Marvella E. Ford

Enrollment of racial and ethnic minorities in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial.

BACKGROUNDnMinority populations in the United States, especially blacks and Hispanics, are generally underrepresented among participants in clinical trials. Here, we report the experience of enrolling ethnic minorities in a large cancer screening trial.nnnMETHODSnThe Prostate, Colorectal, Lung and Ovarian (PLCO) Cancer Screening Trial is a multicenter randomized trial designed to evaluate the effectiveness of screening for the PLCO cancers. Subjects were recruited at 10 U.S. centers between 1993 and 2001. One screening center had a major special recruitment effort for blacks and another center had a major special recruitment effort for Hispanics.nnnRESULTSnAmong almost 155,000 subjects enrolled in PLCO, minority enrollment was as follows: black (5.0%), Hispanic (1.8%) and Asian (3.6%). This compares to an age-eligible population in the combined catchment areas of the PLCO centers that was 14.0% black, 2.9% Hispanic and 5.4% Asian, and an age-eligible population across the U.S. that was 9.5% black, 6.5% Hispanic and 3.0% Asian. About half (45%) of Hispanics were recruited at the center with the special Hispanic recruitment effort. Seventy percent of blacks were recruited at two centers; the one with the major special recruitment effort and a center in Detroit whose catchment area was 20% black among age-eligibles. Blacks, Hispanics and (non-Hispanic) whites were all more highly educated, less likely to currently smoke and more likely to get regular exercise than their counterparts in the general population.nnnCONCLUSIONnSignificant efforts were made to recruit racial/ ethnic minorities into PLCO, and these efforts resulted in enrollment levels that were comparable to those seen in many recent cancer screening or prevention trials. Blacks and Hispanics were nonetheless underrepresented in PLCO compared to their levels among age-eligibles in the overall U.S. population or in the aggregate PLCO catchment areas.

Black participation in the prostate, lung, colorectal and ovarian (PLCO) cancer screening trial

The primary goal of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial is to learn whether widespread use of screening tests to detect these cancers will reduce associated mortality. Blacks have the highest age-adjusted cancer incidence and mortality rates of any population group in the United States, but several barriers to their participation in clinical research such as the PLCO trial exist. These barriers involve sociocultural, economic, and individual factors, as well as factors inherent in trial designs. Population diversity in the PLCO trial is necessary to preserve scientific validity and generalizability of trial results. Therefore, the National Cancer Institute and the Centers for Disease Control and Prevention are collaborating to ensure adequate representation of blacks in the PLCO trial. For example, the agencies have funded several new activities designed to better understand and overcome barriers to participation in the trial. These activities include the African American Men Project, a randomized trial designed to evaluate the efficacy of three increasingly intensive recruitment interventions in recruiting black men; the establishment of a minority-focused PLCO trial screening center, a study to identify factors that influenced the decisions of black women recruited to participate in the PLCO trial; and a study to examine the psychosocial factors that influence blacks decision making to engage in cancer screening and participation in research similar to the PLCO trial. The results of these activities will allow for a more thorough examination of cancer-related issues of importance to blacks and will help shed light on factors that influence their decisions to participate in cancer screening and prevention clinical trials.

Health outcomes among african american and caucasian adults following a randomized trial of an asthma education program

OBJECTIVESnRe-analysis of a randomized trial of an asthma education program designed to assess the effects of the intervention on emergency department visits, limited days of activity and asthma knowledge and beliefs separately for African American and Caucasian adults with asthma.nnnDESIGNnTwo hundred and forty-one respondents between the ages of 18 and 70 were evaluated in two emergency departments (one inner city and one suburban location) of a large, midwestern health care system and were randomized to an intervention or control group.nnnRESULTSnRegardless of race, members of the intervention group showed a decrease in the number of post-intervention emergency department visits (ANOVA interaction between race and group effect p value = 0.93). The greatest decrease occurred during the first four post-intervention months. No differential effect of the asthma education intervention by race was found on the change in asthma knowledge and beliefs over the study period (ANCOVA interaction between race and group effect p value = 0.60).nnnCONCLUSIONnThis study demonstrates that post-intervention, both African American and Caucasian study participants showed a decrease in emergency department visits and an increase in asthma self-management. This finding is especially important for African Americans, who face increasing asthma mortality and morbidity.

Assessing the reliability of the EORTC QLQ-C30 in a sample of older African American and Caucasian adults

The purpose of this study was to examine the structure and reliability of the EORTC QLQ-C30. This 30-item instrument has five functional scales (physical, role, cognitive, emotional, and social), three symptom scales (fatigue, pain, and nausea and vomiting) and a global health and quality of life scale. Confirmatory factor analysis and Cronbachs α estimates were used to assess the functioning of the EORTC QLQ-C30 in a sample of 489 African American (n = 255) and Caucasian (n = 234) adults aged 50 + years. Seven of the nine EORTC QLQ-C30 scales showed good reliability for both the African Americans and the Caucasians in the sample (Cronbachs > 0.75). In contrast, the cognitive functioning scale had a reliability coefficient of only 0.69 for the African Americans and 0.40 for the Caucasians, and the nausea and vomiting scale had a reliability coefficient of only 0.49 for the African Americans and 0.51 for the Caucasians. In summary, although the overall reliabilities of seven of the scales showed good fit, many of the item-to-scale correlations did not. Researchers planning to use the EORTC QLQ-C30 might first consider conducting separate analyses on the different racial or ethnic subgroups in their study populations to determine whether a common set of factors or scales is available for further analysis.

Modifying a breast cancer risk factor survey for African American women.

PURPOSE/OBJECTIVESnTo evaluate a breast cancer risk factor survey for use with African American women.nnnDESIGNnTwo focus groups consisting of women randomly selected from the patient population of Henry Ford Health System in Detroit, MI.nnnSETTINGnA large, vertically integrated, private, nonprofit health system.nnnSAMPLEnFocus Group I consisted of 11 African American women aged 18-50, with a mean age of 41 years. Focus Group II consisted of nine African American women aged 51 and older, with a mean age of 60.9 years.nnnMETHODSnA qualitative approach was used to gather and interpret the focus group data.nnnMAIN RESEARCH VARIABLESnPerceptions of a breast cancer risk factor survey and perceptions of breast cancer risk factors.nnnFINDINGSnThe focus group participants suggested ways to improve the survey. Women in the younger age group appeared to lack awareness regarding breast cancer risk factors. Women in the older age group reported not knowing their family health histories.nnnCONCLUSIONSnBased on comments made by the focus group participants, the survey was modified substantially. Breast cancer risk factors were perceived differently by women in the two age groups.nnnIMPLICATIONS FOR NURSINGnResults of a survey of a large, ethnically diverse sample of women could inform the development of culturally and age-appropriate nursing interventions designed to address breast cancer risk perceptions and enhance the likelihood of adherence to recommended mammography screening guidelines.

Perceptions of Diabetes Among Patients in an Urban Health Care System

Objectives. A major problem facing health care providers today is adherence to treatment regimens by patients. Adherence is of even greater significance for patients with diabetes who shoulder a great deal of responsibility in their disease management. Perceptions of diabetes have been found to play a major role in adherence. The effects of race and socioeconomic status on the disease perceptions remain unclear. This exploratory study encompassed two themes: (1) assessing perceptions of diabetes among African American and white American adults with diabetes who were patients in 1994 in a large Midwestern urban health care system and (2) examining the psychometric properties of the measurement instruments used to study perceptions. Design. A stratified random sampling scheme (by race and socioeconomic status (SES)) was used. Diabetes perceptions were measured using three scales from the Meaning of Illness Questionnaire assessing the impact loss and stress associated with diabetes. Perceptions of physician efficacy were also measured. The study population consisted of 50 (68% response rate) African American and white American patients aged 18-65 years. Results. No differences in SES were found between the African American and white American participants ( p = 0.44). However the African Americans in the study indicated a greater sense of loss associated with diabetes than the white Americans in the study ( p < 0.05). In the combined racial group the reliability coefficients as measured by Cronbachs alpha were 0.76 0.78 0.68 and 0.68 for the Impact Loss Stress and Perceptions of Physician Efficacy scales respectively. However the results of within-racial-group analyses tell a different story. The Impact scale fitted the African American and white American subgroups although there was some item variation by racial group. The Loss scale did not fit the white American subgroup and the Stress and Perceptions of Physician Efficacy scales did not fit the African American subgroup.

Exploring the Factorial Structure of the EORTC QLQ-C30 Racial Differences in Measuring Health-Related Quality of Life in a Sample of Urban, Older Adults

Objectives: To assess the European Organization for Research and Treatment of Cancer’s 30-item Quality of Life Questionnaire (QLQ-C30) for use with a multiracial study population of adults. Methods: Adults aged 50 and older were randomly selected from patients who made at least one visit to the Henry Ford Health System in Detroit, Michigan in 1998. Results: African American (n = 255) and White (n = 234) subsamples were separately subjected to exploratory factor analysis; each yielded seven factors with eigenvalues above 1.00, accounting for approximately 65% of the variance, although the factorial structures of the subsamples were different. Discussion: Participants were not screened for cancer or other illnesses, which may contribute to differences between the known scoring model and these results. Researchers are advised to conduct separate analyses on racial/ethnic groups and to supplement the QLQ-C30 with additional items pertinent to the populations being studied and/or the conceptual/theoretical paradigm being tested.

Gerontological Social Work with Older African American Adults

Abstract The proportion of older adults in the U.S. population is growing. By the year 2050, 21% of all Americans aged 65+ years will be members of minority groups, with African Americans comprising the largest subgroup. Disparities in health status and mortality exist between older African American and Caucasian adults. The charge to gerontolog-ical social work in the new millennium is to develop effective means of reducing racial disparities in health status. This paper presents some of the key health issues facing older African American adults and describes approaches that could be used by gerontological social work practitioners and researchers in helping to close the widening racial gap in health status.

Linking mental and primary health care in rural areas

There has been growing recognition in both developing and industrialized countries of the need to integrate mental and primary health care services in order to provide better care for community members and make the most effective use of scarce community resources (Pincus, 1987; Schulberg, 1991; World Health Organization, 1990). The impetus for creating these models comes from the growing recognition of the ongoing interplay between mental and physical health problems (Katon, VonKorff, Lin, Lipscomb, Russo, Wagner, & Polk, 1990); the need for improved communication between mental health and primary care providers