital quality, and patient psychological distress as predictors of psychological distress among cancer patients' spouses.

This study investigated contextual determinants of psychological distress among 197 spouses of cancer patients. It was hypothesized that higher levels of patient functional impairment would lead to greater patient distress. Patient distress, in turn, would lead to lower spouse marital satisfaction and ultimately to higher spouse distress. Spouses completed measures of distress and marital quality at three time points. Cancer patients rated their functional impairment and psychological distress at the same time points. Results indicated that at all time points, greater patient impairment was associated with higher levels of patient distress, which, in turn, was related to lower marital satisfaction. However, marital quality was related to spouse distress at only 1 time point, but spouse distress was directly associated with patient distress at each time point. Implications for cancer patients and spouses are discussed.

A Multifaceted Intervention to Increase Cervical Cancer Screening among Underserved Korean Women

Objective: Despite the proven survival benefits associated with cervical cancer screening, use of the Pap test continues to be suboptimal in some population subgroups, such as among Korean-American women who face considerable barriers to screening. Therefore, we evaluated a multifaceted intervention that combined psychoeducational counseling with patient navigation to address both psychosocial and access barriers to screening. Method: Women (n = 102) were recruited from Korean community centers and assigned to the intervention or control condition. The intervention group received cervical cancer education and patient navigation delivered by bilingual Korean health educators. The control group received general health education, including information about cervical cancer and screening. Assessments were obtained at baseline and postintervention. Screening behavior was assessed at 6 months postintervention. Results: At baseline, 17% of participants reported having had a Pap test in the previous year. At 6 months postintervention, 83% of women in the intervention group had obtained screening compared with 22% in the control group, χ2(1) = 41.22, P < 0.001. Multivariate logistic regression analyses indicated that participation in the intervention was associated with screening (P < 0.001). Fewer psychosocial barriers (e.g., discomfort at having a stranger perform Pap) and greater self-efficacy were also associated with screening (P < 0.05). Conclusion: A combined modality intervention that delivers education with patient navigation training and assistance resulted in increased screening rates. Multifaceted approaches may be effective in reducing the psychosocial, access, and language barriers that contribute to cancer health disparities in underserved populations. (Cancer Epidemiol Biomarkers Prev 2007;16(6):1–5)

Knowledge, Attitudes, and Behaviors of Hepatitis B Screening and Vaccination and Liver Cancer Risks Among Vietnamese Americans

Hepatitis B Virus (HBV) infection is a serious health problem among Asian Americans. Vietnamese Americans are disproportionately affected by liver cancer compared with other racial and ethnic groups. Vietnamese males have the highest incidence of liver cancer of any racial group; incidence of liver cancer among Vietnamese males is 11 times higher than among White males. Nearly 80% of liver cancer is attributed to HBV. This study measured knowledge, attitudes, and behaviors related to HBV screening and vaccination. The study was conducted among 256 Vietnamese Americans in the greater Philadelphia and New Jersey area, with a large number of underserved, recent immigrants with low socioeconomic status and limited English proficiency. Participants were recruited from Vietnamese community-based organizations. Overall, 46.3% of the sample had heard of HBV or knew about the availability of screening (32.6%) or vaccination (35.5%) while 7.5% were ever screened and 6.3% had been vaccinated. Community-based, culturally appropriate interventions for Vietnamese Americans and health care providers should increase screening and vaccination rates.

Enhanced Psychosocial Well-Being Following Participation in a Mindfulness-Based Stress Reduction Program Is Associated with Increased Natural Killer Cell Activity

BACKGROUND Mindfulness-based stress reduction (MBSR) programs have consistently been shown to enhance the psychosocial well-being of participants. Given the well-established association between psychosocial factors and immunologic functioning, it has been hypothesized that enhanced psychosocial well-being among MBSR participants would be associated with corresponding changes in markers of immune activity. OBJECTIVES The objectives of this study were to examine changes in psychosocial and immunologic measures in a heterogeneous patient sample following participation in a MBSR program. DESIGN A single-group, pretest/post-test design was utilized. SETTING The intervention was conducted at an academic health center. SUBJECTS This pilot study involved 24 participants (aged 28-72 years). Inclusion criteria were as follows: > or =18 years of age, English-speaking, and no known autoimmune disorder. INTERVENTION The intervention was an 8-week MBSR program. OUTCOME MEASURES Distress and quality of life (QOL) measures included the Brief Symptom Inventory-18 and the Medical Outcomes Survey Short-Form Health Survey, respectively. Immunologic measures included natural killer (NK) cell cytolytic activity and C-reactive protein (CRP). RESULTS Patients completed psychosocial assessments and provided a blood sample at baseline (pre-MBSR) and within 2 weeks post-MBSR. Significant improvements in anxiety and overall distress as well as across multiple domains of QOL were observed from baseline to post-MBSR. Reductions in anxiety and overall distress were associated with reductions in CRP. Patients who reported improvement in overall mental well-being also showed increased NK cytolytic activity from pre- to post-MBSR, whereas patients who reported no improvement in mental well-being showed no change in NK cytolytic activity. CONCLUSIONS Positive improvement in psychologic well-being following MBSR was associated with increased NK cytolytic activity and decreased levels of CRP.

A prospective study of quality of life among women undergoing risk-reducing salpingo-oophorectomy versus gynecologic screening for ovarian cancer

OBJECTIVE The primary objective of the study was to prospectively assess quality of life (QOL) among women at increased risk of ovarian cancer who are undergoing risk-reducing salpingo-oophorectomy (RRSO) or serial screening. METHODS Women at increased risk of ovarian cancer who were undergoing RRSO were recruited into the study. At-risk women undergoing serial screening for early detection of ovarian cancer served as a comparison group. Participants completed measures of QOL, sexual functioning, body image, depressive symptoms, and a symptom checklist at baseline (prior to surgery for women obtaining RRSO), and then at 1-month, 6-months, and 12-months post baseline. RESULTS Women who underwent surgery reported poorer physical functioning, more physical role limitations, greater pain, less vitality, poorer social functioning, and greater discomfort and less satisfaction with sexual activities at 1-month assessment compared to baseline. In contrast, women undergoing screening experienced no significant decrements in QOL or sexual functioning at 1-month assessment. Most QOL deficits observed in the surgical group were no longer apparent by 6-month assessment. Women in the surgery group were more likely to report hot flashes and vaginal dryness, but over time, symptoms of vaginal discomfort decreased to a greater extent in women who had RRSO compared to women undergoing screening. No differences in body image or depressive symptoms were observed between the two groups at any time point. CONCLUSIONS Short-term deficits in physical functioning and other specific domains of QOL were observed following RRSO, but most women recovered baseline functioning by 6- and 12-month assessments. Issues regarding the potential impact of surgery on short-term sexual functioning should be considered and weighed carefully, particularly among younger women.

Romance Across the Social Status Continuum: Interracial Marriage and the Ideological Asymmetry Effect

This study examined the asymmetrical relationship between attitudes toward interracial marriage and social dominance orientation across four ethnic groups in the United States. Differences in these correlations were explained with the ideological asymmetry hypothesis, a specific feature of social dominance theory, which asserts that the relationship between attitudes regarding hierarchy-maintaining social practices and antiegalitarian social values will be more positive among members of high-status groups than among members of low-status groups. Using opposition to interracial marriage and dating (i.e., antimiscegenation attitudes) as a case of a hierarchy-maintaining social attitude, the data were found to support the ideological asymmetry hypothesis. With almost no exceptions, the correlations between social dominance orientation and antimiscegenation attitudes were significantly more positive within a high-status ethnic group vis-à-vis a given low-status ethnic group than they were within a low-status ethnic group vis-à-vis a given high-status ethnic group. The theoretical implications of these findings are discussed.

Common biological pathways underlying the psychoneurological symptom cluster in cancer patients.

Background: A symptom cluster is a group of symptoms that occur together and are interrelated. The clinical implication of symptom cluster research is to use the clustering patterns of symptoms to understand the mechanisms for these symptoms and develop management strategies targeted at multiple symptoms. Objective: The purposes of this review were to summarize the evidence for a psychoneurological symptom cluster in cancer patients, to provide information regarding the underlying biological mechanisms for each of the psychoneurological symptoms within the cluster, and to propose possible common biological pathways that may underlie this cluster. Methods: A systematic review of the literature was conducted. Results: Empirical evidence exists to support a cluster of psychoneurological symptoms (ie, depressive symptoms, cognitive disturbance, fatigue, sleep disturbance, pain). At a molecular level, common biological pathways (ie, proinflammatory cytokines, hypothalamic-pituitary-adrenal axis, and monoamine neurotransmission system) may underlie the development of symptoms within this cluster. Activation of proinflammatory cytokines is proposed as a first stage of mechanistic pathway. However, other biological factors, such as lowered estrogen or hemoglobin levels, may influence psychoneurological cluster. Conclusion: Additional studies are needed to confirm the roles of cytokines as well as other biological factors in the development of the psychoneurological cluster and to determine the biomarkers to identify the subgroups of cancer patients who are at greatest risk for this cluster. Implications for Practice: This information can be used by researchers and clinicians to guide the selection of symptom management strategies that are ideally targeted to the biological mechanisms that underlie this symptom cluster.

Psychological functioning of caregivers for head and neck cancer patients

Patients with head and neck squamous cell carcinoma (HNSCC) often require assistance from family caregivers during the treatment and post-treatment period. This review article sought to summarize current findings regarding the psychological health of HNSCC caregivers, including factors that may be associated with poorer psychological health. Online databases (PUBMED, MEDLINE and PSYCINFO) were searched for papers published in English through September 2010 reporting on the psychological health of caregivers of HNSCC patients. Eleven papers were identified. Caregivers experience poorer psychological health, including higher levels of anxious symptoms, compared to patients and to the general population. Fear of patient cancer recurrence is evident among caregivers and is associated with poorer psychological health outcomes. The 6-month interval following diagnosis is a significant time of stress for caregivers. Greater perceived social support may yield positive benefits for the psychological health of caregivers. To date, there have been relatively few reports on the psychological health of caregivers of HNSCC patients. Well designed, prospective, longitudinal studies are needed to enhance our understanding of how caregiver psychological health may vary over the cancer trajectory and to identify strategies for improving caregiver outcomes.

Evidence-Based Intervention to Reduce Access Barriers to Cervical Cancer Screening Among Underserved Chinese American Women

OBJECTIVE The primary objective of the present study was to evaluate the effects of a community-based pilot intervention that combined cervical cancer education with patient navigation on cervical cancer screening behaviors among Chinese American women residing in New York City. METHODS Chinese women (n = 134) who had not had a Pap test within the previous 12 months were recruited from four Asian community-based organizations (CBOs). Women from two of the CBOs received the intervention (n = 80) consisting of education, interaction with a Chinese physician, and navigation assistance, including help in identifying and accessing free or low-cost screening services. The control group (n = 54) received education delivered by Chinese community health educators and written materials on general health and cancer screening, including cervical cancer, the Pap test, and information about sites that provided free screening. Study assessments were obtained in-person at baseline and postintervention. Screening behavior was self-reported at 12-month postintervention and verified by medical staff. RESULTS In the 12-month interval following the program, screening rates were significantly higher in the intervention group (70%) compared to the control group (11.1%). Hierarchical logistic regression analyses indicated that screening behavior was associated with older age (OR = 1.08, 95% CI = 1.01-1.15, p < .05). In addition, women with poorer English language fluency (OR = 0.30, 95% CI = 0.10-0.89, p < .05) and who did not have health insurance were less likely to obtain screening (OR = 0.15, 95% CI = 0.02-0.96, p < .05). Among health beliefs, greater perceived severity of disease was positively associated with screening behavior (OR = 4.26, 95% CI = 1.01-18.04, p < .05). CONCLUSIONS Community-based programs that provide combined education and patient navigation may be effective in overcoming the extensive linguistic and access barriers to screening faced by Chinese American women.