Chanita Hughes Halbert

Collective Efficacy and Obesity-Related Health Behaviors in a Community Sample of African Americans

The social environment is important to body mass index and obesity. However, it is unknown if perceptions of the social environment are associated with obesity-related behaviors in populations at greatest risk for being overweight or obese. We evaluated the relationship between collective efficacy and diet and physical activity in a community-based sample of African American adults who were residents in an urban area. Data were collected as part of an academic-community partnership from November 2009 to 2011. We evaluated whether participants met the recommended guidelines for diet and physical activity based on collective efficacy and their sociodemographic background, health care variables, and self-efficacy in a community-based sample of African American adults (nxa0=xa0338) who were residents in the Philadelphia, PA metropolitan area. Overall, many participants did not meet the recommended guidelines for fruit and vegetable intake or physical activity. The likelihood of meeting the recommended guidelines for fruit intake increased with greater levels of collective efficacy (OR 1.56, 95xa0% CI 1.18, 2.07, pxa0=xa00.002) and self-efficacy for diet (OR 1.56, 95xa0% CI 1.19, 2.04, pxa0=xa00.001). Collective efficacy was not associated with physical activity and the positive association between collective efficacy and vegetable intake was not statistically significant (OR 1.25, 95xa0% CI 0.94, 1.65, pxa0=xa00.12). It is important to determine the most effective methods and settings for improving diet and physical activity behaviors in urban African Americans. Enhancing collective efficacy may be important to improving adherence to recommended guidelines for obesity-related health behaviors.

Ever and Annual Use of Prostate Cancer Screening in African American Men.

Since prostate cancer continues to disproportionately affect African American men in terms of incidence, morbidity, and mortality, prostate-specific antigen (PSA) screening plays an important role in early detection, especially when men engage in informed decision making to accept or decline this test. The authors evaluated utilization of PSA testing among African American men based on factors that are important components of making informed decisions. Utilization of PSA testing was evaluated based on whether men had ever had PSA testing and PSA testing during the past year in a community-based sample of African American men ages 50 to 75 (n = 132). Overall, 64% of men (n = 85) reported that they had ever had a PSA test; the mean (SD) age for first use of PSA testing was 47.7 (SD = 7.4). The likelihood of ever having a PSA test increased significantly with physician communication (odds ratio [OR] = 14.2; 95% confidence interval [CI] = 4.20, 48.10; p = .0001) and with having an annual household income that was greater than

Predictors of Participation in Mammography Screening among Non-Hispanic Black, Non-Hispanic White, and Hispanic Women

20,000 (OR = 9.80; 95% CI = 3.15, 30.51; p = .0001). The odds of ever having a PSA test were also decreased with each unit increase in future temporal orientation (OR = 0.66; 95% CI = 0.47, 0.93; p = .02). Of the men who had ever had PSA testing, 57% were screened during the past year. Only health insurance status had a significant independent association with having annual PSA testing (OR = 5.10; 95% CI = 1.67, 15.60; p = .004). Different factors were associated significantly with ever having PSA testing and annual testing among African American men. African American men may not be making an informed decision about prostate cancer screening.

Beliefs about Genetically Targeted Care in African Americans

Introduction Many factors influence women’s decisions to participate in guideline-recommended screening mammography. We evaluated the influence of women’s socioeconomic characteristics, health-care access, and cultural and psychological health-care preferences on timely mammography screening participation. Materials and methods A random digit dial survey of United States non-Hispanic Black, non-Hispanic White, and Hispanic women aged 40–75, from January to August 2009, determined self-reported time of most recent mammogram. Screening rates were assessed based on receipt of a screening mammogram within the prior 12u2009months, the interval recommended at the time by the American Cancer Society. Results Thirty-nine percent of women reported not having a mammogram within the last 12u2009months. The odds of not having had a screening mammography were higher for non-Hispanic White women than for non-Hispanic Black (ORu2009=u20092.16, 95% CIu2009=u20090.26, 0.82, pu2009=u20090.009) or Hispanic (ORu2009=u20094.17, 95% CIu2009=u20090.12, 0.48, pu2009=u20090.01) women. Lack of health insurance (ORu2009=u20093.22, 95% CIu2009=u20091.54, 6.73, pu2009=u20090.002) and lack of usual source of medical care (ORu2009=u20093.37, 95% CIu2009=u20091.43, 7.94, pu2009=u20090.01) were associated with not being screened as were lower self-efficacy to obtain screening (ORu2009=u20092.43, 95% CIu2009=u20091.26, 4.73, pu2009=u20090.01) and greater levels of religiosity and spirituality (ORu2009=u20091.42, 95% CIu2009=u20091.00, 2.00, pu2009=u20090.05). Neither perceived risk nor present temporal orientation was significant. Discussion Odds of not having a mammogram increased if women were uninsured, without medical care, non-Hispanic White, older in age, not confident in their ability to obtain screening, or held passive or external religious/spiritual values. Results are encouraging given racial disparities in health-care participation and suggest that efforts to increase screening among minority women may be working.

A Comparative Effectiveness Education Trial for Lifestyle Health Behavior Change in African Americans.

We examined beliefs about genetically targeted care (GTC) among African American men and women in a hospital-based sample and identified sociodemographic, cultural, and clinical factors having significant independent associations with these beliefs. Specifically, beliefs about GTC were evaluated after respondents were randomly primed with a racial or non-racial cue about race and genetics. Despite priming with a racial or non-racial cue, many respondents had positive beliefs about GTC. But, 49% believed that GTC would limit access to medical treatment, 46% believed that people will not trust GTC, and 20% believed that people like them would not benefit from GTC. Racial and non-racial priming did not have significant associations with negative beliefs about GTC. However, cultural beliefs related to temporal orientation were associated significantly with believing that genetically targeted care will limit access to medical treatment. Greater levels of future temporal orientation were associated with a reduced likelihood of endorsing this belief (ORxa0=xa00.70, 95% CIxa0=xa00.49, 1.01, pxa0=xa00.05). Respondents who had a chronic medical condition had an almost three-fold greater likelihood of believing that they would not benefit from GTC (ORxa0=xa02.90, 95% CIxa0=xa01.00, 8.37, pxa0=xa00.05). Greater exposure to information about genetic testing for chronic conditions was also associated with a reduced likelihood of believing that they would not benefit from GTC (ORxa0=xa00.40, 95% CIxa0=xa00.64, 0.91, pxa0=xa00.02). African Americans have diverse beliefs about GTC that should be considered as genetic and genomic services are offered.

Perceived Efficacy and Control for Neighborhood Change: the Cross-Cutting Role of Collective Efficacy

Obesity and excess weight are significant clinical and public health issues that disproportionately affect African Americans because of physical inactivity and unhealthy eating. We compared the effects of alternate behavioral interventions on obesity-related health behaviors. We conducted a comparative effectiveness education trial in a community-based sample of 530 adult African Americans. Outcomes variables were physical activity (PA) and fruit and vegetable intake. Outcomes were evaluated at baseline and 1-month following interventions about shared risk factors for cancer and cardiovascular disease (CVD) (integrated, INT) or CVD only (disease-specific). Significant increases were found in the proportion of participants who met PA guidelines from baseline (47.4%) to follow-up (52.4%) (P = 0.005). In the stratified analysis that were conducted to examine interaction between education and intervention group assignment, this effect was most apparent among participants who had ≤high school education and were randomized to INT (OR = 2.28, 95% CI = 1.04, 5.00, P = 0.04). Completing the intervention was associated with a 1.78 odds of meeting PA guidelines (95% CI = 1.02, 3.10, P = 0.04). Education about risk factors for chronic disease and evidence-based strategies for health behavior change may be useful for addressing obesity-related behaviors among African Americans.

Neighborhood Satisfaction and Colorectal Cancer Screening in a Community Sample of African Americans

BackgroundThe premise of community advocacy is to empower residents by increasing their capacity to address and change neighborhood and structural factors that contribute to adverse health outcomes. An underlying assumption is that community residents will advocate for public policy and other changes. However, limited empirical evidence exists on community residents’ perceived ability to advocate for neighborhood change. In this study, we characterized perceived neighborhood control and efficacy for neighborhood change and evaluated independent associations between efficacy and control beliefs and sociodemographic factors, community involvement, and perceptions of social environment.MethodsCross-sectional data from 488 African American adults were analyzed to describe efficacy and control beliefs and to characterize bivariate associations between these beliefs and sociodemographic factors, social environment, and community involvement variables. Variables with significant relationships (pxa0<xa00.10) were included in a multivariate logistic regression model to identify factors having significant independent associations with efficacy and control beliefs.ResultsOverall, beliefs about neighborhood control and confidence were varied, yet approximately half of residents (49 and 55xa0%, respectively) reported having a little control over things that happen in their neighborhood and a little confidence in their ability to change things where they live. The likelihood of reporting confidence to make neighborhood improvements increased with greater collective efficacy (ORxa0=xa01.78, 95xa0% CIxa0=xa01.19–1.31, pxa0=xa00.002). In addition, participants who were involved in a community organization were more likely to report confidence to improve their neighborhood (ORxa0=xa02.03, 95xa0% CIxa0=xa01.21–3.42, pxa0=xa00.01).ConclusionEfforts are needed to improve residents’ ability to become positive agents of change in their community. Creating a research infrastructure within academic community partnerships that focus on strengthening advocacy and public policy may improve resident’s efficacy and ability to seek and encourage neighborhood change.

Social determinants of family health history collection

Social determinants are important to cancer screening among African Americans. To evaluate the association between social determinants (e.g., psychological characteristics, perceived social environment, cultural beliefs such as present temporal orientation) and colorectal cancer (CRC) screening among African Americans. African American adults (nxa0=xa0262) ages 50–75 completed a telephone interview. Multivariate logistic regression analysis was used to identify factors having significant independent associations with CRC screening. Only 57xa0% of respondents reported having CRC screening. The likelihood of screening increased with greater neighborhood satisfaction (ORxa0=xa01.38, 95xa0% CIxa0=xa01.01, 1.90, pxa0=xa00.04), older age (ORxa0=xa01.75, 95xa0% CIxa0=xa01.24, 2.48, pxa0=xa00.002), greater self-efficacy (ORxa0=xa02.73, 95xa0% CIxa0=xa01.40, 5.35, pxa0=xa00.003), and health care provider communication (ORxa0=xa010.78, 95xa0% CIxa0=xa04.85, 29.94, pxa0=xa00.0001). Community resources are important precursors to CRC screening and outcomes among African Americans. In addition to addressing psychological factors and patient–provider communication, efforts to ensure the availability of quality health care facilities that provide CRC screening in the neighborhoods where African Americans live are needed.

Genetic counseling among minority populations in the era of precision medicine

Family health history (FHH) is the most basic form of genomic information. Although public health efforts have been made to promote FHH collection, empirical data on the extent to which community residents in rural areas actively collect FHH is limited. Therefore, we examined rates of FHH collection in a community-based sample of South Carolina residents. We conducted a structured telephone survey in a random sample of black and white South Carolina residents. Respondents were asked if they had ever actively collected FHH from relatives using an item developed by the Centers for Disease Control and Prevention. Overall, 42xa0% of respondents reported that they had actively collected their FHH. Blacks were significantly more likely than whites to have collected their FHH in bivariate analysis, but race did not have a significant association with FHH collection in the multivariate model (ORu2009=u20091.36, 95xa0% CIu2009=u20090.79, 2.35, pu2009=u20090.26). The likelihood of collecting FHH was increased among respondents whose last medical visit occurred in the past year compared to those whose last medical visit was more than 1xa0year ago (ORu2009=u20092.00, 95xa0% CIu2009=u20091.12, 3.56, pu2009=u20090.02). In addition, older respondents had a reduced likelihood of collecting their FHH (ORu2009=u20090.69, 95xa0% CIu2009=u20090.53, 0.90, pu2009=u2009.01). Lastly, women were about twice as likely as men to have collected their FHH (ORu2009=u20091.83, 95xa0% CIu2009=u20091.12, 2.99, pu2009=u20090.02). Greater efforts are needed to increase the collection of FHH information; these efforts may need to target men, the elderly, and individuals who have not had a recent medical visit.

Discordance in perceived risk and epidemiological outcomes of prostate cancer among African American men

Precision medicine includes the use of genetic variation to determine the prevention, pathology, management, and treatment of disease, which has the potential to significantly change the practice of healthcare. As such, its success depends on (a) having reliable information about the effects of genetic variation on disease processes; and (b) the patients understanding of their own genetic makeup such that they can use that information to affect their lifestyle and diet. Given the history of low engagement of under‐represented minority populations in both clinical genetic services and genetic research, both of these aspects will be challenged and must be addressed before the benefits of precision medicine will be fully realized. Reflecting on lessons learned in the field of cancer genetic counseling, we present key issues to consider as we look forward to providing genetic counseling to minority communities in the context of precision medicine.