Larry Laufman

Hispanic women's breast and cervical cancer knowledge, attitudes, and screening behaviors

Purpose. This study examined breast and cervical cancer knowledge, attitudes, and screening behaviors among different Hispanic populations in the United States. Design. Data were collected from a random digit dial telephone survey of 8903 Hispanic adults from eight U.S. sites. Across sites, the average response rate was 83%. Setting. Data were collected as part of the baseline assessment in a national Hispanic cancer control and prevention intervention study. Subjects. Analysis was restricted to 2239 Hispanic women age 40 and older who were self-identified as either Central American (n = 174), Cuban (n = 279), Mexican American (n = 1550), or Puerto Rican (n = 236). Measures. A bilingual survey instrument was used to solicit information on age, education, income, health insurance coverage, language use, U.S.-born status, knowledge of screening guidelines, attitudes toward cancer, and screening participation. Differences in knowledge and attitudes across Hispanic groups were assessed by either chi-square tests or analysis of variance. Logistic regression models assessed the influence of knowledge and attitudes on screening participation. Results. The level of knowledge of guidelines ranged from 58.3% (Mexican Americans) to 71.8% (Cubans) for mammography, and from 41.1% (Puerto Ricans) to 55.6% (Cubans) for Pap smear among the different Hispanic populations. Attitudes also varied, with Mexican Americans and Puerto Ricans having more negative or fatalistic views of cancer than Cuban or Central Americans. Knowledge was significantly related to age, education, income, language preference, and recent screening history. Overall, attitudes were not predictive of mammography and Pap smear behavior. Conclusions. Factors related to mammography and Pap smear screening vary among the different Hispanic populations. Limitations include the cross-sectional nature of the study, self-reported measures of screening, and the limited assessment of attitudes. The data and diversity of Hispanic groups reinforce the position that ethno-regional characteristics should be clarified and addressed in cancer screening promotion efforts. The practical relationships among knowledge, attitudes, and cancer screening are not altogether clear and require further research.

Religious coping and caregiver well-being in Mexican-American families

Objective: We sought to explore the association of religious and spiritual coping with multiple measures of well-being in Latinos caring for older relatives with long-term or permanent disability, either with or without dementia. Methods: Using a multi-dimensional survey instrument, we conducted in-home interviews with 66 predominantly Mexican-American Catholic family caregivers near the US–Mexico border. We assessed caregivers’ intrinsic, organizational and non-organizational religiosity with the Duke Religiosity Index, as well as Pargaments brief positive and negative spiritual coping scale to determine the association of religiosity with caregivers’ mental and physical health, depressive symptomatology and perceived burden. Results: Using regression analysis, we controlled for sociocultural factors (e.g. familism, acculturation), other forms of formal and informal support, care recipients’ functional status and characteristics of the caregiving dyad. Intrinsic and organizational religiosity was associated with lower perceived burden, while non-organizational religiosity was associated with poorer mental health. Negative religious coping (e.g. feelings that the caregiver burden is a punishment) predicted greater depression. Conclusion: Measures of well-being should be evaluated in relation to specific styles of religious and spiritual coping, given our range of findings. Further investigation is warranted regarding how knowledge of the positive and negative associations between religiosity and caregiving may assist healthcare providers in supporting Latino caregivers.

Baylor SBIRT Medical Residency Training Program: Model Description and Initial Evaluation

ABSTRACT The Baylor College of Medicine SBIRT Medical Residency Training Program is a multilevel project that trains residents and faculty in evidenced-based screening, brief intervention, and referral to treatment (SBIRT) methods for alcohol and substance use problems. This paper describes the training program and provides initial evaluation after the first year of the project. The program was successfully incorporated into the residency curricula in family medicine, internal medicine, and psychiatry. Initial evaluations indicate a high degree of satisfaction with the program and, despite a slight decrease in satisfaction scores, participants remained satisfied with the program after 30 days. Implementation barriers, solutions, and future directions of the program are discussed.

Prostate Cancer Screening in a Low-Literacy Population: Does Informed Decision Making Occur?

Rates were even higher among men, AfricanAmericans,the elderly,and those with limited educationalattainment. The purpose of this study was to examine thecontent of physician-patient discussions of prostate cancerscreening and its relation with prostate-specific antigen(PSA) testing in an inner city clinic.

Baylor Pediatric SBIRT Medical Residency Training Program: Model Description and Evaluation

BACKGROUND The Baylor College of Medicine SBIRT Medical Residency Training Program is a multilevel project that trains residents and faculty in evidenced-based screening, brief intervention, and referral to treatment methods for alcohol and substance use problems. METHODS This paper describes the training program created for pediatric residents and provides an evaluation of the program. Ninety-five first-year pediatric residents participated in the training program. They were assessed on satisfaction with the program, self-rated skills, observed competency, and implementation into clinical practice. RESULTS The program was successfully incorporated into the residency curricula in two pediatric residencies. Evaluations indicate a high degree of satisfaction with the program, self-reported improvement in SBIRT skills, observed proficiency in SBIRT skills, and utilization of SBIRT skills in clinical practice. CONCLUSIONS SBIRT skills training can be incorporated into pediatric residency training, and residents are able to learn and implement the skills in clinical practice.

Determinants of Low-Fat Eating Behaviors among Midlife African American Women.

OBJECTIVE The purpose of this study was to explore midlife African American womens low-fat eating habits in the context of health attitudes, social support, and food preferences. DESIGN A cross-sectional design was used. SETTINGS One Midwestern and 1 national African American womens organization were targeted for data collection. PARTICIPANTS African American women between the ages of 45 and 64. MAIN OUTCOME MEASURES Health Attitudes Scale, Social Support Scale, Eating Behaviors subscale, and Low-Fat Eating subscale. ANALYSIS A hierarchical multiple regression analysis was performed. RESULTS Highly educated women did not engage in better eating habits than women with less education. Family members provided more criticism and friends provided more encouragement for healthful eating. However, only family encouragement and criticism for healthful eating and food preferences remained predictive of low-fat eating habits in midlife African American women in the final regression model. CONCLUSIONS AND IMPLICATIONS Changing attitudes may not influence changes in behaviors. Women experience family support as a significant influence to eating habits. Future nutrition interventions should be inclusive of women at every educational level and have a multidimensional focus that targets family involvement and changing behaviors.

The fourth R: Reasoning

Critical thinking should be recognized as a basic skill for all students. One approach for including these skills in a program for the gifted is by teaching philosophy.

Teaching Logical Reasoning to Gifted Students.

A cursory observation of elementary and secondary school curricula reveals very little dealing with systematic critical reasoning. Logic, a branch of philosophy, can provide a regimen and patterns for critical reasoning, but is relegated to college level studies. Consequently, many gifted students are never exposed to the skills which are essential for critical reasoning. For others, the thinking skills of logic are introduced too late to become an inte-

Predictors of Suboptimal Follow-up in Pediatric Cancer Survivors.

Attendance to follow-up care after completion of cancer treatment is an understudied area. We examined demographic, clinical, and socioeconomic predictors of follow-up by pediatric cancer patients at a large center in 442 newly diagnosed patients using multivariable logistic regression analyses. Patients who did not return to clinic for at least 1000 days were considered lost to follow-up. Two hundred forty-two (54.8%) patients were lost. In multivariable analyses, the following variables were independent predictors of being lost to follow-up: treatment with surgery alone (odds ratio [OR]=6.7; 95% confidence interval [CI], 3.1-14.9), older age at diagnosis (reference, 0 to 4; ages, 5 to 9: OR=1.8, 95% CI, 1.1-3; ages, 10 to 14: OR=3.3; CI, 1.8-6.1; and ages, 15 and above: OR=4.8; CI, 2.1-11.7), lack of history of stem cell transplantation (OR=2, 95% CI, 1.04-3.7) and lack of insurance (OR=3.4; CI, 1.2-9.2). Hispanic patients had the best follow-up rates (53.7%) compared to whites and blacks (P=0.03). Attendance to long-term follow-up care is suboptimal in childhood cancer survivors. Predictors that were associated with nonattendance can be used to design targeted interventions to improve follow-up care for survivors of pediatric cancer.

Making the invisible visible: professional education to eliminate disparities in clinical trials.

It is important to remember the basic organizational and behavioral principles that (1) we cannot address problems of which we are unaware, and (2) knowledge alone is never enough to create change. Meaningful change requires commitment at both institutional and individual levels. Using the EDICT Policy Recommendations together with the Clinical Trials BackPack and CLAS-ACT resources will enable clinical research training programs to (1) increase awareness of clinical trials disparities, (2) provide professional education about how to increase recruitment and retention of underrepresented groups, and (3) actually implement concrete activities that can change the face of clinical trials research. By doing so, perhaps it will not require another 50 years to eliminate disparities in clinical trials.ConclusionIt is important to remember the basic organizational and behavioral principles that (1) we cannot address problems of which we are unaware, and (2) knowledge alone is never enough to create change. Meaningful change requires commitment at both institutional and individual levels. Using the EDICT Policy Recommendations together with the Clinical Trials BackPack and CLAS-ACT resources will enable clinical research training programs to (1) increase awareness of clinical trials disparities, (2) provide professional education about how to increase recruitment and retention of underrepresented groups, and (3) actually implement concrete activities that can change the face of clinical trials research. By doing so, perhaps it will not require another 50 years to eliminate disparities in clinical trials.